Browsing by Author "Chiu, Wen-Kuan"

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A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars
(2019-12-01)
Hsieh, Tyng-Shiuan
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Chiu, Wen-Kuan
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Yang, Ten-Fang
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Wang, Hsian-Jenn
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Chen, Chiehfeng
Background A number of studies have investigated the role of platelet-rich plasma (PRP) as an assisted therapy for atrophic acne scars. However, the results are diverse, and no up-to-date meta-analysis was found that exclusively examined atrophic acne scar treatment. Objectives To perform a meta-analysis to assess improvements in the side effects of PRP and the effect of assisted therapy for atrophic acne scars. Methods This study followed PRISMA guidelines. A comprehensive search of the literature was carried out in September 2018 using the electronic databases of PubMed, EMBASE, MEDLINE, and the Cochrane Library. Results Seven articles were included in this review. All of the studies published utilized PRP as additive therapy. The major therapies included fractional carbon laser therapy and microneedling. Five studies (249 participants) reported four degrees of improvement on an improvement scale (degrees 3 and 4 were considered improvement in this analysis). Four studies (200 participants) reported mean improvement scores. A significantly higher degree of improvement was shown in the PRP group compared to the control group (OR = 8.19; 95% CI 4.32-15.52; p < 0.00001), as well as better mean improvement score (WMD = 23.73; 95% CI 18.60-28.87; p < 0.00001). Substantial heterogeneity was seen in the degree of improvement (I-2 = 54% p = 0.07) and the mean improvement score (I-2 = 75%; p = 0.008). There were overall fewer monitored side effects, including erythema and edema (in days), in the PRP groups; however, no significance was found. Conclusions This review shows that PRP is a useful assisted therapy for atrophic acne scars, which can achieve better improvement.
A Quantitative Analysis of Animation Deformity in Prosthetic Breast Reconstruction
(2019-08-01)
Kim, John Y. S.
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Qiu, Cecil S.
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Chiu, Wen-Kuan
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Feld, Lauren N.
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Mioton, Lauren M.
Background: Animation deformity is characterized by implant deformity with pectoralis contraction after subpectoral implant-based breast reconstruction. Extant methods to measure and analyze animation deformity are hampered by the paucity of objective, quantitative data. The authors endeavored to supplement subjective measures with an in-depth quantitative analysis. Methods: Patients undergoing subpectoral implant-based breast reconstruction were followed prospectively with video analysis of animation deformity. Nipple displacement and surface area of contour deformity in resting and contracted states were quantified using imaging software. Degree of animation was compared to breast size, body mass index, division of pectoralis muscle, complications, and radiation therapy. Results: One hundred forty-five reconstructed breasts (88 patients) were analyzed. Mean nipple displacement was 2.12 +/- 1.04 cm, mean vector of nipple displacement was 62.5 +/- 20.6 degrees, and mean area of skin contour irregularity was 16.4 +/- 15.41 percent. Intraoperative pectoralis division, smooth/ round implants, and bilateral reconstructions were associated with greater deformity. A three-tiered grading system based on thresholds of 2-cm net nipple displacement and 25 percent skin contour irregularity placed 41.4 percent of breasts in grade 1, 35.9 percent in grade 2, and 22.8 percent in grade 3. Interrater variability testing demonstrated 89.5 percent overall agreement (kappa = 0.84). Conclusions: This study presents the first quantitative analysis of animation deformity in prosthetic breast reconstruction. Geometric analysis of nipple displacement vector and increasing animation with pectoralis division both implicate the inferior pectoralis myotome as a primary driver of animation deformity. A concomitant grading schema was developed to provide a standardized framework for discussing animation from patient to patient and from study to study.
An overview of animation deformity in prosthetic breast reconstruction
(2019-02-01)
Fracol, Megan
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Feld, Lauren N.
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Chiu, Wen-Kuan
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Kim, John Y. S.
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生物科技學系
Animation deformity is an unsightly complication after sub-pectoral breast reconstruction characterized by implant displacement with pectoralis muscle contraction. Recent increased awareness of this phenomenon has driven interest in pre-pectoral breast reconstruction but research is limited regarding the causes and implications of animation deformity. Specifically, no patient-specific risk factors have been identified as contributing to animation deformity. Placement in a sub-pectoral plane and division of the pectoralis are the only peri-operative factors associated with severity of animation deformity. Our own quantitative analysis of animation deformity has further refined our understanding of this phenomenon, which we present here along with a review of current grading scales. We also more broadly review the current literature surrounding animation deformity, including its causes, risk factors, impact on patient outcomes and current treatment options. Overall, patients find this to be an emotionally distressing complication and most patients would like to be educated on alternative surgical options to avoid animation deformity. Treatment options range from conversion to a pre-pectoral plane to muscle-splitting techniques to selective nerve ablation to Botox injections. Further research into causes, implications and ways to enhance pre-pectoral reconstruction are needed to improve patient outcomes with this phenomenon.
