David T. Chiu, M.D.

Autogenic heterotopic vascularized proximal interphalangeal joint transplantation in children
Chiu, David T W; Lee, Jonathan
2011 Mar;31(3):198-204, Microsurgery
The proximal interphalangeal joint (PIP) joint is the most crucial joint for the functionality of a finger. For a child with complex injury of the hand every effort should be exercised to maximize function restoration. If the PIP joint is irreparably damaged, its reconstruction is indicated. The technique of autogenic heterotopic vascularized toe joint transplantation provides unique advantage of a composite transfer of skin, tendons, bone and joint alone with growth plate and its efficacy has been affirmed in children. It has been suggested that such transfers require intact flexor tendon to achieve satisfactory results, our experience however indicates quite the contrary. As evidenced by this report of a 7-year-old boy with abrasion and avulsion injury to his dominant right hand resulting in a complex defect with skin lose, extensor, flexor avulsion along with cominution of the PIP joint of his long finger. A surgical formulation of staged reconstruction scheme including an autogenic heterotopic vascularized toe joint transplantation led to complete functional restoration to his right hand. (c) 2011 Wiley-Liss, Inc. Microsurgery 2011
— id: 127237, year: 2011, vol: 31, page: 198, stat: Journal Article,

The second world congress for plastic surgeons of chinese descent
Pu, Lee L Q; Chiu, David T W; Wei, Fu-Chan
2011 Jul;128(1):315-318, Plastic & reconstructive surgery
— id: 134730, year: 2011, vol: 128, page: 315, stat: Journal Article,

Nerve grafts and conduits
Colen, Kari L; Choi, Mihye; Chiu, David T W
2009 Dec;124(6 Suppl):e386-e394, Plastic & reconstructive surgery
Peripheral nerve defects are common. The surgeon faced with these problems must provide the best functional recovery for the patient with the tools provided. The ideal nerve reconstruction would create a tensionless repair with direct coaptation. However, this is not always possible and other techniques must be employed. The alternatives to direct coaptation include nerve autografts, nerve conduits, and tissue-engineered constructs. This article reviews commonly used autogenous nerve grafts and conduits. Autogenous nerve grafts have been utilized in various techniques which include the trunk graft, cable graft, interfascicular graft, and vascularized graft. The nerve conduits reviewed fall into the category of autogenous biological conduits, nonautogenous biological conduits, and nonbiological conduits. New technologies are being developed to enhance peripheral nerve regeneration with the concept that conduits can be enriched and manipulated in the laboratory to promote regeneration of the peripheral nerve. Further clinical studies hold the promise of successful alternatives for treating peripheral nerve injuries
— id: 106201, year: 2009, vol: 124, page: e386, stat: Journal Article,

Vascular malformations and upper extremity anomalies associated with a subtelomeric microdeletion of chromosome 4p
Khonsari, Roman Hossein; Blechman, Keith M; Michaels, Joe; Vigler, Mordechai; Chiu, David T W; Wallerstein, Robert; Blei, Francine
2008 Jul;17(3):193-194, Clinical dysmorphology
— id: 95162, year: 2008, vol: 17, page: 193, stat: Journal Article,

Activation and retrograde transport of protein kinase G in rat nociceptive neurons after nerve injury and inflammation
Sung, YJ; Chiu, DTW; Ambron, RT
2006 JUL 31 ;141(2):697-709, Neuroscience
Nerve injury elicits both universal and limited responses. Among the former is regenerative growth, which occurs in most peripheral neurons, and among the latter is the long-term hyperexcitability that appears selectively in nociceptive sensory neurons. Since positive injury signals communicate information from the site of an injury to the cell body, we hypothesize that a nerve injury activates both universal and limited positive injury signals. Studies in Aplysia indicate that protein kinase G is a limited signal that is responsible for the induction of long-term hyperexcitability. Given that long-term hyperexcitability contributes to chronic pain after axotomy in rodent neuropathic pain models, we investigated its underlying basis in the rat peripheral nervous system. Using biochemical assays, Western blots, and immunocytochernistry we found that the Type I a protein kinase G is the predominant isoform in the rat periphery. It is present primarily in axons and cell bodies of nociceptive neurons, including populations that are isolectin 134-positive, isolectin 134-negative, and those that express transient receptor potential vanilloid receptor-1. Surprisingly, protein kinase G is not present in the facial nerve, which overwhelmingly contains axons of motor neurons. Crushing the sciatic nerve or a cutaneous sensory nerve activates protein kinase G in axons and results in its retrograde transport to the neuronal somata in the DRG. Preventing the activation of protein kinase G by injecting Rp-8-pC
— id: 67553, year: 2006, vol: 141, page: 697, stat: Journal Article,

