Objectives: Treatment of congenital facial paralysis is often postponed because patients exhibit only mild dysfunction and inconspicuous facial asymmetry at rest. Surgical facilitation of smiling has significant implications for the quality of life and the physical and mental development of patients. We describe facial reanimation using modified lengthening temporalis myoplasty (LTM) in patients with congenital incomplete facial nerve palsy who first presented to our institution after the age of 10 years.

Methods: Three patients (age, 12-26 years; two males and one female) underwent facial reanimation with modified LTM using an extended S-shaped incision. In two cases, T-shaped fascial grafts were simultaneously applied to the lower lip. Evaluation was conducted using a simple and objective method to assess smile symmetry.

Results: The postoperative follow-up period ranged from one to nine years. Postoperatively, the oral commissure remained symmetrical at rest in all three cases. Good symmetry was observed during voluntary smiling in all three cases and during spontaneous smiling in two cases.

Conclusions: Modified LTM, a technique that does not require microsurgery and leaves no facial scarring, is a useful option for smile reconstruction in patients with congenital incomplete facial nerve paralysis.

Objectives: Plastic surgeons often harvest fascia from the upper thigh or gluteal area of the patient to transplant to other parts of the body. The thickness of the fascia differs depending on its position within the two areas. This anatomical study elucidates the positional variation fascia thickness presents within the two areas.

Methods: 21 upper thighs of 12 cadavers of Japanese persons were included in the study. The gluteal maximum muscle (GM), the iliotibial tract (IT), the biceps femoris muscle (BF), the vastus lateralis muscle (VL), and the rectus femoris muscle (RF) were identified. The thicknesses of the fascia were measured for each of these regions and were compared between the regions belonging to the same area.

Results: Gluteal Area: Fascia thickness presents no statistical differences between the GM and IT regions. Upper Thigh Area: The fascia is thickest in the IT region, followed by the BF region. The fascia is thin in the VL and RF regions.

Conclusions: Fascia thicknesses present regional differences. The fascia of the gluteal area is evenly thick, with 1 mm thickness or more. Hence, the gluteal region is suited as a donor site for harvesting a large-sized, thick graft sheet. In the upper thigh area, the iliotibial tract region is the thickest, with thicknesses of 1 mm or more. The fascia is relatively thick in the posterior regions (0.5-0.6 mm), but thin in the anterior regions (0.2-0.3 mm).

Plastic surgery includes both reconstructive and aesthetic procedures, with residency programs designed to provide comprehensive training. However, practical experience in aesthetic surgeries is often limited because these procedures are not typically covered by public health systems. Body contouring surgeries for patients who have experienced massive weight loss offer a training opportunity, as they are technically similar to aesthetic procedures and are publicly funded. This study surveyed recent graduates from a plastic surgery residency program to assess their perceived competence and autonomy in aesthetic surgery. The survey focused on experiences with post-bariatric procedures such as abdominoplasty, breast surgery, thigh dermolipectomy, brachioplasty, and liposuction. The results indicated that residents felt confident in preoperative consultations and basic surgical skills but felt less prepared in theoretical knowledge, technique comparison, and the use of prostheses. Surgical autonomy was highest in abdominoplasty and lowest in inguinocrural dermolipectomy. The study also emphasized the crucial role of the assistant surgeon progressing toward full surgical autonomy. The findings suggest a need for improved training in aesthetic procedures, as well as in commercial and medicolegal aspects. Incorporating these elements into residency curricula can better prepare future plastic surgeons for comprehensive practice and enhance patient outcomes.

Objectives: To evaluate the effect of resonance tube therapy (RTT) for velopharyngeal inadequacy (VPI) of patients with cleft palate (CP± L), submucous cleft palate (SMCP), and congenital velopharyngeal incompetence (CVPI).

Methods: Thirteen patients were diagnosed with mild or moderate VPI due to either repaired CP± L (7), repaired SMCP (1), or CVPI (5) who had articulation errors. We trained these 13 patients in RTT and performed cephalometry before and after training. Roentgen lateral cephalograms during phonation were used to measure the velar height (mm) and the distance of the narrowest segment of the velopharynx (mm).

Results: After RTT, the velum was significantly elevated, and the velopharynx was narrowed during phonation of /a/ (p< 0.01). Additionally, the velum was significantly elevated, and the velopharynx was more markedly narrowed during phonation of /ɯ/ with tube (tube phonation /ɯ/) than during phonation of /a/ (p < 0.01). The velopharyngeal function (VPF) of all 13 patients was improved by RTT. Ten of 13 showed improved speech and velopharyngeal function. Our findings suggest that RTT is effective in improving velar mobility and velopharyngeal function.

Conclusions: The use of roentgen lateral cephalography during phonation provides quantitative objective findings that distinguish between velar mobility before and after RTT. We propose that RTT is effective for improving velar mobility and velopharyngeal function in patients with and without cleft palate (CP).

Lymphocele is a frequent complication in the early postoperative period following lymph node dissection. In this study, we performed sclerotherapy with OK-432 (picibanil) in two cases of lymphocele after groin lymph node dissection. Case 1 involved a 55-year-old male patient who underwent bilateral groin lymph node dissection. A lymphocele developed in the groin after drain removal. The lymphocele in the left groin worsened after the patient resumed work. After four sessions of sclerotherapy with OK-432, the lymphocele resolved. Case 2 involved a 67-year-old male patient who also underwent bilateral groin lymph node dissection. The lymphocele in the left groin persisted despite the initial treatment, but disappeared after four sessions of sclerotherapy with OK-432. The treatment duration for cases 1 and 2 were 51 and 23 days, respectively. Both cases showed mild dermal back flow on lymphoscintigraphy several years after surgery. Sclerotherapy with OK-432 resulted in acceptable results.

