Giant combined microdissected thin thigh perforator flap.

Despite recent advances in reconstructive surgery, extremely wide and thin flap coverage has rarely been reported. Recently, the authors developed a technique for transferring a very wide and thin flap from the thigh area using microdissection. In this procedure, both perforators of the anterolateral thigh flap and the tensor fasciae latae perforator flap were microdissected simultaneously and these two perforator flaps were elevated in combination based on the common pedicle of the vessels. In this report, the detailed technique of the procedure is described along with a discussion of the safety of this giant flap in consideration of 60 clinical experiences of microdissected thin tensor fasciae latae perforator and anterolateral thigh flaps.

Treatment of Bowen disease using the ultrasonic surgical aspirator.

In most cases, patients with Bowen disease lesions can be easily treated by surgical excision and direct closure; however, the ultrasonic surgical aspirator, an instrument in common use in many fields, offers a good treatment alternative with few drawbacks for patients with lesions that are large and/or located in joint areas, areas that are hard to heal, or areas that are surgically problematic such as the ears, nose, eyelids, and mucous membranes. The clinical application of the ultrasonic surgical aspirator in the treatment of Bowen disease promises considerable benefit in terms of patient comfort because removal of the lesion is easy, is noninvasive, and does not require hospitalization or result in restricted mobility. All of these factors, although benefiting patients, particularly the elderly, can also substantially lower the cost of treatment.

Correction of the bilateral complete cleft lip: transformation to a unilateral incomplete cleft lip closure.

The complete lip alveolus and cleft palate is the most difficult of all bilateral clefts to treat because of the deformity of and tissue insufficiency in the prolabium. A bilateral concomitant procedure is impractical for treatment of this condition because of the problems that have to be resolved postoperatively, including a short columella, a lack of philtrum, labial horizontal and vertical insufficiency, and vermilion and alveolar vestibulum insufficiency. A two-stage procedure called the transformation method has been developed to circumvent these problems, and the authors present it here. With this method one side is closed completely using the maximum amount of tissue available. Concomitantly, incomplete closure is performed on the other side. The result at the end of the first stage of the procedure is a condition approximating unilateral incomplete closure. The results were obtained from 6 patients who underwent complete bilateral closure and were followed for at least 2 years with satisfactory results.

Reduction malarplasty.

One of the most frequently requested facial contour improvement procedures in the Orient is reduction malarplasty. However, until recently, osteotomies in the malar region have been performed by means of a coronal incision that required a larger incision and more invasive procedure than many patients are comfortable with when considering an elective cosmetic surgical procedure. We have developed a reduction malarplasty method to improve facial contours that circumvents the drawbacks inherent in the conventional method. In our method, the protrusion in the cheekbone area is corrected by performing an osteotomy of the zygoma through an intraoral incision and an osteotomy of the zygomatic arch through a small preauricular incision.

Dermabrasion using an ultrasonic surgical aspirator.

We used an ultrasonic surgical aspirator on the epidermal surface to perform dermabrasion instead of the conventional motor-driven grinder. It was determined on histologic examination that it is possible to fragment the epidermis with greater selectively using the ultrasonic surgical aspirator. Abrasion also can be performed safely on spotty lesions and intricate, problematic regions with the ultrasonic surgical aspirator. We feel that the ultrasonic surgical aspirator is a promising device for use in dermabrasion.

Reconstruction of chest wall after full-thickness resection. Two case reports.

Full-thickness reconstruction to repair defects in the chest wall was performed with a new method, using Marlex mesh, artificial bones and musculocutaneous flap. The artificial bones were constructed from ceramic iliac crest spacers connected by wires and methyl methacrylate. The advantage of the method is that the artificial bone can be created in various lengths and curves, tailored for the individual defect.

A case of Cushing's disease successfully treated with bromocriptine.

A case of Cushing's disease is reported. The administration of bromocriptine was extremely effective in reducing excessive adrenocorticotrophic hormone (ACTH) and cortisol in the blood, which were previously not suppressed by 8 mg dexamethasone and persisted even after removal of the ACTH-producing adenoma in the hypophysis.

Cleft lip-nose repair technique: sequential repair.

The results of repairing cleft lip by aesthetic plastic surgery are now excellent. However, the cleft lip-nose deformity is still very difficult to repair with the present techniques. A technique that can repair the cleft lip-nose deformity with good results is presented. The technique is divided into three parts: Part I consists of nasal repair of the primary cleft lip. Part II is nasal reconstruction as a secondary operation with or without lip repair. For example, nasal reconstruction may be secondary to repair of deformities of the sill, rim, limen nasi, septum, or nasal bones. Part III is an aesthetic nasal operation such as rhinoplasty, mentoplasty, or zygomaplasty.

Aesthetic camouflage of bilateral cleft lip scars.

Two operative scar lines remain after bilateral cleft lip repair. A method has been devised in which the two scar lines are reduced into one. The characteristics of this method include (1) an inconspicuous scar, (2) elevation of the nasal tip using the prolabium, (3) repair of the whistling deformity, (4) a natural-looking mustache, (5) formation of a pout, and (6) psychological benefits. Good results have been obtained with this method. The disadvantage of this method is the maxillary retardation. However, this does not occur in adults and can be corrected easily in children.

Seven years' survey of our new cleft foot repair.

The reconstruction of lobster-cleft foot is no longer considered from a functional point of view only. The aesthetic appearance of the repaired foot is now considered to be equally important. Since we reported the reconstruction of five toes in 1976, we have operated on 8 patients, totaling 16 cleft foot anomalies. We have followed-up these patients from 3 years to 7 years. As a result, we emphasize that this operative method is excellent in terms of both the function and the aesthetics, and the newly formed toes help to prevent pincer-like deformities. Since those deformities become more serious as a result of weight-bearing, we are convinced that this operation should be done before the patient is 1 year of age, preferably at about 8 months, before walking.

Repair of the amputated great toe.

A new method has been introduced to form a functional great toe following amputation. This method has several advantages, especially its simple one-stage operation, which uses a local plantar flap. Results are good from the esthetic and functional point of view. It may be used for traumatic and congenital defects of the great toe. Three cases are presented with illustrations.