OBJECTIVE: The purpose of this investigation was to study lateral pharyngeal wall adduction relative to pharyngeal flaps of different widths. The hypothesis to be tested was that pharyngeal wall adduction does not increase postoperatively but may decrease due to the mechanical hindrance of a wide flap. DESIGN: In this prospective study, adaptation of lateral pharyngeal wall adduction during speech was studied relative to pharyngeal flaps of different widths utilizing videoradiography. Flap width was determined nasopharyngoscopically. SETTING: All patients were treated by the Stockholm Cleft Palate Team, Sweden. PATIENTS: Fifty-three patients were strictly selected by discarding conditions known to exert uncontrolled influence on velopharyngeal sphincter function. RESULTS: The results revealed a potential for adaptation of pharyngeal wall adduction to different flap widths. The magnitude and character (increase or decrease) of change in adduction was significantly correlated with the degree of preoperative adduction and with the width of the flap. In patients with limited preoperative adduction, pharyngeal wall activity increased, more in the presence of a narrow flap while less if the flap was wide. When preoperative adduction was pronounced, the postoperative activity decreased because of mechanical hindrance by the flap, and the degree of impediment was correlated to the width of the flap. CONCLUSION: A potential for increased lateral pharyngeal wall adduction after pharyngeal flap surgery was verified, but the result cannot be interpreted as generally applicable because of the strict selection of patients.
Because of the prolonged healing time of diabetic foot ulcers, methods for identifying ways to expedite the ulcer healing process are needed. The angiosome concept delineates the body into three-dimensional blocks of tissue fed by specific source arteries. The aim of this study was to evaluate the benefit of infrapopliteal endovascular revascularization guided by an angiosome model of perfusion in the healing process of diabetic foot ulcers.
A total of 250 consecutive legs with diabetic foot ulcers in 226 patients who had undergone infrapopliteal endovascular revascularization in a single center were evaluated. Patient records and periprocedural leg angiograms were reviewed. The legs were divided into two groups depending on whether direct arterial flow to the site of the foot ulcer based on the angiosome concept was achieved (direct group) or not achieved (indirect group). Ulcer healing time was compared between the two groups. A propensity score was used for adjustment of differences in pretreatment covariables in multivariate analysis and for 1:1 matching.
Direct flow to the angiosome feeding the ulcer area was achieved in 121 legs (48%) compared with indirect revascularization in 129 legs. Foot ulcers treated with angiosome-targeted infrapopliteal percutaneous transluminal angioplasty healed better. The ulcer healing rate was mean (standard deviation) 72% (5%) at 12 months for the direct group compared with 45% (6%) for the indirect group (P
Young, growing individuals with one or more upper incisors missing due to trauma, agenesis or extraction of abnormal teeth can be treated with autotransplantation to restore aesthetics and function and to preserve the volume of the alveolar process. Studies have been performed to evaluate the prognosis, indicating a good prognosis, especially if an immature transplant is available, developed to 3/4 of the full root length. The purpose of this study was to analyse the result of all autotransplantation of teeth performed to the upper incisor region between 1979 and 1990 at the Department of Oral Surgery, Eastmaninstitutet, Stockholm, Sweden. The material consists of 23 immature and 22 mature teeth in 40 patients with a mean age of 12 years. They were systematically followed up clinically and roentgenologically for up to four years after surgery. 22 of the 23 immature (96%) and 18 of the 22 mature teeth (82%) were observed to be without serious complications. The complications occurred, with one exception, within the first year of observation. The conclusion drawn from this study is that autotransplantation to the upper incisor region can be performed with a good prognosis, both for mature and immature teeth.
In Denmark mastectomized women have shown an increasing interest in breast reconstruction. Secondary reconstruction one year after completed oncologic treatment is recommended. Patients are selected in collaboration with the oncologic treatment centers mainly from the group with localized (stage I) disease. Reconstruction of the breast dome is most commonly accomplished by submuscular implantation of a soft silicone prosthesis, often preceded by tissue expansion or combined with transfer of a musculocutaneous flap. In some cases flap transfer may provide sufficient bulk to eliminate the need for a prosthesis. Reconstruction of the nipple-areola complex is performed some months later, when symmetry in breast volume and placement has been established. Altogether the reconstructions may take 1/2-1 year in uncomplicated cases depending on the method used. The cosmetic results achieved are sufficiently good to warrant a recommendation that reconstructive surgery should be available--according to need--as an integral part of the treatment of women with breast cancer.
