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Head and neck, reconstruction

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https://www.readbyqxmd.com/read/29344982/experience-with-pharmacologic-leeching-with-bivalirudin-for-adjunct-treatment-of-venous-congestion-of-head-and-neck-reconstructive-flaps
#1
Aisha Harun, Rachel M Kruer, Andrew Lee, Kofi Boahene, Patrick J Byrne, Jeremy D Richmon
OBJECTIVES: The goal of this study was to review the feasibility of local bivalirudin injection for adjunct treatment of venous congestion of head and neck reconstructive flaps. METHODS: A retrospective chart review of patients who underwent bivalirudin treatment for venous congestion of head and neck reconstructive flaps in a single institution from September 1, 2012 to September 1, 2015 was undertaken. Individuals were treated with variable number of intradermal injections directly into the flap followed by a small skin incision to allow extended passive bleeding...
January 18, 2018: Microsurgery
https://www.readbyqxmd.com/read/29343893/assessment-of-perfusion-of-free-flaps-used-in-head-and-neck-reconstruction-using-pulsatility-index
#2
Akshay Kapoor, Malay Karmakar, Collin Roy, Kaushal Priya Anand
Objective: To detect venous or arterial obstruction in the pedicle of a free flap we can monitor resistance in the flap bed which is reflected in Pulsatility Index (PI) Therefore if we detect change in the values of the PI in these flaps then we can detect complications in flap due to vascular insufficiency early. Materials and Methods: Seven patients of Free Fibular Flap Reconstruction and ten patients of Free Radial Forearm Flap reconstruction were evaluated over a period of 18 months...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/29343026/-applied-research-of-quadri-low-combined-with-automatic-tube-current-modulation-and-iterative-model-reconstruction-technology-in-head-and-neck-ct-angiography
#3
W Cai, C H Hu, X M Wang, S Hu, J Bao, J P Gong, G H Fan, W Zhang, D Shi, M H Qian
Objective: To investigate the feasibility of low tube voltage, low contrast medium concentration, injection rate and volume (quadri-low) combined with automatic tube current modulation (ATCM) and iterative model reconstruction (IMR) technology in head and neck CT angiography (CTA). Methods: A total of 70 patients whose body mass index (BMI)<25 kg/m(2) underwent head and neck CTA and digital subtraction angiography (DSA) from January to July 2017 were enrolled in this prospective study. According to random number table, patients were divided into two groups: group A (n=35) was scanned according to the protocol of 120 kV, 150 mAs, 50 ml and 5 ml/s iopromide (370 mg/ml) and filtered back projection (FBP) reconstruction; group B (n=35) was scanned with 80 kV, ATCM with mean tube current of 100 mAs, 30 ml and 3 ml/s iohexol (300 mg/ml) and IMR; the other parameters kept consistent between the two groups...
January 2, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29336922/segmentation-free-direct-tumor-volume-and-metabolic-activity-estimation-from-pet-scans
#4
Saeid Asgari Taghanaki, Noirin Duggan, Hillgan Ma, Xinchi Hou, Anna Celler, Francois Benard, Ghassan Hamarneh
Tumor volume and metabolic activity are two robust imaging biomarkers for predicting early therapy response in F-fluorodeoxyglucose (FDG) positron emission tomography (PET), which is a modality to image the distribution of radiotracers and thereby observe functional processes in the body. To date, estimation of these two biomarkers requires a lesion segmentation step. While the segmentation methods requiring extensive user interaction have obvious limitations in terms of time and reproducibility, automatically estimating activity from segmentation, which involves integrating intensity values over the volume is also suboptimal, since PET is an inherently noisy modality...
December 27, 2017: Computerized Medical Imaging and Graphics: the Official Journal of the Computerized Medical Imaging Society
https://www.readbyqxmd.com/read/29335032/-sit-and-tilt-preparation-for-subscapular-system-free-flaps
#5
J Mark, H Patwa, M S Costello, Y Patil
BACKGROUND: The ablation of advanced head and neck cancer often results in large three-dimensional defects that require free tissue transfer to optimally address functional and cosmetic issues. The subscapular system is a highly versatile donor site for flaps used for head and neck reconstruction. Traditional methods of harvesting subscapular flaps require repositioning and re-preparing, which significantly increases the operative time and prevents simultaneous harvesting of the flap...
January 16, 2018: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/29332187/human-bite-injuries-to-the-head-and-neck-current-trends-and-management-protocols-in-england-and-wales
#6
Glyndwr W Jenkins, Robert Isaac, Shakir Mustafa
INTRODUCTION: Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper. MATERIALS AND METHOD: A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate...
