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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/PRS.0000000000010428

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.18999/nagjms.85.1.7

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/23320885.2022.2039667

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.7759/cureus.27209

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Microsurgery  

Background: Non-thrombotic skin paddle necrosis occasionally occurs during mandibular reconstructions with free fibula osteocutaneous flaps. The number of perforators, size of the skin paddle, and ischemia time of the flap are considered as causes of skin paddle necrosis. The importance of donor side selection has also been highlighted. This study aimed to investigate the leading cause of skin paddle necrosis and the optimal reconstructive procedure. Methods: A total of 66 patients who underwent mandibular reconstruction using a free fibula osteocutaneous flap were retrospectively analyzed. Skin paddle necrosis, number of cutaneous perforators, size of the skin paddle, and ischemia time of the flap were investigated. An incorrect “laterality” was defined as a skin paddle (septum) covering the reconstruction plate. Donor-site morbidity was recorded. Results: Skin paddle necrosis occurred in 15.2% of patients. An incorrect laterality was associated with a higher incidence of skin paddle necrosis (odds ratio, 22.0; 95% confidence interval, 2.5–195; p =.005). Donor-site morbidity was noted in 18.8% of the patients, without any significant difference in terms of the donor side with and without skin graft (p =.592). The postoperative activities of daily living were not affected. Conclusions: To prevent skin paddle necrosis, donor side selection is an important safety strategy during mandibular reconstruction with free fibula osteocutaneous flap. The postoperative activities of daily living were found to be little affected by differences in the donor side.

DOI： 10.1002/micr.30881

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Language：English  

DOI： 10.1016/j.anl.2021.10.013

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/SCS.0000000000008334

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Eplasty  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Laryngoscope Investigative Otolaryngology  

Purpose: To investigate the oncological outcomes of orbital malignant tumors invading the skull base. Methods: A retrospective analysis was conducted on 16 patients with orbital malignant tumors invading the skull base. Eleven patients were treated with skull base surgery, four patients were treated with particle therapies, and one patient was treated with chemoradiotherapy (CRT) as initial treatment. Results: The most frequent histological type was adenoid cystic carcinoma in seven patients, followed by squamous cell carcinoma in two patients. Local recurrence occurred in two of the six surgically treated patients who did not receive postoperative radiotherapy (RT) or CRT. One of them was successfully salvaged by RT, and the other died of disease. With a median follow-up of 24 months, the 2-year overall, local control, and disease-free survival rates of all patients were 82.5%, 87.5%, and 59%, respectively. Conclusions: Patients with positive surgical margins were at risk of local recurrence. Postoperative RT should be considered for all surgically treated patients. Level of Evidence: 4.

DOI： 10.1002/lio2.687

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Journal of Artificial Organs  

Introduction: We hypothesized that hybrid artificial nerves might overcome the limitations of a nerve conduit by isolating nerve fascicles from autologous nerves. Nerve sacrifice during harvest, a drawback of conventional autologous nerve transplantation, may be reduced by the hot dog method. The hot dog method (based on the morphology of hybrid artificial nerves) adds nerve conduits to autologous nerve fascicles. Methods: Forty-eight rats with a 10-mm sciatic nerve defect were divided into six groups (n = 8 per group) according to the neural reconstruction method: autologous nerve transplantation, the hot dog method, nerve conduit, nerve fascicle transplantation, sham control, and nerve fascicle isolation were classified as Groups I, II, III, IV, V, and VI, respectively. The sciatic nerve function was assessed in these groups, a histological evaluation was performed, and statistical analyses were conducted based on these data. Results: Group III (nerve conduit) and Group IV (nerve fascicle transplantation) showed the lowest functional and axonal regenerative effects, followed by Group II (hot dog method) and Group I (autologous nerve transplantation). Group VI (nerve fascicle isolation) tended to achieve better recovery in motor function and axonal regeneration than Group I (autologous nerve transplantation). Conclusions: The hot dog method is simple, safe, and easy to execute. This method can serve as a new neural reconstruction method that uses artificial nerves.

