Niann-Tzyy Dai

The effect of hyperbaric oxygen and air on cartilage tissue engineering.

AbstractThere is an urgent need to develop tissue-engineered cartilage for patients experiencing joint malfunction due to insufficient self-repairing capacity of articular cartilage. The aim of this research was to explore the effect of hyperbaric oxygen and air on tissue-engineered cartilage formation from human adipose-derived stem cells seeding on the gelatin/polycaprolactone biocomposites. The results of histological analyses indicate that under hyperbaric oxygen and air stimulation, the cell number of chondrocytes in cartilage matrix was not significantly increased, but the 1,9-dimethylmethylene blue assay showed that the glycosaminoglycans syntheses markedly increased compared to the control group. In quantification real-time polymerase chain reaction results, the chondrogenic-specific gene expression of SOX9, aggrecan, and COL2A1 were compared respectively. Within the limitation of this study, it was concluded that 2.5 atmosphere absolute oxygen and air may provide a stress environment to help cartilage tissue engineering development.

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.

Transpulmonary Thermodilution Technique Monitoring in Acute Major Burn Resuscitation-Report of Four Cases

Background: The fluid resuscitation in acute burn injuries are improving. Since 2007, the hourly-adjusted fluid supplement protocol was used in our burn center. More recently, four severe burn patients who underwent such resuscitation also had monitoring for fluid status using the transpulmonary thermodilution technique (PiCCO plus). Aim and Objectives: To share and discuss our experiences by PiCCO monitoring of severe burn patients. Materials and Methods: Since 2007-2009, four patients were resuscitated according to hourly-adjusted fluid resuscitation protocol with monitoring by PiCCO. The parameters were collected and discussed. Results: All patients revealed free of renal failure or pulmonary edema within first 48 hours. The fluid amount of resuscitation was greater than that calculated by Parklands formula. Conclusion: The PiCCO helped to clarify the details of fluid status, cardiac contractility, pulmonary capillary permeability and the best time of albumin administration.

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)

Upper Eyelid Reconstruction Using Fricke Flap in a Rare Case of Basosquamous Cell Carcinoma

Basosquamous (cell) carcinoma is a rare malignancy consisting of the pathological features of both basal cell and squamous cell carcinomas. The reported incidence of basosquamous carcinoma is about 1-2% of all skin malignancies. Here we reported a 97-year-old female with a large size basosquamous cell carcinoma over right upper eyelid. The visual axis of right eye was occluded by the tumor. We performed a frozen section controlled excision of the whole layer of pretarsal tissue of upper eyelid with the immediate one-stage upper eyelid reconstruction by using the Fricke flap, a temporally based monopedicle forehead flap first described by Jochim Fricke in 1829. Autologous full-thickness skin graft was performed for coverage of the forehead defect of donor site. Effective coverage of lateral canthus and anterior lamella for upper eyelid reconstruction was achieved in this case by using the Fricke flap. Furthermore, the patient represented satisfied functional and cosmetic results at 12 weeks follow-up.

Rhinophyma-A Case Report

Rhinophyma is a rare disease that primary affects Caucasian men. It is thought to represent the most severe expression of acne rosacea with a proliferation of sebaceous glands and fibrous tissue. It adversely impacts both the appearance and the function of the nose. Many cases of rhinophyma have been reported in the western world; however, there has none been reported from Taiwan. We reported one case of a 74-year-old man who sustained a growing rhinophyma with nasal deformity for 2 years. He received total excision of tumor mass, and the nasal defect was restored with a full-thickness skin graft from the left supra-clavicle region. Thirteen months follow-up, the patient was satisfied with the surgical result.

