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Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A, Dejean C, Devauchelle B. Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy. Front Oncol 2024; 14:1379861. [PMID: 38665951 PMCID: PMC11043495 DOI: 10.3389/fonc.2024.1379861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy. Methods A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT. Results Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications. Conclusion Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.
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Affiliation(s)
- Juliette Thariat
- Department of Radiotherapy, Centre François-Baclesse, Caen, France
- Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, France
- Faculté de Médecine de Caen, Université de Normandie, Caen, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Deneuve
- Surgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, France
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France
| | - Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, France
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Achebe JU, Okwesili OR, Uche EO. Pedicled Radial Forearm Flap in Reconstruction of Complex Defects in the Craniofacial Region. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:111-115. [PMID: 38449540 PMCID: PMC10914101 DOI: 10.4103/jwas.jwas_296_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/03/2023] [Indexed: 03/08/2024]
Abstract
The radial forearm flap is a fasciocutaneous flap that has been used for reconstructing defects in the craniofacial region, either as a free flap or a pedicled flap. The pedicled radial forearm flap is a reliable option for reconstructing scalp defects. Microvascular free tissue transfer has, however, remained the preferred choice in the reconstruction of most complex scalp defects in the craniofacial region. We present the cases of a 37-year-old woman with an ulcerated malignant lesion on the forehead and a 40-year-old woman with a large malignant tumor on the scalp. Excision of both lesions, which turned out to be squamous cell carcinomas, resulted in complex defects that were reconstructed with pedicled radial forearm flaps. Both patients had satisfactory results and were counseled for radiotherapy.
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Masià-Gridilla J, Gutiérrez-Santamaría J, Álvarez-Sáez I, Pamias-Romero J, Saez-Barba M, Bescós-Atin C. Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment. Cancers (Basel) 2023; 15:cancers15030800. [PMID: 36765758 PMCID: PMC9913539 DOI: 10.3390/cancers15030800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
A single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50-70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment.
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Affiliation(s)
- Jorge Masià-Gridilla
- Noves Tecnologies i Microcirurgia Craniofacial, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Servei de Cirurgia Oral i Maxil·lofacial, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Correspondence:
| | - Javier Gutiérrez-Santamaría
- Noves Tecnologies i Microcirurgia Craniofacial, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
| | - Iago Álvarez-Sáez
- Noves Tecnologies i Microcirurgia Craniofacial, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Servei de Cirurgia Oral i Maxil·lofacial, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
| | - Jorge Pamias-Romero
- Noves Tecnologies i Microcirurgia Craniofacial, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Servei de Cirurgia Oral i Maxil·lofacial, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
| | - Manel Saez-Barba
- Noves Tecnologies i Microcirurgia Craniofacial, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Servei de Cirurgia Oral i Maxil·lofacial, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
| | - Coro Bescós-Atin
- Noves Tecnologies i Microcirurgia Craniofacial, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Servei de Cirurgia Oral i Maxil·lofacial, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
- Unitat Docent Vall d’Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, E-08035 Barcelona, Spain
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Liu Z, Zhu C, Rui T, Yuan K, Zhou B, Wang Y. A Novel design for Local Full-Thickness Skin Graft: Optimizing donor sites of Radial Forearm Free Flap. J Cosmet Dermatol 2022; 21:4595-4604. [PMID: 35106911 DOI: 10.1111/jocd.14823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Donor site deformities remain the primary issues after radial forearm free flap (RFFF) translocations. This study introduced a local full-thickness skin graft (FTSG) from an adjacent cutaneous area to manage RFFF donor sites and evaluated the aesthetic and functional outcomes postoperatively. PATIENTS AND METHODS This was a retrospective study among patients undergoing ablative surgery for head and neck tumors followed by defect reconstruction using a RFFF. The RFFF donor site defects were covered by local FTSGs from the adjacent skins whose harvesting was assisted by a forearm model or traditional FTSGs from abdomen. The color matching degree, surgical scars, ranges of wrist movement, and grip strengths in donor forearms were assessed in two groups at twelve months after surgery. RESULTS Patients undergoing local FTSGs recovery exhibited better color matching than those repaired by traditional FTSGs from the abdomen. In forearm model, the local FTSGs width should be less than 22% of the forearm circumference located 5 cm away from the center of Fossia cubitalis. All the local FTSGs transplanted with this technique showed primary or secondary healing. CONCLUSIONS This study demonstrated using this innovatively designed local FTSGs to close RFFF donor sites was more advantageous than traditional methods.
