Objective To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness. Methods Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm × 5.5 cm to 10.0 cm × 7.5 cm. According to Brown’s classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance. Results All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of seech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions. Conclusion According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for repairing defects.
Objective To introduce operation skill of the spinal wedge osteotomy by posterior approach for correction of severe rigid scol iosis and to discuss the selection of the indications and the range of fusion and fixation. Methods Between July 1999 and January 2009, 23 patients with severe rigid scol iosis were treated with spinal wedge osteotomy by posterior approach, including 16 congenital scol iosis, 5 idiopathic scol iosis, and 2 neurofibromatosis scol iosis. There were 11 males and 12 females with a median age of 15 years (range, 8-29 years). Two patients had previous surgery history. The Cobb’s angles of scol iosis and kyphosis before operation were (85.39 ± 13.51)° and (56.78 ± 17.69)°, respectively. The mean spinal flexibil ity was 14.4% (range, 4.7%-22.5%). The trunk shift was (15.61 ± 4.89) mm. The preoperative CT or MRI showed bony septum in the canal in 2 patients. Results The mean operative time was 241 minutes and the mean blood loss was 1 452 mL. The average fused vertebrae were 10.7 segaments (range, 8-14 segaments). The follow-up ranged from 1 to 4 years with an average of 2 years and 6 months. The postoperative Cobb’s angle of scol iosis was (38.70 ± 6.51)°, the average correction rate was 54.7%. The postoperative Cobb’s angle of kyphosis was (27.78 ± 6.01)°, the average correction rate was 51.0%. The trunk shift was improved to (4.69 ± 1.87) mm, the increased height was 5.2 cm on average (range, 2.8-7.7 cm). The Cobb’s angle of scol iosis was (41.57 ± 6.80)° with an average 2.9° loss of correction at the final follow-up; the Cobb’s angle of kyphosis was (30.39 ± 5.94)° with an average 2.6° loss of correction at the final follow-up; the trunk shift was (4.78 ± 2.00) mm at the final follow-up. There were significant differences (P lt; 0.05) in the Cobb’s angles of scol iosis and kyphosis and the trunk shift between preoperation and postoperation, between preoperation and last follow-up. Four cases had pedicle fracture, 1 had L1 nerve root injury, 2 had superior mesenteric artery syndrome, 1 had exudates of incision, and 2 had temporary dysfunction of both lower extremity. Conclusion Spinal wedge osteotomy by posterior approach is a rel iable and safe surgical technique for correcting severe rigid scol iosis. With segmental pedical screw fixation, both the spinal balance and stabil ity can be restored.