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Functional Results (functional + result)
Kinds of Functional Results Selected AbstractsFunctional results with advanced hypopharyngeal carcinoma treated with circular near-total pharyngolaryngectomy and jejunal free-flap repairHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2006Stephane Temam MD Abstract Background. Patients treated by a circular pharyngolaryngectomy for advanced hypopharyngeal carcinoma have a poor prognosis and disappointing speech restoration. Methods. Three carefully selected patients underwent a near-total laryngectomy circular pharyngectomy with jejunal free flap repair and dynamic tracheopharyngeal shunt for treatment of advanced hypopharyngeal carcinoma. They received induction chemotherapy and postoperative radiotherapy. We assessed the functional outcome. Results. There was no major local complication. One year after the end of radiotherapy, all patients were able to eat solid diets. Two patients were able to speak immediately after the end of the treatment. After speech re-education, a high-quality tracheopharyngeal voice was restored in all three patients. Performance Status Scale for Head and Neck Cancer Patients (PSSHN) showed a mean score equal to 81/100 at 1 year. Conclusions. In selected patients, near-total laryngectomy circular pharyngectomy with tracheopharyngeal shunt and jejunal free-flap repair offers good voice rehabilitation without impairing swallowing function. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Functional outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approachHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2004Rubén Cabanillas MD Abstract Background. Several functional advantages have been described for the transoral laser supraglottic laryngectomy as compared with open techniques. However, comparative studies have been rarely performed. Methods. Functional results in 26 patients treated with a transoral approach were retrospectively compared with those of a comparable series of 26 patients who underwent a transcervical approach. Results. The only significant differences found between the two groups were a lesser number of temporary tracheotomies and a shorter time of removal of the nasogastric tube in the laser group. No significant differences were found in the incidence of postoperative complications, hospital stay, and swallowing capacity. Conclusions. The rate of functional problems after transoral laser surgery did not greatly decrease compared with the rate after the conventional procedure. The mayor advantage of the transoral approach was the lower incidence of temporary tracheotomies. © 2004 Wiley Periodicals, Inc. Head Neck26: 653,659, 2004 [source] Intercostal nerve transfer in infants with obstetric brachial plexus palsyMICROSURGERY, Issue 7 2008Tarek A. El-Gammal M.D. The use of intercostal nerve (ICN) transfer to repair brachial plexus lesions associated with root avulsions is a well known procedure in adults. However, there is a paucity of reports on the use of ICN in infants with obstetrical brachial plexus palsy (OBPP). This study included 46 infants with obstetric brachial plexus palsy who underwent 62 neurotization procedures. Clinically, 2 cases had upper trunk injury, 19 had upper-middle trunk injury, 3 had lower trunk injury, and 22 had total palsy. The average age at surgery was 14 months. Twelve patients underwent surgery younger than 6 months of age, 11 patients at 6 to <9 months, 9 patients at 9,12 months, and 14 patients at >12 months. The average follow-up period was 49 months. ICN transfer resulted in 76% satisfactory (good and excellent) outcome, and was best for restoration of elbow flexion (93.5%). Functional results were best when the operation was done before the age of 9 months; however, the difference between age groups was statistically insignificant. Functional results were also independent of the extent of the original injury. Nine children had preoperative and postoperative CT chest scans. All the nine children developed basal pulmonary atelectasis postoperatively. Pulmonary atelectasis was mostly ipsilateral and was not correlated to the patient age (months), or the duration of anesthesia (in minutes). We conclude that, intercostals nerve transfer is an effective procedure for restoration of function in infants with OBPP and root avulsions. The procedure is associated with variable degree of ipsilateral pulmonary atelectasis. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Long-term functional and subjective results of thumb replantationMICROSURGERY, Issue 8 2006Frank Unglaub M.D. The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992,1997, were reexamined after 6.5 years (range, 4.2,9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. Range of motion, grip strength, cutaneous sensibility, and upper-extremity functioning using the DASH questionnaire were determined. A correlation analysis with important variables was performed. Average range-of-motion in the metacarpophalangeal joint was 44° (±24.2) and in the interphalangeal joint was 12° (±8.4). Grip-strength of the injured hand was 70% (±31.4) and pinch strength was 68% (±28.7) in comparison to the non-injured hand. DASH-scores correlated with grip-strength, pinch-strength, and cutaneous sensation but no correlation was found between DASH and the level of amputation. Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Letter 2: Functional results after extended myotomy for diffuse oesophageal spasm (Br J Surg 2007; 94: 1113,1118)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2008A. G. N. Robertson No abstract is available for this article. [source] Authors' reply: Functional results after extended myotomy for diffuse oesophageal spasm (Br J Surg 2007; 94: 1113,1118)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2008M. Leconte No abstract is available for this article. [source] Submental intubation in complex craniomaxillofacial traumaANZ JOURNAL OF SURGERY, Issue 5 2004Charles Davis The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re-establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, MMF precludes orotracheal intubation. Nasotracheal intubation is often used but is contraindicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. A submental intubation has been used in 11 selected cases amongst 190 consecutively treated patients with craniomaxillofacial trauma over a 3-year period. These cases have been retrospectively reviewed and there have been no significant complications. The indications and technique used are described. Submental intubation is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma and the author's clinical experience with this technique is described. [source] The use of renal scintigraphy in assessing the potential for recovery in the obstructed renal tract in childrenBJU INTERNATIONAL, Issue 9 2001A. Thompson Objective To assess the value of renal scintigraphy with 99mTc-dimercaptosuccinic acid (DMSA) in predicting functional recovery after the surgical relief of obstructed kidneys in children. Patients and methods Forty-three children underwent surgery to relieve upper urinary tract obstruction; 37 had pelvi-ureteric junction obstruction and six had vesico-ureteric junction obstruction. The indication for surgery was a combination of an obstructed renogram with symptoms of either pain or pyelonephritis. Most children (41) had < 40% function on the affected side before surgery, with just two having hyperfunction (> 55%). In all patients intravenous urography before surgery showed hydronephrosis, and a micturating cystogram was used to exclude coexisting reflux in the presence of an associated megaureter. Diuretic renography (using 99mTc-mercaptoacetyl triglycine or 123I-hippuran) and DMSA scintigraphy were both carried out before surgery and the renography repeated 6 months afterward. Results The renographic drainage curves improved from obstructed to unobstructed or ,dilated unobstructed' on all postoperative studies. Regression analysis showed that preoperative DMSA scan was an excellent predictor of outcome (P < 0.001) whilst the preoperative renogram was a relatively poor predictor of the functional result. In four patients where the initial renographic function was < 10%, DMSA scintigraphy predicted correctly the capacity for recovery in three and the inability to improve in the fourth. Conclusion Before surgery, DMSA scintigraphy in children with upper urinary tract obstruction is a more useful estimate of probable long-term renal function than value from diuresis renography. If there is doubt about the desirability of reconstructive surgery, a DMSA scan may eliminate the need for more invasive methods of estimating recovery, e.g. a period of nephrostomy drainage. [source] Differences in ano-neorectal physiology of ileoanal and coloanal reconstructions for restorative proctectomyCOLORECTAL DISEASE, Issue 4 2010A. D. Rink Abstract Objective, Restorative proctectomy with straight coloanal anastomosis (CAA) and restorative proctocolectomy with ilealpouch-anal anastomosis (IPAA) are options for maintaining bowel integrity after rectal resection. The aim of this study was to compare clinical function and anorectal physiology in patients treated with CAA and IPAA. Method, Three-dimensional vector-manometry and neorectal volumetry were performed in straight CAA [53 patients (34 male)] and IPAA [61 patients (39 male)] for ulcerative colitis. Function was assessed using a 14 day incontinence diary. Results, Function was similar in both groups, but neorectal compliance and threshold volumes for sensation, urge and maximum tolerated volume (MTV) were significantly higher after IPAA than after CAA. Mean pressure, vector volume and sphincter symmetry at rest were significant determinants of continence in both groups but squeeze pressure did not correlate significantly with function in either group. Threshold volume, MTV, and compliance were significantly correlated with frequency of defecation in patients with IPAA but not with CAA. Conclusion, A strong consistent resting anal sphincter pressure is one determinant of continence after both IPAA and CAA. Squeeze pressures do not influence the functional result. In IPAA but not CAA, the neorectum has a reservoir function which correlates with the postoperative frequency of defaecation. [source] Periungual Basal Cell Carcinoma: Case Report and Literature ReviewDERMATOLOGIC SURGERY, Issue 2 2006PAUL T. MARTINELLI MD BACKGROUND Basal cell carcinoma, the most common malignancy in humans, rarely occurs on the nail unit and may be frequently misdiagnosed clinically. OBJECTIVES To present a case of basal cell carcinoma of the nail unit successfully treated with the mohs technique and to review the literature regarding this unique presentation of this tumor. MATERIALS AND METHODS: Case report and review of the English literature of nail unit basal cell