• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7627-7632
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• 2015

Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.

• Annals of Surgical Treatment and Research
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• 제95권5호
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• pp.258-266
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• 2018

Purpose: This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion. Methods: Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation. Results: Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029-0.970; P = 0.048) was the only significant factor. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.

• Journal of Chest Surgery
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• 제54권6호
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• pp.500-508
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• 2021

Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519-0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.741-745
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• 2015

Background Microvascular complications after free-flap breast reconstructions are potentially devastating problems that can increase patient morbidity and lead to flap loss. To date, no comprehensive study has examined the rates of salvage and the methods of microvascular revision in breast reconstruction. We reviewed the treatment of microvascular complications of free-flap breast reconstruction procedures over a seven-year period. Methods A retrospective review of all patients who underwent microvascular breast reconstruction at our institution between April 2006 and December 2013 was conducted. Based on their surgical records, all patients who required emergency re-exploration were identified, the rate of flap salvage was determined, the factors associated with flap salvage were evaluated, and the causes and methods of revision were reviewed. Results During the review period, 605 breast reconstruction procedures with a free lower abdominal flap were performed. Seventeen of these flaps were compromised by microvascular complications, and three flaps were lost. The overall salvage rate was 82.35%. No significant differences between the salvaged group and the failed group were observed with regard to age, BMI, axillary dissection, number of anastomotic arteries and veins, recipient vessel types, or use of the superficial inferior epigastric vein in the revision operation. Successful salvage of the flap was associated with a shorter time period between recognizing the signs of flap compromise and the take-back operation. Conclusions The salvage rate of compromised lower abdominal flaps was high enough to warrant attempting re-exploration. Immediate intervention after the onset of flap compromise signs is as important as vigilant postoperative monitoring.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.735-741
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• 2013

Background The prosthetic dura is an essential element in the protection of the cranial parenchyma and prevention of cerebrospinal fluid leakage. Although prosthetic dura are widely used in neurosurgery, they occasionally provoke infection, which can be a major concern after neurosurgical treatment. However, removal of the prosthetic dura carries a risk of brain parenchyma injury and cerebrospinal fluid leakage. The salvage of infected prosthetic dural material has not been adequately addressed in the literature. In this study, we demonstrate the value of the combination of a meticulous surgical debridement of necrotic tissue and simultaneous muscle free flap for intractable postoperative epidural abscess without removal of the infected prosthetic dura. Methods Between 2010 and 2012, we reviewed the data of 11 patients with persistent infection on the prosthetic dura. The epidural infections each occurred after a neurosurgical procedure, and there was soft tissue necrosis with the disclosure of the underlying prosthetic dura and dead bone around the scalp wound. To salvage the infected prosthetic dura, meticulous debridement and a muscle free flap were performed. Results All 11 patients experienced complete recovery from the complicated wound problem without the need for further surgical intervention. No signs of prosthetic dural infection were observed during the mean follow-up period of 11 months. Conclusions The combination of a meticulous surgical debridement and coverage with a muscle free flap is an effective treatment for salvage of infected prosthetic dura.

• 대한골관절종양학회지
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• 제1권1호
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• pp.23-29
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• 1995

Recently limb-salvage operation is widely used for the treatment of malignant bone tumor. But distal leg is out of range of limb-salvage operation due to its technical problem. We report satisfactory limb-salvage operation with tumor prosthesis in 3 cases of osteosarcoma of the distal tibia and fibula. Two cases involved in the tibia and 1 case in the fibula. Average age at operation was 23 years. Neoadjuvant and adjuvant chemotherapy were performed in all 3 cases. We used custom made tumor prosthesis which is designed by Seoul National University Orthopaedic Department. Overall Functional Evaluations by Enneking rating system were good in all 3 cases. All cases are CDF(continuosly disease free since the surgical procedure) state at mean follow-up 2 year and 9 months. In conclusion limb-salvage with tumor prosthesis is useful treatment modality for malignant bone tumor of distal tibia and fibula. Good functional results and few complications suggests limb salvage of distal lower leg may be replaceable with B-K amputation.

