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ABSTRACT: INTRODUCTION: To prevent postoperative pharyngocutaneous fistula (PCF) after total (pharyngo)laryngectomy, simultaneous coverage of pharyngeal anastomosis with vascularised flaps such as pectoralis major muscle, anterolateral thigh or radial forearm, has been reported to be effective. As an alternative to the invasive methods using distant flaps, we used the infrahyoid myofascial flap (IHMFF), which was harvested from the same operation field of (pharyngo)laryngectomy, for covering the site of pharyngeal anastomosis. Herein, we describe the safety and effectiveness of our minimally invasive method for preventing PCF. METHODS: Eleven patients who were at a high risk of developing PCF due to previous chemoradiotherapy underwent simultaneous coverage of pharyngeal anastomosis with IHMFF after total (pharyngo)laryngectomy. The incidence of PCF and the rate of major fistula requiring surgical closure were determined, and the results were compared with the control group (23 patients without IHMFF cover after laryngectomy). RESULTS: PCF developed in 2 of the 11 patients (18.2%). The fistulae of these two patients were closed conservatively and did not require additional surgery. PCF developed in 6 of 23 patients (26.1%) in patients without IHMFF cover. All the six patients with fistula required additional closure surgery. The incidence of PCF did not differ in patients with or without IHMFF cover (Fisher's exact probability test; p = 0.939, NS). However, the rate of major PCF requiring surgical closure was significantly lower in patients with IHMFF cover (Fisher's exact probability test; p = 0.036 <0.05). CONCLUSIONS: For (pharyngo)laryngectomy patients, IHMFF cover is a minimally invasive method that can prevent major PCF.
Journal of Plastic Reconstructive & Aesthetic Surgery 04/2013; · 1.49 Impact Factor
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The Laryngoscope 04/2013; · 1.75 Impact Factor
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ABSTRACT: The objective of this study was to analyze the outcome of hypopharyngeal cancer patients who underwent triple combination treatment with S-1, vitamin A and radiation(TAR therapy), and to analyze the role of TAR therapy for treating locally advanced hypopharyngeal cancer patients. 146 patients(stage I: 10 cases, stage II : 22 cases, stage III : 23 cases, stage IV: 91 cases)with hypopharyngeal squamous cell carcinoma were treated with TAR therapy(S-1; orally, 65mg/m²day, twice a day; vitamin A(retinol palmitate): 50, 000 I U/day, intra-musculary on each day of radiation; radiation: 1. 5-2 Gy/day, 5 days/week). Histologic complete responders at 30-40 Gy continued TAR therapy up to 60-70 Gy. Nonresponders at 30-40 Gy underwent surgery. The overall 5-year survival and disease-specific 5-year survival rates were 50. 5%and 59%respectively. The cumulative 3-year laryngeal preservation rate for stage I was 100%, 82. 5% for stage II, 66. 6% for stage III, and 35%for stage IV. Laryngeal preservation was fair in T1/T2 patients(81%), but not satisfactory in T3/T4 patients(21. 4%). S- 1 is administered orally, and TAR therapy can be conducted in the clinic with low toxicity. However, protocols with high intensity may be necessary to improve laryngeal preservation for locally advanced(T4)hypopharyngeal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 05/2012; 39(5):759-63.
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ABSTRACT: Esophageal perforation with mediastinal abscess formation is a potentially life-threatening complication after chemoradiotherapy
(CRT) in patients with esophageal cancer. We present the case of a 64-year-old woman with cervico-thoracic esophageal cancer
who had previously undergone distal gastrectomy. Definitive CRT was initially performed since the patient refused laryngectomy.
However, she developed an esophageal fistula and a subsequent cervico-mediastinal abscess, which made oral intake impossible.
In order to address the fistula, abscess, and cancer, we decided to perform a staged operation. The patient first underwent
total pharyngo-laryngo-esophagectomy and abscess drainage. She next underwent esophageal reconstruction with an ileocolonic
conduit through a subcutaneous route. The patient is currently alive and well after surgery. This case suggests that surgical
resection may be performed in high-risk patients with cervico-thoracic esophageal cancer via a two-stage operation.
KeywordsSalvage operation–Esophageal cancer with fistula–Two-stage operation–Curative chemoradiotherapy
Esophagus 04/2012; 8(3):197-201. · 0.66 Impact Factor
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ABSTRACT: Flap necrosis due to blood circulation disorders is a serious problem in reconstructive surgery. Methods to achieve both arterial and venous microvascular augmentation at the flap periphery have therefore been developed to prevent post-surgical circulation problems, especially for large pedicle flaps and free flaps containing three more vascular territories. Moreover, the benefits of microvascular venous augmentation (VA; superdrainage) alone have been established, but the optimal duration of post-surgical venous drainage has not yet been determined.
