瞭解更多顯微淋巴結皮瓣移植的適合對象、手術結果、術前及術後的對比和分析，全部來自於鄭明輝教授的多年經驗。 Gallery Treatment of Moderate to Severe Lymphede Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs Case 1 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year. At 2- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 27% and 10% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 36% and 15% above and below the elbow, respectively. The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 and 27 months. At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 60% and 10% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 72- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 50% above and below the elbow, respectively. At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively. Case 2 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 38% and 25% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 6- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 32% and 15% above and below the elbow, respectively. At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 30% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 18- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 90% and 40% above and below the elbow, respectively. At 22- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 35% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively. Case 3 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 56-year-old patient with grade IV breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 5 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 21- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 70% and 30% above and below the elbow, respectively. At 29- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 65% above and below the elbow, respectively. Case 4 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 70-year-old patient with grade III breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 6-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 20% above the elbow and 15% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 24-months follow-up, the reduction rate was 60% above the elbow and 50% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 33-months follow-up, the reduction rate was 50% above the elbow and 25% below the elbow without the use of a compression garment. Case 5 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 12 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 3-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 22% above the elbow and 25% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 6-months follow-up, the reduction rate was 35% above the elbow and 25% below the elbow without the use of a compression garment. At the 12-months follow-up, the reduction rate was 30% above the elbow and 20% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in the wrist and liposuction for the left upper medial arm 14 months after surgery. At the 24-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow without the use of a compression garment. At the 38-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow. The patient was satisfied with the functional and cosmetic outcomes and did not wear a compression garment. Case 6 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 51-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 6 months after mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment. At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment. The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment. At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment. Case 7 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 18 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was received non-vascularized lymph node transfer by other doctor on left elbow, and refractory to conservative decongestive therapy. At the 3-months follow-up, the reduction rate was 10% above the elbow and 23% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 10-months follow-up, the reduction rate was 20% above the elbow and 30% below the elbow without the use of a compression garment. The skin paddle in the middle forearm was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At the 20-months follow-up, the reduction rate was 100% above the elbow and 42% below the elbow without the use of a compression garment. Case 8 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs This is a 46-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 2 years after mastectomy, axillary lymph node dissection, and radiotherapy. She developed one episode of cellulitis per year with the use of compression garments. At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 20% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 24- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 37% and 20% above and below the elbow, respectively. At 38- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 25% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 70- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 75% and 50% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs Case 1 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs A 65-year-old female with grade IV left lower limb lymphedema for 3 years after cervical cancer and radiation. At the 3 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 30% above the knee and 40% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 9 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 85% below the knee without the use of a compression garment. Case 2 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs A 67-year-old female with grade IV right lower limb lymphedema for 8 years after cervical cancer and radiation. She was refractory to conservative decongestive therapy. At the 6 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 15% above the knee and 5% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 67 months of follow-up, after flap revision and right lower limb liposuction. The circumferential reduction rate was 62% above the knee and 50% below the knee without the use of a compression garment. Case 3 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 15-year-old patient with left lower limb congenital lymphedema for 2 years. At the 24 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 36 months of follow-up, after flap revision. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment. Case 4 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 5-year-old patient with right lower limb congenital lymphedema for 2 years. At the 15 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 20% above the knee and 15% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 13 months of follow-up, after flap revision. The circumferential reduction rate was 25% above the knee and 20% below the knee without the use of a compression garment. Case 5 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 40-year-old patient with left lower limb congenital lymphedema for 15 years. At the 6 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 5% above the knee and 23% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 36 months of follow-up, after flap revision and left lower limb liposuction. The circumferential reduction rate was 55% above the knee and 56% below the knee without the use of a compression garment. Case 6 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 52-year-old female with grade II left lower limb lymphedema and grade I right lower limb lymphedema for 5 years after cervical cancer and radiation. At the 1 month of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 19 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment.

