A Case of Super-giant Basal Cell Carcinoma Initially Diagnosed as Multiple Traumas.

Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers.

Bone marrow-derived vasculogenesis leads to scarless regeneration in deep wounds with periosteal defects.

Deep skin wounds with periosteal defects, frequently caused by traffic accidents or radical dissection, are refractory. Transplant surgery is frequently performed, but patients are subjected to stress for long operation periods, the sacrifice of donor regions, or several complications, such as flap necrosis or intractable ulcers. Even if the defects are covered, a scar composed of fibrous tissue remains in the body, which can cause itching, dysesthesia, or repeated ulcers because of the lack of distribution of peripheral nerves or hair follicles. Thus, treatments with the aim of regenerating lost tissue for deep wounds with periosteal defects are needed. Here, we show that the use of gelatin sponges (GS), which have been used as haemostatic materials in clinical practice, allowed the regeneration of heterogeneous tissues, including periosteum, skin, and skin appendages, when used as scaffolds in deep wounds with periosteal defects in rats. Bone marrow transplantation in rats revealed the mechanism by which the microenvironment provided by GS enabled bone marrow-derived cells (BMDCs) to form a vascular niche, followed by regeneration of the periosteum, skin, or skin appendages such as hair follicles by local cells. Our findings demonstrated that vascular niche formation provided by BMDCs is crucial for heterogeneous tissue regeneration.

Bilateral plantar fibromatosis complicated by Dupuytren's contracture.

Plantar fibromatosis (PF) is a rare benign disease. Here we report bilateral PF accompanied by Dupuytren's contracture in the right palm. Magnetic resonance imaging was useful in diagnosing PF, although biopsy was needed to rule out hemangioma. As the patient had been receiving female hormone therapy since orchiectomy, there may be a possibility that estrogen accelerated the growth of PF. Local excision with a 1-cm margin was performed, followed by primary wound closure. Neither complication nor recurrence had occurred 6 months after the surgery.

Medial maxillary fractures revisited.

BACKGROUND: We consider medial maxillary fractures to be a unique type of nasomaxillary buttress fracture involving the lateral margin of the piriform aperture, the maxillary frontal process and the medial aspect of the infraorbital rim. This article aims to define medial maxillary fractures as a unique type of facial bone fracture. METHODS: Eight patients with medial maxillary fractures were treated at our hospital from May 2010 to June 2013. Every patient was preoperatively evaluated using three-dimensional and multidimensional computed tomographic scans and surgically treated. RESULTS: The subjects were seven men and one woman (mean age: 17.5 years). The common mechanism of injury was interpersonal impact followed by small object impact. All of the patients exhibited epistaxis and hypoaesthesia affecting the maxillary nerve and/or its branches, and some patients also displayed nasal deformities and/or diplopia. An oral approach was employed in every case, and it was combined with a subciliary approach in some cases. Medial maxillary fractures involve the maxilla, lacrimal bone, ethmoid bone and/or nasal bone. The main difference between medial maxillary fractures and nasoethmoid orbital fractures is the bones they affect. CONCLUSIONS: Medial maxillary fractures are a unique type of nasomaxillary buttress fracture and should be classified as such because of the bones they affect, their symptoms and the surgical approaches used to treat them.

Macroscopic and histological findings in the healing process of inhalation injury.

Although many investigators reported the diagnostic and therapeutic value of bronchoscopy in the early stage of inhalation injury, few findings in the late stage of inhalation injury have been reported. We investigated histopathological changes of in trachea and bronchi after inhalation injury. Five survivors with inhalation injury underwent bronchoscopic examinations combined with biopsies from the early stage to the late stage. Although the bronchotracheal membranes improved to near normal under the bronchoscopic findings in the late or recovery stage, invasion of inflammatory cells and the capillary dilatation in the subepithelial region were still remarkable histologically. Goblet cells also increased on the surface of mucous membranes. In cases of the inhalation injury with severe burn, pulmonary edema, bronchial edema and secretions tended to be prolonged. Results suggested that continuous secretions in the respiratory tracts sometimes cause airway obstruction. Bronchoscopic and histologic findings in the healing process of inhalation injury predict long-term pulmonary functional outcome. Moreover, the aggressive pulmonary toilet seemed to be effective in removing foreign particles and accumulated secretions which also cause the inflammatory response and the obstruction in inhalation injury.