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Biomedical subjects

Fu-Chan Wei

Publications and source records attributed to Fu-Chan Wei.

At least 73 records · Page 4Linked to original sources
PubMed2004

Strategies for a successful corrective Asian blepharoplasty after previously failed revisions.

Asian blepharoplasty, although a common procedure, has a relatively high rate of complications. Subtle imperfections and more serious iatrogenic complications often require immediate attention by the aesthetic surgeon. After attempted correction of the deformities, residual problems or new ones can arise. Blepharoptosis, supratarsal depression, an excessively high or low crease, a short or discontinuous crease, multiple creases, and asymmetric creases are the most commonly encountered complications that require special attention in this group, which has already undergone more than one surgical procedure. Between January of 1996 and December of 2002, 168 Asian blepharoplasty revisions were performed by one surgeon (S. H.-T. Chen); of these, 36 patients (21 percent) had previously undergone failed revisions. This subgroup of patients consisted of six with blepharoptosis, six with asymmetrical eyelid creases, three with supratarsal depressions, three with high creases, two with short creases, and 16 with combinations of these deformities. The results were graded as excellent, good, fair, or poor, based on the symmetry of the eyelids, palpebral fissures, crease heights, lengths, shapes, eyelid fullness, and overall aesthetics of the final outcome. A survey was performed of patient and surgeon satisfaction and factored into the grading system. With an average follow-up period of 16 months (6 to 60 months), 22 patients (61 percent) were found to have excellent results, 10 (28 percent) had good results, two (5.6 percent) had fair results, and two (5.6 percent) had poor results. Corrective procedures after failed revision Asian blepharoplasty require special strategic considerations because of the presence of extensive scarring and inadequate skin, muscle, and preaponeurotic fat and because of the occasional presence of dehiscence of the levator aponeurosis. By using careful preoperative evaluation, accurate measurements, precise preoperative planning, intraoperative fat repositioning or grafting, skin excision or redraping, and proper placement of anchoring sutures, successful outcomes can be achieved. The authors evaluate the outcomes and detail the surgical procedures that were used to achieve successful outcomes in this particularly challenging group of patients.

Asian People↗
PubMed2004

One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities.

Management of bone loss that occurs after severe trauma of open lower extremity fractures continues to challenge reconstructive surgeons. Sixty-one patients who had 62 traumatic open lower extremity fractures and combined bone and composite soft-tissue defects were treated with the following protocol: extensive debridement of necrotic tissues, eradication of infection, and vascularization of osteocutaneous tissue for one-stage bone and soft-tissue coverage reconstruction. The mechanism of injury included 49 motorcycle accidents (80.3 percent), five falls (8.2 percent), three crush injuries (4.9 percent), two pedestrian-automobile accidents (3.3 percent), and two motor vehicle accidents (3.3 percent). The bone defects were located in the tibia in 49 patients (79 percent; one patient had bilateral open tibial fractures), in the femur in seven patients (11.3 percent), in the calcaneus bone in four patients (6.5 percent), and in the metatarsal bones in two patients (3.2 percent). The size of soft-tissue defects ranged from 5 x 9 cm to 30 x 17 cm. The average length of the preoperative bony defect was 11.7 cm. The average duration from injury to one-stage reconstruction was 27.1 days, and the average number of previous extensive debridement procedures was 3.4. Fifty patients had vascularized fibula osteoseptocutaneous flaps, six had vascularized iliac osteocutaneous flaps, and five patients had seven combined vascularized rib transfers with serratus anterior muscle and/or latissimus dorsi muscle transfers. One patient received a second combined rib flap because the first combined rib flap failed. The rate of complete flap survival was 88.9 percent (56 of 63 flaps). Two combined vascularized rib transfers with serratus anterior muscle and latissimus dorsi muscle flaps were lost totally (3.2 percent) because of arterial thrombosis and deep infection, respectively. Partial skin flap losses were encountered in the five fibula osteoseptocutaneous flaps (7.9 percent). Postoperative infection for this one-stage reconstruction was 7.9 percent. Excluding the failed flap and the infected/amputated limb, the primary bony union rate after successful free vascularized bone grafting was 88.5 percent (54 of 61 transfers). The average primary union time was 6.9 months. The overall union rate was 96.7 percent (59 of 61 transfers). The average time to overall union was 8.5 months after surgery. Seven transferred vascularized bones had stress fractures, for a rate of 11.5 percent. Donor-site problems were noted in six fibular flaps, in two iliac flaps, and in one rib flap. The fibular donor-site problems were foot drop in one patient, superficial peroneal nerve palsy in one patient, contracture of the flexor hallucis longus muscle in two patients, and skin necrosis after split-thickness skin grafting in two patients. The iliac flap donor-site problems were temporary flank pain in one patient and lateral thigh numbness in the other. One rib flap transfer patient had pleural fibrosis. Transfer of the appropriate combination of vascularized bone and soft-tissue flap with a one-stage procedure provides complex lower extremity defects with successful functional results that are almost equal to the previously reported microsurgical staged procedures and conventional techniques.

