Post-laryngectomy simplified dysphagia score (SDS) tool: Potential for screening and comparison with the swallowing outcomes after laryngectomy (SOAL) tool.

BACKGROUND: Our understanding of swallowing disorders after laryngectomy remains limited. A literature search found that documentation of swallowing function in the laryngectomee population is lacking. Furthermore, no consensus exists regarding a suitable evaluation tool to assess swallowing function. While conventional questionnaires are time consuming, cost and time constraints make regular objective swallowing investigations impractical. OBJECTIVES: To develop a 2-question simplified dysphagia score (SDS) screening tool for routine documentation of swallowing function at post-laryngectomy follow-up visits, and to test this new tool against an established dysphagia measuring tool for laryngectomees. We also sought to identify risk factors for poor swallowing outcomes. METHODS: Cross-sectional surveys were used to compare results obtained from the validated swallowing outcomes after laryngectomy (SOAL) questionnaire and our novel SDS tool. The components of the SDS were guided by the experience and expertise of surgeons and speech therapists, as well as insights from patients and their families. Sixty laryngectomy patients (females, n=7; males, n=53) were enrolled in the study. All patients were >18 years of age. Each participant was asked to complete the SDS and the SOAL questionnaires. The results of each tool were compared using non-parametric tests, with multiple pairwise comparisons using Bonferroni tests. RESULTS: Both sets of results showed a linear relationship using the Kruskal-Wallis non-parametric analysis of variance (ANOVA) test. The SDS had a specificity of 96% (95% confidence interval (CI) 76 - 100%), a sensitivity of 81% (CI 64 - 91%), a positive predictive value of 97% (CI 81 - 100%) and a negative predictive value of 76% (CI 56 - 89%) against the SOAL scores. The SDS results yielded 7 false-negative and 1 false-positive result for dysphagia compared with the SOAL questionnaire. Outcomes of the secondary objectives did not reach statistical significance. CONCLUSIONS: The SDS is a 2-question, practical grading system that shows a statistically significant correlation with the recognised SOAL questionnaire, making it a useful alternative for everyday use, which provides outcome scores of direct practical value to patient and clinician. Prospective use of the SDS and higher patient numbers may allow a better understanding of dysphagia, its causes and risk factors.

The posterior interosseous flap for soft-tissue cover of the hand.

The management of soft-tissue defects of the hand with exposed bone and tendons may be difficult. The posterior interosseous flap is a fasciocutaneous island from the dorsal forearm, based on the posterior interosseous vessels. We have used this flap as a one-stage procedure to cover soft-tissue defects of the hand in 6 patients. It provides excellent cover without sacrificing a major blood vessel such as the radial artery. Although the vascular anatomy of the flap is normally consistent, variations exist. This prevented elevation of 1 of the flaps in our series.

Free flap monitoring using a microcomputer linked to a laser Doppler flowmeter.

The problems of free flap monitoring using the Periflux PF108D laser Doppler flowmeter (PLDF) are discussed, as are the indices of flap perfusion that the laser Doppler flowmeter can provide. The use of a microcomputer linked to a laser Doppler flowmeter by a suitable interface and using an appropriate monitoring program is described together with details of the system and program. It is suggested that linkage with a microcomputer offers a relatively simple, low cost method of improving the ease and reliability of free flap monitoring with the laser Doppler flowmeter.

"Is 40 years enough delay?".

The case of a 40-year-old tube pedicle, raised in 1939 and subsequently lost to follow-up, is presented together with a description of its appearance and eventual modified use to accomplish its original purpose.