Jui-Yung Yang

Hospital for Special Surgery, New York City, New York, United States

Are you Jui-Yung Yang?

Claim your profile

Publications (24)35.23 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Several functionally limiting sequelae can follow deep thermal injury to the hand. Despite appropriate initial management, contractures are common. Whereas acute burn care is often managed by multidisciplinary, specialized burn units, postburn contractures may be referred to hand surgeons, who should be familiar with the patterns of burn contracture and nonsurgical and operative options to improve function and expected outcomes. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly are managed with scar excision and local soft tissue rearrangement or skin grafting. The burn claw hand presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstays of management of these contractures include complete surgical excision of scar tissue and resurfacing of the resultant soft tissue defect, most commonly with full-thickness skin grafts. If scar contracture release results in major exposure of the tendons or joints, distant tissue transfer may be required. Early motion and rehabilitative modalities are essential to prevent initial contracture formation and recontracture after surgical release.
    The Journal of Hand Surgery. 09/2014; 39(9):1869–1876.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Carved autologous costal cartilage is widely used in different rhinoplasty procedures because of its availability and proven advantages. However, the usefulness of rib grafts is limited by warping postoperatively. The chimeric autologous costal cartilage graft is proposed. "Chimeric" means the combining of two different tissues (bone and cartilage in this case) to make a single dorsal onlay graft.
    Plastic and reconstructive surgery. 06/2014; 133(6):768e-75e.
  • [Show abstract] [Hide abstract]
    ABSTRACT: In addition to burn surgeons, skilled nurses, and therapists, hand surgeons are a key part of the multidisciplinary team caring for patients following thermal injury to the hand. Despite appropriate initial treatment and compressive therapy, contractures are common after deep burn. The most common and functionally limiting are web space and hand contractures. Web space contractures can be managed with excision followed by local soft tissue rearrangement or skin grafting. The classic burn claw hand deformity includes extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstay of management of these postburn contractures includes complete surgical release of scar tissue and replacement by full-thickness skin graft. In cases in which scar contracture release results in major exposure of the tendons or joints, distant tissue transfer is required. This review focuses on prevention and management of late sequelae of thermal injury to the hand focusing on contractures of the webspaces and hand.
    Current Reviews in Musculoskeletal Medicine 11/2013;
  • Burns: journal of the International Society for Burn Injuries 10/2013; · 1.95 Impact Factor
  • Jui-Yung Yang, Shih-Yi Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: Intrascar excision with debulking procedure is a good choice for scar revision in unique 3-dimensional facial aesthetic units, especially in the auricular area. It can remove or reduce scars in a shorter course without distortion of the surrounding anatomic structures and visible operative scars. This retrospective study was done to present intrascar excision procedures in persistent auricular hypertrophic scars or keloids. Between 1997 and 2010, 18 ears in 13 patient cases with persistent hypertrophic scars and/or keloids in their external ear due to burns or trauma were collected for evaluation. There were 10 males and 3 females. The age distributions ranged from 5 to 49 years with an average of 20.1 years. All received intrascar excision with debulking procedure for their ear deformity. One case combined with YV-plasty procedure to obtain better aesthetic result. The follow-up period ranged from 0.3 to 14 years with an average of 3.6 years. There was no recurrence in a series of average 3.6 years follow-up. Of the 13 patients, 11 (84.6%) objectively presented good and satisfactory surgical outcomes and the other 2 patients were acceptable. The intrascar excision in auricular persistent scars or keloids has the following advantages: it (1) achieves primary closure, (2) does not distort the anatomic landmarks, (3) does not sacrifice the important structures, (4) has a debulking effect, (5) can be done anytime, even if scars are not mature, (6) has good cosmetic results, (7) may combine with Z- or VY-plasty for functional improvement, and (8) has minimal complications.
    Annals of plastic surgery 12/2012; 69(6):637-42. · 1.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Loss of cervicomental angle is characteristic of severe facial and cervical burned patients due to scar contracture. This micrognathia-like deformity is also seen in patients following chin and neck reconstruction using skin expanded flaps. The aim of modern plastic surgery is to restore a harmonious and symmetrical facial appearance for burn survivors. METHODS: Six facial and cervical burned patients with micrognathia-like deformity after neck reconstructions were reported. Chin augmentation with Medpor implant through submental approach was performed in 4 patients and intraoral access in 2 cases to restore their favorable chin projections. Five of them received cervicomental contour reconstruction simultaneously. RESULTS: Patient follow-up ranged from 12 to 18 months. No implants became exposed nor infected. All patients had satisfactory results. We reviewed our experience with the use of the Medpor implant in burn chin reconstruction including preoperative and postoperative radiograph analysis. CONCLUSIONS: With proper patient selection, pre-operative planning, and taking care of details during operation, augmentation genioplasty with Medpor implant offers a reliable, simple and satisfactory solution for improving micrognathia-like facial configurations in patients with scar contracture following severe burns.
    Burns: journal of the International Society for Burn Injuries 09/2012; · 1.95 Impact Factor
  • Jui-Yung Yang, Shih-Yi Yang, Wei F Chen
    [Show abstract] [Hide abstract]
    ABSTRACT: Nail fold deformities from burn injury frequently result in eponychial retraction, proximal nail exposure, pain, and distal phalangeal function impairment. Secondary nail abnormalities including longitudinal ridges, surface cracks, and fragility are common sequelae to nail fold deformities. Surgical management of postburn nail fold deformity is challenging because of scar contractures involving the dorsum of digits and lack of surrounding healthy tissues that can be used as source of soft tissue for reconstruction. Previous reports have discussed several methods for reconstruction of these deformities. However, all of these methods are associated with significant donor site morbidities. From August 2008 to January 2010, "onion" flap reconstruction was performed for postburn nail fold contractures and deformities on 32 fingers of eight patients (five men and three women; average age, 44.4 years; age range, 23-54 years). This novel technique was used to release scar contractures in the eponychial area and allow soft tissue restoration by redraping the eponychium in a single-step procedure. All 32 fingers received single-stage "onion" flap reconstruction for their nail fold deformities at least 6 months after the initial injury. The follow-up period, with an average of 7.8 months, revealed that all nails had good esthetic and functional results. All experienced amelioration of nail abnormalities. The "onion" advancement flap had effectively released the scar contracture around the nail fold and simultaneously restored the eponychial fold. The "onion" flap technique provides superior results compared with those from conventional techniques. We recommend it as the mainstay of treatment for reconstruction of the postburn eponychial deformities. V, therapeutic study.
    The journal of trauma and acute care surgery. 05/2012; 72(5):1424-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Inhalation injuries contribute significantly to morbidity and mortality in both children and adults with burns. Pneumonia is a major compromising factor in these patients. The purpose of this article was to evaluate the characteristics, impact factors, incidence, morbidity, and mortality of pneumonia in inhalation injuries. Furthermore, a severity score has been formulated to help predict the probability of developing pneumonia following inhalation injuries. A retrospective study was performed of 214 patients, treated for inhalation injuries from 1999 to 2009 at the Burn Center in Chang Gung Memorial Hospital, Linkou, Taiwan. Patients' characteristics, length of hospitalization, total burn surface area, initial PaO2:FiO2 ratio, number of intubated days, bronchoscope grade, initial carboxyhemoglobin level (COHb) and mortality rate were recorded. A Student's t-test was used for comparison of inhalation injury patients with and without pneumonia and was also used for comparing a TBSA of >20% to those with a TBSA of ≤20% in patients with inhalation injury and pneumonia. Logistic regression analyses were utilized to create a severity score related to pneumonia. 129 patients with inhalation injury were included in the analysis. Overall, 38% (49/129) patients developed pneumonia. Pneumonia associated with inhalation injury occurred more often in patients with a TBSA>20% (P<0.05). The intubation days, bronchoscope grade and COHb level of pneumonia patients were significantly longer (P<0.05). Initial PaO2:FiO2 ratio (PaO2/FiO2) was significantly lower in patients with pneumonia (P<0.05). Mortality following pneumonia was increased sevenfold (P<0.05). Hospitalization days and intubation days were significantly longer in TBSA>20%. Logistic regression analysis was performed to find out the impact factors of pneumonia in inhalation injury patients and to set a severity score. Patients age >60 years, TBSA >20%, bronchoscope grade is 3 or 4, initial PaO2/FiO2≦300 and initial COHb level>10% showed a significant difference (P<0.05). The total severity scale was set at 5 points. Each impact factor was given one point and when the score ≥2 it means patients have high risk of development of pneumonia. This study had identified the significant risk factors for potential development of pneumonia in a group of inhalation injury patients. The impact of these risk factors should be validated in further prospective trials to improve outcome or at least reduce the incidence of the surrogate diagnosis of pneumonia.
    Burns: journal of the International Society for Burn Injuries 09/2011; 38(2):203-7. · 1.95 Impact Factor
  • Jui-Yung Yang, Chun-Yuan Huang
    [Show abstract] [Hide abstract]
    ABSTRACT: Hypertrophic scars (HScs) are inelastic scars that can cause functional loss and disfigurement. Decorin regulates collagen fibrillogenesis, and its expression is lower in HScs than in normal skin and during wound healing. To evaluate the efficacy of combined verapamil and triamcinolone in treating HScs. Excised human HSc fragments from surgically treated burned patients were divided into three groups: A (normal saline), B (verapamil), and C (verapamil and triamcinolone). The specimens were bilaterally implanted in the back of nude mice, treated using intralesional injections, and observed for 4 weeks. We compared the fibroblast viability and proliferation, decorin staining, and scar weights to evaluate treatment efficacy. Viability and proliferation of HSc fibroblasts from groups B and C were significantly lower at all time intervals after transplantation (p<.001). Treatment (Groups B and C) stimulated strong decorin staining by 4 weeks. Nonsignificant differences in changes in scar weight were observed between groups. We present the first evidence of verapamil-augmented decorin expression spatially correlated with collagen bundles in HScs. Combination therapy can reduce the dosage of each drug but achieve equal or better efficacy than monotherapy, reducing the side effects of a single drug. The authors have indicated no significant interest with commercial supporters.
    Dermatologic Surgery 10/2010; 36(12):1942-9. · 1.87 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Since Jean-Nicolas Marjolin reported carcinoma arising in post-traumatic scars in 1828, the term 'Marjolin ulcer' has been applied to malignant changes in burn scars. Although many papers have been published already in this field, there are few reports from Oriental people. From 1989 to 2008, there were 11 cases noted as burn scar carcinoma in Chang Gung Memorial Hospital. Ten were reported as squamous cell carcinoma (SCC) and the one was verrucous carcinoma. Most of the cases occurred in the extremities (10/11). Ten cases underwent an operation initially with wide excision and skin graft or local flap for coverage. Forefoot amputation was performed in one patient. One patient received above-knee amputation and adjuvant therapy because recurrent verrucous carcinoma occurred 2 years later. One patient suffered from a new lesion 8 years later and another case had inguinal lymph node metastasis 8 months later. Five patients were lost to follow-up and six cases were tumor-free during the follow-up period. Most scar malignancies are SCC while other cell types are rarer. The casual association between burn injuries and a later risk of basal cell carcinoma is questionable. Owing to poor prognosis in advanced scar cancer, the best treatment for scar carcinoma is to prevent the scar from developing repeated ulceration by performing aggressive initial burn wound care: early grafting by surgeons and daily scar care with regular follow-up for patients. This may be why a lower incidence has been noted in recent years.
    Journal of Dermatological Treatment 05/2010; 21(6):350-6. · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dynamic and static complex scar contractures after burn commonly cause tendon adhesion, deep adipose tissue stiffness and further limitation of major joints motion. Skin autografting or locoregional flaps are not adequate reconstructive options, because of the easy recurrence and limitation of donor sites. Therefore, free perforator flaps are playing increasing role in reconstruction of complex scar contractures. The free medial thigh perforator (MTP) flap is an addition to the reconstructive armamentarium and is particularly useful since the medial thigh is commonly spared in burn injury. Between December 2001 and October 2005, eight patients with severe post-burn scar contractures received free MTP flaps treatment in the Linkou Burn Center. The free MTP flap harvest was modified to enhance its reliability and versatility. Flap sizes ranged from 5 x 15 cm to 8 x 24 cm. The follow-up period was from 12 to 26 months. Flap harvest is rapid, averaging 37.8 min. The significantly improved range of motion of the contracture joints approximated to normal activity at 6-22-month follow-up (p<0.05). No free major MTP flap complication was noted, except for mild marginal necrosis in one case. The free MTP flap with new modified harvest is a good choice for dynamic an static complex scar contractures of major joints, due to short harvesting time and few variations of the pedicle. However, thick skin paddle was considered in secondary hand reconstruction.
    Burns: journal of the International Society for Burn Injuries 10/2009; 36(4):565-71. · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Heterotopic ossification (HO) is an uncommon, but high profile complication of burns. In this paper, a retrospective study was undertaken to evaluate our treatment and results of HO. Relevant literature was also reviewed to search for new advances in prevention and management for patients with HO after burns. A retrospective study was undertaken in Chang Gung Memorial Hospital, Linkou. We collected 12 patients who suffered from HO after burn and received operation in our hospital between June 2000 and September 2007. The data was expressed as mean. Patients' gender distribution was 10 males and 2 females. The mean age was 43 years old (range, 30-59). Causes of burn were flame burn (75%), scald burn (8%), contact burn (8%), and high-voltage electrical burn (8%). Mean TBSA was 39% (range, 8-90%). Nine of 12 patients (75%) were admitted to intensive care unit (ICU) and 6 (50%) received mechanical ventilator support. The mean ICU stay was 82 days (range, 26-240 days). The elbow was the most commonly affected joint (92%). The outcome of surgery was acceptable in all elbows at the time of surgery. The mean ROMs before surgery were 31 degrees (range, 0-75 degrees). The mean ROMs after surgery were 99 degrees (range, 70-115 degrees); mean gain was 68 degrees (range, 35-115 degrees). One (8%) patients had recurrent HO after operation. The mean outpatient department follow-up time was 14.6 months (range, 1-40 months). The incidence of HO in our burn center is 0.15%. Although HO after burn is uncommon, physicians should keep the complication in mind. When burn patients complain decreased ROM or "locking sign" in their joints, X-ray examination is indicated to rule out HO. Surgery is the treatment of choice when the diagnosis of HO is confirmed.
    Burns: journal of the International Society for Burn Injuries 06/2009; 35(6):857-62. · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anterior chest burns in young females frequently result in complicated problems such as scar contracture, damage to the nipple-areolar complex and breast tissue. Furthermore, an absent breast mound, hypoplasia or disfigurement of developed breasts can result in breast asymmetry and psychological problems. So we presented an alternative procedure that combines burn scar reconstruction and augmentation mammaplasty performed during one operative session. We believe patients who have either smaller natural breasts or burned breast with anterior chest scar contracture can earn both functional and aesthetic benefits via this simultaneous operation.
    Burns: journal of the International Society for Burn Injuries 10/2008; 35(1):130-6. · 1.95 Impact Factor
  • Burns 10/2007; 33(6):793-7. · 1.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The benefits of free flap transfers in the acute burn injury are early wound closure, early mobility, reduced hospitalization, and possibly limb salvage. This retrospective study will attempt to provide principles to the use of free fasciocutaneous flap for the reconstruction of acute burned-hand injuries. Between 1995 and 2004, 5521 patients were admitted to the burn unit at Linkou Chang Gung Memorial Hospital. Of these, 38 patients (0.7%) patients received free fasciocutaneous flap transfers. Each patient's chart was reviewed the following data: age, gender, burn injury type, percentage of the burned area to total body surface area, flap type, operations prior to free flap coverage, the size and location of recipient area, timing of free flap coverage, operative time, duration of hospital stay, complications, flap survival and returning to work. All 38 free flaps survived and healed well. Three flaps with partial necrosis due to wound infections required subsequent debridement and skin grafting. Arterial thrombosis occurred in one patient and was salvaged successfully. Minimal donor-site morbidity with no intraoperative mortality was observed. Free fasciocutaneous flap transfer is a safe, efficacious one-stage reconstruction for acute burned-hands with satisfactory aesthetic and functional outcomes. Flap survival is not affected neither by the etiologies of burn nor the timing of free flap coverage.
    Burns 04/2007; 33(2):230-5. · 1.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neck contractures after burn produce restrictions in motion and unacceptable aesthetic outcomes. Proper planning and tissue selection is essential to minimize donor site morbidity while optimizing outcomes. A classification system and treatment algorithm aids in achieving this goal. Between December 1999 and January 2003, 40 burn patients underwent release and reconstruction with free perforator flaps. Neck extensibility and zone of injury were evaluated. Choice of reconstruction was based on available tissue, restriction degree and zones involved. Cervical territories were classified according to movement restrictions and amount of improvement. Reconstructive territories were classified as central above (CA), central below (CB), central above and below (CAB) and lateral (L). Single, split, double and preexpanded free flaps were used for the reconstructions. Maximal gain in motion was noted at 4 weeks and maintained for the average 11 months follow-up. Types of reconstructive territories showed significant effects on range of motion while etiology and time between injury and reconstruction showed no impact on the functional outcome. Classification of neck territories aids in improving outcomes while minimizing donor morbidity. The central above territory, when reconstructed with free flaps, yielded the most rewarding improvement. A classification and treatment algorithm aids in achieving significant improvements in range of neck motion while taking into consideration the donor sites.
    Burns 09/2006; 32(5):626-33. · 1.80 Impact Factor
  • Source
    Samir Mardini, Feng-Chou Tsai, Jui-yung Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: Extensive burn injuries and subsequent scarring result in functional and aesthetic impairments. The use of free flaps in burn reconstructions provides superior outcomes especially when other, more conservative reconstructive methods fail and curtail efforts of relentless rehabilitation. Multiple chronic scar-associated problems and extensive acute burn defects are conventionally resolved by multiple procedures. Thus, two or extensive scar regions are typically reconstructed using two free flaps (double free flaps) in two separate, procedures utilizing two independent donor sites. This leads to a protracted course of repetitive operations, hospitalizations, and rehabilitation, causing a prolonged period of discomfort and disability. The definition of double free flaps is two independent free flaps with two sets of microanastomoses. This paper illustrates, via a case-series, that double free flaps could be performed in one procedure, with both flaps harvested from either one or two donor sites. Two flaps are then utilized to resolve one large or two problem areas at the same time. Revascularization of the flaps is achieved via either a sequential-link or independent-link microanastomoses. The advantages of harvesting double free flaps from one region and using them in one stage to reconstruct one or two defect area include: (1) providing a large area of soft, pliable skin from one region for re-surfacing burn injuries or resolving scar associated problems, (2) decreasing the treatment course and potential disability, (3) decreasing donor site morbidities, (4) increasing maneuverability and conformability of the flap, and (5) affording a better functional and aesthetic outcome.
    Burns 12/2004; 30(7):729-38. · 1.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: With recent advances in free-tissue transfer, microsurgical techniques have been used more frequently for the reconstruction of postburn contracture defects. Traditional methods, including full-thickness skin grafts and local flaps, often result in a good outcome; however, multiple operative procedures, long periods of splinting, and physical rehabilitation are often required. Free split-cutaneous perforator flaps, consisting of one large cutaneous paddle with two perforating vessels split into two separate skin regions, were used for two kinds of postburn contractures: rectangular and spatially separate defects. From September of 2000 to October of 2002, seven patients underwent this method of reconstruction at Chang Gung Memorial Hospital in Taiwan. A three-dimensional flap harvest method, in which the skin paddle is circumferentially elevated early in the harvest, was used. Postburn scar contractures had resulted from flame burns in six cases and an electric burn in one case. The reconstructive regions included the neck in two patients, the breast in one patient, and the hand in four patients. There were six male patients and one female patient, with a mean age of 34.8 years (range, 25 to 49 years). The size of the excised scar ranged from 120 cm2 to 308 cm2 (mean, 162.3 cm2). The size of the unsplit flaps ranged from 144 cm2 to 337.5 cm2 (mean, 192.1 cm2). The average time for flap harvest using this three-dimensional harvest technique was 39.1 minutes. The average total operative time was 4.3 hours. The average total hospital stay was 7.3 days (range, 6 to 11 days). All flaps survived without major complications. The donor site was closed primarily in all cases. At a mean follow-up time of 9 months, the functional and aesthetic outcomes showed significant improvement as compared with the preoperative condition. In this study, a new method of flap harvest using a three-dimensional technique is introduced, and its application in the reconstruction of postburn contractures is evaluated.
    Plastic &amp Reconstructive Surgery 02/2004; 113(1):185-93; discussion 194-5. · 3.54 Impact Factor
  • Burns 10/2003; 29(6):622-5. · 1.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The electric water heater has recently become a popular household appliance replacing the hot water dispensing jug. This device provides hot water and potable cool water directly from the faucets thus removing the need to refill the container or boil water separately in a kettle. Along with the convenience of dispensing hot water immediately has come an increased incidence of pediatric burns. This paper presents a 6-year retrospective study of such pediatric scald burns from 1996 to 2001. Computer database records revealed that the incidence of pediatric scald burns caused by the electric water heater during the past 6 years was 6.4% (66/1028). The age of victims ranged 0-6 years (mean 1.5+/-1.1 years), most of the victims were in the 1-2-year-old group. In most common cases burn location was the trunk. The accidents often occurred during the cold months and in the living room of the house. From this retrospective study, it was seen that the etiology and incidence of scald burns among children have changed as people have modified their household practice for obtaining hot water in our country. This study aims to increase public awareness to the problem and suggest some prevention measures to reduce this type of scald injury.
    Burns 10/2003; 29(6):589-91. · 1.80 Impact Factor

Publication Stats

144 Citations
35.23 Total Impact Points

Institutions

  • 2013–2014
    • Hospital for Special Surgery
      New York City, New York, United States
  • 2002–2013
    • Chang Gung Memorial Hospital
      • Division of Plastic and Reconstructive Surgery
      T’ai-pei, Taipei, Taiwan
  • 2012
    • Chang Gung University
      • College of Medicine
      Taoyuan, Taiwan, Taiwan
  • 2004
    • Taipei Medical University
      • Department of Surgery
      T’ai-pei, Taipei, Taiwan