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Ratanapoompinyo S, Kiranantawat K. Effects of Cutting Planes on Costal Cartilage Warping. Plast Reconstr Surg 2024:00006534-990000000-02311. [PMID: 38616315 DOI: 10.1097/prs.0000000000011470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Autogenous costal cartilage becomes a favorable choice for nasal reconstruction and complicated aesthetic rhinoplasty, due to its ample supply, sufficient for most patients. However, a notable drawback is the potential for warping. Our study aims to identify cutting planes that minimize warping. MATERIALS AND METHODS Two hundred and seven costal cartilage grafts were obtained by slicing the extracted costal cartilages from 10 fresh cadavers, along three main planes: cephalocaudal, anteroposterior, and parallel to the synchondrosis plane. Each of these major planes was further divided into grafts taken from both the central and peripheral portions. Furthermore, both subgroups were categorized into three thicknesses: 1mm, 2mm, and 3mm. The warping angles of all grafts were then compared at various time intervals after the initial cutting. RESULTS Cephalocaudal cuts exhibited significantly greater warping than other planes. Anteroposterior cuts displayed the least warping, although this difference lacked statistical significance. Peak warping occurred at 30 minutes. Certain grafts continued to warp even at 1 month. Central grafts had less warping than peripheral ones, though not statistically significant. CONCLUSIONS Cephalocaudal cuts yielded the highest warping angle. Surgeons seeking thin (< 3 mm) straight grafts should opt for anteroposterior or parallel to synchondrosis planes. Thicker grafts (> 3 mm) can be cut in the cephalocaudal plane with an acceptable warping angle, close to parallel with the synchondrosis plane. For curved cartilage, thin cephalocaudal cut is recommended. Additionally, we suggest placing the cartilage in normal saline for at least 30 minutes, allowing for maximum warping to occur.
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Affiliation(s)
- Sanathorn Ratanapoompinyo
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Wongrukmit S, Ngamphaiboon N, Kiranantawat K, Suwanthanma W, Plumworasawat S, Boonsakan P, Pongtippan A, Phanachet P, Warodomwichit D, Shantavasinkul PC. Unusual manifestation of gastric adenocarcinoma presenting with lymphedema, chylothorax, and chylous ascites. Clin J Gastroenterol 2023; 16:822-828. [PMID: 37737943 DOI: 10.1007/s12328-023-01851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
A 62-year-old Thai man with a 2-year history of bilateral lymphedema and an unprovoked left axillary vein thrombosis presented with progressive leg, scrotal, and abdominal swelling, and shortness of breath. He denied any gastrointestinal symptoms. His lymphedema had initially been diagnosed as chronic filariasis due to positive blood tests for anti-filarial antibodies; however, treatment with anti-filarial drugs failed to improve his symptoms. Subsequently, he underwent surgical lymphaticovenular anastomosis with scrotal reduction, which proved to be of limited symptomatic relief. Later investigations revealed bilateral chylothorax and chylous ascites, with the presence of metastatic adenocarcinoma. Histopathological examination of the patient's skin and scrotum biopsy from his previous surgery revealed invasion of the lymphatics by neoplastic cells with signet ring cell formation. Gastroscopy uncovered a gastric mass, and biopsy confirmed the diagnosis of stage IV gastric adenocarcinoma with signet ring cell. He later received palliative chemotherapy. For the management of chyle leakage, he was prescribed a very low-fat diet and supplemented with parenteral nutrition. Despite treatment, he developed cutaneous metastasis and was transitioned to best supportive care. The patient passed away 14 months after diagnosis.
