Repair of large wounds on the back.
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Back↗
Biomedical subjects
W R Panje
Publications and source records attributed to W R Panje.
Angiosarcoma of the head and neck: review of 11 cases.
In this report, 11 cases of angiosarcoma of the head and neck are reviewed. The patients ranged in age from newborn to 78 years; mean age was 64 years. There were eight men and three women. Sites of involvement included the scalp and forehead, cheek, nose and ethmoid sinuses, neck, and mandible. Surgery was the primary method of treatment. The 2-year survival rate was 50% (5/10) and the 5-year survival rate was 22% (2/9). Regional metastases were seen in 18% (2/11). We found that the tumors were poorly circumscribed and spread horizontally within the dermis for considerable distances, especially in the scalp. Total surgical excision using frozen section control before reconstruction may offer the best chance for control of disease.
Adolescent↗
Tracheal stoma reconstruction.
A simple surgical technique prevents or corrects tracheostoma stenosis. Forty-eight (96%) of patients undergoing laryngectomy in whom this technique was used have maintained adequate stomal size for cleaning, ventilation, and tracheoesophageal fistula speech restoration.
Constriction, Pathologic↗
Mandible reconstruction with the trapezius osteomusculocutaneous flap.
The use of the trapezius osteomusculocutaneous island flap for mandibular reconstruction was first described in the American literature by Panje and Cutting in 1980. Since that initial description, we have utilized this composite flap to reconstruct the lower jaw in 24 patients. Approximately 85% of the cases were done for anterior arch defects and/or osteoradionecrosis. With an overall success rate of 87%, this surgical technique offers an especially useful method for immediate reconstruction of the lower jaw.
Adult↗
Extension of the musculocutaneous flap by surgical delay.
The musculocutaneous flap has limits on survival of its skin segment. Random skin extensions beyond muscle margins have, by clinical experience, been shown to survive. It has not been proved, however, what quantity of random skin will survive or whether its viable dimensions can be augmented by surgical delay. Twenty-five porcine musculocutaneous island flaps were created with a random skin extension running beyond the likely limit of survival. Twenty-five paired contralateral flaps subjected to a surgical delay one week earlier were raised simultaneously. The surviving dimensions of random skin on both control and experimental flaps were measured 14 days after delay. The control flaps sustained random skin segments one to 48 times their area of muscle while the delay doubled this, engendering more predictable survival. A new, successful experimental technique of increasing skin survival in musculocutaneous flaps is documented.
Animals↗
Squamous cell carcinoma of the head and neck in patients under 40 years of age.
Between 1960 and 1983, 63 of 3,489 patients treated for squamous cell carcinoma of the head and neck at the University of Iowa Hospitals and Clinics, Iowa City, were under the age of 40 years. Malignancies in these patients occurred in the oral cavity (41%), pharynx (28%), larynx (25%), and other sites (6%). One third of the patients were females and half the patients were smokers. Approximately 50% of the patients presented with a cervical mass. Management consisted of surgery, radiation, or a combination of the two. Actuarial five-year survival for the entire group was 67%. The best prognosis was for patients with cancer of the larynx, while the poorest was for those with cancer of the pharynx.
Adolescent↗
Primary tracheoesophageal fistula formation for feeding and voice rehabilitation.
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Enteral Nutrition↗
Cyanoacrylate adhesive used to stop CSF leaks during orbital surgery.
Butyl-2-cyanoacrylate (Histoacryl Blue) tissue adhesive successfully sealed three cases of CSF leaks encountered during orbital surgery. The application of tissue adhesive was followed by prompt cessation of leak. We have found this tissue adhesive to be a valuable technical adjunct in the intraoperative management of this difficult problem and have not seen any general or local toxic reaction to the material.
Adult↗
Creation of free flaps by arterialization of the venous system.
We attempted to provide free flaps with nutrient circulation by retrograde venous circulation through microsurgically created arteriovenous (AV) fistulas. We used the rabbit auricle as the animal model because of its accessible central and marginal veins. We created four experimental groups to (1) determine flap survival without blood supply, (2) establish efficacy of microvascular anastomosis, (3) test an end-to-end AV fistula, and (4) test an end-to-side fistula that was converted after one week to an end-to-end version. The nutrient blood supply in two groups existed only as retrograde venous perfusion. We found that retrograde venous perfusion alone was sufficient for flap survival, which equaled or exceeded that achieved with conventional microvascular flap reimplantation. This experiment suggests cutaneous free flaps can be created any place on the body wherein an AV fistula can be developed.
Animals↗
Extended latissimus dorsi myocutaneous flap reconstruction of major head and neck defects.
The purpose of this article is to familiarize th surgeon with the latissimus dorsi flap and some particularly useful applications of it. This flap has proved extremely versatile, with many uses, among them immediate coverage for extensive head and neck wounds. It has been equally successful in repairing defects in both normal and irradiated tissue. The range of the arc of utilization has been exceptional, easily reaching the skull vertex from the chest wall. However, to be able to extend this flap so far requires careful dissection of the neurovascular pedicle and intimate anatomic knowledge of the posterior axilla region. This flap's muscle bulk is quite acceptable and the donor site may almost always be closed primarily. There appears to be less functional disability from sacrifice of this muscle than with pectoralis or trapezius myocutaneous flaps. Accordingly, it is ideal when much tissue is needed for single-stage coverage. Additional uses are available when flaps from other sites have failed.
Adolescent↗
Panje-Shagets tracheoesophageal fistula forceps.
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Humans↗
Mandibulectomy without reconstruction can cause sleep apnea.
