Endoscopic-assisted flap harvesting. Endoscopic-assisted procedures are widely performed because of the minimum scarring involved. However, there are a limited number of reports regarding the harvesting of flaps with the assistance of endoscopes. We have described our clinical experience of endoscopic-assisted flap harvesting. Data concerning flaps and operation times, drainage amounts, complications, etc., were retrospectively recorded. From 1996 to 2003, endoscopic-assisted flap harvesting was performed on 30 patients. The harvested flaps were as follows: omental flaps in 9 cases, the latissimus dorsi muscles in 9, fascias lata in 6, jejunal segments in 5 and the rectus abdominis muscle in 1. Mean follow-up was 18 months. Mean flap harvesting time was recorded as 90 minutes in muscle flaps, 40 in fascia lata, 90 (30; intra-abdominal marking using endoscope, 60; harvesting in minilaparotomy) in omental flaps and jejunal segments. Minor complications included 3 patients who showed incomplete cervical neuroparalysis, transient sensory disturbance of the femur, and dehiscence of the umbilical area. No abdominal complications or scar revisions were observed in this series. Endoscopic-assisted flap harvesting should be considered as a useful, minimally invasive procedure for donor sites, despite the longer operation times.

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In our aging society, surgical treatment of wounds in patients with various coexisting illnesses is common. Treatment of such wounds takes a long time, and in several cases MRSA is detected by culture, even if there are no symptoms of infection. Consensus has not been obtained regarding the selection of antimicrobial agents used in operations for wounds that have not been tested for MRSA infection. We operated on 13 cases that did not have any symptoms of infection, even though MRSA was detected after the operation. We then examined the presence of surgical site infection by using first-generation cefem as a preventive antimicrobial agent as well as normal clean operation techniques. As a result, 12 cases fully recovered without MRSA infection after the operation. One case had necrosis of the flap and MRSA infection after the operation. However, we thought that the infection resulted from technical errors. Therefore, we propose that selection of a prophylactic antibiotic for surgery of MRSA-colonized wounds is sufficient, by using the usual preventive antimicrobial agents and clean operation techniques.

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AIM: The aim of this study was to determine the efficiency of honey dressing for wound bed preparation.
BACKGROUND: There are many reports of usefulness of honey for wound care in Europe and New Zealand. However, there are few reports of honey for wound care in the Japanese literature and the use of honey for wound care is not popular in Japan.
Method: Six patients with critically colonized or infected wounds (MRSA, MRSE, S. aureus) were previously treated using conventional wound care (debridement, ointment, negative pressure dressing). We used honey with gauze or silicon gauze in these refractory wounds for 7 days.
RESULTS: In all cases, wound fluid and edema of granulation were reduced. Bacterial content was also reduced. After the honey treatment, all wounds were closed with skin graft or suture, or spontaneously healed.
CONCLUSION: This study showed the clinical benefit of using honey for the purpose of wound bed preparation in critically colonized or infected wounds.

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