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**Laryngology** 

**7** 

 *Singapore* 

**Investigation of Experimental Wound** 

C.B. Chng1, D.P.C. Lau2, J.Q. Choo1 and C.K. Chui1

*1Department of Mechanical Engineering,* 

*National University of Singapore 2Department of Otolaryngology, Singapore General Hospital* 

**Closure Techniques in Voice Microsurgery** 

Microsurgery on human vocal folds typically involves the removal of benign lesions, often results in the creation of wounds in the form of epithelial micro-flaps (Benninger, Alessi et al. 1996). Conventionally, these micro-flaps are left to epithelialize without formal closure, which can result in healing by secondary intention and increased scar tissue formation (Woo 1995; Thekdi and Rosen 2002). Scar tissue in the lamina propria of the vocal fold affects its visco-elastic and vibrational properties (Bless and Welham 2010), disrupting the mucosal wave and often manifesting as hoarseness and a reduction in the phonatory capabilities of the patient (Thibeault, Gray et al. 2002). Since the precision of epithelial approximation accomplished during the surgical procedure and retained during the healing process affects the amount of scar tissue formation (Woo 1995), wound closure is of particular interest in

Extensive work has focused on improving wound closure methods to minimize scar tissue formation, ranging from micro-suturing which allows for primary healing (Woo 1995; Tsuji, Nita et al. 2009), to the use of tissue adhesives like fibrin glue (Bleach, Milford et al. 1997; Flock 2005; Kitahara, Masuda et al. 2005; Finck, Harmegnies et al. 2010; Skodacek, Arnold et al. 2011), and the use of chemical agents (Campagnolo, Tsuji et al. 2010) like Mitomycin-C (Branski, Verdolini et al. 2006; Fonseca, Malafaia et al. 2010) or stem cells (Hong, Lee et al.) to enhance the healing process of vocal fold wounds. However, various challenges faced in the execution of voice microsurgery add to the complexity of wound closure. These include limitations in instrument movement imposed by the laryngoscope, reduced tactile feedback in surgical instruments and loss of stereopsis. These are just some of the common challenges that can add to the intricacy of the closure of a simple wound, resulting in an increase in

With this in mind, experimental evaluations of proposed microsurgical techniques are a necessary step in their development and optimization. Due to the rarity of human specimens for experimentation, different animal and synthetic models have been utilized instead. In this chapter, we discuss various vocal fold wound closure techniques as well as

operation duration and associated risks under general anesthesia.

the models and methods used to evaluate them experimentally.

**1. Introduction** 

voice microsurgery.
