BackgroundTraumatic hemipelvectomy is a catastrophic fracture of the pelvis as a result of high-energy trauma, such as in a car accident. There have been few case reports of traumatic hemipelvectomy because many of these patients die before they are transferred to a hospital. However, an increasing number of patients are being saved and admitted to hospital due to improvements in resuscitation and the emergency response system. Accordingly, there has been a growing body of reports on the management and reconstruction of traumatic hemipelvectomy.Case presentationA healthy 20-year-old Japanese man was trapped beneath a 3-ton steel frame while working on a crane. We describe here a very challenging case of traumatically induced bilateral partial hemipelvectomy with successful reconstruction of our patient’s pelvis using a unilateral anterolateral thigh flap.ConclusionTo the best of our knowledge, there have been few reports of bilateral hemipelvectomy and our case is the first to be successfully treated with a unilateral anterolateral thigh flap.
Background:The use of cultured epithelial autografts for the treatment of extensive burn wounds has become popular in recent years. We examined extensive burn wounds in 14 patients by using a combination of autograft and cultured epithelial autografts developed in Japan (JACE).Methods:We undertook a skin biopsy at 2, 4, and 6 weeks after transplantation with JACE. By using electron microscopy we observed the engraftment process.Results:In transmission electron microscope findings, we recognized the engraftment process of JACE. Keratinocytes matured gradually. Collagen fibers formed thick bundles in the dermis layer. In scanning electron microscope findings, we observed papillary dermis development on the artificial dermis.Conclusions:After managing wound bed preparation by using artificial dermis, we were able to recognize the good result of grafting JACE on meshed 6:1 split thickness autografts. This is because the auto dermis from autograft extended under the JACE, binding between JACE, and the dermis became strong.
Rationale:This study reviewed the use of a combination of meshed dermis graft and cultured epithelial autografts (CEA) made in Japan “JACE” (JACE; Japan Tissue Engineering Co., Ltd. Japan) for the treatment of massively burns. JACE is a Green-type CEA. We recently described a method in which we prepare the wound bed for burned patients by using artificial dermis and graft with JACE on a meshed 6:1 split-thickness autograft. In this report, we used a meshed 3:1 split-thickness dermis graft without epithelial cells. There are several reports of combination of using CEA on meshed split-thickness autograft, however this is the first report of using CEA on meshed split-thickness dermis graft.Patient concerns and diagnosis:Between March 2015 and August 2017, 3 burn patients were enrolled in this study. The patients ranged in age from 51 to 66 years. All 3 patients suffered severe burn injury that caused by flame. % Total Body Surface Area (TBSA) burned were ranged from 37.5% to 69%.Interventions:All patients received surgical treatment with tangential excision within a week from admission. We implanted artificial dermis immediately after debridement. Basically, we applied meshed 6:1 split-thickness autografts to the wound bed and covered with JACE. However, in the absence of split-thickness autografts, we used a meshed 3:1 split-thickness dermis graft instead of a meshed 6:1 split-thickness autograft.Outcomes:At 3 weeks after the transplantation of JACE, the take rate for JACE sheets was >60% on the meshed 3:1 split-thickness dermis graft. Furthermore, almost all of the burn wounds had healed at 6 weeks after surgery.Lessons:We observed good results by grafting JACE on meshed 3:1 dermis graft. With this new method, it is possible to cover a large burn wound by harvesting tissue from only a small site.
Transcatheter Arterial Embolization (TAE) is known to be effective for controlling severe hemorrhage caused by iatrogenic or blunt trauma. Out of more than 100 cases of TAE performed in our hospital, we have treated some cases of skin or muscle necrosis that resulted from embolization of the main arteries. In this study, we report the case of a patient with significant chest wall necrosis after TAE of the bilateral internal mammary arteries (IMAs). A 66-year-old male was transported to our hospital for loss of consciousness while playing golf. Cardiopulmonary resuscitation (CPR) was performed for cardiac arrest, which resulted in several rib fractures and mediastinal hematoma due to bilateral mammary artery injuries. Immediate TAE embolization was performed because of continuous hemorrhage. He was referred to our department 16 days after embolization due to the presentation of chest wall necrosis. Heart, lungs and diaphragm were exposed after surgical debridement under systemic anesthesia. We performed several operations to reconstruct the anterior chest wall. His spontaneous respiration returned, and is now controlled with a tracheostomy tube. Complete epithelialization was achieved, and he was transferred to another hospital for further rehabilitation. To the best of our knowledge, this is the first report of chest wall necrosis resulting from TAE of IMAs. Arterial embolization can cause widespread necrosis of bone, muscle and skin. Although treatment required an extended period, we managed to reconstruct the chest wall with multidisciplinary strategies.
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