Background: Undermining ulcers often require invasive treatments, such as skin incision, debridement, negative pressure wound therapy, and occasionally flap surgery. Sorbact^®, an antimicrobial dressing, has demonstrated efficacy in wound infection control; however, its use in treating undermining ulcers has rarely been reported. This study aimed to evaluate the effectiveness of Sorbact^® Compress in promoting wound closure of ulcers with undermining without invasive procedures.
Methods: We retrospectively reviewed the treatment outcomes and complications in patients with undermining ulcers treated with Sorbact^® alone between July and November 2024.
Results: The mean age was 71.2 years. The ulcer locations were the head (one case), abdomen (two cases), buttock (one case), and lower leg (one case). One patient developed postoperative wound dehiscence, while the other four progressed to ulcer formation following infection. The total ulcer size was < 5 cm in all cases. Wound closure was achieved in four of the five cases. Undermining resolved within an average of 6 weeks, with three cases showing a noticeable reduction within 2–3 weeks after intervention. In one case, deep heterotopic ossification impeded healing, leading to the discontinuation of the procedure. No procedure-related complications were observed during the follow-up.
Conclusions: Successful closure of undermining ulcers with Sorbact^® alone appears feasible under the following conditions: absence of residual foreign bodies, necrotic tissue, or infection requiring debridement; infection as the primary cause of delayed wound healing; total ulcer size ≤ 5 cm; and simple pocket morphology. Careful patient selection makes this a viable treatment option.
The size of the pocket was estimated by probing it with forceps, from which the appropriate size of Sorbact^® Compress was determined, and trimming was conducted accordingly. Although insertion is essentially a blind procedure and the material does not always make perfect contact, the Sorbact^® Compress is packed with the intention of covering as much of the pocket's internal wound surface as possible, as its efficacy increases with the area of contact. Care was taken not to overpack the pocket to avoid expanding it.

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Facial injuries resulting from industrial explosions are often complex, particularly when blast trauma is combined with chemical exposure. We report a rare case of severe facial injury caused by an industrial explosion involving cyanide compounds, resulting in combined blast and chemical injury. The patient sustained extensive facial soft tissue damage with multiple embedded foreign materials and an open fracture of the left frontal sinus with intraluminal foreign body contamination. Initial management consisted of prompt irrigation, surgical debridement, and removal of foreign bodies, followed by staged reconstructive procedures. Although acute-phase wound control was achieved, delayed complications, such as contracture, pigmentation disorders, and deformities, developed, necessitating repeated surgical and laser-based interventions over more than 20 years. The visual function of the left eye was irreversibly impaired at an early stage; however, the eyelid function and ocular surface integrity were preserved through continuous ophthalmologic care as part of long-term multidisciplinary management. This case highlights the importance of early recognition of chemical exposure and sustained multidisciplinary follow-up to achieve acceptable functional and aesthetic outcomes in patients with complex facial injuries. (a) Clinical appearance 5 months after the injury. (b) Twenty-four years after the injury. Pigmentation was reduced through multiple laser treatments, and the scar contracture of the left upper eyelid was resolved.

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Laparoscopic excision of urachal remnants is the standard approach because of its minimal invasiveness and favorable cosmetic outcomes. Although umbilical reconstruction is rarely required, a combined resection may create skin defects that demand specialized techniques, and reports in adults remain limited. Three female patients aged 31, 34, and 45 underwent simultaneous umbilical reconstruction following laparoscopic urachal resection at our institution in 2024. Preoperative computed tomography demonstrated periumbilical subcutaneous fat thickness of 14–24 mm. Reconstruction was performed using the Modified Kajikawa Method 1, thus creating a cutaneous tube from obliquely opposed flaps and securing it to the fascia with caudal Z-plasty or cruciate suturing to prevent a V-shaped deformity. At the 12–16-month follow-up, all patients maintained a stable umbilical morphology with a near-normal height of 11–13 mm and no flap necrosis. The ideal maximum umbilical height is 2 cm. In this technique, geometric calculation shows that a circular umbilicus reaches this height when each flap side measures approximately 3 cm. Because the cutaneous tube length was approximately equal to that of the one-side flap in all cases, patients with subcutaneous fat no thicker than this value were suitable. Although the method leaves a long vertical scar, it provides a good contour and it is useful in near-total umbilical loss. Preoperative and postoperative images were acquired in the standing position, while all other images were obtained in the supine position. (a) Preoperative appearance. No signs of infection were observed in any of the cases. (b) Intraoperative view of the urachal remnant immediately after laparoscopic excision. (c) S-shaped skin-flap design based on the Kajikawa Method 1. (d) Appearance after wound closure and before bolster fixation. The caudal aspect of the umbilical fossa was closed in a cruciate fashion in Case 1, whereas Z-plasty was added in Cases 2 and 3.

