ABSTRACT
PURPOSE: Large pharyngocutaneous fistulas or pharyngostomes are difficult complications to solve, which generate high morbidity and mortality, a poor quality of life and an increase in health costs. Its management must be comprehensive according to general, local and regional factors. We review our experience in treating these pharyngostomes with free flaps. METHODS: Retrospective study analyzing the results of the reconstruction of 50 patients using free flaps during the period 1991-2019. We exclude patients who required free-flap reconstruction due to primary tumor or those who resolved in other ways. The different types of reconstruction were classified into three types. RESULTS: The 86% (43) were men, and the mean age was 57 years (25-76). In 48% (24/50) the flaps performed were anterolateral thigh (ALT), in 24% (12/50) forearm, in 22% (11/50) parascapular, in 4% (2/50) jejunum and in 2% (1/50) ulnar. A salivary by-pass was placed in 74% (37/50) of the cases. Four cases (8%) presented flap necrosis and two patients died due to treatment. In 86% (43/50) there was some type of complication and 34% (17/50) required surgical revision. 94% (45/48) were able to reintroduce oral feeding. CONCLUSION: According to our experience, we proposed a regardless size classification: type 1 when only a mucous closure (pharynx) are required (6%), type 2 exclusively skin for cutaneous coverage (10%) and mixed type 3 (mucous and skin) (84%). The treatment of large pharyngostomes with free flaps, despite its complexity, is in our experience the best option for its management.
Subject(s)
Free Tissue Flaps , Head and Neck Neoplasms , Plastic Surgery Procedures , Female , Humans , Male , Middle Aged , Quality of Life , Retrospective Studies , Thigh/surgery , Treatment OutcomeABSTRACT
OBJECTIVE: The objective [corrected] of this paper is to present the surgical complications in cochlear implant, in a serie of 346 patients, submitted to surgery by the same surgical team with the subsequent control and follow-up for a long period of time. We show the description and the handling of each complication. MATERIAL AND METHODS: A follow-up was carried out on 346 cochlear implant patients by the same surgical team, from February 1993 to March 2004. The complications were assessed and their handling and follow-up is reported. The series includes 211 children and 135 adults. RESULTS: The complication rate was 9.8% (n = 34). The complications found were: Intraoperatory Complications: Cerebrospinal Fluid Leaks (CSF), 7; Facial nerve injury, 1; excessive thinning of the posterior wall, 2; inmediate post operatory complications: infection of the surgical wound, 4; post operatory persistent pain, 1; Tinnitus, 2; late complications: Mastoiditis, 2; extrusion of the stimulating receptor, 1; facial nerve stimulation, 5; late infections of the stimulation receptor, 2; technical failure of the implanted system, 7. Neither alteration or migration was found in the receptor placing. CONCLUSIONS: The cochlear implant surgery has a low morbility. We found no cases of meningitis due to this procedure.
Subject(s)
Cochlear Implantation/adverse effects , Adult , Child , Follow-Up Studies , Humans , Postoperative Complications/epidemiology , Postoperative Complications/etiologyABSTRACT
Objetivo: El objetivo de este trabajo es mostrar nuestra experiencia en complicaciones quirúrgicas del implante coclear, tanto en la descripción como en el tratamiento de las mismas. Se presentan 346 pacientes, operados por el mismo equipo quirúrgico, sometidos a un control y seguimiento prolongado de tiempo. Material y métodos: Se estudió una población de 346 pacientes implantados cocleares, desde febrero de 1993 hasta marzo de 2004. La serie incluye 211 niños y 135 adultos. Se analizan los tipos de complicaciones, su manejo y seguimiento. Resultados: El índice de complicaciones fue del 9,8% (n=34).Las complicaciones más frecuentemente halladas fueron las siguientes: Complicaciones intraoperatorias: fístulas de líquido cefalorraquídeo (LCR) 7; lesiones del nervio facial, 1; excesivo adelgazamiento de pared posterior, 2. Complicaciones postoperatorias inmediatas: infección de herida quirúrgica, 4; dolor postoperatorio persistente, 1; acúfenos, 2. Complicaciones postoperatorias tardías: mastoiditis, 2; extrusión del receptor estimulador, 1; estimulación del VIIº par, 5; infección tardía de la zona del receptor, 2; fallo técnico del sistema implantado, 7. No se encontró ninguna alteración en la colocación del electrodo ni migración del mismo. Conclusiones: La implantación coclear es una cirugía de baja morbilidad. En la serie que se presenta, no hubo ningún caso de meningitis debido a este procedimiento
Objetive: The objetive of this paper is to present the surgical complications in cochlear implant, in a serie of 346 patients, submitted to surgery by the same surgical team with the subsequent control and follow up for a long period of time. We show the description and the handling of each complication. Material and Methods: A follow up was carried out on 346 cochlear implant patients by the same surgical team, from February 1993 to March 2004. The complications were assessed and their handling and follow up is reported. The series includes 211 children and 135 adults. Results: The complication rate was 9.8% (n=34). The complications found were: Intraoperatory Complications: Cerebrospinal Fluid Leaks (CSF), 7; Facial nerve injury, 1; excessive thinning of the posterior wall, 2; inmediate post operatory complications: infection of the surgical wound, 4; post operatory persistent pain, 1; Tinnitus, 2; late complications: Mastoiditis, 2; extrusion of the stimulating receptor, 1; facial nerve stimulation, 5; late infections of the stimulation receptor, 2; technical failure of the implanted system, 7. Neither alteration or migration was found in the receptor placing. Conclusions: The cochlear implant surgery has a low morbility. We found no cases of meningitis due to this procedure