Treatment of Ingrown Toenails by Electrocautery Matricectomy-Experiences of 130 Cases

Ingrown toenail is a common problem resulting from various etiologies including improperly trimmed nails, hyperhidrosis, infection and poorly fitting shoes. Patients commonly present with wound infection and purulent drainage in the affected nail groove associated with severe pain and thereby difficult in walking. The ideal management for ingrown toenails should include removal of the ”fishhook” nail to allow for relief of symptoms and the destruction of related part of germinal matrix of nail bed to prevent recurrence of the nail spikes. To investigate the outcome of using the method of electrocautery matricectomy to treat ingrown toenails, a retrospective study was launched including 130 cases in the past six years (from Jan 1999 to Dec 2004). The follow-up clinical examinations and the questionnaire survey regarding the recurrence rate, the severity of symptoms, the duration of postoperative pain and the other relevant factors were recorded and analyzed. The advantages of this method used for treatment of ingrown toenails include: (1) the surgical procedure is simple; (2) the normal foot-wearing time is earlier; (3) the recurrence rate is low; (4) the severity of postoperative pain is decreased; and (5) the duration of postoperative pain is short. The results concluded that the electrocautery matricectomy is an effective method for treatment of ingrown toenails, only 2.3% recurrence rate in our series.

The Influence of Body Mass Index on the Hand Surface Area in Taiwanese Adult

Accurate assessments of the surface areas of burn injuries are important for the prognosis and initial fluid resuscitation of burn victims. The area of the surface of the hand is often used to estimate the area of a burn. In our previous study, the volar hand surface area is equal to 0.75% of body surface area in Taiwanese adult. But none discusses about variations in individual body weight. In this study, we used two-dimensional projection to estimate hand surface areas of Taiwanese adults in variant of body mass index. The areas of the volar hand, including that of the thumb and fingers, in healthy, overweight and obese Taiwanese were 0.82%, 0.74%, and 0.70% of body surface area, respectively. We conclude that the ratio between hand and body surface area of Taiwanese adults differ from that of individual body weight and suggest an adjustment of the ratio for use with overweight and obese people.

Dynamic Tendon Transfer for Claw Hand Deformity

In low median-ulnar nerve palsy, the complete loss of intrinsic motor muscles (interosseous, lumbrical, thenar, and hypothenar muscles) produces a claw hand deformity. The net effects of intrinsic muscle loss include the disturbance of precision and fine motor coordination, diminished muscle volume, severe impairment of power pinch and grasp, and creation of posture deformity to the index, middle, ring, and little fingers. We describe a 29-year-old man suffering low median-nerve and ulnar-nerve palsy with claw hand deformity. We corrected the claw hand deformity using free tendon grafts to transfer the flexion tension of the extensor carpi radialis brevis tendon unit to the metacarpophalangeal joints.

Limited Open Carpal Tunnel Release through a Small Palmar Incision-Experience in the Usage of a New Instrument-The Indiana Carpal Tunnel Tome

Surgical release of the carpal tunnel for carpal tunnel syndrome has become one of the most commonly performed procedures in hand surgery since the report by Phalen et al. Both the open carpal tunnel release and the endoscopic carpal tunnel release methods has its supporters and its adversaries. To be able to combine the simplicity and safety of both methods, and to reduce its hazard towards tissue trauma and postoperative morbidity, variable operation methods were developed. The Indiana carpal tunnel tome was designed by James W. Strickland, MD, in the Indiana Hand Center 12 This device divides the transverse carpal ligament through a small palmar incision. From April 1998 to August 1998, 8 carpal tunnel releases (CTR) were performed in 7 patients using the Indiana tome by multiple surgeons. The patients ages ranged from 21 to 75 years (mean: 54.71 years). The duration of preoperative symptoms ranged from 2 months to 10 years (mean: 21.38 months). The mean follow-up period was 8 weeks. The efficacy of carpal tunnel release was determined by postoperative tenderness, recovery of postoperative strength, and satisfaction. In our series, four patients (4 CTR-50%) increased postoperative grip strength within 6-8 weeks, and six patients (6 CTR-75%) increased postoperative pinch strength. Seventy-five percent of the patients had either complete resolution or only minimum amount of residual symptoms. Furthermore, the tenderness at incision site, radial and ulnar pillar pain were relatively low. In our clinical experience, the technique of carpal tunnel release through a limited palmar incision with the Indiana tome really represents the advantages of simple, quick, easy learning and safety.