Extra-oral fistula caused by a dental implant.

Dental implantation has become an important procedure for both dental treatment and head and neck reconstructive surgery. However, this useful technique sometimes results in peri-implantitis. We describe a rare complication of peri-implantitis in the maxilla which extended to the soft tissue and caused an extra-oral fistula above the alar region. The patient underwent the placement of dental implants in the maxilla 8 years earlier. Radiography showed osteolysis of the maxilla and implant exposure. After the implants were removed, the patient was fitted with a conventional fixed partial denture. Such unfavorable outcomes are caused by failed endodontic and apicoectomy procedures.

Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap.

BACKGROUND: Spinal osteomyelitis and epidural abscess are uncommon but have a potentially disastrous outcome, although the surgical techniques and antimicrobial therapy have advanced. CASE DESCRIPTION: We present a case of cervical osteomyelitis and epidural abscess resulting from pharyngeal squamous cell carcinoma ablation, which were treated with a pectoralis major muscle flap successfully. CONCLUSION: Muscle flap insertion to the cervical contaminated wound enables radical removal of the contaminated tissue, and the muscle flaps for dead-space obliteration and neovasculation were obligatory for successful management of the infected complex wound. Furthermore, the inserted pectoralis major muscle flap can divide vertebrae and epidural canal from these origins of infection. We believe that this technique is simple, can be performed in a one-stage management, has minimal associated morbidity, and thus, is advocated as a desirable treatment option in the treatment of cervical osteomyelitis and epidural abscess.

Complex wounds tend to develop more rapidly in patients receiving hemodialysis because of diabetes mellitus.

The number of patients requiring dialysis because of diabetes mellitus is increasing and such patients often have complex chronic wounds, which are difficult to heal. However, there are few retrospective studies of wounds requiring surgical treatment. We evaluated 14 patients receiving hemodialysis (HD) (8 because of diabetes and 6 because of other diseases) who had extremity wounds and underwent surgical treatment in our unit from 2004 through 2007. We investigated differences in the cause of wounds, and in the interval between the start of HD and wound development. Wounds in patients undergoing HD because of diabetes originated due to ischemia in 2 cases (25%), trauma in 2 cases (25%), and infection in 4 cases (50%). Seven of 8 wounds developed infection with methicillin-resistant Staphylococcus aureus (MRSA). Wounds in patients undergoing HD because of other diseases developed due to ischemia in 2 cases (33%) and trauma in 4 cases (67%). Three of 6 wounds developed infection and MRSA were isolated from 2 wounds. The interval between the start of HD and wound development was significantly shorter in patients with diabetes than in patients without diabetes. All patients with infectious wounds required immediate debridement. We conclude that patients receiving HD because of diabetes are likely to have more severe and rapidly developing wounds due to infections. Thus, they usually require immediate debridement before blood access shunt infection occurs.

Evaluation of Nutrition in the Healing of Pressure Ulcers: Are the EPUAP Nutritional Guidelines Sufficient To Heal Wounds?

 Malnutrition is a significant factor in the development of pressure ulcers and many nutritional guidelines for preventing pressure ulcers have been published. However, few clinical investigations have examined the energy required to heal pressure ulcers. The aim of the present study was to investigate the relationship between nutritional intake and improvement of pressure ulcers. Total calories, which were supplied by mouth through a feeding tube and via venous alimentation were examined for 40 hospitalized bedridden inpatients who had pressure ulcers. Of these patients, 21 whose wounds improved or healed and 19 whose wounds became worse or did not improve were eligible for this retrospective study. Pressure ulcers in patients who received more than 30 kcal/kg per day improved or healed, while those of patients who received less than 20 kcal/kg per day worsened or failed to improve. Furthermore, intake of 30 kcal/kg per day enabled serum albumin levels to improve. Energy intake of 30 kcal/kg per day is comparable to the predicted total energy expenditure and is thought to be essential for improving pressure ulcers in bedridden patients .

Alcaligenes xylosoxidans cholecystitis and meningitis acquired during bathing procedures in a burn unit: a case report.

The information in this article was presented at the 37th Annual Meeting of the Japan Society of Burn, Nagoya, Japan, June 7-8, 2008. Alcaligenes xylosoxidans, a nonfermentative, Gram-negative rod often found in aqueous environments, has been isolated from respirators, incubators, and disinfectant solutions in the hospital environment. It is known to cause disease in immunocompromised (eg, burn) patients and represents a cross-contamination risk related to wound care. In the authors' burn unit, two patients, admitted with deep dermal burns during a 1-month time period, acquired serious A. xylosoxidans infections. The first involved A. xylosoxidans-associated cholecystitis in an adult with 32% total body surface area (TBSA) burns and the second involved A. xylosoxidans meningitis in an adult with 30% TBSA burns. Both patients received hydrotherapy (bathing) in the same bathing tub, one patient after the other. Culture from environmental sources isolated A. xylosoxidans from the bathing mattress. Bacterial analysis of the isolates, including antimicrobial susceptibility testing and pulsed-field gel electrophoresis, suggested the patients had been infected by the same strain - ie, cross-contaminated - probably during treatment of their burns. The isolated strains were resistant not only to broad-spectrum penicillins and cephalosporins, but also to imipenem, to which past A. xylosoxidans strains have been susceptible. These findings underscore the need for strict infection control to prevent cross-contamination and disease outbreak.

Iliopsoas muscle abscess secondary to sacral pressure ulcer treated with computed tomography-guided aspiration and continuous irrigation: a case report.

Iliopsoas abscess is an aggressive infection usually associated with Crohn's disease, spinal tuberculosis, a septic hip joint (including hip replacement), and spinal cord injury. It rarely occurs secondary to sacral pressure ulcer. The infection requires immediate surgical debridement or drainage. The case of a 78-year-old woman with high fever and severe inflammation caused by iliopsoas abscess secondary to a sacral pressure ulcer is reported. The patient was treated with a computed tomography-guided aspiration; Escherichia coli was isolated from the pus of the ulcer and abscess sites. The abscess completely resolved within 2 weeks but another abscess developed. Following surgery and daily cleansing, the drainage tube was removed after 1 week. Once granulation tissue formation was sufficient, the sacral wound was covered with gluteal fasciocutaneous rotation flaps 6 weeks after admission. The wounds closed and the patient made a full recovery within 2 months. Early recognition followed by immediate drainage of pus and appropriate antibiotic therapy are essential to the treatment of these wounds. Experience confirms that computed tomography-guided aspiration is useful and may be less damaging than surgical debridement.

Cavernous nerve graft reconstruction using an autologous nerve guide to restore potency.

OBJECTIVE: To present our experience of cavernous nerve graft reconstruction, using an autologous nerve vein-guide technique, to restore potency. PATIENTS AND METHODS: Prostate cancers frequently require radical resection involving one or both cavernous nerves that usually results in erectile dysfunction; nerve grafting has been used to restore erectile function, but clinical results are unsatisfactory owing to inadequate surgical techniques. In all, eight patients with prostate cancer who required radical resection involving one cavernous nerve had sural nerve grafting, with two or three sutures using the autologous vein-guide technique, in our unit between 2004 and 2005. Because of the difficulty of performing microsurgical manoeuvres deep within the pelvic cavity, the nerve anastomosis might be unsatisfactory. RESULTS: Seven of the eight patients had spontaneous erectile activity after grafting and six of these patients were able to have intercourse. CONCLUSION: Sural nerve grafting using the autologous vein-guide technique is simple, has minimal morbidity, and yields good outcomes.