Chu-Hsu Jeng

Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton: A case report

Treatment of an avulsion or degloving injury of the hand is a difficult but not unusual operation for plastic reconstructive or hand surgeons. The avulsion may be salvaged by arteriovenous shunting technique. We present a patient with incomplete avulsion injury of the distal phalanx of thumb. Arteriovenous shunting was created and the wound reconstructed primarily under venous arterialization. The avulsed skin envelope was survived well and functional status was improved.

Experience of Surgical Treatment for Occipital Migraine in Taiwan.

PurposeRefractory migraine surgery developed since 2003 has excellent results over the past 10 years. According to the pioneer of migraine surgery, Dr. Bahman Guyuron, 5 major surgical classifications of migraines are described in the field of plastic surgery, namely, frontal migraine, temporal migraine, rhinogenic migraine, occipital migraine, and auriculotemporal migraine. In this study, we present the preliminary surgical results of the occipital migraine surgery. Materials and MethodsA total of 22 patients with simple occipital migraines came to our outpatient clinic for help from June 2014 to February 2015. Thirteen cases were excluded owing to ineligibility for operation or other reasons. The patients who concurrently experienced other types of migraines were precluded even if they received combined migraine surgery. Therefore, 9 simple occipital migraine cases were enrolled in this study. Migraine severity was evaluated by uniform questionnaires to identify the source of migraine. Neurolysis was performed under general anesthesia, with the patient in a prone position. Postoperative conditions were evaluated at the second, fourth, sixth, and eighth weeks by posttreatment questionnaires. ResultsOf all the 9 patients, 5 experienced single-sided migraines of greater occipital nerve origin (2 left-sided and 3 right-sided cases). Two patients had bilateral migraines of greater occipital nerve origin, and unilateral right lesser occipital nerve origin was noted in one patient. The last patient had right-sided migraines of greater and lesser occipital nerve origin. As a result in the follow-up, a response rate greater than 90% was documented, and complete resolution was observed in 2 patients. Drug doses were reduced more than 50% in the remaining patients. The overall efficacy of occipital migraine surgery in this study was 88.8% (8/9 cases). ConclusionSome patients with migraine are good candidates for surgical resolution with appropriate and meticulous selection. Similar to what is observed in Western countries, the migraine surgery is promising and could provide a better quality of life to selected refractory migraine patients in Taiwan.

Idiopathic Granulomatous Mastitis-A Problematic Wound in Breast-Case Report

Background:Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease. Like the autoimmune disease, pyoderma gangrenosum, surgical debridement may lead to problematic wound healing unless aggressive mastectomy is performed. However, some immune-suppressive agents may help wound healing.Aim and Objectives:Treatment of idiopathic granulomatous mastitis by both surgical and medical strategies was discussed.Materials and Methods:A 35 year-old female was diagnosed of idiopathic granulomatous mastitis through pathological examination. Excision biopsy was done but inadequate wound healing with local ulceration was observed. Therefore, oral 5mg prednisolone was prescribed for anti-inflammatory therapy.Results:His wound healed appropriately 3 weeks after oral prednisolone. No recurrent episodes were noted during the follow-up period of 12 months.Conclusion:Oral immune-suppressive agents, instead of surgery, may be the first line therapy of idiopathic granulomatous mastitis when breast preservation is concerned. This therapeutic strategy should be provided to the patients with IGM by both plastic and general surgeons.