Negative pressure wound therapy（NPWT）is useful for intractable ulcers. On the other hand, its utility for infected wounds is difficult because it can exacerbate infection in some cases. For such infected and contaminated wounds, NPWT with continuous irrigation has been considered to be useful, but the conventional method is disadvantageous in that the procedure for exchanging the foam is complicated. At our facility, when performing NPWT with continuous irrigation using the RENASYS® wound treatment system, the cleaning cannula is inserted into the wound during exchange, similar to replacing the existing NPWT device. This method is simple. As a result of employing this method in 7 cases, good infection control was achieved. We describe the construction of this system, including necessary items and application procedures.
Orbital wall fractures are common among cases of facial trauma. Elective surgery will be performed in most cases, but it is difficult to decide the indications of surgery at an early stage because of facial swelling. We retrospectively analyzed cases of orbital wall fracture treated at the department of plastic and reconstructive surgery of Japanese Red Cross Fukui Hospital between 2007 and 2016, and investigated the surgical indications of orbital wall fractures. In total, there were 94 cases, 37 of which underwent surgery. We found that surgery was highly likely to be necessary in cases of inferior wall fracture, multiple medial and inferior wall fractures, burst-type fracture, and fractures reflecting damage beneath the eyeball. In particular, burst-type fractures of the inferior wall, multiple burst-type fractures of the medial and inferior wall, and fractures beneath the eyeball had high surgical rates. In addition, patients in whom the length of herniated orbital tissue exceeded 10 mm or those who had a large volume of herniated tissue were likely to undergo surgery. These trends will be useful in deciding the surgical indication for orbital wall fractures.
Wrist cutting is a common form of self-harm. Extensive scarring of the forearm develops by repeated self-harm acts. Five patients with wrist cutting scars underwent surgical reconstruction using a tissue expander to reproduce the color and texture. However, it is difficult to expand the skin of the forearm and the expanded skin becomes contracted. Therefore, a long time was needed to expand the skin, with an average of 136 days. We also used lambda incisions of the lateral wall of the expanded cuboid to make the most of the expanded skin. This made it possible to apply expanded skin and reconstruct extensive scars. Most scarring was removed in one reconstruction in 3 patients, whereas the others who had extensive scarring on the entire forearm required 2 reconstruction procedures. There were no complications due to lambda incisions. Lambda incision is an effective method for applying expanded skin and covering extensive skin defects.