Topical Therapy As Adjuvant Treatment to Save a Limb With Critical Ischemia From Extensive and Deep Diabetic Foot Infection When Revascularization Is Not Feasible.

BACKGROUND: Patients with diabetes mellitus are susceptible to foot ulcerations associated with the complex triad of peripheral sensory neuropathy, vasculopathy, and trauma. Local infection of a diabetic foot ulcer (DFU) acts a significant deterrent to healing because the response to aggressive debridement antimicrobial therapy is limited when peripheral circulation is poor. CASE REPORT: We share an experience of using silver-impregnated hydrofiber wound dressing as an alternative to amputation in an 85-year-old female patient with an infected, ischemic DFU. This patient had a long-standing history of diabetes mellitus and hypertension for more than 30 years; both conditions were managed with oral medications. Penetrative injury caused by toothpicks resulted in 2 ulcers over the right lateral and medial plantar areas of her right foot. The DFUs were present within a period of 6 months. Due to the deep wound and progressively worsening infection, she was admitted for systemic antibiotics, debridement, and plantar fasciotomy. Percutaneous transluminal angioplasty was indicated, but the patient refused due to concerns related to potential nephrotoxicity associated with contrast use. Amputation was proposed as the final resort if the critical ischemia showed no improvement. Before undertaking amputation, silver-impregnated hydrofiber dressings were applied to the DFUs, along with antiplatelet medications. Following 4 months of treatment, the right medial plantar ulcer healed completely and the DFU over the lateral plantar ulcer was 75% smaller in surface area. Both DFUs remained healed when evaluated at 8 months. CONCLUSION: We found that a silver-impregnated hydrofiber dressing, combined with antiplatelet medications, allowed the patient to avoid amputation despite 2 deep and extensively infected DFUs with critical limb ischemia when revascularization was not feasible.

Application of "parachute" technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting: A retrospective case study.

The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.

Mortality in tongue cancer patients treated by curative surgery: a retrospective cohort study from CGRD.

BACKGROUND: Our study aimed to compare the outcomes of surgical treatment of tongue cancer patients in three different age groups. METHODS: From 2004 to 2013, we retrospectively analyzed the clinical data of 1,712 patients who were treated in the four institutions constituting the Chang Gung Memorial Hospitals (CGMH). We divided and studied the patients in three age groups: Group 1, younger (<65 years); Group 2, young old (65 to <75); and Group 3, older old patients (≥75 years). RESULTS: Multivariate analyses determined the unfavorable, independent prognostic factors of overall survival to be male sex, older age, advanced stage, advanced T, N classifications, and surgery plus chemotherapy. No significant differences were found in adjusted hazard ratios (HR) of death in early-stage disease (stage I-II) among Group 1 (HR 1.0), Group 2 (HR 1.43, 95% confidence interval (CI) [0.87-2.34], p = 0.158), and Group 3 (HR 1.22, 95% CI [0.49-3.03], p = 0.664) patients. However, amongst advanced-stage patients (stage (III-IV)), Group 3 (HR 2.53, 95% CI [1.46-4.38], p  = 0.001) showed significantly worse survival than the other two groups after other variables were adjusted for. Fourteen out of 21 older old, advanced-staged patients finally died, and most of the mortalities were non-cancerogenic (9/14, 64.3%), and mostly occurred within one year (12/14, 85%) after cancer diagnosis. These non-cancer cause of death included underlying diseases in combination with infection, pneumonia, poor nutrition status, and trauma. CONCLUSIONS: Our study showed that advanced T classification (T3-4), positive nodal metastasis (N1-3) and poorly differentiated tumor predicted poor survival for all patients. Outcome of early-stage patients (stage I-II) among three age groups were not significantly different. However, for advanced-stage patients (stage III-IV), the older old patients (≥75) had significantly worse survival than the other two patient groups. Therefore, for early-stage patients, age should not deny them to receive optimal treatments. However, older old patients (≥75) with advanced cancer should be comprehensively assessed by geriatric tools before surgical treatment and combined with intensive postoperative care to improve outcome, especially the unfavorable non-cancerogenic mortalities within one year after cancer diagnosis.