Experience with Flaps After Resection of Vulvar Carcinoma: A Case Series

Background: A defect caused by the radical resection of vulvar cancer requires repair with flap transplantation or vulvoplasty. Therefore, the aim of this study is to present a review of our practice of post-surgical defect reconstruction in cases using different skin flaps.Methods: An observational study was performed among 26 patients with vulvar cancer who were admitted to Sun Yat-Sen Memorial Hospital between February 2015 and February 2020 for surgical and reconstructive procedures. Clinical data of these 26 patients were analyzed. All patients underwent radical resection of vulvar cancer, followed by the repair of post-surgical defects by random flap or axial flap transplantation (even for very complex defects).Results: Among the 26 cases in this study, all patients received 38 soft tissue reconstruction procedures for vulvar perineal defects during the study period. Squamous cell carcinoma was the most commonly diagnosed cancer (80.8%). The average size of the defect was 9.3 ´ 7 cm2. Rhomboid flaps were the most commonly used flaps for performing reconstruction in both the primary and recurrent groups. Poor wound healing was the most commonly discovered complication that occurred in 3 of the 38 flaps (7.9%) used. Previous surgery or radiotherapy did not increase the rate of complications after proper reconstruction was performed.Conclusion: Expanding resection is an effective technique for treating vulvar cancer. Different skin flaps, are effective premium options for post-surgical defect reconstruction, and selective use of skin flaps for treating vulvar defects preserves the vulvar morphology and allows for relatively better functionality.

Mandibular Reconstruction with Bridging Customized Plate after Ablative Surgery for ONJ: A Multi-Centric Case Series

Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

Blepharoplasty and Eyelid Reconstruction

A mastery of facial and eyelid anatomy is paramount to perform oculoplastic surgery safely and successfully. An understanding of periocular structures, vasculature, and innervation highlights the delicate relationship between form and function, which establishes the foundation for cosmetic and reconstructive procedures. This knowledge, coupled with an appreciation for the patient’s goals – both functional and aesthetic – and expectations for the outcome of surgery allows one to complete an effective, multidimensional pre-operative assessment encompassing patient selection, history, physical examination, and ancillary testing. Ultimately, the synthesis of these principles guides the selection and execution of appropriate and efficacious surgical technique for blepharoplasty and eyelid reconstruction. This review contains 15 figures and 28 references Keywords: Eyelid anatomy, Eyelid crease, Eyelid margin, Canthal tendons, Lacrimal system, Blepharoplasty, Tenzel flap, Hughes flap, Cutler-Beard procedure, Canthotomy and cantholysis

Blepharoplasty and Eyelid Reconstruction

A mastery of facial and eyelid anatomy is paramount to perform oculoplastic surgery safely and successfully. An understanding of periocular structures, vasculature, and innervation highlights the delicate relationship between form and function, which establishes the foundation for cosmetic and reconstructive procedures. This knowledge, coupled with an appreciation for the patient’s goals – both functional and aesthetic – and expectations for the outcome of surgery allows one to complete an effective, multidimensional pre-operative assessment encompassing patient selection, history, physical examination, and ancillary testing. Ultimately, the synthesis of these principles guides the selection and execution of appropriate and efficacious surgical technique for blepharoplasty and eyelid reconstruction. This review contains 15 figures and 28 references Keywords: Eyelid anatomy, Eyelid crease, Eyelid margin, Canthal tendons, Lacrimal system, Blepharoplasty, Tenzel flap, Hughes flap, Cutler-Beard procedure, Canthotomy and cantholysis

Management of Early Breast Cancer at an Australian Cancer Centre During the Early Phase of COVID-19 Pandemic

