Swee Tan - Academia.edu (original) (raw)

Papers by Swee Tan

Head & neck, Oct 1, 2002

Background. Permanent loss of the marginal mandibular branch of the facial nerve (MMBFN) may resu... more Background. Permanent loss of the marginal mandibular branch of the facial nerve (MMBFN) may result from an inadvertent injury or an intentional sacrifice during tumor resection. This may occur in isolation or as a part of total facial nerve palsy. The loss of the MMBFN results in paralysis of the depressors of the ipsilateral lower lip with troublesome cosmetic and functional deficits. Method. A series of 14 patients with permanent loss of the MMBFN during resection of head and neck tumors were treated with the anterior belly of digastric muscle transfer (ABDMT). The loss of the MMBFN occurred in isolation in five patients and formed a part of total facial nerve palsy in nine. Immediate reconstruction was performed on nine patients, and it was done as a secondary procedure in the remainder. Two patients in the latter group had prior facial reanimation, although the paralyzed lower lip was not reconstructed. Results. The average follow-up period was 23.2 (range, 3À48) months. Satisfactory results were achieved in all of the patients, although revision of the ABDMT was required in one patient. Conclusions. ABDMT is a simple and reliable reconstructive technique for restoring the depressor function of the lower lip resulting from MMBFN palsy. It is the treatment of choice during primary extirpative surgery for head and neck tumors when the MMBFN requires sacrifice for tumor clearance or is inadvertently injured. The reconstructive options for MMBFN palsy, particularly in the absence of the anterior belly of digastric muscle, are discussed.

Journal of Cancer Science & Therapy, Jul 3, 2017

Introduction: Colorectal cancer (CRC) is the third most common cancer in the USA. Approximately 2... more Introduction: Colorectal cancer (CRC) is the third most common cancer in the USA. Approximately 20% of CRC patients present with synchronous liver metastasis at the time of diagnosis and overall 50% develop liver metastasis during the course of their disease. The median survival of CRC patients with liver metastasis (CRCLM) is 5-20 months if left untreated. This study aimed to identify and characterise the CSC population in CRCLM using OCT4, SOX2, NANOG, c-Myc and KLF4. Methodology: DAB immunohistochemical (IHC) staining was performed on six CRCLM samples for OCT4 SOX2, NANOG, c-Myc and KLF4. Immunofluorescent (IF) IHC staining was performed to investigate co-expression of markers. Nanostring in situ hybridisation (ISH) mRNA analyses was performed for the transcriptional activation. Cell counting was performed on IHC and ISH stains. 2 test and the t-tests were used for statistical analysis to compare the cells within the tumour nests (TNs) and those within the peritumoural stroma (PTS). Results: IHC staining demonstrated the expression of OCT4 SOX2, NANOG, c-Myc and KLF4 within CRCLM. IF IHC staining showed the presence of three CSC: (i) SOX2+/NANOG+/KLF4+/cMYC+/OCT sub population within the TNs; (ii) SOX2+/ NANOG+/KLF4+/cMYC+/OCT4-sub population and (iii) SOX2+/NANOG+/KLF4+/cMYC+/OCT4+ sub population, in PTS. Nanostring transcriptional demonstrated the expression for all markers, except for SOX2. ISH confirmed the expression for all the markers. Conclusion: This study demonstrates 3 putative sub-populations of CSCs within CRCLM: one within the TNs and two in PTS. OCT4 was only observed in the CSC subpopulation within the PTS, offering novel insights into the biology of this cancer.

British Journal of Plastic Surgery, 1991

A 30-year-old farmer with Nezelof s syndrome developed a giant orf on his hand. Recurrence follow... more A 30-year-old farmer with Nezelof s syndrome developed a giant orf on his hand. Recurrence followed surgical excision. Three excisions and split skin grafts were required before its eradication. He represented 8 years later with a further orf on the finger of his opposite hand. This lesion had not grown to the exuberant proportion of the previous lesion, but it defied repeated excisions, and various medical therapies including idoxuridine, interferon and transfer factor. Excision with hypochlorite dressings perioperatively and delayed split shin graftiug led to eventual eradication.

