Cosmetic outcomes following head and neck melanoma reconstruction: DISCUSSION (part 2)
The incidence of recurrence had the greatest impact on emotional impairment when compared with all other factors examined in the present study. In fact, 12 of the 13 patients experiencing recurrence reported VAS scores for emotional impairment of 9 and greater. The observation that the patients’ VAS scores for appearance alteration and for satisfaction with outcome were not affected by recurrence suggests that emotional impairment following recurrence is less a function of reconstructive outcomes and more a function of the psychological impact of recurrence. More than one-half of patients who were diagnosed with recurrence in this study had stage IV disease, which itself is expected to have a large emotional impact on patients. And congruent to other studies, our series showed that the method of reconstruction did not appear to have an effect on recurrence.
Traditionally, the approach to evaluating subjective measures involves assessments by experts and not patients. This is based on the belief that experts can evaluate distinct components of reconstructive outcomes that are aesthetically desirable, offering other surgeons with specific and technical feedback. Our study would suggest that the patient’s opinion of his or her appearance is also an important factor to consider when evaluating aesthetic outcomes. The use of patient-based subjective evaluation scales is gaining popularity in plastic and reconstructive surgery and has provided surgeons with a valid method of assessing outcomes, especially following breast reconstruction. Of these scales, the VAS is often used to evaluate subjective feelings and satisfaction. The VAS has been used in several clinical scenarios including pain assessments and effectiveness of prescription Canadian medications. Advantages of the VAS include its high reproducibility, simplicity and intuitive use for patients, and its sensitivity to differences as small as 1 mm. Therefore, we believe the VAS was the best tool for assessing patient satisfaction and the emotional impact of head and neck melanoma reconstruction. The ordinal scale has different advantages. This scale allows subjects to rank outcomes (ordinal data) and is useful in evaluating subcategories of an outcome. The results of ordinal subcategory scales have been shown to have the greatest potential reliability because they explicitly specify the criteria that one wishes the evaluate. Therefore, we believe the ordinal scale was the best tool to evaluate specific attributes of the reconstructive outcome such as colour match, scarring and thickness.
Limitations of the present study merit discussion. First, the number of patients in this case series was small, limiting the study’s power and ability to draw statistically significant conclusions. For example, only two patients received free flaps in the present study. Although they both reported thickness and contour irregularities, it is difficult to conclude that these results are significant. Furthermore, our conclusion that local tissue transfer is superior to skin grafting is a generalization that does not account for location or defect size. Specific locations and sizes of wounds may benefit greatly from skin grafting. You are welcome to visit one of the best pharmacies on the internet offering its services and best quality drugs to international customers: purchase antibiotics online to make sure of it yourself without having to hope, because now you know for sure.
Tags: Head and neck reconstruction, Local flap, Melanoma, Outcomes, patient satisfaction