Dr. Cheng have trained 87 international fellows and 714 short-term international visiting scholars since 2000. Some of them are actively practicing Lymphedema Microsurgery in their own countries. International Fellows Dr. Cheng have trained 87 international fellows and 714 short-term international visiting scholars since 2000. Some of them are actively practicing Lymphedema Microsurgery in their own countries. MD Joseph H Dayan Fellowship: 2008-2009, Present position: Associate Professor at Division of Plastic Surgery, Memorial Sloan Kettering Cancer Center MD, PhD, FACS Holger Engel Fellowship: 2008-2009, Present position: Professor at Division of Plastic Surgery, BG Trauma Center Ludwigshafen, Germany MD, PharmD Dung Nguyen Fellowship: 2010-2011, Present position: Associate Professor at Division of Plastic Surgery, Stanford University Medical Center MD Wei Fen Chen Fellowship: 2010-2011, Present position: Professor at Division of Plastic Surgery, Cleveland Clinic MD Dhruv Singhal Fellowship: 2011-2012, Present position: Assistant Professor at Division of Plastic Surgery, Beth Israel Deaconess Medical Center/ Harvard Medical School MD, MBA John Chieh-Han Tzou Fellowship: 2012-2013, Present position: Professor at Division of Plastic Surgery, Medical University of Vienna, Austria MD Ketan M. Patel Fellowship: 2013-2014, Present position: Assistant Professor at Division of Plastic Surgery, University of Southern California MD Shan Shan Qiu Fellowship: 2013-2014, Present position: Assistant Professor at Division of Plastic Surgery, Maastricht University Medical Center, the Netherlands MD, FRCSC Hattan Aljaaly Fellowship: 2014-2015, Present position: Assistant Professor at Division of Plastic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia MD, MS, FRCSC Olivia Ho Fellowship: 2016-2017, Present position: Assistant Professor at Division of Plastic Surgery, Mayo Clinic MD, MSc Marco Pappalardo Fellowship: 2016-2017, Present position: Assistant Professor at Division of Plastic Surgery, University of Palermo, Italy MD, FRCSC Arash Izadpanah Fellowship: 2017-2018, Present position: Assistant Professor at Division of Plastic Surgery, University of Manitoba MD Ines Tinhofer Fellowship: 2018-2019, Present position: Assistant Professor at Division of Plastic Surgery, Medical University of Vienna, Austria MD Satomi Koide Fellowship: 2018-2019, Present position: Assistant Professor at Division of Plastic Surgery, St. Vincent Hospital, Australia MD Chrisovalantis Lakhian Fellowship: 2019-2020, Present position: Assistant Professor at Division of Plastic Surgery, Georgetown University Medical Center MD Onur Aksoy Fellowship: 2023-2024, Present position: Prof Dr Cemil Tascioglu City Hospital, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey

案例分享：隆乳 + 縮乳頭 ｜「胸部不腫、不痛，也有下降，感覺更自然。胸型好了，連乳頭也一起變得更美，身材好了，穿衣服更好看。」 美麗見證 2024.4.18 手術 案例分享：隆乳 + 縮乳頭 從小就是個小胸人一直到懷孕哺乳，才體會到什麼叫胸🤣。 產後為了減肥，把剩餘僅存的胸（脂肪）都減掉了（哭哭）。 （術前產後胸部萎縮＋乳頭變形） 看著自己的身材慘不忍睹，進而開始尋求中醫豐胸，花了不少錢。 精神睡眠是有好一點，但胸部一點進展都沒有😭。 意外從網路得知一些隆乳的資訊，就開始做些功課。 除了上網查些相關資料，還有Line的社群可以詢問。 從開始諮詢到決定手術時間很快，因為我怕我後悔就不敢做了 既然有想法就趕快速速決定。 我前前後後總共諮詢了五家大台北知名的整形外科，這5家包含網路上網友們都極推的整外名醫，從一開始的不好意思、模糊懵懂→到知道自己想問什麼、在意什麼，而不是被診所的醫生及諮詢師牽著走。 最後，我選擇了我的隆乳命定首選：安德森整形外科！ 其中有7個因素影響我最後的決定： 本身做了些功課，我傾向胸下緣開刀，鄭明輝院長是胸下外側，跟我想要的手術開法類似。 想要影響生活最小的，因為還要帶小孩也要上班，也不想讓家人知道，本身也是忙碌的一般上班族、職業婦女，不是職業網紅、也不是演藝人員模特兒。 安德森整形外科是我第5間諮詢的整形外科診所，我自己想問的、在意的地方，包括院長、麻醉醫師到整體醫療環境、診所諮詢師，都有正中我心。 鄭明輝院長很有自信，但態度沒有很自負，講話過程中沒有因為我問了蠢問題而反駁我。 診所的裝潢很溫馨自然，從首次來現場諮詢到幾次來診所看到的患者，跟我一樣都是一般老百姓，沒有看到網紅，也沒有整型到很誇張的臉。 諮詢師在見面前的電話初步諮詢聯繫跟實際預約見面後的諮詢，後續聯繫與服務態度是一致的，沒有因為我說我還要思考就愛理不理，還是抱著盡力再為我解說、說明，服務的熱忱跟態度與專業是一致的。 鄭院長是前林口長庚醫院院長，我想這等級應該很厲害。 所以最後就決定預約了手術日期。 在手術當天，當天的刀房護理師佳怡有給我很大的心理支持。 進去刀房前我還問了她說：「如果遇到地震你們會怎麼辦？🤣」 她一直安慰我說不用擔心我會好好照顧妳。 這緩和了我手術當天很大的情緒焦慮與緊張。畢竟是要手術我的心裡還是會害怕與緊張。 【手術當天】 麻醉醫師都有跟我講解細節，在麻醉過程（我清醒時）都有跟我講解，叫我要放輕鬆，不然會打不到血管喔🤣 我很想放輕鬆啊，但是我很緊張一直在發抖 我在手術台上又想哭又想笑。（很怕手術後醒不來，怕手術後很痛，但又覺得我睡個覺起來就有大奶奶了太棒了） 我當下的臉真的是哭哭又笑笑。 在我麻醉昏迷之前，麻醉醫生跟護理師都一直有在跟我講話🤣 術後麻醉的後遺症，讓我極為不適（想吐），離開開刀房後在診所也休息了一陣子，回到家很累很想睡，但也很想吐。 這時會有一個想法冒出：為了愛美讓自己這麼不舒服何必呢？ 睡覺過程沒有很安穩，但也平順度過了第一晚。 【術後第二、三天】 起不了身請老公協助，除了動作比較緩慢外，想吐的症狀沒了（麻醉代謝掉了）。除了左右側邊肋骨跟鎖骨處會有點痛痛，其他沒有什麼疼痛感（早晚都有吃止痛藥跟抗生素）。 吃東西也可以正常吃、也可以陪小孩玩玩具、胸部假體在姿勢轉換時有不舒服感覺（有東西在動的感覺）。 【術後第四天】 自己出門洗頭去、動作依然不敢太快太大、半坐躺的方式洗頭很OK，這時的我行動自如。 【術後第7天回診】 按摩的力道比我想像的大。但按摩時都不會痛。會聽到胸部內有水聲。胸部的皮膚感覺有一點鈍鈍的。冰敷時，有一種隔空的感覺 乳頭換藥有稍微一點點感覺。但不大，壓到的話會痛。 已可以正常手伸直運動，伸展時腋下會有酸拉感。 胸部乳頭部分還是沒什麼感覺、胸部開刀處沒什麼感覺。 在胸部腫脹部分；腫在胸部跟剝離範圍，沒有水腫到肚子跟其他地方。 疼痛感部分： 一開始幾天按壓胸部會覺得一點痛，在姿勢轉換時會有假體移動的瞬間麻辣感。 老公說我是天選之人，要不是他有陪我去開刀跟幫我換藥，不然一點都不覺得我有手術。 可以按摩後，就認真按（早上起床、中午吃飯、晚上睡前） 還有每次在公司上廁所時按一下，我的胸部在2個星期回診時就覺得很軟了。 目前手術快2個月： 胸部不腫、不痛，也有下降，感覺更自然。 胸型好了，連乳頭也一起變得更美，身材好了，穿衣服更好看。 先生也更喜歡這樣轉變後的自己，因為我變得更有自信，也變得更愛自己。 還在觀望的妳 推薦給大家。我的見證與分享。

了解更多有關術後照顧的重點，患者不再需要穿戴壓力袖套、襪，但建議患者在術後接受3~6個月的復健，需要積極治療。 Post-Operative Care Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Post-Operative Rehabilitation The A+ Surgery Clinic provides comprehensive and extensive medical services before and after surgery. It is recommended that lymphedema patients receive post-operative rehabilitation for a period of 3- 6 months. It is most noteworthy that patients no longer need to wear compression garments after Dr. Cheng’s Side-to-End Lymphovenous anastomosis and vascularized submental lymph node flap transfer to distal recipient site for post-operative rehabilitation. It is recommended to massage from the proximal limb to the distal site for 15 minutes 3 times a day one month post-operatively for 3 to 6 months to further improve lymphatic drainage. Post-Operative Follow-Up The lymphedema of both upper and lower extremities can cause pain, discomfort, fibrosis, cosmetic problems, and mobility restraints for patients. It is common that lymphedema patients develop various degrees of depression due to physical discomfort, disfiguration, and emotional distress. With an average of a 2-year follow up after undergoing microsurgical microsurgery including Side-to-End Lymphovenous anastomosis and vascularized lymph node flap transfer to distal recipient site, the affected limb become softer overtime. 