Subcutaneous fat layer in different donor regions used for harvesting microvascular soft tissue flaps in slender and adipose patients.

The aim of this study is to provide valid data concerning the thickness of the subcutaneous fat layer in seven donor regions which are most commonly used for soft tissue replacement in the head and neck region. Furthermore the study focuses on differences in thickness of this layer depending on the nutritional status and sex. In 100 volunteers the thickness of the subcutaneous fat layer was evaluated using ultrasound in seven potential donor regions: radial and ulnar forearm, lateral upper arm, scapular and parascapular region, abdominal/supra-umbilical region and the lateral calf. Volunteers were divided into 4 groups: male and female, slender (body mass index [BMI] < 25) and adipose (BMI > 30). Data obtained was compared and differences were proven to be statistically significant (Student's t-test, P<0.05). The largest thickness was found in the supra-umbilical region followed by the lateral upper arm whereas the ulnar forearm region had the smallest thickness. Depending on the BMI the supra-umbilical and the lateral upper arm regions showed the most wide variation. Depending on sex the most noticeable variation in thickness of the subcutaneous layer was seen in the lateral calf region with a significant larger tissue layer in females.

Defect-related variations in mandibular reconstruction using fibula grafts. A review of 96 cases.

Despite the popularity of the donor region 'laterodorsal calf' with the fibula, the flexor muscles and the overlying skin for microsurgical bone and soft tissue transfer some limitations and possible pitfalls have to be considered. We report on 93 patients who had 96 reconstructions, 65 with and 31 without soft tissue transfer in 8 years using microvascular fibular grafts for mandibular replacement and oromandibular reconstruction. Six patients died within 4 weeks and eight flaps were lost. Necrosis of the skin paddle occurred in 7 (11%) of 61 cases with uncomplicated bony healing.

Ulnar versus radial forearm flap in head and neck reconstruction: an experimental and clinical study.

BACKGROUND: To consider the pros and cons of the microvascular ulnar forearm flap compared with its radial counterpart, this study compares the use of these two flaps for head and neck reconstruction. METHODS: In 75 patients, 51 ulnar and 24 radial forearm flaps were used. Both groups were compared regarding flap dissection, suitability of the flap for the recipient region, complication rate, and secondary morbidity in the donor region. Furthermore, in 40 healthy volunteers, the thickness of the subcutaneous tissue layer was measured by use of ultrasonography. RESULTS: Flap survival rate, respectively wound healing, in the recipient region showed no differences. Clinical and experimental results demonstrated a thinner subcutaneous layer in the ulnar aspect of the forearm. Compared with its radial equivalent, closure of the ulnar donor side by skin grafting resulted in a significantly lower complication rate. CONCLUSIONS: The ulnar forearm flap is favored because of the less hairy skin of the ulnar forearm region, the thinner layer of subcutaneous tissues, and the more conveniently located donor area. The ulnar forearm pedicle is long compared with alternative transplants but shorter than the radial equivalent.

Subclassification of diffuse large B-cell lymphomas according to the Kiel classification: distinction of centroblastic and immunoblastic lymphomas is a significant prognostic risk factor.

Among high-grade malignant non-Hodgkin's lymphomas the updated Kiel classification identifies three major B-cell entities: centroblastic (CB), B-immunoblastic (B-IB), and B-large cell anaplastic (Ki-1+) (now termed anaplastic large cell [CD30+], [B-ALC]). The clinical prognostic relevance of this distinction was evaluated in a randomized prospective treatment trial (COP-BLAM/IMVP-16 regimen randomly combined +/- radiotherapy in complete responders) conducted in adult (age 15 to 75) patients with Ann Arbor stage II-IV disease (n = 219) diagnosed by optimal histomorphology (Giemsa staining) and by immunohistochemistry. Overall survival was significantly better in CB lymphoma as compared to B-IB (P = .0002) or B-ALC (P = .046). Relapse-free survival was worse for B-IB (P = .0003) as compared to CB lymphomas. The prognostic differences between CB and B-IB were confirmed by multivariate analyses including the risk factors of the International Index. Overall survival was significantly determined by performance status (P = .0003), serum-LDH (P = .036), and B-IB histology subtype (P = .036). Relapse-free survival was influenced by age (P = .007) and histological subtype (P = .007). Thus, the diagnosis of the CB and B-IB lymphomas by the histological criteria of the Kiel classification was identified as an independent prognostic factor in diffuse large B-cell lymphomas.