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Affiliation(s)
- Zhixin Liu
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Chuandong Zhu
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Tao Rui
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Kaifang Yuan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China.,Department of Oral and Maxillofacial Surgery, The Oral and Maxillofacial-Head and Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Youyuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China.,Department of Oral and Maxillofacial Surgery, The Oral and Maxillofacial-Head and Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China.,Department of Oral and Maxillofacial Surgery, The Oral and Maxillofacial-Head and Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Craniomaxillofacial Surgery Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, China.,Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Rd, 510120, Guangzhou, China
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A New Look into Cancer-A Review on the Contribution of Vibrational Spectroscopy on Early Diagnosis and Surgery Guidance. Cancers (Basel) 2021; 13:cancers13215336. [PMID: 34771500 PMCID: PMC8582426 DOI: 10.3390/cancers13215336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Cancer is a leading cause of death worldwide, with the detection of the disease in its early stages, as well as a correct assessment of the tumour margins, being paramount for a successful recovery. While breast cancer is one of most common types of cancer, head and neck cancer is one of the types of cancer with a lower prognosis and poor aesthetic results. Vibrational spectroscopy detects molecular vibrations, being sensitive to different sample compositions, even when the difference was slight. The use of spectroscopy in biomedicine has been extensively explored, since it allows a broader assessment of the biochemical fingerprint of several diseases. This literature review covers the most recent advances in breast and head and neck cancer early diagnosis and intraoperative margin assessment, through Raman and Fourier transform infrared spectroscopies. The rising field of spectral histopathology was also approached. The authors aimed at expounding in a more concise and simple way the challenges faced by clinicians and how vibrational spectroscopy has evolved to respond to those needs for the two types of cancer with the highest potential for improvement regarding an early diagnosis, surgical margin assessment and histopathology. Abstract In 2020, approximately 10 million people died of cancer, rendering this disease the second leading cause of death worldwide. Detecting cancer in its early stages is paramount for patients’ prognosis and survival. Hence, the scientific and medical communities are engaged in improving both therapeutic strategies and diagnostic methodologies, beyond prevention. Optical vibrational spectroscopy has been shown to be an ideal diagnostic method for early cancer diagnosis and surgical margins assessment, as a complement to histopathological analysis. Being highly sensitive, non-invasive and capable of real-time molecular imaging, Raman and Fourier transform infrared (FTIR) spectroscopies give information on the biochemical profile of the tissue under analysis, detecting the metabolic differences between healthy and cancerous portions of the same sample. This constitutes tremendous progress in the field, since the cancer-prompted morphological alterations often occur after the biochemical imbalances in the oncogenic process. Therefore, the early cancer-associated metabolic changes are unnoticed by the histopathologist. Additionally, Raman and FTIR spectroscopies significantly reduce the subjectivity linked to cancer diagnosis. This review focuses on breast and head and neck cancers, their clinical needs and the progress made to date using vibrational spectroscopy as a diagnostic technique prior to surgical intervention and intraoperative margin assessment.
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Moltedo NF, Wu SC, Lin CH, Yang JCS, Kuo SCH, Chien PC, Hsieh HY, Hsieh CH. Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity-score-matched patient cohorts. Microsurgery 2020; 40:679-685. [PMID: 33464653 DOI: 10.1002/micr.30635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction. METHODS A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications. RESULTS Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well-balanced pairs of propensity-score-matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026). CONCLUSION This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity-score-matched cohorts.
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Affiliation(s)
- Nicolas Flores Moltedo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Cen-Hung Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Spencer C H Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Peng-Chen Chien
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Hsiao-Yun Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
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Abstract
PURPOSE OF REVIEW The aim of this study was to review the recent literature on the utilization of the lateral arm free flap use in head and neck reconstruction. RECENT FINDINGS The lateral arm free flap provides a reliable fasciocutaneous free tissue transfer option ideally suited for reconstruction of the oral cavity, pharynx and parotid. Primary donor site closure, compartmentalized fat and excellent colour match make it an excellent option for head and neck reconstruction. Donor site morbidity is low, and the primary limitation is the short and narrow vascular pedicle. SUMMARY The lateral arm free flap should be considered in cases of oral cavity and skin reconstruction, particularly in cases wherein pedicle length is not restrictive.
