Objectives: The Ilizarov mini-fixator, an external fixator developed for digits, has a structure different from that of general unilateral external fixators. The purpose of this study was to provide information for clinical external fixator selection by clarifying the biomechanical properties of the Ilizarov mini-fixator.

Methods: Three types of loads were applied to the fracture fixation model using a carbon fiber cylinder as the bone model: axial pressure, 4-point bending, and torsion. Ilizarov mini-fixators with six 1.5 mm pins (6-pin group), four 1.5 mm pins (4-pin group), and four 2.0 mm-threaded-pins (2 mm-pin group) and a group using a 1.5-mm plate (plate group) were set, and the stiffness was compared between these four groups.

Results: Compared to the 6-pin group, which is the basic configuration of the Ilizarov mini-fixator, the 4-pin group had lower stiffness against axial load and bending, and there was no significant difference in stiffness against torsion. The 2 mm-pin group had high stiffness against axial load and bending and low stiffness against torsion. The plate group exhibited high stiffness against axial pressure and low stiffness against bending and torsion.

Conclusions: The Ilizarov mini-fixator is a reasonable option for fixing small phalanges. However, other options should be considered for the fixation of larger bones with higher loads. In particular, a configuration with fewer pins such as the 4-pin model may have insufficient strength during early postoperative exercise, even for fixing the phalanges.

Objectives: Motor neurotization is essential for functional muscle transfer. The aims of this anatomical study were to map the course of the vastus lateralis muscle motor nerve and determine the axonal counts of the main trunk and its branches to assess its suitability as a free functional muscle transfer.

Methods: Ten cadaveric thighs were dissected. The length of the nerve and its branches were measured, harvested en bloc, and cross-sectioned at its origin and each branch. Their calibers and axonal counts were analyzed. The vastus lateralis muscle was used for a functional muscle transfer in a clinical case of upper lip reconstruction.

Results: The branches of the vastus lateralis muscle motor nerve coursed adjacent to the branches of the lateral circumflex femoral artery. Two nerve branching patterns were identified. Type 1 (70%) consisted of two branches, the transverse and descending. Type 2 (30%) consisted of three branches, the transverse, oblique, and descending. The average lengths and axonal counts of the transverse, oblique, and descending branches were 7.1, 6.7, and 15.2 cm and 1021, 545, and 1158, respectively. The average lengths of the accompanying transverse, oblique, and descending branches of the lateral circumflex femoral artery were 5.7, 9.0, and 10.3 cm, respectively. Our clinical case regained muscle function and oral sphincter competency.

Conclusions: Three types of muscle segments of the vastus lateralis muscle may be harvested for functional muscle transfer based on the descending (type A), oblique (type B), and transverse (type C) nerve branches. Types A and C have axonal counts matching the buccal branches of the facial nerve. Clinically, type A functional muscle transfer for lip reconstruction was validated.

Objectives: The temporalis muscle flap is regaining popularity for facial reanimation since recent modifications have improved its efficacy as a single-stage technique. Nevertheless, in all these procedures, the deep temporal nerve innervating the muscle is not visualized. Thus, the purpose of this anatomical study is to track the deep temporal nerve's course and provide a visual guide of it.

Methods: Eighteen hemifacial cadaveric specimens were dissected to trace the deep temporal nerve's course from its origin to its entry point in the temporalis muscle. This was performed without disturbing the native course of the deep temporal nerve in relation to the undetached temporalis muscle. Multiple craniofacial osteotomies were performed for exposure while maintaining the spatial relationship of the deep temporal nerve to the muscle.

Results: In 14 specimens (78%), the deep temporal nerve arose from the mandibular nerve. In four specimens (22%), it originated from the maxillary nerve. The deep temporal nerve was approximately 1.7 cm in length from its origin to its point of entry into the muscle. It entered at an average of 0.91 cm directly above the tip of the coronoid process.

Conclusions: With respect to mobilizing temporalis muscle flap, the high origin of the deep temporal nerve from the maxillary nerve may impact the descent of muscle. Because of the proximity of the nerve entry point to the temporalis tendon, special care must be taken when detaching the tendon from the coronoid process to avoid nerve traction and avulsion. The maxillary nerve is mixed with both sensory and motor components in some cases, which is in contrast to the established concept that it is purely sensory.

