Hiroki Nakaoka

Bilateral vermilion flaps for lower lip repair.

A more natural reconstructive procedure of the lower lip using bilateral vermilion flaps was applied in five patients with excellent results. The vermilion defects were about two-fifths to three-fifths. In three patients, the vermilion defect was repaired using bilateral vermilion flaps alone. In the remaining two patients, a narrow horizontal lip defect was repaired by bilateral vermilion flaps and a subcutaneous V-Y advancement flap of the lower lip. A single vermilion flap or bilateral vermilion flaps are considered to be of great value for vermilion reconstruction because of the inherent elasticity and common anatomic unit. The postoperative scars are not remarkable at all. A long and narrow horizontal lip defect (perhaps within 1.5 cm downward from the vermilion border) may be effectively repaired by the combination of vermilion flap(s) and a V-Y advancement flap without sacrificing any additional healthy tissue.

The square and uniform intensity ruby laser for the treatment of pigmented skin lesions

Summary285 various pigmented skin lesions from 282 patients were treated over the past 2 years and 10 months using the square and uniform intensity laser equipment. Also, laser effects on 44 skin specimens were studied histologically. The treated clinical lesions included 111 pigmented nevi, 97 nevi spili, 6 Beckers nevi, 10 epidermal nevi, 22 senile freckles, 16 seborrheic keratoses, and 23 other skin lesions. Satisfactory results 6 months or more after the final treatment of 212 of the skin lesions were obtained in 12/96 (12.5%) pigmented nevi; 13/75 (17.3%) nevi spili; 3/5 (60.0%) Beckers nevi; 3/7 (42.9%) epidermal nevi; 9/17 (52.9%) senile freckles; and 9/12 (75.0%) seborrheic keratoses. Judged on the histological examination of pigmented nevi, satisfactory results were obtained in 5 out of 11 superficial compound nevi, 1 out of 32 deep compound nevi, and 2 out of 12 deep intradermal nevi. Assessment methods will be discussed, and ruby laser treatment will be compared to conventional therapy.

A treatment of mammae outside Paget's disease.

Thirty-two patients with extramammary Pagets disease during a 15-year period were analyzed.The male to female ratio was 25 to 7, and the average age of the patients was 71.8 years. All the lesions were in the external genitalia or perianal regions. The treatment was composed of a histologically controlled, local wide excision, with regional lymphnode dissection when indicated. The 5-year survival rate was 77.1% and the 10-year rate 48.9%.Bilateral axillary skins in 26 of 32 patients were histologically examined; Pagets cells were also found in bilateral axillae of the 3 patients and in unilateral axilla in another 3 patients. The subclinical, axillary Pagets disease was considered to be a relatively frequent complication.

Impaired upward gaze due to subperiosteal hemorrhage of the orbital roof.

A rare instance of subperiosteal hemorrhage of the orbital roof with satisfactory operative results is described here. Two-dimensional computed tomography was of great value in the preoperative evaluation of the impaired upward gaze and diplopia.

Bilateral cryptophthalmos with multiple associated congenital malformations.

An infant girl manifesting bilateral cryptophthalmos with multiple associated malformations was followed from birth. The globes were almost covered by a fold of skin and the findings were interesting in regard to the etiology of cryptophthalmos. The other congenital deformities included scaphocephaly, somewhat low-set ears, accessory tragi, a high arched palate, and funnel chest. The child was operated on at the age of 4 months with relatively satisfactory results, although she died suddenly of acute heart failure 4 months postoperatively.

Island groin flap.

An island groin flap was used for satisfactory reconstruction of defects in the anterior thigh, lower abdomen, or perineal regions in 9 patients. This flap has several advantages: simple operation, wide range of coverage, large rotation arc, direct closure of the donor site, and no sacrifice of muscle. Comparison with tensor fascia lata and other musculocutaneous flaps is made.

