• Archives of Plastic Surgery
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• v.46 no.1
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• pp.92-94
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• 2019

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.88-91
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• 2019

The burn center in our hospital is a national and regional (Southeast Asia) center. Of all admissions, 10% are related to blast explosions, and 8% due to chemical burns. In the acute burn management protocol of Singapore General Hospital, early surgical debridement is advocated for all acute partial-thickness burns. The aim of early surgical debridement is to remove all debris and unhealthy tissue, preventing wound infection and thereby expediting wound healing. In chemical burns, there can be stubborn eschars that are resistant to traditional debridement. We would like to present a novel technique using the diathermy scratch pad as a cheap and efficient tool for the dual purpose of surgical debridement and dermabrasion.

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.99-103
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• 2024

Because facial nerve injuries affect the quality of life, leaving them untreated can have devastating effects. The number of patients with traumatic and iatrogenic facial nerve paralysis is considerably high. Early detection and prompt treatment during the acute injury phase are crucial, and immediate surgical treatment should be considered when complete facial nerve injury is suspected. Symptom underestimation by patients and clinical misdiagnosis may delay surgical intervention, which may negatively affect outcomes and in some cases, impair the recovery of the injured facial nerve. Here, we report two cases of facial nerve injury that were treated with nerve grafts during the subacute phase. In both cases, subacute facial nerve grafting achieved significant improvements. These cases highlight surgical intervention in the subacute phase using nerve grafts as an appropriate treatment for facial nerve injuries.

• Archives of Plastic Surgery
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• v.41 no.3
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• pp.209-212
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• 2014

Microsurgery training in Singapore began in 1980 with the opening of the Experimental Surgical Unit. Since then, the unit has continued to grow and have held microsurgical training courses biannually. The road to becoming a full-fledged reconstructive surgeon requires the mastering of both microvascular as well as flap raising techniques and requires time, patience and good training facilities. In Singapore, over the past 2 decades, we have had the opportunity to develop good training facilities and to refine our surgical education programmes in reconstructive microsurgery. In this article, we share our experience with training in reconstructive microsurgery.

• Archives of Plastic Surgery
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• v.43 no.1
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• pp.26-31
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• 2016

Background The global prevalence of myelomeningocele has been reported to be 0.8-1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.382-387
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• 2019

Background: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results. Methods: From 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS). Results: For nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n= 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n= 13), and bilobed flaps and primary closure had the highest VAS score (7/10). Conclusion: Nasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.152-158
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• 2008

Purpose: Mandibulotomy approach and mandible sparing approach are most common methods for oropharyngeal cancer surgery. Good surgical view and convenience of flap inset are advantages of mandibulotomy approach but deformity of mandible contour, postoperative malocclusion and radionecrosis are its limitations. To make up for the limitations, mandible sparing method is commonly performed, but limited surgical view and difficulties of flap inset are the weak points of this approach. The purpose of the study is to compare mandibulotomy and mandible sparing approaches in postoperative complications and progression of the treatment in oropharyngeal cancer operation and reconstruction. Methods: Single reconstructive microsurgeon operated for oropharyngeal cancer patients with different surgeons of head and neck department who prefer mandibulotomy and mandible sparing approach respectively, and we compared the frequency of postoperative complication, operation time, duration of hospitalization and recurrence rate between two different surgical approaches. Results: Mandibulotomy approach was used in 18 patients and mandible sparing approach was used in 15 patients. In mandibulotomy approach, there happened one case of teeth injury and one case of necrosis of skin and gingiva, but there happened no malocclusion and radionecrosis. In mandible sparing approach, there were 3 cases of fistula and 2 cases of infection which are significantly higher than mandibulotomy approach. There were no significant differences between early regional recurrence and duration of hospitalization. Conclusion: In this study we compared two different methods for the surgical approach in oropharyngeal cancer surgery. As mandible sparing approach has difficulties of limited surgical view, it can be used for the limited indications of anterior tongue and mouth floor cancer. Mandibulotomy approach has advantages of good surgical view and convenience of flap inset. In this method preservation of gingival tissue, watertight fashion suture, delicate osteotomy and plate fixation to maintain occlusion are the key points for the successful results.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.310-322
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• 2021

The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms "phantom limb pain," "amputation neuroma," and "surgical prevention of amputation neuroma." Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.146-152
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• 2020

Background Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. Methods We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. Results Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were "miscellaneous." In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. Conclusions CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.