ABSTRACT
Introduction: Difficulties to find the ideal donor site with perfect matching tissues have always made the reconstruction of facial complex defect a tough problem for surgeons. The main aim of reconstruction is to restore facial contour (esthetics) and function (mastication, deglutition, and speech). Aim: The aim of the study was to analyze the versatility of forehead flap in maxillofacial/nasal and intraoral defects. Materials and Methods: This retrospective study was conducted to analyze the versatility of forehead flap in maxillofacial/nasal and intraoral defects. A total of 25 consecutive patients, of either sex, who required soft tissue reconstruction of the maxillofacial region, including oral cavity and nasal defects due to tumor ablative surgery. Follow-up was done for up to 4 months – 1 year and on every follow-up visit, patients were questioned about the degree of satisfaction, with mouth opening, swallowing, and donor site esthetics. Cosmetic deformity judged subjectively. Results: Of 25 patients, 17 patients were males, 12 patients were above 60 years. Maximum number of site of tumor involvement was noted in cheek 9 patients (36%) and in lower lip 5 patients (20%). About 44% patient had stage 2 tumors and 28% had stage 3 tumors. About 18 patient had adjuvant radiation, 1 patients had chemo RT, and 6 patients had no adjuvant treatment. About 16% of patients had a complication of altered forehead sensation. Conclusion: Forehead flap is a reliable technique for the reconstruction of maxillofacial region defects. It is easy to rise and can provide coverage for wide defects as far as the para mandibular and submandibular regions. Moreover, it does not require patient repositioning.
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Introduction: Major head and neck surgery involve dissections close to crucial structures such as nerves and vessels. For this reason, it is very important to use safe instruments for dissection and hemostasis. In a wide variety of surgical procedures, advanced vessel sealing devices are replacing traditional techniques for vessel ligation. Aim: Our study aimed to compare the bipolar vessel sealing system versus suture ligation in selective neck dissection in patients with oral cancer. Methods: This prospective comparative study was conducted to compare the outcome of the bipolar vessel sealing system versus suture ligation in selective neck dissection in patients with oral cancer. Out of 40 patients enrolled in the study, 20 patients were in Group A (bipolar vessel sealing system) and 20 patients in Group B (Suture ligation). The outcome measures recorded were blood loss, operating time, duration of hospital stay, pre-operative blood transfusion, Fromme’s surgical field scale, post-operative pain, and drainage volume. Treatment protocol and follow-up protocol were followed and the results were statistically analyzed and discussed. Results: Out of 40 patients, 20 patients had bipolar vessel sealing system and 20 patients had suture ligation. In bipolar vessel sealing system of 20 patients, 12 patients were male and 8 patients were female, mean value of blood loss is 26.84 ± 22.34 ml, operating time is 48.56 ± 5.48 min, duration of hospital stay is 12.92 ± 1.28 days, mean value of post-operative pain in day 0 is 3.5 ± 1, day 1 is 3.1 ± 1, day 2 is 1.8 ± 0.5, and day 3 is 1.1 ± 0.5, and drainage volume (ml) in 24 h is 72.48 ± 28.46, 48 h is 24.57 ± 18.29, and 72 h is 7.24 ± 6.7. In suture ligation of 20 patients, 15 patients were male and 5 patients were female, mean value of blood loss is 39.28 ± 16.44 ml, operating time is 54.22 ± 4.14 min, duration of hospital stay is 13.87 ± 1.42 days, mean value of post-operative pain in day 0 is 4.01 ± 0.9, day 1 is 3.8 ± 1.1, day 2 is 2.4 ± 0.6, and day 3 is 1.6 ± 0.8, and drainage volume (ml) in 24 h is 98.28 ± 36.87, 48 h is 41.28 ± 21.24, and 72 h is 18.29 ± 9.45. Conclusion: Bipolar vessel sealing system is more efficacious in terms of reducing blood loss, operating time, and better surgical field than conventional suture ligation. Thus, bipolar vessel sealing system is more advantageous compared to the traditional techniques, from both a clinical and economic point of view.
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Introduction: The scalp is the most frequent site of occurrence of malignant tumors because this area is generally neglected bythe patient and not closely monitored during physical examinations, scalp tumors can go unnoticed until they become malignant.Aim: The aim of our study was to analyze the histological patterns and management options in malignant tumors of the scalp.Materials and Methods: This prospective study was conducted to analyze the histological pattern and management options inmalignant tumors of the scalp. Medical reports of patients diagnosed with the clinical diagnosis of scalp lesions were studied.H&E stained slides of the scalp lesions were retrieved and reviewed. Clinical and histopathological diagnoses were studiedfor each case to evaluate clinically misdiagnosed cases. Data so obtained were tabulated and were analyzed statistically, andresults were discussed.Results: Out of 25 cases, male patients were 13 (52%) and female patients were 12 (48%), age distribution ranges from 20 to80 years with <30 years 2 patients (8%), 31–40 years 4 patients (16%), 41–50 years 3 patients (12%), 51–60 years 9 patients(36%), >61 years 7 patients (28%), based on histological pattern squamous cell carcinoma is most common of 10 cases (40%),basal cell carcinoma 8 cases (32%), dermatofibrosarcoma 2 cases (8%), fibroxanthoma 1 case (4%), melanoma 2 cases (8%),and metastatic tumors 2 cases (8%) where the primary site is the lung in both the cases. Sixteen cases (64%) were managedby split skin graft, 7 cases (28%) by rotational/transpositional flap, and 2 cases (8%) by free flap.Conclusion: Although malignant scalp tumors are not common, when facing a patient with scalp lesions or lumps, physiciansshould be alert in detecting any suggestive new growth hidden in this hairy area to make an early diagnosis and perhaps todetect primary cancer in case of metastatic scalp tumors.
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Introduction: Surgical incisions are usually made with scalpel. Usage of scalpel usually results in skin bleeding which obscuresthe operating field resulting in wastage of operating time. Although diathermy is increasingly used for underlying tissue dissection,cutting, and hemostasis, its use for making skin incisions is not gaining favor.Aim: The aim of our study was to compare the value outcome of diathermy incisions versus scalpel incisions in abdominalsurgeries.Materials and Methods: This prospective comparative study was conducted to compare the outcome of diathermy incisionsversus scalpel incisions in oncological surgeries. Total of 80 patients who divided into Group A (scalpel incision) for 39 patientsand Group B (diathermy incision) for 41 patients. Treatment protocol and follow-up protocol were followed and the results werestatistically analyzed and discussed.Results: Out of 80 patients, 39 patients had scalpel incision and 41 patients had diathermy incision. In the scalpel group outof 39 patients, 21 patients were male and 18 patients were female, the mean duration of incision time in the scalpel group is116 sec, the mean value of incisional blood loss in the scalpel group is 1.9/ml, the mean operating time in the scalpel group is36.42 min, and the mean value of post-operative pain in day 1 is 6.42, day 2 is 5.18, and day 3 is 3.66. In the diathermy groupout of 41 patients, 26 patients were male and 15 patients were female, the mean duration of incision time in the diathermy groupis 88.52 sec, the mean value of incisional blood loss in the diathermy group is 1.4/ml, the mean operating time in the diathermygroup is 38.75 min, and the mean value of post-operative pain in day 1 is 5.12, day 2 is 3.88, and day is 2.01.Conclusion: The findings of the present study show that diathermy seems to provide some benefit with respect to post-operativewound pain, less incision time, and less incisional blood loss and has obvious safety advantages to the surgical team comparedwith scalpel.