素輪 善弘

Free jejunum was transferred to a patient with recurrent hypopharyngeal carcinoma under unfavorable cervical conditions, caused by prior therapeutic chemoradiotherapy for hypopharyngeal carcinoma and gastric pull-up with cervical leak, resulting from treatment for thoracic esophageal cancer. The cervical recipient vessels were buried in extensively scarred fibrous tissues, so they were thought to be less reliable. Because postoperative vascular occlusion was anticipated, in addition to the ordinary single vascular anastomosis to the damaged cervical vessels, secondary vascular anastomosis to the healthy chest vessels was performed. We designed the graft to have double vascular pedicles that communicated with each other through arcade vessels. This made it possible to anastomose doubly to an intact thoracoacromial artery in the chest by elongating the vascular pedicles of the mesentery without the need for an interpositional vein graft, in addition to ordinary anastomosis in the damaged neck. The flap is nourished by the vessels from two different origins (carotid and axillary arteries, internal jugular and axillary veins) at two different places (damaged and healthy areas). This method increases the quantity of feeding vessels while improving the quality of the recipient vessels within the local area and flow sources. It is one treatment option when conditions are unfavorable for safer jejunal transfer. Copyright © 2008 by Thieme Medical Publishers, Inc.

Juvenile xanthogranuloma is a relatively uncommon benign cutaneous fibrohistiocytic lesion that shows spontaneous regression. We report a case of juvenile xanthogranuloma, which formed a relatively large nodule and rapidly progressed after curettage. A 9-month-old girt had a mass in the skin over the lumbar region of her back that extended to the fascia. The lesion was histologically diagnosed as juvenile xanthogranuloma after total resection of the mass. Although preoperative diagnosis is quite difficult, plastic surgeons should be familiar with this entity. Juvenile xanthogranuloma should be considered in the differential diagnosis of benign tumours and tumour-like lesions in infants. The clinical presentation and histological findings are discussed. (C) 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.