Head and neck surgery during COVID-19.

Thirty-two Head and Neck cancer patients were operated by surgical team of the Indian Institute of Head and Neck Oncology (IIHNO) in a period ranging from May 2020 to the first week of December 2020. Surgical procedures ranged from surgery for tongue cancer, resection of cancers of the oral mucosa/cheek (with or without reconstruction), as well as surgery for paranasal cancers and thyroid cancers, with an average duration of 3 h for the procedures. This article reviews this experience during the peak of covid pandemic regarding the approaches adopted by the team of the IIHNO, a flagship project of the Indore Cancer Foundation, a public charitable trust.

Out Sourcing of Head and Neck Oncologic Surgery: Cost Considerations.

165 surgeries for head and neck cancer have been performed by a team of the Indian Institute of Head and Neck Oncology IIHNO in 1 year. Integration of private players was necessitated because of need to share available facilities without losing objective of reducing the cost. These surgeries were performed at a private hospital using their resources for the operation theatre and post-operative intensive care services, since the IIHNO does not as yet have an operation theatre facility. The pre-op facilities and post-operative care was done at IIHNO a charitable cancer center under the Indore Cancer Foundation a public charitable trust. Cost analysis of these procedures has been done and the system of integration of the two have been analysed.

Palliative Mastectomy Revisited.

Couple of decades ago, Palliative Mastectomy for locally advanced breast cancers was common, if not frequent surgical procedure in the surgical armamentarium. The advent of better understanding of tumor biology and better multidisciplinary management has certainly narrowed down its role. However there are situations where it is still a potent option. In the subset of patients where palliative mastectomy is to be performed, it is important to aim for clear surgical margins, with good clearance at the third dimension, i.e. the tumor base. Surgeons with adequate experience of breast cancer surgeries should perform the procedure to achieve intended palliation.

Collagen dressing versus conventional dressings in burn and chronic wounds: a retrospective study.

OBJECTIVE: Biological dressings like collagen are impermeable to bacteria, and create the most physiological interface between the wound surface and the environment. Collagen dressings have other advantages over conventional dressings in terms of ease of application and being natural, non-immunogenic, non-pyrogenic, hypo-allergenic, and pain-free. This study aims to compare the efficacy of collagen dressing in treating burn and chronic wounds with that of conventional dressing materials. MATERIALS AND METHODS: The records of 120 patients with chronic wounds of varied aetiologies and with mean age 43.7 years were collected and analyzed. The patients had been treated either with collagen or other conventional dressing materials including silver sulfadiazine, nadifloxacin, povidone iodine, or honey (traditional dressing material). Patients with co-morbidities that could grossly affect the wound healing like uncontrolled diabetes mellitus, chronic liver or renal disease, or major nutritional deprivation were not included. For the purpose of comparison the patients were divided into two groups; 'Collagen group' and 'Conventional group', each having 60 patients. For assessment the wound characteristics (size, edge, floor, slough, granulation tissue, and wound swab or pus culture sensitivity results) were recorded. With start of treatment, appearance of granulation tissue, completeness of healing, need for skin grafting, and patients' satisfaction was noted for each patient in both groups. RESULTS: With two weeks of treatment, 60% of the 'collagen group' wounds and only 42% of the 'conventional group' wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of 'collagen group' wounds and 48 (80%) of 'conventional group' wounds were >75% healed (P=0.21). Eight patients in the 'collagen group' and 12 in the 'conventional group' needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility. CONCLUSION: No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients' compliance and comfort.

Honey dressing versus silver sulfadiazene dressing for wound healing in burn patients: a retrospective study.

OBJECTIVE: The aim was to evaluate the effect of honey dressing and silver sulfadiazene (SSD) dressing on wound healing in burn patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 108 patients (14-68 years of age), with first and second degree burns of less than 50% of the total body surface area admitted to our institution, over a period of 5 years (2004-2008). Fifty-one patients were treated with honey dressings and 57 with SSD. Time elapsed since burn, site, percentage, degree and depth of burns, results of culture sensitivity at various time intervals, duration of healing, formation of post-treatment hypertrophic scar, and/or contracture were recorded and analyzed. RESULTS: The average duration of healing was 18.16 and 32.68 days for the honey and SSD group, respectively. Wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with SSD. All wounds treated with honey became sterile within 21 days while for SSD-treated wounds, this figure was 36.5%. A complete outcome was seen in 81% of all patients in the "honey group" while in only 37% patients in the "SSD group." CONCLUSION: Honey dressings make the wounds sterile in less time, enhance healing, and have a better outcome in terms of hypertropic scars and postburn contractures, as compared to SSD dressings.

