Usefulness of the Glove Finger Pad for Ultrasonography in Nasal Fracture Reduction.

The treatment of nasal bone fractures involves closed reduction, in which the reduction position is generally evaluated indirectly by visual examination and palpation. While more direct evaluation methods using ultrasonography can improve treatment outcomes, ultrasonography of the nasal bones requires acoustic coupling materials to hold the entire ultrasonography probe in close contact with the nose. We report the use of the Glove Finger Pad, a homemade acoustic coupling material made from a medical glove. The Glove Finger Pad is easy to prepare and use and produces good images. We believe that the Glove Finger Pad will further enhance the usefulness of ultrasonography for the treatment of nasal fractures.

Reconstruction of Skin Defects in the Medial Canthal Region Using the Novel Hug Flap.

Various methods of reconstructing skin defects in the medial canthal region have been reported. We report 2 skin flaps for the upper and lower eyelids designed to reconstruct soft tissue defects in the medial canthal region based on the approach used for the orbit during surgeries for facial bone fractures. The skin flap was elevated without tension until it reached the defect. The skin flaps of the upper and lower eyelids were moved around the defect as rotational flaps and sutured. Two patients with skin defects in the medial canthal region after basal cell carcinoma resection were treated with this technique. No complications occurred, and good cosmetic and functional outcomes were obtained. This method can be used to reconstruct the eyelid with an elevated skin flap and is considered useful for repairing defects in the medial canthal region.

A Novel Technique of Negative Pressure Wound Therapy for Pharyngeal Cutaneous Fistulas Around Tracheostomas.

ABSTRACT: Fistula formation after free jejunal transplantation is relatively common; however, treating esophago-jejunal anastomosis fistulas is difficult. Herein, the authors report a case of esophago-jejunal anastomosis fistula adjacent to the permanent tracheostoma after free jejunal transplantation that was closed using negative pressure wound therapy (NPWT). A 70-year-old man underwent total pharyngo-laryngo-cervical esophagectomy and free jejunal transplantation for hypopharyngeal cancer. After reconstruction, an esophago-jejunal anastomosis fistula developed on the permanent tracheostoma margin. The fistula was sutured, but it recurred. Therefore, NPWT was performed to close the fistula via the bridge method and balloon compression using a tracheal cannula. NPWT requires the maintenance of local negative pressure. However, esophago-jejunal anastomosis fistula formation after free jejunal transplantation makes this difficult because of the unevenness of the permanent tracheostoma and moist surface of the tracheal mucosa. NPWT performed using the bridge method and balloon compression is an effective option for fistula treatment.

Selection of Artificial Dermis for Shortening Treatment Period: Integra versus Pelnac.

Skin reconstruction of full-thickness skin defect wounds using artificial dermis is performed using secondary split-thickness skin grafting. For the selection of artificial dermis to shorten the treatment period, the waiting time until secondary skin grafting was investigated when the dermis-like tissue was constructed with Pelnac or Integra. METHODS: We evaluated 26 patients who underwent secondary skin grafting after dermis reconstruction with Pelnac (18 patients) or Integra (8 patients) for full-thickness skin defects between 2006 and 2017. The waiting period from artificial dermis application to closure of the full-thickness skin defect with a secondary skin graft was investigated retrospectively. RESULTS: Skin grafts survived well in all cases, and no complications of grafts or donors were observed. The mean waiting period was 17.5 ± 4.2 and 22.0 ± 4.6 days for the Pelnac and Integra groups, respectively (significantly shorter in the Pelnac group). CONCLUSIONS: The difference in waiting period is presumed to be due to the structural differences between the collagen sponge layer, which is the dermal replacement layer of Pelnac and Integra grafts. In cases where shortening the treatment period is important, Pelnac should be the first choice. In addition, in pediatric cases and widespread burns where it is difficult to control the infection during the waiting period, Pelnac is considered to be the first choice because the risk can be reduced by shortening the waiting period.

Effect of Mature Adipocyte-Derived Dedifferentiated Fat Cells on Formation of Basement Membrane after Cultured Epithelial Autograft on Artificial Dermis.

