Shih-Yi Chen

Tri-Service General Hospital, T’ai-pei, Taipei, Taiwan

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Publications (13)15.18 Total impact

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    ABSTRACT: Breast deformities after augmentation with injectable materials carried out by uncertified medical personnel present challenging problems. Materials include liquid silicone, paraffin, polyacrylamide hydrogels, and unknown gels. They usually cause granulomatous reactions, erythema, pain, and even skin necrosis. Tender masses that cannot be differentiated from breast cancers are the major concern. This retrospective study presents the authors' experience in managing 10 symptomatic injected breasts in five patients during the past 8 years. Subcutaneous mastectomies were carried out using periareolar, inverted "T", or inframammary approaches combined with breast reconstruction using bilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. All flaps survived well and gave a satisfactory cosmetic appearance. There was no major complication or late occurrence of breast cancers over the following 8 years. Injectable materials used for breast augmentation should be prohibited until more scientific data are available about the long-term effect of these materials in breast tissues. Once the injected breasts become symptomatic, subcutaneous mastectomy and reconstruction with bilateral pedicled TRAM flaps is a reasonable option for the patient.
    Journal of plastic surgery and hand surgery. 09/2012; 46(3-4):242-7.
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    ABSTRACT: Fournier's gangrene is an acute and potentially lethal necrotising fasciitis that involves the scrotum and perineum. This disease can result in the loss of skin and soft tissue. To repair the scrotal and perineal defects remains a surgical challenge. Between January 2000 and December 2008, 50 patients were admitted to our hospital with a diagnosis of Fournier's gangrene. We retrospectively reviewed 31 of the 44 surviving patients, who needed reconstructive procedures for coverage of scrotal and perineal soft-tissue defects. The choice of reconstructive procedure was based on the size, location, severity of the defects and the availability of local tissue. The patients' age, predisposing factors, defect size and location, reconstructive procedures and outcomes were reviewed. The mean age of the patients was 53.6 years (range, 20-84 years). The average size of the skin defect was 86 cm(2). A total of 12 patients were treated by scrotal advancement flap coverage, nine by split-thickness skin graft, five by pudendal thigh flap, two by gracilis myocutaneous flap, one by gracilis muscle flap plus split-thickness skin graft and three by pedicle anterolateral thigh flap. The overall surgical complication rate was 16%. Early debridement and wound coverage in Fournier's gangrene are mandatory to allow patients to return to normal life. We set up a valuable reconstructive algorithm based on the characteristics of the defects and our 9 years of experience, which adds to the versatility of the armamentarium of the reconstructive surgeon.
    Journal of Plastic Reconstructive & Aesthetic Surgery 04/2011; 64(4):528-34. · 1.44 Impact Factor
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    ABSTRACT: Microvascular free flap transplantation is the current most common choice for reconstruction of difficult through-and-through buccal defect after cancer extirpation. The chimeric anterolateral thigh (ALT) flap is an ideal flap to cover this full thickness defect, but variation in the location of perforators is a major concern. Herein, we introduce computed tomographic angiography (CTA)-guided mathematical perforators mapping for chimeric ALT flap design and harvest. Between September 2008 and March 2009, nine patients with head and neck tumour underwent preoperative CTA perforator mapping before free ALT flap reconstruction of full thickness buccal defects. The perforators were marked on a 64-section multi-detector CT image for each patient, and the actual perforator locations were correlated with the intra-operative dissection. The donor limb of choice, either right or left, was also selected based on the dominant vascularity. Flap success rates, any associated morbidity and complications were recorded. A total of 23 perforators were identified on CTA image preoperatively. Twenty-two of these perforators were chosen for chimeric flap design, and all were located as the CTA predicted, with the rate of utilization being 95.7% (22/23). There were two post-operative complications, including one partial flap necrosis and one microstomia. All of the ALT flaps survived, and there was no donor site morbidity. Preoperative CTA allows accurate perforator mapping and evaluation of the dominant vascularity. It helps the surgeon to get an ideal designing of the chimeric ALT flap with two skin paddles based on individual perforators, but only one vascular anastomosis in reconstruction of full thickness buccal defects.
