Surgical treatment of tracheocutaneous fistula and tracheostomy scars using a hinged flap and local myocutaneous flap.

Tracheocutaneous fistula and tracheostomy scar are complications associated with the prolonged use of tracheostomy tubes. They have functional and cosmetic problems owing to tracheal tugging during swallowing and easily visible scars. Although many procedures exist to correct this issue, there is no consensus on the optimal surgical technique. Therefore, an ideal surgical procedure was devised. The study was performed on 12 patients between September 2016 and May 2021. All patients had persistent tracheocutaneous fistulas or hypertrophic scars on the neck after tracheostomy. All procedures were performed using a hinged flap and two myocutaneous local flaps. All patients had no complications, and their aesthetics were excellent in postoperative photographs. The scar was better on the straight scar when the flap's skin is denuded than on the VY advancement flap. It should be noted, however, that this procedure can cause the flap to become congested in a short period after head and neck surgery. This procedure is safe, reliable and simple for surgical closure. This was found to produce excellent cosmetic results with no major complications.

Formations of Host Fibers and Bacteria in Human Temporal Bones With Otitis Media.

HYPOTHESIS: In temporal bones with otitis media, fibrin and neutrophil extracellular traps (NETs) form a fibrous network with bacteria, which is involved in growth of bacterial clusters/biofilms and chronicity of disease. BACKGROUND: NETs and fibrin are important in host defense against pathogens; however, their role in otitis media is not well understood. METHODS: Eight human temporal bones with serous otitis media, 30 with serous-purulent otitis media, 7 with mucoid otitis media, 23 with mucoid-purulent otitis media (OM), 30 with purulent OM, and 30 with chronic otitis media were selected based on histopathologic findings. Fibrous material with bacteria was detected with hematoxylin-eosin, Gram-Weigert, and propidium iodide stains; and its composition was analyzed with immunohistochemistry. RESULTS: Extensive formations of fibrous material with bacteria were observed in 30% of temporal bones with serous-purulent otitis media, 29% with mucoid otitis media, 50% with mucoid-purulent OM, 57% with purulent OM, and 67% of temporal bones with histological evidence of chronic otitis media. Some of these formations showed large bacterial clusters or biofilms. Immunohistochemical analysis showed that fibrous structures were composed of fibrin or NETs. CONCLUSIONS: Formations of fibrous material with bacteria were detected in human temporal bones with different types of otitis media. Inflammatory cells were observed mostly in areas with low presence of fibrous structures. The network of fibrous material seems to prevent clearance of bacteria by phagocytic cells and thus influences growth of bacterial clusters or biofilms. Fibrin and NETs may be important for the recurrences and chronicity of disease, and contribute to clogging of tympanostomy tubes in children.

Increased wound pH as an indicator of local wound infection in second degree burns.

Wound pH affects a number of important factors in wound healing. It is known that the pH of the skin surface of healthy adults and children is 4.2-5.6 and that it decreases with the lapse of epithelialization. We measured the pH of the exudates from second degree burns in 26 cases. Among these, local burn wound infection developed in 6 cases. The causative organisms were Staphylococcus aureus in 2 cases and Staphylococcus epidermidis in 4 cases. The maximum pH value measured was 10.0 and the minimum was 5.0 for all samples. There were no differences in the initial measurements of pH between the non-infected cases and the local-infected cases. In cases of local infection, the pH rose prior to the onset of clinical signs of local burn infection. By consecutive measurement of pH, early detection of local wound infection can be achieved and this is very beneficial in clinical practice. Moreover, measurement is very easy and results are available immediately. In conclusion, consecutive pH measurement of exudates is considered to be a useful indicator in the treatment of second degree burns.

Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: comparison of eight different adhesive wound dressings.

