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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Pedicled Forehead Flap for Reconstruction of Cheek Defect: A Novel Surgical Case Report
Correspondence Address :
Dr. Senthil Kumar,
House No: 3, First Floor, Rajive Gandhi Nagar, South Mada Street Extention, Villivakkam, Chennai-600049, Tamil Nadu, India.
E-mail: drsenthilkumaromfs@gmail.com
Oral cancers are considered slow killer disease. Every year 3,00,000 cases are diagnosed worldwide. Public awareness has been a great challenge to educate people to avoid harmful oral habits to prevent oral cancer. People are not aware about life threatening complications such as death due to oral cancer. Oral cancer is the eighth most common malignancy in India and third most common malignancy in South East Asia. Buccal mucosa carcinoma spreads rapidly and invades deeply to underlying tissues and has high recurrence rate. Surgical resection is more challenging if the tumour invade adjacent anatomical structures and reconstruction should be planned according to extent of tumour resection. Regional flaps are used for oral cavity after tumour resection such as radial forearm flap, deltopectoral flap, pectoralis major flap, latissimus dorsi flap, transverse rectus abdominis myocutaneous flap, trapezius flap. In this case report of a 46-year-old female, folded forehead pedicle flap was used to provide both inner and outer linings of the cheek defect following buccal mucosa tumour resection.
Buccal mucosa carcinoma, Excision, Lip reconstruction, Transpositional flap
A 46-year-old female reported to the hospital at Chennai with the chief complaint of an ulcer in the left corner of the mouth for past one month (Table/Fig 1). History revealed she was a pan chewer for four years. No other relevant past medical, dental history was reported. On clinical examination, there was an ulcerative proliferative growth in left buccal mucosa not involving buccal sulcus of maxillary and mandibular vestibular region. On palpation the ulcer was measuring 4×2 cm in diameter extended anteriorly left commissure of the mouth and skin of the cheek was also involved (Table/Fig 2). There was no clinical lymph nodes enlargement in submental, submandibular, cervical regions. Clinical staging was stage 2 [T2 N0 M0]. Radiographic investigations were done to see extent of the tumour and local metastasis to adjacent vital structures and cervical lymph nodes status were assessed.
Incisional biopsy was performed and report suggested well differentiated Squamous Cell Carcinoma (SCC) of left buccal mucosa.
Surgery was planned first and it was decided to do wide local excision followed by selective neck dissection up to I-III lymph nodes level and followed by chemo-radiotherapy.
Surgical Procedure
Under nasoendotracheal intubation the patient was painted and draped. Low level apron incision for modified radical neck dissection type 3 was marked at left lateral side of the neck (Table/Fig 3).
Neck dissection was completed to preserve the Sternocleidomastoid Muscle (SCM), Internal Jugular Vein (IJV), Spinal Accessory Nerve (SAN), and level 1, 2, 3, 4 fibro fatty tissue removed along the IJV (Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9),(Table/Fig 10),(Table/Fig 11) Forehead pedicled flap was harvested and delicately mobilised. Skin incision was marked for forehead pedicle flap (Table/Fig 12). The periosteum of the forehead was intact on the frontalbone (Table/Fig 13).
The forehead pedicled flap was mobilised without periosteum medial to zygomatic arch towards left cheek side under the skin, subcutaneous layer of left cheek, so that skin of the pedicle forehead flap reconstructed the left buccal mucosa (Table/Fig 14),(Table/Fig 15). End of the forehead flap was folded and reconstructed the left commissure of the mouth (Table/Fig 15),(Table/Fig 16).
Split skin graft was taken from the right thigh anterior skin surface and used to cover the exposed raw surface on the forehead region on the periosteum of the frontal bone. Raw surface on the thigh region was covered with chlorhexidine mesh dressing (Table/Fig 17). Split Skin Graft (SSG) was sutured to skin of the forehead with 3-0 vicryl (Table/Fig 18). Excisional biopsy reported moderately differentiated SCC with no lymphovacular invasion, perineural invasion (Table/Fig 19),(Table/Fig 20).
Patient was followed-up to three years (Table/Fig 21). Postoperative period of three years showed satisfactory wound healing with acceptable esthetic appearance of the left corner of the mouth (Table/Fig 22),(Table/Fig 23).
Oral carcinoma is the most common in head and neck carcinomas. Oral cancer surgery followed by reconstruction has always been a challenge for the treating surgeons with selection of pedicle local or regional flap. Different types of pedicle flaps and microvascular free flaps have been used for reconstruction of full thickness cheek defects (through-and-through defect) such as pedicled folded forehead flap, double faced pectoralis major flap, folded trapezius island myocutaneous flap, folded submental island flap, double continuous radial forearm flap, and chimeric anterolateral thigh flap (1). We cannot select free flaps due to high technique sensitivity, time consuming, long period of postoperative care and also esthetic problems such as bulkiness, colour, texture mismatch in contrast loco regional flaps have reduced susceptibility to infection, thrombosis (2). So, locoregional pedicle forehead flap was easier to harvest and transfer. Reconstruction of Pectoralis Major Myocutaneous Flap (PMMC) in female patients has been reported with adeno carcinoma developed from the breast tissue (1). In this case report, the patient was a young female patient who needed aesthetic and functional rehabilitation, hence it forehead pedicle flap was choden as mode of treatment.
