Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers

OBJECTIVES: Free flaps are widely used to reconstruct head and neck defects. Despite the improvement in the surgical techniques and the surgeons’ experiences, flap failures still occur due to thrombotic occlusion after small vessels anastomosis. To reduce the possibility of flap loss as a result of thrombotic occlusion, various anticoagulants have been used. In this study we decided to evaluate a new protocol for anticoagulation therapy and its effect on flap survival and complications. METHODS: In this interventional study, 30 patients with head and neck cancer underwent surgical defects were reconstructed by microvascular free flap between 2013 and 2014. In the postoperative period patients have taken aspirin (100 mg/day) for 5 days and enoxaparin (40 mg/day subcutaneously) for 3 days. The flap survival was followed for three weeks. RESULTS: Given that there was no complete necrosis or loss of flap, the free flap success rate was as much as 100%. The need for re-exploration occurred in 3 patients (10%). Only in one patient the need for re-exploration was due to problem in venous blood flow. CONCLUSION: The aspirin-enoxaparin short-term protocol may be a good choice after free flap transfer in reconstruction of head and neck surgical defects.

Tip graft and columellar strut using dorsal osseocartilaginous hump

Although, different grafts are used for nasal tip plasty in cases with under projected or ill defined tip, the selection of a graft material, which provides sufficient amount of tissue with least donor site morbidity and low recipient site complication is challenging. The objectives of the present study were to examine the usefulness of cartilaginous dorsum as a proper material for tip graft, and to introduce the cartilaginous dorsum as an acceptable material for columellar strut. Fifty six [18 males and 38 females] patients were operated for augmentation tip plasty and hump reduction from 2004 to 2008. The tailored cartilaginous or ostecartilaginous dorsum was used as a tip graft or columellar strut in 35 and 21 cases, respectively. The cartilaginous framework was exposed using open or close rhinoplasty approach in 41 and 15 cases, respectively. The patients were followed for 12- 36 months. Cosmetic outcomes and patients' satisfaction were obtained using qualitative measures. The percentage of patients with very improved, improved, unchanged or unacceptable aesthetic outcome were 39.29%, 50%, 3.57% and 7.14%, respectively. Moreover, the percentages of very satisfied, satisfied, indifferent and unsatisfied patients were 66%, 18%, 9%, and 7%, respectively. The procedure provides a well-defined nasal tip with no evidence of bifidity, angularity, or cartilage graft visibility and displacement. The use of dorsal osteocartilaginous graft offers outstanding advantages including ease of harvest, mould, fix, and low resorption

[Students' view points on the educational problems in medical school of Kermanshah University of Medical Sciences [2007]]

There is no doubt that improving quality in medical education is based on analysis of the current situation. Medical students are considered one of the best resources whose viewpoints on the educational shortcomings can provide valuable information on where there is still work to be done. This study presents the students perspective on the educational problems in Medical School of Kermanshah University of Medical Sciences in 2007. This phenomenological qualitative study included 24 medical students who were at different stages of medical training. Group discussions were held and students were interviewed over several sessions. All the sessions were tape recorded and transcribed by the 3 assistants. Information was then categorized in terms of three areas of basic sciences, traineeship and internship. The most important problems were cited under the categories of educational objectives, planning, management, ethics and evaluation by the students. Among subcategories, offering specialty and subspecialty materials, the gap between basic sciences and traineeship, lack of motivation and lack of supervision on education were rated as the most important factors causing concern among the students. The results of the study have revealed a series of problems that require measures at the national level including the shortage of high -quality academic staff. However, most issues can be addressed through careful planning on the part of university officials and academic staffs