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1.
J Egypt Natl Canc Inst ; 24(2): 71-6, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23582598

RESUMO

BACKGROUND: Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap. AIM: To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated. MATERIALS AND METHODS: A group of 20 patients presented with (T1-2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required. RESULTS: The mean age of the patients was 62.3±6years, range (52-69years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20% and the inner surface of the cheek 40%. There was no reported major complication; and only one patient suffered a reactionary haemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most patients (80%), only 20% of patients required revision of the scar at the donor site or release of the tongue. The overall aesthetic results were either very satisfactory or satisfactory in the majority of patients (90%). Two patients were not satisfied with the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem. The functional results (deglutition, speech) were satisfactory in most patients (70%), all were edentulous. CONCLUSION: An inferiorly based pedicled NLF is a reliable flap for the reconstruction of small and medium sized defects in the oral cavity. The flap can be best utilised for old edentulous and high risk patients where it can be used as a single stage procedure which is particularly useful in those types of patients. The flap can be safely combined with neck dissection even when the facial artery was ligated.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Bucais/cirurgia , Boca/cirurgia , Sulco Nasogeniano , Retalhos Cirúrgicos , Idoso , Carcinoma de Células Escamosas/patologia , Bochecha/cirurgia , Feminino , Humanos , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Boca/patologia , Neoplasias Bucais/patologia , Nariz/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Transplante de Pele , Cirurgia Plástica/métodos , Língua/cirurgia
2.
J Egypt Natl Canc Inst ; 23(4): 163-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22776844

RESUMO

BACKGROUND: Oncoplastic breast conservative surgery has evolved as a safe alternative to the standard mastectomy in the treatment of early breast cancer. The procedure involves tumour resection with an adequate safety margin and either breast reshaping with volume displacement procedures (large or ptotic breasts) or volume replacement with latissimus dorsi myocutaneous flap (LDF) (small to medium sized non-ptotic breasts). A contra lateral mastopexy procedure is usually necessary with the volume displacement oncoplastic surgery, a procedure that is often rejected by a significant number of patients. This limits the choice of the reconstruction of breast defects in such patients to autologous tissues i.e. LDF. AIM: Aim is to evaluate the feasibility of volume replacement oncoplastic breast conservative surgery with latissimus dorsi myocutaneous flaps for patients with large ptotic breasts. This involves testing the oncologic safety in terms of adequate safety margin, the complications rate and the final cosmetic outcome. The loco regional recurrence rate will be recorded and compared with oncoplastic volume displacement for similar sized breast defects. PATIENTS AND METHODS: A group of 50 female patients with early breast cancers (T2) who presented to the department of surgery at the National Cancer Institute, Cairo, Egypt in the period between January 2004 and November 2009 were included in the study. Bilateral soft tissue mammography was carried out in all patient groups and was used to annually follow up the patients. All patients were detected with T2 N0 breast cancer by both clinical and radiological examinations. All patients underwent partial mastectomy and reconstruction with LDFs. RESULTS: The average age at presentation was 46.5±9years and the range was 26-65years. Most of the patients were subjected to partial mastectomy in 30 patients (60%), excision of a single quadrant from the four major quadrants was carried out in 15 patients (30%) where skin sparing wide local excision was carried out in only five patients (10%). The safety margin ranged from 1.1 to 3.2cm with an average of 1.8±0.5cm. There was no total flap loss in any patient where as we reported partial flap loss in two patients. Nipple and areola sloughing were reported in two patients, wound infection in five patients, haematoma in four patients, seroma in 16 patients, and donor site morbidity in six patients. The vast majority of patients were either satisfied (score >3 out of 5) (62%) or very satisfied (score 4 or more) (18%) with the results of reconstruction. CONCLUSION: The results of the current study showed the feasibility and the versatility of volume replacement oncoplastic surgery in patients with large ptotic breasts with myocutaneous flaps. The adequacy of safety margin and the acceptable complications rate as well as the comparable local recurrence rate to volume displacement oncoplastic surgery, make it a suitable alternative in a subset of patients who object an immediate contra lateral mastopexy procedure.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Recidiva Local de Neoplasia/prevenção & controle , Adulto , Idoso , Neoplasias da Mama/patologia , Estudos de Viabilidade , Feminino , Humanos , Glândulas Mamárias Humanas/patologia , Glândulas Mamárias Humanas/cirurgia , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Mamilos/patologia , Mamilos/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Resultado do Tratamento
3.
J Egypt Natl Canc Inst ; 20(3): 253-61, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20424656

