Chu Kimura

Clinical application of expanded free flaps based on primary or secondary vascularization.

&NA; Prefabricated free flaps using an expansion technique were used for four reconstructive cases, including two leg reconstructions and two facial reconstructions. In this series, the prefabricated free flaps created by using the expander were classified into two types: the expanded flap based on the conventional vascular pedicle, which is called the expanded flap with primary vascularization; and the expanded flap based on the vascular pedicle in the carrier, which is called the expanded flap with secondary vascularization. The expanded flap with primary vascularization that is created in the trunk has a good indication for leg reconstruction, because it provides an wide and thin flap with minimal donor site morbidity. The expanded flap with secondary vascularization created in the pectoral region has a good indication for facial reconstruction, because it provides good color and texture matches. Although there are some disadvantages in the tissue expansion technique, the prefabricated free flaps using the expander are very effective in facial and leg reconstruction. (Plast. Reconstr. Surg. 102: 1532, 1998.)

A Case of Congenital Infantile Fibrosarcoma of the Right Hand

Congenital infantile fibrosarcoma is a rare soft‐tissue malignant tumor that usually presents as a mass involving the arm or leg. We report a case of congenital fibrosarcoma on the right hand of a newborn infant.

Treatment of ischial pressure sores by means of sclerotherapy using absolute ethanol.

The ischial region is a common site of pressure sore. The ischial pressure sore with a large subcutaneous bursa is resistant to conservative treatment and tends to require radical surgical treatment. In this article the authors describe their experience with a simple surgical treatment on 8 ischial pressure sores in 7 patients with subcutaneous bursa by means of sclerotherapy using absolute ethanol. This method involves causing the bursa to become scarred and closing it up by sterilizing, fixing, and denaturing by the pharmacologic effect of absolute ethanol instead of surgical excision of the bursa. This alternative method has a possibility of treating pressure sores as well as other fistulous diseases in various areas.

Merkel cell carcinoma of the face: an analysis of 16 cases in the Japanese

BACKGROUND There is no agreement regarding a staging system and optimal treatment of Merkel cell carcinoma. Some centres have reported results from larger series of patients, but these do not include Asian or Japanese centres. OBJECTIVE The purpose of this study was to retrospectively review our experience with the surgical treatment of MCC of the face in the Japanese and to study its management and outcome using the staging system described by Clark et al. METHODS We report our experiences with 16 cases between 1991 and 2004. Patients and tumour characteristics, treatment variables and outcome were analysed. RESULTS The follow-up periods ranged from 1 to 180 months. The average was 32.6 months and the median was 17.5 months. The relapse-free survival for all patients was 51% at 2 years. The relapse-free survival was 80% for the patients with Stage I and 33% with Stage II at 2 years. CONCLUSION This staging system was suggested to reflect prognosis although the number of patients in this series was small. Sentinel lymph node biopsy should be considered to determine the accurate nodal staging, and patients with MCC of the head and neck may be treated according to the revised staging system by Clark et al.

Correction of microtia with construction of the tragus using a chondrocutaneous flap

For microtia correction we have been inserting a cartilage framework and reconstructing the tragus at the first operation in one stage, using part of the microtic ear. This procedure is started with transposition of the lower two-thirds of the microtic ear to make a lobule. The upper third of the microtic ear is elevated as a chondrocutaneous flap which is then transposed downwards to the conchal cavity to make a tragus. The cartilage of the chondrocutaneous flap is anchored, using a bolster to pull it back and outwards. Using this technique, we have reconstructed 34 microtic ears. Adequate positioning of the auricle and tragus has been achieved and a natural auricle obtained even when observed from a frontal oblique direction.

Congenital Ectopic Nails Reconstructed with Local Skin Flaps

Congenital ectopic nails are quite unusual and characterized by development of nail‐like tissue on the tips of one or more fingers. We present the case of a boy with congenital ectopic nails on both little fingers. To prevent tapering of the fingertips following surgery, we used subcutaneous pedicle flaps and obtained a satisfactory cosmetic result.

