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1.
Oncol. (Guayaquil) ; 31(2): 104-113, 31 de agosto 2021.
Article in Spanish | LILACS | ID: biblio-1284428

ABSTRACT

Introducción: La maxilectomía es la intervención quirúrgica recomendada para la exéresis de neoplasias faciales, esta técnica comprende la resección de los maxilares y de estructuras anatómicas adyacentes, y conlleva diferentes grados de alteración funcional. La reconstrucción de defectos medio faciales re-presenta un gran desafío, se utilizan diferentes técnicas desde el uso de prótesis obturadoras, colgajos locales, hasta colgajos libres, con la finalidad de la mayor recuperación de funciones sofisticadas como el habla, la deglución y la ventilación en vía área superior. Reporte de caso: Paciente hombre de 89 años de edad con 4 meses de evolución de masa tumoral decrecimiento progresivo y constante en la mitad del paladar superior y se extiende tomando el maxilar superior derecho. Al examen físico se observa la cavidad con deficiente cuidado de las piezas dentales y una masa tumoral de más de 15 cm de diámetro que deforma la cavidad oral. Evolución: Se realizó tumorectomía y vaciamiento ganglionar con preservación de nervio espinal, hipogloso, lingual, musculo esternocleidomastoideo, vena yugular interna, vena y arteria facial. Se realizó una reconstrucción de neopaladar con colgajo nasogeniano. La patología definitiva recibida en días posteriores reportó un carcinoma escamo celular pobremente diferenciado de estirpe epitelial con borde quirúrgico positivo para el tumor. Dentro del período postoperatorio el paciente presentó una neumonía asociada a los cuidados de la salud, acompañada con déficit neurológico, el cuadro involucionó hasta sepsis de origen pulmonar y fallece 21 días posteriores a la cirugía. Conclusiones: El crecimiento acelerado de una masa del maxilar en este paciente se asoció con la presencia de un carcinoma escamo celular pobremente diferenciado.


Introduction: Maxillectomy is the recommended surgical intervention for the excision of facial neoplasms. This technique includes the resection of the jaws and adjacent anatomical structures, and en-tails different degrees of functional alteration. The reconstruction of mid-facial defects represents a great challenge, different techniques are used from the use of obturator prostheses, local flaps, to free flaps, with the aim of greater recovery of sophisticated functions such as speech, swallowing and ventilation in via upper area. Case report: An 89-year-old male patient with a 4-month evolution of a tumor mass with progressive and constant growth in the middle of the upper palate and extending taking the right upper jaw. Physical examination revealed the cavity withpoor dental care and a tumor mass of more than 15 cm in diameter that deformed the oral cavity. Evolution: A lumpectomy and lymph node dissection were performed with preservation of the spinal, hypoglossal, lingual, sternocleidomastoid muscle, internal jugular vein, vein and facial artery. A neo-palatal reconstruction with a nasolabial flap was performed. The definitive pathology received in later days reported a poorly differentiated squamous cell carcinoma of epithelial lineage with a positive surgical border for the tumor. Within the postoperative period, the patient presented pneumonia associated with health care, accompanied by neurological deficit, the condition regressed to sepsis of pulmonary origin and died 21 days after surgery. Conclusions: The accelerated growth of a maxillary mass in this patient was associated with the pres-ence of a poorly differentiated squamous cell carcinoma.


Introdução: A maxilectomia é a intervenção cirúrgica recomendada para a excisão de neoplasias faciais, esta técnica inclui a ressecção da mandíbula e das estruturas anatômicas adjacentes e acarreta diferentes graus de alteração funcional. A reconstrução dos defeitos médios da face representa um grande desafio, diferentes técnicas são utilizadas desde o uso de próteses obturadoras, retalhos locais, até retalhos livres, com o objetivo de maior recuperação de funções sofisticadas como fala, deglutição e ventilação em via. . Relato do caso: Paciente do sexo masculino, 89 anos, com evolução de 4 meses de massa tumoral progressiva e constante decrescente em meio palato superior e extensão em maxilar superior direito. Ao exame físico, observa-se cavidade com mau atendimento odontológico e massa tumoral de mais de 15 cm de diâmetro que forma a cavidade oral. Evolução: Realizada lumpectomia e dissecção dos linfonodos com preservação da coluna vertebral, hipoglosso, nervo lingual, músculo esternocleidomastóideo, veia jugular interna, veia e artéria facial. Foi realizada reconstrução neo-palatina com retalho nasolabial. A patologia definitiva recebida em dias posteriores relatou um carcinoma de células escamosas pouco diferenciado de linhagem epitelial com uma borda cirúrgica positiva para o tumor. No pós-operatório, o paciente apresentou pneumonia associada aos cuidados de saúde, acompanhada de déficit neurológico, o quadro regrediu para sepse de origem pulmonar e faleceu 21 dias após a cirurgia. Conclusões: O crescimento acelerado de uma massa maxilar neste paciente foi associado à presença de um carcinoma espinocelular pouco diferenciado.