RESUMO

BACKGROUND: Reconstruction of head and neck defects can pose many challenges to the reconstructive head and neck surgeon. Achieving the best cosmetic and functional results without compromising the safety of oncologic surgery are the primary reconstructive goals. Speech and articulation are particularly important in oral reconstructive procedures. In addition, preservation of the integrity and function of the donor sites should always be considered in all reconstructive procedures. AIM OF THE STUDY: The aim of the study is to evaluate different reconstructive options in complex defects of the head and neck region after resection of malignant tumours. The feasibility of the reconstructive ladder starting from simple techniques such as local flaps and skin grafts up to free flaps will be assessed. PATIENTS AND METHODS: In this study we evaluated different reconstructive procedures used in 50 patients with complex head and neck defects undertaken at the department of surgery at the National Cancer Institute between July 2003 and December 2007. RESULTS: The average age of patients was 52 years and the range was 26-67 years. Most of the tumours were either squamous cell carcinoma (74 %) or Basal cell carcinoma (20 %). Tumour sites included the nose (6 %), lip (10 %), cheek (12 %) scalp (6 %) as well as mucosal defects of the oral cavity (40 %) and the hypopharynx (20 %). We used local flaps and skin grafts in reconstruction in 36 % of cases and pedicled flaps in 32% while free flaps were used in 32 % of cases. Complications occurred in 32 % of patients of which total flaps loss constituted 6 % and partial flap loss 4 %. Minor complications such as oro-cutaneous fistulae, wound infection, seroma and haematoma were noticed in 22 % and all of them were treated conservatively. The final functional and aesthetic results were satisfactory in 60% of cases while poor results were encountered in patients who suffered some degree of flap loss. KEY WORDS: Head and neck reconstruction - Pedicled flaps - Free flaps.

4.
J Egypt Natl Canc Inst ; 18(1): 41-50, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17237850

RESUMO

BACKGROUND: The pectoralis major myocutaneous pedicle flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Several series of PMMPF procedures in head and neck reconstruction have been reported in the literature. Even with the worldwide use of free flaps, the flap is still considered the mainstay head and neck reconstructive procedures in many centers. However, the flap is usually associated with a high incidence of complications in addition to its large bulk compared with the free fasciocutaneous flaps. Also the final functional and the aesthetic results are not comparable to free flaps head and neck reconstruction. AIM OF THE STUDY: The aim of the study is to evaluate the reliability of such flap in selected cases of head and neck reconstruction. The indications, technique, complications and the functional as well as the aesthetic results of the flap utilization were evaluated. PATIENTS AND METHODS: Between May 2002 and May 2005 a 26 consecutive head and neck reconstruction procedures using the PMMPF were carried out on 25 patients at the Department of Surgery, National Cancer Institute, Cairo University. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the presence or absence of distant metastasis were assessed. Also preoperative assessment included the fitness of patients for such an extensive procedure. The total operative time, the need for blood transfusion, the postoperative complications, were all documented. The length of hospital stay, the follow-up of patients as well as the incidence of local recurrence underneath the flap were all evaluated. RESULTS: Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity (10 patients); oropharynx/ hypopharynx, (5 patients); and neck or face (10 patients). Of the 26 PMMPF reconstructions, 22 flaps were carried out as primary reconstructive procedures, whereas 4 flaps were "salvage" procedures (reconstruction after fistula, free flap failure, coverage of exposed mandibular prosthesis). Fifteen patients (60%) had complications such as wound dehiscence, infection, hematoma, seroma, partial flap failure, total flap failure, fistula, and donor site complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co morbidities, and in oral cavity reconstructions. CONCLUSION: Although the PMMPF is a versatile flap in head and neck reconstruction, being in the proximity of the region with good reach to different areas of the face, oral cavity, and the pharynx; the flap is fraught with a high complication rate. The wide use and the reliability of free flaps in head and neck reconstruction have superseded the use of the PMMPF flap in comparable circumstances. However, the flap still has a place in head and neck reconstruction, particularly after resection of locally advanced tumours. Also the flap can be still used as a salvage procedure after free flaps failure or when there is a shortage of the microsurgery facility.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Músculos Peitorais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do Tratamento
5.
J Egypt Natl Canc Inst ; 17(4): 245-50, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17102819

