Kuo-Feng Huang

Evolution of the free groin flap: the superficial circumflex iliac artery perforator flap.

Background: The free groin flap, revolutionary in 1972, has gradually lost its relative popularity because of the new free flaps available as well as because of some of its inherent disadvantages, including a short arterial pedicle, variable arterial anatomy, the generally small caliber of the included blood vessels, its bulkiness, and numbness at the donor site. Methods: From December of 2002 to May of 2004, the authors successfully overcame a number of these disadvantages by means of clinical application of the superficial circumflex iliac artery perforator flap in 12 patients (age range, 15 to 67 years). These surgical procedures involved nine recipient sites in the upper limbs, two in the foot, and one in the buccal region. Results: This flap not only overcomes most of the disadvantages of the free groin flap but also demonstrates many of its advantages, including the following: (1) concealment of the donor-site scar; (2) primary closure of the donor site; (3) the availability of a large cutaneous flap (25 × 8 cm to 6 × 4 cm); (4) non–hair-bearing skin; (5) longer arterial pedicle (3 to 13 cm); (6) typically requiring no vessel grafting; (7) seldom being a “bulgy” flap; (8) smaller are of numbness at the donor site; and (9) less time required for flap dissection (0.5 to 1.5 hours). Conclusions: The superficial circumflex iliac artery perforator flap is an evolution of the conventional free groin flap. This flap not only overcomes most of the disadvantages of the free groin flap but also offers the many advantages of the successful application of the free groin flap.

Bear Bite with Upper Extremity Amputation and Severe Infection-A Case Report

Background: Animal bite injuries usually cause by cats or dogs. Bear bite injuries and the following medical treatments are rarely reported in the literatures. Materials and Methods: We report a 3-year-old boy who suffered from a circus-bear bite with complete amputation of his right arm. Replantation of the injured limb was performed within 4 hours of warm ischemia. Aggressive broad-spectrum antibiotics treatment and wound debridements were also done post-operatively. Results: Surgical amputation had to be undertaken due to the development of sepsis and severe tissue necrosis of the replanted arm. Conclusion: Bear bites may cause severe mechanical injuries and infection. Multiple antibiotics resistant bacteria may develop in the oral bacterium of bears bred in zoo or circus. Strong broad-spectrum antibiotics should be administered following such injury. In addition, aggressive debridements, prompt bacterial cultures and modification of antibiotic treatment are necessary.

Intramasseteric Vascular Malformation

Intramuscular vascular malformations are uncommon and benign lesions of vascular origin. The masseter muscle is the most common involved site in the head and neck region. Its uncommon incidence and the nonspecific clinical presentations usually make the diagnosis confused. Radiographic studies can usually help us to narrow the differential diagnosis. Especially when hypodense areas are noted associated with vascular lesions in image studies, formation of phlebolithes is favored. Then the differential diagnosis may be confined to vascular lesions. Though the existence of an intramuscular vascular malformation is not an absolute indication for the operation, surgical treatment may become necessary for patients mostly because of cosmetic deformity. However, some factors limit the surgical approaches such as possible bleeding, neural injury or postoperative dysfunction. So adequate exposure and clear operative field are important for optimal tumor resection and preservation of vital anatomic structures. The surgeons are interested in these rare and benign lesions because of the challenge they may offer in difficult location and easily bleeding characteristics. We reported 3 cases of intramasseteric vascular malformation and review the current literature.

A New Method of Extensive Eyebrow and Upper Eyelid Reconstruction: The Hairy Pre-auricular Cutaneous Free Flap

Effective restoration of extensive eyebrow and upper eyelid defect is quite difficult. The direction and density of reconstructed eyebrow hair, the color and texture of the reconstructed upper eyelid, and concealment of donor scar should be considered in detail preoperatively. The authors describe a new method for the effective reconstruction of an extensive eyebrow and upper eyelid defect using a hairy pre-auricular cutaneous free flap. The flap survived smoothly and revealed hair growth not dissimilar to that of the patient’s natural eyebrow. The patient has been followed for more than one year and the overall cosmetic acceptability of final result wound appear to be quite satisfactory. The hairy pre-auricular cutaneous free flap is a new method for the cosmetically acceptable reconstruction of an eyebrow/eyelid defect that can be completed in one-stage procedure.

Is Early Surgical Intervention an Important Role in the Treatment of Patients with Vibrio Vulnificus Soft Tissue Infection

Background: Vibrio Vulnificus (Vibrio V.), a gram-negative bacterium, is capable of causing a rapidly fatal infection in patients with underlying chronic disease. Early suspicion and diagnosis with appropriate antibiotic administration, and early surgical intervention are important and recommended to reduce the mortality rate associated with this disease. Objectives: To report the influence of early surgical intervention. Materials and methods: we analyzed retrospectively the clinical charts in eighty-nine patients with Vibrio V. infection who were treated at Chi. Mei. Medical center between May, 2000 and December, 2004. Sixty-nine patients developed soft tissue infection. Results: Total mortality rate of these patients with Vibrio V. soft tissue infection was 17.39%. The mortality rate was lower in patients with surgical intervention (10.71%, 6/56) compared with those without surgical treatment (46.15%, 6/13, P=0.007). In patients with underlying liver disease, surgical intervention still proves to be able to lower down the mortality rate (27%, 4/15). Conclusion: A high index of suspicion is necessary for the diagnosis of Vibrio V. infection. The willingness to surgical debridement, fasciotomy, or limb amputation without hesitation at a very early time point, not waiting septicemia to occur, can really reduce the mortality rate of the fetal disease, especially for patients with underlying chronic disease.

