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Pectoralis major myocutaneous flaps vs. revascularised free tissue flaps following salvage surgery for recurrent head and neck cancer

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Pazdrowski J., Golusinski P., Szewczyk M., Majchrzak E., Dańczak-Pazdrowska A., Golusiński W.
Polish Journal of Otolaryngology
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2022
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vol. 76
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issue 5
22-28
EN
Introduction: Pectoralis major myocutaneous flaps (PMF) were introduced in the early 1970s and were widely used in head and neck reconstructions following ablative surgical treatment of advanced tumors located in multiple anatomical subsites. Aim: To assess the efficacy of two reconstructive methods: pectoralis major myocutaneous flap and revascularised free flap in salvage surgery for recurrent head and neck cancer. Material and methods: We retrospectively analysed 100 cases of patients who had recurrent head and neck cancer and were tre- ated in the Department of Head and Neck Surgery between 2011 and 2021. The study participants were divided into two groups depending on the method of reconstruction: 62 patients who underwent revascularised free flap reconstruction, and 38 patients with pectoralis major myocutaneous flap. Results: In total, flap necrosis was observed in 20 cases, 18 of which were in the group that received revascularised free flaps (29.03%) and 2 in the pectoralis major myocutaneous flap group (5.26%). The OR of flap failure in the free flap group vs. pectoralis major flap group was 7.36 (95% CI 0.85–63.75; P = 0.067). In the group that underwent revascularised free flap recon- struction the total surgery time was significantly longer than in the other group (P < 0.0001). Conclusion: We present the advantages of using pectoralis major myocutaneous flaps for recurrent head and cancers, which is of the utmost importance for malnourished patients in poor general health whose primary treatment comprised of combination therapy.
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Local recurrence risk in head and neck basal cell carcinoma

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Szewczyk M., Pazdrowski J., Pabiszczak M., Więckowska B., Dańczak-Pazdrowska A., Golusiński W.
Polish Journal of Otolaryngology
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2022
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vol. 76
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issue 4
30-35
EN
Introduction: Basal cell carcinoma (BCC) is the most common skin cancer. Aim: The aim of the study was to ascertain the risk factors of local recurrence in primary basal cell carcinoma of the head and neck. Material and methods: A retrospective analysis of 545 patients with head and neck primary basal cell carcinoma treated in years 2008–2018 was carried out. The following data was recorded: age, sex, tumor site, histological subtype, greatest dimension, margin status, experience of the operating surgeon and local recurrence. Results: Most of the tumors were located in the nose (165; 30.2%) and auricle (119; 21.8%). The most common pathological subtype was nodular (119; 21.8%). Three hundred and ninety-four tumors (72.2%) were under 20 mm in diameter. Positive surgical margins were noted in 107 (19.6%) cases. Local recurrence was observed in 52 (9.5%) cases, of which 29 (29/107; 27%) had positive surgical margins, in 23 (23/438; 5.2%) cases margins were free, which was the only statistically significant factor (p < 0.001; OR 6.71; CI 3.69–12.2). Conclusions: The results of our study have shown that positive surgical margin remains the strongest risk factor for local recurrence. With surgical excision being the gold standard of treatment, the greatest emphasis should be placed on avoiding such a scenario in high-risk patients.
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Does experience of the surgeon affect surgical margins in head and neck basal cell carcinoma?

84%
Szewczyk M., Marszałek A., Golusiński P., Kosińska A., Niewiński P., Pazdrowski J., Dańczak-Pazdrowska A., Golusiński W.
Polish Journal of Otolaryngology
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2022
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vol. 76
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issue 2
1-6
EN
Aim: The aim of our study was to evaluate the impact of surgical experience in a high volume head and neck surgery department on basal cell carcinoma margin status. Material and methods: A retrospective analysis of 546 patients surgically treated for primary basal cell carcinoma of the head and neck region was carried out. Resections were performed by 4 specialists with equal experience in head and neck surgery and 4 ENT residents at the same level of surgical training. A margin of 3–5 mm was chosen, according to guidelines. Results: The study consisted of 304 males and 242 females, mean age of 69 (range 26–100). Most of the tumors were located on the nose (165 pts; 30.2%) and auricle (119; 21.7%). The most common histological subtype was nodular (119; 21.7%). Tumor size was up to 20 mm in 394 cases (72%). Positive surgical margins were found in 112 cases (20.5%). There was no difference in terms of positive surgical margins between residents (19/119 cases; 15.9%) and specialists (93/426; 21.8%; p = 0.161). Conclusions: The results of our study have shown that adequate surgical training in a dedicated head and neck surgery de-partment is an efficient factor in obtaining free surgical margins in head and neck basal cell carcinoma.
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