Takashi Nakatsuka

Comparative Evaluation in Pharyngo-oesophageal Reconstruction: Radial Forearm Flap compared with Jejunal Flap. A 10-year experience

We reviewed 109 consecutive patients with cancer of the hypopharynx or cervical oesophagus who underwent free flap transfer for immediate reconstruction after total pharyngolaryngo-oesophagectomy. The free flaps used were either free jejunal (n = 70) or radial forearm flaps (n = 39). Significantly more fistulas (3/70 compared with 15/39, p < 0.0001) and strictures (6/64 compared with 13/33, p = 0.0008) developed in the radial forearm than the jejunal flap group. However, functional donor site morbidity was minimal and there were no cases of total flap necrosis in the forearm flap group. We consider that the free jejunal flap should be the first choice for total reconstruction of pharyngo-oesophageal defects. However, the forearm flap is suitable for elderly, high risk patients, because it is less invasive and has minimal donor site morbidity, which facilitates early recovery.

High-intensity static magnetic fields modulate skin microcirculation and temperature in vivo

We investigated the acute effect of static magnetic fields of up to 8 T on skin blood flow and body temperature in anesthetized rats. These variables were measured prior to, during, and following exposure to a magnetic field in a superconducting magnet with a horizontal bore. The dorsal skin was transversely incised for 1 cm to make a subcutaneous pocket. Probes of a laser Doppler flowmeter and a thermistor were inserted into the pocket and positioned at mid-dorsum to measure skin blood flow and temperature. Another thermistor probe was put into the rectum to monitor rectal temperature. After baseline measurement outside the magnet, the rat was inserted into the bore for 20 min so that mid-dorsum was exactly positioned at the center, where the magnetic field was nearly homogeneous. Post-exposure changes were then recorded for 20 min outside the bore. Sham-exposed animals were submitted to exactly the same conditions, except that the superconducting magnet was not energized. Skin blood flow and temperature decreased significantly during magnetic field exposure and recovered after removal of the animal from the magnet. The rectal temperature showed a tendency to decrease while the animal was in the magnet. The microcirculatory and thermal reactions in the present study were consistent and agreed with some of the predictions based on mathematical simulations and model experiments.

Complications of craniofacial surgery for tumors involving the anterior cranial base.

OBJECTIVE To evaluate the risk factors for postoperative complications among patients undergoing craniofacial resection for the treatment of anterior cranial base tumors, a retrospective analysis of patients treated in University of Tokyo Hospital between September 1987 and November 1996 was conducted. METHODS Twenty-nine patients underwent 33 craniofacial resections for tumors involving the anterior cranial base. Twenty-three of the 29 patients had malignant tumors and 6 patients had benign tumors. Anterior craniofacial resection was performed using a combination of intracranial and extracranial approaches. Radiotherapy and neoadjuvant chemotherapy were administrated to some patients. RESULTS Severe intracranial infections were more common among patients who underwent partial frontal lobectomies (P < 0.03). These infections occurred only in patients who had been treated previously with a craniotomy (P < 0.02) and a total radiation dose of > or =60 Gy (P = 0.06). Neither management of the extracranial structures nor methods of reconstruction of the cranial base showed significant correlation with major postoperative complications. CONCLUSION Compared with previous reports, craniofacial resection has become a relatively safe and effective procedure for the treatment of tumors involving the anterior cranial base. However, additional care should be taken with patients who have experienced a previous craniotomy, frontal lobe involvement, or radiotherapy with a total dose of > or =60 Gy.

Preservation of the larynx after resection of a carcinoma of the posterior wall of the hypopharynx : Versatility of a free flap patch graft

Preservation of the larynx after resection of a pharyngeal tumor remains a challenging problem for the head and neck surgeon.

Microvascular anastomosis for additional blood flow in reconstruction after intrathoracic esophageal carcinoma surgery

Microvascular anastomosis, designed to achieve additional blood flow to the reconstructed site, was carried out in nine patients with intrathoracic esophageal cancer. This procedure prevents the major complications of esophagogastric and esophagocolic anastomotic leaks after subtotal esophagectomy.

