Manuel Moreno-Sánchez

Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft

PURPOSE Traditional donor-site closure has been associated with serious esthetic and functional morbidity. The purpose of this study was to assess morbidity in esthetics and function and measure the postoperative complications of the radial forearm free flap (RFFF) donor site after using combined local triangular full-thickness skin grafting. MATERIALS AND METHODS This prospective study of patients who underwent reconstruction of head and neck defects using an RFFF was conducted from July 2008 through December 2014. The donor site was repaired with a combined local triangular full-thickness skin graft. Quality of the scar, color match, tendon exposure, presence of necrosis, dehiscence of the suture, and presence of dysesthesia were recorded and analyzed using SPSS 21.0 software. RESULTS One hundred consecutive patients (71 male and 29 female) underwent RFFF harvesting. RFFF donor-site defects ranged from 15 to 70 cm2; partial skin graft loss occurred in 7% of patients. Five patients (5%) had small dehiscences of the forearm skin graft, and 2 cases (2%) presented tendon exposure. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Esthetic results were considered excellent in 87%, good in 11%, and suboptimal in 2% of the cases. CONCLUSIONS The combined local triangular full-thickness skin graft is a reliable method for closing RFFF donor-site defects because it obviates a second surgical site, it provides excellent color match and pliability, and it can be used for covering large defects of the donor site.

Rare primary leiomyosarcoma of the internal jugular vein with cervical extravascular extension.

Leiomysarcoma of intravascular origin is a rare malignant tumour of the soft tissue. We present what is, to our knowledge, the first example of one that has arisen from the wall of the internal jugular vein.

Double-paddled pectoralis major myocutaneous flap as an alternative to microvascularized free flaps in complex orocervical defects

The authors present the double-paddled pectoralis major myocutaneous flap as a successful alternative for the reconstruction of complex orocervical defects following failure of prior microvascularized free flaps or free flap harvest is not feasible. This method was used for the reconstruction of post-ablative defect in a 36-year-old male with a T4 squamous cell carcinoma of the base of tongue with laryngeal involvement. The distal paddle was adapted to reconstruct a defect of the floor of the mouth and further sutured in two layers (musclebasal mandible and skin paddle-oral mucosa) while the proximal skin paddle was used to close the cervical skin and the peri-tracheostomy defect. ABSTRACT

Straightforward Method for Coverage of Major Vessels After Modified Radical Neck Dissection

A new method for covering the internal jugular vein and carotid artery after exposure of the cervical vascular axis subsequent to neck dissection is presented. To cover the most caudal part of the vascular axis, a platysma coli muscle flap is harvested from its most medial and inferior part of the neck in a caudally based fashion and is slightly rotated posteriorly up to 45°. In addition, a superiorly based sternocleidomastoid muscle flap involving the posterior half of the muscle after detachment of the clavicle head is harvested and rotated 45° anteriorly to cover the upper two thirds of the vascular axis. This technique seems to be a good alternative to the pectoralis major myocutaneous flap for covering cervical major vessels, if no classical radical neck dissection is performed, especially in those oncologic malnourished patients who will undergo adjuvant radiotherapy after surgical treatment.

A Modified Single-Step Method to Repair a Central Defect of the Upper Lip.

AbstractIntroductionDefects in the central region of the upper lip are difficult to repair.DiscussionSeveral techniques have been described, many of them requiring a second surgical procedure to obtain acceptable aesthetic results.Case ReportA patient with a soft defect in the central region of the upper lip following aggression by human bite is presented. To repair the defect, the principles described by Goldstein for lateral lip defects were used (Goldstein in Plast Reconstr Surg 85(3):446–452, 1990; Robotti et al. in J Plast Reconstr Aesthet Surg 63:431–439, 2010).ConclusionIn this particular case, two full-thickness advancing miomucosal flaps from the vermilion of the upper lip were used with predictable aesthetic results.

Lemierre syndrome: headache and proptosis as unusual presentation of dental infection by Gemella morbillorum.

