In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
ObjectiveTo evaluate the effect on complication after esophagectomy by comparing the different methods of anastomosis (cervical versus thoracic anastomosis). MethodsWe searched the following databases including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database to identify randomized controlled trials (RCTs) of cervical versus thoracic anastomosis for esophagectomy patients from establishment of each database to October 30, 2014. Quality of the included RCT was evaluated. Meta-analysis was conducted by using RevMan 5.2 software. ResultsWe finally identified 4 RCTs involving 267 patients. In terms of the postoperative complication, the incidence of anastomotic leakage (RR=3.83, 95%CI 1.70 to 8.63, P=0.001) with cervical anastomosis was significantly higher than that of the patients with thoracic anastomosis. However, there was no statistical difference in incidence of anastomotic stricture (RR=1.04, 95%CI 0.62 to 1.76, P=0.87), pulmonary complication (RR=0.73, 95%CI 0.27 to 1.91, P=0.52), and mortality (RR=0.89, 95%CI 0.40 to 1.97, P=0.77) between cervical and thoracic anastomosis. ConclusionCompared with thoracic anastomosis, the method of cervical anastomosis is associated with a higher incidence of anastomotic leakage. But there are many unclear factors about anastomotic stricture, pulmonary complication and mortality, further measurement should be taken.
Objective To discuss the reconstruction of severe neck contracture by transplanting combined scapular/parascapular bilobar flaps, and the probability to reestablish three-dimensional movement of the neck. Methods From January 2003 to November 2004, 9 cases of sustained severeneck contractures were treated (aged 9-32 years). The combined scapular/parascapular bilobar flaps, pedicled on the circumflex scapular vascular bundle, were microsurgically used to cover the soft tissue defect after excision of hypertrophic scar and release of contracture. The maximum size of the combined bilobar flap was 20 cm×8 cm to 20 cm×11 cm，while the minimum one was 15 cm×4 cm to 15 cm×6 cm. Results The combined scapular/parascapular flapswere successfully used to treat 9 cases of severe neck contracture. All patients were satisfied with the final functional and aesthetic results. There was no recurrence during 3-9 months follow-up for 8 patients. The cervicomental angle was 90-105°.Conclusion The combined bilobar scapular/parscapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during operation, is agood option for reconstruction of the severe neck contracture.
OBJECTIVE To repair facial and neck scar using tissue expanding technique. METHODS From January 1991 to January 1995, 16 cases with facial and neck scar were treated. Multiple tissue expanders were put under the normal skin of facial and neck area, after being fully expanded, the scars were excised and the expended skin flaps were transplanted to cover the defects. The size and number of tissue expanders were dependent on the location of the scars. Normally, 5 to 6 ml expanding volume was needed to repair 1 cm2 facial and neck defect. The incisions should be chosen along the cleavage lines or in the inconspicuous area, such as the nasolabial fold or submandibular region. The design of flap was different in the face and in the neck. In the face, direct advanced flap was most common used, whereas in the neck, transposition flap was often used. Appropriate tension was needed to achieve smooth and cosmetic effect. It was compared the advantages and disadvantages of several methods for repair of the defect after facial and neck scar excision. RESULTS Fifteen cases had no secondary deformity after scar excision. Among them, 1 case showed blood circulation disturbance and cured through dressing change. Ten cases were followed up and showed better color and texture in the flap, and satisfactory appearances. CONCLUSION Tissue expanding technique is the best method for the repair of facial and neck scar, whenever there is enough expandable normal skin.
In order to study the clinical efficacy of bilateral cervico-thoracic skin flap on repairing the contracture of the burn scar of the neck, 66 flaps were used in 33 patients from 1983 to 1995. The size of the flap ranged from 5 cm x 6 cm to 8.5 cm x 15 cm. The donor site was covered with split skin graft. The ratio between the length and the width of the flaps should not exceed 3:1. Fifty-nine flaps survived completely, but 7 had necrosis of small area which was healed without any influence on the function and appearance. The operative technique of the bilateral cervico-thoracic skin flaps were reported. The advantages of this type of skin flap and its applied anatomy and the postoperative care were discussed. In the repair of the cicatritial contracture deformity of the neck, it was important to define whether the skin defect was located in the submandibular, anterior cervical or anterior thoracic region, thus appropriate type of repair could then be given accordingly.
