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Biomedical subjects

G A Sisson

Publications and source records attributed to G A Sisson.

At least 73 records · Page 4Linked to original sources
PubMed1981

Pectoral myocutaneous island flap for reconstruction of stomal recurrence.

In 1962, one of us (G.A.S.) reported six mediastinal dissections for stomal recurrence after laryngectomy. Reconstruction of the superior mediastinum depended on the use of several regional flaps. Adequate soft-tissue and muscle coverage is mandatory to avoid major complications in this (usually) previously radiated and/or surgical field. Seven cases in which the greater pectoral myocutaneous island flap was successfully used for a one-stage reconstruction after ablative surgery for stomal recurrence have been reported in the literature. Our series of six patients supports the use of this flap in reconstruction after mediastinal dissection. Partial skin sloughing occurred in two patients. In one patient, a major complication of necrosis of the flap and an innominate artery rupture occurred. A review of this last case reinforces the necessity of adequate artery coverage in reconstruction.

Carcinoma, Squamous Cell↗
PubMed1981

Immediate reconstruction of mandibular defects with a composite sternocleidomastoid musculoclavicular graft.

The problem of mandibular reconstruction has been approached using many surgical techniques. This article studies one such approach--reconstruction using full-thickness clavicle pedicled on the sternocleidomastoid muscle. Five patients with stage II and stage III carcinoma of the anterior part of the floor of the mouth were treated with mandibular resection and neck dissection. The resulting defects were immediately reconstructed with the clavicle-sternocleidomastoid muscle technique. The patients were observed from one to three years and were examined postoperatively with technetium Tc 99m medronate scans, which demonstrated the grafts to be viable. The technique proved reliable in a limited clinical trial.

Carcinoma↗
PubMed1981

Lymphatics of the floor of the mouth and neck: anatomical studies related to contralateral drainage pathways.

An anatomical study was made to determine the role of the regional lymphatic drainage pathways in contralateral flow from the floor of the mouth in the dog. Microsurgical techniques were used to cannulate and perfuse a lymphatic vessel. Following a two hour infusion, bilateral radical neck dissections were performed. An efferent upper jugular communicating pathway was repeatedly identified which crossed the midline and drained into the contralateral subdigastric group of nodes. These studies demonstrate a precise role for the regional lymphatic drainage pathways in contralateral flow from the floor of the mouth.

Animals↗
PubMed1980

Pseudoglottis procedure: update and secondary reconstruction techniques.

Since our first report of 12 cases in 1977, we have added 37 cases and continue to modify our primary procedure for the reconstruction of a pseudoglottis after total laryngectomy. It has been and continues to be applied to a growing number of patients. We have also introduced a procedure modified after Staffieri for the secondary reconstruction of a pseudoglottis after total laryngectomy. A review of our cases reveals that a high percentage have achieved a good voice. Complications and problems continue and are further examined in this report. The current techniques and indications for the secondary reconstruction procedures are discussed. Even with the continuing problems, we believe that the use of Staffieri techniques or modifications thereof continues to be promising and may well become an accepted procedure in American laryngeal surgery.

Artificial Organs↗
PubMed1979

Human laryngeal reinnervation: the Northwestern experience.

Recent publications have reported impressive success with laryngeal reinnervation utilizing a nerve-muscle pedicle. This innovative surgical procedure is claimed to be useful for unilateral and bilateral vocal cord paralysis. Although the surgical results reported by Tucker have been good, they have lacked corroboration from other centers. We have performed six laryngeal reinnervation procedures at Northwestern University Medical School. Four patients presented with bilateral vocal cord paralysis and two patients with unilateral paralysis. All six operations were successful in restoring vocal cord function. The technique, problems, and results are discussed. Our experience supports the initial reports of success with this new operation.

Aged↗
PubMed1978

Adjuvant methotrexate and leucovorin in head and neck squamous cancer. Two-year follow-up of a pilot project.

A series of 17 patients with stage III and IV head and neck cancer received three cycles of methotrexate and leucovorin calcium during an interval of two weeks prior to surgery and/or radiotherapy. The dosage of methotrexate was sequentially escalated to produce mucositis (the usual dose-limiting toxicity). All patients have been followed up for a minimum of two years (range, 24 to 44 months). Two recurrences and two second primary tumors occurred in seven patients with stage III cancer, and one recurrence and one postoperative death (pulmonary embolism) occurred in ten patients with stage IV cancer. Seventy-six percent of patients survived, with 71% disease free. Mucositis occurred in 88% but was transient and prevented oral fluid intake in only one patient. Bone marrow suppression was usually mild and did not delay surgery. Escalation of dosage was thought to be important in achieving these encouraging results. A controlled trial is under way to better define the degree of efficacy of this regimen of adjuvant chemotherapy.

