RESUMO
Six hundred seventy-eight deltopectoral flaps were raised in 604 patients, 125 of which were delayed and 215 of which were used in previously irradiated beds. The rate of major flap necrosis was 16.9 percent and the overall rate of complications, 51.4 percent. Delay in creating the deltopectoral flap had no influence on the risk of complications and necrosis, whereas the use of the flap in a previously irradiated bed was associated with a significantly increased risk of major flap necrosis. The least flap loss occurred when the deltopectoral flap was used without tubulation for skin coverage only. Complications and flap necrosis occurred most frequently when flaps were tubulated in a reversed manner or used for lining of major portions of or for total oropharyngeal and hypopharyngeal reconstruction. The deltopectoral flap remains a useful, reliable, and versatile regional flap that can be used alone or in combination with other flaps in selected circumstances for major head and neck reconstruction.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Feminino , Humanos , Masculino , Músculos , Recidiva Local de Neoplasia/cirurgia , Músculos Peitorais , Estudos Retrospectivos , OmbroRESUMO
We studied 97 patients with recurrent basal cell carcinomas; 20 were treated by surgery, 35 by radiation, 40 with chemosurgery, and two patients had no treatment (because their lesions were too far advanced). There was a treatment failure rate of 11 percent for radiation therapy, 12 percent for chemosurgery and 5 percent for surgical excision. Recurrent BCC requires a careful selection of the mode of therapy, aggressive treatment, and careful long-term follow-up. Using these principles, an excellent cure rate can be achieved by all the 3 modes of therapy included in this report.
Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Basocelular/radioterapia , Criocirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/radioterapiaRESUMO
In a study using paired longitudinal flaps on the back of the rat, we found evidence to support the findings of previous investigators regarding the toxic effects of injecting local anesthetic solutions containing epinephrine into delayed flaps. Epinephrine concentrations of 1:200,000 and 1:400,000 were demonstrated to significantly increase losses in these flaps. Epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000 were not demonstrated to be harmful to undelayed flaps, in the dosages used.
Assuntos
Anestesia Local/efeitos adversos , Epinefrina/efeitos adversos , Sobrevivência de Enxerto/efeitos dos fármacos , Transplante de Pele , Idoso , Animais , Epinefrina/administração & dosagem , Humanos , Masculino , Necrose , Ratos , Pele/patologia , Fatores de Tempo , Transplante AutólogoRESUMO
The results of aggressive surgical treatment of primary lip cancer and advanced and recurrent carcinoma of the lip are illustrated and discussed. Early detection of involved lymph nodes before capsular penetration occurs and careful and complete dissection of the submental and submandibular regions are advocated as possible ways to prevent persistent upper neck disease, the main killer of these patients.
