The Thai Journal of Surgery

Pediatric Living Donor Liver Transplantation from Adult Allograft Liver After Resection of Focal Nodular Hyperplasia: The Report Three Cases

Nattapat Khemworapong — 2024-09-30

Three pediatric living donor liver transplants were performed at Ramathibodi Hospital in Thailand. The recipients were two children with biliary atresia and one child with neonatal cholestasis jaundice with suspected biliary atresia. All three donors had a single liver lesion, which was suspected to be focal nodular hyperplasia (FNH) on preoperative imaging.

Because no other living donor candidates were available for the recipients, living donor liver transplants were performed. First, a wedge resection of the liver mass was performed. The liver mass was sent for a frozen section intraoperatively to confirm the diagnosis of a benign lesion and to ensure free-margin resection. Then, the transplantation was performed using a standard technique. The liver masses were 1.4-2.3 cm in diameter.

The liver donor hepatectomy was performed simultaneously with the recipient's total hepatectomy. The estimated liver graft volume was 176.5-336.5 cm³. The estimated graft-recipient weight ratio (GRWR) was 1.4-3.7%. The actual graft weight was 168-371 grams, and the actual GRWR was 1.6-3.5%. The liver graft was implanted in the recipient using a standard piggyback technique.

The donor and recipient were discharged after the operation without any complications. Follow-up ultrasound of the upper abdomen at six months showed no disease recurrence.

Primary Papillary Mucinous Carcinoma of The Scalp: A Case Report and A Brief Review of Literature

Vivek Kumar — 2024-09-30

Background: Primary papillary mucinous carcinoma of the skin is very uncommon and is seen mainly on the head and neck region. It is difficult to differentiate clinically and pathologically between these primary carcinomas of the skin and the more commonly found mucinous carcinoma distant deposits on the skin from malignancy in the breast and gastrointestinal system.

Case Presentation: We are presenting a case of a 64-year-old lady who presented with a slowly progressive, painful ulcero-proliferative growth on her scalp for 3 years. Incisional biopsy was suggestive of mucinous neoplasm. The patient underwent an oncological workup for another primary malignancy, but no other primary malignancy was detected. Subsequently, the patient underwent wide local excision with local flap reconstruction, and on the basis of the histopathology report, the diagnosis of a primary papillary mucinous carcinoma of the scalp was confirmed.

Discussion: It is a slowly progressive, low-grade carcinoma with the propensity of local tissue invasion and a high recurrence rate. Primary from head and neck, breast, gastrointestinal tract, and pelvic organ must be excluded. Treatment with wide local excision and 1 cm margin or Moh’s microsurgery is advised as these are chemotherapy and radiotherapy-resistant.

Conclusion: Primary papillary mucinous carcinoma of the scalp is a rare tumor, and another primary site of mucinous neoplasm must be ruled out. Wide local excision with adequate margin is the mainstay of treatment.

Use of Modified V-Y Latissimus Dorsi Myocutaneous Flap for Closure of Huge Anterior and Posterior Chest Wall Reconstruction, Our Experience: A Case Report

Nabilah Zaabar — 2024-09-30

Reconstruction of chest wall defects after tumor resection is challenging. With the advancement of reconstructive surgery, more options are available for chest wall reconstruction. Workhorse flaps like the musculocutaneous latissimus dorsi flap are frequently employed. Its modification to the V-Y design of the latissimus dorsi myocutaneous flap allows huge chest wall defect closure with substantial benefits, especially for cancer patients. We describe our experience using this flap design in five patients and the difficulties we faced. All patients underwent immediate chest wall reconstruction with a modified V-Y latissimus dorsi myocutaneous flap with minimal complications and donor site morbidity.

Effectiveness of Trauma Fast Track Protocol in Surat Thani Hospital

Thanakorn Orapan — 2024-09-30

Background: The trauma audit showed that delayed operative surgery was the most important problem for the mortality rate in trauma patients. This study aims to compare timing from the emergency room (ER) to the operative room (OR) and the mortality rate of trauma patients with blunt or penetrated abdomen or active vascular injury with shock before and after trauma fast track (TFT) was established in Surat Thani Hospital.

Materials and Methods: Prospective comparative study with historical control aimed to analyze the association between factors in fast-track trauma patients who visit the Emergency Department (ED) of our hospital between 1 September 2019 to 31 March 2022. We collected 190 trauma patients who met the criteria of TFT. The outcomes were analyzed, including comparing timing from ER to OR, mortality rate, and factors associated with mortality. Given a statistically significant difference of p-value < 0.05.

Results: There were 87 patients in the pre-protocol group and 103 patients in the post-protocol group. The results showed average times from ER to OR time in the post-protocol group were less than the pre-protocol group (31 vs. 58-minute, p-value < 0.001). The mortality cases of the pre- and post-protocol groups were 20 cases (24.10%) and 13 cases (12.15%); respectively, the p-value was 0.031. However, we found that several factors correlated with mortality rate.

Conclusion: After implementing the TFT, injured patients underwent surgery earlier, and the mortality rate decreased. To improve survival, the assessment and referral system and quality of care should be improved and standardized.

External Validation of the Trauma Injury Severity Score (TRISS) in Patients with Major Injuries at a Tertiary Care Public Hospital in Thailand

Ploytip Jansiriyotin — 2024-09-30

Objective: To externally validate TRISS's probability of survival in a tertiary care hospital in northeastern Thailand.

Materials and Methods: A retrospective cohort prognostic study included patients with significant injuries (ISS > 15) admitted to the hospital from 2011 to 2022 from the Khon Kaen trauma registry. Baseline characteristics were identified. AuROC presented the accuracy of the model. The age group was used as a subgroup analysis. The primary outcome was in-hospital mortality.

Results: This retrospective cohort study was conducted at a tertiary care public hospital in northeastern Thailand. A total of 20,867 patients were included. Missing primary outcome data were excluded. Most patients were male (75.23%). The mean age was 38.19 ± 19.65 years. The mean ISS was 20.17 ± 5.28. The mortality rate was 15.33%. AuROC was 0.8388. Subgroup analysis by age group showed a statistically significant reduction in AuROC by increasing age.

Conclusion: The accuracy of the TRISS model in a tertiary care hospital in Thailand was excellent, as close as MTOS. The accuracy was decreased by age. The TRISS model is applied to trauma quality improvement programs in Thailand.