Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature.

UNLABELLED: Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free flap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48-year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free flap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as "excellent" and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable flap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator flap, RFFF, anterolateral thigh and ulnar forearm flap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM flap, latissimus dorsi myocutaneous free flap, pectoralis major musculocutaneous flap and trapezius island flap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

Distally based adipofascial sural flap for foot and ankle reconstruction.

BACKGROUND: this retrospective study of a case series analyzed the results from the application of a distally based adipofascial sural flap for nonweightbearing defects of the foot and ankle. METHODS: twenty-eight patients with post-traumatic ankle and foot defects (ten women and 18 men; age range, 17-63 years) underwent surgery between November 1, 2003, and November 30, 2008. Distally based adipofascial sural flaps were used in ten open fractures, 14 soft-tissue post-traumatic defects, and four deep burns. Defects were on the dorsal side of the foot (eight cases), the lateral malleolus (four cases), the medial malleolus and inframalleolar region (four cases), the Achilles tendon region (eight cases), and the anterior surface of the ankle (four cases). Surgical procedures were performed by a single surgeon (A.M.). RESULTS: all of the flaps healed uneventfully. There was no partial or total flap loss. All 28 patients walked normally at the time of follow-up. Three delayed healings occurred at the donor site. CONCLUSIONS: this is a homogeneous series of lower-limb reconstructions with the distally based adipofascial sural flap, which permits better analysis of the results. This flap has a constant and reliable blood supply. It can be used for the reconstruction of nonweightbearing foot and ankle regions to avoid the bulky volume of the fasciocutaneous flap in this area and to minimize the donor site scar.

Our experience in the application of lipofilling.

Autologous fat grafting, referred to as lipofilling was described first by Neuber in 1893. It has been gaining great popularity recently due in particular to the intensive development of liposuction and the anatomical availability of various subcutaneous adipose tissue depots in the human body. In the present study we present our experience in autulogous fat grafting for the reconstruction of soft tissue defects as well as for face rejuvenation and body contouring. Between May 2003 and May 2005 we performed lipofilling surgery in 13 patients at the Department of Plastic and Craniofacial Surgery in St. George University Hospital, Plovdiv. The grafts were harvested by lipoaspiration and, after subsequent treatment, re-injected. Our results are still preliminary because of the short terms of patients' follow-up. The most common complications at the recipient site were partial resorption of the graft and cyst formation, and at the donor site--hematoma.

Craniofacial fibrous dysplasia. conservative surgical management. Review of literature and report of a case.

The present study presents a case of craniofacial fibrous dysplasia attenuating the orbit and the nasal airway, which was treated by conservative surgical approaches. Nasal and orbital decompression, and facial recontouring were performed simultaneously. This was done via a transconjunctival and transcaruncular approaches with a lateral canthotomy, which provided access to the four walls of the orbit, midface and the lateral nasal wall. The reduction of the turbinates was done through a standard turbinectomy approach and the nasal decompression was done via intercartilaginous access and a full transfixion incision and nasal degloving. The bulk of the lesion was removed with chisels, gauges, and rotary instruments. The orbital debulking extended to the orbital apex, which was not involved by the fibrous dysplasia. Approximately 200 mg of dysplastic bone was removed. The functional and aesthetic results were good. The symptoms of chronic conjunctivitis and nasal obstruction have been alleviated and there is no deterioration of his condition. The symptoms of anosmia have also disappeared. Conservative surgical treatment of craniofacial dysplasia in adults with stable disease is recommended.

Electrocardiographic changes after laparoscopic cholecystectomy.

AIM: To determine whether ECG changes observed after laparoscopic cholecystectomy could be correlated with procedure characteristics. MATERIAL AND METHODS. We studied prospectively 500 patients who underwent laparoscopic cholecystectomy for documented gallstones and prior history of cardiovascular disease, volume of carbon dioxide insufflated in the peritoneal cavity, duration of the procedure and intra-abdominal pressure created. RESULTS: We found that 9 (1.8%) patients developed LV strain, 2 (0.4%) patients--atrial fibrillation, 2 (0.4%) patients--tachyarrhythmia in the presence of AF, 1 (0.2%) patient--RBBB and 1 (0.2%) patient--myocardial ischemia with ST depression regarding these ECG leads. Statistical analysis of the data was performed using multifactorial logistic regression analysis. These changes were not correlated to the above referred procedure characteristics. CONCLUSION: We conclude that ECG changes are frequent events after laparoscopic cholecystectomy (3%) but are not correlated to prior history of cardiovascular disease, the duration of the procedure, the volume of carbon dioxide insufflated and the intra-abdominal pressure.

Low back pain in physical education teachers.

The purpose of this study was to investigate the factors related to occupational low back pain (LBP) occurring in male physical education teachers (PET). The location was set in Athens and we used questionnaires to collect information. Analysis revealed that the prevalence of LBP during the survey was 63%. The correlation of personal factors and LBP showed that the prevalence of LBP was significantly higher in those PET (odds ratio, 2.5) who answered yes to the item "no personal training" than in the PET who did not. Moreover, many occupational factors are related to LBP. These were the items "lifting gym instruments" (odds ratio, 2.6) and "helping students into flexing posture" (odds ratio, 3.0). From the working conditions it was confirmed that the PET (odds ratio, 2.5) who "spent more than 35 hours per week in teaching physical education" were correlated with LBP. Our results suggest that PET, under the current working condition, are vulnerable to low back pain. An improvement of these conditions must be taken into account in order to prevent LBP.

Unilateral superiorly-based nasolabial island flap for the reconstruction of the philtrum.

We present a case of reconstruction of the philtrum with a unilateral superiorly-based nasolabial island flap following a secondary Millard's bilateral cheiloplasty in a 23-year-old man with cleft lip and palate. His philtrum consisted of a full-thickness skin graft transplanted at one of his previous operations.