Symmetrical peripheral gangrene (SPG) is a symmetric ischemic necrosis of the peripheral extremities without proximal arterial occlusion. We encountered an immunocompromised patient with pneumococcal pneumonia complicated by septic shock leading to SPG after chemotherapy for posttransplant lymphoproliferative disorders (PTLDs) secondary to the use of immunosuppressants after living-donor liver transplantation. In this case, symmetric necrosis of the peripheral extremities and necrosis of the nasal tip, apex of the tongue, central part of the lip, and tip of the penis were also observed. This is the first report of the development of SPG after living-donor liver transplantation. Necrosis extended beyond the extremities to the peripheral bloodstream with characterization of the symmetry.

抄録全体を表示

The Ilizarov external fixator fixes the ring frame to the bone using steel wires and pins, then connects the plurality with rods. It enables stronger fixation and adjustment in various angles and directions than that by other modular external fixators. It is often used for damage control and reduction fixation of open fractures, but there are difficulties in handling necrotic skin and soft tissue over time. In particular, when the bone is exposed, it is recommended to cover it with a flap or skin graft as soon as possible. However, in cases of a wound surrounded by an Ilizarov external fixator, flap plasty would be challenging due to the large number of steel wires and pins inserted. Therefore, the wound needs to be carefully managed until it is closed.
We report three cases of lower limb open fractures with tissue defect, in which negative pressure wound therapy was introduced simultaneously with fixation using the Ilizarov external fixator and proper wound management.

抄録全体を表示

Pyoderma gangrenosum is a rare skin disorder and a part of the spectrum of neutrophilic dermatoses. However, its etiology remains unknown. It is characterized by ulcer-like active skin lesions and may develop in skin areas subjected to surgical intervention or injury. Here, we report a rare case of a patient who developed pyoderma gangrenosum after an autologous unilateral breast reconstruction and simultaneous contralateral breast augmentation. In our patient, lesions developed on the left breast and on the abdominal donor site with surgical dermal scarring; however, the other breast was unchanged, without scarring. The patient recovered after a systemic steroid treatment and negative pressure wound therapy.

抄録全体を表示

Factor XIII, also called the fibrin-stabilizing factor, is the last clotting factor in the second stage of coagulation. Postoperative hemorrhage caused by factor XIII deficiency occurs with a delay of a few days and may be lethal, depending on the intensity of bleeding. Prompt diagnosis and treatment interventions are critical for preventing fatal outcomes. There are two types of factor XIII deficiency: congenital and acquired. While the congenital type is usually diagnosed early in relation to bleeding from the umbilical cord, the acquired type manifests during adulthood and may be caused by various factors. One is the increased consumption of factor XIII during trauma and surgery. All routine preoperative coagulation tests are normal in this condition, causing its diagnosis before an operation difficult.
We report a case of acquired factor XIII deficiency that manifested as massive hemorrhage on the first postoperative day after breast reconstruction with a deep inferior epigastric perforator flap. This paper aims to alert plastic surgeons on the condition, since awareness is critical to initiate immediate and effective treatment. We suggest that if surgeons encounter incomprehensible postoperative delayed hemorrhage, verification of factor XIII activity must be promptly done to diagnose factor XIII deficiency and avoid lethal hemorrhage.

抄録全体を表示