Objectives: No detailed country-specific cross-sectional studies have been reported on endoscopic plastic surgery. For the first time, the Japan Society of Plastic and Reconstructive Surgery conducted a nationwide survey to ascertain the status of endoscopic procedures in plastic surgery in Japan. This article discusses the current situation based on this survey findings.

Methods: A questionnaire survey was conducted among 566 Japan Society of Plastic and Reconstructive Surgery-certified training facilities regarding the status of endoscopic plastic surgery procedures completed between January 2020 and December 2021.

Results: Of the 143 institutions, 33 conducted endoscopic plastic surgery operations during the period, for a total of 753 procedures. Two hundred sixty-two procedures were conducted in the craniomaxillofacial region at 19 institutions and 491 in the extremities and trunk region at 19 institutions. Five intraoperative accidents were recorded, but no cases were moved to traditional surgery based on intraoperative choices. Sixteen postoperative problems were reported, but there were no reports of fatalities.

Conclusions: The number of endoscopic plastic surgery cases is anticipated to rise, and this nationwide survey will contribute to this by offering useful data and insights.

Mycobacterium abscessus (M. abscessus) is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment methods for these infections, including the type and duration of antimicrobial agents, have not been established. The function of surgery is also unknown. We report a case of skin and soft tissue infection of the left upper arm in a healthy 47-year-old Japanese man who was treated with complete surgical excision and antimicrobial therapy as feasible on an outpatient basis, which resulted in relapse <1 month later. Given the possibility of developing antibiotic-resistant bacteria, insufficient antimicrobial treatment should not be administered without careful consideration. There are currently few effective oral antimicrobial agents against M. abscessus, so careful antimicrobial therapy along with hospitalization (at least during the early treatment phase) is preferred, regardless of the use/nonuse of surgical treatment.

Skin cancer prominently develops on the face, and local flaps are frequently used for reconstruction because of their similar color and texture. We report two cases of temporal skin defects after skin tumor resection that were successfully covered by transferring supra-eyebrow skin using the frontalis muscle as its pedicle. These two patients underwent a single reconstruction surgery for the skin defect following malignant tumor resection and eyebrow ptosis due to facial nerve palsy. The myocutaneous flap was raised using a rich subcutaneous vascular network in the frontal region, which provided a stable blood supply. As this flap can effectively reconstruct the temporal region in patients with facial nerve palsy, we propose the application of this technique for temporal area reconstruction in patients with facial nerve palsy.

Pressure ulcers are extremely common in individuals with spinal cord injuries, especially ischial pressure ulcers, which have a higher rate of recurrence and are more difficult to treat than those in other regions of the body. We report a case of a 69-year-old man with bilateral ischial defects due to surgical treatment of pressure ulcers. Previous reports have shown that when surgical resection of pressure ulcers extends beyond the ischial tuberosity to the pubic symphysis and acetabulum, the superior psoas and piriformis muscles are easily dislocated, and the pelvic ring can be unstable. Therefore, the region of resection must not extend beyond the acetabulum and pubic symphysis to achieve a stable sitting position. In this article, we discuss an anatomically safe ischial tuberosity resection.

External canal reconstruction of extensive tissue defects, including auricle or ear canal defects, is challenging. We describe the case of a 28-year-old man who underwent staged skin and nasal septum cartilage grafting for ear canal reconstruction after resectioning a giant arteriovenous malformation of the auricle. We performed arteriovenous malformation resection and reconstruction of the significant tissue defect using an anterolateral femoral skin flap. Simultaneously, a Nelaton catheter stent was placed to temporarily form an external auditory canal. Subsequently, split-thickness skin grafting was performed. Following stent removal, severe external auditory canal stenosis developed. Nasal septum cartilage grafting was performed using a stent after dilating the ear canal. Two years after surgery, the ear canal was not stenotic without the stent. Staged treatment with skin and nasal septal cartilage grafting is a simple and practical option for treating patients with total ear defects for whom a skin flap cannot be used.

Objective: It is crucial to know the lengths of the neurovasculature proximal to a penile allograft to allow for better viability of a penile transplant. We performed a cadaveric exploration focused on the deep and superficial dorsal veins as identified in a microsurgical dissection of the penis to help expand the anatomical knowledge for such a procedure.

