Objective Define surgical outcomes of specific donor sites for free tissue transfer in head and neck reconstruction. Design Retrospective cohort review Setting Academic tertiary care center. Patients A review of free tissue transfer procedures performed at a university-based tertiary care facility from October 2004 to April 2011. A total of 1051 patients underwent 6 types of free flaps: fasciocutaneous radial forearm (53%), osteocutaneous radial forearm (16%), rectus abdominus (11%), fibula (10%), anterior lateral thigh (7%), and latissimus dorsi (2%). Main Outcome Measures Demographic data was collected and outcomes measured were: length of hospital stay, flap viability, and major complications (infection, fistula, and hematoma). Results Of the 1051 flaps performed, the most common operative site was oral cavity (40% n=414) followed by hypopharynx/larynx (22%, n=234), cutaneous (20%, n=206), oropharynx (9%, n= 98), mid-face (7%, n= 76), and skull base (2%, n=23). The median hospital stay was 7.9 days (range 1-76) and the overall failure rate was 2.8%. Cutaneous defects required the shortest length of hospitalization (5.8 days, P< .0001), a low free flap failure rate (1.5%, n= 3), and limited major complications (6%, n= 12). Conversely, oropharynx defects were associated with the longest hospitalization (8.9 days). While midface defects had a high incidence of complications (15%, n= 11, P=.10). Defects above the angle of the mandible had higher overall complications when compared to below. Similarly, reconstruction for primary or recurrent cancer had a total failure rate of 2.5% while secondary reconstruction and radionecrosis had a failure rate of 4.0% (P=.29). Additionally, there was no statistical difference between outcomes based on donor site. Conclusions This review demonstrates that certain subsets of patients are at higher risk for complications after free tissue transfer. Patients undergoing free flap reconstruction for cutaneous defects have substantially shorter hospital stays and are at lower risk of flap complications, while reconstruction for radionecrosis or secondary reconstruction tend to have higher overall flap failure rates.

Objective. To assess the advantages of using mechanical anastomotic systems in head and neck free tissue transfer. Study design. Case series with chart review. Setting. A university-based tertiary care center. Subjects and Methods. A retrospective review of mechanical venous coupler devices in head and neck reconstruction performed between October 2004 and December 2006. A total of 261 venous anastomoses were performed in 234 consecutive patients. Five types of flaps were performed: radial forearm (66%), anterior lateral thigh (12%), fibula (9%), rectus abdominis (8%), and latissimus dorsi (2%). Demographic data were collected, and the outcomes measured were flap survival and microvascular complications. Results. The size of the venous anastomosis ranged from 1.5 to 4.0 mm, with most being 3.0 mm (56%) followed by 3.5 mm (23%). The most common recipient vein used was an unidentified venous branch off the internal jugular vein (76%) followed by the external jugular vein (17%). Microvascular complications occurred in <5% (n = 11) of patients, with >50% of those being arterial insufficiency (n = 7). Total failures occurred in 3% (n = 7) of patients: 1.5% (n = 4) acute failures (<5 days) and 1.5% (n = 3) late failures. Of the acute failures, causes included venous congestion (n = 1) and arterial insufficiencies (n = 3). The venous coupler used in the failures was 3.0 mm in diameter. Free flap failures resulting from arterial insufficiency involved coupling to the external jugular vein, while the remaining free flap failures (n = 4) used the internal jugular vein. Conclusion. With an early venous failure rate of 0.38%, mechanical anastomosis is an adequate alternative to hand-sewn techniques.

