The Deep Inferior Epigastric Perforator and Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: A Comparative Study

Shane Tan,Jacklyn Yek,Wei Chen Ong,Chor Hoong Hing,Jane LIM,Thiam Chye LIM 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.3

Background Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group. Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared. Results Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001). Conclusions Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap

The Deep Inferior Epigastric Perforator and Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: A Comparative Study

Tan, Shane,Lim, Jane,Yek, Jacklyn,Ong, Wei Chen,Hing, Chor Hoong,Lim, Thiam Chye Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.3

Background Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group. Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared. Results Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001). Conclusions Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.

Creation of Consistent Burn Wounds: A Rat Model

Cai, Elijah Zhengyang,Ang, Chuan Han,Raju, Ashvin,Tan, Kong Bing,Hing, Eileen Chor Hoong,Loo, Yihua,Wong, Yong Chiat,Lee, Hanjing,Lim, Jane,Moochhala, Shabbir M.,Hauser, Charlotte A.E.,Lim, Thiam Chye Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.4

Background Burn infliction techniques are poorly described in rat models. An accurate study can only be achieved with wounds that are uniform in size and depth. We describe a simple reproducible method for creating consistent burn wounds in rats. Methods Ten male Sprague-Dawley rats were anesthetized and dorsum shaved. A 100 g cylindrical stainless-steel rod (1 cm diameter) was heated to $100^{\circ}C$ in boiling water. Temperature was monitored using a thermocouple. We performed two consecutive toe-pinch tests on different limbs to assess the depth of sedation. Burn infliction was limited to the loin. The skin was pulled upwards, away from the underlying viscera, creating a flat surface. The rod rested on its own weight for 5, 10, and 20 seconds at three different sites on each rat. Wounds were evaluated for size, morphology and depth. Results Average wound size was $0.9957cm^2$ (standard deviation [SD] 0.1845) (n=30). Wounds created with duration of 5 seconds were pale, with an indistinct margin of erythema. Wounds of 10 and 20 seconds were well-defined, uniformly brown with a rim of erythema. Average depths of tissue damage were 1.30 mm (SD 0.424), 2.35 mm (SD 0.071), and 2.60 mm (SD 0.283) for duration of 5, 10, 20 seconds respectively. Burn duration of 5 seconds resulted in full-thickness damage. Burn duration of 10 seconds and 20 seconds resulted in full-thickness damage, involving subjacent skeletal muscle. Conclusions This is a simple reproducible method for creating burn wounds consistent in size and depth in a rat burn model.

Creation of Consistent Burn Wounds: A Rat Model

Elijah Zhengyang Cai,Chuan Han Ang,Kong Bing Tan,Eileen Chor Hoong Hing,Yihua Loo,Yong Chiat Wong,Hanjing Lee,Jane LIM,Shabbir M Moochhala,Charlotte AE Hauser,Thiam Chye LIM,Ashvin Raju 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.4

Background: Burn infliction techniques are poorly described in rat models. An accurate studycan only be achieved with wounds that are uniform in size and depth. We describe a simplereproducible method for creating consistent burn wounds in rats. Methods: Ten male Sprague-Dawley rats were anesthetized and dorsum shaved. A 100 gcylindrical stainless-steel rod (1 cm diameter) was heated to 100°C in boiling water. Temperature was monitored using a thermocouple. We performed two consecutive toe-pinchtests on different limbs to assess the depth of sedation. Burn infliction was limited to theloin. The skin was pulled upwards, away from the underlying viscera, creating a flat surface. The rod rested on its own weight for 5, 10, and 20 seconds at three different sites on eachrat. Wounds were evaluated for size, morphology and depth. Results: Average wound size was 0.9957 cm2 (standard deviation [SD] 0.1845) (n=30). Wounds created with duration of 5 seconds were pale, with an indistinct margin of erythema. Wounds of 10 and 20 seconds were well-defined, uniformly brown with a rim of erythema. Average depths of tissue damage were 1.30 mm (SD 0.424), 2.35 mm (SD 0.071), and 2.60mm (SD 0.283) for duration of 5, 10, 20 seconds respectively. Burn duration of 5 secondsresulted in full-thickness damage. Burn duration of 10 seconds and 20 seconds resulted infull-thickness damage, involving subjacent skeletal muscle. Conclusions: This is a simple reproducible method for creating burn wounds consistent insize and depth in a rat burn model.

Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role?

Teoh Ryan Liang Wei,Fong Pei Yuan,Cai Elijah Zhengyang,Yap Yan Lin,Hing Eileen Chor Hoong,Lee Han Jing,Nallathamby Vigneswaran,Ong Wei Chen,Lim Jane,Sundar Gangadhara,Lim Thiam Chye 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.1

Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.1 Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n = 280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n = 16), frontal sinus (n = 2), Le Fort II/III (n = 8), and > 1 type (n = 48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p = 0.152) or wound infection (p = 0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.

Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role?

Teoh Ryan Liang Wei,Fong Pei Yuan,Cai Elijah Zhengyang,Yap Yan Lin,Hing Eileen Chor Hoong,Lee Han Jing,Nallathamby Vigneswaran,Ong Wei Chen,Lim Jane,Sundar Gangadhara,Lim Thiam Chye 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.2

Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.1 Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n = 280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n = 16), frontal sinus (n = 2), Le Fort II/III (n = 8), and > 1 type (n = 48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p = 0.152) or wound infection (p = 0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.

Bio-Conjugated Polycaprolactone Membranes: A Novel Wound Dressing

Elijah Zhengyang Cai,Erin Yiling Teo,Lim Jing,Yun Pei Koh,Tan Si Qian,Feng Wen,James Wai Kit Lee,Eileen Chor Hoong Hing,Yan Lin Yap,Hanjing Lee,Chuen Neng Lee,Swee-Hin Teoh,Jane LIM,Thiam Chye LIM 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.6

Background: The combination of polycaprolactone and hyaluronic acid creates an idealenvironment for wound healing. Hyaluronic acid maintains a moist wound environment andaccelerates the in-growth of granulation tissue. Polycaprolactone has excellent mechanicalstrength, limits inflammation and is biocompatible. This study evaluates the safety and efficacyof bio-conjugated polycaprolactone membranes (BPM) as a wound dressing. Methods: 16 New Zealand white rabbits were sedated and local anaesthesia was administered. Two 3.0×3.0 cm full-thickness wounds were created on the dorsum of each rabbit, betweenthe lowest rib and the pelvic bone. The wounds were dressed with either BPM (n=12) orMepitel (n=12) (control), a polyamide-silicon wound dressing. These were evaluatedmacroscopically on the 7th, 14th, 21st, and 28th postoperative days for granulation, reepithelialization,infection, and wound size, and histologically for epidermal and dermalregeneration. Results: Both groups showed a comparable extent of granulation and re-epithelialization. Nosigns of infection were observed. There was no significant difference (P>0.05) in wound sizebetween the two groups. BPM (n=6): 8.33 cm2, 4.90 cm2, 3.12 cm2, 1.84 cm2; Mepitel (n=6):10.29 cm2, 5.53 cm2, 3.63 cm2, 2.02 cm2; at the 7th, 14th, 21st, and 28th postoperative days. The extents of epidermal and dermal regeneration were comparable between the two groups. Conclusions: BPM is comparable to Mepitel as a safe and efficacious wound dressing.

Bio-Conjugated Polycaprolactone Membranes: A Novel Wound Dressing

Cai, Elijah Zhengyang,Teo, Erin Yiling,Jing, Lim,Koh, Yun Pei,Qian, Tan Si,Wen, Feng,Lee, James Wai Kit,Hing, Eileen Chor Hoong,Yap, Yan Lin,Lee, Hanjing,Lee, Chuen Neng,Teoh, Swee-Hin,Lim, Jane,Lim, Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.6

Background The combination of polycaprolactone and hyaluronic acid creates an ideal environment for wound healing. Hyaluronic acid maintains a moist wound environment and accelerates the in-growth of granulation tissue. Polycaprolactone has excellent mechanical strength, limits inflammation and is biocompatible. This study evaluates the safety and efficacy of bio-conjugated polycaprolactone membranes (BPM) as a wound dressing. Methods 16 New Zealand white rabbits were sedated and local anaesthesia was administered. Two $3.0{\times}3.0cm$ full-thickness wounds were created on the dorsum of each rabbit, between the lowest rib and the pelvic bone. The wounds were dressed with either BPM (n=12) or Mepitel (n=12) (control), a polyamide-silicon wound dressing. These were evaluated macroscopically on the 7th, 14th, 21st, and 28th postoperative days for granulation, re-epithelialization, infection, and wound size, and histologically for epidermal and dermal regeneration. Results Both groups showed a comparable extent of granulation and re-epithelialization. No signs of infection were observed. There was no significant difference (P>0.05) in wound size between the two groups. BPM (n=6): $8.33cm^2$, $4.90cm^2$, $3.12cm^2$, $1.84cm^2$; Mepitel (n=6): $10.29cm^2$, $5.53cm^2$, $3.63cm^2$, $2.02cm^2$; at the 7th, 14th, 21st, and 28th postoperative days. The extents of epidermal and dermal regeneration were comparable between the two groups. Conclusions BPM is comparable to Mepitel as a safe and efficacious wound dressing.