Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:

Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 562 - файл

.pdf
Скачиваний:
0
Добавлен:
29.08.2026
Размер:
25 Мб
Скачать
☆
15 Physical andOccupational Therapy
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
219
needed. Compression use is to be undertaken with caution on any patient with reduced sensa­tion and any chance of skin breakdown.
Range-of-Motion Assessment
Range-of-motion assessment (ROM) is simple and easy to perform and can provide important information. It gives insight on the patient’s will­ingness and ability to move the part of the body being assessed, any pain with movement, as well as specic limitations of movement and asymme­try. If preoperative measurements were taken, they can now be compared to current measure­ments to determine the effects of surgery. It should be part of every initial evaluation as well as evaluations during ongoing physical therapy treatment to measure improvement. The most accurate measurement method is the use of a standard goniometer or cervical range of motion (CROM) device. A tape measure can also be used. Whichever method is used, it is important that the measurement method be consistent throughout treatment; ROM should be assessed with the patient in the same position each time, and the exact patient position and technique should be documented [73].
Expectation ofthis Visit
The exact details of this visit will depend on planned medical or surgical intervention but should include the following information: heal­ing time frame and progression of postoperative rehabilitation, when exercise will begin, possible impairments and what to look for, risk of devel­oping lymphedema, how it may present, and what to do. Because compression is relatively simple for the management of lymphedema, some patients may try it on their own; however, it is recommended that the patient or family mem­ber contact the clinician or medical team prior to this in order to determine the appropriate patient­specic intervention.
The clinician can discuss and demonstrate early posttreatment exercises and activities for the acute stage of healing. These will all be patient specic but may include some or all of the following:
• Postural control and joint protection
• Neck ROM
• Breathing—diaphragmatic
• Scapula elevation and retraction
• Mandibular opening/stretch
• Upper extremity ROM—ngers, wrists, fore-
arms, elbows, shoulders
It is encouraged that a review of the clinicians
Benets ofPretreatment Physical Therapy Baseline
involved in the patient’s care be performed rou­tinely to determine which one would be appropri­ate to contact for any specic issue. At the time of
There are many advantages of performing a pre­operative or pre-radiation assessment when pos­sible. A baseline assessment allows the clinician to identify preexisting impairments, such as neck or arm tightness or weakness and trismus, and begin working on these areas as needed. Preoperative evaluation provides an opportunity to educate the patient and family on expectations and the post-op therapy program. In addition, it may provide some level of legal protection by identifying pre conditions.
the visit, patients have the opportunity to ask spe­cic questions and express any anxiety about the upcoming procedure. Often, simple and empa­thetic explanations can go a long way to reducing the anxiety the patient or family may have. Simple relaxation techniques are easy to learn yet well worth the time spent if needed. Specics of the preoperative evaluation are described in Table 15.3, and details are collected in the
Physical Therapy Pre-operative Examination Intake Form.
220
J. Gomez et al.
Physical Therapy Pre-operative Examination Intake Form
Please answer the following questions. Circle yes or no. If you answer yes, please add details such as date, if you have fully recovered, and any information about the incident. We will review this information with you at your preoperative visit.
Do you have any prior shoulder injuries, or
surgeries?
Yes No If yes:______________ _______________________________________ _____.
Have you ever had a frozen shoulder?
Yes No If yes:______________ _______________________________________ ______.
Do you have, or have you had, any prior neck injuries, or surgeries?
Yes No If yes:______________ _______________________________________ _______.
Do you have, or have you had, any disc or joint problems in your neck?
Yes No If yes:______________ _______________________________________ _______.
Do you have, or have you had, radiating arm pain?
Yes No If yes:______________ _______________________________________ _______.
Do you have full and pain-free movement of your shoulders and neck?
Yes No If yes:______________ _______________________________________ _______.
Are you limited in any activity that requires the use of your arms or neck?
Yes No If yes:______________ _______________________________________ _______.
Do you have any jaw pain or problem opening your mouth?
Yes No If yes:______________ _______________________________________ _______.
Postoperative Care
There are many patient-specic factors that inform the treatment plan for head and neck cancer patients, including pretreatment func­tion; type of treatment, such as surgery, radia­tion, chemotherapy, or a combination of these; and patients’ goals. In the absence of a specic protocol from the referring physician, the fol­lowing guideline is meant to assist that process.
Table 15.4 identies the structures involved in the surgical eld and the potential clinical implications of impairment of these structures. It is important that donor sites for major head and neck reconstruction surgery be addressed as well.
