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2. Pectoralis Major Myocutaneous Flap Reconstruction for Oromandibular Defects: Analysis of Predictors for Optimum Reconstructive Outcome.

Author

Panda, Smriti, Gautam, Vimmi, Kumar, Rajeev, Mitra, Sandipta, Meena, Jitendra Kumar, Mani, Suresh, Konkimalla, Abhilash, Dheeraj, Kondamudi, Raveendran, Sarath, Singh, Anup, Singh, Chirom Amit, Sikka, Kapil, and Thakar, Alok

Subjects
MANDIBLE surgery, STATISTICS, ADJUVANT chemotherapy, SURGICAL flaps, MOUTH tumors, CONFIDENCE intervals, MULTIVARIATE analysis, PLASTIC surgery, DISEASES, HEAD & neck cancer, FISHER exact test, MANN Whitney U Test, PECTORALIS muscle, TREATMENT effectiveness, CHI-squared test, ODDS ratio, BODY mass index, DATA analysis software, LOGISTIC regression analysis, COMBINED modality therapy, LONGITUDINAL method, SQUAMOUS cell carcinoma
Abstract

Objective: The aim of the study was to identify factors predicting outcomes following pectoralis major myocutaneous flap reconstruction in complex oromandibular defects. Methods: A prospective cohort study was conducted at a tertiary care oncology center in South Asia from January 2020 to May 2022 to include consecutive cases of complex oromandibular defects reconstructed with pectoralis major myocutaneous flap. During pectoralis major myocutaneous flap harvest surgical modifications were incorporated to preserve the choke vessel from the fourth intercostal perforator and lateral pedicle supply apart from the main pedicle from acromiothoracic artery. Results: In our series of 196 patients, overall flap compromise was noted in 17.6% with the most common pattern of failure being partial fullthickness necrosis (n = 23) and complete flap loss was identified in only 3 cases. The factors that showed statistically significant correlation with flap outcome in the univariate model were female sex (42.9% vs. 14.9%) associated with a higher incidence of flap compromise, while bipaddle pectoralis major myocutaneous flap (2.2% vs. 17.3%) and larger surface area of skin paddle (>49 cm²) (20.2%, 16%, and 0% in <49 cm², 50-96 cm², and >96 cm², respectively) were factors favoring a better outcome. Factors that emerged as independent prognostic variables in the multivariate model were female sex (odds ratio: 9.801, P = .001) and high body mass index (odds ratio: 1.19, P = .03) signifying a higher incidence of flap compromise. Conclusion: Pectoralis major myocutaneous flap is still the "workhorse" of head and neck reconstruction. Nevertheless, the female sex and high body mass index may serve as deterrents to the success of this flap. [ABSTRACT FROM AUTHOR]

Published
2023
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4. Airway management, procedural data, and in-hospital mortality records of patients undergoing surgery for mucormycosis associated with coronavirus disease (COVID-19)

Author

Prashant Sirohiya, Saurabh Vig, Tanmay Mathur, Jitendra Kumar Meena, Smriti Panda, Gitartha Goswami, Raghav Gupta, Abhilash konkimalla, Dheeraj Kondamudi, Nishkarsh Gupta, Brajesh Kumar Ratre, Ram Singh, Balbir Kumar, Anuja Pandit, Kapil Sikka, Alok Thakar, and Sushma Bhatnagar

Subjects
Infectious Diseases, Humans, Mucormycosis, COVID-19, Hospital Mortality, Airway Management, Retrospective Studies
Abstract

Although unexpected airway difficulties are reported in patients with mucormycosis, the literature on airway management in patients with mucormycosis associated with Coronavirus disease is sparse.In this retrospective case record review of 57 patients who underwent surgery for mucormycosis associated with coronavirus disease, we aimed to evaluate the demographics, airway management, procedural data, and in-hospital mortality records.Forty-one (71.9%) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) patients had a diagnosis of rhino-orbital mucormycosis, and 2 (3.5%) patients had a diagnosis of palatal mucormycosis. A total of 44 (77.2%) patients had co-morbidities. The most common co-morbidities were diabetes mellitus in 42 (73.6%) patients, followed by hypertension in 21 (36.8%) patients, and acute kidney injury in 14 (28.1%) patients. We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 (92.9%) patients. In our study, mortality occurred in 7 (12.3%) patients. The median (range) mortality time was 60 (27-74) days. The median (range) time to hospital discharge was 53.5 (10-85) days. The median [interquartile range] age of discharged versus expired patients was 47.5 [41,57.5] versus 64 [47,70] years (P = 0.04), and median (interquartile range) D-dimer levels in discharged versus expired patients was 364 [213, 638] versus 2448 [408,3301] ng/mL (P = 0.03).In patients undergoing surgery for mucormycosis associated with the coronavirus disease, airway management was easy to slightly difficult in most patients. Perioperative complications can be minimized by taking timely and precautionary measures.

Published
2022

6. Airway management, procedural data, and mortality records of patients undergoing surgery for mucormycosis associated with coronavirus disease (COVID-19)

Author

Kapil Sikka, Smriti Panda, Tanmay Mathur, Brajesh Kumar Ratre, Raghav Gupta, Saurabh Vig, Gitartha Goswami, Alok Thakar, Nishkarsh Gupta, Balbir Kumar, Sushma Bhatnagar, Jitendra Kumar Meena, Ram Singh, Anuja Pandit, Abhilash Konkimalla, Dheeraj Kondamudi, and Prashant Sirohiya

Subjects
Pediatrics, medicine.medical_specialty, business.industry, medicine.medical_treatment, Mucormycosis, Acute kidney injury, Disease, medicine.disease, medicine.disease_cause, Diabetes mellitus, medicine, Intubation, Airway management, business, Adverse effect, Coronavirus
Abstract

PurposeAlthough unexpected airway difficulties are reported in patients with mucormycosis, the literature on airway management in patients with mucormycosis associated with Coronavirus disease is sparse.MethodsIn this retrospective case record review of 57 patients who underwent surgery for mucormycosis associated with coronavirus disease, we aimed to evaluate the demographics, airway management, procedural data, and mortality records.ResultsForty-one (71.9%) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) patients had a diagnosis of rhino-orbital mucormycosis, and 2 (3.5%) patients had a diagnosis of palatal mucormycosis. A total of 44 (77.2%) patients had co-morbidities. The most common co-morbidities were diabetes mellitus in 42 (73.6%) patients, followed by hypertension in 21 (36.8%) patients, and acute kidney injury in 14 (28.1%) patients. We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 (92.9%) patients. In our study, mortality occurred in 7 (12.3%) patients. The median (range) mortality time was 60 (27–74) days. The median (range) time to hospital discharge was 53.5 (10–85) days. The median [interquartile range] age of discharged versus expired patients was 47.5 [41,57.5] versus 64 [47,70] years (P = 0.04), and median (interquartile range) D-dimer levels in discharged versus expired patients was 364 [213, 638] versus 2448 [408,3301] ng/mL (P = 0.03).ConclusionIn patients undergoing surgery for mucormycosis associated with the coronavirus disease, airway management was easy to slightly difficult in most patients. Perioperative complications can be minimized by taking timely and precautionary measures.

Published
2021

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