Objective: In endoscope-assisted surgery for varicose veins, the anatomical relationship of the s... more Objective: In endoscope-assisted surgery for varicose veins, the anatomical relationship of the saphenous nerve to great saphenous varicosity in the leg was studied in an Asian population. Methods: Primary varicose veins were managed using endoscope-assisted surgery. Results: Between January 2007 and November 2015, 860 legs with primary varicose veins of the great saphenous vein (GSV) were managed. The saphenous nerve was encountered in the operative field in 82 legs (9.5%). The anatomical relationship of the nerve to the main trunk, tributaries, and incompetent perforating veins of great saphenous varicose vessels was evaluated and classified into 4 types, I, II, III, and IV, with incidences of 0.9%, 6.9%, 0.6%, and 1.2%, respectively. The incidences of the presence of this nerve in the upper, middle and lower thirds of the leg were 0.7%, 4.3% and 4.5%, respectively. Conclusion: This study revealed the relative location and incidence of the saphenous nerve among the GS varicose vessels and the possible risk of nerve injury in the management of varicose veins of the GSV.
Background:It's rare to see major infection of sternal wound after median sternotomy in cardi... more Background:It's rare to see major infection of sternal wound after median sternotomy in cardiac surgery which yet may seriously affect the post-operation course including the morbidity, hospital stay, cost, and mortality. Various management strategies have been reported for the sternal wound care including debridement plus rewiring, open wound care, continuous irrigation, Redon tube closed irrigation, open packing then delayed closure, topical negative pressure dressing, and flaps reconstruction. All recent studies share one common principle, that is, adequate debridement of the infected tissue and covering of the defect with well-vascularized tissue.Aim and Objectives:Here we present our treatment strategy for the deep sternal wound infection (DSWI) involving the sternal bone or mediastinal space at Kaohsiung Medical University Hospital in the past ten years.Materials and Methods:From September 2001 to September 2011, 1732 sternotomies were performed at Kaohsiung Medical University Hospital. We identified 41 patients who had suffered from deep sternal wound infection and were referred to plastic department for further treatment.Result:Total 41 patients adopted the surgical reconstruction in our hospital. All patients accepted the extensive debridement and topical negative pressure therapy first. Eight (19.50/0) of them received delay closure. Twenty-one (51.2%) patients with the defect limited to the upper and middle third of the sternum received the pectoralis major muscle (PM) advance flap reconstruction. Seven (17.1%) patients with the defect limited to the lower third of sternum received the rectus abdominis musde (RAM) flap (3), PM turnover flap (2), and PM plus RAM bi-pedicle flap (2) reconstruction. The rest five (12.2%) patients with the defect, involving whole sternum, received the PM plus RAM bi-pedicle flap (3) and Omentum flap (2) reconstruction.One patient got partial wound dehiscence post PM plus RAM bi-pedicle flap due to Mycobacterium tuberculosis infection. The dehiscent lesion got stable and healed after systemic and local anti-tuberculous treatment. Among all the 41 patients, four patients expired during their hospital stay. Three of them who had received the debridement, topical negative pressure dressing, and delay wound closure died of heart failure, and one case with PM advance flap died of sepsis, mediastinitis related.Conclusion:Adequate debridement, local infection control, and wound repair with well vascularized tissue are the keys to successful reconstruction. We prefer to use the PM flap to treat the DSWI. The PM flap is versatile, and 68.3% of the patient with DSWI in KMU hospital were treated with PM based flap including PM advance or turnover flap and PM plus RAM flap. However, the flap design should depend on the patient's status individually.
Background:Bone marrow biopsy (BMB) is the method for assessment of overall bone marrow cellulari... more Background:Bone marrow biopsy (BMB) is the method for assessment of overall bone marrow cellularity. It is also used to screen for unidentified hematological diseases, different storage and infiltrative disorders. The reported complication rate of iliac crest BMB was only about 0.05%.Objectives:We reported the rare complication of pseudoaneurysm formation after iliac crest BMB. The complication was successfully treated by combining endovascular embolization with an endoscope-assisted technique for hematoma removal. We also reviewed the related literature.Patient and Method:A 62-year-old man complained of the formation of a large and tender mass over the right gluteal area after BMB. The mass had persisted even after 4-month conservative treatment. Enhanced computed tomography (CT) scan revealed contrast extravasation within the lesion. Pseudoaneurysm was highly suspected. Selective endovascular coil embolization was performed following endoscope-assisted removal of the residual hematoma.Result:The radiologist successfully embolized the pseudoaneurysm. On the next day, the surgeon evacuated the hematoma and clamped the surrounding vessels on the gluteal maximus muscle via a single small incision. No postoperative sequelae were noted. The patient was highly satisfied with the result.Conclusion:In conclusion, pseudoaneurysm formation after BMB is a rare complication which can be successfully treated with combination of selective endovascular coil embolization and endoscope-assisted hematoma removal. Clamping the surrounding vessels which were embedded in the muscle may prevent the recurrence of hematoma. Endoscopicassisted removal of the hematoma was effective in this case and may reduce the risk of gluteal muscle destruction. (J Taiwan Soc of Plast Surg 2011; 20: 316∼323)
Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is ... more Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is often caused by a variety of diseases, such as atherosclerosis, connective tissue disease, trauma and Raynaud's disease. Patients with this problem usually suffer from poor tissue perfusion and impaired microcirculation. In clinical, ischemic digits often present with pain, cold intolerance, ulceration and even gangrene change. Many strategies are proposed today to overcome this disease. Behavioral therapies, such as avoidance of cold exposure and smoking are a very important intervention. Pharmacologic therapies, like the administration of calcium channel blocker, PGE1 and other vasodilators have been the most commonly used agents. Sympatholytic drugs have also been added to reduce the sympathetic tone in vascular smooth muscles. In addition, anticoagulants or antiplatelet agents are administered to inhibit thrombus formation in occlusive vascular disease. Although these agents are usually effective, unfortunately, in refractory cases, amputation is unavoidable. Those patients have to suffer the fate of partial or total loss of the digits. This ultimate outcome frequently comes with high morbidity and dysfunctions both in physical and psychological terms. In those cases which are refractory to medical therapy, surgical intervention had been carried out to improve tissue perfusion. Tissue perfusion depends on the integrity of the vasculature and the neurovascular regulatory elements. Historically, microsurgical revascularization and sympathectomy were widely performed to recover adequate blood flow. Microvascular reconstruction with interposition vein grafting can be used to reestablish the vascular structure. However, not all cases with digital ischemia are suitable for this procedure due to the possible occurrence of multifocal stenosis. Sympathectomy can reduce sympathetic tone and thus increase the radius of blood vessel. According to Poiseuille's law, blood flow is directly proportional to the fourth power of the vessel's radius. So even a small increase of radius of blood vessel can lead to a very great increase in blood flow. According to Pick and Flatt, sympathetic fibers travel along the epineurium of peripheral nerve, pass to the adventitia, and innervate the smooth muscle of vessels. The removal of adventitia can block the sympathetic tone in the smooth muscle. This procedure may also increase the radius of vessel and reestablish adequate blood flow.
