A retrospective analysis is made of 61 patients with clinical and histological diagnosis of pure sarcomas of the jaw treated between 1950 and 1984. Surgery was the treatment of choice in 41 cases. Biopsy or palliative treatment were undertaken in the remaining patients. Twenty-four cases relapsed before 12 months, and 12 relapsed before 3 years. Twenty-four died before 12 months, nine before 2 years, and three after 2 years. At present there is no evidence of disease in eight patients: three out of 25 fibrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), three out of 15 chondrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), and two out of 15 osteosarcomas (one more than 18 years). The prognosis is gloomy. However, an early diagnosis and radical surgery contribute to an improvement in the course of the disease.

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Background: the problems of reconstructive surgery for the midface are variable and can be very complex. The anatomical proximity of the midface to the orbit, base of the skull and maxillary sinuses is a challenge for the surgeon who must perform a curative resection. Objective: The aim of this presentation is to report the survival rate and disease-free interval in T4a and T4b neoplasms of the palate and paranasal sinuses consecutively resected over a 30-year period. Material and methods: Surgery was extended to the orbit in 85.2%, the skull in 8.3%, the neck in 18.7% and the parotid gland in 7.3%. Soft tissue reconstruction was performed using free flaps in 32.5%, muscle flaps in 21.6%, local flaps in 20.2%, musculocutaneous flaps in 14.7% and skin flaps in 11.3%. Results: Local and general complications were reported, and 4/203 patients (2%) died. At 5 years, overall survival was 62.5% and disease-free survival was 53%. Univariate analysis revealed that lack of previous treatment was significantly associated with recurrence and squamous cell carcinoma was a predictor of survival. Conclusions: The indication of exenteration is mandatory in the presence of ophthalmoplegia or involvement of the orbital content. Survival at 5 years is acceptable, considering the advanced stages of the disease. In some patients, previous treatments were

Colgajos pediculados. Una alternativa no descartable en grandes defectos de la cabeza y el cuelloPedicled flaps. An alternative worth to be considered for large defects of the head and neck Antecedentes: la cirugía de cabeza y cuello requiere la reconstrucción de los defectos que crea la resección de lesiones neoplásicas de dicha área. Para ello, se necesita el aporte de tejidos vecinos o tomados a distancia. Los colgajos libres cumplen a la perfección con tales principios. Sin embargo, los colgajos pediculados podrían suplir en gran medida las falencias que la aparatología y el personal entrenado ocasionan en un servicio de la especialidad. Objetivo: analizar la aplicabilidad, las ventajas y complicaciones de los colgajos pediculados, sin que signifiquen la primera opción cuando hay que reconstruir un paciente. Resultados: los colgajos pediculados resultaron muy nobles en su aplicación tanto como cobertura como para reconstruir distintos sitios de la vía aerodigestiva superior. Solo se requirió una técnica depurada y la atenta preservación de su pedículo arteriovenoso. En general, se les reconocen ventajas y desventajas a todos. Sobresale entre ellos, el de trapecio lateral por la implícita posibilidad de incorporar hueso. La mayoría reveló reducida curva de aprendizaje, tiempo operatorio comparado con el de los colgajos libres y baja tasa de complicaciones. Conclusiones: los colgajos pediculados no son cosa del pasado. En todos los servicios que no cuenten con un microcirujano entrenado, los colgajos pediculados deben formar parte del menú de opciones reconstructivas en la cirugía de cabeza y cuello. 161-166. http://dx.doi.org/10.25132/raac.v109.n4.1307 RESUMEN ABSTRACTBackground: head and neck surgery requires reconstruction of defects after resection of neoplastic lesions. Although free flaps from close or distant locations may largely satisfy this need, pedicled flaps could replace the lack of aparatology and trained personnel in a specilized unit. Objective: to analyze applicability, advantages and complications of pedicled flaps. Results: pedicled flaps resulted a good option for coverage or reconstruction of different areas of the aerodigestive tract. A neat technique and a careful preservation of the arteriovenous pedicle were required. Although all of the pedicles used have advantages and disadvantages, the best of them resulted the lateral trapezius flap for it allows the association of bone to the flap. All pedicled flaps showed shorter learning curve , operative time and lower complication rate as compared to free flaps. Conclusions: pedicled flaps should not be considered a past issue. Any head and neck surgery unit without a trained microsurgeon should include pedicled flaps as an option for reconstructive procedures.