yuancheng chiang - Academia.edu (original) (raw)
Papers by yuancheng chiang
The purpose of this study is to present our experience with patients who underwent traumatic ear ... more The purpose of this study is to present our experience with patients who underwent traumatic ear amputation. Between January 1988 and April 2002, 10 patients sustained ear amputations. Of these, six patients underwent microvascular replantation (arterial anastomosis only and arterial and venous anastomosis in three patients each), and replantation was attempted in one patient. However, no suitable vessel could be found for the anastomosis, and the amputated ear was treated as a composite graft and buried in a retroauricular pocket. Staged costal cartilage reconstruction was performed in three patients who lost the ear replant after trauma (two patients) or due to infection (one patient). The ear replant survived and showed good cosmetic results in the three patients who underwent arterial and venous anastomoses. The patients who had artery anastomosis only required intrareplant heparin injection (chemical leech) to resolve venous congestion and sustained partial loss of the replanted ear. Secondary procedures were necessary to repair the reconstructions, including an advancement, temporoparietal fascia, or retroauricular flap. Those who underwent staged ear reconstruction had late ear deformities. Microvascular replantation is the best method for reattaching an amputated ear, giving excellent esthetic results. If only arterial anastomosis is performed, a chemical leech is an option for decompressing the venous congestion. In those patients without a suitable vessel for microanastomosis, nonmicrosurgical methods are suggested, such as a temporoparietal fascia flap, retroauricular pocket procedure, or staged-costal cartilage reconstruction, depending on the ear defect.
Plastic and Reconstructive Surgery, 1997
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 2011
Congenital constriction ring syndrome (CCRS) is a congenital anomaly with a wide spectrum of clin... more Congenital constriction ring syndrome (CCRS) is a congenital anomaly with a wide spectrum of clinical presentation. The accepted method of correcting a circular constriction is to excise the deep part of the constriction, and break the line of the circular scar with multiple Z- or W-plasties. Specific correction of soft tissue is recommended concurrently, to better correct the "sandglass" deformity. Here we describe a new technique using triangular advancement flaps to correct the deformity in eight patients with constriction ring syndrome, involving either the upper or lower limbs. In this technique, triangular flaps can be introduced either proximal or distal to the ring, depending on the limb circumference, to correct the contour deformity. In all eight patients, a normal extremity contour was obtained, with complete elimination of the deformity caused by the constriction ring. A mean follow-up of 43 months revealed an aesthetically acceptable scar, with no case of recu...
Chang Gung medical journal, 2005
The purpose of this study was to summarize the outcomes we achieved using deceased-donor liver tr... more The purpose of this study was to summarize the outcomes we achieved using deceased-donor liver transplantation (DDLT) in the past 10 years at Chang Gung Memorial Hospital-Kaohsiung Medical Center (CGMH-KMC). Between March 1993 and March 2003, 53 DDLTs were performed at CGMH-KMC. Patients were divided into 2 stages: stage 1 (n = 22) from March 1993 to February 1998, and stage 2 (n = 31) from March 1998 to March 2003. Indications for transplantation, patient demographics, surgical procedures, and long-term outcomes were reviewed. Indications for transplantation were biliary atresia (16), post-hepatitis B/C viral cirrhosis with or without hepatocellular carcinoma (21), Wilson's disease (8), primary biliary cirrhosis (3), and miscellaneous (5). Two retransplants were carried out for secondary biliary cirrhosis using primary live-donor liver transplantation (LDLT). Ten patients received grafts from 6 split-liver transplantations. Over-all Kaplan-Meier 1-, 3-, and 5-year survival rate...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
Clinics in Plastic Surgery, 2005
Microsurgery, 2014
Background: Previous neck dissection and irradiation is believed to affect the success of free ti... more Background: Previous neck dissection and irradiation is believed to affect the success of free tissue transfers in head and neck reconstruction, but evidence is scarce and conflicting. This study seeks to evaluate flap success rates in the presence of these two factors. Methods: Over a ten-year period, a total of 853 free flap cases were evaluated. Success rates were compared between a control group with no prior intervention (non-irradiation and neck dissection, NRTND) against three other groups: irradiation only (RT), previous neck dissection only (ND), and both (RTND). The choices of recipient vessel used were also compared. Results: The flap failure rate was 6.3% (4/63) in the RTND group; 4.8% (1/21) in the ND group; 5.2% (6/115) in the RT group; and 2.1% (14/654) in the NRTND group. There was no statistical significance among the four groups (P 5 0.254). Ipsilateral neck vessels (92.7%) were more frequently used in the NRTND group. In contrast, the superficial temporal vessels, contra-lateral neck vessels were more likely to be selected in the groups with irradiation and/or neck dissection. Conclusions: Free tissue transfer in head and neck patients with previous irradiation and neck dissection is feasible and can be safely done. In addition, superficial temporal vessel could be the first choice in patients with previous radiotherapy and neck dissection.
