Oncology surgery
1. Risks and difficulties in the treatment of the lower face malignant tumors
Carmen Giuglea, I.P.Florescu, S.Marinescu, Noela Ionescu, Ruxandra Mihai,
Anca Oporanu
2. A cervicomediastinoaxillary giant tumor (Recklinghausen Disease). Case
Report
I.P.Florescu, M. Paraschiv¸ Carmen Giuglea, A. Carantino, Ingrid Marinescu
3. Surgical treatment of skin tumors. A 14 years clinic experience
I.Lascar, S.A.Popescu, Ruxandra Andrei, L. Cojocaru, Khaled al Falah
4. Oncologic limits in surgical excision of skin tumors
S.A.Popescu, Ruxandra Andrei, Fragos Athanasios, L. Cojocaru, Khaled al Falah
5. Temporal muscle flap in orbit reconstruction after exenteration
I. Lascar, V. Ibric Cioranu, O. Vermesan, D. Zamfirescu, C. Gheorghita, S. A.
Popescu, G. Lipa, D. Iorgulescu, V. Petrescu, R. Maxim
6. Reconstructive surgery in face and neck tumors
I. Lascar, C. Hariga, Ruxandra Sinescu, A. Cinca, Laura Raducu, G. Udrescu, I.
Zegrea, F. Juravle
7. Nasolabial skin-muscle-mucosal flap to lower lip – case report
L. Rus, A. Carabineanu, C. Ilie, C. Mintioan
8. The antitrombotic therapy efects on the malignant melanoma general
treatment
O. Badea, Paula Luculescu
9. Basic principles for facial physionomical reconstruction in skin cancer
surgery
A. Botan, Alina Cozma
10. Modalities of lower exelid reconstruction after tumor excision
Ovidiu Ivan, Dodea Florin, Onoe Radu
1. Risks and difficulties in the treatment of the lower face malignant tumors
Carmen Giuglea, Florescu I.P., Marinescu S., Noela Ionescu, Ruxandra Mihai,
Anca Oporanu
Plastic, Reconstructive and Aesthetic Surgery Department,
Clinical Emergency Hospital "Bagdasar-Arseni" Bucharest
The extensive malignant tumors of the face impose numerous problems regarding
the surgical treatment due to, on one hand to their extension and on the other hand, to the
aggresivity of the histological entity. The histopatology and the grading of these tumors
are very helpful in orientating the specialist to choose the best therapeutic protocol in
each case.
Sometimes, in borderline cases or in insufficient or incorrect treated cases who
tend to get worse, the treatment must be individualized due to the difficulties
encountered. We shall illustrate this complex pathology by presenting a case treated in
our clinic for recurent floor of the mouth carcinoma, with mandible osteoradionecrosis,
who underwent first pectoralis major flap with titan plate, and secondary
osteoseptofasciocutaneous fibular flap.
We shall present the difficulties encountered in the treatment of these entities and
our original way of solving them.
2. A cervicomediastinoaxillary giant tumor (Recklinghausen Disease). Case
Report
I. P. Florescu, M. Paraschiv¸ Carmen Giuglea, A. Carantino, Ingrid Marinescu
Plastic, Reconstructive and Aesthetic Surgery Department,
Clinical Emergency Hospital "Bagdasar-Arseni" Bucharest
The authors present the case of a young pacient (32 years old)with a diagnosis of
Recklinghausen disease, who develops a tumor at the border of the cervicothoracic area,
with a right axillary extension , having a local invasive pattern.
We chose an anterior approach Dartavelle and we resected almost completely the
tumor. The invasion of the subclavian artery made compulsory its segmental resection,the
artery being reconstructed with a saphena magna graft .
The authors present their etiopathogenic considerations in this case and they
insist on the cervicothoracic anterior approach regarding the borderline tumors with
anterior extension .