    ANZ Journal of Surgery 03/2011; 81(3):142-7. · 1.50 Impact Factor
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    ABSTRACT: Anterolateral thigh flap (ALT) is an useful flap for head and neck reconstruction, but the variable perforators may limit its applications. Our goal was to clarify the benefits of preoperative CT angiography (CTA) in mapping of free ALT perforators for reconstruction of cheek through-and-through defects. We retrospectively reviewed 32 patients undergoing reconstruction of through-and-through cheek defects with a free ALT flap between February 2005 and July 2009. These patients were divided into two groups. Group I (N=17): the ALT flap was designed based on the traditional handheld Doppler probe. Group II (N=15): preoperative imaging with CTA was used to map the perforator's number, size and variations. Surgical results were evaluated for both major and minor complications, as with the operation time, length of hospital stay and donor-site morbidity. Overall flap survival was 96.88% (31 of 32 flaps). The use of preoperative CTA was associated with a significant reduction in major surgical complications, length of surgery and the need for a secondary debulking procedure (p<0.05). There was no difference in minor complication and donor-site morbidity. The use of CTA for preoperative navigation of ALT flap for cheek reconstruction is associated with improved operative outcomes. Detailed data from images allow the surgeon to interpret any anatomical variations, choosing the exact suitable thigh, facilitate flap design, and greatly reduce major postoperative complications.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 02/2011; 39(8):633-8. · 1.25 Impact Factor
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    ABSTRACT: Composite grafting is used to treat nonreplantable fingertip amputations. This procedure has a high success rate and good results in treating fingertip amputations in children, but a lower success rate in adults. From July 2007 to December 2008, 27 patients with 31 injured fingertips were admitted because of traumatic fingertip amputation at the emergency department of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. All 31 injured fingers had a nonreplantable distal amputated fingertip and underwent composite grafting. We refined the surgical technique by excising the bony segment, defatting, deepithelialization, tie-over suturing, and finger splinting to increase the graft survival. The patients' age, mechanism of damage, lesion size, surgical result, and postoperative complications were recorded. The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm. Twenty-one fingers (67.7%) had been injured by crushing injury and the other 10 fingers (32.3%) by cutting injury. The overall graft survival rate was 93.5% (29 of 31). The average 2-point discrimination was 6.3 mm in the sixth month after the operation. The esthetic outcome evaluated by self-report questionnaire was 93.1% satisfied, and 86.2% of the patients could use their injured finger normally in daily work. This easily performed and one-stage surgical procedure provided a reliable method for treating microsurgically nonreplantable fingertip amputations caused by hand trauma. The high overall success rate, satisfactory esthetic outcome, and good functional preservation helped patients return quickly to their daily life.
    The Journal of trauma 01/2011; 70(1):148-53. · 2.35 Impact Factor
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    ABSTRACT: To provide an alternative choice for covering trochanteric pressure sores, we report on a modified pedicle anterolateral thigh (ALT) myocutaneous flap based on the descending branch of the lateral circumflex femoral artery. From August 2007 to January 2010, 20 consecutive patients (10 men and 10 women) underwent 21 pedicled ALT myocutaneous flaps for reconstruction of trochanteric pressure sores. The flap was designed and elevated, resembling the ALT perforator flap including part of the vastus lateralis muscle but without skeletonisation of the perforators. The mean age of patients was 79.4 years (range: 46-103). The mean follow-up period was 13.9 months (range: 3-32). The flaps were 8-21 cm long and 5-11 cm wide. All flaps healed without major complications. All donor sites were closed primarily without skin grafting and showed good aesthetic results. No recurrence was observed. This modified design of pedicled ALT myocutaneous flap without skeletonisation of perforators is a reliable and easily harvested flap for reconstruction of trochanteric pressure sores with limited morbidity.