BACKGROUND: Artificial dermis is an important option for preparing full-thickness wounds for cultured epithelial autografting. Long-term fragility after cultured epithelial autografting remains a problem, probably because of the lack of basement membrane proteins. The authors hypothesized that treating artificial dermis with mesenchymal stem cells would promote basement membrane protein production. The authors tested this using dedifferentiated fat cells in a porcine experimental model. METHODS: This study used four male crossbred (Landrace, Large White, and Duroc) swine. Cultured epithelium and dedifferentiated fat cells were prepared from skin and subcutaneous fat tissue harvested from the cervical region. Full-thickness open dorsal wounds were created and treated with artificial dermis to prepare a graft bed for cultured epithelial autograft. Two groups were established: the control group (artificial dermis treated with 0.5 ml of normal saline solution applied to the wounds) and the dedifferentiated fat group (artificial dermis treated with 0.5 × 10 dedifferentiated fat cells suspended in 0.5 ml of normal saline solution sprayed onto the wounds). On postoperative day 10, the prepared cultured epithelium was grafted onto the generated dermis-like tissue. Fourteen days later, tissue specimens were harvested and evaluated histologically. RESULTS: Light microscopy of hematoxylin and eosin-stained sections revealed the beginning of rete ridge formation in the dedifferentiated fat group. Synthesis of both collagen IV and laminin-5 was significantly enhanced in the dedifferentiated fat group. Transmission electron microscopy revealed a nearly mature basement membrane, including anchoring fibrils in the dedifferentiated fat group. CONCLUSION: Combined use of artificial dermis and dedifferentiated fat cells promotes post-cultured epithelial autograft production and deposition of basement membrane proteins at the dermal-epidermal junction and basement membrane development, including anchoring fibrils.

Stability of Orbital Floor Fracture Fixation After Endoscope-Assisted Balloon Placement.

In recent years, endoscope-assisted balloon fixation using transantral and endonasal approaches has gained popularity as a minimally invasive treatment for orbital floor fractures. However, the optimal duration for balloon placement and the efficacy of the method have not been fully evaluated. The authors report their assessment of this method using postoperative and chronological measurements of the maxillary sinus volume.Fourteen patients with blowout fracture of the orbital floor who underwent reduction using endoscopic transantral and endonasal approaches followed by 6-week fixation with a balloon were evaluated. The volume of the maxillary sinus was measured for comparison using computed tomography at the time of balloon removal and 6 months after the surgery.The ratio of change in the maxillary sinus volume (maxillary sinus volume 6 months after surgery/maxillary sinus volume at balloon removal) for all subjects was 0.90 to 1.04 (0.96 ±â€Š0.44, mean ±â€ŠSD). No postoperative reduction in volume was detected, indicating satisfactory fixation. Postoperative computed tomography showed bone regeneration in the orbital floor in all patients in whom the fractured bone fragments were removed. No subjects had remaining enophthalmos greater than 2 mm.The postoperative change in the maxillary sinus volume was small, confirming the efficacy of 6-week balloon placement. This method was effective even in patients in whom fractured bone fragments were removed. Therefore, it is advisable to remove the fractured bone fragments if there is concern that the fragments will stray into the orbit due to inflation of the balloon.

Endoscopic Endonasal Repair of Isolated Medial Orbital Wall Fracture With Balloon Technique.

Endonasal endoscopic repair of medial orbital wall fractures is minimally invasive and benefits the patients. The authors describe the authors' modified balloon technique, which allows longer support of the orbital wall. From October 2010 through January 2016, the author repaired 9 isolated medial wall fractures by this method. Five patients were diagnosed as having enophthalmos of greater than 2 mm, and 6 patients had persistent diplopia before the operation. The herniated orbital contents that filled the anterior ethmoidal sinus were gently reduced with a 4-mm-diameter 0° sinus endoscope. Then a posterior nasal cavity balloon (Type B # 32014, KOKEN Co, Japan) was inserted into the ethmoidal sinus and filled with normal saline. The inflation tube of the balloon was sutured to the nasal cavity wall with absorbable sutures. After checking the status of the balloon, the inflation tube was ligated and cut so that it could be hidden inside the nasal cavity. The balloon was removed on an outpatient basis 6 to 7 weeks after the surgery. In this series, the mean inflation volume of the balloon was 1.6 mL, the mean period of leaving the balloon in place was 5.7 weeks, and the mean operative time was 38.6 minutes.Resolution of the preoperative diplopia and enophthalmos was achieved in all 9 patients, and there was no recurrence of prolapse of the orbital contents. This method allows leaving the balloon in place for a long period of time without interfering with daily life, which reduces the risk of rebulging of the orbital contents.