Start time for therapy will vary based on surgi­cal technique, patient response to healing, pain, any patient comorbidities, as well as current, ongoing, or future medical interventions.
If a preoperative or pre-radiation assessment was done, repeat measurements should be taken at follow-up visits. The patient is then assessed to determine the appropriate intervention if any for this time. This initial post-op visit is an ideal time to review education on issues such as lymphedema, posture, joint protection, dia­phragmatic breathing, and any others that are appropriate.
Other considerations include CROM and shoulder ROM. If CROM is restricted after 8 weeks, it is recommended to assess passive joint play at the atlanto-occipital (AO) and atlan­toaxial (AA) joints, C2–3 and through T3 joints, in addition to normal soft tissue assessment.
If shoulder ROM is limited, it is recommended to assess passive joint play assessment at the acromioclavicular, sternoclavicular, and gleno­humeral joints, in addition to soft tissue assessment.
Patients should undergo evaluation for cervi­cal radiculopathy. Preexisting degenerative verte­bral disc disease will directly inform patients’ preoperative and ongoing evaluations as well as progress throughout physical therapy treatments [74]. The following maneuvers are done to evalu­ate for cervical radiculopathy:
15 Physical andOccupational Therapy
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Table 15.4 Structures involved in the surgical eld of head of head and neck surgery and the potential clinical implica­tions of impairment of these structures
Anatomy Function Clinical implications Surgical eld
• Anterior border of trapezius
• Levator scapula
• Subplatysmal plane
Platysma muscle (innervated by CN VII)
Sternocleidomastoid (SCM) (CN XI)
Spinal accessory nerve (CN XI)
Hypoglossal nerve (CN XII) Innervates tongue and intrinsic
Phrenic nerve Innervates respiratory diaphragm Impaired respiration Internal jugular vein Drains dural sinuses in brain and face
Common carotid artery Supplies oxygenated blood to head
Scalenes Neck movement and stability
Posterior belly of digastric muscle (CN VII)
Omohyoid muscle (cervical plexus)
Pulls angle of mouth down Pulls skin of chest up
Active rotation opposite side Supercial neck exor AO extension, forward head posture Trapezius and SCM innervation Shoulder/neck/scapula weakness
muscles:
• Styloglossus
• Hypoglossus
• Genioglossus
and neck areas below brain
and neck
Accessory respiration Supercial neck exors
From mastoid process to hyoid bine Stabilizes hyoid bone to assist anterior digastric in mandibular opening From scapula to hyoid bone via clavicle. Stabilizes hyoid bone
Soft tissue involvement. Scarring/brosis can cause signicant functional limitation
Limits neck extension Limits contralateral neck rotation and side-bending Can develop trigger points Can restrict ipsilateral rotation Weakness of contralateral rotation Weakness of neck exion
Limited AROM Pain Tongue function Impaired swallow Impaired articulation Coordinate with SLP
Swelling/edema of ipsilateral face if ligated
Possible stroke
Brachial plexus courses between Possible thoracic outlet syndrome Limited ROM in side-bending, rotation, and extension Weakness of neck motions Limited contralateral neck rotation Can impact active mandibular opening
Can limit neck ROM
221
• Quadrant test: side-bend head and add axial compression, or side-bend and rotate head away.
• Distraction: patient supine, and examiner stands at the head of the bed, places each hand around the mastoid process (or one on fore­head and the other on occiput), and gently exes and pulls patient’s head toward himself or herself. A positive test is the resolution of symptoms with traction.
• Upper limb tension test: brachial plexus ten­sion test, evaluation of peripheral nerve compression.
Physical Therapy Treatment Considerations forFree Flap Donor Sites
For patients who have undergone head and neck reconstruction with free aps, attention should be given to donor-site range of motion and function during the postoperative period. The following are four examples of donor-site management of com­monly used free tissue reconstruction, including manual techniques and exercises. The consider­ations below are not comprehensive, and thorough evaluation of the patient will guide a comprehen­sive patient-specic treatment program.