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Zwierz A, Masna K, Burduk P. The Use of Giant Bilobed Flaps for Tissue Defect Reconstruction After Temporal Bone and Ear Resection. EAR, NOSE & THROAT JOURNAL 2020; 100:651-655. [PMID: 32302227 DOI: 10.1177/0145561320918986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this article was to feature the use of giant bilobed flaps in surgical reconstruction after total or subtotal petrosectomy in oncology cases. The Esser technique was renewed and adopted for coverage huge skin loss. The authors reported 4 cases illustrated pre- and postoperative photography and intraoperative planning and schema. Good coverage and healing with no need for use of free tissue transfer or skin expanders or skin grafts was obtained. In authors' opinion, the cosmetic effect was acceptable. Surgical times of operation were significantly shorter.
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Affiliation(s)
- Aleksander Zwierz
- Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krystyna Masna
- Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Paweł Burduk
- Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
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Yao XY, Liu H, Liu WW. Reconstruction of composite oral and maxillofacial defects by free flaps based on a new classification. Sci Rep 2020; 10:4300. [PMID: 32152445 PMCID: PMC7062725 DOI: 10.1038/s41598-020-61345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
Reconstruction of composite oral and maxillofacial defects using free flaps is challenging. The key to such delicate reconstruction lies in the evaluation of the defect. However, few reports have described the clinical classification of these difficult defects. In this study, we proposed a classification method and developed different reconstructive solutions using free flap techniques according to this classification. This classification method was established based on two parameters (the elements and distribution of the missing tissues). Among the 17 patients with composite oral and maxillofacial defects included in this study, 8 patients presented with type A defects, one patient presented with a type B defect, and the other 8 patients presented with type C defects. No type D defects were observed in this study. Three types of free flaps were used to reconstruct the respective types of composite defects. Perforator-based ALT flaps were used to reconstruct Type A defects. Branch-based ALT flaps were used to reconstruct Type B defects. For Type C defects, two reconstructive solutions were used, including a well-designed fibular flap and a perforator-based ALT flap with or without a metal plate for bony reconstruction. All flaps survived after surgery. This classification system may help select and design specific free flaps for reconstructing composite oral and maxillofacial defects.
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Affiliation(s)
- Xi Yu Yao
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, P. R. China
| | - Hui Liu
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, P. R. China
| | - Wei Wei Liu
- Department of Head and Neck Surgery, Key Laboratory of Oncology in Southern China, Cancer Center of SUN Yat-sen University, Guangzhou, 510060, P. R. China.
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10
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Nokovitch L, Davrou J, Bidault F, Devauchelle B, Dakpé S, Vacher C. Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction. Surg Radiol Anat 2018; 41:447-454. [PMID: 30552489 DOI: 10.1007/s00276-018-2166-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Initially described by Baudet in 1982, the fibula flap including the lateral head of the soleus muscle allows a one-stage reconstruction for large maxillo-mandibular defects. The aim of this study was to evaluate the number of muscular branches destined to the soleus muscle and their distance from the origin of the fibular artery, to assess the vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction. METHODS We performed a cadaveric anatomic study on ten lower limbs, and a CT angiography anatomic study on 38 legs. The number of soleus branches originating from the fibular artery, and the distance between the origin of the fibular artery and each of the identified branches were measured. RESULTS The number of soleus branches destined to the lateral head of the soleus muscle is variable, with in our study 1-3 branches found. Soleus branches destined to the lateral head of the soleus muscle emerged at a distance ranging between 0 and 2.9 cm (mean value = 1.82 cm) from the origin of the fibular artery in 40% of cases, between 3 and 5.9 cm (mean value = 4.27 cm) from the origin of the fibular artery in 37% of cases, and was at a distance of 6 cm or more (mean value = 6.93 cm) from the origin of the fibular artery in 20% of cases. CONCLUSIONS An origin of the soleus vessels in close proximity to the origin of the fibular artery represents the main limitation of this flap, the length of the remaining fibular pedicle making it difficult to achieve secure anastomosis in the cervical area. The vascular distribution of the proximal part of the lateral head of the soleus muscle being segmental, it is possible to lengthen the flap pedicle ligating the most proximal soleus branches originating from the fibular artery.
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Affiliation(s)
- Lara Nokovitch
- Anatomy Laboratory of the University of Medicine Paris V René Descartes, AP-HP Surgical School, Paris, France.,Department of Maxillo-Facial Surgery, University Hospital of Amiens, Picardie Jules Verne University, Amiens, France
| | - Julien Davrou
- Department of Maxillo-Facial Surgery, University Hospital of Amiens, Picardie Jules Verne University, Amiens, France
| | - François Bidault
- Radiology Department, Gustave Roussy Institute, Villejuif, France
| | - Bernard Devauchelle
- Department of Maxillo-Facial Surgery, University Hospital of Amiens, Picardie Jules Verne University, Amiens, France
| | - Stéphanie Dakpé
- Department of Maxillo-Facial Surgery, University Hospital of Amiens, Picardie Jules Verne University, Amiens, France
| | - Christian Vacher
- Department of Maxillo-Facial Surgery, Beaujon Hospital, AP-HP, 100 boulevard du Général Leclerc, 92110, Clichy, France. .,University of Medicine Paris-Diderot, EA 2496, Paris, France.
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Weitz J, Kreutzer K, Bauer FJM, Wolff KD, Nobis CP, Kesting MR. Sandwich flaps as a feasible solution for the management of huge mandibular composite tissue defects. J Craniomaxillofac Surg 2015; 43:1769-75. [PMID: 26330301 DOI: 10.1016/j.jcms.2015.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022] Open
Abstract
In the current therapy of head and neck defects, surgical reconstruction with the aid of pedicle or free flaps is common practice. Suitable single flaps are available to solve most reconstructive challenges. However, reconstruction can become a problem in extensive mandibular defects, as they are often caused by large primary tumors or osteoradionecrosis. These composite defects often lead to large intraoral or extraoral fistulas due to the involvement of mucosa, skin, mandible and soft tissue. These issues call for a double flap approach in order to achieve adequate reconstruction. Therefore, we developed a surgical sandwich technique as presented in this study. The procedure features the acquisition and use of two vascular flaps which can be freely combined according to their desired features (for example being of high tissue volume or osteomyocutaneous). In our study we included 11 patients (ten male, one female) with a mean age of 57 years. Seven of the patients had defects due to osteoradionecrosis and four due to tumor resection. A sandwich technique was performed in a single operation in eight patients, whereas for three patients several operations were necessary. The flaps used included: fibula free flap (FFF); anterolateral thigh (ALT); radial forearm flap (RFF); deltopectoral flap (DPF) and tensor fascia lata (TFL). The following combinations were used: FFF and ALT (three cases), FFF and RFF (two), FFF and DPF (three), ALT and TFL (two), and two ALT flaps (one). The sandwich technique proved suitable for complex reconstructions and led to desirable esthetic and functional results. The flexibility in combining different free or pedicle flaps made it possible to address various defect situations and consequently offer satisfactory surgical reconstruction for complex cases.
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Affiliation(s)
- J Weitz
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany.
| | - K Kreutzer
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - F J M Bauer
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - K-D Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - C-P Nobis
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - M R Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
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Khosla RK, Nguyen C, Messner AH, Lorenz HP. Chondromyxoid Fibroma of the Mandible in an Adolescent: Case Report and Microsurgical Reconstructive Option. Cleft Palate Craniofac J 2015; 52:223-8. [DOI: 10.1597/13-243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chondromyxoid fibroma is a rare bony tumor that usually presents in the lower extremities of middle-aged adults. Involvement of the craniofacial skeleton is extremely rare. We present the unique case of an adolescent boy with a chondromyxoid fibroma of the mandible. The chondromyxoid fibroma in this patient recurred after initial treatment with curettage. We treated the recurrence with resection of the involved mandible and immediate reconstruction using a vascularized musculo-osseus seventh rib flap (“Eve procedure”). Despite complex reconstruction in adolescents due to skeletal immaturity, the rib flap has successfully grown with the patient up to 3 years postoperatively. Therefore, we believe the musculo-osseus rib flap is a feasible solution for complex ramus and condyle reconstruction of the growing mandible in the adolescent patient.