90% of lymphedema patients have seen size improvement with a mean circumferential difference of 50%. With the physical improvement, patients are subjectively pleased to resume daily activities and life styles they used to have. After vascularized submental lymph node flap transfer, you are asked to comply with the rehabilitation program, which includes progressive lower limb muscle strength training and reverse manual proximal (groin) to distal (ankle) lymphatic drainage. You are encouraged to gradually massage the flap, scar, and control body weight control starting after discharge. Reverse manual lymph drainage and flap massage are performed for 15 minutes/time, 3 times daily. You are advised to return to normal activity gradually as tolerated, and all other physiotherapy and compression wrapping are discontinued. Vascularized submental lymph node flap is placed on the wrist in accordance with the “pump” mechanism and effects of gravity. You do not need to wear a compression garment or bandaging after surgery but are allowed to wear a wrist brace or wrist support to hide the scar on the wrist after the wound complete healed. Another revision surgery to remove the skin paddle and superficial fat of the transferred flap to improve the cosmetic appearance and simultaneous liposuction of the thigh to decrease the production of lymph is recommended after 1 year of vascularized submental lymph node flap transfer. 1. Reverse manual lymph drainage: Time: Performed for 15 minutes/time, 3 times a day, from groin to flap. Method: Medium strength massage that compresses the skin, subcutaneous, fat and muscle in proximal (groin) to distal (flap) direction. This helps encourage drainage of the lymph drainage through the lymph flap and appropriate channels. 2. Flap massage: For increasing the venous drainage of lymph node flap pumping Time: Performed for 15 minutes/time, each 3 times daily. Method: Medium strength massage to pump lymph node flap and the scar around flap. 3. Body weight control: Time: Check body weight every day. Lighten your weight if your Body Mass Index(BMI) over 25. 4. Infection/cellulitis prevention and control: Most healthcare-associated infections are preventable through good hand hygiene. It’s important to identify and treat cellulitis early because the condition can spread rapidly throughout your body. Red area or “New red spots” of skin that tends to extend from distal to proximal Swelling Tenderness Pain Fever over 38.5℃ After the initial postoperative period, you are seen on a monthly basis by sending images. You may use any communication apps, such as Line, WhatsApp, Skype, e-mail or WhatsApp. Surgical outcomes are evaluated by your subjective improvement, circumferential measurements, the frequency of cellulitis, and via patient reported health-related quality of life outcome metrics. We will arrange ultrasonography, CT, and lymphoscintigraphy for checking the number of the lymph node on the flap, lymph node function and volume of the arm after one year.

