Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

BackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy.MethodsA systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT.ResultsDespite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap–tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications.ConclusionFlap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning

Ostéoporose (enquête épidémiologique et facteurs de risque chez le sujet âgé)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Évaluation du contrôle glycémique et de la qualité de vie d'une série de patients diabétiques de type 1 sous insulinothérapie "basal-bolus" utilisant l'analogue glargine suivis pendant 20 mois

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Risques pour la santé humaine liés aux arthropodes nuisants et moyens de protection

National audienc

9. Risques pour la santé humaine liés aux arthropodes nuisants et moyens de protection

INTRODUCTION Les Arthropodes regroupent un vaste ensemble d’invertébrés extrêmement divers (Crustacés, Arachnides, Myriapodes, Insectes...). Ils sont la composante principale de la biodiversité à l’échelle de la planète. Avec près de 1,2 million d’espèces décrites, ils représentent au moins 67 % de l’ensemble des espèces vivantes connues. Les insectes à eux seuls représentent près d’un million d’espèces connues sur ce total et les spécialistes estiment que 5 millions d’espèces restent encore ..