RUPTURE OF THE CAROTIDS FOLLOWING RADICAL NECK SURGERY IN RADIATED PATIENTS
Rupture of the common carotid artery following radical neck surgery for malignant head and neck tumors is not an unusual complication, but it is more frequent when radiation and surgery are performed in combination. Some new concepts and techniques which might help to eliminate or lower the incidence of carotid artery rupture following surgery and irradiation are reviewed. Several factors are responsible for the rupture of the carotids in irradiated patients who also undergo surgery. The decreased vascularity of irradiated tissue due to the obliterating endothelial thickening in the blood vessels and changes in the connective tissue are well-known. This decreased blood supply is also responsible to a larger extent for the prolonged healing time of irradiated tissue. Recent investigations show that the healing time in neck dissection following up to 5000-r irradiation was prolonged 59%. Another contributing factor in the rupture of the carotids is the greatly diminished blood supply of the carotids themselves following radical neck surgery. Since the adventitia is removed during neck dissection, the nourishment of the artery is dependent mostly upon the skin flap. Since rupture of the common or internal carotid arteries is almost always associated with irradiation, preoperative planning can greatly reduce the incidence of arterial rupture. Recently, treatment in irradiated patients is being directed toward prevention of complications. Some surgeons advocate raising a flap at the time of neck dissection, and if necessary, sacrificing the radiated skin. If the skin is not sacrificed, the flap is sutured back to place and kept in reserve. Or, the levator scapulae may be divided muscle inferiorly, then brought across the carotid bulb, and attached to the strap muscles anteriorly to improve the nourishment of the common carotid. Blood pressure in the internal carotid artery should be measured during the surgical procedure, and if the pressure drops significantly, anastomosis of the internal carotid artery to the ipsilateral external carotid artery carried out. A flap should be made immediately, if flap necrosis should occur, to cover the carotids. The flap should not include radiated skin. Chest flap based at the shoulder has been used successfully, as have large shoulder flaps based superiorly at the mastoid and occipital region. Skin should not be used for flap where there is likelihood of recurrence of tumor. Ligation of the carotids following radiotherapy should be reserved only for patients with massive rupture or invasion by cancer in the presence of necrotic, infected tissue bed, lack of skin for replacement and oral fistula. In all other patients, resuturing, free vascular grafting, ipsilateral anastomosis of the internal carotid artery to the external carotid artery, or pedicle flap transfer should be carried out, depending on the indications. (BBB)
- Research Organization:
- Univ. of Maryland, Baltimore
- NSA Number:
- NSA-18-011724
- OSTI ID:
- 4106960
- Journal Information:
- Eye, Ear, Nose Throat Monthly, Vol. Vol: 41; Other Information: Orig. Receipt Date: 31-DEC-64
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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