The Effect of Mature Adipocyte-Derived Dedifferentiated Fat (DFAT) Cells on a Dorsal Skin Flap Model.

BACKGROUND: Dedifferentiated fat (DFAT) cells, isolated from mature adipose cell, have high proliferative potential and pluripotency. We report on the expansion of flap survival areas on the back of rats administrating DFAT cells. MATERIALS AND METHODS: Intraperitoneal adipose tissue was collected from a male Sprague-Dawley (SD) rat. The mature fat cells were cultured on the ceiling surface of culture flask to isolate DFAT cells. On day 7 of the culture, the flask was inverted to allow normal adherent culture. A dorsal caudal-based random pattern flap measuring 2 × 9 cm was raised on each SD rat. We prepared a control group (n = 10) and a flap base injection group in which DFAT cells were injected 2 cm from the flap base (n = 10) and a flap center DFAT injection group (n = 10). In which DFAT cells at 1 × 106 cells/0.1 ml were injected beneath the skin muscle layers of the flap. The flap survival areas were assessed on day 14 after surgery. RESULTS: The mean flap survival rates of the control group, flap center injection group and flap base injection group were 53.6 ± 6.1%, 50.6 ± 6.4% and 65.8 ± 2.4%, respectively. The flap survival areas significantly expanded in the flap base injection group (p < .05). In H-E staining beneath the skin muscle layer connective tissue thickened in the flap base injection group. In the India ink staining, abundant neovascularization was observed inside the thickened parts. CONCLUSION: The injection of DFAT cells into the flap base promoted the expansion of survival areas.

Effects of combination therapy using basic fibroblast growth factor and mature adipocyte-derived dedifferentiated fat (DFAT) cells on skin graft revascularisation.

BACKGROUND: Although the benefits of basic fibroblast growth factor (bFGF) for wound healing and angiogenesis are well known, its effects on the process of skin graft revascularisation have not been clarified. It was hypothesised that bFGF would be beneficial to promote taking of skin grafts, but that the effect might be limited in the case of bFGF monotherapy. Therefore, this study investigated the efficacy of combination therapy using bFGF and dedifferentiated fat (DFAT) cells. DFAT cells have multilineage differentiation potential, including into endothelial cells, similar to the case of mesenchymal stem cells (MSC). METHODS: Commercially available human recombinant bFGF was used. DFAT cells were prepared from SD strain rats as an adipocyte progenitor cell line from mature adipocytes. Full-thickness skin was lifted from the back of SD strain rats and then grafted back to the original wound site. Four groups were established prior to skin grafting: control group (skin graft alone), bFGF group (treated with bFGF), DFAT group (treated with DFAT cells), and combination group (treated with both bFGF and DFAT cells). Tissue specimens for histological examination were harvested 48 hours after grafting. RESULTS: The histological findings for the bFGF group showed vascular augmentation in the grafted dermis compared with the control group. However, the difference in the number of revascularised vessels per unit area did not reach statistical significance against the control group. In contrast, in the combination group, skin graft revascularisation was significantly promoted, especially in the upper dermis. CONCLUSION: The results suggest that replacement of the existing graft vessels was markedly promoted by the combination therapy using bFGF and DFAT cells, which may facilitate skin graft taking.

Effects of mature adipocyte-derived dedifferentiated fat (DFAT) cells on generation and vascularisation of dermis-like tissue after artificial dermis grafting.

Although artificial dermis (AD) is effective for skin reconstruction, it requires two separate procedures, because the AD must be vascularised before skin grafts. To shorten the period of the dermis-like tissue generation before the secondary skin grafting must be beneficial. Dedifferentiated fat (DFAT) cells are isolated from mature adipose cell suspensions and have potential to differentiate into multiple cell types including endothelial cells. This study aimed to investigate effects of DFAT cells on dermal regeneration after AD grafts in rats. The effects of combination use of DFAT cells and basic fibroblast growth factor (bFGF) were also tested to mimic clinical situations. DFAT cells were isolated from SD rats. Full-thickness wounds were created on the back of rats followed by AD grafting. Five groups were established; Group I: control, Group II: treated with DFAT cells, Group III: treated with bFGF, Group IV: treated with both of DFAT cells and bFGF, and Group V: treated with Green fluorescent protein (GFP)-labelled DFAT cells and bFGF. Histological evaluation was serially performed. Group IV showed markedly promoted vascularisation of dermis-like tissue. In particular, capillary infiltration into the dermis was obtained within 2 days. Immunohistochemical examination revealed that the transplanted DFAT cells had differentiated into endothelial cells and participated in angiogenesis. Group IV also showed a marked increase in the thickness of the dermis like tissue. The present results suggest that the use of DFAT cells under bFGF treatment could be beneficial to shorten the period required for dermal regeneration and vascularisation and contribute to use AD more effectively and safely.