Wound Repair and Regeneration, 2009
Extracorporeal shock wave (ESW) treatment has a positive effect of rescuing ischemic skin flaps. ... more Extracorporeal shock wave (ESW) treatment has a positive effect of rescuing ischemic skin flaps. This study assessed whether ESW treatment rescues the compromised flap tissue by suppressing the apoptosis of ischemic tissue and recruiting tissue remodeling. We used a random-pattern extended dorsalskin-flap (10Â3 cm) rodent model. Thirty-six male Sprague-Dawley rats were divided into three groups. Group I, the control group, received no treatment. Group II received one session of ESW treatment (500 impulses at 0.15 mJ/mm 2) immediately after surgery. Group III received two sessions of ESW treatment, immediately and the day after the surgery. Results indicated that the necrotic area in the flaps in group II was significantly smaller than that of the flaps in group I (p < 0.01). Transferase dUTP-nick end labeling (TUNEL) analysis revealed a significant decrease in the number of apoptotic cells in group II. Hydrogen peroxide (H 2 O 2) expression in circulation blood was significantly decreased in group II on the day after ESW treatment. Immunohistochemical staining indicated that compared with no treatment, ESW treatment could substantially increase proliferating cell nuclear antigen (PCNA), endothelial nitric oxide synthase, and prolyl 4-hydroxylase (rPH) expression, reduce CD45 expression, and suppress 8-hydroxyguanosine (8-OG) expression in the ischemic zone of the flap tissue. In conclusion, ESW treatment administered at an optimal dosage exerts a positive effect of rescuing ischemic extended skin flaps. The mechanisms of action of ESWs involve modulation of oxygen radicals, attenuation of leukocyte infiltration, decrease in tissue apoptosis, and recruitment of skin fibroblasts, which results in increased flap tissue survival.
Wound Repair and Regeneration, 2009
Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chroni... more Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chronic wound healing. However, the bio-mechanisms operating during ESWT of wounds remain unclear. This study investigated the effectiveness of ESWT in the enhancement of diabetic wound healing. A dorsal skin defect (area, 6Â5 cm) in a streptozotocin-induced diabetes rodent model was used. Fifty male Wistar rats were divided into five groups. Group I consisted of nondiabetic control; group II included diabetic control receiving no ESWT; group III included rats that underwent one session of ESWT (ESW-1) on day 3 (800 impulses at 0.09 mJ/mm 2) postwounding; group IV included rats that underwent two sessions of ESWT (ESW-2) on days 3 and 7; and group V included rats that underwent three sessions of ESWT (ESW-3) on days 3, 7, and 10. The wound healing was assessed clinically. Blood perfusion scan was performed with laser Doppler. The VEGF, eNOS, and PCNA were analyzed with immunohistochemical stain. The results revealed that the wound size was significantly reduced in the ESWTtreated rats, especially in the ESW-2 and ESW-3 groups, as compared with the control (p < 0.01). Blood perfusion was significantly increased after ESWT compared with the controls. Histological findings revealed a significant reduction in the topical pro-inflammatory reaction in the ESWT group as compared with the control. In immunohistochemical stain, significant increases in VEGF, eNOS, and PCNA expressions were observed in the ESWT group, especially in the ESW-2 and ESW-3 groups, as compared with the control. In conclusion, treatment with an optimal session of ESWT significantly enhanced diabetic wound healing associated with increased neo-angiogenesis and tissue regeneration, and topical anti-inflammatory response.
