A comparison of wound healing between irradiated and nonirradiated patients after radical neck dissection.
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1. Approximately 40,000 cases of cancer of the head and neck (excluding skin) are diagnosed each year. 2. Approximately 20,000 of these cases and 30,000 cases of skin cancer are treated by 366 head and neck cancer surgeons. 3. Ninety per cent of the cases are treated by 63 per cent of the surgeons. 4. Fifty-eight per cent of the surgeons care for between 50 and 300 cases per year. 5. While 2,759 new board-certified surgeons of all specialties are recruited annually to maintain a work force of 46,000 board-certified surgeons (3), apparently 730 potential head and neck cancer surgeons are being prepared to maintain a work force of approximately 450 head and neck cancer surgeons. 6. These findings indicate the need for in-depth study of the manpower needs in head and neck cancer surgery by all who are responsible for the training of surgeons in this field.
Three hundred ten evaluable patients received a classic, functional, or spinal accessory-nerve-sparing neck dissection during 1970 to 1975. The functional procedure was at least equal to the classic procedure in the patients in whom it was employed. The spinal accessory-nerve-sparing operation is offered as an alternative to the classic procedure in all patients in whom the nerve is not directly invaded by cancer. If these guidelines are followed, the patient will rarely experience the pain and shoulder dysfunction that result from the loss of the trapezius muscle, while the chances of control of cancer in the neck remain optimal.
Head and neck reconstruction using a free flap composed of latissimus dorsi muscle and overlying skin and attached to vascularized posterior rib based on the thoracodorsal vessel was recently developed in our laboratory. Further clinical experience in the use of this flap is presented, along with a detailed explanation of the surgical technique. This flap provides internal lining, structural support, bulk, and external coverage for head and neck defects in one stage. Herein alternative composite free flaps have been compared with this flap.
The intramandibular sliding myoosseous graft provides a new technique for reestablishment of mandibular continuity. It is well suited for immediate or remote reconstruction of midline or unilateral defects. Close attention to constructing smooth, confluent bone margins reduces the probability of mucosal fenestration. We have found that rigid direct osseous fixation improves the rate and quality of osteosynthesis. The technique is a useful and simple addition to the reconstructive armamentarium.
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The use of the Chinese or radial forearm flap to provide simultaneous oral lining, mandibular reconstruction and skin cover is reported in three patients, and suggestions are made about flap design.
The radial forearm flap has been well described for reconstruction of the oral cavity. The flap is most commonly used as a single-paddle flap with or without a segment of vascularised radius. Double-paddle radial flaps may be required to reconstruct defects of intraoral lining and overlying skin following excision of extensive tumours. We wish to report the first described case of reconstruction using a triple-paddle radial forearm flap including a segment of vascularised radius.
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