Technical Pearls for Breast Reconstruction in Low BMI Asian Women With the Profunda Artery Perforator Flap.

Background: The deep inferior epigastric perforator (DIEP) flap is currently the gold standard for autologous breast reconstruction. In cases where the DIEP is contraindicated, the profunda artery perforator (PAP) flap is now the preferred second-line option in our institution. The PAP flap poses unique challenges to the reconstructive surgeon, especially in Asian women with low body mass index (BMI).

Early results of an orthoplastic multidisciplinary approach to diabetic foot ulcer soft tissue reconstruction.

Objective: Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3-6 months. Hard-to-heal DFUs are a major source of morbidity and mortality.

Strategically shifting paradigms: the new era of DIEP flaps with minimally invasive mastectomy: a retrospective cross-sectional study.

Background: The free deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Asian patients often present with a smaller body mass index with relatively insufficient tissue. To restore appropriate symmetry, a larger flap inset ratio must be transferred.

Double-opposing negative pressure dressing-a useful method for splinting skin grafts on the penile shaft.

The care of skin grafts in the penile shaft is challenging because of its cylindrical shape and constantly changing length and lie, which makes it difficult to apply uniform compression and ensure immobilization during the critical period of skin graft take. These challenges are difficult to overcome with conventional dressings. The authors describe a technique of applying a double-opposing negative pressure dressing to sandwich the penile shaft following reconstruction with a skin graft, which is simple to apply and addresses these issues.

Nylon Suture Loop for Tagging Lymphatic Channels during Lymphaticovenular Anastomosis.

 Lymphaticovenular anastomosis (LVA) requires special supermicrosurgery techniques designed for vessels less than 0.8 mm in size. While preparing the field for LVA, it is often difficult to handle the lymphatic vessel directly without injuring it or fracturing it entirely.

DIEP Donor Site Satisfaction between Patients with and without History of Pregnancy.

Background:  With the success of free autologous breast reconstruction, the abdominal donor site is now an important consideration, especially in patients of childbearing age. In our institution, there are increasing patients who have successfully undergone the deep inferior epigastric artery perforator (DIEP) flap despite previous pregnancy. This study aims to answer questions on the effect of the donor site on pregnancy and vice versa.

High-Fidelity Perforator Visualization for Cadaver Dissection in Surgical Training.

In the first half of the third century B.C., Herophilus and Erasistratus performed the first systematic dissection of the human body.

Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: a retrospective case-control study.

Objective: Breast cancer treatment has evolved to the modern skin-sparing mastectomy and nipple-sparing mastectomy. To better perform these surgeries, minimally invasive techniques using the endoscope, or Da Vinci Robotic Surgery platform have been developed. The deep inferior epigastric perforator (DIEP) flap is the gold standard in breast reconstruction, but it is still not commonly performed after minimally invasive mastectomy due technical difficulty.

Dynamic Reconstruction of Anal Sphincter with Camera Shutter Style Double-Opposing Gracilis Flaps.

Fournier's gangrene is a life-threatening infection which requires prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence.

Extramammary Paget's disease: Our 15-year experience in a Southeast Asian population.

The treatment of choice for Extramammary Paget's disease (EMPD) is wide excision. However, owing to the tendency of microscopic spread and multi-centricity of the disease, resection margins are hard to determine. Despite the use of adjunctive methods such as mapping biopsy and Moh's micrographic surgery, recurrence rates remain high.

Reconstruction of a massive chest wall defect using a free anterolateral-lower medial thigh flaps: a case report.

Critical defects of the chest wall require robust soft tissue coverage to protect the thoracic viscera. We define massive chest wall defects as larger than two-thirds of the chest wall. For such defects, classic flaps like the omentum, latissimus dorsi and anterolateral thigh flaps are usually insufficient.

A Preliminary Experience of Endoscopic Total Mastectomy With Immediate Free Abdominal-Based Perforator Flap Reconstruction Using Minimal Incisions, and Literature Review.

Purpose: Endoscopic total mastectomy (ETM) is predominantly performed with reconstruction using prostheses, lipofilling, omental flaps, latissimus dorsi flaps, or a combination of these techniques. Common approaches include minimal incisions, e.g.

Posterior cervical necrotising fasciitis: a multidisciplinary endeavour in surgery.

A 62-year-old male was diagnosed to the Emergency Department with 5-cm posterior neck carbuncle, and was subsequently discovered to have severe necrotising fasciitis intraoperatively during saucerization of the carbuncle. Subsequently, the patient was admitted to the intensive care unit and underwent combined debridement by the General Surgery, Neurosurgery and Plastic Surgery team. The large defect necessitated a trapezius flap reconstruction for coverage.

Single stage chest wall soft tissue reconstruction with ipsilateral pectoralis major turnover flap, rhomboid skin flap, and inferior nipple transposition.

Extravasation injury is a well-known complication of central venous catheter placement, with potential for extensive soft tissue necrosis. Here, we describe the case of a patient who developed a large right chest well soft tissue defect, due to a chest wall abscess from calcium gluconate infusion via a right internal jugular central venous catheter. After multiple debridements, the chest wall defect was reconstructed with a single stage ipsilateral pectoralis major turnover flap, rhomboid skin flap, and inferior nipple transposition to match the contralateral nipple.

Lower limb re-vascularization based on the angiosome concept with immediate-early local flap reconstruction: a case report.

Lower extremity wounds are a healthcare issue that can result in debilitating consequences. Peripheral arterial occlusive disease (PAOD) being a major contributing factor to the disease, advance revascularization procedures (Angioplasty) based on the angiosome concept has been established in the literature to improve blood supply and promote better healing outcomes. We present a case of a 59-year-old lady with background of hypertension, diabetes and PAOD, was diagnosed with a non-healing foot wound with exposed metal implant.

The diathermy scratch pad: A cheap and efficient tool for chemical and explosion-related burns.

The burn center in our hospital is a national and regional (Southeast Asia) center. Of all admissions, 10% are related to blast explosions, and 8% due to chemical burns. In the acute burn management protocol of Singapore General Hospital, early surgical debridement is advocated for all acute partial-thickness burns.

Two-Blade Guillotine Technique for Nipple Graft Harvest.

The nipple-sharing technique for nipple reconstruction offers excellent tissue matching. The method used for nipple graft harvesting determines the quality of the graft and hence, the success of nipple sharing. Here, we described a guillotine technique wherein the nipple is first transfixed with 2 straight needles to stabilise it.