Evaluation of Postoperative Anastomotic Patency in Lymphaticovenular Anastomosis Using Photoacoustic Imaging.

BACKGROUND AND OBJECTIVES: Lymphaticovenular anastomosis (LVA) is a surgical technique used to alleviate lymphedema by bypassing the lymphatic and venous vessels and facilitating lymphatic fluid drainage. Accurate evaluation of anastomotic patency is crucial for assessing LVA outcomes. Traditional near-infrared fluorescence lymphography has limitations, including fluorescence diffusion in subcutaneous fat and difficulty evaluating areas beneath the dermal backflow. Photoacoustic imaging (PAI) is a potential alternative for high-resolution visualization of lymphatic and blood vessels. We aimed to evaluate the utility of PAI for assessing LVA patency. METHODS: Using the LUB0 PAI system, we examined patients who underwent LVA. Imaging was conducted using subcutaneously injected indocyanine green (ICG) to visualize lymphatic vessels. RESULTS: Results showed clear patency in some cases, inability to evaluate it in others, and confirmed occlusion in certain instances. CONCLUSIONS: While PAI provides valuable insights, challenges remain, including the potential for ambiguous results from the intermittent nature of lymphatic flow and difficulty visualizing low-ICG-concentration lymphatic vessels. Nonetheless, PAI offers a promising method for detailed 3D evaluation of anastomoses. It may improve surgical outcomes and contribute to future evidence in the field. Further advancements, including real-time video assessment, may enhance the accuracy and reliability of LVA patency evaluation.

A Novel Dissection Method of the Internal Mammary (Thoracic) Artery: Anastomotic Vessel of the DIEP Flap.

Deep inferior epigastric perforator flaps are commonly used for breast reconstruction using autologous tissue. For such free flaps, the internal mammary artery provides stable blood flow as the recipient for anastomosis. We report a novel dissection method of the internal mammary artery. First, the perichondrium and costal cartilage of the sternocostal joint are dissected with electrocautery. Then, the incision on the perichondrium is extended along the cephalic and caudal ends. Next, this C-shaped superficial layer of perichondrium is elevated from the cartilage. The cartilage is incompletely fractured with electrocautery, with the deep layer of perichondrium intact. Then, the cartilage is completely fractured by leverage and removed. The remaining deep layer of perichondrium is incised at the costochondral junction and shifted aside, revealing the internal mammary artery. The preserved perichondrium creates a rabbet joint to protect the anastomosed artery. This method not only enables a more reliable, safer dissection of the internal mammary artery, but also allows reusage of the perichondrium as underlayment in the setting of anastomosis, and coverage for the incised rib edge, protecting the anastomosed vessels.

Oral administration of resveratrol or lactic acid bacterium improves lens elasticity.

A decrease in the elasticity of the ocular lens during aging is associated with loss of the accommodative ability of the eye, leading to presbyopia. Although near vision impairment is a social issue affecting the length of healthy life expectancy and productivity of elderly people, an effective treatment to improve near vision has not yet become available. Here we examined the effect of Enterococcus faecium WB2000, Lactobacillus pentosus TJ515, and resveratrol on lens elasticity in rats, where the stiffness of the ocular lens increases exponentially during the aging process. A combination of WB2000 and resveratrol improved lens elasticity not only in the long term but also with just short-term treatment. In addition, TJ515 decreased stiffness in the eye lens with long-term treatment. Therefore, the oral administration of WB2000 and resveratrol or TJ515 may be a potential approach for managing the progression of near vision impairment.

Takotsubo Cardiomyopathy after Head and Neck Reconstructive Surgery.

Takotsubo cardiomyopathy (TCM) is a form of transient heart failure that clinically mimics acute coronary syndrome and is characterized by left ventricular wall motion abnormalities. The pathophysiology of TCM is not well established. TCM is often preceded by emotional or physical stress and may occur after surgery. We present 3 cases of TCM occurring after head and neck reconstructive surgery. Echocardiography plays a central role in the diagnosis of TCM. Left ventricular wall motion abnormalities extend beyond the territory of a single coronary artery. Coronary angiography and cardiac computed tomography can demonstrate the absence of coronary atherosclerosis and are useful for confirming the diagnosis of TCM. Particularly after reconstructive surgery, it is necessary to carefully monitor fluid replacement to avoid dehydration, which may compromise flap blood flow, although congestive heart failure is the most common complication of TCM. It is important to encourage ambulation as soon as possible, while considering the degree of cardiac impairment.