Accidental Falls↗
PubMed2004

Microcirculation study of rabbit ear arterial and venous flow-through flaps using a window chamber model.

Venous flaps are used widely for finger reconstruction because they provide thin tissue, and the flap harvest is associated with less donor-site morbidity. The viability of the venous flap, however, is not as good as that of the ordinary perfused skin flap, and its microcirculation is questionable according to various indirect observations and hypotheses in the literature. Using a window chamber model in a rabbit ear, both arterial and venous flow-through flaps were studied. Factors evaluated were flap viability, flap weight, flap circulation as assessed by laser Doppler flowmetry, and direct observation of the microcirculation. Statistical analysis was performed using the two-sample t test. There was no statistically significant difference in viability between arterial and venous flow-through flaps (p = 0.661). The arterial flow-through flap had better perfusion than thevenous flow-through flap, as measured by laser Doppler perfusion studies (10.40 perfusion units [PU] vs 4.50 PU). However, no statistically significant difference was noted (p = 0.0717). Flap weight assesseed 1 week after surgery and oxygen saturation measured immediately after surgery showed significant differences between the arterial and venous flow-through flaps (p = 0.0001 and 0.0279). These datasuggest that the arterial flow-through flap is subjected to more congestion becauseof the abnormal flow pattern seen, andpossibly because of a superior inflow or nutritional status found in these flaps. Using vital microscopy, direct evaluation of the microcirculation was performed. A to-and-fro phenomenon was noted in both arterial and venous flow-through flaps,which was followed by a reversed direction of flow in part of the microvasculature. With both types of flaps, the blood was directed eventually from the postcapillary venules to the capillaries, through the terminal arterioles, and then to the arterioles. These findings may be explained partially by the normal physiologic pressure gradients present in the microvasculature of these flaps. In this study, direct observation of the microcirculation was used as well as other objective measures to determine the flow patterns and clinical behaviors found in these types of flaps. A model in a rabbit ear for the study of venous and arterial flow-through flaps is described, and clinical correlations are discussed.

Animals↗
PubMed2004

Composite palmaris longus-venous flap for simultaneous reconstruction of extensor tendon and dorsal surface defects of the hand--long-term functional result.

Soft tissue loss in the dorsum of the hand resulting from trauma often involves the extensor mechanism due to its thin skin coverage. When such composite skin and extensor tendon defects occur, the wound could be reconstructed with an ipsilateral forearm venous flap with accompanying palmaris longus tendon. Eighteen dorsal finger defects in 12 patients underwent composite venous flap and tendon transfers in the acute stage. We used both Buck-Gram-cko and Tubiana's methods for objective functional assessments. With the former method, the average composite flexion, extension deficit, and total active motion were 207.2 degrees, 39.0 degrees, and 164.7 degrees, respectively. The average score was 12.1 points, which qualified for a "good" result. With Tubiana's method, the average active flexion was 4.9, and the average extension defect was 2.3. The average score was 7.2 point, which also qualified for a "good" result. Thus, a one-stage composite forearm venous flap could be used to reconstruct dorsal skin and tendon defects of the finger with a predictably good functional outcome.

Acute Disease↗
PubMed2004

Sixty-five clinical cases of free tissue transfer using long arteriovenous fistulas or vein grafts.

