EKSISI DAN MEGA PROSTHESIS PADA GIANT CELL TUMOR PROXIMAL TIBIA (LAPORAN KASUS)

Giant cell tumor (GCT) merupakan tumor destruktif tulang yang muncul di antara dekade kedua dan keempat, lokasi predileksi umumnya pada epifisis tulang panjang. Pemilihan tatalaksana operasi sangat penting dan masih menjadi perdebatan. Sebagaimana masih beragamnya pilihan tindakan pembedahan. Klasifikasi Campanacci dapat digunakan sebagai acuan untuk panduan tatalaksana. Pada kasus ini kami melaporkan seorang wanita, usia 18 tahun dengan diagnosa giant cell tumor pada proximal tibia dextra dengan Campanacci grade III. Pasien telah menjalani operasi limb salvage tahap pertama berupa eksisi luas pada proximal tibia dextra dan knee arthrodesis. Setelah 4 bulan dilakukan operasi limb salvage tahap kedua yaitu knee arthroplasty dengan megaprosthesis. Untuk mencegah komplikasi implant expose, dilakukan muscular flap dan split thickness skin grafting (STSG). Setelah dilakukan evaluasi selama 4 bulan, klinis pasien baik, pasien dapat berjalan alat bantu dan tanpa nyeri, tidak ada komplikasi pada luka operasi dan fiksasi implan baik. Kesimpulan yang didapatkan bahwa limb salvage surgery pada giant cell tumor proximal tibia dapat dilakukan dengan tindakan rekonstruksi dua tahap. Teknik muscular flap dan split thickness skin grafting (STSG) dapat digunakan untuk mencegah terjadinya implant expose.

Cervicofacial surgery and implantable hearing device extrusion: management of challenging cases

ObjectiveTo describe our management of implantable hearing device extrusion in cases of previous cervicofacial surgery.MethodsA review was conducted of a retrospectively acquired database of surgical procedures for implantable hearing devices performed at our department between January 2011 and December 2019. Cases of device extrusion and previous cervicofacial surgery are included. Medical and surgical management is discussed.ResultsFour cases of implant extrusion following cervicofacial surgery were identified: one involving a Bonebridge system and three involving cochlear implants. In all cases, antibiotic treatment was administered and surgical debridement performed. The same Bonebridge system was implanted in the middle fossa. The three cochlear implants were removed, and new devices were implanted in a more posterior region.ConclusionPrevious cervicofacial surgery is a risk factor for hearing implant extrusion. The middle fossa approach is the best option for the Bonebridge system. Regarding the cochlear implant, it is always suitable to place it in a more posterior area. An inferiorly based fascio-muscular flap may be a good option to reduce the risk of extrusion.

Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis

As breast cancer surgery continues to evolve, this study highlights the acute complication rates and predisposing risks following partial mastectomy (PM), mastectomy(M), mastectomy with muscular flap reconstruction (M + MF), mastectomy with implant reconstruction (M + I), and oncoplastic surgery (OPS). Data was collected from the American College of Surgeons NSQIP database (2005–2017). Complication rate and trend analyses were performed along with an assessment of odds ratios for predisposing risk factors using adjusted linear regression. 226,899 patients met the inclusion criteria. Complication rates have steadily increased in all mastectomy groups (p < 0.05). Cumulative complication rates between surgical categories were significantly different in each complication cluster (all p < 0.0001). Overall complication rates were: PM: 2.25%, OPS: 3.2%, M: 6.56%, M + MF: 13.04% and M + I: 5.68%. The most common predictive risk factors were mastectomy, increasing operative time, ASA class, BMI, smoking, recent weight loss, history of CHF, COPD and bleeding disorders (all p < 0.001). Patients who were non-diabetic, younger (age < 60) and treated as an outpatient all had protective OR for an acute complication (p < 0.0001). This study provides data comparing nationwide acute complication rates following different breast cancer surgeries. These can be used to inform patients during surgical decision making.

SKIN-MUSCULAR FLAP OF MAJOR PECTORALIS MUSCLE IN PHARYNGOSTOMAS PLASTIC CLOSURE

Laryngeal and hypopharyngeal cancer accounts for 1.5–3.8% of all malignant neoplasms, accounting for more than half of all ENT-cancer patients in the structure of oncological morbidity in Ukraine. Among them more than 60% are found in III–IV stages. Locally diffused larynx and hypopharynx cancer are indications for laryngectomy and resection of the hypopharynx, depending on the extent of the lesion that, in the presence of regional metastases, can be combined with one-or two-way radical or functional neck dissection. Failure to suture the hypopharynx after laryngectomy further leads to the formation of pharyngeal fistulas, suppurations of postoperative wounds, necrosis of the skin and the formation of pharyngostomas. In the plastic closure of the pharyngostomes, regional skin, and facial, and skin-muscle flaps are used, among which the most common is the large chest muscle. The advantages of the flap are the ease of fence, the large volume of plastic material, stability of a “vascular leg”, reliability and short operating time. Our experience with the use of free and regional flap suggests that the musculo-skeletal system of the large chest muscle can be used not only as a “rescue swaddle”, but also, as a first choice in certain clinical situations. 72 patients with laryngeal and hypopharyngeal cancer were included to the study. The age of patients ranged from 41 to 74 years. All patients (100%) had histologically confirmed flat-cell carcinoma of varying degrees of differentiation. Depending on the spread of the cancer process, stage III (T3N0-1M0) was diagnosed in 47 (65.2%), stage IV (T3N2-3M0, T4N0-3M0) in 25 (34.8%) patients. Laryngeal cancer is found in 52 (72.2%), hypopharyngeal — in 20 (27.8%) patients. Plastic closure of pharyngostomas was carried out after 2–3 months after larynectomy, after reduction of inflammation in postoperative wound and clear formation of pharyngostoma edges. The surgical intervention was carried out by two brigades — one brigade carried out the excision of the skin muscle flap, while the other one carried out the removal of the throat wall in the soft tissues of the neck, and then the sheathing of the skin part of the flap was carried out to the edges of the pharyngostomas, and the stitching of the edges of the skin at the point of excision of the flap on the chest wall. The evaluation of the function was performed on the scale of functioning for head and neck cancer patients, PSS-HN (Performance Status Scale for Head and Neck Cancer Patients). The total necrosis of the flap was observed in 2 patients (2.7%) among 72, that were operated as one of the first, at the stage of development of the surgical technique. Partial flap necrosis was observed in 6 (8.3%) patients. Thus, the plastic closure of pharyngostomas with the help of the skin-mimetic flap of the big chest muscle was successful in the vast majority of patients (70 out of 72). The investigation of the functional status of patients on the PSS-HN scale showed a significant improvement and expansion of the diet from 30 to 90-100 points due to the transfer of patients from probe to usual food intake. The public eating habits improved from 25 to 100 points. The operation of the plastic closure of pharyngostomas did not increase the clarity of the language of patients, but created the anatomical conditions for the development of pseudo-voice and vocal prosthesis. So, the using of the skin-muscular flap of major pectoralis muscle in pharyngostomas plastic closure allows achieving satisfactory surgical and functional results.