Background: The applications of negative-pressure wound therapy (NPWT) have been well documented. Nowadays, NPWT can be used to treat extensive tissue loss after complete resection of soft tissue malignancy, such as invasive skin cancer or sarcoma. Materials and methods: Information on demographics, total days of therapy, complications, recurrence of malignancy, presence of a concave wound, and slough formation was collected from five patients who had been treated with NPWT after resection of invasive skin cancer or sarcoma between April 2018 and March 2019. Results: The patients comprised three men and two women with a median age of 51.4 (range, 30–70) years. Four patients had sarcoma, and one had deep subcutaneous skin cancer. After treatment with NPWT or NPWT i-d (instillation of saline with a 10-min dwell time, followed by NPWT) for an average of 12.6 (range, 6–28) days, none of the patients had a concave wound or slough, and good granulation tissue covered the tendons and vessels in all cases. No recurrences of malignancy were observed during 12–19 months of follow-up. Conclusion: NPWT is extremely effective for complicated wounds after surgery for deep cutaneous malignancy and has a favorable esthetic outcome because of accelerated wound healing.
Introduction: Negative-pressure wound therapy (NPWT) with instillation and dwelling (NPWTi-d) system can be used to treat infected wounds. In 2017, a new reticulated open cell foam dressing (ROCF-CC) for NPWTi-d was launched. The feature of ROCF-CC is that the contact layer contains holes. It allows viscous exudate and infected materials to be removed. We report for the first time the application of NPWT-i-d with ROCF-CC in Japan. Methods: Four patients who were admitted to our hospital between August and December 2019 were indicated for NPWTi-d with ROCF-CC. The causes of the patients' wounds, dosage of saline, saline dwell time, degree and cycle frequency of negative pressure, frequency of foam dressing changes, and duration of NPWTi-d were examined. Results: The treated wounds consisted of necrotizing fasciitis, diabetic skin ulcer, postoperative wound, and ulcer caused by hematoma. A total of 10–100mL of normal saline was instilled. The dwell time ranged from 5 to 10min. The cycle frequency of negative pressure ranged from 2 to 3.5 h, and the level was set at −125mmHg. Dressing changes were conducted every 2–4 days. Granulation tissue formed without infections developing. Since the necrotic tissue was removable due to ROCF-CC, debridement was easy. The problems were pain and maceration. Conclusion: We found that using NPWTi-d with ROCF-CC enabled the removal of necrotic tissue and viscous wound exudate. It allows debridement to be performed easily and safely without affecting the normal tissue and hastens granulation tissue formation.
Introduction: Hidradenitis suppurativa is extremely difficult to treat. In the setting of a widespread infection, skin flaps and skin grafting are used to cover the wound after total excision of the infected region. If the treatment of the excised wound is inadequate and it is still infected, if the skin graft did not take, or if the bottom of the flap could not adhere, a recurrence of the infection might occur. We report the case of a patient with extensive hidradenitis suppurativa of the buttocks who was successfully treated with quick and efficient wound bed preparation using negative pressure wound therapy with instillation and dwell time (NPWTi-d). Case: A 46-year-old man with a subcutaneous abscess on the buttocks presented to our department 3 years ago for the surgical treatment of extensive hidradenitis suppurativa. Result: The patient underwent a wound resection under the superficial fascia, which included fistulas and inflammation. NPWTi-d was started the day after surgery. Wound granulation occurred very quickly using a graft bed, and 2 weeks later mesh split skin grafting was performed, without signs of infection. Discussion: Extensive hidradenitis suppurativa infections require a wait time between the removal of the infection and the occurrence of granulation, making it difficult to predict when the second operation can be performed. In this case, NPWTi-d, which allowed for simultaneous wound irrigation and graft transplantation, was considered useful for the second-stage treatment of hidradenitis suppurativa.
