Introduction: Most animal bites heal without difficulty. However, some animal bite wounds lead to infection, and whether animal bite wounds should be left open or sutured remains controversial. This study aimed to evaluate the risk factors for bite-wound infection, and whether primary closure interfered with wound infection.
Methods: This was a single-center, retrospective cohort study. The following information was extracted: date of treatment, age, sex, location of the injury, severity of injuries, surgical procedure, the interval between injuries, and primary treatment.
Results: A total of 535 patients presented with dog- or cat-bite wounds. Primary closure was performed in 89 patients (17.0%); 73 patients had wound infections (14%). There were no significant differences between infection and age, sex, animal species, wound location, or severity (P = 0.46, 0.35, and 0.30, respectively). However, occurrence of wound infections after primary wound closure increased significantly (P < 0.05). More infections in the head, neck, and lower extremities occurred particularly in the primary closure group than in the open wound group (P < 0.05).
Head and neck bite wounds generally exhibit low infection rates owing to the rich blood supply to the area. However, our study showed that the infection rates of head and neck bite injuries were similar to those of the upper and lower extremities.
Conclusion: There were many cases of infection after primary suturing, even in the head and neck regions. Therefore, careful follow-up after primary care of bite wounds is required.

抄録全体を表示

Background: Pharyngocutaneous fistula is a major complication that occurs after salvage surgery following radiotherapy for laryngeal cancer. It is characterized by extensive neck skin defects and pharyngeal defects, necessitating biplane reconstruction for surgical treatment.
Methods: We retrospectively examined the surgical procedure and postoperative course of pharyngocutaneous fistula in patients with extensive neck skin defects who were operated on in our department.
Results: A pectoralis major myocutaneous flap was employed for reconstruction in five cases, while the free anterolateral thigh flap was used in one. In two cases where the pectoralis major myocutaneous flap was used, reconstruction was done with two skin paddles; in one case, a skin paddle and a muscle flap with a skin graft were used for reconstruction. The patient, for whom an anterolateral thigh flap was used, underwent reconstruction using two skin paddles, each containing one perforator artery. A pectoralis major myocutaneous flap with a skin graft and a free anterolateral thigh flap yielded favorable outcomes.
Conclusion: A free anterolateral thigh flap is recommended if the neck has anastomotic vessels in unilateral neck dissection. Conversely, if the use of free flaps is avoided, a pectoralis major flap with a skin paddle on the pharyngeal side and a skin graft on the muscle flap on the skin side is recommended.
(a) Preoperative finding. The pharyngeal fistula extended into the tracheal foramen. Extensive inflammation of the neck skin on the cranial side. (b) Anterolateral thigh flap design: Two skin paddles based on two myocutaneous branches of the descending branch of the lateral circumflex femoral artery. The white arrow indicates the larger skin paddle based on the cranial perforator, and the yellow arrow indicates the smaller skin paddle based on the caudal perforator. (c) A larger skin paddle was used for the reconstruction of the neck skin defect (white arrow), and a smaller skin paddle was sutured to the pharyngeal defect as a patch graft (yellow arrow). The undivided fascia lata. (d) Appearance one year after the operation.

抄録全体を表示

Introduction: Maintaining blood flow at the incision site following dermal suturing is one of the most important factors affecting postoperative wound healing outcomes. However, this issue has not yet been sufficiently investigated. We aimed to evaluate and compare blood flow following wound closure with a combination of two suturing techniques/materials in pigs using laser speckle contrast imaging.
Materials and methods: Pigs (n = 4) were anesthetized, and three incisions were made in the upper and lower abdomen each (n = 6 incisions per pig). The incisions were closed using set-back continuous suturing with monofilament sutures (incision 1), set-back interrupted suturing with monofilament sutures (incision 2), and set-back continuous suturing with barbed sutures (incision 3) (n = 8 for each incision). Closure time was measured and blood flow was assessed for 20 min after closure of incision 3 using laser speckle contrast imaging.
Results: The mean time required to close incision 3 (4.36 ± 0.48 min) was significantly shorter than that required for incision 2 (5.45 ± 0.67 min) (p = 0.019). Statistical analysis of changes in blood flow from baseline to the three corrected time points (10, 15, and 20) after incision closure showed that the reduction in blood flow tended to be smaller at incision 3 than at incision 2 (p = 0.579).
Conclusions: The closure time was significantly shorter and blood flow impairment was comparable following set-back continuous dermal suturing with barbed sutures and set-back interrupted suturing with monofilament sutures.
(a) Schematic drawing of incision sites. Each pig received three incisions (incisions 1–3) on the upper and lower abdomen each (six incisions in total). (b) Incisions were made at the midline (incision 1), and to the right (incision 2), and left (incision 3) in this order for all animals. (c) Representative image of blood flow measurement using laser speckle contrast imager.

抄録全体を表示

Background: The closed intra-wound continuous negative pressure and irrigation treatment reported here is a very effective method when a wound at risk of infection must be closed. However, this conventional method has the drawback of shunting, which occurs in the early stages. Uninfected areas become adherent, and the source of the infection is not adequately cleaned. Therefore, we report a new method which cleans this area intensively and reliably, and satisfactory results were obtained.
Methods: Irrigation and suction tubes with tips on each other were placed in the most desired area of the wound to be cleaned. The irrigation and suction tubes were connected to a saline bottle and a continuous suction device, respectively. As negative pressure was applied, the saline solution flows through, allowing for the pinpoint cleaning of specific areas around the irrigation tubing.
Results: This method was performed on 7 patients (4 males and 3 females; age: 34–82 years [average 64.7 years]) with infected wounds, at our institution between May 2018 and March 2019. In all the cases, the wounds healed completely without any recurrence.
Conclusions: This method can be as more reliable than the conventional method, to prevent the outbreak of infection in wounds that must be closed.
(a) Findings upon the first visit to our department (left lower leg). Skin necrosis of the left lower leg is observed (arrow), and the plate iscould be palpated under the skin. (b) Surgical findings. After debridement, the plate fixed to the tibia was exposed (arrow). (c) Implementation of method: The slit of the tube for injection was placed around the plate (arrow). (d) Findings immediately after surgery. After the tube was placed, gastrocnemius flap transplantation and split-thickness skin grafting were performed (asterisk). (e) Findings one year after surgery. The wound was completely epithelialized and walking was possible.

