Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection.

PURPOSE: Evaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution. METHODS: An analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap. RESULTS: Tumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6-12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications. CONCLUSIONS: The ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

Expression of selected regulatory molecules on the CD83+ monocyte-derived dendritic cells generated from patients with laryngeal cancer and their clinical significance.

B7H1 and B7H4 overexpression is associated with inhibition of the immune system in many solid tumors, and altogether with CD200 molecule plays an important role in tumor invasion by promoting malignant transformation. However, there is no report about impact of these molecules on laryngeal squamous cell carcinoma. The objective of the present study was to assess by means of flow cytometry the expression of B7H1, B7H4, CD200, and CD200R on CD83+ monocyte-derived dendritic cells (Mo-DC), pulsed with autologous tumor cell lysates (aTCL) in patients who suffer from G1, G2, or G3 laryngeal carcinoma (LC, n = 60) in comparison to healthy donors (HD, n = 15). It has been demonstrated that median value of the percentages of CD83+ B7H1+, CD83+ B7H4+, and CD83+ CD200+ cells were higher in LC patients than HD (p = 0.041, p ≤ 0.0001, and p = 0.02, respectively). Mean fluorescence intensity (MFI) of CD200, CD200R, B7H1, and B7H4 on the Mo-DC pulsed with aTCL of the patients was also higher than on the Mo-DC of HD (p ≤ 0.0001, p ≤ 0.0001, p = 0.002, and p ≤ 0.0001, respectively). The highest MFI levels of all molecules were noted in grade 3 LC. The aforementioned results prove that there is a relation between the presence of laryngeal cancer and the expression of B7H1, B7H4, CD200, and CD200R regulatory molecules on the CD83+ Mo-DC pulsed with autologous cancer cell lysates. Strong association of LC grade and the tested antigens expression suggests a critical role for these proteins in LC biology.

[Complications of surgical treatment in patients with laryngeal and hypopharyngeal cancer]. / Powiklania leczenia operacyjnego raka krtani i gardla dolnego.

INTRODUCTION: Surgical treatment of patients with laryngeal or/and hypopharyngeal cancer is combined with potential risk of complications either local and general. The aim of the study was to evaluate the occurrence of them in the large cohort of patients with mentioned localization of cancer. MATERIAL AND METHODS: The group of 447 patients, treated between 2000-2005 in Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin were analyzed retrospectively. There were 412 men and 35 women. 426 patients underwent surgical removal of the tumour without any reconstruction procedure. In 21 (4.7%) patients we performed reconstructions of the pharyngeal defect implementing pectoralis major muscle flap. Complications were classified into general and local. Furthermore, according to the time we classified sequel of the treatment into recent (those during the first 7 days after surgery) and late. Statistical analysis of variables was performed using χ² test. RESULTS: Uncomplicated treatment were accomplished in 78.6% of patients. Local complications occur in 65 (14.5%) and general in 31 (6.9%) individuals. Pharyngo-cutaneous fistula was the most often occurring local sequel which constituted 50.8% of all local complications. Fistula developed in 33 (7.4%) cases. Cardiovascular and pulmonary diseases were the most often among general complications. They occur at the same rate of 25.8% of all general complications cases. Five patients (1.1%) died due to complications developed during the postoperative period. CONCLUSIONS: We noticed 10.6% local complications in our group of patients whereas only 2.5% of treated persons developed general sequel. The pharyngo-cutaneous fistula was the most often occurring local complication. It has been treated surgically in 15 (45.5%) patients. Whereas cardiovascular and pulmonary diseases were the most often general complications and they occur in above half of all cases with general complications.

[The assessment of selected molecules belonging to B7 family on the mature dendritic cells in laryngeal cancer patients]. / Ocena ekspresji wybranych molekul z rodziny B7 na powierzchni dojrzalych komórek dendrytycznych u chorych na raka krtani.

