Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature.

UNLABELLED: Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free flap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48-year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free flap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as "excellent" and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable flap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator flap, RFFF, anterolateral thigh and ulnar forearm flap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM flap, latissimus dorsi myocutaneous free flap, pectoralis major musculocutaneous flap and trapezius island flap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

Correction of paralytic lagophthalmos.

INTRODUCTION: Bell's palsy causes lagophthalmos of the involved eyelids. Secondary to the atonicity of the eyelids, xerophthalmia, conjunctivitis and epiphora develops. There are dynamic (muscle transfers) and static (gold weights, tarsorrhaphy) approaches to alleviate these problems. The GOALS of this study are to present a technical note for a surgical method for lengthening the retracted upper eyelid with autogenous temporalis fascia and elevation of the lower eyelid with transplantation of autogenous morselized conchal cartilage graft via standard blepharoplasty incisions. MATERIAL AND METHODS: The proposed technique is illustrated in details with an example of a patient with paralytic lagophtalmos. The 4 years follow up of the case operated by this technique shows a stable occlusion of the eyelids with a lowering of the upper eyelid and elevation of the lower eyelid margin. CONCLUSION: If the paralysis is complete this technique will not accomplish adequate relieve of symptoms. In this cases re-animation of the eyelids with either temporalis muscle transfers or free micro neurovascular muscle transfers are indicated.

Autologous fat transplantation in the facial region--clinical and morphological studies of 30 cases.

OBJECTIVE: This study presents the results of a clinicomorphological study of autologous fat transplantation in the face region. The aim was to investigate and compare adipose tissue morphology after it was purified by two methods--centrifugation and serum lavage, and to find a correlation between the histological outcomes and the postoperative results. PATIENTS AND METHODS: The evaluation was performed on a series of 30 patients assigned into two groups of 15 patients. Centrifuged adipose tissue was transplanted in one of the groups, and noncentrifuged (saline solution washed) in the other group. In all cases fat was obtained by syringe liposuction of subgluteal zones, processed by one of the two methods and then transplanted. Part of the material was fixed between vitaline membranes and embedded in paraffin. Histological analysis was performed after hematoxylin eosin staining of the slides. Post-operative effect was assessed by comparison of the pre- and postoperative photos on a 4-grade scale. RESULTS: The morphological analysis revealed that adipose tissue was damaged by neither of the purification methods but the serum lavage preserved greater number of non-differentiated fat cells and connective tissue fragments. Furthermore, our clinical results suggested clearly that the noncentrifuged adipose tissue transplantation was more advantageous than the other type of transplantation. CONCLUSION: The present study is an attempt to make a contribution towards a better understanding of the mechanisms involved in fat graft preservation.

Our experience in the application of lipofilling.

Autologous fat grafting, referred to as lipofilling was described first by Neuber in 1893. It has been gaining great popularity recently due in particular to the intensive development of liposuction and the anatomical availability of various subcutaneous adipose tissue depots in the human body. In the present study we present our experience in autulogous fat grafting for the reconstruction of soft tissue defects as well as for face rejuvenation and body contouring. Between May 2003 and May 2005 we performed lipofilling surgery in 13 patients at the Department of Plastic and Craniofacial Surgery in St. George University Hospital, Plovdiv. The grafts were harvested by lipoaspiration and, after subsequent treatment, re-injected. Our results are still preliminary because of the short terms of patients' follow-up. The most common complications at the recipient site were partial resorption of the graft and cyst formation, and at the donor site--hematoma.