3. Surgical treatment of skin tumors. A 14 years clinic experience
I. Lascar, S.A.Popescu, Ruxandra Andrei, Liviu Cojocaru, Khaled al Falah
U. M. Ph. "Carol Davila" Bucharest
Clinic of Plastic Surgery and Reconstructive Microsurgery
Emergency Hospital Bucharest
This work presents our clinic experience in treating skin tumors in the period
from1991 to 2004.
We analyzed statistically patients with skin tumors (nevocellular naevi, epidermic
tumors, fibrohistiocitar conjunctive, vascular, nervous, fatty tumors) and the skin
malignant tumors (epithelioma, malignant melanoma).
All cases had a complex approach (plastic surgeon, anatomopathologist,
oncologist, radiotherapist), using various surgical techniques: electric oncologic limits
excision, reexcision, direct suture, skin graft, local flaps, and free microsurgical transfer.
We observed an increasing incidence of malignant tumors with small
predominance of males and debut on young ages. In the last 4 years, we saw a slight
decrease in the annual admittance of patients presenting such a pathology compared with
the previous years, an increase of the onset age of the patient (the elder patients were
predominant) and at the admittance the illness was in a more advanced stage of evolution.
4. Oncologic Limits in surgical excision of skin tumors
S.A.Popescu, Ruxandra Andrei, Fragos Athanasios, Liviu Cojocaru, Khaled al
Falah
Plastic Surgery and Reconstructive Microsurgery Clinic
Clinical Emergency Hospital Bucharest
Starting from our observations in checking the MRI images, the aspects found
during the surgery and the results of the histopathological examination we tried to make
an exact appreciation of the oncologic limits for skin tumor excisons. In this work we
also rewiev the newest recommendation for the excision margins as published by
different organizations in the specialty literature and we present the protocol of our clinic
in treating this pathology beeing sustained by the results and patients’ evolution.
The excision margins will be permanently reconsidered because of the
development of new imagistic examinations methods (the dermoscopy, the computer
aided diagnosis for cutaneous melanoma,confocal microscopy) for an accurate diagnosis
which will considerably improve the efficiency of the surgical treatment.
5. Temporal muscle flap in orbit reconstruction after exenteration
I. Lascar, V. Ibric Cioranu, O. Vermesan, D. Zamfirescu, Carmen Gheorghita, S.
A. Popescu, G. Lipa, D. Iorgulescu, V. Petrescu, R. Maxim
U.M.Ph. „Carol Davila”
Plastic Surgery and Reconstructive Microsurgery Clinic
Clinical Emergency Hospital Bucharest
Complex facial defects after exenteration for tumoral invasion is a difficult
problem because of the exhaustion of the local reconstructive possibilities.
The temporalis muscle flap is recommended for use in obliteration of the orbital
cavity following exenteration, reconstruction of massive defects involving upper and
lower eyelid and periorbital tissue, coverage the defects of the upper cheek and ear,
reconstruction of intraoral defects.
In the last year 3 patients were operated for tumoral invasion in the orbital area, in
Plastic Surgery Clinic, Emergency Clinical Hospital Bucharest. Surgical procedures
were done by an interdisciplinary team that include plastic surgeon and oral maxilo facial
surgeon, in collaboration with Bucharest Central Military Hospital.
6. Reconstructive surgery in face and neck tumors
I. Lascar, C. Hariga, Ruxandra Sinescu, A. Cinca, Laura Raducu, G. Udrescu, I.
Zegrea, F. Juravle
U.M.Ph. „Carol Davila”
Plastic Surgery and Reconstructive Microsurgery Clinic
Clinical Emergency Hospital Bucharest
7. Nasolabial skin-muscle-mucosal flap to lower lip – case report
L. Rus1, A. Carabineanu2, C. Ilie2, C. Mintioan2
1- Emergency General Surgery Clinic
2 – Oncologic Surgery Clinic
Clinical Municipal Emergency Hospital Timisoara
Contact e-mail: lianarus @rdslink.ro
crisu@mail.rdstm.ro
When planning a complete reconstruction of the lower lip, the following points
should be considered:
- the flaps used should be local flaps
- the sutures lines should be in natural facial creases or should follow the function
lines of the various facial aesthetic units
- the flaps should be large enough to replace tissue loss
A case report on a total lower lip reconstruction after excision of a lower lip basal
carcinoma is presented.
