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Biomedical subjects

N M Breach

Publications and source records attributed to N M Breach.

At least 19 recordsLinked to original sources
PubMed1999

Management of the N0 neck in early cancer of the oral tongue.

Elective treatment of the clinically negative neck in the management of early oral tongue cancers remains controversial. A retrospective review of 71 patients with T1, 2 N0M0 squamous cell carcinoma of the oral tongue treated at the Royal Marsden Hospital was carried out. Cervical nodal recurrence at 2 years was 17% in the group of patients who received elective neck treatment as compared to 43% in the group who had observation of the neck and the difference is statistically significant (P = 0.025). The difference in 5-year survival between the group who had elective neck treatment and the group who did not (75% versus 65%) was not statistically significant. Until future research allows us to be more selective on the basis of a reliable panel of histological and/or biological markers for propensity to nodal metastases, elective neck treatment should be considered in the initial management of the patients with early oral tongue cancer.

Carcinoma, Squamous Cell↗
PubMed1999

Use of apron flap incision for neck dissection.

Neck dissection is one of the most commonly performed surgical procedures in the management of head and neck cancer. Different skin incisions with various modifications have been described in the literature. Three commonly used but conceptually different incisions were compared with respect to the incidence of wound dehiscence in a retrospective review. There were 166 patients with 184 neck dissections carried out using a triradiate (n = 85), modified MacFee (n = 25), or an apron flap incision (n = 74). The incidence of wound dehiscence in the three groups was 11 percent, 8 percent, and 0 percent for the triradiate, modified MacFee, and apron flap incisions, respectively. There was a statistically significant difference in the incidence of wound dehiscence between the apron flap incision and the triradiate incision groups (p = 0.004). The difference in wound dehiscence was not statistically significant between the apron flap incision and the modified MacFee incision groups (p = 0.06). Overall, there was a significant increase in the incidence of wound dehiscence in previously irradiated necks (p = 0.02), but this was significant only for the triradiate incision (p = 0.005) when analyzed individually. Comparison of triradiate, apron, and MacFee incisions did not show a statistically significant difference between the incisions with regard to other postoperative complications in terms of seroma, hematoma, wound infection, and fistula formation. The apron flap incision is the recommended approach in the presence of previous neck irradiation as it gives easier access than the MacFee incision. The robustness of the flap is because of the absence of a trifurcate point as well as a good vascular supply arising from arterial territory of the external carotid artery.

Female↗
PubMed1998

Development of ganglioneuroma following successful treatment for orbital rhabdomyosarcoma.

A female infant presented with a left orbital embryonal rhabdomyosarcoma at the age of 3 months. She was successfully treated for this tumour with chemo- and radiotherapy. Eight years later she developed a ganglioneuroma in the same area which was treated surgically, but recurred at the age of 19. Re-examination of all of the specimens using immunohistochemistry confirmed that the initial and successive diagnoses had been correct. Two further explanations for this rare sequence of events are considered: whether the initial biopsy had been unrepresentative of the whole tumour, or whether there had indeed been two separate tumours arising in the same area. The theories of this previously undocumented occurrence are discussed further.

Adult↗
PubMed1997

Esophageal leiomyomatosis involving trachea: surgical resection and repair.

We report the case of a 26-year-old man with diffuse esophageal leiomyomatosis involving the trachea. The tumor was resected by total esophagectomy and partial resection of the trachea and the left main bronchus. The tracheobronchial defect was repaired with a free forearm skin graft with satisfactory outcome. This approach offers good long-term prospects.

Adult↗
PubMed1996

Salvage treatment for inoperable neck nodes in head and neck cancer using combined iridium-192 brachytherapy and surgical reconstruction.

The results of debulking surgery and re-irradiation with radioactive implants (brachytherapy) are reported for 39 patients with inoperable metastatic neck nodes from primary head and neck cancers. For 13 patients conventional salvage by partial debulking surgery and brachytherapy proved effective, with 68 per cent control at 1 year, but six patients suffered severe radiation fibrosis, necrosis and contractures. Some 26 patients were treated by combined tumour debulking, skin resurfacing and brachytherapy implant. Initial tumour control and freedom from serious toxicity was achieved in 24 patients. Local control was achieved in 63 per cent of patients at 1 year, with a serious morbidity rate of 12 per cent.

Adult↗
PubMed1996

Aggressive cutaneous squamous cell carcinoma of the head and neck in patients with chronic lymphocytic leukaemia.

We describe multiple cutaneous squamous cell carcinomas of the head and neck in five patients with chronic lymphocytic leukaemia (CLL). When associated with CLL, cutaneous squamous cell carcinomata behave in a much more aggressive manner than otherwise expected. Four patients developed local recurrence after primary treatment. All five patients developed lymph node metastases containing squamous cell carcinoma. Three of five patients (60 per cent) had multiple primary lesions. Whereas the increased incidence of second cancers in CLL and notably of skin cancers is documented, little has been written to describe the aggressive behaviour of these tumours. It is important, when treating these patients, to be aware of the high tendency towards local recurrence and lymph node metastasis and to consider an aggressive management plan and careful follow-up.

Aged↗
PubMed1996

Eusol: the plastic surgeon's choice?

Many products are currently promoted for use on wounds. Edinburgh University Solution of Lime (Eusol) has recently received adverse publicity regarding its use in wound management. One hundred and twenty-four consultant plastic surgeons were surveyed regarding their use of Eusol. Ninety-five replies were obtained (77%); of those who replied, 78 (82%) still use Eusol, while nine out of 17 who do not are prevented from using it as they are unable to obtain necessary supplies. In plastic surgery, Eusol is still being used by plastic surgeons in specific situations.

Anti-Infective Agents↗
PubMed1995

Soft-tissue reconstruction in thoracic surgery.

BACKGROUND: Reconstructive techniques using omental and myocutaneous flaps are widely used in the treatment of infected sternotomy wounds. To illustrate their wider role in thoracic reconstruction, we have retrospectively reviewed our experience over the last 5 years. METHODS: We used complex omental and myocutaneous flaps in 30 patients: 19 men and 11 women with a mean age of 53 +/- 4 years (range, 43 to 75 years). In 18 patients, these techniques were used to provide soft-tissue cover after chest wall resection, and in 12 cases complex myocutaneous flaps were used to obliterate chronic intrathoracic cavities. Rectus muscle was used in 11 of 24 muscle flaps, and omentum was used in 12 cases. There were 23 rotational flaps and seven free myocutaneous flaps with microvascular anastomosis. RESULTS: There were no operative deaths, and there were three complications. In 2 patients with infected lesions, loss of the free flap required subsequent revision. In 1 patient, infection developed underneath a prosthesis, which was treated with drainage and rib resection. In all other cases, the primary aim of the operation was achieved without complications. CONCLUSIONS: The vascularity of the omentum should encourage its wider use, especially when infection exists preoperatively. Excellent results can be achieved when using the rectus muscle as a complex myocutaneous flap. The use of free flaps should be reserved for difficult cases and used only in the absence of infection.

Abdominal Muscles↗
PubMed1995

Seeding of a parotid pleomorphic adenoma.

Recurrent pleomorphic adenoma of the parotid usually occurs in the distribution of the primary procedure. There are numerous reports of widespread local recurrence and a few reported cases of distant metastases. Extensive seeding throughout the entire ipsilateral neck is rare. Treatment involves a combination of radical surgery and radiotherapy. The potential for malignant transformation demands close follow-up of younger patients particularly.

Adenoma, Pleomorphic↗
PubMed1995

Exenteration as palliation for patients with advanced pelvic malignancy.

OBJECTIVE: To examine the place of pelvic exenteration in the palliation of advanced and recurrent pelvic tumours. PATIENTS AND METHODS: The notes of patients referred for palliative exenteration were reviewed retrospectively. Fourteen patients (three men, mean age 52 years, and 11 women, mean age 61 years) with a variety of pelvic tumours associated with severe symptoms, had a laparotomy with a view to pelvic exenteration and 10 underwent total or anterior exenteration. RESULTS: Eight patients achieved excellent or good palliation based on survival and quality of life assessment, and two received no benefit. Four of eight patients were alive and apparently free of tumour at a mean of 17 months after surgery. Four were alive, symptom-free but with evidence of malignancy at a mean of 19 months. Two patients who received no benefit died at 2 and 7 months after surgery. The planned exenteration was abandoned in four patients; three of these four patients were dead at a mean of 13 months and one was alive at 12 months. CONCLUSION: Our results confirm that with careful selection and appropriate multi-specialty care, aggressive pelvic surgery is of value in the palliation of some tumours.

Adenocarcinoma↗
PubMed1992

The latissimus dorsi flap in head and neck reconstructive surgery: a review of 121 procedures.

The results of a prospective study of 121 latissimus dorsi flaps performed during head and neck reconstructive surgery at the Royal Marsden Hospital are presented. Three-quarters of the flaps were pedicled and one-quarter were free. All the patients underwent surgery for malignant disease. The flap failure rate was 5%, other flap related complications occurred in 19% and the overall rate of complications was 26%. Previous radiotherapy, site of reconstruction, type of flap (free or pedicled) and age of the patient were not significant risk factors. Men were more likely to have a complication than women.

Adolescent↗
PubMed1992

Treatment of desmoid tumours in Gardner's syndrome.

A 24 year old woman with Gardner's syndrome developed a massive chest wall desmoid tumour, which required radical excision and prosthetic reconstruction. In view of the local aggressiveness of this tumour and the fact that it does not metastasize a policy of radical surgery when possible is recommended.

Adult↗
PubMed1991

Free flaps in head and neck reconstructive surgery: a review of 77 cases.

Recent advances in surgical technique and instrumentation have ensured that success rates for microvascular free transfer can now exceed 90%. This paper reviews a prospective study of 77 free flaps performed at the Royal Marsden Hospital under the care of one surgeon (NMB) over a 2-year period. 76 patients who underwent 77 free flaps were studied. 68 patients had malignant tumours and 8 had benign lesions. The flap success rate was 95% and the mortality rate 0%. The major complication rate was 20% and the most common complication was a salivary fistula (12%). Microvascular free transfer to the head and neck is not associated with increased morbidity and mortality. It offers single stage, reliable, effective reconstruction using a wide variety of donor sites and tissues.

Head↗
PubMed1990

Perineal, vulval and vaginoperineal reconstruction using the rectus abdominis myocutaneous flap.

Poor perineal healing is a major complication of total or partial pelvic exenteration especially when the pelvis and perineum have previously been irradiated. Perineal, vulval or vaginoperineal reconstruction was performed in five women using the inferiorly based rectus abdominis myocutaneous flap. Primary perineal wound healing occurred in all patients and no flap-related complications developed. Primary healing of abdominal wall wounds occurred in all patients without incisional hernia. Three of the patients had an anterior or total pelvic exenteration with continent urinary diversion by the Mitrofanoff technique. Two of the patients had complete vaginal reconstruction and one patient had after-loading catheters inserted for postoperative interstitial irradiation. The patients were in hospital for 42, 28, 21, 17 and 15 days respectively. The longest stays were associated with training for self-catheterization of the continent urinary diversion. Median follow-up was 9 months. One patient developed two perineal recurrences at 16 months which were resected, and she remains disease-free 6 months later.

Abdominal Muscles↗
PubMed1988

Reconstruction after excision of soft tissue sarcomas of the limbs and trunk.

From a retrospective analysis of 180 surgical interventions for soft tissue sarcoma of the limbs and trunk, it was concluded that complete excision of the tumour can usually be achieved without sacrifice of major artery, vein, nerve or bone. In this series five major arteries were resected but only one required reconstruction. None of six resected major veins or seven resected nerves were reconstructed. Bone resection in the limb required plating in only two of eleven patients who had limb-sparing resection (there were nine amputations). Both in the limbs and the thorax, resection of bone often involved such a wide excision of the superficial soft tissues as to require a flap repair: four were used in the limbs and three in five chest wall resections. In the majority of operations (140/180) primary wound closure was possible. After 15 procedures for tumour predominantly involving the superficial tissues, split skin grafts were used. These were generally successful (13/15), even occasionally when high-dose radiotherapy had been given. In 16 cases earlier radiotherapy influenced the decision to use a flap repair. A total of 18 flap repairs were performed. In various situations Mersiline mesh (Ethicon, Ltd., UK), Silastic implants and omental swings were used. Wound breakdown in heavily irradiated tissues presented a major challenge for reconstruction. Although major reconstruction was required in only 27 operations (15 per cent), a thorough knowledge of the available methods of reconstruction and repair is essential to allow uninhibited resection with an optimal aesthetic and functional result.

Arm↗