Extended, Double-Pedicled Facial Artery Musculomucosal (dpFAMM) Flap in Tongue Reconstruction in Edentulous Patients: Preliminary Report and Flap Design

Background and Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps—the extended, double-pedicled FAMM (dpFAMM) flap—and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMM flap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities.

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Macrodystrophia Lipomatosa of the foot. Extensile dorsal approach for Reductive Surgery. Report of 4 cases

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000123 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Jorge Briceño ◽

Jorge Filippi Nussbaum ◽

Andres Villa ◽

Pablo Mery Ponce ◽

Joaquin Palma ◽

...

Keyword(s):

Wound Dehiscence ◽

Clinical History ◽

Functional Results ◽

Good Alternative ◽

Clinical Results ◽

Unknown Etiology ◽

Dorsal Approach ◽

Clinical Images ◽

Macrodystrophia Lipomatosa ◽

Absorbable Sutures

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Macrodystrophia lipomatosa (ML) is a rare cause of local gigantism affecting hands or feet of congenital non-hereditary origin and unknown etiology. The main characteristic of this disease is the overgrowth of the mesenchymal structures as bone, tendons, vessels, nerves and, predominantly, the fibroadipose tissue. The low frequency of this pathology implies a difficulty to establish management guidelines. The most recommended treatment for this condition is the reductive surgery as an alternative to amputation of the affected segment. Our objective is to report the clinical results of the reductive surgery in four patients with ML in the forefoot. Methods: Four cases of ML surgically treated in our center between 2008 and 2016 were retrospectively analyzed after approval from our institutional review board. For each case, clinical history at admission, pre and post-operative radiographs and pre and post-operative clinical images were obtained. Results: Patients were adults between 28 and 38 years old and followed between 1 and 4 years. The toes involved were: 1 hallux, 2 second toes and 1 fourth toe. All had failed conservative treatment prior to surgery. SURGICAL TECHNIQUE: An extensile dorsal approach preserving the neurovascular bundles was performed. Bone was resected until a harmonic appearance of the toe related to the rest of the foot was obtained. In one case, removal of the distal phalanx was necessary to achieve adequate reduction. The remnant soft tissue was resected from dorsal and distal. Skin was closed using non-absorbable sutures. Wound dehiscence was observed in 2 patients and managed conservatively. No major complications were observed. All the patients were satisfied and able to wear regular shoes postoperatively. Conclusion: The reductive surgery for adults with symptomatic ML of the foot offers good functional results. The extensile dorsal approach allows an excellent surgical exposure, preservation of neurovascular supply and adequate tissue resection. Based on our clinical results and the high satisfaction observed in our 4 patients, we suggest reductive surgery as a good alternative to amputation in selected patients with ML.

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Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold

Hand ◽

10.1177/1558944720918366 ◽

2020 ◽

pp. 155894472091836

Author(s):

Augusto Marcuzzi ◽

Giulia Colzani ◽

Andrea Leti Acciaro ◽

Norman Della Rosa ◽

Antonio Landi

Keyword(s):

Lactic Acid ◽

Progressive Collapse ◽

Surgical Techniques ◽

Good Alternative ◽

Clinical Results ◽

Biological Tissues ◽

Long Term Outcomes ◽

Radiological Findings ◽

Tendon Interposition

Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.

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Long-Term Results in Patients Affected by Testicular Seminoma Treated with Radiotherapy: Risk of Second Malignancies

Tumori Journal ◽

10.1177/030089160509100208 ◽

2005 ◽

Vol 91 (2) ◽

pp. 144-150 ◽

Cited By ~ 4

Author(s):

Lucia Fatigante ◽

Francesco Ducci ◽

Silvana Campoccia ◽

Anna Morgana Nocita ◽

Enrico Paci ◽

...

