記述言語：英語   掲載種別：研究論文（学術雑誌）  

UNLABELLED: No standards for the assessment of axillary odor intensity and the effects of therapy for osmidrosis have been established. This study presents an objective method for assessing odor severity in patients with osmidrosis and investigates the volatile odorants and skin flora. METHODS: The odor intensity was measured pre- and postoperatively using an industrial odor sensor in 79 patients with osmidrosis. Cultures of the axillary skin were obtained during skin flap surgery. Volatile odorants of the patients were assessed using an odor-sensor gas chromatograph mass spectrometer, and samples collected from clothing worn by the patients before and after surgery. The skin pH of the axilla was measured before and after surgery. The locations of odorants and bacteria in the skin were observed using electron microscopy. RESULTS: The mean patient age was 28.8 years, and the male-to-female ratio was 4:3. The odor significantly decreased from 52.6 preoperatively to 20.5 postoperatively (P < 0.001). The bacterial flora on the skin included mostly Staphylococcus. Multiple causative substances (volatile proteins) were identified on gas chromatography. The mean preoperative axillary skin pH was 6.21, which was significantly different than that of patients without osmidrosis (5.92; P < 0.01). CONCLUSIONS: An odor sensor accurately assesses odor intensity in patients with osmidrosis. The neutralization of axillary pH may promote the production of odorants by creating the optimal pH for bacterial growth. Odor sensor and pH values can be used pre- and postoperatively as objective assessment measurements for patients with osmidrosis.

DOI： 10.1097/GOX.0000000000004622

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Objective: The choice between local flap designs for burn reconstruction is largely shaped by aesthetic, vascularity, procedural complexity, and wound-closure considerations. However, another key consideration is how well specific local flap designs release post-burn scar contractures. This is because constant tension on wound edges can generate pathological scarring. However, the ability of specific local flap to release post-burn scar contractures is poorly understood. This question was addressed by this study of patients who underwent local flap surgery to release post-burn scar contractures.Methods: The flap type, its original size, and the degree to which the flap extended 6 months after surgery were recorded.Results: Of the 40 patients enrolled, 20 received an island flap and 20 received a skin-pedicled flap. The scars were most commonly located on the anterior chest, axilla, and cubital fossa, followed by the lateral chest, abdomen, thigh, and popliteal fossa. Six months after surgery, the skin-pedicled and island flaps had extended on average by 1.53-and 1.28-fold, respectively.Conclusions: While it was technically easier to transfer island flaps to the recipient site, they released contractures less effectively than skin-pedicled flaps. The postoperative extensibility of flaps should be considered when determining which flap design is optimal for the individual patient. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.

DOI： 10.1016/j.burns.2017.09.016

Web of Science

Scopus

PubMed

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記述言語：英語  

Keloids are caused by excessive scar formation that leads to scar growth beyond the initial scar boundaries. Keloid formation and progression is promoted by mechanical stress such as skin stretch force. Consequently, keloids rarely occur in paralyzed areas and areas with little skin tension, such as the periauricular region. Therefore, periauricular incision is commonly performed for face lifts. We report a rare case of keloids that arose from face-lift scars in a patient with bilateral facial nerve paralysis. A 51-year-old Japanese man presented with abnormal proliferative skin masses in bilateral periauricular scars. Seventeen years before, he had a cerebral infarction that resulted in permanent bilateral facial nerve paralysis. Three years before presentation, the patient underwent face-lift surgery with periauricular incisions. We diagnosed multiple keloids. We removed the masses surgically, closed the wounds with sutures in the superficial musculoaponeurotic system layer to reduce tension on the wound edges, reconstructed the earlobes with local skin flaps, and provided 2 consecutive days of radiotherapy. The wounds/scars were managed with steroid plasters and injections. Histology confirmed that the lesions were keloids. Ten months after surgery, the lesions did not exhibit marked regrowth. The keloids appeared to be caused by the patient's helmet, worn during his 3-hour daily motorcycle rides, which placed repeated tension on the periauricular area. This rare case illustrates how physical force contributes to auricular and periauricular keloid development and progression. It also shows that when performing surgery with periauricular incisions, care should be taken to eliminate wound/scar stretching.

DOI： 10.1097/GOX.0000000000001417

PubMed

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記述言語：日本語   出版者・発行元：日本発汗学会  

腋臭症は腋窩アポクリン腺からの分泌物を皮膚常在菌が代謝することで特有の臭気を発する疾患であるが、診断は患者や医師の主観に依存しており客観的な評価方法がない。また多汗症や自己臭恐怖症を合併し、日常診療で治療選択に難渋することもある。本稿では著者らがこれまで行ってきた研究から、腋臭症の病態解明と診断学に基づいた最適な治療法のアプローチについて述べる。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

症例は53歳男性で、40歳ごろから歩行時や起床時、脱水時に両下腿の痛みを自覚することがあったが、休息等により自然軽快していた。その後、転職したことにより片道1時間、徒歩と電車での通勤となり、転職3日目に痛みが生じ始め、4日目には間欠性の跛行となった。5日目には痛みは強く持続性となり、その翌日、欠勤のうえ当院受診となった。造影CT所見より下腿前区画コンパートメント症候群を疑い治療を開始した。入院6日目にデブリードマンを施行し、左側は前脛骨筋、長趾伸筋が完全壊死し、右側は前脛骨筋、長趾伸筋、長母趾伸筋が完全壊死していた。入院10日目に左側は一部縫縮、右側は完全縫縮を行い、左側は死腔と潰瘍を認めたため局所陰圧閉鎖療法を併用し、入院18日目に同側大腿部より分層植皮術を施行し治癒した。リハビリテーションの施行と装具の装着により、入院25日で退院となった。発症前と同様の通勤を再開したが、退院後6ヵ月の時点で症状の再燃はない。

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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