Methods: We examined 18 cadavers and measured the (1) vertical distance from the pubic symphysis to the point at which the superficial dorsal vein is no longer on the erectile tissue; (2) point at which the superficial dorsal vein is no longer on the erectile tissue to where its tributary meets the great saphenous vein; and (3) point at which the deep dorsal vein is no longer on the external erectile tissue to its contribution into the prostatic plexus near the prostate. Moreover, we noted the variations of the deep and superficial veins of the penis. We used IBM SPSS in all statistical analyses.

Results: The average length of the superficial dorsal vein when no longer on the external penis to its tributary was 84.9 ± 10.4 mm. The average length of the deep dorsal vein was 72.9 ± 6.43 mm. Three different drain patterns were observed for the superficial dorsal vein, whereas the deep dorsal vein was consistently midline. No statistically significant correlations were identified between cadaveric demographic data and lengths of venous structures.

Conclusions: Further studies regarding the anatomy and dissection of penile allografts would be helpful. More research regarding donor and recipient anatomy and vasculature is needed to establish surgical guidelines.

Objectives: Mandibular condylar fractures are common, accounting for approximately 25%-50% of all mandibular fractures. However, the optimal therapeutic method remains controversial. We have used an internal distraction device for treating mandibular condylar fractures for the past 7 years. The aim of this study was to analyze our clinical outcomes.

Methods: We retrospectively analyzed the medical charts of 62 patients with mandibular condylar fractures (84 joints) treated by internal distraction device fixation from April 2015 to June 2022 at our hospital.

Results: The patients were 34 males and 28 females (mean age of 49.7 years at surgery). At 3 months postoperatively, the mean mouth opening width was 42.3 mm. Postoperative complications included temporary facial nerve paralysis of a temporal branch (6 patients) and breakage of the device during attachment (22 patients, 24 joints). In all cases in which the device was broken, it was removed within a few weeks, and satisfactory results in terms of mouth opening were obtained.

Conclusions: This method is recommended as a treatment option for mandibular condylar fractures because of its simplicity and satisfactory results compared with other methods.

A 77-year-old woman who had been taking iguratimod and sarilumab for rheumatoid arthritis for 3 months had gas gangrene. After hospitalization, she underwent two debridement surgeries, one drainage procedure, and a free latissimus dorsi musculocutaneous flap transfer for the resulting tissue defect on the oral cavity through the temple. Following the free flap surgery, she experienced flap ischemia, possibly caused by the vasospasms of the intraflap and recipient arteries on postoperative days 5 and 6. These immunomodulating drugs might cause vasospasms by downregulating the interleukin-6 and/or tumor necrosis factor-α signaling pathway (s).

Recent developments in antirheumatic drug therapy have increased the chances of performing microvascular surgeries on patients with inhibited immune systems, and this trend will continue or will be reinforced in the future. Close monitoring of the biochemical and clinical status of the microvascular environment is necessary.

Objectives: Submucous cleft palate is a congenital disorder resulting in velopharyngeal insufficiency. Nasal regurgitation is one of the symptoms of submucous cleft palate. This study aims to investigate a relationship between submucous cleft palate and a history of nasal regurgitation in patients during infancy.

Methods: This retrospective study includes patients diagnosed with submucous cleft palate at our hospital for 20 years, from 1998 to 2017. Based on the clinical records of these patients, we investigated sex, age at referral to our facility, age at surgery, presence of nasal regurgitation, method of surgery, association of syndromes and mental retardation, and transition of velopharyngeal function.

Results: There were fifty-seven patients referred to our facility. Patients with episodes of nasal regurgitation were referred to clinics later than those without nasal regurgitation. The timing of surgery was also the same. The velopharyngeal function of patients with nasal regurgitation was worse than that of those without nasal regurgitation.

Conclusions: A history of nasal regurgitation cannot predict submucous cleft palate. However, patients with submucous cleft palate with nasal regurgitation had worse velopharyngeal function than those without nasal regurgitation. An increased understanding of the relationship between submucous cleft palate and nasal regurgitation and further study will predict submucous cleft palate and determine a good timing for surgical interventions.

Complete resection of anterior chest wall keloids and direct closure of wound defects are difficult. Therefore, intrakeloid excision is usually the safest to treat anterior chest wall keloids. Total excision to relieve tension may require tensile suturing of the dermis or skin grafting, which can lead to recurrence or poor cosmetic outcomes. In this study, we performed total resection of the anterior chest wall keloid, followed by defect reconstruction using bilateral lotus petal flaps for the internal mammary artery perforators near the keloid, obtaining satisfactory results. When performing total keloid resection, releasing the precordial tension in the reconstruction area is crucial. The lotus petal flap, which can be elevated from the same precordial chest area, effectively releases tension and thus provides a beneficial treatment strategy.

Ray amputation wounds caused by diabetic foot gangrene are often left to heal by secondary intention. They can be large and take a prolonged time to heal, exposing patients to complications and risk of recurrent infection. A 77-year-old male with diabetes and peripheral vascular disease presented to our institution with left 2nd-5th toe gangrene. He underwent a successful left lower limb angioplasty with good flow to the digital arteries. Left 2nd-5th toe ray amputation was performed, with the excess viable skin of the left second toe preserved as a digital fillet flap for wound coverage. The patient was discharged on postoperative day 1. Healing was complicated by a stitch sinus, but the wound completely healed with good epithelialization at 4 months postoperatively. This case report demonstrates the utility of the toe fillet flap in the coverage of ray amputation wounds in patients with diabetes and peripheral vascular disease.

The plethora of facelift techniques described in literature suggests that no single method addresses all age-related changes in facial anatomy. To reduce the limitations of a single approach, a multimodal technique is recommended. Craniofacial suspension and superficial musculoaponeurotic system plication using a diffuse total superficial musculoaponeurotic system (SMAS) weave is an effective and satisfactory method of dealing with the superficial musculoaponeurotic system. It utilizes a continuous barbed polydioxanone suture that is woven throughout the lower superficial musculoaponeurotic system. This technique preserves facial volume while achieving the symmetrical tightening of the superficial musculoaponeurotic system. In this article, the authors describe over 10 years of experience of applying this procedure with success to different patients, including elderly ones and those with a previous facelift history. It can be integrated into the classic minimal access cranial suspension (MACS) lift or used with more extensive facelifts. It is a safe, easy, and powerful tool that should have a wide application in facial rejuvenation procedures.

Objectives: The reasons for nipple malposition after nipple-sparing mastectomy with implant-based reconstruction are not well characterized, and nipple asymmetry remains a source of patient dissatisfaction. This study employed mathematical simulation to analyze the variables that affect nipple position, developed countermeasures to improve symmetry, and tested them in a case-control cohort.

Methods: Patients who underwent nipple-sparing mastectomy followed by two-stage tissue expander and implant reconstruction were recruited and divided into two groups. The study group (N = 57) underwent reconstructive surgery guided by our mathematical simulations and countermeasures. The control group (N = 32) underwent reconstructive surgery using conventional methods.

Results: Morphological simulation revealed that the fundamental reason for nipple malposition is inadequate superior pole expansion. Thus, we developed a countermeasure: fixing the nipple areolar complex in a more inferior position, combined with inferior expander placement. Good or excellent symmetry was obtained in 45/57 (79%) patients in the study group and only 8/32 (25%) patients in the control group. In the control group, poorer results were associated with mastectomy weight (ρ = 0.47, P < 0.006), preoperative ptosis grade (ρ = 0.38, P = 0.037), and the difference between the superior pole length (B) and sub-mid-clavicle-to-inframammary fold length (l) (B-l; ρ = 0.067, P < 0.0001). In the study group, the results had no relation with those variables.

Conclusions: Morphological simulation found that inadequate superior pole expansion is the primary reason for nipple malposition. On the basis of this result and the patient's breast measurements, we recommend fixing the nipple areolar complex in a more inferior position and possibly pulling the nipple inferiorly, combined with inferior expander placement.

Objective: The pedicled combined superficial circumflex iliac artery and superficial inferior epigastric artery flap has a large vascular territory ideal for coverage of crush-degloving injuries of the upper extremity. We describe our technique of creating a bipedicled flap through a staged inset, first at the wrist and subsequently progressing up the forearm. This process allows primary thinning of the entire flap while facilitating a safe transfer of the flap.

Methods: Three patients with crush-degloving injury of the forearm associated with open fractures of the radius and ulnar bones had their defects reconstructed using the aforementioned flap. Patient 3 also had avulsion of the ulnar artery and crush injury of the median and ulnar nerves. Patients 1 and 2 underwent flap delay and training for 1 week prior to inset. Patient 3 did not undergo delay due to the broad-based nature of the flap. The maximal flap size was 25 × 15 cm. The flap was raised thinly until the sufficient length was obtained for the first-stage inset. Over 2 weeks, further elevation and staged inset were performed to maintain uniform thinness and thereby maximize coverage.