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Affiliation(s)
| | | | | | - H. Peter Lorenz
- Division of Plastic and Reconstructive Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
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Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison. The Journal of Laryngology & Otology 2014; 128:1034-43. [PMID: 25399527 DOI: 10.1017/s0022215114002278] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine whether the fibula free flap is the most frequently used osteocutaneous flap for mandible reconstruction, and whether it provides quality of life, depression and anxiety advantages. METHODS A systematic review of the public Medline database was conducted. Thirteen patients who underwent mandibular reconstruction at our hospital centre completed questionnaires to evaluate quality of life, depression and anxiety outcomes. RESULTS The most frequently used free flaps are those of the fibula (n = 982), radial forearm (n = 201), iliac crest (n = 113), subscapular system (n = 50) and rib-serratus (n = 7). In our patient population, there was a trend towards a better quality of life in those with a fibula free flap. However, patients in this group were significantly younger than patients with other flap types (p = 0.025). Patients with a subscapular system free flap were more depressed (p = 0.031); however, they had large through-and-through defects. CONCLUSION The flap used most frequently in the literature is the fibula free flap. Comparative quality of life data are lacking, and homogeneous populations should be used to reach significant conclusions.
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Glastonbury CM, van Zante A, Knott PD. Ossification of the vascular pedicle in microsurgical fibular free flap reconstruction of the head and neck. AJNR Am J Neuroradiol 2014; 35:1965-9. [PMID: 24948505 DOI: 10.3174/ajnr.a3979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The fibular free flap, often used for osseous reconstruction following extirpation of head and neck malignancies, has been associated with heterotopic periosteal ossification. We aimed to determine the frequency and radiologic characteristics of this process and describe its clinical correlates. MATERIALS AND METHODS Surgical records for 2 years and neck imaging reports for 10 years were evaluated to identify patients with fibular free flap reconstruction and CT and/or PET/CT imaging available for review. The images were evaluated for the quality, type, and contour of ossification, and the reports were reviewed for associated clinical findings and radiologic impressions. RESULTS Of 32 patients with posttreatment CT or PET/CT imaging, ossification was evident in 16 patients (50%) as early as 1 month following fibular free flap reconstruction. In 8 patients, it mimicked a new bone; in 5, it appeared as linear attenuation; in 2, as multiple short segments; and in 1 patient, a mixed appearance was found. No associated FDG uptake was seen on PET/CT. On MR imaging, these findings were extremely subtle or not appreciable. In only 1 patient was new bone associated with symptoms. CONCLUSIONS Periosteal ossification of the vascular pedicle is commonly evident on CT following fibular free flap, even as early as 1 month after reconstruction, though the finding is not typically noted on imaging. While symptoms related to new bone are uncommon, they may mimic recurrent tumor. The location and pattern of ossification and the absence of a soft-tissue mass or FDG uptake are useful distinguishing imaging features.
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Affiliation(s)
- C M Glastonbury
- From the Departments of Radiology and Biomedical Imaging (C.M.G.) Otolaryngology-Head and Neck Surgery (C.M.G., P.D.K.), University of California, San Francisco, San Francisco, California.
| | | | - P D Knott
- Otolaryngology-Head and Neck Surgery (C.M.G., P.D.K.), University of California, San Francisco, San Francisco, California
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Chung J, Bonaparte JP, Odell M, Corsten M. The effect of topically applied tissue expanders on radial forearm skin pliability: a prospective self-controlled study. J Otolaryngol Head Neck Surg 2014; 43:8. [PMID: 24739510 PMCID: PMC4018659 DOI: 10.1186/1916-0216-43-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. METHODS Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant. RESULTS There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [-0.04, 0.12], p = 0.30). CONCLUSIONS This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.
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Affiliation(s)
| | | | | | - Martin Corsten
- The Department of Otolaryngology - Head & Neck Surgery, Ottawa Hospital - General Campus S3, 501 Smyth Road, Ottawa, Ontario K1H 8 L, Canada.
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Tornero J, Cruz-Toro P, Farré A, Vega-Celiz J, Skufca J, Nogués J, Maños-Pujol M. Free Radial Forearm Flap in Head and Neck: Our Experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tornero J, Cruz-Toro P, Farré A, Vega-Celiz J, Skufca J, Nogués J, Maños-Pujol M. [Free radial forearm flap in head and neck: our experience]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:27-32. [PMID: 24342698 DOI: 10.1016/j.otorri.2013.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Oncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. METHODS Retrospective study of procedures performed between 2006 and 2012. RESULTS A total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<05). CONCLUSIONS Reconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology.