222
J. Gomez et al.
General considerations—assessment of donor
and recipient sites:
1. Supercial soft tissue mobilization:
(a) Straight plane and diagonals as well as
circular/rotation
2. Deep facial mobilization:
(a) Can include facial bone interface (b) Distraction (c) Distraction with rotation (d) Joint mobilization if needed
3. ROM—osteokinematics—measure with a
goniometer
4. Functional ROM to include rotations (pro-
prioceptive neuromuscular facilitation (PNF) patterns)
5. Regional mobility—consider facial planes of
multiple joint segments
6. Exercises to maintain between sessions
7. Exercises to help maintain after discharge
8. Strength and functional capacity
Upper Extremity Soft Tissue Flap (e.g., Radial Forearm Free Flap)
When a free tissue ap is harvested from the arm, a split-thickness skin graft is often used to replace the forearm skin that was harvested. Initial con­sideration must be given to not disrupting the skin graft, while also preventing scar tissue for­mation around the exor tendons of the forearm. Once the graft is adequately healed with good blood supply, gentle AROM for the wrist and forearm may begin. If normal healing is pro­gressing around 3–4weeks after surgery, gentle scar tissue mobilization can be performed along with wrist and hand strengthening.
1. Manual therapy
(a) Soft tissue mobilization—begin super-
cial and work deep (Fig.15.6).
(b) Joint mobilization as needed (wrist, fore-
arm, and elbow).
2. Exercises
(a) Tendon gliding exercises started as early
as possible.
(b) Maintaining the wrist in neutral position,
these exercises are not performed with any force, NO hard gripping. Use just gentle exing and extending of the n-
gers, curling from the tips to the palm, keeping nger straight exing from the knuckle.
(c) Gentle AROM to elbow and shoulder as
appropriate.
3. Stretching (Fig.15.7) (a) Prayer stretch (b) Passive wrist extension
4. Strengthening (a) Active wrist ROM
• Flexion, extension, supination, prona­tion, deviation
(b) Hand dexterity exercises (c) Progressive strengthening
Osseous or Osteocutaneous Fibula FreeFlap
As mentioned above, patients who have under­gone osseous or osteocutaneous bula free ap reconstruction are kept on non-weight-bearing restrictions for 4–7days. Gentle active dorsi­exion at the ankle as tolerated is recom­mended for tendon and nerve gliding and to help control swelling. After 4–7days follow­ing surgery, progressive weight-bearing is begun.
Wound healing issues are common at the donor site and should be addressed as soon as possible. Muscle necrosis is a rare sequela and may occur 3–6weeks postoperatively. Other pos­sible long-term issues can include chronic edema, ankle instability, weakness of ankle dorsiexion, plantar exion, pseudo-compartment syndrome, and neuropathic pain. As appropriate, there will be a steady progression of lower extremity strengthening, gait, and balance.
1. Manual therapy (as appropriate) (a) Soft tissue mobilization (b) Fascial mobilization (c) Joint mobilization:
• Ankle
• Proximal tibia-bula joint
• Knee if needed
2. Exercises (a) Active exercise:
• AROM to ankle and knee
3. Stretching
ab
15 Physical andOccupational Therapy
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
223
(a) Increase dorsi and plantarexion, inver-
sion, and eversion
4. Strengthening (a) As appropriate for ankle, knee, and hip
(g) Work on quadratus lumborum muscle
motion for separation of trunk and pelvis
(h) Distraction of arm
2. Exercises
Latissimus Flap
1. Manual therapy. (a) Soft tissue mobilization in area around
incision and, when healed, over the incision
(b) Assess regional motion with respect to
facial planes (c) Work on shoulder ROM planes (d) Measure and work on rib cage mobility—
lateral expansion (e) Work on trunk and low back ROM, side
lying with involved side up, arm in eleva-
tion, trunk inside bending (f) Work on scapula mobility
(a) Stretching:
• Stick stretch (Fig.15.5)
• Doorway stretch
• Quadruped stretch with shoulder in extended rotation
• Side-bend stretch with arm in elevation (Fig.15.5)
(b) Strengthening
• TheraBand shoulder extension from 40 degrees of exion into extension
• TheraBand shoulder extension from overhead (130 degree if able) to neutral
• Trunk stabilization
ab c
Fig. 15.5 Stretching exercises following latissimus dorsi ap, stick exion (a) and stick abduction (b), and side-bend stretch with arm in elevation (c)
Fig. 15.6 Soft tissue mobilization after radial forearm free ap. Begin with supercial tissues and then work on the deeper tissues using nonslip padding (e.g., Dycem) with forearm in neutral position (a) and in extension (b)
224
J. Gomez et al.
Fig. 15.7 Upper extremity stretching following radial forearm free ap. (a) Prayer stretch, (b) wrist extension
ab
Spinal Accessory Nerve
If the spinal accessory nerve remains intact after surgery, the initial phase of treatment following surgery involves protection of the shoulder and healing nerve by passively off-loading or reduc­ing tension on the nerve with a sling or arm sup­port. It is important to maintain range of motion at the glenohumeral joint to decrease the chance of adhesive capsulitis forming. Combinations of active ROM, passive ROM, and functional activi­ties are all benecial. Postural awareness should be emphasized. Weakness of the scapulothoracic musculature combined with anterior scar tissue can produce a forward head posture and pro­tracted shoulders that has the potential to become xed without intervention [75].
