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Effects of prior irradiation on head and neck reconstruction using free tissue transfer
10:30 AM to 12:00 PM Room OCCC 205 •
Scientific Session: Head and Neck Surgery James H. Boyd MD; Lawrence PA Burgess MD (moderators)
10:38
AM
Effects of Prior Irradiation on Head and Neck Reconstruction Using Free Tissue Transfer Samuel J Lin MD (presenter); Jose Carlos F Dutra MD; Sanjay Keni; Neil Fine MD; Gregory Dumanian MD; Harold J Pelzer Jr MD Chicago IL; Chicago IL; Chicago IL; Chicago IL; Chicago IL; Chicago IL
10:30
AM
Value of Sentinel Lymph Node Biopsy for Oral and Oropharynx Carcinoma Peter Zbaren MD (presenter); Laurent Tschopp MD; Michael Wissmeyer MD; Edouard Stauffer MD Bern Switzerland; Bern Switzerland; Bern Switzerland; Bern Switzerland
Objectives: To assess the accuracy of sentinel lymph node identification in an NO neck in squamous cell carcinoma of the oral cavity and oropharynx and to analyze the value of sentinel lymph node biopsy in detecting occult metastases. Methods: Using a radionuclide-labeled colloid, preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification by a gamma probe was performed in 28 patients. The sentinel lymph node was excised in vivo and a frozen section analysis was carried out. A supraomohyoid neck dissection was then performed in all cases. The neck dissection specimens were analyzed according to a prospective protocol. Results: Sentinel lymph node radiolocalization accurately identified one (N ⫽ 16) or more (N ⫽ 12) sentinel lymph nodes in all cases. There were 1.7 sentinel lymph nodes per patient. Fourteen patients had positive sentinel lymph nodes on frozen section analysis. The definitive result of sentinel lymph node analyses revealed a further metastases in one case. The average number of analyzed lymph nodes was 36 per neck. Beside the positive sentinel lymph nodes, no more occult disease was detected in the 28 neck specimens. Conclusions: Accurate localization of the sentinel lymph nodes was possible in all cases by using lymphoscintigraphy and by use of a gamma probe. The detection of occult metastases seems to be accurately feasible by sentinel lymph node biopsy and frozen section analysis.
August 2003
Objectives: Free tissue transfer has emerged as the most sophisticated technique in restoring function following tumor ablation. Successful microvascular anastomosis depends on comorbidities including arteriosclerosis, smoking, diabetes, and prior irradiation. Prior irradiation is considered a significant factor in flap failure. We sought to study the effects of prior irradiation in patients undergoing free tissue transfer following tumor resection. Methods: In the last eight years, we reviewed 114 consecutive patients who underwent free tissue transfer following head and neck tumor ablation. Factors reviewed included free flap type, tumor stage, ischemic time, flap size, postoperative minor/major complications, age, gender, tobacco/alcohol usage, and prior head and neck irradiation. Major complications were defined as total flap loss or revision surgery. Minor complications included limited flap necrosis, infection, and prolonged local wound care. Results: Of 114 patients, 11 patients had revision surgery in their postoperative course. 90.4% of all patients undergoing free tissue transfer had a successful outcome. Mean age was 56 years and there were 66 males. Of 44 patients who had prior head and neck irradiation, 3 patients required revision procedures. One irradiated patient experienced total flap loss. In total, 90.9% of irradiated patients had successful free tissue reconstruction. In 70 non-irradiated patients, 7 (10%) patients required revision surgery. 3 irradiated patients and 3 non-irradiated patients had minor complications. Conclusions: Microvascular reconstruction was accomplished in both irradiated and non-irradiated head and neck cancer patients with similar success rates. We conclude that free tissue transfer may be feasible in head and neck cancer patients with prior irradiation.
Otolaryngology–Head and Neck Surgery P55
SUNDAY
Sunday, September 21, 2003
Scientific Session: Head and Neck Surgery James H. Boyd MD; Lawrence PA Burgess MD (moderators)
10:38
AM
Effects of Prior Irradiation on Head and Neck Reconstruction Using Free Tissue Transfer Samuel J Lin MD (presenter); Jose Carlos F Dutra MD; Sanjay Keni; Neil Fine MD; Gregory Dumanian MD; Harold J Pelzer Jr MD Chicago IL; Chicago IL; Chicago IL; Chicago IL; Chicago IL; Chicago IL
10:30
AM
Value of Sentinel Lymph Node Biopsy for Oral and Oropharynx Carcinoma Peter Zbaren MD (presenter); Laurent Tschopp MD; Michael Wissmeyer MD; Edouard Stauffer MD Bern Switzerland; Bern Switzerland; Bern Switzerland; Bern Switzerland
Objectives: To assess the accuracy of sentinel lymph node identification in an NO neck in squamous cell carcinoma of the oral cavity and oropharynx and to analyze the value of sentinel lymph node biopsy in detecting occult metastases. Methods: Using a radionuclide-labeled colloid, preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification by a gamma probe was performed in 28 patients. The sentinel lymph node was excised in vivo and a frozen section analysis was carried out. A supraomohyoid neck dissection was then performed in all cases. The neck dissection specimens were analyzed according to a prospective protocol. Results: Sentinel lymph node radiolocalization accurately identified one (N ⫽ 16) or more (N ⫽ 12) sentinel lymph nodes in all cases. There were 1.7 sentinel lymph nodes per patient. Fourteen patients had positive sentinel lymph nodes on frozen section analysis. The definitive result of sentinel lymph node analyses revealed a further metastases in one case. The average number of analyzed lymph nodes was 36 per neck. Beside the positive sentinel lymph nodes, no more occult disease was detected in the 28 neck specimens. Conclusions: Accurate localization of the sentinel lymph nodes was possible in all cases by using lymphoscintigraphy and by use of a gamma probe. The detection of occult metastases seems to be accurately feasible by sentinel lymph node biopsy and frozen section analysis.
August 2003
Objectives: Free tissue transfer has emerged as the most sophisticated technique in restoring function following tumor ablation. Successful microvascular anastomosis depends on comorbidities including arteriosclerosis, smoking, diabetes, and prior irradiation. Prior irradiation is considered a significant factor in flap failure. We sought to study the effects of prior irradiation in patients undergoing free tissue transfer following tumor resection. Methods: In the last eight years, we reviewed 114 consecutive patients who underwent free tissue transfer following head and neck tumor ablation. Factors reviewed included free flap type, tumor stage, ischemic time, flap size, postoperative minor/major complications, age, gender, tobacco/alcohol usage, and prior head and neck irradiation. Major complications were defined as total flap loss or revision surgery. Minor complications included limited flap necrosis, infection, and prolonged local wound care. Results: Of 114 patients, 11 patients had revision surgery in their postoperative course. 90.4% of all patients undergoing free tissue transfer had a successful outcome. Mean age was 56 years and there were 66 males. Of 44 patients who had prior head and neck irradiation, 3 patients required revision procedures. One irradiated patient experienced total flap loss. In total, 90.9% of irradiated patients had successful free tissue reconstruction. In 70 non-irradiated patients, 7 (10%) patients required revision surgery. 3 irradiated patients and 3 non-irradiated patients had minor complications. Conclusions: Microvascular reconstruction was accomplished in both irradiated and non-irradiated head and neck cancer patients with similar success rates. We conclude that free tissue transfer may be feasible in head and neck cancer patients with prior irradiation.
Otolaryngology–Head and Neck Surgery P55
SUNDAY
Sunday, September 21, 2003