Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps

To assess the improvement in Quality Of Life [QOL] after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. Quasi-experimental. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007 A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire [including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening]. A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved [p < 0.05]. Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores

Pedicled gastrocnemius muscle flap in the management of complex wound around the knee joint

To highlight the outcome of gastrocnemius muscle flap usage as a management of the complex wounds around the knee joint. Design: It was a retrospective study. Place and Duration: The study was conducted in Combined Military Hospital, Kharian, between January 1, 1998 and June 30, 2000. A total of 18 patients with complex injuries around the knee joint were included in the study. In all the patients, superiorly based pedicled gastrocnemius muscle flap, with skin grafting, was used. The medial head in 15 patients, lateral head in 2 patients and both in 1 patient were used in accordance with the dimensions of the defects. Flap survival was 100%. All the limbs were successfully salvaged. Donor site morbidity and complications resulting from the procedure were limited and manageable. It is a simple, quick and reliable procedure that can be done under any circumstances with very good results