Severe Injuries Associated with Low Voltage Electrical Injuries- Report of Three Cases

Severe injuries such as deep thermal burn, cardiopulmonary arrest or immediate death associated with high voltage or lightning electrocution are well reported in the literatures. However, reports of low voltage electrical injuries with severe associated injuries are few. Three cases of low voltage electrical injuries with severe associated injuries were reported. Case 1: A 27-year-old male electrician who suffered from a 110-V electrical injury leading to cardiopulmonary arrest, was dead on arrival (DOA) at the emergency department. After cardiopulmonary resuscitation (CPR), the patient was survived with hypoxic encephalopathy demonstrated in the magnetic resonance imaging (MRI). Case 2: A 34-year-old man who sustained a 220-V electrical injury without fall from height had a fracture of the right scapula. Case 3: A 43-year-old male worker sustained a 220-V electrical injury resulting in a 2(superscript nd)~3(superscript rd) degree burn injury involving 2% of total body surface area (TBSA) with rhabdomyolysis and acute renal failure. The renal function recovered by adequate hydration without hemodialysis. Through the analysis of these cases and literature review, we suggest: (1). Low voltage electrical injuries may have severe associated injuries. For those patients with suspected, associated injuries, they should be admitted at least for 24 hours and thorough physical examinations are indicated. (2). Laboratory tests for myoglobin, creatine phosphokinase (CK), renal function and electrolyte, etc. are warranted. (3). Cardiac and EKG monitoring, CK-MB and troponin testing should be done for patient with potential cardiac injury. (4). Early fluid resuscitation using formula for crush injury and the urinary output maintenance about 300m1/hour for patient with rhabdomyolysis are warranted.

Use of Tissue Expanders for Reconstruction of an Extensive Abdominal Wall Defect -A Case Report and Literature Review

Laparotomies are indicated for patients suffering pulmonary or renal failure related to abdominal compartment syndrome. Large defects of the abdominal wall usually follow laparotomies that are associated with increased intraabdominal pressure. Therefore, primary closure of a large abdominal wall defect can be quite difficult or virtually impossible. Surgeons are guided by the desire to return the patients abdominal wall, as much as possible, to its preoperative contour, texture and color. A method of accelerated delayed primary closure has been developed which leads to gradual expansion of the skin and subcutaneous tissue by means of the application of external tissue expanders. We report a successful closure of a huge abdominal wall defect for a case of necrotizing pancreatitis following a 14-day period of abdominal wall skin expansion by an implanted device. We also review the literature pertaining to the use of tissue expanders for the reconstruction of abdominal wall defects.

Axillary Hidradenitis Suppurativa: Surgical Treatment by Early Wide Excision and Skin Grafting

Hidradenitis suppurativa is a chronic, debilitating disease of apocrine gland-bearing skin. It leads to painful eruptions with malodorous discharge and causes significant morbidity. Thorough treatment should regard wide excision and skin grafting, especially in young patients. Post operative physical training is important to prevent limitation of shoulder movement. We present three cases from 2001 to 2004 and review the literature.

Use of a New Hydrofiber Dressing (Aquacel) in the Management of Scalp Donor Sites in Burn Patients-A Preliminary Report

The scalp is often not injured in burn traumas. This makes it a most useful donor site. In this article, we tried a new kind of hydrofiber dressing (Aquacel) on scalp donor sites in 15 patients. The healing time compared favorably with those of conventional gauze dressings, and pain also decreased. It could easily be applied to the scalp and conformed well. There was no leakage of fluid or infection. The nursing load was decreased.

Spontaneous Extensor Tendon Rupture in Patients with Rheumatoid Arthritis of the Hand

Extensor tenosynovitis is a common problem in patients with rheumatoid hands. The best treatment is prevention, either using medical management or surgical tenosynovectomy before tendon rupture occurs. Once a rupture has occurred, tendon reconstruction with a tendon transfer provides a reasonable chance of restoration of extensor function. There are complex mechanisms which induce tendon attrition rupture in patients with rheumatoid hands. Complete assessment of the patients along with a clear understanding of the progression of rheumatoid deformities is the key to successful reconstruction. Combined prophylactic dorsal synovectomy, ruptured tendon reconstruction, and distal ulnar resection were seemed effective treatment for resolving these problems. The surgical plan varied from patient to patient and was tailored accordingly. We present our experiences in treating five patients and we also reviewed the relative literature.