Rhinophyma-like hypertrophy of the nose caused by chronic facial pyoderma in a patient with Crohn's disease.

We present our experience with a 22-year-old man who had Crohn's disease with rhinophyma-like hypertrophy of the nose arising from pyogenic skin disease of the face. The clinical appearance did not precisely match any previously reported skin diseases.

Clinical factors associated with postoperative complications and the functional outcome in mandibular reconstruction.

BACKGROUND: Few studies have performed a multiple factor analysis to assess the factors associated with successful mandibular reconstructions in a large number of subjects. The purpose of this study is to evaluate the functional outcome in mandibular reconstruction by means logistic regression analysis. METHODS: Since April 2005 to September 2009, 126 patients underwent segmental resection of the mandible for cancer ablation and mandibular reconstruction with free flaps at 6 Japanese institutions. The patients' charts were reviewed retrospectively. Twelve patients were excluded for the reconstruction was with double flaps, or they went under secondary reconstruction. With logistic regression analysis in 114 subjects, we assessed multiple factors influencing postoperative speech intelligibility, feeding ability, and postoperative complications of mandibular reconstruction. RESULTS: The use of a reconstruction plate with a soft-tissue free flap only was showed to have a deleterious effect on postoperative feeding. The strong association in the level of statistical significance between the use of a reconstruction plate with soft-tissue free flaps only and the occurrences of major complications was indicated. It was also statistically revealed that the postoperative presence of opposing teeth contributed to both speech intelligibility and oral intake. CONCLUSIONS: In our research, osteocutaneous flaps were superior to reconstruction plates with soft-tissue free flaps regard to the postoperative feeding ability and major complication rate.

The effect of a hydrocolloid dressing containing ceramide-2 on split-thickness wounds in a laser-induced erosion model.

OBJECTIVE: Lower levels of ceramides in the stratum corneum are considered to be an etiologic factor in the dry and barrier-disrupted skin of patients with atopic dermatitis, psoriasis vulgaris, and xeroderma pigmentosum. Topical ceramides therapy has currently been used to improve skin barrier function. However, little is known about the effect of topical ceramides on wound healing. This study investigated the effect of ceramide-2 on wound healing using a diabetic mouse model. DESIGN: Using a CO(2) laser to create standard erosions on the dorsal skin of mice, the authors developed a reproducible model of split-thickness wounds. Two wounds were placed on the back symmetrically across the spine of mice. The left-side wounds were covered with the hydrocolloid dressing containing 0.3% ceramide-2, and those on the right were covered with the control hydrocolloid dressing containing no ceramides. MAIN RESULTS: Seven days after the irradiation, controls showed a transepidermal water loss (TEWL) of 66.58 g/m(2)h on average, which was significantly higher than the mean TEWL of the ceramide-treated wounds, 46.22 g/m(2)h (P < .05, Student t test). Histological assessment also revealed ceramide-2 improved recovery of the erosion morphologically. CONCLUSION: The authors' findings suggest for the first time the possibility of the novel application of ceramide as a therapeutic agent for skin erosion.

Efficacy of a poly glycolic acid (PGA)/collagen composite nanofibre scaffold on cell migration and neovascularisation in vivo skin defect model.

Application of tissue engineering currently provides promising therapeutic options in the fields of plastic surgery and wound management. The ability of scaffold material for cell proliferation and differentiation is the key for tissue engineering. This study has developed a novel nanofibre composed of poly glycolic acid (PGA) and collagen, both of which have their own respective beneficial properties. This study aimed to estimate the in vivo efficiency of the PGA/collagen nanofibre on granulation histology and its ability to induce neovascularisation. The electrospinning technique produced the PGA/collagen nanofiber with a diameter of 500 nm and weight mixing ratio of 40%. The skin defects on the mouse model were covered with PGA/collagen or a commercially available collagen matrix (n = 9). The PGA/collagen group histologically showed significantly higher cell density and a fine microstructure with greater number of migrating cells as compared to collagen matrix. Then, both materials were applied to the microcirculatory angiogenesis model. The PGA/collagen group (n = 8) revealed significantly higher functional capillary density on days 5 and 7 after application. The findings substantiated the fact that our material had a superior ability regarding cellular migration and induction of neovascularisation compared with the elementary collagen matrix product. This better result might be attributed to the nano-size effect of fine structure and the incorporation of PGA, which has been associated with enhanced angiogenesis.