Primary tubercular caecal perforation: a rare clinical entity.

BACKGROUND: Intestinal tuberculosis is a common problem in endemic areas, causing considerable morbidity and mortality. An isolated primary caecal perforation of tubercular origin is exceptionally uncommon. CASE PRESENTATION: We report the case of a 39 year old male who presented with features of perforation peritonitis, which on laparotomy revealed a caecal perforation with a dusky appendix. A standard right hemicolectomy with ileostomy and peritoneal toileting was done. Histopathology revealed multiple transmural caseating granulomas with Langerhans-type giant cells and acid-fast bacilli, consistent with tuberculosis, present only in the caecum. CONCLUSIONS: We report this extremely rare presentation of primary caecal tuberculosis to sensitize the medical fraternity to its rare occurrence, which will be of paramount importance owing to the increasing incidence of tuberculosis all over the world, especially among the developing countries.

Penetrating craniofacial arrow injury.

Arrow injuries are an extinct form of injury in most parts of the developed world, but are still seen, albeit infrequently in developing countries. Reports of penetrating injuries of the craniofacial region secondary to projectiles are few and far between. The morbidity-free outcome of surgical removal, in case of penetrating arrow injuries, despite the delay in presentation and, moreover, in the emergency surgical practice, are the salient points to be remembered whilst managing such cases, for 'what the mind knows is what the eyes see and what the eyes see is what can be practiced'. We report the case of a patient who was attacked by a projectile fired from a crossbow. Immediate surgery under general anesthesia was required to remove the arrow, with utmost care to avoid any neurovascular compromise to the facial nerve, as well as minimize postoperative complications such as otitis media and subsequent meningitis.

Comparative study of catheter drainage and needle aspiration in management of large liver abscesses.

OBJECTIVE: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10 cm diameter) liver abscesses. METHODS: Seventy-two patients with liver abscess (amebic 48, pyogenic 24) were randomly allocated to PCD or PNA (36 each), which were done within 24 hours of admission. Both groups received parenteral antibiotics for at least 10 days. PNA was repeated every third day if the cavity size had not declined to 50% of the original for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Duration to attain clinical relief, duration of hospital stay, complications, treatment failure, and deaths were recorded. RESULTS: PNA was successful in 31 of 36 (86%) patients (one aspiration in 10, two in 18, and three in 3 patients), whereas PCD was successful in 35 (97%) patients (p=ns). Duration to attain clinical relief (10.2 [2.0] vs. 8.1 [2.7] days; p=0.02) and parenteral antibiotics needed (15.5 [1.1] vs. 10.9 [2.7] days; p=0.04) were significantly lower in PCD group. Duration of hospital stay was similar in the two groups. One patient with PNA had a subcapsular hematoma and one with PCD had continuous bile leakage which stopped spontaneously. One patient in PCD group died. CONCLUSION: PCD is a better treatment option than PNA for the management of large liver abscesses of size >10 cm, in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed.

Spontaneous tubercular enterocutaneous fistula developing in the scar of a surgery done 14 years earlier.

We report a case of spontaneous tubercular enterocutaneous fistula, which occurred after a long interval of 14 years after an appendicectomy. A 32-year-old male presented with the complaint of fecal matter coming out continuously from an opening present over the scar of previous surgery. The only significant past history was that of appendicectomy done 14 years back for acute appendicitis (nontubercular). Histopathology of tissue taken from the margins of the fistulous opening showed caseating granuloma, consistent with tuberculosis. Treatment was provided successfully in the form of fistulectomy and right hemicolectomy with ileotransverse anastomosis along with a 9-month course of four-drug antitubercular treatment. Regular follow-up for the last 2 years has been uneventful.