Dominant dystrophic epidermolysis bullosa (DDEB) is a rare inherited skin disorder characterized by extreme fragility of the skin and mucosa that poses significant challenges for anesthetic management. Herein, we report a case of a 65-year-old woman with DDEB who underwent a 13-hour surgery for mandibular cancer under general anesthesia. To prevent skin and mucosal injuries, meticulous perioperative strategies were implemented, including the use of barrier films and pressure-relieving pads and avoiding adhesive devices. High-flow nasal cannula oxygenation enabled awake fiberoptic intubation without the need for mask ventilation, minimizing the risk of blister formation and airway trauma. Despite the prolonged duration, no pressure ulcers or new skin injuries developed, other than minor epidermal peeling of the lips. This case demonstrates that comprehensive preoperative planning and intraoperative protection can ensure safe anesthesia in patients with DDEB undergoing long surgical procedures.

There were 10 patients of left ventricular free wall rupture accompanied with acute myocardial infarction in our coronary care unit from Jan. 1987 to Jan. 1991, while 872 AMI patients in the same period. Five of 10 ruptured patients died. All these 5 patients were acute type of rupture. Elder patient, female, 1st attack of infarction and PTCA were considered to be risk factors of rupture. We managed 5 subacute and chronic type ruptured patients successfully at emergent operation with using fibringlue-oxycellulose. Fibringlue-oxycellulose method was useful especially for woozing from infarcted myocardium. The management for acute type rupture is difficult because of its clinical time course, it is considered that prevention of rupture for high risk patient is most important to reduce the mortality of AMI patients in the coronary care unit.