Histomorphometric analysis of irradiated recipient vessels and transplant vessels of free flaps in patients undergoing reconstruction after ablative surgery

The aim of the study was to investigate, histomorphometrically, quantitativ e and qualitative changes in irradiated neck recipient vessels and transpla nt vessels used for microsurgical anastomoses in free flaps in patients und ergoing preoperative radiotherapy and chemotherapy. In 55 patients receivin g 42 radial forearm flaps, 6 latissimus dorsi flaps, 6 osteomyocutaneous fi bula grafts and 1 lateral arm flap, a total of 220 vessels were obtained fr om neck recipient vessels and transplant vessels during anastomosis. Three groups were formed: Group 1 (16 patients) treated with no radiotherapy or c hemotherapy; Group 2 (20 patients) treated with preoperative irradiation (4 0-50 Gy) and chemotherapy (800 mg/m(2) 5-FU and 20 mg/m(2) cisplatin) 1.5 m onths prior to surgery; Group 3 (19 patients) treated with radiotherapy (60 -70 Gy) (median interval 78.7 months; IQR 31.3 months) prior to surgery. Fr om each of the 220 vessel specimens, 3 sections each were histomorphometric ally investigated, both qualitatively and quantitatively. To evaluate these changes as a function of age, radiation dose and chemotherapy, a statistic al analysis was performed using analysis of covariance and chi-square tests . In Group 3, qualitative changes (intima dehiscence, hyalinosis) were foun d in recipient arteries significantly more frequently (25%, P = 0.009) than in Groups 1 and 2. For Group 3 recipient arteries, histomorphometry reveal ed a significant decrease in the ratio of media area/total vessel area (med ian 0.53, IQR 0.10) in comparison with Group 1 (P = 0.02) (median 0.60, IQR 0.29) and Group 2 (P = 0.046) (median 0.59, IQR 0.10). No significant diff erences were found between the vessels of Groups 1 and 2 (P = 0.48). Age an d chemotherapy did not appear to have a significant influence on vessel cha nges in this study.