Subject(s)
Humans , Aged, 80 and over , Carcinoma, Squamous Cell , Free Tissue Flaps , Case Reports , Maxillary Neoplasms , Mouth
2.
Rev. argent. cir. plást ; 26(3): 121-126, 20200900. fig, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1148265

ABSTRACT

El colgajo peroneo posterior es un colgajo fasciocutáneo, que está basado en 4 posibles fuentes como son perforantes fasciocutáneas de la arteria peronea, perforantes fasciocutáneas de la arteria tibial posterior, perforantes venocutáneas de la vena safena menor y perforantes neurocutáneas del nervio sural. El objetivo de este trabajo es describir la técnica quirúrgica y demostrar la versatilidad que tiene el colgajo peroneo posterior para la reconstrucción y cobertura de defectos del tercio distal de la pierna y el tercio proximal del pie, proporcionando el potencial para el cierre simple y eficiente de dichos defectos. Este colgajo proporciona grandes ventajas debido a que es reproducible en cualquier centro quirúrgico y no requiere un entrenamiento específico en microcirugía del cirujano y del resto del equipo quirúrgico. Si bien las complicaciones existen, la mayoría no son graves y en general son de resolución simple. En los últimos años, se ha incrementado el empleo del colgajo fasciocutáneo peroneo posterior para lograr la cobertura de los defectos de partes blandas del tercio distal de la pierna y pie. El éxito de estos colgajos está relacionado con el tipo de paciente y de su lesión: el porcentaje es alto en pacientes jóvenes y sanos en quienes el origen del defecto es traumático.


The posterior peroneal flap is a fasciocutaneous flap, which is based on 4 possible sources such as fasciocutaneous perforations of the peroneal artery, fasciocutaneous perforations of the posterior tibial artery, venocutaneous perforations of the saphenous vein, and neurocutaneous perforators of the sural nerve. The objective of this work is to describe the surgical technique and demonstrate the versatility of the posterior peroneal flap for the reconstruction and coverage of defects in the distal third of the leg and the proximal third of the foot, providing the potential for simple and efficient closure of said defects. It provides great advantages because it is reproducible in any surgical center and does not require specific training in microsurgery of the surgeon and the rest of the surgical team. Although complications do exist, most are not serious and are generally of simple resolution. In recent years, the use of the posterior peroneal flap has been increased to achieve coverage of soft tissue defects of the distal third of the leg and foot. The success of these flaps is related to the type of patient and his injury, the success rate is high in young and healthy patients in whom the origin of the defect is traumatic.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Surgical Procedures, Operative/methods , Foot Deformities , Free Tissue Flaps/transplantation , Surgical Clearance , Leg Injuries
3.
Rev. argent. cir. plást ; 26(2): 61-67, apr-jun 2020. tab, fig
Article in Spanish | LILACS | ID: biblio-1120090

ABSTRACT

Background. Cranioplasty is a procedure that provides coverage for cranial defects after bone resection because of different etiologies such as intracranial hemorrhage, trauma, tumor or infection. One of the most important postoperative complications is the exposure of the plate, that may happen after a skin wound dehiscence. These are challenging situations for the plastic surgeon. Free tissue transfer provides a solution for these patients. The forearm radial flap provides all the conditions to solve these problem Methods. A retrospective study was performed with fourteen patients at the Santojanni Hospital between January 2018 and March 2020. All of them presented exposure of the cranioplasty plate. The defect area was analyzed. The average area to be covered was 5.07 cm2 (1.5 cm2-12.8 cm2). A radial forearm free flap was performed for all patients. Homolateral facial vessels (57%) were used as the first choice; the contralateral facial vessels were used in case of previous radiation therapy (29%) and in these cases a bypass was used in one case with venous interposition in three cases and arterial in the rest; superficial temporal vessels (14%). Results. Flap vitality was 100%. Average follow-up of 12 months (23 m-4 m). One patient presented seroma in the donor area. No new exposures or dehiscences were presented. Conclusions. Free tissue transfer provides an effective coverage to exposed material. The forearm flap provides reliable, thin, well-vascularized soft tissue that can be used to seal the dura, remove dead space, cover the exposed defect, not only but also it provides a long pedicle that allows distant anastomosis in cases of radiation therapy.


