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Papers by Suphalerk Lohasammakul

Journal of surgical case reports, Apr 1, 2024

PLOS ONE, Jan 15, 2024

This study aims to compare two surgical techniques, the standard Vein-to-Artery and the newer Art... more This study aims to compare two surgical techniques, the standard Vein-to-Artery and the newer Artery-to-Vein (Radial Artery Deviation And Reimplantation; RADAR), for enhancing the success of Arterio-Venous Fistula maturation in end-stage renal disease patients. The impact of diseases like anemia, diabetes, hypertension, and chronic kidney disease were considered. The goals are to advance Arterio-Venous Fistula (AVF) surgery, improve patient outcomes, and contribute to evidence-based surgical guidelines. Methods Fluid-structure interaction modeling was employed to investigate how hemodynamic and mechanical stresses impact arteriovenous fistula maturation, with a particular focus on the role of wall shear stress in determining maturation outcomes. The critical threshold for vessel injury was identified as wall shear stress values exceeding 35 N/m 2 , while stenosis formation was projected to occur at levels below 1 N/m 2. This work introduced a novel approach by considering disease-related factors, including blood viscosity (anemia), and vessel elasticity (diabetes, hypertension, and chronic kidney diseases), which directly influence hemodynamics and the generation of wall shear stress. Furthermore, the model was designed to incorporate varying thicknesses and elasticities for both the vein and artery, accurately representing authentic vascular anatomy.

Journal of Reconstructive Microsurgery

Background: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of ... more Background: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline. Methods: Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory. Results: Overall, three SIEA patterns were identified: bilateral presence (45%), ipsilateral presence (30%), and bilateral absence (25%). The territory depended on the vessel course and dominant SIEA diameter, not on its common origin from the femoral artery, at the pubic tubercle level. Regarding the midline territory (pubic tubercle level to umbilicus), SIEA with a diameter of ≥1.4 mm on either side (t...

The Breast, Mar 1, 2017

In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival ... more In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival was 35.4 ± 6.3 months. Histopathological study revealed the presence of invasive ductal carcinoma in all cases. Average tumor size was 2.55 ± 0.43 cm, and the average numbers of removed sentinel lymph node were 3.4 ± 0.5. The numbers of nuclear grade 3 were 9 (42.9%). Vein invasion was seen in 3 cases (14.3%), and lymph vascular invasion was seen in 9 cases (42.9%). All 21 patients were performed ALND after ALN recurrence. The average numbers of dissected lymph node were 13.9 ± 1.5, and of metastatic lymph node were 3.0 ± 0.5. During the median follow up period of 62.7 months from additional ALND, distant metastases were observed in 5 cases (23.9%) and 1 case (4.8%) died. In the group with distant metastases after ALND, the rate of lymph vascular invasion was significantly higher than the group without distant metastases (60.0% vs. 37.5%, p = 0.048), whereas there were no significant differences of clinical or pathological backgrounds between the group with and without distant metastases. But patients who received chemotherapy after ALND had a trend to a lower distant metastases compared with patients who received no chemotherapy (13.3% vs. 50.0%, p = 0.115). Conclusion: In this study, the risk factor for the ALN recurrence is nuclear grade and presence of lymph vascular invasion, and lymph vascular invasion is also the risk of distant metastases. Chemotherapy may probably affect to prevent distant metastases after additional ALND, but still need further investigation.

PLOS ONE

Purpose This study contributes to the multidisciplinary understanding of septal L-strut reshaping... more Purpose This study contributes to the multidisciplinary understanding of septal L-strut reshaping and introduces innovative surgical design concepts based on engineering principles of static equilibrium. The objective is to enhance structural strength and stability, ultimately leading to improved surgical outcomes. Method Finite element analysis is employed to model the three-dimensional septal cartilage in septoplasty. A significant contribution of this work is the introduction of an innovative redesigns for the septal L-strut structure. These redesigns represent the first-ever attempt to incorporate the center of gravity theory into the modeling of the septal L-strut. Results Our findings emphasize the significance of attaining a lower center of gravity in the design of the septal L-strut, as it contributes to optimal core strength and stability. To achieve this, we recommend widening the caudal septum and shaping the interior fillet corner to its maximum size, taking into account...

