Papers by Chung-sheng Lai
International Journal of Medical Sciences, 2018
Objective: No effective treatments have yet been developed for burn-induced neuropathic pain. Pla... more Objective: No effective treatments have yet been developed for burn-induced neuropathic pain. Platelet-rich plasma (PRP) has been reported to ameliorate various types of inflammation pain. However, the effect of PRP on burn-induced neuropathic pain is unclear. Methods: Burn-induced neuropathic pain Sprague-Dawley rat model was confirmed using a mechanical response test 4 weeks after the burn injuries were sustained, following which PRP was injected in the scar area. The rats were divided into four groups (n = 6) as following: Group A, Sham; Group B, Sham + PRP; Group C, Burn; and Group D, Burn + PRP. Four weeks after the PRP injection, the animals were subjected to behavior tests and then sacrificed; specimens were collected for inflammation tests, Masson's trichrome stain and chromosome 10 (PTEN) in the injured skin; and PTEN, phosphorylated mammalian target of rapamycin (p-mTOR), p38, nuclear factor κB (NFκB), chemokine (CC motif) ligand 2 (CCL2), and CCL2 cognate receptor (CCR2) in spinal cord dorsal horns through immunohistochemistry and immunofluorescence staining. Results: PRP significantly alleviated allodynia in burn-induced neuropathic pain 4 weeks after treatment, and PTEN expression in the skin and spinal cord were significantly increased in group D compared with the group C. p-PTEN, p-mTOR, and CCL2 expression in neuron cells; p-p38 and p-NFκB expression in microglia; and p-JNK and p-NFκB activation in spinal astrocytes decreased significantly in the group D compared with the group C. Conclusions: PRP is effective in treating burn-induced neuropathic pain and may be used in clinical practice.
Background:Varicose veins are chronically progressive disease. In the early stage, patients are f... more Background:Varicose veins are chronically progressive disease. In the early stage, patients are free of symptoms except for the disfigurement of the involved lower limb. As time passes however, symptoms and signs, including a sensation of heaviness, itching, soreness, cramping, lipodermatosclerosis, and venous ulceration, will manifest themselves. Superficial thrombophlebitis (STP) is a common complication of primary varicose veins. In this study, radical removal of the varicosities and their associated thromboses were performed with the assistance of endoscopic surgery, and the results have been encouraging. Aim and objective:To evaluate the outcome of endoscopic surgery of superficial thrombophlebitis (STP) in patients with primary varicose veins. Materials and methods:Of 1264 patients who underwent surgery for primary varicose veins, 108 (8.5%) had the STP. There were 32 men and 76 women, ranging from 28 to 85 years old. Before the operations, patients were admitted for conservat...
Ophthalmologica, 2009
W. Behrens-Baumann, Magdeburg S. Binder, Wien R. Brancato, Milan A.J. Bron, Oxford J. Cunha Vaz, ... more W. Behrens-Baumann, Magdeburg S. Binder, Wien R. Brancato, Milan A.J. Bron, Oxford J. Cunha Vaz, Coimbra R. Dana, Boston, Mass. S.S. Hayreh, Iowa City, Iowa P.C.P. Ho, Hong Kong Y.-N. Hui, Xian J.B. Jonas, Mannheim A. Kanpolat, Ankara I. Kim, Boston, Mass. T. Kohnen, Frankfurt B. Lorenz, Giessen A. Negi, Kobe U. Pleyer, Berlin T. Reinhard, Freiburg G. Renard, Paris D. Spalton, London K. Tsubota, Tokyo P. Wiedemann, Leipzig X. Xu, Shanghai L. Zografos, Lausanne International Journal of Ophthalmology
Journal of Poultry Science, 2006
When encounter ammonia inhalation injuries we often focus on oropharynx or tracheal mucosa lesion... more When encounter ammonia inhalation injuries we often focus on oropharynx or tracheal mucosa lesion and lung parenchyma injury, and neglect of other systemic injuries. In our study, we found that the abnormal liver function tests proceed until post injury day 8. It might be an useful study to determine if the liver function tests could be an indicator of the severity of injury and prognostic factor. Besides, the initial serum ammonia level may be a meaningful indicator of severity of injury even it could be fade to normal in 4-5 hours. Reviewing the literatures we finding that close follow up of liver function tests in ammonia injury is necessary.
