Evaluation of functional and aesthetic outcomes of free dermal fat graft versus superficial musculoaponeurotic system flap after superficial parotidectomy: randomized clinical trial.

BACKGROUND: Parotidectomy is the standard procedure for treatment of many parotid lesions; however, it has several drawbacks. Facial asymmetry and Frey's syndrome are the most annoying complications to patients. Insertion of interpositioning grafts into the parotidectomy bed can decrease these complications significantly. Free dermal fat graft (FDFG) and superficial musculoaponeurotic system (SMAS) flap have very promising results. This RCT aimed to compare these two techniques regarding functional and aesthetic outcomes. METHODS: Between February 2016 and October 2021, adult patients undergoing superficial conservative parotidectomy in a single centre for a benign indication were randomized into two equal groups using a closed envelope method. In one group, FDFG was inserted at the parotidectomy bed, whereas, in the other group, SMAS flap was performed. Preoperative, operative, and postoperative data were recorded and analysed. The primary outcome was the development of Frey's syndrome. RESULTS: Seventy-eight patients were randomized into two equal groups of 39 patients. There was no significant difference between the two groups regarding development of Frey's syndrome. There was no significant statistical difference between study groups regarding demographic data, co-morbidities, parotid pathologies, specimen volumes, total operating time, and postoperative complications. A tendency for over correction was observed in FDFG and under correction in SMAS flap. There was no statistically significant difference between the study groups regarding the patients' aesthetic satisfaction with the majority displaying excellent satisfaction with no poor results. CONCLUSION: FDFG and SMAS flap are simple, rapid, and reliable procedures and are effective in improving both functional and aesthetic outcomes post-parotidectomy. They have comparable results; however, selection of either procedure can be determined according to patient and tumour characteristics. Registration number: NCT05452837 (http://www.clinicaltrials.gov).

Role for fibrin glue (sealant) in seroma reduction after inguinal lymphadenectomy; a randomized controlled trial.

BACKGROUND: Seroma is one of the most commonly encountered morbidities after inguinal lymph node dissection (ILND). It causes much nuisance to both patients and doctors and its presence can lead to many complications. This study aimed to evaluate the role and impact of using fibrin glue to decrease seroma formation in patients undergoing ILND. MATERIALS AND METHODS: Thirty-two patients underwent ILND for various reasons. The patients were randomly divided into two groups; 16 in each group. In one group, fibrin glue sealant was applied with a dosage of 2 ml per 100 cm2 surface area. Drain placement was then performed. In the control group, only drain placement was used. Preoperative, operative and postoperative data were recorded and analyzed. RESULTS: There was a significant reduction in the incidence of seroma formation favoring the fibrin glue group when compared to the control group (P = 0.022). There was also a significant reduction of total cumulative amount of serous fluid (P < 0.001), time to remove drains (P < 0.001), and hospital stay (P = 0.012). There was no significant difference between the two groups in occurrences of hematoma, infection or superficial skin edge necrosis. CONCLUSION: Fibrin glue sealant has a role to play in ILND as it significantly reduced the incidence of seroma formation. Standardization of definition of seroma as well as dosage and technique of fibrin glue have to be reached in future studies to determine the true role of fibrin glue in ILND.

Biofeedback versus bilateral transcutaneous posterior tibial nerve stimulation in the treatment of functional non-retentive fecal incontinence in children: A randomized controlled trial.

BACKGROUND: Biofeedback and transcutaneous posterior tibial nerve stimulation (TPTNS) can be used in treatment of Functional non-retentive fecal incontinence (FNRFI). Aim of this study was to evaluate the early effect of Biofeedback versus (TPTNS) and treatment by Kegal exercises and dietetic regulations in management of (FNRFI) in children. METHODOLOGY: The current prospective randomized controlled study included 93 children with FNRFI who were randomly allocated into the 3 groups. Group A (n = 28) were treated by dietetic regulation and Kegal exercises. Group B (n = 34) received biofeedback while group C (n = 31) received (TPTNS) for 3 months. Follow up using St' Mark's incontinence score and high resolution manometry was done at 3 and 6 months and compared to the initial records. RESULTS: There was statistically significant decrease in the incontinence score in Group B and C compared to Group A at 3 and 6 months (p ˂ 0.001). Resting and squeeze pressures showed significant increase group B and C (p ˂ 0.001). Patients in Group B and C showed significant decrease volume of balloon required for 1st sensation (p ˂ 0.001 and 0.034) respectively. CONCLUSION: Biofeedback is more effective than TPTNS, Kegal exercises and dietetic regulations in treatment of FNRFI in children for short term follow-up. LEVEL OF EVIDENCE: Level I. TYPE OF STUDY: Treatment Study.

