The versatility of the Karapandzic flap: A review of 65 cases with patient-reported outcomes.

OBJECTIVE: The Karapandzic flap is an established technique for reconstruction of large lip defects and in our experience is particularly valuable in repair of the upper lateral lip and the commissures as well. We present our experience in a case series of 65 patients under one consultant. METHOD: This is a retrospective study of patients who underwent Karapandzic flap repair for lip defects following cancer resection from 2007 to 2014 in North Yorkshire. A data collection tool was used which incorporated patient demographics, tumour location, histology, complications, resection margins and recurrence including functional and aesthetic outcomes. The Patient and Observer Scar Assessment Scale (POSAS) was used to assess postoperative outcome at more than 1 year. RESULTS: The clearance rate was 98.4%. For those with a follow-up greater than 1 year, there was no recurrence or surgical revision, whilst the most common concern was temporary lip paraesthesia. The mean POSAS scores were low for both patients and observers reflecting a high satisfaction rate. CONCLUSION: The technique of Karapandzic flap reconstruction for defects in both upper and lower lip allows adequate margin clearance with a low level of complications. The advantages of this technique include preservation of both function and sensation utilising local tissue to allow successful aesthetic outcomes.

Bleeding complications in cutaneous surgery for patients on warfarin who have skin cancer of the head and neck.

Many patients who have operations on the head and neck for skin cancer also take warfarin to prevent thromboembolic events, and there is still debate about whether treatment should be continued, adjusted, or temporarily stopped. The main concern is to balance the risk of haemorrhagic and thromboembolic events. In this prospective controlled study we compared bleeding complications in operations for skin cancer of the head and neck between 86 patients who took warfarin (100 tumours) and 87 (100 tumours) who did not. Surgeons of different grades did the operations under the guidance of the same consultant. All those on warfarin had above normal international normalised ratios (INRs) (mean (SD) 2.5 (0.51), mode 2.6, range 1.1-4.0). In the warfarin group 8% of excisions had a bleeding complication compared with 9% in the control group. One patient in each group suffered a severe bleed that required a return to theatre. The difference in tendency to bleed between the groups was not significant (p=0.30), and the site and type of reconstruction did not influence the risk of bleeding significantly. This study shows that patients on warfarin who are within the normal therapeutic range, can be operated on safely for skin cancer by all levels of trained staff.

Cervical epidural abscess presenting as giant cell arteritis.

Maxillofacial surgeons may be involved in the initial investigation and management of temporal arteritis. We present a case of a cervical epidural abscess with clinical features of temporal arteritis.

Parotid gland disease in childhood: diagnosis and indications for surgical intervention.

We retrospectively analysed the clinicopathological profiles of all 9 patients aged 16 years and under who had had parotidectomies at York Hospital, UK from 1995 to 2009. The operations were superficial parotidectomy (n=3), partial parotidectomy (n=4), and total parotidectomy with preservation of the facial nerve (n=2). The histological diagnoses were anomalies of the remnant of the branchial arch (n=4), and pleomorphic adenoma, haemangioma, cat scratch disease, juvenile chronic parotitis, and sarcoidosis (n=1 each) The histological diagnosis matched the clinical diagnosis in only 5. The most common complication (n=6) was transient weakness of the facial nerve. Various conditions that may be difficult to diagnose clinically can affect the parotid gland in young patients and require intervention. We describe our investigations, and indications for intervention in the management of parotid disease in children.

Atypical fibroxanthoma: Case series of 16 patients.

Atypical fibroxanthoma is an unusual tumour of skin seen mainly in the head and neck region of elderly patients. Clinically it appears as red, ulcerated nodules, which can be difficult to differentiate from other tumours without histopathological examination. Immunohistochemical analysis also aids diagnosis. The mainstay of treatment is operation. We present a case series of 16 patients with 17 atypical fibroxanthomas over a 5-year period in a district general hospital.

Penetrating facial injury from angle grinder use: management and prevention.

Injuries resulting from the use of angle grinders are numerous. The most common sites injured are the head and face. The high speed disc of angle grinders does not respect anatomical boundaries or structures and thus the injuries produced can be disfiguring, permanently disabling or even fatal. However, aesthetically pleasing results can be achieved with thorough debridement, resection of wound edges and careful layered functional closure after reduction and fixation of facial bone injuries. A series of penetrating facial wounds associated with angle grinder use are presented and the management and prevention of these injuries discussed.