<i  >Objective</i>. To identify disabilities caused by Buruli Ulcer Disease (BUD) when it affects the Head and Neck Region (HNR) of patients in endemic areas and suggest possible ways to overcome the complications involved. <i  >Methods</i>. Data for the study was collected from six different hospitals in the central part of Ghana from 2004&#x2013;2009. Diagnosis of BUD was based on clinical findings and confirmed by positive result of Ziehl-Neelson Test for Acid Fast Bacilli, Polymerase Chain Reaction, or Histopathology. Treatment of BUD involved a combination of surgical interventions and antimycobacterial chemotherapy for 8 weeks. <i  >Results</i>. The age of the 38 patients ranged from 0&#x2013;56 years (mean age of 14.3 years), with males outnumbering females. Most (55<i  >.</i>3&#x25;, <svg style="vertical-align:-0.0pt;width:54.037498px;" id="M1" height="9.6000004" version="1.1" viewBox="0 0 54.037498 9.6000004" width="54.037498"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,9.6)">
		<g transform="translate(72,-64.32)">
			<text transform="matrix(1,0,0,-1,-71.95,64.37)">
				<tspan style="font-size: 11.21px; " x="0" y="0">𝑁</tspan>
				<tspan style="font-size: 11.21px; " x="17.394815" y="0">=</tspan>
				<tspan style="font-size: 11.21px; " x="31.920383" y="0">2</tspan>
				<tspan style="font-size: 11.21px; " x="37.524384" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>) of the patients reported to the facilities with developed BUD deformities. Patients who lost their eyeball (<svg style="vertical-align:-0.1575pt;width:47.037498px;" id="M2" height="9.9624996" version="1.1" viewBox="0 0 47.037498 9.9624996" width="47.037498"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,9.9625)">
		<g transform="translate(72,-64.03)">
			<text transform="matrix(1,0,0,-1,-71.95,64.24)">
				<tspan style="font-size: 11.21px; " x="0" y="0">𝑁</tspan>
				<tspan style="font-size: 11.21px; " x="17.394815" y="0">=</tspan>
				<tspan style="font-size: 11.21px; " x="31.920383" y="0">5</tspan>
			</text>

		</g>
	</g>
</svg>) recorded the highest in terms of functional disability. A mean total hospital stay of 52 days and follow-up period of 2.3 years were recorded for the study. <i  >Conclusion</i>. Visual impairment was the commonest form of disability recorded in the HNR. Management difficulties and BUD disabilities could be avoided by early detection of the disease and training of health professionals at district levels.

Pius Agbenorku

Multicenter Study of Buruli Ulcer Disabilities in the Head and Neck Region

Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as rucinol and sophora-alpha. <i>Aims</i>. We aim to compare the combined treatment of skin needling and depigmenting serum with that using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance the drug’s transdermal penetration. <i>Methods</i>. Twenty patients were treated with combined skin needling and depigmenting serum on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. <i>Results</i>. The side with combined treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved. <i>Conclusions</i>. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to achieve better results in melasma treatment compared to rucinol and sophora-alpha alone.

G. Fabbrocini

V. De Vita

N. Fardella

F. Pastore

M. C. Annunziata

M. C. Mauriello

A. Monfrecola

N. Cameli

Skin Needling to Enhance Depigmenting Serum Penetration in the Treatment of Melasma

There have been many cases of burn patients who also suffer from psychiatric problems, including eating disorders. We present a case of a 38-year-old female with an eating disorder and depression who became light-headed and fell, spilling boiling water from a kettle on herself at home sustaining partial thickness and full thickness burns over 5&#x25; of her total body surface area: left buttock and right thigh and calf. Eating disorders (in the present case, anorexia nervosa) cause emaciation and malnutrition, and consent for hospitalization from the patient and/or family is often difficult. During the medical treatment of burns for these patients, consideration not only of physical symptoms caused by malnutrition but also the psychiatric issues is required. Therefore, multifaceted and complex care must be given to burn patients with eating disorders.

Minekatsu Akimoto

Akira Takeda

Kazutaka Nagashima

Rie Uehara

Mitsuru Nemoto

Eiju Uchinuma

Medical Treatment for Burn Patients with Eating Disorders: A Case Report

A 47-year-old female with a locally advanced urologic malignancy previously managed with resection, diversion, and postoperative radiation therapy presented for management of her recurrent cancer that had eroded through the soft tissues of the left inner thigh and vulva. On all staging studies the tumor involved the left common femoral artery, and vein, both above and below the inguinal ligament. The difficulty with such tumors is the availability of tissue to reconstruct the defect. The patient had a history of deep venous thrombosis in the femoral venous system. A local flap was the most logical type of reconstruction. The patient had a right lower quadrant ureterostomy with a large parastomal hernia which further limited the local flap options. An anterolateral thigh flap from the opposite thigh was used to reconstruct the soft tissue deficit in this patient. This resurfaced the defect and provided coverage for the vascular reconstruction.

