En bloc groin node resection reconstructed with external oblique flap for solitary metastatic cholangiocarcinoma: a case report

Cholangiocarcinoma requires complete surgical resection for cure. Even so, the recurrence and metastasis rates are high, and further treatment is typically through palliative systemic chemotherapy. Curative-intent resection of metastatic site may provide survival benefit in selected cases. However, there were no previous reports of groin node dissection in cholangiocarcinoma. We have reported the first case of intrahepatic mass-forming cholangiocarcinoma with isolated synchronous groin node metastasis, successfully treated with   resection of the liver mass followed by groin node resection, reconstructed with musculofascial flap. A 73-year-old man presented with right upper quadrant abdominal pain radiating to the right groin for two months. Magnetic resonance cholangiopancreatography revealed a 3.1 × 1.2 cm enhancing mass between hepatic segment 4 and the anterior peritoneum, invading the abdominal wall. Computed tomography of the abdomen revealed a 2.4 × 2.2 cm focal enhancing mass at the anterior aspect of the right lower abdominal wall, just anterior to the right inguinal ligament and iliac vessel. He underwent en bloc resection of hepatic segment 4, gallbladder, and anterior abdominal wall, and the histology result is cholangiocarcinoma. After systemic chemotherapy, he underwent en bloc resection of the right groin mass, reconstructed with external oblique musculofascial flap. The patient was able to achieve a 20-month recurrence free survival after the final operation. This case has demonstrated that in a carefully selected case, resection of distant metastasis cholangiocarcinoma can provide survival benefits, even in the rare site of metastasis.

The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty

OBJECTIVE

Presurgical nasoalveolar molding (PNAM) is widely used in cleft care protocol. This study investigated the correlation between PNAM and oronasal fistula after primary palatoplasty.

METHODS

A case-controlled study of 80 unilateral and bilateral complete cleft palate patients who underwent cleft palate repair were enrolled. Patients were divided into 2 groups: (1) no PNAM use and (2) PNAM use. The incidence of oronasal fistula and postoperative complications were compared between groups.

RESULTS

Forty patients in each group demonstrated the same baseline characteristics. The PNAM group showed a significantly lower postoperative oronasal fistula rate (15% versus 50%, P=0.003). Palatal cleft width wider than 12.5 mm increases the odds ratio of fistula formation by 1.19-fold (P=0.037), and the PNAM protected against postoperative palatal fistula formation (odds ratio 0.20, P=0.003).

CONCLUSION

Presurgical nasoalveolar molding can reduce postoperative oronasal fistula in wide-gap Veau type III and IV cleft palate.

Evaluating the Cost-Effectiveness of Plastic Surgery Based on the Satisfaction with Quality of Life and Nasolabial Appearance in Thai Preteens with Cleft Lip and Palate

Background:

Cleft Lip and Palate (CLP) negatively affect the quality of life (QoL) and nasolabial appearance, especially in preteen patients who start to be interested in their own appearance and society.

Objective:

The objective of this study is to evaluate the cost-effectiveness of plastic surgery for Thai preteen CLP patients through their satisfaction with their QoL and nasolabial appearance.

Methods:

A cross-sectional study covered purposively selected 30 samples aged between 8 and 12 years old.Their satisfaction with their QoL and appearance was reflected through an interview and a questionnaire with the cooperation of their parents as their caregivers including satisfaction with their nasolabial appearance evaluated by five experts. They compared the photos of patients’nasolabial appearance with those of normal faces of children of the same age using 5-rating scales.

Results:

General findings showed 53.3% of samples were male patients with mostly (63.3%) UCLP whose parents were mainly (73.3%) poor, so they relied on government financial supports for the treatment. Only some (15%) earned up to 5,001 to 10,000 baht per month because of their low education with just high school level. Specific findings indicated the overall satisfaction with QoL through five dimensions at average level (3.26±1.39). This was based on the satisfaction with the center services, the overall treatments, the medical additional costs, parental satisfaction with psychosocial effects including concerns about the impacts of CLP on the family ranged from high to low i.e. 4.30±0.98, 3.72±1.15, 3.70±1.14, 3.33±1.08 and 2.81±1.46 respectively. Moreover, five experts trended to be highly satisfied with patients’ nasolabial appearance by rating it from Good (53.3%) to Fair (43.43%) with only Poor (3.3%).

Conclusion:

The good cost-effectiveness of the surgery was represented through the average and high satisfaction of CLP patients with their QoL and their appearance respectively indicating the absence of disability weights for these treated CLP patients.

Lymphaticovenular Anastomosis: Superficial Venous Anatomical Approach

Background  Lymphaticovenular anastomosis (LVA) is an effective, functional treatment for limb lymphedema. This study reports an alternative surgical approach to lymphedema treatment without the use of indocyanine green mapping.

Methods  A retrospective analysis was performed on 29 consecutive lymphedema patients who underwent LVAs from January 2015 to December 2020, whereby incisions were made along the anatomy of the superficial venous systems in both upper and lower extremities around the joint areas. The evaluation included qualitative assessments and quantitative volumetric analyses.

Result  The mean number of anastomoses was 3.07, and the operative time was 159.55 minutes. Symptom improvement was recorded in 86.21% of the patients, with a mean volume reduction of 32.39%. The lymphangitis episodes decreased from 55.17% before surgery to 13.79% after surgery, and the median number of lymphangitis episodes per year decreased from 1 before surgery to 0 after surgery.

Conclusions  The superficial venous anatomical approach is an easy way to start a lymphedema practice using LVA without other advanced surgical equipment. With this reliable technique, microsurgeons can perform LVA procedures and achieve good results.

Radiation ulcer treatment with hyperbaric oxygen therapy and haemoglobin spray: case report and literature review

OBJECTIVE

To explore the effectiveness of a combination of hyperbaric oxygen therapy and haemoglobin spray in radiation ulcer treatment.

METHOD

We reviewed the available literature and present a case report in which radiation ulcer was treated with a combination of hyperbaric oxygen therapy and haemoglobin spray.

RESULTS

After 30 sessions of hyperbaric oxygen therapy (2.4 ATA; 90 minutes each session) and administration of haemoglobin spray, the wounds showed gradual progress towards healing and a good granulating base was achieved. The wounds were closed after two months using a small split thickness skin graft.

CONCLUSION

A combination of hyperbaric oxygen therapy and haemoglobin spray was effective as a short course of treatment for radiation ulcers.

Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision: A Prospective, Multi-centered, Double-blinded Study

BACKGROUND

During burn excision, the clinical judgment whether to excise or not excise the area with indeterminate burn depth is difficult. Indocyanine green angiography (ICGA) has been reported to provide high accuracy in diagnosing indeterminate burns. This study aims to evaluate the complete wound closures in both short-term and long-term outcomes after using ICGA precise marking to guide indeterminate burn excision.

METHODS

This was a prospective, multi-centered, double-blinded, experimental study. The participants were admitted to the hospital with indeterminate burn wounds. ICGA precise marking was performed. The deep second-degree burn was painted, excised, and subsequently covered with skin grafts and measured on day 5. The superficial burns were measured on day 21. All wounds were followed-up at two months.

RESULTS

Thirty indeterminate burn sites were included in this study. Using ICGA precise marking, the overall rate of short-term complete wound closure, which combined superficial and deep burns, was found to be as high as 96.7% (29/30). The long-term complete wound closures at two months confirmed the short-term result and yielded 100.0% of complete wound closure. The complete wound closures between the short-term and long-term measurements were not significantly different (P > 0.999).

CONCLUSIONS

Using ICGA precise marking to guide indeterminate burn excision resulted in an excellent rate of complete wound closure and an insignificant difference between short-term and long-term wound outcomes. ICGA is a competent method to aid decision-making in burn surgery of the indeterminate area.

A Life Saving Emergent Temporary External Carotid Artery Controlled in Extensive Craniofacial Injury

Introduction

Craniofacial trauma may potentially have significant blood loss which may lead to death in some trauma patients.

Case Report

We report a case of a 43-year-old male who had a lethal noncompressible arterial hemorrhage from a penetrating wound on his left frontotemporal and preauricular region. Extensive bleeding was successfully temporarily controlled by external carotid artery (ECA) occlusion. The definitive operation was completed in a staged fashion following a computed tomography angiography assessment extension of the injury.

Conclusion

Temporarily controlling the bleeding from the carotid artery should be considered as a life saving procedure in a lethal craniofacial injury.

Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study

OBJECTIVE

Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect.

METHOD

After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale.

RESULTS

Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (-0.391, p=0.025; -0.435, p=0.013, respectively), and pigmentation scores at three and six months (-0.391, p=0.019; -0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (-0.6609, p=0.000; -0.348, p=0.046, respectively).

CONCLUSION

Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.

Birth Prevalence and Risk Factors Associated With CL/P in Thailand

INTRODUCTION

The objectives of this study were to obtain the birth prevalence of cleft lips and/or cleft palates (CL±P) and to identify potential associated risk factors in the population of the Northeast (NE) region of Thailand.

METHODS

The data were collected from October 1, 2012, to September 30, 2013, for infant deliveries with nonsyndromic CL±P in all hospitals of 4 provinces in the region. Workshops were conducted to establish diagnostic criteria, treatment guidelines, referral systems, data collection, and data reporting. All patients included in this study, including a case (the child born with cleft lip and palate [CLP]) and 2 control cases (2 following children born without CLP in the same hospital), completed a questionnaire regarding demographics, cleft characteristics, and factors of interest such as alcohol intake, smoking, vitamin use, and medication. Unadjusted and adjusted odds ratio were presented for the magnitude of associations between proposed risk factors and CL±P along with 95% CIs.

RESULTS

The overall birth prevalence of CL±P was 1.93 per 1000 live births. There was a significant difference in percentages of infants with low birth weights (P = .03), family history of CL±P (P = .01) in cases than controls. Mothers who took self-medication or a menstrual regulation supplement were more likely to have the child with CL±P (P = .01 adjusted).

CONCLUSIONS

The prevalence of CL±P in the NE Thailand was high. Low infant birth weight, family history of CL±P, and the use of self-medication or menstrual regulation herbal supplement was significant factors.

A Prospective Randomized Double-blind study of silicone gel plus Herbal Extracts Versus Placebo in Pre-sternal hypertrophic scar prevention and amelioration

Objective

Post-surgical hypertrophic scar is more frequently reported in Asians. Many modalities can treat scars but there have not been any publications to define the efficacy of silicone gel plus herbal extracts for scar prevention or amelioration.

Design

48 patients, who underwent median sternotomy were randomized and double-blinded to 2 groups to use topical silicone gel plus herbal extract gel or placebo for 6 months. Patients were treated either with topical silicone gel plus herbal extract gel or control using only placebo for 6 months. The scars were observed by experienced plastic surgeons using the Vancouver scar scale.

Setting

A single tertiary care center at Khon Kaen University.

Paticipants

48 patients who underwent median sternotomy were enrolled in this study. All patients were aged over 18 years. All the wounds were sutured with polyglycolic 4/0 subcuticular suture material and did not receive other scar management before participating in this study.

Intervention

The silicone gel plus herbal extract gel (Bangkok Botanica, Bangkok, Thailand) in semi-liquid form was formulated from 15% Herbal extract (Allium Cepa extract, Centella Asiatica extract, Aloe Vera extract and Paper Mulberry extract), 50% polydemethysiloxane, 30% cyclopentasiloxane and 5% silica. The placebo gel was a composite of water, acrylate, C10-30 alkyl acrylate cross-polymer, polysorbate 20 and fragrance that was similar in color and consistency as that of the active gel and packed in the similar sealed packages.

Main outcome measures

The scar was assessed using the Vancouver scar scale to determine pigmentation, vascularity, pliability and height.

Results

the study showed the silicone gel plus herbal extract gel could improve scar amelioration in height (p = 0.005) and pliability (p < 0.001) when compared to the placebo. The vascularity and pigmentation showed improvement using silicone gel plus herbal extracts but the improvement was not statistically significant.

Conclusion

The silicone gel plus herbal extracts gel was effective for scar improvement in median sternotomy wounds.

An Anatomical Study of Vascular Supply of the Distally Based Sural Artery Flap: A Cadaveric Study

OBJECTIVE

In this study we conducted the vascular anatomy of sural flap to determine the peroneal artery perforator contribution relative to anatomical landmark of tip of lateral malleolus, include the first peroneal artery perforator to identify safely pivot point of the flap.

MATERIAL AND METHOD

A retrospective study of an anatomical study of Vascular supply of the Distally Based Sural Artery Flap was performed by dissection on 12 fresh adult cadavers legs. We recorded number of the perforator, location of each perforators in relationship to the tip of lateral malleolus and location of first peroneal artery perforator.

RESULTS

The anatomical of vascular supply of the distally based sural artery flap, anatomical of peroneal artery perforators was identified and measured from anatomical landmark is tip of lateral malleolus. The mean number of perforators was 3.4 (range, two to five), grouped in 5 perforators at the following average locations proximal to the tip of lateral malleolus: first, at 6.3+0.9 cm; second, at 8.5+1 cm; third, at 11.17+1.4 cm; fourth, at 12.7+1.2 cm; and fifth, at 14.6+0.2 cm proximal to the tip of the lateral malleolus.