Traumatic limb injuries requiring free tissue transfer for coverage, often lack healthy recipient vessels adjacent to the defect. In these patients, vein grafts are required to bridge the gap of either the artery, vein or both. For the latter situation, a temporary arteriovenous fistula (AVF) can be created and allowed to mature and then divided and used as recipient artery and veins for the free flap. These cases are challenging and several variables including vein graft length, vein graft diameter, and arterial inflow affect the patency of the vessels and the final outcome of the reconstruction. Sixty-five defects were reconstructed with free tissue transfers using vein grafts of significant length (>20 cm for the arterial gap). The ipsilateral or contralateral great saphenous veins were used for vessel lengthening in all cases. Inflow arteries were either major arteries (superficial femoral, popliteal or brachial), or lesser arteries (sural, anterior or posterior tibial, thoracodorsal, or superior gluteal). The patients were divided into those that underwent AVF followed by free tissue transfer in two stages (n = 6), AVF followed by free tissue transfer in one stage (n = 28) and patients that underwent vein grafting for the arterial defect only with (n = 6) or without (n = 25) a simultaneous bypass graft for lower limb revascularization. In the two-stage AVF group, the rate of occlusion of the graft after AVF creation was 50% (3/6); re-exploration rate was 33.3% (2/6); free flap failure rate was 33.3% (2/6); and limb salvage rate was 83.3% (5/6). In the one-stage AVF group: re-exploration rate was 28.6% (8/28); free flap success rate was 89.3% (25/28); and limb salvage rate was 92.9% (26/28). In the long vein graft group for arterial defects only: re-exploration rate was 25.8% (8/31); free flap success rate was 96.8% (30/31); and limb salvage rate was 87.1% (27/31). In patients where the graft was anastomosed to a major artery the re-exploration rate and free flap failure rate were 22.4% (11/49) and 8.2% (4/49). In patients where the graft was anastomosed to a lesser artery, the re-exploration rate and free flap failure rate were 43.4% (7/16) and 12.5% (2/16). The limb salvage rate was comparable in both groups (89.8%, 44/49, versus 87.5%, 14/16). In all groups, patients undergoing re-exploration were noted to have a an arterial gap of 31.78 cm as compared with the patients that did not require re-exploration which had an arterial gap of 26.26 cm. Vein grafting for bridging vascular defects is a safe procedure when proper indications and techniques are followed. Although a longer graft length seemed to be associated with a higher re-exploration rate, there was no statistical significance. One-stage AVFs can be used with good results, however, two-stage AVFs are associated with a high graft occlusion rate, wound failure rate and limb amputation rate. In all cases, a large caliber graft such as the great saphenous vein provided a large (relatively low resistance) conduit for bridging the defect.

Adolescent↗
PubMed2004

Anterolateral thigh fasciocutaneous flap for simultaneous reconstruction of refractory scalp and dural defects. Report of two cases.

Infected full-thickness defects of the calvaria including the scalp, cranial bone, and dura mater, are often refractory to treatment and pose a difficult and urgent therapeutic problem for reconstructive surgeons. The authors report two cases in which successful reconstruction was achieved in one stage by using an anterolateral thigh fasciocutaneous flap. The well-vascularized fascia components were used to repair the infected dural defects. The skin flaps were used for coverage reconstruction.

Adult↗
PubMed2004

Breast reconstruction with a muscle-sparing free transverse rectus abdominis myocutaneous flap: comparison between immediate and delayed groups.

BACKGROUND: Breast reconstruction offers not only physical but also psychological rehabilitation. Autologous tissue transfer is a good option for breast reconstruction. The purpose of this study was to investigate the success rate, complications, and cosmetic outcomes following use of a muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap for breast reconstruction. METHODS: Between August 1999 and February 2001, 15 consecutive patients underwent breast reconstruction using a muscle-sparing free TRAM flap after a mastectomy. Ten patients received mastectomies and immediately underwent breast reconstruction using muscle-sparing free TRAM flaps at Chang Gung Memorial Hospital. The remaining 5 patients first received a modified radical mastectomy and then underwent breast reconstruction. RESULTS: The mean age of patients was 43.9 (range, 32 to 50) years. Ten patients (67%) underwent immediate reconstructions, and 5 (23%) underwent delayed reconstructions. The overall success rate was 93.3%. Postoperative complications included 1 abdominal seroma and 1 small area of breast fat necrosis. Six of 10 patients with immediate reconstruction underwent both adjuvant chemotherapy and hormone therapy, while 3 patients received only chemotherapy. None of these adjuvant therapies were delayed by the reconstructive surgery. At a mean follow-up of 26.7 months, no local recurrence had been found, and 93% of patients were satisfied with the esthetic results. CONCLUSIONS: A muscle-sparing free TRAM flap is a good option for breast reconstruction. Both the success rate and patient satisfaction are high. The subsequent adjuvant therapy need not be delayed following immediate reconstruction.

Adult↗
PubMed2003

Perforator flap entity.