Replantation of Severed Foot at the Chopart Joint: A Case Report

Level of Evidence: V, Expert Opinion

Severe Palmo-Plantar Hyperkeratosis in Koebner Epidermolysis Bullosa Simplex

A 22‐year‐old Japanese woman with Koebner epidermolysis bullosa simplex presented with severe palmo‐plantar hyperkeratosis. Skin biopsy specimens from the palm revealed hyperkeratosis and acanthosis with blistering in the basal cell layer. An electron microscopic study showed cytolysis of basal cells and clumping of tonofilaments forming thick bundles and perinuclear electron‐dense bodies. Hand contractures were released and covered with full thickness autografts or split thickness autografts. The donor site was successfully treated with cultured epidermal autografts.

Reduced-HMGB1 suppresses poly(I:C)-induced inflammation in keratinocytes

BACKGROUND High mobility group box 1 (HMGB1) is a nuclear protein that stabilizes DNA and facilitates gene transcription. Additionally, cell stress or death induces the release of HMGB1 outside the cell membrane, where HMGB1 functions as an alarmin, causing an inflammatory response in combination with other cytokines, damage-associated molecular patterns (DAMPs), and pathogen-associated molecular patterns (PAMPs). OBJECTIVE To evaluate the effect of reduced-HMGB1 (previously termed chemoattractive-HMGB1) on polyinosine-polycytidylic acid [poly(I:C)]-induced inflammation in normal human keratinocytes (NHKs). METHODS We focused on downstream components of the poly(I:C)-Toll-like receptor 3 (TLR3), retinoic acid-inducible gene-I (RIG-I), and melanoma differentiation-associated protein 5 (MDA5) pathways, including IκBα, nuclear factor (NF)-κB p65, mitogen-activated protein kinase (MAPK), and interferon regulatory factor 3 (IRF3), and assessed whether these pathways are involved in the suppression of poly(I:C)-induced inflammation in NHKs by HMGB1. An immunoprecipitation was performed to know whether HMGB1 could bind to poly(I:C), and immunofluorescence staining and flow cytometric analysis were performed to check whether reduced-HMGB interferes with cellular uptake of poly(I:C) translocation (possibly by endocytosis). RESULTS Application of exogenous HMGB1 before, but not after, exerted a suppressive effect on poly(I:C)-induced inflammation in NHKs. In addition, reduced-HMGB1, but not disulfide-HMGB1, exerted a suppressive effect on poly(I:C)-induced inflammation in NHKs, suggesting the importance of the redox status of exogenous HMGB1. Pre-treatment with reduced-HMGB1 inhibited the phosphorylation of IκBα, NF-κB p65, and IRF3 induced by poly(I:C) stimulation in NHKs; however, phosphorylation of p38, extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK) was unaffected. Disulfide-HMGB1 formed a complex with poly(I:C), as did reduced- and oxidized-HMGB1, albeit to a lesser extent. Immunofluorescence staining and flow cytometric analysis indicated that reduced-HMGB interferes with cellular uptake of poly(I:C) translocation (possibly by endocytosis). CONCLUSION These findings suggest that pre-treatment with reduced-HMGB1 ameliorates poly(I:C)-mediated inflammation in NHKs.

Statistics of malignant tumor on the skin and soft parts and treatment. Statistical observation of malignant tumor and on the skin and soft part and treatment.

The annual trends in number of deaths from malignant skin and soft tissue tumors (ICD-10, C43, C44 and C49) in Japan, were investigated on the basis of the data from the Ministry of Health and Welfare population trend survey. The number of deaths from skin cancers had decreased remarkably from 1979 on, but had increased again since 1995. The general trends of deaths from both malignant melanoma and malignant soft tissue tumors were upward. The approximate annual increased ratio of deaths from a melanoma was 2.5%, and that from soft tissue tumors 2.6%. For lowering the number of deaths, it is essential to pay attention to treatment of an early and relatively early stages of an actinic keratosis-induced squamous cell carcinoma for age 80 and older, and also of the similar stages of a melanoma and soft tissue tumors for age 40 and older.