Oncologic Validity of Cervical Recipient Vessel Preservation

Abstract

Objective: Determine whether preservation of cervical recipient vessels affects surgical resection margins in patients who undergo microvascular free flap procedures for defects of reconstruction of the head and neck after the treatment of neoplasms. Method: Consecutive patients with adventitial biopsies of recipient neck vessels were identified over the previous 6-month period, and pathology was reviewed. Patient clinical information (age, sex, diagnosis, tumor site, tumor stage, prior treatment with surgery, radiation therapy, chemotherapy) was reviewed as potential risk factors for tumor involvement of recipient vessels. Results: A total of 57 patients with recipient vessel biopsies were identified between June 2010 and January 2011. Tumor sites included oral-oropharnygeal (n = 38), laryngopharyngeal (n = 8), scalp (n = 7), skull base-midface (n = 3), and neck (n = 1). Tumor pathology included squamous cell carcinoma (n = 45), osteoradionecrosis with a history of squamous cell carcinoma (n = 4), adenocarcinoma (n = 2), ossifying fibroma (n = 2), as well as a case each of ameloblastma and melanoma. One (1.7%) recipient vessel biopsy was positive for squamous cell carcinoma. This vessel looked grossly abnormal and was sent for frozen section analysis. Conclusion: Microvascular free flap reconstruction uses recipient vessels in the neck, which can potentially adversely affect resection margins by requiring preservation of recipient vessels in proximity to tumors. However, our results show that frozen section biopsy is necessary only when intra-operative findings are concerning for tumor involvement of the recipient vessels.