Labia Majora Share

Lee, Hanjing,Yap, Yan Lin,Low, Jeffrey Jen Hui,Lim, Jane Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.1

Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients.

Labia Majora Share

Hanjing Lee,Yan Lin Yap,Jeffrey Jen Hui Low,Jane Lim 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.1

Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients.

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.

The superior lateral genicular artery flap for reconstruction of knee and proximal leg defects

O-Wern Low,Tian Fu Loh,Hanjing Lee,Yan Lin Yap,Jane Lim,Thiam Chye Lim,Vigneswaran Nallathamby 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.1

Reconstruction of defects around the knee region requires thin and pliable skin. The superior lateral genicular artery (SLGA) flap provides an excellent alternative to muscle-based flaps. The anatomy and the surgical techniques of the SLGA flap were reviewed and the results of cases using the SLGA flap for coverage of knee and proximal leg defects were analyzed. SLGA flaps were performed in two cases and followed up for at least 6 months. Twelve articles on the use of the SLGA flap were also identified. A review of 39 cases showed that the mean diameter of the perforator supplying the skin of the flap was 1.04 mm, while the mean diameter of the SLGA at its origin was 1.78 mm. The mean length of the pedicle measured from the origin of the popliteal artery was 7.44 cm. The average dimensions of the flap were 14.8×6.6 cm with primary closure of the donor site in 61.5% of cases. Of these cases, 38.5% were due to trauma, 23.1% were post-burn complications, 12.8% were defects after resection of tumors, and 10.3% were for ulcers post-bursectomy. The most common complication was flap tip necrosis. All studies reported favorable outcomes with complete wound healing.

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.