Language：English   Publisher：Elsevier B.V.  

Language：Japanese   Publisher：Japanese Society of Reconstructive Microsurgery  

<p>　In 2012, we reported on the clinical observation method following 544 free flap transfers for head and neck reconstruction. After 10 years, we reviewed the postoperative outcomes using the similar monitoring approach. The success rates of free flap transfer were 97.8% for 495 head and neck defects and 80.8% for 26 lower extremities defects. Compromised flaps were observed in 21 patients. Flap color change was identified as the first clinical sign of flap compromise in 14 out of 21 patients. Of the 14 head and neck cases, emergency salvage surgeries were performed in six cases, and three flaps were salvaged. The other eight flaps were observed conservatively, however, all of them suffered total necrosis. In the five cases of lower extremity reconstruction with flap compromise, one patient underwent salvage surgery; however, the flap could not be salvaged. The other four flaps that did not undergo salvage surgery developed total necrosis. The flap salvage rate using the clinical observation method was comparable to previously reported rates. To further improve the salvage rate, it is essential to inspect the anastomosis site directly and perform salvage surgery promptly upon recognizing subtle and characteristic color changes in the flap.</p>

DOI： 10.11270/jjsrm.37.137

CiNii Research

Language：English   Publisher：Plastic and Reconstructive Surgery  

Surgeons have traditionally believed that swallowing is mainly dependent on gravity after total glossolaryngectomy. However, swallowing function after total glossolaryngectomy varies widely among patients, and a thorough analysis is lacking. The authors aimed to clarify the swallowing function after total glossolaryngectomy and determine whether it is primarily dependent on gravity. The authors retrospectively analyzed videofluorographic examinations of patients who underwent total glossolaryngectomy and free or pedicle flap reconstruction. The authors enrolled 20 patients (12 male; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient's ability to swallow was dependent on gravity alone. Videofluorography showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3 percent of the patients with poor clearance showed adequate constriction, which was significantly different (p = 0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance (p = 0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to previous understanding, constriction of the remnant posterior pharyngeal wall played an important role in swallowing after total glossolaryngectomy, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after total glossolaryngectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

DOI： 10.1097/PRS.0000000000009639

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Japan Society of Cranio-Maxillo-Facial Surgery  

<p>　　Problems of orbital fracture surgeries include the narrow and deep surgical field, the difficulty of detecting the correct position of deep fractures, and the insufficiency of methods of teaching young surgeons. To overcome these problems, we introduced a combination therapy consisting of transorbital endoscopy, image-guided navigation system, and a 3D model.<br>　　Using endoscopy to assist with surgery, all medical staff can share a clear and magnified surgical vision through the high-resolution monitor. Transorbital endoscopic surgeries facilitate finding the microfracture easily even in the deep part of the orbit; thus, the image-guided navigation system adds accuracy and objectiveness to endoscopic surgeries. By a combination of endoscopy and image-guided navigation, we can avoid inadequate reduction of deep orbital fractures, which make orbital surgeries safer and easier and shortens the learning curve of young surgeons. Furthermore, 3D modeling can replicate real orbital shape and facilitate preoperative training of orbital surgeries. Using a mirrored 3D model, a precisely shaped bone graft can be manufactured and placed to the orbital defect.<br>　　Combining endoscopy, image-guided navigation system, and 3D modeling can contribute to safe and accurate orbital surgeries.</p>

DOI： 10.32154/jjscmfs.38.4_113

CiNii Research

Language：Japanese  

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