Stepwise Training for Reconstructive Microsurgery: The Journey to Becoming a Confident Microsurgeon in Singapore

Ramachandran, Savitha,Ong, Yee-Siang,Chin, Andrew Y.H.,Song, In-Chin,Ogden, Bryan,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.3

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.

Stepwise Training for Reconstructive Microsurgery: The Journey to Becoming a Confident Microsurgeon in Singapore

Savitha Ramachandran,Yee-Siang Ong,Andrew YH Chin,In-Chin Song,Bien-Keem Tan 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.3

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.

Radical Surgical Excision and Use of Lateral Thoracic Flap for Intractable Axillary Hidradenitis Suppurativa

Teo, Wan-Lin,Ong, Yee-Siang,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.6

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.

Vascularisation of Urethral Repairs with the Gracilis Muscle Flap

Ee Hsiang Jonah Kua,Kah Woon Leo,Yee-Siang Ong,Christopher Cheng,Bien-Keem Tan 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.5

Background The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. Methods We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. Results After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. Conclusions Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs.

Vascularisation of Urethral Repairs with the Gracilis Muscle Flap

Kua, Ee Hsiang Jonah,Leo, Kah Woon,Ong, Yee Siang,Cheng, Christopher,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.5

Background The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. Methods We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. Results After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. Conclusions Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs.

Use of the Anterolateral Thigh and Vertical Rectus Abdominis Musculocutaneous Flaps as Utility Flaps in Reconstructing Large Groin Defects

Edwin Jonathan Aslim,Mohamed Zulfikar Rasheed,Fangbo Lin,Yee-Siang Ong,Bien-Keem Tan 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: Groin dissections result in large wounds with exposed femoral vessels requiringsoft tissue coverage, and the reconstructive options are diverse. In this study we reviewed ourexperience with the use of the pedicled anterolateral thigh and vertical rectus abdominismusculocutaneous flaps in the reconstruction of large groin wounds. Methods: Groin reconstructions performed over a period of 10 years were evaluated, with amean follow up of two years. We included all cases with large or complex (involving perineum)defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous orthe vertical rectus abdominis musculocutaneous (VRAM) flaps. Smaller wounds which werecovered with skin grafts, locally based flaps and pedicled muscle flaps were excluded. Results: Twenty-three reconstructions were performed for large or complex groin defects,utilising the anterolateral thigh (n=10) and the vertical rectus abdominis (n=13) pedicledmusculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required inone patient, and a combination flap (VRAM and gracilis muscle flap) was performed inanother. Satisfactory coverage was achieved in all cases without major complications. No freeflaps were used in our series. Conclusions: The anterolateral thigh and vertical rectus abdominis pedicled musculocutaneousflaps yielded consistent results with little morbidity in the reconstruction of large and complexgroin defects. A combination of flaps can be used in cases requiring extensive cover.

Use of the Anterolateral Thigh and Vertical Rectus Abdominis Musculocutaneous Flaps as Utility Flaps in Reconstructing Large Groin Defects

Aslim, Edwin Jonathan,Rasheed, Mohamed Zulfikar,Lin, Fangbo,Ong, Yee-Siang,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.5

Background Groin dissections result in large wounds with exposed femoral vessels requiring soft tissue coverage, and the reconstructive options are diverse. In this study we reviewed our experience with the use of the pedicled anterolateral thigh and vertical rectus abdominis musculocutaneous flaps in the reconstruction of large groin wounds. Methods Groin reconstructions performed over a period of 10 years were evaluated, with a mean follow up of two years. We included all cases with large or complex (involving perineum) defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous or the vertical rectus abdominis musculocutaneous (VRAM) flaps. Smaller wounds which were covered with skin grafts, locally based flaps and pedicled muscle flaps were excluded. Results Twenty-three reconstructions were performed for large or complex groin defects, utilising the anterolateral thigh (n=10) and the vertical rectus abdominis (n=13) pedicled musculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required in one patient, and a combination flap (VRAM and gracilis muscle flap) was performed in another. Satisfactory coverage was achieved in all cases without major complications. No free flaps were used in our series. Conclusions The anterolateral thigh and vertical rectus abdominis pedicled musculocutaneous flaps yielded consistent results with little morbidity in the reconstruction of large and complex groin defects. A combination of flaps can be used in cases requiring extensive cover.

Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: Aesthetic outcomes and mitigating nipple-areolar complex necrosis

Wan-Sze Pek,Bien-Keem Tan,Yvonne Ying Ru Ng,Veronique Kiak Mien Tan,Mohamed Zulfikar Rasheed,Benita Kiat Tee Tan,Kong Wee Ong,Yee-Siang Ong 대한성형외과학회 2018 Archives of Plastic Surgery Vol.45 No.3

Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients’ records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.

Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: Aesthetic outcomes and mitigating nipple-areolar complex necrosis

Pek, Wan-Sze,Tan, Bien-Keem,Ng, Yvonne Ying Ru,Tan, Veronique Kiak Mien,Rasheed, Mohamed Zulfikar,Tan, Benita Kiat Tee,Ong, Kong Wee,Ong, Yee Siang Korean Society of Plastic and Reconstructive Surge 2018 Archives of Plastic Surgery Vol.45 No.3

Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.