Successful management of the cervicothoracic esophagus reconstruction by expanded skin flap.

The limited availability of reconstruction materials can often make it difficult to treat defects in the esophagus caused by necrosis of the transplanted intestinal tissue after cervicothoracic esophagus reconstruction. We were forced to perform flap reconstruction on a patient who suffered necrosis due to impeded blood flow of the transplanted intestinal tract after twice conducting cervicothoracic esophagus reconstruction with an intestinal tract flap. The procedure we performed was esophagus reconstruction using a pectoralis major myocutaneous flap that had been expanded with a tissue expander due to the small volume of tissue available to perform the reconstruction. This case suggested that esophagus reconstruction with a skin flap using a tissue expander should be considered as a possible treatment choice when performing reconstruction of the cervicothoracic esophagus, which requires stable blood flow and a large amount of tissue.

Measurement of calf muscle oxygenation during light-intensity exercise in patients with post-thrombotic syndrome.

BACKGROUND: Near-infrared spectroscopy (NIRS) provides continuous noninvasive monitoring of changes in the levels of oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) in tissues. The purpose of this study was to investigate changes in calf muscle O2Hb and HHb levels during standing and exercise in the follow-up of deep venous thrombosis (DVT). METHODS: Forty-three patients with a first episode of unilateral proximal DVT were included. Final clinical manifestations were evaluated at a mean follow-up point of 53 months after diagnosis of DVT, and post-thrombotic syndrome (PTS) was considered to be present if the Villalta score was >5. Moreover, to assess the severity of PTS, the revised Venous Clinical Severity Score (VCSS) was employed. NIRS was used to measure changes in the levels of O2Hb and HHb in calf muscle. On standing, increases in O2Hb and HHb were calculated by subtracting the baseline value from the maximum value (ΔO2Hbst and ΔHHbst). The times taken for the O2Hb and HHb concentrations to become maximal (TO2Hbst, and THHbst) were also measured. During 10 tiptoe movements, the relative change in O2Hb was calculated by subtracting the value measured at the end of exercise from the value measured at the beginning of exercise (ΔO2Hbex). On the other hand, 10 tiptoe movements produced venous expulsion (ΔHHbEex) and a subsequent retention (ΔHHbRex). The oxygenation index (HbD; HbD = O2Hb - HHb) was also calculated at the end of standing and at the end of 10 tiptoe movements (ΔHbDst and ΔHbDex). RESULTS: Among the 43 limbs evaluated, 21 had PTS. On standing, the ΔHbDst was significantly decreased in patients with PTS relative to the patients without PTS (12 ± 8, 22 ± 11 µmol/L; P = .001). The TO2Hbst was also significantly reduced in patients with PTS relative to those without (43 ± 41, 107 ± 58 seconds; P = .001). During 10 tiptoe movements, the ΔHHbEex was significantly reduced in patients with PTS relative to those without (-2 ± 1, -3 ± 3 µmol/L; P = .016). Similarly, the ΔHHbRex was significantly increased in patients with PTS relative to those without (8 ± 7, 3 ± 2 µmol/L; P = .001). Furthermore, falls in ΔHbDex were more pronounced in patients with PTS (-10 ± 16, 10 ± 10 µmol/L; P < .001). NIRS-derived TO2Hbst (r = -0.568; P < .001) and ΔHbDex (r = -0.645; P < .001) showed strong inverse correlations with VCSS. Similarly, NIRS-derived ΔHHbEex (r = 0.409; P < .01) and ΔHHbRex (r = 0.476; P < .01) showed moderate positive correlations and ΔHbDst (r = -0.422; P < .01) had a moderate inverse correlation with VCSS. CONCLUSIONS: Changes in O2Hb and HHb concentrations differ between patients with and without PTS. The reduced TO2Hbst may indicate impairment of the venoarteriolar reflex in patients who have PTS. Furthermore, severe falls in HbD in patients with PTS might reflect the pain of venous claudication. These findings may have implications for investigations of the microcirculation in the context of post-thrombotic sequelae.

