Mitinari Muraoka

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.

Rectangular mucosal flap with artificial dermis grafting for vermilion deformity in cleft lips

UNLABELLED The treatment of whistling deformity in patients with cleft lip remains controversial. Previous reconstruction methods of whistling deformity have been limited in volume due to the necessity for primary closure of the donor site. This article presents a new method for secondary reconstruction of the vermilion deformity in patients with cleft lip. Our method is very simple and advantageous, in that primary closure after correction is not required. A rectangular mucosal flap is designed at the wet mucosal aspect of the upper lip. Inferiorly, this flap is based at the junction of the vermilion and mucosa, while the upper incision line should be at the buccal sulcus. This rectangular flap is advanced sagittally, and a labial thickness is reconstructed. Artificial dermis is grafted to the mucosal defect after flap advancement and mucosa regenerates secondarily. We applied this technique to secondary reconstruction in 32 patients with cleft lip between January 2001 and January 2005. Major complications (necrosis of mucosal flap and recurrence of whistling deformity) did not occur in any of the patients. Four patients required minor operations to reduce the volume. CONCLUSIONS This rectangular mucosal flap with artificial dermis offers many advantages, including easy technique and minimal sacrifices. The combination of mucosal flap and artificial dermis prevents postoperative scar contracture and reduces the limitations of using the available volume of flap. We believe that this procedure is versatile and reliable not only for whistling deformity in cleft lip patients, but also for tissue defects of the lip resulting from other causes.

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.

Reconstruction of the inner site of the auricle with two local skin flaps.

The external auditory canal and the auricular concha were reconstructed with two local skin flaps after resection of a primary adenoid cystic carcinoma of the external auditory canal. The upper part of the inner site of the auricle was covered with a superiorly-based posterior skin flap and the lower part of it with an inferiorly-based anterior one. Both were cutaneous flaps with a random pattern of blood supply. At the same time the surgical field after the flaps had been raised made additional excision easy, including partial mastoidectomy and parotidectomy. After 10 years of the operation auricular disfigurements and recurrence of the tumour are not observed.

Elongated uvula with a pleomorphic adenoma: a rare cause of obstructive sleep apnea syndrome.

The authors encountered a case of elongated uvula with a pleomorphic adenoma originating from the minor salivary gland, causing frequent upper airway obstruction. A 75-year-old woman had obstructive sleep apnea syndrome brought about by the swallowing impact of the pendulous tumor into the hypopharyngeal and supralaryngeal spaces. Although there are some case reports about tumors originating from the uvula, this is the first reported to cause obstructive sleep apnea syndrome.

Pulsed dye laser treatment for linear scars with concave and erythematous appearance

Facial linear scars with concave and erythematous appearance sometimes occur after long observation even if adequate conservative treatments have been applied. Because the regenerated epithelium is thin, those scars are seen as red or pink, and are sometimes accompanied with postinflammatory hyperpigmentation. For these scars, flashlamp-pumped pulsed dye of the wavelength of 585 nm and pulse-width of 450 µs was used, and acceptable results were obtained. Three cases required one treatment and one case needed two, and any side effects were not recognized. Compared with the carbon dioxide laser, which often shows severe scarring as a side effect, the pulsed dye laser with a short down time is useful.

Tranilast as an Additional Treatment with Conservative Therapy for Concave Deformity Following Traumatic Hematoma

Fibrotic scar tissue resulting from a cheek hematoma sometimes seriously contracts to form a concave deformity, despite conservative therapy. We used Tranilast as an additional treatment with conservative therapy for four patients who were resistant to massage and compression therapy. Four months after oral administration of Tranilast, all the deformities were resolved. Tranilast is used for the treatment of allergic diseases and keloids. It inhibits the release of transforming growth factor b-1, interleukin-1 b, and prostaglandin E2. It also suppresses collagen synthesis by fibroblasts.