Adrian Ooi

Mount Elizabeth Hospital

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David W. Chang

University of Chicago

David Song

Georgetown University

Bien‐Keem Tan

Singapore General Hospital

Yee Siang Ong

Singapore General Hospital

Chad M. Teven

Northwestern University

Si Jack Chong

Ministry of Health

Marcus J.M. Ng

Tan Tock Seng Hospital

Lawrence J. Gottlieb

University of Chicago

Sri Iyenger

University of Southampton

Daniel R. Butz

University of Chicago

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Singapore General Hospital

American Society of Plastic Surgeons

University of Miami

University of Chicago

University of Illinois Chicago

Aesthetic Surgery Center

Harvard University

Center For Reconstructive Urethral Surgery

The University of Texas Southwestern Medical Center

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Comparison of Outcomes of Fasciocutaneous Free Flaps and Jejunal Free Flaps in Pharyngolaryngoesophageal Reconstruction

Annals of Plastic Surgery (2019)

Hui Kai Koh Ngian Chye Tan Bien‐Keem Tan Adrian Ooi

The literature reports a wide variety of reconstructive methods for pharyngolaryngoesophageal (PLO) defects, the most widely used being anterolateral thigh (ALT), radial forearm (RFF), and jejunal free flaps (JFF). However, there is a lack of uniform agreement among head and neck surgeons as to which technique offers the best results. With an increasing number of salvage PLO extirpations, determining the role of radiotherapy in influencing postoperative complication rates is becoming ever more important. Hence, this study aims to provide an up-to-date comparison of surgical and functional outcomes of the fasciocutaneous ALT and RFF versus the intestinal JFF for circumferential and partial PLO defects and determine whether radiotherapy, both preoperative and postoperative, influences the postoperative fistula and stricture rates in circumferential defects.A systematic review and meta-analysis were performed using PubMed for reports published in the most recent 10 years between 2007 and 2017.A total of 33 articles comprising 1213 patients were reviewed. For circumferential defects, fistula and stricture rates were significantly lower in JFF than ALT and RFF. Of note, there was no statistical difference in tracheoesophageal speech and oral alimentation rates between JFF and the FC flaps. For near-circumferential and partial defects, ALT has a significantly lower fistula rate than RFF. There was no statistical difference in stricture and oral alimentation rates between ALT and RFF [corrected]. Fistula rates were significantly higher in patients who had preoperative radiotherapy than those without. However, there was no significant difference in fistula and stricture rates for postoperative radiotherapy.Jejunal free flaps still remain an excellent first choice for PLO reconstruction of circumferential defects. For near-circumferential and partial defects, ALT seems to have a better performance than RFF. Preoperative radiotherapy was associated with an increased risk of fistula formation in circumferential PLO defects but not postoperative radiotherapy.

Tracheoesophageal Fistula

10.1097/sap.0000000000001776

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Citations (35)

Case report Boxer's pericardium

Adrian Ooi

A 65-year-old retired professional boxer presented with progressively worsening shortness of breath, peripheral oedema and mild abdominal swelling over a period of 6 months. His only past medical history was hypertension. Subsequent investigations revealed chylous ascites, pericardial constriction and bilateral chylothorax. He had uneventful pericardectomy, and post-operatively the chylothorax resolved only after administration of octreotide for 10 days. The histopathological features of fibrosis, haemosiderin deposition in the pericardium and abundant haemosiderin-laden macrophages are consistent with chronic resolving haemopericardium. These findings suggested that the cause of pericardial constriction was repeated chest trauma from boxing. q 2003 Elsevier B.V. All rights reserved.

Constriction

Chylous Ascites

Chylothorax

Peripheral edema

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The Unfavorable Result in Plastic Surgery

Mimis Cohen Seth R. Thaller David J. Birnbach Joshua Fosnot Lawrence J. Gottlieb

The unfavorable result in plastic surgery , The unfavorable result in plastic surgery , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

10.1055/b-005-143642

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Citations (68)

A Uniform Open Rhinoplasty Approach in Improving Nasal Aesthetics and Function in South-Asian Unilateral Cleft Patients

The Aesthetic Meeting 2014 (2014)

Adrian Ooi

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Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

Plastic Surgery International (2016)

Adrian Ooi Jonathan Patrick Ng Christopher Hoe‐Kong Chui Terence Goh Bien‐Keem Tan

Background . Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods . Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion . 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm 2 (range 36–420 cm 2 ). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results . While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion . We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.