Upon return of nerve function, which can take up to 12months following surgery, exercise can focus on return of strength and function to the reinnervated musculature.
Manual therapy consists of joint mobilization, soft tissue mobilization, as well as mobilization with movement, which is a manual correction of scapular thoracic position while active motions are performed of the shoulder.
Mobilization to the glenohumeral, acromio­clavicular, and sternoclavicular joints is recom­mended. Soft tissue mobilization to help loosen anterior structures may be needed as well. Exercises may consist of:
• Scapular stabilization-type exercises
– Scapular squeezes – Bent row – External rotation – Wall exion with ball compression
– Rotator cuff strengthening with TheraBand
progression – Eccentric exion using band – Shoulder shrugs – Functional PNF
Predictors for mid- to long-term shoulder dis­ability after neck dissection include the following [76]:
(a) Decreased AROM for abduction and exion
after SND (b) Shoulder droop (c) Pain with passive shoulder extended rotation (d) Increased pain on a numerical rating scale
Trismus
Trismus is the progressive reduction in the ability to open the mouth and can lead to difculty eat­ing and resultant malnutrition, poor oral hygiene, difculty with speech, and possible airway com­promise. Trismus can occur between 5 and 38% of patients undergoing treatment for head and neck cancer [6, 77]. The prevalence varies across studies based on the denition of mouth opening used, which is typically ≤3.5cm [6]. Trismus can result from surgical intervention, such as man­dibular reconstruction, as well as radiation­induced brosis.
Proper mandibular function requires bilateral symmetrical function of bilateral temporoman­dibular joints (TMJs). Upon initial mouth open­ing, the condyles of the mandible roll in the mandibular fossa. This rolling alone allows 35–50% of opening. For further opening, the condyles must slide or translate forward along
15 Physical andOccupational Therapy
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
the articular eminence of the temporal bone. Normal range of motion for mandibular opening is between 40 and 55mm measured between the upper and lower incisors. It is generally accepted that normal lateral deviation is approximately 25% of opening. Normal protrusion is estimated to be between 6 and 9mm. Involvement or tight­ness of one TMJ will result in a deviation of movement to the involved side upon mouth open­ing and protrusion, and asymmetry of lateral translation.
Assessment ofTrismus
As mentioned previously, patient positioning should be consistent between tests. The patient is initially observed for movement and limita­tion. A cursory evaluation of the status of denti­tion and any signs of infection is highly recommended. Measurement of the distance between the mandibular and maxillary incisors during maximal mouth opening can be done with a simple clear plastic ruler. Another simple way to measure mouth is to assess the number of the patients’ ngers that can be placed between the incisors upon opening. Generally, three ngers are considered normal functional and fewer than three is considered limited open­ing. Protrusion can be quantied by measuring the distance between the incisors while a patient maximally protrudes the mandible. Lateral translation is measured by the amount of move­ment between the central upper and lower teeth. It is important to note any differences between the two sides.
In addition to ROM measurements, the thera­pist can palpate the mandibular condyles when the patient opens and laterally deviates, to assess for asymmetry between sides.
As an example, a patient presents with right­sided TMJ involvement. Mouth opening is 29 mm with deection of mandible to right upon opening. Protrusion is 2mm with deec­tion to right. Lateral translation to right is 7mm and 2mm to the left. Palpation of TMJs reveals increased tissue turgor on right. Passive joint play of right TMJ reveals slight reduction of
225
Fig. 15.8 Soft tissue mobilization of the right TMJ using nonslip padding, for the management of trismus
distraction and more notable reduction of translation.
Treatment ofTrismus
Delaying treatment can lead to secondary tissue changes in joint and muscle, making the recovery of function difcult. Therefore, early treatment is important for return of function.
Based on the clinical presentation above,
treatment could include:
• Soft tissue mobilization to right (Fig.15.8)
• Joint mobilization to right TMJ for distraction and anterior translation
• AROM/home program
• Use of tongue depressors on right side, with tongue blades placed between back molars and slowly adding tongue blades to allow a gentle distraction/stretch
Devices such as TheraBite for assisted open-
ing can be helpful. These should be combined with manual distraction or use of tongue blades for distraction of the joint.
