OUR RECONSTRUCTIVE SURGERY SERVICES
SKIN CANCER EXCISION AND RECONSTRUCTION
Skin cancers usually occur in elderly patients who have accumulated significant ultraviolet-related sun damage over their lifetimes. Skin cancers often occur in the face, neck and the upper extremities, and may present with pain, ulceration, bleeding, and may occasionally have distant spread to other organs. With appropriate resection and reconstruction, patients may be cured and whilst having optimal functional and aesthetic restoration. These are usually simple, low-risk procedures.
HEAD AND NECK CANCER RECONSTRUCTION
The head contains many anatomical structures critical for life and essential function, and cancer resection may result in exposure of such structures, functional deficit, as well as significant aesthetic deformities. Reconstruction of the head and neck is one of the most challenging fields in plastic surgery and it is important to engage experienced professionals to undertake these cases.
Dr Yeo has previously completed a one-year fellowship in Advanced Reconstructive Microsurgery in Taiwan ROC, where he was privileged to train under world-renowned reconstructive plastic surgeon Professor Hung-Chi Chen. He has since successfully performed the first free colonic flap transfer for reconstruction of the pharynx in Singapore, amongst other pioneering surgeries locally. He is shares his expertise in this area with his colleagues in the capacity of visiting consultant at the Singapore General Hospital.
The craniomaxillofacial skeleton forms the structural basis for many of the functional subunits of the face. Facial fractures cause pain, may result in visual disturbances, difficulty in breathing, and malalignment between the upper and lower jaws and teeth. In many cases, operative reduction and fixation of these fractures may reduce recovery time, improve function and the facial appearance. Surgery is usually performed through inconspicuous incisions and the bones are fixed with inert titanium implants, which do not require removal in the majority of cases.
The breast is central to the feminine identity, and patients frequently seek breast reconstruction at the same time as the mastectomy surgery. The goals of breast reconstruction are to restore a breast mound that is symmetrical in shape, size, and position with the
contralateral breast, improve self-confidence, and facilitate social reintegration. Reconstruction may be performed at the time of the mastectomy (primary reconstruction), or following completion of radiation and/or chemotherapy (delayed reconstruction). Reconstruction may also be performed using breast implants (alloplastic reconstruction), or various body tissues (autologous reconstruction), with the abdomen and the back being the commonest sources of tissue for reconstruction. Breast reconstruction does not impact future breast cancer screening and does not have any adverse impact on long-term survival. Balancing procedures may sometimes be performed on the non-cancerous breast to achieve good symmetry. Nipple reconstruction may be performed following completion of appropriate adjuvant chemotherapy and/or radiotherapy.
CHEST WALL RECONSTRUCTION
Resection of intrathoracic tumors may involve removal of significant portions of the chest wall, resulting in significant deficits in respiratory function. In the past, such cases required prolonged postoperative artificial ventilator support in the intensive care unit due to flail chest, or reconstruction with various forms of meshes and/or cement.
In collaboration with cardiothoracic surgeons, Dr Yeo has performed pioneering work in this field and has devised on a novel method of chest wall reconstruction utilizing a combination of the patient’s own ribs, titanium plates and screws, and artificial skin. This method has been published in peer reviewed medical journals, and presented at multiple international conferences. Patients who undergo this method now require much reduced artificial ventilator support, experience less postoperative pain, are discharged from hospital earlier, and have much improved chest wall contour postoperatively as compared with traditional methods of reconstruction.
The upper and lower extremities hold special functional significance for our activities of daily living. Skeletal and soft tissue defects of the upper and lower extremity may arise from trauma, burn injuries, or tumor resections, and may potentially result in chronic wounds and/or infection, and loss of extremity function. Early reconstruction and rehabilitation is aimed returning such patients to normal activities of daily living and work, as expediently as possible. These cases usually require collaboration between experienced orthopedic or hand surgeons, and plastic surgeons to deliver optimal outcomes.
Lymphedema is the accumulation of protein-rich interstitial fluid in the extremities. This may be due to congenital malformations, or acquired due to infections, previous cancer surgery, or previous radiation therapy. Patients may experience infection, heaviness and difficulty with mobilization of the affected extremity, and may have difficulty finding clothes and/or shoes that will fit them. In long-standing cases, lymphedema has been associated with a rare form of cancer.
Dr Yeo has received extensive exposure lymphatic surgery during his fellowship in Taiwan ROC. He has also performed various pioneering lymphatic surgeries in Singapore, including vascularized lymph node transfers and resection procedures. He is currently a visiting consultant in Singapore General Hospital and is enthusiastic about sharing his expertise in this area with his colleagues.