Anterior mandibulectomy can precipitate the development of sleep apnea. All head and neck tumor patients having had extensive composite anterior oral cavity resections should be evaluated for sleep apnea before decannulation of their tracheostomy tube. Subsequent flap and/or rigid reconstruction of the lower jaw appears to prevent the development of sleep apnea. Fascial sling suspension of the lower lip does not appear to prevent sleep apnea.
Aged↗
Musculocutaneous and free flaps: physiology and practical considerations.
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Animals↗
Delayed skin grafting in facial reconstruction. When to use and how to do.
To assess the effectiveness of delayed skin grafting for the reconstruction of facial defects following Mohs excision of cutaneous malignant neoplasms, an analysis was done on 40 patients. All grafts in this series survived. Satisfactory results were obtained in 95% of the patients. Complications were minor and uncommon. Results of this study demonstrate indications for the use of delayed skin grafting to include recurrent or aggressive primary lesions and defects that are large, deep, and favorably located. Advantages of delayed skin grafting are as follows: improved recipient bed vascularity providing high survival of a thicker graft; provision of additional tissue bulk; reduced length of time for healing; less contracture than with granulation healing; and elimination of additional scarring adjacent to the defect. In properly selected patients, this technique offers an additional method of reconstruction of facial defects.
Adult↗
Single agent chemotherapy for head and neck cancers. The murine subrenal capsule assay.
The murine subrenal capsule assay was used to determine chemotherapeutic sensitivities of metastatic, primary, or recurrent head and neck cancers. Tumor fragments (1 cu mm) were implanted under the renal capsule of 2- to 4-month-old normal female C57 BL/6 X DBA/2 F1 hybrid mice. Xenografts included 20 squamous cell carcinomas (SCCs), one mucoepidermoid carcinoma, one adenoid cystic carcinoma, and two melanomas. Groups of tumor-bearing mice were treated with chemotherapy daily for five days. Sensitivities of the tumor were assessed on day 6 by comparison of final implant size with initial implant size. Significant oncolytic activity was detected against 16 of 24 tumors (14 of 20 SCCs and both melanomas). Correlations between the in vivo assay and clinical studies are needed to determine its predictive value.
Animals↗
Immunomodulatory activity in regional lymph nodes.
This study is, to our knowledge, the first attempt to evaluate cellular immune mechanisms in regional lymph nodes of patients with head and neck cancer. Twenty lymph nodes from eight patients with stage III-IV squamous cell carcinoma were evaluated using an in vitro culture system. The T-cell mitogenic (concanavalin A) response of patients' peripheral blood mononuclear cells was modulated by the addition of cells from regional lymph nodes removed at neck dissection. Modulatory activity showing augmentation was significantly correlated with the size of the primary tumor and histopathologic grade of the tumor. Modulatory activity did not correlate with the histologic pattern of lymph node reactivity. Although these relationships suggest that regional immunity may be important in tumor-host interactions, further study is necessary to establish their biologic and prognostic importance.
Adult↗
Delayed skin grafting.
The use of skin grafts on granulating wounds is an established practice. Delaying the application of a full- or split-thickness skin graft may be an advantageous alternative method of surgical reconstruction in selected cases. Partial healing by secondary intention is useful for filling in deeper defects and usually produces a wound that is much smaller and of more normal contour than the original defect. Contraction of the graft bed is markedly influenced by location, tissue laxity, surface tension lines, motion, and wound geometry. Proper wound care, correct surgical preparation of the defect, and timing of the graft procedure are all important considerations in maximizing the overall result. Through-and-through defects and wounds produced over areas with little underlying support (eyelids and lip) often need flap reconstruction or immediate grafting to prevent undesirable functional and cosmetic results. By combining delayed healing and conventional reconstructive techniques, major tissue loss can often be restored while minimizing patient morbidity.
Humans↗
Indomethacin sensitive suppressor cell activity in head and neck cancer patients pre- and postirradiation therapy.
The effects of the addition of indomethacin to PHA or Con A stimulated lymphocytes from patients with untreated squamous cell carcinoma of the head and neck or from patients with the disease who have just finished irradiation therapy from the disease was quantitated and compared to those of the control group. Lymphocytes from eight of 26 patients with untreated carcinoma were significantly augmented by the addition of indomethacin. The remaining eighteen patients were equal to the controls. For all 17 patients who had just finished extensive field irradiation therapy, significant enhancement of PHA and Con A reactivity by indomethacin was found, which did not appear to be solely a function of low baseline mitogen reactivity. In additional studies, stimulated lymphocytes of irradiated patients were tested for their sensitivity to the inhibitory effect of PGE2. The mitogen treated lymphocytes from all patients that had just finished irradiation therapy were found to be significantly more sensitive to the inhibition by PGE2 as compared to the normal lymphocyte response. This effect was also found not to be related merely to a low PHA or Con A reactivity of the lymphocytes. In both patient groups there was a striking correlation between the percent augmentation of indomethacin and the percent inhibition of PGE2 in that when the percent augmentation values were low so were percent inhibition values and when the degree of augmentation by indomethacin was elevated so was the inhibition by PGE2. This data suggests that increase sensitivity of stimulated lymphocytes to PGE2 may be responsible, at least in part, for the depressed mitogen response and the significant augmentation of this immune response by indomethacin in about 1/3 of the untreated patients with advanced head and neck carcinoma and in those patients who have just finished irradiation therapy. The results of this study support the hypothesis that perhaps patients receiving irradiation therapy may benefit by the oral administration of indomethacin, an approach that needs further consideration.
Carcinoma, Squamous Cell↗