The perforator flap is not a new concept in microsurgery but there is still confusion. The number of centers that is using these flaps for various indications is increasing. Studies about the differences between these flaps and the conventional flaps, including donor site morbidity and long-term follow-ups, will be seen in the medical literature. Better accuracy in reconstruction, including the use of only cutaneous tissue, minimization of the morbidity, and preserving the same survival rate in free flaps are reassurances to microsurgeons to perform perforator flaps. We believe that in the near future with refinements in the techniques and instruments, perforator flaps will be the first choice flap.

Humans↗
PubMed2003

Technical tips in perforator flap harvest.

Advances in the field of microsurgical reconstruction have focused on decreasing donor site morbidity and increasing the function and aesthetics of the reconstructed site. Since the advent of perforator flap surgery, most of these expectations have been satisfied. On the other hand, we need refinements in the surgical techniques and clinical reports studying these flaps. In the future, the clinical use of these flaps and the familiarity of surgeons will increase; perforator flap reconstruction will be as reliable as other types of free flaps.

Humans↗
PubMed2003

Chimeric flap in clinical use.

With the development of modern microsurgical reconstruction, there are several alternative methods for the complicated head and neck defect or injured extremity. The double-paddled flap, double flaps, and double flap with vascular flow-through linkage are good tools for extensive wide, composite, and three-dimensional defects. When faced with a difficult reconstruction, the expense, morbidity of the donor site, and operative time must be taken into consideration. Compared with other combined composite flaps and other methods, the chimeric flap has many advantages including: easy three-dimensional insetting, acceptable aesthetic appearance, reduced donor site morbidity, design with the least effort and operation time, and one pair of recipient vessel. The disadvantages of the chimeric flaps include: the variation of perforators, the requirement of a learning curve, and, sometimes, the need for a second venous drainage or shifting to double flaps. Overall, in selected cases, the chimeric flap is a good option for the reconstruction of extensive, composite, and three-dimensional defects.

Bone and Bones↗
PubMed2003

The thigh as a model for free style free flaps.

Following a set of principles, free style free flaps may be harvested from any region of the body where a Doppler signal is heard. By using a retrograde dissection technique, the skin vessel is traced through its subfascial course (intramuscular or septocutaneous), until adequate length or vessel size is achieved. If a "free style free flap" is not originally planned, this approach can be usedwhen anatomic variations or unexpected events are encountered. The thigh, a region that is familiar to the surgical team at Chang Gung Memorial Hospital, was chosen as the site to begin exploring this style of flap harvest. Nine flaps were harvested as free style free flaps from the thigh and were used successfully for the reconstruction of complex defects.

Adult↗
PubMed2003

Toe-to-hand transplantation.

In the mutilated hand microsurgical toe-to-hand transplantation provides thumb and finger reconstruction that is superior to conventional techniques in appearance and function. Hand reconstruction using toe transplantation should be individually planned and carefully executed to obtain optimal results and minimal disability in the donor foot.

Amputation, Traumatic↗
PubMed2003

Reactive thrombocytosis without endothelial damage does not affect the microvascular anastomotic patency.

There is still controversy about the correlation of thrombocytosis and thrombosis complication. Using a rodent splenectomy-induced thrombocytosis model and a thrombogenic endothelial damage model (inverted suture resulting in an intraluminal thrombogenic adventitia of divided femoral artery), the authors investigated whether reactive thrombocytosis with or without endothelial damage contributes to the patency of microvascular anastomosis. Four experimental groups were evaluated in this study: 1) sham operation without thrombogenic anastomosis after femoral artery division; 2) sham operation with thrombogenic anastomosis; 3) thrombocytosis alone without thrombogenic anastomosis; 4) thrombocytosis with thrombogenic anastomosis (each subgroup n = 10, total N = 40). Vascular patency was assessed after immediate operation and on the seventh day postoperatively. Platelet counts and platelet activation (CD62P) were studied in correlation to microvascular patency. In rats without thrombogenic anastomosis groups, there were no significant differences in CD62P expression on platelets (p = 0.09), the patency rates (p = 0.561), or perfusion units (p = 0.746) before and after arterial reanastomosis between rats with and without thrombocytosis, respectively. However, the thrombogenic anastomosis of femoral artery in thrombocytosis and control groups showed significantly increased CD62P expression (p < 0.05), decreased the perfusion unit (p < 0.05), and patency rate (p < 0.001), compared with rats without thrombogenic anastomosis of femoral artery in both groups. In summary, this study demonstrates that microvascular anastomosis can be performed safely with reactive thrombocytosis alone without thrombogenic anastomosis. Meticulous microvascular anastomosis without triggering platelet activation is the most important factor to prevent thrombosed vessels in microsurgical anastomosis.

Anastomosis, Surgical↗