"风筝"皮下蒂皮瓣在头颈部修复术中的应用

目的：探讨“风筝”皮下蒂皮瓣（简称皮下蒂皮瓣）在头颈部修复术中的应用。方法：对头颈部皮肤缺损者设计三角形皮下蒂皮瓣,三角形的底靠近缺损侧。于三角形两腰切开皮肤,向下外潜行分离皮下组织,然后将皮下组织蒂的中央部分用剪刀分离,形成双蒂,将皮瓣向缺损侧推进,修复组织缺损。结果：应用皮下蒂皮瓣30例,切口Ⅰ期愈合,形态较满意,切口瘢痕不明显。结论：采用皮下蒂皮瓣修复头颈部皮肤缺损,效果确定,方法简便易行。     

Omental free flap reconstruction in complex head and neck deformities

BACKGROUND: Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers. METHODS: All patients who underwent free omental transfer to the head and neck region were reviewed. RESULTS: Fifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months-13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas. CONCLUSIONS: The omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue.     

The submental island flap in head and neck reconstruction

BACKGROUND: The submental island flap (SIF) is a new alternative in the reconstruction of various head and neck defects. We present our preliminary experience in the use of this flap and describe the surgical technique. METHODS: Nine patients underwent reconstruction with the SIF between January 1998 and July 1999. The SIF has been used for the reconstruction of the cervical esophageal stenosis in 2 patients, floor of mouth and tongue defects in 6 patients, and a hemilaryngectomy defect in 1 patient. RESULTS: With the exception of one partial flap loss caused by arterial insufficiency, no flap failures were observed. All the donor site defects but one were closed primarily. One patient who underwent reconstruction of a hemilaryngectomy defect underwent revision surgery because of intractable hair growth on the transferred skin paddle. Marginal mandibular nerve function was intact in all the cases. CONCLUSIONS: When combined with the reported experience of other surgeons, our preliminary experience showed that the SIF was an excellent alternative in the reconstruction of head and neck defects because of its reliability, versatility, and relative ease of application.     

胸廓内动脉穿支皮瓣修复气管造瘘口和颈前皮肤缺损

目的 探索带蒂胸廓内动脉穿支皮瓣修复气管造瘘口和颈前皮肤缺损的临床效果.方法 2009年4月至12月应用带蒂胸廓内动脉穿支皮瓣修复颈部皮肤缺损共4例,其中气管造瘘口周围缺损2例,颈部手术后皮肤缺损2例.4例均选择第2肋间穿支血管供血,皮瓣面积(4～7)cm×(10～13)cm.结果 3例皮瓣全部存活,1例发生部分坏死.供区缺损均直接拉拢关闭且无并发症.结论 带蒂胸廓内动脉穿支皮瓣是头颈部缺损修复的新技术,供区并发症低,主要适用于气管造瘘口和颈部手术后皮肤缺损.

Abstract：

Objective To investigate the application of pedicled internal mammary artery perforator(IMAP) flap for tracheostoma and anterior cervical defect. Methods From April to December 2009, 4 IMAP flaps, based on the second internal mammary artery perforator, were used for two cases of tracheostoma and two cases of anterior cervical skin defect. The flap size was (4-7) cm× ( 10-13 )cm.Results 3 of 4 flaps survived completely. Partial necrosis happened in one flap. The defects at donor sites were closed directly. Conclusions The IMAP flap is a new method for head and neck defect. It is very suitable for tracheostoma and cervical skin defect, with less morbidity at donor site.     

Squamous cell carcinoma of the head and neck in solid organ transplant recipients

BACKGROUND: The increased incidence of cancer after solid organ transplantation is well established in the literature, yet outcome studies in this population are rare. Excluding skin cancers, squamous cell carcinomas make up most head and neck cancers in transplant recipients. METHODS: At our institution, of 5300 solid organ transplant recipients, 34 have had head and neck cancer develop. We reviewed the records of the 23 recipients whose cancer was treated here. RESULTS: Only 6 of the 23 recipients were alive at the time of our chart review. Of these, three had already survived 5 years. The 10 recipients diagnosed early (stage I or II) had significantly longer survival after cancer diagnosis than the 13 diagnosed at an advanced stage (stage III or IV) (96.0 mo vs 9.0 mo, p <.001). In all, 14 (60.8%) of the 23 recipients died of cancer within 2 years after diagnosis, 12 (50.2%) within 12 months. The sum of the daily doses of immunosuppressive drugs at cancer diagnosis was significantly greater for recipients who died within 2 years (p =.02). Furthermore, the difference in average doses of both prednisone (p =.001) and azathioprine (p =.028) was also significantly greater for those who died within 2 years. The average dose of cyclosporine was also greater, but this difference did not reach statistical significance (p =.18). The average dose of prednisone was significantly lower for recipients diagnosed early (p =.001). This correlation between high immunosuppressive drug doses and worse outcome has not been shown previously. CONCLUSIONS: Solid organ transplant recipients who are diagnosed with advanced head and neck cancer while receiving high doses of immunosuppressive drugs fare extremely poorly. High doses of immunosuppressive drugs, most notably prednisone, correlate significantly with advanced diagnosis of head and neck cancer and earlier death.     

Molecular mediators of metastasis in head and neck squamous cell carcinoma

BACKGROUND: The presence of regional metastasis in patients with head and neck squamous cell carcinoma (HNSCC) is a common and adverse event associated with poor prognosis and high mortality. Although significant improvements in standard therapies have increased the efficacy of local tumor management, the high incidence of tumor recurrence has resulted in limited improvements in overall survival rates. Understanding the molecular mechanisms that mediate HNSCC invasion and metastasis may enable identification of novel therapeutic targets for the prevention and management of tumor dissemination. METHODS: A literature review was performed. RESULTS: Several biologic mediators and mechanisms that have been implicated in HNSCC metastasis, such as cell adhesion molecules, proteolytic enzymes, growth factor signaling, metastasis suppressor genes, and chemokine receptors were reviewed. CONCLUSIONS: Prevention of HNSCC metastasis is an important clinical objective that requires an increased understanding of the molecular mechanisms of tumor invasion and dissemination.