Transplantation Proceedings, 1998
Transplant International, 2003
Exogenous citrate load from blood transfusion during orthotopic liver transplantation is thought ... more Exogenous citrate load from blood transfusion during orthotopic liver transplantation is thought to be the main cause of ionized hypocalcemia, which may result in hemodynamic instability. This implies that if no blood is transfused, chelation of free ionized calcium (Ca' ') by citrate is avoided and supplemental calcium need not be given. For this study, we divided 39 pediatric living-donor liver transplant patients into two groups according to the blood component replacement given: group I received + + monitoring and adequate replacement are, therefore, still required in this setting. Keywords Liver surgery. Transplantation. Anesthesia. General. Monitoring. Serum ionized calcium. Transfusion-Blood-bank products. 5% Albumin
Plastic and Reconstructive Surgery, 2006
Plastic and Reconstructive Surgery, 2006
Background: A thin skin flap is often required for optimal resurfacing of particular areas of the... more Background: A thin skin flap is often required for optimal resurfacing of particular areas of the body. An anterolateral thigh perforator flap can be thinned to an extent to which it is vascularized by the subdermal plexus only. This study presents a novel flap thinning technique and its application for resurfacing the dorsum of the foot. Methods: From July of 2002 to October of 2003, 18 patients underwent resurfacing of the dorsum of the foot with thin anterolateral thigh flaps. The main perforators were strategically located in the flap center to keep the peripheral area within the vascular territory. The flaps were larger than needed, initially elevated subfascially, and then thinned to the suitable thickness while the pedicle was still attached. The dissection of perforators in the adipose layer close to the dermis entry was carried out microscopically. Flap sizes ranged from 3 ϫ 3 to 16 ϫ 8 cm. Results: Seventeen flaps survived completely and one had distal superficial necrosis of 1 ϫ 2 cm. No debulking procedures were necessary. Average follow-up was 12 months. Conclusions: A thin flap vascularized through subdermal plexus is reliable. Microsurgical dissection of the perforator is a recommended technique. The thin anterolateral thigh perforator flap provides ideal reconstruction in resurfacing the dorsum of the foot.
Plastic & Reconstructive Surgery, 1997
Plastic and Reconstructive Surgery, 1995
Plastic and Reconstructive Surgery, 1993
Plastic and Reconstructive Surgery, 2001
Plastic and Reconstructive Surgery, 2009
Plastic and Reconstructive Surgery, 2004
The purpose of this study is to present our experience with patients who underwent traumatic ear ... more The purpose of this study is to present our experience with patients who underwent traumatic ear amputation. Between January 1988 and April 2002, 10 patients sustained ear amputations. Of these, six patients underwent microvascular replantation (arterial anastomosis only and arterial and venous anastomosis in three patients each), and replantation was attempted in one patient. However, no suitable vessel could be found for the anastomosis, and the amputated ear was treated as a composite graft and buried in a retroauricular pocket. Staged costal cartilage reconstruction was performed in three patients who lost the ear replant after trauma (two patients) or due to infection (one patient). The ear replant survived and showed good cosmetic results in the three patients who underwent arterial and venous anastomoses. The patients who had artery anastomosis only required intrareplant heparin injection (chemical leech) to resolve venous congestion and sustained partial loss of the replanted ear. Secondary procedures were necessary to repair the reconstructions, including an advancement, temporoparietal fascia, or retroauricular flap. Those who underwent staged ear reconstruction had late ear deformities. Microvascular replantation is the best method for reattaching an amputated ear, giving excellent esthetic results. If only arterial anastomosis is performed, a chemical leech is an option for decompressing the venous congestion. In those patients without a suitable vessel for microanastomosis, nonmicrosurgical methods are suggested, such as a temporoparietal fascia flap, retroauricular pocket procedure, or staged-costal cartilage reconstruction, depending on the ear defect.
Plastic and Reconstructive Surgery, 1997
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 2011
Congenital constriction ring syndrome (CCRS) is a congenital anomaly with a wide spectrum of clin... more Congenital constriction ring syndrome (CCRS) is a congenital anomaly with a wide spectrum of clinical presentation. The accepted method of correcting a circular constriction is to excise the deep part of the constriction, and break the line of the circular scar with multiple Z- or W-plasties. Specific correction of soft tissue is recommended concurrently, to better correct the "sandglass" deformity. Here we describe a new technique using triangular advancement flaps to correct the deformity in eight patients with constriction ring syndrome, involving either the upper or lower limbs. In this technique, triangular flaps can be introduced either proximal or distal to the ring, depending on the limb circumference, to correct the contour deformity. In all eight patients, a normal extremity contour was obtained, with complete elimination of the deformity caused by the constriction ring. A mean follow-up of 43 months revealed an aesthetically acceptable scar, with no case of recu...
