Local control of pediatric head and neck sarcoma with free flap reconstruction obviating the need for radiotherapy: a case report.

Microvascular free-tissue transfer is a widely used technique for surgical site reconstruction following head and neck mass resection. While it is commonly used in adults, the rarity of head and neck cancers in children makes free flap reconstruction relatively rare in this population. Free flap reconstruction allows for coverage of large defects which may result from wide resections performed to avoid exposing pediatric patients to primary radiotherapy. We present two pediatric oncologic cases using free flap reconstruction. The first, a 4-year-old male, presented with a rapidly enlarging tongue lesion that was diagnosed as a biphasic synovial sarcoma. The mass was resected, and a radial forearm free flap was placed. The second, a 9-year-old male, presented with jaw pain and a mandibular mass. Biopsy confirmed a diagnosis of Ewing sarcoma. The patient was treated initially with chemotherapy, followed by surgical resection and placement of an osteocutaneous fibular free flap. Both patients are disease-free 5 years post-operation. In each patient, complete resection of the primary tumor was performed eliminating the need for radiotherapy with utilization of free flap reconstruction. As advances in medicine enable better evaluation of clear margins resulting in larger resection defects, free tissue transfer provides a useful reconstructive option in the pediatric population.

Dairo K ，Bishop R ，Sethia R ，Old M ，Jatana KR ，Elmaraghy CA ... -  《Translational Pediatrics》

Primary non-metastatic Ewing sarcoma of the jaw in children: results of surgical resection and primary reconstruction.

The rarity of Ewing sarcoma (ES) of the jaw coupled with the technical challenge of resection and associated functional and cosmetic impairment has resulted in deficient data on surgical management of these tumors. The purpose of this study is to describe the results of surgical excision and reconstruction of primary non-metastatic ES of the mandible and maxilla in children. Consecutive patients (mandible = 6, maxilla = 5) treated with surgery from August 2005 to January 2013 were selected. All patients received induction chemotherapy and were selected for surgical resection based on the presence of specific criteria for operability. The median age was 11.5 years (range 5-16 years). Free fibular osteocutaneous flap was commonly used for reconstruction. There were no complications related to microvascular anastomosis or flap loss. Five patients had 100% tumor necrosis and did not receive radiotherapy. Teeth alignment, chewing, swallowing, and speech were normal in all and donor site morbidity occurred in one. The 5-year overall, event-free survival, and local control are 87.5%, 72.9%, and 90%, respectively. In eligible patients, surgery with contemporary reconstruction results in optimal oncological and functional outcome. Surgery also has the added advantage of identifying patients who may not need radiotherapy.

Qureshi SS ，Kembhavi S ，Bhagat M ，Laskar S ，Chinnaswamy G ，Vora T ，Prasad M ，Ramadwar M ，Desai S ，Khanna N ，Kurkure P ，Shah S ，Shankdhar V ，Yadav P ... -  《-》

FUNCTIONAL RECONSTRUCTION OF SOFT TISSUE OROFACIAL DEFECTS WITH MICROVASCULAR GRACILIS MUSCLE FLAP.

Stebel A ，Hocková B ，Abelovský J ，Štorcelová D ，Poruban D ，Slávik R ... -  《-》

[Free microvascular fibula graft for skeletal reconstruction after tumor resections in the forearm -- experience with five cases].

Giessler GA ，Bickert B ，Sauerbier M ，Germann G ... -  《Handchirurgie Mikrochirurgie Plastische Chirurgie》

Microsurgical reconstruction of the head and neck: interdisciplinary collaboration between head and neck surgeons and plastic surgeons in 305 cases.

Jones NF ，Johnson JT ，Shestak KC ，Myers EN ，Swartz WM ... -  《ANNALS OF PLASTIC SURGERY》