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The oral-facial-digital syndromes (OFDS) represent a heterogenous group of disorders characterized by oral malformation, facial anomalies, and digital anomalies. Type II OFDS was reported by Mohr in 1941. Mohr syndrome is an autosomal recessive inherited disease characterized by median cleft lip, poly lobed tongue, absence of medial incisors, and polydactyly of hands and feet. Some other different expressive types of OFDS cases have been reported, and identified with 11 different clinical entities up to the present. Until now, only three cases of OFDS II in Japanese patients have been detected except for our patient. At this time, we observed a Japanese patient of Mohr syndrome with median cleft lip and tongue, hypertrophied frenula, absence of left medial incisor, and bilateral bifidity of great toe. Lip and tongue plasty was performed at 7 months after birth and toe plasty was done at 11 months with good results.

The management of severe burns requires the suppression of bacterial growth, particularly when eschar and damaged tissue are present. For such cases, silver sulfadiazine (AgSD) cream has been traditionally applied. This antibacterial cream, however, cannot be used in conjunction with a temporary wound dressing that is needed to promote healing. The authors developed a synthetic wound dressing with drug delivery capability for clinical use by impregnating a poly-L-leucine spongy matrix with AgSD, which is released in a controlled, sustained fashion. In general, the dressing adhered firmly to the wound in the case of superficial second-degree burns, and during the healing process it separated spontaneously from the re-epithelialized surface. In the management of deep second-degree burns where eschar and damaged tissue were present, the dressing had to be changed at intervals of 3 to 5 days until it adhered firmly to the wound. Once the dressing had firmly attached to the wound, it was left in place until it separated spontaneously from the re-epithelialized surface. Dressing changes were fewer than with other treatments and the pain was effectively reduced. Cleansed wounds were effectively protected from bacterial contamination. Of 52 cases treated with this wound dressing, 93% (14/15) of superficial second-degree burns, 75% (3/4) of deep second-degree burns, 85% (6/7) of superficial and deep second-degree burns, and 75% (12/16) of split-thickness skin donor sites were evaluated as achieving good or excellent results.

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Ideally, treatment for fingertip injury should involve the least pain possible, using durable and sensate skin with due consideration to aesthetic aspects. This paper presents two cases of fingertip reconstruction through the use of thenar flaps and nail bed grafts. In either case, injury had been due to fingertip crushing and reconstruction was conducted immediately thereafter. A full-thickness nail bed with hyponychium and perionychium from the severed part was used for dorsal reconstruction and thenar flaps for finger pulp reconstruction. In both cases, the grafting was quite satisfactory and good soft-tissue healing was observed. Subsequent nail growth and adherence were good. The outcome was pleasing to both patients. Thus, the presented method may be considered quite satisfactory from aesthetic and functional recovery standpoints.

Superoxide radicals were measured in the blood of six patients who underwent vascular reconstruction after ischemic injury in an attempt to predict prognosis following surgery. Three free-tissue transfers (two free latissimus dorsi flaps, one free vascularized fibular osteocutaneous graft) were performed on patients with skin or bone defects associated with open tibial fractures. Vascular reconstructions were performed on two patients with popliteal vascular injuries, in one case with an open femoral fracture and in another with an open knee dislocation. A third vascular reconstruction was performed on a patient with a subclavian artery injury associated with a clavicular fracture. Superoxide levels in the blood were quantified by a chemiluminescence method using a derivative of luciferin. Blood was obtained prior to reperfusion and periodically to 72 hr postoperatively. In patients who underwent successful reconstructions, superoxide levels increased after reperfusion. Vascular insufficiency was associated with acute drops in superoxide concentrations. Superoxide levels are a promising clinical marker which can predict insufficiency during reperfusion following tissue ischemia.

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