Naotaka Ishikura

The use of a free medialis pedis flap for resurfacing skin defects of the hand and digits: results in five cases.

A free medialis pedis flap was used to repair skin defects of the fingers and hand in five patients, the flap sizes ranging from 2 x 3 cm to 5 x 10 cm. Four flaps survived completely, but the largest flap turned necrotic along the dorsal margin, which is thought to have resulted from an incorrect flap alignment. A free medialis pedis flap possesses several advantages: (1) It is very thin in comparison with other standard free flaps; (2) it can be used for small repairs, unlike many conventional free flaps; (3) it possesses two draining venous pathways, the vena comitans and the subcutaneous veins; (4) the diameters of its vessels are similar to those of the fingers; (5) it provides a good color and texture match for finger repairs; and (6) a good recovery of protective sensation is achievable, probably due to its thinness. However, this flap also has some disadvantages: A skin graft is usually required for donor-site closure, and it cannot be used as a sensory flap.

Repair of complete syndactyly by tissue expansion and composite grafts

Repair of complete syndactyly by a combination of tissue expansion and composite grafts from the glabrous non-weight bearing areas of the foot has been performed on three syndactylies in two patients. The commissure and the lateral areas of the proximal and middle phalanges were covered with expanded skin and the separated fingertips were covered with composite grafts. Without using an ordinary skin graft, this method can provide aesthetically excellent results with good skin colour and texture.

Treatment for chronic abscess after cranioplasty: reconstruction of dura maters using the anterolateral thigh flap with fascia lata.

Although artificial dura maters such as Gore-Tex® are used in cranioplasty, the use of artificial products occasionally results in the formation of infectious lesions. Recently, we encountered two patients who underwent brain surgery and contracted infection from artificial dura maters used for cranioplasty. To treat the postoperative infection, we prepared a vascularized fascia lata attached anterolateral thigh flap that could be applied to the infected wounds in the reconstruction of dura maters and obtained satisfactory results. The present study demonstrated that fascia lata attached anterolateral thigh flaps were useful for reconstructing intractable cranial fistulae complicated by infection. The disadvantages of our surgical technique were the impossibility of simultaneous bone reconstruction and the difficulty in creating a watertight closure of fascia and dura mater, although leakage of cerebrospinal fluid was not observed so far.

Use of skin staples to fix film dressings on scalp donor wounds in patients with burns.

Split-thickness skin grafts (STSGs) from the scalp have been used in large burns. The donor site wounds are usually covered using occlusive dressings, such as film dressings because they contribute to reduce donor site pain and infection under exudative crust and to enhance re-epithelialization. However, it is not always easy to fix such film dressings to the scalp because of the presence of hair. In this paper, we report the use of skin staplers to fix the film dressings. Eight donor sites in four patients were dressed in this way. The patients had 50-78% of the body burned, all of them survived. The mean healing time for the donor sites was 6.8 days. Three patients had their scalps re-harvested several times (range two to three times). There were no infections nor secondary skin ulcers at the donor sites. The technique of this dressing is very simple and speedy, thus we recommend the use of skin staplers to fix the film dressing to scalp donor wounds in patients with burns.

Burn due to misuse of an acetylene gas burner: a case report

A rare case of deep penetrating burn injury caused by misuse of a high-pressure acetylene burner is reported. A 35 year old man was admitted with second and third degree burns involving the right arm cubital area and a subcutaneous burn on his right arm caused by a high-pressure acetylene gas flame. Early surgical debridement and secondary skin grafting using a preserved subcutaneous vascular network skin graft (PSVNSG) proved effective in this patient. Skin contracture was prevented and function was recovered. The basis of PSVNSG is that the vascular system existing in the graft is used as a permanent vascular system without degeneration. This case shows that, in this kind of burn injury, subcutaneous tissue damage should be suspected and that it is important to perform surgical debridement early after admission.

Rudimentary polydactyly: Report of five cases

Rudimentary polydactyly was found in five patients. Surgical exploration of the papules revealed findings that have not been previously published. A cord-like structure arises from the bottom of the papule, with its proximal portion joining the neurovascular bundle of the digit. Histologic examination of the cord showed strong similarity to the neurovascular bundle of a finger. From these findings, we assume that rudimentary polydactyly may represent the amputation stump of pedunculated fingers.