Masato Yasuta

Aesthetic Total Reconstruction of Lower Eyelid Using Scapha Cartilage Graft on a Vascularized Propeller Flap.

Background: The aim of this study was to review the results of a cohort of patients based on our experience with a new technique for total lower eyelid reconstruction after a large defect caused by malignant tumor and trauma. A scapha cartilage graft with small skin on a vascularized propeller flap was used for 16 cases requiring lower eyelid reconstruction. Methods: Patients were identified from a database, and a retrospective case note review was conducted. The scapha cartilage graft was sutured to the margin of the defect of the palpebral conjunctiva and tarsus. The propeller flap, rotated by a perforator-based lateral orbital flap or a subcutaneous-based nasolabial flap, was vascularized on the scapha cartilage graft as anterior lining of the lower eyelid. The follow-up, including results of slit-lamp examination, lasted for varying periods, but often it was for 12 months. Results: The scapha cartilage graft with small skin on a vascularized propeller flap was viable in all cases. Slit-lamp examination detected no irritation or injury of the conjunctiva and cornea, and visual acuity was maintained in all cases. A deformity in the donor helix by this technique was also improved by getting a smaller skin harvested from the scapha. Conclusion: Use of the scapha cartilage graft with small skin on a vascularized propeller flap allows for a good fit to the orbit, short operative time under local anesthesia, good graft viability, and a good esthetic result with minimal donor site morbidity.

Treatment of venous ulcers with bone marrow-impregnated collagen matrix

Abstract Bone marrow attracted our attention as a potentially beneficial material for the treatment of wounds, because it contains multipotential progenitor cells and produces growth factors. We impregnated autologous bone marrow cells on to a collagen matrix that had been used for the treatment of chronic wounds. The bone marrow-impregnated collagen matrix was then as a biomaterial scaffold for the treatment of wounds. This study was designed with the aim of clinically evaluating the effects of bone marrow-impregnated collagen matrix on wound healing of venous ulcers. We applied the matrix in 15 patients with chronic venous ulcers, and evaluated the transcutaneous oxygen tension (TcPO2) and vascular density. The application of the matrix induced healthy granulation tissue. All patients were given a split-thickness skin graft on to the induced granulation tissue, and have remained free from complications for more than eight months since the treatment. The mean (SD) vascular density at the ulcer base increased after the treatment (before 0.011 (0.006) mm2/mm2, after 0.064 (0.036) mm2/mm2, p < 0.001). The periwound TcPO2 values tended to increase (before 17.1 (12.7) mmHg, after 30.6 (13.4) mmHg, p < 0.001). Our results have shown the efficacy of bone marrow-impregnated collagen matrix for the treatment of intractable venous ulcers.

Switch Flap for Upper Eyelid Reconstruction—how Soon Should the Flap Be Divided?

Background: The results of a cohort of patients treated at one institution for upper eyelid reconstruction with the switch flap method after a defect due to excision of malignant tumor were reviewed. Methods: A retrospective data file review of all patients who had undergone total upper eyelid reconstruction with the switch flap method was conducted at the Saga University Hospital between April 2000 and October 2014. The follow-up lasted for varying periods during which the preoperative and postoperative photographs were compared as well. Results: A total of 10 patients with upper eyelid tumors, that is, 7 sebaceous carcinoma, 2 squamous cell carcinoma, and 1 basal cell carcinoma, underwent reconstructive surgery. With the switch flap technique, the defects resulting from tumor excision were completely covered in all cases. The mean of defect widths after tumor excision (A) was 18.8 mm (range, 15–25 mm), the mean of widths of switch flaps (B) was 13.3 mm (range, 8–22 mm), and the mean of B/A ratios was 0.69 (range, 0.5–0.88). When the switch flap was divided at 7 to 14 days, there was no flap loss, trichiasis, or corneal ulcer. Conclusion: Our protocol managed to make flaps with a B/A ratio of 0.5–0.7, and the flaps were divided at 7 to 14 days after surgery, the timing of which was much earlier than in the conventional method, lessening the possibility of complications.

Acral junctional nevus with prominent pagetoid spread

for CEA, EMA and GCDFP-15, and positive for Ber-EP4. Luminar cells of the ducts were positive for CEA (Fig. 2c), EMA and AE1/AE3. Innermost cells of cystic structures were not positive for CEA or EMA. Gli1 transcript levels were measured by real-time quantitative reverse transcriptase polymerase chain reaction using RNA extracted from formalin-fixed, paraffin-embedded tissue of the present case and another typical BCC case. Both cases demonstrated high expression of Gli1 mRNA. Basal cell carcinomas usually have an atrophic epidermis due to sun-exposed areas of the elderly. Only two cases of BCC have been reported accompanied by an epidermal collarette. Furthermore, BCC with ductal differentiation have been reported in only a few articles. Lewis et al. postulated that BCC on the feet were derived from immature pluripotent epithelial cells analogous to eccrine sweat gland germ cells. Mleczko et al. reported a case of Ber-EP4-negative BCC on the palm and speculated the origin from common progenitor cells of eccrine glands and epidermis. Histological findings of an epidermal collarette and ductal structure in the present case were similar to those of these reports. Immunohistochemical findings are consistent with those of Mleczko’s case with the exception of Ber-EP4. Basaloid cells in the present case express Ber-EP4 immunoreactivity as seen in nodular BCC. Because BCC with an epidermal collarette and ductal differentiation on the feet can be confused with eccrine poromas, molecular techniques measuringGli1 transcripts may be helpful in the differential diagnosis. The activation of hedgehog signals and upregulation of its critical transcriptional factor Gli1 are well documented in BCC, while the expression is absent in eccrine poroma/porocarcinoma. The present case corresponded to BCC with an epidermal collarette and ductal differentiation on the dorsal foot, which was unique for not only its location but also histopathology.

