Ju-Peng Fu

Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction?

BACKGROUND Surgical wound infection is a common complication, which increases the hospital stay and costs after surgery for head and neck cancer. In this study, we evaluated the effect of Triclosan-coated sutures on surgical wounds and analyzed the risk factors for wound infections in head and neck cancer surgery. PATIENTS AND METHODS From January 2007 to December 2009, 253 consecutive patients underwent wide excision of a head or neck cancer and reconstructive procedures. All patient data were collected prospectively. Of these, 241 patients were included in this study, divided into two groups. The Triclosan group contained 112 patients, whose surgical wounds were closed with Triclosan-coated sutures (Vicryl Plus). The control group included the remaining 129 patients, whose surgical wounds were closed with conventional Vicryl sutures. We conducted a retrospective, multivariate analysis to determine independent risk factors for the cervical wound infection. RESULTS The cervical wound infection rate was 14.9% (17/112) in the Triclosan group and 14.7% (19/129) in the control group, and these rates were not significantly different. Tumour stage and delayed intra-oral flap healing were independent risk factors for cervical wound infection. CONCLUSIONS In this preliminary study, Triclosan-coated Vicryl sutures did not reduce the infection rate of cervical wounds after head or neck cancer surgery. The effectiveness of this suture material in head and neck cancer surgery should be considered with caution.

Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction

BACKGROUND The anterolateral thigh (ALT) flap is a frequent choice for free flap transfer in head and neck cancer reconstruction because of its versatility. Preoperative mapping of the perforator pedicles of an ALT flap is still a challenge because of variations in vasculature. Although computed tomographic angiography (CTA) is used increasingly to evaluate the peripheral vasculature, the use of this method for evaluating the perforators of an ALT flap has not been described in detail. METHODS From September 2008 to March 2009, 32 patients underwent preoperative CTA before free ALT flap transfer for head and neck cancer reconstruction. The perforators were marked on a 64-section multidetector CT image for each patient. The preoperatively mapped perforators were compared with the actual intraoperative findings. Flap success rates and associated morbidity and complications were recorded. RESULTS Preoperative CTA identified major variations in perforators. Eighty-four were found by preoperative CTA; 64 of these were mapped to be explored during the operation, and 13 additional perforators were identified during surgery. The accuracy rate of identifying the branching origin of the ALT perforators was 98% (63/64). All of the ALT flaps survived except for one with necrosis (survival rate 97%). There was no donor site morbidity. CONCLUSIONS Preoperative mapping of perforators by CTA proved valuable in free ALT flap transfer and shortened the operation time significantly. This modality provides useful information for head and neck cancer reconstruction in difficult cases, especially in patients with large or through-and-through defects that might need multiple perforators in flap design.

Reconstruction of trochanteric pressure sores with pedicled anterolateral thigh myocutaneous flaps

BACKGROUND To provide an alternative choice for covering trochanteric pressure sores, we report on a modified pedicle anterolateral thigh (ALT) myocutaneous flap based on the descending branch of the lateral circumflex femoral artery. METHODS From August 2007 to January 2010, 20 consecutive patients (10 men and 10 women) underwent 21 pedicled ALT myocutaneous flaps for reconstruction of trochanteric pressure sores. The flap was designed and elevated, resembling the ALT perforator flap including part of the vastus lateralis muscle but without skeletonisation of the perforators. RESULTS The mean age of patients was 79.4 years (range: 46-103). The mean follow-up period was 13.9 months (range: 3-32). The flaps were 8-21 cm long and 5-11 cm wide. All flaps healed without major complications. All donor sites were closed primarily without skin grafting and showed good aesthetic results. No recurrence was observed. CONCLUSIONS This modified design of pedicled ALT myocutaneous flap without skeletonisation of perforators is a reliable and easily harvested flap for reconstruction of trochanteric pressure sores with limited morbidity.

Deep sole burns in several participants in a traditional festival of the firewalking ceremony in Kee-lung, Taiwan-Clinical experiences and prevention strategies

PURPOSE Firewalking is a common Taoist cleansing ceremony in Taiwan, but burns associated with the practice have rarely been reported. We analyzed the patients with plantar burns from one firewalking ceremony. MATERIALS AND METHODS In one firewalking ceremony, 12 Taoist disciples suffered from contact burns to the soles of their feet while walking over burning coals. Eight of them had at least second-degree burns over areas larger than 1% of their total body surface areas (TBSAs). The age, sex, medical history, date of injury, time taken to traverse the fire pit, depth and TBSA of the burns, treatment, length of stay, and outcome were recorded and analyzed. RESULTS Deep, disseminated second- to third-degree burns were noted and healing took as long as three weeks in some patients. Because disseminated hypertrophic scars form after burns, the soles involved regain much of their tensile strength while walking. The patients experienced only a few difficulties in their daily lives three months after injury. CONCLUSION From our experience treating patients with deep disseminated second- to third-degree plantar burns caused by firewalking, we conclude that they should be treated conservatively, with secondary healing rather than a skin graft.

