Management of free flap failure in head and neck surgery

Lutilizzo dei lembi liberi è oggi considerata lopzione di prima scelta nella ricostruzione dei difetti testa-collo, con una percentuale di successo di circa il 95%. La gestione del fallimento di un lembo libero e quale soluzione, tra un secondo lembo libero e un lembo peduncolato, sia più sicura è ancora controversa. Lobiettivo del presente lavoro è descrivere le opzioni adottate dagli Autori e confrontare le scelte e i risultati ottenuti con quelli riportati in letteratura. Dal Gennaio 2012 al Gennaio 2016, presso lUO di Chirurgia Maxillo-Facciale dellOspedale Casa Sollievo della Sofferenza, sono stati allestiti 149 lembi liberi per la ricostruzione di difetti interessanti il distretto testacollo. Di questi, 6 lembi sono stati persi a causa della comparsa di una necrosi totale nel post-operatorio. In 5 casi si è scelto di allestire un secondo lembo libero, nel restante paziente invece è stato utilizzato un lembo di muscolo temporale. Tutti i lembi liberi di salvataggio allestiti hanno avuto successo, senza complicanze e con un buon recupero estetico e funzionale dei pazienti. Analizzando i dati ottenuti e confrontandoli con quanto riportato in letteratura, è possibile concludere come lallestimento di un secondo lembo libero costituisca una procedura sicura e ideale come salvataggio dopo necrosi totale di un precedente lembo

Designing a Masterclass in free flap surgery for head and neck surgeons: Our experience

Not required by the editorial policy - letter to the edito

Adenoid cystic carcinoma of intraoral minor salivary glands

We present a retrospective multicentric study of 67 patients with adenoid cystic carcinomas of the intraoral minor salivary glands, who were diagnosed and treated between 1986 and 2004 in the Operative Units of Maxillofacial Surgery of the University of Parma and of the Bellaria Hospital in Bologna. There were 28 males and 39 females with a mean age of 54.5 years (range 28-84 years). The palate was the most common site of involvement, with 71.6% of cases. All the patients were treated with surgery as the primary modality. Neck dissection was performed in 9% of the patients, and more than half (59.7%) were treated with adjuvant radiation therapy. All surviving patients had a minimum of 2 years follow-up, with a range of 2-20 years (median: 12 years). Of the 67 patients examined in this study, 19 were dead at the end of the follow-up, 16 of them due to tumor disease. Distant or loco-regional recurrence was documented in 29 of the 67 patients (43.3%). Disease-free intervals ranged from 1 month to 12 years. Twenty-two percent of patients had loco-regional failure, whereas 29.8% had distant metastases. The disease specific survival rates were 76.1% at 5 years and 74% at 10 and 15 years.The actuarial loco-regional control rates at 5-, 10- and 15-years were 79.7%, 74.8% and 70%, respectively. The actuarial freedom from distant relapse was 76.5% at 5 years, 64.9% at 10 years and 61.1% at 15 years. Stage T, cervical lymph node metastasis and surgical margin status proved to make a statistically significant contribution when describing the outcome. © 2008 Elsevier Ltd. All rights reserved

Adenoid cystic carcinoma of intraoral minor salivary glands.

ABSTRACT Summary We present a retrospective multicentric study of 67 patients with adenoid cystic carcinomas of the intraoral minor salivary glands, who were diagnosed and treated between 1986 and 2004 in the Operative Units of Maxillofacial Surgery of the University of Parma and of the Bellaria Hospital in Bologna. There were 28 males and 39 females with a mean age of 54.5 years (range 28–84 years). The palate was the most common site of involvement, with 71.6% of cases. All the patients were treated with surgery as the primary modality. Neck dissection was performed in 9% of the patients, and more than half (59.7%) were treated with adjuvant radiation therapy. All surviving patients had a minimum of 2 years follow-up, with a range of 2–20 years (median: 12 years). Of the 67 patients examined in this study, 19 were dead at the end of the follow-up, 16 of them due to tumor disease. Distant or loco-regional recurrence was documented in 29 of the 67 patients (43.3%). Disease-free intervals ranged from 1 month to 12 years. Twenty-two percent of patients had loco-regional failure, whereas 29.8% had distant metastases. The disease specific survival rates were 76.1% at 5 years and 74% at 10 and 15 years.The actuarial loco-regional control rates at 5-, 10- and 15-years were 79.7%, 74.8% and 70%, respectively. The actuarial freedom from distant relapse was 76.5% at 5 years, 64.9% at 10 years and 61.1% at 15 years. Stage T, cervical lymph node metastasis and surgical margin status proved to make a statistically significant contribution when describing the outcome

Intraoperative navigation in complex head and neck resections: indications and limits

PURPOSE: The surgical removal of head and neck tumors often represents a highly complex surgery. The three-dimensionality and the anatomy of the head and neck area make sometimes difficult a correct intraoperative orientation and the obtaining of an adequate oncological safety. In the present pilot study, the authors propose a protocol of application of intraoperative navigation in the resection of head and neck tumors. The purpose is to develop a methodology that can be helpful to ensure oncologic free margins of resection and to facilitate the orientation of the specimen by pathologists.MATERIALS AND METHODS: A sample of 16 patients with head and neck tumors was selected, and they were differentiated into two groups: a "study group" treated with CT computer-assisted surgery and a "control group" surgically treated without the use of technology. The following data were analyzed: operative and pre-surgical planning times, issues related to the use of the technologies, respect of the planned landmarks, description and orientation of the surgical specimen and distance of the tumor from the margins of resection.RESULTS: In the "study group" were noticed a reduced rate of errors in the specimen orientation and an increased distance of the tumor from the margins of resection. Similar operative times were observed in both groups.CONCLUSIONS: Intraoperative navigation resulted to be a reliable method to improve oncological safety in a selected group of patients

Designing a free flap course for head&neck surgeons

Free flap surgery is considered the gold standard in H&N reconstruction worldwide. Performing this type of surgery is challenging for trainees and young specialists, due to the long microsurgical training required. We observed a lack of microsurgical training in Italy and therefore we decided to design and realize a free flap course for young surgeon

Reconstruction of full-thickness defects of the lower lip with a double overlying cervical flap

Reconstruction of full-thickness total or subtotal lower lip defects represents a challenge for the reconstructive surgeon because of the difficulty to create a functional and aesthetically good lip. Many surgical techniques, going from local to free flaps, have been reported, each of them having its own advantages and disadvantages. In particular, the free fascio-cutaneous flaps in most cases are the first reconstructive option, even though several disadvantages such as the complexity of the procedure, longer operative times, morbidity, longer hospitalization, and conspicuous donor-site scar. To avoid these problems, especially in aged patients and in presence of low compliance and/or comorbidities, the Authors propose a single stage reconstruction with a double overlying cervical flap