DOI： 10.1177/03913988211026000

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Journal of craniofacial surgery  

ABSTRACT: A total of 47 patients who underwent the craniofacial implantation of unsintered hydroxyapatite particles and a poly-L-lactide device were evaluated for clinical local findings and computed tomography (CT) images after about 6 months. Long-term follow-up of 3 patients was done from 5 to 11 years. The patients underwent CT imaging pre- and postoperatively, while local clinical examination was done upon follow-up. For the 3 patients who were followed up for more than 5 years, implant changes were evaluated by using CT. Computed tomography revealed 3 patients of dislocation, 2 patients of insufficient bone union, and 3 patients of implant breakage. All patients healed well with no complications requiring a secondary operation. The CT findings of the long-term cases revealed the following: a plate and screw were still present 5 years postsurgery (patient 1), mesh implants were completely resorbed after 9 years and 6 months (patient 2), and plates were almost resorbed after 11 years but some of their shapes remained (patient 3).The unsintered hydroxyapatite/poly-L-lactide device is useful in the maxillofacial region in terms of strength and radiographic contrast. However, since the absorption rate is slow, it is necessary to keep in mind its long-term radiographic detectability and the possibility of late-onset granuloma.

DOI： 10.1097/SCS.0000000000007491

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Reconstructive Microsurgery  

Background Intraoperative vasospasm during reconstructive microvascular surgery is often unpredictable and may lead to devastating flap loss. Therefore, various vasodilators are used in reconstructive microsurgery to prevent and relieve vasospasm. Lidocaine is a vasodilator commonly used in microvascular surgery. Although many reports have described its in vitro and in vivo concentration-dependent vasodilatory effects, limited studies have examined the pharmacological effects of lidocaine on blood vessels in terms of persistence and titer. Methods In this study, the vasodilatory effect of lidocaine was examined by using the wire myograph system. Abdominal aortas were harvested from female rats, sliced into rings of 1-mm thickness, and mounted in the wire myograph system. Next, 10, 5, 2, and 1% lidocaine solutions were applied to the artery, and the change in vasodilation force, persistence of the force, and time required to reach equilibrium were measured. Results The vasodilatory effect was confirmed in all groups following lidocaine treatment. Although strong vasodilation was observed in the 10% lidocaine group, it was accompanied by irreversible degeneration of the artery. Vasodilation in the 1% lidocaine group was weaker than that in the other groups 500 seconds after lidocaine addition (p < 0.05). Between the 5 and 2% lidocaine groups, 5% lidocaine showed a stronger vasodilatory effect 400 to 600 seconds after lidocaine addition (p < 0.01); however, there was no significant difference in these groups after 700 seconds. Additionally, there was no difference in the time required for the relaxation force to reach equilibrium among the 5, 2, and 1% lidocaine groups. Conclusion Although our study confirmed the dose-dependent vasodilatory effect of lidocaine, 5% lidocaine showed the best vasodilatory effect and continuity with minimal irreversible changes in the arterial tissue.

DOI： 10.1055/s-0040-1722759

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: This study aimed to evaluate the occurrence and treatment outcome of late complications after free fibula osteocutaneous flap reconstruction for mandibular osteoradionecrosis (ORN).

Methods: We enrolled 15 consecutive patients (14 men, one woman; median age 65 years, range 57-80 years) who underwent free fibula reconstruction for advanced mandibular ORN during 2013-2017 with two or more years of follow-up. Late complications included infection, plate exposure, and recurrence at the resection margin. The effect of perioperative antibiotic administration on late complications was also assessed.

Results: Late complications occurred in 33.3% (5/15) of patients, including two infections (local and distant), two plate exposures, and two recurrences (plate exposure and recurrence occurred in one patient). Perioperative antibiotic administration duration did not significantly affect the occurrence of postoperative late complications. All late complications were treated without problems.

Conclusions: Late complications after ORN reconstructive surgery are not uncommon, but can be treated properly.

DOI： 10.7759/cureus.13833

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Journal of Surgery Case Reports  

Introduction: Limited literature exists regarding the positional relationship between the pedicled-rectus abdominis myocutaneous (p-RAMC) flap and residual pelvic organs post posterior pelvic exenteration (PPE). Presentation of case: Four patients underwent PPE and reconstruction with a p-RAMC flap. After harvesting the p-RAMC flap with the deep inferior epigastric artery and veins as the vascular pedicle, the intra-pelvic shortest pathway of the flap was created. We dissected the subcutaneous tissues of the flap donor site toward the perineal defect along the inner wall of the pelvis. The pubic origin of the rectus abdominis muscle was preserved. A three-dimensional model was constructed using an image processing software. The vascular pedicle ran almost linearly along the inner wall of the pelvis. The muscle belly was placed on the pelvic floor through the posterior wall of the urinary bladder which filled the dead space of the resected area. All flaps survived without significant complications. Discussion: Assigning the cranial side of the flap to the perineum and caudal side to the pelvic floor could reduce postoperative intrapelvic complications. By preserving the pubic origin of the rectus abdominis muscle, a shock absorber of the pedicle of the flap was created, preventing over-traction of the flap while passing through the intrapelvic pathway. Conclusion: A p-RAMC flap via intra-pelvic shortest pathway is an ideal reconstructive method for large skin defect in perineal area after PPE.

