Bruce Ashford

Surgical aspects of operation Bali assist: initial wound surgery on the tarmac and in flight

Background:  The explosion of three bombs on 12 October 2002 in Kuta, Bali resulted in mass casualties akin to those seen in war. The aim of the present report is to describe the sequence of events of Operation Bali Assist including triage, resuscitation and initial wound surgery in Bali at Sanglah Hospital in the aeromedical staging facility (ASF), Denpasar airport and the evacuation to Darwin.

Prospective study of sentinel node biopsy for high‐risk cutaneous squamous cell carcinoma of the head and neck

Nodal metastasis from cutaneous squamous cell carcinoma (SCC) is poorly predicted clinically and is associated with a high mortality rate.

Improved survival with elective neck dissection in thick early-stage oral squamous cell carcinoma†

Management of the node–negative neck in T1 to T2 oral squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to determine if elective neck dissection improves outcomes in thick primary tumors since this reflects current practice in most institutions and has not been specifically addressed in the literature.

Advances in temporomandibular joint reconstruction.

Purpose of reviewThis article reviews the reconstructive techniques commonly employed in temporomandibular joint (TMJ) surgery with an emphasis on recent developments in the field. Recent findingsTMJ reconstruction remains one of the most challenging tasks faced by surgeons who operate in the head and neck, with a variety of autogenous and alloplastic techniques available. The role of alloplastic TMJ reconstruction needs to be reassessed in light of recent literature showing excellent long-term functional outcomes, which reflect advances in prosthetic materials and surgical technique. More recently, transport distraction osteogenesis has been applied to reconstruction of the ramus–condyle unit with promising early results suggesting it may ultimately become the standard of care in selected patients providing a cost-effective approach with low morbidity and excellent functional outcomes. SummaryThe myriad of available TMJ reconstructive options reflect the fact that it remains an evolving field. Although no gold standard currently exists, the various techniques each have their own proponents and potential advantages and drawbacks. Ultimately, the reconstructive surgeon must consider the ablative defect and underlying pathology, the needs of the individual patient, the resources of the providing institution and the capabilities of the surgical team.

Internal mammary artery perforator flap for head and neck reconstruction.

Background:  The internal mammary artery perforator (IMAP) flap is a useful modification of the classic deltopectoral flap that has a number of important roles in head and neck reconstruction.

Temporoparietal fascia free flap for pharyngeal coverage after salvage total laryngectomy

The aim of this study was to assess whether the use of the temporoparietal fascia as a free flap for pharyngeal closure reinforcement reduced the incidence of pharyngocutaneous fistula (PCF) in the salvage setting.

Options for configuring the scapular free flap in maxillary, mandibular, and calvarial reconstruction.

Background: A number of microvascular free-flap tissue transfer techniques exist for reconstruction of head and neck defects. The scapular free flap is a versatile option that can be used for a wide variety of defects in this complex region. Methods: A series of 42 free flaps from 41 patients was retrospectively identified from the senior author’s (Z.H.) database between 2006 and 2012. Information regarding patient demographics, indication for surgery, type of flap, reconstructive methods, complications, and prosthodontic outcome were reviewed and have been described. Result: A wide range of defects were reconstructed using the scapular free flap. Of the 42 reconstructions, 24 were for mandibular, 13 were for maxillary, and five were for calvarial reconstruction. The patients’ ages ranged from 28 to 82 years, with a median of 70 years. Dental restoration was achieved in eight patients with maxillary reconstruction and two patients with mandibular reconstruction. There were 11 major complications, including two total flap failures. Conclusions: The authors have found the scapular free flap to be a reliable, robust, and versatile flap that provides an unparalleled range of reconstructive options, with minimal donor-site morbidity. Thus, the authors believe that the scapular free flap is a valuable reconstructive option for patients with complex head and neck defects and in patients in whom comorbid disease contraindicates the use of the fibular free flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Education and support needs in patients with head and neck cancer: A multi-institutional survey

Head and neck cancer (HNC) encompasses a diverse group of tumors, and thus providing appropriate and tailored information to patients before, during, and after treatment is a challenge. The objective of the current study was to characterize the experience and unmet needs of patients with HNC with regard to information and support provision.

Reviewing the genetic alterations in high-risk cutaneous squamous cell carcinoma: A search for prognostic markers and therapeutic targets

Cutaneous squamous cell carcinoma (SCC) is second only in incidence to basal cell carcinoma (BCC), effecting up to 500 000 people in the United States annually. Metastasis to regional lymph nodes occurs in approximately 5% of cases and imparts significant morbidity. Standard treatment in this group involves a combination of surgery and adjuvant radiation. Currently, there are no clinically useful biomarkers of metastatic potential in primary cutaneous SCC and histological predictors can be unreliable. The high level of mutational burden in normal UV‐exposed skin has hampered the search for novel drivers of invasive disease, and indeed metastatic potential. This review outlines the clinical problems in high‐risk and metastatic cutaneous SCCs, reviews the known genetic events and molecular mechanisms in high‐risk primary cutaneous SCC and metastasis, and identifies avenues for further investigation and potential therapy.

Oropharyngeal cancer and human papilloma virus: evolving diagnostic and management paradigms.

The significant increase in human papilloma virus (HPV)‐associated oropharyngeal carcinoma (OPC) over recent years has lead to a surge in research and an improved understanding of the disease. Most patients with HPV‐associated OPC present with cystic nodal metastases with a small primary tumour, and respond well to all treatment modalities including primary surgery and primary chemoradiotherapy. Current research is evaluating treatment de‐escalation to reduce long‐term treatment‐associated morbidities. Transoral robotic surgery (TORS) is particularly relevant as the transoral approach allows small primary tumours to be removed with lower morbidity than traditional surgical approaches. The current American Joint Committee on Cancer staging system for oropharyngeal cancer does not appropriately stratify HPV‐associated OPC; hence, alternative risk stratification and staging classifications are being proposed.