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Affiliation(s)
- Siree Wongrukmit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Nuttapong Ngamphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Suwanthanma
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirithep Plumworasawat
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Atcharaporn Pongtippan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pariya Phanachet
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Daruneewan Warodomwichit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
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3
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Ciudad P, Kaciulyte J, Agko M, Kiranantawat K, Nicoli F, Lo Torto F, Chen HC. Carotid artery and soft tissue reconstruction with superficial femoral artery-sartorius muscle-anteromedial thigh chimeric free flap: A case report and review of the literature. Microsurgery 2022; 42:504-511. [PMID: 35702811 DOI: 10.1002/micr.30925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/03/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022]
Abstract
Tumoral involvement of the carotid artery may require en-bloc resection in order to achieve a better regional control. Among the carotid reconstruction methods at disposal, autologous tissues appear to be more reliable in cases with high risk of infection and poor tissue healing like in radiated necks. We describe a case of a 55 year old man, who suffered from recurrent squamous cell carcinoma in the neck region, invading the common carotid artery. After en-bloc resection of the tumor together with skin, internal jugular vein, vagus nerve and common carotid artery, carotid reconstruction was performed with a flow-through chimeric flap based on superficial femoral vessels (15 cm). After resection of the tumor, the flap was used to replace the soft tissue defect (23 × 12 cm). Anteromedial thigh skin paddle (8 × 5 cm) and sartorius muscle (12 × 3 cm) were included in the flap. The superficial femoral vessels were reconstructed with 8-mm ringed polytetrafluoroethylene graft interposition. Thanks to an accurate surgical planning and a 2-team approach, the ischemia time of the leg was 42 min and there were no limb ischemia nor pathologic neurological signs after surgery. During the 12-month follow up, no other complication was registered. In our experience, microsurgical carotid reconstruction represents a reliable option with important advantages such as resistance to infection, optimal size matching, and good tissue healing between the irradiated carotid stump and the vascular graft.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.,Division of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Academic Department of Surgery, School of Medicine Hipolito Unanue, Federico Villarreal National University, Lima, Peru
| | - Juste Kaciulyte
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Rome, Italy
| | - Mouchammed Agko
- Section of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Fabio Nicoli
- Division of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Federico Lo Torto
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Rome, Italy
| | - Hung-Chi Chen
- Division of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
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4
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Koedwut S, Kaewlai R, Sudsang T, Kiranantawat K, Wongwaisayawan S. Clear Sinus Sign on Head CT Scan: Reliable Criterion to Exclude Paranasal Sinus Fracture. J Oral Maxillofac Surg 2020; 78:996.e1-996.e6. [PMID: 32035837 DOI: 10.1016/j.joms.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The clear sinus sign has been described in facial computed tomography (CT) as an indication of the absence of fluid in the paranasal sinuses. It is a highly reliable criterion to exclude fracture involving the paranasal sinus wall. Very scarce data on this sign on head CT scan is currently available. We conducted the present study to assess the usefulness of the clear sinus sign on head CT scan to exclude paranasal sinus fracture. MATERIALS AND METHODS A retrospective cross-sectional review of the medical records and head and facial CT images was performed for 80 trauma patients with a total of 640 paranasal sinuses. The presence and absence of paranasal sinus fracture was recorded and analyzed. RESULTS The clear sinus sign was found in 207 paranasal sinuses (32.3%) on head CT, and none of these had a paranasal sinus fracture (P < .001). CONCLUSIONS The presence of the clear sinus sign on head CT scans is an excellent indication for exclusion of a paranasal sinus fracture in trauma patients.
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Affiliation(s)
- Suwalai Koedwut
- Resident, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Lecturer, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanwa Sudsang
- Lecturer, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kidakorn Kiranantawat
- Lecturer, Division of Plastic and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirote Wongwaisayawan
- Lecturer, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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5
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Chilgar RM, Khade S, Chen HC, Ciudad P, Yeo MSW, Kiranantawat K, Maruccia M, Li K, Zhang YX, Nicoli F. Surgical Treatment of Advanced Lymphatic Filariasis of Lower Extremity Combining Vascularized Lymph Node Transfer and Excisional Procedures. Lymphat Res Biol 2019; 17:637-646. [PMID: 31038386 DOI: 10.1089/lrb.2018.0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lymphatic filariasis (LF) in advanced stage is a clinically challenging disability resulting in poor quality of life. In advanced stage of filariasis, medical management is seldom effective and few surgical procedures are beneficial. In this study, we assessed clinical efficacy of a surgical technique combining vascularized lymph node transfer (VLNT) and serial excision for patients affected by advanced LF. Patients and Methods: A total of 17 patients with grades 2 and 3 lower limb lymphedema after three consecutive humanitarian missions in India between 2014 and 2018 underwent excision of excessive soft tissue of leg and supraclavicular lymph node flap transferred to dorsum of foot. Recipient vessels were prepared and microanastomosis was performed. Lymphedema was assessed by measuring leg circumferences at different levels, episodes of infectious lymphangitis, and lymphoscintigraphy. Results: A significant decrease of lower limb circumference measurements at all levels was noted postoperatively. Postoperative lymphoscintigraphy revealed reduced lymph stasis. One patient suffered of a seroma on donor site. Six patients had partial loss of skin graft over the flap at recipient site and it was managed by regrafting. Data analysis observed statistically significant reduction in feeling of heaviness (p < 0.005) and episodes of acute lymphangitis after surgery. Conclusion: Advanced LF of leg is difficult to manage using traditional medical treatment. The combination of VLNT and surgical excision provided a safe and reliable approach to treat this debilitating disease.