January 14, 2018: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29331076/submental-artery-island-flap-with-simultaneous-level-i-neck-dissection
#7
Antoine Eskander, Daniel Strigenz, Nolan Seim, Enver Ozer
BACKGROUND: The purpose of this study was to illustrate the submental island flap elevation technique with simultaneous level I neck dissection followed by the inset and reconstruction of an oropharyngeal defect. METHODS: A 63-year-old patient with a T2N1M0 human papillomavirus-positive squamous cell carcinoma of the tonsil was treated with concurrent chemoradiotherapy (cisplatin + 66 Gy). A local recurrence 2.5 years after treatment was treated surgically and reconstructed with a submental island flap...
January 13, 2018: Head & Neck
https://www.readbyqxmd.com/read/29328540/case-of-late-onset-relapsing-surgical-site-infection-related-to-a-venous-coupler-placed-during-free-flap-reconstruction-for-major-head-and-neck-cancer
#8
Yin Ren, Daniel G Deschler, Dipti Sajed, Marlene L Durand
BACKGROUND: Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. METHODS: We conducted a case report. RESULTS: A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy...
January 12, 2018: Head & Neck
https://www.readbyqxmd.com/read/29327731/transoral-robotic-surgery-in-eagle-s-syndrome-our-experience-on-four-patients
#9
D H Kim, Y H Lee, D Cha, S H Kim
Eagle's syndrome is characterised by focal pain in the tonsillar fossa on wide mouth opening or head rotation and various accompanying symptoms. While the syndrome is difficult to diagnose, shortening the styloid process via a transoral or transcervical surgical approach has been shown to be the most effective treatment. The aim of this article was to document our experience with a transoral robotic approach to treat Eagle's syndrome and to present the outcomes of four patients. We reviewed the cases of four patients with Eagle's syndrome who underwent transoral robotic surgery (TORS)...
December 2017: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/29304960/editorial-commentary-arthroscopic-hip-ligamentum-teres-reconstruction-reality-or-mythology
#10
EDITORIAL
Ali S Bajwa, Richard N Villar
The ligamentum teres (LT) is perceived to contribute to hip stability and proprioception. LT incompetence can lead to pain and instability, which may play a role in chondral damage. Hip arthroscopy plays a role in diagnosing and treating LT tears. Reconstruction of the LT is feasible, but careful attention needs to be paid to tunnel positioning, graft material, graft length, and fixation methods. An anatomic femoral tunnel should exit at the fovea capitis on the femoral side, whereas the location for safe placement of the acetabular attachment is thought to be in the posteroinferior part of the cotyloid fossa...
January 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29299509/salivary-fistula-blue-dye-testing-as-part-of-an-algorithm-for-early-diagnosis
#11
Kimberley L Kiong, Ngian Chye Tan, Thakshayeni Skanthakumar, Constance E H Teo, Khee Chee Soo, Hiang Khoon Tan, Elizabeth Roche, Kaisin Yee, N Gopalakrishna Iyer
Objective: Orocutaneous and pharyngocutaneous fistula (OPCF) is a debilitating complication of head and neck surgery for squamous cell carcinoma (SCC), resulting in delayed adjuvant treatment and prolonged hospitalization. As yet, there is no established test that can help in prompt and accurate diagnosis of OPCF. This study aims to determine the accuracy of bedside blue dye testing and its role as part of an algorithm for early diagnosis. We also analyze the risk factors predisposing to OPCF...
December 2017: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/29290568/outcome-predictors-in-elderly-head-and-neck-free-flap-reconstruction-a-retrospective-study-and-systematic-review-of-the-current-evidence
#12
Cindy Siaw-Lin Goh, Yee-Onn Kok, Cheryl Pei-Chyi Yong, Esther Wan-Xian Tan, Lee-Gan Goh, Khong-Yik Chew, Constance Ee-Hoon Teo, Terence Lin-Hon Goh
Free flap tissue transfer has become the gold standard for reconstruction of composite head and neck defects. We sought to investigate the efficacy and morbidity of these procedures in the elderly. We retrospectively reviewed 245 head and neck free flap procedures (234 patients). Patients were stratified by age group (≥ or <65 years). Univariate and multivariate analyses were used to evaluate the following primary outcomes - free flap survival, postoperative medical and surgical complications and 30-day mortality...
December 12, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29288289/anterolateral-thigh-flap-combined-with-reconstruction-plate-versus-double-free-flaps-for-composite-mandibular-reconstruction-a-propensity-score-matched-study
#13
Anaeze C Offodile, Jennifer An-Jou Lin, Kai-Ping Chang, Mohamed Abdelrahman, Hao-Wei Kou, Charles Yuen Yung Loh, Mario A Aycart, Huang-Kai Kao
OBJECTIVE: This study was designed to examine the comparative effectiveness of oromandibular defect reconstruction via anterolateral thigh flap and bridging plate (ALT only) versus simultaneous soft tissue and vascularized bone flap (DFF), with regards to long-term plate exposure and complications. METHODS: A propensity score-matched analysis of patients with an oncologic head and neck defect who underwent microvascular reconstruction was performed. Two surgical groups, i...
