Hiroo Saito

Pharyngoesophageal reconstruction using a fabricated forearm free flap.

A new microsurgical alternative in reconstruction of the pharynx and cervical esophagus is reported. A trapezoidal forearm flap is fabricated into an inverted skin tube and placed in the pharyngoesophageal defect. Although microvascular anastomoses are required to revascularize the transferred forearm flap, the long and large nutrient vessels of the flap make anastomoses easy and reliable. None of our 12 patients demonstrated any necrosis of the transferred flap. This one-stage, less invasive operation for pharyngoesophageal reconstruction greatly benefits older persons, who are the more likely to be involved with pharyngoesophageal carcinomas.

Correlation between prognosis and degree of lymph node involvement in carcinoma of the head and neck.

The purpose of this report is to discover the correlation between the prognosis and the degree of lymph node involvement in carcinoma of the head and neck. Three hundred and thirty-eight cases of head and neck carcinoma who had undergone neck dissection at the National Cancer Center Hospital from 1962 through 1979 were reviewed and analyzed. The sites of the primary lesions were the oral cavity, larynx, and hypopharynx. Radical whole neck dissection had been performed in 177 cases, partial neck dissection in 97 cases, and bilateral neck dissection in 60 cases. The cervical lymph node metastases from oral cavity carcinoma were mostly confined to L1 and rare in L4 (L-classification by UICC). The prognosis of L4 cases was extremely poor, and thus oral carcinoma cases could be spared posterolateral dissection. The control rate of neck lymph nodes by neck dissection and the prognosis of the patients were influenced by the existence and number of histologically positive nodes. The cervical recurrence rates were 28% of all cases, 11% of histologically negative cases, and 39% of histologically positive cases. Recurrences in the dissected part of the neck were observed in 10% of all cases. The five-year survival rates were 75% of the cases without histologically positive nodes, 35% with histologically positive nodes, 59% with single node metastasis, and 26% with multiple node metastasis.

Implantation of Solvent Dehydrated Dura for Preventing Frey's Syndrome.

We attempted to prevent Freys syndrome by using solvent dehydrated human dura mater in the closing procedure after parotidectomy. The area was covered by the dura and sutured. The presence or absence of symptome was noted subjectively and by Minors method. One out of 17 patients reported a positive symptom during the observation period of 6 to 35 months.Neither foreign body reaction, infection nor other adverse reaction occured after the dura implantation. This method is useful in prevention of Freys syndrome.