226
J. Gomez et al.
Conclusion
Initiation of rehabilitation and physiotherapy after head and neck oncologic resection and reconstruction is crucial for the eventual return of function for head and neck patients. Management of functional complications and other surgical sequelae can be addressed during physiotherapy. Patients benet from continued care long after surgery has been performed as they continue to improve function and quality of life.
The rehabilitation therapist will be challenged by the complexity of care involved when treating patients that have undergone surgical and/or radi­ation treatment for head and neck cancers. The complex surgeries that involve the vital anatomic structures of the head and neckmay contribute to signicant impairments and functional limita­tions. A wide range of skill in assessment and manual techniques is needed to provide compre­hensive care. In addition, patient-specic clinical problem-solving is needed to be able to provide the best treatment at the appropriate time, with respect to tissue healing, ongoing medical care, and medical comorbidities. Herein, we have addressed in detail the morbidity that can follow major head and neck surgery and thecritical role that physiotherapy and occupational therapy play in rehabilitation of these patients in the peri- and posttreatment setting.
References
1. Yeung JK, Dautremont JF, Harrop AR, Asante T, Hirani N, Nakoneshny SC, de Haas V, Mckenzie D, Matthews TW, Chandarana SP, Schrag C, Dort JC.Reduction of pulmonary complications and hos­pital length of stay with a clinical care pathway after head and neck reconstruction. Plast Reconstr Surg. 2014;133(6):1477–84. https://doi.org/10.1097/PRS.
2. Nkenke E, Vairaktaris E, Stelzle F, Neukam FW, St PM.No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruc­tion. Head Neck. 2009;31(11):1461–9.
3. Bertelsen C, Hur K, Nurimba M, Choi J, Acevedo JR, Jackanich A, Sinha UK, Kochhar A, Kokot N, Swanson M. Enhanced recovery after sur­gery-based perioperative protocol for head and neck free ap reconstruction. OTO Open.
2020;4(2):2473974X20931037. https://doi.org/10.1
177/2473974X20931037.
4. Dort JC, et al. Optimal perioperative care in major head and neck cancer surgery with free ap reconstruc­tion: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol–Head Neck Surg. 2017;143(3):292–303.
5. Yoda T, Ogi N, Yoshitake H, Kawakami T, Takagi R, Murakami K, et al. Clinical guidelines for total temporomandibular joint replacement. Jpn Dent Sci Rev. 2020;56(1):77–83. https://doi.org/10.1016/j.
jdsr.2020.03.001.
6. Dijkstra PU, Huisman PM, Roodenburg JL. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg. 2006 Apr;35(4):337–42. https://doi.
org/10.1016/j.ijom.2005.08.001.
7. Scott B, D’Souza J, Perinparajah N, Lowe D, Rogers SN.Longitudinal evaluation of restricted mouth open­ing (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg. 2011;49(2):106–11. https://
doi.org/10.1016/j.bjoms.2010.02.008.
8. Lazarus CL, Husaini H, Anand SM, Jacobson AS, Mojica JK, Buchbinder D, Urken ML. Tongue strength as a predictor of functional outcomes and quality of life after tongue cancer surgery. Ann Otol Rhinol Laryngol. 2013;122(6):386–97. https://doi.
org/10.1177/000348941312200608.
9. Baggi F, Santoro L, Grosso E, etal. Motor and func­tional recovery after neck dissection: comparison of two early physical rehabilitation programmes. Acta Otorhinolaryngol Ital. 2014;34(4):230–40.
10. Sandler ML, Lazarus CL, Ru M, Sharif KF, Yue LE, Grifn MJ, Likhterov I, Chai RL, Buchbinder D, Urken ML, Ganz C. Effects of jaw exercise inter­vention timing on outcomes following oral and oro­pharyngeal cancer surgery: Pilot study. Head Neck. 2019;41(11):3806–17. https://doi.org/10.1002/
hed.25908.
11. Urken ML, Moscoso JF, Lawson W, Biller HF. A systematic approach to functional reconstruction of the oral cavity following partial and total glos­sectomy. Arch Otolaryngol Head Neck Surg. 1994 Jun;120(6):589–601. https://doi.org/10.1001/archo
tol.1994.01880300007002.
12. Lewin JS, Teng MS, Kotz T. Speech and swallow­ing rehabilitation of the patient with head and neck cancer. UpToDate; 2020. https://www.uptodate.com/
contents/speech- and- swallowing- rehabilitation- of­the- patient- with- head- and- neck- cancer.