目的:探讨18F-FDG PET/CT在头颈部肿瘤的临床应用价值。方法:58例头颈部恶性肿瘤病例,男37例,女21例,年龄21~78岁。其中:牙龈癌3例,上颌窦癌2例,舌癌2例,腮腺癌1例,鼻咽癌24例,喉癌8例,甲状腺癌4例,原发灶不明的颈部淋巴结转移瘤14例。使用18F-FDG行全身PET/CT扫描,依据PET图像、CT图像和PET/CT融合图像及标准化摄取值(SUV)进行综合评价。结果:29例放疗患者中的11例拟行根治性放疗的患者,有4例改行姑息性放疗,8例重新勾画了放疗靶区及调整了放疗剂量,3例改行其它治疗;15例进行了放疗后的疗效评估;14例原发灶不明的颈部淋巴结转移瘤8例找到了原发灶。结论:PET/CT可以对头颈部恶性肿瘤进行准确的临床分期,精确勾画放疗的生物靶区,准确而快捷地确定肿瘤复发的位置与侵犯范围,在颈部不明原发灶转移瘤的应用中具有简便、快捷、无创和灵敏等临床特点。
Objective To evaluate the effect of a combined cervicalexpanded skin flap in repairing cervical scar contracture deformity after burn injury. Methods From April 2001 to May 2003, 16 cases （10 males and 6 females）of scar contracture deformity in the cervix were treated withexpanded clavipectoral axis skin flap combined with reverse axis skin flap．The tissue expanders were embedded under the part containing cutaneous branches of transverse cervical artery in cervical segments and the second and/or the third perforating branch of internal thoracic artery for the first operation. Normal saline was injected regularly. The expanded clavipectoral skin flap and reverse axis skin flap with perforating branch of internal thoracic artery were designed,the scar in the cevix was loosed or dissected according to the size of the skinflaps, the skin flaps were transferred to cover the wound, and the contracture deformity in the cervix was corrected. The size of the flaps were 9 cm×5 cm-15 cm×7 cm. Results All skin flap survived. The function and appearance of the cervix was improved significantly after 6-30 months follow-up. However, venous return dysfunction in reverse perforating branch of internal thoracic artery occurred in 1 case, andblood circulation was improved after treatment. Conclusion Expanded clavipectoral axis skin flap combined with reverse axis skin flap can be used to repair scar contracture deformity in cervix, which lessen scar and abatethe chance to contract again.
OBJECTIVE To evaluate the clinical efficacy of thin flap with subdermal vascular network of the neck-pectoral region on repair of the contracture of the burn scar on the neck. METHODS From March 1990 to May 1998, 21 cases of deformity of neck due to burn scar were repaired with the thin flap ranging from 8 cm x 5 cm to 14 cm x 8 cm, and all of the cases were followed up for 6 to 42 months. RESULTS Except partial necrosis of the distal end of the flap in 1 case, the flaps in the other 20 cases all survived and presented a satisfactory appearance and function. CONCLUSION The thin flap with subdermal vascular network in neck-pectoral region may provide a large area of flap, and could be easily transferred. It’s an ideal flap for the repair of skin defect on the neck.
ObjectiveTo systematically review the efficacy and safety between intrathoracic anastomosis (IA) and cervical anastomosis (CA) after esophagectomy using gastric tube. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 11, 2014), Web of Knowledge, CNKI, CBM, and WanFang Data for randomized controlled trials (RCTs) of IA vs. CA after esophagectomy using gastric tube from inception to Nov, 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 138 patients were included, of which, 570 patients were in the IA group and the other 568 patients were in the CA group. The results of meta-analysis showed that the incidences of anastomotic leak (RR=2.72, 95%CI 1.67 to 4.45, P<0.05) and injury of recurrent laryngeal nerve (RR=5.64, 95%CI 2.41 to 13.18, P<0.05) in the IA group were significantly lower than those in the CA group, but the IA group had a higher rate of positive margins (RR=0.25, 95%CI 0.09 to 0.67, P<0.05). There were no significant differences between two groups in postoperative anastomotic stricture (RR=1.12, 95%CI 0.73 to 1.74), pulmonary complications (RR=1.10, 95%CI 0.60 to 2.01), operation mortality (RR=1.03, 95%CI 0.55 to 1.94), tumor recurrence (RR=1.57, 95%CI 0.72 to 3.44) and chylothorax (RR=0.76, 95%CI 0.24 to 2.36). ConclusionIA after esophagectomy using gastric tube has lower rates of anastomotic leak and injury of recurrent laryngeal nerve than CA but with a higher rate of positive margins. There are no significant differences between the two surgical operations in operation mortality, postoperative anastomotic stricture and pulmonary complications. IA could reduce the incidence of postoperative complications and is an effective and safe surgical operation for digestive tract reconstruction after esophagectomy. Due to limited quality and quantity of included studies, more high quality studies are needed to verify the conclusion for long-term efficacy and the quality of life.