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Rattaplee Pak-Art

Publications and source records attributed to Rattaplee Pak-Art.

5 recordsLinked to original sources
PubMed2003

Immediate closure of the open abdomen with bilateral bipedicle anterior abdominal skin flaps and subsequent retrorectus prosthetic mesh repair of the late giant ventral hernias.

BACKGROUND: Management of the open abdomen in trauma and nontrauma patients is difficult, and some areas of controversy remain. Gastrointestinal fistulas are serious complications that are associated with significant mortality. We present our method for management of patients with open abdomen and also present a logical technique of subsequent repair of the late giant ventral hernias that uniformly occur in these patients. METHODS: From January 1992 to December 2001, nine patients with open abdomen underwent successful immediate closure with bilateral bipedicle anterior abdominal skin flaps. The major points of this technique of abdominal closure are coverage of abdominal viscera with absorbable mesh and mobilization of the skin and subcutaneous tissue on both sides of the abdominal wound to cover the absorbable mesh. All patients had uneventful recovery and also had subsequent late giant ventral hernias. Repair of the late giant ventral hernias was performed several months later by inserting a large sheet of nonabsorbable mesh under the rectus abdominis muscles that form the neck of the ventral hernia bilaterally. This technique of ventral hernia repair is also called retrorectus prosthetic mesh repair. RESULTS: Five men and four women were entered into the study. The age ranged from 22 to 53 years (median, 35 years). Seven patients suffered from blunt and penetrating trauma and two patients suffered from nontrauma causes. All patients with immediate closure of the open abdomen had uneventful recovery. Late giant ventral hernias (diameter, > 10 cm) occurred in all patients. The time from closure of the open abdomen to subsequent repair of the giant ventral hernias ranged from 7 to 48 months (median, 14 months). Follow-up after hernia repair ranged from 1 to 72 months (median, 9 months), and we have seen no evidence of recurrence. CONCLUSION: Immediate closure of the open abdomen with bilateral bipedicle anterior abdominal skin flaps is an effective technique for dealing with such potentially complicated problems. Management of late giant ventral hernias with retrorectus prosthetic mesh repair is theoretically reasonable and, so far, no recurrence has been observed in our patients.

Abdomen↗
PubMed2002

Prospective, randomized, controlled trial of proximally based vs. distally based gluteus maximus flap for anal incontinence in cadavers.

PURPOSE: The aim of this study was to compare the lengths of proximally based and distally based gluteus maximus flaps created as for anal sphincter reconstruction in soft human cadavers. METHODS: Twelve soft cadavers were used in this prospective, randomized, controlled study. In each cadaver, a proximally based flap of the gluteus maximus muscle was performed on one side and a distally based flap on the other. All flaps were carefully dissected with neurovascular preservation by one surgeon. After the dissected flap was placed across the anus, the length of the flap that projected beyond the anus was measured. The differences between such lengths of both types of flaps were assessed by paired t-test. RESULTS: The average lengths of the parts that projected beyond the anus for proximally based and distally based flaps were 8.08 and 4.50 (standard deviation, 0.51 and 0.79) cm, respectively. The average difference was 3.58 (standard deviation, 0.51) cm, which was statistically significant (P < 0.001). CONCLUSION: Results showed that proximally based flaps were significantly longer than distally based flaps and that transposition and wrapping around the anus with proximally based flaps were always easily performed without tension. These findings support the use of unilateral proximally based gluteus maximus flaps instead of unilateral or bilateral distally based flaps in patients with anal incontinence. The location of the neurovascular pedicle of the gluteus maximus was consistent at 1 cm superior and lateral to ischial tuberosity. Knowledge of this landmark allows quick and safe dissection of the gluteus maximus flap.

Buttocks↗
PubMed2002

Pelvic fractures: experience in management of 170 cases at a university hospital in Thailand.

UNLABELLED: BACKGROUND, OBJECTIVE AND METHOD: Management of patients with pelvic fractures requires a multidisciplinary team approach. Currently, survival has been dramatically improved but some controversies still remain. The purpose of this study was to examine management and results of treatment of patients with pelvic fractures who were admitted to the Trauma Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000. RESULTS: There were 170 patients in the study. The age ranged from 15 to 91 years (mean 33.89 +/- 16.14). The most common cause of injuries was motorcycle accidents (50.0%). There were 27 (15.9%), 47 (27.6%), 80 (47.1%) and 16 (9.4%) patients with Type I, II, III and IV pelvic fractures, respectively. Forty per cent of patients were in shock when they first arrived at the emergency room. Seventy two patients (42.4%) had 274 associated injuries. Sixteen patients (9.4%) had open pelvic fractures. The Injury Severity Score (ISS) ranged from 4 to 75 (mean 17.55 +/- 12.86). Eighty two patients (48.2%) received blood transfusion from 1 to 40 units (mean 10.04 +/- 8.47). Sixteen patients (9.4%) underwent pelvic angiography, 10 bleeding points were demonstrated and successfully treated by transcatheter embolization. One hundred and thirty two patients (77.6%) received no specific treatment for the pelvic fractures. The remainder (22.4%) were treated with pelvic sling in 6 patients (3.5%), skeletal traction in 21 patients (12.4%), external fixation in 6 patients (3.5%), internal fixation in 4 patients (2.4%), and right hemipelvectomy in 1 patient (0.6%). Fifteen patients (8.8%) died. Causes of death were exsanguination in 6 patients (40% of death), severe head injuries in 6 patients (40% of death) and sepsis with multisystem organ failure in 3 patients (20% of death). Nonsurvivors had a significantly higher ISS and units of blood transfusion than survivors (P < 0.001). The hospital stay ranged from 1 to 300 days (mean 24.7 +/- 34.19). CONCLUSION: Approximately 75 per cent of patients in our study had major pelvic fractures (Type II and Type III pelvic fractures). The majority of bleeding from pelvic fractures could be treated conservatively. Angiography with transcatheter embolization was extremely helpful when conservative treatment failed to stop pelvic bleeding. External fixation for early control of bleeding pelvic fractures was infrequently employed.

Adolescent↗