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hemostasis with conventional management (p=0.003).
There was no sequelae or major complications after TAE.
There were six patients died from traumatic brain injury.
Non-TAE related morbidity and mortality have no signifi-
cant difference between these two groups.
CONCLUSION: We demonstrated TAE could be an effective
treatment for life-threatening oronasal bleeding among patients
with severe craniofacial trauma. Initial presentation with shock
index > 0.9 was a strong independent predictor of angiographic
hemostasis and TAE should be initiated as soon as possible.
Disclosure/Financial support: None of the
authors has a financial interest in any of the products,
devices, or drugs mentioned in this manuscript.
REFERENCE:
1. Liao CC, Hsu YP, Chen CT, et al. Transarterial emboliza-
tion for intractable oronasal hemorrhage associated with
craniofacial trauma: evaluation of prognostic factors. J
Trauma Injury Infection Crit Care. 2007;63:827–830
2. Cogbil TH, Cotheran CC, Aheran MK, et al. Manage-
ment of maxillofacial injuries with severe oronasal
hemorrhage: a multicenter perspective. J trauma Injury
Infection Crit Care. 2008;65:994–999
3. Shachika Khanna, BDS, DMD* and Alexander B. Dagum
A Critical Review of the Literature and an Evidence-
Based Approach for Life-Threatening Hemorrhage in
Maxillofacial Surgery Ann Plast Surg 2012;69: 474Y478)
4. K.Ho et al, J.J. Hutter, J. Eskridge et al. The management
of lif-threatening haemorrhage following blunt facial
trauma Journal of Plastic, Reconstructive & Aesthetic
Surgery (2006) 59, 1257e1262
Preoperative Computed Tomographic
Angiography for Complicated Head and
NeckReconstructions
Jung-Hsing Yen, MD; Yen-Wei Chen, MD;
Wen-Hsien Chen, MD
INTRODUCTION: Reconstruction of complicated head
and neck of after multiple operations and radiation thera-
pies continue to be a challenge for plastic surgeons. It not
only affects the anatomy due to considerable adhesions of
fibrotic tissues, but also can lead to endothelial dysfunction,
pronounced fibrosis and decreased vascularization pattern.
We utilize the multi-detector computed tomography angi-
ography (CTA) for preoperative evaluation to detect reli-
able vessels for anastomosis. Surgical options would be
considered whether to abort, to proceed on using free flaps
or altered local flaps for reconstruction.
METHODS: Based on retrospective review of our experi-
ences for complicated of head and neck tumor resection from
2011 to 2015, the preoperative neck vessels were evaluated by
CTA. The findings were divided into three groups: Group I,
Present recipient vessels; Group II, Present recipient vessels
with small or stenosis vessels; Group III, No recipient vessels.
The preoperative surgical planning was made according to
the reports of CTA.
RESULTS: Total of 28 patients ranging from 42 to 74 years
old (average, 58) and previous operation frequency from 1 to
8(average, 2.2) were evaluated. In 23 patients, peri-operation
radiotherapy was performed. In CTA reports, Group I, 7
patients have received free flap (free ALT flap: 5, free fibula
flap: 2). All free flaps survive without partial loss. Group II,
there are 6 free flaps (free forearm flap: 1, free ALT flap: 5), 5
local flaps (PMMC flap: 4, PMMC + DP flap: 1) and one with-
out surgery. Group III, 5 patients received local flaps (PMMC
flap: 2, DP flap: 1, PMMC + DP flap: 2) and four patients
without surgery. A treatment algorithm was developed.
CONCLUSIONS: MDCT angiography provides high-
resolution, three dimensional vascular imaging for preop-
erative surgical planning to evaluate reliable vessels for
anastomoses. The use of CTA should be considered for dif-
ficult microsurgical reconstructions in head and neck. When
an abnormality in vascular anatomy is detected by CTA, the
surgeon is advised to consider altering the operative plan
accordingly. In addition, CTA indeed increases the surgical
confidences of preoperative planning, increases the success-
ful rate of difficult reconstructions in head and neck and
diminishes the patient’s discomforts.
Disclosures: The authors have nothing to disclosure
and have no financial interest in any of the products or
devices mentioned in this manuscript.
