Visible Blood Flow in a Case of Rubeosis Iridis

A 72-year-old Japanese woman presented to our hospital with decreased vision. At the initial visit, her best-corrected visual acuity (BCVA) and intraocular pressure (IOP) in her right eye (OD) were 0.02 and 36 mm Hg, respectively. By slit lamp examination, rubeosis iridis was observed on the iris surface. With higher magnification observation, movement of clustered RBCs were clearly observed; the blood drained into episcleral vessels that were connected with the main trunk of rubeosis iridis. She was diagnosed with the neovascular glaucoma secondary to central retinal vein occlusion OD. She underwent panretinal photocoagulation, intravitreal injection of aflibercept, and Ahmed Glaucoma Valve implantation. At 2 weeks postoperatively, the BCVA and IOP OD were 0.2 and 7 mm Hg, respectively; rubeosis iridis was partially regressed and movement of RBCs was not observed. Acquisition of directional flow by the connection of the main trunk of neovessels with the episcleral vessels and reduction of flow speed by the high IOP could explain the reason for visible blood flow in our case

The perifascial areolar tissue and negative pressure wound therapy for one-stage skin grafting on exposed bone and tendon

Background : Factors such as exposed bones or tendons can inhibit wound healing and make it a lengthy process unless aggressive debridement or vascularized flap surgery are performed. We have developed a new procedure involving simultaneous application of a skin graft and perifascial areolar tissue (PAT) and negative pressure wound therapy. Methods : Of 8 patients with wounds, bones, tendons, and thick fascia were exposed in 4, 2, and 2 cases, respectively. These wounds were adequately covered with PAT, and split-thickness skin grafts were applied simultaneously on the PAT with a VAC® device. Results : In 6 of 8 cases, the skin graft and PAT were successful, and epithelialization was achieved within 4 weeks. PAT adapted but skin graft was unsuccessful in one case, and both the skin graft and PAT failed to adapt of a pressure ulcer. Using the PAT to overlap more than 400% of the exposed areas resulted in better adaptation. Conclusions : This procedure contributed to reducing the burden on the patients because we were able to use a skin graft on the exposed areas, without the need for removal of bone or tendons. This potentially means patients avoid loss of function in the affected areas and achieve better outcomes

Effect of Environmental Change while Climbing Mt. Daisen on Forced Vital Capacity and Forced Expiratory Volume % in Young Women

The aim of the present study was to clarify the effects of environmental change while climbing Mt. Daisen on forced vital capacity and forced expiratory volume % in young women in summer. Seven healthy Japanese women (age: 22.6 ± 4.2 years) volunteered to climb Mt. Daisen (1,709m), located in Tottori prefecture, in August. Participants\u27 expiratory forced vital capacity (FVC), forced expiratory volume % (FEV_%) and arterial oxygen saturation (SpO_2) were measured at 4 points (Ground: 10m, Rest point: 780m, Summit: 1,709m, Goal point: 780m). The measurements were conducted soon after the subjects\u27 arrival at each point. The degree of dyspnea sensation was measured at Ground, Rest point, Goal point and at each station. There were no significant changes in FVC. FEV_% at the summit was significantly lower than at the Ground and Rest point. No significant differences were found in SpO_2 at each measuring point. The degree of dyspnea sensation at each station soon after the subjects\u27 arrival was significantly higher than those at the Rest point. The results of this study indicated mild airway contraction induced by stresses on the respiratory system from increasing exercise intensity during an ascent of Mt. Daisen

Reduction mammaplasty and mastopexy for the contralateral breast after reconstruction surgery following cancer resection : A report of 3 cases

Background : Breast reconstruction generally involves autologous tissue transplantation and placement of a mammary prosthesis. When the patient’s breasts are extremely large and ptotic, breast reconstruction often results in significantly asymmetrical appearance. However, a good aesthetic outcome after reconstruction surgery following cancer resection is an important quality-of-life factor. We evaluated the efficacy of touch-up surgery, either reduction mammaplasty or mastopexy, performed on the contralateral breast for symmetrization. Methods : Reduction mammaplasty was performed on the contralateral breast in 2 patients and mastopexy was performed on the contralateral breast in 1 patient after reconstruction surgery following cancer resection, between 2008 and 2014. We reviewed each patient’s medical record for general clinical information and for the methods of breast cancer resection and breast reconstruction used, wait time between breast cancer resection and touch-up surgery, preservation of the sensitivity of the nipple-areola complex after the touch-up surgery, and aesthetic outcome (based on visual analog scale score). Results : Wait times in the 3 cases were 4, 9, and 18 months. Nipple-areolar sensitivity was well preserved in all 3 cases. Aesthetic outcomes were judged “excellent” or “very good.” Conclusion : Revision surgery on the contralateral breast 4 to 18 months after breast reconstruction substantially improves the aesthetic outcome

Development of Skin Flaps for Reconstructive Surgery : Random Pattern Flap to Perforator Flap

Flap transplantation has been an important procedure in plastic and reconstructive surgery to cover and fill various defects. Flap necrosis due to blood circulation failure leads to severe complications, especially in a patient undergoing reconstruction concerning the body cavity after tumor ablation. Surgical procedures for flap transplantation have been further improved and developed. We have reviewed from the random pattern flap to the newest procedure, the perforator flap. Perforator vessels were investigated in the process of development of the fasciocutaneous flap and have become important for blood supply of the skin flap. Blood circulation of the flap has become more stable and reliable than ever with the development and findings of the perforator vessels. Further development of a skin flap will be based on the perforasome concept, which involves the study of the territory and linking of perforator vessels