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We report on a patient with septic arthritis of the knee with Pantoea agglomerans after a penetrating black locust thorn injury. Antibiotics alone or in combination with an arthroscopy may be insufficient for achieving source control. Accurate medical history and open debridement with a search for a thorn fragment are key to successful treatment.

Cleft lip repair is performed in the supine position, tilting the head back under general anesthesia. However, postoperative results are evaluated in the upright position while patients are awake. The purpose of this study was to anthropometrically assess whether nasolabial features of infants with unilateral cleft lip are influenced by posture and anesthesia.Three-dimensional facial images in a preoperative upright position and operating supine position under general anesthesia were captured from 51 consecutive infants with unilateral cleft lip. Twenty-four indirect anthropometric measurements (11 for the nose and 13 for the lip elements) were considered on each infant.In the supine position under general anesthesia, alar surface distance was significantly shorter (p 0.001). Regarding lip measurements, medial lip height of the cleft side and philtrum height were significantly smaller (p 0.05 and p 0.05, respectively), whereas vermilion height was greater (p 0.01). In addition, the cleft width and lip width were significantly broader (p 0.001 and p 0.001, respectively) after general anesthesia.Several nasolabial alteration patterns are found after general anesthesia that are presumably attributable to cessation of nasal breathing and the action of muscle relaxation. Surgeons should take these nasolabial changes into account during preoperative planning and postoperative assessment.

Objectives Conventional 2-stage expander-implant breast reconstruction is frequently performed. However, direct to implant reconstruction should be considered if indicated and if circumstances allow. One difficulty in breast reconstruction postmastectomy is selection of the appropriate implant size prior to surgery. The ability to estimate implant volume and mastectomy-specimen volume from the preoperative breast volume using a 3-dimensional (3D) scanner would greatly facilitate reconstruction. We investigated the relation between preoperative breast volume, mastectomy-specimen volume, and implant volume. Materials and methods Forty-eight women who underwent 2-stage expander-implant reconstruction between April 2014 and September 2015 were included in this study. A 3D scanner (Kinect V1; Microsoft Corporation, Redmond, Wash) was used for measuring preoperative breast volume. We evaluated the relation of the measured preoperative breast volume, the mastectomy-specimen volume, and the implant volume using the Pearson correlation coefficient. Results and conclusions A strong correlation existed between preoperative breast volume, mastectomy-specimen volume, and implant volume. The following formulae were calculated:Mastectomy-specimen volume (mL) = 1.01 × preoperative breast volume (mL) + 9.91Implant volume (mL) = 0.90 × preoperative breast volume (mL) + 65.42Implant volume (mL) = 0.68 × mastectomy-specimen volume (mL) + 68.26This study shows that preoperative breast volume, as measured by a 3D Kinect scanner, can provide useful assistance in the preoperative choice of implant size.

Purpose: Haemangiomas and vascular malformations are not easy to differentiate clinically. We describe a patient who was initially thought to have a scrotal venous malformation (VM) but after pathological examination was diagnosed to be afflicted with an arteriovenous malformation (AVM) with a micro-fistula in pathorogical photo. We think that even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated. Material and Method: A 38-year-old man who noticed a mass in his scrotum. The patient was seen at our hospital in May 2009 with concern for progression of the scrotal mass. That mass appeared to indicate a simple case of VM of the scrotum. Result and Conclusion: A biopsy of the mass was performed and was diagnosed to be a micro-fistula AVM, with no tumour growth in the vascular endothelial cells. Resection was performed in September 2009. And there is no recurrence. Even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated.