CONCLUSION

Complete vascularization of venoneurofasciocutaneous sural flap was accomplished by peroneal perforator, the blood supply of the distally based sural venoneurofasciocutaneous flap can be pivoted at the lowest perforators in the posterolateral region, which are about 5.4 to 7.2 cm proximal to the tip of lateral malleolus.

Dorsalis pedis Perforator Flap: Cadaveric Anatomical Study

BACKGROUND

The Dorsalis pedis perforator flap is a thin and pliable fasciocutaneous tissue. No previous study has demonstrated the surgical anatomy among Asians.

MATERIAL AND METHOD

Demonstrate the surgical anatomy of Dorsalis pedis perforator flap in 12 limbs from Thai cadavers.

RESULTS

We found the Dorsalis pedis perforators in all limbs and average the distance of distal perforators was 3.25+0.5 cm proximal to the metatarso-phalangeal joint. The first dorsal metatarsal artery was mainly type 1 (83.3%) while another 16.7% were type 2.

CONCLUSION

Dorsalis pedisperforator flaps were versatile with a constant surgical anatomy and acceptable donor site morbidity.

Rapidly developed Secondary Cutaneous Squamous cell Carcinoma after Post-Surgical Radiation Therapy for Breast Cancer

BACKGROUND

Radiation therapy is generally accepted treatment of choices for many benign and malignant tumors. A potential late sequela is the development of secondary malignancies around the treated zone.

OBJECTIVE

To report a case of rapid development of a secondary cutaneous squamous cell carcinoma, as a potential adverse sequence of post-radiation therapy.

MATERIAL AND METHOD

A case report and a literature review are provided.

RESULTS

A middle aged woman with locally advanced breast cancer of her left breast developed a secondary squamous cell carcinoma at two years after radiotherapy.

CONCLUSION

A post-radiation cutaneous carcinomas is an uncommon complication of radiation therapy. Diagnosis of the secondary malignancy is often delayed because of its similarities with post-radiation skin lesion or the recurrence of the original tumors.

Development of Information System for Patients with Cleft Lip and Palate undergoing Operation

BACKGROUND

Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation.

OBJECTIVE

To develop information system for patients with cleft lip-palate undergoing operation.

MATERIAL AND METHOD

This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire.

RESULTS

100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications.

CONCLUSION

The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

Challenges and Long-Term Management of Patients with Craniofacial Clefts in Thailand

OBJECTIVE

To report challenges and long-term management of patients with craniofacial clefts, treated at Srinagarind Hospital, Khon Kaen, Thailand.

MATERIAL AND METHOD

Patients who were treated at Srinagarind Hospital, between 1993 and 2001. A review of data was performed including general information, classifications, photographs, radiographic findings, dental records, reconstructive surgeries, and long-term management.

RESULTS

A total of 20 patients were recruited; six males and 14 females, grouped into six median, two paramedian and 12 oblique clefts. Age of the first treatment ranged from one to 39 years, age of the last follow-up ranged from 11 to 48 years and the range of follow-ups was 11 to 24 years. The reconstructive procedures included a variety of techniques of plastic surgery for soft tissue repairs and bone grafting for facial reconstructions. Four patients with median clefts and paramedian clefts died. One patient lost to follow-up. Fifteen patients were followed-up and the results were satisfying.

CONCLUSION

Diagnosis, evaluation, and treatment of clefts and craniofacial deformities are complex. The proper management is challenging because of socioeconomic, cause difficulties in follow-ups according to the planned protocol. Other associated anomalies are important. Protocols with well-co-ordination of an interdisciplinary team in Craniofacial Center and continuing evaluation at appropriate schedule and age group until completion of facial growth are critical factors. Establishment of a foundation and comprehensive care model with families, local health professionals and school will benefit the most to this group of patients.

Comparison of wound dehiscence and parent's satisfaction between spoon/syringe feeding and breast/bottle feeding in patients with cleft lip repair

BACKGROUND

Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.49 of every 1,000 children born in North-east of Thailand. Srinagarind Hospital has 100-150 cases of cleft lip each year. Children with cleft lip and palate need surgical procedures as soon as possible. After lip repair the normal recommendation is not using bottle or breast feeding for 2 weeks to avoid tension at the sutured area during sucking and possible cause of wound dehiscence. So this is quite complicated for the parents, and patients feel frustrated, cry, and move their head around, because of hunger which cannot easily be satisfied. Previous research found that sucking does not cause wound dehiscence, but mentioned no detail about severity of cleft.

OBJECTIVE

Primary objective is to compare surgical wound dehiscence between breast feeding/bottle and spoon/syringe feeding after lip repair.

