Carboxymethylchitosan, alginate and tulle gauze wound dressings: a comparative study in the treatment of partial-thickness wounds.

Background: Carboxymethylchitosan is a chitosan-derivative obtained from the carboxymethylation of chitin with chloroacetic acid in alkaline solution. It has shown its potential in animal model studies as an accelerator of wound healing. Materials and methods: Prospective, comparative clinical trials of traditional tulle gauze, alginate membrane, and carboxymethylchitosan sponge were carried out in the treatment of partial- thickness skin graft donor sites. Between June 2005 and March 2006, 70 donor sites from 44 patients were randomly treated by these three different wound dressing materials. Each wound was treated until it was completely healed, and a visual analogue scale was used for the pain evaluation. Results: The results showed that the donor sites dressed with carboxymethylchitosan or alginate healed more rapidly than those treated with tulle gauze. There was no significant difference in the healing rate between carboxymethylchitosan and alginate. The pain scores evaluated among these three dressing groups did not significantly differ. Conclusion: Carboxymethylchitosan is as efficacious as traditional tulle gauze or alginate membrain in the treatment of partial thickness skin graft donor sites.

Anatomy of the facial nerve branching patterns, the marginal mandibular branch and its extraparotid ramification in relation to the lateral palpebral line.

Background: Surgery of face and parotid gland may cause injury to branches of the facial nerve, which results in paralysis of muscles of facial expression. Knowledge of branching patterns of the facial nerve and reliable landmarks of the surrounding structures are essential to avoid this complication. Objective: Determine the facial nerve branching patterns, the course of the marginal mandibular branch (MMB), and the extraparotid ramification in relation to the lateral palpebral line (LPL). Materials and methods: One hundred cadaveric half-heads were dissected for determining the facial nerve branching patterns according to the presence of anastomosis between branches. The course of the MMB was followed until it entered the depressor anguli oris in 49 specimens. The vertical distance from the mandibular angle to this branch was measured. The horizontal distance from the LPL to the otobasion superious (LPL-OBS) and the apex of the parotid gland (LPL-AP) were measured in 52 specimens. Results: The branching patterns of the facial nerve were categorized into six types. The least common (1%) was type I (absent of anastomosis), while type V, the complex pattern was the most common (29%). Symmetrical branching pattern occurred in 30% of cases. The MMB was coursing below the lower border of the mandible in 57% of cases. The mean vertical distance was 0.91±0.22 cm. The mean horizontal distances of LPL-OBS and LPLAP were 7.24±0.6 cm and 3.95±0.96 cm, respectively. The LPL-AP length was 54.5±11.4% of LPL-OBS. Conclusion: More complex branching pattern of the facial nerve was found in this population and symmetrical branching pattern occurred less of ten. The MMB coursed below the lower border of the angle of mandible with a mean vertical distance of one centimeter. The extraparotid ramification of the facial nerve was located in the area between the apex of the parotid gland and the LPL.

The anatomy of the thoracodorsal artery in perforator flap for resurfacing shallow defect.

OBJECTIVE: To systematically determine the location and number of cutaneous perforators greater than 0. 5 mm in diameter of the lateral branch of the thoracodorsal artery perforator flap for resurfacing shallow defect. MATERIAL AND METHOD: Sixty dissections of the thoracodorsal arterial system were carried out in 30 preserved cadavers. The location and number of cutaneous perforators greater than 0.5 mm in diameter of the lateral branch of the thoracodorsal artery perforator flap were studied and measured. RESULTS: Seventy-six perforators were found in 60 flaps (1.3 perforators per flap). The first perforator was exited in all dissections. It emerged from the latissimus dorsi muscle 9.8 cm below the dome of the axilla. In 21.67% of the cases, the second perforator of the thoracodorsal artery arose 3.4 cm distal to the origin of the first perforator The third perforator was found in 5% of dissections, and originated 3.0 cm away from the origin of the second perforator In addition, most perforators penetrated the muscle within 7.0-14. 0 cm below the dome of the axilla. CONCLUSION: The center of the flap designed should be placed between 7 to 14 cm from the dome of the axilla.

Neurovascular anatomy of the deep inferior epigastric perforator flap for breast reconstruction.

