Relationship between pharyngeal or esophageal reconstruction and esophageal pressure after swallowing.

BACKGROUND: High-resolution manometry, which measures esophageal luminal pressure changes after swallowing, could shed more light on food-transport dynamics after pharyngeal/esophageal reconstruction. This prospective cohort study assessed the influence of two head-and-neck and esophageal tumor-resection and reconstruction approaches on esophageal pressure. METHODS: The cohort consisted of 17 patients who underwent esophageal/pharyngeal resection/reconstruction for cancer and then participated in postoperative high-resolution manometry. Five healthy controls also underwent manometry for comparison. RESULTS: Partial pharyngectomy with patch grafts associated with smooth and continuous esophageal/pharyngeal movement. By contrast, surgery that removed the thoracic esophagus led to complete loss of peristalsis and poor food transport. CONCLUSIONS: High-resolution manometry effectively characterized the changes in food-transport dynamics caused by pharyngeal/esophageal resection/reconstruction. These findings suggest that continuous and smooth movement of the pharynx and esophagus is important for swallowing and high resolution manometry could be useful in patients after pharyngeal/esophageal resection/reconstruction.

Applying the Microvascular Anastomotic Coupler Device to End-to-side Venous Anastomosis in Reconstructive Surgery.

BACKGROUND: Microsurgical vascular anastomosis plays an important role in successful free-tissue transfer. The Microvascular Anastomotic Coupler Device (MACD) aims to simplify anastomosis and decrease the time spent on this step, thereby reducing surgeon stress and improving the overall quality of the surgery, especially when venous end-to-side anastomosis is required. Our comparative retrospective cohort study aimed to determine the effect of this widely used device on anastomosis times and complications in head and neck/esophageal reconstruction cases involving venous end-to-side anastomosis using the internal jugular vein as the recipient vessel. METHODS: All consecutive patients who underwent head and neck/esophageal reconstruction with hand-sewn or MACD-mediated venous end-to-side anastomosis using the internal jugular vein by three experienced microsurgeons in our tertiary-care hospital in 2012-2020 were identified. Venous anastomosis times and venous trouble cases were recorded. RESULTS: Of the 191 cases, 44 and 147 underwent hand-sewn and MACD-mediated anastomosis respectively. The average venous anastomosis times of these groups were 31 and 11 minutes, respectively. Venous trouble was observed in two hand-sewn (4.5%) and four MACD (2.7%) cases, respectively. Vein twisting and improper coupler placement were the causes in the latter four cases. CONCLUSIONS: This study confirmed that MACD simplifies end-to-side venous anastomosis and reduces the time spent on this procedure. Also, for safer anastomosis, it is necessary to pay attention to preventing twisting and improper coupler placement when using MACD. We believe the MACD can improve the quality of reconstructive surgery.

A Case of Erythema Elevatum Diutinum (EED) Exhibiting A Keloid-Like Appearance.

INTRODUCTION: Most severe-appearing keloids tend to occur around joints because of the increased extensional stimulation of the scar in those areas. However, erythema elevatum diutinum (EED) appears more commonly on friction sites including extensor surfaces of the extremities and dorsal surfaces of joints. EEDs also presents as red-brown and elevated lesions. CASE PRESENTATION: In this report, we describe a 42-year-old female who presented with firm, sporadic, brown-colored raised nodules on her bilateral lower extremities. As the appearance of these nodules resembled keloids, resection of the affected area with subsequent radiation therapy was initiated. However, histopathologic examination performed after treatment revealed tuberous lesions in the dermis, increased wired collagen fibers, neutrophilic infiltrate with nuclear dust, and edematous endothelial cells in the small vessels. Consequently, the patient was later diagnosed with EED. Post-surgery, no recurrence or abnormal scars appeared. DISCUSSION: Whereas clinical findings of EED are similar to that of keloids, the mechanisms of the two conditions differ considerably, leading to varying management strategies. EEDs can be misdiagnosed as keloids on several grounds; they can both appear morphologically similar, exhibit as stiff lesions, demonstrate chronic inflammation of the reticular dermis, and appear anywhere on the body. The only definitive method of differentiating between the two is through histopathologic examination. CONCLUSION: EED should be considered as one of the differential diagnoses for any patients presenting with keloid-like lesions on friction sites and biopsy should be performed prior to resection and radiotherapy.

Optic Canal Decompression with a Lateral Approach for Optic Nerve Injury Associated with Traumatic Optic Canal Fracture.

Optic canal fracture (OCF) is a traumatic injury that requires urgent intervention because it can induce optic nerve damage and visual impairment. Despite the severity of OCF, a standard treatment method has not been established. In this article, we report a case of OCF and traumatic optic nerve injury in which visual acuity was recovered by releasing the optic canal using an unconventional lateral approach. A 43-year-old man presented with right lateral ethmoid fracture, right orbit blowout fracture, and OCF. The visual acuity was "hand motion" before surgery. Decompression was performed 10 hours after injury by approaching the right optic canal laterally from a coronal incision in front of the right ear, cutting along the border of the sphenoid bone, and scraping away some of the sphenoid wing and zygomatic bone. Steroid pulse therapy was added. Eventually, the visual acuity improved to 0.2 and the intraocular pressure decreased to 16.0 mm Hg. Compared with conventional methods, this method associates with better safety because (1) it causes relatively little bleeding and cerebrospinal fluid leak; (2) once the sphenozygomatic suture is identified, the distance to the optic canal is relatively short; and (3) if the fracture point is on the outer optic canal, the fracture line can be observed directly. Steroid pulse therapy may also have contributed to the good visual outcome. This is the first report of a novel lateral approach to OCF that is safe, effective, and only requires plastic surgery skills.

Distensibility and Gross Elasticity of the Skin at Various Body Sites and Association with Pathological Scarring: A Case Study.

Objective: Pathological scars, including hypertrophic scars and keloids, have a strong predilection for specific regions of the body. Such site specificity might reflect regional differences in skin properties. Greater knowledge about the characteristics of the skin at various body regions can promote the development of clinical approaches to skin incision and flap design and reduce the formation of cutaneous scars. It could also help elucidate the etiology of pathological scar development and progression. Thus, we measured the distensibility and gross elasticity of the skin at various body sites. Methods: Five healthy adult volunteers were enrolled. In each, the cutaneous viscoelasticity at 16 sites (forehead, superior eyelid, lower jaw, earlobe, deltoid, outside and medial side of the upper arm, palm, scapular region, anterior chest, upper abdomen, lateral abdomen, lower abdomen, lateral thigh, anterior lower leg, and planta) was examined using a Cutometer MPA 580® (Courage Khazaka electronic GmbH, Cologne, Germany). Results: The skin was particularly distensible at the medial side of the upper arm, followed by the earlobe, lower jaw, upper abdomen, lateral abdomen, lower abdomen, and superior eyelid. It was poorly distensible at the planta, followed by the anterior lower leg, palm, and forehead. The skin was poorly elastic at the earlobe, superior eyelid, planta, and palm and highly elastic at the lateral and upper abdomen, scapular region, and deltoid. Conclusions: Except for the earlobe, all regions with poorly distensible and hard skin are not prone to pathological scarring. This association between these skin properties and abnormal scarring could be useful for skin surgeons.