Abstract

OBJECTIVES To evaluate the role of thrombin based hemostatic agent Surgiflo® (Ethicon, Somerville, USA) in improving the outcome of cricotracheal resection anastomosis. DESIGN Randomized controlled clinical trial. SETTING Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. PARTICIPANTS This study included 55 patients with grade III and IV subglottic and/or cervical tracheal stenosis, who underwent cricotracheal resection anastomosis. Patients were randomly assigned into two groups: Surgiflo group (n=20) and control group (n=35). In Surgiflo patients, Surgiflo® was applied at the end of surgery over the whole operative field including the line of airway anastomosis with the purpose of adequate hemostasis and enhancing healing of the anastomosis. MAIN OUTCOME MEASURES The success rate and the incidence of complications in both groups were compared. RESULTS At the end of treatment, decannulation rate was 95% (19/20) in the Surgiflo groups and 82.8% (29/35) in the control group. The overall incidence of complications was significantly lower in the Surgiflo group (p=0.021). Need for further surgical airway interventions in the form of repeated dilatation, granulation tissue removal or performing a tracheotomy was reported in 22.9% (8/35) of control group patients, in comparison to 5% (1/20) in Surgiflo group. CONCLUSION Direct Surgiflo® application in the operative field enhances the anastomotic healing, decreases the incidence of anastomotic complications and subsequently improves the outcome. It can be recommended as an adjuvant to surgery in patients undergoing cricotracheal resection anastomosis.

Abstract

OBJECTIVES The aim of this study was to evaluate the potential role of platelet-rich fibrin (PRF) application on the pharyngeal repair on decreasing the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy. METHODS This randomized controlled clinical trial was conducted on 67 patients with advanced laryngeal carcinoma who underwent total laryngectomy, over 2 years in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: PRF group (n = 35) and control group (n = 32). Risk factors for development of PCF as well as the incidence of PCF were studied in both groups. RESULTS There was no statistically significant difference between groups regarding demographic data, medical comorbidities, basal hemoglobin and albumin levels, data related to the tumor (location, grade and TNM staging) and surgical details (preoperative tracheotomy and neck dissection). However, regarding the incidence of PCF, there was a statistically significant difference between groups as shown in Table 2. PCF was detected in 2/35 patients (5.7%) in the PRF group and in 10/32 patients (31.3%) in the control group (p = 0.004). CONCLUSION PRF application on the pharyngeal repair after total laryngectomy enhances the healing process and consequently decreases the incidence of PCF.

Abstract

Purpose: The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO2 (Fr: CO2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions. Patients and methods: This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO2 laser, and combined Fr: CO2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months. Results: A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO2 laser. Conclusion: According to our study, combined Fr: CO2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO2 alone showed poor improvement. Combined ablative Fr: CO2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.