    Journal of Plastic Reconstructive & Aesthetic Surgery 09/2010; 64(5):671-6. · 1.44 Impact Factor
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    ABSTRACT: Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was diabetes mellitus in 21 patients (51.2%), followed by cirrhosis of the liver, uremia, alcoholism, and underlying malignancy. The most common symptoms were fever (87.8%) and pain or swelling over the genital region (85.4%). The initial treatment included extensive debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.
    Annals of plastic surgery 06/2010; 64(6):765-9. · 1.29 Impact Factor
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    ABSTRACT: The purpose of this study was to develop a modified method to implant a totally implantable access port (TIAP) using the femoral vein approach. We designed a modified method using the femoral vein approach to implant a TIAP in patients with synchronous bilateral breast cancer requiring bilateral mastectomy and postoperative chemotherapy. TIAP implantation was performed with parenteral sedation and local anesthesia in the operating room. All patients were followed for at least 12 months and the complications of TIAP were recorded. In this retrospective study, 86 patients received the TIAP using the modified femoral vein approach. All patients had a history of bilateral breast cancer and underwent bilateral mastectomy. The early complication rate within the first 30 postoperative days was 2.3% and involved groin hematoma caused by missed puncture to the femoral artery during the operation. The late postoperative complication rates were 2.3% caused by local port infection, 1.2% by groin wound infection, and 3.5% by catheter occlusion. There were no complications associated with TIAP disconnection or systemic infection. Traditional implantation of TIAP through the subclavian vein or cephalic vein is simple and is used worldwide. However, both the percutaneous puncture and cutdown methods have limitations and risks. We describe a safe and effective method using the modified femoral vein approach for specific patients.
    Journal of Surgical Oncology 10/2008; 98(3):197-9. · 2.64 Impact Factor
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    ABSTRACT: Background: The purpose of this study was to report our experience in management of emphysematous cholecystitis. Patients and Methods: We reviewed the medical records of 11 cases (6 male, 5 female) over the last 5 years. The clinical characteristics, laboratory tests, imaging studies and treatments were recorded. Results: The average age was 72 years. Seven patients presented with right upper quadrant (RUQ) abdominal pain on admission. Nine patients had a history of diabetes mellitus (DM). Over half of the patients were pyrexial on admission. Nine patients had leukocytosis. The abdominal plain films (kidneys, ureters, bladder; KUB) were all reviewed. Only 3 patients were reported as being suspicious of gas bubbles in the RUQ. Sonography of abdomen were performed in 8 patients. Only 2 patients had suspicious of emphysematous cholecystitis. CT of abdomen was performed in 9 patients, including two patients reported as air in wall with pericholecystic fluid and air-fluid level in gallbladder. Six of 11 patients were treated by emergency cholecystectomy. One patient was treated conservatively by antibiotics and interval cholecystectomy 4 weeks later. Four patients were treated with percutaneous transhepatic gallbladder drainage followed by cholecystectomy and broadspectrum antibiotics. These 4 patients had uncomplicated postoperative recoveries. Conclusion: Percutaneous transhepatic gallbladder drainage followed by cholecystectomy and broad-spectrum antibiotics is an effective treatment of emphysematous cholecystitis.
    Chirurgische Gastroenterologie 01/2007; 23(1):75-78. · 0.14 Impact Factor
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    ABSTRACT: Diagnosis of pseudoaneurysm of the aorta or its main branches is a challenge in patients with blunt chest trauma. Computed tomography helps to demonstrate intrathoracic hemorrhage and suspected great vascular injury when a chest radiograph reveals widening of the mediastinum. Aortic angiography remains the gold standard in the determination of the site, and severity of vascular injury for definitive surgical intervention. Timing of surgical repair is controversial. Delayed repair of traumatic pseudoaneurysm of the aorta after primary control of associate injuries decreases mortality significantly, thus improving prognosis. We report a case of successful repair of a traumatic pseudoaneurysm of the aortic arch with extension to the left common carotid artery in an 18-year-old female patient. The diagnosis, surgical approaches, and timing of operation are discussed along with case presentation.
