[Quality of life after primary parotidectomy for benign tumor]. / Parotidectomie conservatrice pour tumeur bénigne: résultats sur la qualité de vie à long terme.

INTRODUCTION: Parotidectomy is commonly performed for various indications, including benign tumors of the parotid region. Esthetic or functional sequels of various importance and lasting effects may occur, as after any surgical procedure. These disorders may impact the patient's quality of life. The authors retrospectively evaluated the long-term outcome of patients having undergone conservative primary parotidectomy for a benign tumor, with a minimum follow-up of 10 years. PATIENTS AND METHODS: A hundred and twenty-six superficial conservative primary or secondary parotidectomies were performed during 5 years, 94 (74.6%) of which for benign tumors. A flap of the sternocleidomastoid muscle (SCM) was inserted between the skin and facial nerve branches to prevent Frey's syndrome and alleviate surgical site depression according to some criteria. Questionnaires were completed at least 10 years after surgery. RESULTS: The data of 53 patients was analyzed. 88.7% of patients had undergone a superficial parotidectomy and 11.3% a total one. The average histological tumor size was 3.3 cm (2.6 to 6.3 cm). The tumors were distributed as follows: pleomorphic adenoma in 79.4% of patients, cystadenolymphoma in 15.1%, oncocytoma in 3.7%, and basal cell adenoma in 1.8%. Twenty-six SCM flaps (49.1%) were performed. No patient presented with facial paresis or facial paralysis at the end of the study. The average follow-up was 10.4 years (10-11 years). Overall, social, psychological, and professional implications were reported by 7.5% of patients, and in 1.8% of cases the impact was significant. The use of a SCM flap seemed to prevent Frey's syndrome (Fischer test P=0.00001) and improved cosmetic results (Fisher test P<0.00001). DISCUSSION: Conservative parotidectomy for primary benign tumors has a limited impact on the quality of life in the long run. This impact concerned 7.4% of patients. There was a significant impact in 2% of patients. We recommend filling the surgical site to improve functional and esthetic results and decrease long-term effects on the patient's quality of life.

Anatomical study of the palmar intermetacarpal perforator flap.

The authors present an anatomical study of a small flap that may be harvested from any of the palmar intermetacarpal spaces while performing fasciectomy in Dupuytren's contracture. The flap is diamond-shaped, vascularised by two perforating branches originating from the underlying true digital arteries and may be rotated through 90 degrees to 180 degrees in either direction to provide skin cover and subcutaneous padding over the distal palm and/or the base of the finger.

Prospective evaluation of quality of surgery in soft tissue sarcoma.

BACKGROUND: Prospective application of the French Sarcoma Group (FSG) method of surgery reporting in soft tissue sarcoma (STS) in a single centre. METHODS: Patients with primary STS of the extremities or trunk wall consecutively operated at the same institution from January 1996 to December 2002 were evaluated for local recurrence (LR). There were 205 patients, with AJCC/UICC stages III and IV in 51% of cases. Resection types according to FSG were R0 in 147, R1 in 53 and R2 in five cases. Radiotherapy was delivered in 163 patients and chemotherapy in 103. Multivariate analysis was performed. Overall five-year survival was 75%. Median follow-up for surviving patients was 53 months. RESULTS: Actuarial five-year LR incidence was 13% in 200 patients with gross resection (R0+R1), it was 7% in R0 and 30% in R1 patients (p<0.0001). At univariate analysis, significant prognosticators for LR were age, histotype, tumour invasion, grade and resection type R. At multivariate analysis, resection R1 (relative risk (RR) 4.3, p=0.001) and grade 3 (RR 3.9, p=0.013) independently predicted LR. Combining these two variables produced three prognostic groups for LR: group 0 (no factor, n=70), group 1 (one factor, n=94) and group 2 (two factors, n=36) with five-year LR of 4%, 12% and 39%, respectively (p=6.4x10(-7)). CONCLUSION: This first prospective evaluation of surgery reporting in STS evidences a fourfold, highly discriminating difference in LR between resections R0 and R1.

[Antebrachial flap based on distal perforators of the radial artery: anatomic study of 10 cases]. / Lambeau antébrachial fondé sur les perforantes distales de l'artère radiale: étude anatomique sur dix cas.

PURPOSE: The radial forearm flap based on distal perforators of the radial artery is a recent flap, derived from the so-called << chinese-flap >>. The interest of this flap resides in the preservation of the main arteries of the forearm. The aim of this study was to count the distal perforators of the radial artery and to study sub-cutaneous vascular system. MATERIALS AND METHOD: We performed 10 dissections on fresh cadavers, after selective injection of the radial artery with a solution of plasticized resin. The dissection was performed from the palmar flexor fold of the wrist up to 15 cm proximally, allowing to count all of the distal perforators. RESULTS: We determined three different intervals, among which the one located between 2 and 6 cm from the palmar flexor fold of the wrist was the most vascularized. This interval should be considered as the rotation point of the flap. CONCLUSION: This study allowed to make clear and more reliable the operative procedure to raise the flap. This procedure is easy to handle and intended to cover proximal defects of the dorsal aspect of the hand, while sparing the radial artery.