No abstract

Penetrating wounds to the face are cosmetically devastating and can be life-threatening. If the foreign body causing the penetrating wound is a piece of wood, small remnants might be left behind after the initial treatment. A 33-year-old male patient presented to the emergency center after a piece of lumber pierced his face as a passenger in a traffic accident. The patient’s vital signs were stable, and emergency surgery was performed to remove the foreign body and repair the soft tissue. No noteworthy complications were seen after open reduction and internal fixation of the facial bone fractures. Seven months after the accident, the patient underwent scar revision along with full-thickness skin grafting for post-traumatic scars. After the surgery, pus-like discharge which was not previously present was observed, and the graft did not take well. A residual foreign body, which was the cause of graft failure, was found on computed tomography and the remaining foreign body was removed through revision surgery. The patient is receiving outpatient follow-up without any complications 6 months after surgery. This case demonstrates the importance of performing a careful evaluation to avoid missing a residual foreign body, especially if it is of wooden nature.Abbreviation: CT, computed tomography

Lipoma is one of the most common benign soft tissue tumors. However, giant lipomas compressing and deforming the neurovascular structure rarely occur in the lateral neck. A 70-year-old man visited our outpatient clinic for treatment of a visible painless neck mass that had been identified 2 years prior. Neck magnetic resonance imaging revealed that a 10 × 9 × 4 cm fatty mass located between the sternocleidomastoid and sternohyoid muscles invaded the carotid sheath. Under general anesthesia, the mass was excised without damage to the adjacent neurovascular structures. Upon histopathological examination, the mass was identified as a lipoma. During the surgery, enlargement of the internal jugular vein was observed under the resected mass. However, on ultrasound examination, the function of the internal jugular vein was evaluated as good. No recurrence or neurological and vascular complications were reported during a 6-month follow-up after the surgery. As a giant lipoma located in the deep layer of the lateral neck can deform important cervical structures, its impact on the surrounding structures should be carefully assessed preoperatively to minimize the rate of possible complications.

Many reports have described cases where pesticides were drunk, inhaled, or applied to body surfaces with the intent to commit suicide, but incidents of direct intramuscular pesticide injection are rare. Cyantraniliprole is a pesticide that causes disorganized muscle contraction, paralysis, and death in insects. Herein, we report a case in which a man injected cyantraniliprole into his abdomen but recovered well. An 80-year-old man visited the emergency room with abdominal pain after intramuscularly injecting 3 mL of cyantraniliprole into his abdomen. The injection site showed cellulitis with local redness, edema, and pain. Diffuse fluid collection over the right rectus abdominis muscle and subcutaneous layer was observed on abdominal computed tomography. There were no other systemic symptoms such as dyspnea or general weakness. After the abdominal inflammation improved, the tissue where the pesticide had penetrated was excised and delayed primary closure was performed. Six months after surgery, the patient had recovered well without any other local complications or systemic symptoms. Based on the outcome of the patient’s hospital course, the lethality of intramuscular injection of cyantraniliprole appears to be low.

Microsurgical replantation is considered the best method to treat avulsion or amputation injuries of unique head parts, including the scalp, eyelid, nose, ear, lip, and tongue. However, there is currently no report on microsurgical replantation of substitutable facial tissues in the literature. This report presents a patient with avulsed facial composite tissue composed of the skin and subcutaneous layers treated by microsurgical replantation. The present case shows that microsurgical replantation of small facial composite tissues is feasible. The authors suggest that the indication spectrum for microsurgical replantation should be expanded beyond current clinical practice.