Hisashi Motomura

Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap.

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowens disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.

Surgical treatment for greater sphenoid wing fracture (orbital blow-in fracture).

The authors present 2 patients with greater sphenoid wing fractures that were treated surgically. This type of fracture is classified as a blow-in fracture of the lateral orbital wall. The first patient was a 16-year-old boy who was involved in a motor vehicle accident. Computed tomography (CT) disclosed a medial displacement of the inner wall of the greater sphenoid wing of the left orbit. He was unconscious for 3 days. After he recovered consciousness, he presented limited abduction of the left eye with diplopia in all gaze directions and mild left proptosis. Although these symptoms did not improve for 1 week, displaced bone fragments of the greater sphenoid wing were removed via the lateral orbital approach. The patient had a good postoperative course with progressive improvement in eye movement over the next several weeks. The second patient was a 22-year-old man whose face was hit in a fight. CT disclosed medial displacement of the inner wall of the greater sphenoid wing of the left orbit. Although the patient also presented limited abduction of the left eye on admission, this symptom improved gradually. However, diplopia in all gaze directions and mild left proptosis did not improve. Therefore, the displaced inner wall of the greater sphenoid wing was reduced via the lateral orbital approach. The patient showed a good postoperative course with progressive improvement over the next several weeks. This type of orbital fracture, which is classified as an orbital blow-in fracture, is relatively rare. This type of greater sphenoid wing fracture is caused by buckling of the orbital wall secondary to severe compression of the orbital rim. Surgical treatment using the lateral orbital approach through a hemicoronal skin incision afforded a wider operative field and better cosmetic result.

Aggressive conservative therapy for refractory ulcer with diabetes and/or arteriosclerosis

A foot ulcer due to diabetes and/or arteriosclerosis obliterans (ASO) frequently results in an intractable condition that resists treatment. To cope with this condition, we have developed a combination therapy that includes conventional conservative therapy plus surgical therapy. This aggressive conservative therapy using aggressive debridement, trafermin (Fiblast Spray, Kaken, Japan) treatment and vacuum‐assisted closure (VAC) therapy was adopted to treat seven patients suffering from diabetes and ASO‐related refractory foot ulcer accompanied by bone exposure. With the exception of one patient who died during the treatment, the remaining six patients obtained limb salvage. The mean time to cure was 8.3 months. This approach should be considered before amputation. Some patients may refuse amputation or cannot tolerate highly invasive surgical treatment including tissue transplantation. In such cases, this aggressive conservative therapy can be employed as a highly useful and reproducible technique requiring simple techniques.

Simple maxillary reconstruction following total maxillectomy using artificial bone wrapped with vascularized tissue: five key points to ensure success.

Abstract Conclusion: Our new method for hard tissue maxillary reconstructions using artificial bone implants provides stable results during long-term follow-up. Objective: To date, vascularized bone/cartilage grafting has been the most popular method for hard tissue reconstruction after total maxillectomy; however, such three-dimensional reconstruction requires complex and lengthy invasive surgery. We have developed a simple maxillary reconstruction procedure using artificial bone. Methods: This study included six patients who had undergone hard tissue reconstructions using artificial bone (CeratiteTM) implants after total maxillectomies between October 2002 and October 2010. We considered the following five key points to ensure success: (1) the procedure was conducted in two stages without communicating with the nasal cavity and sinuses; (2) when constructing the artificial bone, the curvature was reduced; (3) the space for the implant was kept to a minimum; (4) the artificial bone implant was closely and accurately fixed to the stump of the zygomatic arch; and (5) the artificial bone implant was wrapped with a vascularized tissue flap. Results: The follow-up period ranged from 12 to 94 months. The postoperative zygomatic contour was maintained satisfactorily in all patients with no signs of late complications.

Clinical results of OK-432 injection therapy for ganglions.

