Dr. Subramania Iyer K. currently serves as Professor & Head at the Department of Head & Neck Surgery, School of Medicine, Kochi.

Qualification : MS (Otorhinolaryngology), MCh (Plastic Surgery), FRCS


Publication Type: Journal Article
Year of Publication Publication Type Title
2016 Journal Article S. Iyer, Thankappan, K., and Balasubramanian, D., “Early detection of oral cancers: Current status and future prospects”, Current Opinion in Otolaryngology and Head and Neck Surgery, vol. 24, pp. 110-114, 2016.[Abstract]

Purpose of review: This article reviews the current literature and summarizes the latest developments in screening and early detection of oral cancers and looks at the future possibilities. Recent findings: Oral cancer is the best model for screening and prevention. The screening for oral cancer can be population based, opportunistic, or targeted. A long-term 15-year follow-up data of a randomized controlled study from a developing country setting indicated a sustained reduction in oral cancer mortality in high-risk individuals. Visual oral examination remains the mainstay in the screening. Several adjunctive techniques have been described to aid in the clinical examination of these lesions. A Cochrane review revealed that there is no evidence to recommend these adjuncts in clinically visible lesions. Salivary biomarkers seem to be promising as a tool for screening in the future. A Targeted Evidence Update for the US Preventive Services Task Force found no evidence on screening either in the general or selected high-risk population for oral cancer in the United States or on benefit of any adjunctive device affecting the performance of the screening examination. Summary: Current evidence shows that community based screening has a value in reducing the oral cancer mortality in high-risk group of population. But this evidence may not be universally applicable. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

More »»
2013 Journal Article M. Sharma, Balasubramanian, D., Thankappan, K., Sampathirao, C. L., Mathew, J., Chavre, S., and Iyer, S., “Propeller flaps in the closure of free fibula flap donor site skin defects”, Annals of Plastic Surgery, vol. 71, pp. 76-79, 2013.[Abstract]

The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects. Copyright © 2013 by Lippincott Williams & Wilkins.

More »»
2013 Journal Article D. Balasubramanian, Thankappan, K., Shetty, S., Jayaprasad, K., Mathew, J., and Iyer, S., “Cricotracheal reconstruction with free radial forearm flap and titanium mesh”, Head and Neck, vol. 35, pp. E178-E180, 2013.[Abstract]

Background Reconstruction after partial cricotracheal resection is technically demanding and is seldom reported in literature. The purpose of this study was to report a technique of reconstruction of such a defect with a radial forearm flap supported by a titanium mesh. Methods A 75-year-old man who was diagnosed with a case of papillary carcinoma thyroid, underwent excision of the tumor with a partial cricotracheal resection. The defect was reconstructed with a free radial forearm flap with fascia suspended on a titanium mesh. Results At a follow-up of 6 months after treatment, the patient has normal nasal breathing and an acceptable voice. Conclusion This reconstructive technique enabled us to maintain the integrity of the subglottic airway. Our technique was unique in that we used the skin-lined part of the radial forearm flap to line the airway and the fascia to cover the titanium mesh outside, thereby preventing plate exposure. © 2012 Wiley Periodicals, Inc.

More »»
2013 Journal Article D. Balasubramanian, Iyer, S., and Thankappan, K., “Tracheoesophageal puncture site closure with single perforator-based deltopectoral flap”, Head and Neck, vol. 35, pp. E60-E63, 2013.[Abstract]

Background Tracheoesophageal puncture (TEP) combined with a voice prosthesis is commonly used for voice production in postlaryngectomy patients. In certain cases, however, leakage occurs around the prosthesis. Many techniques have been described to correct this problem. Surgical closure of the puncture site has to be done if the conservative techniques fail. We present the use of the pedicled deltopectoral flap on the basis of a single perforator in the closure of these fistulae. Methods The reported technique was used in 6 patients over a period 8 years from 2004 to 2011. Results The technique was successful in 5 patients. In 1 case there was dehiscence at the leading edge of the flap because of severe local wound infection. Conclusion The novel technique described by us avoids the need for layered closure or dissection of the trachea and esophagus. It is simple and reliable and provides durable results. © 2011 Wiley Periodicals, Inc.