DOI： 10.1016/j.ijscr.2021.02.015

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Language：English   Publishing type：Research paper (scientific journal)  

Advanced mandibular osteoradionecrosis (ORN) sometimes requires extended resection (e.g., hemimandibulectomy). Bacterial infection contributes to ORN pathogenesis. To control infection and determine the extent of debridement required, an understanding of bacterial spread within sites of mandibular ORN is important. The current study used a histopathological approach to assess bacterial colonization in the mandibular condyle and elucidate possible paths of bacterial spread towards the mandibular condyle. Four hemimandibulectomy specimens were selected. Areas of bone destruction were macroscopically assessed and confirmed using hematoxylin and eosin staining. Bacterial presence within mandibular condyle was confirmed with Gram staining. Bone exposure was observed in the molar area in all specimens. Macroscopic bone destruction was apparent especially near the medial side of the cortical wall. Gram staining revealed bacterial colonization of the mandibular condyle in three of the four specimens. In conclusion, bacteria tended to spread posteriorly and through the medial side of the mandibular cortical wall. In patients with advanced ORN, the potential for bacterial colonization of the mandibular condyle should be considered during treatment.

DOI： 10.1155/2021/9998397

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Language：Japanese   Publisher：Journal of Cranio-Maxillofacial Surgery  

Purpose: This study aimed to examine the usefulness of treating orbital blowout fracture using a customized rigid carrier. Material and methods: Patients who underwent surgery for orbital blowout fractures in our department from April 2016 to March 2019 were recruited in the study. We molded a rigid thermoplastic material into the same shape as the reconstruction material according to the 3D model and transplanted it into the orbital space along with the reconstruction material. We assessed Hertel exophthalmometry, awareness of diplopia, and the Hess area ratio (HAR%). Results: We performed this procedure in 15 patients with blowout fractures. Reconstruction materials used were iliac bone, absorbable plates, and titanium mesh in 12, 2, and 1 patient, respectively. None of the patients showed a difference of more than 2 mm on Hertel exophthalmometry. Only one patient had diplopia after surgery. The average preoperative and postoperative HAR% were 83.1 and 90.6, respectively. HAR% was more than 85% in 6 of 7 postoperative cases. Conclusions: This method can be applied for surgery using various reconstructive materials and can be a useful method, especially in patients with a wide range of orbital bone defects.

DOI： 10.1016/j.jcms.2020.09.002

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Language：Japanese   Publisher：Journal of Craniofacial Surgery  

Correct anatomical reconstruction of the orbital wall for function and cosmesis is important; however, this is difficult because of the structure’s complexity. The authors aimed to analyze and classify orbital morphology from computed tomography (CT) images and examine the relationship between orbital morphology and eyelid morphology in the Japanese population. CT images of 60 men (right side, 29; left side, 31) and 44 women (each side, 22) were included. The lengths of the orbital medial wall and floor in the coronal plane at the anterior, middle, and posterior planes of the orbit; angle between them; simotic index; and the thickness of upper eyelid were measured. Additionally, the presence or absence of double eyelids was evaluated. Non-paired Student’s t test and Pearson correlation coefficient test were used for analysis. Orbital morphology was symmetrical on both sides, and men had a larger orbit than women. Orbital morphology was classified into 2 groups according to the posterior angle, and there was a difference between the groups in the simotic index. The difference between groups may represent a genetic difference between the Jomon and Yayoi people and not only provide a new classification for the orbit of the population but also be useful in orbital reconstruction.

DOI： 10.1097/SCS.0000000000006634

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Language：Japanese   Publisher：Operative Neurosurgery  

DOI： 10.1093/ons/opaa124

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Language：Japanese   Publisher：Pediatric Dermatology  

Infantile hemangioma (IH) is a benign vascular tumor that gradually involutes over several years. Rapidly involuting congenital hemangioma (RICH) is the relatively rare congenital vascular tumor that is fully grown at birth and does not undergo postnatal growth and involutes during the first year. However, after involution of both IH and RICH, some have severe sequelae, such as redundant skin or conspicuous scarring, requiring additional treatment. We present the case of a 6-year-old girl with a concave deformity due to subcutaneous atrophy, skin darkening, and altered skin texture of her left zygomatic region following involution of a hemangioma. We successfully treated this patient by transferring a dermal fat graft. This technique can be beneficial for atrophic sequelae after regression of a hemangioma and is easy to perform and cosmetically effective.

DOI： 10.1111/pde.14207

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Language：Japanese   Publisher：Genes to Cells  

The human skin has previously been described to be affected by light; however, the underlying mechanism remains unknown. OPN4 (melanopsin) expression was first identified in the skin of amphibians; however, whether it is also expressed and functioned in the human skin has not yet been identified. Here, we show that OPN4 was expressed in the human skin tissue and cultures of isolated keratinocytes, melanocytes and fibroblasts. Additionally, Ca2+ influx in vitro and ex vivo and phosphorylation of extracellular signal-regulated kinases 1/2 in human fibroblasts were observed by stimulation of blue light irradiation. Notably, our findings showed that this Ca2+ influx and phosphorylation of extracellular signal-regulated kinases 1/2 are promoted in an intensity-dependent manner, indicating that the light signal is converted to an intracellular signal via OPN4 in the human skin. Overall, in this study we showed that the human skin functions as a photoreceptor by demonstrating that in human skin, the photoreceptive protein was expressed, and photoreception was conducted via photoreceptive protein.

DOI： 10.1111/gtc.12751

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Language：Japanese   Publisher：Journal of Plastic, Reconstructive and Aesthetic Surgery  

Background and objective: Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios. Methods: This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal–Wallis test, and Scheffe test were used in statistical analyses. Results: Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59–2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3–1.8, and ≥1.8. Conclusion: Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.

DOI： 10.1016/j.bjps.2019.03.015

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Language：Japanese   Publisher：Kobe Journal of Medical Sciences  

Background: Prolonged drain placement occasionally causes complications such as infection in patients who have undergone implant-based breast reconstruction; therefore, the drainage period must be shortened to avoid complications. Purpose: To identify the factors that prevent prolonged drain placement in patients who have undergone immediate breast reconstruction with tissue expanders. Methods: This was a retrospective medical chart review of all patients who underwent immediate breast reconstruction with tissue expanders at a single center from April 2013 to March 2016. Closed-suction drains were placed in and on the implant pocket. An extra drain was positioned in the axilla in patients undergoing axillary lymph node dissection. The drains were removed at a drainage volume of ≤50 ml per 24 hours. Prolonged drain placement was defined as a period greater than the 75th percentile among all patients. Nine potential risk factors associated with prolonged drain placement were analyzed with multivariate logistic regression analysis. Results: In total, 89 tissue expanders in 89 patients were placed in this study. Prolonged drain placement, determined as ≥9 days (range, 5–14 days), was significantly associated with body mass index ≥25 kg/m2, tissue expander size ≥500 ml, and intraoperative bleeding ≥100 ml, in the multivariate analysis. Axillary lymph node dissection with extra-axillary drainage did not prolong the drainage period. Conclusions: Our findings suggested that placing an extra-axillary closed-suction drain following axillary dissection, and reducing intraoperative bleeding and surgical trauma, could prevent prolonged drain placement in immediate breast reconstruction with tissue expanders.

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Language：English   Publisher：Case Reports in Plastic Surgery and Hand Surgery  

A reverse vascular pedicle digital island flap is a useful treatment option for reconstruction in fingertip amputation. We describe a surgical procedure to preserve the dorsal branch of the digital nerve in the middle phalanx during elevation of this flap with favourable outcomes.

DOI： 10.1080/23320885.2019.1632202

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Language：English   Publisher：Case Reports in Plastic Surgery and Hand Surgery  

Teratomas and lymphatic malformations are included in the differential diagnosis of congenital neck masses. They can exhibit similar clinical findings. The authors present a case of mature teratoma that had been managed as a lymphatic malformation for years. Clinicians should be careful not to dismiss clues for the correct diagnosis.

DOI： 10.1080/23320885.2019.1619458

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Language：Japanese   Publisher：Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology  

Oroantral fistulas (OAF), which develop as a result of maxillary sinus infection caused by oroantral communication, are sometimes intractable. We present a case of closure with a facial artery musculomucosal flap (FAMM flap) for intractable OAF. A 73-year-old man presenting with an OAF and rhinorrhea was referred to our department. Twenty-eight years earlier, he had undergone bilateral radical surgery for maxillary sinusitis, and six years earlier, he underwent extraction of his right maxillary first and second molars. Six months after the dental extractions, he developed maxillary sinusitis secondary to oroantral communication. Four years after the dental extractions, he underwent endoscopic sinus surgery with closure of the OAF with a rotational pedicled palatal flap, but the OAF recurred. To treat the OAF recurrence, we used a FAMM flap. His postoperative course was good, with no OAF recurrence 6 years after surgery. FAMM flaps are useful to close intractable OAFs.

