Thinned anterolateral thigh cutaneous flap and radial fasciocutaneous forearm flap for reconstruction of oral defects: comparison of donor site morbidity.

PURPOSE: The thinned anterolateral thigh flap (tALT) has been utilized in clinical applications for soft tissue reconstruction. This flap has many advantages: no major artery is sacrificed; functional and esthetic results are often good. The purpose of this study is to investigate the esthetic outcome of the donor site after reconstruction of oral defects with tALT compared to the radial fasciocutaneous forearm flap (RFFF). PATIENTS AND METHODS: Between January 2003 and December 2005, 42 patients affected by oral squamous cell carcinoma (27 males, 15 females; age range: 34-82 years, mean age, 61.4 years) received microsurgical reconstruction. We treated 17 patients with RFFF and 25 cases with tALT. RESULTS: The RFFF group showed a success rate of 94.2% with only 1 total flap loss due to not reversible venous thrombosis. In the tALT group we accomplished a 100% flap survival. Functional results at donor site in the RFFF group showed a persistent forearm movement impairment in about 30% of cases and sensitivity alterations in skin graft area in 75% of patients; in the tALT group we noticed only a transitory gait impairment in 1 patient; no clinical signs of circulatory disturbance were observed and no sensory disturbance of the thigh was reported. CONCLUSIONS: In our experience, we found the thinned ALT cutaneous flap the ideal soft tissue flap in oral reconstruction. This flap presents functional results at the receiving site with the additional advantage of minimal donor-site morbidity and a high level of patient satisfaction.

[Sentinel lymph node in breast cancer: experience of 4 years]. / Il linfonodo sentinella nel cancro della mammella: 4 anni di esperienza.

The aim of the study was to describe our experience with sentinel lymph node biopsy in patients with breast cancer. 326 consecutive patients with breast cancer operated on from December 1998 to December 2002 were studied. All patients gave their informed consent. Patients were mapped with an intradermal injection of Tc-99 (median dose: 0.5 mCi) and/or Patent Blue. Sentinel lymph nodes were analyzed with serial sections. 333 procedures were performed in the 326 patients. A median of two sentinel lymph nodes were identified in 322 cases (97%). 3165 additional non-sentinel lymph nodes were removed and analyzed to assess the accuracy of the technique. The correlation between sentinel lymph nodes and final pathological status was 97% (314/322). In 66/133 cases with axillary metastases (50%) the sentinel lymph node was the only site of metastasis. Micrometastases were diagnosed in 35/66 cases (26%), while isolated tumour cells were found in 15 cases (11%). At a median follow-up of 21 months one patient presented an axillary relapse (0.3%). Our experience confirms that sentinel lymph node biopsy is accurate and reproducible. Routine axillary dissection is no longer the gold standard in patients with early breast cancer. Prospective studies are under way in an attempt to provide, definitive answers.