Objectives: Liposuction effectively reduces limb volume in cases of advanced fat-dominant lymphedema. This study compares surgical outcomes between men and women using Brorson's liposuction for lymphedema protocol.

Methods: A total of 11 men and 11 women with unilateral limb lymphedema who underwent liposuction were matched based on preoperative volume difference (Vol Diff) and percentage volume difference (%Vol Diff) between the affected and unaffected limbs. Individuals were secondarily matched for age, body mass index, and lymphedema duration. The volume of fat aspirated was compared to preoperative Vol Diff to calculate a percentage (%) aspirate volume. The preoperative %Vol Diff and postoperative %Vol Diff at two-time intervals over 12 months were recorded. Differences between the groups were assessed for significance.

Results: Preoperative male group mean %Vol Diff of 35.1% matched the female group mean %Vol Diff of 34.8% (p = 0.928). The surgical male mean %aspiration volume of 80.4% was significantly less than the female group of 119% (p = 0.004). The reduction in male mean %Vol Diff was significantly less at the two postoperative time intervals. At 3-6 months, the mean %Vol Diff for men was 20.7% and 3.8% for women (p = 0.009). At the 9-12 months, the mean %Vol Diff was 13.2% for men and 4.2% for women (p = 0.006).

Conclusions: The male group matched for preoperative volume with a female group had a lower %aspiration volume and higher postoperative %Vol Diff which was most likely due to sex-based fat differences.

Objectives: The coronavirus disease 2019 pandemic has encouraged the use of masks in Japan, and areas of the face that are covered by masks are less likely to be seen by others. This concealment may lead to a decrease in laser treatment in masked areas; however, no study has examined this change. This retrospective comparative study investigated the effects of mask use during the coronavirus disease 2019 pandemic on facial regions targeted for laser treatment among Japanese patients.

Methods: We compared two groups of 103 patients who underwent facial laser treatment before and after the pandemic onset. We analyzed patient data, such as age, sex, treatment area, and preferences in masked and unmasked areas.

Results: The number of patients seeking laser treatment remained unchanged during the two 3-year periods before and after the pandemic onset. However, after the onset of the pandemic, the number of patients who desired treatment only outside the masked area significantly increased. Treatment area preferences significantly shifted from the cheeks before the pandemic to the eyelids and glabella after the onset of the pandemic.

Conclusions: The findings suggest that the coronavirus disease 2019 pandemic has influenced the facial areas where patients seek cosmetic enhancements, possibly due to changes in mask-wearing habits and social behaviors. Plastic and cosmetic surgeons should be aware of these changes in aesthetic preferences to provide updated and relevant treatments to their patients. Further studies are needed to better understand the impact of the pandemic on cosmetic preferences and practices.

Objectives: Sofpironium bromide is the first topical anticholinergic drug approved in Japan for the treatment of primary axillary hyperhidrosis. This study aimed to investigate the effectiveness of sofpironium bromide in patients with primary axillary hyperhidrosis who experienced residual axillary odor or recurrence of axillary odor after surgery with subdermal excision of apocrine glands by skin flap procedure for axillary osmidrosis.

Methods: A total of 56 patients who underwent surgery for axillary osmidrosis at our hospital between January 2022 and April 2023 were included in this study. Axillary odor and sweat volume were evaluated with patient-reported visual analog scale in 56 patients who underwent surgery for axillary osmidrosis and 13 patients administered with sofpironium bromide after the surgery.

Results: Surgery in patients with axillary osmidrosis significantly improved axillary odor and excessive sweating by approximately 90% and approximately 54%, respectively. Treatment with sofpironium bromide in patients with axillary hyperhidrosis after the surgery significantly improved axillary odor and excessive sweating by approximately 70% and approximately 63%, respectively.

Conclusions: These results suggest that sofpironium bromide is effective in patients with axillary hyperhidrosis after the surgery. Since this study was conducted with a small number of patients in a retrospective single-arm design, it is necessary to validate the results in a prospective controlled study with a large number of patients.

Objectives: Hypervascularity, hypertrophy, and hyperpigmentation of breast scars often persist for several years after reconstruction. There are few reports on the long-term follow-up of postoperative scars after breast reconstruction. We previously reported that at 1 year after reconstruction, >30% of Asian patients showed abnormal scars. In this study, we followed these patients for as long as 5 years postoperatively.

Methods: We followed 101 Asian patients who underwent immediate two-stage implant-based breast reconstructions between 2013 and 2017 and still had abnormal scars involving hypervascularity, hypertrophy, or hyperpigmentation at 1 year postoperatively. We conducted annual follow-up for an additional 4 years, assessing the time until improvement and performing statistical analysis of factors related to the persistence and healing of abnormal scars.

Results: Hypervascularity improved in 12%, 37%, 68%, and 82% of patients at 2, 3, 4, and 5 years, respectively. Most cases improved between 3 and 4 years postoperatively. Among the patients with both hypervascularity and hypertrophy at 1 year, 36% had residual hypervascularity at 5 years compared with 9.8% of those with hypervascularity only at 1 year. Hypertrophy improved within 5 years in 56% of the cases. Hyperpigmentation improved within 5 years in only 21% of the cases. There was no significant association between abnormal scars and age or body mass index.

Conclusions: Even in Asian patients with persistent hypervascularity of breast scars, most cases improve within 5 years after reconstruction. However, hypervascularity tends to persist in cases that also show hypertrophy. Compared with hypervascularity and hypertrophy, hyperpigmentation showed worse 5-year improvement.

