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Click photo to enlarge Cancer Surgery Head
& Neck Cancers If
cancer surgery has been revolutionized in the earlier part of the last
century by the introduction of better anaesthesia in the latter part
of the century this credit surely goes to better Reconstructive Surgery.
Ablative surgeries for Head and Neck Cancers, Oesophageal cancer, Breast
Cancer, Penile cancer and Cancers of skin and soft tissues owe a lot
of their success and acceptability to the current reconstructive techniques. The use of vascularized composite tissue to reconstruct lining, cover and bone has ensured not only lesser infection and fistula formation in Oral cancer patients but also assured good quality dental prosthesis with perfect occlusion courtesy osteo-integrated implants. Our easy access to the skull base today ensures cranio-facial tumour clearance, and our micro-surgical free tissue transfer ensures best possible reconstruction. Free micro vascular jujunal grafts are an ideal answer to the post oesophagectomy defects. With
more and more breast cancer patients being detected early and with better
available adjuvant therapy, more and more post mastectomy patients are
opting for breast reconstruction, and now with convincing evidence that
breast reconstruction does not prevent early detection of recurrences
but conversely ensures better tolerance to radiotherapy of the local
site, more and more surgeons doing mastectomy are suggesting the possibility
of reconstruction to their patients.
The
traditional Abdomino-pereneal resection for Cancers of Anal Canal has
also been repackaged for patient’s comfort. The large raw area in the
perineum, which was usually left to heal secondarily is now routinely
covered by an inferiorly based Rectus Abdominis Myocutaneous flap or
a Pereneal Lotus perforator flap. Penis
is the newest organ, which we have tried to reconstruct after ablative
cancer surgery. A micro-vascular Radial forearm flap or the 2nd. Toe
on Dorsalis pedes pedicle can be used for this purpose and it forms
a nice long urinary conduit. Skin and Soft tissue cancers are best left to the ingenuity of the Reconstructive surgeon to restore both form and function, but perhaps the most recent challenge is the salvage of distal normal limbs in ablative surgery for proximal locally malignant lesions like Osteoclastoma using Chimeric Peroneal Artery flaps with separate vascular branches supporting part of Fibula, soleus muscle, Peroneal nerve and skin with deep fascia. With a wealth of 158 Soft tissue reconstructions in Head & Neck Cancers, 68 mandibular reconstructions, 76 Breast reconstructions, 80 Skin and Soft tissue reconstructions, 24 Pereneal reconstructions, 9 Penile reconstructions, 7 distal limb salvages and 12 Oesophageal reconstructions under our belt, we are today in an enviable position to highlight the importance of Reconstructive Surgery in the management of Cancer patients. Mandibular reconstruction Graduating from the era of non vascularized bone grafts to the present age of vascularised bones for reconstruction of the missing segment of mandible, we appreciate a marked change in our cosmetic and functional results. The morbidity associated with the loss of mandibular segment has reduced considerably because of the primary bony union achieved by vascularized grafts. The prolong post operative morbidity of bone necrosis, osteomylitis, fistula formation, fibrous bony union, and inability to withstand masticatory pressure are problems which are less and less encountered today. Osteo-integrated implants can support good quality dentures of reasonable functional efficacy. We have used vascularised split iliac bone grafts mostly and find them better than vascularised fibula and second metatarsal. Breast
Reconstruction The last two decades has seen a dramatic evolution in the quality, predictability and complication rate in post mastectomy breast reconstruction. Early detection, better understanding of the disease and better adjuvant therapy has prompted the surgical oncologist towards tissue conservation. Historical concerns that immediate breast reconstruction may compromise tumour ablation, alter survival or impede detection of recurrences, has been most convincingly addressed. Now we know for certain that the reconstructed breast tolerates Radiotherapy better than skin grafted chest wall. Our
experience of 76 Post Mastectomy Breast Reconstructions, using mostly
TRAM flap and LD flap and sparingly Superior Gluteal artery flap and
DIEP flap has over the last decade helped us to evolve a method of
symmetrical breast reconstruction if the uninvolved breast is not too
big or too pendulous. Nipple areola reconstructions have also improved
all these years from tattooing to nipple sharing to reconstruction with
pigmented skin but nipple areola sparing mastectomies have made it
possible to give excellent cosmetic results.
Head
& Neck Cancers
Parotid
Tumour
Useful Links: www.tatamemorialcentre.org |
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