Breast cancer-related axillary node dissection is the commonest cause of upper extremity lymphedema. The ability of lymphatics to regenerate spontaneously or reconnect with native lymphatics after free or pedicled flap reconstruction has been demonstrated on lymphoscintigraphy. Lymphatic anastomosis is not always needed in these flaps. In patients who underwent axillary clearance with risk factors for the development of lymphedema, we harvested a vascularized serratus anterior fascia flap during concurrent latissimus dorsi flap harvest (for breast or chest wall reconstruction). The vascularized fascia was wrapped around the axillary vessels to provide a conduit for lymphatic regeneration, protect the axillary vessels from radiotherapy, and reduce scarring and axillary cording. This procedure was performed on three patients with none of them experiencing upper limb lymphedema or cording.

The reconstruction of scarring eyebrow defects is a challenging task for plastic surgeons as the eyebrow is an important cosmetic landmark of the face. Various methods are used for eyebrow reconstruction; free hair follicle transplantation, scalp composite graft, local flap transposition, and hair-bearing island scalp flap have been widely reported in the past and are applied according to the size and position of the eyebrow defect. For partial eyebrow defects, the best option is the use of local flaps from the remaining ipsilateral eyebrow, which have characteristics highly similar to those of the recipient site. Herein, we present a case in which an orbicularis oculi muscle pedicled flap from the contralateral eyebrow was used as a donor site with good results.

An 8-year-old girl suffered a penetrating trauma when a house key was stuck in her forehead. The CT scan showed the key-penetrated scalp and the brain. The bone around the key was scraped and the key was removed, but no reconstruction was performed at the time to avoid any infection. After 8 months, we performed the reconstruction. A full-thickness bone of the same size as that of the defect was collected and split into two tables. The outer table was used for the correction of the defect, whereas the inner table was restored to the original site. There were no complications, and no step was touched through the surface. An autologous skull bone is useful as a reconstruction material when a patient is a child and a skull has sufficient thickness to divide it into two tables. It can be regarded as a useful method for cranial reconstruction in children.

An epidermal nevus is known to appear at birth or in early childhood. Generally, it does not undergo major changes throughout life and can be left untreated. We report a case of basal cell carcinoma arising from an epidermal nevus in a 79-year-old man with congenital linear brown epidermodysplasia and nodular lesions on the right posterior neck. He had no other symptoms that could be attributed to epidermal nevus syndrome. He reported leakage of exudate from the nodule in recent years. Upon resection, the histopathological examination revealed an eccrine sweat gland tumor and basal cell carcinoma in a portion of the epidermal nevus. Cases of malignant tumors (e.g., squamous cell carcinoma and basal cell carcinoma) arising from an epidermal nevus have been reported previously. Nevertheless, preventive resection is not recommended in all cases. Epidermal nevi, even those left untreated or with changed properties, are rarely malignant.

Macrodystrophia lipomatosa is a rare, congenital, non-hereditary form of localized gigantism characterized by abnormal fibroadipose tissue proliferation. Here, we report a case of a 39-year-old male with macrodystrophia lipomatosa of the whole left extremity with refractory foot ulcer. Imaging showed fibroadipose tissue proliferation and severe giant deformities of the second and third toes. The plantar pressure measurements during gait revealed that both peak pressure and pressure-time integral around the ulcer were increased; therefore, the forefoot deformities might have caused the ulceration. To decrease and redistribute the plantar pressure, debulking the forefoot soft tissue, involving the second and third toe amputation, and cutting the flexor tendon of the fifth toe of severe flexion contracture were performed. No recurrences were found 6 months after surgery. The plantar pressure measurements helped in planning surgical strategies, and we evaluated the loading condition of the foot sole despite a severe congenital deformity.

In this paper, we present a technique for immediate nipple reconstruction in two patients who underwent ipsilateral mid-abdominal transverse rectus abdominis myocutaneous breast reconstruction. The umbilical stalk and surrounding skin were included in the harvested flap. The flap was transferred and inset placing the umbilicus in the ideal nipple position. The umbilicus was then everted with traction, and its height was maintained with cerclage suturing, dermal grafts, and horizontal-to-vertical skin closure. This "nipple-licus" achieves immediate nipple reconstruction without a need for a second surgery or an additional donor site.