Toe-to-hand transfer from a cross-foot replantation in a traumatic four-extremity amputation - Invited discussion
Upton, J; Chiu, D
2005 OCT ;21(7):459-462, Journal of reconstructive microsurgery
— id: 58644, year: 2005, vol: 21, page: 459, stat: Journal Article,

Neurotropism revisited
Chiu, David T W; Smahel, Jiri; Chen, Lilly; Meyer, Viktor
2004 Jul;26(4):381-387, Neurological research
The purpose of this study is to re-examine the probable directive effect of the distal stump of a severed peripheral nerve on regenerating axons. Forssman postulated the existence of such a directive influence and Cajal interpreted it as chemotactic in nature. This view was subsequently refuted by Weiss and Taylor. In our study the proximal stumps of transected rodent sciatic nerve were inserted into the single inlet end of a Y-shaped autogenous inferior vena cava graft. Into one limb of the double outlet end, namely the common iliac nerve bifurcation, the distal stump of the same sciatic nerve was inserted, while the counter limb was ligated in one group, left open in the second group, inserted with a segment of autogenous tendon in the third, and grafted with a segment of autogenous nerve in the fourth group. Both outlets were left unoccupied in yet another group as the control. The vena cava conduit was prepared so that a 1.5 cm gap existed between the proximal stumps of the sciatic nerve and the distal sciatic nerve stumps and the tendon grafts respectively. The grafted sciatic nerves were explored and biopsied after 12 weeks. The direction of nerve tissue regeneration in each group was analyzed histologically. Predilection of the regenerating nerve fibers toward the distal stumps was observed in each of the test groups. These results indicate the existence of a guiding influence at the distal stump toward the regeneration nerve fibers
— id: 46044, year: 2004, vol: 26, page: 381, stat: Journal Article,

Histologic analysis of Schwann cell migration and peripheral nerve regeneration in the autogenous venous nerve conduit (AVNC)
Tseng, CY; Hu, GL; Ambron, RT; Chiu, DTW
2003 JUL ;19(5):331-339, Journal of reconstructive microsurgery
Over the last two decades, the autogenous venous nerve conduit (AVNC) has been established as an effective treatment modality for the repair of nerve gaps less than 3 cm. In this study, the spatial-temporal progression of Schwann-cell migration and peripheral-nerve regeneration across a 10-mm gap bridged by a venous conduit was examined, using immunoctyochemical techniques. Histologic analysis revealed that the process of nerve regeneration through an AVNC occurs in four phases: the hematoma phase, cellular migration phase, axonal advancement phase, and myelination and maturation phase. The authors found that: 1) the lumen of the vein conduit remains patent through-out the process of nerve regeneration; 2) Schwann cells migrate into the vital space of the vessel lumen from the proximal and distal nerve stumps; 3) axonal growth into the conduit lags behind Schwann-cell migration; 4) Schwann cells migrate to the regenerating axons to form mature nodes of Ranvier when the distal stump is present; and 5) mechanical injury alone is sufficient to induce axonal outgrowth from the proximal nerve stump
— id: 38537, year: 2003, vol: 19, page: 331, stat: Journal Article,

Cranial reossification with absorbable plates
Ascherman J; Knowles S; Marin V; Prisant N; Hu G; Chiu DT
2001 Mar;107(3):763-768, Plastic & reconstructive surgery
The purpose of this study was to examine the effect of Lactosorb absorbable plates on bone healing across cranial bone defects in the rabbit skull. Two 10-mm diameter parietal skull defects were created in each of 20 rabbits, with one defect being placed on either side of the sagittal suture. In 10 rabbits, an absorbable plate was placed across both the inner and outer cortices of the left defect, and in the other 10 rabbits, an absorbable plate was placed across the outer cortex only of the left defect. The right defect always served as the control side, with no plate being placed across it. Rabbits were killed an average of 25 weeks postoperatively. Areas of reossification in the experimental and control defects of each rabbit were then measured, examined histologically, and compared. Growth across defects spanned by one plate was also compared with growth across defects spanned by two plates. Histologic and statistical analyses revealed no significant differences in reossification between the control and experimental defects in each animal and between the defects spanned by one versus two plates. This study suggests that these copolymer absorbable plates neither inhibit nor facilitate reossification across 10-mm diameter rabbit cranial defects
— id: 30795, year: 2001, vol: 107, page: 763, stat: Journal Article,