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Affiliation(s)
- Ram M Chilgar
- Department of Plastic and Reconstructive Surgery, Elrevo Clinic, Aurangabad, India.,Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Sujit Khade
- Department of Plastic and Reconstructive Surgery, Elrevo Clinic, Aurangabad, India
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Matthew Sze-Wei Yeo
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ke Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yi Xin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.,Department of Plastic and Reconstructive Surgery, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, United Kingdom
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Nicoli F, Orfaniotis G, Ciudad P, Kiranantawat K, Lazzeri D, Maruccia M, Constantinides J, Sacak B, Chilgar RM, Li K, Zhang YX, Chen HC. Cover Image, Volume 117, Number 6, May 1, 2018. J Surg Oncol 2018. [DOI: 10.1002/jso.24845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; University of Rome “Tor Vergata”; Rome Italy
- Plastic Reconstructive and Aesthetic Surgery; Villa Salaria Clinic; Rome Italy
- Department of Plastic and Reconstructive Surgery; St. Thomas' Hospital; London United Kingdom
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; St. Thomas' Hospital; London United Kingdom
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Faculty of Medicine Ramathibodi Hospital, Department of Plastic and Maxillofacial Surgery; Mahidol University; Bangkok Thailand
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery; Villa Salaria Clinic; Rome Italy
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; St. Thomas' Hospital; London United Kingdom
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; Marmara University School of Medicine; Istanbul Turkey
| | - Ram M. Chilgar
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Ke Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital; Shanghai JiaoTong University School of Medicine; Shanghai China
| | - Yi Xin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital; Shanghai JiaoTong University School of Medicine; Shanghai China
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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Ciudad P, Vijayan R, Pafitanis G, Kaya B, Parra Pont L, Agko M, Manrique OJ, Kiranantawat K, Chang WL, Chen HC. A simple and effective method to optimize limb position after complex lower limb free flap reconstruction with concurrent external fixation. Microsurgery 2018; 39:98-99. [PMID: 29418025 DOI: 10.1002/micr.30301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/06/2017] [Accepted: 01/24/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Roshan Vijayan
- The Royal London Hospital, BartsHealth NHS Trust, London, United Kingdom
| | - Georgios Pafitanis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,The Royal London Hospital, BartsHealth NHS Trust, London, United Kingdom
| | - Burak Kaya
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Luis Parra Pont
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Mouchammed Agko
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wei-Ling Chang
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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Nicoli F, Orfaniotis G, Ciudad P, Kiranantawat K, Lazzeri D, Maruccia M, Constantinides J, Sacak B, Chilgar RM, Li K, Zhang YX, Chen HC. Alternative vascular constructs of lymph node flap transfer. J Surg Oncol 2018; 117:1144-1147. [PMID: 29355962 DOI: 10.1002/jso.24966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/09/2022]
Abstract
Vascularized lymph node transfer is a quite innovative physiological surgical procedure for the lymphedema treatment. Although is gaining more popularity due to its promising results, there are some concerns regarding difficult to harvest it and the potential risk of iatrogenic lymphedema. Here, we present alternative vascular constructs of lymph node flap for the treatment of lymphedema, which provide the benefits of a technically easier dissection and physiological reconstruction of the damaged lymphatics. Furthermore, we introduce a classification based on the flap vascular supply including six types of flaps and we provide the details of the surgical technique.