Keyword(s):

Postoperative Radiotherapy ◽

Late Toxicity ◽

Clinical Results ◽

Incidence Rates ◽

Long Term Results ◽

Unknown Primary ◽

Second Malignancy ◽

Second Malignancies ◽

Testicular Seminoma ◽

The Difference

Aims To report clinical results in patients with testicular seminoma treated with postoperative radiotherapy with regard to survival, acute and late toxicity, and risk of second malignancy. Materials and methods 176 stage I-II testicular seminoma patients treated with radiotherapy from 1964 to 1994 at the Radiotherapy Division of Pisa University, using 60Co or Linac, were analyzed retrospectively. The follow-up ranged from 0.13 to 32.37 years, with a median of 12.1 years. The observed numbers of second malignancies were compared with those expected, taking into account age, sex, and incidence rates from the Tuscany Tumor Registry. Results Overall and specific survival at 10-15 years were 89-82% and 93-92%, respectively. Multivariate analysis revealed a significantly better survival in patients younger than 50 years and in those treated with Linac. Severe late sequelae occurred in 8% of the patients. Sixteen second malignancies were observed (14 solid tumors and 2 leukemias); median latency was 13 years (range, 3-27) and the observed/expected ratio 1.4 ( P not significant). Solid cancers were localized in the bladder (2), kidney (2), skin (2), stomach (1), prostate (1), lung (1), larynx (1), uvea (1) and contralateral testicle (1); 1 patient presented an intestinal carcinoid and 1 a metastasis from an unknown primary. The risk of a second malignancy was higher in the patient group receiving less than 4000 cGy (observed/expected, 2.8; P = 0.015). Conclusions The study confirmed the high cure rate in stage III seminomas after postoperative radiotherapy. Incidence of a second malignancy was higher than expected, but the difference was not statistically significant.

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Islanded facial artery musculomucosal flap for tongue reconstruction

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2016.11.010 ◽

2017 ◽

Vol 46 (4) ◽

pp. 453-455 ◽

Cited By ~ 13

Author(s):

S.T. Joseph ◽

B.S. Naveen ◽

T.M. Mohan

Keyword(s):

Facial Artery ◽

Tongue Reconstruction

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Flap vs flapless technique for impacted third molar removal: A split mouth prospective randomized control study

Journal of Oral Medicine Oral Surgery Oral Pathology and Oral Radiology ◽

10.18231/j.jooo.2021.051 ◽

2021 ◽

Vol 7 (3) ◽

pp. 167-171

Author(s):

Neeraj ◽

Banshilal Beniwal ◽

Padmanidhi Agarwal ◽

Vikas Berwal ◽

Richa Malik

Keyword(s):

Healing Process ◽

Third Molar ◽

Mouth Opening ◽

Third Molars ◽

Pocket Depth ◽

Second Molar ◽

Group I ◽

Flap Design ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique. Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed. The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap). The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.

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Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1709493 ◽

2020 ◽

Vol 36 (07) ◽

pp. 507-513

Author(s):

Chang Ryul Yi ◽

Woo Shik Jeong ◽

Tae Suk Oh ◽

Kyung S. Koh ◽

Jong-Woo Choi

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Speech Therapy ◽

Tongue Cancer ◽

Postoperative Radiotherapy ◽

Postoperative Chemotherapy ◽

Radiotherapy Group ◽

Tongue Reconstruction ◽

And Function ◽

Tip Of The Tongue

Abstract Background Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction. Methods Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline. Results Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes. Conclusion We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

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A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2007.09.056 ◽

2009 ◽

Vol 62 (6) ◽

pp. 795-799 ◽

Cited By ~ 23

Author(s):

Minoru Sakuraba ◽

Takayuki Asano ◽

Shimpei Miyamoto ◽

Ryuichi Hayashi ◽

Mitsuo Yamazaki ◽

...

Keyword(s):

Flap Design ◽

Tongue Reconstruction

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Associated Titanium Mesh and Native Bone Cranioplasty in Posttraumatic Reconstruction of Frontal Skull Defects

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.752.29 ◽

2017 ◽

Vol 752 ◽

pp. 29-34

Author(s):

Vincentiu Săceleanu ◽

Elena Teodora Tâlvan ◽

Mihai Iulian Făgeţan ◽

Calin Mohor ◽

Alexandru Vlad Ciurea

Keyword(s):

