Satoshi Urushidate

Is prolonged and excessive cooling of a scalded wound effective

An experimental study was carried out using rats to evaluate the effectiveness of prolonged and excessive cooling on the burned wound just immediately after injury. The wound was produced by applying a lint immersed in boiled water at 99 degrees C. The wound produced by applying a lint for 3 s, and then immediately soaking with tap water for 1 min, resulted in little damage. However, the wound produced by applying a lint for 10 s, and immediately after an ice cube applied for 10 min, resulted in the most severe damage. The wound produced by applying a lint for 10 s, and no treatment applied thereafter, and the wound produced by applying a lint for 10 s and immediately after soaked with tap water for 1 min, resulted in moderate damage. From this experiment, it is suggested excessive and prolonged cooling of the burn wound, such as using an ice cube immediately after injury, is harmful in some instances.

nasal Reconstruction Based on Aesthetic Subunits in Orientals

&NA; Reconstruction based on the aesthetic subunit principle has yielded good aesthetic outcomes in patients with moderate to severe nasal defects caused by trauma or tumor resection. However, the topographic subunits previously proposed are often unsuitable for Orientals. Compared with the nose in white patients, the nose in Orientals is low, lacks nasal muscle, and has a flat glabella; the structural features of the underlying cartilage and bone are not distinctly reflected in outward appearance. The authors devised aesthetic subunits suitable for Orientals, and they used these units to reconstruct various parts of the nose. The major difference between these units and those presented previously is the lack of soft triangles and the addition of the glabella as an independent unit. The authors divided the nose into the following five topographic units: the glabella, the nasal dorsum, the nasal tip, and the two alae. The border of the nasal dorsum unit was extended to above the maxillonasal suture. The basic reconstruction techniques use a V‐Y advancement flap from the forehead to reconstruct the glabella, an island flap from the forehead to reconstruct the nasal dorsum and nasal tip, a nasolabial flap to reconstruct an ala, and a malar flap to reconstruct the cheek. A combination of flaps was used when the defect involved more than one unit. This concept was used for nasal reconstruction in 24 patients. In one patient undergoing reconstruction of the nasal dorsum and in one undergoing reconstruction of the nasal tip, the texture of the forearm flap did not match well, which resulted in a slightly unsatisfactory aesthetic outcome. In one patient in whom the glabella, nasal dorsum, and part of the cheek were reconstructed simultaneously, a web was formed at the medial ocular angle, and a secondary operation was subsequently performed using Z‐plasty. In one patient undergoing reconstruction with a forehead flap, defatting was required to reduce the bulk of the subcutaneous flap pedicle at the glabella. However, suture lines were placed in the most inconspicuous sites in all patients, and the use of a trapdoor contraction emphasized the three‐dimensional appearance of the nose. The use of these aesthetic subunits for reconstruction offers several advantages, particularly in Oriental patients. Because the nasal dorsum is reconstructed together with the side walls, tenting of the nasal dorsum is avoided, which prevents a flat appearance of the nose. A forehead flap is useful in the repair of complex defects. Defects of the alae should be separately reconstructed with a nasolabial flap to enhance the effect of the trapdoor contraction and to highlight the three‐dimensional appearance of the nose. Candidates for reconstruction should be selected on the basis of nasal structure. The results suggest that these units can also be used in some white patients. (Plast. Reconstr. Surg. 106: 36, 2000.)

Association between concentration of trace elements in serum and bronchial asthma among Japanese general population.

BACKGROUND AND AIMS A number of previous studies had revealed the association between trace elements in serum and bronchial asthma. However, only a few researches had focused on serum concentration of trace elements in a general population. In this study, an association between trace elements in serum and bronchial asthma was investigated in a general population. METHODS Subjects were 1025 volunteers (385 males and 640 females between ages 19 and 82 years old) who had participated in the Iwaki Health Promotion Project 2005. Bronchial asthma was diagnosed based on the European Community Respiratory Health Survey II according to the self-questionnaires on health conditions of subjects. The serum concentrations of certain trace elements (manganese, copper, zinc, selenium and iron) were measured and compared. Also, an association between serum trace elements level and neutrophil-related functions (oxidative burst activity, phagocytic activity, serum opsonic activity) were determined. RESULTS In males, no significant differences were seen in any serum trace elements concentrations. In females, serum zinc level was significantly higher in bronchial asthma group than in control. A positive correlation was seen between serum concentration of zinc and serum opsonic activity in both genders. CONCLUSIONS In female asthmatics, increase of oxidative stress was suggested to be caused by superoxide dismutase pathway (elimination system of reactive oxygen species) rather than serum opsonic activity (production system of reactive oxygen species from neutrophils) pathway, as the zinc concentration in bronchial asthma group was higher than that in control.

Estlander flap combined with an extended upper lip flap technique for large defects of lower lip with oral commissure

Various methods of reconstructing lower lip partial defects have been reported, for example those using the upper lip such as the Abbe and Estlander flap techniques. However, when a large defect of the lower lip with oral commissure is presented, the choice of reconstruction method is often difficult. For such cases, the Estlander flap technique is often used, although displacement of the oral commissure is one of the remaining problems. In the case of large defects of the lower lip with oral commissure, we opted for a reconstruction method in which the entire upper lip was incised and extended, a portion of which was reflected as a traditional Estlander flap. Four cases were treated using this method, and in all cases there were no complications such as venous return disturbance, and the site healed well. Sensation returned within 3 months, and contraction of the lips appeared within 6 months. The symmetry of oral commissures was maintained and the appearance was almost cosmetically satisfactory. Our technique is especially useful for reconstructing defects affecting 1/3-2/3 of the lower lip including the oral commissure. This technique is cosmetically and functionally successful and the symmetry of the oral commissure is maintained.

