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Introduction: Immediate breast reconstruction provides oncological safety, requires longer operation time. It does not influence the initiation of adjuvant therapy and radiological control, and results in favourable cosmetic outcome., Aim: Assessing the Hungarian data of immediate postmastectomy breast reconstructions, and comparing them to international findings., Method: Between May, 2011 and September, 2014 121 therapeutic and prophylactic, postmastectomy immediate breast reconstructions were performed in 100 patients. The clinico-pathological findings were assessed retrospectively, and surgical, oncological and cosmetic outcomes were evaluated statistically., Results: The mean age of patients was 42.6 years, the follow up time was 29.4 months, and the duration of operation was 132 minutes. Skin-sparing mastectomy was performed most commonly (64%) with submuscular tissue expander placement (70%). Early postoperative complication was identified in 18 patients, and loco-regional recurrence in 1 patient. Most patients (89%) were satisfied with the cosmetic outcome. The average initiation time of adjuvant therapy was 4.8 weeks., Conclusions: Immediate breast reconstruction is a safe and effective option in line with international findings. Orv. Hetil., 2016, 157(46), 1830-1838.

Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian.

Breast screening programs along with advances in diagnostic methods and oncologic treatment have resulted in full recovery for a decisive number of patients diagnosed with early-stage breast cancer. The results of the ultra-radical-, followed by the breast conserving era pose new opportunities and challenges for the oncologic breast surgeon. The focus of oncoplastic surgery is not only on the tumor, but also on the female patient, allowing for individualized immediate breast reconstruction with acceptable esthetic result following radical tumor exstirpation. Modern procedures differ both in concept and technique from that of traditional breast surgery. This paper provides a comprehensive and detailed overview of reconstructive and oncoplastic breast surgery.

The mandible and the fibula are two totally different bones of the human skeleton. The fibula is a long straight bone of the lower leg playing secondary role compared with the tibia. The mandible, or jaw bone, is the only facial bone that moves and has complex spatial structure. The blood supply of the mandible is mainly endosteal, the inferior mandibular artery, which is one of the more important branch of the maxillary artery is responsible for its arterial supply. The fibula shows the uniform pattern of periosteal blood supply receiving many small branches from the peroneal artery, and having only weak endosteal supply. The mandible articulates with the two temporal bone, and the fibula articulates with the tibia at the tibio-fibular syndesmosis and distally has a role in the formation of the lateral talocrural joint. The demand for mandibular replacement was approved simultaneously with the appearance of ablative surgery for head and neck cancer. As knowledge of physiology and pharmacology expanded in the twentieth century, major developments in the field of anesthesiology and surgery opened new windows of ablative cancer surgery that were previously unimaginable. Soldiers were badly wounded with extensive soft-tissue defects during World Wars and in certain countries, high gun ownership rates show substantial correlations with gun-related injuries. Health care development and the invention and wide-spread use of antibiotics revolutionized medical treatment and improved recovery rates and reduced mortality following trauma. Total or partial loss of the mandible without reconstruction incurs serious functional and psychological morbidity for patients. Prior to the development of advanced reconstruction options for mandibular defects, they were left with terrible cosmetic deformities. Throughout the second half of the twentieth century, various attempts were made to replace the mandible but the major breakthrough was the appearance of the microvascular technique at the end of the seventies and the beginning of the eighties.

In Hungary the number of oral and pharyngeal cancers is alarmingly high. While the mortality rate in 1955 was 282, by 2005 it rose to 1567. However, in the last 1-2 years stagnation can be observed. Nevertheless, even now significant proportions of men and women are involved. Alcohol consumption and smoking are invariably the leading causes, but one cannot disregard the shortcomings of oral cancer screenings, either. Unfortunately, drastic changes in this field are not likely to occur in the near future. Numerous solutions have been developed for the replacement of soft tissue. In our article, we describe and evaluate four of them. When using these techniques, we were often successful in replacing soft tissue deficiencies.

Oral cancer incidence in Hungary is strikingly high, even by international standards. In most cases the tumours are to be treated in advanced stage. Hence it follows that we are often forced to remove a part of the mandible, too. We usually use a fibula free flap to reconstruct the bone deficiency. In this paper we report on our clinical experience with fibula free flap.

