Secondary reconstruction of thoracic digestive tract for relapsed or recurrent thoracic esophageal-gastric cancer after operation of esophageal and preventriculus cancer / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical characteristics of thoracic esophageal-gastric cancer (TEGC) and the safety and effectiveness of secondary reconstruction of thoracic and gastrointestinal tract after esophageal and preventriculus cancer (esophagogastric junction) surgery. Methods    The clinical data of 353 patients with esophageal and preventriculus cancer who underwent endoscopic review from July 2007 to December 2019 were retrospectively analyzed. A total of 31 (8.78%) patients with relapsed or recurrent TEGC were found, including 24 males and 7 females with a mean age of 58.5 years (range: 42 to 68 years). There were 18 (58.06%) patients of adenocarcinoma and 13 (41.94%) squamous cell carcinoma. All patients underwent TEGC resection and secondary reconstruction of thoracic gastrointestinal tract. Thoracoabdominal computed tomography (CT) and upper gastrointestinal imaging (GI) were performed during follow-up, and gastroscopy was performed for suspected patients. All the patients were followed-up till death or December 30, 2019. The survival rate was calculated by Kaplan-Meier method, and the survival was analyzed using the log-rank test. Results    Thirty-one patients underwent thoracic esophagectomy and gastric cancer resection, and then reconstruction of the thoracic and gastrointestinal tract. Eight patients underwent residual gastroesophageal thoracic anastomosis, 13 patients colon esophagectomy, 6 patients jejunal esophagectomy (1 patient esophago-jejunal Roux-en-Y anastomosis), and 4 patients cervical esophagogastric anastomosis. The mean operation time and intraoperative blood loss were 404.8 (340-475) min and 378.4 (180-620) mL. The postoperative complications ocurred in 4 patients, including 3 patients of pulmonary infection and 1 patient of cervical incision infection. The mean hospital stay was 17.1 (14-21) d. All patients were followed up, the median survival time of 11 patients in stage Ⅰ-ⅡA was 25 (19.8-35.0) months and 20 patients in stage ⅡB-ⅢA was 16 (12.5-19.5) months. There was a significant difference between the two groups (χ2=7.840 8, P<0.01). Conclusion    Postoperative relapsed and recurrent TEGC occurs after the surgery for esophageal and preventriculus cancers, most of which are caused by metachronous gastric cancer or residual esophageal carcinoma recurrence which leads to invasion of the thoracic and gastric wall. Regular endoscopic review is the main method after operation. It is technically safe and feasible to reconstruct the thoracic and esophageal digestive tract in patients with TEGC after reoperation, which can benefit the survival of patients.

Secondary Reconstruction of Frontal Sinus Fracture

Fractures of frontal sinus account for 5%–12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

Secondary Reconstruction for Head and Neck Cancer Patient

The purpose of secondary reconstruction for head and neck cancer patient is to manage complications and to improve functional and aesthetic defects following previous surgery. The complications following primary treament of tumor include radionecrosis in bones and soft tissue following radiotherapy, formation of orocutaneous fistula, dehiscence of wounds, secondary infection in wounds, and total or partial necrosis in transferred flaps. Following the resection of tumor some functional deficiencies appear such as dyspnea, swallowing and chewing difficulty due to strictures of reconstructed aerodigestive tract and bulkness of flap. In addition, we performed adjuvant surgery for aesthetic improvement or prosthetic appliance after head and neck reconstruction. We have experienced secondary reconstructions in 29 patients who underwent previous surgical resection for head and neck cancer from June 1988 to March 2000. Ages ranged from 36 to 77 with an average of 58.3. We have performed free flaps in 21 cases, skin grafts in 3 cases, local or regional flaps in 2 cases, and other adjuvant procedure in 4 cases. Secondary reconstructions were successful in all cases. The complicated wounds and fistulae were healed completely, the aerodigastric tract with the stricture was reconstructed with healthy tissue and respiration and swallowing functions were recovered. Aesthetic improvement and prosthetic appliance were also achieved through secondary adjuvant treatment. In conclusion, the successful secondary reconstruction for head and neck cancer needs a careful preoperative planning and therapeutic strategy. We believe that secondary reconstruction for head and neck reconstruction is very important for these cancer patients even though primary resection had been successfully performed for cancer removal, because it can provide better quality of life and sometimes save the patient's life itself.

A Clinical Study of neurovascular Island Flap as a Seound Stage Procedure / 대한정형외과학회잡지

The transfer of a sensory island of skin to an anesthetic area on the hand has been the most important development in hand surgery in the past decade. A neurovascular island flap transfer has proved useful for the treatment of finger injuries in primary cases and in secondary cases. The purpose of this paper is to describe the use of local composite tissue, isolated and transferred on a neurovascular pedicle graft for the secondary reconstruction procedures of finger injuries. Thirty two fingers had been operated on for "neurovascular island flap" coverage operation at the Department of Orthopedic Surgery, Yonsei University, Severance Hospital and Inchon Severance Hospital during the period from 1983 to 1992. The follow up study was carried out on twenty hands over a year period after an operation. The results obtained were as follows. 1. Among twenty hands the cases of thumb are ten. The index are eight, other fingers are two. 2. The ratio between male and female was about 4: 1 The most common procedures of primary treatment were abdominal distant flap (14cases). 3. All had better touch, pain and temperature sensibility in the flap than the surrounding recipient area. Thirteen patients reffered a pinprick in the flap to the donor finger, All had decreased two point discrimination corresponding to the pulp about 6 months after operation. 4. The use of neurovascular pedicle graft as a method of tissue transfer which permits a wide range of motion and comfortable appearance without jeopardizing either circulation or sensation.