Vascular grafts in head and neck reconstructive surgery

The best management of advanced head and neck tumors invading the carotid artery utilizes a collaborative, anticipatory approach. Preoperative characterization of the anatomy and extent of tumor involvement, coupled with the physiologic assessment of the cerebrovascular circulation through the variety of adjunctive studies, facilitates operative planning. Careful preoperative evaluation allows the surgeon to make the most informed decision regarding extracranial carotid artery reconstruction, should carotid artery resection be required for adequate tumor removal. When the preoperative evaluation indicates that adequate cerebral perfusion or collateral reserve will not be maintained with carotid artery occlusion, carotid artery reconstruction needs to accompany any resection of this vessel. Autogenous saphenous vein remains the graft conduit of choice, but prosthetic materials may be used. Graft patency and healing require appropriate concomitant soft- tissue coverage of any overlying mucosal or cutaneous defects.