Early Outcome of Enhanced Recovery Programs Versus Conventional Perioperative Care in Elective Open Left Side Colonic Carcinoma Surgery: Analysis of 80 Cases.

According to recent clinical practice guidelines, enhanced recovery programs (ERP) have been practiced to improve surgical outcomes and decrease cost. However, these are still opposed by the traditional measures in the treatment of colorectal carcinoma that is still practiced with the concept of protection of anastomosis and decrease postoperative complications. The aim of this study was to report our experience in ERP in elective open left side colonic carcinoma surgery in comparison with the conventional perioperative care. The current prospective multicenter randomized controlled study included a total of 80 adult patients with left side colonic cancer who were eligible for elective colonic resection. Included patients were randomly divided into two equal groups: group (A) where conventional perioperative care was performed and group (B) where ERP were applied. Follow-up was designed for at least 1 month to evaluate and compare hospital stay and postoperative complications. There was no statistically significant difference between the two groups as regards demographic data and preoperative comorbidities. There were statistically significant less pain (P = 0.24), less postoperative nausea and vomiting (P = 0.045), and less hospital stay (P < 0.001) in group B than group A. Otherwise, there was no statistically significant difference in comparing the rest of postoperative surgical or non-surgical complications or rates of readmissions between the two groups. ERP are safe, reliable, simple, and applicable in open left side cancer colon surgery with no negative impact over the postoperative complications in comparison with the conventional care.

Predictive Factors of Positive Circumferential and Longitudinal Margins in Early T3 Colorectal Cancer Resection.

BACKGROUND: Malignant involvement of circumferential resection margin (CRM) and longitudinal resection margin (LRM) after surgical resection of colorectal cancer (CRC) are associated with higher rates of recurrence and development of distant metastasis. This can influence the overall patient's prognosis. The aim of the current study was to identify pathological factors as predictors for the involvement of resection margins in early T3 CRC. Patients and Methods. Fifty patients radiologically diagnosed to have cT3a/b (CRC) were included in the study. After resection, the pathological examination was performed to identify patients with positive CRM and/or LRM. Relations between the different pathological parameters and the CMR and LRM involvements were assessed. RESULTS: Positive CRM was present in 17 cases (34%), while positive LRM was found in 6 cases (12%). The involvement of both margins was significantly associated with rectal tumors and tumors with infiltrative gross appearance, grade III, deeper invasion, and positive lymph node metastases. Also, there was a significant association between both margins' positivity and other pathological parameters as signet ring carcinoma, tumor budding, perineural and vascular invasion, high microvessel density (MVD), and sinusoidal vascular pattern, while the presence of necrosis and infiltrative advancing tumor front was significantly associated with CRM involvement only. The depth of tumor invasion and signet ring carcinoma were identified as independent predictor factors for positive CRM and LRM, respectively. CONCLUSION: Preoperative identification of these pathological parameters can be a guide to tailor the management plan accordingly.

Oncoplastic Volume Replacement for Breast Cancer: Latissimus Dorsi Flap versus Thoracodorsal Artery Perforator Flap.

BACKGROUND: Volume replacement oncoplastic breast techniques have become one of the standard lines in the treatment of early breast cancer. They have better cosmetic outcome and patient satisfaction. Latissimus dorsi (LD) flap is one of the most commonly used flaps for these techniques. Although it shows satisfactory surgical outcomes, postoperative shoulder dysfunction is an obvious drawback. The aim of this study was to compare LD flap with thoracodorsal artery perforator (TDAP) flap after breast-conserving surgery regarding surgical outcomes, patient satisfaction, and impact on shoulder function. METHODS: The study included 42 adult female patients with early breast cancer who were eligible for conservative breast surgery and immediate breast reconstruction. Patients were divided into 2 equal groups: group A where patients underwent immediate reconstruction using LD flap and group B where patients underwent reconstruction using TDAP flap. Follow-up was designed for 12 months for early outcome, patient satisfaction, and shoulder functions. RESULTS: The mean age of the included patients in group A and group B was 40.95 ± 5.06 and 40.33± 5.25 years, respectively. There was no significant difference in flap dimensions, postoperative complications, or cosmetic outcome in both groups. However, significantly less shoulder dysfunction was documented in cases of TDAP compared to LD flap at 3, 6, and 12 months postoperatively. CONCLUSIONS: TDAP flap is as reliable a technique as LD flap regarding the feasibility, postoperative complications, and the cosmetic outcome with significantly better functional outcome of the shoulder.