Introduction: Patients with advanced carcinoma tongue end up with near-total/total glossectomy (NTG/TG). We intended to compare functional, oncological, and survival outcomes of patients undergoing pedicled and microsurgical flap reconstruction in NTG/TG patients at our hospital. Methodology: A prospective study was conducted for 7 years on 91 patients with carcinoma tongue who underwent NTG/TG at our institute. Patients underwent anterolateral thigh (ALT), free radial artery forearm flap (FRAFF), and pectoralis major myocutaneous (PMMC) flap reconstruction and were followed up for immediate complications and functional outcomes for speech, swallowing, and decannulation after completion of adjuvant treatment and then for survival rates for a period of 60 months and statistically analysed with log rank test and Fisher’s exact test for correlation. Results: Ninety-one (42.85%) patients underwent NTG, while 57.14% underwent TG. 85% of patients had >5 mm margin, 14% had ≤ of 5 mm, and none were positive. 57% of patients did not have postoperative complications and 10% underwent re-exploration. During follow-up, 85.7% of patients were able to take orally: 52% soft diet and 32% liquid diet. Multivariate analysis of individual flaps, swallowing, and speech intelligibility values were significant. After 5 years of postadjuvant therapy, there was 76% overall survival, 11% local recurrence and 12% had regional recurrence. Discussion: Morbidity and functional outcome depends on the extent of resection. PMMC flaps can be done on lack of expertise. FRAFF has better functional outcomes owing to pliability of flap. ALT and other bulky flaps require expertise and are prone to flap-related complications. Planning of reconstruction should be based on the defect size together with counseling of patients regarding the risk of complications and delay in adjuvant therapy.
A 33-year-old male, chronic alcoholic for 15 years, came to General Surgery OPD with pain upper abdomen radiating to the back for one and half months and upper abdominal fullness for three weeks. Pain was sudden in onset and severe in intensity, relieved on bending forward and aggravated on taking food. On chest X-ray patient had also developed generalized distension of abdomen with upper abdominal fullness of three weeks. The upper abdominal fullness had been increasing over time. Patient also had massive left sided pleural effusion [Table/ Fig-1] and developed respiratory distress for which a left sided Inter Costal Drainage (ICD) was put and about 800ml of blood tinged, amylase rich fluid was drained with relief of symptoms.Patient had similar episodes of pain abdomen on and off for last six years but the intensity was less severe and was relieved by medications. On per abdominal examination, abdomen was distended with tenderness over the epigastrium, left hypochondrium and umbilical regions. A 10x10cm tense, cystic and tender lump was palpable over the epigastrium with well-defined margins however, the upper border could not be felt. The lump had no movement with respiration and showed no side-to-side mobility. There was also free peritoneal fluid as evidenced by shifting dullness. Investigations revealed haemoglobin to be 11.2g%, total leucocyte count, differential leucocyte count, kidney function test, coagulation profile were within normal limits, serum amylase and lipase were raised at 700 and 863U/L respectively and pleural fluid amylase was also high at 223U/L. /Fig-2,3] showed a massive left sided pleural effusion with right mediastinal shift; a large 12x11x11cm sub-capsular collection with wall thickness of 6mm in the left lobe of liver causing scalloping of liver. The spleen also had a sub-capsular collection measuring 7x8x7cm; pancreas was heterodense around the body and tail and the Main Pancreatic Duct (MPD) was mildly dilated. Gallbladder and the extra-hepatic biliary system were normal. Contrast Enhanced Computed Tomography (CECT) abdomen [TablePatient did not have any haematemesis or melaena during the hospital stay but had a drop in haematocrit. Two units of packed red blood cells were transfused and the haemoglobin stabilized at 10g%.As the patient was stable except for severe pain, he was initially managed conservatively by keeping nil per oral, maintaining hydration by IV fluids and adequate analgesia, oxygen inhalation by facemask and SpO 2 monitoring. The pain and epigastric lump size was increasing in size; hence the subcapsular pseudocyst was drained percutaneous by placement of a 10 Fr malecot catheter under USG guidance [Table /Fig-4]. Approximately 500ml of cyst fluid was drained which was dark colored, with clots and high amylase level (6000IU/L). The USG repeated after seven days showed collapse of the cavity and resolution of the pseudocyst with no residual collection. During the two months follow-up, no peripancreatic or subcapsular collection was observed. DisCussion aBstRaCtA...
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