Journal of Poultry Science, 2005
Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasin... more Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasing glomerular filtration rate. The incidence of ARF in burns patients varies widely between 0.5 and 30 per cent depending on patient's age and severity of injury. Many studies have reported a high mortality rate from 73% to 100%. Peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy (CRRT) are methods to treat ARF. In general, continuous renal replacement therapy is used for patients in whom intermittent hemodialysis fails to control hypovolemia, and for those who do not tolerate intermittent hemodialysis and in whom peritoneal dialysis is not suitable owing to burnt abdominal area. Three burn patients received continuous renal replacement therapy-CVVH (continuous venovenous hemofiltration)-in our burn unit from 2001 to 2004. All of these patients were male with a mean age of 61 year (41~80) and a mean burned surface area of 47% (30~71). Two patients...
Background:It's rare to see major infection of sternal wound after median sternotomy in cardi... more Background:It's rare to see major infection of sternal wound after median sternotomy in cardiac surgery which yet may seriously affect the post-operation course including the morbidity, hospital stay, cost, and mortality. Various management strategies have been reported for the sternal wound care including debridement plus rewiring, open wound care, continuous irrigation, Redon tube closed irrigation, open packing then delayed closure, topical negative pressure dressing, and flaps reconstruction. All recent studies share one common principle, that is, adequate debridement of the infected tissue and covering of the defect with well-vascularized tissue.Aim and Objectives:Here we present our treatment strategy for the deep sternal wound infection (DSWI) involving the sternal bone or mediastinal space at Kaohsiung Medical University Hospital in the past ten years.Materials and Methods:From September 2001 to September 2011, 1732 sternotomies were performed at Kaohsiung Medical Univer...
Journal of Poultry Science, 2009
Background: Sternal osteomyelitis is a potentially life-threatening complication after cardiac su... more Background: Sternal osteomyelitis is a potentially life-threatening complication after cardiac surgery. The infection can spread into the mediastinum, involving the prosthetic valve, grafts, and suture lines. It may be the cause of postoperative morbidity and mortality. Aim and Objectives: Topical negative pressure (TNP) dressing, muscle flap and hyperbaric oxygen therapy (HBO) have been proved to be effective for sternal wound healing. We want to take advantages of these methods to improve the results of intractable sternal wound infection. Materials and methods: From January 2005 to January 2008, 12 patients with sternal wound infection were treated at Kaohsiung Medical University Chung-Ho Memorial Hospital. All wounds received extensive debridement, irrigation, and TNP dressing. Seven patients received pectoralis major (PM) muscle flap coverage. Three patients accepted rectus abdominis myocutaneous (RAM) flaps coverage. Four patients received HBO therapy. Results: These patients ...
Background: Levator function is usually graded as good (＞8 mm), fair (5-7 mm) and poor (1-4 mm), ... more Background: Levator function is usually graded as good (＞8 mm), fair (5-7 mm) and poor (1-4 mm), which are generally associated with mild, moderate, and severe blepharoptosis, respectively. To date, no large study has evaluated the relationship between levator function and blepharoptosis severity in oriental eyelids. Aim and Objectives: The aim is to analyze the relationship between levator function and severity of blepharoptosis by means of a large retrospective study. Materials and Methods: We reviewed patients who were examined for blepharoptosis in our hospital between April 2004 and April 2014 by using detailed medical records of age, sex, time of onset, severity, and levator function. 323 patients with total eyelid number of 519 were studied. We divided levator function into four grades: excellent (＞12mm), good (8-12mm), fair (5-7 mm), and poor (＜5 mm). All the eyelids were divided into congenital and acquired groups. Within these two groups, we calculated the percentages of e...
Background: Based on data from the Surveillance, Epidemiology, and End Results database, recent s... more Background: Based on data from the Surveillance, Epidemiology, and End Results database, recent studies have reported an improved breast-cancer-specific survival in patients who undergo breast reconstruction immediately following mastectomy, and research by our institution obtained consistent findings. However, the relationship between improved survival and breast reconstruction remains unclear. Aim and Objectives: We evaluated whether conformity with the practice guideline among breast cancer patients who underwent transverse rectus abdominis myocutaneous (TRAM) flap reconstructions immediately following modified radical mastectomy (MRM) was better than that of patients who underwent MRM alone. We also evaluated whether better conformity with the practice guideline could improve survival and reduce local recurrence. Materials and Methods: We analyzed the data of all women who had received TRAM flap reconstruction immediately after unilateral MRM at a single institution from January...
Journal of Poultry Science, 2006
Twenty patients suffering from HF dermal burns in Kaohsiung Medical University Hospital from Janu... more Twenty patients suffering from HF dermal burns in Kaohsiung Medical University Hospital from January 1997 to December 2004 were investigated in order to further identify the efficiency of continuous intra-arterial calcium gluconate infusion. The infusion dose of calcium gluconate, the set-up of this technique, the necessity of adjuvant procedure such as nail removal or de-roofing of bullae, and the decrease of the technique-related complications are also discussed. A total of 51 fingers in twenty patients were all salvaged without major complications. Furthermore cosmetic appearance and hand function were maintained. In conclusion, the feasibility of applying this technique in any concentration of HF injury can be considered and advocated universally in order to salvage more digits from HF dermal burns.
Journal of Poultry Science, 2004
Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is ... more Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is often caused by a variety of diseases, such as atherosclerosis, connective tissue disease, trauma and Raynaud's disease. Patients with this problem usually suffer from poor tissue perfusion and impaired microcirculation. In clinical, ischemic digits often present with pain, cold intolerance, ulceration and even gangrene change. Many strategies are proposed today to overcome this disease. Behavioral therapies, such as avoidance of cold exposure and smoking are a very important intervention. Pharmacologic therapies, like the administration of calcium channel blocker, PGE1 and other vasodilators have been the most commonly used agents. Sympatholytic drugs have also been added to reduce the sympathetic tone in vascular smooth muscles. In addition, anticoagulants or antiplatelet agents are administered to inhibit thrombus formation in occlusive vascular disease. Although these agents are ...
Microsurgery, 2021
Severe facial disfigurement caused by major burn, trauma, gunshot, or even tumor ablation is part... more Severe facial disfigurement caused by major burn, trauma, gunshot, or even tumor ablation is particularly challenging for reconstructive surgeons (Pomahac et al., 2011; Siemionow, 2017). These patients usually have suboptimal functional and aesthetic results even after multiple reconstructive procedures (Siemionow & Ozturk, 2012; Sosin & Rodriguez, 2016). Advances in transplant immunology and surgical techniques have made face transplantation become a clinical reality in recent years (Siemionow, 2017; Siemionow & Ozturk, 2012; Sosin & Rodriguez, 2016). To date, more than 40 face transplantations have been accomplished worldwide since the first face transplantation performed in 2005 (Devauchelle et al., 2006; Sosin & Rodriguez, 2016). Most reports demonstrated satisfactory aesthetic outcomes with an enhanced quality of life and social reintegration postoperatively (Aycart et al., 2017; Fischer et al., 2015; Roche et al., 2015; Siemionow, 2017; Siemionow & Ozturk, 2012; Sosin & Rodriguez, 2016). Though significant outcomes are evident, the concomitant ethical and moral arguments from medical communities and the general public alike have been fiercely debated (Kiwanuka et al., 2013; Theodorakopoulou et al., 2017; Vercler, 2010). However, most surveys on the attitudes toward face transplantation have been conducted in the Western population. Due to the paucity of the literature on the opinions and concerns of Asian people, these have motivated us to assess the attitude of the Taiwanese toward face transplantation. This study was