A rare case of a broken dental bur perforating the medial orbital wall without damaging the eye.

Rotating instruments used in the fields of dentistry and oral surgery operate at high speeds. Therefore, if small particles are projected and strike the orbit, injuries of varying severity can occur. We report here a case in which a broken dental bur pierced into the orbit. The bur fortunately did not damage the eyeball and stopped after penetration of the medial orbital wall. The subject was a 27-year-old dental assistant and not wearing protective eyewear. A foreign body had penetrated the medial wall of the right orbit and the tip had reached the ethmoid sinus. The medial orbital wall was exposed subperiosteally after dissection of the medial canthal ligament, and the foreign body was removed. Although the importance of protective eyewear had been advocated, eye protection compliance differed by region and dental personnel. Eye protection use needs to increase in not only dentists but also other dental personnel.

Recurrent Myoepithelioma Treated by Palatal and Piriform Apertural Approaches.

Myoepithelioma is a rare, benign salivary neoplasm, most frequently located in the salivary gland; extrasalivary cases most commonly occur in the palate. This tumor is prone to recurrence. We present a case of recurrent myoepithelioma in the nasal cavity with a palatal fistula treated both by a palatal approach and a piriform apertural approach. The combination of these approaches widens the surgical space, allowing removal of the mass. It is important not only to excise the mass but also to allow for reconstruction.

Evaluation of bone volume after secondary bone grafting in unilateral alveolar cleft using computer-aided engineering.

The purpose of this study was to evaluate the initial defect and the outcome of bone grafts for unilateral alveolar cleft. To determine the absorption of the bone graft in patients with unilateral cleft, computer-aided engineering (CAE) with multi-detector row computed tomography (MDCT) was used. MDCT scans of 29 patients were taken immediately preoperatively and at 1 month and 6 months postoperatively. The patients underwent bone grafting between 8 and 14 years of age using iliac crest bone grafts. Three-dimensional models were created in each period, and the defect at the alveolar cleft and volume of the bone graft were determined in each patient using CAE. Cleft volume and success of alveolar bone grafting were significantly correlated (P < .01). Alveolar clefts with cleft palate required more bone volume than those without cleft palate (P < .01), but the resorption rate did not significantly differ between alveolar clefts with and without cleft palate (0.48 ± 0.14 and 0.49 ± 0.18, respectively; P = .93). In conclusion, three-dimensional reconstruction of bone grafts using CAE based on MDCT provides a valuable objective assessment of graft volume.

Adaptation process for standing postural control in individuals with hemiparesis.

PURPOSE: To study the adaptation process for standing postural control in patients with hemiparesis after stroke. METHODS: The changes of a standing posture developed in nine hemiparetic patients who had never maintained an upright stance alone (aged 48-62 years; 6-19 days after stroke) was evaluated by recording ground reaction forces and surface electromyographic (EMG) from lower limbs. A 60-s standing trial without any instruction about body alignment was repeated five times, and the experience-related changes of centre of pressure (COP) and integrated EMG data were estimated. RESULTS: In the early standing trials, patients balanced themselves by managing the average COP position around the midline of both feet, accompanied by increased muscular activity of the non-paretic leg. COP displacement gradually decreased in the later standing trials (P < 0.05). Postural adaptations were achieved by shifting the centre of body sway to the side of the non-paretic foot (P < 0.05) while reducing biceps femoris muscular activity (P < 0.01) in the non-paretic leg. CONCLUSIONS: This study revealed that weight-bearing asymmetry might contribute to improving increased body sway and muscular over-activity of the non-paretic leg. When planning rehabilitative treatment for hemiparetic patients, we should consider that weight-bearing asymmetry may be a result of systematic postural control.