RESUMEN
Aim: To find out the utility of the island nasolabial flap in patients with oral cavity malignancy. Materials and methods: This was an observational study conducted at a super-specialty hospital in Maharashtra from October 2019 to December 2021. Patients with oral malignancy planned for island nasolabial flaps were only considered. Results: A total of 20 patients were operated on, out of which 16 were males and 4 were females. All the patients were followed up for a minimum period of 6 months. The hospital's online reporting system is used for the data collection including the post-operative assessment. Out of the 20 patients, 10 patients were suffering from tongue carcinoma, 6 patients from buccal mucosal carcinoma, two from hard palate carcinoma and one patient each from the floor of the mouth and lip carcinoma. The mean age of the series was 52.3 years, the average duration of the surgery is 169.4 min and the average hospital stay in the series was 4.35 days. The Ryle's tube was removed on an average of 4.35 days. No flap-related complications were noted during the series, and healing of the donor site was uneventful. The functional outcomes after the reconstruction are acceptable in all the cases except in the lip reconstruction patient where there was post-operative drooling. Conclusion: The island nasolabial flap is relatively easy to harvest and less time-consuming. The other advantages include the post-operative surgical scar falls along the nasolabial fold, long pedicle length with preservation of the facial pedicle for future microvascular use, early transfer to the oral feed from the nasogastric feed, and early de-cannulation. In our small study, we observed that the island nasolabial flap is a very useful flap for the small to moderate-sized defects of the oral cavity. We feel, one of the disadvantages of this flap is that it is not an ideal flap for lip reconstruction.
RESUMEN
Purpose Regular practice, quality clinical exposure, and academic discussion are essential in any surgical specialty training. This study discusses and validates the option of using a fresh "chicken quarter" model with a measurable scoring system, as a standard training regimen in microvascular surgery. This can be a very effective, economical, and easily accessible model for residents. Materials and Methods This study was conducted in the Department of Plastic surgery, from October 2020 to May 2021. Twenty-four fresh "chicken quarter" specimens were dissected and the ischial arteries and femoral veins' external diameter (ED) were measured. The microsurgical skills of the trainee were assessed in 6 months intervals using the Objective Structured Assessment of Technical Skills Scale (OSATS) as well as the time taken for anastomosis. All the data were analyzed using SPSS (statistical package for social sciences) version 21. Results A task-specific score value of 50% on October 2020 improved to 85.7% by May 2021. This was found to be statistically significant ( p = 0.043). The mean ED of the ischial artery and femoral vein was 2.07 and 2.26 mm, respectively. The mean width of the vein measured at the lower one-third of the tibia was 2.08 mm. A greater than 50% reduction in anastomosis time was observed after a period of 6 months. Conclusion In our minimal experience, the "chicken quarter model" with OSATS scoring system seems to be effective, economical, very affordable, and easily accessible microsurgery training model for the residents. Our study is done only as a pilot project due to limited resources and we have the plan to introduce it as a proper training method in the near future with more residents.
RESUMEN
To find out the utility of the scalp flap based on the posterior branch of the superficial temporal artery in patients with head and neck mucormycosis and malignancy. This was a multi-institutional observational study conducted at a tertiary cancer centre in North East India and a super-speciality hospital in Maharashtra from January 2021 to June 2021. Patients with malignancy and mucormycosis were only considered. In our study, we have seven patients (n = 7), two of them had mucormycosis and 5 had squamous cell carcinoma of the head and neck region. Out of the 5 cases of the head and neck malignancy, two cases were recurrent ones, another two cases where primary flap failed and in the last case, the patient was unfit for free tissue transfer due to cardiac issues. The mean age in the series was 50.42 years and the average duration of raising the flap was 22.86 min. Average hospital stays for head and neck cancer patients are 4.6 days and for mucormycosis patients, it is 22.5 days. No flap related complications were noted during the series. Scalp flap based on the posterior branch of the superficial temporal artery is a useful option in recurrent malignancy cases, in primary cases as a salvage option and in patients where long duration surgery is not possible due to poor general condition like in critical mucormycosis. Post-operative hair growth at the flap site and alopecia at the donor scalp are concerns and therefore, careful patient selection is a must.
RESUMEN
Local flaps are important parts of oncoreconstruction. The idea of writing this article is to give knowledge to my fellow aspiring plastic surgeons about the common locoregional flaps that are essentially done in a tertiary cancer centre. This is a retrospective study carried out in the Department of Plastic Surgery, Dr. B Borooah Cancer Institute, Guwahati, from May 2018 to April 2019. Musculoskeletal and soft tissue, head and neck and thorax and gynaecological malignancies which required locoregional flaps for reconstruction were taken up for the study. Flap reconstructions performed by oncosurgeons are not included in the study. We have done a total of 74 locoregional reconstructions during this 12-month period apart from 43 free tissue transfers. In our study, age ranged from 12 to 84 years. Most commonly performed flap during this time was pectoralis major myocutaneous flap. Complications of various flaps were assessed. Out of the 74 flaps, total necrosis of one flap occurred, and re-surgery was required in one case. Most of the oncosurgeons have a good idea of locoregional reconstructions in cancer centres. In such centres, the need of plastic surgeon for locoregional reconstruction is mainly for complex reconstructions and unfamiliar anatomic locations, for second flap after initial local flap failure or after free flap-related complications.
RESUMEN
Soft tissue sarcomas of the upper extremities are very rare tumors. Due to the complex anatomy of the arm, the management of the soft tissue sarcoma becomes very challenging for the operating surgeons. Nonetheless, a large portion of the patients can be treated in a limb-sparing manner ,if surgical expertises are present .We report a case of 30 years old lady with soft tissue sarcoma of right arm operated in an another hospital, came to our institute with pain in the operated site and positive histological margins. The patient had feeble radial and ulnar artery pulses. We had done a MR angiography of that limb and it showed no flow from mid arm level in the brachial artery, but presence of collaterals around elbow joint. We had removed the residual tumor and also excised 14 cm of right brachial artery. On opening the brachial artery, tumor thrombus was seen along the whole length of the excised segment. The defect was reconstructed with reverse great saphenous vein graft taken from left leg. Post-operative period was uneventful. Doppler ultrasonography done at 6 and 12 months later showed good flow in the grafted segment with minimal narrowing of the anastomosis sites.