The sacral pilonidal sinus is known to be more common in men, and reports of pilonidal sinuses in women are scarce. We treated seven cases of sacral pilonidal sinuses in women in our department. This case series focuses on the sacral pilonidal sinus in women. Most of the cases did not have clinically obvious obesity or hypertrichosis around the pilonidal sinus, but all had defective granulation tissue in the sacral region. In the previous case, computed tomography fistulography was performed to confirm that the fistula remained subcutaneous. For surgery, a simple suture was chosen if the tissue defect after fistula excision was < 3 cm in length and almost flat, Z-plasty was chosen if the defect was between 3 and 5 cm, and local skin flap reconstruction was chosen if the defect was larger or in cases of recurrence. Histopathology showed hair infiltration in 86% of cases, a typical finding of a pilonidal sinus. After surgery, recurrence was observed in 29% of patients; who were under 20 years old and required two revision surgeries of Z-plasty and local flap reconstruction. It is important to recognize that sacral pilonidal sinus can develop in women without risk factors. Moreover, we should also be mindful of the need to accurately diagnose the presence of congenital disease involvement in women, which will lead to prompt appropriate treatment.

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Introduction: Cold atmospheric plasma (CAP) is an effective disinfection and wound-care tool. We conducted the first clinical trial for plasma care^® in Japan to evaluate bacterial load reduction.
Methods: Seven patients with chronic foot ulcers were treated with plasma care^® for one week. Plasma care^® was used once daily during dressing changes. Bacterial load was measured before and after treatment.
Results: Treatment with plasma care^® reduced bacterial load in five patients, while two patients showed no changes. The treatment was safe with no adverse events. Although CAP exerted antibacterial effects, we observed no clear reduction in wound size during the observation period.
Conclusion: Plasma care^® is safe and effective for bioburden reduction in patients with chronic foot ulcers.

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Introduction: In sacral pressure ulcers, wound healing is poor and closure is difficult, resulting in complications, such as dissection. Skin flap utilization is the mainstay of treatment for ulcers with concerns regarding dissection and recurrence, intractable pockets, and bone exposure. We selected a perforator-preserving gluteal artery-based fasciocutaneous (FC) rotation flap as the first choice for sacral ulcer reconstruction. In addition to the commonly used back cut and typical Burow's triangle for rotation flaps, we have placed modified Burow's triangles to reduce the size of the second defect and used the deepithelialization technique for suturing ulcers to prevent dissection and recurrence.
In this study, we aimed to describe the usefulness and our ingenuity of the perforator-preserving gluteal artery-based rotation FC flap.
Materials and methods: We evaluated 14 patients with sacral pressure ulcers who underwent surgery. In all patients, the perforator-preserving gluteal artery-based rotation FC flap was used and had good wound bed preparation. The method (unilateral or bilateral, back cut, Burow's triangle, and deepithelialization technique) as well as the postoperative wound dehiscence, infection, epidermal necrosis, small fistula, and recurrence were retrospectively evaluated as outcomes.
Results: A unilobar rotation flap or double-opposing unilobar rotation flap was selected in nine and five cases, respectively. The back cut technique (82.4%), Burow's triangle (42.1%), and deepithelialization technique (100%) were used to close the ulcer. The mean follow-up period was 9.8 ± 6.5 months with no observed cases of wound dehiscence (0%) or infection (0%). Although epidermal necrosis of the wound edge (28.7%) and small fistula (21.4%) were observed, wound closure was achieved conservatively and in a short period of time. No recurrence was observed.
Conclusion: The perforator-preserving gluteal artery-based rotation FC flap can be safely used in cases of sacral pressure ulcer reconstruction when using the back cut, Burow's triangle, and deepithelialization techniques appropriately under fine wound bed preparation.

