Noriko Uemura

Histological investigation of common insensate flaps obtained from the hand and forearm regions for use in fingertip reconstruction.

Abstract Objective: Many skin flaps have been described for fingertip reconstruction; however, they have not been compared histologically. The aim of this study is to compare the histological features of common insensate flaps that are used for fingertip reconstruction. Method: Skin from fingertips and common flap donor sites on the hand and forearm of cadavers were harvested. This study investigated four histological characteristics, namely thickness of the epidermis and dermis; the ratio of collagen to elastic fibres (C/E ratio) in subdermal tissues, and distribution densities of Merkel cells and Meissner’s corpuscles. It then compared the values obtained to determine which flap donor site best matched the fingertip. Results: Epidermal thickness of the reverse digital artery island flap, thenar flap, and hypothenar flap was similar to that of fingertip tissue; dermal thickness of the hypothenar flap was similar to that of fingertip tissue. The C/E ratio of the reverse digital artery island flap was similar to that of fingertip tissue. Merkel cells were abundant in the reverse digital artery island flap, but Meissner’s corpuscles were few in each of the flaps compared with fingertip tissue. Conclusion: The flap donor site with histological properties most similar to fingertip tissue was the palmar lateral aspect at the finger base, representative of the reverse digital artery island flap with respect to epidermal thickness, C/E ratio, and presence of Merkel cells. The thenar and hypothenar flaps also showed similar properties.

An Examination of 123 Reconstructions of Facial Bone Patients with Titanium Implants: Does Titanium Benefit the Human Body?

There are various commercial tapes and necklaces containing titanium metal that are currently being marketed as sports and health-promoting products. The metal is advertised as being a performance-enhancing accessory for a winning athlete, and one such advertisement shows a piece of therapeutic equipment used to treat stiff shoulders and headache. What is the basis for the claims that titanium benefits the human body? If titanium is beneficial to the human body, patients who have had surgery to repair facial bones using such implants should experience the positive influence of titanium.

Desmoplastic transformation of a nodular melanoma arising from a speckled lentiginous nevus

Dear Editor, Melanomas arising from a speckled lentiginous nevus (SLN), which is also called nevus spilus, is extremely rare. Here, we present a case of a nodular melanoma arising from SLN and its transformation to desmoplasia. Our case is also intriguing due to the fact that desmoplasia was prominent at the metastatic sites. A 49-year-old woman presented with a pigmented plaque on her left thigh that had been present since birth. She had recognized a reddish nodule in the pigmented plaque 4 years prior. In September 2004, she visited a clinic and the nodule was resected. Physical examination at the previous clinic revealed a 5 mm 9 4 mm reddish nodule within a

Skin Necrosis Caused by Simple Massage Equipment

1 A 11-year-old boy was diagnosed as having ulcerative colitis at the age of 6 years, although his condition was almost cured. We report a rare case of extensive skin necrosis caused by simple massage equipment. The boy massaged his left thigh by using simple massage equipment (Fig. 1) before going to bed. At dawn, he noticed pain in his left thigh and found that a 10-cm portion of skin had turned dark. Therefore, at 9:00 am, he visited a dermatology clinic, where he received ointment treatment. However, the area with an abnormal color tone expanded and became darker, so he visited our hospital’s emergency department and was admitted. The anterolateral skin of his left thigh showed some blisters and a purplish black color within a surface area of 20 × 10 cm. Reminiscent of keloid constitution, posttraumatic and postoperative hypertrophic scars were scattered on the limbs and trunk. The inhalation activated partial thromboplastin time was 48.4 seconds, and the amount of fibrin degradation product was 40.7 μg. Blood tests conducted in the hospital revealed coagulation and fibrinolysis. The affected skin showed necrosis, including fat tissue. We performed debridement of the area 1 month after the injury (Fig. 2). Hematoma spread on the fascia, and obstructed perforating branches of the affected area were observed. The defect was covered with full-thickness skin grafts from the left groin. After more than 9 years, his left leg had fine motor function, and the affected skin was in good condition.

A Breast Foreign Body Migrating to the Back

1 Osamu Ito, MD, PhD Tomoyuki Yano, MD, PhD Department of Plastic Surgery Yokohama City Minato Red Cross Hospital Yokohama, Kanagawa, Japan Minako Ito, MD, PhD Medical Check Center Yokohama City Minato Red Cross Hospital Yokohama, Kanagawa, Japan Takayuki Shirai, MD Hiroki Miyashita, MD Noriko Uemura, MD Department of Plastic Surgery Tokyo Medical and Dental University Bunkyo, Tokyo, Japan Takeshi Kawazoe, MD, PhD Department of Plastic Surgery Kyoto University Kyoto, Japan Sir: A 72-year-old woman presented to our hospital with bilateral back nodules. She had received breast augmentation with silicone injections over 40 years ago; however, the silicon had moved in recent months and spread outside the breasts, resulting in breast deformations. She underwent silicone removal with partial resection of the pectoralis major muscle 6 months after the breast augmentation.

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia.

Backgrounds: The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. Methods: After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. Results: As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Conclusion Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained.

Volumetric changes in transplanted vascularized fat flaps after ischemic or congestive stresses and their relationship to capillary density in a zucker fatty rat model.

The aim of this study was to examine volumetric changes in fat flaps after stresses as well as their relationship with capillary density (CD) in a Zucker fatty rat model.