ABSTRACT
Variations in the radial arterial system, although rare, may still be encountered during harvest of a radial forearm flap. The reconstructive surgeon should be aware of these possible variations as some may significantly affect the harvest, jeopardising the survival of the radial forearm flap as well as causing ischaemia in the hand. We present a case with coexisting anomalies of the radial arterial system encountered during the harvest of the radial forearm flap, which has never before been described in the reconstructive surgery literature. In this patient the radial artery supplied the overlying skin with only a single small proximal perforator; a median artery existed and arose from the radial artery; the median artery supplied the forearm with unusually large perforators which passed ulnar to the flexor carpi radialis tendon; and the common interosseous artery originated from the radial artery. It is important for the reconstructive surgeon to be aware of these anomalies for the success of the operation. The embryology, incidence and significance of the median artery during radial forearm free flap harvest are also discussed.
Subject(s)
Plastic Surgery Procedures/methods , Radial Artery/abnormalities , Surgical Flaps/blood supply , Carcinoma, Squamous Cell/surgery , Forearm/blood supply , Humans , Male , Middle Aged , Mouth Neoplasms/surgery , Neck Dissection , Radial Artery/surgery , Skin Transplantation/methods , Tissue and Organ Harvesting , Tongue Neoplasms/surgeryABSTRACT
Pharyngocutaneous fistula (PCF) is not uncommon after laryngeal surgery. Because it leads to prolonged hospitalization and increased patient morbidity, it is important to predict the formation of fistula. We studied the wound amylase concentrations of 87 consecutive laryngectomized patients. The PCF rate was 11.5% in this series. The amylase levels in patients with PCF begin to elevate significantly on the third, fourth, and fifth postoperative days. Our data indicate that increase in the wound amylase levels seems to be a significant predictor of PCF, and this should alert the surgeon for the presence of fistula.
Subject(s)
Amylases/metabolism , Fistula/enzymology , Fistula/etiology , Laryngectomy , Pharynx , Postoperative Complications , Skin , Surgical Wound Infection/enzymology , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
Congenital vallecular cyst is fairly uncommon in neonates and infants. Although benign in nature, it may cause stridor and even life-threatening airway obstruction in early infancy. A 3-month-old male baby presented with failure to thrive and respiratory distress was found to have a vallecular cyst. Marsupialization with CO(2) laser was performed.