MATERIAL AND METHOD

This is an experimental study: non-inferiority trials study. The population is the patients with cleft lip who underwent lip repair in Inpatient Department 3C, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The study period is during May 2010-February 2013. The total sample size in the present study is 192 participants, 96 cases breast/bottle feeding, 96 cases spoon/syringe feeding. The wound dehiscence rate was analyzed by Z-test. Parents'satisfaction is a qualitative data and was analyzed through content analysis.

RESULTS

No statistical significant diference between breast/bottle and spoon/syringe groups (p-value = 0.320, 95% confidence interval -0.031-0.010). Parents were more satisfied to feed children by breast/bottle and patients were more relaxed with breast/bottle feeding.

CONCLUSION

Breast/bottle feeding and syringe/spoon feeding have the same result on the surgical wound. Breast/bottle feeding are not causes of wound dehiscence.

The use of nanocrystalline silver for the treatment of massive soft tissue defects with exposed bone

BACKGROUND

In a complex wound with exposed tendon, joint or bone caused by trauma, soft tissue reconstruction is required to obtain function and aesthetic coverage. Surgical reconstruction can be performed using a variety of different techniques.

OBJECTIVE

The authors report their experience using a nanocrystalline silver with or without vacuum assisted wound closure to salvage the exposed vital structures such as bone, joint or tendon in traumatic wounds.

MATERIAL AND METHOD

The present study included 12 patients with 15 wounds that exposed vital structures especially in the lower extremities. After adequate debridement, four wounds were treated with nanocrystalline silver dressing and vacuum assisted wound closure, and ten wounds were treated in an out-patient program using nanocrystalline silver dressing.

RESULTS

A preliminary evidence of impressive result was achieved with subsided infection and complete bony coverage by granulation tissue after treatment. Subsequently, a secondary healing or a split thickness skin graft was applied.

CONCLUSION

The authors present the satisfactory results of alternative techniques that may be used for the massive soft tissue defects with exposed bone.

Nursing outcome in patients with cleft lip and palate who underwent operation: follow-up cases

BACKGROUND

Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.5 of every 1,000 children born in North East of Thailand. Srinagarind Hospital has 150-200 cases of cleft lip and palate each year. The lengthy treatment process of care, requires continuity of care involving a multidisciplinary team. The holistic and interdisciplinary care is very important to patients, family, health care professionals and the health care system. After operation patients stay in hospital about 2-3 days, during this time they will receive information regarding how to take care of the wound,feeding and details about activities to avoid. Before patients leave hospital the nurse will confirm if parents can take care of patients wound, feeding, know about avoiding activities. The Nurses or health care professional can check patients progress again when they come back to hospital for follow-up.

OBJECTIVE

To promote continuity care and resolve any problems for developing quality of care.

MATERIAL AND METHOD

The present study is retrospective descriptive study. Data was collected from follow-up case forms using 205 medical records of patients with cleft lip and palate who were admitted in 3c ward Srinagarind Hospital between June 2010 to May 2011. The records were purposively selected for the study and recorded with a data collection form.

RESULTS

95.12% of patients with cleft lip and palate came back for follow-up. 2.44% of patients had wound infection. 7.69% of patients have flap separation. The authors also found that some care givers could not take care of the patients correctly and were not concerned about follow-up.

CONCLUSION

To contracts the patients and family when they visit hospital for follow-up can make health care professional ensure the patients understand what they need to know and do, also can find any uncomfortable points/problem of patients/ family then can develop the strategies or system to solve the problem.

Surgery first orthognathic approach for skeletal Class III malocclusion corrections--a literature review

Management for patients with skeletal Class III malocclusion is orthognathic surgery which involves both orthodontics and surgery. Nowadays, there are two approaches for orthognathic surgery: orthodontics-first and surgery-first approaches. The orthodontics-first approach, or presurgical orthodontics treatment, causes longer treatment time and worsens facial appearance before surgery compared with a surgery-first approach. Conversely, with the surgery-first approach or the surgery-first-orthognathic-approach (SFOA), correction can be resolved more rapidly. SFOA needs high level skill of orthodontist and surgeon and also needs good cooperation between them to accomplish best results. The purpose of this article is to review the concept, indications, contraindications, the stages of treatment and advantages, and disadvantages of SFOA.

Nursing outcome in patients with craniofacial anomalies who underwent operation

BACKGROUND

The Northeast of Thailand has patients with craniofacial anomalies about 2.5: 1,000 children birth. Ward 3C Srinagarind Hospital has about 150-200 cases of patients with craniofacial anomalies each year. Some of them have an operation about 10 times. When the patients go to hospital to undergo operation, patients and families experience fear and anxiety. They need information about their disease, operation, feeding and wound care. Nurses who work continuously and closely with the patients need to have ability to support patients needs by using nursing process. Nursing outcome will help nurses to measure the quality of nursing care.

