Reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer by multiple tissue flaps / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore a new method for the reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer using pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.</p><p><b>METHODS</b>From June 2010 to June 2014, 56 cases of hypopharyngeal or cervical esophageal cancer were treated with pharyngogastric anastamosis, in 5 cases of them, because the length of pulled-up stomach was limited and could not reach oral pharynx, free jejunal flap was used in 2 cases with laryngeal invasion and laryngotracheal flap was used in 3 cases without laryngeal invasion to reconstruct the defect between oral pharynx and stomach.</p><p><b>RESULTS</b>Pharyngeal fistula occurred in 1 case with laryngotracheal flap reconstruction, but healed after 2 weeks of wound dressing. Other 4 cases had oral liquid diet two weeks after surgery and did not occur any complications such as infection or pharyngeal fistula. Follow-up showed 1 case died from mediastinal and lung metastases after 3 years, 1 case had cervical lymph recurrence after 2 years and still survived, and other 3 cases were tumor free survival for 28, 37, and 56 months respectively.</p><p><b>CONCLUSIONS</b>The defect after resection of hypopharyngeal and esophageal cancer can be reconstructed with pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.</p>

Application of scapula osteomyocutaneous flap in the repair of maxillary defect / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Preliminary study on free scapula osteomyocutaneous flap to repair maxillary defect.</p><p><b>METHODS</b>Central maxillofacial soft and hard tissue defect after nasal sinus or oral tumor surgery was repaired with free scapual osteomyocutaneous flap in 4 patients to reconstruct their maxillofacial functions. The primary tumors included an ameloblastoma, a recurrent low-grade mucous epidermoid carcinoma a jaw sarcoma and a squamous cell carcinoma.</p><p><b>RESULTS</b>All the 4 cases had good wound healing within 2 weeks after surgery, with no complications, could take in semifluid food after 3 weeks, and had clear language communication after 1 month. Three cases wore denture after 2 months and recovered maxillofacial contour and partial chewing function, and had no tumor recurrences with the follow-up of 37, 25 and 10 months respectively. One case of maxilla sarcomas had recurrence with invasion of parapharyngeal space and skull base and pulmonary metastasis 9 months after surgery, who gave up further treatment and died 1 year later. No obvious dysfunction occurred in shoulder and back donation sites and well blood supply in transplanted bones were showed with CT and bone scan.</p><p><b>CONCLUSIONS</b>Scapula osteomyocutaneous flap has some advantages including reliable blood supply, hidden incision and little affect on the donation site, and it can apply with multiple tissues including bone, muscle, and skin for repair. This flap also has good shape adaptability and availability. So scapula osteomyocutaneous flap is a satisfactory method for the repair of facial maxillary complex defects. But some limitations exist in the flap, by which less amount of bone can be applied and more operation time is required due to the changes of patient's body position during surgery.</p>