Combination of hypoglossal-facial nerve jump graft by end-to-side neurorrhaphy and cross-face nerve graft for the treatment of facial paralysis.

The cross-face nerve graft and the interpositional jump graft were performed simultaneously for 13 patients with facial paralysis. The period between the onset of paralysis and surgery ranged from 3 to 32 weeks. In nine patients, surgery was performed within 3 months of the onset of paralysis. The patients in whom reinnervation by both grafts succeeded could smile without closing their eyes by moving the tongue and could close the eye on the affected side without an accompanying oral movement. The expression was natural and included fine muscle movements. Spontaneous recovery of the facial nerve was observed in three patients. Among patients who showed functional recovery without spontaneous recovery, House-Brackman's palsy grade was II in one patient, III in five patients, and IV in one patient. Functional deficits of the tongue were not observed. We recommend that this surgery be performed within 3 months of onset of paralysis.

Posterior-wall-first continuous suturing combined with conventional interrupted suturing for microvascular anastomosis.

Vascular anastomosis with conventional interrupted suturing is often difficult to perform when the vascular clamp is not reversed, because of a narrow operative field or a short vascular pedicle. A posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is one method of solving this problem. The authors conducted a comparative study of posterior-wall-first continuous suturing combined with standard interrupted suturing and conventional interrupted suturing in rat vessels. There was no statistically significant difference in patency rates or suturing times. Electron microscopy demonstrated no significant difference in recoverability of the intima. The posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is a useful alternative to the conventional interrupted suture technique.

Approaches to repigmentation of vitiligo skin: new treatment with ultrasonic abrasion, seed-grafting and psoralen plus ultraviolet A therapy.

Vitiligo vulgaris is a common disease throughout the world although its pathogenesis is not yet known. The most frequent treatment used for vitiligo is PUVA (psoralen plus ultraviolet A) and topical steroids but against stable refractory vitiligo, various other surgical techniques have been developed such as autografting, epidermal grafting with suction blisters, epithelial sheet grafting, and transplantation of cultured melanocytes. We have discovered a new method using ultrasonic abrasion, seed-grafting and PUVA therapy. The ultrasonic surgical aspirator abrades only the epidermis of recipient sites. This easily and safely removes only the epidermis, even on spotty lesions or intricate regions which are difficult to remove using a conventional motor-driven grinder or liquid nitrogen. Epidermal seed-grafting can cover more area than sheet-grafting, and subsequent PUVA treatment can enlarge the area of pigmentation with coalescence of adjacent grafts. In this article, we provide a general overview of the current surgical therapies including our method for treating stable refractory vitiligo.