A total of 10 patients with abdominal wall metastasized visceral cancer underwent reconstruction of full-thickness abdominal wall defects after metastatic tumor ablation using free or pedicled perforator flaps. The primary tumor sites were as follows: colon in 3, stomach in 2, urinary bladder in 2, bile duct in 2, and rectum in 1. One patient was considered to have port-site recurrence after endoscopic surgery. No primary malignant tumors of the abdominal wall were included in this series. For reconstruction, 3 free anterolateral thigh flaps, 4 pedicled anterolateral thigh flaps and 3 pedicled deep inferior epigastric artery perforator flaps were used. The dynamic reconstruction procedure with innervated vastus lateralis and anterolateral thigh flap was not employed. All flaps completely survived. Postoperative complications included one case of mild adhesive ileus and one case of MRSA pneumonia resulting in abdominal wall abscess.
Although the vascularized medial femoral condyle corticoperiosteal graft（V-MFCG) is useful for difficult scaphoid nonunion, its usefulness and indications are controversial. We report a small case series of V-MFCG in comparison with conventional bone grafting for scaphoid nonunion. We treated three difficult scaphoid nonunion cases using V-MFCG. The results were compared with those of six cases of conventional bone grafting for scaphoid nonunion. Bone healing was evaluated by X-ray and computed tomography（CT). We measured the operation time, and postoperative functions were evaluated by range of motion（ROM), ROM improvement rate, symptoms, and Mayo Wrist Score. The operation time for V-MFCG was approximately twice that for conventional bone grafting. Bone union was achieved in all cases of V-MFCG, whereas bone union was not achieved in two cases of conventional bone grafting. The improvement rate for ROM and postoperative symptoms were significantly higher with V-MFCG than with conventional grafting. V-MFCG provides relatively good results even in difficult scaphoid nonunion cases, although it is technically more difficult than conventional grafting.
Early revascularization of traumatic extremity vascular injuries is the most important factor for functional limb salvage. Use of a temporary intravascular shunt (TIVS) is one method for shortening the ischemic time. We present five cases in which a TIVS for traumatic major arterial vascular injury of the extremities was used. The average temporary revascularization time was 257 minutes after injury. The average definitive vascular repair time was 383 minutes after injury. The TIVS was inserted in an average of 22 minutes including approach to injured vessels. Thus, use of the TIVS shortened the revascularization time by 104 minutes on average. The average blood loss during the operation was 314 ml (90-950 ml). No patients developed ischemia-reperfusion injury. Fasciotomy was performed for two patients. All limbs were not infected and were able to be salvaged. Although use of a TIVS may increase the risk for bleeding, it plays an important role in shortening the ischemic time, and may be a standard treatment method for traumatic extremity vascular injuries.
Glomus tumors are benign tumors found mainly in the digits of the hands, but rarely in the toes. In this study, we report a case of glomus tumor in the hallux. A 63-year-old female patient visited our department for a 10-year history of right hallux nail pain of unknown cause. Physical examination revealed redness, tenderness and nail deformity. On MRI examination, low iso-intense signals were observed on T1 images and high-intensity signals in a tumor under the nail bed on T2 images. We diagnosed it as a glomus tumor of the hallux and excised the tumor under microscopic guidance, followed by confirmation by histological examination. After the surgery, the patient reported no pain in the hallux. MRI examination revealed no signs of recurrence and no deformity of the nail. For glomus tumors, early diagnosis is important and they may occur outside of the digits.
For patients with advanced stages of malignancy, local treatment will improve the quality of life by relieving pain, simplifying daily treatments, controlling hemorrhage and reducing the mental burden. Therefore, palliative surgery as a modality of local treatment aimed to maintain activities of daily living should be performed accurately. When planning palliative reconstructive surgery, several factors must be taken into account such as the patient's performance status, the surgical site condition, treatment history, and surgeon's skill. Here, we present three cases of palliative reconstructive surgery with free flaps, all of which were successful without any complications. Regarding palliative reconstructive surgery, free flaps may be a useful choice. In certain cases, aggressive use of free flaps beyond the reconstruction ladder is more effective than other methods such as skin grafts, local flaps and pedicled flaps. To achieve the best outcome, consideration for individual patients and solid surgical skills are warranted.