13. Rademaker AW, Logemann JA, Pauloski BR, Bowman JB, Lazarus CL, Sisson GA, Milianti FJ, Graner D, Cook BS, Collins SL, et al. Recovery of postoperative swallowing in patients undergoing par­tial laryngectomy. Head Neck. 1993;15(4):325–34.
https://doi.org/10.1002/hed.2880150410.
14. Ewing MR, Martin H. Disability following radi­cal neck dissection; an assessment based on the postoperative evaluation of 100 patients. Cancer. 1952;5(5):873–83. https://doi.org/10.1002/1097-
15 Physical andOccupational Therapy
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
227
0142(195209)5:5<873::aid- cncr2820050504>3.0.co ;2- 4.
15. Sua rez O. El problema de las metastasis linfa ticas y alejadas del ca ncerde laringe e hipofaringe. Rev Otorrinolaringol. 1963;23:83–99.
16. Bradley PJ, Ferlito A, Silver CE, Takes RP, Woolgar JA, Strojan P, Suárez C, Coskun H, Zbären P, Rinaldo A. Neck treatment and shoulder morbidity: still a challenge. Head Neck. 2011;33(7):1060–7. https://
doi.org/10.1002/hed.21495.
17. Leipzig B, Suen JY, English JL, Barnes J, Hooper M.Functional evaluation of the spinal accessory nerve after neck dissection. Am J Surg. 1983;146:526–30.
18. Dijkstra PU, van Wilgen PC, Buijs RP, et al. Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors. Head Neck. 2001;23:947–53.
19. Patten C, Hillel AD. The 11th nerve syn­drome. Accessory nerve palsy or adhesive cap­sulitis? Arch Otolaryngol Head Neck Surg. 1993;119(2):215–20. https://doi.org/10.1001/archo
tol.1993.01880140105016.
20. Lauchlan DT, McCaul JA, McCarron T. Neck dis­section and the clinical appearance of post-operative shoulder disability: the post-operative role of physio­therapy. Eur J Cancer Care (Engl). 2008;17(6):542–8.
https://doi.org/10.1111/j.1365- 2354.2007.00862.x.
21. De Jong AA, Manni JJ. Phrenic nerve paralysis fol­lowing neck dissection. Eur Arch Otorhinolaryngol. 1991;248(3):132–4.
22. Gane EM, McPhail SM, Hatton AL, Panizza BJ, O’Leary SP. Neck and shoulder motor func­tion following neck dissection: a comparison with healthy control subjects. Otolaryngol Head Neck Surg. 2019;160(6):1009–18. https://doi.
org/10.1177/0194599818821885.
23. Guru K, Manoor UK, Supe SS. A comprehen­sive review of head and neck cancer rehabili­tation: physical therapy perspectives. Indian J Palliat Care. 2012;18(2):87–97. https://doi.
org/10.4103/0973- 1075.100820.
24. Stubbleeld MD.Radiation brosis syndrome: neuro­muscular and musculoskeletal complications in can­cer survivors. PM&R. 2011;3(11):1041–54. https://
doi.org/10.1016/j.pmrj.2011.08.535.
25. Lo C-Y, Kwok K-F, Yuen P-W.A prospective evalua­tion of recurrent laryngeal nerve paralysis during thy­roidectomy. Arch Surg. 2000;135(2):204–7. https://
doi.org/10.1001/archsurg.135.2.204.
26. Suárez C, Fernández-Alvarez V, Hamoir M, Mendenhall WM, Strojan P, Quer M, Silver CE, Rodrigo JP, Rinaldo A, Ferlito A. Carotid blowout syndrome: modern trends in management. Cancer Manag Res. 2018 Nov;13(10):5617–28. https://doi.
org/10.2147/CMAR.S180164.
27. Song R, Song Y, Yu Y, Song Y. The upper arm free ap. Clin Plast Surg. 1982;9(1):27–35.
28. Depner C, Erba P, Rieger UM, Iten F, Schaefer DJ, Haug M. Donor-site morbidity of the sen­sate extended lateral arm ap. J Reconstr
Microsurg. 2012;28(2):133–8. https://doi.
org/10.1055/s- 0031- 1,289,165.
29. Zenn MR, Hidalgo DA, Cordeiro PG, Shah JP, Strong EW, Kraus DH. Current role of the radial forearm free ap in mandibular reconstruction. Plast Reconstr Surg. 1997;99(4):1012–7. https://doi.
org/10.1097/00006534- 199,704,000- 00014.
30. Arganbright JM, Tsue TT, Girod DA, etal. Outcomes of the Osteocutaneous Radial Forearm Free Flap for Mandibular Reconstruction. JAMA Otolaryngol Head Neck Surg. 2013;139(2):168–72. https://doi.
org/10.1001/jamaoto.2013.1615.