approved and supported by the Institutional Review Board and Ethics Committee (KMUHIRB-E(I)-20190279). A survey was conducted between November 2019 and November 2020 and involved 1020 adult volunteers selected randomly from the general public in Taiwan. One volunteer was excluded due to incomplete answers. The volunteers completed a self-administered anonymous questionnaire consisting of 20 questions and covering three parts: (1) sociodemographic information, including gender, age, education, religion, organ, and blood donor status; (2) knowledge about face transplantation such as the source of information about face transplantation, understanding of the risks and benefits of face transplantation; (3) willingness to support face transplantation, including the indication for face transplantation, number of procedures before receiving face transplantation, willingness to be a donor/recipient of face transplantation. Statistical analysis was performed by using SPSS (SPSS Inc., Chicago, IL). Chi-square test was applied to compare each category. P < .05 was considered statistically significant. The demographic and background profiles showed that, out of 1019 respondents, 515 (50.54%) were men and 504 (49.46%) were women. The mean age was 39.66 years, ranging from 20 to 75 years. Among the respondents, 55.54% were college-educated. The distribution of religion was 37% Buddhism, 36.31% Taoism, 10.30% Christian, and 8.15% were atheists. Medical professional, which was defined as a person with a medical education background and has medical practicing experience, constituted 43.57% of all respondents. Among the respondents, 47.11% had a history of being a blood donor and 20.61% were registered as an organ donor. Of all respondents, 70.26% of them would be willing to receive face transplantation if it was indicated, while 56.23% of them agreed to be face transplantation donors. Factors associated with willingness to undergo face transplantation were analyzed. The respondents who were either medical professionals (p = .003), blood donors (p = .002), organ donor registrants (p < .001), willing to be recipients (p < .001), and had knowledge about face transplantation (p < .001) were more willing to accept face transplantation (Table 1). The primary reasons for refusing face transplantation were high risks of the operation (63.37%), family opinion (31.68%), and ethical concern (28.38%). For face donation, respondents who were medical professionals (p < .001), blood donors (p < .001), organ donor registrants (p < .001), participants who had willingness to be an organ transplant recipient (p < .001), or knowledge about face transplantation (p = .008) were more agreeable to be face donors (Table 2). The reasons for refusing face donation were mainly due to family opinion (66.14%) and religious concern (42.38%). To investigate the knowledge about face transplantation, among the medical professionals, mass media (70.96%) and scientific journals (55.30%) were their main sources of knowledge about face transplantation. Nonmedical professional respondents garnered much of their understanding about face transplants from the mass media (71.69%). Among medical professional respondents, 90.99% agreed that face transplantation is indicated for severe facial deformities and functional defects. Meanwhile, 76.17% of the nonmedical professional respondents agreed on this statement. In terms of the indications, most…
International Journal of Biological Macromolecules, 2020
This study aimed to evaluated the potential of core-shell poly(D,L-lactide-co-glycolide)-chitosan... more This study aimed to evaluated the potential of core-shell poly(D,L-lactide-co-glycolide)-chitosan (PLGA-chitosan) nanospheres encapsulating simvastatin (SIM) and doxycycline (DOX) for promoting periodontal and large-sized osseous defects. SIM, and/or DOX were encapsulated in PLGA-chitosan nanospheres using double emulsion technique and were delivered to sites of experimental periodontitis and large-sized mandibular osseous defects of rats for 1-4 weeks. The resultant nanospheres were ~200 nm diameter with distinct core-shell structure and released SIM and DOX sustainably for 28 days. DOX and SIM-DOX nanospheres significantly inhibited P. gingivalis and S. sanguinis. In experimental periodontitis sites, SIM-DOX nanospheres significantly down-regulated IL-1b and MMP-8 and significantly reduced bone loss. In mandibular osseous defects, VEGF was up-regulated, and osteogenesis was significantly augmented with SIM nanospheres treatment. In conclusion, core-shell PLGAchitosan nanospheres released SIM and DOX sustainably. SIM-DOX and SIM nanospheres could be considered to promote the repair of infected periodontal sites and non-infected osseous defects respectively.
