Shin-Chen Pan

Management of Liposarcoma in NCKUH

Background: Liposarcoma is a common soft tissue sarcoma, which account for almost one fifth of all soft tissue sarcoma in adults. It often occurs at the age older than forty, and is a little more common in male patients than in female patients. The most common site is the extremity, especially the thigh, and the retroperitoneum. Aim and Objectives: we collect our cases of liposarcoma from the past 15 years and present our experience. Materials and methods: This series was a retrospective analysis of consecutive adult patients with liposarcoma treated in the Department of Plastic Surgery at National Cheng Kung University Hospital from 1994 to 2009. The patients whose ICD-9-CM code range from 171.0~171.9 were included for data search. The definite diagnosis was searched by chart review. The patients with liposarcoma diagnosis were included in this study. The patient demography, tumor characteristics, clinical management were all reviewed. Results: From 1994 to 2009, nineteen patients with liposarcoma were collected in a retrospective study. There were 11 males and 8 females in this group. The age ranged from 25 to 82 years with an average of 59.5 years. The tumors located at thigh area in 13 patients. Three patients had liposarcoma at buttock. Three were at calf area. The average follow-up time is 30.0 months. All nineteen patients underwent tumor excision and primary closure with or without adjuvant therapy. The tumor size ranges from 6cm to 28cm. The average size is 15.0 cm. Fourteen patients received adjuvant therapy. Three of them received both chemotherapy and radiotherapy, the others received radiotherapy only. The histopathology showed 13 well-differentiated types, 6 myxoid types. Six patients had local recurrence of tumor after surgery. Two patients presented with distant metastasis after tumor excision. No disease-related mortality is noted. Conclusion: In our series, myxoid type of liposarcoma has a higher rate of recurrence compared with well-differentiated type. If the pathology showed well-differentiated liposarcoma, complete exicision with free surgical margin is enough. If the margin is not free, adjuvant radiation is recommended. If the pathology revealed myxoid liposarcoma, radical surgical treatment with adjuvant radiotherapy is indicated.

Reconstruction of Recurrent Rectocele with a Sling Pedicle Gracilis Muscle Flap: Case Report

Rectocele is common in elderly women. Herniation of the anterior rectal wall into the vaginal canal results from the weakness of rectovaginal fascia. The combined presence of local fibrosis and scarring makes the treatment of recurrent rectocele difficult. Herein, we present a complicated case of recurrent rectocele treated successfully with muscle sling using gracilis muscle flap. Postoperative outcome is acceptable with good muscle tone and absence of recurrence during 2 years OPD follow up.

Successful Treatment of Extensive Primary Cutaneous Cryptococcosis in Patients of Different Immune Status with Combination of Surgery and Antifungal Agents-Two Case Reports

We reported two cases of extensive primary cutaneous cryptococcosis successfully treated with combination of early surgical debridement and antifungal agents. Initially both cases mimic bacterial infection and were treated with antibiotics and simple debridement only. The definite diagnosis of primary cutaneous cryptococcosis was confirmed by pathologic findings and fungus cultures. The first case was an immunocompetent female and was successfully treated with aggressive debridement and fluconazole. The second case was an immunocompetent male with diabetes mellitus, liver cirrhosis and chronic hepatitis B and C. Fluconazole was ineffective in this case. The lesions were cured with aggressive debridement and amphotericin B. The choice of antifungal agents should depend on the immune status of the patient but aggressive debridement plays an important role in management of the extensive primary cutaneous cryptococcosis.

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)

Splenic-Cutaneous Fistula in Melioidosis-A Case Report

A case of an unhealed local abscess was found to be a splenic-cutaneous fistula by incidental CT examination. This DM patient, who traveled to Thailand 10 years ago, was sustained by a painful mass on his back for 3 months. The cutaneous mass was caused by rupture of splenic abscess, which had never been reported in melioidosis patients. The patient received splenectomy, fistulectomy and skin graft of the local wound. The postoperative course was uneventful. The etiology, treatment and the literature of melioidosis are therefore discussed.

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.

Mucosa-Associated Lymphoid Tissue Lymphoma of Salivary Gland-2 Case Reports

Mucosa-associated lymphoid tissue (MALT) lymphomas are a kind of non-Hodgkins lymphoma. Patients with MALT lymphoma present with localized disease and usually have a long survival rate. No more than 20 cases of MALT lymphoma of the salivary gland have been reported in the literature.1 We present 2 cases of painless parotid mass which was later confirmed to be MALT lymphoma. They generally appear as a swelling of the salivary gland with indolent growing pattern. The patients were treated with superficial parotidectomy with preservation of facial nerves. Both of them were free of local recurrence in parotid region at least 6 months after surgical treatment.

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.

Total Vault Remodeling for Scaphocephaly-A Case Report

Scaphocephaly is one of the most common form of deformity associated with craniosynostosis. It is characterized by a narrow, elongated cranial vault with reduced bitemporal dimension. The goal of surgery for these patients are two folds: (1) decompression of the intracranial space, and (2) achievement of a aesthetic craniofacial form. Method of treatments include: strip craniectomy, vertex craniectomy, Pi craniectomy, cranial vault remodeling, etc. We report a 2 year-old-boy with congenital scaphocephaly, total cranial vault remodeling is performed with a pleasing result.