Siriraj Medical Journal

Objective: Nose deformity, including nasal deviation, is conspicuous since it locates in central ... more Objective: Nose deformity, including nasal deviation, is conspicuous since it locates in central face area. Regarding this and its prevention, nasal septum is one of the important supporting structures. Understand bending tolerance of the cartilaginous septum not only helps mitigate secondary deformity from surgical intervention, but also provides baseline information for further study regarding the nasal septum.Materials and Methods: Nineteen fresh cadavers were dissected to expose the cartilaginous nasal septum. It was connected with the set-up computer system for detection of electrical signal at 1-mm septal bending from the midline. Mechanical load (bending load) was applied over the dorsal septum to quantify its bending tolerance. The data of bending tolerance and Pearson’s correlation were reported.Results: The mean of septal thicknesses is 1.5 ± 0.4 with the average bending load of 19.0 ± 11.2 g. The majority of the septal thicknesses (15/19; 78.9%) of the dissections are wit...

Siriraj Medical Journal

The deep peroneal nerve (DPN) is considered one of the clinically significant nerves of the lower... more The deep peroneal nerve (DPN) is considered one of the clinically significant nerves of the lower extremity since several clinical abnormalities can commonly be caused by its defects, either in its sensory or motor functions. Its derivatives, classified as muscular, cutaneous, and articular, mainly supply the muscles in the anterior fascial compartment of the leg and the dorsum of the foot, the 1st dorsal web space of the foot, the ankle joint, and certain joints of the foot. To improve the effectiveness of clinical practices involving the DPN, it is important to first understand its anatomical nature, including its typical characteristics and the variants (orientation, branching, and analogous structure), prior to applying such practices in clinical implementation. This review, therefore, aims to review the previously studied information of DPN on its fundamental anatomy and link it to the provided examples of current commonly used procedures, both non-invasive and invasive, e.g., ...

Background: The ultrasound-guided proximal intercostal block (PICB) is performed at the proximal ... more Background: The ultrasound-guided proximal intercostal block (PICB) is performed at the proximal intercostal space (ICS) between the internal intercostal membrane (IIM) and the endothoracic fascia/parietal pleura (EFPP) complex. Injectate spread may follow several routes and allow for multilevel trunk analgesia. The goal of this study was to examine the anatomical spread of large-volume PICB injections and its relevance to breast surgery analgesia. Methods: Fifteen two-level PICBs were performed in ten soft-embalmed cadavers. Radiographic contrast mixed with methylene blue was injected at the 2nd(15ml) and 4th(25ml) ICS, respectively. Fluoroscopy and dissection were performed to examine the injectate spread. Additionally, the medical records of 12 patients who had PICB for breast surgery were reviewed for documented dermatomal levels of clinical hypoesthesia. The records of twelve matched patients who had the same operations without PICB were reviewed to compare analgesia and opioid...

Journal of Contemporary Brachytherapy

Purpose: The dose distributions obtained from three imaging approaches for target delineation in ... more Purpose: The dose distributions obtained from three imaging approaches for target delineation in cervical cancer using high-dose-rate (HDR) brachytherapy were investigated. Material and methods: Ten cervical cancer patients receiving four fractions of HDR brachytherapy were enrolled. Based on different imaging approaches, three brachytherapy plans were developed for each patient: with the high-risk clinical target volume (HRCTV) delineated on magnetic resonance (MRI) images for every fraction (approach A; MRIonly); on MRI for the first fraction and computed tomography (CT) images for the subsequent fractions (approach B; MRI 1st /CT); and on CT images for all fractions (approach C; CT-only). The volume, height, width at point A, width at maximum level, and dosimetric parameters (D 100 , D 98 , D 95 , and D 90 of the HRCTV; and D 0.1cc , D 1cc , and D 2cc of all organs at risk, or organ at risk-OAR: bladder, rectum, sigmoid colon, and bowel) provided by each approach were compared. Results: The mean HRCTV volume, width, and height obtained from approach C (CT-only) were overestimated compared to those from approaches A (MRI-only) and B (MRI 1st /CT). The doses to the HRCTV for approaches A and B were similar. However, the HRCTV doses for approach C were significantly lower than those for approaches A and B for all parameters (D 95-D 100). As to the OAR, the three approaches showed no differences. Conclusions: A combination of MRI and CT is a safe alternative approach for cervical cancer HDR brachytherapy. The technique provides comparable dosimetric outcomes to MRI-based planning, while being more cost-effective.

Plastic and Reconstructive Surgery

Microsurgery, Jan 25, 2018

Medial plantar artery perforator (MPAP) flap was proposed as proper option for finger pulp recons... more Medial plantar artery perforator (MPAP) flap was proposed as proper option for finger pulp reconstruction. To provide the previously unavailable vessel information required for this small flap design, this study aimed to gather all necessary anatomy of MPA, MPAP, and their territories of blood supply to apply in clinical MPAP flap reconstruction minimizing perforator injury. Dissection of 30 Thai cadaveric feet for visualizing superficial branch of MPA and its perforators (MPAP) using acrylic dye cannulation were performed. Diameter, length, number of branches, course, distributing areas of these vessels, and also their areas of blood supply were recorded in relation to specified landmarks, eg, C-MTH line; medial calcaneal tuberosity to plantar side of the first metatarsal head and S point; emerging point of superficial branch of MPA from deep fasciae into subcutaneous layer. Average diameter of MPA at its origin and total length are 1.63 ± 0.3 and 52.8 ± 16.1 mm, respectively. It p...

Annals of Plastic Surgery

Brachytherapy

Titanium ring cap applicator (VariSource) was applied in treating cervical cancer patients by usi... more Titanium ring cap applicator (VariSource) was applied in treating cervical cancer patients by using image-guided brachytherapy (IGBT). However, its sizes appeared to be relatively large for most of our patients. Thus, we have developed a specific applicator "Siriraj Ring Cap," which is slightly smaller and more suitable for our patients. This study was to evaluate effectiveness of this equipment. Locally advanced cervical cancer patients were treated with external beam radiation therapy with or without concomitant chemotherapy. Siriraj Ring Cap was applied in all of the patients for at least one fraction. Dosimetric analysis was performed in each fraction of IGBT. Clinical outcomes of these patients were evaluated. Twenty-nine patients with 117 dosimetric planning were evaluated between January and December of 2014. Siriraj Ring Cap was fit to all patients in this study. By using this applicator, radiation doses to the targets (D90 high-risk clinical target volume and D90 intermediate-risk clinical target volume) were higher in each fraction. There were no statistically differences of radiation doses to the bladder, rectum, sigmoid colon, and small bowel. Within 2-year followup, 3 patients (10.3%) developed locoregional recurrence. Two-year disease-free survival and overall survival were 75.9% and 89.7%, respectively. According to RTOG/EORTC complication criteria, Grade 1, 2, and 3 gastrointestinal complications were developed in 2 (6.9%), 4 (13.8%), and 1 (3.4%) patients, respectively. For genitourinary complications, 3 patients (10.3%) and 1 patient (3.4%) had Grades 1 and 2, respectively. Siriraj Ring Cap is feasible for IGBT in cervical cancer patients with narrow vagina. Dosimetry and clinical outcomes were satisfactory by using our specific applicator.

European Journal of Plastic Surgery

Plastic and Reconstructive Surgery - Global Open, 2017

The purpose of this study is to determine if depressed women undergoing breast reconstruction hav... more The purpose of this study is to determine if depressed women undergoing breast reconstruction have worse outcomes? Despite a plethora of data examining the effect of depression after reconstruction there is little information to assess if concurrent depression affects patient outcomes in a similar manner. To answer this question we undertook a retrospective study using the Nationwide Inpatient Sample (NIS). METHODS: The NIS was queried for 2010-2013 for all patients undergoing breast reconstruction after mastectomy. Patients with a diagnosis of depression at the time of operation were compared to those without depression. Chi-squared, students't-test, and risk-adjusted multivariate logistic regression were performed with SPSS. A p value <0.05 was considered significant. RESULTS: A total of 175,508 patients were included in this study. 35,473 had depression at time of breast reconstruction and 140,035 did not. Depression was associated with an increased age, length of stay, cost of care, more comorbidities, and higher incidence of pulmonary, hematologic, gastrointestinal, infectious, wound and venous thromboembolic complications, p<0.05. Pulmonary, Genitourinary, and Hematologic complications, Infection, VTE, wound, and transfusion were associated with depression when multivariate risk-adjusted regression was performed. CONCLUSION: A co-morbid diagnosis at time of breast reconstruction should prompt the breast surgeon and plastic surgeon to ensure that depressed patients have their depression addressed prior to undergoing breast reconstruction to ensure optimal patient outcomes.

