【Abstract】 Objective To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap. Methods Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.6 years (range, 39-67 years). According to Union for International Cancer Control (UICC) 1997 standards of oropharyngeal cancer, 1 case was classified as T1N1M0, 2 as T2N1M0, 2 as T2N2M0, 3 as T3N1M0, 2 as T3N2M0, 2 as T4N1M0, and 1 as T4N2M0. The disease duration was 1-8 months with an average of 4.3 months. The tumor invaded lateral wall of nasopharyngeal in 1 case, lateral wall of hypopharynx in 3 cases, epiglottis in 1 case, soft palate in 4 cases, and tongue root in 3 cases. The tumor infiltrating range was from 2 cm × 2 cm to 12 cm × 6 cm. All the 13 cases underwent integrated methods of surgery and postoperative radiotherapy. After resection of tumor by combined neck-mandible-oral cavity approach, pectoralis major myocutaneous flaps were transplanted in 5 cases, forearm free skin flaps in 5 cases, and anterolateral thigh free skin flaps in 3 cases. Results The postoperative pathological results showed 10 cases of cervical lymph node metastasis; 2 cases had local recurrence and 3 cases had cervical lymph node metastasis after postoperative radiotherapy. Neck infection occurred at 5 days after operation in 1 case undergoing transplantation of pectoralis major myocutaneous flap, and vascular crisis occurred at 12 hours after operation in 1 case undergoing transplantation of forearm free skin flap, which were cured after correspondent treatments. The other flaps survived with incision healing by first intention. Second suture was carried out in 1 case undergoing anterolateral thigh free skin flap transplantation because of wound disruption at the donor site. All the patients were followed up 1 to 6 years, with an average of 3.6 years. In 5 cases undergoing pectoralis major myocutaneous flap transplantation, swallowing obstruction and stomatolalia occurred. In 8 cases undergoing free skin flaps transplantation, the appearances of the flaps and the functions of swallowing or speaking were satisfactory, with no dysfunction at the donor site. All the patients returned to normal occlusion, facial appearance and function were normal. According to the direct calculation method, the three-year survival rate was 60.0% (6/10), and five-year survival rate was 37.5% (3/8). Conclusion For the patients with advanced-stage tonsillar cancer, forearm free skin flaps, or anterolateral thigh free skin flaps is the first choice for repairing defect. However, it is better to choose pectoralis major myocutaneous flaps in patients who need large flap and fail to radiotherapy.
Objective To discuss and evalue the effects and the advantages of pectoral is major myocutaneous flap in repair of defect caused by resection of tonsillar cancer. Methods The data were retrospectively summarized from 10 patients with recurrent tonsillar cancer after radical radiotherapy from January 1998 to December 2005, including 7 cases of squamouscell carcinoma, 2 cases of undifferentiated carcinoma, and 1 case of adenoid cystic carcinoma. There were 8 males and 2 females, aged 43-68 years with an average of 58 years. All cases were classified as stages III and IV before radiotherapy according to staging standard of oropharyngeal cancer (International Union Against Cancer, 1997). The time of relapse was 6-32 months after radiotherapy. Recurrent tonsil cancer invased tongue base, soft palate, posterior wall of pharyngeal, parapharyngeal space, and palate. Tumor size was from 4 cm × 2 cm to 8 cm × 5 cm. Seven cases were accompanied by lymph node metastasis. After carcinoma were completely resected and defects were reconstructed by pectoral is major myocutaneous flap of 7 cm × 5 cm- 12 cm × 9 cm. The donor sites were sutured directly. Results After operation, pectoral is major myocutaneous flap completely survived in 9 cases. Partial necrosis of pectoral is major myocutaneous flap was found in 1 case; after treatment, the necrotic flap remained small pharyngeal defect. Incision at donor site healed by first intention in 10 cases. All patients showed satisfactory functions of respiratory, voice, and swallowing with no compl ication. Ten patients were followed up 2 years to 5 years and 8 months. The 3-year survival rate was 66.7% (6/9), and the 5-year survival rate was 20.0% (1/5). Conclusion Pectoral is major muscle flap has a high survival rate, which is safe, rel iable, easy-to-operate, and can repair larger defect. Pectoral is major myocutaneous flap is an ideal material in repair of defect caused by resection of recurrent tonsillar carcinoma after radiotherapy.
Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.
Objective To investigate the clinical effect of the reverse transposition of pedicled soleus muscle flap in repairing soft tissue defects after Pilon fracture fixation. Methods From May 2002 to June 2006, 14 patients (11 males, 3 females; aging 2050 years) with soft tissue defects afterPilon fracture fixationunderwent repairing operations with the reverse soleus muscle flaps. The soft tissue defects ranged from 7.0 cm×3.5 cm to 100 cm×60 cm. Of the patients, Pilon fractures were treated by internal fixations in 9 cases, open Pilon fractures weretreated by external fixations in 5 cases. The area of muscle flap ranged from 8.5 cm×5.5 cm to 12.5 cm×7.5 cm. Results All patients achieved primary healings, and the grafting skin survived. Twelve flaps survived completely but 2 flapshad mildinfection, which survived after dressing change. Eleven patients were followed up for 3 to 26 months, averaged 15 months. The flap appearances were good and smooth without ulceration. The dorsiflexion ranges of ankle joint were 10-25°, and plantar flexion ranges were 15-40°. The gait was normal. Conclusion The reverse soleus muscle flap is no need to reveal blood vessel pedicle and has constant position of anatomy. It has big muscle belly, convenient to move and circuitation 180°. It is profitable to reduce infection rate and to promote wound healing to raise local osteotylus.
