Locally advanced low rectal cancers pose a challenge for surgeons as reported local recurrence remain high despite the performance of Total Mesorectal Excision and the provision of neoadjuvant treatment. Extralevator Abdominoperineal Excision offers better oncologic margins with reported decreased recurrence rates when compared to the conventional technique. The improvement in oncologic outcomes, however, comes at the cost of producing larger perineal defects—and with this comes concerns related to coverage. Presented here is a case of a patient with a locally advanced low rectal cancer with gluteal extension where a Vertical Rectus Abdominis Myocutaneous flap was utilized as a means of perineal reconstruction.

Human ; Male ; Aged: 65-79 Yrs Old ; Rectal Cancer ; Rectal Neoplasms

The epidemiologic data and management done to patients with maxillofacial fractures admitted at the Philippine General Hospital from January 2004 to December 2007 were studied.
METHODS: The records of 512 patients were reviewed. The data obtained included age, gender, date of the injury, etiology and types of fractures, and management done. The relationship between the patient age and the etiology of the injury as well as the relationship between the etiology and the type of fracture was determined through a single factor analysis of variance (ANOVA) using STAT-EASE Design Expert Statistical Software Version 7.1.5.
RESULTS: The data obtained from the study is consistent with international data, however, some differences may be noted. Maxillofacial fractures were most common among young adults aged 21 to 30 years old (34.8%), followed by adults aged 31 to 40 years old (22.1%). Men were injured more than women with a 7:1 ratio (males = 87% females = 13 %). The most common etiology of maxillofacial fracture was traffic-related accidents (63.7%) in contrast to physical assault as what was apparent a couple of decades back . Other common causes were physical assault or mauling (14.5%), falls (11.5%), gunshot wounds (6.4%) and hacking (3.1%). Mandibular fractures were the most common (32.8%, n=168) in contrast to nasal bone fractures as what is reported in international literature. Other fractures included frontal (30.9% n=158), orbital (24%, n=123), maxillary (16.4%, n=84), zygomatic (15%, n=77), and nasal bone fractures (14.1%, n=72). Open reduction with internal fixation using titanium miniplates is the most common treatment for displaced fractures. A statistically significant relationship was noted between etiology and type of fracture, as well as age and etiology of fracture.
CONCLUSION: In the last 30 years, a change in the epidemiologic trends of patients consulting for maxillofacial trauma was noted. Presently, traffic-related accidents overshadow interpersonal violence as the cause of facial fractures. Maxillofacial fractures are more common amongst 21-30 year-olds. The frontal bone is second only to the mandible as the most commonly involved bone in maxillofacial fractures. Miniplate osteosynthesis is the method of choice of fixation, mainly due to its functional and technical advantages. The significant relationship between age and etiology of injury as well as etiology of injury and type of fracture indicates that maxillofacial fractures and ORIGINAL ARTICLE their extent can be brought about and influenced by some other factors such as age, etiology and type of injury which have statistically established their own interactions.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Mandibular Fractures ; Accidental Falls ; Titanium ; Frontal Bone ; Wounds, Gunshot ; Hospitals, General ; Philippines ; Maxillofacial Injuries ; Nasal Bone ; Skull Fractures ; Mandible ; Violence