Syed Afroze, Hussain (2011) Morbidities of Ilio Inguinal block dissection and the role of tensor fascia lata flap in preventing wound dehiscence. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION : Ilio inguinal block dissections involve the removal of all the nodes in the inguinal region including both the superficial and the deep groups along with the removal of nodes in the pelvis below the bifurcation of the common iliac artery. When only the inguinal groups of nodes are removed, they are termed inguinal block dissections. Inguinal block dissections may be superficial or inguino-femoral depending on the dissection of deep group of inguinal nodes. The dissection of these groups of nodes are done as a part of staging procedure in most of the malignancies involving the genital region, lower limb, skin over the anterior abdominal wall below the umbilicus, gluteal region, anal canal and perianal region. The most important prognostic factors for survival in invasive carcinomas are the presence and the extent of inguinal lymph node metastasis. The survival decreases with increasing number of positive nodes. These dissections may be considered as a curative procedure if only the inguinal nodes are involved, especially in carcinoma of the penis (less than or equal to 2 nodes positive) in various studies. In other malignancies, positive macroscopic nodal status is an indicator for multi modal management. AIM : 1. To study the various morbidities associated with Ilio inguinal block dissection. 2. To compare the standard tensor fascia lata flap with a modified extended tensor fascia lata flap. 3. To compare the outcome between primary closure and the two methods of TFL flap design used in the department in reducing the incidence of wound dehiscence. CONCLUSION : Nodal dissections in the inguinal region are not to be taken lightly. Wound breakdown and necrosis is the worst of all its complications. Tensor fascia lata flap are recommended to prevent wound necrosis. The study proves the above hypothesis when the standard form of the flap is used for reconstruction. The modified form is easier to apply and may cover a larger area but the medial part of the flap has a precarious supply and prone for necrosis. We recommend a flap delay when the modification is planned. Primary closure of the wound may sometimes heal without any complications. When wound necrosis develops there is delay in starting adjuvant therapy which may have adverse impact on the survival. Radiation treatment breaks due to radiation dermatitis have been found to be associated with patients who had flap necrosis. The standard tensor fascia lata flap has the best outcome followed by the modified extended tensor fascia lata flap. The worst outcome was seen in the wounds closed primarily. The necrosed wounds healed without further complication in all the cases with conservative measures. Some of the healed wounds had to be covered with split skin grafts.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Morbidities ; Ilio Inguinal block dissection ; tensor fascia lata flap ; wound dehiscence. |
| Subjects: | MEDICAL > Surgical Oncology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 25 Jul 2017 04:14 |
| Last Modified: | 25 Jul 2017 04:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2112 |
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