Aim:The aim is to study the assessment of feasibility of medial sural artery perforator (MSAP) free flap for head and neck reconstruction at our center.Materials and Methods:Oral cancer patients with squamous cell carcinoma of the tongue, buccal mucosa, and floor of mouth cancer attending our center were reconstructed using MSAP flap after oncologic resection. Handheld 8 MHz Doppler was used to identify the perforator preoperatively.Results:We reconstructed 10 patients using MSAP flap. The flap was designed according to defect and donor site was primarily closed in all cases. Excellent results were seen in nine patients reconstructed with MSAP flap without any postoperative complication. Flap failure occurred in one patient due to venous thrombosis. The thickness of flap ranged from 4 to 8 mm. The vascular pedicle length ranged from 9 to 13 cm.Conclusion:The MSAP flap is appropriate for medium-sized oral defect reconstruction, with a long pedicle of matching caliber, adequate tissue volume, and minimal donor-site morbidity which makes it comparable to other microvascular free flaps such as radial artery free flap (RAFF) and anterolateral thigh flap.
The aim of this paper is to study the outcome of single-layer end to side dunking pancreatojejunostomy technique in 32 patients of malignant pancreatic disease undergoing Whipple's surgery in a tertiary care oncology centre in India. From January 2013 to January 2016, 32 consecutive patients who underwent pancreatoduodenectomy for malignant diseases were analysed retrospectively. All the patients underwent standard Whipple's operation. Pancreatojejunostomy was established in a single-layer end to side dunking manner with PDS 4-0. Various patient data, i.e. preoperative symptoms and demography, intra-operative time, blood loss and need of blood transfusion, postoperative hospital stay and complications, were noted. Mean operative time was 3.5 h approximately. Mean blood loss was 328 ml approx (range 150-600 ml). Postoperative delayed gastric emptying was observed in 8 (25%) patients. Three (9.4%) patients developed superficial surgical site infection. Mean hospital stay was 16.5 days (range 13-20 days). There were no pancreatic leak or fistula and no perioperative mortality. It is a feasible technique. It achieved zero leak rates, zero mortality and minimal morbidity without compromising any oncologic principles.
Background: Papillary squamotransitional cell carcinoma is a histopathological subcategory of squamouscell carcinoma of the uterine cervix that often resembles transitional cell carcinoma of the urinary tract.Histologically, it can be misdiagnosed as transitional cell carcinoma or other papillary lesions of thecervix. Stromal invasion on biopsy is difficult to diagnose due to the exophytic papillary growth of thetumor. It also has a propensity for local recurrence and late metastasis. The study is performed to diagnoseand categorize this uncommon variant of carcinoma cervix.Materials and Methods: Eighteen cases of Papillary squamotransitional cell carcinoma were diagnosedon a punch biopsy specimen on routine hematoxylin and eosin-stained sections. The tumors werecategorized into three groups according to the percentage of squamous and transitional components.Further, immunohistochemical evaluation for cytokeratin7 and cytokeratin20 was done.Results: The mean age of the patients was 51.61 years (range 37-62 years). The most common clinicalpresentation was postmenopausal bleeding. All the cases showed papillary architecture with fibrovascularcores. The papillae were lined by three cell types: clear, intermediate, and basaloid. Stromal invasionwas seen in all the cases. All the cases showed positive immunostaining for cytokeratin7 and negativeimmunostaining for cytokeratin20.Conclusions: Papillary squamotransitional cell carcinoma deserves accurate pre-operative biopsydiagnosis due to the risk of misdiagnosis as benign papillary or malignant transitional lesions.Immunohistochemistry plays an important role in the diagnosis of these tumors and is recommended inevery case. Late recurrence and metastasis warrants a longer duration of follow up.
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