Objective To introduce the experience of the cl inical appl ication of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection. Methods Between June 2008 and February 2010, 12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years (median, 54 years). Twelve cases including 2 cases of basal cell carcinoma of orbital skin, 2 cases of squamous cell carcinoma of the parotid gland, 2 cases of submandibular gland mal ignant mixed tumor, 2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy, 1 case of squamous cell carcinoma of tongue, and 3 cases of squamous cell carcinoma of occipital skin, and all were classified as TNM stages T3 or T4. The area of soft tissue defect ranged from 13 cm × 6 cm to 25 cm × 13 cm. The vertical trapezius myocutaneous flap ranged from 14 cm × 7 cm to 26 cm × 14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously. The donor sites were sutured directly. Results All incisions healed primarily without infection. Eleven flaps survived except 1 flap with edge necrosis, which was cured after dressing change. Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively, and they were cured by sucted and pressured dressing. Eleven patients were followed up 1-3 years (mean, 2 years). Nine cases had no tumor recurrence and the flaps had statisfactory appearance; the abduction function of shoulder joint were normal. One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation. Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap, which can meet the needs of repairing tissue defect of head and neck.
Objective To evaluate the efficacy and side effect of non-conventional fractionated radiotherapy for head and neck cancer.Methods Trials were identified by searching CENTRAL, MEDLINE, EMBASE, Chinese Biological Medicine Database (CBMdisc) and Chinese VIP Database. We handresearched the data from 10 kinds of important Chinese journals. Two reviewers assessed and extracted the studies. The following primary outcomes were assessed: complete relief (CR), overall survival (OS), acute side effect and late side effect. Results Twenty-three trials involving 8 411 patients were included. Thirteen trials were of good quality, and the rest were of poor quality. Meta-analysis of these trials showed that: (1) non-conventional fractionated radiotherapy vs conventional fractionated radiotherapy: ① Only S-HART and CAIR resulted in higher CR, RR=1.21 (95%CI 1.02 to 1.44), 3.31 (95%CI 1.16 to 9.42), respectively; ② Only HRT could improve 2-year OS (RR=1.32, 95%CI 1.13 to 1.54), but this difference wasn’t found in 5-year follow up; ③ Most of the non-conventional fractionated radiotherapy could increase acute side effects, but not the late ones; (2) non-conventional fractionated radiotherapy combined with concurrent chemotherapy vs non-conventional fractionated radiotherapy: ① Only C-HRT resulted in higher CR (RR=1.58, 95%CI 1.18 to 2.11); ② Higher 2-year OS could be gained when combined with chemotherapy (RR=1.35, 95%CI 1.18 to 1.54), and only C-HRT resulted in higher 5-year OS (RR=1.57, 95%CI 1.19 to 2.07). ③ Acute and late side effects of radiotherapy would not increase when combined with chemotherapy. Conclusion It can not be concluded that non-conventional fractionated radiotherapy can improve the CR and OS of head and neck cancer, for a small number of patients, but it will get effect when combined with concurrent chemotherapy, and would not increase acute or late side effects. The effects of HRT and C-HRT should be cared specially.
ObjectiveTo explore the effect of full nutritional management pattern on perioperative nutritional status in patients with head and neck malignancies. MethodsSixty-four patients with head and neck cancer treated in our department between March 2012 and June 2013 were randomly divided into control group and study group with 32 in each. The control group received conventional dietary guidance, while patients in the study group were given full nutritional management. Nutritional Risk Screening Scale 2002 (NRS-2002) was used for nutrition screening and assessment before surgery (after admission) and after surgery (3 days after surgery). The study group received full nutritional support, along with nutrition-related physical examination and biochemical tests, and observation of postoperative complications, and hospital stay and costs were also observed. ResultsNutritional risk existed in 29.7%-48.4% of the head and neck cancer patients during various stages of the perioperative period. Through the full nutritional support, patients in the study group had a significantly lower risk than those in the control group (P<0.01). Body mass index, triceps skinfold thickness, mid-arm muscle circumference, prealbumin, and creatinine in the study group were significantly more improved compared with the control group (P<0.01). No significant difference was detected in blood urea and serum albumin between the two groups. Postoperative complications in the study group was significantly lower (P<0.05), and hospital stay and costs were significantly lower than the control group (P<0.001). ConclusionFull nutritional management pattern can significantly improve the perioperative nutritional status in head and neck cancer patients. Early detection of nutritional risk and malnutrition (foot) in the patients and carrying out normal and scientific nutrition intervention are helpful in the rehabilitation of these patients. We suggest that qualified hospitals should carry out the full nutritional management model managed by a Nutrition Support Team for patients with malignancies.