Reconstruction of large nasal defects with a combination of local flaps based on the aesthetic subunit principle.

Herein is described a technique that uses a combination of local flaps to reconstruct large defects involving the nasal dorsum and cheek. The flaps used are a transposition flap elevated from the area adjoining the defect and bilateral cheek advancement flaps. This technique leaves all suture wounds at borders of the aesthetic subunits that have been described previously. Color and texture matches were good and symmetrical. The transposition flap can be modified according to whether the defect includes the nasal tip. After raising the cheek advancement flap, it is also possible to use a dog‐ear on the nasolabial region for any alar defects. Nine patients were treated using this procedure. The technique is very reliable (no complications such as congestion and skin necrosis in our series) and is easy to perform. One patient had palpebral ectropion after the operation and underwent secondary repair. In this series, defects measuring 45 × 30 mm in maximum diameter and including the nasal dorsum, nasal tip, ala, and cheek were treated. (Plast. Reconstr. Surg. 107: 1358, 2001.)

Helical crus reconstruction using a postauricular chondrocutaneous flap

The authors describe a helical crus reconstruction technique using a postauricular chondrocutaneous flap vascularized by the postauricular vessels. They used this procedure on 7 patients who had developed a large defect on the helical crus following surgery. In each patient the flap design was adjusted to fit the form of the defect. All flaps were in easy reach of the defect and all flaps survived without any complications. The reconstructed ears had good three-dimensional form, and the color and texture match was satisfactory. The flap donor site was not noticeable because it was hidden behind the ear. Constriction did not occur and a good form was maintained. Neither deformity due to scar contracture nor absorption of the cartilage was observed.

Hydration and occlusive treatment of a sutured wound

To evaluate the effects of surgical tape application to an incised wound after suture removal, a test using Micropore and Blenderm tape (3M, St. Paul, MN) was carried out. Eighteen patients with a sutured wound following surgery in the groin and extremities were divided into two groups. Each group was treated in one of the following ways for a period of 3 months: with Micropore, Blenderm, or with no treatment at all. After 3 months the plaster was removed and no further treatment was rendered. Evaluation of the scar was carried out for 6 to 9 months after surgery and the two areas were compared in each patient. In 13 groin wounds, better cosmetic results were achieved in the areas treated with Blenderm compared with the areas treated with Micropore or no treatment, although the difference was not significant. Better results were also observed on areas treated with Blenderm in 5 patients with scars on the extremities. The areas treated with Blenderm were less red and less hypertrophic than the areas treated with Micropore.

Reconstruction of a three-dimensional structure using cartilage regenerated from the perichondrium of rabbits.

Human tissues such as those found in the ear, nose, eyelid, lip, and larynx have complicated and delicate three-dimensional structures, which are difficult to reconstruct and restore to normal function following damage by tumor, congenital disease, or trauma. We devised a new reconstructive technique for the lost tissues by using cartilage regenerated from the perichondrium. In 12 ears of 12 rabbits, the layer between the perichondrium and the cartilage was stripped off. The exposed cartilage was punched out in large amounts to resemble a flexible, honeycomb-like structure. Then, we sandwiched the rabbit ears with two thermoplastic plates, which maintained a structure of the anterior surface of the human ear for 8 weeks. Structural change was studied in all cases, and some parts of the remodeled tissue were studied pathologically. Out of 12 ears, 8 had a rigid structure with a shape like a human ear using regenerated cartilage from the perichondrium of rabbits, 2 were infected, and 2 had a decubitus ulcer on the conchal surface as a result of compression from the plate. This study suggests that the use of the cartilage regenerated from the perichondrium may lead to a successful treatment also in humans for a variety of three-dimensional structures that have been damaged.

Reconstruction of congenital stenosis of external auditory canal with a postauricular chondrocutaneous flap

&NA; We describe here a new surgical technique for treatment of congenital stenosis of the external auditory canal using a postauricular chondrocutaneous flap. Our technique prevents recurring stenosis by cartilage support and provides a sufficient extension of the canal. The chondrocutaneous flap is safely elevated, easily reaches the canal, and has ample blood supply. It is beneficial for its self‐cleaning function that the remnant canal, which contains cerumen glands, is used as part of the reconstructed canal. Six patients with congenital stenosis of the external auditory canal were treated by our procedure. In these patients, three patients were treated by a postauricular approach and the others were treated by an endaural approach. All patients had very satisfactory results. (Plast. Reconstr. Surg. 102: 2320, 1998.)

Three cases of giant pilomatrixoma – considerations for diagnosis and treatment of giant skin tumours with abundant inner calcification present on the upper body

BACKGROUND Pilomatrixoma frequently occurs as a solitary, small tumour on the face or upper extremities of people younger than 20 years. METHODS We report three cases of giant pilomatrixoma. In all these cases, outward appearances and imaging investigations suggested malignant tumours. Preoperative biopsies suggested that case 1 was a basal cell carcinoma, but cases 2 and 3 had no malignant features on biopsy. Two of the cases experienced rare complications - hypercalcaemia caused by parathyroid-related protein (PTHrP) production and multiple occurrences. RESULTS All three tumours were removed with a 1-3-cm margin. The postoperative histopathologies showed pilomatrixoma in all three cases. CONCLUSIONS Rarely, pilomatrixoma develops to a giant size with various atypical outward appearances consistent with a malignant tumour. Preoperative clinical appearances frequently lead to misdiagnosis, and preoperative examinations are unreliable. Therefore, when a giant tumour with abundant inner calcification is present in a young patient, the possibility of a pilomatrixoma should be considered.