carcinoma. RESULTS In addition to the currently described patient, 17 other patients with nail unit basal cell carcinaoma have been reported. The tumor occurred approximately 3 times more often on the fingers then on the toes and had a slight predilection to occur in men. Ulceration, noted in more than one-half of patients, was the most common presentation of nail unit basal cell carcinoma. Mohs micrographic surgery. Often with second intention healing, was successfully employed in 39% of patients. CONCLUSIONS Basal cell carcinaom infrequently involves the nail unit and often presents as ulceration. Adequate biopsy of the lesion is essential in making a timely diagnosis. Mohs micrographic surgery with second intension healing is an effective treatment that may offer excellent cosmetic and functional results. [source] Influence of psychopathological changes on quality of life after laparoscopic fundoplication for the treatment of gastroesophageal refluxDISEASES OF THE ESOPHAGUS, Issue 1 2010Á. Díaz de Liaño SUMMARY There are references in medical literature to the influence of psychopathological changes and their negative impact on the results of laparoscopic fundoplication. The objective of this study is to analyze the influence of psychological changes, as assessed by the General Health Questionnaire-28 (GHQ-28), on patients undergoing surgery for gastroesophageal reflux. This is a prospective study in a series of 103 consecutive patients (62 males and 41 females with a mean age of 40 years) undergoing laparoscopic fundoplication. In addition to functional studies, patients completed the SF-36, Gastrointestinal Quality of Life Index, and GHQ-28 before surgery. Functional tests and questionnaires were repeated 6 months after surgery. Patients were also questioned about their degree of satisfaction. Postoperative results of patients with a normal GHQ-28 and patients showing psychopathological changes as defined by the GHQ-28 questionnaire before surgery were compared. Overall, all patients experienced an improvement in their quality of life. Forty-one patients showed a pathological result in the preoperative GHQ-28 questionnaire. No differences were found in functional results and degree of satisfaction with surgery between patients with normal and pathological results in the preoperative GHQ-28 questionnaire. However, patients with a pathological result in the preoperative GHQ-28 had poorer results in all domains of the postoperative Gastrointestinal Quality of Life Index and SF36 quality of life questionnaires as compared to patients with a normal preoperative GHQ-28 questionnaire. Patients with pathological results in the preoperative GHQ-28 had poorer results in terms of postoperative quality of life despite having normal postoperative physiological studies; this decreased quality of life did not have an impact on the degree of satisfaction with surgery performed. The GHQ-28 does not therefore appear to serve as a predictor of postoperative satisfaction. [source] A new endoscopic technique for suspension of esophageal prosthesis for refractory caustic esophageal stricturesDISEASES OF THE ESOPHAGUS, Issue 3 2008E. Ancona SUMMARY., There is no clear consensus concerning the best endoscopic treatment of benign refractory esophageal strictures due to caustic ingestion. Different procedures are currently used: frequent multiple dilations, retrievable self-expanding stent, nasogastric intubation and surgery. We describe a new technique to fix a suspended esophageal silicone prosthesis to the neck in benign esophageal strictures; this permits us to avoid the frequent risk of migration of the expandable metallic or plastic stents. Under general anesthesia a rigid esophagoscope was placed in the patient's hypopharynx. Using transillumination from the optical device, the patient's neck was pierced with a needle. A n.0 monofilament surgical wire was pushed into the needle, grasped by a standard foreign body forceps through the esophagoscope and pulled out of the mouth (as in percutaneous endoscopic gastrostomy procedure). After tying the proximal end of the silicone prosthesis with the wire, it was placed through the strictures under endoscopic view. This procedure was successfully utilized in four patients suffering from benign refractory esophageal strictures due to caustic ingestion. The prosthesis and its suspension from the neck were well-tolerated until removal (mean duration 4 months). A postoperative transitory myositis was diagnosed in only one patient. One of the most frequent complications of esophageal prostheses in refractory esophageal strictures due to caustic ingestion is distal migration. Different solutions were proposed. For example the suspension of a wire coming from the nose and then fixed behind the ear. This solution is not considered optimal because of patient complaints and moreover the aesthetic aspect is compromised. The procedure we utilized in four patients utilized the setting of a silicone tube hanging from the neck in a way similar to that of endoscopic pharyngostomy. This solution is a valid alternative both for quality of life and for functional results. [source] Colon interposition in the treatment of esophageal caustic strictures: 40 years of experienceDISEASES OF THE ESOPHAGUS, Issue 6 2007J. Ð. Knez SUMMARY., The objective of this article was to analyze 40 years of experience of colon interposition in the surgical treatment of caustic esophageal strictures