Reconstruction Of Postoperative Defects Research Articles

Reconstruction of postoperative defects using carbon nanostructured implants with intramedullary osteosynthesis after extremity long bone resection for primary and metastatic tumors

Background. Recent studies have shown that a combination of surgery with chemotherapy and radiotherapy can signifcantly improve survival in patients with primary and metastatic bone tumors. Reconstruction of bone defects after resection of long bones is critical for successful functional limb salvage. The choice of the reconstruction technique depends on the tumor location, tumor extension, presence of pathological fracture, and somatic status of the patient. Reconstruction of bone defects in cases with diaphyseal tumor location can pose a surgical challenge. For the reconstruction of diaphyseal bone defects, endoprostheses, alloimplants, and autologous bone grafts are used. To achieve stability of the affected segment of the limb, various options for osteosynthesis are used. Modern technological achievements provide the emergence of materials with characteristics close to those of human bone tissue, however, without the disadvantages inherent in allo- and autologous implants. The purpose of the study was to improve surgical treatment outcomes in patients with long tubular bone tumors. Material and Methods. For the reconstruction of postoperative long bone defects, we used carbon nanostructured implants (СNI) in combination with intramedullary osteosynthesis with a blocked pin. A total of 25 patients underwent surgery (including 9 patients with a pathological fracture), 24 of them had metastases. Results. There were no intraoperative and postoperative complications. All patients had a signifcant decrease in pain 1 month after surgery. At 3 months after surgery, functional outcomes were satisfactory. None of the patients had a local recurrence, instability of the operated limb segment, or a reaction of rejection of a carbon nanostructured implant. Conclusion. Reconstruction of postoperative defects with carbon nanostructured implants after resection of long tubular bones for metastatic cancer provides good functional results and satisfactory local control.

PERFORMANCE STATUS AND QUALITY OF LIFE AFTER RECONSTRUCTIONS OF BUCCAL MUCOSAL AND RETROMOLAR TRIGONE DEFECTS BY SKIN AND FASCIAL FLAPS IN ONCOLOGYCAL PATIENTS

The aim: of the study is to compare surgical and functional results as well as quality of life after use of skin flaps - platysma myocutaneus flap, supraclavicular artery flap and fascial flaps - temporoparietal fascial flap, buccal fat pad for plastic closure of the buccal and retromolar trigone mucous surgical defects in cancer patients. Material and methods: A retrospective comparative analysis of the results of surgical treatment of buccal and retromolar trigone mucosal cancer in 56 patients operated from 2009 to 2014 was made. The patients were divided into two groups: the first included 26 patients, with reconstruction of fascial flaps, the second group included 30 patients, with reconstruction of postoperative defects with skin flaps. Surgical results: the average duration of surgery, the average duration of inpatient treatment and the presence of complications were compared in the both groups. Functional results in both groups were compared in 6 and 12 months after surgery with the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN), and quality of life was assessed by the University of Washington Quality of Life questionnaire, version 4. Results: Average duration of surgery, average time of inpatient treatment, and postoperative complications did not differ significantly in both groups (P> 0.05). Data of performance status and quality of life in patients with reconstruction of mucosal defects and retromolar trigone with skin flaps were significantly better (P> 0.05) in 6 and 12 months after surgery, compared with the group of patients who underwent defect reconstruction with fascial flaps. Conclusions: The method of choice in reconstruction of medium and large defects of the buccal and the retromolar trigone mucous is usage of skin flaps: the platysma myocutaneus flap and the flap of the supraclavicular artery.

The management of submental flap in the reconstruction of the oral cavity and skin of face defects

One of the most current problems in surgical treatment of the head and neck malignant neoplasms is the necessity for plastic replacement of defects that occur after tumor removal. The management of a submental flap in 34 patients with squamous cell cancer of the oral cavity and skin cancer of the face has been analyzed. There were 29 males and 5 females. The average age of patients was 56.9±5.23 years. The squamous cell cancer of the tongue was diagnosed in 18 patients, the floor of mouth — 7, the mucous of the cheek — 5, the retromolar triangle — 1 and skin basaloma of face in 3 patients. Single-stage reconstruction of postoperative defects after removal of the primary tumor was carried out simultaneously with the neck dissection. The submental flap with orthograde blood supply was used for reconstruction of the oral cavity defects in 31 patients and submental flap with the retrograde variant of blood supply was used to replace skin defects of face in 3 patients. The flap, which included skin, subcutaneous fat and the anterior belly of digastric muscle was used in 25 patients. A submental flap that included skin, subcutaneous fat, anterior belly of digastric muscle, and the fragment of the mylohyoid muscle was used in 9 patients. Total flap failure was observed in 2 patients and partial flap failure was observed in 3 patients. To replace the defect the supraclavicular artery skin and fascial flap were used in patients with total flap failure. Completion of primary plastics was 94%. Salivary fistula was observed in 2 patients and orostoma was not observed. Oral nutrition was restored for all 33 patients with oral cancer after surgery on 7–8 day. The hematoma in the donor’s site was diagnosed in 1 patient and partial sutures failure was observed in 4 patients. The obtained results allow us to recommend the submental flap as an effective way to reconstruct the defects of the oral cavity and the skin of the face after the removal of malignant tumors.

