Reconstruction in head-and-neck cancers - analysis of the learning curve.

BACKGROUND: Oral cancers are some of the most common cancers in India. Most patients present with locally advanced disease requiring extensive resection resulting in large defects. Reconstruction of these defects plays a major role in restoring form and function to these patients, as well as enabling the delivery of adjuvant therapy on time. AIM OF THE STUDY: The aim of this study was to analyze the learning curve involved in microvascular surgery. MATERIALS AND METHODS: A retrospective analysis of the case records of all patients of oral cancers, who underwent resection and reconstruction between January 2008 and December 2012 at our institute, was done. Demographic, clinical, and pathological data were collected and analyzed. Statistical analysis was done using the SPSS software. RESULTS: The operative time and the postoperative ventilation (7.8 h and 3.7 days, respectively) were significantly higher than those for pedicled flaps (3.6 h and 1.4 days, respectively). Both these variables reached statistical significance with P < 0.05 and < 0.04. The hospital stay was also statistically significantly longer for patients who underwent free-flap reconstruction (17.9 days vs. 7.9 days; P < 0.05). The number of reexplorations were higher in the free-flap group (31), when compared to the pedicled flap group (9). However, partial flap loss was higher in the pedicled flap subset when compared to the free-flap group. The complications significantly dropped after the performance of 30-40 free flaps. CONCLUSION: There is a steep learning curve in microvascular surgery, but the cosmetic and functional outcomes outweigh the complications.

Physical activity ratio of selected activities in Indian male and female subjects and its relationship with body mass index.

The physical activity level of an individual can be determined by assigning physical activity ratios (PAR) to different activities. The PAR is the ratio of the energy expended in a particular activity and the BMR, and is thought to be independent of body weight. PAR values of selected activities in Indian male and female subjects were measured and their association with BMI was assessed. The BMR and energy cost of selected activities were measured in thirty male and thirty female subjects in the age group of 20-40 years, who were categorised into different groups of BMI. The PAR values of the underweight male subjects were significantly lower than the overweight subjects for activities such as walking at 3.2 and 4.8 km/h and walking at 3.2 km/h with a 5 kg load. In the female subjects, the underweight subjects had significantly lower PAR values for floor swabbing, and walking at 3.2 and 4.8 km/h when compared with overweight females. The mean data of the male and female subjects of the present study were slightly but significantly different to the previously reported FAO, WHO and United Nations University values and other compilations. The BMI was significantly correlated with the PAR value of the studied activities. In India, where a large proportion of the population have BMI below 18.5 and above 25 kg/m2, considerations of the influence of body weight and BMI on PAR become important in accurately determining total energy expenditure.