Treatment of painful neuromas: a case report
Chiu DT; Wu J
2000 Mar;44(3):340-342, Annals of plastic surgery
The authors report a 15-year history of management of multiple recurrent neuromas in a patient with an amputated arm. Various surgical modalities were employed, including burying the nerve ends in muscle and bone. In addition, they also treated successfully one of the neuromas in this patient by capping the transected nerve with an extended autologous vein graft. This application of the extended autologous venous nerve conduit may be a novel alternative in the treatment of this challenging problem
— id: 30796, year: 2000, vol: 44, page: 340, stat: Journal Article,

Painful neuromas: a review of treatment modalities
Wu J; Chiu DT
1999 Dec;43(6):661-667, Annals of plastic surgery
There are numerous methods cited in the literature on the treatment of painful neuroma. Nonsurgical methods range from injections with various materials into the nerve end to desensitization of nerve pain conduction pathways. Some surgical treatments aim to alter the environment of the amputated nerve end by transposing it into muscle or bone, others have designed various flaps to protect truncated nerve ends from scar tissue, and still others try to 'cap' the nerve with silicon, a nerve graft, or epineurium to prevent nerve regeneration. All of these methods have proved efficient. However, none of these methods work universally. The authors review the common treatments for painful neuromas. In addition, they review the preliminary results of the extended autologous venous nerve conduit as a novel technique of treating painful neuromas. They also report recent investigations into the pathophysiology of injured nerves
— id: 30797, year: 1999, vol: 43, page: 661, stat: Journal Article,

Effect of optical temperature feedback control on patency in laser-soldered microvascular anastomosis
Pohl D; Bass LS; Stewart R; Chiu DT
1998 Jan;14(1):23-29, Journal of reconstructive microsurgery
Feedback control has been postulated to improve the efficacy of laser welding in microsurgery, but alteration of outcome has not been clearly shown. The authors evaluated the ability of an optical closed loop temperature feedback control to improve patency, aneurysm rate, and to histologically limit thermal damage. Rat femoral artery anastomoses were performed under operating microscope magnification. One hundred and twenty-four anastomoses were performed in five groups using 1) free-hand (FH) 1.9-microm laser soldering without feedback; 2) temperature controlled (TC) 1.9-microm laser soldering with optical feedback; 3) FH 808 nm laser; 4) TC 808 nm laser soldering; and 5) 10-0 nylon suture control. In Groups 2 and 4, an optical feedback system controlling laser exposure to produce a preset temperature was used. Anastomotic time was significantly less for all laser groups (p < 0.05). Late patency for all 1.9-microm laser anastomoses was almost 0. Temperature controlled 808-nm anastomoses showed no significant difference from sutures in terms of patency (88 percent vs. 96 percent), bursting pressure, and aneurysm rate, while freehand 808-nm anastomoses had a significantly lower patency (71 percent) and more tissue damage (ANOVA, p < 0.05). The authors conclude that temperature control improves outcome in microvascular anastomosis by reducing transmural thermal injury caused by variations in surgeon technique
— id: 66231, year: 1998, vol: 14, page: 23, stat: Journal Article,

The posterior intermuscular approach to the vessels of the leg
Abouzahr MK; Chiu DT
1995 Jun;95(7):1280-1287, Plastic & reconstructive surgery
The posterior intermuscular approach emphasizes preservation of the soleus muscle by an intermuscular surgical approach to the vessels of the leg. The dissection proceeds from a normal zone proximally toward the zone of injury and facilitates selection of the site of microanastomosis. The neurovascular supply of the soleus is guarded, and its numerous venous channels are avoided. The indications and surgical planning are discussed. Two illustrative cases are presented
— id: 17848, year: 1995, vol: 95, page: 1280, stat: Journal Article,