Chang Gung medical journal, 2005
The purpose of this study was to summarize the outcomes we achieved using deceased-donor liver tr... more The purpose of this study was to summarize the outcomes we achieved using deceased-donor liver transplantation (DDLT) in the past 10 years at Chang Gung Memorial Hospital-Kaohsiung Medical Center (CGMH-KMC). Between March 1993 and March 2003, 53 DDLTs were performed at CGMH-KMC. Patients were divided into 2 stages: stage 1 (n = 22) from March 1993 to February 1998, and stage 2 (n = 31) from March 1998 to March 2003. Indications for transplantation, patient demographics, surgical procedures, and long-term outcomes were reviewed. Indications for transplantation were biliary atresia (16), post-hepatitis B/C viral cirrhosis with or without hepatocellular carcinoma (21), Wilson's disease (8), primary biliary cirrhosis (3), and miscellaneous (5). Two retransplants were carried out for secondary biliary cirrhosis using primary live-donor liver transplantation (LDLT). Ten patients received grafts from 6 split-liver transplantations. Over-all Kaplan-Meier 1-, 3-, and 5-year survival rate...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
Clinics in Plastic Surgery, 2005
Microsurgery, 2014
Background: Previous neck dissection and irradiation is believed to affect the success of free ti... more Background: Previous neck dissection and irradiation is believed to affect the success of free tissue transfers in head and neck reconstruction, but evidence is scarce and conflicting. This study seeks to evaluate flap success rates in the presence of these two factors. Methods: Over a ten-year period, a total of 853 free flap cases were evaluated. Success rates were compared between a control group with no prior intervention (non-irradiation and neck dissection, NRTND) against three other groups: irradiation only (RT), previous neck dissection only (ND), and both (RTND). The choices of recipient vessel used were also compared. Results: The flap failure rate was 6.3% (4/63) in the RTND group; 4.8% (1/21) in the ND group; 5.2% (6/115) in the RT group; and 2.1% (14/654) in the NRTND group. There was no statistical significance among the four groups (P 5 0.254). Ipsilateral neck vessels (92.7%) were more frequently used in the NRTND group. In contrast, the superficial temporal vessels, contra-lateral neck vessels were more likely to be selected in the groups with irradiation and/or neck dissection. Conclusions: Free tissue transfer in head and neck patients with previous irradiation and neck dissection is feasible and can be safely done. In addition, superficial temporal vessel could be the first choice in patients with previous radiotherapy and neck dissection.
Wound Repair and Regeneration, 2009
Extracorporeal shock wave (ESW) treatment has a positive effect of rescuing ischemic skin flaps. ... more Extracorporeal shock wave (ESW) treatment has a positive effect of rescuing ischemic skin flaps. This study assessed whether ESW treatment rescues the compromised flap tissue by suppressing the apoptosis of ischemic tissue and recruiting tissue remodeling. We used a random-pattern extended dorsalskin-flap (10Â3 cm) rodent model. Thirty-six male Sprague-Dawley rats were divided into three groups. Group I, the control group, received no treatment. Group II received one session of ESW treatment (500 impulses at 0.15 mJ/mm 2) immediately after surgery. Group III received two sessions of ESW treatment, immediately and the day after the surgery. Results indicated that the necrotic area in the flaps in group II was significantly smaller than that of the flaps in group I (p < 0.01). Transferase dUTP-nick end labeling (TUNEL) analysis revealed a significant decrease in the number of apoptotic cells in group II. Hydrogen peroxide (H 2 O 2) expression in circulation blood was significantly decreased in group II on the day after ESW treatment. Immunohistochemical staining indicated that compared with no treatment, ESW treatment could substantially increase proliferating cell nuclear antigen (PCNA), endothelial nitric oxide synthase, and prolyl 4-hydroxylase (rPH) expression, reduce CD45 expression, and suppress 8-hydroxyguanosine (8-OG) expression in the ischemic zone of the flap tissue. In conclusion, ESW treatment administered at an optimal dosage exerts a positive effect of rescuing ischemic extended skin flaps. The mechanisms of action of ESWs involve modulation of oxygen radicals, attenuation of leukocyte infiltration, decrease in tissue apoptosis, and recruitment of skin fibroblasts, which results in increased flap tissue survival.