Background: Sternal osteomyelitis is a potentially life-threatening complication after cardiac su... more Background: Sternal osteomyelitis is a potentially life-threatening complication after cardiac surgery. The infection can spread into the mediastinum, involving the prosthetic valve, grafts, and suture lines. It may be the cause of postoperative morbidity and mortality. Aim and Objectives: Topical negative pressure (TNP) dressing, muscle flap and hyperbaric oxygen therapy (HBO) have been proved to be effective for sternal wound healing. We want to take advantages of these methods to improve the results of intractable sternal wound infection. Materials and methods: From January 2005 to January 2008, 12 patients with sternal wound infection were treated at Kaohsiung Medical University Chung-Ho Memorial Hospital. All wounds received extensive debridement, irrigation, and TNP dressing. Seven patients received pectoralis major (PM) muscle flap coverage. Three patients accepted rectus abdominis myocutaneous (RAM) flaps coverage. Four patients received HBO therapy. Results: These patients received 1-3 times debridement before flap reconstruction or wound healed. Two patients did not receive any muscle flap for reconstruction after HBO management. After management, the infections were controlled and the wounds healed. There was no recurrence of sternal osteomyelitis during the follow-up periods. Conclusions: (1) The TNP dressing can apply several advantages to make the wound bed suitable for reconstruction. (2) According to the anatomic site of wound, we can choose proper muscle flap for sternal wall reconstruction. (3) The HBO therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.
Background: This study of stage III (locally advanced) breast cancer patients evaluated the survi... more Background: This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) f lap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone. Methods: This retrospective study analyzed data for all women who had received TRAM immediately after unilateral modified radical mastectomy for locally advanced breast cancer at a single institution from January 2002 to December 2009. The analysis included 192 patients divided into 2 groups: patients who had received MRM immediately followed by TRAM f lap reconstruction (MRM-TRAM group, n = 52) and patients who had received MRM alone (MRM group, n = 140). Data collection included demographic characteristics, underlying comorbidities, and cancer characteristics. Postoperative adjuvant therapies, oncologic outcomes, and survival were compared between the 2 groups. Kaplan-Meier plots, univariate log-rank test, multivariate Cox proportional hazards regression models, and t-test were used to evaluate potential predictors of cancer recurrence and patient survival. Results: In comparison with the MRM group, significant differences in the MRM-TRAM group included a younger mean age, a better overall health status, and a higher education level (all P G 0.001). Severity of breast cancer disease did not significantly differ in terms of cancer characteristics. Additionally, there were no significant differences in local recurrence (P = 0.326) and distant metastasis (P = 0.338). Immediate breast reconstruction was not associated with delays in detection of local recurrence and initiation of adjuvant therapies The 5-year breast cancer-specific survival rate was significantly higher in the MRM-TRAM group (84.6%) compared with the MRM group (61.2%) (P = 0.003). Multivariate analysis showed that TRAM f lap reconstruction is an independent predictor of survival in breast cancer patients. The MRM-TRAM group had a significantly lower hazard of death (HR, 0.235; 95% CI, 0.070Y 0.788; P = 0.019) compared with the MRM group. Conclusions: Immediate TRAM f lap reconstruction is oncologically safe and is unassociated with delayed adjuvant therapies or delayed detection of local recurrence. Patients with locally advanced breast cancer can be considered appropriate candidates for TRAM f lap reconstruction because the procedure is an independent predictor of breast cancer survival and is associated with a 76.5% decrease (HR, 0.235) in the risk of cancer death.
Background: Levator function is usually graded as good (＞8 mm), fair (5-7 mm) and poor (1-4 mm), ... more Background: Levator function is usually graded as good (＞8 mm), fair (5-7 mm) and poor (1-4 mm), which are generally associated with mild, moderate, and severe blepharoptosis, respectively. To date, no large study has evaluated the relationship between levator function and blepharoptosis severity in oriental eyelids. Aim and Objectives: The aim is to analyze the relationship between levator function and severity of blepharoptosis by means of a large retrospective study. Materials and Methods: We reviewed patients who were examined for blepharoptosis in our hospital between April 2004 and April 2014 by using detailed medical records of age, sex, time of onset, severity, and levator function. 323 patients with total eyelid number of 519 were studied. We divided levator function into four grades: excellent (＞12mm), good (8-12mm), fair (5-7 mm), and poor (＜5 mm). All the eyelids were divided into congenital and acquired groups. Within these two groups, we calculated the percentages of excellent, good, fair, and poor levator function in the mild, moderate, and severe blepharoptosis subgroups. In addition, we evaluated the percentage of mild, moderate, and severe blepharoptosis in the excellent, good, fair, and poor levator function subgroups. Results: The number of eyelids in the male and female groups was 189 (36.4%) and 330 (63.6%), respectively. Congenital and acquired blepharoptosis were observed in 413 (79.6%) and 106 (20.4%) eyelids, respectively. Most eyelids with mild or moderate blepharoptosis exhibited good or excellent levator function. However, good or excellent levator function was not completely associated with mild blepharoptosis. In addition, most eyelids with poor levator function had severe blepharoptosis. However, severe blepharoptosis was not completely associated with poor levator function. Conclusion: Acquired blepharoptosis can be caused by various factors other than levator muscle dysfunction. Congenital blepharoptosis generally causes worse levator function than acquired blepharoptosis. Most eyelids with mild or moderate blepharoptosis had good or excellent levator function. However, good or excellent levator function was not completely associated with mild blepharoptosis. Poor levator function eyelids generally lead to severe blepharoptosis, but severe blepharoptosis was not completely associated with poor levator function. This association may be related to the two-layer extensions of the levator palpabrae muscle, which makes the relative preservation of levator function possible in aponeurotic and mechanical blepharoptosis.
Background:Axillary osmidrosis is an embarrassing condition that causes disturbing social problem... more Background:Axillary osmidrosis is an embarrassing condition that causes disturbing social problems, especially in Asian societies. However, topical treatment could only provide temporary improvement. Permanent solutions required surgical intervention. The conventional operation has some disadvantages, such as large wounds, conspicuous scars and long recovery time. The ideal operation should comprehend permanent effect, an outpatient surgery with local anesthesia, short operation time, rapid recovery, minimized complications and inconspicuous scar. The use of suction-assisted cartilage shaver accomplishes all these needs and is already a prevalent treatment of axillary osmidrosis. However, small wound complications still occur postoperatively.Aim and Objectives:We modified the procedure in dissecting the axillary area in order to diminish such complications mentioned.Materials and Methods:From July 2003 to August 2011, 76 patients with axillary osmidrosis (57 females and 19 males) were treated under suction-assisted cartilage shaver with modified procedure. We tunneled the subcutaneous layer above the deep fascia and kept several septa attaching to the skin without completely dissecting the subcutaneous layer. Finally, the complete removal of the apocrine gland was checked by endoscope.Results:All patients were followed up but only 55 patients completed the questionnaire. Patients were followed 2~67 months with an average of 27 months. The satisfaction of malodor improvement was scored from 1~5 (5 indicates very satisfied and 1 indicates disappointed). No odor: 30.9%, almost complete odor elimination: 41.8%, partial odor elimination: 16.4%).One (1.8%) revealed hematoma over right axilla.Conclusion:The modified design of preserving septa without full dissection and endoscopy viewing were used in order to diminish the complications and complete eradication of the apocrine glands.