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Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.,Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, United Kingdom
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, United Kingdom
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Faculty of Medicine Ramathibodi Hospital, Department of Plastic and Maxillofacial Surgery, Mahidol University, Bangkok, Thailand
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, United Kingdom
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ram M Chilgar
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ke Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yi Xin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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Ciudad P, Agko M, Manrique OJ, Date S, Kiranantawat K, Chang WL, Nicoli F, Lo Torto F, Maruccia M, Orfaniotis G, Chen HC. The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck. Microsurgery 2017; 37:902-909. [PMID: 28753219 DOI: 10.1002/micr.30193] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Reconstruction in a vessel-depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel-depleted neck. METHODS Between July 2010 and June 2016, nine patients with a vessel-depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release (n = 3), oral (n = 1), mandibular (n = 3) and pharyngoesophageal (n = 2) reconstruction necessitating free anterolateral thigh (n = 3) and medial sural artery (n = 1) perforator flaps, fibula (n = 3) and ileocolon (n = 2) flaps respectively. RESULTS There was 100% flap survival rate with no re-exploration or any partial flap loss. One case of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow-up period. CONCLUSIONS In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Mouchammed Agko
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Oscar J Manrique
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, United Sates
| | - Shivprasad Date
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wei Ling Chang
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Federico Lo Torto
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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10
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Maruccia M, Orfaniotis G, Ciudad P, Nicoli F, Cigna E, Giudice G, Kiranantawat K, Ribuffo D, Chen HC. Application of extended bi-pedicle anterolateral thigh free flaps for reconstruction of large defects: A case series. Microsurgery 2016; 38:26-33. [PMID: 27991695 DOI: 10.1002/micr.30141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/27/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Michele Maruccia
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
- Department of Plastic and Reconstructive Surgery; “Sapienza” University; Rome 00161 Italy
- Department of Emergency and Organ Transplantation; University of Bari “Aldo Moro,” Plastic and Reconstructive Surgery and Burns Unit, Bari, Italy
| | - Georgios Orfaniotis
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Pedro Ciudad
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Fabio Nicoli
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Emanuele Cigna
- Department of Plastic and Reconstructive Surgery; “Sapienza” University; Rome 00161 Italy
| | - Giuseppe Giudice
- Department of Emergency and Organ Transplantation; University of Bari “Aldo Moro,” Plastic and Reconstructive Surgery and Burns Unit, Bari, Italy
| | - Kidakorn Kiranantawat
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
| | - Diego Ribuffo
- Department of Plastic and Reconstructive Surgery; “Sapienza” University; Rome 00161 Italy
| | - Hung-Chi Chen
- Department of Plastic Surgery; China Medical University Hospital; Taichung 40447 Taiwan
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11
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Ciudad P, Manrique OJ, Date S, Sacak B, Chang WL, Kiranantawat K, Lim SY, Chen HC. A head-to-head comparison among donor site morbidity after vascularized lymph node transfer: Pearls and pitfalls of a 6-year single center experience. J Surg Oncol 2016; 115:37-42. [PMID: 27440739 DOI: 10.1002/jso.24349] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Oscar J. Manrique
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Shivprasad Date
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Wei-Ling Chang
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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12
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Yeo MSW, Kiranantawat K, Ciudad P, Pek CH. Dysplasia, not malignancy, present in a 41-year-old colonic interposition flap. Asian J Surg 2016; 39:124-5. [PMID: 26948301 DOI: 10.1016/j.asjsur.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022] Open
Affiliation(s)
- Matthew Sze-Wei Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore.
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pedro Ciudad
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chong Han Pek
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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13
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Yang HR, Thorat A, Gesakis K, Li PC, Kiranantawat K, Chen HC, Jeng LB. Living donor liver transplantation with abdominal wall reconstruction for hepatocellular carcinoma with needle track seeding. World J Transplant 2015; 5:360-5. [PMID: 26722665 PMCID: PMC4689948 DOI: 10.5500/wjt.v5.i4.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/17/2015] [Accepted: 11/10/2015] [Indexed: 02/05/2023] Open
Abstract
Malignant cell seeding in subcutaneous tissues along the needle track and/or percutaneous biliary drainage catheters is rare complication, but pose various technical issues in planning surgical treatment of such patients. If underlying primary hepatic malignancy can be treated, an aggressive resection of subcutaneous tissue bearing cancer cell with subsequent abdominal wall reconstruction has been sporadically reported. But, when hepatic resection is not possible due to underlying advanced cirrhosis, liver transplantation along with abdominal wall resection and subsequent reconstruction remains only feasible option. Herein, we describe our successful experience of living donor liver transplantation for hepatocellular carcinoma with full-thickness abdominal wall resection bearing the tumor seeding followed by reconstruction in single stage surgery.