from the standpoints of our long-term personal experience. Colon interposition has proved to be the most suitable type of reconstruction for esophageal corrosive strictures. The choice of colon graft is based on the pattern of blood supply, while the type of anastomosis is determined by the stricture level and the part of colon used for reconstruction. In the period between 1964 and 2004, colon interposition was performed in 336 patients with a corrosively scared esophagus, using the left colon in 76.78% of the patients. In 87.5% a colon interposition was performed, while in the remaining patients an additional esophagectomy with colon interposition had to be done. Hypopharyngeal strictures were present in 24.10% of the patients. Long-term follow-up results were obtained in the period between 1 to up to 30 years. Early postoperative complications occurred in 26.48% of patients, among which anastomosic leakage was the most common. The operative mortality rate was 4.16% and late postoperative complications were present in 13.99% of the patients. A long-term follow up obtained in 84.82% of the patients found excellent functional results in 75.89% of them. We conclude that a colon graft is an excellent esophageal substitute for patients with esophageal corrosive strictures, and when used by experienced surgical teams it provides a low rate of postoperative morbidity and mortality, and long-term good and functional quality of life. [source] Supracricoid partial laryngectomy as salvage surgery for radiation therapy failureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2008Alberto Deganello MD Abstract Background The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions. Methods A series of 31 patients who underwent an SPL as salvage procedure after radiotherapy failure was reviewed. Results Locoregional control rate was 75%, with 60% 5-year overall survival; no patients were lost to follow-up, and a death-from-disease rate of 19.35% was recorded. Restoration of laryngeal functions was achieved in 89.29% of the patients. No statistically significant differences were found in locoregional control regarding anterior commissure involvement, elective neck dissection versus wait-and-see policy, pathologic positive neck disease, and restage I,II versus restage III,IV. Conclusion The oncologic and functional results indicate the consistency of salvage SPL, proposing this type of operation as a serious alternative to total laryngectomy in carefully selected cases. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Transoral laser surgery for supraglottic cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2008Juan P. Rodrigo MD Abstract The goal of treatment for supraglottic cancer is to achieve cure and to preserve laryngeal function. Organ preservation strategies include both endoscopic and open surgical approaches as well as radiation and chemotherapy. The challenge is to select the correct modalities for each patient. Endoscopic procedures should be limited to tumors that can be completely visualized during diagnostic microlaryngoscopy. If complete resection can be achieved, the oncologic results of transoral laser surgery appear to be comparable to those of classic supraglottic laryngectomy. In addition, functional results of transoral laser resection are superior to those of the conventional open approach, in terms of the time required to restore swallowing, tracheotomy rate, incidence of pharyngocutaneous fistulae, and shorter hospital stay. The management of the neck remains of paramount importance, as survival of patients with supraglottic cancer depends more on cervical metastasis than on the primary tumor. Most authors advocate bilateral elective neck dissection. However, in selected cases (T1,T2 clinically negative [N0] lateral supraglottic cancers), ipsilateral selective neck dissection could be performed without compromising survival. The authors conclude that with careful selection of patients, laser supraglottic laryngectomy is a suitable, and often the preferred, treatment option for supraglottic cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Reconstruction of floor of mouth defects by the facial artery musculo-mucosal flap following cancer ablationHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2008FRCSC, Tareck Ayad MD Abstract Background. The purpose of this study is to review our experience with the use of the facial artery musculo-mucosal (FAMM) flap for floor of mouth (FOM) reconstruction following cancer ablation to assess its reliability, associated complications, and functional results. Methods. This was a retrospective analysis of 61 FAMM flaps performed for FOM reconstruction from 1997 to 2006. Results. No total flap loss was observed. Fifteen cases of partial flap necrosis occurred, with 2 of them requiring revision surgery. We encountered 8 other complications, with 4 of them requiring revision surgery for an overall rate of revision surgery of 10% (6/61). The majority of patients resumed to a regular diet (85%), and speech was considered as functional and/or understandable by the surgeon in 93% of the patients. Dental restoration was successful for 83% (24/29) of the patients. Conclusion. The FAMM flap is well suited for FOM reconstruction because it is reliable, has few significant complications, and allows preservation of oral function. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [source] New modification of the mandibulotomy approach without lip splittingHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2006Chung-Hwan Baek MD Abstract Background. A lower lip-splitting incision has traditionally been performed with different types of mandibulotomy approaches for obtaining wide access to oral and oropharyngeal cancers. However, lip splitting can be associated with unfavorable aesthetic results. We describe our new modification of a traditional mandibulotomy approach without lip splitting to avoid these morbidities. This is a case series in a tertiary referral center. Methods. The primary tumor site was the oropharynx in four cases, the oral cavity in two cases, and the parapharynx in one case. Each case was assessed for TNM staging, perioperative complications, status of the resection margins, tumor recurrence, and the aesthetic and functional results of the lower lip. Results. All the tumors were safely removed by means of our modified non,lip-splitting mandibulotomy approach through the combined intraoral and transcervical routes with adequate resection margins. There were no troublesome difficulties in reconstruction of the surgical defects with various major flaps. The cosmetic results were excellent with intact lip function. Conclusion. We believe this new modified non,lip-splitting mandibulotomy approach could replace the conventional mandibulotomy approach for some selected malignant lesions, with excellent cosmetic and functional results of the lower lip. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Neoadjuvant chemotherapy for squamous cell carcinoma of the oral tongue in young adults: A case seriesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Erich M. Sturgis MD Abstract Background. Squamous cell carcinoma of the oral tongue (SCCOT) in the young population has emerged as a growing worldwide health problem. Standard therapies, consisting primarily of surgery with possible adjuvant radiotherapy, have resulted in only modest improvements in survival in recent decades, whereas the treatments for SCCOT continue to impair oral function. With the increased use and improved functional results of neoadjuvant chemotherapy in the treatment of squamous cell carcinoma of other upper aerodigestive tract sites, we have reviewed our experience with neoadjuvant chemotherapy in young patients with SCCOT. Methods. A retrospective review was conducted of all patients younger than 45 years (N = 49) with previously untreated SCCOT evaluated at a comprehensive cancer center from July 1995 to August 2001. Charts were reviewed to obtain demographic data, comorbidities, nutritional status, tumor status, treatment and response information, and follow-up data. Results. Fifteen patients were identified who received neoadjuvant chemotherapy with taxane-based regimens before undergoing glossectomy and neck dissection. Thirteen of these patients (87%) exhibited stage III or IV disease at presentation, and all exhibited at least a partial response at the primary site. Pathologically positive nodes were identified in only six patients (40%), although 13 (87%) had clinically or radiographically suspicious nodes at presentation. Adjuvant radiation therapy was administered to seven patients (47%). With a median follow-up of 39 months, no patient has had local or regional recurrence, although three patients (20%) have had distant metastases develop; one patient with an isolated distant metastasis was successfully salvaged with radiation. By comparison during the same period, 34 young adult patients with SCCOT were treated with surgery with or without postoperative radiotherapy but without the use of chemotherapy. Although these patients had lower T classifications (18% vs 67% T3/T4; p = .0007), incidence of nodal metastases (15% vs 87% N+; p < .0001), and overall disease stage (24% vs 87% stage III/IV; p < .0001) than the neoadjuvant chemotherapy group, the overall survival (82%), disease-specific survival (88%), and recurrence-free survival (82%) of the surgery-first group was similar to that of the neoadjuvant chemotherapy group (87%, 87%, and 80%, respectively). Conclusions. This retrospective investigation demonstrates that neoadjuvant chemotherapy with taxane-based regimens may play a role in the successful treatment of SCCOT in young adult patients. Ultimately, this treatment plan may lead to improved functional outcomes in young patients with SCCOT by allowing function-sparing surgery and avoiding postoperative radiotherapy, without sacrificing disease control and survival, but a prospective trial is needed. We have initiated a prospective clinical trial to further investigate the impact of neoadjuvant chemotherapy in patients younger than 50 with SCCOT. