Background: A significant number of systemic juvenile idiopathic arthritis (sJIA) patients discontinue biologic disease-modifying antirheumatic drugs (bDMARDs) due to lack of efficacy or safety concerns. Studies of biologic therapy switch regimens in sJIA are required.
Methods: Patients with sJIA who switched from tocilizumab (due to lack of efficacy or safety) to canakinumab (4 mg/kg every 4 weeks) and were hospitalized at the rheumatology department from August 2012 to July 2020 were included.
A one-stage procedure to restore the cervical part of the esophagus and laryngopharynx included extended surgery for advanced cancer of the larynx and laryngopharynx and grafting a free revascularized small intestine segment using microvascular technique. Free small intestine transplant proved well-fed by sufficiently large branches of the external carotid artery, and normal venous drainage was retained. The transplant proved biologically best suitable for such type of plastic surgery.
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