case of carotid artery secondary hemorrhage successfully managed by extra anatomic axillary-internal carotid bypass

Carotid artery rupture post oncologic Head and Neck surgery is relatively rare but potentially lethal complication. To the best of the author's knowledge, the management options are restricted to ligation and resection of the pathologic segment of the artery accepting with helplessness a potential of stroke and sometimes mortality secondary to interruption of the blood supply of the brain. A patient with recurrent tongue cancer post resection and radiofrequency ablation. Salivary leak and infection in the neck resulted in a "Blow out" of the bifurcation of the carotid artery. Bleeding was controlled by minimal digital pressure, awakening test during cross clamping of the internal carotid artery lead to neurologic deficit. An extra-anatomic bypass was constructed with the inflow from the axillary artery and the outflow at the internal carotid artery at the skull base above and separate from the infected area and the tunnel in the posterior triangle of neck away from infection. The patient suffered no neurologic deficit. The vascular exposure wounds healed uneventfully .The patient was sent to chemotherapy. Occlusion of the graft occurred silently and hence left well alone. We hope that this bypass, or perhaps any other better option, proves to offer a management option for this frustrating morbidity that carries the risk of adding a neurologic deficit to the misery of the advanced head and neck malignancy

Reconstruction after laryngopharyngectomy: free-jejunal autograft versus gastric pull-up

Treatment of carcinoma of the hypopharynx and cervical esophagus is challenging as regards both cure and palliation. Many alternative methods for restoring the continuity of the alimentary tract were tested. These methods could be classified into two broad categories: locoregional skin or myocutaneous units, and free or pedicled enteric substitutes. Recent development in the techniques of microvascular anastomosis introduced the free jejunum autograft as a method of pharyngoesophageal reconstruction comparable to the stomach pull-up in achieving the goals of speed, safety, and effectiveness of rehabilitation. Fifteen patients with hypopharyngeal carcinoma were treated surgically at the National Cancer Institute [NCI] by the free- jejunal autograft technique. These patients were compared to thirty patients who had reconstruction by the gastric pull-up technique. The use of jejunal reconstruction for high lesions, early confined lesions, elderly patients, and patients with poor cardiopulmonary reserve were advocated. For lesions that invade the esophagus and for free transplant failure, stomach pull-up is recommended

Sigmoido-recto-urethroplasty after radical cystectomy for carcinoma of the urinary bladder

A sigmoido-recto-urethroplasty was performed for total bladder substitution in 24 selected patients. In 16 new patients the recto-sigmoid segment was isolated, partially detubularized in its upper end for a convenient length, and connected to the urethra. Through the open upper end of the segment, an effective low ureterocolonic end to side anastomosis was performed according to the method of Le Duc and Camey. Simple reconfiguration into a spherical pouch increased the capacity. In the remaining 8 patients the previous rectosigmoid bladder was converted to the continent urethral pouch