Plastic and Reconstructive Surgery, May 1, 2005

Congenital auricular anomalies are heterogeneous, with various descriptive and eponymous terms be... more Congenital auricular anomalies are heterogeneous, with various descriptive and eponymous terms being used. Current classification systems are useful in guiding surgical treatment of severe anomalies. However, they do not generally account for the less severe anomalies, which form the majority of congenital auricular anomalies, nor their contemporary treatment. In this article, the authors review the anatomy and embryology of the external ear and propose a simple classification of congenital auricular anomalies that encompasses all forms of congenital auricular anomalies, facilitates proper diagnosis, and guides treatment. Congenital auricular anomalies should be classified as malformational or deformational anomalies. Malformational auricular anomalies are caused by embryologic maldevelopment that occurs between the fifth and ninth week of gestation resulting in deficient and/or supernumerary auricular components. Deformational auricular anomalies result from in utero or ex utero deformational forces, including those caused by an aberrant insertion of the intrinsic or extrinsic auricular muscles. Malformational auricular anomalies generally require surgical correction during childhood or adolescence. For practical purposes, deformational auricular anomalies have a full complement of chondrocutaneous com-From the

International Archives of Medicine, 2015

The aim of this study was to determine the treatment outcome of spider naevi using pulse dye lase... more The aim of this study was to determine the treatment outcome of spider naevi using pulse dye laser (PDL) therapy. Patients and Methods: This was a retrospective study reviewing the results of PDL on spider naevi in 49 consecutive patients undergoing PDL for spider naevi, between 15 October 2003 and 19 August 2008. A questionnaire was used to investigate patient satisfaction and recurrence. Results: There was improvement seen in all patients with complete resolution in 31 patients (76%) and 67 lesions (82%). There was a high level of satisfaction with the treatment with 30 patients (78%) being very satisfied and six (15%) satisfied with the result. Hypopigmentation occurred in one patient. Two patients (4.9%) with a total of four lesions developed recurrence in two lesions only. Conclusions: PDL is an effective and safe treatment of spider naevi.

Plastic and Reconstructive Surgery, Aug 1, 2002

British Journal of Dermatology, Jan 19, 2018

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Journal of Plastic Reconstructive and Aesthetic Surgery, Aug 1, 2010

We present the results of our evolving treatment strategy for pyogenic granuloma (PG) affecting c... more We present the results of our evolving treatment strategy for pyogenic granuloma (PG) affecting cosmetically sensitive areas, from 1996 to 2007. Fifty-one lesions in 49 patients aged six weeks to 87 years (mean, 23.5 years) affecting the head and neck skin (39%) and lip vermillion (14%), limbs (31%) and trunk (16%) were treated. Fifteen lesions (29%) had failed previous treatments elsewhere. Forty-two lesions (in 40 patients) underwent pulsed-dye laser (PDL) therapy alone, using fluences of 5.3-9.4 J/cm(2) (Photogenica V) or 15 J/cm(2) (V-Beam) without dynamic cooling, at 7 mm spot-size. An average of 1.8 (range, 1-5) treatment sessions were required for lesions &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5 mm, while an average of 2.7 (range 1-6) sessions were needed for lesions 5-10 mm in size. Five patients (with five lesions) measuring 4-6 mm elected for surgical excision following 1-3 (mean, 1.7) PDL treatments. Since 2001, nine PG (in nine patients) measuring 5-20 (mean, 11) mm underwent shave-excision and immediate PDL and repeat PDL as necessary. One patient elected for surgical excision following two PDL sessions. The remaining eight patients required an average of 1.1 (range, 0-5) additional PDL sessions for eradication of their PG. PDL alone for PG &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5 mm, and shave-excision and immediate PDL to the base for larger lesions are effective treatments for lesions affecting cosmetically sensitive areas.

Surgical Practice, Feb 1, 2007

Neurothekeoma, also known as nerve sheath myxoma, perineural myxoma and plexiform myxoma, is a ra... more Neurothekeoma, also known as nerve sheath myxoma, perineural myxoma and plexiform myxoma, is a rare benign neoplasm of presumed nerve sheath origin. This tumour typically presents as a slowly enlarging painless cutaneous swelling most commonly in female adolescents in the head and neck region or upper limb. Nerves in the dermis are more frequently involved than those in the subcutaneous tissue. It rarely affects subfascial peripheral nerves or the central nervous system. Of the 150 cases published since its first description in 1969, three cases involved deep peripheral nerves in the hand. To the best of our knowledge a neurothekeoma affecting a deep peripheral nerve of the lower limb has not been reported. We present such a case involving the sciatic nerve with significantly larger size compared with previously described cases.