UNLABELLED: B7-H1, B7-H2 and B7-H4 molecules play various roles in the adaptive immune system and are broadly expressed on many cells, especially those localized in cancer tissue. The aim of the study was to assess the surface expression of B7-H1, B7-H2 and B7-H4 molecules on the mature dendritic cells (DC) generated from peripheral blood monocytes of laryngeal cancer patients and healthy donors. MATERIAL AND METHODS: Forty-four male patients treated surgically for squamous cell carcinoma of the larynx were included in the study. Peripheral blood from twelve healthy male donors was used as a control. Mononuclear cells were separated from all individuals by density gradient centrifugation, incubated with anti-CD14 microbeads, and passed through MACS separation columns. The CD14 positive cell population was used to prepare monocyte derived DC. Laryngeal cancer tissue was obtained from patients during surgical treatment and homogenized to prepare tumor cell lysates for further stimulation. We evaluated with the use of flow cytometry method the percentage of cells with an expression and mean fluorescent intensity (MFI) of surface markers, such as: CD83, B7-H1, B7-H2, B7-H4. RESULTS: Our study revealed that the percentage of mature dendritic cells, stimulated with autologous tumor cell lysates, with the expression of B7-H1 molecule in patients was lower than in healthy donors (61.81 ± 25.58% vs 93.02 ± 4.63%, p=0.007). In laryngeal cancer patients, the percentage of CD83+/B7-H2+ cells was higher than in healthy individuals (18.32 ± 10.74% vs 2.89 ± 0.43%, p=0.019). CONCLUSIONS: There is a relation between the presence of laryngeal cancer and the expression of B7 family molecules.

[Importance of donor site vascular imaging in free fibula flap reconstruction]. / Znaczenie diagnostyki obrazowej unaczynienia miejsca pobrania w planowaniu rekonstrukcji wolnym platem strzalkowym.

INTRODUCTION: Free fibula flap is widely used in head and neck reconstruction. Imaging studies of the donor site can reveal vascular abnormalities and therefore prevent acute leg ischemia. AIM: Evaluation of the role of donor site vascular imaging studies for free fibula flap planing. MATERIAL AND METHODS: Out of 35 free flap reconstructions performed in Otolaryngology Head and Neck Surgery Department in Medical University in Lublin in 2011-2012, there were 10 fibula flaps. Each patient had preoperative lower leg subtraction angiography performed. RESULTS: Lower leg angiography revealed vascular abnormalities in two out of 10 patients scheduled for free fibula flap transfer. One had dominant peroneal artery and second occlusion of anterior tibial artery. In both cases fibula was harvested from the other leg. CONCLUSIONS: Imaging studies reveal lower leg vascular abnormalities in 20% of cases thus facilitate surgical plans alternations and prevent serious complications in free fibula flap patients.

[Evaluation of cytochrome concentration in peripheral blood lymphocytes of patients with laryngeal cancer]. / Ocena stezenia cytochromu c w limfocytach krwi obwodowej chorych na raka krtani.

The aim of the study was evaluation of cytochrome concentration in the peripheral blood lymphocytes of patients with laryngeal cancer. The study was conducted in a group of 62 patients presenting different clinical advancement of the disease. The study material consisted of the studied population's peripheral blood from which T lymphocytes were isolated and incubated with monoclonal antibodies. To evaluate antigens' expression, a FACS Galibur flow cytometre was used; the evaluated cells were labeled with fluorochrome-conjugated monoclonal antibodies. Next, mononuclear cells were rinsed with cold PBS and suspended in the lysis buffer. In the obtained cell lysate the c cytochrome concentration was determined with the use of an immunoenzymatic test, HumanCytochrome cELISA Kit (BenderMed Systems, Austria). Obtained results were compared with the measurements taken in 20 healthy individuals who constituted the control group. On the basis of conducted study it was found that the level of c cytochrome concentration was significantly increased in the T CD3+ lymphocytes in the peripheral blood of patients with stage IV of laryngeal cancer. A positive correlatio was also found between the cytochrome level in lymphocytes and the advancing stage of the disease. Our own observation give grounds to conjecture that together with the progress of laryngeal cancer the energetic potential of lymphocytes increases and so does the readiness of the lymphatic cells to undergo the redox processes, therefore the amount of c cytochrome in the cells increases.