We performed a study of intralesional OK‐432 injection therapy for the non‐surgical treatment of ganglions. OK‐432 is an agent made from penicillin‐killed and lyophilized preparations of a low‐virulence strain of group A streptococcus pyogenes, which has been developed as an immune‐augmentation agent for cancer therapy. Derived from an extract of bacterial culture it, induces an immunological response and causes local inflammation and subsequent tissue shrinkage following intralesional injection. After skin anesthesia and aspiration of the ganglion contents, OK‐432 was injected into the ganglion cavity. When the ganglion recurred, this procedure was repeated usually up to a total of three times. Clinical evaluations six months after the last injection were: 56.6% complete cure, 35.3% incomplete cure with size reduced, 7.5% no change. Complications were as follows. There were no cases of shock. High fever was seen in five patients (9.4%); two patients suffered a high fever up to 39.0°C for one day, and the others had fevers from 1 to 3 days. Thirty‐two patients (60.4%) complained of local swelling that persisted for 1 to 7 days, and 11 (20.8%) complained of continuous pain for 1 to 3 days. Intralesional OK‐432 injection therapy is thought to be a safe and convenient alternative to surgical treatment.

Changes in fresh nasal bone fractures with time on computed tomographic scans

Twenty cases of fresh nasal bone fractures were examined for which computed tomographic (CT) scans were obtained at the time of initial consultation, immediately after surgery, and 1 month after surgery. CT scans were obtained in the axial position from the nasal bone to the nasal apex, with slice intervals and slice thicknesses of 2 mm. For evaluation after reduction, classification of fracture and measurement of angle (&thgr;) of the fractured portion were performed by CT examination. The authors considered angles close to 0 deg to indicate good reduction. In addition, they performed overall evaluation based on the shape of the arch formed by the nasal bone and maxilla. Based on this, they compared the result of evaluation immediately after surgery with that found 1 month after surgery. Evaluation of reduction by CT examination performed immediately after surgery revealed excellent results in 2 patients, good results in 10 patients, and fair results in 8 patients. Reevaluation of reduction by CT 1 month after surgery revealed excellent results in 10 patients, good results in 9 patients, and fair results in 1 patient. The shape of the nasal bone tended to improve with time.

Dynamic eye socket reconstruction after extended total maxillectomy using temporalis transfer

The functional and cosmetic results of the reconstructive surgery after extended total maxillectomy greatly depend on the quality of the orbital reconstruction. In order to achieve good orbital reconstruction, we developed the dynamic eye socket reconstruction using temporalis transfer. In this report, I will present the details of the technique, including tips and innovations for dynamic eye socket reconstruction.Two patients (2 males, aged 70 and 72 years old) who underwent extensive resection of midfacial tumours were treated with dynamic eye socket reconstruction using temporalis transfer. The follow up period was 16 and 102 months. No acute complications were observed. The movements of the upper/lower eyelids including crows feet were observed and a good shape in the reconstructed medial/lateral canthal area was maintained in all patients.This procedure provides both the eyelids with movement and also a good shape in the reconstructed medial/lateral canthal region. Furthermore, it contributes to achieving satisfactory functional and cosmetic results in the orbital reconstruction.

The use of test skin grafting in pemphigus vegetans

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Aggressive Basal Cell Carcinoma in the Nasal Region

see front matter a 2008 Published by Elsevier Ltd on behalf of doi:10.1016/j.bjps.2008.04.064 One reason is skin problems caused by the disease itself and the other is systemic and cutaneous complications associated with long-term steroid therapy for the underlying disease. We performed surgery in a patient with an extensive skin ulcer caused by cryptococcosis who had severe pemphigus vegetans, a rare variant of pemphigus

arterialized Occipitoparietal Osteocutaneous Flap

It is extremely rare for basal cell carcinoma (BCC) to metastasize, so it is often only simply excised. However, BCC may cause severe local tissue destruction, which often extends to surrounding muscle, cartilage, and bone; it is then termed “aggressive” BCC. We evaluated the safety margin and the reconstruction method in four cases of nasal BCC that were diagnosed as aggressive BCC histopathologically or by imaging, including magnetic resonance imaging (MRI) and computerized tomography (CT) and then treated by excision. The results showed that the larger the aggressive BCC was, the smaller the histopathological safety margins became. The lateral nasal region was classified into three regions, and individual reconstruction was performed according to anatomical unit, resulting in favorable outcomes. Nasal BCC should be closely examinated, it requires a careful treatment strategy similar to that for other malignant skin tumors.