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14
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Abstract
A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.
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Affiliation(s)
| | - Anh H Nguyen
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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15
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Larbcharoensub N, Kayankarnnavee J, Sanpaphant S, Kiranantawat K, Wirojtananugoon C, Sirikulchayanonta V. Clinicopathological features of dermatofibrosarcoma protuberans. Oncol Lett 2015; 11:661-667. [PMID: 26870263 DOI: 10.3892/ol.2015.3966] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 08/25/2015] [Indexed: 01/19/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a superficial cutaneous tumor of low malignant potential characterized by a high rate of local recurrence. The histopathological appearance shows uniform spindle neoplastic cells arranged in a predominantly storiform pattern, typically with positive staining for cluster of differentiation (CD)34 and vimentin on immunohistochemistry. A minority of cases of DFSP have areas of sarcomatous transformation. Wide surgical excision is the cornerstone of treatment for DFSP. The objective of the present study was to determine the clinicopathological features of DFSP. Pathological records were searched for cases of DFSP in the database of the Department of Pathology, Faculty of Medicine Ramathibodi Hospital (Mahidol University, Bangkok, Thailand) between 1994 and 2013. The results showed 68 cases with DFSP. The mean age at diagnosis was 40 years (range, 3-86 years). Among this group of patients, 26 cases (38.2%) experienced local recurrence and 6 (8.8%) exhibited sarcomatous transformation of DFSP. The factors that predict the recurrence of DFSP are an incorrect first pathological diagnosis and an inadequate surgical margin. The factors that predict the sarcomatous transformation of DFSP are a larger tumor size and an incorrect first pathological diagnosis. In patients who have tumors with spindle cells arranged in a storiform pattern, CD34 immunohistochemical staining provides the definitive diagnosis. Exact histopathological categorization is important to select the appropriate treatment and predict the clinical outcome.
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Affiliation(s)
- Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Jitchai Kayankarnnavee
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suda Sanpaphant
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Kidakorn Kiranantawat
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chewarat Wirojtananugoon
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Vorachai Sirikulchayanonta
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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16
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Nicoli F, Orfaniotis G, Lazzeri D, Lim SY, Kiranantawat K, Chen PY, Ciudad P, Chilgar RM, Sapountzis S, Sacak B, Chen HC. The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema. Microsurgery 2015; 36:689-694. [PMID: 26466971 DOI: 10.1002/micr.22515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 07/28/2015] [Accepted: 09/25/2015] [Indexed: 11/11/2022]
Abstract
Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:689-694, 2016.
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Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.,Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital, London, UK
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pei-Yu Chen
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ram M Chilgar
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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17
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Abstract
In contrast with Caucasian blepharoplasty, which is usually done for rejuvenation purposes, eyelid surgery for Asians is mainly done for cosmetic reasons. Here the authors present preoperative evaluation methods of Asian eyelids to overcome anatomical variations and determine the right aesthetic options. Proper selection of the most suitable operative methods guarantees optimal surgical results.
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Affiliation(s)
- Jeong Hoon Suhk
- Cheongdam i Plastic Surgery Clinic, Uijeongbu-si, Gyeonggi-do, Korea
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anh H Nguyen
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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18
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Abstract
The eyelid of Asians has its own unique characteristics. If the surgeon does not acknowledge this, aesthetically pleasing results will seldom be achieved. Here the authors review and summarize important up-to-date anatomical and relevant clinical studies of the Asian upper eyelid, aiming to help surgeons thoroughly understand its unique features, including Asian eyelid morphology, anatomical details, and the mechanisms of upper eyelid crease formation. Hopefully, an in-depth understanding of the Asian eyelid will aid surgeons to accomplish their work and lead to novel new techniques in this field.