31. Shnayder Y, Tsue TT, Toby EB, Werle AH, Girod DA.Safe osteocutaneous radial forearm ap harvest with prophylactic internal xation. Craniomaxillofac Trauma Reconstr. 2011;4(3):129–36. https://doi.
org/10.1055/s- 0031- 1,279,675.
32. Werle AH, Tsue TT, Toby EB, Girod DA.Osteocutaneous radial forearm free ap: Its use without signicant donor site morbidity. Otolaryngol– Head Neck Surg. 2000;123(6):711–7. https://doi.
org/10.1067/mhn.2000.110865.
33. Ling XF, Peng X.What is the price to pay for a free bula ap? A systematic review of donor-site morbid­ity following free bula ap surgery. Plast Reconstr Surg. 2012;129(3):657–74. https://doi.org/10.1097/
PRS.0b013e3182402d9a.
34. Takebe K, Nakagawa A, Minami H, Kanazawa H, Hirohata K.Role of the bula in weight-bearing. Clin Orthop Relat Res. 1984;184:289–92.
35. Segal D, Pick RY, Klein HA, Heskiaoff D.The role of the lateral malleolus as a stabilizing factor of the ankle joint: preliminary report. Foot Ankle. 1981;2(1):25e9.
36. Momoh AO, Yu P, Skoracki RJ, Liu S, Feng L, Hanasono MM.A prospective cohort study of bula free ap donor-site morbidity in 157 consecutive patients. Plast Reconstr Surg. 2011;128(3):714–20.
https://doi.org/10.1097/PRS.0b013e318221dc2a.
37. Babovic S, Johnson CH, Finical SJ. Free b­ula donor-site morbidity: the Mayo experi­ence with 100 consecutive harvests. J Reconstr Microsurg. 2000;16(2):107–10. https://doi.
org/10.1055/s- 2000- 7544.
38. Urken ML.Atlas of Regional and Free Flaps for Head and Neck Reconstruction: Flap Harvest and Insetting. LWW; 2012.
39. Song YGCG, Chen GZ, Song YL.The free thigh ap: a new free ap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37(2):149–59.
40. Lakhiani C, DeFazio MV, Han K, Falola R, Evans K. Donor-Site Morbidity Following Free Tissue Harvest from the Thigh: A Systematic Review and Pooled Analysis of Complications. J Reconstr Microsurg. 2016;32(5):342–57. https://doi.
org/10.1055/s- 0036- 1,583,301.
41. Noel CW, Vosler PS, Hong M, Orsini M, Sultanov F, Lu Z, Busato GM, Enepekides D, Higgins K.Motor and sensory morbidity associated with the antero­lateral thigh perforator free ap. Laryngoscope.
228
J. Gomez et al.
2018;128(5):1057–61. https://doi.org/10.1002/
lary.26865. Epub 2017 Nov 6
42. Mangelsdorff G, Cuevas P, Rodriguez JR, Pereira N, Ramirez E, Yañez R.Reduced Anterolateral thigh ap donor-site morbidity using incisional negative pres­sure therapy. J Reconstr Microsurg. 2019;35(3):229–
34. https://doi.org/10.1055/s- 0038- 1,672,126. Epub 2018 Sep 27
43. Chan YW, Ng RWM, Wei WI. Anatomical study and clinical applications of free posterior tibial ap in the head and neck region. Plast Reconstr Surg. 2011;128(3):131e–9e. https://doi.org/10.1097/
PRS.0b013e318221db67.
44. Smith RB, Henstrom DK, Karnell LH, Chang KC, Goldstein DP, Funk GF. Scapula osteocutaneous free ap reconstruction of the head and neck: impact of ap choice on surgical and medical complica­tions. Head Neck. 2007;29(5):446–52. https://doi.
org/10.1002/hed.20540.
45. Kim H, Wiraatmadja ES, Lim S-Y, Pyon J-K, Bang S-I, Oh KS, Lee JE, Nam SJ, Mun G-H.Comparison of morbidity of donor site following pedicled muscle- sparing latissimus dorsi ap versus extended latissimus dorsi ap breast reconstruction. J Plast Reconstr Aesthet Surg. 2013;66(5):640–6. https://doi.
org/10.1016/j.bjps.2013.01.026.
46. Ferrari S, Ferri A, Bianchi B, Varazzani A, Perlangeli G, Sesenna E. Donor site morbidity after scapu­lar tip free aps in head-and-neck reconstruction. Microsurgery. 2015;35(6):447–50. https://doi.
org/10.1002/micr.22454.