Summary: Background: The most important element during breast reconstruction preoperative planning is determining the new position and shape of the breast. A youthful breast with no signs of ptosis may not necessarily be the ideal breast for women of all ages. However, indicators have not been established on how breasts should be positioned depending on age. We investigated and reported on the proper positioning of the breasts based on age during breast reconstruction using mean age-based data from three-dimensional (3D) modeling. Methods: We photographed 110 breast cancer patients using a compact 3D scanner and calculated the measured means. Data were grouped according to age group. Three-dimensional simulation images from all patients were reconstructed from the data. Breasts from all age groups were divided into healthy and affected breasts. For each measured value, the means of the two groups were compared. Results: There were no major differences in the mean values in the 30s, 40s, and 50s age groups. Major changes were noted in the 60s age group compared with the 30s, 40s, and 50s age groups. There were no statistically significant differences between healthy and affected breasts. Conclusions: This is the first study to use a 3D method to calculate the means based on age group. This study showed that particular attention should be paid to age-related changes during breast reconstruction surgeries for women aged ≥60 years. We believe that the method used in our study on mean breast shape based on age group can be used as a reference or indicator to ensure that the reconstruction of natural breasts befits the age of the patient. Keywords: breast, mastopexy, measurement, reconstruction, three-dimensional

Purpose The purpose of this study is to evaluate clinical and radiological outcomes of patients treated with autologous matrix-induced chondrogenesis (AMIC) for fullthickness chondral and osteochondral defects of the femoral condyles and patella. Method A retrospective evaluation of clinical and radiographic outcomes of patients treated with AMIC for chondral and osteochondral full-thickness cartilage defects of the knee was performed with a mean follow-up of 28.8 ± 1.5 months (range, 13–51 months). Results Significant improvements in clinical outcome scores (IKDC, Lysholm, Tegner, and VAS pain score) were noted. The largest improvements were seen in the osteochondral subgroup (mean age 25.9 years), whereas patients treated for chondral defects in the patellofemoral joint and on the femoral condyles improved less. Patients in all groups were generally satisfied with their results. MRI evaluation showed that tissue filling was present but generally not complete or homogenous. Conclusions AMIC is a safe procedure and leads to clinical improvement of symptomatic full-thickness chondral and osteochondral defects and to regenerative defect filling. The value of AMIC relative to other cartilage repair procedures and to the natural course remains undefined. Level of evidence Case series, Level IV.

We report a case of a 37-year-old Japanese female. She had a Tessier no. 8 craniofacial cleft and an orbital lipoma in the lateral canthal region. Excisional surgery and pathological examination revealed a genuine lipoma. No other case has been reported in the literature. Here, we present our case of a rare genuine lipoma located in lateral canthal region of the Tessier no. 8 cleft.

Ectopic nail is a rare disorder, and the majority of the reported cases are congenital. We report a case of posttraumatic ectopic nail of the right IV toe, with a review of the literature.

ABSTRACT: It is difficult to cure severe open fractures of the lower extremities due to the frequent occurrence of severe damage to soft tissues or blood vessels, as well as bone defects, and concomitant infection, such as osteomyelitis. If appropriate treatment is not performed, long-term complications, such as nonunion of the bone, intractable ulcers, or other disorders, may arise. Between 1993 and 2010, we reviewed the records of 27 patients, and 28 limbs were treated. A total of 31 free-tissue transfers were performed on these 28 limbs. In this study, we classified the degree of damage based on the operative appearance of the condition of the recipient vein. A state that was normal or near-normal was described as type I-normal. A vein that was buried under a scar, but was comparatively easy to detach and retained a moderate adventitia was classified as type II-moderate. A vein with close adhesion between the wall and the scar that was not easy to detach was described as type III-severe. We also examined the relationships between recipient vein type and each of the following: (1) concomitant injury, (2) bone reconstruction, (3) preoperative infection, (4) length of time from injury to reconstruction, (5) eventual reoperation, and (6) flap necrosis. The results showed that there was a statistically significant relationship between recipient vein type and each of the following: bone reconstruction, preoperative infection, eventual reoperation, and flap necrosis. The selection of recipient vein is a factor that greatly affects the outcome of reconstruction of open fractures of the lower extremities. It is important to preoperatively estimate the condition of recipient vein even though it is difficult to preoperatively assess the condition. In some cases, only recipient veins in poor condition can be found intraoperatively on the affected leg. Under such circumstances, a cross-leg flap or a vein graft should be performed without hesitation to use recipient veins in a better condition.