Journal of surgical case reports, Apr 1, 2024

PLOS ONE, Jan 15, 2024

This study aims to compare two surgical techniques, the standard Vein-to-Artery and the newer Art... more This study aims to compare two surgical techniques, the standard Vein-to-Artery and the newer Artery-to-Vein (Radial Artery Deviation And Reimplantation; RADAR), for enhancing the success of Arterio-Venous Fistula maturation in end-stage renal disease patients. The impact of diseases like anemia, diabetes, hypertension, and chronic kidney disease were considered. The goals are to advance Arterio-Venous Fistula (AVF) surgery, improve patient outcomes, and contribute to evidence-based surgical guidelines. Methods Fluid-structure interaction modeling was employed to investigate how hemodynamic and mechanical stresses impact arteriovenous fistula maturation, with a particular focus on the role of wall shear stress in determining maturation outcomes. The critical threshold for vessel injury was identified as wall shear stress values exceeding 35 N/m 2 , while stenosis formation was projected to occur at levels below 1 N/m 2. This work introduced a novel approach by considering disease-related factors, including blood viscosity (anemia), and vessel elasticity (diabetes, hypertension, and chronic kidney diseases), which directly influence hemodynamics and the generation of wall shear stress. Furthermore, the model was designed to incorporate varying thicknesses and elasticities for both the vein and artery, accurately representing authentic vascular anatomy.

Journal of Reconstructive Microsurgery

Background: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of ... more Background: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline. Methods: Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory. Results: Overall, three SIEA patterns were identified: bilateral presence (45%), ipsilateral presence (30%), and bilateral absence (25%). The territory depended on the vessel course and dominant SIEA diameter, not on its common origin from the femoral artery, at the pubic tubercle level. Regarding the midline territory (pubic tubercle level to umbilicus), SIEA with a diameter of ≥1.4 mm on either side (t...

The Breast, Mar 1, 2017

In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival ... more In these 21 cases, median age at first operation was 51 (range 34-80), and disease free survival was 35.4 ± 6.3 months. Histopathological study revealed the presence of invasive ductal carcinoma in all cases. Average tumor size was 2.55 ± 0.43 cm, and the average numbers of removed sentinel lymph node were 3.4 ± 0.5. The numbers of nuclear grade 3 were 9 (42.9%). Vein invasion was seen in 3 cases (14.3%), and lymph vascular invasion was seen in 9 cases (42.9%). All 21 patients were performed ALND after ALN recurrence. The average numbers of dissected lymph node were 13.9 ± 1.5, and of metastatic lymph node were 3.0 ± 0.5. During the median follow up period of 62.7 months from additional ALND, distant metastases were observed in 5 cases (23.9%) and 1 case (4.8%) died. In the group with distant metastases after ALND, the rate of lymph vascular invasion was significantly higher than the group without distant metastases (60.0% vs. 37.5%, p = 0.048), whereas there were no significant differences of clinical or pathological backgrounds between the group with and without distant metastases. But patients who received chemotherapy after ALND had a trend to a lower distant metastases compared with patients who received no chemotherapy (13.3% vs. 50.0%, p = 0.115). Conclusion: In this study, the risk factor for the ALN recurrence is nuclear grade and presence of lymph vascular invasion, and lymph vascular invasion is also the risk of distant metastases. Chemotherapy may probably affect to prevent distant metastases after additional ALND, but still need further investigation.

PLOS ONE

Purpose This study contributes to the multidisciplinary understanding of septal L-strut reshaping... more Purpose This study contributes to the multidisciplinary understanding of septal L-strut reshaping and introduces innovative surgical design concepts based on engineering principles of static equilibrium. The objective is to enhance structural strength and stability, ultimately leading to improved surgical outcomes. Method Finite element analysis is employed to model the three-dimensional septal cartilage in septoplasty. A significant contribution of this work is the introduction of an innovative redesigns for the septal L-strut structure. These redesigns represent the first-ever attempt to incorporate the center of gravity theory into the modeling of the septal L-strut. Results Our findings emphasize the significance of attaining a lower center of gravity in the design of the septal L-strut, as it contributes to optimal core strength and stability. To achieve this, we recommend widening the caudal septum and shaping the interior fillet corner to its maximum size, taking into account...

