Total pharyngolaryngectomy and voice reconstruction with ileocolon free flap: functional outcome and quality of life.

Total pharyngolaryngectomy (PL) reconstruction with an ileocolon free flap not only restores swallowing but also provides potential for speech. We report our surgical technique, functional outcome and quality of life (QoL) of 17 (15 males and two females) patients who underwent total PL/voice reconstruction with an ileocolon free flap between 2004 and 2009. The patients were retrospectively reviewed and swallowing, speech and QoL evaluated. Speech intelligibility was assessed using Hirose and Chen scoring systems, in addition to sound spectrogram analysis. QoL was evaluated using the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) in conjunction with the disease-specific Head & Neck Cancer Module (QLQ-H&N35). The mean age of patients was 49 (range 35-69) years and the mean follow-up period was 22 (range 6-72) months. There was one partial flap failure and another flap was successfully salvaged. Swallowing function was achieved by 16 (94%) patients at 4 weeks, whilst 12 (71%) demonstrated moderate-to-excellent speech intelligibility. There were no cases of aspiration pneumonia. QLQ-C30 global QoL and functional subscales indicated patients had average-to-good functioning. Comparison of QLQ-H&N35 scores with EORTC reference values indicated our patients had greater difficulty with social contact, mouth opening and weight gain. Total PL/voice reconstruction with the ileocolon free flap is a viable option in selected patients, who desire autologous voice reconstruction. A low complication rate and reasonable QoL support this reconstructive method.

Optimizing outcome of charles procedure for chronic lower extremity lymphoedema.

BACKGROUND: The Charles procedure for late-stage lower limb lymphoedema (LLL) is often criticized for its unpredictable and poor results. We have adopted a systematic approach to optimize outcome of patients treated with this excisional surgery. METHODS: From June 2004 to March 2009 we performed the Charles procedure on 1 lower limb of 19 women and 8 men with late-stage LLL. Mean age and follow-up was 48 (range, 16.5-77.8) years and 21.6 (range, 1.5-48) months, respectively. RESULTS: Average inpatient stay was 27 (range, 11-54) days. After discharge, 16 (59.3%) patients underwent further minor surgery. The most frequent complication was a single, short episode of cellulitis, affecting 5 (18.5%) patients. Self-reported mobility was either the same or improved at 6 months, and appearance of their limbs satisfactory. CONCLUSIONS: The Charles procedure is an effective treatment for selected patients and by applying our systematic approach, a positive outcome can be achieved.

Psychological profile of Taiwanese female cosmetic surgery candidates: understanding their motivation for cosmetic surgery.

BACKGROUND: Psychological processes consisting of body image and self-esteem are considered key to the motivation for cosmetic surgery (CS). The current study aimed to investigate such processes as well as social support, perception of other people's opinion, and sex life satisfaction of Taiwanese female CS candidates. Further analyses were conducted to identify which processes predicted motivation for CS. METHOD: Questionnaires comprising subscales of the Multidimensional Body-Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, the Perception of Other Peoples' Opinion Scale, and social support and sex life questions were completed by Taiwanese female CS candidates (n = 85) preoperatively. The results were compared with those for a sex-matched nonsurgical control group (n = 105) as well as previously published data and reference norms. Correlation and multiple regression analysis also was conducted to identify any relationship between variables as well as which variable best predicted the likelihood of a patient having surgery. RESULTS: A total of 29 CS candidates (34.1%) reported before their surgical consultation that they would "very likely" or "likely" have CS, and 54 (63.5%) received support from all three social groups, namely, family, friends, and partner. The body image (appearance evaluation, orientation, and body area satisfaction) of the CS candidates was not significantly different from that of the control group. The former had significantly higher self-esteem and perception of other people's opinion scores. Self-esteem was positively correlated with appearance evaluation (r = 0.484; p < 0.01) and body area satisfaction (r = 0.494; p < 0.01). Body area satisfaction had a fair degree of negative correlation with the likelihood of having CS (r = -0.413; p < 0.01). Regression analysis indicated that only body area dissatisfaction predicted the likelihood of having CS, accounting for 29.4% of the total variance. CONCLUSIONS: The results of this study indicate that the Taiwanese female CS candidates did not have higher body image dissatisfaction or greater body image investment than the control group. However, body area dissatisfaction was the only significant predictor for the likelihood of having CS, a feature not previously recognized in Asian CS candidates. The higher self-esteem of the CS candidates opposes the view that low self-esteem is a principal motivating factor for CS.

'Through-the-loop' tie for microsurgical suturing.

