In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall.

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20-70 mm), the mean width of these was 14.9 mm (range, 8-20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.

Switch Flap for Upper Eyelid Reconstruction-How Soon Should the Flap Be Divided?

BACKGROUND: The results of a cohort of patients treated at one institution for upper eyelid reconstruction with the switch flap method after a defect due to excision of malignant tumor were reviewed. METHODS: A retrospective data file review of all patients who had undergone total upper eyelid reconstruction with the switch flap method was conducted at the Saga University Hospital between April 2000 and October 2014. The follow-up lasted for varying periods during which the preoperative and postoperative photographs were compared as well. RESULTS: A total of 10 patients with upper eyelid tumors, that is, 7 sebaceous carcinoma, 2 squamous cell carcinoma, and 1 basal cell carcinoma, underwent reconstructive surgery. With the switch flap technique, the defects resulting from tumor excision were completely covered in all cases. The mean of defect widths after tumor excision (A) was 18.8 mm (range, 15-25 mm), the mean of widths of switch flaps (B) was 13.3 mm (range, 8-22 mm), and the mean of B/A ratios was 0.69 (range, 0.5-0.88). When the switch flap was divided at 7 to 14 days, there was no flap loss, trichiasis, or corneal ulcer. CONCLUSION: Our protocol managed to make flaps with a B/A ratio of 0.5-0.7, and the flaps were divided at 7 to 14 days after surgery, the timing of which was much earlier than in the conventional method, lessening the possibility of complications.

Aesthetic Total Reconstruction of Lower Eyelid Using Scapha Cartilage Graft on a Vascularized Propeller Flap.

BACKGROUND: The aim of this study was to review the results of a cohort of patients based on our experience with a new technique for total lower eyelid reconstruction after a large defect caused by malignant tumor and trauma. A scapha cartilage graft with small skin on a vascularized propeller flap was used for 16 cases requiring lower eyelid reconstruction. METHODS: Patients were identified from a database, and a retrospective case note review was conducted. The scapha cartilage graft was sutured to the margin of the defect of the palpebral conjunctiva and tarsus. The propeller flap, rotated by a perforator-based lateral orbital flap or a subcutaneous-based nasolabial flap, was vascularized on the scapha cartilage graft as anterior lining of the lower eyelid. The follow-up, including results of slit-lamp examination, lasted for varying periods, but often it was for 12 months. RESULTS: The scapha cartilage graft with small skin on a vascularized propeller flap was viable in all cases. Slit-lamp examination detected no irritation or injury of the conjunctiva and cornea, and visual acuity was maintained in all cases. A deformity in the donor helix by this technique was also improved by getting a smaller skin harvested from the scapha. CONCLUSION: Use of the scapha cartilage graft with small skin on a vascularized propeller flap allows for a good fit to the orbit, short operative time under local anesthesia, good graft viability, and a good esthetic result with minimal donor site morbidity.

Infrazygomatico-coronoid fixation in a segmental mandibular reconstruction with a free vascularized flap: A simple and correct repositioning method without interfering with reconstructive and microsurgical procedures.

BACKGROUND: In a segmental mandibular reconstruction with a free vascularized flap, reproducing the optimal relationship between the condyle and glenoid fossa, and maintaining correct occlusion are important. We examined the practicality of a repositioning technique that combined bone plate fixation of the infrazygomatic crest and the coronoid process (infrazygomatico-coronoid fixation [IZCF]) with maxillo-mandibular fixation (MMF). METHODS: Eight patients were treated with this method. To investigate masticatory function, the status of the dental and temporomandibular joints were examined, and a food scale questionnaire was administered. RESULTS: IZCF and MMF resulted in correct repositioning of the segmented mandibles and enabled accurate reconstructions. Most patients recovered to be able to ingest the same preoperative food in scale with stable occlusion. CONCLUSION: This method is a simple and correct repositioning method without interfering with reconstructive and microsurgical procedures. We propose this technique as a reliable method for obtaining a functional outcome in mandibular reconstruction. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

A statistical study on malignant melanoma over the past 12 years in Fukui University Hospital.

