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operative radiotherapy). Median fol- low-up for living patients was approxi- mately 5 years. These analyses include chemotherapy responses and toxicities, surgical complications, radiotherapy toxicities, patient compliance, survival time, and patterns of treatment failure. Overall chemotherapy response was 0.70 (0.19 CR, 0.51 PR). The median survival time for conventional treat- ment was longer than the time for pa- tients receiving preoperative chemo- therapy, although the survival time dif- ferences were not statistically significant. This final analysis demon- strates no benefit in survival using pre- operative chemotherapy for advanced stage, resectable head and neck squa- mous cell carcinoma.

H. TIDEMAN

Rat ionale for e lect ive modif ied neck dissect ion

Robert M. Byers, Patricia F. Wolf, Alando J. Ballantyne Head and Neck Surgery 1988: 10:160-67

A retrospective study was conducted to give surgeons direction in deciding which type of modified neck dissection is proper elective treatment for the pa- tient with a clinically negative neck. The study included medical records of 428 previously untreated patients (seen be- tween January 1, 1970 and December 31, 1979) whose necks (i.e., NO) were electively dissected and who had had a

primary squamous carcinoma of the oral cavity, oropharynx, larynx, or hy- popharynx. The 3 major types of modi- fied neck dissections studied were the supra-omohyoid, the anterior, and the functional. Sixteen percent (70 of 428) of the patients had multiple positive nodes and 6% (28 of 428) had evidence of extracapsular invasion. A unilateral supra-omohyoid dissection was most often used for primaries of the oral cav- ity. Bilateral anterior dissection was common for cancers of the larynx and hypopharynx, and functional neck dis- section was equally distributed among the primary sites. None of the patients with primaries of the larynx or hypo- pharynx had pathologically positive nodes in the submental or submaxillary triangles. Advanced T-stage was gener- ally associated with a greater incidence of subclinically positive nodes. Thirty percent of the patients received post- operative radiotherapy. The total num- ber of nodes removed, the number of positive nodes with or without extracap- sular invasion, and the anatomic loca- tion of the positive nodes were corre- lated with the type of dissection, the stage and site of the primary cancer, the degree of histologic differentiation of the primary cancer, the use of post- operative radiotherapy, the regional (neck) failure, and survival. An elective modified neck dissection appeared to be an appropriate part of the initial surgi- cal treatment for patients with primaries of the tongue, floor of the mouth, retro- molar trigone, pharyngeal wall, base of the tongue, pyriform sinus, and glottic and supraglottic larynx. Adjunctive postoperative radiotherapy appeared to have a statistically significant effect for

only those patients who had patholo- gically multiple positive nodes and ex- tracapsular invasion.

H. TIDEMAN

The " reduced" lat issimus dorsi muscu locutaneous f lap

Akiteru Hayashi, Yu Maruyama Plast. Reconstr. Surgery 1989: 84: 290-95

This report introduces a new device among latissimus dorsi flaps: the "redu- ced" latissimus dorsi musculocutaneous flap. This flap consists of a proximal musculocutaneous unit and a distal, thin fasciocutaneous unit (the "redu- ced" portion). The former unit carries a reliable blood supply from the thoraco- dorsal artery and is able to cover deeper recipient defects, while the latter pro- vides a well-contoured reconstruction of the defect. If needed, an extended por- tion and/or a thin cutaneous flap can be carried along with the flap according to the defect. In their clinic, the authors have so far used 4 pedicled and 1 free reduced latissimus dorsi musculocu- taneous flap in the repair of a variety of defects. All flaps survived, and satis- factory contour of the recipient site was achieved in each case. These clinical ex- periences clarify that a reduced portion 10 cm in length can be safely carried, and it is suggested that survival of this flap does not depend on its width-to- length ratio.

H. TIDEMAN