10.1155/2016/2841816

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Outcomes in emergency redo cardiac surgery: cost, benefit and risk assessment

Interactive Cardiovascular and Thoracic Surgery (2003)

Andrew Goodwin Adrian Ooi J Kitcat S NASHEF

Emergency redo surgery is rare, but may be required in patients with conditions such as endocarditis, unstable angina and acute aortic dissection. To date there are no published data on the outcome of these difficult patients. Prospective consecutive data were collected from a single institution on 65 patients (51 male) undergoing coronary artery bypass grafts (27), mitral valve replacement or repair (13), aortic valve replacement (7), aortic surgery (13), and other (combined procedures) (5). Indications for surgery were unstable angina (12), endocarditis (11), resuscitation/catheter lab complications (11), torn prosthetic leaflet (6), aortic dissection (4), paraprosthetic leak (2), other (19). Mean ITU stay was 45 h (0-284) and hospital stay was 13.3 days (0-68). There were 14 intra-operative deaths and 14 further in-hospital deaths (overall mortality 43%). Predicted mortality rates were 26% (Parsonnet), 11% (EuroSCORE) and 31% (EuroSCORE logistic). Mean hospital cost per patient was 18,299 euros (or 32,147 euros per hospital survivor). In conclusion, the mortality in these difficult patients is very high, however, often no other treatment option is available. More sophisticated models, such as EuroSCORE logistic, may allow better prediction of risk in very high risk cases.

EuroSCORE

Unstable angina

Aortic valve repair

10.1016/s1569-9293(03)00041-0

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Citations (17)

Abstract PR146

Anesthesia & Analgesia (2016)

Hironobu Hayashi Tsunenori Takatani Adrian Ooi Makiko Kawaguchi

Background & Objectives: Intraoperative facial nerve motor evoked potential (FNMEP) monitoring using transcranial electrocortical stimulation has been used to avoid disruption of neural tract or trauma to facial nerve during skull base surgery. However, FNMEP has some limitations including significant artifact to the recordings because of the proximity of the stimulation location and the recording point, and small amplitude compared with that obtained during direct stimulation of the intracranial facial nerve. This study was designed to investigate the reliability of intraoperative FNMEP monitoring during skull base surgery. Materials & Methods: Forty-three patients undergoing elective skull base surgery with FNMEP monitoring were retrospectively reviewed between January 2013 and February 2016. Anesthesia was maintained by total intravenous anesthesia using propofol without neuromuscular blocking agent. In FNMEP, stimulation was applied using corkscrew electrodes placed in the scalp at the C3 and C4 positions (contralateral to the affected side) according to the International 10–20 EEG system. Stimulus intensity was done with 20% stronger than the threshold stimulus intensity (approximately 40–50 mA) with a train of four pulses. Subdermal needle electrodes placed in the orbicularis oculi muscle at the lateral angle of the bilateral eyes and in the orbicularis oris muscle at the bilateral angle of the mouth for recording FNMEP. MEE-1232 (Nihon Kohden, Tokyo, Japan) was used as an electrophysiological device. Significant change of amplitude was defined as more than 50% decrease compared with baseline amplitude. Facial nerve function was evaluated preoperatively and postoperatively using the House and Brackmann grading system. The reliability of intraoperative FNMEP was assessed by sensitivity and specificity to detect postoperative facial nerve dysfunction. Results: Control FNMEP waveforms were successfully recorded in all patients. Of 43 patients, significant sustained decreases of FNMEP until the end of surgery were observed in 9 patients. Postoperative new facial nerve dysfunction or worsen facial nerve function were observe in 10 patients. Of the 10 patients with postoperative deterioration of facial nerve function, 6 patients had intraoperative significant decline of FNMEP. The sensitivity and specificity of intraoperative FNMEP to detect postoperative facial nerve dysfunction were 60.0% and 90.9%, respectively. Conclusion: The results in this study indicated the feasibility of intraoperative FNMEP monitoring during skull base surgery. Disclosure of Interest: None declared

Orbicularis oculi muscle

10.1213/01.ane.0000492549.72854.d1

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Ipsilateral Pedicled Tram Flap for Immediate Breast Reconstruction

Springer eBooks (2015)

Bien‐Keem Tan Adrian Ooi Julian J. Pribaz

10.1007/978-3-319-18726-6_56

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Combined use of liposuction and arthroscopic shaver in lower-limb fasciocutaneous flap contouring

Journal of Plastic Reconstructive & Aesthetic Surgery (2013)