ABSTRACT
The concept of a flow-through flap refers to a free flap in which both the proximal and distal ends of the vascular pedicle are anastomosed to provide blood flow to the distal tissues. The purpose of this paper is to highlight the use of this technique, which may be useful in selected cases of head and neck reconstruction. In certain situations, like bilateral resection of the base of the tongue involving both lingual arteries, the application of a flow-through forearm free flap can provide an anatomical and functional restoration of the defect while revascularizing the anterior two-thirds of the tongue. We review this technique, which was used in a case of adenoid cystic carcinoma of the base of the tongue with excellent results.
Subject(s)
Carcinoma, Adenoid Cystic , Free Tissue Flaps , Plastic Surgery Procedures , Tongue Neoplasms , Carcinoma, Adenoid Cystic/surgery , Forearm/surgery , Humans , Tongue/surgery , Tongue Neoplasms/surgeryABSTRACT
Objetivos. Analizar la aplicación del score predictivo (SP) de Cameron para la traqueostomía reglada (TR) en cirugía tumoral oral. Material y métodos. Estudio retrospectivo y descriptivo de pacientes intervenidos de cirugía tumoral oral consecutivamente entre enero de 2010 y diciembre de 2012. Se recogieron los ítems del SP: la reconstrucción y el tipo de injerto, la maxilectomía inferior, la disección bilateral cervical y la localización tumoral. Se agruparon los pacientes según el manejo de la vía aérea al final de la cirugía en 4 grupos: extubados, intubados, TR y traqueostomía urgente. Se consideró un punto de corte ≥ 5 puntos del SP para la realización de TR. Resultados. Se registraron un total de 90 pacientes. La distribución por grupos fue: extubados = 27,8% de los casos, intubados = 17,8%, TR = 53,3% y un caso (1,1%) de traqueostomía urgente. Los 3 pacientes en los que se efectuó una traqueostomía no reglada tenían un SP ≥ 5 puntos. Usando el valor del SP ≥ 5 puntos se obtuvo un valor de sensibilidad diagnóstica de 0,7 para un intervalo de confianza (IC) del 95% de 0,57-0,82 y un valor de especificidad diagnóstica de 0,9 (IC del 95% 0,79-0,99). El VPP fue de 0,9 (IC del 95% 0,81-0,99) y el VPN de 0,67 (IC del 95% 0,54-0,8). El ABC dio un valor de 0,87 (error estándar 0,36). El cociente de probabilidad positivo fue 6,48. Conclusión. La decisión de realizar una TR durante la cirugía tumoral oral puede reforzarse utilizando el SP de Cameron basándose en datos objetivos (AU)
Objectives. The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery. Material and methods. A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of ≥ 5 points PS was considered for conducting ET. Results. A total of 90 patients were included. Group distribution was: extubated = 27.8%, intubated = 17.8%, ET = 53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS ≥ 5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48. Conclusion. The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Tracheostomy , Airway Extubation/methods , Head and Neck Neoplasms/drug therapy , Anesthesiology/methods , Confidence Intervals , Retrospective Studies , Sensitivity and SpecificityABSTRACT
OBJECTIVES: The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery. MATERIAL AND METHODS: A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of≥5 points PS was considered for conducting ET. RESULTS: A total of 90 patients were included. Group distribution was: extubated=27.8%, intubated=17.8%, ET=53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS≥5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48. CONCLUSION: The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data.
Subject(s)
Mouth Neoplasms/surgery , Oral Surgical Procedures , Severity of Illness Index , Tracheostomy , Aged , Aged, 80 and over , Airway Extubation , Area Under Curve , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Neck Dissection , Orthognathic Surgical Procedures , Plastic Surgery Procedures , Retrospective Studies , Sensitivity and SpecificityABSTRACT
BACKGROUND: Many growth factors influence the bone healing cascade. Furthermore, the occasional failure of bone repair may in part be due to perturbation in the activation of local growth factors. Local activation of fibroblast growth factors (FGFs) at the fracture site may serve to increase neovascularization, and induce early granulation formation that can affect bone healing. METHODS: We have performed a rat parietal (6 x 3 mm) critical size defect (CSD). Human recombinant acidic fibroblast growth factor (hraFGF) imbided in agarose was topically administered at the craniectomy site. Control animals received agarose alone in the same manner. Three weeks after surgery, osteopromotion was histologically evaluated. RESULTS: hraFGF-treated animals show a continuous bridge of regenerated bone extending from one edge of the defect to the other. None of the parietal defects that had been treated with agarose contained new bone in the central portion. CONCLUSION: Our results suggest an important role of FGFs to promote large cranioplasty repair and support the use of these proteins as an alternative choice for bone grafts and bone substitutes.