An Investigation of the Behaviour of the Epithelium of Radial Forearm Flaps Transplanted Into the Oral Cavity

Badran, Darwish Hasan (1991) An Investigation of the Behaviour of the Epithelium of Radial Forearm Flaps Transplanted Into the Oral Cavity. PhD thesis, University of Glasgow.

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This project is a collaborative study between the Anatomy Department, Canniesburn Hospital and the Western Infirmary, Glasgow, and consists of two parts. I. A scanning electron microscopical study documenting the variation in the surface pattern of buccal epithelial cells obtained by repeated swabbing of the buccal mucosa at a defined site in normal control subjects, and investigating the possibility of using oral swabs to monitor the dose of radiotherapy without the need for biopsies. From this study it is concluded that: 1) There is considerable variation in the surface morphology of normal buccal epithelial cells as seen by scanning electron microscopy of oral swabs. 2) These variations seem to reflect the level at which the cells lie within the epithelium. 3) Adjacent cells can have different surface patterns. 4) The superficial and deep surfaces of one cell may show different patterns. 5) These findings in normal buccal epithelium suggest caution in attributing particular patterns to the effect of specific doses of radiation. 6) Swabs from the surface of intraoral radial forearm flaps are not helpful in monitoring the behaviour of the flap. II. A clinical, histological and ultrastructural study of the behaviour of free radial forearm flaps transplanted into the oral cavity for treatment of oral tumours. In particular the study aimed to document the structural basis of a change in the gross appearance of some of the flaps from skin to that of oral mucosa. Data was collected from 53 patients from whom a total of 77 biopsies were taken at different periods following their treatment by either surgery alone or surgery and radiotherapy. The clinical observations were correlated with the histological and ultrastructural findings and it is concluded that: 1) Radiotherapy is not essential for the skin to change to an appearance similar to mucosa. 2) The time of onset of the change is variable. 3) The change can start anywhere in the flap and may involve the whole flap or parts of it. 4) The change to an appearance resembling oral mucosa is reversible. 5) The epidermis of the changed flaps showed signs of hyperactivity i. e. parakeratosis, acanthosis and increased glycogen content. The dermis showed various grades of inflammatory reaction. 6) Transmission electron microscopy showed the tonofilaments in keratinocytes of the changed flaps to be dispersed in the cytoplasm, as seen in cells of normal lining mucosa, with persistence of fat droplets in the cells of the stratum corneum. 7) Radiotherapy at the dose given to these patients produces permanent damage to the hair follicles. 8) Candidal infection is probably an important factor in producing the change.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Surgery, Morphology
Date of Award: 1991
Depositing User: Enlighten Team
Unique ID: glathesis:1991-78381
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09

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