Background: Upper eyelid retraction may occur as a condition of hyperthyroidism, previous surgery... more Background: Upper eyelid retraction may occur as a condition of hyperthyroidism, previous surgery, or trauma. It is usually associated with dry eye syndrome, corneal compromise, and unsatisfactory cosmetic appearance. We used the autologous deep temporal fascia as an upper eyelid spacer graft to treat the eyelid retraction. Materials and Methods: Records of 11 patients (15 lids) treated by a single surgeon were reviewed retrospectively from 2008 to 2012. All eyelid retractions ranged from 1 to 3 mm above its ideal position and were corrected with the technique of deep temporal fascia spacer grafting. Preoperative etiologies, characteristics and postoperative outcomes were analyzed. Results: Of the 11 patients (15 lids), 8 patients were observed as acceptable results, and 3 were observed as unfavorable postoperative results (2 lids overcorrection and 1 lid undercorrection). Two of the three unsatisfactory cases were corrected through early revision surgery. Lid margin contour showed improvement after the revision. No other complications were observed. Graft resorption, extrusion, and infection did not occur. The overall asymmetry rate was 27% (3/11). The total revision rate was 13 % (2/15). Conclusion: Correction of upper eyelid retractions with autologous deep temporal fascia grafts is efficient and safe. This technique is a simple and reproducible method for the repair of upper lid retraction.
Sacral pressure sores are frequently seen in long term bedridden or spinal cord injury patients. ... more Sacral pressure sores are frequently seen in long term bedridden or spinal cord injury patients. Gluteus maximus muscle flaps, with numerous modifications, have been the first choice in treating sacral wounds. We have used the gluteus maximus muscle based on the inferior gluteal artery as turnover flaps for covering recurrent sacral pressure sores in two cases. The flap design tangentially splits the lower one-half of the gluteus maximus muscle, rather than using the superficial portion or the entire muscle, as in conventional turnover methods. The bulk and length of these flaps are sufficient to easily fill defects and act as excellent cushions in selected patients.
Twenty patients suffering from HF dermal burns in Kaohsiung Medical University Hospital from Janu... more Twenty patients suffering from HF dermal burns in Kaohsiung Medical University Hospital from January 1997 to December 2004 were investigated in order to further identify the efficiency of continuous intra-arterial calcium gluconate infusion. The infusion dose of calcium gluconate, the set-up of this technique, the necessity of adjuvant procedure such as nail removal or de-roofing of bullae, and the decrease of the technique-related complications are also discussed. A total of 51 fingers in twenty patients were all salvaged without major complications. Furthermore cosmetic appearance and hand function were maintained. In conclusion, the feasibility of applying this technique in any concentration of HF injury can be considered and advocated universally in order to salvage more digits from HF dermal burns.
When encounter ammonia inhalation injuries we often focus on oropharynx or tracheal mucosa lesion... more When encounter ammonia inhalation injuries we often focus on oropharynx or tracheal mucosa lesion and lung parenchyma injury, and neglect of other systemic injuries. In our study, we found that the abnormal liver function tests proceed until post injury day 8. It might be an useful study to determine if the liver function tests could be an indicator of the severity of injury and prognostic factor. Besides, the initial serum ammonia level may be a meaningful indicator of severity of injury even it could be fade to normal in 4-5 hours. Reviewing the literatures we finding that close follow up of liver function tests in ammonia injury is necessary.
Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasin... more Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasing glomerular filtration rate. The incidence of ARF in burns patients varies widely between 0.5 and 30 per cent depending on patient's age and severity of injury. Many studies have reported a high mortality rate from 73% to 100%. Peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy (CRRT) are methods to treat ARF. In general, continuous renal replacement therapy is used for patients in whom intermittent hemodialysis fails to control hypovolemia, and for those who do not tolerate intermittent hemodialysis and in whom peritoneal dialysis is not suitable owing to burnt abdominal area. Three burn patients received continuous renal replacement therapy-CVVH (continuous venovenous hemofiltration)-in our burn unit from 2001 to 2004. All of these patients were male with a mean age of 61 year (41~80) and a mean burned surface area of 47% (30~71). Two patients recovered from the course of acute renal failure: one patient expired due to acute myocardial infarction during hospitalization, the other patient survived. We analysis the usage of continuous renal replacement therapy for burned patient with ARF and discuss its indication, contraindication, advantages, disadvantages and complications.
Background: Based on data from the Surveillance, Epidemiology, and End Results database, recent s... more Background: Based on data from the Surveillance, Epidemiology, and End Results database, recent studies have reported an improved breast-cancer-specific survival in patients who undergo breast reconstruction immediately following mastectomy, and research by our institution obtained consistent findings. However, the relationship between improved survival and breast reconstruction remains unclear. Aim and Objectives: We evaluated whether conformity with the practice guideline among breast cancer patients who underwent transverse rectus abdominis myocutaneous (TRAM) flap reconstructions immediately following modified radical mastectomy (MRM) was better than that of patients who underwent MRM alone. We also evaluated whether better conformity with the practice guideline could improve survival and reduce local recurrence. Materials and Methods: We analyzed the data of all women who had received TRAM flap reconstruction immediately after unilateral MRM at a single institution from January 2002 to December 2009. The 734 patients were divided into 2 treatment groups: TRAM flap reconstruction immediately after MRM (MRM-TRAM group, n = 226) and MRM alone (MRM group, n = 508). Subsequently, the patients were assigned to a poor conformity group if they met any of the following criteria (against the practice guideline for breast cancer treatment in our institution): (1) tumor size ＞ 1 cm, but the patient refused chemotherapy following mastectomy; (2) positive estrogen receptor status, but the patient refused hormone therapy after mastectomy; and (3) metastases in ≥ 3 axillary lymph nodes, but the patient refused radiotherapy. The remaining patients were assigned to a good conformity group, and the survival and local recurrence rates of the 2 groups were then compared. The collected data comprised age, histology, tumor grade, cancer stage, estrogen receptor status, progesterone receptor status, and further adjuvant therapies (radiation therapy, chemotherapy, hormone therapy). Results: The conformity rate of the MRM-TRAM group (82.3%) was significantly better than that of the MRM group (74.4%) (P=.019). Compared with the poor conformity group, the good conformity group exhibited significantly higher breast cancer-specific survival (P＜.001). The 5-year breast-cancer-specific survival rate of the good conformity group (87.0%) was significantly higher than that of the poor conformity group (75.3%) (P＜.001). The 5-year survival rates of good conformity and poor conformity group in each cancer stage were: stage I, 94.1% and 97.6%, p=.502; stage II, 87.8% and 86.1%, p=.401; stage III, 74.5% and 51.6%, p=.001, respectively. A multivriate analysis revealed that good conformity, MRM with immediate breast reconstruction, and earlier TNM stage are accurate independent predictors of survival. Compared with the MRM group, the MRM-TRAM group exhibited a significantly lower mortality (hazard ratio; HR, .495; 95% confidence interval; CI, .276–0.886; P = .018). The poor conformity group exhibited a 73.4% increase in the risk of cancer-related death (HR, 1.734; 95% CI, 1.136-2.645; p = .011) in comparison with the good conformity group. The 5-year local recurrence rate of the poor conformity group (25.3%) was significantly higher than that of the good conformity group (14.7%) (P＜.001). The multivariate analysis results indicated that good conformity and earlier TNM stage are accurate independent predictors of a reduced the rate of local recurrence. Conclusion: Recent studies and a previous research by our institution have demonstrated an improved breast cancer-specific survival in patients undergoing immediate breast reconstruction after mastectomy. This study points out that patients who undergo TRAM flap breast reconstruction immediately following MRM have better conformity with the practice guideline than those who undergo MRM alone. Furthermore, multivariate analytical model results indicate that good conformity and MRM with TRAM flap reconstruction are accurate independent predictors of survival. All these evidences prove that patients in MRM-TRAM group possess both factors of better conformity with the practice guideline and breast reconstruction can have better survival than non-reconstructed patients.
