Management of two rare cases of dermatofibrosarcoma protuberans arising in the parotid region

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour, accounting for less than 1% of malignant tumours of the head and neck region. This tumour rarely presents metastatic disease, but has a high recurrence rate. Therefore, wide surgical excision with microscopically free margins is the therapeutic gold standard. Only five cases are described in literature of this tumour arising in the parotid region, a site that presents challenges both in achieving a wide demolition and in reconstructing the resulting defect. Here we describe two cases of DFSP arising in the parotid region that were treated surgically, achieving microscopically free margins. Reconstruction of the vast skin defect was achieved by means of a supraclavicular artery island flap, with good functional and aesthetic results.

Technique of neo-pharynx reconstruction with supra-clavicular artery island flap in a case of pharyngeal stricture

<p class="abstract">Pharyngeal stenosis frequently occurs after laryngectomy or laryngo-pharyngectomy, more commonly in patients complicated with a post-operative pharyngo-cutaneous fistula. Oral feeding becomes challenging, restricted to liquids. In such cases, dilatations can be futile if there is a complete stricture necessiating surgery. We present a case of 72 -year-old man who underwent total laryngectomy with partial pharyngectomy with pectoral major myocutaneous flap reconstruction for second primary of hypopharyngeal T3N0M0, after primary laryngeal T1N0M0 treated with RT presented with nearly 4 cm pharyngeal stricture causing him absolute dysphagia. Multiple dilations failed to create adequate passage, pharyngeal stricture was then excised, and a neopharynx was constructed with supraclavicular artery island flap. The outcome was uneventful with restoration of normal pharyngeal permeability and swallowing by 12^th post-operative day. Post-operative follow-up after 8 months remained satisfactory. Resection of limited height pharyngeal stenosis can be successfully performed as end-to-end anastomosis whereas reconstruction of a long segment pharyngeal stricture utilizing a loco-regional flap gives satisfactory outcome.</p>

Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ≤ 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

Use of the supraclavicular artery island flap for reconstruction of maxillofacial defects: a case report and literature review

Background Free flaps are widely used in maxillofacial reconstruction; however, this approach was not feasible in the current case. It was not possible because the free flap method requires microvascular anastomosis expertise, which is difficult, time-consuming and costly. Case presentation An 86-year-old woman suffered squamous cell carcinoma on the right side of her face, which resulted in a large soft-tissue defect. Here, we present a case of facial reconstruction from the inferior margin of the jaw to the top of the head. The size of the defect was 18.5 cm × 7.5 cm, which is rare for a patient of this age in the maxillofacial area. We used the supraclavicular artery island flap (SCAIFP) which measured 19.3 cm × 8.3 cm to repair the defect. After the operation, the flap survived without complications. Then, the patient was followed for 10 months and was satisfied with the aesthetic and functional results at the donor and recipient sites following the tumour resection. The tumour did not recur, and facial nerve function was preserved. Conclusion Our results provide a new choice for the reconstruction of large defects of the head and face, and expand the potential applications of the SCAIFP.