Search

Introduction: In severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma. Patients and Methods: The three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions. Results: We successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation. Conclusions: Highly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives.

Objective: To examine morphological changes of the lip and nose during resting and lip protrusion in patients with unilateral cleft lip. Methods: A total of 41 patients with unilateral cleft lip who underwent primary lip repair were included in the study population. The distortion of the lip and nose was measured and evaluated using photographs of the preoperative and postoperative resting lips and the postoperative protruding lips. Results: The position of the labial commissure on the affected side was cranially deviated before lip repair, and the deviation remained after surgery. The degree of cranial deviation was increased by lip protrusion. The position of the alar base on the affected side was caudally deviated before lip repair and improved after surgery; however, it was displaced cranially by lip protrusion. Horizontal displacement of the lip and nose was improved after surgery, and there was no change during lip protrusion. Conclusions: The characteristic facial distortion in patients with unilateral cleft lip were confirmed. Patients with cleft lip had distortions in the labial commissure and the nose. One of the important future challenges in cleft lip treatment is to focus on changes caused by muscle movement and provide natural and symmetrical facial expressions.

Large bilateral symmetrical vulvar tumors are rare. A 30-year-old multiparous Asian woman presented with severe discomfort during urination and intercourse owing to a large bilateral symmetrical lipoma in the labia majora. En bloc resection through a pre-existing Caesarean scar achieved good cosmetic and symptomatic results. This alternative and unique approach may be helpful in similar rare cases.

Internal fixation using plates remains the gold standard for facial fracture fixation. External wound fixators are rarely used. In the present study, we successfully treated multiple comminuted facial fractures with midfacial depressions by using a Hoffman-type external fixator and achieved good functional and cosmetic results. Internal fixation using plates is sometimes problematic in comminuted facial fractures, such as those associated with high-energy trauma. Depending on the fracture pattern, a Hoffman-type external fixator, which is a single pillar type of external fixator, can be effective.

Abstract Background In recent years, the number of patients with ischemic skin ulcers due to diabetes mellitus and arteriosclerosis obliterans are increasing. Accordingly, endovascular therapy, drugs, and various wound dressings have been developed and applied to diabetic foot ulcers, and negative-pressure wound therapy, which often requires expensive and burdensome procedures for medical personnel, has also become popular. So simple and minimal invasive home treatment by the patient or their caregiver is required. Case presentation The present patient (77 years old, male, Asian) had developed left sole ulcers with draining pus that were resistant to conventional treatment, and he suffered from gait disturbance. We report a case of metatarsal osteomyelitis in a patient with diabetes mellitus and arteriosclerosis obliterans, in whom artificial carbon dioxide foot bathing and povidone–iodine sugar ointment were used continuously to promote bone and joint regeneration, and skin ulcer healing. Conclusions A simple therapeutic intervention with artificial carbon dioxide foot bathing and povidone–iodine sugar ointment can improve not only ischemic skin ulcers, but also the bone and joint regeneration of ischemic limbs. This therapy can lead to a reduction in healthcare costs for a huge number of diabetic patients.

Background. Efficient treatment of extensive skin defects by using skin grafting is a significant challenge because the skin available to use is limited. A mesh graft is usually used; however, the expansion ratio is small (up to 1:6) and inaccurate. The Meek technique is a method of skin grafting that processes the skin into micrografts by cutting. The advantage of the Meek technique is its efficient use of available skin, expanding its area by up to 9 times. In 2020, Japanese insurance companies began to cover treatment using the Meek technique. This report aimed to show the usefulness of the Meek technique for treating left leg necrotizing fasciitis. Methods. A 55-year-old male was referred to our hospital for treating necrotizing fasciitis of the left leg. Debridement was performed, and antibiotics were administered immediately. After 1 month, Meek micrografts were applied to the left knee wound. The expansion ratio of the Meek micrografts was 1:9. Results. The skin was processed 9 times using the Meek technique, enabling effective use of a small amount of skin. Epithelialization of the Meek micrograft area was completed 1 month after skin grafting. The scar after Meek micrografting was soft and not reddish. The range of motion of the knee joint was >90 degrees. Conclusions. The Meek technique allows expansion of limited skin efficiently. Meek micrografts can cover a larger wound with smaller skin grafts than is possible with mesh grafts. After healing with Meek micrografts, the scar was soft, and the knee joint flexed smoothly. The Meek technique is useful for treating large wounds requiring skin grafts. [ABSTRACT FROM AUTHOR]

Background. The pectoralis major musculocutaneous (PMMC) flap is a versatile and commonly used technique for reconstruction of the head and neck in patients at high risk in free tissue transfer procedures. In this report, a "supercharged" PMMC flap, in which the lateral thoracic artery was cut, preserved, and anastomosed to the cervical vessels, was developed to stabilize blood flow. Methods. The supercharged PMMC flap was introduced in a patient who was at high risk for partial necrosis of the flap and underwent surgery for reconstruction of the tongue. Intraoperative perfusion monitoring using laser-assisted indocyanine green angiography (ICGA) was also performed to verify the status of blood flow in the flap. Results. ICGA monitoring of blood flow in the flap revealed instability. Subsequently, a supercharged PMMC flap was applied, which prevented partial necrosis of the flap. Conclusions. Combined with ICGA, a supercharged PMMC flap contributed to successful reconstruction in a patient at high risk for necrosis of the flap region. [ABSTRACT FROM AUTHOR]