Combined Subbrow Excision with Upper Blepharoplasty Using a Tadpole Shaped Excision for Blepharochalasis

BACKGROUND: In efforts to solve blepharochalasis, induced by aging process, various surgical methods have been developed over the years. Among them, classical upper blepharoplasty has a problem that severe lateral hooding may be restricted in making correction, cause of difference in thickness between the pretarsal skin and subbrow skin. And also subbrow excision (SE) blepharoplasty cannot be easily corrected in severe drooping of the medial skin. In an effort to make up for the disadvantages of these methods, we attempted SE-tadpole shaped excision blepharoplasty (TSEB). METHODS: Fifteen patients underwent SE-TSEB from January 2013 to November 2014. SE-TSEB was performed the following cases: 1) patients who showed moderate to severe blepharochasis with severe lateral wrinkles; 2) patients with a history of pre-existent SE blepharoplasty; 3) patients with a tattoo on the eyebrows, who want to make revision; and 4) patients with eyelid skins that are thick or have overly protuberant fat pads of the retro-orbicularis oculi fat (ROOF), and have a plan to extirpate them. RESULTS: During the follow-up observation period, most patients showed amicable correction of visibility difficulty and were aesthetically satisfied with the postoperative results with respect to correction of the lateral wrinkles. Scars formed in the subbrow incision line were within the scope of management. CONCLUSIONS: SE-TSEB is a treatment modality that overcomes the disadvantages and limitations of classical upper blepharoplasty and SE blepharoplasty. Furthermore, maximizing the advantage of each surgical approach is another innovative approach for correction of changes in the upper eyelid, induced by aging.

Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site

In this article, we present two cases of femoral pseudoaneurysm (PA) at the femoral arterial puncture site followed by necrotizing fasciitis, which is rare but can be fatal when not managed appropriately. PA was revealed by lower-extremity angiography and color-flow Doppler ultrasonography. Hematoma removal, thrombolysis, and bleeder ligation with Gelfoam were repeatedly performed by a vascular surgeon. When necrotizing fasciitis developed, aggressive surgical drainage and creation of a viable wound bed for reconstruction were mandatory. We adopted a vacuum-assisted closure device (Kinetics Concepts International) as the standard treatment for complicated, serious, infected PA of the puncture site. Excellent clinical outcomes were obtained.

Bipartite os Centrale Carpi in a Patient with the First Metacarpal Bone Fracture

No abstract available.

Effects of Minimizing Scar Formation by Early Fractional CO2 Laser Resurfacing

BACKGROUND: Much of the theory regarding the treatment of surgical scars advocates a wait-and-see approach. The use of lasers prophylactically against scarring in the early postoperative period is relatively new. We introduced lasers during the early treatment of scars. METHODS: We present results using the Vancouver Scar Scale (VSS) Score and discuss the efficacy and safety of our approach. Fractional CO2 lasers (Line-Xel) were used 4 weeks after injury, which is the early remodeling phase, at 4-week intervals. Five treatments were performed. VSS scores were counted before treatment and 5 months after final treatment. RESULTS: Each VSS score showed great improvement over time and finally achieved near-normal skin values. No adverse effects or complications, such as wound disruption, postinflammatory hyperpigmentation, or dyspigmentation, occurred in the present study. CONCLUSIONS: This study shows that the use of early fractional CO2 lasers 4 weeks after surgery or trauma is an effective and safe method to minimize scar formation.