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There have been many reports to date with respect to treatments on reconstruction of the cranium without accompanying infections following trauma and tumor resection. The morality is, however, high in patients observed with generation of cranial bone defect of all layers accompanying infection and cerebrospinal fluid leakage, and moreover, there are barely any reports on such cases because of the reconstruction thereof being very difficult. In this study, the authors were able to cure such 2 cases by carrying out continuous negative pressure and irrigation treatment inside the wound by a closed system following transplant of free latissimus dorsi muscle flap. This method is believed to be very effective for cranial bone defect of all layers accompanying infection and cerebrospinal fluid leakage, in which treatment was determined to be very difficult.

Background: As a common treatment for pulmonary fistula, pleurosclerosis is performed. However, in the case of pulmonary fistula with empyema, it is difficult to develop adhesion through pleurosclerosis. Therefore, it is necessary to fill the dead space with a tissue graft., Method: This surgical procedure is performed in two stages. In the first-stage surgery, the thoracic empyema cavity is opened widely, and sufficient drainage and debridement are performed within the thoracic empyema cavity. After the surgery, the wound is washed every day to suppress infection and promote the proliferation of benign granulation tissue (wound bed preparation). In the following second-stage surgery, a graft of latissimus dorsi muscle flap is performed to fill the dead space and close the fistula. In this case, a negative pressure drain is placed around the fistula to reliably drain air leaks from the pulmonary fistula, and thus the latissimus dorsi muscle flap and the tissue surrounding the pulmonary fistula can reliably adhere to the site. CASES AND RESULTS: Treatment with this method was performed in five cases, all of which successfully healed with no complications or recurrence., Conclusion: When treating pulmonary fistula that has developed into thoracic empyema, it is believed that the following three points are important: (1) wound bed preparation around the pulmonary fistula, (2) inserting a latissimus dorsi muscle flap having a high wound-healing capacity and (3) promoting strong adhesion of the muscle flap and tissue surrounding the pulmonary fistula by reliably draining air leaks from the pulmonary fistula with a negative pressure drain., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Background: The objective of the current study is to elucidate the three-dimensional vascular distribution as far as the peripheral areas of a latissimus dorsi musculocutaneous flap and to establish a safe procedure for creating it., Methods: A lead oxide with gelatin-contrast agent was injected into fresh cadavers and the angiosomes in the muscle and skin were examined in detail., Results: In the muscle, three vascular territories were observed. The first vascular territory was formed by the thoracodorsal artery, the perforating branches of the ninth intercostal artery and those of the tenth intercostal artery located in the lateral part of the muscle. The second vascular territory was formed by the perforating branches of the tenth intercostal artery located in the medial part of the muscle, those of the 11th intercostal artery and the subcostal artery. The third vascular territory was formed by perforating branches of the first and second lumbar arteries. In the dorsal skin above the muscle, two vascular territories were observed. The first vascular territory was formed by perforating cutaneous branches of the thoracodorsal artery, perforating branches of the ninth through 11th intercostal arteries and the scapular circumflex artery. The second vascular territory was formed by perforating branches of the subcostal artery and the first and second lumbar arteries., Conclusions: When using a latissimus dorsi musculocutaneous flap with the thoracodorsal artery as a pedicle, the flap can be safely elevated as far as the inferior border of the 12th rib where perforating branches of the subcostal artery are distributed. At the same time, skin above the muscle can be safely harvested up to the iliac crest. It is essential, however, that the skin paddle includes perforating branches of the ninth intercostal artery or perforating branches of the 10th intercostal artery in the lateral part of the muscle., (Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been used to examine muscle activity during running. The dash is a basic activity in various kinds of sports but differs from running in terms of intensity and severity. The purpose of this study was to evaluate muscle activity during running at full speed using FDG PET., Methods: Six healthy men were investigated during a dash for 10 min after intravenous injection of FDG (37 MBq). Another six healthy men were studied as controls. PET images were obtained 45 min after the FDG injection. Regions of interest were drawn on the anterior and posterior thighs and the anterior and posterior legs. The standardized uptake value (SUV) was calculated to examine the FDG uptake of muscle tissue per unit volume according to an equation., Results: In the control group, the mean SUVs of the anterior thigh, posterior thigh, anterior leg, and posterior leg were 0.49 +/- 0.04, 0.44 +/- 0.02, 0.46 +/- 0.05, and 0.44 +/- 0.07, respectively. In the dash group, the mean SUVs of the anterior thigh, posterior thigh, anterior leg, and posterior leg were 0.74 +/- 0.20, 0.79 +/- 0.08, 0.61 +/- 0.07, and 0.60 +/- 0.08, respectively. FDG accumulation of every one of the four compartments in the dash group was significantly higher than that in the control. FDG accumulation of the posterior thigh was significantly higher than that of the anterior and the posterior leg in the dash group (P < 0.02)., Conclusion: Based on the results of our investigation, posterior thigh muscles were especially active during a dash.