Assessment of Outcomes of a Metatarsal Bone Ostectomy for Chronic Plantar Ulcers A Preliminary Study
(2020-01-01)
Chiu, Wen-Kuan
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Yang, Ten-Fang
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Wang, Hsian-Jenn
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Chen, Chiehfeng
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生物科技學系
Background Clinical management of chronic plantar ulcers is a difficult issue in medical practice. Pressure overloading is a problem that needs to be resolved. Herein, we report a surgical method to reduce plantar pressure: a dorsal approach to a metatarsal ostectomy. Methods From March 2011 to October 2016, 16 patients suffering from chronic plantar ulcers underwent ostectomy procedures at Taipei Wan-Fang Municipal Hospital (Taipei Medical University). A bone segment about 0.5 to 1 cm long was removed via a dorsal foot approach. The plantar wound was treated with debridement only or was simultaneously covered with a skin graft. In total, 16 patients with an average age of 57.81 (SD, 11.6) years (12 males and 4 females) were included; 15 patients (93.75%) had a diagnosis of type 2 diabetes for a mean of 20.66 years (range, 5-30 years). The mean glycated hemoglobin was 9.14 g/dL (range, 5.2-13.2 g/dL). The mean plantar wound size was 5.72 cm(2). Four patients (25%) needed to receive a skin graft with a mean skin graft size of 8.13 cm(2). Results The mean follow-up time was 15.2 months. The plantar wounds completely healed in 14 patients (87.5%) in an average of 2.14 months. No plantar ulcer was complicated with recurrence, but transfer ulcers developed in 2 patients (12.5%) at an average of 7.5 months postoperatively. Conclusions Metatarsal ostectomy surgery via a dorsal foot approach is an efficient way to reduce pressure overloading of chronic plantar wounds. Our study provides an alternative method to treat this difficult problem with a high wound healing rate and less recurrence.
Is sequential free flap safe in oral cancer reconstruction in the same patient? An outcome and complication analysis
(2020-02-01)
Chiu, Wen-Kuan
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Chou, Chang-Yi
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Chen, Shyi-Gen
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Chen, Chiehfeng
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Wang, Hsian-Jenn
Background Sequential free flap reconstruction in patient with head and neck cancer can provide reliable and effective wound coverage. Only a few studies have reported on the outcome and complications analysis but without consensus on the recipient vessels and flap chosen. Herein, we presented the outcome and analysed the risk factors for complications in sequential free flap reconstruction. Patients and methods Patients who had sequential free tissue transfers due to cancer recurrence, second primary cancer, or secondary correction of the soft tissue contractures and volume deficits were all included. Variables extracted included demographics, comorbidities, free flap characteristics, infection, dehiscence and flap necrosis rates. Results In total, 40 patients with 92 free flaps were analyzed; 42 initial and 50 sequential free flaps. The most common recipient vessels for sequential flap were contralateral superficial thyroid vessels (68%). The most common flap for both initial and sequential free flap was anterolateral thigh flap (64.3 and 62%). The success rate of sequential free flap was 92.0 compared to 92.9% for initial free flap, which showed no significant difference. Female was independently associated with delayed wound healing with an odds ratio of 90.91 (95% confidence interval 0.001-0.17, P = 0.001), as well as diabetes with an odds ratio of 31.14 (95% confidence interval 2.60-373.19, P = 0.007). Sequential free flap was not a risk factor for any complication. Conclusions Sequential free flap is a reliable method for head and neck surgery without more complication rate comparing to initial free flap reconstruction. More attentions should be paid on patients with preferential risk for certain complications.
Myotomy-Capsulotomy With Intramuscular Fat Grafting: A Novel Technique for Secondary Treatment of Prepectoral Upper Pole Defects in Breast Reconstruction
(2019-04-01)
Fracol, Megan
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Qiu, Cecil S.
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Feld, Lauren N.
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Chiu, Wen-Kuan
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Kim, John Y. S.