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Affiliation(s)
| | - Jeong Hoon Suhk
- Cheongdam i Plastic Surgery Clinic, Uijeongbu-si, Gyeonggi-do, Korea
| | - Anh H Nguyen
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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19
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Ciudad P, Maruccia M, Orfaniotis G, Weng HC, Constantinescu T, Nicoli F, Cigna E, Socas J, Sirimahachaiyakul P, Sapountzis S, Kiranantawat K, Lin SP, Wang GJ, Chen HC. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction. Microsurgery 2015; 36:359-366. [PMID: 26440546 DOI: 10.1002/micr.22459] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/04/2015] [Accepted: 07/09/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University; Taichung Taiwan
- Graduate Institute of Biomedical Engineering; National Chung Hsing University; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic Surgery; Reconstructive and Aesthetic Surgery, ‘Sapienza’ University; Rome Italy
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hui-Ching Weng
- Institute of Gerontology, College Of Medicine, Cheng Kung Kung University; Tainan Taiwan
| | - Thomas Constantinescu
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Emanuele Cigna
- Department of Plastic Surgery; Reconstructive and Aesthetic Surgery, ‘Sapienza’ University; Rome Italy
| | - Juan Socas
- Department of Plastic and Reconstructive Surgery; Indiana University School of Medicine; Indianapolis USA
| | | | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Shu-Ping Lin
- Graduate Institute of Biomedical Engineering; National Chung Hsing University; Taichung Taiwan
| | - Gou-Jen Wang
- PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University; Taichung Taiwan
- Graduate Institute of Biomedical Engineering; National Chung Hsing University; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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20
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Ciudad P, Maruccia M, Socas J, Lee MH, Chung KP, Constantinescu T, Kiranantawat K, Nicoli F, Sapountzis S, Yeo MSW, Chen HC. The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes. Microsurgery 2015; 37:197-205. [PMID: 26175309 DOI: 10.1002/micr.22450] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lymph node flap transfer popularity for treatment of extremity lymphedema is increasing quickly. Multiple flap donor sites were described in search of the optimal one. We describe the technique and outcomes of a laparoscopically harvested right gastroepiploic lymph node flap for treatment of extremity lymphedema. METHODS From January 2012 to January 2013, 10 consecutive female patients, average age 54.8 years, with International Society of Lymphology stage II-III extremity lymphedema refractory to conservative management were included. Five patients had upper limb breast cancer-related lymphedema and five patients had lower limb pelvic cancer-related lymphedema. All patients underwent laparoscopic harvest of the right gastroepiploic lymph node flap, transferred to the wrist and ankle as recipient sites. Flaps were covered with a small skin graft taken from the thigh. Perioperative assessment included physical exam, photography, circumference measurements, CT scans, lymphoscintigraphy, and Lymphedema Quality of Life (LYMQOL) questionnaire. Clinical and CT evaluation of donor-site morbidity were performed. RESULTS The flap survival rate was 100%, with a mean harvest time of 32 minutes and total operating time of 164 minutes. One case required regrafting for skin graft loss. The mean limb reduction rate was 39.5% at a mean follow-up of 14.7 months. Perioperative lymphoscintigraphy demonstrated transferred lymph node viability and lymphatic transport improvement. LYMQOL showed a 2.6-fold quality-of-life improvement (P < 0.01). No donor-site morbidity was encountered. CONCLUSIONS The use of the laparoscopically harvested right gastroepiploic lymph node flap may be a safe technique that improves limb measurements and quality of life in extremity lymphedema patients. © 2015 Wiley Periodicals, Inc. Microsurgery 37:197-205, 2017.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Tissue Engineering and Regenerative Medicine Program, Department of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic, Reconstructive, and Aesthetic Surgery, "Sapienza" University, Rome, Italy
| | - Juan Socas
- Department of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Ming-Hsien Lee
- Department of General Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kuo-Piao Chung
- Institute of Healthcare Policy and Management, Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Thomas Constantinescu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | | | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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21
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Sirimahachaiyakul P, Orfaniotis G, Gesakis K, Kiranantawat K, Ciudad P, Nicoli F, Maruccia M, Sacak B, Chen HC. Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel. Microsurgery 2015; 35:356-63. [PMID: 25597746 DOI: 10.1002/micr.22377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Pornthep Sirimahachaiyakul
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Division of Plastic Surgery; Department of Surgery; Faculty of Medicine Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kanellos Gesakis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Maxillofacial Surgery; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; Sapienza University; Rome Italy
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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22
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Ciudad P, Kiranantawat K, Sapountzis S, Sze-Wei Yeo M, Nicoli F, Maruccia M, Sirimahachaiyakul P, Chen HC. Right gastroepiploic lymph node flap. Microsurgery 2014; 35:496-7. [PMID: 25355384 DOI: 10.1002/micr.22344] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/18/2014] [Accepted: 10/10/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Tissue Engineering and Regenerative Medicine Program; National Chung Hsing University; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Matthew Sze-Wei Yeo
