Objectives: Many reconstruction techniques exist for full-thickness defects of the lower lip, which all have advantages and disadvantages. We performed lower-lip reconstruction using the Japanese Fusuma sliding flap method and obtained good results. Here, we introduce this method and report on its results, including long-term follow-up, and its details.

Methods: A lateral advancement flap from the cheek, pedicled on the facial artery, reconstructs the lower lip. If needed, a subcutaneous flap from the cranial nasolabial fold reconstructs the donor site of the first flap. We retrospectively examined nine patients with full-thickness, full-width lower-lip defects who underwent reconstructive surgery using the Fusuma sliding flap method between 2006 and 2021. The postoperative evaluation items were as follows: (1) survival of skin flaps, (2) appearance, (3) eating function, (4) perception, and (5) presence or absence of revision surgery.

Results: Regardless of the form or extent of defects, the flaps survived successfully in all cases, and their appearance, feeding function, and sensation were good. However, revision surgery was required for cases where defects exceeded the commissure.

Conclusions: Although the number of cases was small, and issues that the need to be addressed remain, this procedure is simple, highly versatile, and provides stable results.

Objectives: Remote medical care is becoming popular worldwide, but not as much has yet been done in plastic surgery. We provided online treatment related to plastic surgery using a 5G system. This study aimed to investigate the usefulness and future of online telemedicine in plastic surgery.

Methods: A plastic surgeon alternated between face-to-face and telemedicine. The interval between consultations was 1 week. Specifically, local doctors and staff provided medical care to patients at the suburban hospital, and the plastic surgeon remotely observed patients and provided instructions and guidance on procedures to the local doctors and staff. In this study, we evaluated the patients who were treated under telemedicine with respect to their age, use, and effectiveness. The study encompassed the period from August 2021 to October 2022.

Results: Thirty-five patients were treated via online telemedicine (mean age, 73.0 years). Twenty-one (60%) of the postoperative procedures were related to surgeries performed by a plastic surgeon. Consultation for simple wound care was performed in 8 (22.9%) patients. Guidance on pocket incision surgery for pressure ulcers was given to one patient. As for the quality of communication, images were clear, no delays were encountered, and no cases interfered with medical care.

Conclusions: Our system was primarily useful as a postoperative management tool. The high image quality and low-latency communication allowed for real-time instruction during complex postoperative procedures and surgical techniques. Even in hospitals with infrequent visits from plastic surgeon, telemedicine has the potential to make surgery safer and more proactive.

Objectives: This study aimed to compare the quality of scarring of DERMABOND PRINEO (Ethicon, Inc., Somerville, NJ, USA) ^® by conducting a half-side test on the same wound to determine its superiority. If the utility of DERMABOND PRINEO^® is established, its use can be expanded for more cases and higher quality medical care can be provided.

Methods: Patients who underwent two-stage breast reconstruction were included. The first surgery was half closed with DERMABOND PRINEO^® and nylon threads, and the time was measured. At the second surgery, all scars were removed, and a histopathological examination was done. Scars were evaluated with the Vancouver Scar Scale (VSS) and visual analogue scale (VAS), and statistical analysis was performed.

Results: Time to closure was significantly shorter in the DERMABOND PRINEO^® group. Postoperative VSS scores for pliability were significantly lower in the suture group, and the total VSS score was significantly lower in the suture group from 3 to 6 months postoperatively. Patients rated postoperative wound pain, itching, appearance, and satisfaction with the VAS, but no significant differences were observed between the two groups. The scars were compared with hematoxylin-eosin staining and Elastica van Gieson staining. Differences were seen in the increase of elastic fibers in the dermal reticular layer, a characteristic difference between the two groups.

Conclusions: The use of DERMABOND PRINEO^® leads to a reduction in operative time and impacts the maturity of the scar. It is expected that the indications for DERMABOND PRINEO^® can be further expanded in the future.

A 39-year-old woman diagnosed with persistent congenital tibial pseudoarthrosis until adulthood presented with a right leg angular deformity, associated pain, and significant limb length discrepancy. Over a 17-year period, the case was closely monitored and treated through excision of the pseudarthrosis, vascularised fibular graft with bone marrow-derived and cultured mesenchymal cells, combined with highly purified β-tricalcium phosphates, internal fixation, and the application of a ring Ilizarov fixator. The successful union of bones and correction of deformities was achieved through consideration of both mechanical and biological aspects.

