Microvascular Regeneration and Perfusion of Partially Decellularized Tracheal Grafts.

OBJECTIVES: A critical barrier to successful tracheal transplantation is poor vascularization. Despite its importance, little is known about microvascular regeneration in tissue-engineered grafts. We have demonstrated that partially decellularized tracheal grafts (PDTG) support neotissue formation including new submucosal microvasculature (CD31+). However, the perfusion of this neovasculature is unknown. In this study, we used a mouse model of tracheal replacement to measure the microvascular regeneration and perfusion of PDTG. METHODS: PDTG and syngeneic tracheal grafts (STG, surgical control) (n = 5 for each group) were orthotopically transplanted into C5BL/6 J mice. We quantified vascularity of STG and PDTG samples at 1 and 3 months with conventional histology (N = 3 ~ 10/group). At 1, 3, and 6 months, animals were injected with fluorescein isothiocyanate (FITC) tomato lectin into the left ventricle. After perfusion, tracheas were fixed, harvested, mounted, stained for CD31 expression, and imaged with resonant scanning confocal microscopy. Percent CD31+, FITC area was compared between groups and endpoints compared with native trachea. Microvascular intersections were quantified using Sholl analysis. RESULTS: Functional microvasculature was seen in both groups. Although percent vascularization (CD31) in PDTG was restored by 3 months, microvascular pattern in PDTG displayed a unique morphology compared with control. Surgery alone appeared to globally change microvascular pattern and perfusion. PDTG demonstrated equivalent perfusion to surgical control by 6 months. Sholl analysis revealed a reduction of microvessel intersectionality that persisted in PDTG and was not seen in surgical or native controls. CONCLUSIONS: PDTG exhibited microvascular regeneration. Perfusion was present in PDTG, improved, and persisted over long-term time points. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

The osteocutaneous radial forearm free flap: A multidisciplinary review of the evidence.

The osteocutaneous radial forearm (OCRFF) is a versatile free flap option for bony defects of the head and neck, given the thinness and pliability of the forearm cutaneous paddle, pedicle length, reliability, lack of atherosclerosis, and functional concerns common to other osseous donor sites. The OCRFF was once associated with a high risk of radial fracture, in addition to concerns about the quality and durability of bone stock for osseous reconstruction, particularly for the mandible. Following the introduction of prophylactic plating of the radius, the incidence of symptomatic radial fracture has drastically decreased. Furthermore, modifications of the bony osteotomies and other evolutions of this flap harvest have increased the use of the OCRFF throughout the head and neck. Despite these advantages, the OCRFF is not widely utilized by microvascular reconstructive surgeons due to perceived limitations and risks. Herein, we present a multidisciplinary, contemporary review of the harvest technique, outcomes, and perioperative management for the OCRFF.

Demographic and Academic Productivity Trends Among American Head & Neck Society Fellows Over a 20-Year Period.

Importance: Historical data reveal that, compared with women, men are more likely to pursue a head and neck surgical oncology fellowship, but little is known about possible gender differences in academic productivity. Objective: To assess demographic trends and academic productivity among American Head & Neck Society (AHNS) fellowship graduates. Design, Setting, and Participants: This cross-sectional study used electronically published data from the AHNS on fellowship graduates in the US and Canada from July 1, 1997, to June 30, 2022. Scopus was used to extract h-indices for each graduate. Exposure: Scholarly activity. Main Outcomes and Measures: Main outcomes were changes in demographic characteristics and academic productivity among AHNS graduates over time. Data analysis included effect size, η2, and 95% CIs. Results: A total of 691 AHNS fellowship graduates (525 men [76%] and 166 women [24%]) were included. Over the study period, there was an increase in the number of programs offering a fellowship (η2, 0.84; 95% CI, 0.68-0.89) and an increase in the absolute number of women who completed training (η2, 0.66; 95% CI, 0.38-0.78). Among early-career graduates pursuing an academic career, there was a small difference in the median h-index scores between men and women (median difference, 1.0; 95% CI, -1.1 to 3.1); however, among midcareer and late-career graduates, there was a large difference in the median h-index scores (midcareer graduates: median difference, 4.0; 95% CI, 1.2-6.8; late-career graduates: median difference, 6.0; 95% CI, 1.0-10.9). A higher percentage of women pursued academic positions compared with men (106 of 162 [65.4%] vs 293 of 525 [55.8%]; difference, 9.6%; 95% CI, -5.3% to 12.3%). Conclusions and Relevance: This cross-sectional study suggests that women in head and neck surgery begin their careers with high levels of academic productivity. However, over time, a divergence in academic productivity between men and women begins to develop. These data argue for research to identify possible reasons for this observed divergence in academic productivity and, where possible, develop enhanced early faculty development opportunities for women to promote their academic productivity, promotion, and advancement into leadership positions.