Multiple Free Flap Reconstruction of a Complex Intraoral Defect after Squamous Cell Carcinoma Excision: A Case Report.

Background: Squamous cell carcinoma is the most frequent malignant cancer of the oral cavity. Metastasis involvement is one of the most relevant prognostic factors in terms of survival probability. Patients with oral cancers often undergo extensive en bloc resective surgery of the mandible and maxilla, with or without cervical nodal dissection, based on the presence or occult risk of regional metastases. Several factors affect the choice of flap, to recover aesthetics and function. Case Presentation: The case of a 60-year-old man who underwent maxillectomy with neck dissection as well as a reconstruction with a combination of multiple vascularized free flaps is presented. Conclusions: The excellent integration of the free flaps and the total absence of complications led to a high-quality aesthetic and functional performance of the reconstruction obtained through two different flaps. More specifically, the fibular free flap for bone reconstruction allows a two-team approach and maintains an excellent vascularization, even in case of several osteotomies for the maxillary reconstruction as reported. In addition, the use of free radial forearm flap for soft tissue reconstruction permits to obtain long caliber vessels, thus facilitating surgery without repositioning of the patient during surgery and therefore, consequently reducing surgery times.

INDICATIONS FOR LIMITATIONS OF THE OMENTAL PEDICLE FLAP IN IMMEDIATE BREAST RECONSTRUCTION - SURGICAL RESULTS EVALUATION AND BREAST-Q© 2.0 SURVEY.

BACKGROUND AND AIM: Immediate reconstruction with an omental flap is a recognized suitable method for a full-thickness breast reconstruction or implant coverage for well-selected cases of nipple or skin-sparing mastectomies as well as cases of skin-reducing mastectomies. The authors' aim is the evaluation of indications and limitations of this technique with an original approach and also based on the analysis of patients' global satisfaction using the BREAST-Q 2.0© survey. MATERIALS AND METHODS: From January 2014 to March 2018, 12 women aged between 29 to 67 years old (mean age: 49 years) underwent immediate breast reconstruction alone or with a definitive implant covered by a pedicled omental flap. All of them were asked to fill out the BREAST-Q© 2.0 survey. CONCLUSIONS: The careful analysis of the cases shows that the indications for the immediate breast reconstruction based on the omental flap with a minimal resulting donor-site morbidity are strictly linked to its limitations, which are correctly reported in the study, but in the same way, it suggests that patients who underwent implant-based immediate breast reconstruction with omental flap reported significant improvements in satisfaction and health-related quality of their life.

[Reconstruction of the gastrointestinal tract in the absence of the oesophagus, stomach and colon, with preservation of the larynx]. / Ricostruzione del tratto alimentare in assenza dell'esofago, dello stomaco e del colon, con conservazione della laringe.

The authors report a case of reconstruction of the gastrointestinal tract in a young woman of 36 years of age who, after ingesting muriatic acid, and after a series of consecutive operations found herself without an oesophagus (from the hypopharynx) stomach and colon. She was fed with a jejunostomy and had a large pharyngostomy to prevent sialorrhoea. After one year, the patient manifested the need to resume eating by mouth. The problem was serious due both to the anastomosis above the level of the larynx and the very long period of rehabilitation. The technical problem included the need to avoid the thoracic cavity due to the previous empyema, and thus to bring a viable jejunal loop up to the neck in a subject already operated on four times. The solution was a Roux loop at the level of the 4th-5th jejunal arcade brought to the neck via a subcutaneous presternal route and anastomised in a supraglottic location at the level of the right pyriform sinus. The viability of the loop was guaranteed by an arterial shunt with a branch of the mesenteric artery by means of a segment of saphenous vein and a venous shunt over the right internal jugular vein to guarantee venous flow. The pharyngo-jejunal anastomosis was done with a 21 mm circular stapler with a rotary head after a partial parietal resection of the laryngeal cartilage and under the protection of a provisional tracheostomy. After 4 months' treatment, partly in intensive care and partly in a rehabilitation centre with logopaedic assistance, the tracheal cannula could be removed and the patient is now able to eat by mouth with normal phonation.

Optical coherence tomography accurately identifies intermediate atherosclerotic lesions--an in vivo evaluation in the rabbit carotid artery.

OBJECTIVE: We tested the ability of optical coherence tomography (OCT) to identify very early stages of atherosclerosis in vivo. METHODS: Twelve New Zealand white male rabbits (weight 3.5-4.0 kg) underwent perivascular electrical injury of the common carotid arteries, and were then fed a cholesterol-rich diet. At 43+/-16 (range 27-63) days after injury, arteries were imaged by OCT, then rabbits were euthanized and vessels processed for histology. RESULTS: A total of 14 carotid arteries were imaged by OCT and histology; 22 atherosclerotic lesions were identified, 16 (73%) occurring at the site of the electrical injury. At histology, 4 lesions were defined as Stary type I (isolated macrophages), 8 as type II (intracellular lipid accumulations), and 10 as type III (small extracellular lipid pools). No advanced (> or =type IV) lesions were documented. OCT failed to detect any type I lesions, but correctly defined a minority (2/8, 25%) of type II lesions and the majority (8/10, 80%) of type III lesions. For type III lesions, sensitivity, specificity and diagnostic accuracy of OCT were 80%, 95%, and 95%, respectively. CONCLUSIONS: OCT can accurately detect intermediate (type-III) atherosclerotic lesions in vivo, but still fails to identify earlier stages of atherosclerosis.