[in Japanese]

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[in Japanese]

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Treatments for scalp reconstruction include simple closure by suturing, skin grafting, local flap, and free tissue transfer. In most cases, the optimal method is selected based on the defect size. Although simple suturing and local flaps are superior to other options for preserving hair-bearing qualities, careful selection should be made because advancements are limited. Intraoperative scalp expansion using a balloon-type expander was introduced in the 1980s, by which scalp defects less than 4 to 4.5 cm in length could be closed in one stage without an extra incision or skin graft. However, the mechanism of skin stretching by intraoperative expansion is unclear, and stretchback, scalp necrosis, and alopecia have been reported as postoperative complications. Intraoperative expansion was performed using Foley catheter balloons in eight cases of scalp defects. Patient characteristics, surgical techniques, postoperative courses, and complications were reviewed, along with relevant literature, which showed its usefulness even in a larger defect than that reported in combination with a local flap.

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Endoscopic modified medial maxillectomy (EMMM) is a method of directly approaching the maxillary sinus endoscopically. We report on EMMM performed in our department. We performed EMMM in 26 cases. There were 18 men and 8 women, with an average age of 56.5 years. The breakdown of cases was as follows: 9 cases were inverted papilloma, 8 cases were postoperative maxillary cyst, 3 cases were choanal polyp, 2 cases were radicular cyst, 2 cases were impacted teeth, 1 case was hematoma of the maxillary sinus, and 1 case was maxillary sinus mycosis. Of these, there were 3 cases of postoperative recurrence and 3 cases of cheek numbness and pain.

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[in Japanese]

View full abstract

[in Japanese]

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We report on two cases of bear attack injuries involving a nasal fracture, canalicular laceration, and an amputated finger. Emergency surgeries, including wound washing, canaliculus repair, and amputated finger replantation, were performed. In one case, canalicular laceration was detected six months post-operatively, which required multiple re-operations. In another case, the post-operative course of the replanted finger was uneventful for the first 10 days; however, necrosis occurred suddenly on post-operative day 11 and required additional surgery. Our cases suggest that we should carefully assess for canalicular laceration in the setting of facial injury on arrival, and that for amputated finger injury by bear attack, observation after replantation surgery should be longer than typically recommended in previously reported cases.

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Situs inversus totalis (SIT) is a rare anomaly in which the thoracic and abdominal organ’s position is mirror image of normal anatomy. Due to the mirror position and vascular abnormalities, laparoscopic surgery for patients in SIT is considered difficult. We here report a patient with SIT who underwent laparoscopic sigmoidectomy for sigmoid cancer. The operation surgeon stood on the patient’s left side, opposite the normal location for laparoscopic sigmoidectomy, while medial to lateral approach. During the rectal dissection and anastomosis, the surgeon's position was changed from the left side to the right side of the patient. Because the location of the pelvis is almost the same as the normal anatomy, the operation was performed like that of a normal dissection. The operation time was 221 minutes with almost no blood loss. There was no postoperative complication, and the patient left the hospital 10 days after surgery. Laparoscopic surgery can be performed safely even in SIT, by effectively changing the position of the operator.

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It has been reported that intracranial atherosclerotic disease-large vessel occlusion (ICAD-LVO) accounts for 10-20% of acute revascularization treatments (literature), and maintenance of recanalization is necessary. Stent placement is sometimes unavoidable; therefore, countermeasures are required. Wingspan (Stryker, Kalamazoo, MI, USA) is the only stent approved as a rescue stent for emergencies in which the major arteries are occluded. Our hospital has had it in stock since November 2023, and has established a system that allows it to respond to situations that require a rescue stent in acute phase revascularization. We have experienced an example of this and will report it based on a review of the literature.

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A healthy one-year-old girl presented with onychomycosis in the left foot unilaterally, with the toes and all fingers affected. Five months prior to the onset, she had a history of toenail injury. As two months of topical ketoconazole treatment showed no improvement, topical efinaconazole was selected as an alternative to alleviate symptoms. Although onychomycosis in children is extremely rare, trauma is an important predisposing factor. However, the literature is scant. Moreover, as limited data exist on the use of efinaconazole in children younger than six years of age, this case is the first report to suggest its efficacy and safety in a one-year-old infant.

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Here, we report two cases of floating-type polydactyly of the thumb. The supernumerary thumb, including the nail and hypoplastic osseous component, had a narrow and long cutaneous pedicle or a wide base. The histological findings of the supernumerary thumbs were notable for the proliferation of nerve bundles, eccrine ducts, and intramembranous ossification. Suture ligation or surgical excision was selected based on the estimation of the functional outcome from the bifurcation level of the supernumerary thumb, and the parent’s preference. No major complications were observed in either of the groups.

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