RESUMO
BACKGROUND: Free-flap reconstructions (FFRs) are the standard-of-care following resections for oral cancer. This study assessed an alternative, the pedicled submental flap (SF) for its versatility, oncological outcomes, and comparative operative time and cost. METHODS: This was a longitudinal prospective study of 1169 patients of oral cancer reconstructed with the SF. Oncological outcomes in terms of recurrence rate and disease-free survival (DFS), were analyzed in 730 cases with a minimum of 18 months follow-up. Surgical time and cost were compared between 20 SFs and 14 FFRs performed consecutively. RESULTS: SF was used to reconstruct defects in the cheek (29.2%), mandible (41.6%), tongue (26.3%) and palate (2.7%) with a 94% flap survival. N+ at level 1 did not adversely affect the recurrence rate as compared with N+ at levels other than level 1 (27.52% vs 29.81%). SFs took a shorter time (186 minutes vs 474 minutes) and cost significantly less than FFRs (P < .0001). CONCLUSIONS: SF can reconstruct various oral defects, is sturdy, and esthetically and functionally satisfactory. The procedure time is much shorter than for FFR and costs considerably less. With careful case selection and meticulous clearance, SF reconstruction is oncologically safe even in N+ neck.
RESUMO
Congenital diaphragmatic hernia (CDH) which mainly occurs in the newborn or in childhood with severe respiratory distress and high mortality, is rarely found in adults (Yamaguchi et al. Ann Thorac Cardiovasc Surg 8:106-108, 2002; Dalencourt and Katlic Ann Thorac Surg 82:721-722, 2006; Fraser et al. Endosc Percutan Tech 19: e5-e7, 2009; Kanazawa et al. Surg Today 32:812-815, 2002). These patients are been accustomed to adjust their lifestyle to manage symptoms associated with frank herniation of the large bowel and liver inside the diaphragmatic hernial sac. Bowel above the liver surface especially the transverse colon is suggestive of a Chilaiditi's syndrome in these group of patients. Diagnostic laparoscopy plays an important role for diagnosis of diaphragmatic hernia in some cases over other investigations like CT scan and ultrasonography. Chilaiditi's syndrome has no surgical line of treatment but a symptomatic diaphragmatic hernia requires surgical correction. Liver as the main hernial content has been reported only in three cases throughout the world (Goh et al. Am J Surg 194: 390-391, 2007; Luo et al. Hepatobiliary Pancreat Dis Int 6: 219-221, 2007; Bosenberg and Brown RA Curr Opin Anaesthesiol 21: 323-331, 2008). A case of a 27 year old female patient presenting with a symptomatic congenital diaphragmatic hernia is reported.
RESUMO
Mesenteric cysts are one of the most rare intra-abdominal tumours [1], classified as chylolymphatic, mesothelial (simple), enterogenous, urogenital remnant, dermoid cyst (teratomatous), gas, mycotic, parasitic, tubercular cysts and cysts following malignant degeneration [2]. Dermoid cysts are uncommon mesenteric cysts [3]. Cysts of the mesocolon are rare and usually differentiated from a mesenteric cyst only at the operation [4]. We here report a rare case of a dermoid cyst that was present in the mesentery of the transverse colon.
