plastische, reconstructieve en esthetische chirurgie - UZ Leuven

Unilateral glottic cancer and lateralizedchondrosarcomas of the cricoid cartilage are resectedwith a hemilaryngectomy including one-half of the cricoidcartilage. After tumor resection, a radial forearm flap witha skin paddle and a fascial paddle are taken. The skinpaddle restores the laryngeal defect temporarily, and thefascial paddle wraps the upper 4 cm of cervical trachea.A 'tracheostomy' is preserved in the area between thereconstructed larynx and the fascia-wrapped trachea.The radial forearm vessels are sutured to the neckvessels. After 4 months, the skin island of the radialforearm flap is removed from the defect and therevascularized, fascial enwrapped trachea istransplanted to the laryngeal defect. The trachealcontinuity is re-established with preservation of atracheostoma. The tracheotomy can be closed after 6weeks. Two case reports are presented: a unilateral T3glottic cancer and a chondrosarcoma of the cricoidcartilage. The two patients showed normal oral feeding 1week after the operation. Hand-free speaking waspossible after closure of the tracheostomy. Trachealautotransplantation after vascular induction of thetrachea with the radial forearm flap leads to optimalrepair of extended hemilaryngectomy defects.HIERNER R.: Operative treatment of pressure sores: howand when? J. Wound Healing, 2005; 10: 110-123.Pressure sores still presents a challenging problem ofdiagnosis and choice of treatment. Nowadays defectclosure alone is not sufficient to fulfil the criteria ofsuccessful defect reconstruction, which are as follows: 1)complete wound closure, 2) persistent wound closure, 3)functional reconstruction allowing early mobilization, 4)acceptable length of time for rehabilitation (and return tonormal life), and to a lesser degree 5) acceptableesthetic result. Successful treatment requires a globaltherapy concept based upon: 1) basic (plastic) surgicalprinciples, 2) defect-related factors, 3)- therapy relatedfactors, and 4) patient-related factors. The global therapyconcept is delivered by a multidisciplinary therapy-team(surgeon, nurse staff, physiotherapist, occupationaltherapist, social service...).HIERNER R., BECKER M., BERGER A.: Indications andresults of operative treatment in birth-related brachialplexus injuries. Handchir. Mikrochir. Plast. Chir., 2005; 37:323-331.Introduction: A review of the literature reveals that underconventional treatment alone or in combination withsecondary muscle/tendon transfer about 4 to 43% ofcases show incomplete recovery with severe functionaland/or aesthetic impairment. If those patients underwentearly microsurgical brachial plexus revision aregeneration without any significant functional and/or