Reconstruction of a deep burn-afflicted knee joint using a superior medial genicular artery flap

　We herein present a case of an 88-year-old female. The left knee joint was injured by a low-temperature burn due to a heater, and the patient had undergone conservative treatment at a local primary care physician. Since the skin necrosis was spreading, she was referred to our department on the 36th day after the injury. 8×4 cm black necrosis was observed on the left patella, and when debridement was performed, the patella was exposed but the joint was not exposed. For soft tissue defects, it was possible to sufficiently cover the exposed part of the patella with superior medial genicular artery flap. After the procedure, the knee joint did not show any contracture, had good mobility, and the patient was able to walk independently. Knee joint deep burn is often difficult to treat due to joint exposure and gait disorder associated with joint contracture. The superior medial genicular artery flap is considered to be a good indication for patients with advanced complications and the elderly because the procedure is simple

Risk factors for sternal wound infection

Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study

Fibrosarcomatous variant of dermatofibrosarcoma protuberans on the right cheek: A case report

A 52-year-old man presented with a subcutaneous mass on his right cheek. The tumor was resected. Histopathological examination of the resected tissue revealed fibrosarcomatous deromatofibrosarcoma protuberans (FS-DFSP). Since the resection resulted in a large skin defect, his cheek was reconstructed using a deep inferior epigastric artery perforator flap (DIEP). As the pathological findings showed positivity for tumor cells at the excised end, radiation therapy was applied to his right cheek. FS-DFSPs are found in about 10% of all DFSP cases, and are more malignant than other types of DFSP. Because there is a risk of local recurrence or distant metastasis, the patient should undergo close, long-term observation

当科における基底細胞癌の統計的観察

皮膚に発生する悪性腫瘍のうち比較的高頻度に見られる基底細胞癌(BCC)について統計的観察をおこなった.1990年1月から2001年5月までの11年5ヶ月間に川崎医科大学附属病院形成外科において治療した基底細胞癌の48患者49症例を対象として年齢・部位・臨床および組織分類・切除範囲・切除後の再建方法・再発の有無などについて若干の文献的考察をふまえて検討した.男女比は1.3 : 1,年齢は13～98歳(平均63.4歳),初診までの期間は平均3.6年であった.腫瘍の長径は4～100mm(平均15.1mm)であった.部位は顔面が最も多く眼窩部が19例(38%),鼻部が13例(26%)を占めており,いわゆる胎生期顔裂線に一致する傾向にあった.臨床分類は結節型・結節潰瘍型の2型で85%を占め,組織型ではsolid typeが75%を占めた.腫瘍辺縁からの切除距離は5mmが最多で18例(42%),次いで3mmが8例(19%)などであった.眼周囲19例に限ると切除辺縁は3～5mmが11例,3mm以下が8例であったがいずれも再発は見られなかった.再建方法は局所皮弁が最多で33例(67%)続いて単純縫縮が8例(16%),植皮が6例(12%),遊離皮弁が2例(4%)であった.再発例は頭部,顔面発症の2例であった.Basal cell carcinoma (BCC) is one of the most frequent malignant skin tumors and is often seen on the face. This study aims to analyze the tumor diameter, site, patient\u27s age, surgical treatment and so on. This study analyzed 49 cases of basal cell carcinoma (BCC) which were treated at the Department of plastic and Reconstructive Surgery at Kawasaki Medical School Hospital from January 1990 to May 2001. The patients were between (13-98) years old, average was 63.4 years. The male to female ratio was 1.3 : 1 respectively. The average duration between the onset of BCC and the patient\u27s initial visit was 3.6 years. Tumor diameter ranged from 4 mm to 100 mm (average was 15.1mm). Almost all tumors occurred on the face (especially on the so-called "facial cleft") except one case which occurred on the left knee. Eighty-five percent of clinical types of tumor were nodular and nodulo-ulcerative. Seventy-five percent of histological types were solid. Surgical excision was performed in all cases and skin defects were closed by local flaps (67%), simpleclosure (16%) and other methods. The surgical margin was less than 5 mm in 81.6% of the cases. There were 2 recurrent cases. One was a case of Xcroderma pigmentosum on the face (ulcus tereblans, solid type) and the other was case of BCC on the temporal region (nodular, keratotic type). In accordance with previous results, we suggest further detailed classification and analysis of surgical margins