An objective analysis of composite free flap donor site morbidity in head and neck surgery: Prospective series.

BACKGROUND: A poor evidence basis exists regarding the objective donor site morbidity associated with osseous free flap harvest. This study prospectively assessed the objective donor site morbidity associated with osseous free flap harvest for the fibula, scapula, and iliac crest (DCIA) donor sites. METHODS: A single-site, prospective cohort clinical research study was conducted. Sixty-four patients were recruited between 2017 and 2021. Patients were assessed using a donor site specific assessment tool pre-operatively, and again >12 months post-operatively. RESULTS: There was a significant reduction post-operatively in assessment tool scores compared to the pre-operative period for the fibula, scapula and DCIA. Females were more likely to report a greater reduction in Harris Hip Score post-operatively compared to males. CONCLUSIONS: The fibula, scapula, and DCIA donor sites are associated with reduced objective function post-operatively compared to patient's pre-operative baseline. The implications are least pronounced for the fibula.

Management of proliferative verrucous leukoplakia: Justification for a conservative approach.

BACKGROUND: Proliferative verrucous leukoplakia (PVL) is a progressive, multifocal, exophytic form of leukoplakia with high rates of malignant transformation. The purpose of this study was to evaluate a cohort of patients with PVL in a single tertiary referral clinic. METHOD: Cases meeting accepted diagnostic criteria were reviewed with regard to their pathology, demographic characteristics, management, and outcomes. Human papillomavirus (HPV) testing was undertaken on a subset. RESULTS: Almost half of the 48 patients with PVL (48%; n = 23) underwent malignant transformation after a median 23.4 months. The characteristics of this cohort were similar to those previously described, but management was notably more conservative. Conservative management of PVL was used in 92% of our patients, but the clinical outcomes seem comparable with previously described cohorts in which PVL was predominantly treated by surgical excision. All HPV testing was negative. CONCLUSION: Aggressive surgical intervention in the premalignant phase of PVL may not influence the rate of malignant transformation.

A simplified approach for the reduction of specific closed anterior table frontal sinus fractures.

We describe a simplified approach to the management of closed anterior table fractures of the frontal sinus. Forty-seven patients were diagnosed with this type of fracture during a 3-year period. Of these, 6 had minimally-invasive periosteal raising of the anterior table through a small perieyebrow skin incision, and access to the fracture was through a small trephine or the edge of the fracture itself. We compared this with the more traditional approach of a coronal flap, which was associated with an increased duration of stay in hospital and the potential for neurological complications. Surgical intervention with a minimally-invasive trephine approach provides good cosmesis, minimal blood loss, intact neurological function, and rapid recovery. This makes it an important technique to consider in carefully selected patients.

Factors affecting return to work following facial trauma.

BACKGROUND: Injury has a major impact on work absence. The aim of this study was to document the rate and timeframe at which facially injured patients return to work, and to identify the preinjury and injury-related factors that affect return to employment. METHODS: A prospective cohort study was undertaken of facially injured patients over a 12-month period. The primary measure of outcome assessed was time taken (in days) to return to employment. Sixteen preinjury and injury-related variables were identified to analyze their effect on return to work. Both univariate and multivariate Cox regression analyses were performed on each variable. RESULTS: Seven hundred fourteen adult, facially injured trauma patients presented in the 12-month period. Two hundred thirteen patients (30 percent) were excluded because of being unemployed or retired, and 21 patients did not return to work. The remaining 480 patients were included in the study. The median time to return to work was 15 days (mean, 19 days). Seven preinjury and injury-related variables were identified that significantly affected return to employment: sex, operation status, income band, cause, work-related accident, concomitant injuries, and number of facial fractures. CONCLUSIONS: As a cohort, facially injured patients have a relatively high rate of return to work (80 percent at 30 days, 96 percent at 12 months). Clinicians should identify those patients at risk of having a poor return to employment outcome and provide appropriate support and referral to allied health services. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.