瞭解更多鄭明輝院長首創的淋巴水腫分級評分系統，透過客觀測量和先進的影像技術來分析症狀，能夠精準盤段及確保術後最好的結果。 Cheng Lymphedema Grading Systems Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema Grading Systems Using physical exam findings, history of disease and imaging modalities, several classification schemes have been proposed to stage lymphedema. Perhaps the most widely used is the International Society of Lymphology staging system. But this staging system is based only the clinical symptoms, but no objective measurement or imaging assessment. As our understanding of lymphedema has evolved and technologies improved, other staging systems based on clinical presentation, circumferential measurements, objective measurements, lymphatic imaging or a combination thereof have been proposed. Effective and precise treatment A system adopted by the world At our center, we use the Cheng Lymphedema Grading system based on symptom severity, circumferential difference, and lymphoscintigraphy imaging to determine appropriate treatment, which was published on the Annals of Surgical Oncology, a renowned journal: A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. (Patel KM, Lin CY, Cheng MH.) and book: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015. Cheng Lymphedema Grading Chinese English 上肢淋巴水腫分期（病例） Chinese English 資料來源： Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204. 下肢淋巴水腫分期（病例） Chinese English 資料來源： Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204. Novel Taiwan Lymphoscintigraphy Staging System Dr. Cheng is the author of the Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging which was published in Annals of Surgery (the top Surgery Journal) in July 2018. The Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging, a comprehensive objective assessment tool that analyzes lymphedema symptoms with quantitative measurements and advanced imaging technology, can effectively help physicians evaluate