Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Optimizing Wound Healing in Radial Forearm Donor Sites: A Comparative Study of Ulnar-Based Flap and Split-Thickness Skin Grafting

Background: The radial forearm free flap (RFFF) is a common technique in head and neck reconstructive surgery. This study aimed to compare the clinical and biochemical outcomes of wound healing following ulnar-based transposition flap (UBTF) versus split-thickness skin grafting (STSG) for donor site closure, with a particular emphasis on tissue regeneration. Materials and Methods: A total of 24 patients (6 women, 18 men), underwent RFFF reconstruction. The donor site was closed using the UBTF technique in 10 cases, while STSG was performed in 14 cases. Postoperative complications-including necrosis, edema, hematoma, infection, and wound dehiscence-along with healing times were assessed daily during the first seven postoperative days and at monthly follow-ups over six months. Pre- and postoperative biochemical analyses included hemoglobin (HB), white blood cell count (WBC), platelets (PLT), albumin, and C-reactive protein (CRP) levels. An aesthetic evaluation of the flap was also performed. Results: The two groups were homogeneous. Postoperative complications occurred more frequently in the STSG group, which also demonstrated significantly longer healing times (p = 0.0004). In contrast, the UBTF group showed significantly better aesthetic outcomes in terms of skin color (p = 0.000021), skin texture (p = 0.000018), and flap stability (p = 0.0398). Additionally, pre- and postoperative PLT counts were significantly higher in the UBTF group (p = 0.001 and p = 0.043, respectively). Conclusions: While STSG remains a well-established method for forearm donor site closure following RFFF harvest, this study demonstrates that UBTF is a viable alternative associated with better clinical and aesthetic outcomes.

Impact of tumor localization and choice of microvascular flap on posterior airway changes following ablative surgery in primary oral squamous cell carcinoma: A monocentric cross-sectional study

BACKGROUND

The aim of this study was to determine the influence of intraoral reconstructions following oral squamous cell carcinoma (OSCC) resection with a free microvascular flap on the posterior airway space (PAS) and to correlate these results with the potential risk of developing an obstructive sleep apnea syndrome (OSAS).

MATERIALS AND METHODS

Only primary OSCC cases of the tongue or floor of the mouth which were operated and reconstructed. The PAS displayed in computed tomography (CT) scans at three time points were analyzed: t0 = preoperative, t1 = first postoperative CT, and t2 = most recent situation. The following three PAS parameters were calculated: minimum cross-sectional area (minCSA), mean cross-sectional area (meanCSA), and volume.

RESULTS

MinCSA increased from t0 to t2: t0 = 86.9 cm2 (0.0 - 251.8), t1 = 106.6 cm2 (1.0 - 483.4), and t2 = 124.8 cm2 (0.5 - 395.6). MeanCSA increased from t0 to t2: t0 = 225.1 cm2 (79.0 - 500.2), t1 = 247.8 cm2 (102.8 - 674.3), and t2 = 272.2 cm2 (92.2 - 668.4). The volume increased from t0 to t2: t0 = 21.5 cm3 (8.0 - 63.2), t1 = 24.1 cm3 (9.6 - 67.3), and t2 = 26.9 cm3 (6.2 - 67.4).

CONCLUSIONS

Posterior airway space PAS values became higher than preoperatively. In particular, flap type had a significant influence on the three PAS parameters.

Navigating the Complexities of Radiation Injuries: Therapeutic Principles and Reconstructive Strategies

Radiation injuries, particularly those resulting from therapeutic or accidental exposure, present complex challenges for medical management. These injuries can manifest localized skin damage or extend to deeper tissues, presenting as various clinical entities that require treatment strategies, ranging from conservative management to complex surgical interventions. Radiation treatment constitutes a fundamental component of neoplastic management, with nearly two out of three oncological instances undergoing it as an element of their therapeutic strategy. The therapeutic approach to radiation injury consists of expanding prophylactic measures while maintaining the efficacy of treatment, such as conservative treatment or local debridement followed by reconstruction. The armamentarium of reconstructive methods available for plastic surgeons, from secondary healing to free tissue transfer, can be successfully applied to radiation injuries. However, the unique pathophysiological changes induced by radiation necessitate a careful and specialized approach for their application, considering the altered tissue characteristics and healing dynamics. The therapeutic strategy is guided by both the severity and progression of the injury, with the primary aim of restoring functionality and aesthetic aspects while simultaneously minimizing the risk of complications. This paper explores the various conditions encompassed by the term "radiation injury," reviews both non-surgical and surgical therapeutic strategies for managing these injuries, and highlights the unique challenges associated with treating irradiated tissues within specific oncological contexts.