抄録全体を表示

In traumatic lacrimal duct injury, stent placement and anastomosis are commonly performed soon after injury. However, stent selection for pediatric lacrimal duct injuries has rarely been discussed. Herein, we present three pediatric cases (one 1-year-old and two 3-year-olds; all patients were males) of lacrimal duct injury and discuss them along with a literature review. The site of injury was the canaliculus in all cases. Two patients were treated with nylon thread stents and one with a 90-mm Nunchaku-style silicone tube. In the case of the Nunchaku-style silicone tube, insertion around the nasolacrimal duct opening was difficult. None of the patients had any epiphora at 6 months postoperatively. We also estimated the length of the lacrimal duct in the children. According to this estimated length, the 90-mm Nunchaku-style silicone tube may have been too long for a child՚s lacrimal tract. The lacrimal duct size of the children shown in this study may provide suggestions for making treatment decisions in the future. (A) Length from the upper lacrimal punctum to the lachrymal sac. (B) Length from the inferior lachrymal punctum to the lachrymal sac. (C) Length from the lacrimal sac to the nasolacrimal duct opening.

抄録全体を表示

Cultured epidermal autografts have been used in recent years, despite the difficulty of treating extensive burns. Appropriate wound management after cultured epidermal autograft device transfer is also necessary. Physicians must ensure appropriate cultured epidermal autograft administration by managing the growth of microorganisms and meticulously changing patients’ dressings. Moreover, cultured epidermal autograft requires a dry environment and exposure to air after engraftment. We provide a better dressing environment using the newly developed material Aquacel® Ag Advantage to manage wounds. A 71-year-old man sustained extensive burns on the right upper extremity, left arm, face and neck, chest, abdomen, anterior thighs, and right back. The total burn area was 38%, and the majority were full-thickness burns. Burn inhalation complicated the patient’s condition. We performed consecutive surgical operations of debridement and skin grafting of the cultured epidermal autografts. We used Aquacel® Ag Advantage to manage the burn wounds after cultured epidermal autograft transfer, which helped control the growth of the resistant microbes Pseudomonas aeruginosa, and prevented adherence when changing dressings. This approach also absorbs the extra exudate, thereby keeping the surface of the cultured epidermal autograft dry. This innovative dressing approach may substitute air exposure following cultured epidermal autograft, hence increasing the cultured epidermal autograft take ratio. Just after transplantation of CEA and a 6:1 mesh split-thickness autograft (a). Photos taken 14 days (b), 21 days (c), and 35 days (d) after the operation.

抄録全体を表示

In the case of abdominal injury, the extent of damage should be assessed prior to reconstruction. Herein, we report a rare case of abdominal wall burns with molten aluminum. A 70-year-old man was admitted to the emergency department. Melted aluminum blew during die casting and fell on the patient while he was working at an aluminum-refining plant. When he arrived at our hospital, metal particles were embedded in his lower left abdomen. We urgently removed the aluminum particles and debrided the surrounding tissue on the day of admission. From the 4th to 31st day after the injury, negative pressure wound therapy with instillation and dwell time was performed for wound management. After therapy, the wound was covered with sufficient granulation tissue. We decided not to reconstruct the components to strengthen the abdominal wall, and the wound was closed using a split-thickness skin graft. We report this rare case along with a review of the literature. (a) Photograph of the wound immediately after the patient arrived at the hospital. The large mass in the center and the small mass scattered around it are aluminum clumps. (b) Radiographic image before surgery. Abdominal radiography revealed a high absorption area in the left abdomen. (c) Computed tomography image (coronal) before surgery. A mass with high absorption is observed in the left abdominal wall. We assumed that the external oblique, inner abdominal oblique, and lumbar quadrate muscles were damaged. (d) Intraoperative photographs of debridement on the day of injury. Clumps of aluminum cooled and solidified in the belly. As much necrotic tissue as possible was removed. (e) Intraoperative photographs of debridement on the day of injury. After debridement, a small defect was observed in the transverse abdominal muscle (arrow).

抄録全体を表示

Different methods have been used to reconstruct the lower eyelids. Herein, we report a case of lower eyelid reconstruction using a reverse facial artery flap. A 66-year-old woman underwent a partial maxillectomy that included the orbital floor and received radiotherapy for maxillary sinus cancer. The lower eyelid gradually atrophied, resulting in incomplete closure. Thus, lower eyelid reconstruction was performed using a reverse facial artery flap, which was applied for nose and lip reconstruction. However, to date, there have been no reports on lower eyelid reconstruction in Japan. The reverse facial artery flap was a good match for the lower eyelid in terms of color and texture. A relatively large flap was harvested, and the lower eyelid was reconstructed as a unit. The flap was thick, which was favorable for correcting the eyelid depression. Cheek contracture was observed after maxillectomy; therefore, cutting the mimetic muscles to elevate the flap was not considered a newly identified complication. Thus, the application of the reverse facial artery flap may be limited. However, this can be an option for lower eyelid reconstructions. (a) A subcutaneous tunnel was created. (b) The flap was trimmed to fit the eyelid unit and was sutured. (c) The donor site was closed primarily.

抄録全体を表示