New application of the gluteal-fold flap for the treatment of anorectal stricture.

PURPOSE: Total intersphincteric resection (total ISR) is a surgical option for patients with advanced cancer of the lower rectum. However, anorectal stricture can develop after total ISR, which stretches from the anus to the lower rectum. Conventional anoplasty for anal stricture is often ineffective for them because the areas of stricture are long and the most proximal points of the strictures are too far for advancement flaps or rotation flaps to reach. We have developed a new surgical treatment method using a gluteal-fold flap (GFF) for anal stricture after total ISR. METHODS: From April 2004 through June 2007, hemilateral GFFs were transferred to treat anorectal strictures after total ISR in three patients at the National Cancer Center Hospital East, Chiba, Japan. Postoperative results and anal function were evaluated. RESULTS: In all three patients, GFFs were successfully transferred, and good dilation of the anorectal stenosis was achieved. Postoperative anal function was satisfactory. CONCLUSION: The GFF has a rich vascular supply and can be simply and reliably transferred. We believe that GFF transfer is an excellent option for treating anorectal strictures after total ISR.

One-sided soft palatal reconstruction with an anterolateral thigh fasciocutaneous flap: report of two cases.

Soft palate reconstruction is one of the greatest challenges for reconstructive surgeons. In the last 2 decades, anterolateral thigh (ALT) flaps have emerged as a popular reconstructive option because of the low donor morbidity, replacing radial forearm (RF) flaps. For soft palatal reconstructions, however, the RF flap remains the option of first choice, and only a few reports have described soft palatal reconstruction using an ALT flap. At our hospital, ALT flaps were utilized in two cases with soft palatal tumors. During the operation, the nasal side was left unepithelized. To prevent infection of the perforators and pedicles, we dissected a muscle cuff for the perforators and positioned the perforators near the edge of the flap. The postoperative courses were uneventful, and the patients gained almost normal function. ALT fasciocutaneous flaps are a feasible option for soft palatal reconstruction.

Morphologic study of mandibles in Japanese patients for mandibular reconstruction with fibula free flaps.

BACKGROUND: In mandibular reconstruction with a fibula flap, 3-dimensional models are sometimes used but are not available to all plastic surgeons. To establish a simpler method, we performed a morphologic study of the mandible. METHODS: Three-dimensional images of the mandible from 79 Japanese patients were analyzed. Four theoretical osteotomy points were placed on each image and the lengths of each segment and the angles between every 2 segments were measured. RESULTS: The SDs of the angle formed by the right and left canines and the left mandibular angle; the angle formed by the left canine, the left mandibular angle, and the left condyle; and the segment between the canines were so small that these values would easily be exceeded by manipulation errors during an osteotomy. CONCLUSION: Mandibular bones show a close similarity among Japanese patients. Acceptably accurate osteotomies can thus be performed in Japanese patients without requiring accurate templates.

Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model.

OBJECTIVE: The anastomosis of very small vessels (external diameter: < or = 0.5mm) is challenging and requires high microsurgical skill. This study aims to investigate the optimal technique for the anastomosis of very small vessels. We compared three anastomotic techniques on the basis of success rate and anastomosis time in a superficial inferior epigastric arterial flap model in rats. METHODS: Forty-five Sprague-Dawley rats were divided into three groups of 15 rats. The superficial inferior epigastric artery flap was elevated, and only the artery was cut and anastomosed under magnification. The anastomosis was performed with the conventional technique, with the intravascular stenting technique or with the open guide suture technique. Flap survival was assessed on postoperative day 5, and the success rates of the groups were compared. In addition, the time required for anastomosis was compared between the groups. RESULTS: All flaps survived, and success rates did not differ significantly between the groups. The average anastomosis times with the conventional technique (770.0s) and the intravascular stenting technique (822.8s) did not differ significantly but were significantly greater than that with the open guide suture technique (699.2s). CONCLUSION: The open guide suture technique simplifies anastomosis and can be recommended as a new standard technique for the anastomosis of very small vessels. Furthermore, the benefit of the intravascular stenting technique is minimal for either skilled or unskilled microsurgeons.