Presbylarynx: Does Body Muscle Mass Correlate With Vocal Atrophy? A Prospective Case Control Study.

OBJECTIVE: To analyze the potential association between body muscle mass and presbylarynx. METHODS: Study performed on subjects referred to the otorhinolaryngology department in a tertiary center between January and September 2019 . Based on endoscopic findings of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Data regarding gender, body composition, self-assessment of vocal complaints, and functional assessment were collected. STUDY DESIGN: Case control, prospective, observational and cross-sectional. RESULTS: The study population included a total of 115 Caucasian subjects (43 males; 72 females). Presbylarynx was identified in 43 patients (37, 39%) with no statistically predilection by gender (P = .668). The mean age of the patients with presbylarynx was slightly higher, but differences between groups were not statistically significant (P = .072). Results showed an association between functional impairment (score 4 of Katz Index and score 5 of Functional Ambulation Classification) and presence of presbylarynx (P < .001). Additionally, a positive association between the absence of presbylarynx and sport activity was also observed (P < .001). The mean value of muscle mass between presbylarynx and no presbylarynx groups was statistically different (P < .01), with a lower mean for subjects with presbylarynx. CONCLUSION: This case control prospective study confirms that the general age-related degeneration of body muscle mass might play an important role in the course of presbylarynx. In the future, preventing strategies based on regular sport activities and improvements on functional status can play an important role in the management of aging voice. LEVEL OF EVIDENCE: 2b Laryngoscope, 131:E226-E230, 2021.

The use of forearm free fillet flap in traumatic upper extremity amputations.

BACKGROUND: Complete traumatic upper extremity avulsions are an infrequent but devastating injury. These injuries are usually the result of massive blunt trauma to the upper limb. Intact issue from amputated or nonsalvageable limbs may be transferred for reconstruction of complex defects resulting from trauma when the indications for replantation are not met. This strategy allows preservation of stump length or coverage of exposed joints, and provides free flap harvest for reconstruction without additional donor-site morbidity. METHODS: A retrospective review at São João Hospital was performed on seven patients who had undergone immediate reconstruction with forearm free fillet flaps between 1992 and 2007. RESULTS: There were six men and one woman, with patient age ranging from 17 to 74 years (mean, 41 years). Amputation sites were at the humeral neck (n = 1), at the humeral shaft (n = 5), and below the elbow (n = 1). The area of the forearm free fillet flap skin paddle was 352.14 +/- 145.48 cm (mean +/- SD). The two major complications were the flap loss and the patient death on postoperative day 3 in other case. The postoperative course in the remaining five cases was uneventful with good healing of the wounds. Minor complications included two small residual defects treated by split-thickness skin grafting and one wound infection requiring drainage and revision. CONCLUSIONS: The forearm free fillet flap harvested from the amputated limb provides reliable and robust tissue for reconstruction of large defects of the residual limb without additional donor-site morbidity. Microsurgical free fillet flap transfer to amputation sites is valuable for achieving wound closure, improving stump durability, and maximizing function via preservation of length.