To evaluate the long-term result of free forearm skin flap in the repair of soft tissue defects of the oral and maxillofacial regions, 26 cases which had received radical resection of maxillofacial tumors were follow-up for 4.5 years. Twenty cases, having complete data were analyzed. In this series, There were 8 males and 12 females, with ages ranged from 40 to 69 years old. The size of the flaps ranged from 4 cm x 5 cm-6 cm x 13 cm. The radial artery and the cephalic vein were used as the donor vessels, and the maxillary artery, superior thyroid artery, external jugular vein and the anterior jugular vein were prepared as the recipient vessels. According to the shape, colour, temperature, sensation, mucosoid degree of the flap, the blood supply and function of hand and the configuration of the forearm, the overall results of the recepient regions in 20 cases were all satisfactory and the overall results of 16 cases donor regions were satifactory in 16 cases. The results were poor in 4 cases. The conclusion were: 1. Free forearm skin flap was worth trying in the repair of soft tissue defects of oral region; 2. The radial artery need not to be reconstructed because of the abandant vascular net-work in the upper limb and 3. The residual scar on the forearm was the main shortcoming, but most of the patients could tolerate it because of the obvious advantages received from the operation.
From 1984 to 1994, 236 different types of traumatic defects of foot were repaired by microsurgical tissue grafting. They included simple cutaneous flap in 187 and composite flap in 49. Among the 236 different tissue flaps, vascularized flap was used in 97 and pedicled flap in 139. The 4 fore-foot and 6 heel defects were repaired by composite skeleted cutaneous grafts with scapula and vascularized febula respectively. After the follow-up from 1 to 10 years, all the grafted tissues were survived and healed well. The functions were satisfactory, and 186 patients had resumed their original works. The key to good function following repair was to maintaion the integrity of foot structures and the sensation of the sole and heel.
The penetrating wound of palm with the defect of tissues was usually caused by blunt crushing of gun-shot injury. It was difficult to treat clinically. In order to repair the skin defect of palm and dorsum in one operation, 2 kinds of dumbbell-shaped double-leaf flap were desigened. From February 1993 to March 1996, 5 cases with penetrating wound of palm were treated by this method in which the interosseous posterior artery flap in 4, and the superficial epigastric flap in 1. There were 4 males and 1 female with the ages ranging from 15 to 47 years old. The results were as follows: total survival of the flap in 4 cases and partial necrosis of skin margin of the distal leaf in 1 case. The appearance and function of the flap were satisfactory after a follow-up from 4 months to 3 years. It was concluded that the interosseous posterior artery flap had a long vascular pedicle with its constant anatomical distribution, and the 2nd stage of division of the pedicle of the flap was not necessary. It was a perfect flap in repairing the penetrating wound of the palm with small skin defect. The superficial epigastric flap was cumbersome in appearance and was necessary to divide the pedicle of the flap in 2nd staged operation. It was suitable in repairing the penetrating wound with large skin defect. Regarding the operative technique, a meticulous debridement and the appropriate flap area were required, and the blood vessel of the flap should not be compressed by the surrounding tissues. The advantages of this operation provided a simple method to handle, high rate of survival, and one-staged operation.
From 1984 to 1993, 49 cases with varioussoft tissue defects around the knee were treated with pedicled calf myocutaneous flap, lateral sural cutaneous artery island skin flap, saphenous neurovascularskin flap and fasciocutaneous flap. The postoperation results were sucessful in 47 cases, and failure 2 cases, in one case with flap infection and theother with scar formation surrounding the knee. Both the failure cases were cured with split skin graft. The patient were followed up for an average of three and a halfyears, the knee function was almost completely regained, and the blood supply of the flaps, the elasticity and colour of the flaps were similiar to that of the normal skin, without being cumbersome. The sensation of the saphenous neurovascular flaps and the lateral suralcutaneous artery island flaps was preserved, except partial numbness was presented at the distal part of the flaps. Operative indications and selection of cases were discussed.
Form April 1991 to August 1994, ten cases of extensive soft tissue injury of the extremities with bone and tendons exposed were treated by emergency transfer of latissimus dorsi myocutaneous flaps. The types of the myocutaneous flap were as follows: with vascular pedicle in 1 case, free latissimus dorsi myocutaneous flap in 8 cases,and transfer of combined bilateral latissimus dorsi myocutaneous flaps in 1 case. There were 8 males and 2 females with the ages ranging from 7 to 44 years (an average of 24.4 years). The operations were all performed within 6 hours after trauma except in 1 case, due to its delayed arrival to our hospital, the operation was carried out 14 days after trauma. The results were as follows: total survival of the flap in 6 cases, necrosis of the distal portion of the skin of the flap in 3 cases and necrosis of a greater portion of the skin in one case who had been subjected the transfer of combined bilateral latissimus dorsi myocutaneous flap. but the deep muscle layerwas intact. However, the result was encouraging. The operative technique and the advantages of emergency coverage of the wound were discussed.
Abstract From March, 1987 through May, 1996, a total of 13 cases of severe deep burn and bone defect of hand and wrist were treated by groin skin and iliac bone composite graft with vascular pedicle and had resulted in satisfactory result. The operation was relatively simple. Because thecomposite graft carried its own blood supply in the pedicle, it was not necessary to revascularize the composite graft by anastomosis of blood vessel during operation. Owing to the presence of abundant vascular supply of the iliac bone, the antiinfection potency was high, so its application was suitable for those conditions such as fresh severe deep burn with infection and bone defect. As a result, this technique gave the best chance to save the limb from amputation, and the duration required for treatment could be markedly shortened. This method provided the possibility to solve effectively the difficult problem dealing with the treatment of severe deep burn with infection and bone defect of the hand and wrist.