Objective To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Methods Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. Results The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. Conclusion The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.
【摘要】 目的 探讨颈部对称性脂肪瘤的诊断和治疗。 方法 对2004年3月-2010年10月收治的5例颈项部脂肪瘤患者，其临床症状、体征、术前术后处理及结果等临床资料进行回顾。 结果 5例均为男性，以颈、项部大量皮下脂肪堆积为主要临床表现，其中1例伴有胸部上分皮下脂肪堆积，呈对称性隆起。3例患者伴阻塞性睡眠呼吸暂停低通气综合征，2例患者有睡眠打鼾但无明显呼吸暂停。4例患者有脂肪肝和长期酗酒史，但肝功能无异常改变，其中1例（1/4）有多次乙醇中毒史。1例患者无酗酒史，但诉经常作颈部刮痧治疗。5例均行外科手术切除，术中见肿瘤为白色无包膜脂肪组织。术后随访3个月~2年，1例术后1年复发，未行再次治疗，其余未见明显复发。 结论 颈部对称性脂肪瘤是脂肪组织弥漫性、对称性沉积于颈胸部皮下浅筋膜间隙和（或）深筋膜间隙的良性疾病。患者以中年男性居多，长期的酗酒史及典型的临床表现对于该病的诊断有一定帮助，但酗酒可能并非唯一病因。对于影响美观及功能的患者，其手术疗效较理想。【Abstract】 Objective To explore the diagnosis and treatment of symmetric lipomatosis in the neck. Methods We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010. Results All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group. Conclusions Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.
ObjectiveTo evaluate the feasibil ity and effectiveness of suture ligation combined with super-wet tumescent technique to replace embolization before surgical resection of peri pheral arteriovenous malformations (AVMs) of the head and neck. MethodsBetween July 2007 and November 2010, 9 patients with peri pheral AVMs of the head and neck were treated, including 4 males and 5 females with a median age of 21 years (range, 8 months to 55 years). The causes were congenital malformation in 6 cases, trauma in 2 cases, and unknown origin in 1 case. The lesions were located at the frontotemporal region in 2 patients, cheek in 2 patients, occi pitocervical region in 2 patients, temporoparietal region in 1 patient, upper lip in 1 patient, and lower lip in 1 patient. The size of the AVMs lesions ranged from 2.2 cm×1.2 cm to 13.0 cm×10.0 cm. Of 9 cases, 8 were classified as Schobinger gradeⅡand 1 as gradeⅢ. The AVMs involved 2 to 7 main nutrient arteries, with a diameter range of 1.7-3.1 mm. At one-stage operation, AVMs was removed and direct suture, skin graft or flaps were used for repair in 6 cases; the skin was expanded at one-stage operation, and then AVMs removal and repair were performed at twostage operation in 3 cases. Before resection of AVMs, No.7 silk suture was used to l igate the main nutrient vessels, and then annular interrupted suture of soft tissue was performed with the silk sutures around the lesions, at least two rings. Tumescent anesthetic solution was injected into lesions, and super wet end-point achieved. ResultsPartial incision dehiscence occurred in 1 patient; the flaps and grafting skin survived, and primary healing of incision was obtained in the other patients. The mean operation time was 136 minutes (range, 42-367 minutes). The mean intraoperative blood loss was 268 mL (range, 15-1 000 mL). Only 1 patient received 3 units of blood transfusion. All patients were followed up for 4.2 years on average (range, 2 years to 6 years and 6 months); there was no recurrence case. The self-assessment cosmetic results were excellent or good in 5 cases and fair in 4 cases. ConclusionIntensive suture ligation followed by super-wet tumescent techniques might partially substitute preoperative embolization to facil itate surgical resection of peri pheral AVMs of the head and neck, due to simple operation and less bleeding.