Background Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy—both separately and jointly—need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap.Methods This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7–10 days after surgery and 10–14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance.Results The average volume reduction of LD at 10–14 months after completing POCTx and PORTx was 64.5% (range, 42.8%–81.4%) in comparison to the volume measured 7–10 days after surgery. This change was statistically significant (P<0.05).Conclusions Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.

Severe temporal hollowing deformities can occur in patients who undergo craniectomy after intracranial hemorrhage. Reconstruction surgery for cosmetic purposes using silicone implants in patients with temporal hollowing deformities after craniectomy is advantageous because the procedure is simple and rapid, with a short recovery time, resulting in lower overall treatment costs. Of paramount importance, this option yields highly satisfactory results for patients. The authors present three cases of simple and fast surgery using silicone implants where highly satisfactory outcomes were obtained.

Background This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy. Methods We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18 ± 4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P < 0.05. Results A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%-80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P < 0.05). All cases were observed clinically for over 3 years. Conclusions The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eL-DMC flap if the LD is thick or if it occupies a large portion of the flap.

BackgroundThe endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach.MethodsFourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated.ResultsPostoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications.ConclusionsWe obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

Background: Negative pressure wound therapy (NPWT) facilitates recovery of pressure injuries. This study aimed to investigate whether preoperative NPWT affected complications after musculocutaneous flap reconstruction of pressure injury wounds that required surgical treatment.Methods: Of 71 patients with sacral pressure injury wounds, 28 did not undergo preoperative NPWT (no-NPWT group), while 43 received preoperative NPWT. Both groups received flap coverage for pressure injury wounds. Differences in complications such as wound dehiscence, hematoma, and seroma were compared between the two groups.Results: In the no-NPWT group, seven postoperative complications occurred, of which five were wound dehiscence and two were seroma. There were no hematomas. In the NPWT group, a total of nine postoperative complications occurred, including two cases of wound dehiscence, six hematomas, and one seroma (P=0.029).Conclusion: The overall incidence of complications was higher in the no-NPWT group. The incidence of hematoma was significantly higher in patients with preoperative NPWT. NPWT before reconstruction of pressure injury wounds may assist wound healing after the surgical treatment. However, care must be taken because NPWT may increase the risk of hematoma after surgical treatment.