Results: Complete flap division was accomplished in 3 weeks. All flaps survived with no marginal flap necrosis. Donor sites were closed directly (n = 2) or skin grafted (n = 1).

Conclusions: Staged insetting created a bipedicled construct, which allowed primary thinning of the base and bridging portion, thereby allowing maximal use of the entire flap. Maximising the flap was possible because our technique maintained a bipedicled circulation throughout the entire inset process.

Objectives: The majority of infantile hemangiomas shrink on their own, but when there is a chance of functional impairment, ulceration, or aesthetic issues, an active therapeutic intervention is needed. Propranolol is effective in treating infantile hemangiomas in recent years, although little information is known regarding the consequences of long-term oral administration of propranolol for treating infantile hemangioma or regarding when to stop propranolol treatment. We looked back at the therapeutic effectiveness, sequelae, and side effects of propranolol in actual clinical settings for infantile hemangiomas.

Methods: The study comprised 25 patients under the age of 6 months who had propranolol treatment for infantile hemangiomas in our department between April 2011 and May 2021.

Results: At one month and 6 months following the commencement of treatment, propranolol treatment was successful in 72% and 96% of patients, respectively. In 84% of patients, there were cutaneous sequelae. Only one patient with sequelae of hair loss required early surgery because of a cosmetic problem. There were substantial side effects in one case, but these were not related to the propranolol dose.

Conclusions: This study found that the effect of propranolol did not differ depending on the kind of infantile hemangiomas, although propranolol was expected to be extremely helpful for head lesions regardless of site. A degree of sequelae remained in many cases following propranolol therapy, whereas the subcutaneous type was less likely to develop sequelae with propranolol treatment.

Supermicrosurgical lymphaticovenular anastomosis represents an established procedure for lymphedema treatment, the effectiveness of which has been well documented in international literature.

Nevertheless, currently, no standards for supermicrosurgical lymphaticovenular anastomosis have been established regarding the type, location, and number of anastomoses so that the approach to surgical scenarios still depends on the surgeons' preference and ability.

A comprehensive literature search for articles involving supermicrosurgical lymphaticovenular anastomosis techniques was performed on the PubMed/Medline/SCOPUS databases. Results, including the names of the technique and their characteristics, such as indications, surgical time, and configuration of the vessels, are reported.

Each technique included was then performed five times, and for each of them, patency was tested intraoperatively and 30 days after surgery. Moreover, an efficacy score was assigned, taking into consideration the number of lymphatic vessels anastomosed, the average time for anastomosis, and the difficulty of each technique.

A total of 148 articles resulted from the literature search. In total, 16 papers met the criteria for inclusion as defined in the methods and were included in the review as a "supermicrosurgical lymphaticovenular anastomosis technique."

Efficacy scores ranged from 0.21 to 1, intraoperative patency ranged from 80% to 100%, and the 30-days patency test ranged from 60% to 100%.

To perform effective anastomoses and aim to maximize the results of supermicrosurgical lymphaticovenular anastomosis, a modern microsurgeon should be trained to recognize and manage the most common vessel configurations, performing the most adequate one of the several techniques described. Further studies are required to validate and compare the use of the supermicrosurgical lymphaticovenular anastomosis techniques reviewed.

Autologous costal cartilage grafts remain the gold standard method for microtia reconstruction. However, reports on its long-term outcomes are limited. We present two cases with >40-year outcomes after auricular reconstruction with autologous costal cartilage. A 56 year-old woman and a 53 year-old man presented to our institution with complaints of wire exposure. In both cases, the reconstructed ear was deformed. A computerized tomography scan revealed calcification of the reconstructed costal cartilage graft framework. To our knowledge, these cases present the longest outcomes (50 and 42 years for the 56 year-old woman and 53 year-old man, respectively) of microtia reconstruction using autologous cartilage grafts. We found that ear frameworks constructed from costal cartilage tended to calcify in the long term, as in the natural course of costal cartilage. Therefore, the possibility of calcification of costal cartilage grafts should be relayed to patients and parents, and lifelong surveillance after reconstruction should be recommended.