荒木 淳

Reconstruction of the external auditory canal (EAC) after malignant tumor resection requires functional, aesthetic, and radiation-resistant coverage. However, flap selection criteria remain lacking. The authors retrospectively reviewed 11 patients who underwent EAC reconstruction using a temporoparietal fascia flap (TPFF), temporalis muscle flap (TMF), or a combination of both between 2004 and 2025. Clinical data, surgical techniques, and outcomes were analyzed. Reconstruction procedures involved TPFFs alone (n=6), TMFs alone (n=2), and a combination of both (n=3). TMFs were used when the superficial temporal artery was sacrificed or when a TPFF alone was insufficient in volume. Skin grafts from the groin were used in all but 1 case. Seven patients received postoperative radiotherapy, with no radiation-related complications. TPFFs and TMFs, used alone or in combination, are safe and effective for EAC reconstruction. As reflected in our proposed algorithm, flap selection should be based on defect volume and vascular availability.

BACKGROUND: Local recurrence after surgical resection is a major clinical challenge in patients with advanced head and neck cancer (HNC). We previously reported using transfer of a flap treated with dendritic cells (DCs) ("immuno-flap") as a novel cancer immunotherapy in a rat model of HNC. However, several problems, such as the improvement of DC yield and the verification of DC tracking, remained to be solved. METHODS: The initial DC production protocol was revisited, and the specific mechanism of the antitumor effect associated with functional DCs was investigated. RESULTS: The yield and the purity of potent DCs were improved, and an in vivo tracking experiment revealed that, when injected into the skin flap, the DCs migrated to local lymph nodes within 24 h. In an in vivo long-term protection model in which DCs were injected into the skin flap weekly for 4 weeks, no strong antitumor effect on HNC tumor progression was observed, but a remarkable pathological effect was verified. Moreover, an enzyme-linked immunospot assay demonstrated that more CD8+ T cells positive for PD-1, CD40LIG, and TNF-α expression and producing interferon γ specific to SCC-158 tumor cells were identified in tumors and spleens from rats treated using immuno-flaps. CONCLUSIONS: These results indicate that immuno-flap transfer to prevent local recurrence in patients with HNC has potential for clinical application given the improved yield and quality of antitumor DCs.

BACKGROUND: Options for microscopic hepatic artery (HA) reconstruction include direct anastomosis (DA), arterial transfer (AT), and graft interposition (GI). Despite the advantage of AT in requiring only one anastomosis site, its clinical applicability and outcomes in HA reconstruction after hepatobiliary tumor resection remain underexplored. This study aimed to evaluate the feasibility and safety of AT compared with DA. METHODS: A retrospective analysis of patients who underwent microscopic HA reconstruction after hepatobiliary tumor resection between 2003 and 2024 was performed. Feasibility was assessed based on the proportion of cases successfully reconstructed without GI and the distribution of cases among the DA, AT, and GI groups. Safety was evaluated by comparing the severity of overall complications, incidence of potential complications related to decreased HA flow, incidence of postoperative anastomotic thrombosis, and survival outcomes between the AT and DA groups. RESULTS: Among 130 patients, 99.2% of cases did not require GI, with the DA, AT, and GI groups accounting for 56%, 43%, and 0.8%, respectively. No significant differences between the AT and DA groups were observed in the severity of overall complications (p = 0.27), incidence of potential complications related to decreased HA flow (p = 0.50), postoperative anastomotic thrombosis (p > 0.99), or five-year overall survival rate (29.7% vs. 35.1%, p = 0.37). CONCLUSIONS: AT provides favorable outcomes comparable to DA, even in complex resections. AT is a safe and feasible option for microscopic HA reconstruction when DA is not feasible, effectively minimizing the need for GI.

BACKGROUND: The external jugular vein (EJV) is commonly used as a recipient vein in free flap head and neck reconstruction. However, the branching patterns of the EJV vary significantly, influencing its usability during surgery. In this study, we aimed to classify the confluence patterns of the EJV by using preoperative contrast-enhanced computed tomography scans to assess its suitability as a recipient vein. METHODS: A retrospective observational study was conducted using 100 side images of 50 patients who underwent contrast-enhanced computed tomography before head and neck reconstruction between April 2022 and November 2022. EJV confluence was categorized into 4 types: subclavian vein (SCV), venous angle (junction of the SCV and internal jugular vein [IJV]), IJV, and absence of the EJV (non-EJV). The frequency of each pattern was then calculated. RESULTS: The EJV drained into the SCV in 47%, the venous angle in 37%, and the IJV in 11% of cases, whereas 5% showed no EJV. In the IJV type, the proximal EJV can be ligated during neck dissection or resection of the IJV, rendering up to 16% of cases unsuitable for EJV-based microvascular anastomosis (combined IJV and non-EJV types). CONCLUSIONS: Preoperative imaging is essential to confirm the confluence pattern of the EJV, particularly in cases where resection of the IJV is planned. For patients without EJV- or IJV-type patterns, alternative recipient veins should be prepared in advance to avoid intraoperative complications. This approach underscores the importance of interdisciplinary planning in head and neck reconstruction.