During the 5-year period from July 1984 to 1988, 72 patients over the age of 50 underwent microvascular free tissue transfers for head and neck reconstruction. There were 22 patients aged 50-59 years, 31 patients aged 60-69 years, and 19 patients aged 70-79 years. Seventy of these procedures (97%) were done at the time of ablative surgery utilizing a two-team approach. There was 1 total flap loss for a flap viability rate of 99% (73/74). There were 46 complications in 40 patients: 21 surgical and 25 medical. Twelve of the surgical complications required reoperation for a major surgical complication rate of 16%. Major medical complications developed in 12 patients (16%). Medical complications more commonly were observed in patients aged 60-69 years who had significant preoperative comorbidity and were classified as ASA class 3 or greater. There were 5 postoperative deaths for a mortality rate of 7%. Advanced chronologic age does not compromise the technical success of microsurgical free tissue transfer in the elderly patient with head and neck cancer. The risk of medical complications is significant and is directly related to concurrent illness of the individual patient rather than to age alone.

Age Factors↗

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The contribution of microsurgical reconstruction to craniofacial surgery.

Craniofacial surgery has revolutionized the surgical treatment of congenital anomalies affecting the facial and cranial skeleton. Similar techniques have since been used in the reconstruction of patients with extensive craniofacial injuries and following craniofacial resection of tumors involving the midface. The application of microsurgical free flaps to some of these craniofacial problems is another significant advance. Microsurgical transfer of deepithelialized skin flaps or omentum will allow the augmentation of soft tissue contour defects of the face in patients with hemifacial microsomia and Romberg's progressive facial hemiatrophy. Following craniofacial resection of extensive tumors of the midface, microsurgical free flaps and vascularized bone grafts will provide soft tissue coverage and, occasionally, both bone and soft tissue composite reconstruction of the resultant defect. Finally, intracranial infection, following craniofacial surgery and neurosurgical excision of tumors involving the skull base, may be effectively prevented by separation of the dura from the nasopharynx by microsurgical transfer of free muscle flaps and omentum.

Adult↗

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Vascularized free-tissue transfer in head and neck surgery.

Microsurgical vascularized free-tissue transfer has had a dramatic impact on the field of head and neck reconstruction. This technique has extended the extirpative limits of resection by facilitating complex reconstruction of head and neck defects in one stage with very high success and minimal patient morbidity. Although its impact on improving cure rates and survival statistics has yet to be determined, it has proven very valuable in the palliation of patients with advanced malignancies. The horizons for future applications are infinite. Neurotization of free-flap transfer may potentially improve the functional outcome for patients. In the future, free flaps may be prefabricated to allow for improved mandibular reconstruction or tracheal reconstruction. These tissue composites may potentially be a vehicle through which adjuvant therapy can be better delivered to the tumor bed. Microsurgical free-tissue transfer will have an expanding role in the treatment of patients with head and neck tumors, and continued refinements in these techniques will open new vistas for the reconstructive surgeons in the future.

Face↗

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Panic-fear: a personality dimension related to intractability in asthma.

A 15-item MMPI scale has been developed that relates to the reported frequency of panic-fear symptoms on the Asthma Symptom Checklist (ASC). High scale scores describe fearful, emotionally labile individuals who profess to be more sensitive than others and unable or disinclined to persist in the face of difficulty. The relationship between the MMPI panic-fear scale and the ASC panic-fear symptoms is highly replicable and related to a crucial aspect of chronicity in asthma. High scoring asthmatic patients were prescribed more intensive discharge steroid regimens upon completion of residential treatment. This relationship was not mediated by available objective pulmonary function measurements used to index medical condition. Development of the MMPI panic-fear scale should enable further investigation of personality and behavioral aspects related to the perceived severity and intractability of other medical conditions and disabilities.

Adaptation, Psychological↗

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Attitudes of Korean and American mental patients toward mental illness and hospitalization.

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Attitude↗

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Candida peritonitis treated with 5-fluorocytosine in a patient receiving hemodialysis.

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Adult↗

PubMedDate not supplied

Operative procedures: is standardization feasible or necessary?

Standardization of surgical procedures is both feasible and necessary in clinical trials. To the extent that an operation may influence prognosis, identify prognostic factors, or reveal variables upon which additional treatment is contingent, the operation must be defined precisely enough to permit the determinations to be made uniformly and to enable the surgeons to meet the necessary standardization. If uniform procedures are to be applied widely, surgeons who participate in therapeutic trials must meet the standards of clinical scientists and accept special obligations for eduction and self-discipline.

Age Factors↗