Purpose: Primary varicose veins have been treated using endoscopic surgery and achieved an encour... more Purpose: Primary varicose veins have been treated using endoscopic surgery and achieved an encouraging result, with very low incidence of recurrence. In this study, the result of endoscope-assisted operation for primary varicose veins with venous ulceration was evaluated. Materials and Methods: From February 1997 to December 2006, 103 legs in 91 patients of primary varicose veins with skin ulceration (C5 and/or C6 lesions) were treated with the assistance of endoscopic surgery. The mean age of these patients at the time of operation was 58.1 (range 28-87) years. The numbers of C5 and C6 lesions were 55 and 48 respectively. A total of 97 legs in 87 patients received complete follow-up. The follow-up period ranged from 2 to 104 months. The results for the rate of ulcer healing and recurrence were analyzed with the Kaplan-Meier survival analysis. Results: Among the 97 legs receiving complete follow-up, initial ulcer healing was achieved in 95 legs (97.9%), including 50 legs in the C5 group and 45 legs in the C6 group. The mean time for ulcer healing was 11.3 and 15.2 weeks in C5 and C6 groups respectively. The total number of recurrences was 5 and the mean time of recurrence was 35.8 months. The 5-year ulcer recurrence rate was 7.3%. Only two legs in two patients did not heal completely after the operation in this series. This study revealed that there were always clustered varicose veins with variable incompetent perforating vessels running immediately beneath the ulcerated skin and/or at the base of the ulcer. To achieve a complete and non-recurrent ulcer healing, radical excision of these varicose veins was mandatory. Conclusion: In the treatment of primary varicose veins with ulceration, surgery with assistance of the endoscope achieved an excellent ulcer healing rate with low recurrence of ulcerations. Besides, with the advantages of the endoscope providing a magnified monitoring view with good illumination, the relationship between varicose veins and the venous ulcer was also established. This is a good alternative for the treatment of venous ulceration.
Background:Varicose veins are chronically progressive disease. In the early stage, patients are f... more Background:Varicose veins are chronically progressive disease. In the early stage, patients are free of symptoms except for the disfigurement of the involved lower limb. As time passes however, symptoms and signs, including a sensation of heaviness, itching, soreness, cramping, lipodermatosclerosis, and venous ulceration, will manifest themselves. Superficial thrombophlebitis (STP) is a common complication of primary varicose veins. In this study, radical removal of the varicosities and their associated thromboses were performed with the assistance of endoscopic surgery, and the results have been encouraging. Aim and objective:To evaluate the outcome of endoscopic surgery of superficial thrombophlebitis (STP) in patients with primary varicose veins. Materials and methods:Of 1264 patients who underwent surgery for primary varicose veins, 108 (8.5%) had the STP. There were 32 men and 76 women, ranging from 28 to 85 years old. Before the operations, patients were admitted for conservative management of their acute STP symptoms. The operations proceeded through access incisions (2.5-3.0 cm in length) of the skin overlying the varicose veins. With the aid of good illumination and magnified monitor view, the thrombosed veins, incompetent perforating veins and existing varicose veins were completely dissected, divided and excised radically.Results: The 58% of patients were discharged on the day after surgery. Hospital stays were short, varying from 3 days to 12 days with a mean of 4.8 days. Although 45 patients were lost to follow-up, the remaining 63 patients were followed up for from 6 months to 72 months with an average of 20 months. 85.7% of the follow-up patients were satisfactory about the outcome. There were no incidents of significant postoperative morbidity, and recurrence of varicose veins and STP. Scarring was minimal and aesthetically acceptable.Conclusions:This method may be a new and good alternative for management of STP in patients with primary varicose veins.
The International Journal of Lower Extremity Wounds
Skin avulsion wounds are expected to be swollen and tense after trauma, and skin perfusion can be... more Skin avulsion wounds are expected to be swollen and tense after trauma, and skin perfusion can be compromised after primary closure, resulting in wound dehiscence and poor healing. The artificial dermis (AD) serves as a dermal regeneration template that is used to heal skin defects with secondary intention. Therefore, the aim of this study is to evaluate the effect of AD application on traumatic skin avulsion injuries compared to conventional primary closure. A retrospective cohort of 20 patients with skin avulsion injuries were included the study: ten patients were treated with AD and ten patients were managed with primary closure. When compared to the primary closure group, AD group had a shorter average healing time (58.40 ± 26.94 days V 65.50 ± 46.45 days) and significantly higher flap viability (92.00 ± 13.17% V 78.00 ± 13.98%; p = .03). In conclusion, AD is a promising material for the treatment of skin avulsion injury and produces better clinical results.
Background: The ischial pressure sore is associated with pressure in the sitting position. The ro... more Background: The ischial pressure sore is associated with pressure in the sitting position. The roles of surgical debridement and flap reconstruction are well-established. However, most of the patients are young and paraplegic, and the recurrence of their pressure ulcers is an important issue during their lifetime. Aim and Objectives: This study provides our experiences in the reconstruction of ischial pressure sores. Based on these results, we propose a rationale for flap selection in the reconstruction of ischial pressure sore. Materials and Methods: From April 1999 to March 2009, there were one hundred and twenty-six ischial pressure-sore patients operated on at Kaohsiung Medical University Hospital. Forty patients underwent reconstructive flap surgery for definitive wound closure. Thirty-two patients (twenty-one men and eleven women) with long-term follow-up data were included in this study. A total of sixty flap operations were performed during the period. We categorized the tra...
Augmentative and reconstructive rhinoplasty surgical procedures use autologous tissue grafts or s... more Augmentative and reconstructive rhinoplasty surgical procedures use autologous tissue grafts or synthetic grafts to repair the nasal defect and aesthetic reconstruction. Donor site trauma and morbidity are common in autologous grafts. The desperate need for the production of grafted 3D cartilage tissues as rhinoplasty grafts without the adverse effect is the need of the hour. In the present study, we developed a bioactive 3D histotypic construct engineered with the various ratio of adipose-derived stem cells (ADSC) and chondrocytes together with decellularized porcine nasal cartilage graft (dPNCG). We decellularized porcine nasal cartilage using supercritical carbon dioxide (SCCO2) extraction technology. dPNCG was characterized by H&E, DAPI, alcian blue staining, scanning electron microscopy and residual DNA content, which demonstrated complete decellularization. 3D histotypic constructs were engineered using dPNCG, rat ADSC and chondrocytes with different percentage of cells and cultured for 21 days. dPNCG together with 100% chondrocytes produced a solid mass of 3D histotypic cartilage with significant production of glycosaminoglycans. H&E and alcian blue staining showed an intact mass, with cartilage granules bound to one another by extracellular matrix and proteoglycan, to form a 3D structure. Besides, the expression of chondrogenic markers, type II collagen, aggrecan and SOX-9 were elevated indicating chondrocytes cultured on dPNCG substrate facilitates the synthesis of type II collagen along with extracellular matrix to produce 3D histotypic cartilage. To conclude, dPNCG is an excellent substrate scaffold that might offer a suitable environment for chondrocytes to produce 3D histotypic cartilage. This engineered 3D construct might serve as a promising future candidate for cartilage tissue engineering in rhinoplasty.
