title: Use of a protein-based tissue adhesive as an aid for the surgical reconstruction of advanced and recurrent skin cancer tumors to the head and neck region: a technical report.
abstract: BACKGROUND
  Patients with advanced skin cancer present a unique challenge to neurosurgeons. Treatment involves aggressive surgical intervention and lengthy reconstructive procedures with considerable morbidity to obtain adequate and safe oncological margins. We reviewed our experience with BioGlue Surgical Adhesive, a protein-based adhesive, as an adjunct in free tissue transfer procedures to prevent CSF leakage and seroma formation.
  
  
  METHODS
  Between January 2000 and June 2004, 11 patients ranging in age from 32 to 87 years presented with advanced skin cancer tumors in the head and neck. Pathology included squamous (7) and basal (3) cell carcinoma and malignant schwannoma (1). Of the 11 patients, 8 had undergone previous surgery and/or radiation therapy. All were treated with a combination of craniotomy, skull base, and craniofacial approaches with reconstruction of the large defects using muscular or myocutaneous free flaps in a single operation. Fat, muscle, and a 1-mm epidural layer of BioGlue were used to seal the dural sutures and to obliterate any potential seroma-forming dead space.
  
  
  RESULTS
  A total of 6 patients underwent craniofacial resection with orbital exenteration and partial rhinectomy, whereas the remaining 5 underwent frontal, parietal, and/or occipital craniotomies. All patients required dural repair. Three patients required additional brain resection because of tumor infiltration. No patient developed a CSF leak or seroma. There were no adverse events related to the use of BioGlue. Three patients died of medical complications (pulmonary embolism, myocardial infarction, late-onset myelodysplasia). The remaining patients are alive, and our follow-up (range, 9-58 months) has revealed no recurrence or distal metastasis.
  
  
  CONCLUSIONS
  Advanced skin cancer tumors in the head and neck region are associated with complex and disfiguring surgical procedures with increased morbidity. We demonstrate that an adjunctive use of a sufficiently strong tissue adhesive can yield acceptable outcomes and minimize comorbidity in this challenging patient population.
authors.affiliation: Department of Neurological Surgery, Hospital de Clinicas Caracas, San Bernardino, Caracas 1011, Venezuela. leolust@cantv.net
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lustgarten
authors.forename: Jose R
authors.initials: JR
authors.lastname: Abadi
authors.forename: Radovan
authors.initials: R
authors.lastname: Sancevic
authors.forename: Pedro
authors.initials: P
authors.lastname: Meneses
authors.forename: Alberto
authors.initials: A
authors.lastname: Perez Morrel
authors.forename: Joaquin
authors.initials: J
authors.lastname: Lugo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000601:surgery; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003399:Craniotomy; D004388:Dura Mater / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009442:Neurilemmoma / Q000601:surgery; D019635:Neurosurgical Procedures; D009666:Nose / Q000601:surgery; D009915:Orbit / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D011506:Proteins / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: C472676:Bio-glue; D011506:Proteins; D014014:Tissue Adhesives