Partial Second Toe Pulp Flap Transfer for the Coverage of Great Toe Hemipulp Flap Donor Site.

The great toe hemipulp flap transfer is a viable reconstructive method for finger pulp defect. However, early functional recovery of the donor foot is essential for returning to daily life activities, and functional and aesthetic restoration of the donor site remains challenging. We present a case in which the great toe hemipulp flap donor site was reconstructed with pedicled partial second toe pulp flap transfer, aiming for early recovery of the donor foot and aesthetically and functionally satisfactory donor-site reconstruction. A 62-year-old man underwent left little finger-pulp crush amputation in Tamai zone 2 and received free great toe hemipulp flap transfer. For the defect following flap harvest, the partial second toe pulp flap was elevated and transferred. The donor site of the partial second toe pulp flap was primarily closed. The postoperative course was uneventful, and the patient started walking on postoperative day 2. Postoperatively, the sensory recovery of the transferred flap was excellent, and the reconstructed great toe was functionally and aesthetically satisfactory. The pedicled partial second toe pulp flap transfer may be a viable alternative for the coverage of great toe hemipulp flap donor site.

Acromioclavicular Joint Cyst Treated with Excision and Anterolateral Thigh Flap Reconstruction.

Acromioclavicular joint (ACJ) cysts are a rare clinical entity that can impair patients' cosmetic appearance as well as activities of daily living. Both nonsurgical and surgical treatments are available, but nonsurgical treatments are often associated with a high recurrence rate. Surgical excision can provide resolution of patients' symptoms, but excision of the cyst as monotherapy is also associated with recurrence. Therefore, various surgical techniques to prevent recurrence have been described, but there is no general consensus regarding the appropriate surgical methods. We describe the case of an 81-year-old man with a recurrent ACJ cyst. The cyst had been excised twice, but it recurred shortly after the excisions. We performed surgical resection and anterolateral thigh (ALT) flap reconstruction. The deteriorated ACJ capsule was repaired with durable fascia lata and the defect after tumor excision was obliterated with an ALT flap harvested from the same donor site as fascia lata. On the 12-month follow-up, the patient had no recurrence of the ACJ cyst. Our case suggests that excision of ACJ cysts as monotherapy is likely to fail, and fascia lata patch for durable ACJ capsule reconstruction can be a viable alternative preventing cyst recurrence.

Surgical Lymphoedema Treatment of Morbihan Disease: A Case Report.

ABSTRACT: Morbihan disease is a rare condition characterized by persistent erythema and solid edema of the upper two thirds of the face, leading to visual impairment and significant esthetic disfigurement. The underlying etiology of the disease remains uncertain, but its correlation with lymphoedema has been conjectured. Definitive treatment options are also lacking, and most current topical, systemic, and surgical interventions provide transient or partial results.In this report, we describe a case of Morbihan disease in a 32-year-old man. He suffered from erythema and swelling over the left periorbital region for 6 years, and was diagnosed with Morbihan disease. As the edema was unresponsive to drug therapy, he was referred to our department. Indocyanine green lymphography was performed, and the diagnosis of facial lymphoedema was confirmed. Manual lymphatic drainage was not effective, so we proceeded with surgical procedures. Lymphaticovenous anastomosis was performed to improve lymphatic drainage, and blepharoplasty was performed to debulk the enlarged tissue of lymphoedema. The visual field improved significantly, and the patient remains free from reexpansion of the lesion during the 1-year follow-up.The surgical approach for lymphoedema treatment can be a viable option for severe Morbihan disease unresponsive to nonsurgical therapies.

Superthin Thoracodorsal Artery Perforator Flap for the Reconstruction of Palmar Burn Contracture.

Treating burn scar contractures is challenging. Although free flap transfer is an effective tool for hand reconstruction, free flaps are often bulky, causing functional disturbance and poor cosmetic appearance. Secondary debulking operations are required, resulting in a prolonged total treatment period and delayed return to daily life and work for the patient. Therefore, 1-stage reconstruction using a thin and pliable flap is ideal. In this report, we present the superthin TDAP flap as an option for the reconstruction of postburn palmar contracture. During TDAP flap elevation, the thoracodorsal artery perforator was identified and traced distally until its penetration into the dermis. Subsequently, the subdermal tissue was removed and a uniformly superthin TDAP flap was elevated. Postoperatively, early functional recovery was achieved with excellent palmar contour and texture. No revision surgery was required and no recurrence of contractures occurred during the 6-month follow-up. This procedure is useful in elevating a superthin TDAP flap and is a feasible option for the reconstruction of working surfaces, such as the palm.

Free lateral supramalleolar flap transfer as a small, thin flap.

Lateral supramalleolar flaps were elevated as free flaps and transferred with microvascular anastomoses in 3 patients. The peroneal vessels were used for the vascular anastomosis. In all patients, the flaps survived completely. The free lateral supramalleolar flap is thinner than the peroneal flap and is as thin as the radial forearm flap. This flap is useful when thin, small flaps are required, and may be a valuable alternative to the radial forearm flap because it necessitates less donor site morbidity.

Heterotopic graft of infant rat brain as an ischemic model for prolonged whole-brain ischemia.

By using a heterotopic brain graft model, we have made histological and electrophysiological studies of the infant rat brain after prolonged ischemia. An infant rat head which had undergone ischemia for more than 90 min, was grafted onto an adult rat by anastomosing the thoracic vessels to the femoral vessels of the host rat. Histological and histochemical studies carried out 10 days after the operation showed that the development of the hippocampus and cerebellum in the grafted brain appeared to be normal. Interneuron growth in the hippocampus and migration of the granule cells in the cerebellum had occurred to a similar extent as in control rats. Extracellular recordings in the hippocampus showed normal characteristics of the postsynaptic potentials including long-term potentiation. This heterotopic graft model would be useful for studying brain function after long periods of ischemia.