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August 1997

Adjunctive Intraoperative Photodynamic Therapy and Microvascular Anastomoses

Author Affiliations

Hertfordshire, England; London, England

Arch Otolaryngol Head Neck Surg. 1997;123(8):888. doi:10.1001/archotol.1997.01900080122017

We read with interest Biel's1 article. The longterm survival in the patients he describes is nothing short of miraculous for a disease that most of us after all would think beyond the scope of intervention. Sadly, our own experience2 with adjunctive, intraoperative photodynamic therapy (PDT) has not been as good. In addition, experimental work currently being prepared for publication shows that in animal models, adjunctive, intraoperative PDT can be very damaging to small vessel microvascular free flap anastomoses because of the high-intensity white light from the operating microscope activating photosensitizer within the vessel wall, causing failure of the venous anastomoses. The arterial anastomoses were generally viable until sequential extirpation at 7 days. Small vessel damage was most pronounced with porfimer sodium when compared with temoporfin, but even the latter drug caused all venous microvascular anastomoses to fail even at optimal drug-light intervals. Therefore, we question the definitive acceptance