Management Of Reconstruction Research Articles

Endovascular Management of Post-Irradiated Carotid Blowout Syndrome in Patients with Lower Neck Cancers

Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE). This was a single institute, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil/adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included proximal and distal ends of the pathological lesion in all patients. Rebleeding events, haemostatic period, and neurological complications were evaluated. A total of 59 patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61). No difference in rebleeding risk and neurological complications was observed between DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.

LAPORAN KASUS: PERBANDINGAN PROSEDUR CUTLER BEARD DAN DIRECT CLORUSE PADA DEFEK PALPEBRA YANG LUAS AKIBAT TRAUMADI RSU DR. SAIFUL ANWAR MALANG

The paper aimed to report a different management ofreconstruction for large traumatic upper eyelid defect. Case 1 : a 17 years old woman with traumatic upper eyelid defect in the right eye since 2 years old. The defect was linear but wide, looks like a triangle defect. Defect had repaired by direct closure. After the operation the defect remain. Case 2 : a 45 years old man with more than 50 % traumatic upper eyelid defect in the left eye. Cutler-beard procedurwas made to close the defect. Separation of the flap had been done at the second procedure. Cutler-beard procedure, done to the second patient, had succed to close the upper eyelid defect. Reconstruction procedure carried out for  the first patient was not adequate to restore the large upper eyelid  defect. Cutler-beard procedure is used for upper eyelid defect involving more than 50% seem to have a good result.Key words: Cutler beard, Direct closure