Esthetic Posterior Reconstruction of Lower Eyelid Using Stripe-Shaped Antihelix Cartilage With Perichondrium.

Eyelid malignancies are often resected in the entire layer, typically requiring anterior and posterior lamellae reconstruction. Posterior lamella reconstruction has been reported using grafts from the nasal septum, palatal mucosa, and auricular cartilage, which have advantages and disadvantages. The authors performed anterior and posterior lamellar reconstruction using a local skin flap and stripe-shaped anti-helical cartilage with the perichondrium in 3 total defect cases after basal cell carcinoma resection of the lower eyelid. The auricular cartilage was excised in strips with the surrounding perichondrium attached and simultaneously reconstructed, with the auricular cartilage as the tarsal and the perichondrium as the conjunctival substitute. In all 3 cases, good results were obtained without eyelid ectropion or corneal irritation 1 year postoperatively. No auricular deformities were observed. However, partial lower eyelid ptosis was observed in 2 cases. In future cases, correctively over-fixating the lower eyelid morphology is necessary.

An Elderly Patient With Crouzon Syndrome Treated With Monobloc Distraction.

Monobloc advancement by distraction osteogenesis is the treatment of choice in patients with syndromic craniosynostosis. This procedure is usually performed at 18 to 24 months/5 to 10 years of age. Herein, we present the case of a male patient with Crouzon syndrome who underwent monobloc advancement at the age of 62 years. Although the patient lived a normal life (employed, married, and being a father of a daughter), he visited our hospital for surgical improvement in facial esthetics. The patient underwent monobloc advancement by distraction osteogenesis. He was satisfied with the postoperative esthetic improvement and did not experience any major complications. This case highlights the fact that patients with syndromic craniosynostosis desire esthetic improvement and suggests that multidisciplinary treatment involving both the neuro and plastic surgeons is important in such cases.

The Growth Factors of Subcutaneous Benign Lipoma: Consideration from Anatomical Position of Occurrence.

Subcutaneous lipomas are the most common benign soft-tissue tumors. Theoretically, adipocyte sites could be the primary foci; however, lipomas are likely located in the occipital, neck, shoulder, torso, and thigh areas. To date, no study has reported the anatomical relationship between these subcutaneous structures and lipomas. Therefore, we aimed to investigate the anatomical locations of lipomas and considered their growth factors. In addition, we discussed the mechanism of fat amplification to improve the success of fat grafting. Methods: In the present study, lipomas measuring more than 5 cm in diameter from patients hospitalized between 2017 and 2021 were retrospectively examined using preoperative computed tomography and magnetic resonance imaging as well as clinical records with intraoperative pictures. Results: In total, 22 lipomas of 22 patients were examined. All lesions (100%) were accompanied by neurovascular perforators. Nineteen lesions (86%) were located deep in the superficial fascia, where it was clearly defined. Moreover, all lesions were located at the mobile adipofascial layer adjacent to an anchored fixed or less mobile structure. Conclusions: Lipoma growth might require neurovascular perforators that supply both blood flow and continuous stretching stimuli. The mobile adipofascial layer with bones adjacent to a fixed or less mobile area might also be necessary to grow lipomas. If these findings can be used as clues to elucidate the mechanism of fat amplification in the future, it may lead to an improvement in the survival rate of fat grafts.

Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer.

BACKGROUND: Decellularized porcine small intestinal submucosa (SIS), commercialized as an extracellular matrix rich in cell-inducing substrates and factors, has been clinically applied to treat intractable skin ulcers and has shown therapeutic effects. The SIS reportedly induces cell infiltration and integrates with the ulcer bed after 3-7 days of application. The attached SIS degenerates over time, and the remaining mass appears as slough, below which is granulation tissue that is essential for healing. This study aimed to determine whether the slough should be removed in clinical settings. METHODS: Five patients with intractable skin ulcers were included in this case series. Seven days after applying a two-layer fenestrated-type SIS to the ulcer, the removed slough was histopathologically examined. RESULTS: The collagen fibers of the SIS somewhat degenerated, and inflammatory cell infiltration was observed from the ulcer side to the surface side of the SIS. Neovascularization was similarly observed on the ulcer side. The degree of inflammatory cell infiltration decreased from the ulcer side to the surface side, whereas pus (ie, aggregates of neutrophils) was observed on the surface and ulcer edges. Additionally, the removed slough contained regenerative epithelium on the ulcer side of the remaining collagen fibers. CONCLUSIONS: After treating intractable skin ulcers using SIS, we recommend removal of the upper surface and ulcer edge of the degenerated SIS or slough to prevent infection and preservation of the lower side of the degenerated SIS to maintain the granulation tissue and regenerative epithelium.