Annals of plastic surgery, 2017
The reported rate of isolated medial orbital wall fractures varies widely but has been found to b... more The reported rate of isolated medial orbital wall fractures varies widely but has been found to be as high as 55% of all orbital fractures. Identifying and repairing medial orbital wall defects by using appropriate materials improves patient outcome considerably; however, most related research has focused on orbital floor defect management rather than medial orbital wall treatment, and no consensus on repairing medial orbital wall fractures exists. Furthermore, medial orbital wall fracture is a main cause of posttraumatic enophthalmos. In this study, we introduce a modified surgical technique for repairing large medial wall fractures stably, also reviewed relevant literature and established an algorithm for managing medial orbital wall fractures. We reviewed the outcomes of facial trauma patients who underwent facial bone reduction and internal fixation surgery in our hospital between October 1, 2010, and October 1, 2013. The patients were all treated medial orbital wall reconstruct...
The Journal of craniofacial surgery, Jan 6, 2017
Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to ... more Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated favorable results in facial rejuvenation. In the present study, the authors applied the MAFT technique with an innovative instrument in sunken temporal fossa and reported its results. Microautologous fat transplantation was performed on 208 patients during the 4-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200 g for 3 minutes. Then purified fat was microtransplanted to the temporal fossa with the assistance of an instrument, MAFT-Gun. The patients were followed up regularly and photographs were taken for comparison. On average, the MAFT procedure took 48 minutes to complete. The aver...
Annals of Plastic Surgery, 2016
Complex, nontraumatic diabetic foot ulcers with peripheral vascular compromise often lead to exte... more Complex, nontraumatic diabetic foot ulcers with peripheral vascular compromise often lead to extensive lower-limb amputation. The aim of this study is to determine the outcome of combined vascular intervention and free tissue transfer for critical diabetic limb salvage. A total of 26 consecutive diabetic patients with 28 legs with diabetic foot ulcers who underwent limb salvage with a combination of revascularization (bypass surgery or endovascular angioplasty) and free flap transfers were reviewed. There were 14 male and 12 female patients. The average age was 58.8 years (range, 35-85 years). Amputation-free survival and complete wound healing were defined as the primary endpoints. All preoperative and postoperative data were retrospectively analyzed. Thirty flaps were used for reconstruction in 28 legs, including 21 free anterolateral thigh (ALT) perforator flaps, 3 ALT myocutaneous flaps, 5 gracilis muscle flaps, and 1 latissimus dorsi muscle flap. All flaps used end-to-side anastomoses for the recipient artery and end-to-end anastomoses for the recipient vein. The overall flap success rate was 90% (27/30). Two flaps failed completely because of severe arteriosclerosis, which resulted in anastomosed vessel thrombosis. New flaps were applied in both cases after debridement and trimming of necrotic tissue. One flap failed because of restenosis and inadequate perfusion combined with severe infection, resulting in pedicle thrombosis. A below-knee amputation was subsequently performed. Seven flaps exhibited a partial loss, including 6 ALT perforator flaps and 1 latissimus dorsi flap, because of inadequate margin perfusion. After debridement, the flap revision and wound care, 5 flaps healed uneventfully without additional intervention. The remaining 2 ALT perforator flaps required debridement with a skin graft. The limb-salvage rates were 92.8% after 1 year and 89.2% after 5 years. The combination of peripheral arterial intervention and free tissue transfer resulted in successful wound healing and limb salvage instead of amputation in select diabetic patients with difficult-to-heal wounds.
