Blepharoptosis as a complication of percutaneous ethanol injection of thyroid cyst.

Complications of percutaneous ethanol injection (PEI) for thyroid cyst are rare. Almost all complications reported have been transient, including Horner's syndrome. We provide herein the first description of persistent blepharoptosis subsequent to PEI, necessitating surgical correction. A 54-year-old woman presented to our hospital with left blepharoptosis that had occurred the day after PEI for a thyroid cyst. She showed 2 mm of blepharoptosis and 1 mm of miosis in the left eye compared to the right eye. Magnetic resonance imaging of the brain demonstrated no abnormalities, and computed tomography detected no lesions in the neck or chest other than the already known cyst. Instillation of phenylephrine eye drops allowed elevation of the left upper eyelid. Considering these findings, we diagnosed the blepharoptosis as part of Horner's syndrome. The ptosis was corrected by levator aponeurosis advancement. No recurrence has been observed as of 9 months postoperatively.

Reconstruction of Completely Circumferentially Degloved Thumb Using Omental Flap and Tubular Split-thickness Skin Graft.

Various types of thin flaps have been used for reconstruction in cases of complete circumferential degloving injuries of digits (Urbaniak classification class III). The omental flap has extensive, pliable, and well-vascularized tissue and helps prevent bone resorption of the distal phalange that can result from avascular necrosis. A 31-year-old right-handed man with class III left thumb injury and compartment syndrome of the left forearm was treated successfully with a free omental flap wrapped around the thumb and then covered with a tubular split-thickness skin graft. The postoperative course was good, except that the distal third of the phalange of the thumb was resected because of insufficient omentum volume transplanted to the thumb tip resulting from omental volume bias in the distal part of the thumb. Bone scintigraphy 1 year after injury showed technetium-99m accumulation in the remaining two-thirds of the distal phalange, although there was no blood supply before the reconstruction. The advantages of our treatment method are that the thickness of the reconstructed digits can be adjusted by the amount of the omental flap. Skin grafting can be simplified; and with multiple digital injuries, separated fingers can be reconstructed in a single operation by wrapping each digit with a divided omental flap. Use of the free omental flap and tubular split-thickness skin graft is a therapeutic reconstruction option for Urbaniak class III injury.

Reconstruction of nasal vestibular obstruction after total nasal reconstruction using superior subcutaneous pedicle nasolabial flaps.

OBJECTIVE AND METHODS: Nasal obstruction after total nasal reconstruction is a serious complication that contributes to breathing difficulty, snoring, and obstructive sleep apnea, which can negatively influence daily activities. However, few treatments have been reported in detail for this condition. Here, a case of nasal vestibular obstruction after total nasal reconstruction that was treated with bilateral superior subcutaneous pedicle nasolabial flaps is reported. RESULTS: An intranasal stent was used postoperatively for five months to prevent restenosis. Internal stenosis was not noted 25 months postoperatively. The patient could breathe easily through his nose and mouth dryness improved. CONCLUSION: The flap is relatively thin, easy to elevate with high flexibility and stable blood flow, and useful for nasal vestibular lining reconstruction.

Madelung's disease: long-term follow-up.

Madelung's disease (MD) is a rare lipid metabolic disorder of adipose tissue overgrowth, which has been reported to be related to alcohol abuse. Although it does not affect survival itself, alcoholism and metabolic disorders associated with MD can be life-threatening. Although surgical procedures and classifications have been reported, long-term follow-up has rarely been reported. Here, we report a 61-year-old Japanese man with MD who has been followed-up for 12 years. Lipectomy was performed three times over the first 3 years and a total of 4 kg of adipose tissue was excised. Relapse has not been observed. He was diagnosed with multiple hepatocellular carcinomas (MHC) and placed on dialysis due to hepatorenal syndrome caused by alcoholism. Moreover, one of the MHC ruptured resulting in hemorrhagic shock. The cause of death in MD is not fat proliferation but comorbidities. Long-term observation and multidisciplinary systemic management are necessary for MD patients.

Intertendinous epidermoid cyst of the forearm.

As epidermoid cysts generally originate from hair follicle infundibulum, they appear as intradermal or subcutaneous tumors and are very rare in locations away from the skin. Here, we report a rare case of intertendinous epidermoid cyst of the forearm in a 68-year-old man that was treated surgically.

Therapeutic strategies for elbow ankylosis due to heterotopic ossification in patients with severe burns.

BACKGROUND: Heterotopic ossification (HO) occurs frequently in the elbow in burn patients, and extends beyond the anatomical structure. HO of the elbow can cause joint contracture and adversely affect activities of daily living.Currently, there is no effective prophylaxis for HO as the precise underlying mechanism remains unknown. Therefore, there is no choice but to treat HO after it has developed. To date, however, no effective standard treatment has been reported, and therefore treatment methods vary between different facilities. Surgical resection is widely accepted as the only therapeutic option once HO limits functional mobility of the elbow. PURPOSES: Based on past reports, we examined our cases and recommend effective therapeutic strategies. We posed the following three questions: (1) Is the surgical intervention effective or detrimental for elbow ankylosis due to HO? (2) What is the best timing for the intervention? (3) What is the most effective postoperative rehabilitation plan? METHODS: We treated three patients with complete ankylosis of the elbow due to HO after severe burn injury using different protocols. RESULTS: Surgery was performed in two cases and rehabilitation therapy was commenced immediately from the first postoperative day. Both patients showed improvement in the active range of motion in their elbow joints. The other patient did not undergo surgery, and his elbows became fixed in the completely extension position. CONCLUSION: Surgical resection is beneficial for elbow ankylosis due to HO after burn injury. Although the exact surgical timing is still controversial, we recommend that surgery should be performed as soon as possible after improving the skin condition around the elbow and confirming the maturation of HO on radiographs. Early rehabilitation and pain control are also important after surgery.