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Simplifying head and neck microvascular reconstructionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004Eben Rosenthal MD Abstract Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results. © 2004 Wiley Periodicals, Inc. Head Neck26: 930,936, 2004 [source] Secondary end-to-end repair of extensive facial nerve defects: Surgical technique and postoperative functional resultsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2004Hildegunde Piza-Katzer MD Abstract Background. Repair of the transected facial nerve is imperative for restoration of muscle function, including the ability to produce appropriate facial expressions. Injury might involve the main trunk and its several branches. Restoration of function presupposes meticulous repair of all injured nerve branches. Methods. Here we report three cases of secondary tension-free end-to-end coaptation of a transected trunk and branches of the facial nerve by removal of the superficial part of the parotid gland. Results. Facial tone and symmetry at rest and motion were achieved. In two patients, a slight residual synkinesis is observed under stress. Conclusions. Direct end-to-end coaptation of the facial nerve and its branches by the technique described should be considered before deciding on grafts or rerouting procedures to deal with gaps of up to 15 mm. This technique is not recommended in the presence of infection and nerve defects. Intensive postoperative physiotherapy is required for optimal results. © 2004 Wiley Periodicals, Inc. Head Neck26: 770,777, 2004 [source] Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynxHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004Manuel Bernal-Sprekelsen MD Abstract Background. CO2 -laser surgery is a relatively new treatment for selected carcinomas of the upper aerodigestive tract. The purpose of our study was to evaluate prospectively the functional results for swallowing after C02 -laser resections. Methods. The sample was composed of 210 consecutive patients with malignancies of the larynx and hypopharynx treated with CO2 laser between February 1998 and January 2002. Endoscopic resections included all T1 and T2 tumors and selected T3 and T4 tumors. T1 glottic tumors were not included in the analysis. We assessed the need for a feeding tube and the period the tube remained in place, aspiration pneumonia, tracheotomy secondary to aspiration, the need for a permanent or temporary gastrostomy, and total laryngectomy secondary to aspiration. Results. The nasogastric feeding tube was used in 23.2% of small tumors (2.5 ± 8.04 days) and in 63% of locally advanced tumors (13.95 ± 22.55 days). Frequency and period of storage of the feeding tube were higher in locally advanced tumors (p = .0001). Twelve patients (5.7%) had postoperative pneumonia and 59 (28.1%) had temporary postoperative cough during oral intake. Aspiration symptoms correlated with location (p = .001) and locally advanced tumors (p = .016). Eight patients (3.8%) needed a postoperative tracheotomy for severe swallowing difficulties; six (2.9%) of them were definitive and two (0.95%) temporary. Thirteen gastrostomies (6.2%) were performed to avoid severe aspirations; five of them were definitive. The need for gastrostomy correlated significantly with location (p = .002), pT3 and pT4 tumors (p = .002), age (p = .02), and postoperative radiotherapy (p = .04). No correlation was found with the period of feeding tube (p = .38), or aspiration pneumonia (p = .24). Conclusions. Endoscopic resection of laryngeal and hypopharyngeal tumors is associated with good recovery of deglutition. Many tracheotomies are avoided, the need for a feeding tube is usually reduced, and organ preservation is often feasible even in locally advanced tumors. © 2003 Wiley Periodicals, Inc. Head Neck26: 103,110, 2004 [source] Single-stage surgical repair of benign laryngotracheal stenosis in adultsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004Jolanda van den Boogert PhD Abstract Background. Benign laryngotracheal stenosis causes considerable morbidity. In a retrospective study, we describe the results of our surgical treatment. Methods. Between June 1999 and June 2002, 14 adults with laryngotracheal stenosis were referred to our hospital. Stenosis resulted from mechanical ventilation in 11 patients, from Wegener's granulomatosis in 2 patients, and from strangulation in 1 patient. Eleven patients had a tracheotomy. One patient was found unfit for surgery. Nine patients underwent cricotracheal resection (CTR) with end-to-end anastomosis, and four patients underwent single-stage laryngotracheoplasty (SS-LTP) without stenting. Results. There were no perioperative deaths. Patients were extubated after mean of 3 days (range, 0,10 days; CTR 2.3 days vs SS-LTP 3.5 days, p = .45). There were in-hospital complications in five patients. Mean hospital stay was 19 days (range, 8,53 days; after CTR 24 days vs SS-LTP 9 days, p = .015). With regard to airway patency and voice recovery, 10 patients (77%) had good results, including 1 patient with two readmissions, and 3 (23%) had satisfactory results, including 1 patient with 11 additional nonsurgical interventions. Conclusions . Benign laryngotracheal stenosis in the adult patient can be repaired successfully using a strategy of two single-stage surgical procedures. All patients had good or satisfactory functional results. A multidisciplinary approach was essential to achieve these good results. © 2004 Wiley Periodicals, Inc. Head Neck26: 111,117, 2004 [source] mTHPC-mediated photodynamic therapy for early oral squamous cell carcinomaINTERNATIONAL JOURNAL OF CANCER, Issue 1 2004Colin Hopper Abstract Surgery and radiotherapy are standard treatments for early oral squamous cell carcinoma, both resulting in good tumour control. However, neither of these modalities is without consequent functional or cosmetic impairment, and there are patients in whom both are contraindicated. Furthermore, there is a significant risk of metachronous tumours developing in the oral cavity, and salvage or retreatment with either surgery or radiotherapy poses difficulties. Photodynamic therapy (PDT) offers the potential for improved functional and cosmetic