Adult↗
PubMed1978

Total laryngectomy and reconstruction of a pseudoglottis: problems and complications.

A modified procedure for the reconstruction of a pseudoglottis after total laryngectomy is examined. The history of this technique, including our experience, is reviewed with emphasis on problems and complications. Indications and justifications for surgery are discussed. Though we can only speculate on the basis of a few cases, we believe that a good voice can be obtained when a pseudoglottis is either primarily or secondarily constructed after laryngectomy. We acknowledge that perhaps the risk of liability tempers our approach and restricts our case selection which, no doubt, in part accounts for our modification of the procedure that was initially performed in Europe. We believe that continued careful application of this technique and its variations will improve the results of modern laryngeal surgery.

Glottis↗
PubMed1977

Mediastinal dissection--1976: indications and newer techniques.

Head and neck neoplasms may invade the mediastinum by direct extension or metastases to the tracheoesophageal or jugulo-subclavian lymph nodes. The clavicles and manubrium are a barrier to adequate resection in this type of disease. In 1962, the senior author reported six mediastinal dissections for stomal recurrences after laryngectomy. Later techniques for staging the removal of manubrium and clavicles and preparing the regional flaps were devised to avoid major complications arising from operating in this area which usually had prior treatment with radiation and/or surgery. Over 60 transsternal radical neck dissections have been performed in the past 20 years. We have in the past evaluated the morbidity and survivals in stomal cases and present here our revised indications and techniques.

Dissection↗
PubMed1977

Tumors of the major salivary glands.

Tumors of the major salivary glands are reviewed according to classification, location, surgical procedure and end results. Our data of the incidence of benign and malignant tumors show that the most commonly involved area is the parotid gland and the most frequent is of the mixed variety. In the parotid region 80 percent are benign and 20 percent are malignant; whereas, in the submandibular gland, the malignant and benign tumors are equally distributed. The need for an extensive surgical attack and inclusion of contiguous structure is dictated by the nature of the malignant disease. The role of postoperative irradiation is discussed as is the indication for neck dissection. Management of the facial nerve, relative to malignant tumors of the parotid gland, is considered in detail.

Adenocarcinoma↗
PubMed1977

Squamous cell carcinoma of the soft palate.

Thirty-eight patients with squamous cell carcinoma of the soft palate treated between 1960 and 1975 were reviewed. Males in the seventh decade predominated. All symptomatic patients complained of sore throat and/or odynophagia. Seventy-eight percent were symptomatic less than three months. Approximately equal numbers of patients presented with T1, T2, and T3 tumors. Twenty-seven percent had cervical metastases when initially seen. The majority (89%) of patients were treated with radiation initially and the remainder (11%) received radiation therapy at the time of postsurgical recurrence with an absolute five year survival of 33%. Patients less than 60 years of age and those with small primary tumors and no neck metastases demonstrated better survival. Radiation therapy to the primary tumor and neck appears to be the preferred modality of initial treatment.

Adult↗
PubMed1976

Clinical staging of cancer of the head and neck: a new "new" system.

A revised clinical staging system for cancers arising in head and neck sites has been prepared. It utilizes a uniform N classification for cervical node metastases. The T classifications describing the extent of the primary tumor are generally similar but differ in specific details for each site. Although the present system makes use of past field trials and more recent clinical studies, it cannot be considered final. Clinicians managing cancer in head and neck sites are encouraged to test the system with their own patient data to elicit further areas for improvement.

Head and Neck Neoplasms↗
PubMed1975

Transsternal radical neck dissection. Postoperative complications and management.

In 1962, Sisson et al reported the use of the transsternal radical neck dissection for carcinoma recurring in the peristomal area after laryngectomy. We have performed over 50 transsternal radical neck dissections in the past 14 years. A significant number of early cases succumbed to the postoperative problems of fistula, infection, and large vessel rupture. Our two cases illustrate intraoperative and postoperative complications. Management of these complications is discussed. Morbidity and mortality has decreased as we have gained experience in the management of these problems.

Aneurysm↗
PubMed1975

Voice rehabilitation after laryngectomy. Results with the use of a hypopharyngeal prosthesis.

The Northwestern voice prosthesis for laryngectomees is described. The prosthesis contains no vibrator but activates vibration of the patient's pharyngeal or upper esophageal tissue by transporting air from the tracheostoma to a fistula in the upper neck, well away from major blood vessels. The prosthesis fits directly onto the laryngectomy tube and allows the patient to breathe, speak, and cough without any manual adjustments. The important advantage of this prosthesis is the fistula location. It can be placed at the time of original surgery and is also workable in patients who have had radiation and extensive radical surgery with total reconstruction of their gullet. The prosthesis can be used by primary total laryngectomees while learning esophageal speech or installed in those who are unable to use the electronic larynx or to learn esophageal speech. Four case studies are presented.

Adult↗