RESUMO

BACKGROUND: Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the colour mismatch, it is not cosmetically identical to the face. The use of regional flaps such as the median forehead flaps are usually bulky, can not cover a wide range of facial reconstruction and usually require the donor area to be grafted. The naso-labial flaps are very useful and versatile local flaps, with robust vascularity that can be readily elevated without a delay. The flap can be superiorly based to reconstruct defects on the cheek, side wall or the dorsum of the nose, alae, collumula and the lower eye lid. Inferiorly based flaps can be used to reconstruct defects in the upper lip, anterior floor of the mouth and the lower lip. The flap can be turned over and used as a lining of the nose and the lip. AIM OF THE STUDY: In the current study we present our experience with utilization of the nasolabial flaps in facial reconstruction. We evaluated the indications, flap designs, technique, and complications. We will also assess the final functional and aesthetic results. MATERIAL AND METHODS: The study included 20 patients (12 males and 8 females) presented at the surgical department, National Cancer Institute (NCI) Cairo University with skin cancer at different areas of the face. Preoperative assessment includes. Assessment of the stage of the disease, the flap design and patient general condition. RESULTS: The mean age of the patients was 56.3 +/-6 years (range 16-62 years). Fifteen patients presented with basal cell carcinoma, 2 squamous cell carcinoma, one malignant melanoma, one keratoacanthoma, and one xeroderma pigmentosa. Nasal defects constituted 75% of cases, the rest were lower eye lid (2), one upper lip and one oral commisure beside a case of cheek reconstruction. There was no major complication; only one patient suffered a reactionary hemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most of the patients (80%), only 4 patients required revision of the scar at the donor site. The overall aesthetic results were very satisfactory in the majority of patients (16), and satisfactory in 2 cases. Only 2 patients were not satisfied by the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem. CONCLUSION: The nasolabial flap is a versatile, simple, easy to harvest local flap that can cover a variety of defects in the face. It is ideally suitable for covering small and moderate sized defects in the eye lid, cheek, nose, the anterior floor of the mouth and the lip.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz
6.
J Egypt Natl Canc Inst ; 17(3): 149-57, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16799652

RESUMO

BACKGROUND AND PURPOSE: Breast conserving surgery has been a recognised method of treatment of early breast cancer. The treatment methods include quadrantectomy or skin sparing mastectomy combined with ipsilateral axillary nodal dissection followed by radiotherapy. In the current study we evaluate the feasibility and oncologic safety of the quadrantectomy and SSM operations with preservation of the nipple and areola, and the cosmetic results of immediate reconstruction by using the latissmus dorsi flap. MATERIALS AND METHODS: A breast conservative surgery (quadrantectomy or nipple sparing mastectomy) was carried out in a group of 55 patients with invasive breast cancer treated at the Department of Surgical Oncology, NCI, between January 2001 and April 2004. The selection criteria included those patients who presented with T1 or T2 breast cancer and were located at least 2 cm from the nipple as the centre for the nipple areola complex. RESULTS: The age of the patients ranged from 32 years to 65 years. The follow up period ranged from 2 to 33 months with an average of 21 months. Pathological assessment of the specimens showed a negative safety margin in all cases. Most of our cases were invasive duct carcinoma grade 1-2 (42) (75%). The complications of the flap reconstruction included one major sloughing of the latissmus dorsi flap, 4 partial flap sloughing, 4 sloughing of the nipple and fat necrosis in 6 patients. The donor site healed normally in all of our cases except for one patient who suffered from a hypertrophic scar which settled down during the follow up period. The aesthetic assessment of the patients, showed an excellent to good results in the majority of cases (42) (75%) while in 6 (12%) results were fair and in 7 (13%) results were poor. CONCLUSION: Breast conservative surgery with quadrantectomy or skin sparing technique with preservation of the nipple and areola combined with immediate LD flap reconstruction is a valid procedure for treatment of early breast cancer. Immediate reconstruction by using the extended latissmus dorsi is as safe, relatively easy procedure which can provide an adequate volume replacement for small to moderate sized breasts.


Assuntos
Mamoplastia/métodos , Mastectomia Segmentar , Mamilos/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Feminino , Humanos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias
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