OBJECTIVE: To find out the most suitable perforator and cutaneous nerve for strategic design of the deep inferior epigastric perforator (DIEP) flap. MATERIAL AND METHOD: The characteristics of the pedicles, perforators, intercostal nerves and the relationship between nerves and vessels in DIEP flaps were studied in 31 formalin-preserved cadavers. RESULTS: Four hundred and five perforator vessels were divided into three vertical rows. These perforators were mostly contained in the medial row (45.4%), the average size of the perforators in the lateral row was the largest (1.0+/- 0.3 mm). The largest perforators (1.4+/- 0.3 mm) were mostly located within 1 cm horizontally from the umbilicus. Lateral row perforators, usually rectilinear course (82.7%), traveled with nerves from the beginning. Whereas, the perforators in the medial row usually coursed obliquely (86.4%) and were not related to nerves initially, they joined before piercing the rectus sheath. CONCLUSION: The present findings indicate that it would be more beneficial to use the lateral row perforators.

Bilateral scrotal flaps: a skin restoration for penile paraffinoma.

Foreign body injection into the penile shaft, in the mistaken belief that it could increase the size, is not uncommon among Thai males. Paraffin, oil, and other materials had been injected into the penile skin and predictably followed by a lot of complications. Foreign body granuloma, disfigurement, chronic and unhealed ulcer, painful erection, and the inability to achieve sexual activities are those following complications. In the severe cases, even though the complete resection of the skin and all of the infiltrated tissue was meticulously performed, some foreign bodies had to be left since they had incorporated into either the corpus cavernosum or corpus spongiosum. Durable resurfacing skin can't be perfectly achieved by skin grafting in these situations. Between 1996 and 2002, 31 patients with penile paraffinoma have been treated using bilateral scrotal flaps. Both functional and cosmetic goals without any major complications were achieved in all of the patients.

Sex reassignment surgery in Thailand.

Many years ago Thai society considered transsexualism (Gender identity disorder or Gender dysphoria) which is commonly known as Kathoey (a word originally used to denote hermaphrodites), Sao Prapet Song or Tut (as in 'Tootsie') were low class citizens, dirty dressing and had to hide in a dark corner selling their services as prostitutes. This made us unwilling to do sex reassignment surgery for this group of people because the idea of eradicating normal sexual organs for the purpose that was not accepted by the society. Consequently the authors have experience in cases where these people wandered seeking doctors who had no competency nor enough experience to do the surgery. The authors could not inhibit the desire of these people who usually suffer from gender identity disorder from strongly wishing to change their genital sex to the sex they want. The outcome of the surgery was not satisfactory for the patients. There were complications and sequelae which caused the authors to correct them later which might be more difficult than doing the original surgery. In addition there were more studies about the etiology and affect of the disorder on these people that changed the social point of view. The women who wanted to be a him and men who would like to be a her should be considered as patients who need to be cured to set the harmony about their genetic sex and the desire to be the opposite sex and also to be regarded by others as a member of that other sex. The treatments of transsexualism usually begin with conventional psychiatric and endocrinological treatment to adjust the mind to the body. For those who failed conservative treatment in adjusting the mind to the body then sex reassignment surgery will be the only way to transform their body to their mind and give the best result in properly selected patients. Preecha Tiewtranon, the pioneer in sex reassignment surgery in Thailand, did his transsexualism case in 1975 together with Dr. Prakob Thongpeaw. Sex reassignment surgery has been taught in Chulalongkorn University Hospital since 1983. (At present, it is the only medical school in Thailand that has sex reassignment surgery systematically taught and with good results). There have been many versions of development of the surgical techniques to gain better and better results.

The role of SMAS flap in preventing Frey's syndrome following standard superficial parotidectomy.

Between 1992 and 2002, 46 patients who underwent standard superficial parotidectomy with a superficial muscoloaponeurotic system (SMAS) preservation technique were included in a retrospective study. Twenty-six patients were evaluated by questionnaire for subjective symptoms of gustatory sweating and flushing as well as satisfaction with the aesthetic appearance of their cheek. Six of twenty-six patients (23.1%) complained of symptoms of Frey's syndrome. Seven of twenty-six patients (26.9%) demonstrated a positive Minor's starch iodine test. By this technique the incidence of Frey's syndrome is substantially reduced from 48% by subjective review and 72% by objective measurement reported in the previous study by the same group of surgeons without using the SMAS preservation technique. This study supports the role of the SMAS flap in preventing Frey's syndrome following standard superficial parotidectomy.