Introducción. La craneoplastia es un procedimiento necesario para cubrir defectos craneales luego de resección ósea por distintas etiologías, tales como hemorragia intracraneal, traumatismos craneoencefálicos, tumores o infecciones. Una de las complicaciones frecuentes es la exposición de placas de craneoplastia por dehiscencia de herida cutánea. Estas son complicaciones frecuentes y frustrantes para el paciente y el cirujano plástico. La transferencia de tejidos a distancia brinda una solución para estos pacientes. El colgajo radial antebraquial reúne las condiciones necesarias para la cobertura. Material y métodos. Se realiza un estudio retrospectivo con un total de 14 pacientes en el Hospital Santojanni en el período comprendido entre enero de 2018 y marzo de 2020. Todos presentaron exposición de la placa de craneoplastia. Se analizó el área de defecto, siendo el área promedio a cubrir de 5,07 cm2 (1,5-12,8 cm2). Se realiza cobertura con colgajo radial antebraquial. Se utilizan vasos faciales homolaterales (57%) como primera elección; vasos faciales contralaterales, por radioterapia (29%) y en ellos se utilizó bypass en un tiempo con interposición venosa en tres casos y arterial en el restante; vasos temporales superficiales (14%). Resultados. Se logró cobertura completa en todos los pacientes. La vitalidad de los colgajos fue del 100%. Seguimiento promedio de 12 meses (4-23 meses). Un paciente presentó seroma en la zona dadora. No se presentaron nuevas exposiciones ni dehiscencias. Conclusiones. La transferencia con tejido a distancia permite una eficaz cobertura de material expuesto. El colgajo antebraquial proporciona tejido blando confiable, delgado y bien vascularizado, que se puede utilizar para sellar la duramadre, eliminar el espacio muerto, cubrir el defecto expuesto y también posee un pedículo largo que permite anastomosis a distancia en casos de defectos tratados con radioterapia. Palabras claves: complicaciones de craneoplastias, reconstruccion de cuero cabelludo,


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Prostheses and Implants , Rheology , Skull , Surgery, Plastic , Free Tissue Flaps , Composite Tissue Allografts
4.
Rev. argent. cir. plást ; 26(1): 45-48, ene-mar 2020. fig
Article in Spanish | LILACS | ID: biblio-1120512

ABSTRACT

Luego del tratamiento quirúrgico de la patología maligna y premaligna de la región vulvoperineal nosenfrentamos al desafío de la reconstrucción del defecto de cobertura, el cual en la mayoría de los casos no puede resolverse con un cierre primario. Se presentan 2 casos de reconstrucción con colgajos locales con el objetivo de reparar el defecto, ofrecer un tejido vascularizado, el cual aporta mayor oxigenación, migración celular y un buen resultado estético ­ funcional. La reparación se realizó con colgajos de trasposición dependientes de la arteria pudenda y colgajos de avance y rotación del lado contralateral. Hemos concluido que la confección de colgajos locales en la región vulvar para la reconstrucción de defectos es una opción a tener en cuenta debido al aporte vascular, la presencia de perforantes dependientes de la arteria pudenda, la conservación nerviosa, el bajo índice de morbilidad y el aceptable resultado estético ­ funcional.


After the surgical treatment of the malignant and premalignant pathology of the vulvoperineal region we have the challenge of reconstruction the coverage defect, which in most cases cannot be resolved with a primary closure. We describe 2 cases of reconstruction with local fl aps, the aim is to repairing the defect, off ering a vascularized tissue, which provides more oxygenation, cell migration and a good aesthetic-functional result. The repair was performed with transposition fl aps dependent on the pudendal artery and advance and rotation fl aps of the contralateral side. We concluded that the repairwith local fl aps in the vulvar region for the reconstruction of defects is an option to take into account due to the vascular contribution, the presence of perforators dependent on the pudendal artery, nerve conservation, low morbidity index and acceptable aesthetic result - functional.


