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BACKGROUND: Oral propranolol is the first-line therapy for infantile hemangioma. Combining it with pulse dye laser (PDL) (595nm-long PDL) could reduce treatment duration and sequelae incidence and severity. OBJECTIVE: To determine the effect of PDL-propranolol treatment on duration to cure and sequelae. METHODS: All consecutive patients with infantile hemangioma who were cured by PDL-propranolol treatment were identified. RESULTS: In the 27 cases, average age at treatment start was 4.3 ± 3.8 months, mean tumor diameter was 11.1 ± 14.0 cm2, and tumor-type was most common (72.4% of lesions). The patients received 9.8 ± 10.5 PDL sessions. After ensuring patients had no physical contraindications, including heart disease, oral propranolol was started at 1 mg/kg/d, increased up to 3 mg/kg/d as a maintenance dose. Mean propranolol treatment duration was 11.1 ± 4.9 months. Total treatment duration was 15.3 ± 10.8 months. CONCLUSION: Our data in the context of recent literature suggest combining propranolol with PDL may reduce propranolol duration without increasing harms.

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BACKGROUND: Various materials and methods have been used for augmentation mammaplasty since it was first performed in Japan in the late 1940s. Although augmentation mammaplasty is not associated with an increased risk of breast cancer, a number of studies have reported that breast implants, or subsequent changes around these foreign substances, can affect images made by mammography, CT, or MRI during breast cancer screening. A method that is increasingly being used to detect cancer is positron emission tomography (PET). METHODS: To determine the effect of augmentation mammaplasty on PET imaging, we subjected ten women who had previously undergone augmentation mammaplasty to PET imaging as well as other imaging methods. We also measured tumor markers and performed pathologic studies. RESULTS: The histologic analyses failed to detect any cases of malignancy. We assess the efficacy of PET for detecting breast cancer in women who had undergone augmentation mammaplasty and describe the features of the PET images of these women. Finally, we discuss future research objectives in relation to PET-based screening for breast cancer. CONCLUSION: It is important to identify an imaging methodology that improves the detection of breast cancer in patients with a previous mammaplasty. We show here that FDG-PET may improve breast cancer detection after mammaplasty.

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Usefulness of the descending branch of the lateral circumflex femoral vessels as a vascular bundle interposition graft was introduced. Large calvarial defect with no recipient vessel for direct anastomosis was successfully covered with free flap nourished by the cervical vessels through the vascular bundle interposition graft of the descending branch of the lateral circumflex femoral artery and its venae comitantes. The vascular bundle interposition has remarkable advantages over the venous graft regarding its patency and durability, especially in the head and neck region in which grafted vessels is difficult to be set on the straight. The descending branch of the lateral circumflex femoral vessels can be harvested up to 20 cm, and its diameter is suitable for interposition between conventional free flaps and recipient vessels in the head and neck region.

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BACKGROUND: The V-Y flap is a well-known method for closure of round skin defects. However, with conventional V-Y flaps, it is sometimes difficult to advance the flap sufficiently, especially where there is a lack of subcutaneous tissue. Thus, the authors have devised a new technique named after a famous Japanese video game. METHOD: The flap design is almost the same as a conventional V-Y flap. Instead of cutting off the two triangular parts of the V flap, those two parts are rotated and advanced to meet at the center of the defect. RESULTS: The authors have operated on 18 patients with this method, and in all the cases, the flap survived completely. No secondary surgery was required to correct dog-ear deformity. CONCLUSIONS: This method is easy and can be applied in many situations. The authors conclude that this can be the first choice for closing circular skin defects.

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The purpose of this study was to assess the usefulness of silicone-selective multishot echo-planar imaging (EPI) for the rapid magnetic resonance imaging (MRI) survey of breast implants. Twenty patients with bilateral breast implants underwent MRI. The use of inversion recovery and magnetization transfer pulses led to silicone-selective images. The rapid MRI survey required only 43 s, which accurately distinguished between silicone and non-silicone materials in the implants, and therefore induced the final MRI sequences appropriate for the detailed characterization of the implants. In 5 of the 20 patients, the rapid MRI survey showed implanted materials that were not indicated from clinical information. This silicone-selective multishot EPI allows a rapid survey of breast implants, which is useful to avoid unnecessary sequences in these patients.

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A newly-developed fixation technique using bioabsorbable screws gave satisfactory results in fractures of the condylar head. The fracture lines ran obliquely (craniolateral to mediocaudal) on three-dimensional computed tomography. Two bioabsorbable screws were positioned vertically to the fracture lines. This technique is useful despite limited access to the condyle.

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BACKGROUND: Over the years, breast augmentation with injectable artificial materials has presented significant clinical and social problems, particularly in Japan, because of later complications. The authors have used autologous tissue to treat patients who want not only to have these materials removed but also to maintain breast contour. The purpose of this study was to review the clinical outcome of the authors' reconstruction procedures retrospectively. METHODS: A total of 38 breasts in 19 consecutive cases treated between 1991 and 2002 were reviewed. The patients were all women, ranging in age from 41 to 70 years old (mean age, 53.4 years). The average period from injection to reconstruction was 26.5 years. After removal of the injected materials, both breasts were simultaneously reaugmented with deepithelialized rectus abdominis flaps. The incidence of associated complications was investigated. RESULTS: The 38 flaps consisted of 31 free transverse rectus abdominis musculocutaneous flaps, five pedicled transverse rectus abdominis musculocutaneous flaps, and two pedicled vertical rectus abdominis musculocutaneous flaps. Three flaps with total necrosis (7.9 percent) because of venous thrombosis were found in two cases. Partial flap necrosis was observed in six flaps (15.8 percent). Hematoma requiring a surgical procedure occurred in one case (5.3 percent). Negligible abdominal bulging requiring no additional procedure was found in seven cases (36.8 percent). CONCLUSIONS: The complication rate seemed to be relatively high compared with that for breast reconstruction after mastectomy. Nevertheless, autologous tissue transfer may be one of the ideal procedures for breast reaugmentation after the removal of injectable materials, because affected patients prefer not to undergo reaugmentation with other artificial materials.

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Reanimation of longstanding facial paralysis is a difficult clinical problem commonly tackled with the method of pedicled muscle flap transfer. The temporalis muscle has been the most popular. In the past, one common problem was that the flap was not long enough to reach parts of the face distant from the affected area. To overcome this disadvantage, we have devised a flap consisting of the pedicled temporalis muscle, temporal fascia and galea together and have achieved good static results in paralyzed faces. From June, 1996 to May, 2003, we used this procedure with 38 longstanding facial paralysis patients (16 male and 22 female); 23 had right-sided and 15 had left-sided facial paralysis. The patients were followed-up over three years. Our results were recorded as "Excellent", "Good", "Fair" or "Poor". Excellent or good results were obtained in 33 patients (87%). In these patients, the static results are very good. The oral commissure on the affected side maintained a favorable position and almost complete symmetry of expression was attained. We have achieved dynamic reconstruction by using a temporalis muscle-galea pedicled flap in 38 longstanding facial paralysis patients. Our results show that this is a good option in treating such patients.

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