outcomes, while achieving comparable tumour control. We conducted an open-label, multicentre study to assess the efficacy and safety of meta-tetrahydroxyphenylchlorin (mTHPC) in patients with early oral cancer. One hundred twenty-one patients received intravenously administered mTHPC, followed 96 hr later by illumination of the tumour surface with 652 nm laser light. Of these patients, 114 were protocol compliant. A complete tumour response was achieved in 85% of protocol-compliant patients (97 of 114 patients). A complete response was maintained in 85% of responders at 1 year and in 77% at 2 years. One- and 2-year actuarial survival rates were 89% and 75%, respectively. In the opinion of the investigators, tumour clearance was accompanied by excellent cosmetic and functional results, without impact on the patients' performance status. Mild-to-moderate pain at the treatment site, a recognised side effect of PDT in the oral cavity, was reported by 82% of patients but was manageable with appropriate analgesia. Mild-to-moderate skin photosensitivity reactions were reported for 13% of patients. mTHPC offers an effective alternative treatment for early oral squamous cell carcinoma. It is associated with excellent functional and cosmetic results and can be used in conjunction with other standard therapies. © 2004 Wiley-Liss, Inc. [source] The purse-string suture revisited: a useful technique for the closure of cutaneous surgical woundsINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2007Philip R. Cohen MD The purse-string suture provides complete or partial closure of round postoperative skin defects. It is a rapid and simple procedure to perform. Tension placed on the suture uniformly advances the skin from the entire periphery of the wound, resulting in a significant reduction of the defect size and enhancement of hemostasis at the wound edge. The history, modifications of the technique, advantages, and potential complications of the purse-string suture are reviewed. It is not only useful following the removal of nonmelanoma skin cancer but also after the local excision of melanoma. In addition, this technique is especially suitable for the repair of round surgical wounds for patients who are unable to modify their active lifestyles during the week following surgery, individuals concurrently being treated with anticoagulants, antiplatelet agents or both, and people with extensive postoperative defects that would otherwise require either a skin graft or a large cutaneous flap. Typically, the site of the surgical wound following partial or complete closure with the purse-string suture demonstrates excellent long-term cosmetic and functional results. [source] Hypospadias repair: an overviewINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2010Michael Pfeil Hypospadias is a birth defect in boys where the meatus is not placed at the tip of the glans of the penis. This article reviews the rapidly developing international literature surrounding hypospadias and hypospadias repairs paying specific attention to important aspects of nursing care, including preparing for surgery, use of dressings, stents and catheters as well as medication. It concludes by considering the long-term impact of hypospadias and its surgical correction on the patient's life. Hypospadias is treated surgically, normally during the second 6 months of the boy's life. Hospitalization periods vary from day case surgery to several days. The success of the hypospadias repair can be measured according to functional results and cosmetic appearance of the penis. The post-operative use of dressings as well as urinary catheters or stents is common but not uniform. Complication rates for hypospadias surgery vary from below 10% in boys with distal hypospadias to above 50% in children with a proximal meatus. The most common complications are urethral fistulas, strictures and stenoses. The continuing efforts by paediatric urologists focus on further optimizing the cosmetic and functional results. [source] Postoperative morbidity, functional results and quality of life of patients following orthotopic neobladder reconstructionINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2003Tatsuaki Yoneda Abstract Aim: To evaluate postoperative morbidity, functional results and health-related quality of life of patients with an orthotopic neobladder. Methods: A total of 37 patients with orthotopic neobladder (modified Studer method: 35 cases; Hautmann method: one case; sigmoid neobladder: one case) were included in the present study. Postoperative morbidity and neobladder function were analyzed. To determine quality of life, the Sickness Impact Profile questionnaire was used. The quality of life of patients who underwent orthotopic neobladder was compared with that of patients who underwent ileal conduit. Results: In 37 consecutive patients with neobladder reconstruction, early complications included 10 cases of pyelonephritis (27.0%) and one of stenosis of ureterointestinal anastomosis (2.7%). Two patients died of ARDS and sepsis following peritonitis and pneumonia in the perioperative period. Late complications included pyelonephritis in three patients (8.6%). In 32 cases, except for an early postoperative case and those that died, complete daytime and night-time continence was achieved in 31 patients (96.9%) and 16 patients (50.0%), respectively. Concerning health-related quality of life, the mean sum scores per category of the Sickness