Various grafts with autogenous bone, cartilage, and alloplastic substitutes have been used for orbital floor reconstruction in surgery of facial fractures. Nevertheless, none has been the gold standard of graft material. We have demonstrated good clinical results in cases of pure blowout fracture in which the orbital floor was reconstructed with iliac cancellous bone sheets used as graft material. Here, we detail our surgical technique for orbital floor reconstruction with iliac cancellous bone.
The outline of our procedure is as follows:
1)to approach the orbital floor, mainly the subciliary incision is used,
2)the orbital content herniating into the maxillary sinus is repositioned, and the fracture and defect site are exposed subperiosteally,
3)a bone block, a few millimeters thick, is harvested from the inner aspect of the ileum,
4)the cortical bone of the harvested block is burred away and thinned to about a 1 mm-thick cancellous bone sheet,
5)the sheet can be adequately trimmed with surgical scissors,
6)the sheet is placed onto the orbital floor to cover the defect, without any fixation.
The iliac cancellous bone graft is as pliable and flexible as to fit the delicate curve of the orbital floor, and as soft as to cut easily with surgical scissors. We consider it the most appropriate material for orbital reconstruction.

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Acidic water with a lower pH has strong anti-bacterial effects. We investigated the effects of irrigation with electrolyzed acidic water (EAW) on infected wounds in mice.
Five-week-old female C57 BL/6J mice were used; a patch of their back skin was removed and covered by a plastic sheet, that had been inoculated with Staphylococcus aureus. We divided the mice into three groups: a non-irrigation (NI) group; saline solution irrigation (SI) group; and EAW irrigation (AI) group. Once a day for 3 days, closed wounds were irrigated with saline solution or EAW using a low pressure-irrigation device. At the end of study, mice were sacrificed and examined.
There were no harmful effects of EAW, including deterioration and inflammation, were found in wounded tissue. Although a quantitative analysis of bacterial load on wounds did not show any significant differences among the groups, the AI group showed the lowest value among the groups and tended to be lower than NI group. Morphometric analysis of bacterial density on the wounds also showed the lowest density in the AI group compared to the other groups and the difference was significant.
EAW, which did not show any injurious or irritating effect on the wounded tissue, showed equivalent or superior irrigation effects on wound infection compared to those obtained with saline solution. Therefore, irrigation of EAW could be an effective means of wound treatment.

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We developed a new scar scale (Kyoto Scar Scale) to assess keloids following surgery and irradiation. The scale consists of objective signs (0~2 points each); redness, hardness and elevation, and subjective symptoms (0~1 point each); itching and pain. We then divided the results using the total scores (0~8 points) into four grades; excellent (0 point), good (1~2 points), fair (3 points) and poor (4~8 points). In our results, 25 keloids (73.5%) were excellent, 3 keloids (8.8%); good, 4 keloids (11.8%); fair and 2 keloids (5.9%); poor. Our local control rate was 82.3%.
All keloids that were scoved as excellent 6 months after treatment have remained excellent for two years. After all symptoms disappeared, recurrence seldom occurred. The recurrence was noted within 1 year, indicating that follow up beyond one year is necessary. Assessed scores change during clinical follow up, the timing of the assessment is important.

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We sometimes perform further amputation of the great toe because of infected ulcerations associated with limited joint mobility and foot deformities that develop after great toe amputation. Here, we investigated any relationship between foot deformities and ulcerations after great toe amputation, as well as the relevancy of the level of amputation, on 28 patients who underwent the procedure at our hospital between December 2002 and May 2010. Eight patients developed new ulcerations, and seventeen developed deformities of the lesser toes. Foot deformity was frequently observed among the 92.8% of the patients who underwent amputation below the metatarsophalangeal joint. It is important, therefore, to conduct long-term follow-up and to customize insoles and shoes, and alignment of shoes, in order to reduce the risk of ulcer recurrence.

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