Presentation and clinical outcome of patients with malignant salivary gland tumors

Salivary gland cancer is a rare disease and comprises approximately 5 to 6% of cancers of the head and neck and 0.3% of all cancers. These tumors display a diverse biological behaviors and clinical presentation. Currently, many series has described site, size stage, histology and grade of the tumors as important prognostic factors affecting the outcome. Aim of the work was to evaluate the presentation and management outcome of patients presented with salivary gland cancer in search of prognostic factors for locoregionl control, disease free survival, and overall survival. The records of all patients with malignant salivary gland tumors presenting for treatment at our institution between October 1997 and October 2002 were reviewed. Variables were collected and outcome measures were defined in terms of locoregional, and distant control, and overall survival and disease-free survival [DFS], in 5 years follow up. Survival was described using the Kaplan-Meier method. This study included 46 patients [24 males and 22 females] ranging in age from 22 to 86 years with mean age of 53 +/- 18 years. The disease-free survival and overall survival rate were 65.5% and 69.5%, at 5 years, respectively. We found that survival was significantly better in younger patients [P = 0.05], male patients [P = 0.001] early stage [P = 0.001], patients with parotid cancer [P = 0.004], low/intermediate grade [P = 0.0006] and patients who received postoperative adjuvant radiation [P = 0.003]. The majority of our patients presented in advanced stage, which necessitated aggressive surgical treatment. Postoperative adjunctive radiotherapy seems to play an important role in those patients. However, the benefits of combined modality therapy await prospective clinical trials. This study confirmed the contributions of age, sex, site, stage, and grade for locoregional control and survival

Maximizing aesthetic results in huge breast reduction using the inferior pedicle technique

Inferior pedicle reduction mammaplasty technique is a reliable technique used in reduction mammaplasty. This technique includes a well-vascularised dermalparenchymal pedicle for safe nipple-areola transposition, but it has been criticised as resulting in a flat breast with inadequate projection after long-term follow-up. Various techniques in which internal shaping of the pedicle are used have demonstrated decreased secondary ptosis. We used internal shaping sutures for the inferior pedicle flap together with lateral and medial sutures hoping for long lasting aesthetic projection and narrow base for the reduced breast. Evaluation by review of the patient charts, photographic analysis and patient-satisfaction questionnaire has revealed acceptable long term results. Inferior pedicle reduction mammoplasty technique with internal shaping sutures is an easy and uncomplicated modification that provides additional advantages for prevention of the secondary ptosis of the reduced breasts in the long term

Definitive treatment of recurrent pilonidal sinus disease using rhomboid excision and limberg flap reconstruction

Introduction and Aim of the work: despite the various techniques described to treat pilonidal sinus still recurrence is a common occurrence. Recurrent pilanidal sinus is a difficult problem to treat, the deep natal cleft and the rolling effect of one buttock aufaa over the other contribute to the high recurrence rate. The aim of this study was to describe the technical defiles analysis the advantages and present the results of the modified approach applied in patients with recurrent pilonidal disease

Patients and Methods: In the period from January 2001 to may 2003,26 patients with recurrent pilonidal disease [24 males and 2 females] every one of them had endured one or more preview surgical procedure to treat their condition . More than one midline pits were evident in all of our cases. Six patients presented with acute pilonidal abscess and required initial incision and dm'mge the definitive treatment to the pilonidal disease with the modified limberg flap after one month . The rhomboid [Modified Limbax] flap was applied to all patients after wide rhomboid excision of the pilonidal sinus bearing area and finally closure of the wound after transposing the flap in several layers

Results and Conclusion: All the patients tolerated the procedure well, with minimal post operative discomfort, hospital discharge varied from 3 to 12 days. There was one case of limited primary healing due to moderate wound infection which was treated with repeated dressing and antibiotics and did not require any additional surgery. No recurrence has developed in the follow-up period which ranged from 6 months to three years . The suggested modified limberg flap[Rhomboidflap] reconstruction after wide excision of the pilonidal sinus bearing area is an effective, mfe, relatively easy to perform, with minimal morbidity and rapid recovery of the patient

Early experience of autologous breast reconstruction after mastectomy: accebtability, complications, and outcome

Introduction and aim of the work: Breast reconstruction after mastectomy became well accepted during the past 20 years and it is now an essential part of the interdisciplinary treatment for breast cancer. We aimed in this study to offer the Egyptian women the option to obtain a nearly normal looking breast after mastectomy and to assess the complications, esthetic results and patient satisfaction

Patients and methods: from January 2003 to June 2004, 12 patients were offered and accepted post mastectomy autologous breast reconstruction using either Transversus rectus abdominis myocutaneous [TRAM] 0r Latissimus dorsi myocutaneous [LDM] flaps. Esthetic results, complications and outcome were recorded

Results: Four patients were reconstructed by pedicled TRAM fIap and 8 patients were reconstructed by LDM flaps. The mean age was 46.6 year and the mean BMI was 29.8. Mean operative time for mastectomy was 77. 8 min. and the mean operative time for TRAM flap was 130 min. versus 95. 6 min. for LDM flap. Seroma in the back occurred in 3 cases in LDM flap. Partial flap necrosis and delayed wound healing each occurred in one case in TRAM flap. Esthetic results and patient’s satisfaction were good in both groups except in two patients

Conclusion: Breast reconstruction after mastectomy in our locality is still not gaining popularity and had low acceptability rate. Autologous breast reconstruction with TRAM or LDM flap gave good esthetic results and satisfaction in most of our Patients with few complications. Proper patient selection is the key for success of this reconstructive surgery

treatment severe axillary contractures using of the parascapular flap in conjunction with other reconstruction techniques

Axillary scar contracture is observed frequently after severe bum insult and is usually accompanied by injuries to the adjacent area. [Kim et a1]. Inappropriate treatment of axillary burns frequently results in adduction contractures. Management of severe axillary contractures is a challenging task and requires well-planned management. One should always aim at restoring full function, and this is best accomplished by performingfull release of the contracture to restore the full range of movement together with the creation of a natural non bulky axillary pit with the minimal possibility of recurrence of the contracture and with minimal donor site morbidity. Although many therapeutic methods, including skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been established, each technique has its own advantages and disadvantages in specific situations. The decision regarding which technique to use can only be made after consideration is given to the merits of the individual case. In this study the paraseapularflap was used to reconstruct only the axillary pit and the residual raw area on the chest wall closed either using Z-pasty technique or split thickness skin graft and the residual raw area on the inner aspect of the upper arm is either closed primary or covered with a split thickness graft, and very good functional and esthetic results could be accomplished using this technique. We concluded that the parascapular flap either pedicled or island [for reconstructing the axillary pit combined with z' plastics or split thickness skin grafts to cover any residual raw areas in the arm or chest wall] is the best choice for reconstruction of severe types of axillary contracture, releasing defects with satisfactory results in terms of function and tosmom