Wen Kuan Chen

External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction

Abstract Conclusion: The radial forearm free flap (RFFF) is one of the optimal choices for hypopharyngeal reconstruction. Our series demonstrates that the technique of an indicator flap for the monitoring of the buried flap is simple, reliable, and inexpensive. The condition of the indicator flap can be easily interpreted by the physicians and the nursing staff. Therefore, the success rate of this microsurgical reconstruction may be improved. Objectives: The RFFF is increasingly applied in reconstruction of the hypopharynx after radical resection for advanced hypopharyngeal cancer. However, postoperative monitoring of the buried free flap is extremely difficult. We designed a small external component as an indicator flap to monitor the perfusion of the buried vascular pedicle. Methods: Eight consecutive patients with hypopharyngeal cancer underwent radical surgery and hypopharyngeal reconstruction using RFFF at the Sun Yat-sen University Cancer Center between January 2005 and January 2007. The indicator flap was sutured to the surface of the neck for postoperative monitoring. Results: All of the indicator flaps remained viable. One patient experienced vascular compromise and was successfully salvaged. The success rate of the buried flaps was 100%. Pharyngocutaneous fistula occurred in one patient. All patients resumed an oral diet eventually.

Irradiation of the recipient site does not adversely affect successful free flap transfer in the repair of head and neck defects after salvage surgery for recurrent nasopharyngeal carcinoma originally treated with radiotherapy

Abstract Irradiation of the recipient site has been associated with postoperative complications and an increased rate of flap failure in facial reconstruction. The aim of this study was to report the outcomes of our use of four different types of flaps (two free and two pedicled) for the reconstruction of patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy, who subsequently received salvage surgery after the development of recurrence or secondary primary tumours. The records of 12 NPC patients who underwent salvage surgery and reconstruction from 2002–2007 were retrospectively reviewed. There were no intraoperative or significant postoperative complications. All flaps survived. The average cosmetic outcome was 2.7 (1 = poor, 4 = excellent), all patients could tolerate a liquid to normal diet, and nine patients had normal or intelligible speech, while three exhibited slurred speech. These results indicate that the effects of irradiation on the recipient site do not appear to adversely affect successful flap transfer or outcomes.

Long-term survival of induction chemotherapy plus surgery and postoperative radiotherapy in patients with stage IV hypopharyngeal cancer

This study was conducted to evaluate the safety, efficacy, and tolerability of induction chemotherapy plus surgery and postoperative radiotherapy in patients with stage IV hypopharyngeal cancer. The patients received two to three cycles of induction chemotherapy before surgery, with cisplatin (100 mg/m2) by rapid intravenous (i.v.) infusion over 15–20 min on day 1, bleomycin (10 mg/m2) on days 1 and 5, and 5-fluorouracil (800 mg/m2/day) by continuous i.v. infusion on days 1 through 5, repeated every 21 days. Adjuvant radiotherapy was begun 4–6 weeks after surgery. From July 1999 to December 2004, a total of 52 patients were enrolled. After completion of two to three courses of induction chemotherapy, 22 cases of CR (complete response) and 16 cases of PR (partial response) in the primary site were confirmed, giving an overall response rate (ORR) of 73.1% [95% confidence interval (CI), 61.1–85.2%]. There were 17 CRs and 19 PRs in neck lymph nodes, giving an ORR of 69.2%. The combined primary tumor site and lymph node response was 17 CRs and 16 PRs, giving an ORR of 63.5% (95% CI, 50.4–76.6%). The median time to progression and overall survival for all the patients were 32 months (95% CI, 7.6–56.4 months) and 36 months (95% CI, 22.3–49.7 months), respectively. The estimate of time to progression and overall survival at 5 years was 24.5% (95% CI, 12.5–36.5%) and 35.9% (95% CI, 23.2–48.6%), respectively. In conclusion, induction chemotherapy plus surgery and postoperative radiotherapy is a treatment modality that is tolerated with encouraging activity and survival outcome in patients with stage IV hypopharyngeal cancer.