Subject(s)
Humans , Female , Middle Aged , Aged , Vulvar Neoplasms/surgery , Reconstructive Surgical Procedures , Free Tissue Flaps/transplantation , Retrospective Studies
5.
Article in Chinese | WPRIM | ID: wpr-828884

ABSTRACT

OBJECTIVE@#To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma.@*METHODS@#Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition).@*RESULTS@#All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation ( < 0.05).@*CONCLUSIONS@#The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.


Subject(s)
Arteries , Free Tissue Flaps , Humans , Oropharyngeal Neoplasms , Perforator Flap , Quality of Life , Reconstructive Surgical Procedures , Skin Transplantation , Soft Tissue Injuries
6.
Rev. argent. cir. plást ; 25(2): 54-67, apr-jun.2019. tab, fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1152220

ABSTRACT

Introducción. El linfedema de miembro superior postratamiento del cáncer de mama es una afección progresiva y crónica que compromete a una gran cantidad de pacientes causando efectos físicos, psicológicos y sociales. El linfedema secundario se da en un 20-40% de los casos luego de la cirugía del cáncer de mama con vaciamiento y radioterapia. Este es un problema desafiante. El tratamiento conservador ha demostrado no ser suficientemente exitoso por lo que su tratamiento quirúrgico es una buena opción. La transferencia microquirúrgica de nódulo linfático vascularizado (TNLV) brindó una nueva esperanza para este grupo de pacientes. Material y métodos. En el periodo comprendido entre marzo 2016 y agosto 2018 se analizaron 16 pacientes con una edad promedio de 50,25. Se realizó tratamiento quirúrgico basándose en la transferencia de nódulo linfático vascularizado (TNLV) de la ingle a la axila por medio de una anastomosis microquirúrgica de la arteria circunfleja ilíaca superficial en pacientes que presentaron linfedema secundario al tratamiento del cáncer de mama. Se realizó simultáneamente a la cirugía reconstructiva de la mama con colgajo libre DIEP y también en un segundo tiempo quirúrgico. Tiempo quirúrgico de 4,3 horas y una estadía en internación de 2,3 días. Resultados. La vitalidad de los colgajos fue 100%. Como morbilidad, se presentaron cuatro casos de seroma, una infección y una dehiscencia en la zona dadora. Con un seguimiento promedio de 10,43 meses y una reducción significativa de volumen del miembro afectado del 27.47% en comparación con el preoperatorio. La incidencia de celulitis descendió. La linfografía posoperatoria indicó una mejoría en el drenaje linfático del miembro afectado. Conclusiones. La transferencia linfática vascularizada al miembro afectado en conjunto con la cirugía reconstructiva mamaria DIEP es un procedimiento seguro y eficaz en el tratamiento del linfedema de miembro superior en pacientes mastectomizadas con vaciamiento ganglionar y radioterapia.


Purpose: Upper limb lymphedema post breast cancer treatment is a progressive and chronic condition that involves a large number of patients causing psychological, physical and social effects. The incidence of secondary lymphedema is about 20-40% before breast cancer treatment. This is a challenging problem. The conservative treatment has shown not to be successful enough so the surgery is a really good option. The vascularized lymph node transfer (VLNT) offers some hope to this group of patients. The purpose of the investigation is to demonstrate that te VLNT is an efficacious approach to treating postmastectomy upper limb lymphedema. Methods: From March 2016 to August 2018 were analyzed sixteen patients with a mean age of 50.25 years. They all have secondary lymphedema. They underwent surgical treatment based on vascularized lymph node transfer from the groin to the axially area or elbow as a recipent site. The deep inferior epigastric perforator flap was made at the same time, as a stacked flap. In only six cases, the VLNT was made on a second surgical time. The serrato's vessels were used as a recipient vessels in the axilary area and a radial artery branch and the cephalic vein were used in the elbow. Results: The flaps vitality was 100%. There were four seroma cases, one infection and one dehiscence. At a mean follow up of 10.43, the mean circumference reduction rate of the lymphedematous limb was about 27.47% between the preoperative and the postoperative groups. The postoperative lymphoscintigrapy showed a little improvement. The follow up of the vitality of the nodes was made by a lymphatic contrast tomography, and it showed all nodes survived. Conclusions: The vascularized lymph node transfer and the DIEP flap were confirmed as an effective and safe treatment to the secondary lymphedema in this type of patients, and it really improves postmastectomy upper limb lymphedema