Reconstruction of a Large Abdominal Wall Defect by Using a Pedicled Vastus Lateralis Muscle Flap: A Case Report and Literature Review

The pedicled anterolateral thigh (ALT) flap is safe and reliable for repairing abdominal wall defects. This flap has a long pedicle and a wide arc of rotation, and it can extend from above the umbilicus and the lower back to the upper thigh, including the groin and perineum. The ALT flap is a technically simple muscle flap that permits primary closure and minimal morbidity of the donor site. We report a case of successful reconstruction of a large abdominal defect after tumor resection by using a pedicled vastus lateralis muscle flap. Literature review on the clinical applications of the ALT and pedicled vastus lateralis muscle flap for reconstruction of soft tissue defects were performed.

First Successful Major Lower Limb Replantation in the Penghu Islands-a Case Report

Background:Although major limb replantation is not a life-saving procedure, it is a highly important and urgent operation, allowing for superior patient outcomes.Aim and objectives:Shorter the ischemia time, greater are the chances of a successful replantation, especially in major limb replantations.Materials and Methods:We report the case of a 36-year-old fisherman from Mainland China. His fishing craft was located across the Taiwan Strait near the Penghu archipelagos. In an accident, both his legs were crushed by a rapidly stretching boat hawser, while he was trying to put a fishing net down in the sea. His legs were amputated above the ankle and the amputated parts fell into the sea. Fortunately, the left foot could be recovered, but the right foot could not. As Mainland China was over 8 hours away, a distance too far for the injured man to travel, they contacted our hospital, only 2 hours away, to try to salvage the amputated limb. We accepted the case and instructed them on how to preserve the amputated part according to the guidelines for preserving the amputated limb. This entailed preserving the amputated part in a closed bag with rinsed and normal saline, and keeping it in a cold ischemic state in the refrigerator before reaching it to our hospital. The cold ischemic state helped us achieve successful salvage.Results:Successful replantation (lower third leg level) was performed in a 10-hour operation at the Tri-Service General Hospital Penghu Brance included only 4 days of attending physician experience in plastic surgery, as thch by a new, young, and inexperienced plastic surgeon. The surgeons prior experiene surgeon had completed his final exam 3-4 days earlier and had recently passed the oral examination of our plastic surgery association. The below-knee amputation was performed on the contralateral limb. The patient was discharged 22 days after the operation and subsequently returned to Mainland China.Conclusion:This was the first case of a successful replantation of the major limb in Penghu and the extra-islands of Taiwan, R. O. C. Successful replantation was achieved because of a short warm ischemia time, adequate debridement, and an aggressive control of infection.

Acrometastasis of Parotid Gland Cancer Presenting as a Felon

Background:Metastases occurring in the hands (acrometastasis) are rare and often misdiagnosed.Aim and Objectives:Herein, we report a patient who had acrometastasis of the finger from carcinosarcoma ex pleomorphic adenoma of parotid gland.Material and Methods:A 59-year-old right-handed man, suffering from a two-week history of progressive painful swelling, changed over pulp region of right little finger. Clinical assessment indicated a felon disease of right little finger. He also had history of the carcinosarcoma ex pleomorphic adenoma of parotid gland with the clinical stage of T3N1M1 diagnosed one year ago. Excisional biopsy was then performed and the wound was left open drainage for second intention healing. Histological study further revealed a metastatic carcinosarcoma ex pleomorphic adenoma of parotid gland.Results:But patient refused the surgery of amputation of right little finger and underwent adjuvant radiotherapy afterwards. One month later, he died of pulmonary metastases with massive malignant pleural effusion and respiratory failure.Conclusion:Herein we present a rare case of CXPA with hematogeneous matastasis to the finger pulp presenting as a felon disease. Carefully tracing the past history of malignancy and making meticulous differential diagnosis are necessary to prevent misdiagnosis and ensure best therapeutic outcome. (J Taiwan Soc of Plast Surg 2011; 20: 339∼343)

Malignant Melanoma in a Patient with Oculocutaneous Albinism-A Case Report

Background:Malignant melanomas in patients with albinism are rare, with only a few cases having been reported to date.Aim and objectives:A pink mole lesion that had been ignored for one year was noted on the lower abdominal region in a patient with oculocutaneous albinism. An excisional biopsy revealed a malignant melanoma.Materials and methods:A wide excision combined with sentinel lymph node mapping was done. The work-up study revealed no metastatic lesions.Results:The patient was followed for three years without evidence of local recurrence or metastasis.Conclusion:Early diagnosis, protection from sunlight, and treatment of actinic keratoses and skin cancers in patients with albinism are crucial in assuring their longevity. Evaluation of all suspicious lesions is important in patients with albinism, as they have a strong tendency to develop morphologically confusing malignancies.

