Palliative surgery for advanced fungating skin cancers.

Advanced skin cancers sometimes develop complex wounds with associated pain, infection, malodor, massive discharge, and bleeding, which distresses patients and decreases his or her quality of life (QoL). The following cases presented large fungating skin ulcers that were treated with palliative abrasion along with wound resurfacing using free skin grafting. Palliative surgery allowed the patients to lead a more comfortable daily life at home with family.

Basic fibroblast growth factor is beneficial for postoperative color uniformity in split-thickness skin grafting.

Color changes of visible and exposed body surfaces, such as the face and extremities, after burn injury or surgery, such as skin grafting, flap, or sclerotherapy for vascular malformations, are sometimes a concern. The consequences reduce the satisfaction of both patients and physicians. An easy and reproducible method has not yet been established for an objective analysis of color changes; therefore, we tested a hand-held color analyzer (NF-333; Nippon Denshoku Co.

Extra-oral fistula caused by a dental implant.

Dental implantation has become an important procedure for both dental treatment and head and neck reconstructive surgery. However, this useful technique sometimes results in peri-implantitis. We describe a rare complication of peri-implantitis in the maxilla which extended to the soft tissue and caused an extra-oral fistula above the alar region.

Unusual Cheek and Upper Extremity Pressure Ulcers Resulting from Head-on-Hand and Arm Napping.

 Pressure ulcers commonly occur on the sacrum, ischium, lateral trochanter, and heel where pressure or shearing forces continuously affect bony prominences. The following describes three cases of unusual pressure ulcers of the cheek and upper extremity. Patients developed the wounds as a result of lying face downward on the hand for a prolonged period.

Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap.

Background: Spinal osteomyelitis and epidural abscess are uncommon but have a potentially disastrous outcome, although the surgical techniques and antimicrobial therapy have advanced.

Case Description: We present a case of cervical osteomyelitis and epidural abscess resulting from pharyngeal squamous cell carcinoma ablation, which were treated with a pectoralis major muscle flap successfully.

Conclusion: Muscle flap insertion to the cervical contaminated wound enables radical removal of the contaminated tissue, and the muscle flaps for dead-space obliteration and neovasculation were obligatory for successful management of the infected complex wound.

Evaluation of Nutrition in the Healing of Pressure Ulcers: Are the EPUAP Nutritional Guidelines Sufficient To Heal Wounds?

 Malnutrition is a significant factor in the development of pressure ulcers and many nutritional guidelines for preventing pressure ulcers have been published. However, few clinical investigations have examined the energy required to heal pressure ulcers. The aim of the present study was to investigate the relationship between nutritional intake and improvement of pressure ulcers.

Complex wounds tend to develop more rapidly in patients receiving hemodialysis because of diabetes mellitus.

The number of patients requiring dialysis because of diabetes mellitus is increasing and such patients often have complex chronic wounds, which are difficult to heal. However, there are few retrospective studies of wounds requiring surgical treatment. We evaluated 14 patients receiving hemodialysis (HD) (8 because of diabetes and 6 because of other diseases) who had extremity wounds and underwent surgical treatment in our unit from 2004 through 2007.

Human mesenchymal stem cells may be involved in keloid pathogenesis.

Background: The pathogenesis of keloid is poorly understood. Although vigorous investigations have attempted to elucidate the mechanisms or causative factors of keloid, there are little data on why keloids are very intractable and recur easily in each patient.

Methods: In an attempt to analyze the possible interaction between human mesenchymal stem cells and keloid-derived fibroblasts, the dual-chamber cell-migration assay, cell proliferation, ultrastructural morphology, and Western blot analysis were used to investigate the production of the extracellular matrices of the coculture.

Reconstruction of velopharyngeal competence for composite palatomaxillary defect with a fibula osteocutaneous free flap.

Velopharyngeal competence reconstruction is indispensable for acquiring the fine speech and ingesting function. However, the maxillary prosthesis becomes unstable in some patients who have undergone extensive palatomaxillary. We present a case of total palatomaxillary defect resulting from squamous cell carcinoma ablation of the palate, which was reconstructed using a fibula-free osteocutaneous flap.

Spontaneous flexor tendon rupture of the flexor digitorum profundus secondary to an anatomic variant.

We report a case of the flexor digitorum profundus tendon rupture of the little finger, which was predisposed by an anatomic variation of the tendon. Intraoperative findings and magnetic resonance imaging of the opposite hand suggested that the flexor digitorum profundus tendons of the ring and the little finger bifurcated. The patient had tendon reconstruction and regained function.

Combined surgical excision and radiation therapy for keloid treatment.

Various methods have been attempted for the treatment and management of keloids; however, there is little satisfactory clinical evidence in long-term follow ups. Also, there is a preference for occurrence and recurrence in anatomic location. Usually anatomic locations with higher regional tension and more sebaceous glands are inclined toward pathogenesis.

Cavernous nerve graft reconstruction using an autologous nerve guide to restore potency.

Objective: To present our experience of cavernous nerve graft reconstruction, using an autologous nerve vein-guide technique, to restore potency.

Patients And Methods: Prostate cancers frequently require radical resection involving one or both cavernous nerves that usually results in erectile dysfunction; nerve grafting has been used to restore erectile function, but clinical results are unsatisfactory owing to inadequate surgical techniques. In all, eight patients with prostate cancer who required radical resection involving one cavernous nerve had sural nerve grafting, with two or three sutures using the autologous vein-guide technique, in our unit between 2004 and 2005.

Evaluation of Pressure Ulcers in 202 Patients with Cancer.

Countermeasures for pressure ulcers, which have been promoted as a national policy in Japan since 2002, have reduced the development of new pressure ulcers due to insufficient observation or treatment. On the other hand, it has become clear that pressure ulcers continue to develop in patients with cancer. The authors evaluated 419 patients (202 of whom had cancer) who had newly developed pressure ulcers.

Both nasal cerebral heterotopia and encephalocele in the same patient.

Unlabelled: OBJECTIVE AND PATIENT: Both nasal cerebral heterotopia and encephalocele are rare congenital benign masses of neurogenic origin caused by an embryonic developmental abnormality. It is generally accepted that nasal heterotopia is a sequelae to encephalocele. This report presents an unusual case of nasal cerebral heterotopia and encephalocele arising in the same patient.