OBJECTIVE

To study nursing outcome in the patients with craniofacial anomalies who were admitted in 3C ward.

MATERIAL AND METHOD

The present study is retrospective descriptive study. Data was collected from medical records of 27 patients with craniofacial anomalies who were admitted in 3C ward Srinagarind Hospital between June 2010 to May 2011. Medical records were purposively selected for the study and recorded with a data collection form.

RESULTS

The authors found that 2.36% of patients had wound infection. 100% of parents received information about disease, medication, self care but some information was not received or was received but not understand. 1 case of patients unplanned readmit. Length of stay of patient 2.74 days. Parents satisfaction is 91.81%.

CONCLUSION

Patients had wound infection when back home because care giver cannot clean patients wound correctly, parents and care giver did not receive enough information or did not understand all information.

Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial

Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring. Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy. In a randomized, double blinded, placebo-controlled study, 60 patients after median sternotomy incisions were separated into two groups. All patients were treated either with silicone derivative plus onion extract gel (Cybele(®) scagel) or placebo gel twice daily for a total treatment period of 12 weeks. During each visit, pain and itching scores were graded by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale. Pain and itch score values from patients' who applied silicone derivative plus onion extract gel was less than another group (P < 0·05). Pigmentation was significantly different between two groups (P < 0·05) and the reduction of scores on vascularity, pliability, height in treated group was not superior to the untreated group. No adverse events were reported by any of the patients. A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy.

Properties and biocompatibility of chitosan and silk fibroin blend films for application in skin tissue engineering

Chitosan/silk fibroin (CS/SF) blend films were prepared and evaluated for feasibility of using the films as biomaterial for skin tissue engineering application. Fourier transform infrared spectroscopy and differential scanning calorimetry analysis indicated chemical interaction between chitosan and fibroin. Chitosan enhanced β-sheet conformation of fibroin and resulted in shifting of thermal degradation of the films. Flexibility, swelling index, and enzyme degradation were also increased by the chitosan content of the blend films. Biocompatibility of the blend films was determined by cultivation with fibroblast cells. All films showed no cytotoxicity by XTT assay. Fibroblast cells spread on CS/SF films via dendritic extensions, and cell-cell interactions were noted. Cell proliferation on CS/SF films was also demonstrated, and their phenotype was examined by the expression of collagen type I gene. These results showed possibility of using the CS/SF films as a supporting material for further study on skin tissue engineering.

Postoperative pain in patients with cleft lip and palate in Srinagarind Hospital

BACKGROUND

Srinagarind Hospital has about 150-200 cases of patients with cleft lip and cleft palate each year. The operating process requires continuity of care involving a multidisciplinary team. When the patients go to hospital to undergo operation, pain is one of the most important symptoms to try and control effectively. During pre and post operative care nurses who work continuously and closely with the patients are the best persons to assist with pain relief. They need to have knowledge, experience and ability to take excellent care about pain control as well as having to have continuing assessment and selection of pain measurement tool. They can then better help to relieve patients pain, decrease parents stress and encourage better cooperation.

OBJECTIVE

To the present study pain score level in patients with cleft lip cleft palate during the 24 hour period after operation.

MATERIAL AND METHOD

This is the retrospective descriptive study. Data was collected from medical records. 86 Medical records of the patients with cleft lip cleft palate who were admitted in 3c ward between January to December 2010. Medical Records were purposively selected for the study and recorded with a data collection form.

RESULT

39% of patients after cheiloplasty and 55.6% of patients after palatoplasty received painkillers before leaving operating room, 29.29% of patients after cheilopalsty and 15.50% of patients after palatoplasty had severe pain immediately in ward. 48.8% of patients after cheiloplasty have moderate to severe pain at the 4th hour. Pain score was less when longer time after operation. Only 7.3% have pain after the 16th hour and pain finish after the 20th hour after operation. 51.1% in patients after palatoplasty have moderate to very severe pain at the 4th hour and 15.6% have moderate to very severe pain still occurring until the 24th hour.

CONCLUSION

Some of the patients with cleft lip and palate after operation received painkillers before leaving operating room. Pain score immediately at ward is severe to very severe pain. 22.09% of patients after cheiloplasty and palatoplasy have moderate to severe pain at the 4th hour. For patients after cheiloplasty pain will continue until the 16th hour after operation, but patients after palatoplasty pain will continue more than 24 hours.

Prediction of final treatment for class III malocclusion of patients with oral clefts

OBJECTIVE

To evaluate the value of predicted treatment plans interpreted from a previously developed Formula for Orthodontics and Surgery Prediction (FOSP) in patients with cleft lip and/or palate (CLP).

MATERIAL AND METHOD

Orthodontic treatment records were collected of 105 non-syndromic CLP patients between the ages of 5 and 29 years, having Class III malocclusions of varying severity. Three cephalometric values from pre-treatment lateral cephalometric radiographs were determined for use with the FOSP. A receiver operating curve (ROC) was used to identify the optimal cut-off score for classifying predicted treatment needs, whether orthodontics alone or orthognathic surgery. The clinical merit of using the FOSP was determined by comparing predicted plans with actual treatments.

RESULTS

The predictive value using a cut-off score of 0.6475 from the FOSP-for recommending the final treatment provided--was correctly classified for 79 subjects (75.2%). Sensitivity and specificity of the FOSP for prediction of the need for orthognathic surgery were 68.1% (52.9%-80.9%) and 81.0% (68.6%-90.1%), respectively.

CONCLUSION

The FOSP can be used for early treatment prediction and counseling, and for more objectively specifying the type of orthodontic treatment for CLP patients. Other sources of information-such as evaluation of psychological and socioeconomic status, and patient's wishes-are still necessary for finalizing the treatment plan.

Quality of life in patients with cleft lip and palate after operation

BACKGROUND

Cleft lip and cleft palate are the most common craniofacial anomalies. Srinagarind Hospital has 150-200 cases each year. The operating process of care, requires continuity of care involving a multidisciplinary team. When the patients go to hospital for an operation they experience pain, limited activity and also food is very different from normal life. When attending school they suffer speech articulation problems and feel shy and isolated, which has a detrimental affect on their life style and quality of life.

OBJECTIVE

The main purpose of the study is to the present study quality of life in patients with cleft lip and palate after operation.

MATERIAL AND METHOD

The present study is descriptive research using qualitative and quantitative approaches. The studied population were patients age 8-18 years old who were admitted at 3C Ward and Outpatient Department, Srinagarind Hospital. 33 patients were interviewed for the quantitative approach. Guideline for in-depth interview with 15 patients were used for the qualitative approach. Quantitative data were analyzed and presented in frequency, percentage and standard deviation. The qualitative data were analyzed through content analysis.

RESULTS

Patients consider their QOL is high level, but in detail they still worry about self concept psychological well-being. From indept interview patients would like to get further treatment to minimize their scar as soon as possible.

CONCLUSION

Patients consider their quality of life as high level, but they would like to get further treatment.

Challenges in evaluation, management and outcome of the patients with Treacher Collins Syndrome

BACKGROUND

The challenges for management of Treacher Collins Syndrome (TCS) are the analysis of deformities and staged soft tissue and bony reconstruction.

OBJECTIVE

To present clinical and radiologic findings, the evaluation methods and the concept of staged reconstruction for patients with TCS.

MATERIAL AND METHOD

The authors reviewed the clinical and radiologic findings, the evaluation methods, the staged reconstruction and early surgical outcome of three patients with TCS treated at Srinagarind Hospital, between 1994 and

RESULTS

One patient underwent evaluation by CT scan for planning, reconstruction of the zygoma and orbit, correction of the lower eyelid coloboma, bilateral staged ear reconstruction with costal cartilage. At the age of 8 years, he had acceptable initial outcome with planned middle ear management and staged facial reconstruction. Palatoplasties of a cleft palate were performed in two patients,

CONCLUSION

TCS is a rare craniofacial deformity but poses challenges in evaluation, management and reconstructive surgery. The development of Craniofacial Center and interdisciplinary management is important for provision proper evaluation, initial management and longitudinal care, including appropriate timing for staged reconstruction of bone, ear and soft tissue reconstruction in patients with TCS. This treatment should be tailored and balanced with the functional and psychological needs of patient and his/her family. In developing countries, funding from other resources, including the not-for-profit foundations, is needed in order to increase patients' accessibility, and improve the quality of the entire treatment program.

Home visit patients and family with cleft lip and palate

BACKGROUND

The operating process for cleft care, requires continuity of care involving a multidisciplinary team. When the patient goes to hospital to receive surgery, parents and family feel nervous about their children and need to know how to take care of their children afterwards. Some patients will have operations into their teenage years. The scar on their face will give them low self esteem and feelings of isolation. Patients and family need information and encouragement. Home visit should be a good process to convey information and encourage patients and family.