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We encountered a case of unilateral breast late seroma suspected to be breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) after a bilateral breast augmentation surgery. A 48-year-old woman had undergone breast augmentation surgery using a breast implant approximately 20 years ago. She had used an electrical muscle stimulation (EMS) exercise device on the right side of her breast for pectoral muscle exercise. One week later, she noticed swelling in the right breast, with no obvious redness or mass formation. She underwent punctures of the right breast several times, and up to 1,000 mL of serous fluid was aspirated. Ultrasonography revealed a large amount of fluid collected around the right breast implant. There were no findings of a mass or breast implant rupture. Considering the possibility of infection and malignancy, the aspirated fluid specimens were sent for culture, cytology, histology, and flow cytometry testing. There was no evidence of infection or malignant change, and the swelling of the right breast improved spontaneously without any specific treatment. Her medical history suggested that the patient had developed a traumatic late seroma caused by excessive electrical stimulation.

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Cranioplasty is sometimes problematic in patients whose scalp is severely scarred, contracted, or infected. Although tissue expansion is a useful treatment technique, wound dehiscence may occur during expansion. Withdrawal of normal saline solution from the tissue expander and successive wound resuturing is a treatment option but carries the risk of wound dehiscence recurrence. Complete removal of the tissue expander is another treatment option, although it prolongs the overall treatment period. We conceived a novel method that repositions the tissue expander by 2–3 cm in a direction distal to the wound. A full-thickness skin graft was then applied to cover the skin defect created as a consequence of debridement of the dehiscent wound. The grafted skin was removed at the time of cranioplasty to minimize the hairless area. We report two cases in which our method provided esthetically satisfactory outcomes without any complications: an 11-year-old girl with a history of acute subdural hematoma and a 43-year-old man with a history of brain tumor removal. Our method is believed to have the potential to reduce the risk of recurrence of wound dehiscence and minimize the prolongation of the overall treatment period.

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The forehead flap is one of the oldest flaps used to reconstruct the upper face and remains a useful option. The defect due to this flap is often healed by secondary intention; however, this is rarely performed in Asians due to the increased frequency of conspicuous scars. Our patient was a 38-year-old Caucasian male who underwent forehead flap reconstruction for a rare forehead dermatofibrosarcoma protuberans. After surgery, there was a positive margin; therefore, an additional resection was performed on the periosteum. At the patient's request, an artificial dermis was attached to the defect, and healing by secondary intention occurred. We report an unexpected case of a Caucasian forehead full-thickness defect healed by secondary intention, resulting in an inconspicuous scar.

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We report four cases of successful resurfacing with radial artery perforator flaps. Two flaps fully survived, and the remaining two flaps developed partial necrosis in the distal and middle parts, which healed through secondary intension. Several factors, including the number of perforators, location of the perforator, flap length, flap length/width ratio, and involvement of the cutaneous sensory nerve were reviewed retrospectively, and the correlations between these factors and flap survival were statistically analyzed, without any significant correlations. However, the two flaps that developed partial necrosis were larger and longer than the other two, suggesting that the size of the two flaps outsized the angiosomes of the perforators. Intraoperative near-infrared fluorescence angiography with intravenous administration of indocyanine green is a promising technique for preventing flap failure due to vascular disorders.

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In a typical surgical setting, the viability of an internal mammary artery perforator flap can be assessed based on the surgeon's clinical findings, including bleeding from the flap, or by use of imaging modalities such as indocyanine green near-infrared fluorescence angiography. However, because neither method is highly sensitive, a combination of these methods is often used to diagnose flap viability. This study describes a case of necrosis of the distal end of an internal mammary artery perforator flap that was used for thoracic skin reconstruction. Indocyanine green near-infrared fluorescence angiography performed on the fifth internal mammary artery perforator flap revealed that the distal end was of poor contrast. However, as the distal end demonstrated sufficient blood flow, we sutured the flap without trimming it. Consequently, the distal end of the flap developed necrosis, which coincided with the area of poor contrast on indocyanine green near-infrared fluorescence angiography. This is probably because of multiple vascular territories and areas around the inframammary fold that lack the lubricating adipofascial system. Thus, indocyanine green near-infrared fluorescence angiography may be a beneficial clinical indicator for evaluating internal mammary artery perforator flap viability around the inframammary fold.

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