Yuiro Hata

Long-term outcome of intralesional injection of triamcinolone acetonide for the treatment of keloid scars in Asian patients.

We studied the long-term outcome of injection of triamcinolone acetonide into keloid scars in Asian patients. Between 1985 and 2003, we treated 109 keloid scars in 94 patients by injecting 1 to 10 mg of triamcinolone acetonide depending on the size of the lesion at four week intervals. There was little morbidity. Thirty-one patients gave up treatment within 10 injections because of pain and lack of immediate improvement. Improvement in subjective symptoms was seen in 52 of the remaining 63 patients (82%). In objective symptoms, fair or better results were seen in 40 of 63 (63%), and good or better results in 25 of 63 (39%). The treatment method required 20–30 injections over three to five years. Although we did not achieve as good results as other authors, we think it was safer because we used a smaller dose of a steroid.

Treatment of chronic facial palsy by transplantation of the neurovascularized free rectus abdominis muscle.

We performed neurovascularized free rectus abdominis muscle transplantations in two patients with chronic facial palsy. In one patient, the postoperative course was uneventful, but the patient died from rupture of esophageal varices. In the other patient, both morphologic and functional results were satisfactory. Therefore, the rectus abdominis muscle is considered to be a suitable donor for muscle transplantation for the treatment of chronic facial palsy. The rectus abdominis muscle is advantageous in that (1) simultaneous operations by two teams are possible with the patient in the supine position, (2) it is supplied by long nerves and long and large vessels, (3) it is flat and consists of segments with appropriate lengths, (4) the force and distance of contraction are appropriate, and (5) the tendinous intersections are suitable for anchoring sutures.

Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry

An anterolateral thigh flap is very useful in head and neck reconstruction because of its long and large-caliber vascular pedicle, large skin territory and elevation simultaneous with tumour resection. However, the number and locations of cutaneous perforators vary individually, and thus, it is not widely used because flap elevation is often complicated and time-consuming owing to unexpected anatomical variations. To overcome this disadvantage, we assessed the number and locations of cutaneous perforators preoperatively by colour Doppler flowmetry. These data were compared with the intraoperative anatomical findings and their reliability evaluated. A total of 48 cutaneous perforators were found by preoperative colour Doppler flowmetry scanning of 17 anterolateral thigh flaps. All the perforators except two were found intraoperatively. Doppler scanning failed to detect four perforators. Colour Doppler flowmetry assessment therefore has a 92% true-positive rate and a 95.8% positive predictive value. All the flaps except one included multiple perforators, and sufficient blood circulation was observed in all cases. No flaps were unexpectedly changed to anteromedial thigh flaps or contralateral anterolateral thigh flaps because of inappropriate cutaneous perforators or the absence of perforators. Though this investigation is relatively time-consuming (30-40 min) and requires skill, it is very useful for preoperative flap planning and increases the reliability and safety of elevating an anterolateral thigh flap.

Correction of congenital microtia using the tissue expander.

We attempted auricular reconstruction using Ra-dovan-type inflatable silicone expanders in six children and one adult, with the complete hypoplastic, the conchal remnant, and constricted type of microtia. Ear frameworks, including the helix, anthelix, concha, and tragus, were prepared using autologous rib cartilage. Based on the surface area of the normal adult auricle, the silicone expander was tentatively shaped and sized into a rotated semiellipse and expanded with 70 cc saline. Auricular reconstruction on the framework was completed at the time of insertion in four of the seven patients, requiring no elevation of the ear. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. Mild complications were noted in three of the seven patients. However, no resorption of the inserted rib cartilage has been observed 14 months to 2 years and 5 months after the operation. Slight shrinkage of the expanded skin was noted in each patient.

Two cases of Merkel cell carcinoma cured by intratumor injection of natural human tumor necrosis factor

Two patients were treated with intratumor injection of natural human tumor necrosis factor for recurrent or primary Merkel cell carcinoma. In both patients, local chemotherapy achieved complete tumor regression without causing ulceration or scarring. These results suggest that intratumor injection of natural human tumor necrosis factor may be very effective for the treatment of Merkel cell carcinoma.

Toxic shock syndrome after suction lipectomy.

We present a case of toxic shock syndrome with necrotizing fasciitis after suction lipectomy. The patient underwent aesthetic suction lipectomy of the abdomen, buttocks, and thighs during an office procedure by a cosmetic surgeon. On postoperative day 2, the patient was referred to the emergency department of our hospital because of pain. On admission, the patient was in toxic shock. She required intensive medical treatment for about 1 month, along with psychiatric help to adapt after the illness. Although toxic shock syndrome is a rare postoperative complication, every plastic surgeon should be acquainted with it. A combination of early recognition, diagnosis, and aggressive supportive therapy is the only successful treatment.

Treatment of nevus Ota: combined skin abrasion and carbon dioxide snow method.

&NA; Thirty‐seven patients with nevus Ota were treated by skin abrasion—carbon dioxide snow therapy. Data obtained from 24 patients (including 5 infants) who completed treatment were analyzed to determine the number of treatment courses and to assess the outcome by color and histologic type. The 5 infants completing treatment received a mean of 10 courses of carbon dioxide snow therapy. Excluding these infants, the mean number of treatment courses was 3 for skin abrasion and 16 for carbon dioxide snow therapy. The therapeutic outcome was satisfactory, being graded as “excellent” in 6 patients, “excellent to good” in 6 patients, “good” in 10 patients, and “fair” in 2 patients. None of the patients had a “poor” outcome. Darker lesions were generally less responsive to treatment. Lesions with melanocytes in the superficial dermis showed a better response with fewer courses of treatment. Those with melanocytes throughout the whole dermis generally had a poorer outcome. The results confirm that the benefits of this procedure are limited by the associated pain and the need for great skill and a long treatment duration. (Plast. Reconstr. Surg. 97: 544, 1996.)

Treatment of tattoos with pure epidermal sheet grafting

We treated tattoos with a new method in which the epidermis of the tattooed skin was replaced after removing the dermis, which contained tattoo pigments. The separation of the epidermis from the dermis was performed enzymatically with the use of dispase. The time required for healing of the wound was markedly shortened.

Results of the Allen test on 2,940 arms.

The ulnar arterial circulation to bilateral hands of 683 men and 787 women was assessed with the Allen radial artery compression test. Of the 2,940 arms, the Allen test showed abnormalities in 105 (3.6%). The incidence of abnormality generally increased with age: 2.2% in the first decade and 6.9% after the ninth decade. It is very likely that circulatory failure in the hand develops after several decades among those whose radial artery was removed in their youth. When the radial artery is removed in the young, attention should therefore be paid to future consequences.

Repair of mild umbilical hernia.

A mild, persistent umbilical hernia that does not cause any functional problem is often ignored. The authors have devised a new technique to treat the mild, protrusive deformity of the umbilicus without associated complications. In this report, the new operative procedure is introduced. The authors have treated 72 patients with this method and have obtained good results.