    Saudi medical journal 11/2006; 27(10):1591-3. · 0.62 Impact Factor
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    ABSTRACT: Salmonella infections are commonly selflimiting and usually cause gastroenteritis. Rarely, Salmonella infections lead to severe bacteremia and lethal infection of the spleen. Isolated splenic abscess is an unusual, but potentially life-threatening clinical entity, and is a challenge for the clinical physician to diagnose early. Case Report: We present a 22-year-old soldier with a Salmonella abscess of the spleen following acute gastroenteritis. Fever, left upper quadrant pain, leukocytosis, and splenomegaly were noted on admission. Abdominal ultrasonography and CT scan were performed, and a splenic abscess was diagnosed. The initial treatment includes ultrasound-guided percutaneous drainage and antibiotics. Due to persisted sepsis and deterioration, splenectomy was performed. The postoperative course was uneventful. Conclusion: Clinicians should be alert to patients with left upper abdominal pain and sepsis at clinical presentation, even in patients who are immunocompetent and in whom minor �gastroenteritis� is diagnosed. Immediate exploration should be considered if the sepsis progresses despite antibiotics and/or percutaneous drainage. Early awareness and timely definitive splenectomy are important in the management of a splenic abscess.
    Chirurgische Gastroenterologie 01/2006; 22(3):201-203. · 0.14 Impact Factor
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    ABSTRACT: Background: Choledochoduodenal fistula is an abnormal tract between the common bile duct and the duodenum. Common etiology includes iatrogenic instrumentation, choledocholithiasis, and duodenal ulcer. In rare cases, the fistula is a complication secondary to an occult malignancy such as biliary adenocarcinoma. Here we report a case with adenosquamous carcinoma of the common bile duct that causes a choledochoduodenal fistula. Case Report: A 72-year-old female patient presented with epigastralgia and poor appetite for 3 months. Upper gastrointestinal endoscopy showed an orifice with bile leakage in the posterior wall of the second portion of the duodenum. A biliodigestive fistula was noted. Endoscopic retrograde cholangiopancreatography (ERCP) showed a choledochoduodenal fistula and a contrast filling defect in the distal common bile duct. Endoscopic transpapillary biopsy of the distal common bile duct revealed poorly differentiated adenocarcinoma. Pancreatoduodenectomy was performed by laparotomy. Pathological assessment revealed a moderately differentiated adenosquamous carcinoma of distal common bile duct. The patient�s postoperative period was uneventful. Conclusion: For clinical evaluation of choledochoduodenal fistula of unknown etiology and if occult malignancy is suspected upper gastrointestinal endoscopy and ERCP should be done. Surgical resection is mandatory in choledochoduodenal fistulas with biliary cancer origin.
    Chirurgische Gastroenterologie 01/2006; 22(2):88-91. · 0.14 Impact Factor
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    ABSTRACT: This study was to compare the postoperative complication rates of continuous ambulatory peritoneal dialysis (CAPD) catheter insertion via open technique between two groups of patients, those with and those without a history of previous abdominal surgery. A review was carried out in 122 patients over a 2-year period. The patients were divided into two groups: those with and those without previous lower abdominal surgery. All patient records were retrospectively analyzed until the time of catheter failure or to current time if alive and receiving CAPD. Patient characteristics, operative factors, and postoperative complications were recorded. Postoperative complications were reported as catheter malfunction in 16 patients and CAPD-related peritonitis in 36 patients. The complication rates in the group of patients with previous abdominal surgery were 16.7% catheter malfunction and 33.3% CAPD-related peritonitis. In patients without previous lower abdominal surgery, a catheter malfunction rate of 12.5% and a peritonitis rate of 28.8% were seen. The operation time in patients with previous abdominal surgery was longer than that in patients without previous abdominal surgery. However, no statistically significant difference in postoperative complication rates was detected between patients with and patients without previous lower abdominal surgery. CAPD remains a reliable modality in the treatment of end-stage renal disease and does not increase postoperative complications in patients with previous abdominal surgery.
    Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis 27(5):557-9. · 2.21 Impact Factor