Chung-Lin Chen

Comparison of Open and Closed Reduction in Subcondylar Fracture

The aim of this study was to evaluate the long term result of open reduction plus rigid internal fixation as compared with that of closed reduction and intermaxillary fixation in the cases of dislocated mandibular subcondylar fracture. Twenty three patients were enrolled into the series, with 12 cases undergoing open reduction and 11 others having intermaxillary fixation alone. Patients treated with open or closed methods were assessed according to the maximum interincisal opening, protrusive movement, deviation on opening, scar quality, motor function, sensory perception, contour change, occlusion and intensity of joint pain. Long term follow-up results revealed that cases treated with closed reduction tend to have suboptimal outcome, especially in cases with axial inclination of the condylar head, intracapsular fractures, dislocation of the condyle from the confines of the glenoid fossa, and their clinical manifestation include symptoms like severe pain, jaw deviation/deflection upon mouth opening or malocclusion. (J Plast Surg Asso R.O.C. 2006; 15:241~250)

Colonic Perforation in a Burn Injury

Colonic necrosis and perforation in burn patients were extremely rare and of high mortality. The authors will report a 77-year-old female suffered from a flame burn with an area of 16% of the total body surface complicated with sigmoid colonic perforation. Her past medical records included hypertension, atrial fibrillation, and mild senile dementia. She was sent to a medical center where she received the standard therapeutic procedure for burn injury. Unfortunately, she was accidentally found free air under the diaphragm via chest plain film. There was necrotic tissue with perforation in the sigmoid colon under urgent exploratory laparotomy. The patient was rescued finally after a long term medical care. When referring to the English literature from Medline, there was no report of burned patient complicated with sigmoid colon perforation. Hence, the authors would share their experience in this case by warning the serious abdominal complication cause by burn injury.

Iatrogenic Burns Sustained from Alcohol during Operation: Report of Two Cases

Alcohol-related burns sustained by patients while being operated on are rare, but they can have serious consequences. We report two fires in operating rooms where both patients sustained burns due to pools of povidone-iodine alcohol solution and alcohol solution ignited by an electrocautery unit. The related literature is also reviewed.

Transposition of Gracilis Muscle Flap for Treatment of Recurrent Rectovaginal Fistulas Due to Obstetrical Injury

Rectovaginal fistula, an abnormal epithelium-lined communication between the rectum and vagina, poses a great impact emotionally, socially, and sexually in all affected women. Traditionally, treatment of RVF is excision of the fistula and layer repair of the healthy tissue. However, too much tension around the sutured wound is unpreventable. The fistula recurs eventually. The chief effect of transposing the gracilis muscle is the interposition of well-vascularized, healthy muscle between the rectum and vagina to promote healing of the intractable fistula. From July 2000 to January 2003 at out hospital, four patients following vaginal deliveries endured a complex and recurrent rectovaginal fistula. All of the fistulas were larger than 2.5 cm in size, which were difficult to repair primarily. After fistulectomy was performed, the gracilis muscle flap was transposed to tamponade in the space between vagina and rectum. No colostomy was performed in our all patients. No patients experienced recurrence upon six to eighteen month follow-up. The additional advantages of the gracilis muscle flap for reconstruction of perineal defects is its reliability and long-standing use. It has proved to be a time-honored workhorse for perineal reconstruction. Functional donor site morbidity is minimal, In addition, the long slender shape of the gracilis muscle flap provides the advantage of this muscle to fill the perineal area appropriately.

Branchial Cleft Cyst in Parotid Gland

Branchial cleft cyst is a rare condition and a first branchial cleft cyst in the parotid, or parotid lymphoepithelial cyst, is an even rarer condition. We have reviewed the branchial cleft cysts in the parotid gland for the past 16 years at National Cheng-Kung University Hospital. There were three cases present among 340 parotid tumors. The clinical pictures and courses of all three cases will be presented. All three patients received superficial parotidectomies and had uneventful post operative courses, except one who sustained mild Frey syndrome. Final diagnosis was proven by histopathology. This paper summarizes the embryological background of the clefts probable pathogenesis and the main histological findings. The clinical pictures, diagnostic tools, treatment recommendations and prognosis are also discussed in this paper.

Application of Hydrofiber Dressing (Aquacel) in Treatment of Pediatric Burn Patients

From January to July 2001, a total of 18 pediatric patients with partial thickness burn wounds were treated with a kind of hydrofiber dressing (Aquacel) in our hospital. 14 patients were superficial partial thickness burn and 4 patients were deep burn. The average wound size covered with Aquacel was 8.4% of TBSA (Total Body Surface Area). In 14 patients the wounds healed within 2 weeks. One patient failing to heal within 2 weeks was treated with silver sulfadiazine ointment after detachment of the dressing. In one patient, split thickness skin graft was needed 8 days after application of the dressing due to poor attachment of the material with wound. One had wound infection due to contamination of the dressing in buttock area 11 days after application. The others had good result. We conclude that the hydrofiber dressing (Aquacel) is a safe, convenient and easy applied material in treatment of pediatric partial thickness burn wounds. However, we suggest not to use the dressing in perineum area and it is better to convert the treatment protocol to traditional methods if poor adherence of the dressing is found.

