Squamous cell carcinoma (SCC) of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. It is a slow-growing cancer, and can be diagnosed and treated easily and effectively;however, e...Squamous cell carcinoma (SCC) of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. It is a slow-growing cancer, and can be diagnosed and treated easily and effectively;however, early treatment is important because its mortality rate is 10%-30%. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. Here, we present a 52-year-old male with a large T3 SCC, which started 13 years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. It was reconstructed by local flaps with good aesthetic and functional results. The lip was reconstructed with a combination of a Karapandzic flap on one side and a contralateral Webster cheek advancement, using a functional neck dissection on the tumor side and supraomohyoid neck dissection contralaterally. Histopathology results of the neck were negative for metastasis. We were satisfied with the aesthetic and functional results of the neck.展开更多
Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our cont...Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our context of exercise, we sometimes have a different attitude dictated by various constraints. Observation: 55-year-old patient with no notable history, seen in consultation for a very large ulcerative-budding lesion on the right 2/3 of the lower lip with mucocutaneous involvement without lymph node findings found on examination. Faced with this suspicious lesion and the patient’s financial difficulties, we decided to operate under local anesthesia to remove this tumor. The oncological excision was followed by immediate plasty using a Camille-Bernard flap with a good immediate aesthetic and functional result and postoperative day 7. The patient was unable to take his surgical specimen to anatomy-pathology and was lost to follow-up due to lack of financial resources. On anatomo-pathological analysis of the surgical specimen, the margins were healthy with confirmation of squamous cell carcinoma (anapathological reading made for scientific interest). Discussion: The particular mentality of certain patients and their difficult financial conditions push us to have an unconventional therapeutic attitude in oncology, but which nevertheless makes it possible to resolve certain problems that we often face. Local anesthesia is possible and realistic in cases like ours and the results can be acceptable and life-saving.展开更多
Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizar...Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. Methods Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm2 and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. Results Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.展开更多
BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c...BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.展开更多
We report a patient with breast cancer whose breast was immediately reconstructed using a local adipofascial flap and was then subsequently resected 3 years after the original surgical procedure due to local recurrenc...We report a patient with breast cancer whose breast was immediately reconstructed using a local adipofascial flap and was then subsequently resected 3 years after the original surgical procedure due to local recurrence. In order to achieve local control of the solitary recurrent lesion, we resected the remnant breast, which gave us a useful opportunity to examine the previously implanted flap histologically. A 33-year-old Japanese female was diagnosed with T2N0M0 breast cancer in the outer area of her left breast and underwent partial mastectomy with immediate reconstruction using a local adipofascial flap. The breast lesion was considered to be invasive ductal carcinoma, scirrhous carcinoma, lymphatic invasion+, venous invasion-, estrogen receptor+, progesterone receptor+, and HER2/neu-. Involvement was noted in three of the twenty-five resected axillary lymph nodes. She received adjuvant hormone therapy, but developed a solitary local recurrence of the skin forty-five months after the initial procedure, for which she received total mastectomy, systemic chemotherapy, and hormone therapy. During the histological examination of the local adipofascial flap that had been implanted into the partial breast defect, normal fatty tissue and the implanted fascia were seen at the implantation site. This is a rare report in which a local flap that was implanted during oncoplastic breast surgery was histologically examined.展开更多
Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reco...Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.展开更多
A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perfora...A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.展开更多
文摘Squamous cell carcinoma (SCC) of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. It is a slow-growing cancer, and can be diagnosed and treated easily and effectively;however, early treatment is important because its mortality rate is 10%-30%. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. Here, we present a 52-year-old male with a large T3 SCC, which started 13 years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. It was reconstructed by local flaps with good aesthetic and functional results. The lip was reconstructed with a combination of a Karapandzic flap on one side and a contralateral Webster cheek advancement, using a functional neck dissection on the tumor side and supraomohyoid neck dissection contralaterally. Histopathology results of the neck were negative for metastasis. We were satisfied with the aesthetic and functional results of the neck.
文摘Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our context of exercise, we sometimes have a different attitude dictated by various constraints. Observation: 55-year-old patient with no notable history, seen in consultation for a very large ulcerative-budding lesion on the right 2/3 of the lower lip with mucocutaneous involvement without lymph node findings found on examination. Faced with this suspicious lesion and the patient’s financial difficulties, we decided to operate under local anesthesia to remove this tumor. The oncological excision was followed by immediate plasty using a Camille-Bernard flap with a good immediate aesthetic and functional result and postoperative day 7. The patient was unable to take his surgical specimen to anatomy-pathology and was lost to follow-up due to lack of financial resources. On anatomo-pathological analysis of the surgical specimen, the margins were healthy with confirmation of squamous cell carcinoma (anapathological reading made for scientific interest). Discussion: The particular mentality of certain patients and their difficult financial conditions push us to have an unconventional therapeutic attitude in oncology, but which nevertheless makes it possible to resolve certain problems that we often face. Local anesthesia is possible and realistic in cases like ours and the results can be acceptable and life-saving.
文摘Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. Methods Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm2 and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. Results Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.
文摘BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.
文摘We report a patient with breast cancer whose breast was immediately reconstructed using a local adipofascial flap and was then subsequently resected 3 years after the original surgical procedure due to local recurrence. In order to achieve local control of the solitary recurrent lesion, we resected the remnant breast, which gave us a useful opportunity to examine the previously implanted flap histologically. A 33-year-old Japanese female was diagnosed with T2N0M0 breast cancer in the outer area of her left breast and underwent partial mastectomy with immediate reconstruction using a local adipofascial flap. The breast lesion was considered to be invasive ductal carcinoma, scirrhous carcinoma, lymphatic invasion+, venous invasion-, estrogen receptor+, progesterone receptor+, and HER2/neu-. Involvement was noted in three of the twenty-five resected axillary lymph nodes. She received adjuvant hormone therapy, but developed a solitary local recurrence of the skin forty-five months after the initial procedure, for which she received total mastectomy, systemic chemotherapy, and hormone therapy. During the histological examination of the local adipofascial flap that had been implanted into the partial breast defect, normal fatty tissue and the implanted fascia were seen at the implantation site. This is a rare report in which a local flap that was implanted during oncoplastic breast surgery was histologically examined.
文摘Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.
文摘A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.