We report here a patient whose glans penis gangrene healed after autoamputation without surgery. The patient was a 52-year-old man who was diagnosed with acute exacerbation of chronic renal failure and underwent hemodialysis. Ulcers were observed on the glans penis and both toes with painful peripheral purpura. He underwent hyperbaric oxygen therapy and low-density lipoprotein apheresis while on pain management therapy. Healing of toe gangrene was achieved after percutaneous transluminal angioplasty followed by transmetatarsal amputation. Healing of glans gangrene was achieved by maintaining the affected area dry, thus enabling autoamputation. When penile or glans necrosis develops, treatment often involves surgical removal of the affected area, followed by stump plasty. In these cases, the penis or glans is shortened by the amount of skin used in the stump closure. In some cases, the suture wound does not heal due to ischemia, and additional resections may be required. On the other hand, autoamputation is less invasive and results in only minor tissue loss. If there are no symptoms of infection with glans gangrene, and if the affected areas can be kept dry, simple patient monitoring is sufficient for recovery.
Although gout is a common disease, patients with tophi are infrequently clinically examined. In this case report, a 40-year-old man presented with multiple nodules in both soles. The nodules, gouty tophus, were diagnosed following pathological examination, and multiple gouty tophi in both soles is a rare condition. The take-home message is that subcutaneous nodular lesions in soles need to be considered during evaluation.
Fingertip reconstruction requires flap transplantation rather than a skin graft. Depending on the amputation level, or the lack of volar side, palmar side, or nail matrix, surgeons can consider some surgical strategies for the reconstruction of a single fingertip, and various flap-implantation methods have been reported. However, there are few reports describing multiple fingertip reconstructions. This case report describes a 55-year-old man diagnosed with bilateral multiple fingertip necrosis caused by frostbite. A multiple fingertip salvage procedure with a piece of free medialis pedis flap was performed for the non-dominant left hand, and the donor site was transplanted with an artificial dermis. Three weeks later, the flap was cut to separate the fingers, and a full-thickness skin graft taken from the left inguinal region was transplanted to the donor site. Subsequently, the same procedure was performed for the dominant hand. The course of treatment allowed the patient to return to his original job with minimal hand dysfunction. The outcomes were functionally and aesthetically satisfactory, and no additional surgery such as debulking was required. This report showed the usefulness of a free medialis pedis flap for multiple fingertip reconstruction.
Background: Steatocystoma is a benign cystic lesion. Steatocystoma multiplex presents as multiple lesions that occur frequently on the axilla, chest and upper limbs. Cyst removal as treatment is fundamental; methods include simple excision, puncture aspiration, punch biopsy excision and CO2 laser. However, this is difficult due to the widespread lesions of steatocystoma multiplex. We have devised a new treatment approach for steatocystoma multiplex, which involves minimally invasive incisions and the use of foreign body forceps. Method: We first made an incision of approximately 1 mm with a scalpel. While extruding the contents, foreign body forceps were advanced to grasp the inner wall of the cyst capsule. The cyst wall was peeled off from its surroundings and was removed as a lump. This was repeated for each of the cysts presented. Result: The excision time per cyst was approximately 1 minute. Since no sutures were required, 20–30 excisions could be made in a single setting within 30 minutes. The wound was hardly conspicuous. Consideration: Steatocystoma multiplex often causes stress to patients in terms of aesthetics, resulting in the desire to be treated. We think that this method of using foreign body forceps on minimal incisions is an optimal surgical technique because it is simple, with short operation time and reduced patient burden.
Hidradenitis suppurativa is a chronic recurrent folliculitis that results in the development of abscesses and the formation of sinus tracts and scarring. Studies identifying the optimal surgical technique in patients with hidradenitis suppurativa are lacking, but the reused skin-graft technique is a reliable approach for the resection of chronic hidradenitis suppurativa. Among the advantages of this technique is that it minimizes or even eliminates the need for a donor site for harvesting normal skin. We performed a pathological study of areas with graft survival, graft loss, and no graft in a patient with hidradenitis suppurativa who underwent the reused skin-graft technique. Our results demonstrate the effectiveness of this surgical technique in the treatment of hidradenitis suppurativa as it avoids donor site pain and scar formation in addition to promoting healthy granulation and early epithelialization.