Surgical Treatment of Eyelid Carcinoma:-A Review of Data on Nine Surgically Treated Patients-

眼瞼部悪性腫瘍の形成外科的治療-最近2年間における自験9例を中心に-

We have surgically treated 9 patients with eyelid carcinoma from 1984∼86. The histopathological diagnosis was basal cell carcinoma in 4 and sebaceous carcinoma in 5. The lower eyelid was affected in 1 and the upper eyelid, medial angle of the eye, lateral angle of the eye and total eyelid were involved in 2 cases each. The manifold tumor locations require different methods of reconstruction. Tumor defects in the region of the medial or lateral angle of the eye were relatively easily covered by local sliding flaps taken from the forehead or the temple. The defect of the lower lid was reconstructed by rotation of the cheek flap. Because of the complex anatomical condition of the upper lid, the deep and large defect required complicated reconstructions. We tried to reconstruct the large defect of upper lid using a lower lid "switch flap". When the remaining conjunctiva was not sufficient for the inner lining, a composite mucosa-cartilage component from the nasal septum or mucosa from the buccal sulcus were used. There was a local recurrence in 1 with sebaceous carcinoma. The various reconstructive procedures are discussed in detail.

最近2年間に経験した眼瞼部の悪性腫瘍9例(基底細胞癌4例, 脂腺癌5例)の形成外科的治療について報告した．腫瘍発生部位は上眼瞼, 内眼角部, 外眼角部, 眼瞼全周囲の各2例と下眼瞼1例であり, 眼瞼全周囲のうち1例は耳前部および頸部リンパ節転移をきたした．発生部位により再建法をかえ, 上眼瞼再建には下眼瞼(switch flap), 下眼瞼再建には頬部皮弁(rotation flap), 内眼角再建には前額正中皮弁, 外眼角再建には側頭皮弁, 眼瞼全周囲には額皮弁を利用し, 口腔粘膜移植あるいは鼻中隔の軟骨·粘膜複合移植を裏打ちとして用いた(うち眼球摘出術と眼窩内容除去術を施行した各1例を含む)．いずれも観察期間が短いので予後の検討は十分でないが, 現在まで脂腺癌の1例を除き腫瘍の再発はなく経過良好である．


Perceptive Deafness by Fradiomycin Ointment in Two Burned Patients

フラジオマイシン含有軟膏が原因と考えた両側感音難聴の2例

It is well known that the systemic application of a large amount of aminoglycoside antibiotics causes irreversible perceptive deafness. We report here two cases of perceptive deafness caused by the topical use of 0.2% Fradiomycin ointment onto burned surfaces of the skin. The burns were extensive and deep, in both cases. When the total amount of 38 kg and 48 kg of the ointment had been applied over a 4, 5 months period, tinnitus and perceptive deafness occurred. The symptoms were progressive for several months after cessation of the topical use of these ointments.

フラジオマイシン(FRM)含有軟膏の大量使用が原因と考えられた両側感音難聴の2例を報告した．症例1は53才男子．たきびの火が着衣に引火し, 体表面積の70%(III度55%)の熱傷を受け, FRM含有軟膏を外用して総計38.5kgを使用した．外用開始約4ヵ月後より耳鳴の訴えがあり, 聴力検査で高音障害型の両側感音難聴を指摘された．症例2は18才男子．ガソリンの爆発で, 体表面積の70%のIII度熱傷を受け, 受傷後4週目頃より, FRM含有軟膏を外用し総計48kgを使用した．外用開始, 約5ヵ月後より耳鳴を訴え, 聴力検査で高音障害型の両側感音難聴を指摘された．2症例とも難聴は外用剤中止後も徐々に進行し, 約1年でほぼ全聾状態となつた．


皮膚科・形成外科領域における術中出血に対するトロンビンの局所使用経験

皮膚科・形成外科領域における術中出血に対するトロンビンの局所使用経験


水素ガスクリアランス法を用いた皮弁血行動態の判定法

水素ガスクリアランス法を用いた皮弁血行動態の判定法


フルオロカーボンによる皮弁灌流

フルオロカーボンによる皮弁灌流


薬剤内服で発生したと思われるDisseminated Intravascular Coagulation Syndrome


創傷治療からみた血管新生の役割

創傷治療からみた血管新生の役割


Angiostatic effects of corticosteroid on wound healing of rabbit ear

Wound healing is a complex biologic process with initial inflammation, granulation tissue formation, and matrix remodeling. We observed the relation between angiostatic effects and corticosteroid administration time in the rabbit ear chamber. Angiogenesis in the chamber was studied using a microscope-television system. Two experiments were undertaken to represent the systemic and the topical administration of steroids. In experiment 1, 10 mg of triamcinolone acetonide was injected three times intramuscularly (on the day of implantation of the chamber, and the 7th and 14th day after implantation). Vascularization in this group was significantly delayed at the 7th, 14th, and 21st days but no difference from controls was observed in the size and density of vessels after its completion. In experiment 2, 3 mg of triamcinolone acetonide was injected once into the skin adjacent to the chamber on the 10th day after installment of chambers or on the day of installment. In the former group, new vascular growth was delayed until the 21st day after installment. The hemorrhagic zone had narrowed and vascular dilation was observed. In the latter group, endothelial budding was delayed and vascular constriction occurred. New vascular growth was severely delayed and granulation filling of the chamber was not completed. These results suggest not only that the topical administration had the stronger inhibitory effect on neovascularization than the systemic administration but that the effect differed depending on the stage of wound healing. In view of this effect of this steroid, we should pay careful attention to the time when steroids are administered to patients.

The Journal of Medical Investigation : JMI


Application of the Distraction Techinique to Scaphocephaly

The case of a 1-year-old boy who underwent correction of a scaphocephalic deformity using distraction devices is described. Double pi-shaped osteotomies were cut. Bilateral temporal bone flaps were gradually expanded, and the frontal bone was pulled back simultaneously. The patient showed a good skull contour 2 years postoperatively. Although previous distractions were aimed only at expansion of the cranium, we used the distraction technique to successfully shorten the cranial vault in the anteroposterior direction. This case demonstrates that the osteotomized bone flaps can be moved in various directions. This feature of the distraction technique may contribute greatly toward meticulous reconstruction of the cranial vault.


教育講演 形成外科の現状

教育講演 形成外科の現状

Journal of the Japan Organization of Clinical Dermatologists

日本臨床皮膚科医学会雑誌