the severity of lymphatic obstructions, determine the accurate diagnosis, select the most appropriate procedures to treat lymphedema, and ultimately ensure the favorable functional outcome and finest quality of life for lymphedema patients. Taiwan Lymphoscintigraphy Staging Chinese English 資料來源： Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Ann Surg. 2018 Sep;268(3):513-525 Partial obstruction Total obstruction Recommended reading journal A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Patel KM, Lin CY, Cheng MH. Ann Surg Oncol. 2015 Jul;22(7):2424-30 https://www.ncbi.nlm.nih.gov/pubmed/25515196 Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Ann Surg. 2018 Sep;268(3):513-525. https://www.ncbi.nlm.nih.gov/pubmed/30004927

深股動脈穿通枝皮瓣(PAP flap) 在乳房重建的運用 一直以來，腹部皮瓣（特別是深下腹動脈穿通枝皮瓣DIEP flap）是自體組織乳房重建的首選；但是有些患者腹部脂肪太少或是腹部經過多次手術（如腹部拉皮、抽脂、或是多次的腹腔手術），在這種情形下，摘取腹部皮瓣變的不可行，便要考慮來自其他部位的皮瓣，包括背部、臀部或大腿。 其中，位在大腿內側的深股動脈穿通枝皮瓣（profunda artery perforator flap; PAP flap）是一個非常好的選擇。深股動脈穿通枝皮瓣第一次在2012年，由美國Robert Allen醫師發表運用在乳房重建，此皮瓣的特點是血管解部位置變異少，脂肪厚度足夠且取皮瓣區的疤痕隱密，容易隱藏，在Allen醫師的案例中，皆成功的完成令人滿意的乳房重建。而目前長庚醫院已使用此皮瓣用在各式的顯微重建手術（包括乳房重建、頭頸部重建、婦科重建等）超過百例，相關研究已在美國整形外科醫學會表發，並獲Plastic and Reconstructive Surgery期刊登載。 深股動脈穿通枝皮瓣在手術時並不會犧牲任何肌肉，幾乎不會有無力的情形發生；而使用穿通枝皮瓣，可以早點下床， 不用住院很久，對於工作量大或運動量大的女性是很重要的一個優點。有人會擔心摘取深股動脈穿通枝皮瓣後的疤痕或對稱性，但我們的觀察與研究顯示，大腿內側的疤痕是很隱密的，並不容易被別人察覺，而不對稱性的情況也並不明顯。 比起深下腹動脈穿通枝皮瓣（DIEP flap），深股動脈穿通枝皮瓣（PAP flap）能摘取的脂肪是比較少的；但是在目前長庚醫院乳房重建中心完成的的乳房重建案例中，深股動脈穿通枝皮瓣仍能達到令患者滿意的重建結果，提供足夠隱密的疤痕，並讓患者保有腿部肌肉的力量；因此我們建議在腹部脂肪不夠的患者仍想考慮自體組織乳房重建時，深股動脈穿通枝皮瓣（PAP flap）不失為一個好的選擇。 深股動脈穿通枝皮瓣( PAP flap)手術示意圖 深股動脈穿通枝皮瓣( PAP flap)實際案例 回到乳房重建中心

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認識安德森的專業醫師團隊： 院長 鄭明輝、主任醫師 杜隆成 和 主任醫師 ​張豫苓，了解更多醫師的專業領域及門診時間 Our Team 院長 鄭明輝 淋巴水腫： 淋巴管靜脈吻合術、顯微淋巴結皮瓣移植 乳房重建： 自體皮瓣重建、義乳重建、自體脂肪移植、對稱性調整、隆乳、縮乳 / 提乳、男性女乳症、乳頭整形、乳頭 / 乳暈重建 ◎ 門診時間：每週二、四、五 下午13:30-16:00 LEARN MORE 主任醫師 杜隆成 顏面、眼部整形： 雙眼皮進化式縫法、內開上眼瞼下垂手術、內開下眼袋整形手術、顏面脂肪移植年輕化手術 美體雕塑： 乳房脂肪移植整形手術、男性女乳症手術、腹部鬆弛整形手術 ◎ 門診時間：每週一 下午14:00-17:00 LEARN MORE 主任醫師 江天恩 顱顏外科、唇顎裂、正顎手術、口腔顎面外科、全口顎骨重建 ◎ 門診時間：每週一 下午13:00-17:00，週五上午9:00-12:00 LEARN MORE