Impact Profile were calculated for 32 patients with orthotopic neobladder and 30 patients with ileal conduit. There were no significant differences in overall satisfaction, however, the scores for patients with orthotopic neobladder reconstruction were significantly higher than those for patients with ileal conduit in the three categories of emotions, feelings and sensation, social interaction and recreation. Conclusion: Orthotopic neobladder reconstruction exhibited good functional results with acceptable complications. Patients who underwent neobladder reconstruction were satisfied with their voiding. Assessment of quality of life using the Sickness Impact Profile questionnaire demonstrated that orthotopic neobladder improved their quality of life better than ileal conduit, especially with regard to mental, physical and social functioning in daily life. [source] Wound conditioning of a deep tissue defect including exposed bone after tumour excision using PROMOGRAN* Matrix, a protease-modulating matrixINTERNATIONAL WOUND JOURNAL, Issue 3 2005Anne-Kathrin Tausche MD Abstract A case study reporting on the successful treatment of a patient affected by a basal cell carcinoma is submitted. Because the carcinoma had infiltrated deeply, a wide excision was necessary, including the removal of bone tissue. The deep tissue defect was treated with PROMOGRAN* Matrix, a protease-modulating matrix, to promote granulation and ensure that the skin graft do survive and heal successfully. In this case study, a rapid development of granulation tissue on the exposed surface of the bone was observed. The benefits of the dressing enabled a successful split-thickness skin grafting to be carried out which gave very good aesthetic and functional results. [source] How to Avoid Problems in Redo Coronary Artery Bypass SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2004V. R. Machiraju M.D. When a patient accepts redo cardiac surgery in spite of known higher morbidity and mortality, the patient strongly believes that he will come out of this operation successfully and enjoy several more years of life. Weintraub1 reported that redo cardiac surgery has higher mortality and morbidity; 5% in elective cases, 11% in urgent cases, and 16.4% in emergency cases. He and associates2 described that the female gender, a low ejection fraction (EF), and preoperative arrhythmias are significant risk factors. Lemmer and associates3 described poor postoperative functional results with the majority of patients having emergency repeat coronary artery revascularization developing recurrent ischemic syndrome within a short period of time. I am outlining the problems from our experience of 543 patients in the last five years. [source] Mid-term Results of the Ross ProcedureJOURNAL OF CARDIAC SURGERY, Issue 4 2001Domenico Paparella M.D. Although the Ross procedure has been performed for over three decades, its role in the management of patients with aortic valve disease is not well established. This study reviews our experience with this operation. From 1990 to 1999, 155 patients underwent the Ross procedure. The mean age of 106 men and 49 women was 35 years. Most patients (85%) had congenital aortic valve disease. The pulmonary autograft was implanted in the subcoronary position in 2 patients, as an aortic root inclusion in 78, and aortic root replacement in 75. The follow-up extended from 9 to 114 months, mean of 45 ± 28 months, and it was complete. All patients have had Doppler echocardiographic studies. There was only one operative and one late death. The survival was 98% at 7 years. The freedom from 3+ or 4+ aortic insufficiency was 86% at 7 years and the freedom from reoperation on the pulmonary autograft was 95% at 7 years. Dilation of the aortic annulus and/or sinotubular junction was the most common cause of aortic insufficiency. One patient required three reoperations on the biological pulmonary valve. Most patients (96%) have no cardiac symptoms. The Ross procedure has provided excellent functional results in most patients, but progressive aortic insufficiency due to dilation of the aortic annulus and/or sinotubular junction is a potential problem in a number of patients. [source] Retropubic versus perineal radical prostatectomy in early prostate cancer: Eight-year experienceJOURNAL OF SURGICAL ONCOLOGY, Issue 6 2007Gianni Martis MD Abstract Background Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. A randomized study was performed on patients with localized prostate cancer and treated with radical prostatectomy using the perineal or the retropubic approach comparing oncological outcomes, cancer control, and functional results. Study Design Between 1997 and 2004, in a randomized study 200 patients underwent a radical prostatectomy performed by retropubic (100 patients) or perineal (100 patients) approach. Results Differences between hospital stay, duration of catheter drainage, intraoperative blood loss, and transfusion requirements were statistically significant in favor of perineal prostatectomy. Differences between positive surgical margins and urinary continence in the two groups were not statistically significant at 6 and 24 months. Differences between erectile function at 24 months were statistically significant in favor of retropubic prostatectomy. Conclusions Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer. J. Surg. Oncol. 2007; 95: 513,518. © 2007 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||