Endoscopic transmaxillary repair of orbital floor fractures: a minimally invasive treatment.

Although endoscopic transmaxillary repair of orbital floor fractures is a minimally invasive treatment, controversy remains regarding the method for supporting the orbital floor after elevation of the orbital contents. To date, a urethral balloon catheter has been widely used. However, it can be difficult to leave the catheter in place for a long time period due to the inconvenience, and prolapse of the orbital contents may recur in the case of its premature removal. This study described the techniques for endoscopic reduction and use of a balloon for orbital floor fractures. From June 2006 through November 2011, 30 of 52 patients (57.7%) with an isolated orbital floor fracture underwent endoscopic transmaxillary repair. A maxillary sinus balloon (#3007, Koken Co., Japan) was inserted into the maxillary sinus to support the orbital floor after endoscopic transmaxillary reduction, and the connecting tube of the balloon was pulled into the nasal cavity through the maxillary ostium. After confirmation of accurate reduction by postoperative CT, the connecting tube was shortened and hidden in the nasal cavity. The balloon was left in place for 4-8 weeks, and then removed via the maxillary ostium on an outpatient basis. Complete resolution of the preoperative diplopia was achieved in 93%, and no late-developing enophthalmos was seen in 97% of the patients. There were no significant complications. This technique is safe and permits prolonged retention of the balloon, without interfering with daily life.

Wound dressing material containing lyophilized allogeneic cultured cells.

Although topical application of a single growth factor is known to accelerate wound healing, treatment with allogeneic cultured cells is more efficient and physiological, because they release various mediators that interact and regulate the wound healing mechanism. However, in clinics, the cells must be cryopreserved until use. To overcome this inconvenience, we designed novel wound dressing materials containing lyophilized allogeneic cultured epithelial cells and/or fibroblasts. This study aimed to confirm growth factor release from those lyophilized products. The results revealed that the cultured cells retained their morphology even after lyophilization and released growth factors. When fibroblasts were used alone, they released growth factors in significantly higher concentrations after lyophilization than after cryopreservation. In particular, bFGF release was almost a hundredfold higher in the lyophilized group compared to the cryopreserved group. When epithelial cells and fibroblasts were co-cultured, both bFGF and VEGF were released in higher concentrations by the cryopreserved dressing material than by the lyophilized dressing material. The growth factors' release was probably regulated by interaction between epithelial cells and fibroblasts. We speculate that repeated application may be necessary for treating difficult wounds with the lyophilized product, because the lyophilized cells release the mediators in a single, transient burst.

False-negative monitoring flap in free jejunal transfer.

We treated a case that exhibited dissociation between blood flow in the transferred jejunum and the monitoring flap. The monitoring flap showed a false-negative, indicating blood flow to be favorable despite blood congestion in the transferred jejunum. The patient was a 69-year-old man. After tumor resection, reconstruction was performed with free jejunal transfer. Vascular anastomosis was performed on the jejunal artery and transverse cervical artery and on the jejunal vein (V1) and external jugular vein. After esophagus anastomosis, blood congestion was noted in the transferred jejunum. An engorged arcade vein (V2) was observed in the mesenterium on the transferred jejunum side. Therefore, it was anastomosed to the external jugular vein bifurcation. The first postoperative day, thrombus had formed in the vein (V2). The transferred jejunum side vein (V2) was re-anastomosed to the external jugular vein, and improved blood flow was observed in the transferred jejunum. Monitoring transferred jejunum blood flow with monitoring flap exteriorization appears to be a simple and highly reliable method. However, because the monitoring flap cannot directly evaluate transferred jejunum blood flow, blood flow obstruction can occur between the transferred jejunum and the true situation may not be reflected.

Measurements of calf muscle oxygenation during standing and exercise in patients with primary valvular insufficiency.

