Comparison of Emla cream and topical lidocaine tape for pain relief of V-beam laser treatment.

The authors compared the analgesic effects of two topical applications; Emla® cream (Sato Pharmaceutical Co. Ltd., Tokyo, Japan) and 60% lidocaine tape (Penles® tape; Maruho, Osaka, Japan). The authors examined 20 outpatients with capillary malformations. Emla® cream or Penles® tape was applied 1 h before laser irradiation using V-Beam. After V-Beam irradiation, pain intensity was measured using Pain Vision® (NIPRO, Osaka, Japan), while subjective pain was converted into numerical values using the VAS system. In the assessment using Pain Vision®, pain was significantly lower in patients who received Emla® cream (Welch test), whereas no difference was observed in VAS ratings between the two applications (student's t test). The objective system showed that Emla® cream had a significantly greater analgesic effect. We plan to evaluate the analgesic effects of these topical anesthetics by applying them to other anatomical areas.

Sudden shrinkage of free rectus abdominis musculocutaneous flap 15 years after maxilla reconstruction.

A 60-year-old male displayed sudden shrinkage of a left free rectus abdominis musculocutaneous flap, which had been grafted to his left maxilla 15 years previously. No post-reconstructive irradiation had been performed, and no late occlusion of the vascular anastomosis, local infection, recurrence of the maxillary cancer, or body weight loss was observed. However, the shrinkage amounted to approximately 50%. This is considerably more than previously reported cases of shrinkage of various free flaps, which ranged between 10% and 25%. The resultant depression was successfully augmented with a right free deep inferior epigastric artery perforator flap. The residual fat volume of the previously grafted shrunken flap was revealed to be compatible with that of the newly harvested contralateral perforator flap. Thus, the volume of the previously grafted flap may reflect the status of the intact contralateral donor site, although the mechanism of sudden flap shrinkage is unclear.

Multiple nodules on the left cheek represented pseudolymphomatous folliculitis.

Pseudolymphomatous folliculitis (PLF) is a rare lesion. Sometimes, the clinical appearance is characterized by multiple large, firm violaceous nodules. In cases with multiple lesions, such biopsy should be performed on one lesion, and once PLF is determined, monitoring for the remained tumor is considered to be the best treatment.

Dermoid cyst of the auricle: a rare manifestation.

Cases of dermoid cysts of the auricle are presumed to be quite rare. We report such a case and make references to 10 previously reported cases. It is important to treat a tumour in the auricular area at an early stage to prevent it from transforming into malignancy.

Abdominoplasty of cloacal exstrophy: application of reconstructive methods to recurrent and primary cases.

BACKGROUND: Surgical repair of cloacal exstrophy is still challenging. At birth, patients undergo bladder closure, colostomy, and osteotomy of the pubic bone (if necessary, when the interpubic range is wide and cannot be brought together with the hands). This abdominal defect is closed primarily by urologists or pediatric surgeons, if possible, but the patient may experience a relapse of bladder exstrophy and an abdominal defect. Abdominal reconstruction was performed for a series of recurrent and primary (preventive) cases. METHODS: Abdominal wall reconstruction was performed using the rectus abdominis and external oblique muscle fascia flaps, and reinforcement of the bilateral rectus abdominis muscles in 2 cases of cloacal exstrophy patients. One was a recurrent case treated at 7 months old, and the other was done primarily at 2 days after birth. RESULTS: The closure of the abdominal wall was successful and no relapse of bladder exstrophy or abdominal defect has occurred. These patients are now undergoing rehabilitation. CONCLUSION: Cloacal exstrophy usually has many serious complications. The abdominal-wall defect is often large and accompanied by a wide detachment of the pubic bone. Even if the simple closure of abdominal wall is possible at birth, it is usually insufficient. Abdominal-wall repair must be done thoroughly, soon after birth, and plastic surgery techniques should be used.

Ortho-phthalaldehyde-induced skin mucous membrane damage from inadequate washing.

Because body fluids and blood have a tendency to adhere to transesophageal echo devices, a high level of sterilisation is required when cleaning them. Ortho-phthalaldehyde (OPA) has been widely used in Japan since being approved as a high-level sterilant. The authors report a patient with widespread, severe skin and mucous membrane damage of the lip, tongue, pharynx and oesophagus areas that was attributed to inadequate washing after the sterilisation of a transesophageal echo device with OPA. This patient experienced sequelae, which did not improve after more than 1 year of continuous treatment. When using medical devices sterilised with OPA, the use of a probe cover, when applicable, is recommended and complete washing prior to use is required.

Aesthetic repair for syndactyly of the toes using a plantar rectangular flap.

BACKGROUND: Use of a dorsal rectangular flap is the most common method of creating a deep interdigital space for syndactyly of the toes. However, the pigmented skin grafts exposed to the dorsal side are conspicuous. To resolve this problem, several methods have been reported. However, the local flap methods could be adapted only in mild syndactylies, and plantar skin flaps exposed to the dorsal side are too whitish. Meanwhile, in the methods using skin grafts from the inframalleolar region, the marginal scars of the skin grafts are still conspicuous on the dorsal side. To resolve these problems, the authors devised a new surgical method using a plantar rectangular flap. METHODS: In this method, the authors designed a rectangular flap on the plantar side. Only a small triangular flap and a slight zigzag skin-incision line were designed on the dorsal side. The plantar rectangular flap was put down into the bottom of the interdigital space and was sutured with the dorsal triangular flap. Full-thickness skin was grafted to the raw surface at the sides of the divided toes. RESULTS: The authors performed this method on 18 syndactylies of 12 patients. In all cases, the corrected toes showed a deep and natural interdigital space without exposure of skin grafts or conspicuous scars. CONCLUSIONS: The authors devised the plantar rectangular flap to avoid extra skin defects on the dorsal side. Using this method, the authors can create a deep interdigital space without any exposure of skin grafts or whitish plantar skin flaps on the dorsal side. This method is not appropriate for syndactyly of the fingers but is an ideal method for syndactyly of the toes.

Respiratory management of Pierre Robin sequence using nasopharyngeal airway with Kirschner wire.

BACKGROUND: The Pierre Robin sequence (PRS) is a relatively rare symptom complex characterised by glossoptosis, micrognathia and respiratory obstruction. The initial problem that children with PRS face is obstructive dyspnoea, which can result in death without appropriate respiratory management. We designed and used a modified airway with a Kirschner wire (K-airway) in children with PRS who suffered from dyspnoea that did not improve with conservative treatment. METHODS: The subjects were four children diagnosed with PRS at the Department of Plastic Surgery, Shizuoka Children's Hospital, from February 2007 to December 2008. Since dyspnoea was not improved by conservative treatment, a phi0.8-mm Kirschner wire was set inside a nasopharyngeal airway bent in a form to lift the root of the tongue in order to prevent glossoptosis. The respiratory condition was evaluated with a test for sleep apnoea. RESULTS: Successful improvement in dyspnoea with the K-airway was noted in all cases. In Case 1, the subject was discharged from hospital without using the K-airway (92 days of age). In Case 2, the subject was discharged from hospital using the airway only at nighttime (122 days of age). CONCLUSIONS: This method is safe because it is less invasive, and its effects can be easily evaluated, suggesting that it is a good method to try prior to surgical treatment.