Background: Operation on tumors situated in the posterior part of the oral cavity is a challenging aspect of head and neck surgery. Both the approach and the postablative reconstruction of the remaining defect require special procedures. An arsenal of reconstructive methods are available depending on the size and complexity of the defect. The goal should be to employ the simplest surgical reconstructive method, resulting in the best functional result and allowing for later complex oncotherapy., Objective: To study the outcomes of patients treated using buccal mucosal transposition flaps for reconstruction of posterior oral cavity and oropharyngeal border defects., Study Design: A total of 6 patients with defects of the posterior oral cavity and mesopharynx were treated with buccal mucosal transposition flaps. The patients were followed for up to 24 months., Results: Defects ranging from 12 to 27 cm 2 were reconstructed with the buccal mucosal transposition flap. One patient developed an orocutaneous fistula and 1 had some trismus requiring a Z-plasty scar reorientation. One patient suffered from nasal regurgitation. Five of the 6 patients lived past 24 months, the time of follow-up of this study., Conclusions: The buccal mucosal transposition flap, with its random pattern of circulation, used alone proved to be a safe method to reconstruct soft tissue defects or line exposed hard tissues located in the posterior oral cavity and oropharynx.

The authors' aim was to introduce a simple, safe and reliable method for reconstruction of soft tissue defects after excision of carcinomas of the tongue, tongue base and posterior part of the floor of the mouth. The musculocutaneous flaps are options of larger soft tissue defects in the maxillofacial area. After excision of a tongue-tongue base tumour with mandibular splitting method a platysma myocutaneous flap was applied for reconstruction. The flap was taken from an appropriate place convenient to functional acceptions and was adapted anatomically into the defect. The result was that the patient healed primarily with undisturbed blood circulation of the flap. The functional rehabilitation period was short, the flap tolerated the irradiation. The authors observed that the use of the platysma island flap can be an option for reconstruction of defects after ablative surgery on the tongue-tongue base. This simple method worked reliable even after intra-arterial cytostatic treatment. The acceptable functional result depends on the placement of the island flap on the neck flap prepared for neck dissection.

The modified PM myocutaneous flap was applied in 75 cases between 1982 and 1986 for the closure of major defects of the oral cavity, meso- and hypopharynx and the neck region. Notwithstanding almost all of the patients had stage IV tumour, we had a good aesthetic and functional result. There was no total flap necrosis. In three cases the partial necrosis spontaneously regressed. The details of the operation techniques are compared with other reconstructive methods, the advantage of the PM flap is discussed.

We describe the Erlangen microconducting spectrometer (EMPHO I), a device that measures the oxygen saturation and relative haemogloblin content in the capillaries. These factors determine the oxygen supply and survival of cutaneous flaps. The EMPHO I was used for intraoperative measurements in pectoralis major myocutaneous flaps and showed reproducible results, so that it is valid for intraoperative monitoring in plastic surgery.

The authors report on the use of angiography in the application of pectoralis myocutaneous flaps in head and neck surgery on the basis of 18 cases. They state that angiographic information is very useful in planning the transplantation and for the security and viability of the flap.

The principles of reconstructive operations successfully performed with the pectoralis major or myocutaneous flap in the oral cavity, pharynx and trachea are reviewed. The author's modification is demonstrated on one case of each group.

The modified pectoralis major myocutaneous paddle flap has been used in 75 cases since 1982 for the closure of major defects of the oral cavity, oro- and hypopharynx and neck. Although almost all of the patients had a stage IV tumour, we had good aesthetic and functional results. There was no total flap necrosis. Three cases of partial necrosis underwent spontaneous healing. The details of the operative techniques are compared with other reconstructive methods, and the advantage of the pectoralis major flap is discussed.

The first experience gained in Hungary with application of myocutaneous flap after Ariyan for reconstruction of the oral cavity is discussed. A modified procedure after Ariyan and indications are described. The method should be used for reconstruction of soft tissues of the head and neck.