The surviving flap area was compared after standard and short-term VA in the extended island flap model of the rat abdomen. A flap model using the left superficial inferior epigastric artery/vein as the vascular pedicle was used as a control group (n = 6). The lateral branch of the right superficial inferior epigastric vein remained unresected at the end of the flap in the VA group (n = 7), but was ligated at 24 h post-surgery in the temporary venous augmentation (TVA) group (n = 7).
The flap survival rates on postoperative day 7 in the control, VA and TVA groups were 74.8 ± 8.4%, 90.1 ± 3.7% and 89.9 ± 3.5%, respectively. The surviving areas were significantly improved in the VA and TVA groups in comparison to the control group (p ＜ 0.01), but there was no significant difference between the VA and TVA groups.
The short-term venous drainage from the flap end after surgery was as effective as long-term VA. Flap transplantation could therefore be clinically easier and more reliable when starting short-term venous drainage during surgery.
Journal of Plastic Reconstructive & Aesthetic Surgery 01/2012; 65(5):650-6. · 1.49 Impact Factor
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ABSTRACT: Malignant neoplasms occurring from the trachea are extremely rare. Therefore, their clinical characteristics and surgical results have not been thoroughly discussed. These tumors are often misdiagnosed and treated as bronchial asthma or chronic obstructive pulmonary disease. It is critically important to probe the cause-effect relationship between the medical presentations and the clinical diagnosis. In this report, two cases of tracheal malignancy suffering from dyspnea due to obstruction of the proximal trachea are described, and a review of the literature is presented.
Case Reports in Oncology 01/2012; 5(2):302-7.
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ABSTRACT: Microsurgery is difficult to perform in necks that have been previously irradiated and operated upon because of the limited availability of recipient vessels. The objective of this study was to clarify the feasibility and safety of performing microsurgery in necks that are scarred and fibrous owing to previous treatment.
Twenty patients whose necks were previously irradiated and operated upon and who underwent free tissue transfer were included in this study. All patients had been previously administered an average of 60.7 (range, 30-95)Gy of radiotherapy. Thirteen patients had undergone hemilateral neck dissections, 5 patients had undergone bilateral neck dissections, 8 patients had undergone (pharyngo)laryngectomies, and 10 patients had undergone prior flap transfer. The success rate of microsurgery and the selection of recipient vessels were examined.
All recipient vessels could be adopted in the neck field without vessel grafting. One patient developed necrosis of the flap, which was salvaged with retransfer of another flap after trimming the same cervical vessels. For the remaining 19 patients, free tissue transfers were successful.
Suitable recipient vessels are residual and available even in the previously irradiated and operated neck field. When performed properly, free tissue transfer in the previously treated neck is not as risky a surgery as was generally believed.
Auris, nasus, larynx 11/2011; 39(5):496-501. · 0.58 Impact Factor
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ABSTRACT: Free flaps are considered to revascularize from the surrounding tissue and survive without their original pedicle flow after a certain period postoperatively. We report 2 patients who developed mucosal ischemia of the transferred jejunum by ligation of its vascular pedicle 10 and 25 months after microvascular free jejunal transfer. Both patients had a history of heavy smoking, and had undergone definitive radiotherapy and previous surgery to the recipient bed. Both were treated conservatively; however, a stenotic change of the transferred jejunum remained in 1 patient. If poorly revascularized flaps, such as jejunal flaps, were transferred to the irradiated and scarred recipient bed, revascularization might never reach completion. If pedicle division is required in such cases, reanastomosis of the pedicle would be ideal regardless of the time after the transfer.
Annals of plastic surgery 05/2011; 67(6):612-4. · 1.29 Impact Factor
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ABSTRACT: Through our experiences in the parapharyngeal space (PPS) surgery, we have learned that it is possible to gain wide exposure of the PPS near to the skull base with a transcervical approach alone. Thus, we presumed that if this type of transcervical approach would be combined with a transoral approach, a less invasive oropharyngectomy without mandibulotomy and lip-splitting might be feasible for the resection of advanced oropharyngeal cancer, sparing the morbidities associated with conventional mandibular swing approach or its modified procedures. We termed this method as a mandible preserving pull-through oropharyngectomy (MPPO) and evaluated its feasibility and efficacy in this pilot study.
MPPO was applied for a series of 7 patients with advanced lateral and/or upper oropharyngeal cancer including 2 patients with T4 stage. Our current application of MPPO excludes tumors, which involves mandibular bone, the higher part of the medial pterygoid muscle, and the lateral pterygoid muscle.
Safe and sufficient excision of tumors was feasible by MPPO avoiding morbidities associated with mandibulotomy or lip-splitting without compromising oncological outcomes.
Although preliminary, our favorable outcomes indicate that MPPO might be a useful alternative to conventional mandibular swing approach or its modified procedures for selected cases with advanced oropharyngeal cancer. Further accumulation of data is encouraged.