Wound Repair and Regeneration, 2009
Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chroni... more Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chronic wound healing. However, the bio-mechanisms operating during ESWT of wounds remain unclear. This study investigated the effectiveness of ESWT in the enhancement of diabetic wound healing. A dorsal skin defect (area, 6Â5 cm) in a streptozotocin-induced diabetes rodent model was used. Fifty male Wistar rats were divided into five groups. Group I consisted of nondiabetic control; group II included diabetic control receiving no ESWT; group III included rats that underwent one session of ESWT (ESW-1) on day 3 (800 impulses at 0.09 mJ/mm 2) postwounding; group IV included rats that underwent two sessions of ESWT (ESW-2) on days 3 and 7; and group V included rats that underwent three sessions of ESWT (ESW-3) on days 3, 7, and 10. The wound healing was assessed clinically. Blood perfusion scan was performed with laser Doppler. The VEGF, eNOS, and PCNA were analyzed with immunohistochemical stain. The results revealed that the wound size was significantly reduced in the ESWTtreated rats, especially in the ESW-2 and ESW-3 groups, as compared with the control (p < 0.01). Blood perfusion was significantly increased after ESWT compared with the controls. Histological findings revealed a significant reduction in the topical pro-inflammatory reaction in the ESWT group as compared with the control. In immunohistochemical stain, significant increases in VEGF, eNOS, and PCNA expressions were observed in the ESWT group, especially in the ESW-2 and ESW-3 groups, as compared with the control. In conclusion, treatment with an optimal session of ESWT significantly enhanced diabetic wound healing associated with increased neo-angiogenesis and tissue regeneration, and topical anti-inflammatory response.
Transplantation Proceedings, 1998
Transplant International, 2003
Exogenous citrate load from blood transfusion during orthotopic liver transplantation is thought ... more Exogenous citrate load from blood transfusion during orthotopic liver transplantation is thought to be the main cause of ionized hypocalcemia, which may result in hemodynamic instability. This implies that if no blood is transfused, chelation of free ionized calcium (Ca' ') by citrate is avoided and supplemental calcium need not be given. For this study, we divided 39 pediatric living-donor liver transplant patients into two groups according to the blood component replacement given: group I received + + monitoring and adequate replacement are, therefore, still required in this setting. Keywords Liver surgery. Transplantation. Anesthesia. General. Monitoring. Serum ionized calcium. Transfusion-Blood-bank products. 5% Albumin
Plastic and Reconstructive Surgery, 2006
Plastic and Reconstructive Surgery, 2006
Background: A thin skin flap is often required for optimal resurfacing of particular areas of the... more Background: A thin skin flap is often required for optimal resurfacing of particular areas of the body. An anterolateral thigh perforator flap can be thinned to an extent to which it is vascularized by the subdermal plexus only. This study presents a novel flap thinning technique and its application for resurfacing the dorsum of the foot. Methods: From July of 2002 to October of 2003, 18 patients underwent resurfacing of the dorsum of the foot with thin anterolateral thigh flaps. The main perforators were strategically located in the flap center to keep the peripheral area within the vascular territory. The flaps were larger than needed, initially elevated subfascially, and then thinned to the suitable thickness while the pedicle was still attached. The dissection of perforators in the adipose layer close to the dermis entry was carried out microscopically. Flap sizes ranged from 3 ϫ 3 to 16 ϫ 8 cm. Results: Seventeen flaps survived completely and one had distal superficial necrosis of 1 ϫ 2 cm. No debulking procedures were necessary. Average follow-up was 12 months. Conclusions: A thin flap vascularized through subdermal plexus is reliable. Microsurgical dissection of the perforator is a recommended technique. The thin anterolateral thigh perforator flap provides ideal reconstruction in resurfacing the dorsum of the foot.
Plastic & Reconstructive Surgery, 1997
Plastic and Reconstructive Surgery, 1995
Plastic and Reconstructive Surgery, 1993
Plastic and Reconstructive Surgery, 2001
Plastic and Reconstructive Surgery, 2009
Plastic and Reconstructive Surgery, 2004