Carpal tunnel release using limited direct vision
Abouzahr MK; Patsis MC; Chiu DT
1995 Mar;95(3):534-538, Plastic & reconstructive surgery
A novel method to release the carpal tunnel is presented. It combines the advantages of endoscopic and open techniques while utilizing standard instruments. A lighted Killian nasal speculum is introduced between the palmar fascia and the transverse carpal ligament. The ligament is incised under direct vision. The procedure was performed in 28 cadaver hands and followed by inspection utilizing the open method through an interthenar incision. The transverse carpal ligament was completely divided in all hands without nerve or tendon injury. The superficial palmar arch was injured in one hand (3.6 percent). The advantages, disadvantages, pitfalls, and results are discussed. The technique is simple and effective, employs inexpensive instruments, and has a low complication rate
— id: 17849, year: 1995, vol: 95, page: 534, stat: Journal Article,

Coverage of traumatic chest-wall defect using a fasciocutaneous forearm flap: case report
Chiu, D T; Barone, C M
1992 Mar;8(2):143-145, Journal of reconstructive microsurgery
Complete, stable chest-wall reconstruction was accomplished in a single operative procedure, using a fasciocutaneous free forearm flap based on the brachial artery. This allowed coverage of an extensive chest-wall defect
— id: 134796, year: 1992, vol: 8, page: 143, stat: Journal Article,

A comparative electrophysiological study on neurotisation in rats
Chiu DT; Chen L; Spielholtz N; Beasley RW
1991 Dec;16(5):505-510, Journal of hand surgery (British volume)
A comparative experimental study has been carried out in rats with denervated gastrocnemius muscles. Three groups of five rats were treated by three different types of implantation of nerve directly into muscle (neurotisation). In the fourth group, the common peroneal nerve was sutured to the transected tibial nerve. The fifth group was left denervated as a control. The muscles were studied by serial electrodiagnostic studies and later histologically. The results showed little difference between nerve suture and implantation of nerve directly into muscle. Extension of the common peroneal nerve with a pair of sural nerve grafts did not produce a detrimental effect
— id: 13824, year: 1991, vol: 16, page: 505, stat: Journal Article,

RAT EAR REATTACHMENT AS AN ANIMAL-MODEL
Chiu, DTW; Chen, L; Chen, ZW
1990 May;85(5):782-788, Plastic & reconstructive surgery
— id: 31878, year: 1990, vol: 85, page: 782, stat: Journal Article,

EFFECTS OF NEURITE-PROMOTING FACTORS ON RAT SCIATIC-NERVE REGENERATION
KHOURI, RK; CHIU, DTW; FEINBERG, J; TARK, KC; HARPER, A; SPIELHOLZ, N
1989 SEP ;10(3):206-209, Microsurgery
— id: 41872, year: 1989, vol: 10, page: 206, stat: Journal Article,

NERVE REGENERATION THROUGH AN AUTOLOGOUS VENOUS NERVE-CONDUIT - THE EFFECTS OF CONDUIT DIAMETER AND NEURITE PROMOTING FACTORS ON MOTOR ACTION-POTENTIALS
Feinberg, JH; Khouri, RK; Spielholz, N; Harper, A; Chiu, DTW
1988 Sep;69(9):704-705, Archives of physical medicine & rehabilitation
— id: 31439, year: 1988, vol: 69, page: 704, stat: Journal Article,

BONE AND JOINT SURGERY - LOOKING AHEAD
CHIU, DTW; EDGERTON, BW
1986 APR ;13(2):281-287, Clinics in plastic surgery
— id: 41601, year: 1986, vol: 13, page: 281, stat: Journal Article,

MANAGEMENT OF PERIPHERAL-NERVE INJURIES
CHIU, DTW; ISHII, C
1986 JUL ;17(3):365-373, Orthopedic clinics of North America
— id: 41570, year: 1986, vol: 17, page: 365, stat: Journal Article,

Introduction to microsurgery : a microvascular and microneurological laboratory manual
Ballantyne, Donald L.; Chiu, David T. W.; Razaboni, Rosa Maria.; Harper, Alice D.; Chen, Lilly.; Pollick, Joel
Baltimore : University Park Press, c1985,
— id: 33, year: 1985, vol: , page: , stat: ,

The place of internal skeletal fixation in surgery of the hand
Meyer, V E; Chiu, D T; Beasley, R W
1981 Jan;8(1):51-64, Clinics in plastic surgery
— id: 115265, year: 1981, vol: 8, page: 51, stat: Journal Article,