Lucas de Villalaín

Microvascular Free Tissue Transfer for Tongue Reconstruction After Hemiglossectomy: A Functional Assessment of Radial Forearm Versus Anterolateral Thigh Flap

PURPOSE The purpose of this study was to evaluate tongue function and donor site morbidity in patients with oral cancer surgically treated and reconstructed with radial or anterolateral thigh free flaps. PATIENTS AND METHODS Twenty patients underwent primary reconstruction after hemiglossectomy between January 2002 and June 2004. Ten patients were reconstructed using a free forearm flap and the remaining with an anterolateral thigh flap. Eight patients on each group underwent postoperative radiotherapy (average, 60 Gy). All of them were followed postoperatively to determine after 6 months their functional outcome as it related to speech, deglutition, tongue mobility, and donor site morbidity. The intelligibility, deglutition, and tongue mobility were each scored on a scale ranging from 1 to 7 by an independent investigator. Data were analyzed by the 2-tail Mann-Whitney U test. RESULTS No differences in mean speech intelligibility, tongue mobility, or deglutition mean scores were seen between radial forearm flap and anterolateral thigh flap (P > .05). In all anterolateral thigh flap-treated cases, the donor site was closed directly and no complications were seen. However, in all forearm flaps donor site closure was carried out with skin grafts and dorsal forearm splinting was applied for 1 week postoperatively. In 4 cases a partial skin graft failure was observed and donor sites healed for second intention. CONCLUSION Anterolateral thigh flap, with its versatility in design, long pedicle with a suitable vessel diameter, and low donor site morbidity, could be the ideal flap for hemiglossectomy defect reconstruction.

Use of Autologous Skin Equivalents With Artificial Dermal Matrix (Integra) in Donor Site Coverage in Radial Forearm Free Flaps: Preliminary Cases

PURPOSE The radial forearm flap is one of the most commonly used methods for intraoral reconstruction in oral carcinoma surgery. One of its disadvantages is the residual functional and unaesthetic defect in the donor site. The objective of this report is to describe preliminary cases of a novel method to cover such donor sites based on the use of autologous skin equivalents (ASEs) and an artificial dermal matrix (Integra, Prim, Barcelona, Spain). MATERIALS AND METHODS The donor sites of 2 patients were treated with the artificial dermal matrix after raising a radial forearm flap. A skin biopsy and a blood sample were taken to construct an ASE. After 3 weeks, the ASE was applied over the dermal template and left to heal. The functional and esthetic results were recorded. RESULTS Good functional and esthetic results were achieved, with correct wrist motility, although a natural skin color could not be achieved. Neither the Integra nor the ASE was rejected. Total wound coverage was achieved at 4 months, and completely normal skin was observed at 6 months. CONCLUSIONS This technique of combining an artificial dermal matrix with an ASE could be an alternative method to cover the donor sites of radial forearm flaps.

Modified facelift approach combined with a superficial musculoaponeurotic system flap in the treatment of benign parotid tumors

PURPOSE The purpose of this study was to investigate the adequacy of a modified facelift incision combined with an SMAS flap for the resection of benign parotid lesions in terms of cosmesis and incidence of Freys syndrome. MATERIALS AND METHODS A hundred patients who underwent superficial parotidectomy were divided into 2 groups according to approach: Blair incision (57 cases) and modified facelift incision (43 cases). In the latter group, 36 patients were reconstructed with a superficial musculoaponeurotic system (SMAS) flap. During follow-up, patients were asked to rate their satisfaction with their postoperative appearance using a 1 to 3 scale. RESULTS Clinical Freys syndrome was present in 8.5% of patients with SMAS flap, and in 19% patients without SMAS flap (p = 0.16). The average cosmetic outcome score for patients who underwent a modified facelift approach combined with an SMAS flap was 2.87, whereas patients whose tumors were approached through a Blair incision reported a lower score of 2.1 (p < 0.005). CONCLUSION A modified facelift incision combined with an SMAS flap improved the cosmetic appearance of patients who underwent extrafacial or superficial parotidectomy. In addition, this flap seems to reduce the occurrence of Freys syndrome.

Management of facial dermatofibrosarcoma protuberans: case report, justification of aggressive surgical treatment, and reconstruction with an anterolateral thigh flap.

g c i d t v t ( d i he term “sarcoma” is used to designate a group of alignancies arising from the mesenchymal cells. his group is composed of more than 100 different ntities, one of which is dermatofibrosarcoma protuerans (DMFSP). Although this term was coined by offman in 1925, the description of its pathologic haracteristics was by Darier and Ferrand in 1924. DMFSP is considered a primitive fibroblastic tumor f the skin that originates in the dermis. As the mass rows, it can affect the deep structures or even infilrate the epidermis. Histologically, it has fusocellular eatures, with a radial arrangement, evoking the tip of brush, and has been called a “storiform pattern.” typical immune reaction to CD34 is present. Charcteristically, the tumor at its periphery emits digiti-

Blue Rubber Bleb Nevus Syndrome: Immunohistochemical Study

Blue rubber bleb nevus is a rare entity consisting of distinctive angiomas in the skin and gastrointestinal tract, leading to occult or profound gastrointestinal bleeding and chronic anemia. The efficacy has been documented of systemic treatment with corticoids, interferon, vincristine, and, more recently, subcutaneous octreotide in the presence of active lesion proliferation or disseminated intravascular coagulation. A case of blue rubber bleb nevus syndrome with oral hemangiomas in a 24-year-old woman is reported. The surgical specimens were subjected to immunohistochemical study, which showed all of the hemangiomas to be in an inactive phase.

Relevance of level IIb neck dissection in oral squamous cell carcinoma

Background The purpose of this study was to determine the prevalence of level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs). Material and Methods A prospective analysis of 56 patients with OSCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection was performed. During neck dissection, level IIb lymph nodes were separately removed and processed. Neck dissection was bilateral in 26 patients (46%) and unilateral in 30 patients (54%). Results The mean number of nodes found in the level IIb specimens was 4.7 (range: 0-8 nodes). The prevalence of metastasis at level IIb was 0% in pN0 necks and 3.4% in pN+ necks, with an overall prevalence of 1.8%. A significant association between metastasis to level IIb and type of neck dissection was observed. There were no isolated metastases to level IIb without the involvement of other nodes in the remaining neck specimen. Four regional recurrences were observed during follow-up. Conclusions Based on our findings, we suggest that dissection of the level IIb region in patients with OSCC may be required only in patients with multilevel neck metastasis or if level IIa metastasis is found intraoperatively. Key words: Oral squamous cell carcinoma, neck dissection, level IIb, metastasis, spinal accessory nerve.

Angiomixoma superficial de la región parotídea y revisión de la literatura

Superficial angiomyxoma (SA) is a rare benign cutaneous neoplasm first described by Allen et al in 1988. To the best of our knowledge, we report the first case of superficial angiomyxoma located in the parotid region. We also stress the importance of distinguishing this entity from other lesions that may be involved in this location such as cutaneous neoplasms, parotid tumours or cysts. We emphasise the need to rule out the Carney complex, which has been associated with these tumours.