Evaluating the outcomes of temporal bone resection in metastatic cutaneous head and neck malignancies: 13-year review.

OBJECTIVE: To evaluate the survival outcomes of patients who underwent lateral temporal bone resection as treatment for metastatic skin cancers. METHODS: A single-institute, retrospective chart review was carried out on patients who underwent lateral temporal bone resection between January 2000 and December 2012. Overall survival and disease-free survival rates were calculated. RESULTS: Forty-seven patients underwent temporal bone resection for primary (n = 21) or recurrent (n = 26) malignancies. The majority of patients (95.4 per cent) had advanced disease (stage III or IV). Average patient follow-up duration was 45 months. The 5-year and 10-year overall survival rates were 40 per cent and 23 per cent respectively. The five-year disease-free survival rate was 28 per cent. CONCLUSION: Aggressive initial surgical resection is warranted in the treatment of these tumours.

The use of lasers in the treatment of cutaneous lesions.

INTRODUCTION: Laser has progressed significantly over the last three decades. Light amplification by stimulated emission of radiation (lasers) are currently employed by a number of medical and surgical specialties and used to treat a wide range of conditions. AIM: This article aims to provide an insight into laser science and describe its current usage in the treatment of cutaneous lesions and its potential for future developments. CONCLUSION: There are many types of lasers, each having unique properties that enable them to fulfil their task and achieve the desired result. Their applications will no doubt continue to expand with the parallel advancement in laser technology.

Free tissue transfer versus pedicled flap reconstruction of head and neck malignancy defects.

BACKGROUND: With the advent of microsurgery the pedicled flap is considered by many to be an outdated surgical option. AIMS: To explore the relationship between flap survival and pre-morbid risk factors, conduct a comparative analysis of flap and systemic morbidities and complete a cosmesis and functionality assessment for oral and oropharyngeal reconstruction patients. METHODS: 114 patients, over a 13-year period, who had a one-stage reconstructive procedure employing the pectoralis major myocutaneous flap (PMMF) or radial forearm-free flap (RFFF). RESULTS: Variables, including age, smoking and radiation exposure were not statistically significant predictors of flap survival probability. Atelectasis was a significant post-op finding of RFFF patients. Flap dehiscence of >50% was a significant morbidity of PMMF. No statistical difference in cosmetic deformity, diet and socialisation was noted. CONCLUSIONS: Pectoralis major myocutaneous flap remains an enduring and safe flap; however, the RFFF has markedly improved speech performance over the PMMF.

Stress fracture of the tibia following a vascularised free fibular flap.

A 49-year-old female presented with a T4 N2 Mo moderately differentiated squamous cell carcinoma of the right cheek mucosa and involving the mandible. Patient treatment included resection of the tumour with partial mandibulectomy, maxillectomy and a free osteocutaneous fibular flap to reconstruct the bony mandibular and soft tissue intraoral defects. Six weeks postoperatively the patient developed a stress fracture of the right tibia, a complication which has not been reported in the literature previously. Pre- and postoperative measures should be considered to avoid such a complication.

Subcutaneous adrenaline infiltration in paediatric burn surgery.

Paediatric burn surgery may be associated with significant blood loss and postoperative pain. To investigate methods of reducing these symptoms, we studied a prospective series of 29 children with small to medium sized burns. Presurgically both the burn wound and split skin graft donor sites were injected with a 1:500,000 adrenaline solution, to which bupivicaine had been added. No patient required blood transfusion and no patient developed systemic side effects from the injected solution. Four patients required parenteral analgesia, two in the immediate postoperative period and two at first dressing change. In all other patients pain was controlled with oral analgesia alone. Mean graft take in our series was 95%, indicating that this technique does not compromise burn depth assessment, nor impair graft survival.

Is there still a role for traditional methods in the management of fractures of the zygomatic complex?

With the introduction of low-profile mini-plating systems, a trend has developed towards open reduction and rigid internal fixation (ORIF) of fractures of the cranio-facial skeleton. The current policy for management of zygomatic fractures in our unit is to attempt primary reduction by traditional methods, and proceed to ORIF in the event of unsatisfactory fracture stability or alignment. Over a one-year period, 109 patients underwent surgical correction of fractures of the zygomatic complex. Standard Gilles' elevation was performed in 71 cases, percutaneous elevation in three cases, and ORIF was performed in 35 cases. Mean follow-up was 190 days. One case of persistent infraorbital step and three cases of residual malar flattening were documented in patients who underwent Gilles or percutaneous elevation. Morbidity associated with ORIF was minimal. We conclude that while ORIF of zygomatic fractures may offer better results than traditional methods in the management of complex fractures, traditional methods still have a role to play in less complex fractures.

A new quantitative scale for clinical scar assessment.

Wound healing in adult human skin results in varying degrees of scar formation, ranging clinically from fine asymptomatic scars to problematic hypertrophic and keloid scars, which may limit function and restrict further growth. At present, no good objective method of clinically assessing scars exists, which is problematic for the evaluation of scar prevention or treatment regimens. Similarly lacking are histologic correlates of what we consider good and bad clinical scars. The objective of this study was to quantitatively assess human scarring (1) clinically, by developing a comprehensive rating scale, (2) photographically, using an image capture system and a scar assessment panel, and (3) by histologic analysis following scar excision. We assessed 69 scars, with a wide clinical range of severity, in patients who were undergoing surgery, for whatever reason, that involved removal of an old scar. Preoperatively, patients had their scars assessed, clinically using our newly developed scale and photographically using a computerized image capture system. These photographs were then sent to a panel for assessment using similar criteria to those used clinically. Assessment of scars from photographs correlated well with the clinical scar evaluation, indicating its potential utility in multicenter scar prevention/treatment trials. Following excision, scars were processed and analyzed for histology. We also found a strong correlation between the macroscopic and microscopic appearance of scars, particularly between the clinical appearance and histologic scores of features in the epidermis and papillary dermis. This suggests that our clinical scale is a sensitive instrument in scar assessment, allowing validated quantification of the severity of a wide range of scars.

Calcium alginate dressings promote healing of split skin graft donor sites.

A prospective controlled trial was carried out to assess the healing efficacy of calcium alginate and paraffin gauze on split skin graft donor sites. Thirty patients were randomised to the calcium alginate group and 21 to the paraffin gauze group. The donor sites were assessed at 10 days post harvesting to determine if they were completely healed (100%) or not. Twenty one of the 30 patients dressed with calcium alginate were completely healed at day 10, while only 7/21 in the paraffin gauze group were healed (p < 0.05). There were two infections in the study, both occurring in the alginate group while there was no difference in dressing slippage between the two groups. Calcium alginate dressings provide a significant improvement in healing split skin graft donor sites.

Burns from a dust explosion.

Two cases of burn injury following a dust explosion are presented. It is important to (1) rule out other serious injuries and (2) continuously reassess the patient for respiratory injury. The mechanism of dust explosions is described and preventative measures are discussed.