Since a radial forearm flap is thin and flexible, and has a long vascular pedicle, it is suitable for reconstructing soft tissue defects, particularly of the tongue, in oral cancer surgery. In general, the raw surface on the donor site of the harvested radial forearm flap is covered with full- or split-thickness skin harvested from the thigh or abdomen. However, such skin graft from the thigh or abdomen may cause complications such as hypertrophic scar formation and color mismatch on the forearm as well as delayed wound healing and surgical scar at the new donor site. Since 2001, we have harvested skin from an ipsilateral volar forearm instead of the thigh and abdomen, for covering the donor site of the radial forearm flap. In this method, triangular-shaped full-thickness skin is harvested from ipsilateral volar skin adjacent proximally to the forearm flap site. The present study clinically compared this skin graft with a skin graft from the abdomen. The skin harvested from the ipsilateral forearm showed a better color match and more satisfactory aesthetic appearance than that from the abdomen. In addition, the skin was sufficiently large to cover the donor site of the flap in all cases. Skin graft from the forearm is a useful technique for covering the donor site of a radial forearm flap.

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We report a case of cancer of the oral floor (T4aN3M0) treated successfully with thermochemoradiotherapy.
A male in his 60's with a mass in the oral floor was referred to our department. There was a tumor in the oral floor measuring 40 × 35 mm and left cervical swelling. CT images showed that the tumor had invaded extrinsic tongue muscles and its size was 42 × 35 × 30 mm, and there were also large metastatic lymph nodes from level II to IV. After the biopsy, the patient was diagnosed as squamous cell carcinoma of the oral floor (T4aN3M0). As the patient wanted to preserve oral function and refused to undergo operation of the primary site excluding neck dissection, we performed superselective intra-arterial chemotherapy via bilateral superficial temporal arteries (cisplatin: total 264 mg, docetaxel: total 144 mg) with daily concurrent radiotherapy (1.8 Gy/day, total 59.4 Gy) and thermoradiotherapy for cervical lymph node metastases (RF capacitive hyperthermia: twice). After the treatments, the primary and cervical sites became remarkably small. Although the treatment effect was complete response of the primary tumor and cervical lymph node metastases 6 weeks after the treatment, CT images revealed lung metastasis. The patient died 20 months after the initial treatments in spite of chemotherapy. During follow-up, there was no recurrence of the primary tumor or cervical lymph node metastases.

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Pleomorphic adenoma is the most frequent benign tumor derived from salivary glands. Usually, this tumor presents as a painless and solid mass. In this report, we describe an extremely rare case of pleomorphic adenoma of the submandibular gland with remarkable cystic formation. The patient was a female in her fifties who had a painless mass that had persisted for 20 years in the left submandibular region. CT and MRI revealed the existence of a large cystic mass in the submandibular gland. The patient was histopathologically diagnosed as pleomorphic adenoma by needle biopsy, and then the left submandibular gland was surgically removed under general anesthesia. Histopathological examination of the excised specimen showed remarkable cystic formation in the tumor parenchyma including the duct-like bilayered structure. Immunohistochemical staining revealed that the tumor cells expressed cytokeratin (AE1/AE3) and α-SMA, and S-100 protein was mainly expressed in the stromal cells. Furthermore, the Ki-67 labeling index of the tumor cells was less than 1%. The cystic wall mainly consisted of duct-like bilayered epithelium and α-SMA was expressed only in the basal layer. These histopathological findings suggested that the cystic lesion in this case might have been formed by enlargement of the duct-like structure in the tumor tissue. The histopathological diagnosis was finally pleomorphic adenoma. There has been no evidence of recurrence as of 1 year and 9 months after the operation.

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