We present a technique for tying microsurgical knots called 'through-the-loop'. The main advantage of this technique is that the short end of the microsuture is always held by the instruments and thus prevented from falling and adhering to the surrounding tissue. Consequently, the short end can be easily re-grasped and the knot tied without difficulty. This technique can be performed by either right- or left-hand-dominant surgeons and can facilitate faster and more efficient microsurgical knot tying, which the novice microsurgeon may find useful.

Avoiding pitfalls of the pins and rubbers traction technique for fractures of the proximal interphalangeal joint.

Treatment of comminuted intra-articular fractures of the digits with the Pins and Rubbers Traction System (PRTS) has been reported in many small series to give good results. Our experience in more than 40 cases with this technique, however, has not always been favorable. We analyzed outcomes and complications of PRTS treatment in 25 patients with proximal interphalangeal joint fractures reviewed at a mean 13 months (range, 6-52 months) after surgery. Mean arc of motion at this joint was 67.2 degrees (range, 35-110 degrees ) and at the distal interphalangeal joint 40.7 degrees (range, 0-90 degrees ). The latter was immobile in 3 (12%) and 7 patients (28%) had superficial pin track infections. Loss of extension at both joints was a major factor in poor outcomes. Based on this experience, we suggest ways of avoiding common pitfalls of PRTS treatment. Concurrent internal fixation impacts significantly on interphalangeal joint stiffness.

Randomised clinical trials in plastic surgery: survey of output and quality of reporting.

Randomised clinical trials (RCTs) are considered the best level of evidence when evaluating interventions. Report quality is often used as a surrogate measure of methodological quality, with poorly reported trials assumed to be poorly conducted. To address this problem the CONsolidated Standards of Reporting Trials (CONSORT) statement was published, encouraging authors to explicitly report certain items of information. The aim of this study was to survey RCTs published in the plastic surgery literature and determine quality of reporting. All RCTs published in Plastic & Reconstructive Surgery, British Journal of Plastic Surgery and Annals of Plastic Surgery from 1980 to 2004 were retrieved using a Medline search. Quality of reporting was assessed using a 17-item checklist derived from the CONSORT statement. One hundred and thirty three trials were eligible for assessment. 56 (42.1%) originated from European countries. Anaesthesia/analgesia was the most popular topic addressed and accounted for 23 (17.3%) of all studies. Quality of reporting analysis revealed wide variation between items. Sample size calculation was only reported in 17(12.8%) trials. Randomisation methodology, allocation concealment and blind investigator/assessment was reported in 39 (29.3%), 25 (18.8%) and 69 (51.9%) trials respectively. Study limitations were also infrequently reported and present in only 45 (33.8%) trials. This study indicates the annual output of plastic surgery RCTs is increasing and a variety of topics are covered. However, reporting of certain key items is inadequate. Awareness of the CONSORT statement and more attention to the quality of reporting may improve matters.

Bowel perforation as a presenting feature of pheochromocytoma: case report and literature review.

OBJECTIVE: To report a case of colonic perforation as the initial manifestation of pheochromocytoma and discuss the underlying pathophysiologic mechanism. METHODS: The clinical, biochemical, radiologic, and pathologic findings are described. In addition, the management of the patient is discussed and the relevant literature reviewed. RESULTS: A 57-year-old man presented with large bowel perforation after pseudo-obstruction. Emergency laparotomy revealed two cecal perforations but no obstructing lesion; however, hypertension persisting postoperatively raised the suspicion of pheochromocytoma. This diagnosis was confirmed by measurement of 24-hour urinary hydroxymethylmandelic acid excretion and computed tomography of the abdomen. The tumor was subsequently resected without complication or recurrence of bowel symptoms. The pathophysiology of bowel perforation in patients with pheochromocytoma is not entirely clear but most likely involves bowel ischemia and necrosis as a result of mesenteric vasoconstriction. This setting coupled with increased intraluminal pressure as a consequence of pseudo-obstruction may cause perforation. CONCLUSION: Bowel perforation in patients with pheochromocytoma is rare and thought to be a consequence of intestinal ischemia and altered motility. This is potentially a life-threatening complication, particularly if the tumor remains undiagnosed and an emergency surgical procedure is necessary. Pharmacologic treatment of pheochromocytoma during pseudo-obstruction may prevent subsequent perforation. Clinicians should be aware of the potential gastrointestinal presentation of this tumor.

Introducing a novel haptic interface for the planning and simulation of open surgery.

Existing simulation software, originally developed for the simulation and planning of inguinal hernia repair, was fused with two haptic feedback devices: the SensAble Technologies Phantom Desktop, and the ACROE/ICA Telluris system. The former allows easy integration on a PC-based platform, though in the long run, the Telluris system is preferred because of its robustness and its ability to design custom-built solutions.