The reconstruction was performed with two innervated nasolabial skin-musclemucosal flaps that give to the newly reconstructed lower lip a satisfactory motor function.
8. The antitrombotic therapy efects on the malignant melanoma general
treatment
O. Badea, Paula Luculescu
Plastic Surgery Department, Deva County Hospital
Contact e-mail: paulaluculescu@hotmail.com
It is already known that patients with established cancer are at increased risk of
venous thrombembolism, explained through the tumor elaboration of tissue factor, which
is a physiological procoagulant. The risk of thrombosis is further increased when the
patients receive therapeutic surgical interventions for their cancer. Chemotherapy also
carries a serious thrombotic risk because of its cytotoxicity, which damage the
endothelium and release procoagulants and cytokines, which activate the process of
coagulation, and it depletes circulating concentrations of naturally anticoagulants. These
are enough reasons to administer low molecular weight heparins. Besides these reasons,
recent studies revealed that antithrombotic therapy might influence tumor biology. The
powerful techniques of in vitro mutagenesis and gene transfer have shown that expression
of tissue factor by tumor cells is associated with enhanced growth, metastasis and
angiogenesis. The tissue factor activates blood coagulation, so generate the thrombin (the
end product of the coagulation cascade). Thrombin may release vascular endothelial
growth factor, thereby contributing to tumor angiogenesis. Angiogenesis is required by
solid tumors for the development of a vasculature, in order to ensure an increasing supply
of nutrients for growth and metastasis. Due to this, interference with the activation of
coagulation with low molecular weight heparins could be a useful antitumoral strategy.
According to exposed theory, 14 patients – out of which 11 with malignant
melanoma and 3 with breast cancer – was treated by us in the last 3 years. The efficiency
of this theory will be confirmed by the continuation of the study upon a higher possible
number of cases.
9. Basic principles for facial physionomical reconstruction in skin cancer
surgery
A. Botan*, Alina Cozma**
*Burn Centre &Plastic Surgery Dept.County Emergency Hospital Targu Mures
**Maxillo-Facial Surgery Dept. County Emergency Hospital Targu Mures
Contact e-mail: adrian.botan@rdslink.ro
czmaalina@yahoo.com
Introduction: head and neck skin cancers mark an important percentage of all skin
cancers and for this reason many surgeons have been concerned in the surgical treatment
of the above mentioned conditions, among all, excision followed by early either delayed
reconstruction being considered the best option.
Material & Method: this topic tries to emphasize the practical importance of some
simple and very convenient surgical techniques which can be summarized as follows:
tumor excision with such surgical edges in order to avoid relapse either local spreading of
the skin cancer. The excision limits have to follow whenever possible the Langer's line
("rstl" ) within the aesthetic units of the face and neck. Early either delayed
reconstruction can then be accomplished by several techniques such as split skin grafts,
local and distant flaps, microvascular free flap transfer, spontaneous epithelialization and
so on.
Results: all reconstructive procedures listed above are rich illustrated with many
cases operated in our department in the last years. According with the pathological result,
surgical treatment have usually to be followed by the oncological one.
Conclusions: functional and physionomical reconstruction following skin cancer
excision of the face and neck is one of the most important aspects of the plastic and
reconstructive head and neck surgery, due to the huge importance of the early social (and
professional) re-connection of those patients. On the other hand one have to be
concerned with the deep psyhological impact which can occur and needs to always keep
in mind the particular "quo ad vitam" future in such cases.
10. Modalities of lower exelid reconstruction after tumor excision
Ovidiu Ivan, Florin Dodea, Radu Onoe
Modalitati de reconstructie ale pleoapei inferioare dupa exereza tumorala
Ovidiu Ivan, Florin Dodea, Radu Onoe