Dystrophic epidermolysis bullosa (DEB) causes extensive blisters and erosions due to a genetic abnormality, significantly reducing patients' quality of life. Recently, transplantation of reversion-mutated mosaicized skin has shown promise as a radical cure. In 2019, the use of cultured epithelial autograft for DEB was approved in Japan.

Meanwhile, the Meek micrografting technique, first described in 1958 by Dr. Cicero Parker Meek in the United States of America, was reintroduced in 2019 as a new device for split-thickness skin grafting. This system can harvest skin grafts more efficiently than conventional methods.

In this case report, we report on our successful treatment of DEB using the Meek technique and cultured epithelial autografts.

Risk-reducing mastectomy and risk-reducing salpingo-oophorectomy (RRSO) for patients with hereditary breast and ovarian cancer with a BRCA gene mutation can be performed with simultaneous breast reconstruction. In this report, we present a rare case of umbilical necrosis in bilateral deep inferior epigastric artery perforator flap breast reconstruction with concomitant risk-reducing mastectomy and RRSO. Both deep inferior epigastric artery flaps were elevated based on the perforators cranial to the umbilicus, which may have completely ceased the blood supply from the deep inferior epigastric arteries and caused umbilical necrosis. The supra-umbilical port was used for RRSO, which may have caused damage to the ligamentum teres hepatis, located cranial to the umbilicus. In the preoperative enhanced computed tomography, the ligamentum teres appeared to be a vein. Damage to the ligamentum teres through the supra-umbilical port might have caused umbilical necrosis due to venous congestion. Perforators and port positions might have contributed to the umbilical necrosis.

A Spigelian hernia is a rare abdominal wall herniation that occurs within the Spigelian fascia, located between the semilunar line and the outer border of the rectus abdominis muscle. A 2-year-old boy was brought to our medical facility because of a longstanding bulge in his right lower abdominal quadrant. Computed tomography revealed the presence of a spinal hernia, right undescended testicle, and right kidney defect. Given the potential association of Spigelian hernias with an undescended testis, a comprehensive examination of the scrotal region at the time of diagnosis is warranted. In the absence of intestinal obstruction or hernia abruption, surgical intervention is recommended on a standby basis. Furthermore, concurrent treatment of any undescended testicle is advised to alleviate patient burden.

This case report presents a rare instance of distal sciatic nerve injury caused by bone fragments from a blast injury. It provides valuable insight for plastic reconstructive surgeons, offering guidance on the management of complex sciatic nerve injuries. Sciatic nerve injuries often have a poor prognosis and require long-term management. Due to limited research and established guidelines, management can vary based on surgeon expertise. Initial treatment focused on limb salvage, with the nerve injury initially overlooked. Nerve conduction studies confirmed the extent and level of the nerve injury, leading to surgical exploration, removal of bone fragments within the nerve, neurolysis, and neurorrhaphy.

Breast augmentation using copolyamide fillers, such as Aquafilling^®, is associated with various complications, leading to an increasing consensus against their use. However, the occurrence of breast cancer in patients who have undergone augmentation with fillers has been rarely reported. The management of such cases, particularly in terms of breast reconstruction, presents unique challenges owing to the presence of filler materials. We report the case of a patient with breast cancer who underwent immediate two-stage implant-based breast reconstruction after breast augmentation with Aquafilling^®. No capsular formation was observed around the tissue expander during the second reconstruction procedure. To prevent implant migration, the normal tissue of the marginal pocket was identified and sutured. However, caudal migration of the implant still occurred. This case highlights the need for improved surgical techniques to stabilize silicone breast implants effectively. Further research is warranted to understand the long-term implications of copolyamide fillers on breast reconstruction outcomes.

Depressed scars may develop from subcutaneous fat damage after facial trauma. For cases without visible scars on the skin surface, a non-incisional approach is preferred. We treated a depressed scar on the mandible with string-shaped dermal fat grafts. Using an 18-gauge needle, the scar was released from the underlying tissue. A dermal fat graft, harvested from the postauricular area and cut into strings, was inserted through the needle hole. The depression improved with satisfactory aesthetic results, requiring no special equipment and avoiding new visible scars on the exposed areas of the face.

A 15-year-old male patient was referred to our hospital with a congenital elevated lesion in the sacrococcygeal region, which measured 8 × 5 cm. Six months prior to presentation, the patient developed redness and pain in the lesion during cycling. Computed tomography revealed dorsal angulation of the 5th sacral segment (S5) and the 1st coccygeal segment (Cy1) and ventral angulation of Cy2 to 4th coccygeal segment (Cy4). Under general anesthesia, Cy1 to Cy4 were resected and S5 was flattened. Soft tissue and overlying tissue of the coccyx were not resected. At the 18-month follow-up, the patient exhibited no recurrence of the coccygeal pad (CCP) or associated pain. Pathologically, CCP consists of connective tissue. However, the coccyx deformity can cause subjective symptoms. This case suggests that coccygectomy without skin or soft tissue resection can be an effective treatment for CCP.

Parotid gland arteriovenous malformation (AVM) may present as a parotid mass. Most parotid masses are benign, and the majority of these are pleomorphic adenomas; therefore, the initial diagnosis of vascular malformations can be challenging without the pathognomonic turkey-wattle sign. We present a case of a parotid gland AVM that was initially misdiagnosed as a parotid gland cyst. The clinical and radiological findings are also discussed here. The AVM was managed with surgical intervention and sent for histopathological study to confirm the diagnosis.