Breast cancer is the most common malignant tumour in women, and more than 5000 new cases are discovered each year in Sweden, this means that one woman in nine will be treated for breast cancer during her lifetime. For unknown reasons, the incidence increases by 1% each year. Partial mastectomy is the most common surgical treatment today, but a large number of women undergo mastectomy--that is, excision of all breast tissue including the nipple-areola complex with or without an axillary biopsy. Radical mastectomy--that is the Halsted mastectomy with excision of the pectoral muscles (51)--is almost never done today, so chest wall defects are smaller than in the early days of breast reconstruction. There is, however, still a demand from patients for good, natural-looking, and longlasting breast reconstructions, and reconstructive surgeons have to search for perfection both in existing methods and also in new methods of breast reconstruction. The purpose of this article is to review this complex subject.
Departments of Radiology and Plastic Surgery, Hôtel-Dieu de Montréal, Centre Hospitalier de l'Université de Montréal, 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8. fannypg@videotron.ca
Breast reconstruction after mastectomy is often requested by women with breast cancer who are ineligible for breast-conserving therapy and women with a high genetic risk for breast cancer. Current breast reconstruction techniques are diverse and may involve the use of an autologous tissue flap, a prosthetic implant, or both. Regardless of the technique used, cancer may recur in the reconstructed breast; in addition, in breasts reconstructed with autologous tissue flaps, benign complications such as fat necrosis may occur. To detect breast cancer recurrences at a smaller size than can be appreciated clinically and as early as possible without evidence of metastasis, radiologists must be familiar with the range of normal and abnormal imaging appearances of reconstructed breasts, including features of benign complications as well as those of malignant change. Images representing this spectrum of findings were selected from the clinical records of 119 women who underwent breast magnetic resonance (MR) imaging at the authors' institution between January 2009 and March 2011, after mastectomy and breast reconstruction. In 32 of 37 women with abnormal findings on MR images, only benign changes were found at further diagnostic workup; in the other five, recurrent breast cancer was found at biopsy. Four of the five had been treated initially for invasive carcinoma, and one, for multifocal ductal carcinoma; three of the five were carriers of a BRCA gene mutation. On the basis of these results, the authors suggest that systematic follow-up examinations with breast MR imaging may benefit women with a reconstructed breast and a high risk for breast cancer recurrence.
Burn injuries caused by hot air sauna burns constitute a Finnish burn rarity. The patients are usually middle-aged men having passed out on the sauna benches under the influence of alcohol. Sauna air causes a deep injury penetrating all layers of the skin, accompanied with necrosis of the subcutaneous tissue and consequent rhabdomyolysis. The initially harmless-looking erythema of the skin rapidly transforms into a third-degree burn. Therapy includes the prevention of kidney damage and surgery. Local flaps are recommended for the treatment of tissue defects caused by destruction of deep tissues and amputations.
Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Haartmaninkatu 4E, P.O. Box 220, FI-00029 HUS, Helsinki, Finland. mari.markkanen-leppanen@hus.fi
Articulatory proficiency of /r/ and /s/ sounds, voice quality and resonance, speech intelligibility, and intraoral sensation were examined prospectively before operation, and at four time points during a 1-year follow-up after microvascular transfer. Forty-one patients with a large oral or oropharyngeal carcinoma undergoing tumor resection and free-flap reconstruction usually combined with radiotherapy participated in the study. Articulation, voice, and resonance were investigated both live and from recorded speech samples by two trained linguistic examiners. The patients completed a self-rating of their speech intelligibility and were assessed for anterior intraoral surface sensation by means of 2-point moving discrimination. Misarticulations of /r/ and /s/ increased significantly after the therapy. Voice quality and resonance remained essentially normal. Speech intelligibility deteriorated significantly. Intraoral sensation decreased postoperatively but was not related to speech outcome. Sensate flaps did not prove to be superior in relation to speech tasks. A multidisciplinary approach is advocated in assessment of speech outcome after cancer surgery. Speech therapy is strongly recommended, even in the absence of a gross articulatory handicap.