Objective: In endoscope-assisted surgery for varicose veins, the anatomical relationship of the s... more Objective: In endoscope-assisted surgery for varicose veins, the anatomical relationship of the saphenous nerve to great saphenous varicosity in the leg was studied in an Asian population. Methods: Primary varicose veins were managed using endoscope-assisted surgery. Results: Between January 2007 and November 2015, 860 legs with primary varicose veins of the great saphenous vein (GSV) were managed. The saphenous nerve was encountered in the operative field in 82 legs (9.5%). The anatomical relationship of the nerve to the main trunk, tributaries, and incompetent perforating veins of great saphenous varicose vessels was evaluated and classified into 4 types, I, II, III, and IV, with incidences of 0.9%, 6.9%, 0.6%, and 1.2%, respectively. The incidences of the presence of this nerve in the upper, middle and lower thirds of the leg were 0.7%, 4.3% and 4.5%, respectively. Conclusion: This study revealed the relative location and incidence of the saphenous nerve among the GS varicose vessels and the possible risk of nerve injury in the management of varicose veins of the GSV.
Background:It's rare to see major infection of sternal wound after median sternotomy in cardi... more Background:It's rare to see major infection of sternal wound after median sternotomy in cardiac surgery which yet may seriously affect the post-operation course including the morbidity, hospital stay, cost, and mortality. Various management strategies have been reported for the sternal wound care including debridement plus rewiring, open wound care, continuous irrigation, Redon tube closed irrigation, open packing then delayed closure, topical negative pressure dressing, and flaps reconstruction. All recent studies share one common principle, that is, adequate debridement of the infected tissue and covering of the defect with well-vascularized tissue.Aim and Objectives:Here we present our treatment strategy for the deep sternal wound infection (DSWI) involving the sternal bone or mediastinal space at Kaohsiung Medical University Hospital in the past ten years.Materials and Methods:From September 2001 to September 2011, 1732 sternotomies were performed at Kaohsiung Medical University Hospital. We identified 41 patients who had suffered from deep sternal wound infection and were referred to plastic department for further treatment.Result:Total 41 patients adopted the surgical reconstruction in our hospital. All patients accepted the extensive debridement and topical negative pressure therapy first. Eight (19.50/0) of them received delay closure. Twenty-one (51.2%) patients with the defect limited to the upper and middle third of the sternum received the pectoralis major muscle (PM) advance flap reconstruction. Seven (17.1%) patients with the defect limited to the lower third of sternum received the rectus abdominis musde (RAM) flap (3), PM turnover flap (2), and PM plus RAM bi-pedicle flap (2) reconstruction. The rest five (12.2%) patients with the defect, involving whole sternum, received the PM plus RAM bi-pedicle flap (3) and Omentum flap (2) reconstruction.One patient got partial wound dehiscence post PM plus RAM bi-pedicle flap due to Mycobacterium tuberculosis infection. The dehiscent lesion got stable and healed after systemic and local anti-tuberculous treatment. Among all the 41 patients, four patients expired during their hospital stay. Three of them who had received the debridement, topical negative pressure dressing, and delay wound closure died of heart failure, and one case with PM advance flap died of sepsis, mediastinitis related.Conclusion:Adequate debridement, local infection control, and wound repair with well vascularized tissue are the keys to successful reconstruction. We prefer to use the PM flap to treat the DSWI. The PM flap is versatile, and 68.3% of the patient with DSWI in KMU hospital were treated with PM based flap including PM advance or turnover flap and PM plus RAM flap. However, the flap design should depend on the patient's status individually.
Background:Bone marrow biopsy (BMB) is the method for assessment of overall bone marrow cellulari... more Background:Bone marrow biopsy (BMB) is the method for assessment of overall bone marrow cellularity. It is also used to screen for unidentified hematological diseases, different storage and infiltrative disorders. The reported complication rate of iliac crest BMB was only about 0.05%.Objectives:We reported the rare complication of pseudoaneurysm formation after iliac crest BMB. The complication was successfully treated by combining endovascular embolization with an endoscope-assisted technique for hematoma removal. We also reviewed the related literature.Patient and Method:A 62-year-old man complained of the formation of a large and tender mass over the right gluteal area after BMB. The mass had persisted even after 4-month conservative treatment. Enhanced computed tomography (CT) scan revealed contrast extravasation within the lesion. Pseudoaneurysm was highly suspected. Selective endovascular coil embolization was performed following endoscope-assisted removal of the residual hematoma.Result:The radiologist successfully embolized the pseudoaneurysm. On the next day, the surgeon evacuated the hematoma and clamped the surrounding vessels on the gluteal maximus muscle via a single small incision. No postoperative sequelae were noted. The patient was highly satisfied with the result.Conclusion:In conclusion, pseudoaneurysm formation after BMB is a rare complication which can be successfully treated with combination of selective endovascular coil embolization and endoscope-assisted hematoma removal. Clamping the surrounding vessels which were embedded in the muscle may prevent the recurrence of hematoma. Endoscopicassisted removal of the hematoma was effective in this case and may reduce the risk of gluteal muscle destruction. (J Taiwan Soc of Plast Surg 2011; 20: 316∼323)
Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is ... more Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is often caused by a variety of diseases, such as atherosclerosis, connective tissue disease, trauma and Raynaud's disease. Patients with this problem usually suffer from poor tissue perfusion and impaired microcirculation. In clinical, ischemic digits often present with pain, cold intolerance, ulceration and even gangrene change. Many strategies are proposed today to overcome this disease. Behavioral therapies, such as avoidance of cold exposure and smoking are a very important intervention. Pharmacologic therapies, like the administration of calcium channel blocker, PGE1 and other vasodilators have been the most commonly used agents. Sympatholytic drugs have also been added to reduce the sympathetic tone in vascular smooth muscles. In addition, anticoagulants or antiplatelet agents are administered to inhibit thrombus formation in occlusive vascular disease. Although these agents are usually effective, unfortunately, in refractory cases, amputation is unavoidable. Those patients have to suffer the fate of partial or total loss of the digits. This ultimate outcome frequently comes with high morbidity and dysfunctions both in physical and psychological terms. In those cases which are refractory to medical therapy, surgical intervention had been carried out to improve tissue perfusion. Tissue perfusion depends on the integrity of the vasculature and the neurovascular regulatory elements. Historically, microsurgical revascularization and sympathectomy were widely performed to recover adequate blood flow. Microvascular reconstruction with interposition vein grafting can be used to reestablish the vascular structure. However, not all cases with digital ischemia are suitable for this procedure due to the possible occurrence of multifocal stenosis. Sympathectomy can reduce sympathetic tone and thus increase the radius of blood vessel. According to Poiseuille's law, blood flow is directly proportional to the fourth power of the vessel's radius. So even a small increase of radius of blood vessel can lead to a very great increase in blood flow. According to Pick and Flatt, sympathetic fibers travel along the epineurium of peripheral nerve, pass to the adventitia, and innervate the smooth muscle of vessels. The removal of adventitia can block the sympathetic tone in the smooth muscle. This procedure may also increase the radius of vessel and reestablish adequate blood flow.
