It has long been known that neck surgery following radiation therapy for primary and metastatic carcinomas is fraught with complications. These complications include necrosis of the skin flaps, oral and pharyngeal fistulas, and necrosis and rupture of the common carotid artery. Since the carotid artery derives 80% of its blood supply from its adventitia, and the adventitia is removed in the course of radical neck dissection, the artery is dependent upon the skin flaps for its future nourishment. Irradiated tissues with their decreased vascularity do not heal well after surgery, and no other region is more in need of adequate vascularity than the tissues of the neck. Failure of the flaps to heal predisposes to oral and pharyngeal fistulas and necrosis and rupture of the common carotid artery. While flap necrosis and fistulas can be treated with deliberation, rupture of the common carotid artery is a dire emergency demanding immediate
McCALL JW, WHITAKER CW, HENDERSHOT EL. Rupture of the Common Carotid Artery Following Radical Neck Surgery in Radiated Cases. AMA Arch Otolaryngol. 1959;69(4):431–434. doi:10.1001/archotol.1959.00730030441009
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