Haruaki Sato

Perineural and Neural Involvement in Skin Cancers

BACKGROUND Malignant skin tumors rarely spread along nerves. Complete resection of involved nerves is often unsuccessful. OBJECTIVE In the treatment of tumors with perineural invasion, surgeons should accurately estimate the extent of distant spread. METHODS We report six cases of skin cancers, including two basal cell carcinomas, two squamous cell carcinomas, and two neurotropic malignant melanomas, that invaded nerve or perineural spaces. RESULTS In three of the cases, the tumors developed on the face and involved the infraorbital nerves or its branches. Two patients suffered from tumors on aid burn scars of lower legs. Branches of posttibal nerves were involved in both cases. In the last case, tumor invasion of a branch of the greater occipital nerve was detected. CONCLUSION The extent of surgical excision should include the area of skin supplied by the affected nerve, which must be resected in continuity.

Sural perforator flap: Assessment of the posterior calf region as donor site for a free fasciocutaneous flap

Three kinds of free fasciocutaneous flap from the posterior calf region have been described in the literature: the medial sural perforator flap, the lateral sural perforator flap, and the traditional posterior calf fasciocutaneous flap that is supplied by superficial cutaneous vessels. Moreover, it has been reported that superficial cutaneous vessels are of a suitable size for microanastomosis when deep musclocutaneous perforators are absent or relatively tiny. To establish a safe technique for free fasciocutaneous flap elevation from the posterior calf region, we examined the number and location of the musculocutaneous perforators and the size of superficial cutaneous vessels at their origin from the popliteal artery in six formalinized cadavers. We found that all legs had at least one perforator either from the medial sural artery or the lateral sural artery. By contrast, we failed to find superficial cutaneous vessels of suitable size for microanastomosis in three legs, and there was no significant inverse relationship between the diameter of the superficial cutaneous artery and the number of musculocutaneous perforators. Our results suggest that the medial sural perforator flap and the lateral sural perforator flap might be the surgeons first and second choice, respectively. The traditional posterior calf fasciocutaneous flap should be the third choice because our study suggests that its availability is doubtful. Another site is recommended, when preoperative Doppler study suggests that the existence of musculocutaneous perforator is in doubt. Two clinical cases, with a medial sural perforator flap and a lateral sural perforator flap, respectively, are presented.

Use of groin flap and anterolateral thigh adipofascial flap of tensor fascia lata for reconstruction of a wide lower abdominal wall defect.

We describe a patient in whom a wide defect of the lower abdominal wall was repaired by an anterolateral thigh adipofascial flap with tensor fascia lata and groin flap.

Frontonasal Flap for Reconstruction of Complete Alar Defects

background It is difficult to reconstruct a satisfactory ala. Axial frontonasal flap has been common in reconstruction of nasal tip. We modified this flap to reconstruct nasal ala. objective A modified axial frontonasal flap was applied for reconstruction of complete unilateral alar defects in two patients. methods Skin from an intact nasal tip covered the alar defect. The resulting defect in the nasal tip was covered with dorsal skin from the nose. Extended mucosa or a hinged nasolabial flap was used to line the mucosal side of the reconstructed ala. results The outcome judged by shape, and texture, was satisfactory. This technique can be employed under field block. conclusion The modified frontonasal flap is one of the ideal techniques to reconstruct an entire nasal ala.

Extended V-Y flap: patient reports and reconsideration.

The extended V-Y flap, a modified V-Y advancement flap, is very useful in closing relatively large defects on the face. Its extension limb is hinged down as a transposition flap on the end of the V-Y advancement flap to close the most distal portion of the defect. We applied this flap in closing a defect following excision of skin tumors on the face with excellent cosmetic results in 11 patients. However, this flap tended to make a distortion at the base of the flap in the primary closure site. By drawing figures, we concluded that the distortion was due to the characteristic of this technique as a V-Y advancement-rotation flap or V-Y advancement flap with rotation.

Skin Cancer Screening on a Fishing Island and in an Inland Agricultural Area of Japan

We performed skin cancer screening from 2000 to 2004 at two locations in Japans Oita Prefecture: Himeshima, a small fishing island, and Naoiri, an inland agricultural area. We found 108 and 21 cases of AK in Himeshima and Naoiri, respectively. None of the AKs transformed into SCC, and 21.7% of the AKs underwent spontaneous remission during our observation period. The prevalence and incidence of AK in Himeshima were five times higher than in Naoiri: 1,399 and 826 per 100,000 population, respectively, in the fishing village, vs. 261 and 164 in the agricultural community. Seven and three cases of BCC were observed in Himeshima and Naoiri, respectively. There were two cases of SCC in Himeshima. The highest risk ratio of skin types I to III was 9.2 in Himeshima. Although people engaged in outdoor occupations are thought to be more prone to skin cancer and precancerous skin lesions, our results suggested different potentials for AK in people engaged in different outdoor occupations.

Free composite graft for lip reconstruction after tumor excision

This paper represents 10 patients for whom lip defects following excision of malignant tumors were reconstructed by the free composite graft technique using the opposite side of the lip. Usually, for upper lip reconstruction, a switch flap or Zisser-Madden method is commonly used. For lower lip reconstruction, the methods of the double cross-lip flaps or the rotation flap are most frequently used. However, we recommend the free composite graft technique for selective patients, since this method is simpler than the other techniques and the results are excellent both cosmetically and functionally.

Conservative surgical treatment for early-stage vulvar malignant melanoma

PurposeTo investigate the efficacy of wide local excision as a surgical treatment for early-stage vulvar melanomas.MethodsWide local excision with or without lymph node dissection was performed in three patients with stage I vulvar melanoma (American Joint Committee on Cancer classification, 1992).ResultsAll three patients were successfully treated by wide local excision. There was no evidence of recurrence at long-term follow-up in any of the patients.ConclusionsWide local excision with adequate tumor-free margins should be considered the treatment of choice for early-stage vulvar melanomas.

A Case of Orbital Xanthogranuloma Treated by Surgical Excision

Orbital xanthogranuloma is an uncommon tumor. It is usually associated with a systemic or hematological disease. This report presents a rare case of orbital xanthogranuloma associated with heart disease and thrombocytopenia. A 52-year-old female presented with a bilateral periorbital subcutaneous tumor that had existed for 3 years. Although immunoglobulin levels were within the normal limits, thrombocytopenia, slight anemia and increased levels of C-reactive protein and alkaline phosphatase were observed. The mass was excised successfully. The malar flap elevation technique made it easy to approach the periorbital subcutaneous mass. A histopathological study led to a diagnosis of xanthogranuloma based on the presence of infiltration of histiocytes and Touton-type giant cells.