Emergent Exploration after Free Tissue Transfer in Head and Neck Cancer

PURPOSE: Microvascular reconstructive surgery has become an integral part of the treatment of head and neck cancer patients. This review of 121 free flaps for head and neck cancer patients performed over the last 11 years was done to evaluate circulatory crisis, salvage, and secondary reconstruction and to investigate which factors may contribute to these rates. METHOD: Nine emergent explorations among 121 head and neck reconstruction with free flaps were reviewed to analyze detection of vascular crisis, the time interval from detection of circulatory crisis to exploration, operation procedures and results, and secondary reconstructions. Emergent exploration was done with our protocol. RESULT: Nine free flaps exhibited signs of vascular problems between 1 day and 6 days postoperatively. The emergent exploration rate of this series was 7.4% (9/121). The salvage rate was 55.6% (5/9), giving an overall flap viability of 96.7% (117/121). In our study, preoperative radiation therapy, positive smoking history, alcohol consumption history, combined disease such as diabetes mellitus and hypertension, recipient vessels and types of vascular anastomosis were not related to the causes of circulatory crisis. The mean time interval between the onset of clinical recognition of impaired flap perfusion and re-exploration of the salvaged 5 flaps was 3.2 hours, that of failed 4 flaps was 11.25 hours. CONCLUSION: Despite high overall success rate, relatively low salvage rate may be attributed to late detection of circulatory crisis and in long time interval between detection and exploration. We conclude that early detection of circulatory crisis and expeditious re-exploration are a matter of great importance for the success of salvage operation.

Clinical Experience of Mucosal Amelanotic Melanoma in the Nasal Cavity and Maxillary Sinus

Malignant melanoma comprises 1.2% of all malignant tumors and more than 90% of malignant melanoma arises in the skin. About 1% of all malignant melanomas occur in the nasal cavity and paranasal sinuses. Mucosal melanoma of head and neck are rare and show poor prognosis. Although melanoma in the oral cavity sometimes tends to be neglected more than similar lesions on the skin and other locations, pigmented melanoma is usually easy to diagnose clinically because of its red to black or brown color and its irregular outline. However, amelanotic melanoma with lack of pigmentation, often defies correct clinical diagnosis initially before confirmation by biopsy. The authors have recently experienced a case showing good clinical result to the present, after total maxillectomy and split thickness skin graft and postoperative radiotherapy in the mucosal amelanotic melanoma involving the nasal cavity and right maxillary sinus, so report this case with a review of literature