Pursuing Mirror Image Reconstruction
in Unilateral Microtia: Customizing
Auricular Framework by Application of
Three-Dimensional Imaging and Three-
Dimensional Printing
Hsin-Yu Chen, MD; Zung-Chung Chen, MD
INTRODUCTION: The advances in three-dimensional
imaging and three-dimensional printing technology have
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Posters
expanded the frontier of pre-surgical design for microtia
reconstruction from two-dimensional curved lines to three-
dimensional perspectives. This study presents the algo-
rithm of combining three-dimensional surface imaging,
computer-assisted design, and three-dimensional printing
to create patient-specific auricular frameworks in unilateral
microtia reconstruction.
METHODS: Patients with unilateral microtia, who under-
went auricular reconstruction with MEDPOR® implant,
were enrolled. Three-dimensional image of the patient’s
head was captured by the 3dMDcranial® and virtual sculp-
ture carried out using the Geomagic® Freeform® software
and Touch™ X Haptic device for fabrication of the auricu-
lar template. Each template was tailored according to the
patient’s unique auricular morphology. The final construct
was mirrored onto the defective side and printed out with
biocompatible acrylic material.
RESULTS: During the surgery, the prefabricated custom-
ized template served as a three-dimensional guide for surgi-
cal simulation and sculpture of the MEDPOR® framework.
The template was used to simulate the appearance after skin
draping and helped the surgeon to assess the sufficiency of
soft tissue coverage.
Symmetrical and good aesthetic results with regards to
auricular shape, projection, and orientation can be obtained
using this method.
CONCLUSION: The combination of three-dimensional
imaging and manufacturing technology with the malleability
of MEDPOR® has surpassed existing limitations resulting
from the use of autologous materials and the ambiguity of
two-dimensional planning. This approach allows surgeons to
customize the auricular framework in a highly precise and
sophisticated manner, taking a big step closer to the goal of
mirror-image reconstruction for unilateral microtia patients.
Disclosure/Financial support: The authors
have no financial interest to declare in relation to the con-
tent of this article. No funding was received for this work.
Pyoderma Gangrenosum of the Hand:
a Case Series and Literature Review of
Clinical Presentation and Management
Jiayi Hu, MD; Wendy Ng, MD; Zhen Meng,
MD; Edward Liu, MD; Achilles Thoma,
MD; Michael J. Cooper, MD
BACKGROUND: Pyoderma gangrenosum (PG) is an
extremely rare condition and often not considered in the
differential diagnosis of hand wounds. This may lead to
delayed diagnosis that causes prolonged and unnecessary
morbidity. Herein, we present a case series of PG involving
the hands to better appreciate the clinical features in order
to guide an accurate diagnosis. This is the largest case series
of this condition to date.
METHODS: A retrospective chart review between 1995
and 2015 was carried out at our institutions. Eight patients
were identified to have biopsy proven PG involving the
hand. Clinical data were collected which include patient
demographics, location of lesion, past medical history, and
clinical management. Also, an extensive literature review of
case reports was carried out by searching “pyoderma grang-
renosum” and “hand” using various databases limited to
English language (MEDLINE, EMBASE, and PubMED),
followed by screening reference lists of database search
results. Relevant clinical data were then collected.
RESULTS: Our study had 6 females and 2 males with
ages ranging from 35 to 62. All patients were initially
diagnosed as having infections, and had received a com-
bination of antibiotics and/or surgical debridement. Only
one patient’s wound culture showed bacterial growth. One
patient had an unusual presentation of PG involving all
four extremities. Two patients’ wounds involved the dor-
sum of the left hand only. Interestingly, four of the remain-
ing five patients demonstrated PG exclusively to the index
fingers. Once steroid was administered, either intralesional
or systemic, all lesions showed clinical improvement of
wound healing.
Our literature search revealed 23 other cases. Five patients
had index finger involvement exclusively. 15 patients expe-
rienced extensive hand involvement. The affected sites for
the remaining three patients were: index/long fingers (right
hand), index (right hand) and ring/small (left hand), and
long (left hand). All 23 cases were initially misdiagnosed as
infection, similar to our case series.
The management of PG is multimodal, which includes local
and systemic anti-inflammatory measures, negative pres-
sure wound therapy, hyperbaric oxygen, and skin grafting.
Surgical debridement has a limited role.
CONCLUSION: PG of the hand is a rare condition that,
unfortunately, is commonly misdiagnosed as infection. The
index finger seems to be the most involved digit. It could be
due to its great independence that it is prone to minor trauma.