Jag Chana

• BSc MBBS ( Hons) MD FRCS ( Plast)
• Consultant at Royal Free London NHS Foundation Trust

We recently published data for the duration of donor site drain use in latissimus dorsi and deep inferior epigastric perforator breast reconstruction, due to a reported requirement in the literature; evidence is still required for transverse rectus abdominis myocutaneous (TRAM) reconstruction. To compare inpatient hospital stay, drainage parameters...

Introduction: The deep inferior epigastric perforator (DIEP) flap is often preferred for breast reconstruction as it allows for autologous reconstruction with less donor site morbidity versus transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Our group has presented and published data for the duration of donor site back drain use...

Seroma formation remains a significant problem in abdominoplasty procedures - the cause of which remains to be elucidated. It has been suggested that one of the causative factors for seroma formation is the use of handheld electrocautery as opposed to scalpel for abdominal flap dissection. Prospective trial in 102 consecutive abdominoplasty patient...

The pedicled latissimus dorsi myocutaneous (LD) flap is a popular breast reconstruction choice, representing approximately 50% of procedures undertaken in the UK. Donor site drain use may reduce complication rates, however no evidence exists regarding the duration of back drain use for LD flap breast reconstruction and calls have been made in the l...

The latissimus dorsi flap, first performed by Tansini in 1892, was popularised for use by Olivari in 1976. The successful transfer of a latissimus dorsi flap during breast reconstruction has previously been thought to be dependent on having an intact thoracodorsal pedicle to ensure flap survival. It is well documented that the flap may also survive...

Free tissue transfer has revolutionized the management of complex head and neck defects. Perforator flaps represent the most recent advance in the development of free flap surgery. These flaps are based on perforating vessels and can be harvested without significant damage to associated muscles, thereby reducing the postoperative morbidity associat...

The anterolateral thigh flap is becoming the flap of choice for reconstruction of soft tissue defects. By applying the chimaeric principle, we describe a technique to achieve primary donor-site closure in the use of the anterolateral thigh for the reconstruction of very large defects. A long anterolateral thigh flap is marked out using standard poi...

Results: The results for 20 colonoscopists were reviewed. 'Clinical Per-formance' was compared by plotting individual 'Caecal Intubation Rates' (CIR) against Number of Points/List. In total, 7578 procedures were performed with a mean of 8.2 Points/List, and included 3873 colonoscopies. The mean CIR was 90.1% which is above the JAG standard of 90%....

The anterolateral perforator flap is becoming the flap of choice for a wide variety of complex defects. It has been known to provide excellent donor site morbidity even in cases where vastus lateralis is included within the flap. We report a case of herniation of the vastus lateralis and rectus femoris muscles through the overlying fascia, followin...

Extremely large chest wall defects may result following salvage oncological surgery. Typically these defects involve a large skin defect combined with a variable resected area of underlying muscle and ribs. In situations where the skin defect is very large the use of a large latissimus dorsi flap may require skin grafting to the donor site if a myo...

Previous studies from our group had identified c-myc oncoprotein expression as an important prognostic parameter in a series of retrospective studies of primary and metastatic melanoma and other variants of this disease. This study set out to prospectively evaluate the prognostic significance of c-myc positivity in a consecutive series of primary m...

The extended deltopectoral flap is still the best choice in selected cases. During the period 1987-2004, 34 patients required reconstruction of the head and neck using this flap. Twenty-nine had had one or more failed attempts at microsurgical reconstruction after excision of cancer. Five were treated primarily. The flap was divided at least three...

Interferons (IFN) are currently being used to treat melanoma, including some patients with uveal melanoma. IFN is thought to inhibit tumour growth through downregulation of the c-myc oncogene; the overexpression of which has been shown to be associated with resistance in cell lines. The aim of this study was to investigate the relation between c-my...

Thirteen patients with large ameloblastomas of the mandible underwent segmental mandibulectomy and immediate reconstruction, with simultaneous placement of osseointegrated implants. All patients received palatal mucosal grafts around the dental implants 6 to 10 months after surgical treatment and received implant-supported prostheses another 1 to 2...

Choking is a serious problem in pharyngoesophageal reconstruction, which may occur following tumor ablation of the pharynx or following corrosive injury involving the epiglottis and other parts of the upper airway. To prevent choking and the risk of severe pulmonary complications, patients have to give up oral intake and assume feeding via jejunost...

A technique for vaginal reconstruction is described that uses a pedicled jejunal flap. A neovagina was constructed using a segment of jejunum based on the fourth branch of the superior mesenteric artery. This provided an excellent result with adequate length, without the need for a lubricator or stent. Hypersecretion has not been observed.

Malocclusion may result after free fibula flap reconstruction of the mandible, because of inadequate positioning of the temporomandibular joint, inaccurate contouring of the reconstruction plate, or subsequent fracture of a miniplate. Factors that alter the vascularity of the transplanted fibula may also result in a delayed presentation of malocclu...

Free flaps in skull base reconstruction are indicated for providing an effective separation of the intracranial cavity from the oronasal space, for eliminating a dead space, and for the treatment of established wound complications such as dural exposures and cerebrospinal fluid leaks. Seven patients with cranial base defects underwent reconstructio...

The c-myc oncogene has been shown to be overexpressed in a number of malignancies, and may play an important role in the pathogenesis of malignant melanoma. Previous prognostic studies have demonstrated c-myc overexpression in a range of cutaneous melanomas, and levels of c-myc oncoprotein expression have been shown to correlate with clinical outco...

The consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avo...

The consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avo...

This report outlines a microsurgical technique for total esophageal reconstruction in situations in which conventional methods using stomach or colon are not available. Eleven patients with corrosive injury and one patient following tumor resection underwent total esophageal reconstruction in a two-stage procedure. In the first stage, skin flaps or...

Free thin anterolateral thigh flaps combined with cervicoplasty were used in a series of seven patients undergoing reconstruction for previous burn injury from September of 2000 to May of 2001 at Chang Gung Memorial Hospital. This method uses a suprafascial dissection technique to provide a thin flap to improve cervical contour. Neck contractures h...

The goal of this study was to prospectively assess the long-term results of ruby laser depilation in 346 consecutive patients who underwent hair removal at 402 anatomical sites. The patients were treated using a ruby laser, with mean power ranging from 8.6 J to 15.7 J according to skin type. Results were assessed using two outcome measures-the perc...

Melanomas of the head and neck have a poorer prognosis than melanomas arising at other cutaneous sites. To study the biology of this disease, the expression of the c-myc oncogene was studied in tumors from 97 patients with head and neck melanoma using the technique of flow cytometry. Survival analysis revealed that stratification of patients accord...

Merkel cell carcinoma (MCC) is a rare and malignant tumour. Survival data and prognostic factors are scarce. To investigate the usefulness of biological markers to predict the prognosis for these aggressive tumours. C-myc oncoprotein and proliferation was analysed in specimens from 13 patients with MCC, treated between 1983 and 1997. The average ag...

Isolated paralysis of the marginal mandibular branch of the facial nerve results in an asymmetrical smile with elevation of the lower lip on the affected side. We discuss the surgical options for its correction and present a series of 26 patients who underwent either botulinum toxin injection, anterior belly of digastric transfer or free extensor d...

Acral lentiginous melanoma is a particularly aggressive melanocytic lesion but, due to its comparative rarity, biological investigations into the behaviour of this subtype of melanoma are lacking. The activity of the recently described p16 tumour suppressor gene, thought to be the 'familial melanoma gene', was studied in 24 patients with subungual...

Advanced melanoma has a poor prognosis and chemotherapy provides little benefit for most patients. This may be related to heterogeneity of chemosensitivity as well as frequent constitutive resistance to individual cytotoxic drugs. We have therefore examined the heterogeneity of chemosensitivity in metastatic cutaneous melanoma specimens using an ex...

Acral lentiginous melanoma is a particularly aggressive tumour with a worse prognosis than other varieties of primary cutaneous melanoma. In order to study the biology of this disease, the activity of the c-myc oncogene was studied in tumours from 45 patients using flow cytometry. High levels of oncoprotein were found in all tumours and exceeded th...

Overexpression of c-myc protein has independent prognostic significance in a variety of primary and metastatic cutaneous melanomas which suggests a possible role for this gene in melanomagenesis. We have therefore examined the importance of this oncogene in uveal melanoma and studied the coexpression of two other gene products, Bcl-2 and p53, which...

The cauliflower ear presents a challenge to the surgeon. Patients complain of discomfort and appearance. Three patients were treated surgically via a posterior approach to remove the hardened segment and re-sculpture a leaf of cartilage left in place. An acceptable cosmetic result was achieved and all patients are currently pain free.

Inactivation of p16 tumour suppressor gene has been reported frequently in melanoma cell lines, and mutations have been detected in familial melanoma kindreds. The aim of this study was to assess the role of p16 inactivation in melanocytic progression by measuring the level of p16 protein in a range of sporadic, benign and malignant melanocytic les...

Melanomas of the scalp are rare and have a poorer prognosis than melanomas arising at other cutaneous sites. In order to study the biology of this disease, the activity of the c-myc oncogene was studied in tumours from 25 patients with scalp melanoma using the technique of flow cytometry. Survival analysis revealed that stratification of patients a...

The role of the c-myc oncogene has been little investigated in uveal melanoma. In this study an analysis of c-myc oncoprotein expression was undertaken using flow cytometry in 71 patients with posterior uveal melanoma. Nuclear c-myc oncoprotein was detected in all of the tumours, and survival analysis revealed a significant association between high...

The role of tissue expansion in ear reconstruction has not been clearly defined. Tissue expansion was used to reconstruct 16 ears for posttraumatic, burn and congenital defects. Previous surgery or scarring in the region of the reconstruction was not regarded as an absolute contraindication. The overall complication rate was 31.2%. According to the...

This report describes a family in which the father and three children had a sliding hiatus hernia. In each case there was gastro-oesophageal reflux from the neonatal period which proved unresponsive to medical therapy, ultimately requiring anti-reflux surgery. The trait in this family supports an autosomal dominant genetic component to the infant h...

Spondylotic change of the spine is common in the cervical and lumbar regions and may present with compression of the spinal cord and nerve roots. Myelopathy due to degenerative disease in the thoracic spine is exceptional. Only a few cases have been reported in the literature and these reports have described disease in the lower four thoracic segme...

To determine the incidence of urologic trauma during surgical correction of anorectal malformations (ARM). The records of 228 children with ARM were retrospectively reviewed. Operative trauma to the genitourinary tract was seen in 12 patients, all male. Of 133 patients with a high ARM, 92 underwent an abdominoperineal pull-through and 41 underwent...