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- 검색키워드
- 저자 : Bien-Keem Tan (검색결과 41 건)
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Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes
Tan, Bien-Keem,Kang, Gavin Chun-Wui,Tay, Eng Hseon,Por, Yong Chen Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.4
Background Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction. Methods From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps. Results The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.
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Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes
Bien-Keem Tan,Gavin Chun-Wui Kang,Eng Hseon Tay,Yong Chen Por 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.4
Background: Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstructionof vulvar defects restores form and function for the purpose of coitus, micturition,and defecation. Many surgical options exist for vulvar reconstruction. The purpose of thisarticle is to present our experience with vulvar reconstruction. Methods: From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most commoncause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget’sdisease of the vulva. Method s of reconstruction ranged from primary closure to skin graftingto the use of pedicled flaps. Results: The main complications were that of long term hypertrophic and/or unaestheticscarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexualintercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions: We present a subunit algorithmic approach to vulvar reconstruction based ondefect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstructionof a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap wassuperior because of the well-concealed donor scar. We advocate the routine use of these 2flaps for vulvar reconstruction.
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Tan, Bien-Keem,Chim, Harvey,Ng, Zhi Yang,Ong, Kong Wee Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.4
Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer. Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision. Results 281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction. Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.
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Bien-Keem Tan,Harvey Chim,Zhi Yang Ng,Kong Wee Ong 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.4
Background: The advent of skin-sparing mastectomy has allowed for the reconstruction ofthe breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) inAsian patients is more pigmented and scars easily. Therefore, commonly described incisionstend to result in poor aesthetic outcomes in Asian patients with breast cancer. Methods: We describe an algorithmic approach to skin-sparing mastectomy incisions inAsian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distantskin paddle, “racquet handle,” and peri-areolar with adjacent skin excision. Results: 281 immediate breast reconstructions were performed between May 2001 andFebruary 2012 after skin-sparing mastectomy. The mastectomy incisions used included theperi-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle(n=39, 14%), “racquet handle” (n=21, 7.5%), and peri-areolar design with adjacent skinexcision (n=42, 14%). The traditional elliptical incision and other variants where the NACoutline was not preserved were performed in the remaining 55 patients. The average followupwas 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flapnecrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequentnipple reconstruction. Conclusions: Our algorithm avoids breast incisions that are randomly placed or excessivelylong and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparingmastectomy and immediate breast reconstruction to be performed with a consistentlyachievable aesthetic result in Asian women without neglecting oncological safety.
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Weihao Liang,Bien-Keem Tan 대한성형외과학회 2019 Archives of Plastic Surgery Vol.46 No.3
Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.
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Liang, Weihao,Tan, Bien Keem Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.3
Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.
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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.
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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.
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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.
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