Imaging for Recipient Vessels of the Head and Neck for Microvascular Transplantation
Free microvascular tissue transfer has become the method of choice in head and neck reconstruction, particularly for signicant defects post-tumour resection. A signicant determinant of free-ap success is the status of the recipient vessels as revascularisation of the free ap is dependent on them. As such, preoperative evaluation of these vessels is crucial as it enables planning of the pedicle length, ap type, ap orientation to the recipient site, and requirement for a vein graft.38 This is particularly important in head and neck cancer patients who have undergone previous neck dissection or chemoradiotherapy as well as those with cardiovascular co-morbidities, particularly tobacco smoking, as these may compromise the recipient vessels.31 Radiotherapy has been shown to cause various injuries to blood vessels including endothelial damage, perivascular brosis, and microvascular occlusion,4,7,35 but there is conicting evidence in the literature about whether previous radiotherapy impairs ap survival and patency of the microvascular anastomosis.1,5,29-31 The gold standard for imaging the head and neck vasculature is digital subtraction angiography (DSA). However, non-invasive imaging methods, such as ultrasonography (US), computed tomographic angiography (CTA), and magnetic resonance angiography (MRA), are preferred in current practice given their low-risk prole.