Chikako Murakami

Evaluation of Superficial and Deep Self-Inflicted Wrist and Forearm Lacerations

PURPOSE Self-inflicted wrist or forearm laceration is a specific type of injury presenting to emergency departments. Many investigators have described wrist-cutting from a psychiatric viewpoint. We hypothesized that the character of patients with deep wounds is different from those with superficial wounds. We investigated patients who cut their wrist or forearms as an act of self-mutilation from the viewpoint of wound severity. METHODS We reviewed 31 patients with self-inflected wrist injuries who were treated in our medical center from 2004 through 2009. We divided them into 2 groups: deep (15 patients) and superficial (16 patients). We investigated differences in age and gender, sites of self-cutting, frequency of self-injury attempts, object used for wrist cutting, group psychiatric parameters, required wound treatments, and psychiatric history and follow-up. RESULTS Younger patients were more likely to have injured themselves severely compared with older patients. Differences in clinical findings between deep and superficial injury groups included the following: (1) all male patients had deep injuries; (2) patients with superficial wounds were more likely to have cut themselves previously; (3) patients in the deep injury group tended to injure themselves at multiple sites; (4) patients in the deep injury group tended to perform self-cutting with any sharp-edged object at hand; (5) 50% of our patients had received no psychiatric care before being seen by us for their injury; and (6) one-third discontinued the psychiatric treatment prematurely. CONCLUSIONS There are differences between patients who perform self-inflicted deep versus superficial wrist cutting. We also found that the ages and psychiatric diagnoses of our patients differed from previous reports. This is likely because the available literature includes only patients who received psychiatric care. We found that 50% of our patients had received no psychiatric care, which highlights the importance of hand surgeons treating these patients to initiate psychiatric consultation.

Emergent free flow-through anterolateral thigh flaps for Gustilo-Anderson III fracture of the upper extremity

Title Emergent free flow-through anterolateral thigh flaps for Gustilo-Anderson III fracture of the upper extremity Author(s) Fujioka, Masaki; Hayashida, Kenji; Murakami, Chikako Citation Journal of Emergencies, Trauma, and Shock, 7(1), pp.53-55; 2014 Issue Date 2014-01 URL http://hdl.handle.net/10069/34229 Right

Tetanus following replantation of an amputated finger: a case report

IntroductionTetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, this is the first published case report of such an entity.Case presentationA 49-year-old Japanese man had an amputation of his right middle finger at the distal interphalangeal joint region in an accident at work. His middle finger was successfully replanted, but his fingertip was partially necrotized because of crushing and so additional reconstruction with a reverse digital arterial flap was performed 15 days after the injury. Tetanus developed 21 days after replantation of the middle finger, but symptoms remitted via rapid diagnosis and treatment.ConclusionsIn replantation after finger trauma with exposure of nerve and blood vessel bundles, concern over injuring nerves and blood vessels may prevent irrigation and debridement from being performed sufficiently; these treatments may have been insufficiently performed in this patient. It is likely that the replanted middle finger partially adhered, and Clostridium tetani colonized the partially necrotized region. Even when there is only limited soil contamination, administration of tetanus toxoid and anti-tetanus immunoglobulin is necessary when the fingers are injured outdoors and the finger nerves and blood vessels are exposed. The drugs should be administered just after replantation if the finger has been amputated. However, if clinicians pay attention to the possibility of tetanus development, treatment can be rapidly initiated.

Cutaneous Malignant Rhabdoid Tumor in the Palm of an Adult

Malignant rhabdoid tumor is a rare tumor occurring mostly in the neonatal kidneys and central nervous system. Cutaneous malignant rhabdoid tumors are extremely rare in adults. The aim of the study was to report on the clinical, histologic, and immunophenotypic characteristics of this cutaneous malignant rhabdoid tumor which developed in an adult. A 27-year-old male complained of a right palm neoplasm that had been present for 6 months, which was initially diagnosed as an epithelioid sarcoma by biopsy. However, detailed investigation with immunohistochemistry enabled us to make a diagnosis of a rhabdoid tumor. The patient underwent radical abrasion, chemotherapy, and irradiation, and has survived for 1 year without relapse. Only 20 adult cases have been reported thus far in the English literature. We are reporting the 21st case, who remains disease-free at 12 months. Complete resection and local irradiation may increase survival, because there is no standard and reliable curative chemotherapeutic regimen.

Artificial dermis is not effective for resurfacing bone-exposing wounds of Gustilo–Anderson III fracture

We read the article of Chen X. et al. (Management of wounds with exposed bone structures using an artificial dermis and skin grafting technique. J Plast Reconstr Aesthet Surg. 2010 Jun; 63(6):e512-8. Epub 2009 Dec 9.), and would like to congratulate the authors on their interesting study. They presented 5 patients with fresh open fractures using an artificial dermis and skin grafting technique. Among them, the bone-exposing wounds of 4 patients healed successfully. Artificial dermis is beneficial for the reconstruction of wounds with exposed tendons or bone. The unique characteristic of artificial dermis, promoting granular regeneration evenonbarebone,mayallow resurfacingwith a free skin graft instead of flap surgery for the treatment of several boneexposing wounds including deep burns, post-abrasion of neoplasms and skin defects due to trauma. However, we feel that it is impossible to prepare a favorable wound bed on the

Resurfacing Patella Using Pedicled Soleus Perforator Flap

Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. To resurface the wound, many flaps are used, including free flaps, musculocutaneous flaps, axillary flaps, local flaps, and sometimes distant flaps. However, each flap has disadvantages. In this report, we present 2 cases of soft-tissue defects on the surface of the patella reconstructed with a pedicled soleus perforator flap, resulting in a successful outcome. Pedicled soleus perforator flaps enable the reconstruction of local soft-tissue defects of the patella without microvascular anastomoses and with minimal donor-site morbidity. We conclude that the pedicled soleus perforator flap is a favorable option for defect coverage around the knee, because of its fast and easy harvesting and very good esthetic results.

Vulvar reconstruction should be performed using gluteal-fold perforator flap because of less morbidities and complications.

The authors present a case of bilateral vulvar defects after abrasion of malignant skin neoplasm, reconstructed with a gluteal-fold perforator flap, resulting in a successful outcome.

Vascularized bone graft is a better option for the reconstruction of maxillary defects.

We read the article of Kinnunen et al., which evaluated the result of maxillary defects, and feel some objections. We present our considerations of their operative indication and thoughts based on our surgical experiences. Defects after palatectomy, which have left no dentition for the retention of an obturator, require vascularized bone-containing free flaps. Local flaps are available in only small defects of Class 1 and 2a. Most palatomaxillary defects following malignant tumor abrasion are classified as 2b, 2c, 3, or 4, which require microsurgical free flap transfer combined with bony reconstruction. Regarding bony reconstruction, non-vascularized bone grafts tend to be absorbed. Thus, we believe that bony reconstruction should be performed with vascularized bone. We agree with the authors’ comment that PTMF may be useful in repairing defects due to complications in microvascular procedures in the palatal area. However, even when bone segment is required for salvage surgery, using a vascularized bone flap is more preferable. A parietal bone-fascial-periosteal flap based on the superficial temporal vessels is a suitable and reliable bone flap for the reconstruction of a maxillary defect following free skin flap transfer to the palate.

Palliative Surgery for Cutaneous Ulcers Improves the Symptoms of Patients with Terminal Cancer

For cutane-ous ulcers complicated with infections and a large amount ofexudate and bleeding, medical professionals employ radio-therapy and topical dermal drugs to relieve the symptoms.However, such treatments have provided less than satisfac-tory effects and in many cases patients have no choice but toendure these symptoms. In these patients, a surgical proce-dure may lead to symptom relief and postoperative im-provement of the QOL.

Maxillary reconstruction using free rectus abdominis myocutaneous flap combined with vascularized costal cartilages

We describe two cases of zygomaticomaxillary bone defect after the resection of a maxillary carcinoma, reconstructed using a rectus abdominis myocutaneous flap combined with vascularized costal cartilages. Eighth and ninth costal cartilages could be harvested connecting with the rectus abdominis muscle. The zygomaticomaxillary buttress was reconstructed using vascularized costal cartilages, while the nasal and oral lining, or facial skin defect were reconstructed with a RAM flap. The shape of the harvested costal cartilages fitted the zygomaticomaxillary bone defect; thus, the result was favorable cosmetically.