ABSTRACT
BACKGROUND: To assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre. METHODS: This study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers. RESULTS: Pronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient's and the observers' subjective evaluations. CONCLUSIONS: Donor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.
Subject(s)
Forearm/surgery , Free Tissue Flaps/surgery , Hand Strength/physiology , Motor Skills/physiology , Otorhinolaryngologic Neoplasms/surgery , Pinch Strength/physiology , Postoperative Complications/diagnosis , Range of Motion, Articular/physiology , Tissue and Organ Harvesting , Touch/physiology , Transplant Donor Site/physiopathology , Adult , Aged , Cicatrix/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/physiopathology , Skin Transplantation , Survivors , Transplant Donor Site/surgery , Wound Healing/physiologyABSTRACT
Deep vein thrombosis (DVT) with subsequent pulmonary embolus (PE) is frequently fatal if untreated. Athletes may be susceptible to DVT following minor blunt trauma to the popliteal fossa. We report an adult male hockey player with no "classic" risk factors for DVT who presented with a DVT and bilateral PE following minor popliteal blunt trauma. This case report illustrates the utility of likelihood ratios when interpreting the results of diagnostic tests such as Doppler ultrasonography.