Background: This study aimed to prospectively record changes to treatment for early breast cancer patients during the first wave of the COVID-19 pandemic in Australia. The purpose was to assess the impact on breast cancer outcomes and to determine the need for any mitigative actions. Methods: The study was conducted in the breast cancer unit of a tertiary referral hospital. Patients with early (non-metastatic) breast malignancy discussed in multidisciplinary team meetings between March and June 2020 were included. Patients were newly diagnosed, post-operative or post-neoadjuvant chemotherapy. Standard treatment was defined by Westmead Breast Cancer Institute protocols and any variations related to the pandemic were recorded. Results: In the study, 145 patients were included (median age 59 years). Pandemic-related changes to management were noted in 13 of 145 (9.0%) patients. Four patients experienced a delay to cancer treatments, four were not offered reconstructive/ symmetrisation surgical procedures, three had altered radiotherapy protocols and two patients were not offered enrolment to a clinical trial. These impacts affected the groups presenting with new cancers (n=7/86, 8.1%), post-operative cases (n=4/25, 16.0%) and post-neoadjuvant chemotherapy cases presenting for surgical planning (n=2/34, 5.9%). Conclusion: Most patients (91.0%) received standard treatment during the first wave of the pandemic. The minor variations from institutional protocols observed in this study are unlikely to affect local control or survival in this patient cohort, but close follow-up is required. Quality of life may have been affected for four patients who had downgraded or delayed reconstructive procedures.

Surgical Decision Making in Complex Facial Gunshot Wound Reconstruction

Introduction: With a rise in gun violence across the United States, facial gunshot wounds (GSWs) present a challenging reconstructive problem that was once seldom encountered in civilian populations. Reconstruction of facial GSW injuries requires a combination of both microvascular and craniofacial surgical techniques. The aim of this study is to explore our experience with facial GSW injuries through an anatomic classification scheme and investigate the surgical techniques necessary to complete such reconstructions. Methods: A retrospective review was conducted at a tertiary academic center. All subjects who suffered facial GSWs and underwent definitive reconstruction at our institution were included. Facial GSWs were classified into 4 distinct anatomical zones of injury: lower (mandible), middle (maxilla and orbit), upper (above the orbit), and multi-zone injury. Microvascular reconstruction was further investigated based on the types of flaps used and the location of flap inset. Surgical outcomes, numbers of procedures, and complications were assessed, and statistical comparisons were made. Results: Thirty-six subjects underwent a total of 322 surgeries. Twenty subjects had multi-zone injury; 16 had single zone injury. Eighteen of the 36 subjects (50%) required microvascular reconstruction. These 18 subjects underwent a significantly increased number of reconstructive procedures ( P = .023). Twenty-six flaps were used, as multiple subjects required >1 flap. Fourteen of the 26 flaps were used in the middle third (54%), 7 in the lower third (27%), and 5 in the upper third (19%). Six flap complications required further surgical revision. On average, multi-zone injuries required more surgical procedures to complete reconstruction ( P = .018). Conclusion: Composite multi-zone facial GSW injuries present a higher degree of reconstructive complexity, and thus often require more surgical procedures, especially when the midface is involved. In our experience, microvascular reconstruction is more often used in multizone injury, and in our series was associated with an increased number of reconstructive procedures.

The impact of orthotopic reconstruction on female sexuality and quality of life after radical cystectomy for non-malignant bladder conditions

Objective: To review the literature on the impact on female quality of life and sexual function of orthotopic reconstruction after radical cystectomy for non-malignant bladder conditions. Radical cystectomy is commonly required to treat malignant conditions but may also be considered for the treatment of non-malignant diseases. These heterogeneous group of disorders includes interstitial cystitis, painful bladder syndrome, neurogenic bladder, haemorrhagic/ radiation cystitis, endometriosis and refractory genitourinary fistula. Treatment begins with non-invasive medical therapies but, in non-responder cases, a surgical solution should be considered. Such invasive techniques include urinary diversion and reconstructive procedures that have an impact on healthrelated quality of life, physical, social, and mental status. Materials and methods: This narrative review research was done using the PubMed database up until 2020, July. All papers referring to cystectomy for benign indication were considered. Results: In comparison to other reconstructive options, orthotopic neobladder allows the restoration of a normal self-image and consequently it is the most suitable procedure when a surgical reconstruction is necessary for non-malignant conditions. However, women can face many disorders that impact on everyday life, such as voiding dysfunction or sexual activity problems. Conclusions: Scant data is available about quality of life, sexual life and self-perception in women treated by cystectomy for benign conditions and most literature is dedicated to those indicators in cancer patients. More research is needed to understand the tolerability and the quality of life results of the female population affected by benign conditions undergoing this kind of surgical approach.