Germain Ma

Reconstruction with Free Jejunal Autograft after Circumferential Pharyngolaryngectomy: Eighty-Three Cases

The free jejunal autograft (FJA) has become a common procedure for pharyngeal reconstruction after circumferential pharyngolaryngectomy. In order to evaluate the postoperative outcome and the functional and carcinologic results, we retrospectively reviewed 83 cases of reconstruction with FJA. Fifty-one patients had received no prior radiotherapy, and 25 had received prior radiotherapy for their hypopharyngeal tumor or for another previous primary. Seven patients underwent a secondary reconstruction. In the postoperative course, there were 2 postoperative deaths, 4 graft failures (5%), and 11 salivary fistulas. The median time to removal of the nasogastric tube was 16 days, and to discharge, 23 days. Forty-eight patients received postoperative radiotherapy, with good tolerance. At 1 year postoperatively, 98% of the patients were able to eat a solid or soft diet. The postoperative radiotherapy did not impair the quality of the functional results in a long-term assessment. The vocal results were disappointing. The 3-year survival rate was 40%. The main carcinologic failures (45 patients) were locoregional recurrences (20 patients) and metastasis, which was the cause of death in 34% of the cases. It seems clear that FJA allows one-stage reconstruction and good swallowing rehabilitation, tolerates postoperative radiotherapy, and increases the quality of life in these patients with a poor prognosis.

FUNCTIONAL RESULTS WITH ADVANCED HYPOPHARYNGEAL CARCINOMA TREATED WITH CIRCULAR NEAR-TOTAL PHARYNGOLARYNGECTOMY AND JEJUNAL FREE-FLAP REPAIR

Patients treated by a circular pharyngolaryngectomy for advanced hypopharyngeal carcinoma have a poor prognosis and disappointing speech restoration.

Microsurgery in liver research: end-to-side portocaval microanastomoses in dogfish.

BACKGROUND The use of an operating microscope in animal liver surgery has made it possible to obtain new experimental models. The goal of this prospective animal study is to present our experience with dogfish portocaval microanastomoses. METHODS Nineteen portocaval microanastomoses were performed in dogfish. The end-to-side anastomoses were accomplished using continuous 11-0 sutures. The diameter of the vessels and time required for the anastomoses were measured. A patency test and its outcome were also prospectively evaluated at the time of anastomoses and then 3 and 6 months after. RESULTS The mean vessel diameter was 2.5 ± 0.2mm. The mean anastomosis time was 14 ± 1.5 min. The anastomoses patency rate was 100% at the time of surgery. A postoperative control performed after 3 and 6 months showed a partial stenosis in three animals. CONCLUSION The dogfish appears to be a reliable experimental model in liver research. Moreover, this technique could be used for microsurgical training.

Cirugía de los tumores malignos del piso de la boca: exéresis y reparación

Los carcinomas del piso de la boca requieren un tratamiento quirurgico en numerosas ocasiones, que debe incluir el lecho tumoral y las areas ganglionares. El tratamiento del lecho tumoral consiste siempre en una fase de exeresis y, despues, en una etapa de reparacion. La fase de exeresis debe adaptarse a la extension del tumor tanto a nivel de los tejidos blandos como del hueso. Si se produce una discontinuidad osea, su reparacion (sobre todo si es anterior), es indispensable para evitar secuelas morfologicas y funcionales muy graves.

Chirurgia dei tumori maligni del pavimento orale: exeresi e riparazione☆

I carcinomi del pavimento orale vengono trattati nella gran parte dei casi con un trattamento chirurgico. Questo trattamento chirurgico deve interessare il letto tumorale e le aree linfonodali. Il trattamento del letto tumorale comporta sempre un tempo di exeresi e successivamente un tempo di riparazione. Il tempo di exeresi deve essere adattato sia all’estensione del tumore sia ai tessuti molli e all’osso. In caso di interruzione ossea, la riparazione della continuita ossea, specialmente se l’interruzione e anteriore, e indispensabile per evitare gravi postumi morfologici e funzionali.