Subject(s)
Humans , Anastomosis, Surgical , Retrospective Studies , Reconstructive Surgical Procedures , Seroma , Free Tissue Flaps , Breast Cancer Lymphedema/diagnosis , Iliac Artery , Lymph Nodes , Lymphedema/diagnosis
7.
Rev. bras. oftalmol ; 78(2): 144-149, mar.-abr. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1042375

ABSTRACT

Resumo Objetivo: Os autores revisaram o uso de periósteo em cirurgias oftalmológicas e seus resultados. Métodos: Uma revisão de literatura usando os bancos de dados do Google Scholar, PubMed e SciElo com todos os artigos sobre o uso de periósteo em Oftalmologia publicados de 1977 até 2018. Resultados: Um total de 21 estudos cumpriram o objetivo do estudo: 9 relatos de caso, 9 séries de casos, 1 coorte retrospective e 2 coortes prospectivas. 206 pacientes foram submetidos aos procedimentos cirúrgicos com uso de periósteo nas duas formas principais: enxerto e retalho. Os principais motivos para uso do periósteo foram: recobrimento de implante orbitário e reconstrução palpebral. Resultados cirúrgicos foram satisfatórios com baixas taxas de complicação de 10.67% e mínima necessidade de nova intervenção cirúrgica de 2.42%. Conclusão: O uso de periósteo em Oftalmologia é uma técnica promissora com bons resultados até o momento e deve sempre ser uma opção terapêutica para o Oftalmologista. Todavia, mais estudos com poder estatístico para sedimentação do conhecimento sobre o tema são recomendados.


Abstract Purpose: The authors reviewed the periosteum use in ophthalmic surgery and its results. Methods: A comprehensive review of the literature using Google Scholar, PubMed and SciElo databases with all articles about the periosteum use in Ophthalmology published from 1977 to 2018. Results: A total of 21 studies followed the review's purpose: 9 case reports, 9 case series, 1 retrospective cohort and 2 prospective cohorts. 206 patients were submitted to the procedures with the periosteum use in the two main forms: graft and flap. The principal reasons for periosteal use were: orbital implant covering and eyelid reconstruction. Surgical outcomes were very satisfactory with low complication rates of 10.67% and minimal necessity of new surgical intervention of 2.42%. Conclusion: The periosteum use in Ophtalmology is a promising technique with good results so far and should always be a therapeutic option for the ophthalmologist. However, based on available data in the literature, more studies with statistical power for knowledge sedimentation in this subject are recommended.


Subject(s)
Periosteum , Ophthalmologic Surgical Procedures , Transplantation, Autologous , Free Tissue Flaps , Databases, Bibliographic
8.
Article in English | WPRIM | ID: wpr-787521

ABSTRACT

Recent studies have reported on the reconstruction of oral mucosal defects using acellular dermal matrix (ADM). This case report describes the reconstruction of a soft-palate mucosal defect using ADM. A 43-year-old man developed a 2.5 cm × 3 cm soft-palate mucosal defect after the removal of a lump on the soft palate andreconstructed the defect using ADM without further complications. Reconstruction of the soft palate with ADM could be more convenient than traditional methods including primary closure, skin graft, and local or free flap without complications.


Subject(s)
Acellular Dermis , Adenoma, Pleomorphic , Adult , Free Tissue Flaps , Humans , Palate, Soft , Skin , Transplants
11.
Article in English | WPRIM | ID: wpr-762865

ABSTRACT

BACKGROUND: The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. METHODS: This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. RESULTS: Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. CONCLUSIONS: Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.


