Reconstruction of medium-sized defects of oral commissure by combining double full-thickness cheek rhomboidal flaps and a small lip switch flap.

Reconstruction of oral commissure defects aims at securing oral competence and providing an acceptable appearance. The methods described by using either a cross lip flap or a flap from the adjacent cheek skin and mucosa may not be able to achieve such goals if each method is used on its own. We have combined double full-thickness cheek rhomboidal flaps with a small lip switch flap from the remaining lip segment to reconstruct medium-sized full-thickness defects of the oral commissure, following tumor excision in 7 patients. The functional and aesthetic outcomes were assessed by the evaluation of 3 parameters under each category. Each parameter received a score of good, moderate, or poor. Six patients had a good overall functional score. Microstomia was noted only in 1 patient. The overall aesthetic score for all the 7 patients was moderate. In conclusion, reconstruction of medium-sized commissural defects by the present technique achieves adequate oral competence and a satisfactory cosmetic result.

The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature.

BACKGROUND: Autologous breast reconstruction using the extended latissimus dorsi flap has been infrequently reported. In the current study, the authors are reporting their own clinical experience with this method. A review of the literature is also discussed. MATERIALS AND METHODS: Over a three year period, 14 patients underwent breast reconstruction using the extended latissimus dorsi (LD) flap. Patients with small to medium sized breasts were selected. The age of the patients ranged from 29 to 42 years with a follow-up period ranging from six to 18 months. The indications, flap-related complications and donor site morbidity and aesthetic results were evaluated. RESULTS: The main indication to use the flap was dorsal donor site preference by patients. The remaining patients were either not suitable for a flap from the abdomen or wished to get pregnant and were offered the dorsal donor site. Neither total nor partial flap loss was recorded but donor site morbidity was mainly due to seroma, which was treated conservatively in all patients, except for one who required surgery. Another two patients suffered from wound breakdown and distal necrosis of the back flaps. Mild contour deformity was also noted on the back of all patients but caused no major concern. Indeed, the overall patient satisfaction was very high. CONCLUSION: The extended LD flap proved to be a good option for autologous breast reconstruction in selected patients. Patients should be warned of the potential for seroma and mild contour back deformity.

Lower lip reconstruction after tumor resection; a single author's experience with various methods.

BACKGROUND: Squamous cell carcinoma is the most frequently seen malignant tumor of the lower lip. The more tissue is lost from the lip after tumor resection, the more challenging is the reconstruction. Many methods have been described, but each has its own advantages and its disadvantages. The author presents through his own clinical experience with lower lip reconstruction at the NCI, an evaluation of the commonly practiced techniques. PATIENTS AND METHODS: Over a 3 year period from May 2002 till May 2005, 17 cases presented at the National Cancer Institute, Cairo University, with lower lip squamous cell carcinoma. The lesions involved various regions of the lower lip excluding the commissures. Following resection, the resulting defects ranged from 1 /3 of lip to total lip loss. The age of the patients ranged from 28 to 67 years and they were 13 males and 4 females. With regards to the reconstructive procedures used, Karapandzic technique (orbicularis oris myocutaneous flaps) was used in 7 patients, 3 of whom underwent secondary lower lip augmentation with upper lip switch flaps. Primary Abbe (Lip switch) flap reconstruction was used in two patients, while 2 other patients were reconstructed with bilateral fan flaps with vermilion reconstruction by mucosal advancement in one case and tongue flap in the other. The radial forearm free flap was used only in 2 cases, and direct wound closure was achieved in three cases. All patients were evaluated for early postoperative results emphasizing on flap viability and wound problems and for late results emphasizing on oral continence, microstomia, and aesthetic outcome, in addition to the usual oncological follow-up. RESULTS: All flaps used in this study survived completely including the 2 free flaps. In the early postoperative period, minor wound breakdown occurred in all three cases reconstructed by utilizing adjacent cheek skin flaps, but all wounds healed spontaneously. The latter three cases involved defects greater than 2 /3 of lower lip and one of them was previously irradiated. Those patients then suffered from occasional drooling of saliva. The best results in terms of oral continence and cosmetic outcome were achieved in those cases reconstructed with flaps utilizing residual lower lip or upper lip tissues (i.e; the Karapandzic technique (orbicularis oris myocutaneous flaps, and the Abbe (upper lip switch flaps). Nevertheless, microstomia developed in four patients primarily reconstructed with the Karapandzic technique in which defects were greater than one half of the lip. Only one of those patients tolerated her microstomia and required no further treatment. The remaining three patients showed marked improvement after augmenting the lower lip with bilateral paraphiltral lip switch flaps from upper lip in a second stage. The follow-up period ranged from 6 months to three years during which no patient had developed local recurrence or distant metastasis. CONCLUSION: Lower lip reconstruction aims to restore function and appearance with the best results obtained by utilizing residual normal lip tissues incorporating potentially innervated muscle fibers. With larger defects, reconstruction is less than optimal, but every effort should be taken to obtain an adequate sphincter function and lip continence to saliva, both of which are the most important goals to achieve in lip reconstruction.

Locally advanced tumors of the scalp: the Egyptian National Cancer Institute experience.

BACKGROUND: It is well recognized that recurrent disease can occur following malignancy in the head and neck region. This is particularly true for basal cell & squamous cell carcinoma, whereby recurrence may occur many years following initial surgery or other modalities. We report here on skin malignancy occurring in the scalp with skull invasion down to the dura mater. Composite resection of scalp, craniectomy, dural resection and reconstruction including a free tissue transfer was analyzed. PURPOSE: To evaluate our experience in full thickness scalp resection and reconstruction. PATIENTS AND METHODS: At the National Cancer Institute, Cairo University, twelve patients with locally advanced tumors of the scalp invading the calvarium were treated with wide local excision of the scalp combined with underlying craniectomy and dural resection if needed. Reconstruction was completed using fascial graft for the dura, methyl methacrylate for the skull, and either giant rotational flap or free tissue transfer. RESULTS: Between 1998 and 2002, twelve patients with locally advanced tumors of the scalp were subjected to this surgery. All patients successfully tolerated the procedure and completely recovered with minimal morbidity with acceptable cosmetic results. CONCLUSION: With the advent of free tissue transfer to cover large defects in the skull and the availability of polymethyl methacrylate (bone cement) for cranioplasty, large defects in the calvarium can be successfully resected and grafted with satisfactory outcome, improved salvage rate, and prolonged survival.