Management of radiation wounds

Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currentlyKEY WORDS: Lymphoedema, osteoradionecrosis, plexopathy, radiotherapy, wounds     

Total cardiopulmonary bypass with the Lande-Edwards membrane oxygenator

Use of a commercially available disposable membrane oxygenator for total body perfusion and open heart surgery has been evaluated in clinical cases. Preliminary data indicate excellent oxygenation and minimal trauma to blood under conditions requiring prolonged perfusion. Two perfusion circuits are described. One has an intrinsic recirculating circuit to minimize pressure exerted on the membrane and multiple oxygenator units combined in series. The other utilizes gravity venous drainage directly into the multiple oxygenator units which are arranged in parallel to decrease resistance to gravity flow. Eighteen patients were perfused with the first method. Three have been perfused with the second. Physiologic data from both groups are presented. The technical advantages and disadvantages of each of the methods are described. Both methods are adequate for perfusion. The latter method of perfusion seems more desirable because the technicians have 1 less pump to operate and therefore can be more accurate in their control of total body perfusion.     

Anatomic basis for an algorithmic approach for free fibula flap donor side selection in composite oro-mandibular defects

Introduction:Head and neck oncological resections may result in composite oro-mandibular defects involving the oral mucosa (lining), mandibular bone and the skin (cover). Reconstructive options for such defects have evolved over a period. Free fibula flap reconstruction is currently accepted the world over as the gold standard for oro-mandibular defect reconstruction. Existing literature provides conflicting views about the use of a particular side and orientation of the fibula flap for achieving the optimal outcome. The purpose of this study is to confirm anatomically the effect of bone, soft tissue and vessel orientation on the ease of doing reconstruction.Results:Keeping the peroneal surface for plating, that is, facing outwards, four different configurations of the fibula flap are possible for a given mandibular defect. With a posterior vascular pedicle ipsilateral fibula is suitable for skin cover and contralateral for mucosal lining and the reverse for an anteriorly placed pedicle.Conclusion:The algorithm based selection of appropriate sided fibula flap facilitates complex mandibular reconstruction by placing the right kind of tissue at the right place and helps in reducing the donor site morbidity by allowing the surgeon to harvest only the required amount of skin.KEY WORDS: Free fibula flap, ideal side of fibula, mandibular reconstruction     

Infants affected by Rh sensitization: A 2-year Canadian National Surveillance Study

IntroductionRh sensitization occurs when Rh(D)-negative women develop anti-Rh(D) antibodies following exposure through pregnancy or transfusion. Rh disease may cause jaundice, anemia, neurological impairment, and death. It is rare in countries where Rh Immune Globulin (RhIg) is used. Canadian Rh sensitization and disease rates are unknown.MethodsThis survey-based study was conducted using a Canadian Paediatric Surveillance Program questionnaire sent to Canadian paediatricians and paediatric subspecialists to solicit Rh disease cases from May 2016 to June 2018. Paediatricians reported Rh-positive infants ≤ 60 days of age, born to Rh-negative mothers with RhD sensitization.ResultsSixty-two confirmed cases of infants affected by Rh(D) sensitization were reported across Canada. The median gestational age of neonates was term, age at presentation was 2 hours, and hemoglobin at presentation was 137.5 g/L (33 to 203 g/L). The median peak bilirubin and phototherapy duration were 280 µmol/L (92 to 771 µmol/L), and 124 hours, respectively. Thirty (48%) infants received Intravenous immune globulin (IVIG) (median two doses). Seventeen (27%) received one to three simple transfusions; 10 (16%) required exchange transfusions. Six (10%) infants presented with acute bilirubin encephalopathy, and less than five presented with seizures. Fourteen mothers with affected infants were born outside of Canada.DiscussionRh disease continues to exist in Canada. Additional efforts are needed to raise awareness of Rh disease, prevent disease, and minimize sequelae when it does occur. The ongoing global burden of Rh Disease, as well as the possibility of emerging Rh immunoglobulin refusal are among factors that could be taken into consideration in future prevention efforts.     

Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction

A free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome.     

Salmonella serotypes isolated from man in Malaysia over the 10-year period 1973-1982.

The results of serotyping of 10 953 salmonella isolates from humans over a 10-year period, 1973-82 at the Bacteriology Division, Institute for Medical Research, Malaysia are presented. A total of 104 serotypes from 22 ''O'' groups were encountered; 95 isolates were considered untypable. The three most predominant serotypes, namely Salmonella typhi, S. typhimurium and S. weltevreden together accounted for 54.1% of all isolates whilst the 25 most frequent serotypes accounted for 93.6% of the total. Whilst the commoner serotypes occurred regularly throughout the study period, the rarer ones tended to appear only in one year, when they might be associated with an outbreak, and never again. The pattern of serotypes, though quite similar to the one seen in neighbouring Singapore, is different from those experienced in other places such as Hong Kong, Jakarta, Bangladesh and Manchester.