Microvascular "supercharged" cervical colon: minimizing ischemia in esophageal reconstruction.

Traditional colonic reconstruction of the esophagus is performed by cervical transposition of an isolated segment of colon with the vascular supply derived from one of the mesenteric colic vessels. The transposed cervical portion of the colon is farthest from the vascular supply and is at risk of ischemic injury. Despite notable risk of ischemic complications to the colonic neoesophagus, reports advocating a "supercharged" microvascular augmentation of the vascular supply to the cervical portion of the colon remain few in number. Herein, the ischemic complications associated with traditional transposition of the colon for esophageal reconstruction are reviewed, and avoidance by microvascular "supercharging" of the cervical colon is advocated under particular circumstances. The authors present a case of colonic interposition for esophageal replacement requiring a cervical microvascular anastomosis for survival of the transferred colon.

Alloplastic and microvascular restoration of the mandible: a comparison study.

The evolution of mandibular reconstruction following composite resection is advanced by improved alloplastic prosthesis and reliable microvascular free tissue transfers. A 42-case, 6-year experience is presented using both methods at the University of California, San Francisco. The advantages and complications of both are discussed. The authors conclude that the success rate for lateral defect restoration is equivalent with either technique, and that the anterior defects are more reliably reconstructed with free tissue transfer. The advantage of microvascular flaps in the anterior defect must be gauged against the physical status of the patient, disease extent, and likelihood of dental rehabilitation by interosseous fixation.

Comparison of response amplitude versus stimulation threshold in predicting early postoperative facial nerve function after acoustic neuroma resection.

OBJECTIVE: This study aimed to better predict the early postoperative facial nerve (FN) function after acoustic neuroma (AN) resection. STUDY DESIGN: This study was a prospective series. SETTING: The surgery was conducted in a tertiary referral center. PATIENTS: A total of 44 patients undergoing AN resection with cranial nerve monitoring were observed for at least 1 year after surgery. MAIN OUTCOME MEASURES: The predictive value of amplitude of the FN stimulus response on the early postoperative FN function was measured. RESULTS: Cranial nerve monitoring in AN surgery was used to obtain the stimulation threshold and facial electromyograph response amplitudes to FN stimulation proximal and distal to the tumor at 0.2 V above threshold. Thirty-eight of forty-four patients studied had a low postresection threshold (< or = 0.1 V). Of these (10), 26% sustained a postoperative FN dysfunction of House-Brackmann (HB) grades 3-6. In an effort to improve the predictive value from cranial nerve monitoring, the response amplitude to suprathreshold stimulation was compared with the threshold and FN function. Eighty-nine percent of patients with an amplitude of > or =200 microV had a grade 1-2 early postoperative FN function, whereas only 41% of patients with < 200 microV had a grade 1-2 early postoperative FN function (p = 0.00035). Eighty-eight percent of patients with both a low threshold and high amplitude had a grade 1-2 early postoperative FN function, whereas the remaining 12% of patients had a grade 3-6 FN function (p = 0.0032). The false-positive rate of threshold alone in predicting a grade 1-2 FN function was 26% compared to 12% for low threshold and high amplitude combined. CONCLUSIONS: The use of FN threshold and amplitude together is superior to threshold alone as a predictor of early postoperative FN function.