In recent years, adhesive wound dressings have been increasingly applied postoperatively because of their ease of use as they can be kept in place without having to cut and apply surgical tapes and they can cover a wound securely. However, if a wound dressing strongly adheres to the wound, a large amount of stratum corneum is removed from the newly formed epithelium or healthy periwound skin. Various types of adhesives are used on adhesive wound dressings and the extent of skin damage depends on how much an adhesive sticks to the wound or skin surface. We quantitatively determined and compared the amount of stratum corneum removed by eight different wound dressings including polyurethane foam using acrylic adhesive, silicone-based adhesive dressing, composite hydrocolloid and self-adhesive polyurethane foam in healthy volunteers. The results showed that wound dressings with silicone adhesive and self-adhesive polyurethane foam removed less stratum corneum, whereas composite hydrocolloid and polyurethane foam using acrylic adhesive removed more stratum corneum.

Chronological histological findings of cultured epidermal autograft over bilayer artificial dermis.

The application of cultured epidermal autograft (CEA) over bilayer artificial dermis theoretically should minimize surgical stress and donor site morbidity in severe burn patients. However, CEA over regenerated dermis is very fragile and easily detaches soon after application, because the very weak attachment. We performed chronological histological studies of the wounds of a 29 year-old patient, which was reconstructed using CEA (JACE(®)) and bilayer artificial dermis (Integra™). These studies included immunohistochemistry of anti-collagen (types III, IV, and VII) and anti-laminin, in addition to H&E and EVG staining. Reconstructed epidermis and dermis showed almost normal histological appearance with time, but formation of basement membrane proteins was delayed. Absent or immature basement membrane protein in the early phase after the CEA application was considered to be an important problem. In the late phase after the CEA application over the bilayer artificial dermis, the reconstructed skin was very durable and demonstrated no sign of skin stripping (although there was still a lack of basement membrane proteins).

Both bronchial and vascular stenting followed by chemoradiotherapy for locally advanced non-small cell lung cancer.

Airway and vascular constrictions are expected problems for lung cancer patients. The clinical course of a patient in whom stents were inserted in 3 constriction regions is reported. A 72-year-old man with advanced primary lung cancer (squamous cell carcinoma stage IIIB) developed suffocating constriction of the trachea and showed superior vena cava (SVC) syndrome. Self-expandable metal stents were inserted into the trachea, SVC and left subclavian vein and the patient was treated by radiotherapy and weekly irinotecan. Within 5 months of treatment, complete local control was achieved and there was no reconstriction. Both endobronchial and endovascular stenting prior to antitumor therapy may be beneficial in the treatment of locally advanced cases of lung cancer.

Continuous exposure to nitric oxide enhances diazepam binding inhibitor mRNA expression in mouse cerebral cortical neurons.

Effects of sustained exposure to nitric oxide (NO) formed by long-term activation of N-methyl-D-aspartate (NMDA) receptors and liberated from a long-lasting NO generator, DETA NONOate, on diazepam binding inhibitor (DBI) and its mRNA expressions were examined using mouse cerebral cortical neurons. Long-term exposure to NMDA increased DBI mRNA expression, and NO synthase inhibitors dose-dependently inhibited this increase. DETA NONOate dose-dependently increased DBI mRNA expression when exposing the neurons to this agent for 3 days and a maximal enhancement of the expression was found at 100 microM of the NO generator. In addition, a significant increase in DBI mRNA expression was observed 1 day after the exposure to 100 microM DETA NONOate, and the maximal expression was observed 2 days after the exposure, whereas transient exposure for less than 3 h to 100 microM DETA NONOate produced no changes in the expression. DETA NONOate (100 microM)-induced increase in DBI mRNA expression was completely abolished by concomitant exposure to hemoglobin. DBI content was also dose-dependently increased by DETA NONOate after the exposure for 3 days. The inhibition of cGMP formation by 1H-[1,2,4] oxadiazolo [4,3-alpha]quinoxalin-1-one (ODQ) showed no affects on the DETA NONOate-induced expression, suggesting that the increased expression of DBI mRNA is mediated via processes independent of cGMP. These results indicate that continuous exposure of the neurons to NO is an essential factor for increasing DBI mRNA expression in the neurons.