Microvasculaire vrije lap-reconstructies in de mondholte en orofarynx: Naar een betere kwaliteit van leven

Reconstructive objectives after major head and neck surgery include adequate wound healing and optimal residual function. The most appropriate means to achieve this is through the applications of microvascular free flaps. Mainly defects in the oral cavity and oropharynx are reconstructed in this way. The most often used flap is the free radial forearm flap. When bulk or bone is needed other free flaps such as the rectus abdominis flap, the lattisimus dorsi flap, fibula flap or iliac crest flap can be used. The overall success rate is more than 90% and is mainly determined by the patency of the vessels. Comorbidity is an important prognostic factor. Using free flap reconstructions a good quality of life can be achieved. The costs of free flap reconstructions are not higher than reconstructions using pedicled flaps

Decision support for maintenance managent of high voltage components

Electrical Engineering, Mathematics and Computer Scienc

Larynx preservation surgery for advanced posterior pharyngeal wall carcinoma with free flap reconstruction: a critical appraisal.

To report the functional and oncologic results of larynx preservation surgery with free flap reconstruction for posterior pharyngeal wall carcinoma. Retrospective medical chart review. Tertiary care referral center. We present a series of seven patients, who were treated for an advanced stage posterior pharyngeal wall carcinoma between 1995 and 1998. All patients underwent posterior pharyngectomy with larynx preservation via a suprahyoidal approach for carcinoma of the posterior pharyngeal wall, with radial forearm free flap reconstruction. Complications occurred in three patients with grade 3 comorbidity, one of whom suffered flap loss. After a mean follow-up of 48 months, three patients are alive without disease. One patient is alive with a second primary tongue carcinoma. Two patients died of disease, whereas one patient died of another cause. All patients could be decannulated and maintain their voice. Six out of seven patients were able to take oral nutrition, although four patients needed additional PEG-tube feeding. Posterior pharyngectomy with larynx preservation and radial forearm free flap reconstruction is feasible in selected patients, with acceptable functional results and survival. However, the patient must be aware of the risk of chronic aspiration and the possibility of long-term PEG feedings

Severe atherosclerosis of the radial artery in a free radial forearm flap precluding its use.

The free radial forearm flap is the most frequently used free flap for head and neck reconstructions. Survival of free flaps is dependent on adequate blood supply. A 69-year old woman was scheduled for excision of a T3N0M0 oropharyngeal carcinoma, neck dissections and reconstruction with a free vascularized radial forearm flap. During the operation it appeared that the entire radial artery was almost completely obstructed by atherosclerotic plaques precluding microvascular anastomosis. Despite systemic risk factors certain artery types are more prone to develop clinically manifest atherosclerosis. There are no reports on the pathology of the radial artery in free flap reconstructions. In head and neck cancer patients severe atherosclerosis of the radial artery is very rare, but if present makes free radial forearm flap reconstruction impossible. Therefore, in patients with risk factors for peripheral vascular disease screening for radial artery stenosis should be considered

Valeur pronostique de l’envahissement ganglionnaire microscopique dans le cancer papillaire de la thyroïde

International audienc