ABSTRACT
Background@#Reconstruction after removal of a malignant tumor in the head and neck region is crucial for restoring tissue integrity, function, and aesthetics. We retrospectively analyzed patients who underwent intraoral reconstruction surgery using radial forearm free flaps (RFFF) and anterolateral thigh free flaps (ALT) at a single institution to provide more information supporting the choice of a reconstruction method after removal of head and neck cancer. @*Methods@#The charts of 708 patients who underwent head and neck reconstruction between 1998 and 2018 at the Department of Plastic and Reconstructive Surgery at our institution were retrospectively reviewed. Patients’ age, sex, and history of radiation therapy, diabetes mellitus, and smoking were retrieved. The primary cancer site, types of defects, and complications were investigated. @*Results@#Overall, 473 and 95 patients underwent reconstruction surgery with RFFF and ALT, respectively. RFFF was more often used in patients with cancers of the pharynx, larynx, esophagus, or tonsil, while ALT was more frequently used in patients with cancers of the mouth floor with tonsil or tongue involvement. The proportion of patients undergoing ALT increased gradually. Flap failure and donor site morbidities did not show significant differences between the two groups. @*Conclusions@#RFFF and ALT flaps resulted in similar outcomes in terms of flap survival and donor site morbidity. ALT can be an option for head and neck reconstruction surgery in patients with large and complex defects or for young patients who want to hide their donor site scars.
ABSTRACT
Subpectoral implant insertion is considered to be the standard procedure for breast augmentation and reconstruction. However, in some patients who have undergone breast augmentation or reconstruction surgery with a prosthesis, implant removal may be required for various reasons, including infection or implant rupture. According to a literature review, the standard technique for implant removal has not been thoroughly investigated. This study aimed to report the case of a patient who developed animation deformity after implant removal and to suggest a technique for preventing such complications. A 51-year-old woman underwent breast augmentation surgery with silicone implants. However, the patient complained of an unpleasant foreign body sensation; hence, the implant was removed 6 months after the first operation. After removal of the implant, undesirable movement of the chest wall on both breasts occurred. Revision surgery under general anesthesia was planned 18 months after implant removal. Capsulectomy was performed on both sides, and the pectoralis major muscle was completely isolated and repositioned. The undesirable movement in the skin of the chest wall disappeared postoperatively. This case suggests the need for capsulectomy and repositioning of the pectoralis muscle to its original position during implant removal.
ABSTRACT
Impregnated filters treated with alkali and humectant were first used as collection media to assess occupational exposure to sulfur dioxide (SO2), as outlined in the National Institute for Occupational Safety and Health Method 6004 in 1979. Since then, updated treatment protocols have been proposed with decreased amounts of alkali and glycerol, which claim the same filtering capacity. However, there has been no report on how the collection of SO2 on such impregnated media is influenced by relative humidity (RH). This study investigated the role of glycerol (G) amount on impregnated filters (G2 and G10, referring to 2 and 10% glycerol, respectively) in the collection of SO2 (100 l of 10 ppm at 1 l per minute) under low, medium, and high RHs. The testing results show that RH significantly impacted G2 filters with respect to breakthrough time, capacity, and recovery. At low RH, the 5% breakthrough time was less than 10 min and its recovery was merely 42%; at medium and high RHs, although the recovery was satisfactory, the 5% breakthrough time was still less than 100 min. By contrast, G10 filters illustrated nearly 100% recovery and evaluation by analysis of variance showed no significant effect of RH on recovery. In summary, the current treatment protocol of 2% glycerol leads to a significant underestimation of the exposure to SO2 in a low-RH environment; increasing the glycerol content can be an effective alternative to compensating for the effect of RH.
