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Kameni LE, Januszyk M, Berry CE, Downer MA, Parker JB, Morgan AG, Valencia C, Griffin M, Li DJ, Liang NE, Momeni A, Longaker MT, Wan DC. A Review of Radiation-Induced Vascular Injury and Clinical Impact. Ann Plast Surg 2024; 92:181-185. [PMID: 37962260 DOI: 10.1097/sap.0000000000003723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
ABSTRACT The number of cancer survivors continues to increase because of advances in therapeutic modalities. Along with surgery and chemotherapy, radiotherapy is a commonly used treatment modality in roughly half of all cancer patients. It is particularly helpful in the oncologic treatment of patients with breast, head and neck, and prostate malignancies. Unfortunately, among patients receiving radiation therapy, long-term sequalae are often unavoidable, and there is accumulating clinical evidence suggesting significant radiation-related damage to the vascular endothelium. Ionizing radiation has been known to cause obliterative fibrosis and increased wall thickness in irradiated blood vessels. Clinically, these vascular changes induced by ionizing radiation can pose unique surgical challenges when operating in radiated fields. Here, we review the relevant literature on radiation-induced vascular damage focusing on mechanisms and signaling pathways involved and highlight microsurgical anastomotic outcomes after radiotherapy. In addition, we briefly comment on potential therapeutic strategies, which may have the ability to mitigate radiation injury to the vascular endothelium.
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Affiliation(s)
- Lionel E Kameni
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Michael Januszyk
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Mauricio A Downer
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jennifer B Parker
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Annah G Morgan
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Caleb Valencia
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Michelle Griffin
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Dayan J Li
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Norah E Liang
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Arash Momeni
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Derrick C Wan
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
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Wang W, Ong A, Vincent AG, Shokri T, Scott B, Ducic Y. Flap Failure and Salvage in Head and Neck Reconstruction. Semin Plast Surg 2020; 34:314-320. [PMID: 33380919 DOI: 10.1055/s-0040-1721766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
With advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has become the standard for complex head and neck reconstruction. With continued refinements in surgical techniques, larger surgical volumes, and technological advancements, free flap success rates have exceeded 95%. Despite these high success rates, postoperative flap loss is a feared complication requiring the surgeon to be aware of potential options for successful salvage. The purpose of this article is to review free flap failure and ways to optimize surgical salvage in the scenario of flap compromise.
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Affiliation(s)
- Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Adrian Ong
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Britney Scott
- Department of Otolaryngology - Head and Neck Surgery, Kettering Health Network, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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