BACKGROUND: The survival rate of patients with malignant melanoma is still low, and there is no established chemotherapeutic method. With the appearance of molecular targeted drugs, improvement in the survival rate can be expected. However, at present, malignant melanoma remains a disease associated with one of the poorest prognoses. MATERIALS AND METHODS: We analyzed a total of 51 cases of malignant melanoma who were treated at the Department of Dermatology, University of Fukui from September 2001 to May 2013. RESULTS: The survival rate was significantly lower in patients aged ≥65 years. The 5-year survival rate was 100 % for Stage 0/I, 79.59 % for Stage II, and 52 % for Stage III. The incidence of lymph node metastasis was highest in nodular melanoma, and zero in lentigo maligna melanoma. There was a significantly high risk of lymph node metastasis in the presence of ulceration. There was no association between incisional biopsy and lymph node metastasis. CONCLUSIONS: Although the data were obtained in only one institution and the number of cases was limited in this study, the results are close to previous international data.

Usefulness of CT-lymphography in sentinel lymph node navigation.

BACKGROUND: There are many methods for sentinel lymph node (SLN) navigation. The methods using radioisotopes and blue dyes are performed mainly for the identification of SLN. Our current method for SLN biopsy is a combination of three techniques with 99mTc-phytate, patent blue V dye, and preoperative CT-lymphography (CTLG). PATIENTS AND METHODS: Iomeprol (Iomeron®) as a water-soluble contrast agent is diluted twofold with 1 % lidocaine and intradermally injected into a few sites (2-5 ml at each site) around the tumor. After the injection, CT imaging is performed using a 64-row MDCT system (Siemens SOMATOM Definition AS+). We performed CTLG in 34 patients (16 men, 18 women) between September 2008 and March 2013. RESULTS: CTLG clearly visualized the SLN and the lymphatic drainage in 21 out of 34 patients. CONCLUSIONS: We can detect the SLN and lymphatic flow near to tumors without shine-through effect, especially in the head and neck regions. It is thought that CTLG may be useful to determine the range of lymph node dissection.

Treatment of venous ulcers with bone marrow-impregnated collagen matrix.

Bone marrow attracted our attention as a potentially beneficial material for the treatment of wounds, because it contains multipotential progenitor cells and produces growth factors. We impregnated autologous bone marrow cells on to a collagen matrix that had been used for the treatment of chronic wounds. The bone marrow-impregnated collagen matrix was then as a biomaterial scaffold for the treatment of wounds. This study was designed with the aim of clinically evaluating the effects of bone marrow-impregnated collagen matrix on wound healing of venous ulcers. We applied the matrix in 15 patients with chronic venous ulcers, and evaluated the transcutaneous oxygen tension (TcPO(2)) and vascular density. The application of the matrix induced healthy granulation tissue. All patients were given a split-thickness skin graft on to the induced granulation tissue, and have remained free from complications for more than eight months since the treatment. The mean (SD) vascular density at the ulcer base increased after the treatment (before 0.011 (0.006) mm(2)/mm(2), after 0.064 (0.036) mm(2)/mm(2), p < 0.001). The periwound TcPO(2) values tended to increase (before 17.1 (12.7) mmHg, after 30.6 (13.4) mmHg, p < 0.001). Our results have shown the efficacy of bone marrow-impregnated collagen matrix for the treatment of intractable venous ulcers.

Treatment of scattered glass foreign bodies in both the superficial and deep neck: a case report.

There have not been any reports about scattered glass foreign bodies in the neck, while injuries of the head and neck region as a result of traffic accidents have been frequently reported. We report the case of a 17-year-old male injured in a traffic accident, with scattered glass foreign bodies in both the superficial and deep neck. A CT scan indicated the existence of numerous glass foreign bodies in the various layers of the neck. Most of the foreign bodies were very fine or sand-like. The wounded skin was keloidal and expected to lead to remarkable facial edema of the left side. The foreign bodies and cervical keloidal lesions with small pieces of glass were carefully removed, and then reconstruction was conducted in stages using tissue expanders. The facial edema was reversed and the aesthetic reconstruction satisfied the patient.