Siriraj Medical Journal

Objective: Nose deformity, including nasal deviation, is conspicuous since it locates in central ... more Objective: Nose deformity, including nasal deviation, is conspicuous since it locates in central face area. Regarding this and its prevention, nasal septum is one of the important supporting structures. Understand bending tolerance of the cartilaginous septum not only helps mitigate secondary deformity from surgical intervention, but also provides baseline information for further study regarding the nasal septum.Materials and Methods: Nineteen fresh cadavers were dissected to expose the cartilaginous nasal septum. It was connected with the set-up computer system for detection of electrical signal at 1-mm septal bending from the midline. Mechanical load (bending load) was applied over the dorsal septum to quantify its bending tolerance. The data of bending tolerance and Pearson’s correlation were reported.Results: The mean of septal thicknesses is 1.5 ± 0.4 with the average bending load of 19.0 ± 11.2 g. The majority of the septal thicknesses (15/19; 78.9%) of the dissections are wit...

Siriraj Medical Journal

The deep peroneal nerve (DPN) is considered one of the clinically significant nerves of the lower... more The deep peroneal nerve (DPN) is considered one of the clinically significant nerves of the lower extremity since several clinical abnormalities can commonly be caused by its defects, either in its sensory or motor functions. Its derivatives, classified as muscular, cutaneous, and articular, mainly supply the muscles in the anterior fascial compartment of the leg and the dorsum of the foot, the 1st dorsal web space of the foot, the ankle joint, and certain joints of the foot. To improve the effectiveness of clinical practices involving the DPN, it is important to first understand its anatomical nature, including its typical characteristics and the variants (orientation, branching, and analogous structure), prior to applying such practices in clinical implementation. This review, therefore, aims to review the previously studied information of DPN on its fundamental anatomy and link it to the provided examples of current commonly used procedures, both non-invasive and invasive, e.g., ...

Background: The ultrasound-guided proximal intercostal block (PICB) is performed at the proximal ... more Background: The ultrasound-guided proximal intercostal block (PICB) is performed at the proximal intercostal space (ICS) between the internal intercostal membrane (IIM) and the endothoracic fascia/parietal pleura (EFPP) complex. Injectate spread may follow several routes and allow for multilevel trunk analgesia. The goal of this study was to examine the anatomical spread of large-volume PICB injections and its relevance to breast surgery analgesia. Methods: Fifteen two-level PICBs were performed in ten soft-embalmed cadavers. Radiographic contrast mixed with methylene blue was injected at the 2nd(15ml) and 4th(25ml) ICS, respectively. Fluoroscopy and dissection were performed to examine the injectate spread. Additionally, the medical records of 12 patients who had PICB for breast surgery were reviewed for documented dermatomal levels of clinical hypoesthesia. The records of twelve matched patients who had the same operations without PICB were reviewed to compare analgesia and opioid...

Journal of Contemporary Brachytherapy

Purpose: The dose distributions obtained from three imaging approaches for target delineation in ... more Purpose: The dose distributions obtained from three imaging approaches for target delineation in cervical cancer using high-dose-rate (HDR) brachytherapy were investigated. Material and methods: Ten cervical cancer patients receiving four fractions of HDR brachytherapy were enrolled. Based on different imaging approaches, three brachytherapy plans were developed for each patient: with the high-risk clinical target volume (HRCTV) delineated on magnetic resonance (MRI) images for every fraction (approach A; MRIonly); on MRI for the first fraction and computed tomography (CT) images for the subsequent fractions (approach B; MRI 1st /CT); and on CT images for all fractions (approach C; CT-only). The volume, height, width at point A, width at maximum level, and dosimetric parameters (D 100 , D 98 , D 95 , and D 90 of the HRCTV; and D 0.1cc , D 1cc , and D 2cc of all organs at risk, or organ at risk-OAR: bladder, rectum, sigmoid colon, and bowel) provided by each approach were compared. Results: The mean HRCTV volume, width, and height obtained from approach C (CT-only) were overestimated compared to those from approaches A (MRI-only) and B (MRI 1st /CT). The doses to the HRCTV for approaches A and B were similar. However, the HRCTV doses for approach C were significantly lower than those for approaches A and B for all parameters (D 95-D 100). As to the OAR, the three approaches showed no differences. Conclusions: A combination of MRI and CT is a safe alternative approach for cervical cancer HDR brachytherapy. The technique provides comparable dosimetric outcomes to MRI-based planning, while being more cost-effective.

