Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materi...Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.展开更多
Aim: Breast reconstruction has several beneficial effects on psychosocial well-being and quality of life. The ultimate goal has always been to create the most natural breast mound. Thus in many centers, the unilateral...Aim: Breast reconstruction has several beneficial effects on psychosocial well-being and quality of life. The ultimate goal has always been to create the most natural breast mound. Thus in many centers, the unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains the most common technique for breast reconstruction. Our objective was to retrospectively compare the outcomes of ipsilateral and contralateral pedicle TRAM flaps. Methods: The total of 110 patients underwent unilateral breast reconstruction with pedicle TRAM flap at Cancer Institute of Tehran University of Medical Science from January 1996 to June 2011. Premorbid risk factors, postoperative outcomes and demographic data were assessed. The analysis of the recordings was done by SPSS 20. Results: Out of 110 patients who were included in the study, 87 had ipsilateral and 23 contralateral pedicle TRAM flaps. The incidence of flap complications that did not require surgical intervention was 19.7% in ipsilateral and 30.4% in contralateral pedicle TRAM flap. The incidence of flap loss requiring revision was significantly higher in contralateral group (P = 0.001). Major complications were noted in 11.5% of the ipsilateral pedicle TRAM patients and 26.1% of the contralateral group (P < 0.001). Minor complications were noted in 17.2% of the ipsilateral pedicle TRAM patients and in 34.8% of the contralateral group (P < 0.001). Total early hospital stay was longer in contralateral pedicle TRAM flaps (7.66 days vs. 10.68 days, P = 0.83). H igher c omplications were e ncountered i n c ontralateral p edicle T RAM flaps compared to ipsilateral pedicle TRAM patients (39.1% vs. 19.5%, P = 0.001). The type of pedicled TRAM flap (ipsilateral vs. contralateral), had significant effect on complications (odds ratio = 0.007, P = 0.002) while other variables had no significant effect on the incidence of complications. Conclusion: This study indicates that the overall outcome and mid-term morbidity-free survivals of ipsilateral pedicle TRAM flap breast reconstruction are statistically superior to contralateral pedicle TRAM flap breast reconstruction. Both of these procedures are reasonably feasible and safe. These findings lead us to discourage the use of contralateral pedicle TRAM flap when an ipsilateral option is feasible.展开更多
文摘Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.
文摘Aim: Breast reconstruction has several beneficial effects on psychosocial well-being and quality of life. The ultimate goal has always been to create the most natural breast mound. Thus in many centers, the unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains the most common technique for breast reconstruction. Our objective was to retrospectively compare the outcomes of ipsilateral and contralateral pedicle TRAM flaps. Methods: The total of 110 patients underwent unilateral breast reconstruction with pedicle TRAM flap at Cancer Institute of Tehran University of Medical Science from January 1996 to June 2011. Premorbid risk factors, postoperative outcomes and demographic data were assessed. The analysis of the recordings was done by SPSS 20. Results: Out of 110 patients who were included in the study, 87 had ipsilateral and 23 contralateral pedicle TRAM flaps. The incidence of flap complications that did not require surgical intervention was 19.7% in ipsilateral and 30.4% in contralateral pedicle TRAM flap. The incidence of flap loss requiring revision was significantly higher in contralateral group (P = 0.001). Major complications were noted in 11.5% of the ipsilateral pedicle TRAM patients and 26.1% of the contralateral group (P < 0.001). Minor complications were noted in 17.2% of the ipsilateral pedicle TRAM patients and in 34.8% of the contralateral group (P < 0.001). Total early hospital stay was longer in contralateral pedicle TRAM flaps (7.66 days vs. 10.68 days, P = 0.83). H igher c omplications were e ncountered i n c ontralateral p edicle T RAM flaps compared to ipsilateral pedicle TRAM patients (39.1% vs. 19.5%, P = 0.001). The type of pedicled TRAM flap (ipsilateral vs. contralateral), had significant effect on complications (odds ratio = 0.007, P = 0.002) while other variables had no significant effect on the incidence of complications. Conclusion: This study indicates that the overall outcome and mid-term morbidity-free survivals of ipsilateral pedicle TRAM flap breast reconstruction are statistically superior to contralateral pedicle TRAM flap breast reconstruction. Both of these procedures are reasonably feasible and safe. These findings lead us to discourage the use of contralateral pedicle TRAM flap when an ipsilateral option is feasible.