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Affiliation(s)
- Jordi Tornero
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España
| | - Paula Cruz-Toro
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España.
| | - Anna Farré
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España
| | - Jorge Vega-Celiz
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Skufca
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Unidad Funcional de Otorrinolaringología y Alergia. Agrupació Mèdica I Quirúrgica (AMiQ). Hospital Universitario Quirón Dexeus. Estadificación Barcelona, España
| | - Julio Nogués
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Manel Maños-Pujol
- Servicio de Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Reilly DJ, Shoukath S, Behan FC, Bennett T, Grinsell D, Wilson JL, Findlay MW. Economic Analysis of Reconstruction for Fasciocutaneous Head and Neck Defects. Plast Reconstr Surg 2013. [DOI: 10.1097/01.prs.0000435871.00237.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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L'Heureux-Lebeau B, Odobescu A, Harris P, Guertin L, Danino A. Chimaeric subscapular system free flap for complex oro-facial defects. J Plast Reconstr Aesthet Surg 2013; 66:900-5. [DOI: 10.1016/j.bjps.2013.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 11/29/2022]
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Militsakh ON, Sanderson JA, Lin D, Wax MK. Rehabilitation of a parotidectomy patient-A systematic approach. Head Neck 2012; 35:1349-61. [DOI: 10.1002/hed.23095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/10/2022] Open
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Sikka A, Kaur M, Agarwal C, Deep G, Agarwal R. Metformin suppresses growth of human head and neck squamous cell carcinoma via global inhibition of protein translation. Cell Cycle 2012; 11:1374-82. [PMID: 22421144 DOI: 10.4161/cc.19798] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth leading cancer in the world; the main risk factors are alcohol and tobacco use. Advancements in therapies have yet to improve the prognosis of HNSCC. The connection between diabetes and cancer is being recognized, and metformin has been shown to decrease cancer incidence in diabetic patients. Accordingly, here, for the first time, we investigated metformin's efficacy on the growth and viability of human HNSCC FaDU and Detroit cells. Our results show that metformin treatment (5-20 mM) dose-dependently inhibits the growth of both cell lines. In FaDU cells, metformin caused 18-57% and 35-81% growth inhibition after 48 and 72 h treatments, respectively. Similarly, in Detroit 562 cells, 48 and 72 h metformin treatment resulted in 20-57% and 33-82% inhibition, respectively. Mechanistically, metformin caused G 1 arrest, which coincided with a decrease in the protein levels of CDKs (2, 4 and 6), cyclins (D1 and E) and CDK inhibitors (p15, p16, p18 and p27), but no change in p19 and p21. Metformin also decreased the levels of oncogenic proteins Skp2 and β-Trcp. In other studies, metformin decreased the phosphorylation of 4E-BP1 at Ser65, Thr37/46 and Thr70 sites, but drastically increased the phosphorylation of EF2 at Thr56 and AMPK at Thr172, which results in global translational inhibition. In summary, the observed wide spectrum of mechanistic effects of metformin on HNSCC cells provides support for the anticancer capability of the drug and its potential use in future therapies.
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Affiliation(s)
- Arron Sikka
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO, USA
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[Microsurgical fasciocutaneous and musculocutaneous free flaps in head and neck surgery]. Otolaryngol Pol 2011; 65:53-9. [PMID: 22000251 DOI: 10.1016/s0030-6657(11)70709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/19/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Reconstruction of the head and neck continues to pose a significant challenge for reconstructive surgeons. In many cases microsurgical free flaps provide superior functional and aesthetic results with limited donor-site morbidity and are considered as a method of choice. The purpose of this article was to present the experience of our institution with free flaps used for reconstruction of various cutaneous and mucosal defects in the head and neck region. MATERIALS AND METHODS This is a retrospective study of 9 consecutive patients who received free revascularized soft tissue flaps for reconstruction in the head and neck area. Among flaps performed in this group, there were: 7 radial forarm flaps, 1 anterolateral thigh flap, and 1 rectus abdominis myocutaneous flap. RESULTS 7 of 9 flaps healed uneventfully. In 2 patients postoperative neck exploration was required due to neck hematoma with signs of compromised venous outflow from flaps. Both flaps were salvaged, however one of them developed partial necrosis. A normal oral diet and an intelligible speech were recovered in all patients. CONCLUSIONS The use of microsurgical free flaps has proved to be a versatile, reliable and effective method of reconstruction in the head and neck area. Careful postoperative monitoring allows for early detection of flap compromise and appropriate surgical revision which lead to significant improvements in overall success rates.
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