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | | | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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23
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Nicoli F, Chilgar RM, Sapountzis S, Yeo MS, Lazzeri D, Ciudad P, Kiranantawat K, Sönmez TT, Maruccia M, Lim SY, Constantinides J, Chen HC. Reconstruction after orbital exenteration using gracilis muscle free flap. Microsurgery 2014; 35:169-76. [DOI: 10.1002/micr.22339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgeryUniversity of Rome “Tor Vergata”Rome Italy
| | - Ram M. Chilgar
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgeryMaharashtra University of Health SciencesNashik Maharashtra India
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Matthew Sze‐Wei Yeo
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic SurgeryVilla Salaria ClinicRome Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Maxillofacial SurgeryFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok Thailand
| | - Tolga Taha Sönmez
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Oral and Maxillofacial SurgeryMedical FacultyRWTH Aachen UniversityAachen Germany
| | - Michele Maruccia
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgerySt. Thomas' HospitalLondonUK
| | - Hung Chi Chen
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
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24
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Kiranantawat K, Sze-Wei Yeo M, Maruccia M, Sapountzis S, Lim SY, Ciudad P, Nicoli F, Chen HC. Non-crushing intestinal clamps used as a tourniquet for resection of a large vascular malformation at the lower lip. J Plast Reconstr Aesthet Surg 2014; 67:e234-5. [PMID: 24893899 DOI: 10.1016/j.bjps.2014.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/11/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Kidakorn Kiranantawat
- Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Matthew Sze-Wei Yeo
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
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25
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Ciudad P, Yeo MSW, Sapountzis S, Lim SY, Nicoli F, Maruccia M, Kiranantawat K, Chen HC. Microsurgical debulking procedure after free lymph node flap transfer. Microsurgery 2014; 34:670-1. [PMID: 24867589 DOI: 10.1002/micr.22280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/27/2014] [Accepted: 05/12/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Tissue Engineering and Regenerative Medicine Program; National Chung Hsing University; Taichung Taiwan
| | - Matthew Sze-Wei Yeo
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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26
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Maruccia M, Kiranantawat K, Yeo MSW, Nicoli F, Ciudad P, Chen HC. Donor site of toe transfer: is combined second and third toe transfer the better choice? A 31 years of long-term follow-up. Microsurgery 2014; 34:500-1. [PMID: 24788916 DOI: 10.1002/micr.22268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/14/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Michele Maruccia
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
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27
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Sapountzis S, Ciudad P, Lim SY, Chilgar RM, Kiranantawat K, Nicoli F, Constantinides J, Wei MYS, Sönmez TT, Singhal D, Chen HC. Modified Charles procedure and lymph node flap transfer for advanced lower extremity lymphedema. Microsurgery 2014; 34:439-47. [PMID: 24677042 DOI: 10.1002/micr.22235] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 01/15/2014] [Accepted: 01/24/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Stamatis Sapountzis
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Pedro Ciudad
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Seong Yoon Lim
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Ram M. Chilgar
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | | | - Fabio Nicoli
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | | | - Matthew Yeo Sze Wei
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Tolga Taha Sönmez
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Dhruv Singhal
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
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28
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Sapountzis S, Kiranantawat K, Lim SY, Constantinides J, Ciudad P, Nicoli F, Wei MYS, Sönmez TT, Chen HC. A novel “continuous-interrupted” method for microvascular anastomosis. Microsurgery 2013; 34:82-4. [PMID: 24030656 DOI: 10.1002/micr.22174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/01/2013] [Accepted: 07/19/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Stamatis Sapountzis
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | | | - Seong Yoon Lim
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | | | - Pedro Ciudad
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Matthew Yeo Sze Wei
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Tolga Taha Sönmez
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung Chi Chen
- Department of Plastic Surgery; China Medical University Hospital; Taichung Taiwan
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29
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Wilasrusmee C, Kiranantawat K, Horsirimanont S, Lertsithichai P, Reodecha P, Soonthonkit Y, Boonbavonrutanakun A, Tangsakuntong P, Panichvisai S, Jirasirithum S, Kittur DS. Deep Venous Thrombosis in Surgical Intensive Care Unit: Prevalence and Risk Factors. Asian J Surg 2009; 32:85-8. [DOI: 10.1016/s1015-9584(09)60016-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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