Subject(s)
Ameloblastoma , Female , Fibula , Follow-Up Studies , Free Tissue Flaps , Humans , Male , Mandible , Mandibular Osteotomy , Mandibular Reconstruction , Medical Records , Recurrence , Retrospective Studies , Venous Thrombosis
12.
Article in English | WPRIM | ID: wpr-762862

ABSTRACT

BACKGROUND: Most patients with head and neck cancer successfully undergo oncologic resection followed by free or local flap reconstruction, depending on the tumor’s size and location. Despite effective curative resection and reconstruction, head and neck cancer patients still face a high risk of recurrence and the possibility of a second primary cancer. Moreover, surgeons hesitate to perform sequential reconstruction following curative resection for several reasons. Few large-scale studies on this subject are available. Therefore, we retrospectively evaluated the outcome of sequential head and neck reconstruction to determine the possible risks. METHODS: In total, 467 patients underwent head and neck reconstruction following cancer resection at our center from 2008 to 2017. Of these cases, we retrospectively reviewed the demographic and clinical features of 58 who had sequential head and neck reconstruction following resection of recurrent cancer. RESULTS: Our study included 43 males (74.1%) and 15 females (25.9%). The mean age at the initial operation was 55.4±15.3 years, while the mean age at the most recent operation was 59.0±14.3 years. The interval between the first and second operations was 49.2±62.4 months. Twelve patients (20.7%) underwent surgery on the tongue, and 12 (20.7%) had procedures on the oropharynx. Thirty-four patients (58.6%) received a sequential free flap reconstruction, and 24 patients (41.4%) were treated using locoregional flaps. No cases of flap failure occurred. CONCLUSIONS: Our findings suggest that patients who need additional operations with recurrent head and neck cancer could optimally benefit from sequential curative resections and reconstructions.


Subject(s)
Female , Free Tissue Flaps , Head and Neck Neoplasms , Head , Humans , Male , Microsurgery , Neck , Neoplasms, Second Primary , Oropharynx , Recurrence , Retrospective Studies , Surgeons , Tongue
13.
Article in English | WPRIM | ID: wpr-762841

ABSTRACT

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.


Subject(s)
Cognition , Craniocerebral Trauma , Debridement , Follow-Up Studies , Free Tissue Flaps , Hemodynamics , Humans , Male , Metabolism , Middle Aged , Motor Skills , Myocutaneous Flap , Neurologic Manifestations , Postoperative Period , Reconstructive Surgical Procedures
14.
Article in English | WPRIM | ID: wpr-762824

ABSTRACT

Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.


Subject(s)
Arteries , Bandages , Estrogens, Conjugated (USP) , External Fixators , Free Tissue Flaps , Heel , Humans , Immobilization , Leg Injuries , Lower Extremity , Perforator Flap , Sural Nerve , Surgical Flaps , Tissue Donors , Wounds and Injuries
15.
Article in English | WPRIM | ID: wpr-762812

ABSTRACT

BACKGROUND: The masseter nerve is a useful donor nerve for reconstruction in patients with established facial palsy, with numerous advantages including low morbidity, a strong motor impulse, high reliability, and fast reinnervation. In this study, we assessed the results of masseter nerve–innervated free gracilis muscle transfer in established facial palsy patients. METHODS: Ten patients with facial palsy who received treatment from January 2015 to January 2017 were enrolled in this study. Three patients received masseter nerve–only free gracilis transfer, and seven received double-innervated free gracilis transfer (masseter nerve and a cross-face nerve graft). Patients were evaluated using the Facial Assessment by Computer Evaluation software (FACEgram) to quantify oral commissure excursion and symmetry at rest and when smiling after muscle transfer. RESULTS: The mean time between surgery and initial movement was roughly 167.7 days. A statistically significant increase in excursion at rest and when smiling was seen after muscle transfer. There was a significant increase in the distance of oral commissure excursion at rest and when smiling. A statistically significant increase was observed in symmetry when smiling. Terzis’ functional and aesthetic grading scores showed significant improvements postoperatively. CONCLUSIONS: Masseter nerve innervation is a good option with many uses in in established facial palsy patients. For some conditions, it is the first-line treatment. Free gracilis muscle transfer using the masseter nerve has excellent results with good symmetry and an effective degree of recovery.


Subject(s)
Facial Nerve , Facial Paralysis , Free Tissue Flaps , Humans , Smiling , Tissue Donors
16.
Article in English | WPRIM | ID: wpr-762747

ABSTRACT

Colon interposition is commonly used for esophageal reconstruction in patients with a previous gastrectomy. However, when colon interposition fails and alternative reconstruction is required, there are few options for reconstructing the long segment from the esophagus to the stomach. Here, we report on cases of esophagogastric reconstruction with limited alternative options after the failure of transverse and left colon interposition. In these cases, reconstruction was performed using two different microvascular methods: double-pedicle jejunal free flap and supercharged ileocolic interposition graft.