OBJECTIVE: Despite the established role of the calf muscle pump for preventing chronic venous disorders, hemoglobin flow in the calf muscle is poorly understood. Near-infrared spectroscopy (NIRS) provides continuous noninvasive monitoring of changes in tissue-oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) levels. The purpose of this study was to investigate the changes in calf muscle O2Hb and HHb levels during standing and exercise in patients with primary valvular insufficiency (PVI). METHODS: Eighty-three limbs in 81 patients with PVI were enrolled. The clinical manifestations of these patients were categorized according to the CEAP (Clinical, Etiologic, Anatomical, and Pathophysiologic) classification, and patients were divided into group I (C1-3S,Ep,As,d,p,Pr) and group II (C4-6S,Ep,As,d,p,Pr). Moreover, to assess the severity of PVI, the revised Venous Clinical Severity Score (VCSS) was employed. NIRS was used to measure changes in the calf muscle O2Hb and HHb levels. On standing, increases in O2Hb and HHb were calculated by subtracting the baseline value from the maximum value (ΔO2Hbst and ΔHHbst). The time elapsed until the maximum increases in O2Hb and HHb concentrations (TO2Hbst, and THHbst) were also measured. During 10 tiptoe movements, the relative change in O2Hb was calculated by subtracting the value measured at the end of exercise from the value measured at the beginning of exercise (ΔO2Hbex). On the other hand, 10 tiptoe movements produced venous expulsion (ΔHHbEex) and a subsequent retention (ΔHHbRex). The oxygenation index (HbD; HbD = O2Hb - HHb) was also calculated at the end of standing and 10 tiptoe movements (ΔHbDst and ΔHbDex). RESULTS: Among the 83 limbs evaluated, 48 were classified as group I and 35 as group II. Standing caused increases in the levels of both ΔO2Hbst and ΔHHbst. However, there were no significant differences in these increases between the two groups. In contrast, the TO2Hbst was significantly reduced in group II in comparison with group I (55 ± 29 vs 36 ± 30 seconds; P = .007). During 10 tiptoe movements, a decrease in O2Hb concentration was observed, and there was no significant difference in ΔO2Hbex between group I and group II. In contrast, the ΔHHbRex was significantly increased in group II compared with group I (6 ± 7 vs 9 ± 6 µmol/L; P = .013). Furthermore, falls in ΔHbDex were more pronounced in group II (7 ± 16 vs -7 ± 16 µmol/L; P = .001). A statistically significant correlation was found between C of CEAP and the VCSS (r = 0.778; P < .001). Moreover, NIRS-derived TO2Hbst (r = -0.312; P < .01) and ΔHbDex (r = -0.332; P < .01) showed moderate inverse correlations with C of CEAP. Similarly, NIRS-derived ΔHbDex (r = -0.501; P < .001) had a strong inverse correlation, and ΔHbDst (r = -0.383; P < .001) and TO2Hbst (r = -0.378; P < .001) had moderate inverse correlations with VCSS. CONCLUSIONS: Changes in O2Hb and HHb concentrations differ according to CEAP manifestation and VCSS. These data offer new insights into calf muscle hemodynamics at the microcirculation level in patients with PVI.

Preliminary report of novel technique for cryopreservation--vacuum-assisted cryoprotectant infiltration.

To date, cryopreservation of large soft tissues has not been successfully achieved because of limitation of cryoprotective agent (CPA) infiltration into the tissue. This study aimed to investigate the effects of a vacuum on the tissue-infiltration of a CPA. An instant pickle-maker was modified for use as a vacuum apparatus, and glycerol was selected as the CPA. Twenty-six rats were used, and their thighs were divided into three treatment groups. Group 1: fresh control; Group 2: cryopreserved control, i.e., immersed in the CPA for 1h under atmospheric pressure and cryopreserved; Group 3: vacuum-assisted CPA infiltration, i.e., immersed in the CPA under negative pressure (20, 40 and 60 cmHg, for durations of 10, 20 and 30 min at each) and cryopreserved. The Groups 2 and 3 specimens were thawed after 3 weeks of cryopreservation at -80 °C and histologically examined, in comparison with Group 1. Skin: in Groups 2 and 3, the skin was well preserved. Muscle: in Group 2, both extracellular and intracellular ice crystal formation was widely distributed throughout the muscle tissue. In Group 3, under an adequate vacuum, the muscle tissue was well preserved, with no ice crystal formation. However, when the treatment was conducted under excessive vacuum conditions, the muscle tissue showed focal necrosis. Blood vessels: in Group 3, both the arteries and veins were well preserved up to the tunica intima. The method described in this paper may be a useful technique for achieving cryopreservation of large soft tissues.

Anomalies of the arterial tree that coexist with arteriovenous malformations in the lower extremity.

Several previous reports have documented arteriovenous malformations associated with anomalies of the arterial tree. We report two cases in which a malformation on the foot coexisted with arterial variants of the popliteal artery. Careful therapeutic planning was required to avoid jeopardising perfusion to the distal area.