47. Adams WP Jr, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbid­ity following latissimus dorsi muscle ap trans­fer. Ann Plast Surg. 2004;53(1):6–11. 10.1097/01. sap.0000106430.56501.b5
48. Giordano S, Kääriäinen K, Alavaikko J, Kaistila T, Kuokkanen H. Latissimus dorsi free ap har­vesting may affect the shoulder joint in long run. Scand J Surg. 2011;100(3):202–7. https://doi.
org/10.1177/145749691110000312.
49. Chang EI, Chang EI, Soto-Miranda MA, Zhang H, Nosrati N, Robb GL, Chang DW. Comprehensive analysis of donor-site morbidity in abdominally based free ap breast reconstruction. Plast Reconstr Surg. 2013;132(6):1383–91. https://doi.org/10.1097/
PRS.0b013e3182a805a3.
50. Monteiro ME.Physical therapy implications following the TRAM Procedure. Phys Ther. 1997;77(7):765–70.
https://doi.org/10.1093/ptj/77.7.765.
51. Kearns M, Ermogenous P, Myers S, Ghanem AM.Osteocutaneous aps for head and neck recon­struction: a focused evaluation of donor site mor­bidity and patient reported outcome measures in different reconstruction options. Arch Plast Surg. 2018;45(6):495–503. https://doi.org/10.5999/
aps.2017.01592.
52. Twomey R, Matthews TW, Nakoneshny SC, et al. From pathways to practice: impact of implement­ing mobilization recommendations in head and neck
cancer surgery with free ap reconstruction. Cancers (Basel). 2021;13(12):2890. https://doi.org/10.3390/
cancers13122890.
53. Deng J, Ridner SH, Dietrich MS, etal. Prevalence of secondary lymphedema in patients with head and neck cancer. J Pain Symptom Manag. 2012;43(2):244–52.
https://doi.org/10.1016/j.jpainsymman.2011.03.019.
54. Deng J, Murphy BA, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Gilbert J, Ridner SH.Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013;35(7):1026–35.
https://doi.org/10.1002/hed.23084.
55. Deng J, Ridner SH, Murphy BA, et al. Preliminary development of a lymphedema symptom assess­ment scale for patients with head and neck cancer. Support Care Cancer. 2012;20:1911–8. https://doi.
org/10.1007/s00520- 011- 1294- 6.
56. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer. 2008;112(12):2809–19.
https://doi.org/10.1002/cncr.23494. PMID: 18428212
57. Zuther JE, Norton S.Lymphedema management: the comprehensive guide for practitioners. New York: Thieme; 2018. p. 4–9; 78–79, 170, 333–345, & 361–363.
58. Purcell A, Nixon J, Fleming J, McCann A, Porceddu S. Measuring head and neck lymphedema: The “ALOHA” trial. Head Neck. 2016 Jan;38(1):79–84.
https://doi.org/10.1002/hed.23853.
59. Deng J, Ridner SH, Aulino JM, Murphy BA.Assessment and measurement of head and neck lymphedema: state-of-the-science and future direc­tions. Oral Oncol. 2015;51(5):431–7. https://doi.
org/10.1016/j.oraloncology.2015.01.005.
60. Tyker A, Franco J, Massa ST, Desai SC, Walen SG. Treatment for lymphedema following head and neck cancer therapy: a systematic review. Am J Otolaryngol. 2019;40(5):761–9. https://doi.
org/10.1016/j.amjoto.2019.05.024.
61. Smith BG, Hutcheson KA, Little LG, et al. Lymphedema outcomes in patients with head and neck cancer. Otolaryngol Head Neck Surg. 2015;152(2):284–91. https://doi.
org/10.1177/0194599814558402.
62. Shim JY, Lee HR, Lee DC.The use of elastic adhe­sive tape to promote lymphatic ow in the rabbit hind leg. Yonsei Med J. 2003;44(6):1045–52. https://doi.
org/10.3349/ymj.2003.44.6.1045.
63. Gutiérrez C, Mayrovitz HN, Naqvi SHS, Karni RJ. Longitudinal effects of a novel advanced pneu­matic compression device on patient-reported out­comes in the management of cancer-related head and neck lymphedema: A preliminary report. Head Neck. 2020;42(8):1791–9. https://doi.org/10.1002/
hed.26110.
64. Suarez EM, Knackstedt RJ, Jenrette JM.Signicant brosis after radiation therapy in a patient with
Соседние файлы в папке @xirurgi_2025
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности