Chung-Sheng Lai

Kaohsiung Medical University · Department of Surgery

Background Marin-Amat syndrome is a rare, irreversible, and hard-to-treat neurological sequalae that has recently been associated with COVID-19 vaccination. Given the rarity of this condition and the absence of curative treatment to date, the authors herein review the literature to date and report the first ever successful surgical treatment of 2 p...

Intraoperative teaching is a challenging task. The briefing–intraoperative teaching–debriefing (BID) model, which is based on guided discovery learning at limited time intervals, has rarely been investigated. This study validated the benefits of the modified BID model on medical clerks. This study involved 37 first-year medical clerks enrolled from...

Background Refractory apraxia of eyelid opening (AEO) is mostly unresponsive to botulinum toxin (BTx) and inevitably leads to functional blindness. To treat this challenging condition, an innovative surgical technique was proposed. Methods The extended frontalis orbicularis oculi muscle (FOOM) flap shortening consisting of frontalis suspension, pa...

Background: How to evaluate blepharoptosis concomitantly presented with refractory and uncontrollable blepharospasm? To date, there is a paucity of publications on the ideal evaluation methods. An innovative method-video recordings, idiosyncratic facial expressions, sensory tricks, and ancillary procedures (VISA)-is developed for preoperative eval...

Background: Meige syndrome is characterized by involuntary blepharospasm and varied subphenotypes of oromandibular tonic-clonic muscle contraction. Despite botulinum toxin (BTx) being the mainstay of treatment for Meige syndrome, a small subset of patients remain refractory to its effects because the disease is a form of functional blindness. An i...

Medical education has traditionally been rooted in the teaching of medical knowledge and surgical technique in the operating room, with little attention to the nontechnical skills (NTS) that include situational awareness, decision‐making, teamwork and communication, and leadership. Under the guidance of adult learning principles, the aim of this st...

Background: The most challenging complication associated with lower blepharoplasty is ectropion, and the traditional lateral canthopexy or canthoplasty procedure may carry the risk of eyelid malposition or subsequent chemosis. We propose lateral tarsoplasty with a detailed description of the techniques to treat and even prevent ectropion by not in...

Background Kimura's disease is a rare, chronic inflammatory condition that usually manifests as highly recurrent head and neck tumors. Objective Systematic review of recurrence predictors following surgical excision. Materials and methods The pathologically confirmed cases at the tertiary medical center were reviewed. PubMed, Medline, the Cochran...

Background Self-directed learning is the cornerstone of adult learning. The aim of the study was to investigate the improvement of core competency and increase interest to be a surgeon among medical students after a perioperative training through a structured learning with written record model. The mediating role of adult learning pattern on core c...

Background: Cilostazol is an antiplatelet agent with vasodilating, endothelial function restoration, and anti-inflammatory effects. This study aims to investigate the efficacy of oral cilostazol for preventing the development of diabetic peripheral neuropathy (DPN). Materials and Methods: Ninety adult male Sprague-Dawley rats were divided into five...

Background Severe blepharoptosis with poor LF has traditionally been managed with exogenous frontalis suspension but complications such as lagophthalmos, infection, rejection were often reported. Objectives The function-preserving frontalis orbicularis oculi muscle (FOOM) flap was designed to correct severe blepharoptosis with poor levator functio...

Background The rates of aesthetic breast augmentation have risen substantially in Asia. Outcomes of various breast augmentation approaches in Asia have not been comprehensively studied. In the past, the inframammary approach to breast augmentation was not popular because of conspicuous scarring. In this article, the authors review academic articles...

Abstract Background To build a consensus about learning objectives in the operating room, the aim of the study was to evaluate both surgical teacher and learner perspectives on perioperative teaching and learning in Taiwan. Methods Twelve main technical and non-technical learning objectives in the operating room were evaluated by learners and surgi...

Background: Full myectomy is recommended for benign essential blepharospasm (BEB) refractory to botulinum toxin (BT) treatment, but long-term swelling, scar contracture, hollow appearance, and unnatural contour of the eyelids are common postoperative complications. We present myotomy in situ to minimize these adverse outcomes. Methods: The redun...

Background: Blepharoptosis correction in oculopharyngeal muscular dystrophy (OPMD) patients may result in severe ocular complications owing to lagophthalmos and ophthalmoplegia. Managing the acute episode to prevent further aggravation of the keratopathy or blindness is of paramount importance. Methods: A review of the literature for severe chem...

Background: Current understanding of steroid treatments for keloids is in regards to modulation of inflammation, proliferation, and apoptosis, with no in vivo study on the latter. Using a nude mouse model, we investigated whether triamcinolone acetonide (TA) injections induce keloids regression through enhancing apoptosis. Materials and methods:...

Clinically available materials, including allogeneic irradiated costal cartilage and fibrin glue polymer, were used as scaffolds for in vivo chondrogenic differentiation of human adipose-derived stem/stromal cells (hASCs) in the attempt to develop a more efficient treatment over current methods. Current studies include the use of growth-factor stim...

Background: The application of adipose tissue-derived stromal cells (ASCs) in regenerative medicine has become a growing trend due to its abundance and differentiation potentials. However, several breast cancer studies indicated that ASCs promote tumor progression, therefore, the use of ASCs for reconstruction after oncological surgery poses potent...

Background Blepharoptosis describes a condition of low-lying upper eyelid that may affect individuals of all ages under various etiologies. It may be of congenital or acquired form by the timing of onset or be divided into myogenic, neurogenic, aponeurotic, or mechanical types according to the mechanism. Our goal was to report the characteristics o...

Background Lower blepharoplasty has been used for rejuvenating lower eyelids, and diverse modifications have been used to treat conjunct deformities at the tear trough/lid-cheek junction. Strategies for recontouring prominent tear trough/lid-cheek junctions, including orbital fat manipulation, have been reported with good results in the literature....

We would like to submit the correction to our published paper [1]. [...]

Various surgical techniques for canalicular laceration reconstruction have been described in previous study. But there are still two difficult points which may take time in the operation even with the assistance of magnification. We present a simple and effective way to achieve the bicanalicular nasal intubation for the single canalicular laceratio...

Background A gummy smile is treated using a number of techniques, including botulinum toxin injection and various surgical interventions. Micro-autologous fat transplantation (MAFT) is a potentially advantageous alternative approach that has not been previously evaluated. Objective This study sought to determine the long-term results of MAFT in pa...

Background: Bulky appearance after free flap reconstruction in patients with head and neck cancer is common and requires revision to achieve improved final outcomes. Although different delayed debulking methods have been reported, the procedure can be technically difficult in patients with severe scaring after adjuvant radiotherapy. The present st...

Background: Floppy eyelid syndrome (FES) is typically characterized by chronic eye irritation and an increased laxity of the upper eyelid that can be easily everted by applying minimal upward traction. However, it is a clinical entity that is less known to most plastic surgeons. Blepharoptosis is one of the most common features, which links to FES...

Objective: No effective treatments have yet been developed for burn-induced neuropathic pain. Platelet-rich plasma (PRP) has been reported to ameliorate various types of inflammation pain. However, the effect of PRP on burn-induced neuropathic pain is unclear. Methods: Burn-induced neuropathic pain Sprague-Dawley rat model was confirmed using a mec...

Background Rejuvenation of the dorsal surface of the hand for various conditions, such as cutaneous dyschromia, fine wrinkling, skin laxity, visible extensor tendons, and varicosities appear vital to prevent wrist and digit flexion resulting from hiding of the aged appearance of the hand. Numerous fillers have been applied to re-contour the ageing...

Restoring sufficient vascularity of the ischemia/hypoxia flap is always the critical issue in flap surgeries. In a previous studies microRNA-21 (miR-21) expression was upregulated after rat skin flap surgery. MiR-21 has been reported to be induced by hypoxia and the function of miR-21 involves in the process of angiogenesis. However, the precise re...

Oral cancers associated with submucosal fibrosis-induced trismus are common. They may affect the patients' quality of life, cause nutritional deficits, and interfere with postoperative cancer surveillance. In such cases, locating desirable recipient vessels in the head and neck can be difficult. This report presents a 47-year-old man with severe tr...

Secreted protein acidic and rich in cysteine (SPARC) is a secreted protein which is involved in various biological processes. SPARC expression is associated with tumor metastasis and poor prognosis in several types of cancer. However, the SPARC-induced signaling pathway was not fully understood in head and neck cancer. In this study, our results sh...

Objective: Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated fa...

The role of microRNAs (miRNAs) in the regulation of nerve injury-induced neuropathic pain is unclear. The aims of this study were to assess and compare miRNA expression profiles in dorsal root ganglia (DRG) following three different kinds of peripheral nerve injury, including spinal nerve ligation (SNL), dorsal root transection (DRT), and ventral r...

Background: Involutional blepharoptosis is the most common type of acquired blepharoptosis. The etiology is believed to be the degeneration of the levator aponeurosis, and levator superioris muscle function was believed to be normal. However, there are a few studies analyzing levator function (LF) in involutional blepharoptosis. Our study aimed to...

Nuchal-type fibroma (NTF) is a rare, benign subcutaneous tumor that usually arises from the posterior neck. NTF is histologically characterised by dense collagen bundles and sparse fibroblasts. Only four trauma-related cases have been previously published. Herein, we present a case of extra NTF with histopathology, and six palanquin porters by usin...

Human umbilical cord mesenchymal stem cells (hUCMSCs) derived from the umbilical cord matrix have been reported to be used as anti-tumor gene carrier for attenuation of tumor growth, which extends the half-life and lowers the unexpected cytotoxicity of the gene in vivo. Interferon-β (IFNβ) is known to possess robust anti-tumor effects on different...

Background: Non-replantable fingertip amputation is still a clinical challenge. We performed modified composite grafting with pulp adipofascial advancement flap for Hirase IIA fingertip amputations. Results from a series of patients are presented and achieved better outcome than traditional composite grafting. Patients and methods: From Septembe...

The aim of this literature review is to examine Hering's law, a welldocumented phenomenon in blepharoptosis patients, with 10% to 20% noted in cases of unilateral ptosis. Predominantly presenting as contralateral eyelid drop postoperatively, it poses a challenge for eyelid surgeons in the pursuit of symmetry and appropriate eyelid height. Proper pr...

Melatonin is found in animals as well as plants. In animals, it is a hormone that anticipates the daily onset of darkness and regulates physiological functions, such as sleep timing, blood pressure, and reproduction. Melatonin has also been found to have anti-tumor properties. Malignant cancers are the most common cause of death, and the mortality...

Intracompartmental sepsis (IS) is a rare complication in patients with burns. Intracompartmental sepsis presents in patients with inadequate perfusion of intracompartmental tissues and subsequent ischemic necrosis and infection. Contributing factors include high-volume resuscitation, delayed escharotomies, and previous bacteremia. We describe a cas...

Introduction: Various management strategies have been reported for sternal wound care; however, they exhibit limited effectiveness or are associated with severe complications. Furthermore, it is difficult for the standard pectoralis major (PM) muscle advance flap to reach the lower third of the sternum. This article examines using the PM-rectus ab...

Purpose: Treatment of blepharoptosis caused by ocular myasthenia gravis (OMG) is challenging in patients with serious side effects or failed response to medical therapy. Only a few surgical reports have been published for refractory myathenic blepharoptosis. This study is aimed at the evaluation of the surgical outcome of blepharoptosis correction...

Background: Numerous techniques and materials are available for increasing the dorsal height and length of the nose. Microautologous fat transplantation (MAFT) may be an appropriate strategy for augmentation rhinoplasty. Objectives: The authors sought to determine the long-term results of MAFT with the so-called one-third maneuver in Asian patie...

Background: This study reviewed the mini invasive technique, microautologous fat transplantation (MAFT), as a strategy in simultaneously treating sunken upper eyelids with multiple folds and recreating a double eyelid crease in Asian people. Methods: The MAFT was performed with the assistance of a patented medical device, the MAFT-GUN, on 34 pat...

Burn-induced neuropathic pain is complex, and fat grafting has reportedly improved neuropathic pain. However, the mechanism of fat grafting in improving neuropathic pain is unclear. Previous investigations have found that neuroinflammation causes neuropathic pain, and anti-inflammatory targeting may provide potential therapeutic opportunities in ne...

Peripheral nerve block guidance with a nerve stimulator or echo may not prevent intra-fascicular injury. This study investigated whether intra-fascicular lidocaine induces peripheral neuropathic pain and if this pain can be alleviated by minocycline administration. One hundred sixty-eight male Sprague-Dawley rats were included. In experimental one,...

Traumatic wounds inflict small- and large-fiber sensory nerve damage, causing neuropathic pain in scar tissue, thus impairing patients' quality of life and leading to the development of psychological disorders. Autologous fat grafting has been clinically shown to improve scar quality, but few studies have explored the effects of this technique on p...

Muscle infarction, which may be caused by changes in local hemodynamics, vascular structures, and blood viscosity, is a complication of spontaneous ischemic necrosis occurring in skeletal muscle and is particularly common in patients with diabetes who have impaired sugar regulation. The clinical presentations of muscle infarction include acute onse...

Currently available injectable fillers have demonstrated limited durability. This report proposes the in vitro culture of human adipose-derived stem cells (hASCs) on hyaluronic acid (HA) gel for in vivo growth of de novo adipose tissue. For in vitro studies, hASCs were isolated from human adipose tissue and were confirmed by multi-lineage different...

Intimal dissection can cause an irregular internal surface with intimal flaps and subendothelial collagen exposure. This has been associated with a high risk of thrombosis. Trimming the artery to a healthy level is routinely recommended to avoid intimal dissection. However, this method is limited when there is inadequate vascular length to work wit...

Although fat grafting has been clinically applied by surgeons in esthetic and reconstructive surgery, it has widely evolved in processes such as harvesting, processing, and placement of fat, using the fat-grafting procedure, which dates back over 100 years. Surgeons frequently use fat grafting to recontour, augment, or fill soft-tissue defects, fac...

Background Measuring clinical learning environment is crucial for the quality improvement of medical education, especially for medical trainees at transition stages. Medical education in Taiwan is shaped by multiple socio-cultural influences. The aims of this study were to construct an instrument for measuring clinical learning environment in align...

Background: This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone. Methods: This retrospective study analyzed d...

AimThis paper describes a 1-year follow-up study of post-traumatic stress disorder (PTSD) symptomatology and depression in an elderly minority population who experienced Typhoon Morakot in Taiwan.Methods The PTSD Symptom Scale - Interview and the 10-item short form Center for Epidemiological Studies Depression Scale were used to examine PTSD sympto...

Background: The management of neuropathic pain after burn injury is a critical clinical issue. Autologous fat grafting has been shown to alleviate neuropathic pain in certain cases, but has not been shown to alleviate the pain associated with burn-induced scars. The authors assessed the effectiveness of autologous fat grafting for the management o...

Cystic hygroma (CH) is an uncommon congenital anomaly of the lymphatic channels that occurs mainly in children. CH is usually found in the cervical, axillary, inguinal, retroperitoneal, or thoracic region. CH is rare in adults, and to the best of our knowledge, there are only three adult case reports in the English literature (searched via PubMed)...

The purpose of this study was to determine whether using Aquacel Ag (ConvaTec, Skillman, New Jersey) with Vaseline (Unilever, London, England) gauze instead of silver sulfadiazine cream (SSD) as the wound care protocol to treat toxic epidermal necrolysis (TEN) can improve wound healing, pain control, and reduction of labor costs. A retrospective ch...

Necrotizing soft-tissue infection (NSTI) is a life-threatening disease with rapid progression, which has rarely been discussed in the medical literature with regard to marathon runners. We present the case of a 51-year-old Taiwanese woman, a female ultramarathon runner who had a medical disaster after her participation in La Trans-Gaule French ultr...

Background Adipose-derived stromal/progenitor cells (ADSCs) are of great interest because of their unique capacity for prolonged or unlimited self-renewal and their ability to differentiate into multiple lineages. Combining ADSCs with biomaterial scaffolds provides a promising strategy for cellular delivery and tissue engineering. Objectives A wid...

Cystic hygroma (CH) is an uncommon congenital anomaly of the lymphatic channels that occurs mainly in children. CH is usually found in the cervical, axillary, inguinal, retroperitoneal, or thoracic region. CH is rare in adults, and to the best of our knowledge, there are only three adult case reports in the English literature (searched via PubMed)...

Multi-modality electrophysiological techniques were performed to assess the effects of quinidine on peripheral nerve conduction. Twenty-seven rats were treated with 1, 3, and 5 μmol quinidine in 0.1 ml 5 % glucose. The mixed-nerve somato-sensory evoked potential (M-SSEP), dermatomal-SSEP (D-SSEP), and compound muscle action potentials (CMAP) were e...

On the basis of the close anatomical interdigitation between the longitudinal-oriented frontalis muscle and the horizontal-oriented orbicularis oculi muscle (OOM), frontalis OOM (FOOM) flap was developed to treat blepharoptosis. Retrospective study during an 11-year period, 66 patients with 81 poor levator function ptotic eyelids accepted FOOM flap...

Clinical ethic situations in modern multiprofessional healthcare systems may involve different healthcare professions who work together for patient care. The undergraduate interprofessional education of clinical ethics would help to incubate healthcare students' ability of interprofessional collaboration in solving ethical problems. However, the im...

Objectives: Gouty arthritis results from the deposition of monosodium urate crystals in synovial spaces. The literature shows that a tophus may require surgical treatment to improve cosmesis or function, to alleviate pain, to eradicate sinus drainage or to remove large urate deposits. However, forceful curettage to remove tophus particles embedded...

This case report presents salvage of a partially failing anterolateral thigh flap. A 37-year-old male, a victim of head and neck squamous cell carcinoma, received tumor ablation and a chimeric anterolateral thigh skin and vastus lateralis muscle flap reconstruction. Before ligation of pedicle, both skin and muscle portions had robust blood supply;...