Annals of plastic surgery, Jan 21, 2016
Treatment of blepharoptosis caused by ocular myasthenia gravis (OMG) is challenging in patients w... more Treatment of blepharoptosis caused by ocular myasthenia gravis (OMG) is challenging in patients with serious side effects or failed response to medical therapy. Only a few surgical reports have been published for refractory myathenic blepharoptosis. This study is aimed at the evaluation of the surgical outcome of blepharoptosis correction in intractable OMG patients. Twelve OMG patients who accepted frontalis sling with frontalis orbicularis oculi muscle (FOOM) flap for blepharoptosis correction were reviewed. Patients' demographies, perioperative changes of the interpalpebral fissure height (IPFH), margin reflex distance 1 (MRD1), levator function (LF), and quality of life (QOL) score were evaluated. The duration of OMG ranged from 3 to 31 years. LF was normal in 6 patients, good in 5, and poor in 1. There is no significant change of LF before and after surgery. MRD1 improved significantly from -1.8 mm (range, 0 to -5 mm) preoperatively to 2.9 mm (range, 2-4 mm) postoperatively...
Annals of Plastic Surgery, 2016
Intracompartmental sepsis (IS) is a rare complication in patients with burns. Intracompartmental ... more Intracompartmental sepsis (IS) is a rare complication in patients with burns. Intracompartmental sepsis presents in patients with inadequate perfusion of intracompartmental tissues and subsequent ischemic necrosis and infection. Contributing factors include high-volume resuscitation, delayed escharotomies, and previous bacteremia. We describe a case of massive burns from a gas explosion and the subsequent development of IS in our intensive care burn unit. The patient presented with a 75% total body surface area burn on admission, with 39% superficial, deep partial-thickness and 26% full-thickness burns. Intracompartmental sepsis was diagnosed 45 days after admission. Anterior compartment muscles, including the tibialis anterior, extensor hallucis longus, and extensor digitorum longus, were necrotic with relatively fair nerve and vascular structures. Intracompartmental sepsis is an overwhelming, infectious complication that appears late and can occur easily in patients with major burns. Early diagnosis and management are a must for improving outcomes.
Annals of Plastic Surgery, 2016
The aim of this literature review is to examine Hering&amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more The aim of this literature review is to examine Hering&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s law, a well-documented phenomenon in blepharoptosis patients, with 10% to 20% noted in cases of unilateral ptosis. Predominantly presenting as contralateral eyelid drop postoperatively, it poses a challenge for eyelid surgeons in the pursuit of symmetry and appropriate eyelid height. Proper preoperative evaluation is of utmost importance, consisting of one of either lifting test, covering test, or phenylephrine test. A deeper understanding of Hering&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s law further provides adequate information for optimal management of ptosis. In regard to ptosis etiology, congenital ptosis does not appear to have a distinct relation to positive Hering&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s law, commonly associated with a low incidence, when compared with acquired ptosis. Ptosis in the dominant eye seems to be related to a higher incidence of the phenomenon than ptosis in the nondominant eye, with statistical significance in studies ranging from P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 to P = 0.09. This can be explained as an innate response for increased innervation to regain the field of vision. Both ptosis severity and levator function appear to be of lesser importance than ptosis etiology, with minimal incidence of Hering&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s law in congenital ptosis regardless of these factors. It is, however, noted that ptosis severity has direct association with contralateral eyelid position in acquired ptosis, whereas there is a lack of studies for levator function. In the event of preoperative contralateral eyelid drop, surgeons should consider simultaneous surgery instead of delayed surgery for bilateral ptosis (P = 0.002). For unilateral ptosis, although reoperation is done per patient request, it may be more appropriate to first wait for roughly 2 weeks and reassess for self-regulation to a normal eyelid position.
Formosan Journal of Surgery, 2014
Cystic hygroma (CH) is an uncommon congenital anomaly of the lymphatic channels that occurs mainl... more Cystic hygroma (CH) is an uncommon congenital anomaly of the lymphatic channels that occurs mainly in children. CH is usually found in the cervical, axillary, inguinal, retroperitoneal, or thoracic region. CH is rare in adults, and to the best of our knowledge, there are only three adult case reports in the English literature (searched via PubMed) that discuss the development of CH in the axilla during adulthood. The lesion in our case presented as a soft, painless, mobile, and transilluminable mass on physical examination. Surgical removal was performed, CH was diagnosed, and the patient recovered uneventfully.
Uploads
Papers by Chung-sheng Lai