More »»
2012 Journal Article S. Iyer, Chatni, S., and Kuriakose, M. A., “Free tensor Fascia Lata-Iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect”, Annals of Plastic Surgery, vol. 68, pp. 52-57, 2012.[Abstract]

Reconstruction of maxillectomy with extensive orbital rim and floor excision defects is a challenging problem. The goal of reconstruction here is to provide adequate orbital support to prevent enophthalmos and diplopia as well as obturation of the palatal defect. The existing methods of the reconstruction fail to simultaneously address these 2 goals of reconstruction. A new method of reconstruction of these defects using tensor fascia lata-iliac crest flap was used in 7 cases of cancers of the maxilla, which necessitated extensive resection of the orbital floor along with the maxillectomy. The flap was raised as a muscle and bone flap in 5 cases and in 2, a skin paddle was included. The immediate and delayed outcome at 6-month follow-up was analyzed. The functional outcome with regards to the ocular position and function, palatal obturation, speech, and swallowing were recorded. The bone viability at 6 months was assessed by computed tomography scan. The flap was successful in all the 7 cases. The delayed outcome assessment showed that the orbital support was excellent with no diplopia in all the cases. The palatal defect could be covered successfully in all the cases, resulting in normal speech and swallowing. The computed tomography scan showed excellent integration of the bone. The free tensor fascia lata-iliac crest flap is a reliable and safe method of reconstruction of the orbitomaxillary defects, addressing the issues of both orbital support and palatal obturation. © 2012 by Lippincott Williams & Wilkins.

More »»
2011 Journal Article B. Murali, Vijayaraghavan, S., Kishore, P., Iyer, S., Jimmy, M., Sharma, M., Paul, G., and Chavare, S., “Cross-chest liposuction in gynaecomastia”, Indian Journal of Plastic Surgery, vol. 44, pp. 81-86, 2011.[Abstract]

Background: Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Objective: Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. Materials and Methods: The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. Results: This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts), belonging to Simon′s Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Conclusions : Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar. More »»
2010 Journal Article S. Iyer and Kuriakose, M., “Tensor Facia Lata-iliac crest osteocutaneous flap for orbitomaxillary reconstruction: A preliminary report”, Indian Journal of Plastic Surgery, vol. 43, pp. 8-13, 2010.[Abstract]

Tensor Fascia Lata muscle and musculocutaneous flap has been used in the past for reconstruction of trunk defects and also as a free flap for soft tissue reconstruction elsewhere in the body. Transferring the iliac crest along with the muscle as a free flap has been described earlier, reported for bridging calcaneal defect and small mandibular defects. The use of this flap as a source of free vascularised bone has not been widely practised since these initial few reports. Anatomical studies were carried out to assess the feasibility of using this flap for reconstructing maxillary and other head and neck defects, following which it was successfully used for these indications. The preliminary report describes the flap anatomy, method of harvest and its potential uses in head and neck reconstruction. More »»
2008 Journal Article N. P. Trivedi, Swaminathan, D. K., Thankappan, K., Chatni, S., Kuriakose, M. A., and Iyer, S., “Comparison of quality of life in advanced laryngeal cancer patients after concurrent chemoradiotherapy vs total laryngectomy”, Otolaryngology - Head and Neck Surgery, vol. 139, pp. 702-707, 2008.[Abstract]

Objective: To compare quality of life (QOL) of patients with advanced laryngeal cancers treated by total laryngectomy with those who received concurrent chemoradiotherapy. Study Design: This is a cross-sectional study of the patients treated in our institution who have completed one year of follow-up and were disease-free at the time of evaluation. Subjects and Method: Forty patients treated for advanced cancer of the larynx (stage III/IV), either by concurrent chemoradiation (11) or total laryngectomy and postoperative radiation (29), have been included in this study. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4 questionnaire was used. Results: Total scores for overall QOL are equal in both treatment groups (P = 0.69). Scores for individual components are similar in both treatment groups. However, dryness of mouth is significantly worse in the chemoradiotherapy group (P = 0.01) and ability to communicate with others is poorer in the laryngectomy group (P = 0.03). Conclusion: Long-term overall QOL remains similar in all the patients treated for advanced carcinoma of the larynx irrespective of treatment modality. © 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. More »»
Faculty Details


Faculty Email: