Septocutaneous perforator mapping and clinical applications of the medial arm flap

The medial arm flap has a long history but remains underused despite providing multiple advantages. We reviewed our experience with using the medial arm flap in order to clarify the distribution of septocutaneous perforators and its relationship with pedicled flap design.

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Digital Model Simulation Technology for Ear Reconstruction of Microtia with Craniofacial Asymmetry

Craniofacial asymmetry is often observed in microtia patients, duing to the accompanied craniofacial microsomia deformity, such as mandibular dysplasia and/or depression of the mastoid region, which makes it difficult to obtain symmetrical results in ear reconstruction [1]. In the process of reconstruction, both ear location and framework fabrication are interfered by the asymmetry. Mandibular hypoplasia and the heterotopic residual ear can not be regarded as an appropriate locating reference, which poses difficulties to the surgeon when determining the location for the reconstructed ear.

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Post mastectomy upper limb lymphedema: combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients’ related outcomes. a retrospective comparative study

Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. Several works have documented the efficacy of vascularized lymph node flap transfer (VLNT) for the treatment of advanced stage lymphedema. Given that the axillary scar may contribute to the patient's existing lymphedema, authors assumed that combining VLNT and scar release with fat graft could be an effective strategy of treatment. The purpose of this study is to compare the efficacy in limb's circumference reduction and health-related quality of life between a combined strategy, namely VLN and axillary scar release with fat grafting, and just VLN transfer for patients' affected by post mastectomy upper limb lymphedema.

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Carbon dioxide laser treatment in burn-related scarring: a prospective randomised controlled trial

To investigate the effect of ablative fractional CO2 laser (AFCO2L) on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment.

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“SCARLESS REVERSE UMBILICOPLASTY”: A NEW TECHNIQUE OF UMBILICAL TRANSPOSITION IN ABDOMNOPLASTY

The navel plays a major role in the aesthetics of the abdomen. A navel which is abnormally shaped, malpositioned or has evident scarring may compromise the outcome of an otherwise well executed full abdominoplasty. The aim of the technique in question is to recreate a navel that looks natural, with no visible scar and properly positioned.

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Revisiting the reconstructive surgery framework: the reconstruction supermarket

Plastic and reconstructive surgeons apply a variety of techniques throughout the body with analogies having evolved to provide a conceptual framework for the selection of techniques. Well-known examples include: the reconstructive ladder with increasingly complex rungs, the reconstructive elevator where the surgeon moves directly to the most suitable reconstruction, the reconstructive toolbox, and the reconstructive triangle.1,2 Extended models have been proposed to incorporate developments such as negative pressure wound therapy, and include the extended ladder,3 the reconstructive solar system,4 and the reconstructive clockwork.

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Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Abstract

Background

Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC).

Methods

Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD‐RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high‐dose radiation (HD‐RT) as an EQD2 >60 and <70 Gy.

Results

HD‐RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD‐RT was associated with increased mortality (HR1.09; 95%CI 1.02‐1.16). In nonoropharynx or human papillomavirus‐negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD‐RT was still not associated with improved survival (HR 1.01, 95% CI 0.91‐1.12).

Conclusions

There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high‐risk cohort.

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Dynamic changes in chemosensitivity immune predictors in patients with hypopharyngeal cancer treated with induction chemotherapy

Abstract

Background

There are currently no data predicting chemosensitivity of induction chemotherapy (ICT) for hypopharyngeal squamous cell carcinomas (SCC).

Methods

Associations between immune cells and overall response (OR) to ICT and changes in immune cells during ICT were observed in 40 patients with hypopharyngeal SCC undergoing ICT.

Results

CD4⁺ and CD8⁺ T‐cell and regulatory T‐cell (Treg) frequencies reached diagnostic accuracy for OR to ICT. OR rate was significantly higher in CD4⁺‐high T cell, CD8⁺‐high T cell, and low Treg groups. A transient reduction in Tregs and increases in Tregs in the non‐OR and OR groups were observed during the course of ICT. Conversely, increases in CD8⁺ T cells and reductions in CD8⁺ T cells in the non‐OR and OR groups were observed.

Conclusion

High CD4⁺ T‐cell, high CD8⁺ T‐cell, and low Treg frequencies can be predictors for high efficacy of ICT in patients with hypopharyngeal SCC.

