Lateral nasal advancement flap for reconstruction of the nasal sidewall and dorsum

Malignant skin tumors and precancerous lesions have a predilection to be located in the nasal dorsum or sidewall. Although invasive reconstructions have been presented, no simple and suitable method has yet been reported for this area. The flap presented herein, named the lateral nasal advancement flap, is designed on the adjacent lateral region of the sidewall or nasal dorsum and advanced in the medial direction. Two Burow’s triangles are removed in the upper and lower portions of the flap: the upper triangle along the nasofacial sulcus and the lower triangle along the nasofacial sulcus and/or the alar groove. Excellent results were obtained in the two clinical cases described in this report. Neither a trap door deformity nor dog-ears developed in either case. The postsurgical scars followed the aesthetic lines and became inconspicuous. A distinct angle was formed in the nasofacial sulcus without anchor sutures. This surgical procedure is technically simple and is performed under local anesthesia. Although the flap is a cheek-based advancement flap, postsurgical scars do not remain in the cheek; instead, they are located in the nasofacial sulcus and alar groove. The lateral nasal advancement flap is recommended for reconstruction of the nasal sidewall and dorsum.

Surgical Treatment of Infective Endocarditis / 日本心臓血管外科学会雑誌

In the past 9 years, 37 patients with infective endocarditis underwent valve replacement. The aortic valve was involved in 17 patients, the mitral valve in 10, and both valves in 10, respectively. 35 patients had native valve and 2 had prosthetic valve endocarditis. Bacterial findings were <i>Streptococcus</i> in 20 patients (54%), <i>Staphylococcus</i> in 5 (13.5%), gram-negative in 3 (8%), and undetected in 10 (27%). 10 patients developed aortic annular abscess. After aggressive debridement of all apparently infected tissue of annular abscess, the defects left in the left ventricular outflow tract were repaired by interrupted mattress sutures with pledgets in 4 patients, by autologous pericardial patch in 4, and by valved conduit in 2 PVE patients, respectively. Retrograde cardioplegic infusion from the coronary sinus not only facilitated operative manipulation but also provided superior myocardial protection in such patients. Operative mortality was 11% (4/37). Reoperation was necessary in 2 patients; one for periprosthetic leak, and the other for newly developed severe left coronary ostial stenosis after the first operation, but both died eventually. Late mortality was 8% (3/37). Mean follow-up of 31 months was achieved in all 30 survivors, in whom there was no recurrence of infection and clinical improvement was excellent.