Early Experience of the Use of Cohesive Silicone Implants for Breast Reconstruction

Background: The silicone gel implants have been widely used for breast augmentation and reconstruction since 1960s. In 1992, the use of the silicone gel implants for breast reconstruction and augmentation was limited by United States Food and Drug Administration (FDA) because of a possible link to connective tissue diseases. Implant manufacturers began developing new generation silicone implants, so-called ”cohesive gel” implants, that had increased silicone cross-linking to create a more viscous gel. Several prospective, multicenter trials had been performed to ensure their safety and efficacy. The cohesive silicone implant was qualified for the use of breast reconstruction in Taiwan on Nov, 2008. As the silicone gel controversy has resolved, the reintroduction of gel devices as the preferred implant following two-stage or one stage breast reconstruction surgery was suggested with improved aesthetics Aim and Objectives: The purpose of this study was to examine the surgical outcomes of a single medical center in a consecutive series of breast reconstruction cases using the cohesive silicone implants. Materials and methods: A retrospective chart review was conducted to identify all patients who underwent breast reconstruction with cohesive silicone breast implant in a single medical center over 21 months period (Dec 2008 to Aug 2010). For each patient, demographic information, comorbidities, and surgical information (implant size, number, the type of excision, incision site and concomitant surgery) were recorded. In addition, outcomes were analyzed to identify complications and the need for surgical revision. The cosmetic result was evaluated with the self-assessment sheets. Results: A total of 28 smooth wall cohesive silicone gel implants were placed in 21 patients during the 21-month study period. The overall complication rate per implant was 10.7% (3/28). The most common complication was wound infection (7.1%; 2/28). No implant rupture or gel bleed was found. No significant difference of complication rate was found between the patients who had immediate or delayed breast reconstruction (1/13 vs. 2/15; p=1.00, Fishers exact test). Two revisions were noted in our case series due to radiation ulcer with implant extrusion and implant intolerance. The self-assessment report revealed a good result of the overall satisfaction and improvement in self-confidence (each of the average scores was 8.5 and 8.3 in a 10-point scale). Eighty-eight percent of the patients (16/18), who returned the self-assessment sheets, would recommend other patient to do the breast reconstruction with cohesive silicone implants. No any connective tissue disease was found in our study. Conclusions: In our study, no causal relationship has been established between cohesive silicone breast implants and other disease. Our study illustrates a good preliminary result of the cosmetics, safety and efficacy of smooth wall cohesive silicone implants use for breast reconstruction in both immediate and delayed breast reconstruction groups with relative low complication and revision rate. This is the first preliminary result of breast reconstruction with cohesive silicone implants in Taiwan and long-term follow-up should be continued.

A Comparison of Parasacral Perforator Flaps and Superior Gluteal Artery Perforator Flaps for Sacral Defects

Background: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Gluteal perforator flaps have been used widely for reconstructing sacral defects. We present our experience of using parasacral perforator flaps or superior gluteal artery perforator (SGAP) flaps in reconstructing sacral defects and compare the surgical outcomes. Methods: Between January 2003 and August 2009, 44 patients with sacral defects were included in this study. All the patients had undergone surgical reconstruction of sacral defects with a parasacral perforator flap or an SGAP flap. The patients’ gender, age, medical comorbidity, flap size, flap type, number of perforator used, rotation angle, postoperative drainage amount and postoperative complications were recorded, and a comparison was done between the two groups. Results: There were 27 SGAP flaps and 17 parasacral perforator flaps in this series. All survived uneventfully except for three SGAP flaps and one parasacral perforator flap. The flap survival rate was 91 percent (40/44). There were no significant differences between the two groups in flap size or survival (P=0.47). The mean operation time was significantly shorter in the parasacral flap group (P=0.01). Conclusion: Both parasacral perforator flaps and SGAP flaps are durable and reliable in reconstructing sacral defects. By saving operation time and offering a short learning curve for the surgeon, we recommend the parasacral perforator flap as a good choice for reconstructing sacral defects.