The size of the buccal mucosa tumour and defect caused by surgery determine reconstructive options for a particular patient. Small lesions up to 2 cm closed primarily. Very superficial lesions can be skin grafted or left to heal by secondary intention. Larger defects such as buccal mucosa defect from upper to lower gingivobuccal sulcus with or without alveolectomy needs regional flap like pedicle forehead flap (3). Forehead is the site where anastomosis of supra orbital, supra trochlear arteries at lateral orbital rim and one side the Frontal Branch of Superior Temporal Artery (FBSTA) enters 75% of the cases at middle and inferior thirds of the forehead (4). The forehead is a reliable option because of its dependability and anatomic similarities with the nose and other facial parts, so it was used for reconstruction and also given its ideal colour and texture where other regional local flaps and free grafts would have been inadequate (5). So, pedicle forehead flap was selected as treatment option for her. The main function of the oral cavity is mastication, speech, deglutition, salivary secretion, so the goal of reconstruction after oral cancer ablative surgery is to restore functions (6). Full thickness cheek defects (through-and-through) involved both oral lining and external facial skin had been planned in this case report
and selected pedicle flap for particular clinical situation.
The superficial temporal arteries, supratrochlear arteries and the supraorbital arteries were three main vessels supply forehead (7).
Chummuna S et al., reviewed 501 cases undergoing Radical Neck Dissection (RND) for SCC of oral cavity and observed 78% of most metastasis were contained to level I-III with only 20% of the patients having metastasis to level IV and 2% spreads to level -V and never occurred in the absence of palpable metastasis in other levels of neck (8). Based on this study, it was decided to perform modified neck dissection from level I-III including the primary tumour excision with 1 cm margin and sent to histopathological examination. The excisional biopsy report confirmed moderately differentiated squamous cell carcinoma of left buccal mucosa and revealed all the cervical lymph nodes from level I-III free of tumour.
Latissimus Dorsi Flap (LDF) may appear less aesthetic because of its large volume, so it was decided not to select LDF in the present case (9). Different pedicle flaps used for through and through surgical defect caused by resection of oral cavity has been proposed such as radial forearm free flap, deltopectal, pectoralis major, latissimus dorsi free, transverse rectus abdominis myocutaneous and trapezius myocutaneous flaps, sub mental flap, platysmal flap (9).
The PMMC was not performed as breast deforming effects can occur in adolescent female patients because of PMMC flap harvest (10).
Blood supply and venous drainage of a Platysmal Flap (PF). PF are uncertain, which may lead to partial or total necrosis and submandibular lymph nodes metastasis may preclude the use of PF, and if positive lymph nodes are suspected before, or are identified during surgery, a PF is not recommended. Therefore, it was not selected as the treatment of choice in this case (10).
Radial Free Forearm Flap (RFFF) is a popular pedicle flap for soft tissue defects described by Fang QG et al., in 1981. It needs more surgeon experience and more technical sensitivity and more costly (10). Delto Pectoral flap (DP) has a limited role due to the introduction of other regional or distant tissue transfer flaps, so not the best choice for flap facial, oral and pharyngeal reconstruction (11). A unique feature of the rectus abdominis flap is that a substantial amount of muscle and skin can be harvested and more bulk needed (11). In the present case, we needed less bulk of soft tissues required to reconstruct left corner of mouth and less width needed for lip reconstruction so it was not selected as the treatment of choice.
Submental flap can have some disadvantages when used for intraoral reconstruction including the thickness of the flap, hair-bearing nature of the region in male patients, marginal mandibular nerve paresis, and increased regional lymph nodes metastasis (11). So, it was not selected for reconstruction in the present case.
To perform a trapizeus flap, the patient should be placed in lateral decubitus position for flap harvest, which is a major disadvantage during reconstruction (11). The ideal candidate for a forehead flap is bald and there can sometimes be problems of recipient site hair growth. Depilation can be performed for management of intra oral hairs, however, in some cases there still may be undesirable hair growth (12).
In recent practice locoregional flap is playing major role where micro vascular free tissue transfer is not possible. Pedicled forehead flap is easy to harvest, does not require patient repositioning and provides excellent skin colour match around the mouth. In conclusion, pedicled forehead flap remains a reliable option in reconstruction of cheek defects following wide local excision of buccal mucosa carcinoma in female patient.
DOI: 10.7860/JCDR/2022/50171.16796
Date of Submission: May 04, 2021
Date of Peer Review: Aug 12, 2021
Date of Acceptance: Jul 30, 2022
Date of Publishing: Aug 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 03, 2021
• Manual Googling: Jun 23, 2022
• iThenticate Software: Jul 12, 2022 (14%)
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