Re: Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: A national analysis

Simultaneous Restoration of Swallowing and Voice Function With Ileocolon Free Flap

BACKGROUND

Free ileocolon flap is a reliable technique allowing simultaneous restoration of swallowing and speech. The aim is to report our 6-year experience in a single center.

METHODS

Thirty-seven patients treated between 2010 and 2015 were included in the study. Swallowing and speech function were evaluated in 27 patients with a 7-point and 5-point Likert scale, respectively. Moreover, 12 of them consented to voice spectrum analysis (VSA).

RESULTS

Complications noted were: aspiration (3), esophagocutaneous fistula (2), and stricture (1). Seven patients experienced self-limited diarrhea. Regarding swallowing function, 77.8% scored ≥5 on Likert scale whereas speech Likert scale showed excellent results (score >12) in 74%. VSA demonstrated mean phonation time of 10.75 seconds, mean frequency of 131 Hz and mean dynamic range of 56 dB.

CONCLUSION

In experienced hands, the ileocolon flap is safe and effective, particularly in patients with long-life expectancy, providing good swallowing and speech function without further procedures/prostheses.

From the "Fat Capsule" to the "Fat Belt": Limiting Protective Lipofilling on Irradiated Expanders for Breast Reconstruction to Selective Key Areas

BACKGROUND

The number of patients undergoing mastectomy and immediate breast reconstruction with tissue expanders followed by post-mastectomy radiotherapy (PMRT) is exponentially increasing. To reduce the rate of complications, in 2011, the senior author of this manuscript described the use of protective lipofilling in patients undergoing unplanned PMRT to the expander with a specific protocol aiming to decrease the rate of complications.

OBJECTIVES

A study was performed to evaluate the thickness of the breast irradiated tissue to create a standard pattern of "protective" lipofilling infiltration on limited key areas that could re-establish a thickness similar to non-radiotreated tissues.

METHODS

We studied 15 patients who had modified radical mastectomy (MRM) with immediate breast reconstruction with tissue expanders and PMRT (Group 1) before expansion (Time1), before PMRT (Time2), after PMRT (Time3), 3 months after "protective" lipofilling (Time4), and 6 months after "protective" lipofilling (Time5). As a control group, we studied 15 patients who had MRM and immediate breast reconstruction with tissue expanders that would not undergo PMRT (Group 2) at the same time points of GROUP 1 (Time1,2,3). Tissue thickness was studied in specific areas using ultrasounds (US) and magnetic resonance imaging (MRI).

RESULTS

US and MRI measurements obtained 6 weeks after PMRT and 3 months after lipofilling showed an initial decrease and then an average increase in tissue thickness reaching values even higher than the non-radiotreated control group.

CONCLUSIONS

This preliminary report shows how a one-step "fat belt" surgical pattern of lipofilling delivered to central "selected" areas of the breast can achieve adequate tissue thickness in patients who underwent breast reconstruction with PMRT reaching a thickness similar (and in most cases higher) to non-radiotreated tissues. Further follow-up studies are needed to analyze long-term complications of tissue thinning such as ulceration and implant exposure, in comparison with the "fat capsule" pattern.

LEVEL OF EVIDENCE IV

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