Quality of life in head and neck cancer patients at 5 years after free flap reconstruction: a significant decline during the follow-up

Purpose Free flap reconstructions following head and neck tumor resection are known to involve more than 50% rate of complications and other adverse events and up to 50% mortality during a 5-year follow-up. We aimed to examine the difference in the long-term quality of life (QoL) between the 2-year and 5-year assessments after free flap surgery for cancer of the head and neck. Methods A total of 28 of the 39 eligible patients responded to the survey. QoL was assessed at 5 years after operation and compared with the assessment performed at 2 years after the operation using RAND-36, EORTC-C30 and H&N-35, and SWAL-QOL tools. Results The criteria for poor QoL using RAND-36 tool was met in 11 (39.3%) patients in contrast to 4 (14.3%, P = 0.003) patients in the 2-year assessment. EORTC-C30 global score was decreased from 83.9 (SD16.4) to 64.6 (SD 24.0, P < 0.001) during the follow-up. In both RAND-36 and EORTC-C30 surveys, decline was found in physical and role functioning together with energy and emotional well-being domains. SWAL-QOL showed poor swallowing-related QoL in both assessments. Conclusion We found a significant decline in QoL during a 5-year follow-up after free flap surgery for cancer of the head and neck.

Usefulness of Kaloderm® in Finger Tip Necrosis : A Case Report

We experienced a case of crush injury of the hand for which we performed a flap surgery and treated the necrotic parts placement using cultured allogeneic keratinocytes (Kaloderm^® ) with good results. The patient was a 31-year-old woman whose left middle finger was caught in a door, causing a crush injury. Although primary repair was performed, a 2 × 2.5-cm-sized necrosis developed, and a V-Y advancement flap was performed after the removal of dead tissues. However, a 1 × 2-cm-sized partial necrosis occurred and was treated using Kaloderm ^® . After the use of Kaloderm^® , the patient’s wound was healed, and no complications, except for mild pain, were observed for 1 year after the surgery. If a necrotic site appears after flap placement of fingertip, its treatment is difficult. If used well, Kaloderm^® may be a good option for necrosis of the fingertips and other areas that are difficult to cure.

Clinical Application of a Modified Local Transposition Flap Surgery in Repairing Fingertip Defects

Background: A modified local transposition flap surgery was performed for fingertip injuries, which allows a more significant transfer distance with good outcomes.Methods: The study collected patients who underwent parallelogram transposition flaps and V-Y flaps to repair fingertip defects from 2017 to 2020. 122 cases (122 fingers) were included in our study, The interval between the injury and operation was 5.78 h (the mean value was 4.7-8.4 h). All operations were performed by one surgical team, and the average operation time was 31.2 min.Record the operation time，two-point discrimination（2PD），Total Active Movement (TAM)and the MHQ (Michigan Hand Questionnaire) of the injured fingers to evaluate the therapeutic effect.Results: All parallelogram （Group A）and V-Y flaps （Group B）had survived postoperatively. There was no difference with operative duration and follow-up time in two groups. At last follow-up, there was no difference with the 2PD of the palmar part of the flaps and the TAM of injured figures in Group A and Group B . The MHQ summary scores in Group A were much higher than in Group B . Evaluation of the MHQ subscale performance showed that the overall hand function, activities of daily living, work performance and pain score had no differences, but aesthetics and satisfaction score was higher in Group A .Conclusions: The reconstruction using parallelogram flaps is a easier and more versatile treatment with better functions, less morbidity and better aesthetics. This method is a better choice for reconstruction of fingertip injury.

Medicine Matters: Special Considerations For Sglt2 Inhibitors And Prolonged Nothing Per Os Status Following Free Flap Surgery (Preprint)

UNSTRUCTURED A 59-year-old female patient undergoing deep inferior epigastric perforator flap surgery for autologous breast reconstruction became acutely ill with tachypnea, nausea, and vomiting on post-operative day three. A work-up elucidated a diagnosis of diabetic ketoacidosis (DKA) with lower-than-expected glucose levels as a result of recent semaglutide use. She required intensive care unit resuscitation with an insulin drip and glucose administration. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a class of oral anti-hyperglycemic agents used for the treatment of type II diabetes (DMII). As the use of these medications become more prevalent, surgeons must be educated of this serious complication and plan for patient management in advance of minor and major surgeries.