December 30, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29284163/geometric-three-dimensional-end-to-side-microvascular-anastomosis-a-simple-and-reproducible-technique
#14
Adrian S H Ooi, Daniel R Butz, Sean M Fisher, Zachary J Collier, Lawrence J Gottlieb
BACKGROUND:  End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is critical. The ideal ETS microanastomosis should maintain a wide aperture and have a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity of the suture line. We have developed a unique, dependable, and reproducible geometric technique for ETS anastomoses, and analyze its efficacy in our series of patients. METHODS:  The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped defect on the recipient vessel wall, followed by a slit incision of the donor vessel to create a "spatula" fitting this defect...
December 28, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29283939/rabdomyosarcoma-of-the-mandible-an-uncommon-clinical-presentation
#15
Cleverton Roberto de Andrade, Guilherme Dos Santos Trento, Fabiano Jeremias, Elisa Maria Aparecida Giro, Marisa Aparecida Cabrini Gabrielli, Mario Francisco Real Gabrielli, Oslei Paes de Almeida, Valfrido Antonio Pereira-Filho
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm...
December 27, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29280859/outcome-analysis-of-free-flap-salvage-in-outpatients-presenting-with-microvascular-compromise
#16
Rene D Largo, Jesse C Selber, Patrick B Garvey, Edward I Chang, Matthew M Hanasono, Peirong Yu, Charles E Butler, Donald P Baumann
BACKGROUND: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. METHODS: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. RESULTS: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room...
January 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29277855/bifurcation-of-brachial-artery-into-a-common-radial-interosseous-trunk-and-superficial-ulnar-artery-a-rare-variation
#17
Suresh Narayanan, Senthil Murugan
Variations in the branching pattern of brachial artery and abnormal course of its branches are not uncommon. The present article describes a case of bifurcation of the brachial artery into a common radial-interosseous trunk and superficial ulnar artery. The embryological basis behind the present case report could be, the radial artery establishing a connection with the axis artery just below the level of origin of ulnar artery, the posterior interosseous artery arising from the axis artery distal to the origin of the radial artery...
December 26, 2017: Anatomical Science International
https://www.readbyqxmd.com/read/29249632/perforator-flaps-from-the-lower-leg-for-intraoral-reconstruction-experience-of-131-flaps
#18
Klaus-Dietrich Wolff, Andrea Rau, Andreas Kolk
BACKGROUND: During the last decade, perforator flaps have become popular for defect cover in the head and neck because they increase the choice of reconstructive possibilities and can lead to minimal donor site morbidity. In particular, the lower leg is considered a suitable option, as it provides thin and pliable skin for intraoral lining. Having gained experience with 131 flaps raised from four different donor sites at the lower leg, the aim of this paper is to evaluate success rates and patient satisfaction, but also difficulties and pitfalls during flap transfer...
November 26, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29249263/reconstructive-methods-in-mohs-micrographic-surgery-in-uruguay-a-bidirectional-descriptive-cohort-analysis
#19
J Navarrete, J Magliano, M Martínez, C Bazzano
BACKGROUND AND OBJECTIVES: The primary goal of Mohs micrographic surgery (MMS) is to completely excise a cancerous lesion and a wide range of reconstructive techniques of varying complexity are used to close the resulting wound. In this study, we performed a descriptive analysis of patients who underwent MMS, with a focus on wound closure methods. MATERIAL AND METHODS: We conducted a bidirectional descriptive cohort analysis of all MMS procedures performed by a single surgeon between November 2013 and April 2016...
December 14, 2017: Actas Dermo-sifiliográficas
https://www.readbyqxmd.com/read/29246276/nutrition-management-for-head-and-neck-cancer-patients-improves-clinical-outcome-and-survival
#20
REVIEW
Urs Müller-Richter, C Betz, S Hartmann, R C Brands
Up to 80% of patients with head and neck cancers are malnourished because of their lifestyle and the risk factors associated with this disease. Unfortunately, nutrition management systems are not implemented in most head and neck cancer clinics. Even worse, many head and neck surgeons as well as hospital management authorities disregard the importance of nutrition management in head and neck cancer patients. In addition, the often extensive resection and reconstruction required for tumors in the upper aerodigestive tract pose special challenges for swallowing and sufficient food intake, placing special demands on nutrition management...
December 2017: Nutrition Research
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