Successful repair of flayed tissue in a degloving injury of the hand by arteriovenous anastomosis.

We report the case of a 43-year-old man who had a degloving injury of the left hand from a printer machine. There was no response to a pin prick test over the peripheral portion of the degloved skin, so a branch of a digital artery was selected for anastomosis to a subcutaneous vein, which resulted in survival of the degloved tissue with no signs of congestion. Postoperative care and rehabilitation were straightforward, and functional results.were satisfactory.

Perforator-supercharged occipitocervicopectoral flaps for lower face and neck reconstruction.

BACKGROUND: The occipitocervicopectoral flap has a local skin pedicle in the occipital region, with the distal portion of the flap in the pectoral region. One disadvantage of the occipitocervicopectoral flap is its limited flap length. To overcome this disadvantage, a perforator supercharging technique was applied to enlarge the original flap length. The aims of this study are to present a clinical application of the perforator-supercharged occipitocervicopectoral flap for face and neck reconstruction and to discuss a perforator supercharging technique and perforator anatomy. METHODS: All perforator-supercharged occipitocervicopectoral flaps that were used for face and neck reconstructions were analyzed retrospectively. RESULTS: In all nine cases, the second internal mammary artery perforator was attached at the end of the occipitocervicopectoral flap and supercharged with the contralateral recipient facial artery vessels. The average flap size was 22.6 × 6.2 cm, without any flap loss. It was possible to cover a large defect extending to bilateral sides with thin and pliable local skin tissue. All patients were satisfied with functional and aesthetic results achieved postoperatively after 6 months. CONCLUSIONS: The internal mammary artery perforator-supercharged occipitocervicopectoral flap can be considered a type of bipedicle perforator flap and can provide reliable flap vascularity. By using a perforator supercharging technique, we can adjust and enlarge the flap length tailored to the defect. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A false-positive fluorodeoxyglucose positron emission tomography (FDG-PET) imaging result for a patient after augmentation mammaplasty.

BACKGROUND: Various materials and methods have been used for augmentation mammaplasty since it was first performed in Japan in the late 1940s. Although augmentation mammaplasty is not associated with an increased risk of breast cancer, a number of studies have reported that breast implants, or subsequent changes around these foreign substances, can affect images made by mammography, CT, or MRI during breast cancer screening. A method that is increasingly being used to detect cancer is positron emission tomography (PET). METHODS: To determine the effect of augmentation mammaplasty on PET imaging, we subjected ten women who had previously undergone augmentation mammaplasty to PET imaging as well as other imaging methods. We also measured tumor markers and performed pathologic studies. RESULTS: The histologic analyses failed to detect any cases of malignancy. We assess the efficacy of PET for detecting breast cancer in women who had undergone augmentation mammaplasty and describe the features of the PET images of these women. Finally, we discuss future research objectives in relation to PET-based screening for breast cancer. CONCLUSION: It is important to identify an imaging methodology that improves the detection of breast cancer in patients with a previous mammaplasty. We show here that FDG-PET may improve breast cancer detection after mammaplasty.

Experimental analysis of silicone leakage.

We analyzed whether gel bleed, the leakage of silicone gel from breast implants, occurs in the human body. We simulated the phenomenon with olive oil. Silicone breast implants were submerged in olive oil, and the concentration of silicone polymers in the olive oil was measured periodically with nuclear magnetic resonance spectroscopy. We found no increase in the silicone concentration. However, clinical conditions might not be adequately simulated because of the shortness of the experimental period and the lack of external stress. However, when clinical experiences and our data are considered, we think that silicone implant durability is an important factor to prevent leakage or gel bleeding.

Usefulness of the nipple-suspension piercing device after correction of inverted nipples.

The authors have devised a new piercing instrument for postoperative nipple suspension of inverted nipples. The instrument can be used not only postsurgically, but also for nipple suspension in light inverted nipple cases without surgical repair. Details of the device and the method of piercing are described.

Use of a bioabasorbable bone pin fixation for nasal fractures.

After repairing a nasal fracture, it is customary to provide postoperative support for the nasal bone with intranasal, antibiotic-soaked gauze packing and an external splint. However, in cases of a skull base fracture with liquorrhea, this procedure is generally contraindicated because of the risk of infection. To lessen this risk, the authors used a bioabsorbable pin which is ultimately absorbed by the body through the natural process of hydrolysis. An intranasal support was inserted from outside the skin down to the maxilla. The operative results were satisfactory with no postoperative complications such as an inflammatory reaction or an infection.

An anatomical study and clinical cases of 'super-thin flaps' with transverse cervical perforator.

We present a microangiogram study and clinical cases of super-thin flaps based on a transverse cervical perforator. This flap is the first to use the perforator of the superficial branch of the transverse cervical artery. This flap is more useful for providing colour and texture matches than a skin graft, and it is easier to harvest the flap than a free flap because it is a kind of skin flap.

Extramammary Paget's disease of the vulva subclinically extending to the bladder neck: correct staging obtained with endoscopic urethral biopsy.

We report a 65-year-old woman with extramammary Paget's disease which recurred on the skin flap. We performed a mapping-biopsy of the urethra by ureteroscopy to select the appropriate treatment. This method is presumed to be useful for determining the margin, deciding the correct staging for extramammary Paget's disease and for making a judgement on appropriate therapy.

A case of systemic sclerosis with abdominal surgery for stenosis of the terminal ileum.

A 71-year-old woman was admitted to our hospital with prominent abdominal distention. The diagnosis of systemic sclerosis (SSc) was made based on the sclerosis on her face, forearms, fingers, and toes as well as pitting ulcers on fingers and toes. After conservative therapy, she presented more severe signs of peritoneal irritation. Abdominal surgery was performed, revealing stenosis at the terminal ileum. Pathologically, this region showed muscularis propria becoming fibrotic. She was discharged from the hospital, returning about once a month as an outpatient.