Utilidad del colgajo anterolateral de muslo en cirugía reconstructiva de cabeza y cuello

Antecedentes: El colgajo libre anterolateral de muslo está poco difundido en Occidente dado lo complejo de su anatomía y las características morfológicas de nuestra población. No obstante, cuando las condiciones son propicias, representa una alternativa eficaz en la reconstrucción de cirugías de cabeza y cuello ya que puede proveer una cantidad suficiente de piel, músculo y eventualmente fascia con relativamente poca morbilidad en el sitio dador. Objetivo: Evaluar resultados en la utilización del colgajo libre anterolateral de muslo en patología de cabeza y cuello. Material y Método: Estudio retrospectivo y descriptivo de pacientes tratados entre 2004-2011. Se analizaron datos poblacionales y del tumor, resección, tamaño del colgajo, número y tipo de perforantes, complicaciones del col¡gajo y lecho dador, morbimortalidad. Resultados: Se trataron 20 pacientes, 15 (75%) hombres, edad promedio 55,5 años (rango: 22-77). Doce pacientes presentaban tumores de cavidad oral y 8 de piel. Todas fueron reconstrucciones primarias, siendo 3 cirugías de rescate. Quince fueron colgajos fasciocutáneos y 5 fasciomiocutáneos. By-pass venoso: 1 caso. Promedio de perforantes por colgajo: 2, la mayoría miocutáneas (23/31). Superficie promedio de isla de piel: 118 cm² (rango: 24-319 cm²). Complicaciones del colgajo: 1 caso (5%). Cierre primario del lecho dador: 17 pacientes, 2 requirieron injerto y un cierre por segunda. La mortalidad fue de 5%. Conclusiones: El colgajo libre anterolateral de muslo representa una alternativa válida para reconstrucción quirúrgica en tumores de cabeza y cuello, dada su versatilidad y la posibilidad de cubrir defectos de diferentes tamaños, poco defecto en lecho dador y morbimortalidad aceptable.(AU)

Background: Because of its complex anatomy and the morphology of our population the anterolateral thigh flap has not been widely spread in Occident. Nevertheless, in selected situations, it represents a useful alternative for reconstruction in surgery of head and neck because it may provide enough amounts of skin, muscle and eventually fascia with little donor site morbidity Objective: To evalúate the results in the utilization of anterolateral thigh free flap in head and neck pathology Materials and Method: Retrospective and descriptive study of patients treated between 2004 and 2011. Population and tumor data, type of resection, flap size, quantity and type of perforators, flap and donor site complications, morbidity and mortality was evaluated. Results: Twenty patients was treated, 15 (75%) males, average age was 55,5 (range: 22-77). Twelve patients had oral cavity tumors and 8 skin tumors. All the reconstructions were primary, with 3 rescuers surgeries. There were 15 fas-ciocutaneous flaps and 5 fasciomyocutaneous. Venous by-pass: 1 case. Average flaps perforators: 2, the majority myocutaneous (23/31). Average skin paddle surface: 118 cm² (range: 24-319 cm²). Flap complications: 1 case (5%). Primary cióse of donor site: 17 patients, 2 with skin graft and 1 secondary cióse. Mortality rate 5%. Conclusions: Anterolateral thigh flap represents a useful alternative for reconstructive surgery in head and neck tumors, due its versatility and possibility of resolve defectsof variables sizes, little donor site defect and acceptable mor¡bidity and mortality.(AU)

Activation of two C-H bonds of NHC N-methyl groups on triosmium and triruthenium carbonyl clusters.

The thermolysis of the NHC triosmium cluster [Os3(Me2Im)(CO)11] (1a; Me2Im = 1,3-dimethylimidazol-2-ylidene) in toluene at reflux temperature sequentially affords the edge-bridged cluster [Os3(micro-H)(micro-kappa2-MeImCH2)(CO)10] () and the face-capped derivative [Os3(micro-H)2(micro3-kappa2-MeImCH)(CO)9] (3a). These products result from the sequential oxidative addition of one (2a) and two (3a) N-methyl C-H bonds of the original NHC ligand. The related face-capped triruthenium cluster [Ru3(micro-H)2(micro3-kappa2-MeImCH)(CO)9] (3b) has been prepared by heating the NHC triruthenium cluster [Ru3(Me2Im)(CO)11] (1b) in THF at reflux temperature. In this case, the pentanuclear derivatives [Ru5(Me2Im)(micro4-kappa2-CO)(CO)14] (4b) and [Ru5(Me2Im)2(micro4-kappa2-CO)(CO)13] (5b) are minor reaction products, but a ruthenium cluster analogous to has not been obtained. The face-capped oxazole-derived NHC triruthenium cluster [Ru3(micro-H)2(micro3-kappa2-OxCH)(CO)9] (3c; MeOx = N-methyloxazol-2-ylidene) is the only isolated product of the thermolysis of [Ru3(MeOx)(CO)11] (1c) in THF at reflux temperature.

Triruthenium and triosmium carbonyl clusters containing chiral bidentate NHC-thiolate ligands derived from levamisole.

The trinuclear complexes [M3(mu-Cl)(mu-S approximately CH)(CO)9] (M=Ru, Os; S approximately CH=1-ethylenethiolate-3-H-4-(S)-phenylimidazolin-2-ylidene) and [M3(mu-H)(mu-S approximately CMe)(CO)9] (M=Ru, Os; S approximately CMe=1-ethylenethiolate-3-methyl-4-(S)-phenylimidazolin-2-ylidene) have been prepared by treating [Ru3(CO)12] and [Os3(CO)10(MeCN)2] with levamisolium chloride or [M3(mu-H)(CO)11]- with methyl levamisolium triflate, respectively. The chiral N-heterocyclic carbene-thiolate ligands S approximately CH and S approximately CMe arise from the oxidative addition of the C-S bond of levamisolium or methyl levamisolium cations to anionic trinuclear clusters.

Easy activation of two C-H bonds of an N-heterocyclic carbene N-methyl group.

The first trinuclear clusters containing NHC ligands are described; the compound [Ru3(Me2Im)(CO)11](Me2Im=1,3-dimethylimidazol-2-ylidene) is easily converted into [Ru3(mu-H)2(mu3-MeImCH)(CO)9] by a process involving the activation of two C-H bonds of a methyl group that is an example of degradation of a metal-coordinated NHC ligand under mild conditions.