Laryngeal and hypopharyngeal cancer accounts for 1.5–3.8% of all malignant neoplasms, accounting for more than half of all ENT-cancer patients in the structure of oncological morbidity in Ukraine. Among them more than 60% are found in III–IV stages. Locally diffused larynx and hypopharynx cancer are indications for laryngectomy and resection of the hypopharynx, depending on the extent of the lesion that, in the presence of regional metastases, can be combined with one-or two-way radical or functional neck dissection. Failure to suture the hypopharynx after laryngectomy further leads to the formation of pharyngeal fistulas, suppurations of postoperative wounds, necrosis of the skin and the formation of pharyngostomas. In the plastic closure of the pharyngostomes, regional skin, and facial, and skin-muscle flaps are used, among which the most common is the large chest muscle. The advantages of the flap are the ease of fence, the large volume of plastic material, stability of a “vascular leg”, reliability and short operating time. Our experience with the use of free and regional flap suggests that the musculo-skeletal system of the large chest muscle can be used not only as a “rescue swaddle”, but also, as a first choice in certain clinical situations. 72 patients with laryngeal and hypopharyngeal cancer were included to the study. The age of patients ranged from 41 to 74 years. All patients (100%) had histologically confirmed flat-cell carcinoma of varying degrees of differentiation. Depending on the spread of the cancer process, stage III (T3N0-1M0) was diagnosed in 47 (65.2%), stage IV (T3N2-3M0, T4N0-3M0) in 25 (34.8%) patients. Laryngeal cancer is found in 52 (72.2%), hypopharyngeal — in 20 (27.8%) patients. Plastic closure of pharyngostomas was carried out after 2–3 months after larynectomy, after reduction of inflammation in postoperative wound and clear formation of pharyngostoma edges. The surgical intervention was carried out by two brigades — one brigade carried out the excision of the skin muscle flap, while the other one carried out the removal of the throat wall in the soft tissues of the neck, and then the sheathing of the skin part of the flap was carried out to the edges of the pharyngostomas, and the stitching of the edges of the skin at the point of excision of the flap on the chest wall. The evaluation of the function was performed on the scale of functioning for head and neck cancer patients, PSS-HN (Performance Status Scale for Head and Neck Cancer Patients). The total necrosis of the flap was observed in 2 patients (2.7%) among 72, that were operated as one of the first, at the stage of development of the surgical technique. Partial flap necrosis was observed in 6 (8.3%) patients. Thus, the plastic closure of pharyngostomas with the help of the skin-mimetic flap of the big chest muscle was successful in the vast majority of patients (70 out of 72). The investigation of the functional status of patients on the PSS-HN scale showed a significant improvement and expansion of the diet from 30 to 90-100 points due to the transfer of patients from probe to usual food intake. The public eating habits improved from 25 to 100 points. The operation of the plastic closure of pharyngostomas did not increase the clarity of the language of patients, but created the anatomical conditions for the development of pseudo-voice and vocal prosthesis. So, the using of the skin-muscular flap of major pectoralis muscle in pharyngostomas plastic closure allows achieving satisfactory surgical and functional results.
The aim: of the study is to compare surgical and functional results as well as quality of life after use of skin flaps – platysma myocutaneus flap, supraclavicular artery flap and fascial flaps – temporoparietal fascial flap, buccal fat pad for plastic closure of the buccal and retromolar trigone mucous surgical defects in cancer patients. Material and methods: A retrospective comparative analysis of the results of surgical treatment of buccal and retromolar trigone mucosal cancer in 56 patients operated from 2009 to 2014 was made. The patients were divided into two groups: the first included 26 patients, with reconstruction of fascial flaps, the second group included 30 patients, with reconstruction of postoperative defects with skin flaps. Surgical results: the average duration of surgery, the average duration of inpatient treatment and the presence of complications were compared in the both groups. Functional results in both groups were compared in 6 and 12 months after surgery with the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN), and quality of life was assessed by the University of Washington Quality of Life questionnaire, version 4. Results: Average duration of surgery, average time of inpatient treatment, and postoperative complications did not differ significantly in both groups (P> 0.05). Data of performance status and quality of life in patients with reconstruction of mucosal defects and retromolar trigone with skin flaps were significantly better (P> 0.05) in 6 and 12 months after surgery, compared with the group of patients who underwent defect reconstruction with fascial flaps. Conclusions: The method of choice in reconstruction of medium and large defects of the buccal and the retromolar trigone mucous is usage of skin flaps: the platysma myocutaneus flap and the flap of the supraclavicular artery.
The aim — to assess life quality of patients with trophic ulcers of venous genesisMaterials and methods. A survey of 85 patients who are on inpatient treatment for venous trophic ulcers was conducted. According to the CEAP classification all patients had chronic venous insufficiency of the C4—C6 stages. The mean age of the patients was 74 years. The duration of the ulcer was at least 1 year. To assess the patients’ life quality with varicose veins, the CIVIQ scale was chosen. The total score was from 20 to 100, and the higher the value the worse the life quality.Results and discussion. After the questioning, the scoring was carried out. When comparing two groups of patients, it was found that the living standard in the main group was 45.7 in the standard group, and 23 in the control group. Thus, the presence of chronic venous insufficiency, and, as a consequence, of trophic ulcers, worsens the life quality almost 2fold.Conclusions. Complicated forms of varicose veins significantly impair the patients’ life quality, and cause both physical and moral discomfort for a long time.
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