Apirag Chuangsuwanich

Comparison of the ionic silver-containing hydrofiber and paraffin gauze dressing on split-thickness skin graft donor sites.

The split-thickness skin graft (STSG) donor site dressing has been an inconclusive topic. Each of the Hydrofiber (Aquacel, ConvaTec A Bristol-Myers Squibb Company, Deeside, UK) and silver dressings have applied in many types of wound care with favorable outcomes. Our study compared the ionic silver-containing Hydrofiber dressing and paraffin gauze dressing. The subjects were randomized into group A: ionic silver-containing Hydrofiber and group B: paraffin gauze. From February 2006 to 2007, 20 donor sites were recorded. The mean donor site surface area was 145.5 cm2 (group A) and 135.8 cm2 (group B). The completed re-epithelization day was 7.90 and 11.20 days, respectively (P = 0.031). The average pain score at rest were 0.74 and 0.80, respectively (P = 0.894). The average pain score on dressing removal were 3.12 and 4.70, respectively (P = 0.027). There was no infection or seroma in both groups. In conclusion, ionic silver-containing Hydrofiber dressing can reduce STSG donor site pain and promote re-epithelization compared to paraffin gauze dressing.

Short Incisional Double-Eyelid Blepharoplasty for Asian Patients

BACKGROUND The author found that nonexcisional techniques commonly used to create a double eyelid in Asian patients did not create a natural-looking fold, while most transcutaneous double-lid procedures involved unnecessary excision of eyelid skin and orbicularis muscle, which could increase tension on the scar and make it more noticeable. OBJECTIVE The author describes a technique for creation of a double eyelid, based in part on new anatomic findings, that uses a short incision to minimize the scar. METHODS The thick orbital septum was opened, the supratarsal tendon was divided, the central fat compartment was removed, and the dermis was fixed to the tarsal plate. RESULTS Between January 2000 and December 2004, 652 patients were operated using this technique. The mean age of the patients was 24 years. There were no serious complications. Four hundred twenty patients (64.4%) were followed up to 2 months, and 162 patients (24.8%) had 1-year follow-up. All had satisfactory results, except for 8 patients who underwent a second procedure to correct unequal folds 2 months postoperatively. Ten patients lost their supratarsal folds within 1 year postoperatively; all had satisfactory results after reoperation. CONCLUSIONS The short incisional technique for creation of a double eyelid described here provides excellent results with no visible scar and no serious complications.

Cost-Effectiveness Analysis in Comparing Alginate Silver Dressing with Silver Zinc Sulfadiazine Cream in the Treatment of Pressure Ulcers

Background The treatment of pressure ulcers is complicated, given the various wound dressing products available. The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated. We compare two wound dressing protocols-alginate silver dressing (AlSD) and silver zinc sulfadiazine cream (AgZnSD) with regard to wound healing and cost-effectiveness. Methods Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible for this prospective, randomized controlled trial. The patients were randomized to receive one of the two dressings for an eight-week period. The criteria of efficacy were based on the Pressure Ulcer Scale for Healing (PUSH) scoring tool. The cost of treatment was also assessed. Results Twenty patients (12 women and 8 men) were randomly assigned to receive either AlSD (n=10) or AgZnSD cream (n=10). The demographic data and wound characteristics were comparable in the two groups. The two groups showed no significant difference in the reduction of PUSH score, wound size, or volume of exudate. The tissue type score was significantly lower in the AlSD group (3.15±0.68-1.85±0.68 vs. 2.73±0.79-2.2±0.41; P=0.015). The cost of treatment was significantly lower in the AlSD group (377.17 vs. 467.74 USD, respectively; P<0.0001). Conclusions Alginate silver dressing could be effectively used in the treatment of grade III and IV pressure ulcers. It can improve wound tissue characteristics and is cost-effective.

The Healing Effect of Low-Temperature Atmospheric-Pressure Plasma in Pressure Ulcer A Randomized Controlled Trial

Pressure ulcers are difficult to treat. Recent reports of low-temperature atmospheric-pressure plasma (LTAPP) indicated its safe and effectiveness in chronic wound care management. It has been shown both in vitro and vivo studies that LTAPP not only helps facilitate wound healing but also has antimicrobial efficacy due to its composition of ion and electron, free radicals, and ultraviolet ray. We studied the beneficial effect of LTAPP specifically on pressure ulcers. In a prospective randomized study, 50 patients with pressure ulcers were divided into 2 groups: Control group received standard wound care and the study group was treated with LTAPP once every week for 8 consecutive weeks in addition to standard wound care. We found that the group treated with LTAPP had significantly better PUSH (Pressure Ulcer Scale for Healing) scores and exudate amount after 1 week of treatment. There was also a reduction in bacterial load after 1 treatment regardless of the species of bacteria identified.

Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: A 15-year experience.

Background: Asians have low nasal dorsum, thick skin envelope, low defined alar cartilage, low projection of nasal tip and broad alar base. Augmentation rhinoplasty with silicone prosthesis has been performed with predictable results, but unfavourable results and complications still present. This series show techniques and results from single surgeon experience. Materials and Methods: We retrospectively reviewed 548 patients chart during January 1995 to December 2009. All patients underwent custom-made S-shape implant silicone augmentation rhinoplasty operated by a single surgeon. There were three major operative steps: (1) Intra-operative S-shape implant carving; (2) pocket dissection through bilateral rim incision and (3) tension adjustment before closure. All the patients were recorded for early surgical complications and satisfaction. Results: There were 519 women and 29 men. The mean age is 25.5 years (18-56 years). Mean follow-up period was 6 months (1-60 months). The majority of patient were appointed for esthetic augmentation (86.8%). 515 cases (94.9%) showed well satisfaction following the operation. The total complication rate was 6.5% (4.9% deviation, 0.7% extrusion, 0.5% hematoma and 0.3% infection). All the complications were corrected with uneventful sequelae. Conclusion: Augmentation rhinoplasty with custom-made S-shape silicone implant by closed approach provides high satisfaction with acceptable early complication rate.

Siliconoma of the breasts

Despite prohibiting of the foreign material injection for aesthetic breast augmentation in many countries. Its late complications still bring patients back for corrective and reconstructive surgery. There is no clinical management consensus or international guideline. Most of the literatures recommend surgical removal with immediate reconstruction with autologous tissue. We report a case of bilateral breast siliconoma which was treated by total mastectomy with two stage tissue expander-prosthesis reconstruction.