Bone Fractures ◽

Critical Role ◽

Good Alternative ◽

Clinical Results ◽

Frontal Bone ◽

Long Term Results ◽

Nerve Function ◽

Titanium Mesh ◽

Native Bone ◽

Skull Defects

Cranioplasty of frontal skull defects are used for cosmetic reasons, helping correct disfigurement, but also play a critical role in protecting intracranial content from exposure and compression. Modern surgical management is based on principles of craniofacial surgery such as early one-stage repair- if possible, exposure of all fracture fragments by well-sited cosmetic incisions, precise internal fixation and definitive soft tissue management. The choice of surgical approach depends on fracture severity, complexity, patient comorbidities, and surgeon preference and experience. In large skull defects, titanium mesh reconstruction offers good alternative to other biomaterials by eliminating the time consuming task of contour moulding. The aim of the study is to provide a comprehensive review of aesthetic and functional outcomes, involving titanium mesh implants associated with native bone reconstruction of frontal area posttraumatic defects. Also, the article is related to the authors own experience, in treating several patients with posttraumatic deformity of the frontal bone, assessing forehead contour aesthetics, pain, nerve function and late cerebral complications. A retrospective study was conducted using records from 14 adult patients, between 21-74 years of age, who underwent reconstruction of depressed frontal bone fractures, by receiving titanium mesh implants, between February 2013- October 2015. All patients had a minimum follow up of 5 months by clinical examination and periodic CT-scans. In order to evaluate the experimental results we follow different clinical parameters than late complications, like facial nerve function, cosmetic outcome, and pain. According our clinical results, titanium mesh is an effective method of forehead reconstruction, which provides predictably good long term results.

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Complications of Open Appendectomy Versus Laparoscopic Appendectomy in Children. Comparative Assessment

Acta Medica Transilvanica ◽

10.2478/amtsb-2019-0017 ◽

2019 ◽

Vol 24 (4) ◽

pp. 56-57

Author(s):

Alina Dragoman ◽

Cristian-Ştefan Berghea-Neamţu

Keyword(s):

Laparoscopic Surgery ◽

Laparoscopic Appendectomy ◽

Surgical Complications ◽

Open Appendectomy ◽

Good Alternative ◽

Clinical Results ◽

Low Risk ◽

Clinical Benefits ◽

Pediatric Laparoscopic Surgery ◽

Meta Analyses

Abstract Laparoscopic pediatric surgery (LA) is becoming a good alternative in many centres of the entire world, being associated with low risk of surgical complications and it offers a better alternative for the management of the appendectomy than open surgery. The goal of the study was to evaluate a comparative LA versus open appendectomy (OA) through the prism of the clinical results as they were reflected in specialty literature in the last two decades. In general, pediatric laparoscopic surgery has become acceptable in centres of the whole world. Many studies and meta-analyses have proven that laparoscopic surgery is a feasible and secure procedure, with many clinical benefits. Because laparoscopic appendectomy (LA) was associated with low risk of surgical complications, it may be a better alternative for appendectomy than OA.

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Outcome analysis of vacuum assisted closure therapy in patients with open wounds

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174689 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1132

Author(s):

Ravi Kant Jain ◽

Danish Mohammad ◽

Pranav Mahajan ◽

Tanveer Sheikh ◽

Awyay Rege

Keyword(s):

Healing Process ◽

Good Alternative ◽

Lower Limbs ◽

Outcome Analysis ◽

Patient Acceptance ◽

Vacuum Assisted Closure ◽

Vac Therapy ◽

Short Course ◽

Severe Infections ◽

Short Time

Background: Vacuum assisted Closure (VAC) of wound is a recent trend and proven method of fast and better healing of wounds. The basic concept is the removal of blood and serous collection from the wound site with negative pressure and promoting the healing process rapidly by altering the local microcellular environment.The objective of the study was to show the efficacy of healing process in open wounds treated by VAC method of dressing.Methods: In this prospective study, total of 50 patients with upper and lower limbs non-healing open wounds were recruited. Before the application of VAC, surgical debridement was performed to remove all the devitalized necrotic tissues and the wound was packed with povodine iodine. Prior to and at the end of VAC dressing, wound dimensions were noted.Results: Patients mean age was 46.72±7.63 years and out of which 42 patients (84%) were males and 8 patients (16%) were females. All patients had suffered an acute trauma. VAC therapy was applied through continuous or intermittent suction on wounds and dressing were changed every second or third day. After application of VAC therapy all wounds showed improvement, which were indicated by presence of healthy granulation tissue, absence of necrotic tissue and subsequent wound closure. Conclusions: VAC dressing in an open wound is an efficient and safe adjunct to treat severe infections and may be a good alternative to treat the open wounds in selected patients. Short time intervals between VAC changes and short course of therapy result in good patient acceptance. This method is recommended for all the types of non-healing wounds management.

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