Background: Sternal osteomyelitis is a potentially life-threatening complication after cardiac su... more Background: Sternal osteomyelitis is a potentially life-threatening complication after cardiac surgery. The infection can spread into the mediastinum, involving the prosthetic valve, grafts, and suture lines. It may be the cause of postoperative morbidity and mortality. Aim and Objectives: Topical negative pressure (TNP) dressing, muscle flap and hyperbaric oxygen therapy (HBO) have been proved to be effective for sternal wound healing. We want to take advantages of these methods to improve the results of intractable sternal wound infection. Materials and methods: From January 2005 to January 2008, 12 patients with sternal wound infection were treated at Kaohsiung Medical University Chung-Ho Memorial Hospital. All wounds received extensive debridement, irrigation, and TNP dressing. Seven patients received pectoralis major (PM) muscle flap coverage. Three patients accepted rectus abdominis myocutaneous (RAM) flaps coverage. Four patients received HBO therapy. Results: These patients received 1-3 times debridement before flap reconstruction or wound healed. Two patients did not receive any muscle flap for reconstruction after HBO management. After management, the infections were controlled and the wounds healed. There was no recurrence of sternal osteomyelitis during the follow-up periods. Conclusions: (1) The TNP dressing can apply several advantages to make the wound bed suitable for reconstruction. (2) According to the anatomic site of wound, we can choose proper muscle flap for sternal wall reconstruction. (3) The HBO therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.
Background: This study of stage III (locally advanced) breast cancer patients evaluated the survi... more Background: This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) f lap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone. Methods: This retrospective study analyzed data for all women who had received TRAM immediately after unilateral modified radical mastectomy for locally advanced breast cancer at a single institution from January 2002 to December 2009. The analysis included 192 patients divided into 2 groups: patients who had received MRM immediately followed by TRAM f lap reconstruction (MRM-TRAM group, n = 52) and patients who had received MRM alone (MRM group, n = 140). Data collection included demographic characteristics, underlying comorbidities, and cancer characteristics. Postoperative adjuvant therapies, oncologic outcomes, and survival were compared between the 2 groups. Kaplan-Meier plots, univariate log-rank test, multivariate Cox proportional hazards regression models, and t-test were used to evaluate potential predictors of cancer recurrence and patient survival. Results: In comparison with the MRM group, significant differences in the MRM-TRAM group included a younger mean age, a better overall health status, and a higher education level (all P G 0.001). Severity of breast cancer disease did not significantly differ in terms of cancer characteristics. Additionally, there were no significant differences in local recurrence (P = 0.326) and distant metastasis (P = 0.338). Immediate breast reconstruction was not associated with delays in detection of local recurrence and initiation of adjuvant therapies The 5-year breast cancer-specific survival rate was significantly higher in the MRM-TRAM group (84.6%) compared with the MRM group (61.2%) (P = 0.003). Multivariate analysis showed that TRAM f lap reconstruction is an independent predictor of survival in breast cancer patients. The MRM-TRAM group had a significantly lower hazard of death (HR, 0.235; 95% CI, 0.070Y 0.788; P = 0.019) compared with the MRM group. Conclusions: Immediate TRAM f lap reconstruction is oncologically safe and is unassociated with delayed adjuvant therapies or delayed detection of local recurrence. Patients with locally advanced breast cancer can be considered appropriate candidates for TRAM f lap reconstruction because the procedure is an independent predictor of breast cancer survival and is associated with a 76.5% decrease (HR, 0.235) in the risk of cancer death.
Background: Levator function is usually graded as good (＞8 mm), fair (5-7 mm) and poor (1-4 mm), ... more Background: Levator function is usually graded as good (＞8 mm), fair (5-7 mm) and poor (1-4 mm), which are generally associated with mild, moderate, and severe blepharoptosis, respectively. To date, no large study has evaluated the relationship between levator function and blepharoptosis severity in oriental eyelids. Aim and Objectives: The aim is to analyze the relationship between levator function and severity of blepharoptosis by means of a large retrospective study. Materials and Methods: We reviewed patients who were examined for blepharoptosis in our hospital between April 2004 and April 2014 by using detailed medical records of age, sex, time of onset, severity, and levator function. 323 patients with total eyelid number of 519 were studied. We divided levator function into four grades: excellent (＞12mm), good (8-12mm), fair (5-7 mm), and poor (＜5 mm). All the eyelids were divided into congenital and acquired groups. Within these two groups, we calculated the percentages of excellent, good, fair, and poor levator function in the mild, moderate, and severe blepharoptosis subgroups. In addition, we evaluated the percentage of mild, moderate, and severe blepharoptosis in the excellent, good, fair, and poor levator function subgroups. Results: The number of eyelids in the male and female groups was 189 (36.4%) and 330 (63.6%), respectively. Congenital and acquired blepharoptosis were observed in 413 (79.6%) and 106 (20.4%) eyelids, respectively. Most eyelids with mild or moderate blepharoptosis exhibited good or excellent levator function. However, good or excellent levator function was not completely associated with mild blepharoptosis. In addition, most eyelids with poor levator function had severe blepharoptosis. However, severe blepharoptosis was not completely associated with poor levator function. Conclusion: Acquired blepharoptosis can be caused by various factors other than levator muscle dysfunction. Congenital blepharoptosis generally causes worse levator function than acquired blepharoptosis. Most eyelids with mild or moderate blepharoptosis had good or excellent levator function. However, good or excellent levator function was not completely associated with mild blepharoptosis. Poor levator function eyelids generally lead to severe blepharoptosis, but severe blepharoptosis was not completely associated with poor levator function. This association may be related to the two-layer extensions of the levator palpabrae muscle, which makes the relative preservation of levator function possible in aponeurotic and mechanical blepharoptosis.
Background:Axillary osmidrosis is an embarrassing condition that causes disturbing social problem... more Background:Axillary osmidrosis is an embarrassing condition that causes disturbing social problems, especially in Asian societies. However, topical treatment could only provide temporary improvement. Permanent solutions required surgical intervention. The conventional operation has some disadvantages, such as large wounds, conspicuous scars and long recovery time. The ideal operation should comprehend permanent effect, an outpatient surgery with local anesthesia, short operation time, rapid recovery, minimized complications and inconspicuous scar. The use of suction-assisted cartilage shaver accomplishes all these needs and is already a prevalent treatment of axillary osmidrosis. However, small wound complications still occur postoperatively.Aim and Objectives:We modified the procedure in dissecting the axillary area in order to diminish such complications mentioned.Materials and Methods:From July 2003 to August 2011, 76 patients with axillary osmidrosis (57 females and 19 males) were treated under suction-assisted cartilage shaver with modified procedure. We tunneled the subcutaneous layer above the deep fascia and kept several septa attaching to the skin without completely dissecting the subcutaneous layer. Finally, the complete removal of the apocrine gland was checked by endoscope.Results:All patients were followed up but only 55 patients completed the questionnaire. Patients were followed 2~67 months with an average of 27 months. The satisfaction of malodor improvement was scored from 1~5 (5 indicates very satisfied and 1 indicates disappointed). No odor: 30.9%, almost complete odor elimination: 41.8%, partial odor elimination: 16.4%).One (1.8%) revealed hematoma over right axilla.Conclusion:The modified design of preserving septa without full dissection and endoscopy viewing were used in order to diminish the complications and complete eradication of the apocrine glands.