Auris, nasus, larynx 10/2010; 38(3):392-7. · 0.58 Impact Factor
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ABSTRACT: Salvage surgery after definitive chemoradiotherapy is often associated with a higher rate of perioperative complications and poor prognosis. The objective of this study is to examine the safety and efficacy of free jejunal transfer after salvage pharyngolaryngectomy for patients with locally recurrent hypopharyngeal carcinoma after definitive chemoradiotherapy.
A retrospective analysis of patients with advanced hypopharyngeal carcinoma who underwent pharyngolaryngectomy and reconstruction using free jejunum.
Forty patients who underwent pharyngolaryngectomy with jejunal transfer were included in this study. Fourteen patients underwent surgery after definitive chemoradiotherapy (the salvage-surgery group), whereas 26 patients underwent surgery after planned preoperative chemoradiotherapy (the planned-surgery group). The perioperative conditions, mortality, morbidity, functional outcomes, and oncologic outcomes in each group were compared.
The patients in the salvage-surgery group lost an average of 9 kg in weight before surgery, which thus indicated a malnourished condition. However, the incidence of all perioperative complications did not differ significantly between the groups. All patients in both groups achieved oral intake without tube feeding, and the intervals to start oral intake were 12.8 days in the salvage-surgery group and 15.6 days in the planned-surgery group, which was not significantly different. The 5-year disease-free survival was 57.1% in the salvage-surgery group and 50.4% in the planned-surgery group, which was not significantly different.
Salvage pharyngolaryngectomy and jejunal transfer can be performed safely and reliably for patients with locally recurrent hypopharyngeal carcinoma, and it is an excellent option after a failure of definitive chemoradiotherapy.
The Laryngoscope 06/2010; 120(6):1103-8. · 1.75 Impact Factor
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Masaru Morita,
Keisuke Ikeda,
Masahiko Sugiyama,
Hiroshi Saeki,
Akinori Egashira,
Keiji Yoshinaga,
Eiji Oki,
Noriaki Sadanaga,
Yoshihiro Kakeji, Junichi Fukushima,
Yoshihiko Maehara
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ABSTRACT: Anastomotic leakage with an intractable cutaneous fistula frequently develops after an esophagectomy and reconstruction via the subcutaneous route.
A pectoralis major muscle (PMM) flap was used for the treatment of 6 patients with esophageal cancer who developed anastomotic leakage with fistula after reconstruction via the subcutaneous route. A gastric tube and colon had been used for reconstruction in 2 and 4 patients, respectively. A trimming and repair of the leakage site was initially performed and the anastomotic site was then covered with a muscle flap.
Recurrent anastomotic leakage did not develop in 5 patients. Among these patients, oral intake was initiated from 11-15 days after the repair operation in 4 patients. A patient having recurrent anastomotic leakage after a repair operation recovered well with conservative therapy.
The coverage with a PMM flap over the repair site is a simple method for preventing the development of recurrent leakage after a repair operation. Even when recurrent anastomotic leakage has occurred after this operation, healing is normally expected by means of conservative treatment. We, therefore, recommend this method for the repair of intractable anastomotic leakage after reconstruction via the subcutaneous route for esophageal cancer.
Surgery 10/2009; 147(2):212-8. · 3.10 Impact Factor
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ABSTRACT: In the treatment of microtia, the search has been for surgical techniques that prevent postoperative complications and realize sufficient and stable projection of the constructed ear.
Cartilage was fixed with absorbable synthetic thread instead of wire because wire has a high risk of exposure. A subcutaneous pedicle was added to the concha to prevent skin necrosis. Dead space and hematoma creation were prevented with vacuum aspiration, bolster fixation, and microdrainage with small tubes. A triangular skin flap connecting to the ear lobe was used to prevent shrinkage on the posteroinferior portion of the concha. Projection of the inferior portion of the auricle was supported with a hydroxyapatite-tricalcium phosphate ceramic.
Our technique was applied to 42 patients, and none of them experienced slip of the fixed cartilage, auricular deformation, skin necrosis, or infections. Shrinkage of the inferior portion of the auricle was minimal, and good projection was obtained.
The authors' technique prevents complications and realizes good shape and projection of the auricle in total reconstruction of the auricle. Hydroxyapatite-tricalcium phosphate ceramic is a useful material that complements the cartilage shortage.
Plastic and reconstructive surgery 07/2006; 117(7):2414-23. · 2.74 Impact Factor
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ABSTRACT: A huge arteriovenous malformation (AVM) extending from the lower lip to the chin was surgically resected and the area was reconstructed during the same surgery in three patients. To control hemorrhage during surgery, a radiologist performed embolization of major arteries in the lesion 2 or 3 days before the surgery. After total resection of the AVM, facial reconstruction was performed by using a double cross lip flap from the upper lip and a local skin flap from the lower jaw. As a result, bleeding was well controlled, the AVM was totally resected, and satisfactory functional and esthetic results were obtained.
Journal of Craniofacial Surgery 06/2005; 16(3):443-8. · 0.82 Impact Factor