Negative-Pressure Suction Therapy for Epidermal Cysts

Epidermal cysts are a common cutaneous tumor. They are usually located on the scalp, face, neck, back, and trunk. There are many surgical approaches for epidermal cysts. Although complete surgical excision prevents recurrence, it is time consuming and requires suture closure. The minimal excision technique has been reported to be a lessinvasive method for successful removal of the sac. The minimal excision technique involves a 2to 3-mm incision, removal of the cyst contents, and extraction of the cyst wall through the incision. Although vigorous finger compression is used to express the cyst contents, cystic contents and blood will sometimes come in contact with each other.

In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20–70 mm), the mean width of these was 14.9 mm (range, 8–20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.

Infrazygomatico‐coronoid fixation in a segmental mandibular reconstruction with a free vascularized flap: A simple and correct repositioning method without interfering with reconstructive and microsurgical procedures

In a segmental mandibular reconstruction with a free vascularized flap, reproducing the optimal relationship between the condyle and glenoid fossa, and maintaining correct occlusion are important. We examined the practicality of a repositioning technique that combined bone plate fixation of the infrazygomatic crest and the coronoid process (infrazygomatico‐coronoid fixation [IZCF]) with maxillo‐mandibular fixation (MMF).

Superficial sebaceous carcinoma on the areola clinically mimicking mammary Paget's disease

the trunk, extremities, male genitalia and face. The disseminated subtype usually occurs on the back and genitoscrotal area, and it usually appears as flat, greyish-brown hyperkeratotic papules. The etiology and histogenesis of EH is unknown, but it has been suggested to represent an abnormality of keratinization, most commonly due to mutations in keratins 1 and 10. Similarly, these keratin mutations have also been demonstrated in EA. It is thought that keratin alterations have a hereditary basis in some disorders with EH, but in EA these keratin alterations are more probably induced by exogenous factors such as virus, immunosuppression, ultraviolet light, trauma or other environmental triggering factors. Light microscopy of EA reveals the characteristic features of EH. In addition, it may exhibit acanthosis, parakeratotic foci, papillomatosis and slight superficial perivascular lymphoid cell infiltrate. Three histological architectural patterns have been described: papillomatous, cup-shaped, and acanthotic, being the first the most common type. Differential diagnosis should include seborrheic keratosis, epidermodysplasia verruciformis and verruca plana, mainly in the disseminated type involving the trunk or the face. In the genital area, differential diagnoses may include condyloma accuminata, molluscum contagiosum, bowenoid papulosis and localized Darier’s disease, which can be clearly distinguished by histopathology. The absence of koilocytes, the lack of acantholytic dyskeratosis and the normal polarity of the epidermis are useful to rule out these entities. EA should also be distinguished from other benign acanthomas such as acantholytic acanthoma, which is characterized by the presence of acantholysis instead of EH. Treatment is not necessary because lesions are benign. If distressing to the patient, different options may be tried. Solitary EA may be treated by surgical excision, ablative laser CO2 or other destructive options such as cryotherapy. Disseminated EA has been successfully treated with focused cryodestruction. Other options for disseminated EA could be topical imiquimod and topical retinoids. Because calcipotriol regulates the proliferation and differentiation of keratinocytes and it has been used in disorders of keratinization, it could be an adequate treatment for this disorder. As it was effective in the case reported herein, we suggest considering calcipotriol in the treatment of disseminated EA.

Irregular fibrillar pattern is an artifactual expression of parallel ridge pattern on the pressure-loaded area of the sole: the efficacy of oblique view dermoscopy.

Dear Editor, Acral nevi can show three major dermoscopic patterns, depending on the anatomical site on the sole, namely the parallel furrow pattern (PFP), lattice-like pattern (LP) and fibrillar pattern (FP). Although the parallel ridge pattern (PRP) is highly specific to early acral melanoma, irregular FP is encountered partly or entirely. For the effective early detection of acral melanoma, Saida et al. revised their 7-mm criterion so that acquired acral melanocytic lesions with PRP or marked irregularity should also be excised, even when they are 7 mm or less. Recently, Saida et al. further revised their management strategy into a three-step algorithm. In this article, FP is first divided into regular and irregular types. Lesions of 7 mm or less without PRP and lesions larger than 7 mm showing typical benign patterns such as PFP, LP or regular FP should only be observed for changes. It is important to distinguish between regular and irregular FP in order to discriminate acral nevi from early acral melanomas. A 54-year-old Japanese woman presented with a 16 mm · 12 mm, irregularly shaped, variegated, black macule on the frontal site of the right sole (bodyweight-loaded area) (Fig. 1a). She had been aware of the lesion for several years. Dermoscopy demonstrated an irregular diffuse pigmentation and irregular FP, and a diagnosis of acral melanoma was made. After a few days, we applied oblique view dermoscopy (OVD) to the irregular FP according to the method reported by Maumi et al. While a picture taken by ordinary dermoscopy showed an irregular FP (Fig. 1b), a picture by OVD demonstrated a PRP (Fig. 1c).

Myxoid dermatofibrosarcoma protuberans prominently involving subcutaneous tissue: Efficacy of molecular analysis

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