Plastic and Reconstructive Surgery

Microsurgery, Jan 25, 2018

Medial plantar artery perforator (MPAP) flap was proposed as proper option for finger pulp recons... more Medial plantar artery perforator (MPAP) flap was proposed as proper option for finger pulp reconstruction. To provide the previously unavailable vessel information required for this small flap design, this study aimed to gather all necessary anatomy of MPA, MPAP, and their territories of blood supply to apply in clinical MPAP flap reconstruction minimizing perforator injury. Dissection of 30 Thai cadaveric feet for visualizing superficial branch of MPA and its perforators (MPAP) using acrylic dye cannulation were performed. Diameter, length, number of branches, course, distributing areas of these vessels, and also their areas of blood supply were recorded in relation to specified landmarks, eg, C-MTH line; medial calcaneal tuberosity to plantar side of the first metatarsal head and S point; emerging point of superficial branch of MPA from deep fasciae into subcutaneous layer. Average diameter of MPA at its origin and total length are 1.63 ± 0.3 and 52.8 ± 16.1 mm, respectively. It p...

Annals of Plastic Surgery

Brachytherapy

Titanium ring cap applicator (VariSource) was applied in treating cervical cancer patients by usi... more Titanium ring cap applicator (VariSource) was applied in treating cervical cancer patients by using image-guided brachytherapy (IGBT). However, its sizes appeared to be relatively large for most of our patients. Thus, we have developed a specific applicator &amp;amp;amp;amp;amp;amp;quot;Siriraj Ring Cap,&amp;amp;amp;amp;amp;amp;quot; which is slightly smaller and more suitable for our patients. This study was to evaluate effectiveness of this equipment. Locally advanced cervical cancer patients were treated with external beam radiation therapy with or without concomitant chemotherapy. Siriraj Ring Cap was applied in all of the patients for at least one fraction. Dosimetric analysis was performed in each fraction of IGBT. Clinical outcomes of these patients were evaluated. Twenty-nine patients with 117 dosimetric planning were evaluated between January and December of 2014. Siriraj Ring Cap was fit to all patients in this study. By using this applicator, radiation doses to the targets (D90 high-risk clinical target volume and D90 intermediate-risk clinical target volume) were higher in each fraction. There were no statistically differences of radiation doses to the bladder, rectum, sigmoid colon, and small bowel. Within 2-year followup, 3 patients (10.3%) developed locoregional recurrence. Two-year disease-free survival and overall survival were 75.9% and 89.7%, respectively. According to RTOG/EORTC complication criteria, Grade 1, 2, and 3 gastrointestinal complications were developed in 2 (6.9%), 4 (13.8%), and 1 (3.4%) patients, respectively. For genitourinary complications, 3 patients (10.3%) and 1 patient (3.4%) had Grades 1 and 2, respectively. Siriraj Ring Cap is feasible for IGBT in cervical cancer patients with narrow vagina. Dosimetry and clinical outcomes were satisfactory by using our specific applicator.

European Journal of Plastic Surgery

Plastic and Reconstructive Surgery - Global Open, 2017

The purpose of this study is to determine if depressed women undergoing breast reconstruction hav... more The purpose of this study is to determine if depressed women undergoing breast reconstruction have worse outcomes? Despite a plethora of data examining the effect of depression after reconstruction there is little information to assess if concurrent depression affects patient outcomes in a similar manner. To answer this question we undertook a retrospective study using the Nationwide Inpatient Sample (NIS). METHODS: The NIS was queried for 2010-2013 for all patients undergoing breast reconstruction after mastectomy. Patients with a diagnosis of depression at the time of operation were compared to those without depression. Chi-squared, students't-test, and risk-adjusted multivariate logistic regression were performed with SPSS. A p value <0.05 was considered significant. RESULTS: A total of 175,508 patients were included in this study. 35,473 had depression at time of breast reconstruction and 140,035 did not. Depression was associated with an increased age, length of stay, cost of care, more comorbidities, and higher incidence of pulmonary, hematologic, gastrointestinal, infectious, wound and venous thromboembolic complications, p<0.05. Pulmonary, Genitourinary, and Hematologic complications, Infection, VTE, wound, and transfusion were associated with depression when multivariate risk-adjusted regression was performed. CONCLUSION: A co-morbid diagnosis at time of breast reconstruction should prompt the breast surgeon and plastic surgeon to ensure that depressed patients have their depression addressed prior to undergoing breast reconstruction to ensure optimal patient outcomes.