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We herein report a case of successful minimally invasive abdominal wall reconstruction in a 37-year-old female patient who developed severe peritonitis associated with hemolysis, elevated liver enzymes, and low platelet count syndrome after a cesarean section. This outcome was achieved by combining open abdominal management using the ABTHERA™ dressing system with rectus sheath reconstruction. On postoperative day 9, relaparotomy was performed because of intra-abdominal hematoma and abscess formation. A total hysterectomy with abscess drainage was performed. The ABTHERA™ system was used for open-abdomen management. Definitive abdominal wall reconstruction using the anterior rectus sheath was performed with wound closure on postoperative day 19. This approach may represent a practical option for abdominal wall reconstruction in critically ill patients with contaminated surgical fields. (a) On postoperative day 9 at the initial consultation, the rectus abdominis muscle was partially damaged, and the bowel was significantly edematous, thus making primary wound closure impossible. (b) The ABTHERA™ negative-pressure wound therapy system was applied to the open abdomen for temporary abdominal closure and wound management.

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The number of reports of keloids and scar contractures in the umbilical region following laparoscopic surgery has increased in recent years. Surgical excision and umbilicoplasty may be required in cases accompanied by pain or infection. This case series describes five patients treated with umbilicoplasty using a modification of the Kajikawa method. Defect morphology was classified as either partial or total, with Method II applied in three partial defect cases and Method I applied in two total defect cases. Postoperative electron beam irradiation was performed in four patients. After observation periods of 6–14 months, three patients achieved a favorable umbilical contour, one showed flattening of the umbilical fossa, and one developed hypertrophic scarring. The Kajikawa method can be flexibly applied depending on the defect morphology and it can simplify the selection of reconstructive techniques. However, inadequate management of subcutaneous fat and postoperative care may affect the outcomes. Additional cases and long-term follow-up are necessary to better evaluate the effectiveness and long-term outcomes of this technique. (a) Preoperative view showing induration with exudation throughout the umbilical fossa. (b) The umbilicus was completely absent after resection, thus creating a total defect. (c) Temporary diagonal suturing and design of Method I of Kajikawa technique. (d) Immediate postoperative view. (e) Follow-up at 14 months postoperatively showed a deep umbilical fossa without recurrence. (f) Oblique view at 14 months postoperatively

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Postoperative nasal obstruction, rhinorrhea, and sneezing are common complaints following closed reduction of nasal bone fractures. These symptoms may cause premature displacement of intranasal gauze, leading to discomfort and the need for reinsertion. Kampo medicine has recently gained attention as an adjunctive therapy for surgical and trauma care. This brief communication examines the potential role of two Kampo formulations, Shin’iseihaitō and Shōseiryūtō, in the postoperative management of nasal bone fractures, with an emphasis on symptom relief and maintenance of internal fixation.
Shin’iseihaitō is traditionally indicated for nasal obstruction and chronic rhinitis, particularly when accompanied by local heat or inflammation. Shōseiryūtō is prescribed for rhinorrhea, sneezing, and watery sputum. Both formulations contain multiple crude drugs that are expected to exert anti-inflammatory, anti-edematous, antitussive, expectorant, and warming effects. A retrospective clinical review demonstrated reduced episodes of rhinorrhea- or sneeze-induced gauze dislodgement following the introduction of these medications. No Kampo-related adverse events were observed.
Shiniseihaitō and Shoseiryutō may serve as practical adjuncts in postoperative care after nasal bone fracture reduction, potentially improving patient comfort and maintaining internal fixation. Although these findings support their clinical utility, further prospective studies and standardized symptom-assessment methods are needed to establish their role in surgical wound care.

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