Importance:As new institutions incorporate transoral robotic surgery (TORS) into their everyday practice, it is helpful to have a timeline reference of expected goals to follow as their experience increases. This article evaluates a single tertiary care academic institution's experience with TORS for head and neck tumors and reports its 4-year learning curve.Objective: To evaluate a single institution's experience with TORS over a 4-year period and report treatment trends and clinical outcomes.Design: Prospective case study. Results: Significant decreases in operative time, length of intubation, and hospital stay were seen as TORS experience increased. Overall, the mean operative time decreased by 47% (group 4, 86 minutes; group 1, 183 minutes). Total mean intubation time decreased by 87% (group 1, 12.9 hours; group 4, 1.7 hours) and mean hospital stay decreased from 3.0 days to 1.4 days. There was not a significant difference between groups in number of cases unable to be performed robotically (7-9 per group), tumor stage (majority T1/T2), tumor subsite (majority oropharynx), positive margin status (2-5 per group), number of salvage cases performed (7-9 per group), and number of tracheostomies (2-4 per group) or feeding tubes (22-25 per group) required. Conclusions and Relevance:This is the first multiyear prospective study to document a single institution's TORS experience over time and demonstrate particular areas of expected improvement as case number increases.

CD147 is upregulated in multiple cancer types, but its expression in advanced cutaneous squamous cell carcinoma (cSCC) is unknown. This study retrospectively evaluated the expression patterns of CD147 and related proteins monocarboxylate transporters (MCT1, MCT4) in patients with advanced stage cSCC (n=50). CD147, MCT1 and MCT4 expression levels were assessed in archived tumor samples and correlations were made with survival and clinicopathologic characteristics. The incidence of CD147 overexpression (93%, n=42) was higher than that of MCT1 (23%) or MCT4 (47%). Colocalization of MCT1 or MCT4 with CD147 was also observed. The two-year survival rate was 69% and the 5-year survival rate was 61%. A trend towards decreased survival was seen with overexpression of CD147 (p= .17), MCT1 (p= .11) and MCT4 (p= .15). Expression levels were not correlated with clinicopathologic characteristics. CD147 is overexpressed in the majority of advanced cSCC and may represent a biomarker or potential therapeutic target.

BackgroundTongue fibrosis resulting from head and neck cancer, surgery, radiation, chemotherapy, or a combination thereof devastates one's quality of life. Therapeutic options are limited. Here we investigate human bone marrow–derived multipotent stromal cells (MSC) as a novel injectable treatment for post‐injury tongue fibrosis.MethodsMSCs were grown in culture. Eighteen athymic rats underwent unilateral partial glossectomy. After two weeks for scar formation, a single injection was performed in the tongue scar. Three treatment groups were studied: low and high concentration MSC, and control media injection. Tongues were harvested for evaluation at three weeks post‐treatment.ResultsDense fibrosis was achieved in control animals at five weeks. High concentration MSC reduced cross sectional scar burden (P = .007) and pathologic score for inflammation and fibrosis.ConclusionThis study establishes the feasibility of a novel rodent tongue fibrosis model, and begins to assess the utility of human MSCs to reduce scar burden.Level of EvidenceN/a

RMCs seemed to often be undissected during primary FESS and, thus, were commonly encountered in revision FESS. The majority of analyzed cells in this cohort demonstrated an LM score of ≥1, which indicated that these cells frequently harbor residual diseased mucosa that may contribute to the need for revision surgery.

CD147 is upregulated in multiple cancer types, but its expression in advanced cutaneous squamous cell carcinoma (cSCC) is unknown. This study retrospectively evaluated the expression patterns of CD147 and related proteins monocarboxylate transporters (MCT1, MCT4) in patients with advanced stage cSCC (n=50). CD147, MCT1 and MCT4 expression levels were assessed in archived tumor samples and correlations were made with survival and clinicopathologic characteristics. The incidence of CD147 overexpression (93%, n=42) was higher than that of MCT1 (23%) or MCT4 (47%). Colocalization of MCT1 or MCT4 with CD147 was also observed. The two-year survival rate was 69% and the 5-year survival rate was 61%. A trend towards decreased survival was seen with overexpression of CD147 (p= .17), MCT1 (p= .11) and MCT4 (p= .15). Expression levels were not correlated with clinicopathologic characteristics. CD147 is overexpressed in the majority of advanced cSCC and may represent a biomarker or potential therapeutic target.

Inhibition and downregulation of CD147 in cutaneous SCC resulted in suppression of the malignant phenotype in vitro and in vivo, which may be mediated in part by an alteration in EGFR expression. As a result, CD147 may serve as a potential therapeutic target for advanced cutaneous SCC.