Polydactyly-A Study on Complications for Early Operation

From October 1988 to March 2000, 110 patients with 125 polydactyly underwent surgical correction at NCKUH were retrospectively studied for sex distribution, age at time of operation, type of polydactyly, and surgical complications. Of these patients, the male to female ratio is 59 to 51. Most patients received surgery within the first two years of life (81 cases, 73.6%), only 29 patients (26.4%) underwent surgical ablation after two years of age (ranging from one month to 39 years). In 125 hands with polydactyly, the classification was as follows: 118 preaxial (Wassels classification type Ⅰ: 3; type II: 20; type Ⅲ: 2; type Ⅳ: 54; type Ⅴ: 14; type Ⅵ: 9; type Ⅶ: 13; and 3 unclassified), 6 postaxial (three patients, bilaterally) and the other one had seven digits in the left hand. Our data showed that the most common type of polydactyly in our institution is preaxial type (94.4%), and Wassels type IV thumb is the most common type in the preaxial group. There were six complications (4.8%), including two joint deviation of the thumb, two stitch abscesses, one partial dehiscence of the wound and one partial necrosis of the reconstructed fingertip. The complication rate of early operation was 4.9% (4/81). Early surgical correction of polydactyly is effective, and the incidence of surgical complications is acceptably low.

Aeromonas Sepsis in Severe Burn Patients

Aeromonas infection is uncommon in burn patients, with less than twenty cases reported in English literature. From January of 1993 to April of 1999, seven patients developed aeromonas infection at National Chen Kung University Hospital Burn Center. Among these patients, two had aquatic exposure. Blood cultures revealed aeromonas bacteremia. All of them demonstrated clinical manifestations of sepsis, such as fever, hypotension, acute renal failure, altered consciousness. None of them survived, in spite of the combination of medical therapy and surgical management with tangential excision and STSG. The microbiology, epidemiology, pathophysiology and therapy of this pathogen were also discussed. Aeromonas infection in burn patients is rare but may cause tremedous rate of mortality, up to 100%. According to the painful experience, we will try more aggressive surgical intervention, for example, fasciectomy on infectious burned lesions, and the third-generation cephalosporins combined with suitable aminoglycosides.

Primary Costochondritis or Osteomyelitis of the Ribs

Rib infection is often secondary to trauma or from the direct spread of infection from the underlying lung or pleura. Primary costochondritis or osteomyelitis is rare in medical literature. We have treated 5 patients with these problems at NCKUH in the last ten years. All of the treated patients are older than 40 and only one patient was female. One patient was diagnosed with diabetes mellitus and received regular treatment, another one patient had pulmonary TB and was cured about 20 years ago. No other systemic problems can be traced during hospitalization. Different causative pathogens are cultured in these cases. CT scan, MR image and bone scan are helpful tools for pre-operative diagnosis although ultrasound is a more available modality. Wide excision and systemic antibiotics are cornerstones to cure these diseases, followed by muscle flap or omen-tum transfer to nourish the denuded bed and to restore the contour in selected cases.

Complications of Silicone Gel Sheeting for Burn Scar

Silicone gel sheet has been used to manage fresh burn scar for years. Some burn units have demonstrated improved scar maturaton with silicone gel sheets also. Rare author illustrates the complications of this sheeting. In south Taiwan, it is warm and high humidity, many patients who used the silicone gel sheet complained discomforts and other drawbacks. For these reasons, we designed a questionnaire to survey the problems. The questionnaire including complications, drawbacks and efficacy of silicone gel sheets management is designed to 150 burn scar patients at outpatient clinics of our hospital from Jan. 1995 to Dec. 1996. Sixty-three patients (42%) responded. They are 29 males and 44 females and 22 years old in mean age. The results showed itching (67%) is the most complaint, then foul odor (29%), rash (24%), maceration (19%), sweating (16%), and allergy (10%) in order. About the drawbacks, poor attachment is the highest (48%), then expensive in cost (44%), poor durability (19%) and easy contamination (13%). Subjective improvements of scar after applying the silicone gel sheet are diminished scar thickness (84%), thinner colory (78%), improved scar texture (74%). About 65% patients think that silicone gel sheet can reduce the scar. According to these results, we subjectively offer the good clinical response in using the sheet on burn scar snd, necessarily, explain in detail the high complications and drawbacks to patients in south Taiwan.