Lemierre syndrome has usually been related to oropharyneal infection by Fusobacterium necrophorum. We describe rare case with symptoms of headache and proptosis secndary to odontogenic infection by Gemella morbillorum. To ur knowledge, no previous case of Lemierre syndrome with his aetiology and clinical presentation has been described. A 59-year-old man was admitted to the emergency departent with trismus, headache, and proptosis of his left eye. ntraoral inspection showed trismus of 2 fingerbreadths and n infected mouth with poor dental hygiene. A vertical rigid ainful “cord” was palpated along the whole anterior border f the right sternocleidomastoid muscle. Contrast-enhanced omputed tomography (CT) and magnetic resonance imagng (MRI) showed an abscess in the right pterygomaxillary egion, thrombophlebitis of the left internal jugular vein, nd thrombosis of the left ophthalmic vein with proptosis Figs. 1 and 2). The right pterygomaxillary collection was drained intraoally and involved teeth were removed. Postoperative CT howed a substantial reduction in the abscess in the pteryomaxillary space, but bilateral nodular formations in the hest compatible with septic emboli. Microbiological culures grew multisensitive G morbillorum. He progressed avourably on piperacillin/tazobactam (4 g/500 mg every 8 h) nd linezolid (600 mg every 12 h), given intravenously and as discharged to his local hospital until he had recovered ompletely. Lemierre syndrome is a rare but serious disease usully associated with oropharyngeal infection.1 Diagnosis is ainly decided by clinical findings related to the infecion (fever (in a 82.5% of cases), sore throat, trismus, pain nd swelling or induration at the angle of the mandible nd along the sternocleidomastoid muscle), and by imagng showing thrombophlebitis of the internal jugular vein, eptic emboli, or pulmonary infarcts.2 Final diagnosis is con-

Intraorbital aspergilloma: a rare cause of orbital apex syndrome.

A 43-year-old man presented to our department with eakness of vision, ptosis, proptosis, and impaired eye moveent, all on the left side. Magnetic resonance imaging (MRI) Fig. 1) showed an extraconal mass in the superointernal uadrant of his left eye socket, without extension to the thmoid sinus. With the presumptive diagnosis of orbital nflammatory pseudotumour, we started him on a course of rednisolone. When there was no improvement, we excised he pearly white, cartilaginous mass through an upper eyelid pproach. Histological analysis suggested Aspergillus spp. Fig. 2), so we gave him amphotericin B and caspofungin ntravenously and after four weeks, the pain, ptosis, and eye ovements had improved, and he had regained perception f light. Few symptoms remained at follow up 6 months ater. Orbital apex syndrome is characterised by optic neuropthy and ophthalmoplegia. Possible causes are inflammatory, nfective, neoplastic, or vascular lesions. Orbital fungal infecions occur less often and are usually secondary to infection f the adjacent paranasal sinuses. 1–3 There are two presentations of aspergillosis, invasive and on-invasive. The invasive form often crosses the tissue lanes and causes necrosis, and the non-invasive presents s either a ball of fungus or aspergilloma. A ball of fungus s defined as an accumulation of dense fungal hyphae in the inus cavity.1,3 In our patient, it appeared in the orbit without ny involvement of the sinuses and, to our knowledge, there ave been no other similar reports. Classical treatment of aspergillosis is wide debrideent followed by systemic antifungal treatment, as we ave. Loss of vision caused by aspergillosis orbital apex yndrome has a poor prognosis overall and a high mor1,2

Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: Primary malignant melanoma in the base of the tongue

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in literature). The extension study doesn´t revealed distant metastatic lesions. The patient was treated by subtotal glossectomy and bilateral functional neck dissection. Tongue is one of the most difficult structures to reconstruct, because of their central role in phonation, swallowing and airway protection. The defect was reconstructed with anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant immunotherapy. The post-operative period was uneventful. At present, 24 months after surgery, patient is asymptomatic, there isn´t evidence of recurrence of melanoma and he hasn´t any difficulty in swallowing or phonation. Key words:Malignant mucosal melanoma, anterolateral thigh free flap, phonation, swallowing.

Unusual case of cervical syphilis with Piringer-Kuchinka-like lymphadenitis

Syphilis rarely presents with cervical lymphadenopathy. We describe a patient with a cervical mass associated with weight loss, asthenia, and night sweats. The mass was excised and histological examination suggested Piringer-Kuchinka lymphadenitis, which is usually present in cervical toxoplasmosis. To the best of our knowledge, Piringer-Kuchinka lymphadenitis has not previously been reported in cervical syphilis.