The meeting started with an update on Indus Charity Hospital by Mr AM Khan (Cardiff) who had visited Karachi recently. He explained the various ENT facilities available there and what one could expect if one decides to visit.
The main speaker for the evening was Mr Saghir Shaikh (Consultant ENT Surgeon, Glasgow), who delivered a talk on ‘Management of facial cutaneous malignancies’. Mr Shaikh spoke about various facial defect management options which could range from small and superficial to large and full thickness. There was also a reminder to colleagues to follow the guidelines for basal cell and squamous cells carcinoma from the British Dermatological Society emphasising on the margins of excision.
The MOHS micrographic surgery provides superior margin control and low recurrence, and ENT should form an active part of the reconstructive team with dermatology colleagues to adopt this form of surgery. Mr Shaikh emphasised that prior to any reconstruction; the defect should be assessed with regard to its size, location in facial subunit, depth and missing structures. It is important to consider that skin on different regions of the face differs in colour, texture, thickness, vascularity and hair bearing nature. These issues should be considered prior to deciding on donor sites. Secondary intention healing has many advantages and it should be employed whenever applicable; for example mainly in defects of concave areas of the face; however the patient should be prepared psychologically to deal with an open wound. The primary repair is possible but repair should be layered and without any tension. When primary repair is not possible other methods like skin grafts, local flaps and distant flaps could be used.
Various flaps in different facial sites were also discussed along with options for reconstruction of auricular defects following cutaneous malignancy. Mr Shaikh explained that one should not forget that nasal and auricular prostheses give excellent cosmetic results in cases of advanced cutaneous malignancies. Mr Shaikh was asked many probing questions by the appreciative audience and was thanked for making his long journey to deliver an entertaining and informative lecture.
ENT NEWS | VOL 18 NO 3 | JUL/AUG 2009