Subject(s)
Colon , Esophageal Neoplasms , Esophagus , Free Tissue Flaps , Gastrectomy , Humans , Jejunum , Microsurgery , Stomach , Transplants
17.
Article in English | WPRIM | ID: wpr-762712

ABSTRACT

PURPOSE: An enhanced recovery after surgery (ERAS) protocol incorporates up-to-date perioperative care principles; the primary aim in using an ERAS protocol is to reduce issues that delay the recovery and cause the complications. The aim of this study was to compare outcomes associated with head and neck cancer surgery with free-flap reconstruction before and after implementation of an ERAS protocol. METHODS: Outcomes were analyzed by dividing patients into 2 groups: 29 patients in the non-ERAS group and 60 patients in the ERAS group. The ERAS group performed a prospective observational cohort study of patients who underwent a head and neck cancer surgery with free-flap reconstruction in Ajou University Hospital from August 2015 to December 2017. The non-ERAS group retrospectively reviewed the medical records of patients who had undergone the same surgery from August 2012 to July 2015. RESULTS: Demographics, comorbidities, hospital length of stay (LOS), postoperative complications, starting time of rehabilitation, and postoperative periods before radiotherapy for the non-ERAS and ERAS groups were compared. Hospital LOS was significantly lower for patients whose care followed the ERAS protocol than for patients in the non-ERAS group (30.87 ± 20.72 days vs. 59.66 ± 40.43 days, P < 0.0001). CONCLUSION: In this study, hospital LOS was reduced through fast recovery after the implementation of the ERAS protocol. Therefore, the ERAS protocol appeared feasible and safe in head and neck cancer surgery with free-flap reconstruction.


Subject(s)
Cohort Studies , Comorbidity , Demography , Free Tissue Flaps , Head and Neck Neoplasms , Head , Humans , Length of Stay , Medical Records , Perioperative Care , Postoperative Care , Postoperative Complications , Postoperative Period , Prospective Studies , Radiotherapy , Radiotherapy, Adjuvant , Rehabilitation , Retrospective Studies
18.
Article in English | WPRIM | ID: wpr-766347

ABSTRACT

Treatment of metastatic carcinoma of the oral cavity can be a challenge due to its rarity. The current case report details metastatic carcinoma of the mandible originating from follicular thyroid carcinoma, which is the second most prevalent tumor of the thyroid. As the mandibular lesion developed, the primary thyroid lesion of thyroid. Here, we report a case of metastatic carcinoma of the mandible in a 67-year-old female that was treated with partial mandibulectomy and fibular free flap.


Subject(s)
Adenocarcinoma , Adenocarcinoma, Follicular , Aged , Female , Free Tissue Flaps , Humans , Mandible , Mouth , Neoplasm Metastasis , Thyroid Gland , Thyroid Neoplasms
19.
Article in English | WPRIM | ID: wpr-766318

ABSTRACT

Clear cell odontogenic carcinoma (CCOC), a rare tumor in the head and neck region, displays comparable properties with other tumors clinically and pathologically. In consequence, an incorrect diagnosis may be established. A 51-year-old male patient who was admitted to the Department of Oral and Maxillofacial Surgery at Pusan National University Dental Hospital was initially diagnosed with ameloblastoma via incisional biopsy. However, the excised mass of the patient was observed to manifest histopathological characteristics of ameloblastic carcinoma. The lesion was ultimately diagnosed as clear cell odontogenic carcinoma by the Department of Oral Pathology of Pusan National Dental University. Therefore, segmental mandibulectomy and bilateral neck dissection were performed, followed by reconstruction with fibula free flap and reconstruction plate. Concomitant chemotherapy radiotherapy was not necessary. The patient has been followed up, and no recurrence has occurred 6 months after surgery.


Subject(s)
Ameloblastoma , Ameloblasts , Biopsy , Diagnosis , Diagnostic Errors , Drug Therapy , Fibula , Free Tissue Flaps , Head , Humans , Male , Mandibular Osteotomy , Middle Aged , Neck , Neck Dissection , Pathology, Oral , Radiotherapy , Recurrence , Surgery, Oral
20.
Article in English | WPRIM | ID: wpr-739377

ABSTRACT

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.


Subject(s)
Free Tissue Flaps , Hyperemia , Lower Extremity , Microsurgery , Perforator Flap , Surgical Flaps , Thigh , Veins
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