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Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma

Abstract

Background

The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.

Methods

Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.

Results

A total of 10 832 patients were selected. Five‐year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses.

Conclusions

OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

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The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age‐related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

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Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SAbAW3

Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Abstract

Background

Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC).

Methods

Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD‐RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high‐dose radiation (HD‐RT) as an EQD2 >60 and <70 Gy.

Results

HD‐RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD‐RT was associated with increased mortality (HR1.09; 95%CI 1.02‐1.16). In nonoropharynx or human papillomavirus‐negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD‐RT was still not associated with improved survival (HR 1.01, 95% CI 0.91‐1.12).

Conclusions

There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high‐risk cohort.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SFecSq

Dynamic changes in chemosensitivity immune predictors in patients with hypopharyngeal cancer treated with induction chemotherapy

Abstract

Background

There are currently no data predicting chemosensitivity of induction chemotherapy (ICT) for hypopharyngeal squamous cell carcinomas (SCC).

Methods

Associations between immune cells and overall response (OR) to ICT and changes in immune cells during ICT were observed in 40 patients with hypopharyngeal SCC undergoing ICT.

Results

CD4⁺ and CD8⁺ T‐cell and regulatory T‐cell (Treg) frequencies reached diagnostic accuracy for OR to ICT. OR rate was significantly higher in CD4⁺‐high T cell, CD8⁺‐high T cell, and low Treg groups. A transient reduction in Tregs and increases in Tregs in the non‐OR and OR groups were observed during the course of ICT. Conversely, increases in CD8⁺ T cells and reductions in CD8⁺ T cells in the non‐OR and OR groups were observed.

Conclusion

High CD4⁺ T‐cell, high CD8⁺ T‐cell, and low Treg frequencies can be predictors for high efficacy of ICT in patients with hypopharyngeal SCC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MXh1sF

Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma

Abstract

Background

The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.

Methods

Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.

Results

A total of 10 832 patients were selected. Five‐year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses.

Conclusions

OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SFe8Ca

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age‐related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MXgVBj

Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

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Realization and representation of Nepali laryngeal contrasts: Voiced aspirates and laryngeal realism

In this study we push laryngeal realist theory in a new direction – to segments proposed to be specified for both [voice] and [spread] features – a combination which poses challenges to the current diagnostics. To do so, we analyze acoustic data from Nepali, an Indic (a.k.a. Indo-Aryan) language with a single class of stops described as both voiced and aspirated. We apply the same criteria and diagnostics used in laryngeal realism. We find support for the proposed representation, with a caveat that the [voice] feature appears 'stronger' than [spread]. (Source: Journal of Phonetics)

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Do Children Recall Numbers as Generic? A Strong Test of the Generics-As-Default Hypothesis

. (Source: Language Learning and Development)

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Exploring participation experiences of youth who use AAC in social media settings: impact of an e-mentoring intervention.

Authors: Grace E, Raghavendra P, McMillan JM, Gunson JS Abstract The contribution of cross-age peer e-mentoring on reported experiences of participation during online conversations using social media was explored in this pre-experimental study. Young people (n = 4, aged 13; 4-18;3 [years; months]) who used augmentative and alternative communication (AAC) participated in an e-mentoring intervention. Two mentors who also used AAC had regular conversations with the participants via Facebook 1 , email, or Skype 2 . It was predicted that the mentoring support would contribute to experiences of participation in online conversations outside of the e-mentoring intervention. Reported experiences of participation in online conversations with communication partners other than the mentor w...

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Loudness Trumps Pitch in Politeness Judgments: Evidence from Korean Deferential Speech.

Authors: Idemaru K, Winter B, Brown L, Oh GE Abstract Social meaning is not conveyed through words alone, but also through how words are produced phonetically. This paper investigates the role of loudness and pitch in determining the perception of politeness-related judgments in Korean. It has been proposed that high pitch is universally associated with polite or deferential social meanings. In contrast to this, Experiment 1 examined the perceptual effect of pitch and found no effect. Experiment 2 tested the effect of loudness, and found that listeners associate quieter speech with deference. Finally, Experiment 3 investigated the simultaneous effects of loudness and pitch, and found again that loudness had a consistent effect, whereas pitch only had a weak effect. Analyses of indi...

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