Background: Upper eyelid retraction may occur as a condition of hyperthyroidism, previous surgery... more Background: Upper eyelid retraction may occur as a condition of hyperthyroidism, previous surgery, or trauma. It is usually associated with dry eye syndrome, corneal compromise, and unsatisfactory cosmetic appearance. We used the autologous deep temporal fascia as an upper eyelid spacer graft to treat the eyelid retraction. Materials and Methods: Records of 11 patients (15 lids) treated by a single surgeon were reviewed retrospectively from 2008 to 2012. All eyelid retractions ranged from 1 to 3 mm above its ideal position and were corrected with the technique of deep temporal fascia spacer grafting. Preoperative etiologies, characteristics and postoperative outcomes were analyzed. Results: Of the 11 patients (15 lids), 8 patients were observed as acceptable results, and 3 were observed as unfavorable postoperative results (2 lids overcorrection and 1 lid undercorrection). Two of the three unsatisfactory cases were corrected through early revision surgery. Lid margin contour showed improvement after the revision. No other complications were observed. Graft resorption, extrusion, and infection did not occur. The overall asymmetry rate was 27% (3/11). The total revision rate was 13 % (2/15). Conclusion: Correction of upper eyelid retractions with autologous deep temporal fascia grafts is efficient and safe. This technique is a simple and reproducible method for the repair of upper lid retraction.
Sacral pressure sores are frequently seen in long term bedridden or spinal cord injury patients. ... more Sacral pressure sores are frequently seen in long term bedridden or spinal cord injury patients. Gluteus maximus muscle flaps, with numerous modifications, have been the first choice in treating sacral wounds. We have used the gluteus maximus muscle based on the inferior gluteal artery as turnover flaps for covering recurrent sacral pressure sores in two cases. The flap design tangentially splits the lower one-half of the gluteus maximus muscle, rather than using the superficial portion or the entire muscle, as in conventional turnover methods. The bulk and length of these flaps are sufficient to easily fill defects and act as excellent cushions in selected patients.
Twenty patients suffering from HF dermal burns in Kaohsiung Medical University Hospital from Janu... more Twenty patients suffering from HF dermal burns in Kaohsiung Medical University Hospital from January 1997 to December 2004 were investigated in order to further identify the efficiency of continuous intra-arterial calcium gluconate infusion. The infusion dose of calcium gluconate, the set-up of this technique, the necessity of adjuvant procedure such as nail removal or de-roofing of bullae, and the decrease of the technique-related complications are also discussed. A total of 51 fingers in twenty patients were all salvaged without major complications. Furthermore cosmetic appearance and hand function were maintained. In conclusion, the feasibility of applying this technique in any concentration of HF injury can be considered and advocated universally in order to salvage more digits from HF dermal burns.
When encounter ammonia inhalation injuries we often focus on oropharynx or tracheal mucosa lesion... more When encounter ammonia inhalation injuries we often focus on oropharynx or tracheal mucosa lesion and lung parenchyma injury, and neglect of other systemic injuries. In our study, we found that the abnormal liver function tests proceed until post injury day 8. It might be an useful study to determine if the liver function tests could be an indicator of the severity of injury and prognostic factor. Besides, the initial serum ammonia level may be a meaningful indicator of severity of injury even it could be fade to normal in 4-5 hours. Reviewing the literatures we finding that close follow up of liver function tests in ammonia injury is necessary.
Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasin... more Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasing glomerular filtration rate. The incidence of ARF in burns patients varies widely between 0.5 and 30 per cent depending on patient's age and severity of injury. Many studies have reported a high mortality rate from 73% to 100%. Peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy (CRRT) are methods to treat ARF. In general, continuous renal replacement therapy is used for patients in whom intermittent hemodialysis fails to control hypovolemia, and for those who do not tolerate intermittent hemodialysis and in whom peritoneal dialysis is not suitable owing to burnt abdominal area. Three burn patients received continuous renal replacement therapy-CVVH (continuous venovenous hemofiltration)-in our burn unit from 2001 to 2004. All of these patients were male with a mean age of 61 year (41~80) and a mean burned surface area of 47% (30~71). Two patients recovered from the course of acute renal failure: one patient expired due to acute myocardial infarction during hospitalization, the other patient survived. We analysis the usage of continuous renal replacement therapy for burned patient with ARF and discuss its indication, contraindication, advantages, disadvantages and complications.
Background: Based on data from the Surveillance, Epidemiology, and End Results database, recent s... more Background: Based on data from the Surveillance, Epidemiology, and End Results database, recent studies have reported an improved breast-cancer-specific survival in patients who undergo breast reconstruction immediately following mastectomy, and research by our institution obtained consistent findings. However, the relationship between improved survival and breast reconstruction remains unclear. Aim and Objectives: We evaluated whether conformity with the practice guideline among breast cancer patients who underwent transverse rectus abdominis myocutaneous (TRAM) flap reconstructions immediately following modified radical mastectomy (MRM) was better than that of patients who underwent MRM alone. We also evaluated whether better conformity with the practice guideline could improve survival and reduce local recurrence. Materials and Methods: We analyzed the data of all women who had received TRAM flap reconstruction immediately after unilateral MRM at a single institution from January 2002 to December 2009. The 734 patients were divided into 2 treatment groups: TRAM flap reconstruction immediately after MRM (MRM-TRAM group, n = 226) and MRM alone (MRM group, n = 508). Subsequently, the patients were assigned to a poor conformity group if they met any of the following criteria (against the practice guideline for breast cancer treatment in our institution): (1) tumor size ＞ 1 cm, but the patient refused chemotherapy following mastectomy; (2) positive estrogen receptor status, but the patient refused hormone therapy after mastectomy; and (3) metastases in ≥ 3 axillary lymph nodes, but the patient refused radiotherapy. The remaining patients were assigned to a good conformity group, and the survival and local recurrence rates of the 2 groups were then compared. The collected data comprised age, histology, tumor grade, cancer stage, estrogen receptor status, progesterone receptor status, and further adjuvant therapies (radiation therapy, chemotherapy, hormone therapy). Results: The conformity rate of the MRM-TRAM group (82.3%) was significantly better than that of the MRM group (74.4%) (P=.019). Compared with the poor conformity group, the good conformity group exhibited significantly higher breast cancer-specific survival (P＜.001). The 5-year breast-cancer-specific survival rate of the good conformity group (87.0%) was significantly higher than that of the poor conformity group (75.3%) (P＜.001). The 5-year survival rates of good conformity and poor conformity group in each cancer stage were: stage I, 94.1% and 97.6%, p=.502; stage II, 87.8% and 86.1%, p=.401; stage III, 74.5% and 51.6%, p=.001, respectively. A multivriate analysis revealed that good conformity, MRM with immediate breast reconstruction, and earlier TNM stage are accurate independent predictors of survival. Compared with the MRM group, the MRM-TRAM group exhibited a significantly lower mortality (hazard ratio; HR, .495; 95% confidence interval; CI, .276–0.886; P = .018). The poor conformity group exhibited a 73.4% increase in the risk of cancer-related death (HR, 1.734; 95% CI, 1.136-2.645; p = .011) in comparison with the good conformity group. The 5-year local recurrence rate of the poor conformity group (25.3%) was significantly higher than that of the good conformity group (14.7%) (P＜.001). The multivariate analysis results indicated that good conformity and earlier TNM stage are accurate independent predictors of a reduced the rate of local recurrence. Conclusion: Recent studies and a previous research by our institution have demonstrated an improved breast cancer-specific survival in patients undergoing immediate breast reconstruction after mastectomy. This study points out that patients who undergo TRAM flap breast reconstruction immediately following MRM have better conformity with the practice guideline than those who undergo MRM alone. Furthermore, multivariate analytical model results indicate that good conformity and MRM with TRAM flap reconstruction are accurate independent predictors of survival. All these evidences prove that patients in MRM-TRAM group possess both factors of better conformity with the practice guideline and breast reconstruction can have better survival than non-reconstructed patients.
