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Summary:. Currently, an increasing number of patients are undergoing hemodialysis. However, little is known regarding the outcome or perioperative management of head and neck cancer reconstruction in patients undergoing hemodialysis. Here, we report two cases of patients with maxillary squamous cell carcinoma undergoing hemodialysis. The patients underwent total maxillectomy and free abdominal flap transfer. A short-thread double-needle was used in one patient because arterial calcification and intimal dissection were observed during microvascular anastomosis. Maintenance hemodialysis was performed the day before and after the surgery. Nafamostat mesylate, an ultra-short acting anticoagulant, was used in the postoperative hemodialysis for 2–3 weeks to prevent bleeding. The flaps survived completely, and no major postoperative complications occurred in either case. One patient showed no evidence of disease at 1 year following the surgery, whereas the other patient died of cancer metastasis 6 months following the surgery. Although further standardization of perioperative hemodialysis management is needed, free flap reconstruction could be considered a safe and effective therapeutic strategy for patients with head and neck cancer undergoing hemodialysis.

Summary:. Enterocutaneous fistula (ECF), which is an abnormal connection between the gastrointestinal tract and skin, is a serious complication of abdominal surgery, and a multidisciplinary approach is required for its treatment. Here, we report the case of a 46-year-old woman who had a large ECF measuring 6 × 12 cm that was successfully treated with a 2-stage surgery. After the first surgery of intestinal wall reconstruction, an abdominal negative pressure wound therapy (NPWT) device was administered to facilitate the reexploration of the abdominal cavity. On postoperative day 5, intestinal perforation and abdominal cavity infection were found during dressing change and were immediately repaired. Subsequently, after 10 days of abdominal NPWT, the second surgery comprising abdominal wall reconstruction was performed using a pedicled anterolateral thigh flap (8 × 19 cm) combined with the fascia lata (12 × 20 cm). The defective rectus sheath and skin were uneventfully closed with the fascia lata and flap skin paddle, respectively. In the follow-up after 7 months, ECF had not recurred. The abdominal NPWT device enabled easy reentry of the abdominal cavity and reduced the size of the flap needed to cover the defect. Moreover, open abdominal management can be performed consistently, independent of the surgeon’s expertise. Therefore, this report suggests that 2-stage surgery with abdominal NPWT management is a useful strategy for ECF treatment.

Appropriate positioning of the inframammary fold (IMF) is essential for breast reconstruction. The purpose of this study was to quantitatively measure and evaluate the anthropometric position of the IMF in the thorax. A total of 145 Japanese women with unilateral breast cancer were analyzed. To indicate the superior-inferior position of the IMF on the non-diseased side, the distances from the sternal notch (SN) to the IMF along the midline (SN-IMFM) and from the SN to the umbilicus (UB) (SN-UB) were measured. A new index, the thorax anthropometric position (TAP) index for the IMF, was then defined as the ratio of SN-IMFM to SN-UB. The TAP index was calculated for each patient, and its correlations with demographic parameters, including age, body height, and body mass index, were statistically assessed. The TAP index was normally distributed and ranged from 0.500 to 0.704, with a mean of 0.590. Multivariate analysis revealed that age was an independent factor associated with a higher TAP index (

Summary Background Pelvic lymphoceles are the most common complications after pelvic lymphadenectomy. Microsurgical procedures have attracted attention as an alternative treatment for lymphoceles. Here, we report six cases of refractory lymphoceles that were successfully treated using lymphovenous anastomosis. Methods Six patients underwent surgery for gynecologic cancers and developed pelvic lymphoceles, which did not respond to conventional treatment. We mainly performed lymphovenous anastomosis on the ipsilateral lower limbs, although some procedures were also performed on the contralateral limbs. The lymphocele volume change after lymphovenous anastomosis was examined using computed tomography and compared using the Wilcoxon test. Results Five of the six refractory lymphocele cases were successfully treated using lymphovenous anastomosis, and the remaining case exhibited an 87% reduction in lymphocele volume. The average numbers of anastomoses were 6.7 on the ipsilateral side and 2.8 on the contralateral side (the median numbers: 6 [range: 5-9] vs. 3 [range: 1-4], P=0.034). The average lymphocele volume significantly decreased from 414.0 mL preoperatively to 8.0 mL postoperatively (the median lymphocele volume: 255.8 [range: 61.5-1,329.2] vs. 0 [range: 0-47.7], P=0.0313). Conclusion We found that microsurgical treatment was potentially effective for lymphoceles that did not respond to conventional treatment.

PURPOSE The purpose of this study was to compare the midfacial fracture patterns and management approaches between pediatric and adult patients. METHODS We retrospectively analyzed 164 pediatric patients (

Frontonasal dysplasia (FND) is a congenital malformation of the central portion of the face, including the eyes, nose, and forehead. Owing to its rarity and wide spectrum of phenotypes, the optimal timing and technique of surgery remain controversial. Here, we report a case of a patient with FND, who presented with respiratory distress. The deformed nostrils were so small that the patient could not normally breathe through the nose immediately after birth. Rhinoplasty using a costochondral graft was performed at 16 months of age. After surgery, the nostrils enlarged and the appearance of the nose improved. Although congenital nasal deformity is frequently corrected during adolescence, surgery at an early stage can be considered when important issues are noted, such as inability to breathe through the nose.

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy.