Background: Wound healing is challenging in patients on dialysis. Impaired immunocompetence makes these patients susceptible to infection, which prolongs hospital stays and shortens survival. Negative pressure wound therapy, especially with instillation and dwell time, is becoming established in wound care. This study compared the indications for and therapeutic effects of the different types of negative pressure wound therapy devices in patients on hemodialysis.
Methods: Patients on hemodialysis at our institution between September 2016 and December 2018 who developed skin wounds were retrospectively divided according to whether they received conventional negative pressure wound therapy (Group I) or negative pressure wound therapy with instillation and dwell time (Group II). Patient and wound characteristics, treatment regimens, and outcomes were compared between the groups.
Results: Sixty-five wounds occurred in 56 patients during the study period. There was no significant difference in comorbidities; however, the initial C-reactive protein value was significantly higher in Group II (2.3 vs. 0.9 mg/dl; P = 0.02), as was the increased positive wound culture rate. Group II included a range of wounds, including infected wounds in addition to diabetic foot ulcers. The wound closure rate was significantly higher in Group II (50.0% vs. 15.8%; P = 0.01), and the infection-related treatment cessation rate was lower. The mean duration of negative pressure wound therapy was longer in Group II.
Conclusions: Negative pressure wound therapy with instillation and dwell time can be used safely on wounds in patients on hemodialysis with a significantly higher wound healing rate than that achieved by conventional negative pressure wound therapy.
On day 1 of NPWTi-d, the wound was covered mainly with yellow wet necrotic tissue. Good granulation was achieved after the application of NPWTi-d, and skin grafting was performed after 24 days of NPWTi-d. Complete wound closure was achieved 2 months after skin grafting. NPWTi-d: negative pressure wound therapy with instillation and dwell time

抄録全体を表示

In lower eyelid transconjunctival blepharoplasty, lower eyelid protrusion is addressed by removing orbital fat via a transconjunctival approach. While this procedure has the advantage of avoiding skin scarring, improper surgical manipulation can lead to skin damage that induces postoperative eyelid contraction and ectropion. We report the case of a 38-year-old woman who developed ectropion after skin damage during blepharoplasty. The postoperative ectropion was treated with an incision beneath the lower eyelid lashes to release the subcutaneous contracture, followed by transplantation with a full-layer skin graft from the opposite lower eyelid to cover the area of skin loss. The graft was secured with gauze and elastic tape. After surgery, the patient had improved left eyelid valgus, and her dry eye symptoms disappeared. No complications were observed. In previous case reports of lower eyelid ectropion surgery, the upper eyelid skin was generally used as the primary graft source. Our excellent results suggest that lower eyelid skin may be a valuable alternative due to its superior color and texture and minimal impact on the appearance of the upper eyelid. However, the method is not recommended for bilateral ectropion and is limited by the small amount of donor skin that is available. The contracture of the left lower eyelid was incised, and the resulting skin defect was addressed with a fullthickness skin graft from the contralateral lower eyelid. Additional right orbital fat was resected at the same time. (A) Preoperative design. (B) A picture of when the contracture was released. (C and D) Photos taken immediately after surgery before (C) and after (D) tap fixation.

抄録全体を表示

In Charcot foot deformity caused by diabetes, the tarsal bones undergo pathological fractures due to diabetic neuropathy, resulting in a protruding plantar surface deformity known as a rocker-bottom deformity. Ulcer formation on the bony prominences is difficult to heal and often leads to major amputation. In this study, we performed ostectomy of the protruding bones and closure with a free anterolateral thigh flap for two patients with plantar ulcers associated with Charcot foot deformity. The flaps survived in all cases and long-term ulcer-free healing was achieved with the use of offloading devices. While arthrodesis is considered the primary treatment for deformed joints, it may be challenging to perform in cases with significant ulceration and exposed bone. Closure with a flap is considered a viable option in such cases. Charcot foot deformity in diabetes can continue to progress during the course of treatment. Therefore, the continued use of offloading devices and regular adjustments, along with multidisciplinary support, are crucial.

抄録全体を表示

Bilateral facial nerve palsy is an exceedingly rare condition. Sequelae caused by facial paralysis, including facial deformity, visual field disturbance and drooling, can have significant functional, aesthetic and even psychological impacts. We report an unusual case of a 49-year-old Japanese woman with visual field disturbance associated with brow ptosis by bilateral facial nerve palsy. Treatment involved brow lift after the failure of conservative measures. Various methods of brow lift have been reported, but midforehead lift was used in this case to sufficiently elevate the medial brow and glabellar ptosis. At the one-year follow-up examination, there had been no recurrence of brow ptosis, and the patient was satisfied from psychological, aesthetic and functional perspectives. We recommend this procedure because it is simple, effective and safe for a single plastic surgeon to perform without the need for special equipment. In cases of brow ptosis due to bilateral facial nerve palsy, especially in middle-aged and elderly patients, a midforehead lift seems to be a reasonable treatment option. Further cases are needed to confirm these benefits. (a) At the level above the lateral brows, the width of the area to be excised was approximately 20 mm, and in the middle area of the glabella, it was approximately 15 mm. This was designed so that most of the final scarring would be located within the furrow line. (b) The wound was meticulously closed in layers.

抄録全体を表示

Iliac bone grafting is frequently used in plastic surgery. Complications occur in approximately 10% of iliac bone harvesting cases; among these, iliac bone fractures rarely occur (4%). However, there are no reports of plastic surgery for iliac bone fractures after iliac bone harvesting in Japan. We herein report a case in which orbital floor fracture reduction was performed using an iliac bone graft. Although no abnormalities were observed in the intraoperative findings during iliac bone harvesting, postoperative iliac bone fracture was observed, requiring conservative treatment. We recommend that the iliac bone be harvested at least 20–30 mm posterior to the anterior superior iliac spine with the long axis along the iliac crest to reduce the risk of postoperative iliac bone fracture in iliac bone harvesting. The possibility that a low bone mineral density increases the likelihood of fracture after iliac bone harvesting should also be considered.

抄録全体を表示

Labial adhesion is an acquired vulvovaginal disorder in which the labia minora are fused and cover the vaginal fornix. Although there have been reports of surgical cases from departments specializing in vulvodynia, such as obstetrics, gynecology, and urology, physicians in the field of plastic surgery have had relatively little experience with this condition, and reports of its occurrence are rare. We herein report a postmenopausal woman with labial adhesion due to lichen sclerosus who underwent surgical treatment and postoperative management with Estriol vaginal tablets and achieved a favorable outcome. The 71-year-old patient had been followed up by the dermatology department for lichen sclerosus for 3 years. She was referred to our department for surgery with a chief complaint of dysuria due to an adhesive tendency of the labia. Z-plasty under general anesthesia was performed to prevent postoperative recurrence by placing the skin surface adjacent to the labia. Postoperatively, the patient was instructed to self-treat using Estriol vaginal tablets. Follow-up showed that the favorable postoperative results were still maintained even two years after the surgery.

抄録全体を表示

Facial trauma, which is occasionally encountered in emergency medicine, may lead to hemorrhagic shock, particularly when accompanied by fractures of the facial bones. We herein report a case of hemorrhagic shock due to minor facial trauma that did not involve facial fractures. An 88-year-old Japanese man was admitted to the emergency room with epistaxis and a flap-like laceration from the right side of the nose to the upper lip. The patient was hypotensive and in shock, with continuous bleeding from the wound. The volume of blood loss was estimated to be 800 mL based on information provided by ambulance attendants. The patient recovered from shock after adequate fluid resuscitation, blood transfusion, and hemostatic treatment. The flap-like wound was repaired via primary intention and healed without necrosis of the skin flap. Hemorrhagic shock may occur with seemingly minor facial trauma. Therefore, it is important to thoroughly examine the lesions and attempt to close them as completely as possible. This case is novel in that the patient had hemorrhagic shock resulting from facial trauma that did not involve facial fractures. (a) Right anterior oblique aspect. (b) Axial slices from computed tomography (CT) during emergency treatment. Some fluid accumulation was noted; however, there were no signs of zygomatic fracture. (c) Coronal CT slices of computed tomography during emergency treatment. Each nasal concha was intact, and no fluid accumulation was observed. A flap-like wound was observed extending from the right side of the nose, including the tip, to the upper lip.

抄録全体を表示

A 76-year-old man complained of frequent bleeding from the left IV toe and was diagnosed with a traumatic arteriovenous malformation based on examination findings and a history of bruising in the same area. Surgical ligation of the dorsal ankle, dorsal foot, and posterior tibial arteries at the level of the ankle joint was performed by a surgeon at the previous hospital. However, the lesion worsened, so the patient was referred to the radiology department and underwent four percutaneous sclerotherapy treatments. Thereafter, the pain improved, but erythema, pus drainage, and necrosis of the skin of the left third and fourth toes were observed. The patient was referred to our hospital for sclerotherapy and toe amputation. After amputation, negative-pressure wound therapy was performed, and the patient healed with split-thickness skin grafting. In this case, a patient with an arteriovenous malformation of the foot underwent ligation of a nutrient artery at another hospital, which resulted in worsening of the lesion and necrosis of the toe. It was considered difficult to preserve the affected limb beyond the ankle joint. However, we performed toe dissection combined with sclerotherapy at our hospital and successfully preserved the affected limb. (A) First visit to our hospital (B) Operation photo of amputation, design of dermal incision line (C) Split thickness-skin graft was harvested on 15 days after amputation. (D) Wound epithelialization was obtained at 5 month after skin graft.

抄録全体を表示