Plastic and burns surgery

This chapter discusses the anaesthetic management of plastic and burns surgery. It begins with general principles of the anaesthetic management of plastic surgical patients. Surgical procedures covered include breast augmentation, reconstruction and reduction surgery; free flap surgery; liposuction; skin grafting and burns reconstructive surgery. The chapter includes pertinent anaesthetic features for a series of additional miscellaneous plastic surgical operations.

Retrospective Analysis of Flap Based Management in Deep Sternal Wound Infection in a Tertiary Care Centre –A Single Centre Study

Aims: In this retrospective study we analyzed the outcomes of flap based management in deep sternal wound infection (DSWI). Materials & Methods: Patients, who had undergone open heart surgery through median sternotomy between September 2017 and March 2020 and had developed deep sternal infections, were retrospectively analyzed in this study. Few patients found to have DSWI were managed only by Negative Pressure Wound Therapy (NPWT) and few were managed by NPWT and Bipectoral musculo fascial flap cover. The outcomes in terms of mortality and readmission in the postoperative course were obtained from the records during subsequent follow ups in OPD for six months. Results: Out of 925 patients 11 patients (1.2%) had deep sternal wound infection There were six patients (n=6, 54.55%) who received NPWT where as five patients (n=5, 45.45 %) received flap surgery following NPWT. The patient who underwent Flap surgery had a longer postoperative stay than NPWT group (46.2+/- 22.21, C.I 95%) days Vs (25.5+/- 14.41, C.I 95%) days. However, the readmission due to recurrence of infection was seen only in NPWT group (n=3, 50%) with in the period of six months following discharge. One patient out of the three readmitted patients expired due to sepsis. Conclusion: NPWT followed by bipectoral muscle flap closure has a better surgical outcome than NPW alone in deep sternal wound infection in early postoperative period

Platelet-rich fibrin to manage different periodontal defects combine with Flap surgery and other uses in dentistry. A descriptive review

In these days, periodontal diseases are very much common in Asian subcontinent especially in Bangladesh, due to some relevant factors that is more prevalent in this country. Most of the time patient neglect their condition and ultimately loss their teeth. Even after doing phase 1 therapy that is scaling, polishing with antimicrobial agents, it could not heal the periodontal condition with advanced bone destruction or clinical attachment loss. Therefore, after proper oral hygiene maintenance therapy, different flap surgery should consider. . In recent study, it is found that platelet rich fibrin (PRF) PREPARED From the patient’s Own blood and then placement within defect could enhance the early healing procedure. This PRF membrane is also used in a variety of discipline in dentistry, including regenerative surgery. This PRF membrane is now used in a variety of disciplines in dentistry, including regenerative surgery and enhancing early healing. The goal of this study is to critically analyze and appraise the currently available research with an emphasis on the use of PRF in regenerative periodontal surgery. An electronic search was conducted (PubMed/MEDLINE, Google Scholar, BanglaJOL, Cochrane library). Various combinations of the following keywords were used: ‘prf’, ‘prf membrane’, ‘periodontal regenerative surgery’, ‘prf in dentistry’, ‘systemic diseases and periodontitis’, ‘drawback of prf’, ‘platelet-derived growth factors’, ‘prf in oms’, ‘prf in orthodontics’. Articles were searched until August 2021 All of these studies reveal that the PRF membrane enhances the healing of various defects in a variety of periodontal diseases and in several fields of dentistry. Studies are going on pulp regeneration and socket healing after extraction with PRF in dentistry. More emphasis should have to give to the prevention of periodontal diseases as well as more concern should have to give on PRF with flap surgery to enhance healing and improve the social health of the general population by preventing tooth loss and for different research purposes on PRF in different other fields of dentistry in Bangladesh. Update Dent. Coll. j: 2021; 11(2): 43-51