Surgical Treatment of Mandibular Osteoradionecrosis: Versatility of the Scapular Osteocutaneous Flap

Osteoradionecrosis of the mandible is a serious complication of radiotherapy for head and neck cancer and no single treatment has to date met with consistent success. A free scapular osteocutaneous flap was successfully transferred in nine patients with mandibular osteoradionecrosis who before this had not responded to conservative treatment. All but one of the patients had good bone union and there was no evidence of recurrence during a mean follow up period of four years and one month. This flap not only provides a well-vascularised segment of the bone but also multiple, large skin paddles, each with an abundant and reliable blood supply. In addition, well-vascularised fascia and overlying subcutaneous tissue can be used to fill dead spaces and cover the bony segment and fixation plates. This reduces postoperative infection and promotes primary wound healing. This flap has proved useful for reconstruction of mandibular osteoradionecrosis, particularly when there is a large soft tissue defect.

Dumbbell Type Jugular Foramen Meningioma Extending Both into the Posterior Cranial Fossa and into the Parapharyngeal Space: Report of 2 Cases with Vascular Reconstruction

Summary Two cases with huge dumbbell type jugular foramen meningioma with extension into the parapharyngeal space are reported. A well co-ordinated surgical strategy for total resection to this high risk tumour with neurosurgeons, otolaryngologists and plastic surgeons is mandatory to minimise operative complications. Both of our patients presented with a cervical mass and lower cranial nerve palsies, and had huge dumbbell type masses extending from the posterior cranial fossa through the jugular foramen to the parapharyngeal space, encasing the cervical internal carotid artery. Gross total resection of the tumours was successfully achieved by basically a 2-stage operation. In the first stage, posterior fossa tumours were removed by the transjugular approach, combined with the petrosal approach in one case. In the second stage, cervical tumours were removed along with the cervical carotid artery by the transcervical and/or transmandibular approach, followed by vascular reconstruction from the ipsilateral carotid artery to the middle cerebral artery using saphenous vein graft. From these experiences, we recommend this 2-stage operation for large dumbbell type meningiomas extending to the infratemporal/parapharyngeal space. The intracranial tumour is removed at the first operation. The extracranial portion is resected at the second, and if necessary, the involved cervical carotid artery is resected and simultaneous revascularisation using saphenous vein graft is performed with a vascularised free muscle graft. This strategy could maximise the functional preservation on the one hand, and minimise the surgical risk, such as postoperative infection, on the other.

Osteogenic capacity of vascularised periosteum: experimental study using rib periosteum in rabbits

The osteogenic capacity of vascularised periosteum was investigated in rabbits using island rib periosteum nourished by intercostal vessels as an experimental model. Twenty-three adult white female rabbits were used. Excellent bone formation was observed after 2 postoperative weeks in each case. In the early stages of bone formation, extensive chondral ossification was observed. Newly formed bone became mature after 4 to 8 postoperative weeks, on histological examination.

Evaluating the donor site after harvest of free jejunum grafts

Free jejunal grafts are commonly used for reconstruction after surgery for hypopharyngeal and cervical esophageal cancer. However, few reports have addressed postoperative morbidity at the abdominal donor site.

A Second Primary Squamous Cell Carcinoma Arising in a Radial Forearm Flap Used for Reconstruction of the Hypopharynx

A 63-year-old man had undergone hypopharyngectomy for hypopharyngeal carcinoma in 1985. A free radial forearm flap was used for reconstruction of the pharynx. Ten years after the surgery, a second primary squamous cell carcinoma occurred in the neopharynx. Persistent exposure to alcohol, saliva and foodstuffs was considered as a possible cause of second primary carcinoma. Long-term follow-up is indicated in patients undergoing reconstruction using cutaneous or musculocutaneous flaps.