美體除毛療程 Beauty treatments 體毛太多易悶熱、出汗、毛囊炎，經常要刮毛好麻煩!!! 不再毛手毛腳(~別再叫我毛怪~)雷射永久性除毛 幾乎無痛感、免上麻、療程舒適 恢復光滑肌膚一勞永逸，大方舉手露腿不怕尷尬~~ 皮膚光滑不再「毛」躁：除毛5大重點部位 1. 手腳四肢增生的體毛 2. 臉部汗毛與眉雜毛 3. 腋下、胸毛、腹部等體毛 4. 鬍鬚、落腮鬍 5. 比基尼線、私密處、乳暈部位體毛 去除體毛的方式有哪些? 1.雷射除毛 此方式獲得醫學認證，可有效破壞毛囊根部、抑制毛髮生長，省時方便，且可避免傷害皮膚表層。因毛囊有生長週期，在進行雷射時有些毛囊可能正處於休眠期，所以通常雷射需要5~8次 才能除乾淨。 ​ 2.刮毛刀 只能刮除表面毛髮，很快會再長出刺刺的「小黑頭」，且刮毛刀容易傷害到皮膚，可能造成黑色素沉澱和毛囊炎。 ​ 3.除毛膏 雖然可簡單、快速、無痛去除毛髮根部，但化學成分製品會刺激皮膚，容易造成過敏，不適合用在皮膚細緻的部位。 ​ 4.蜜臘除毛 能暫時去除毛髮的根部，平均維持3週時間，無法有效達到永久除毛的效果。 永久性除毛的治療原理 毛囊生長毛髮有一定的週期循環，稱為毛囊生長週期，分為3個階段：生長期、衰退期、和休止期。 雷射除毛是針對處於生長期的毛囊，破壞其毛囊幹細胞，達到抑制毛髮生長的效果。醫學上認定的「永久除毛」，是指以雷射連續進行6~8次的療程，可達到抑制80~90%毛髮生長，經過每次療程後，毛髮生長會變得越來越慢、越細！ 配合毛髮生長週期，原則上建議每3~4週規律的施打一次雷射。過程中會根據每個人體質狀況不同而有所調整。 雷射除毛術前須知 1.不可「拔毛」以免導致黑色素不足，影響效果或引發毛囊炎而無法進行雷射。 2.治療區域1週內避免塗抹刺激性藥品、磨砂膏、去角質霜。 3.皮膚正在過敏發炎或皮膚乾癢粗糙，應暫時避免治療。 4.治療時應於前一天將治療區域毛髮刮乾淨。 5.治療當日應著寬鬆衣物，以減少術後治療部位摩擦。 雷射除毛療程需要除毛幾次? 根據每個人的除毛部位及毛量多寡，治療次數也會有所不同。這又回到上面提到的，毛囊分為成長期、衰退期及休止期3個階段，每次雷射只對當時正在成長期階段的毛髮有作用。 雷射除毛治療一次約可減少 5~10% 生長期的毛髮，由於毛髮有週期性，每次雷射間隔的時間不宜太密集，這樣才能打到不同生長週期的毛囊，發揮較佳的除毛效果。 一般來說，配合醫師評估你的毛髮週期，約每 6~8 週做一次治療，通常雷射治療 6 次以上，毛髮會逐次逐量慢慢減少或變細，最終達到視覺上乾淨的效果，獲得治療者普遍滿意的程度。當然每個人狀況不一，建議以門診現場諮詢評估為準。 什麼樣的情況不適合雷射除毛？ 1.懷孕和哺乳 基於醫學倫理考量，由於尚未有針對孕婦及哺乳媽媽進行雷射除毛的人體實驗，因此不建議懷孕及哺乳期間進行雷射除毛。 ​ 2.正在使用某些藥物 除毛雷射前 6 個月有口服 A 酸，或正在服用光敏感藥物，或是光敏感者，需主動告知醫師，與醫師充分討論自己進行中的療程狀況後，再評估是否可以雷射除毛。 ​ 3.患特定疾病 現存癌症或有癌症病史、患有免疫抑制疾病（例如 AIDS 或 HIV），或使用免疫抑制藥物導致免疫系統受損、因病態或藥物引起的多毛症，建議優先處理病症。 ​ 4.毛髮顏色淺 白色、顏色較淺的毛髮，雷射作用效果可能較差。這也是為什麼在歐美地區，蜜蠟除毛較雷射除毛盛行的原因。 ​ 5.欲雷射部位感染中 雷射區域有任何現症感染，例如：濕疹、牛皮癬、瘡、毛囊發炎、開放性撕裂或擦傷等，不適合進行雷射除毛。 ​ 6.未受控的內分泌失調 例如：患有糖尿病、甲狀腺功能紊亂、多囊卵巢症、賀爾蒙雄性化者。 雷射除毛術後護理事項 1.治療區域1週內避免使用到各式果酸、各式美白類、各式香精類、去角質和酒精類的成分產品。 2.可使用沐浴乳或香皂洗澡，水溫宜稍低。 3.治療後不會有傷口，但偶有輕微泛紅現象，配合使用冰敷和保濕乳液，數小時到數天 內就會消退。 4.治療後患部若有黑頭毛根，約 1 週後脫落。 5.術後需加強保濕和防曬，且1週內避免高溫場所蒸汽浴、三溫暖和泳池。