Clinical results of OK-432 injection therapy for ganglions.

We performed a study of intralesional OK-432 injection therapy for the non-surgical treatment of ganglions. OK-432 is an agent made from penicillin-killed and lyophilized preparations of a low-virulence strain of group A streptococcus pyogenes, which has been developed as an immune-augmentation agent for cancer therapy. Derived from an extract of bacterial culture it, induces an immunological response and causes local inflammation and subsequent tissue shrinkage following intralesional injection. After skin anesthesia and aspiration of the ganglion contents, OK-432 was injected into the ganglion cavity. When the ganglion recurred, this procedure was repeated usually up to a total of three times. Clinical evaluations six months after the last injection were: 56.6% complete cure, 35.3% incomplete cure with size reduced, 7.5% no change. Complications were as follows. There were no cases of shock. High fever was seen in five patients (9.4%); two patients suffered a high fever up to 39.0 degrees C for one day, and the others had fevers from 1 to 3 days. Thirty-two patients (60.4%) complained of local swelling that persisted for 1 to 7 days, and 11 (20.8%) complained of continuous pain for 1 to 3 days. Intralesional OK-432 injection therapy is thought to be a safe and convenient alternative to surgical treatment.

Treatment of saddle type nasal fracture using Kirschner wire fixation of nasal septum.

For nasal fracture presenting saddle nose deformity, the nasal septum was fixed with the frontal process of the maxillary bone by Kirschner wire. Good results were confirmed with computed tomography, and there was no secondary deformity. This method is easy and provided a firm support for nasal septum. By burying Kirschner wire under the skin, it can be left intact for sufficient time, without disruption of daily life.

Superiority of water application to water sealing in burn wound healing.

BACKGROUND: Recently there have appeared on the market many external dressings for wound management. They all use water-sealing materials to maintain wounds in a moist state. However, in our daily clinical observations, a water-sealing material sometimes results in poor wound healing. Although a water-sealing material does in fact keep the wound moist, the quality of the water is far from that of the optimum extracellular fluid. METHODS: A second-degree burn wound was made in the rat by contact with a metal stick. Experiment 1 was to evaluate the influence of delayed primary wound treatment on burn-wound depth progression. We used a time lag procedure. Each group was treated with a water-sealing application (hydrocolloid sheet). Experiment 2 was to investigate the progression-preventing effect of normal saline on a burn allowed to dry for 3 hours, we compared a group that received a water sealing (non-moistening and incomplete moisture) dressing with one that received a water-supplying (moistening) dressing with using chi-square test. RESULTS: In the Experiment 1 (time lag and water sealing test), the early group showed quite normal wound healing at 7 days after onset. The slough was thin (about 10-20% of full dermal thickness). The delayed groups showed the poor healing characteristic. The slough was relatively thick (about 30-60% of full dermal thickness). Three hours' delay seemed to bring about poor healing. In the Experiment 2 (water application test), the moistening (water application) group showed relatively good healing after seven days. The slough was as thin as in the early group in the Experiment 1. The non-moistening group showed a poor healing process like the delayed group in the Experiment 1. For the moistening group, the healing percentage of 77.8% was significantly greater than the 41.3% observed in the non-moistening group (chi-square test, p < 0.05). CONCLUSIONS: All the materials in wound dressing are water-sealing. When the component water under the sheet is far from the extracellular fluid, these applications bring about poor healing. Delayed application and incomplete moisture should be corrected by external water-application.

Double opposing V-Y hinge flap.

A relatively large earlobe hole was closed with triangular flaps on both sides using a V-Y plasty. The design and elevation of this flap are simple and easy. This flap can close relatively large earlobe holes, preventing earlobe deformity.

Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap.

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowen's disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.

Pulsed dye laser treatment for linear scars with concave and erythematous appearance.

Facial linear scars with concave and erythematous appearance sometimes occur after long observation even if adequate conservative treatments have been applied. Because the regenerated epithelium is thin, those scars are seen as red or pink, and are sometimes accompanied with postinflammatory hyperpigmentation. For these scars, flashlamp-pumped pulsed dye of the wavelength of 585 nm and pulse-width of 450 micro s was used, and acceptable results were obtained. Three cases required one treatment and one case needed two, and any side effects were not recognized. Compared with the carbon dioxide laser, which often shows severe scarring as a side effect, the pulsed dye laser with a short down time is useful.

Tranilast as an additional treatment with conservative therapy for concave deformity following traumatic hematoma.

Fibrotic scar tissue resulting from a cheek hematoma sometimes seriously contracts to form a concave deformity, despite conservative therapy. We used Tranilast as an additional treatment with conservative therapy for four patients who were resistant to massage and compression therapy. Four months after oral administration of Tranilast, all the deformities were resolved. Tranilast is used for the treatment of allergic diseases and keloids. It inhibits the release of transforming growth factor b-1, interleukin-1 b, and prostaglandin E2. It also suppresses collagen synthesis by fibroblasts.

Reconstruction of the inner site of the auricle with two local skin flaps.

The external auditory canal and the auricular concha were reconstructed with two local skin flaps after resection of a primary adenoid cystic carcinoma of the external auditory canal. The upper part of the inner site of the auricle was covered with a superiorly-based posterior skin flap and the lower part of it with an inferiorly-based anterior one. Both were cutaneous flaps with a random pattern of blood supply. At the same time the surgical field after the flaps had been raised made additional excision easy, including partial mastoidectomy and parotidectomy. After 10 years of the operation auricular disfigurements and recurrence of the tumour are not observed.