Promising long-term outcomes of the reused skin-graft technique for chronic gluteal hidradenitis suppurativa

BACKGROUND The reused skin-graft technique can be used to treat chronic gluteal hidradenitis suppurativa, but long-term outcomes and the reliability of the technique have not been reported. METHODS In a retrospective review of 18 men with chronic gluteal hidradenitis suppurativa (age range, 18-68 years) treated with a reused skin graft between June 2004 and March 2012, we evaluated disease severity (Hurley classification system), skin-graft thickness, the need for an additional normal skin graft, histological findings and recurrence rate at the surgical site. RESULTS The mean duration of follow-up was 61.3 months (range, 17-113 months). Five cases were classified into severity group I, 12 cases into severity group II and one case into severity group III. The range of skin-graft thicknesses was 0.013-0.020 inches. An additional donor site was unnecessary in 10 cases (three cases in group I (60%) and seven cases in group II (58.3%)). Histological examination indicated that a buried epidermal cyst could cause chronic gluteal hidradenitis suppurativa recurrence, although none of the patients experienced recurrence at the surgical site during follow-up. CONCLUSION The reused skin-graft technique is reliable for chronic gluteal hidradenitis suppurativa resection, and it shows promising long-term outcomes.

Utility of the method using the tsukisui device to control intraoperative bleeding applied to neurofibroma resection.

Summary: The resection of neurofibromas in Von Recklinghausen’s disease [neurofibromatosis type 1 (NF-1)] is frequently complicated due to size, location, hypervascularity, and tissue friability. A repeat resection, however, is necessary for patients with functional problems such as unexpected tumor bleeding or with changes in esthetic appearance. This report describes application of the method using the Tsukisui device to resecting NF-1 tumors while minimizing blood loss. The method using the Tsukisui device was applied for the resection of 8 NF-1 tumors (5 patients), and intraoperative blood loss, operative time, and postoperative complications were recorded. In all cases employing this method, intraoperative blood loss was <360 ml (10–360 ml), and none of the patients developed postoperative hematoma or other notable bleeding complications. The method using the Tsukisui device, which provided excellent hemostasis and was associated with few complications, shows promise for application to neurofibroma resection.

A new aspect of metastasis in cutaneous cancer: two cases of presacral squamous cell carcinoma with metastases to internal iliac nodes.

We report 2 cases of presacral squamous cell carcinoma. In these cases, it was suspicious that the tumor disseminated to the internal iliac nodes through the direct pathway called the neurovascular lymphatic space (NVLS) around the superior/inferior gluteal vessels or sciatic nerve bypassing external iliac nodes. NVLS was initially reported as accessory pathway which follows the major vessels forming a sheath like structure with an actual or potential space between the vessel wall and the enveloping membrane. NVLS has been reported to be observed as a tubular shadow within the neurovascular sheath by lymphangiographies of lymphedema patients using oil-based contrast material. These cases provide insights into the potential pathway through which a cutaneous tumor disseminates.

Wound Care: Maggot Debridement Therapy

Maggot debridement therapy (MDT) has long been used to treat various wounds or ulcers. Although the mechanisms underlying MDT are not completely understood, laboratory studies have clarified the various effects of larval secretions/excretions. The most noticeable change in maggot-treated wounds is debridement. Other characteristics include microbial death (disinfection) and accelerated wound healing (growth stimulation). Recently, it has been reported that the amino acid-like compounds present in maggot excretions/secretions may mediate wound healing by stimulating angiogenesis. In the clinical setting, MDT for critical limb ischemia has been reported to lead to an increase in skin perfusion pressure, which serves as an index of peripheral circulation in the skin and subcutaneous tissue. Laboratory and clinical findings to date suggest that ischemic ulcer is a good candidate for MDT.