Robert M. Whitfield

David King

Peter  Rossi

Michael  Loffredo

Pedicle Anterolateral Thigh Flap Reconstruction after Pelvic Tumor Resection: A Case Report

<i>Objectives</i>. Several modalities have been advocated to treat traumatic scars, including surgical techniques and laser resurfacing. Recently, a plasma skin regeneration (PSR) system has been investigated. There are no reports on plasma treatment of mesh skin grafted scars. The objective of our study is to evaluate the effectiveness and complications of plasma treatment of mesh skin grafted scars in Asian patients. <i>Materials and Methods</i>. Four Asian patients with mesh skin grafted scars were enrolled in the study. The plasma treatments were performed at monthly intervals with PSR, using energy settings of 3 to 4&#x02009;J. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 months post treatment. The patients were also evaluated for any side effects from the treatment. <i>Results</i>. All patients showed more than 50&#37; improvement. The average pain score on a 10-point scale was 6.9 +/&#x02212; 1.2&#x02009;SD and all patients tolerated the treatments. Temporary, localized hypopigmentation was observed in two patients. Hyperpigmentation and worsening of scarring were not observed. <i>Conclusions</i>. Plasma treatment is clinically effective and is associated with minimal complications when used to treat mesh skin grafted scars in Asian patients.

Takamitsu Higashimori

Taro Kono

Hiroyuki Sakurai

Hiroaki Nakazawa

William Frederick Groff

Treatment of Mesh Skin Grafted Scars Using a Plasma Skin Regeneration System

The nose is a common site for basal and squamous cell carcinomas. Surgical excision can leave a defect that is appropriate for reconstruction with full thickness skin grafting. Tie-over dressings have gained popularity in this setting. We propose that steri-strips alone provide the necessary support to facilitate excellent graft take.

A. Harb

A. N. Pandya

Avoiding Sutured Tie-Over Dressings on the Nasal Dorsum

<i>Introduction</i>. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. <i>Method and Materials</i>. We report the case of a 43-years-old man with a painful tumefaction of the left hypothenar region. The ulnar artery appeared thrombosed clinically and radiologically. The patient underwent surgery to resolve the ulnar nerve compression and revascularise the artery. <i>Results</i>. The symptoms disappeared immediately after surgery. The arterial flow was reestablished. Postoperatively on day 20, a new thrombosis of the ulnar artery occurred. 
<i>Conclusion</i>. Hypothenar hammer syndrome is caused by repetitive trauma to the heel of the hand. The alterations of the vessel due to its chronic inflammation caused an acute compression of the ulnar nerve at the Guyon&#39;s canal and, in our case, do not allow a permanent revascularisation of the ulnar artery.

Emanuele Cigna

Anna Maria Spagnoli

Mauro Tarallo

Liliana De Santo

Giampaolo Monacelli

Nicol&#242; Scuderi

Therapeutic Management of Hypothenar Hammer Syndrome Causing Ulnar Nerve Entrapment

<i  >Purpose</i>. To describe the long-term results of frontalis suspension using autogenous fascia lata in children with congenital ptosis under 3 years old. <i  >Methods</i>. Forty three-eyes of 35 patients were enrolled in the study. Frontalis suspension using autogenous fascia lata was performed in all patients. The postoperative eyelid level, ptosis recurrence, visual acuity, and cosmetic results were evaluated. <i  >Results</i>. The mean age of the patients was <svg style="vertical-align:-1.09097pt;width:52.9375px;" id="M1" height="12.175" version="1.1" viewBox="0 0 52.9375 12.175" width="52.9375"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,12.175)">
		<g transform="translate(72,-62.26)">
			<text transform="matrix(1,0,0,-1,-71.95,63.4)">
				<tspan style="font-size: 12.50px; " x="0" y="0">1</tspan>
				<tspan style="font-size: 12.50px; " x="6.2515001" y="0">6</tspan>
				<tspan style="font-size: 12.50px; " x="12.503" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="15.62875" y="0">8</tspan>
				<tspan style="font-size: 12.50px; " x="24.655916" y="0">±</tspan>
				<tspan style="font-size: 12.50px; " x="35.996136" y="0">9</tspan>
			</text>

		</g>
	</g>
</svg> months (7&#x2013;36 months). The mean follow-up time was <svg style="vertical-align:-1.09097pt;width:60.75px;" id="M2" height="12.2375" version="1.1" viewBox="0 0 60.75 12.2375" width="60.75"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,12.2375)">
		<g transform="translate(72,-62.21)">
			<text transform="matrix(1,0,0,-1,-71.95,63.35)">
				<tspan style="font-size: 12.50px; " x="0" y="0">5</tspan>
				<tspan style="font-size: 12.50px; " x="6.2515001" y="0">2</tspan>
				<tspan style="font-size: 12.50px; " x="12.503" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="15.62875" y="0">8</tspan>
				<tspan style="font-size: 12.50px; " x="24.655916" y="0">±</tspan>
				<tspan style="font-size: 12.50px; " x="35.996136" y="0">1</tspan>
				<tspan style="font-size: 12.50px; " x="42.247639" y="0">5</tspan>
			</text>

		</g>
	</g>
</svg> months (14&#x2013;95 months). All patients had good (ptosis <svg style="vertical-align:-0.30096pt;width:22.987499px;" id="M3" height="11.0625" version="1.1" viewBox="0 0 22.987499 11.0625" width="22.987499"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
		<g transform="translate(72,-63.15)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="12.027886" y="0">2</tspan>
			</text>

		</g>
	</g>
</svg>&#x2009;mm) or moderate (2-3&#x2009;mm ptosis) eyelid level after the operation. All patients achieved satisfactory cosmetic results. Succesfull harvesting was performed in all cases and no additional materials or surgical manipulation were needed during the surgery. <i  >Conclusion</i>. Frontalis suspension using autogenous fascia lata can be used in children under 3 years old without harvesting problems. Surgical experience and good knowledge of anatomy are important factors for successful results after the surgery.

Lale Kozer Bilgin

Baris Yeniad

The Long-Term Results of Frontalis Suspension Using Autogenous Fascia Lata in Children with Congenital Ptosis under 3 Years Old

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