Background:Differentiating dermatofibrosarcoma protuberans (DFSP) from keloids presents significant clinical challenges, particularly when skin biopsies are contraindicated. This study introduces a novel, non-invasive diagnostic method leveraging the Japan Scar Workshop Scar Scale (JSS) combined with the cosine of the angle (cosθ) to distinguish between these conditions. Methods:In this case-control study, 43 cases were retrospectively analyzed using the new evaluation method, JSS × cosθ, designed specifically for this differential diagnosis. This method applies JSS in conjunction with cosθ to assess lesion characteristics non-invasively. Results:The JSS × cosθ scores effectively differentiated between DFSP and keloids. Scores ≥16 were indicative of keloids, whereas scores <16 suggested DFSP, with these findings achieving statistical significance ( p < 0.001). Conclusion:The JSS × cosθ scoring system provides a reliable and safe diagnostic tool for distinguishing DFSP from keloids, particularly in cases where biopsy is avoided due to the risk that stimulation of the reticular dermis may lead to the development, enlargement, or worsening of keloids. This method promises to significantly impact the specific management of DFSP and keloids.
Complex dorsal hand and forearm injuries with extensor tendon and soft tissue loss are challenging to manage. Single-stage reconstruction using composite anterolateral thigh (ALT) fasciocutaneous free flaps with vascularized fascia lata may reduce the need for multiple surgeries and accelerate functional recovery, but clinical evidence is limited. We conducted a retrospective case series of nine patients with complex extensor tendon and soft tissue defects who underwent single-stage reconstruction with composite ALT flaps between 2009 and 2018. Six patients were available for long-term follow-up (average 2-3 years). Data included demographics, injury characteristics, operative details, complications, and functional outcomes assessed using Miller's criteria. One donor site hematoma resolved without sequelae. Functional assessment revealed that two patients achieved excellent and poor outcomes in wrist and finger extension, respectively, while one patient demonstrated good and fair results . Poor outcomes were associated with missed follow-up, prolonged immobilization, and concomitant skeletal injuries. All patients returned to work and reported satisfaction with their functional status. This approach offers durable soft tissue coverage, restores tendon continuity, and allows early rehabilitation with minimal donor site morbidity.
Background:Surgical approaches for zygomaticomaxillary complex (ZMC) fractures have evolved toward minimizing cutaneous incisions while maintaining adequate exposure. Conventional approaches for frontozygomatic fixation, such as lateral brow or transconjunctival incisions with lateral extension, may result in visible scarring or periocular complications. Building on previous transconjunctival techniques, we applied an independent upper eyelid transconjunctival incision as a non-cutaneous approach for frontozygomatic fixation in selected ZMC tripod fractures. Methods:This retrospective comparative study included 27 patients with unilateral ZMC tripod fractures, of whom 12 underwent non-scar fixation using an upper eyelid transconjunctival approach, and 15 underwent fixation through preexisting periorbital traumatic lacerations. The surgical strategy consisted of initial reduction and fixation via an intraoral approach, followed by selective additional fixation of the frontozygomatic region when residual step deformity or instability was present. Preoperative and 6-month postoperative computed tomography and three-dimensional photogrammetry were used to evaluate bony and soft tissue intermalar height differences. Results:Preoperative intermalar height differences were comparable between groups. At 6 months postoperatively, both groups showed marked improvement, with bony differences of -0.2 ± 1.2 mm and -0.4 ± 0.4 mm, and soft tissue differences of 0.0 ± 0.6 mm and -0.2 ± 0.7 mm in the non-scar and control groups, respectively, with no clinically meaningful between-group differences. No clinically significant approach-related ophthalmic complications were observed. Conclusions:The upper eyelid transconjunctival approach is a reliable non-cutaneous option for frontozygomatic fixation in selected ZMC tripod fractures, providing adequate exposure and stable fixation without visible scarring.
Background:The omentum is a vascularized, immune-active tissue with regenerative potential, particularly when activated by intraperitoneal stimuli. Its secreted factors may promote lymphangiogenesis, offering a novel approach to lymphedema treatment. Methods:The omentum was activated in mice using an intraperitoneal polydextran slurry. Gene expression was evaluated over time to assess inflammatory and lymphatic markers. Culture supernatants from the activated omentum were collected, and vascular endothelial growth factor-C ( VEGF-C ) levels were measured. Therapeutic potential was tested in a mouse hindlimb lymphedema model through local application of the supernatant. Histological analysis assessed skin thickness, lymphatic vessel density, and macrophage infiltration. Results:Activation of the omentum induced early upregulation of hypoxia-inducible factor-1 α ( HIF-1α ) and angiopoietin-2 ( Ang2 ), followed by increased expression of Forkhead Box C2 ( Foxc2 ) and Prospero homeobox-1 ( Prox1 ) by day 7, indicating lymphatic maturation. VEGF-C levels in the supernatant were significantly elevated. In the lymphedema model, treated mice exhibited reduced peak edema, faster resolution, and increased skin thickness and lymphatic vessel density compared with controls. Histological analysis revealed enhanced lymphangiogenesis and reduced macrophage infiltration. Downregulation of lymphatic vessel endothelial hyaluronan receptor 1 ( Lyve1 ) and Neuropilin-1 ( NRP1 ) suggested a predominance of tissue remodeling over structural maintenance. Conclusions:Activated omental tissue secretes potent bioactive factors that promote lymphangiogenesis and tissue regeneration. These findings indicate the potential of activated omentum for functional characterization and possible applications in regenerative medicine. Further investigation in chronic and clinical models is warranted to advance its translational potential.
Supermicrosurgery, defined as the anastomosis of vessels smaller than 0.8 mm, represents a significant evolution in the field of reconstructive microsurgery. This review explores its technical foundations, clinical applications, and future directions, with a particular focus on lower extremity reconstruction. By utilizing perforator-to-perforator anastomosis and thin flap techniques, supermicrosurgery allows for reduced donor morbidity, minimized risk to major vessels, and improved aesthetic and functional outcomes. The integration of high-frequency ultrasonography and advanced microsurgical tools has enhanced preoperative planning and intraoperative precision. Despite a steep learning curve, supermicrosurgery is increasingly applied in oncologic, traumatic, ischemic, and diabetic foot reconstructions. Continued innovation in imaging, instrumentation, and robotic assistance suggests a promising future for this subspecialty.