Journal of Craniofacial Surgery, Nov 1, 1999

The Journal of Hand Surgery, May 1, 1999

Anomalous extensor muscles of the hand are not uncommon. Well-recognized anomalies Ϫ anomalous ex... more Anomalous extensor muscles of the hand are not uncommon. Well-recognized anomalies Ϫ anomalous extensor indicis proprius, extensor digitorum brevis manus, extensor medii proprius, and extensor indicis et medii communis are reviewed and discussed in detail. Anomalous extensor indicis proprius and extensor digitorum brevis manus may occasionally give rise to dorsal wrist pain and the diagnosis is often confused especially in the presence of other pathologic findings such as a ganglion. An analysis of the embryologic development of the extensor muscle mass with phylogenetic comparisons between species of the animal kingdom is presented to underscore the clinical relevance of these anomalous extensors.

Anz Journal of Surgery, Jun 1, 2018

Surgical Practice, Aug 1, 2006

Lipoma is the commonest soft tissue tumour, usually found subcutaneously. However, intermuscular ... more Lipoma is the commonest soft tissue tumour, usually found subcutaneously. However, intermuscular and intramuscular lipomas are uncommon and they rarely occur in the distal extremities where they can be associated with restriction of movement or nerve compression syndromes. These lesions can prove a diagnostic challenge, and should be managed differently from subcutaneous lipomas as their proximity to neurovascular structures and distortion of anatomy pose a risk during excision. As well, intramuscular lipomas are prone to recur.

Journal of Plastic Reconstructive and Aesthetic Surgery, Jun 1, 2010

To document the current practice of postoperative fluid management and evaluate its effectiveness... more To document the current practice of postoperative fluid management and evaluate its effectiveness in major elective plastic surgery. We conducted a retrospective review on consecutive adult patients undergoing major elective plastic surgery necessitating intensive care unit or high dependency unit admission between May 2005 and May 2007. Hourly fluid input, output and vital signs were recorded for the first 48h postoperatively. Hourly urine output was used as a measure of adequacy of tissue perfusion with 0.5-1.5mlkg(-1)h(-1) being considered normal. Urine output outside of this range for more than four consecutive hours was considered clinically abnormal. These measurements were related temporally to any adjustment of the rates of fluid administration. Intra-operative balance and daily total fluid balance were recorded. Twenty-four out of 85 patients were excluded because of pre-existing renal impairment (n=12), regular diuretic use (n=8) or incomplete documentation (n=4). No patients had pre-existing cardiac failure. The mean intra-operative positive fluid balance was 3687ml (range 1300-8711), with a mean cumulative volume of 4522ml (range 2560-9465) on postoperative day 1 and this increased with the length of hospital stay. A brisk diuresis (range 1.5-9.0; mean, 3.6mlkg(-1)h(-1)) occurred in 41 (67%) patients, half of them within 7h postoperatively. 26 (43%) patients received excessive fluid, which were responded to within 1-31h (mean 13.5). Six (10%) patients developed cardiac failure, requiring fluid restriction and/or diuretics. Patients undergoing major elective plastic surgery are in massive positive fluid balance. Majority of these patients develop a brisk diuresis in the early postoperative period. Current practice centres on preventing oliguria, often with excessive and unnecessary fluid being administered resulting in cardiac failure in some patients. Postoperative fluid management should be guided by a protocol with minimal fluid administration that maintains adequate tissue perfusion, guided by lower and upper limits of desirable urine output. The rates of fluid administration should be adjusted dynamically by the surgical or the nursing staff using such a protocol.

British Journal of Plastic Surgery, Oct 1, 1999

... a Wellington Regional Plastic and Maxillo-facial Surgery Unit, Hutt Hospital. b Swee Tan Plas... more ... a Wellington Regional Plastic and Maxillo-facial Surgery Unit, Hutt Hospital. b Swee Tan Plastic Surgery Trust, Wellington, New Zealand. ... 9. ANB Kauvar, DH McDaniel and RG Geronemus, Pulsed dye laser treatment of warts. Arch Fam Med 4 (1995), pp. 1035–1040. ...

Plastic and Reconstructive Surgery, Feb 1, 1997

The New Zealand Medical Journal, Mar 13, 2009

British Journal of Plastic Surgery, 1993

A prospective, randomised, controlled study compared DuoDERM ER (DE) with scarlet red (SR) in the... more A prospective, randomised, controlled study compared DuoDERM ER (DE) with scarlet red (SR) in the treatment of split skin graft donor areas in 60 patients. Healing and donor site comfort were significantly better in the DE group. There was no clinical infection in either group. The wound leakage rate was higher in the DE group, requiring an average of 0.8 replacement dressings per donor site as compared with an average of 0.04 for the SR group. An estimate of the cost per donor site for the first ten days of dressing is given.