Application of CT angiography in design of anterolateral thigh perforator flap for reconstruction of defect after head and neck cancer resection

To evaluate the benefits of CT angiography (CTA) in preoperative mapping of anterolateral thigh perforator flap (ALTPF) for reconstruction of defect after head and neck cancer resection. Twenty-four patients underwent reconstruction of postoperative defect with ALTPF from March 2011 to March 2014 were retrospectively reviewed. According to the imaging methods used for examining perforating artery, these patients were divided into two groups: color Doppler flow imaging (CDFI)-group and CTA-group, 12 patients in each group. The surgical results of all patients were evaluated for consistency in number of perforating artery, operation time and flap-related complications. Only one of all patients had complete flap necrosis, with an overall flap survival rate of 95.83%. All perforating branches showed with preoperative CTA were found in operation (12/12), significantly higher than CDFI-group (8/12). The mean operation time of CTA-group was significantly shorter than that of CDFI-group (Unilateral neck dissection: (6.80±0.53) vs (8.39±0.75) h, bilateral neck dissection: (8.79±0.97) vs (10.96±0.26) h, both P<0.05). Flap-related complication occurred in one case in CTA-group, but in 5 cases in CDFI-group. CTA can accurately provide anatomical information of perforator vessels and guide preoperative design of ALTPF to improve operative outcomes, including the decrease in operation time and surgical injury.

Reconstructive procedures in maxillofacial oncosurgery.

Oropharyngeal cancers are a biologically heterogenous group of tumors with diverse risk factors including tobacco, alcohol, HPV, inherited disorders, the acquired immunodeficiency of Karposi's Sarcoma and non Hodgkin's lymphoma. In the Czech Republic, oropharyngeal cancers represent around 2% of all cancers. The treatment of these tumors is long and complex. Reconstructive procedures in maxillofacial oncosurgery demand good interdisciplinary collaboration and great professional preparedness of the surgical and nursing team. Patient age and stage of disease, including the presence of metastases are of key importance. A prerequisite for the success of surgical treatment is removal of the tumor with a sufficient safety margin. Reconstructive procedures then follow. To highlight the importance of radical tumor resection and describe reconstruction of the defect in a group of our patients. From 2008 to 2013, 23 patients with oropharyngeal carcinoma underwent radical surgical removal of tumor, followed by reconstruction of postoperative defects using distant and free flaps. The histopathology showed predominantly squamous cell carcinomas and one of Merkel cell carcinoma. 16 patients had malignant disease detected in III-IV. In only 7 cases was treatment initiated in the first and second stages of the disease. In these patients, the tumors were removed with a safety margin of healthy tissue and in none, did the basic cancer recur . The postoperative course in terms of flap engraftment and overall condition of the patient was uneventful. All of these patients still enjoy a good life quality with a current mean survival in range 5 - 76 months. Radical surgical removal of a malignant tumor in the early stages of the disease is associated with fewer postoperative complications and longer survival. To avoid the risk of local and/or systemic postoperative complications, appropriate patient selection is important. Overall, the traditional, classic reconstructive procedures with the use of prostheses, in many cases is still the best option in our experience.

Clinical study of submental artery island myocutaneous flap for reconstruction of oral and maxillofacial defects following operation

To evaluate the outcome and indication of the reconstruction of oral and maxillofacial postoperative defects by submental artery island myocutaneous flaps. Sixty eight cases with the reconstruction of oral and maxillofacial defects by submental artery island myocutaneous flaps from January 2006 to May 2010 were analysed retrospectively. Primary lesions included carcinomas originating from tongue (28 cases), palate (13 cases), mouth floor (9 cases), gingiva (4 cases), buccal mucosa (6 cases), lip (3 cases), and other malignant or benign tumors (5 cases). The ages ranged from 25 to 84 years (mean 58 years); 47 males and 21 females. The sizes of skin paddle varied from a minimum of 4 cm × 4 cm to a maximum of 15 cm × 10 cm. Of the 68 flaps, 62 were survival, 4 had partial necrosis but healed with treatments, and 2 failed due to complete necrosis. Appearance and functions of recipient sites were satisfactory. The followed-up time was 3 - 24 months, local recurrence occurred in 5 cases and cervical lymph node metastases were found in 15 patients. Submental island flap is reliable for the reconstruction of postoperative defects in early oral cancer without regional lymph node metastasis or in benign tumor.