• Archives of Plastic Surgery
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• 제44권1호
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• pp.42-47
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• 2017

Background Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition. Methods The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0-1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study. Results Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage. Conclusions Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.

• 대한골관절종양학회지
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• 제1권1호
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• pp.30-37
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• 1995

The prognosis of parosteal osteosarcoma is better than any other malignant bone tumors, but there are many controversies in its treatment. We tried to evaluate the prognosis and the effectiveness of limb-salvage operation in the treatment of the parosteal osteosarcoma. We experienced 12 patients of conventional parosteal osteosarcoma(2 males and 10 females) from 1981 to 1991. The limb-salvage operations with wide resection margin were done in 8 patients(5 tumer prosthesis, 2 resection arthrodesis and 1 vascularized fibular transplantation), marginal en-bloc resection and amputation in 2 patients, respectively. The duration of mean follow up was 5 years and 9 months, ranging from 2 year-3 months to 11 years, except of the patient who died with metastasis 1 year 8 months after. The disease-free survival rate(DFSR) of all patients was 68% and that of the patients treated with limb-salvage operation was 88% at 7 years. The DFSR was 33% with marginal margin(3 cases) and 89% with wide margin(9 cases) at 7 years. The results were unsatisfactory in the conventional parosteal osteosarcoma treated with marginal resection. The limb-salvage operation with wide surgical margin was thought to be the treatment of choice.

• 대한두경부종양학회지
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• 제12권1호
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• pp.3-7
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• 1996

Nasopharyngeal carcinoma(NPC) is a disease whose primary initial treatment is radiation. Results of radiation therapy in early stage disease is promising; however, in stage IV disease, the best reported five-year survival is only about 30%. In patients with post-radiation recurrent disease, radiation controls only a small portion of patients, as well as being associated with significant radiation injury. In this paper we discuss the use of salvage treatment modalities for post-radiation recurrence. A retrospective chart review and analysis of salvage treatment results were performed for 39 patients with recurrent post-radiation NPC and positive cervical lymph nodes during the period beginning 1985 until 1995. Mean age of these patients was 52.3$\pm$10.37 years and male: female ratio was 1.8 : 1. Twenty patients were treated with salvage treatment, and ten patients were treated by salvage chemotherapy. A total of nine patients underwent surgical salvage treatment, including neck dissection(6), transnasal laser surgery and booster radiotherapy(2), and primary surgery(1). Salvage treatment were effective in reducing patients' pain in twenty patients (51.3%) and prolonging life in nine patients(23.1%); however, recurrence of disease within six months and/or residual disease by clinical or radiologic exam was noted in all patients receiving salvage radiotherapy, chemotherapy, laser surgery with radiotherapy, and primary site surgery. In the group undergoing salvage neck dissection, three patients(50%) were disease free for at least two years. Of the different modalities, radiotherapy was associated with the best quality of life while catastrophic salvage surgery resulting in insignificant prolongation of life was associated with the poorest quality of life. We conclude that salvage surgery is the optimal choice of treatment for regional recurrence such as nodal failure, however palliative salvage therapy could be preferred in other cases with recurrent post-radiation NPC.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권2호
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• pp.97-101
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• 2015

Maxillary transverse deficiency is one of the most common deformities among occlusal discrepancies. Typical surgical methods are segmental Le Fort I osteotomy and surgically-assisted rapid maxillary expansion (SARME). This patient underwent a parasagittal split with a Le Fort I osteotomy to correct transverse maxillary deficiency. During follow-up, early transverse relapse occurred and rapid maxillary expansion (RME) application with removal of the fixative plate on the constricted side was able to regain the dimension again. RME application may be appropriate salvage therapy for such a case.