OBJECTIVE

Of this project were to convey information and encourage patients and family and to evaluate patients/family problems and needs as well as to promote networking.

MATERIAL AND METHOD

A team meeting took place to decide about the families to be visited. After selection the family nurse coordinator contacted them by telephone, as well as contacting the primary care unit near to the family and then travelled to visit the family. The collected data was by questionnaire, observation and in-depth interview.

RESULTS

2 families were visited before and after operation, 8 families were visited 2-3 days after operation. The families have better knowledge, more confidence and can take better care of their children. Unfortunately health care professionals in primary care unit were too busy to join with the team.

CONCLUSION

Home visit is a good process to convey information and find patients and family problems/needs because they are more relaxed than in hospital, so can better understand and talk more easily. The families are happy to see the home visit team and are more confident to take care of their children after visit.

Results of multidisciplinary therapy of squamous cell carcinoma of the buccal mucosa at Srinagarind Hospital, Thailand

OBJECTIVE

Review the clinical presentation and treatment of buccal carcinoma and compare it to the results of treatment as per survival rate.

MATERIAL AND METHOD

The authors reviewed the medical records of newly diagnosed seen between 1995 and 2005 at the Division of Plastic Surgery and the Department of Radiotherapy, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University Patients previously treated elsewhere or those whose lesions secondarily involved the buccal mucosa were excluded.

RESULTS

The authors reviewed the medical records of 107 buccal carcinoma patients (94 females and 13 males) averaging 67 years of age. The 5-year survival rates of patients with Stage I (5.6%), 11 (6.5%), III (12.1%), and IVa (75.7%) were 67%, 43%, 47%, and 26%, respectively. A combined modality treatment (surgery and radiation or chemotherapy) was used to treat the advanced stage (III and IV) patients. The rate of incomplete therapy was high (47.78%). In the group that completed the protocol (i.e., neoadjuvant, surgery, and post operative radiation), there were five patients for whom the 5-year survival seemed higher than the patients who followed the standard treatment of surgery and post-operative radiation but it was not statistically significant.

CONCLUSION

The treatment of buccal carcinoma requires a multidisciplinary team approach because most of the patients are elderly and present with an advanced stage. If treatment continues through to completion of the protocol, the survival rate would increase.

Ankyloblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome in monozygotic twins: two cases report and reviews

Ankyloblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome (or Hay-Wells syndrome) is a rare congenital malformation. Our first cases were a pair of female monozygotic twins with AEC syndrome at Srinagarind Hospital. In this study, we describe monozygotic female twins concordant for ankyloblephaon, ectodermal dysplasia and helical rim deformities, but discordant for cleft, syndactyly of toes, heart and urinary tract abnormalities. Twin A had syndactyly of the right third and fourth toes with incomplete bilateral cleft lip and complete bilateral cleft palate. Twin B had left ventricular enlargement, caliectasia of both kidneys with complete left unilateral cleft lip and cleft palate. The twins were treated by multidisciplinary teams with satisfactory results.

Post operative penicillin-non-susceptible Streptococcus pneumoniae meningitis and septic shock in a child

The authors describe a one-year-old girl with a fronto-ethmoidal encephalomeningocele who developed wound infection, purulent meningitis and septic shock 5 hours after operation. The patient was treated with intravenous ceftazidime and vancomycin empirically. The cerebrospinal fluid (CSF) and eye discharge grew Streptococcus pneumoniae (S. pneumoniae). The minimal inhibitory concentration (MIC) by E-test of penicillin and cefotaxime were 1.0 and 0.38 ug/ml respectively so the antibiotics were switched to cefotaxime 300 mg/kg/day. She recovered completely after appropriate treatment. Penicillin-non-susceptible S. pneumoniae should be considered as one of the causes of post-operative serious infection of the face and neck in the era of increasing prevalence of penicillin-resistant S. pneumoniae.

Modified bilateral neurovascular cheek flaps: a new technique for reconstruction of extensive upper lip defects

The authors present a modified bilateral neurovascular cheek flap as a new technique for extensive upper lip reconstruction. The technique is modified from the bilateral neurovascular cheek flap for lower lip reconstruction described by Vatanasapt and colleagues in 1987 by designing rectangular and triangular flaps in the cheek tissues lateral to the lip defect on both the skin and the mucosal sides. This method has the advantage of preserving neurovascular structures as well as the original position of the oral commissure. Five patients are presented with acceptable surgical results. The technique is a good choice for functional reconstruction of near-total or total upper lip defects.