Necrotizing fasciitis is a rare, severe, life-threatening, and rapidly progressing infection characterized by necrosis of the fascia and subcutaneous tissue with systemic toxicity. In this study, we report a male patient with only controlled hypertension who was diagnosed with necrotizing fasciitis of his middle finger after sustaining a kitchen knife injury. Successful treatment involved amputating the third finger at the level of the medial proximal phalanx due to the severe and rapid progression of symptoms and the elevated risk of Vibrio spp. and Staphylococcus spp. causing necrotizing fasciitis, considering the patient's profession as a cook and his being immunocompetent. The patient was able to resume a working life after a short hospitalization without any severe complications. This is a reminder that even a minor injury can result in a life-threatening infection. Early surgical intervention saved the patient's life, eliminated the need for reoperation, and shortened the hospitalization.

We report a case of a 1-year 7-month-old boy who had resection of a divided nevus and skin grafting that resulted in the disappearance of residual nevi, graying of eyelashes, and depigmentation at the donor site of the skin graft and around the lips. The nevus partially remained on the lid margins, although resected as much as possible from the upper and lower eyelids. Nevus cell nevus was the histopathological diagnosis of the resected lesion. Approximately 3 years after surgery, the pigmentation of the nevus remaining on the lid margins started to regress, and the eyelashes at the same sites became gray. Vitiligo gradually developed on the skin grafted from the clavicular region. Approximately 5 years after surgery, the findings remain similar. In this patient, immune responses against nevus cells were established, followed by Sutton's phenomenon accompanied by the destruction of epidermal melanocytes.

A subcutaneous rheumatoid nodule is a superficial soft tissue lesion that generally affects areas of frequent mechanical contact, such as the extensor aspect of the extremities, occiput, and sacrum. Rheumatoid nodules of the foot are rare, occurring in only 1% of cases. Herein, we present a case of a rheumatoid nodule on the plantar side of the left hallux in a 65-year-old woman with rheumatoid arthritis. The tumor was a 15 × 10 mm, dome-shaped, nontender, elastic hard mass in the plantar aspect of the left hallux. The discovery of rheumatoid nodules provides crucial information for the treatment and management of rheumatoid arthritis. Giant cell tumors may cause symptoms similar to those of rheumatoid nodules. Furthermore, difficulties are associated with differentiating rheumatoid nodules from giant cell tumors using imaging modalities. Therefore, the identification of these tumors requires careful observation.

Atypical Spitz tumors are one type of the Spitzoid melanocytic lesion, characterized by one or more atypical features, and often demonstrate indeterminate biological potential. Atypical Spitz tumors pose challenges in both clinical and pathological diagnoses. Herein, we report a case of a 1-year-old Japanese girl who presented with a rapidly enlarging lesion mimicking a pyogenic granuloma. The patient was ultimately diagnosed with an atypical Spitz tumor. The challenging clinical nature and diagnostic complexity of atypical Spitz tumors underscore their significance as crucial considerations in pediatric skin tumor differential diagnosis. Consistent consideration of atypical Spitz tumors within the diagnostic framework of pediatric cutaneous neoplasms is essential for timely and accurate assessment, thereby ensuring optimal patient care.

Herein, we describe the case of a 33-year-old woman with a rare 16-mm congenital midline upper lip fistula with a broad, cystic lumen. No connection with the oral cavity was observed. Congenital midline upper lip fistulas are not clearly associated with hereditary factors or sex. Sinus computed tomography revealed an inner ear malformation; however, no associations between external and inner ear malformations and upper lip fistulas have been reported. Because the developmental processes of the upper lip and inner ear are different, each develops independently, as in the current case. The standard treatment for congenital upper labial fistula is surgical excision. Shallow fistulas are often approached through a fusiform incision around the fistula. For deep fistulas, expanding the surgical field via a small skin incision is difficult, with a high possibility of a large incision. However, an incision through the oral mucosa minimises the incision size around the fistula.

Basal cell carcinoma (BCC) usually occurs as a solitary lesion but occasionally presents as multiple lesions. The proportion of multiple BCCs is 5.9%-7.1% in Asian patients. We conducted BCC screening in April 2021, focusing on the presence or absence of multiple lesions. Patients examined between April 2021 and March 2022 (161 lesions in 136 patients) were classified as the screening group (SG) and those examined between April 2020 and March 2021 (111 lesions in 103 patients) were classified as the non-screening group (NSG). The proportion of patients with multiple BCCs was significantly higher in the SG than in the NSG (15.4% and 6.8%, p = 0.04). We provisionally classified the head and neck gaze region into the 'central region' and 'peripheral region' based on gaze patterns. In the SG, the proportion of lesions in the peripheral region was higher in patients with multiple BCCs (32.6%) than in patients with a solitary BCC (14.8%). We speculate that we missed recognizing tumours in different areas, especially peripheral areas of the head and neck. Our results indicate that the increase in multiple lesion cases through screening occurred owing to more conscious observation of different regions, especially head and neck regions, thereby overcoming human gaze patterns.