ABSTRACT
A histological study of both recipient and flap vessels was performed in 30 patients with head and neck cancer, and relevant preoperative risk factors were assessed. A total of 35 free flaps were transferred in 30 patients; 16 patients had preoperative radiotherapy, 13 were smokers, eight had hypertension and six had peripheral vascular disease. No significant venous pathology was found in either the flap or the neck veins. However, over two-thirds of the neck arteries and one-half of the flap arteries were found to have microscopic arterial pathology. The only pre-existing factor significantly influencing vessel pathology was hypertension (P=0.007). All flaps survived, although in two there was some loss of the skin paddle. This study reveals that the majority of patients undergoing microsurgery in the head and neck region have pre-existing arterial damage in both the flap and the recipient arteries, but this does not have a significant effect on the overall patency of the microvascular anastomoses.
Subject(s)
Head and Neck Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , Female , Head and Neck Neoplasms/blood supply , Head and Neck Neoplasms/surgery , Humans , Male , Microcirculation , Middle Aged , Neoplasm Recurrence, Local/blood supply , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Postoperative Complications/etiology , Preoperative Care/methods , Prospective Studies , Plastic Surgery Procedures/methods , Risk Factors , Surgical Flaps/blood supply , Surgical Flaps/pathology , Time Factors , Treatment OutcomeABSTRACT
"In this paper we outline and evaluate a nine-parameter version of the Heligman-Pollard formula. In our applications, using mortality data for five European countries we found that this version provides closer fits to empirical mortality data than the classical eight-parameter formula, thus eliminating a source of systematic error in this latter formula."
