Reconstruction of a pathologic fracture following osteomyelitis of the mandible using a fibula osteocutaneous flap

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

Reconstruction of a pathologic fracture following osteomyelitis of the mandible using a fibula osteocutaneous flap

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

Squamous cell carcinoma arising from a long-standing epidermoid cyst of the back

Epidermoid cysts are commonly encountered benign lesions in the field of plastic surgery, but their malignant transformation into squamous cell carcinoma (SCC) is extremely rare. A 68-year old woman with a cystic mass on her left lower back presented to our department. We excised the lesion under the suspicion of an epidermoid cyst or metastatic colon cancer based on the patient’s medical history. The skin defect was covered with a split-thickness skin graft, and histopathological evaluation revealed the presence of SCC. Because of the low incidence of SCC arising from an epidermoid cyst, the mechanism of transformation of such cysts to SCC and the prognosis of this condition have not yet been well established. We therefore share the details of this rare case to contribute to the growing base of knowledge about SCC that arises from an epidermoid cyst.

Volumetric changes of the pedicled transverse rectus abdominis musculocutaneous flap and the contralateral native breast during long-term follow-up

BACKGROUND: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies. METHODS: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed. RESULTS: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects. CONCLUSIONS: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.

Risk Factors of Donor Site Seroma Formation and Laboratory Analysis of Seromas after Breast Reconstruction with a Latissimus Dorsi Flap

BACKGROUND: Donor site seroma is the most frequent and troublesome complication of latissimus dorsi (LP) flaps. This study aimed to identify the risk factors of seroma formation after an LD flap and to evaluate the biochemical composition of seromas. METHODS: The medical records of 84 patients who underwent an LD flap from September 2007 to May 2017 were reviewed. Age; body mass index (BMI); the type of breast surgery, reconstruction, and nodal dissection; the usage of fibrin glue; smoking; chemotherapy; and history of diabetes mellitus or hypertension were evaluated. In 11 of the 84 patients, the levels of electrolytes, glucose, proteins, lipids, and inflammatory markers present in seromas were investigated. RESULTS: The overall incidence of seroma was 66.7%. Advanced age (≥45 years) and overweight (BMI ≥23 kg/m²) were significant risk factors for seroma. Patients who underwent an extended LD flap had a higher incidence of seroma than those who underwent a standard LD flap, while those who underwent breast-conserving surgery had a lower incidence of seroma than those who underwent other breast procedures. Lactate dehydrogenase (LDH) levels in seromas on postoperative day 2 demonstrated a positive linear correlation with the duration of drainage, but this relationship did not reach statistical significance. CONCLUSIONS: Advanced age, overweight, wider excision or mastectomy, and use of an extended LD flap were found to be risk factors for seroma formation after breast reconstruction with an LD flap. It may be possible to infer whether a seroma will be long-lasting by measuring LDH levels in the seroma.

An Anthropometric and Three-Dimensional Computed Tomographic Evaluation of Two-Point Fixation of Zygomatic Complex Fractures

BACKGROUND: Maintaining stability and restoring the aesthetic appearance are the fundamental goals when managing zygomatic fractures. We aimed to evaluate the stability and anthropometric outcomes of zygomatic fracture patients who underwent two-point fixation involving the infraorbital rim and zygomaticomaxillary buttress via the transconjunctival and gingivobuccal approaches without any skin incisions. METHODS: We examined 15 zygomatic fracture patients who underwent two-point fixation during a 3-year period. Stability was evaluated using three-dimensional facial bone computed tomography. Superoinferior and anteroposterior displacement of the zygoma was quantified. The aesthetic appearance of the periorbital region was evaluated using indirect anthropometry with standardized clinical photographs. The ratios between the eye fissure height and width, and lower iris coverage ratio were used to evaluate aesthetical changes. The bony displacement and aesthetic ratios were analyzed using Wilcoxon or Friedman tests. The correlation between the preoperative zygoma position and anthropometric values was analyzed. RESULTS: The positions of the zygoma were similar to those on the contralateral side at the long-term follow-up. The preoperative anthropometric measurements on the fractured side differed from those on the contralateral side, although these values were close to the normal values at the long-term follow-up. Furthermore, we noted that the anteroposterior displacement strongly positively correlated with the lower iris coverage rate (Spearman's coefficient= 0.678, P=0.005). CONCLUSIONS: Two-point fixation of zygomatic fractures achieved stable outcomes on long-term follow-up, and also appeared to be reliable in restoring the aesthetic appearance of the periorbital region.