Chieh-Chi Huang

Interdental distraction osteogenesis and rapid orthodontic tooth movement. A novel approach to approximate a wide alveolar cleft or bony defect

The closure of a wide alveolar cleft and fistula in cleft patients and the reconstruction of a maxillary dentoalveolar defect in traumatic patients are challenging for both orthodontists and surgeons. This is due to the difficulty in achieving complete closure by using local attached gingiva and the great volume of bone required for the graft. In this article, the authors propose using interdental distraction osteogenesis to create a segment of new alveolar bone and attached gingiva for the complete approximation of a wide alveolar cleft/fistula and the reconstruction of a maxillary dentoalveolar defect. They performed this procedure on one patient with a traumatic maxillary dentoalveolar defect and 10 patients with unilateral or bilateral cleft lips and palates who had varied dentoalveolar clefts/fistulas. Interdental and maxillary osteotomies were performed on one side of the dental arch by the cleft or defect. After a latency period of 3 days, the osteotomized distal segment of the dental arch was then distracted and transported toward the cleft or defect by using a toothborne intraoral distraction device. The alveoli and gingivae on both ends of the cleft or defect were approximated after distraction osteogenesis. The need for extensive alveolar bone grafting was eliminated. A segment of new edentulous alveolus and attached gingiva was created interdentally at a site distant to the cleft or defect. In the cleft patients, teeth were moved orthodontically into the regenerate (newly formed alveolar bone) dental crowding 1 week after distraction. The orthodontic tooth movement was rapidly completed in 3 months, and the edentulous space was eliminated. Interdental distraction osteogenesis minimizes an alveolar cleft/fistula and helps reconstruct a maxillary dentoalveolar defect by approximating the native alveoli and gingivae; it also creates new alveolar bone and gingiva for rapid orthodontic tooth movement. (Plast. Reconstr. Surg. 105: 1262, 2000.)

Subtotal Resection of Gastrocnemius Muscles for Hypertrophic Muscular Calves in Asians

Background: Many Asian women are bothered by plump calves, which they consider to be unsightly. In the past, liposuction was frequently performed to treat oversized legs, but little effect could be obtained if the condition was caused by hypertrophy of calf muscles. Methods: Gastrocnemius muscle resection for hypertrophic muscular calves was performed in 20 patients at Buddhist Tzu Chi General Hospital from May of 2001 through September of 2004. One patient underwent resection of the medial head only, two underwent total resection of both medial and lateral heads, and the other 17 patients underwent subtotal resection with preservation of the proximal 4 to 6 cm of muscle of both heads. Results: The resected gastrocnemius muscle weighed from 250 to 430 g per calf (mean, 343 g). The maximal calf circumference was between 32 and 41 cm (average, 35.2 cm) preoperatively and 26 and 35 cm (average, 30.5 cm) postoperatively. Calf reduction was 3.5 to 7 cm (average, 4.7 cm), or 10.1 to 21.2 percent (average, 13.3 percent). Two patients developed seroma and three developed late hematoma. One patient had dragging of one foot because of incidental severance of the nerve to the soleus muscle that lasted for 6 months, until complete recovery occurred. No patient complained of functional deficits during gait or sports activities after 3 to 6 months. Conclusions: Subtotal resection of both heads of the gastrocnemius muscle can result in satisfactory calf reduction without impairment of leg function and avoid hollow deformity in the popliteal fossa. Five patients still had scar problems during the short-term follow-up period, but all were rather satisfied with their reduced calf sizes.

Reconstruction of extensive composite oromandibular defects with simultaneous free anterolateral thigh fasciocutaneous and fibular osteocutaneous flaps.

Massive composite defects of the face are difficult to reconstruct. Such defects are usually created after ablation of advanced cancers of the head and neck region. The use of a free fibular osteocutaneous flap for the bone and mucosal lining of the oral cavity and anterolateral thigh flap for the outer cutaneous lining are well established. We present our experience of using these two flaps simultaneously in the reconstruction of such defects and to evaluate the outcome. There were a total of 10 patients in our study. Their average age was 48.8 years. All had squamous cell carcinoma of the oral cavity. Their pathological stages were mostly stage T4 with only one case being T3. Flap survival was 100%. The application of dual free flaps, though technically more demanding, allows good orientation of the flaps. Seven patients maintained a good functional outcome. They were able to eat a soft diet. Their speech was easily comprehensible. The combination of a free anterolateral thigh flap with vascularized fibular osteocutaneous flap can be performed safely with adequate functional outcome. This combination of flaps should be considered for this group of patients.

The proximal lateral lower leg perforator flap revisited: Anatomical study and clinical applications

The proximal lateral lower leg flap is a flap suited for the reconstruction of small and thin defects. The purpose of this study was to map the position and consistency of the perforator vessels and to review its reliability and technical considerations clinically.

A comparison between proximal lateral leg flap and radial forearm flap for intraoral reconstruction.

AbstractFree flaps have become a popular option for the reconstruction of intraoral defects. The radial forearm flap used to be the workhorse flap for small and thin defects, but was associated with numerous donor-site morbidities. The proximal lateral leg flap can provide a thin and pliable tissue similar to the radial forearm flap but without the related donor-site morbidities. We compared the differences between these 2 flaps. Thirty-four patients with intraoral defects from September 2005 to October 2011 were reconstructed, using the radial forearm flap in 23 cases, and the proximal lateral leg flap in 11 cases. The radial forearm flap group had a success rate of 95.6%. The flap survival rate was 100% in the proximal lateral leg flap group. However, the difference was statistically insignificant. Skin graft was required in 22 of the 23 cases for the donor site of the radial forearm flap. Partial loss of the skin graft occurred in 5/22 (23%) of the patients, with exposure of tendons in 3/22 (14%). Delay in healing of the donor sites occurred in 6/23 (26%) of the patients. The donor sites of the proximal lateral leg flap were all closed primarily. One case developed wound dehiscence and this healed by conservative treatment. Long-term follow-up showed functional impairment of the donor forearm (reduced extension or grip strength) in 17% of the patients. Thirty percent of the patients developed sensory disturbance and 48% complained of poor outcome of the donor forearms. In the proximal lateral leg flap group, no motor or sensory functional deficits were seen. No patients complained of poor outcome of the donor legs. Primary closure of the donor site of the proximal lateral leg flap could be performed if the flap width was less than 6 cm. This flap is useful for patients with small and thin intraoral defects and is associated with minimal donor-site morbidity when compared to the radial forearm flap.