Purpose: Primary varicose veins have been treated using endoscopic surgery and achieved an encour... more Purpose: Primary varicose veins have been treated using endoscopic surgery and achieved an encouraging result, with very low incidence of recurrence. In this study, the result of endoscope-assisted operation for primary varicose veins with venous ulceration was evaluated. Materials and Methods: From February 1997 to December 2006, 103 legs in 91 patients of primary varicose veins with skin ulceration (C5 and/or C6 lesions) were treated with the assistance of endoscopic surgery. The mean age of these patients at the time of operation was 58.1 (range 28-87) years. The numbers of C5 and C6 lesions were 55 and 48 respectively. A total of 97 legs in 87 patients received complete follow-up. The follow-up period ranged from 2 to 104 months. The results for the rate of ulcer healing and recurrence were analyzed with the Kaplan-Meier survival analysis. Results: Among the 97 legs receiving complete follow-up, initial ulcer healing was achieved in 95 legs (97.9%), including 50 legs in the C5 group and 45 legs in the C6 group. The mean time for ulcer healing was 11.3 and 15.2 weeks in C5 and C6 groups respectively. The total number of recurrences was 5 and the mean time of recurrence was 35.8 months. The 5-year ulcer recurrence rate was 7.3%. Only two legs in two patients did not heal completely after the operation in this series. This study revealed that there were always clustered varicose veins with variable incompetent perforating vessels running immediately beneath the ulcerated skin and/or at the base of the ulcer. To achieve a complete and non-recurrent ulcer healing, radical excision of these varicose veins was mandatory. Conclusion: In the treatment of primary varicose veins with ulceration, surgery with assistance of the endoscope achieved an excellent ulcer healing rate with low recurrence of ulcerations. Besides, with the advantages of the endoscope providing a magnified monitoring view with good illumination, the relationship between varicose veins and the venous ulcer was also established. This is a good alternative for the treatment of venous ulceration.
Background:Varicose veins are chronically progressive disease. In the early stage, patients are f... more Background:Varicose veins are chronically progressive disease. In the early stage, patients are free of symptoms except for the disfigurement of the involved lower limb. As time passes however, symptoms and signs, including a sensation of heaviness, itching, soreness, cramping, lipodermatosclerosis, and venous ulceration, will manifest themselves. Superficial thrombophlebitis (STP) is a common complication of primary varicose veins. In this study, radical removal of the varicosities and their associated thromboses were performed with the assistance of endoscopic surgery, and the results have been encouraging. Aim and objective:To evaluate the outcome of endoscopic surgery of superficial thrombophlebitis (STP) in patients with primary varicose veins. Materials and methods:Of 1264 patients who underwent surgery for primary varicose veins, 108 (8.5%) had the STP. There were 32 men and 76 women, ranging from 28 to 85 years old. Before the operations, patients were admitted for conservative management of their acute STP symptoms. The operations proceeded through access incisions (2.5-3.0 cm in length) of the skin overlying the varicose veins. With the aid of good illumination and magnified monitor view, the thrombosed veins, incompetent perforating veins and existing varicose veins were completely dissected, divided and excised radically.Results: The 58% of patients were discharged on the day after surgery. Hospital stays were short, varying from 3 days to 12 days with a mean of 4.8 days. Although 45 patients were lost to follow-up, the remaining 63 patients were followed up for from 6 months to 72 months with an average of 20 months. 85.7% of the follow-up patients were satisfactory about the outcome. There were no incidents of significant postoperative morbidity, and recurrence of varicose veins and STP. Scarring was minimal and aesthetically acceptable.Conclusions:This method may be a new and good alternative for management of STP in patients with primary varicose veins.
The International Journal of Lower Extremity Wounds
Skin avulsion wounds are expected to be swollen and tense after trauma, and skin perfusion can be... more Skin avulsion wounds are expected to be swollen and tense after trauma, and skin perfusion can be compromised after primary closure, resulting in wound dehiscence and poor healing. The artificial dermis (AD) serves as a dermal regeneration template that is used to heal skin defects with secondary intention. Therefore, the aim of this study is to evaluate the effect of AD application on traumatic skin avulsion injuries compared to conventional primary closure. A retrospective cohort of 20 patients with skin avulsion injuries were included the study: ten patients were treated with AD and ten patients were managed with primary closure. When compared to the primary closure group, AD group had a shorter average healing time (58.40 ± 26.94 days V 65.50 ± 46.45 days) and significantly higher flap viability (92.00 ± 13.17% V 78.00 ± 13.98%; p = .03). In conclusion, AD is a promising material for the treatment of skin avulsion injury and produces better clinical results.
Background: The ischial pressure sore is associated with pressure in the sitting position. The ro... more Background: The ischial pressure sore is associated with pressure in the sitting position. The roles of surgical debridement and flap reconstruction are well-established. However, most of the patients are young and paraplegic, and the recurrence of their pressure ulcers is an important issue during their lifetime. Aim and Objectives: This study provides our experiences in the reconstruction of ischial pressure sores. Based on these results, we propose a rationale for flap selection in the reconstruction of ischial pressure sore. Materials and Methods: From April 1999 to March 2009, there were one hundred and twenty-six ischial pressure-sore patients operated on at Kaohsiung Medical University Hospital. Forty patients underwent reconstructive flap surgery for definitive wound closure. Thirty-two patients (twenty-one men and eleven women) with long-term follow-up data were included in this study. A total of sixty flap operations were performed during the period. We categorized the tra...
Augmentative and reconstructive rhinoplasty surgical procedures use autologous tissue grafts or s... more Augmentative and reconstructive rhinoplasty surgical procedures use autologous tissue grafts or synthetic grafts to repair the nasal defect and aesthetic reconstruction. Donor site trauma and morbidity are common in autologous grafts. The desperate need for the production of grafted 3D cartilage tissues as rhinoplasty grafts without the adverse effect is the need of the hour. In the present study, we developed a bioactive 3D histotypic construct engineered with the various ratio of adipose-derived stem cells (ADSC) and chondrocytes together with decellularized porcine nasal cartilage graft (dPNCG). We decellularized porcine nasal cartilage using supercritical carbon dioxide (SCCO2) extraction technology. dPNCG was characterized by H&E, DAPI, alcian blue staining, scanning electron microscopy and residual DNA content, which demonstrated complete decellularization. 3D histotypic constructs were engineered using dPNCG, rat ADSC and chondrocytes with different percentage of cells and cultured for 21 days. dPNCG together with 100% chondrocytes produced a solid mass of 3D histotypic cartilage with significant production of glycosaminoglycans. H&E and alcian blue staining showed an intact mass, with cartilage granules bound to one another by extracellular matrix and proteoglycan, to form a 3D structure. Besides, the expression of chondrogenic markers, type II collagen, aggrecan and SOX-9 were elevated indicating chondrocytes cultured on dPNCG substrate facilitates the synthesis of type II collagen along with extracellular matrix to produce 3D histotypic cartilage. To conclude, dPNCG is an excellent substrate scaffold that might offer a suitable environment for chondrocytes to produce 3D histotypic cartilage. This engineered 3D construct might serve as a promising future candidate for cartilage tissue engineering in rhinoplasty.
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