Objectives: Dermatofibrosarcoma protuberans (DFSP) usually arises in the dermis and spreads to the underlying subcutaneous tissue (cutaneous DFSP). However, it rarely appears in the subcutaneous tissue (subcutaneous DFSP). This study aimed to retrospectively analyze the clinicopathological features of patients with the subcutaneous dermatofibrosarcoma protuberans and compare them to those of cutaneous dermatofibrosarcoma protuberans.

Methods: A total of 24 patients with dermatofibrosarcoma protuberans who underwent surgical excision at our institution between 1991 and 2022 were included in this study.

Results: The tumors were located on the trunk in 18 patients (75%), upper extremity in 2 (8%), and lower extremity in 4 (17%). The median tumor diameter was 4.35 cm. A total of 18 patients underwent surgical resection before arriving at our hospital, 16 of whom had positive surgical margins. At our institution, the tumors were radically resected with a median surgical margin of 2 cm, following which reconstructive surgery was performed in 17 patients (70%). Fibrosarcomatous changes were observed in five patients (21%). Excluding four recurrent cases, the remaining 18 (90%) and 2 (10%) patients were diagnosed with cutaneous dermatofibrosarcoma protuberans and subcutaneous dermatofibrosarcoma protuberans, respectively. The median follow-up period was 5 years. There were no cases of metastasis or recurrence.

Conclusions: When subcutaneous dermatofibrosarcoma protuberans appears as a subcutaneous nodule, it is frequently misdiagnosed and improperly treated with unplanned excision owing to the absence of typical skin surface changes. Dermatofibrosarcoma protuberans is locally aggressive regardless of the depth of the principal lesion, and appropriate initial surgical excision with an adequate surgical margin is crucial for definitive treatment.

In recent years, the medial sural artery perforator flap has attracted attention due to its thin, pliable, and long vascular pedicle without sacrificing the major vessels of the lower extremities. We encountered six cases of head and neck or limb reconstruction using a medial sural artery perforator flap. All flaps survived; however, one patient developed partial necrosis of the medial head of the gastrocnemius muscle at the donor site.

Necrosis of the gastrocnemius muscle does not usually occur after harvesting the medial sural artery perforator flap. However, blood flow to the muscle could decrease after flap harvest. The dissection of the deep surface of the gastrocnemius muscle and between the medial and lateral heads during flap harvest should be minimized to preserve blood flow, and skin grafting should be used when presumable tension is critical.

A 72-year-old woman was referred for noticing a nodule on the arteriovenous fistula spontaneous obstruction. Physical examination revealed a dark reddish, non-pulsatile nodule in the right forearm that measured 21 × 13 mm, bled easily, and was partially crusted. During the course of examinations, the patient developed trauma-induced excessive bleeding from the lesion. At the initial examination, based on the clinical findings, we considered the possibility of cutaneous neoplasm. Eventually, we made the diagnosis of an organized hematoma and an arteriovenous fistula pseudoaneurysm. No previous report of an arteriovenous fistula pseudoaneurysm mimicking a neoplasm arising from a stenosed arteriovenous fistula, as in our case, has been available. An arteriovenous fistula pseudoaneurysm can arise even from a stenosed arteriovenous fistula, so that an early diagnosis can be made and impending rupture prevented.

Polydactyly of the foot is one of the most frequently observed congenital deformities. Although resection of the extra phalanx generally leads to a favorable outcome, functional disorder may sometimes occur.

We present a rare case of bilateral metatarsal-type polydactyly of the foot. The patient underwent resection of the bilateral extra phalanxes at the age of 1, followed by reoperation at the age of 9 years due to the complaint of pain on the lateral side of his left anterior foot while walking. Therefore, we performed metatarsal transfer to preserve the articulation between the extra metatarsal bone and fifth phalanx, which led to a favorable outcome. In complicated cases, we believe that a "wait and see" strategy is reasonable to facilitate appropriate preoperative evaluation, taking into account the future growth of the reconstructed toes and preserving the foot function.

Giant cell tumors of the tendon sheath (GCTTS) are locally invasive and have a high likelihood of recurrence in adults, but it is rare in children. Its potential to be invasive or recur has not been characterized. We present a 9-year-old patient with a dumbbell-shaped GCTTS that had small intraarticular and large extraarticular components with a narrow connection between them. This case suggests that GCTTS can be locally invasive in children. This case report could help hand surgeons who treat GCTTS in children.

Perineuriomas (PNs) are soft tissue tumors originating from the perineurium. We report the case of a 51-year-old man who presented with a right mandibular mass. Initial examination revealed a palpable, painless, solid mass at the right mandibular angle. Preoperative computed tomography revealed a highly absorbent mass with uneven staining margins in contact with the mandible. Surgery was performed under general anesthesia for diagnosis, and a well-defined solid tumor of 8 cm was excised. Subsequently, immunohistological staining revealed that the tumor was diagnosed with perineuriomas recurrence of mental nerve origin. This is the first report on perineuriomas of mental nerve origin and the third report on recurrent perineuriomas. Our findings highlight the need for immunohistological staining of tumors for perineuriomas diagnosis, and follow-up observation might be recommended given the risk of recurrence.

Staged pedicled flaps continue to be a safe and effective technique for reconstructing complex wounds when free tissue transfer is not possible. To induce ischemic preconditioning, serial cross-clamping of the pedicle is performed, which is also known as flap training. Current protocols for flap training are based on arbitrary schedules of progressively increasing periods of ischemia. We describe a simple, safe, and reproducible technique of using near-infrared spectroscopy to objectively guide the process of pedicle cross-clamping and aid in determining the optimal timing for flap division. This technique enables surgeons to adopt a more aggressive clamping schedule based on objective parameters, tailors the clamping schedule to the physiologically tolerable limits of each flap, and allows for early flap division. The principles, feasibility, and advantages of using near-infrared spectroscopy to guide pedicled flap training and early flap division are discussed.