Expanding the applications of the pedicled anterolateral thigh and vastus lateralis myocutaneous flaps.

AbstractWe describe our experience in expanding the use of pedicled anterolateral thigh and vastus lateralis myocutaneous flaps. A total of 33 patients underwent 34 flaps between March 2003 and January 2012. The defects included 18 ischial, 3 trochanteric, 5 lower abdomen, 2 perineogenital, 1 groin, and 5 knee defects. There were 29 proximal pedicled (2 of which were preexpanded), 3 distal pedicled, and 2 propeller flaps. Complications included 1 total necrosis, 1 partial necrosis, 3 wound dehiscence in recipient site, 1 hematoma, and 1 donor-site dehiscence. The total flap survival rate was 94%. There were no donor-site morbidities except poor cosmesis in the skin-grafted sites. Pedicled anterolateral thigh flap is highly versatile with a wide arc of rotation. A proximal pedicled flap can be used for lower abdomen, perineogenital, ischial, and trochanteric defects and the distal pedicled or a propeller flap for knee and proximal lower leg defects.

Reconstruction of advance head and neck cancer patients after tumor ablation with simultaneous multiple free flaps: indications and prognosis.

AbstractSimultaneous multiple free flaps have become a useful option in head and neck reconstructions. We performed a 10-year retrospective study between 2001 and 2010. There were 58 men and 1 woman. The overall mortality rate was 51.7%. The longest surviving patient is 9 years and 4 months, whereas the shortest surviving patient was 72 days. The mean survival period was 47.1 (6.8) months. Age (P = 0.755) and tumor size (P = 0.115) did not play a major role, but surgical margin, lymph node, and tumor recurrence were significant in patient survival with a P value of 0.026, 0.01, and 0.026, respectively. If wide excision with a margin that can be free of tumor can be performed, lymph nodes are not involved, and this is a primary tumor, then time and effort should be spent in a successful simultaneous multiple free flap reconstruction.

Endovascular revascularization and free tissue transfer for lower limb salvage

Combined bypass surgery with free flap reconstruction is an established method for lower limb salvage. But the success of the combination of endovascular revascularization together with free tissue transfer has so far not been well established. A retrospective review of all patients who had undergone endovascular revascularization and reconstructed with free tissue transfer for lower limb salvage at Tzu Chi Dalin General Hospital between 2008 and 2012 was performed. A total of 26 legs underwent limb salvage in 24 patients. There were 10 male and 14 female patients. Their average age was 71.4 years. The average time interval between endovascular intervention and free tissue transfer was 8 days. There was 100% flap survival but partial flap necrosis was seen in three patients. A high rate of wound infection was seen in eight patients, all requiring further debridement. The total limb salvage rate at 1-year follow-up was 96% and 92% at the 2-year follow-up. In conclusion, the success rate of lower limb salvage using a combination of endovascular revascularization and free tissue reconstruction is comparable to using a combination of bypass surgery and free tissue transfer. It is associated with a high flap success rate and a high limb salvage rate. It provides physicians with a further treatment option in the management of ischemic lower limbs with extended tissue loss.

A comparison between combined open bypass revascularization and free tissue transfer versus endovascular revascularization and free tissue transfer for lower limb preservation.

Extensive defects of the lower limb as a result of diabetes and peripheral vascular disease require multidisciplinary treatment. Numerous studies with regards combining vascular bypass surgery and free tissue reconstruction of the lower limb had been published. However the trend has evolved toward a combination of endovascular revascularization and free flap reconstruction. The aim of this study was to compare the safety and efficacy of this combination of treatment to the traditional combination of bypass surgery and free tissue reconstruction.

Treatment of Venomous Snakebites in Eastern Taiwan

Background: The incidence of snakebites decreased gradually in recent years due to change of the socioeconomic environment in Taiwan. However, venomous snakebites still can cause severe morbidity and even death occasionally. Aim and Objectives: This report described treatment and result of poisonous snakebites in Eastern Taiwan. We hope to improve management and decrease complications. Materials and Methods: The medical records of the patients admitted to the Buddhist Tzu Chi General Hospital due to venomous snakebites from Jan 2000 to Sep 2004 were retrospectively reviewed. The patients demographic data, species of causative snake, manifestations of envenomation, treatment and clinical course were collected and analyzed. Results: There were 93 cases of snakebites collected. Most of the snakebites (27%) occurred in the fourth decade of age. The species of snakebites included: Taiwan habu bites (29%), Taiwan bamboo viper bites (16%), cobra bites (7.5%) and unknown bites (34%). The most common locations of the bite were in the upper extremity (60%). 24 patients (25.8%) required surgical intervention, including fasciotomy which was performed in 17 patients (18.3%). The average lengths of hospital stay in non-operated group and operated group were 4.2 days and 18.8 days respectively. Acute renal failure developed in three patients, and one of them required temporary hemodialysis. There was only one death in this series. Conclusion: Surgical intervention is indicated in a particular group of patients and different treatment algorithms should be developed according to snake species to decrease the morbidity of venomous snakebites.