DOI： 10.1016/j.ajoms.2018.05.001

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Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

For sclerotherapy in venous malformations, three agents, i.e., ethanol, ethanolamine oleate, and polidocanol have been used in Japan. Among these, superiority with regard to outcome and complications has rarely been discussed. Between June 2000 and July 2015, we had 187 patients with venous malformations who were treated by percutaneous sclerotherapy with surfactant sclerosants; we evaluated the efficacy and safety of the therapy retrospectively. Patients were divided into three subgroups depending on the surfactant sclerosants used for treatment: liquid ethanolamine oleate (1-EO group; n=68, 128 sessions), foamy ethanolamine oleate (f-EO group; n=56, 101 sessions), and foamy polidocanol (f-Po group; n=63, 81 sessions). High success rate with excellent and good outcomes were as follows: 71% in the 1-EO group, 65% in the f-EO group, and 78% in the f-Po group. There was no significant difference among the 3 subgroups. Hemoglobinuria occurred in 49 sessions (38%), in 26 sessions (26%), and none, in the 1-EO, f-EO, and f-Po groups, respectively. Thus, less hemoglobinuria was observed with the use of f-Po in comparison with the other two agents. Soft tissue necrosis occurred in 18 sessions (14%), 9 sessions (8%), and 2 sessions (2%) in the 1-EO, f-EO, and f-Po groups, respectively. Therefore, f-Po showed lower incidence of tissue necrosis compared with 1-EO. Since polidocanol demonstrated lower complication rates than ethanolamine oleate, while its efficacy was equivalent to that of the other agents, polidocanol is strongly recommended as a useful surfactant sclerosant for the treatment of venous malformations in Japan.

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Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

Although various grafts using autogenous bone, autogenous cartilage, and alloplastic substitutes have been used for orbital wall reconstruction in facial fracture surgery, none have proven to be the gold-standard graft material. We have used iliac cancellous bone sheets as graft material in cases of orbital fracture. The iliac cancellous bone graft is considered the most appropriate material for orbital wall reconstruction because it is pliable enough to fit the delicate curve of the orbital wall and soft enough to be cut easily with surgical scissors. Here, we describe the details of our surgical technique for orbital floor reconstruction with iliac cancellous bone. A summary of our procedure for orbital floor fracture repair is as follows : 1. to approach the orbital floor, a subciliary incision is usually used ; 2. the fracture and defect site are exposed subperios-Teally, and the orbital content herniating into the maxillary sinus is carefully repositioned ; 3. a milli-meter-Thick bone block is harvested from the ileum; 4. the harvested block is thinned to a 1-2 mm-Thick cancellous bone sheet with a surgical burr ; 5. the sheet is adequately trimmed with surgical scissors; and 6. the sheet is placed onto the orbital floor to cover the bone defect without fixation.

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CiNii Research

Language：Japanese   Publisher：The Japanese Skin Cancer Society  

<p>The present case was of a 67-year-old male patient, who detected a black spot under his left hallux nail plate approximately one year prior to his initial medical examination. Subsequently, the lesion expanded, causing destruction of the nail ; this led the patient to undergo an examination at the department of dermatology at our hospital. Clinical analysis revealed primary malignant melanoma in the left hallux. Based on positron emission tomography-computed tomography results, the patient was suspected to have popliteal and inguinal lymph node metastasis ; he was therefore referred to our department. We performed a primary tumor resection, a sentinel lymph node biopsy, and a popliteal lymph node dissection. The primary tumor had a thickness of 11 mm and had infiltrated the periosteum. The inguinal lymph node biopsy was 1/3 positive (denoting metastasis to superficial inguinal lymph node) and the popliteal lymph node dissection was 1/2 positive (denoting metastasis to deep popliteal lymph node). At a later date, we performed an inguinal lymph node dissection and lymph node metastasis was no longer observed. Invasion of the primary tumor up to the hallux periosteum suggested that the tumor may have metastasized to the deep popliteal lymph node from the periosteum via deep lymphatic vessels. In conclusion, in cases where a primary tumor extends to deep tissues, it is important to consider the possibility of flow to deep lymphatic vessels.[<i>Skin Cancer (Japan)</i> 2016 ; 31 : 233-237]</p>

DOI： 10.5227/skincancer.31.233

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Publisher：株式会社医学書院  

DOI： 10.11477/mf.1411200656

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DOI： 10.11477/mf.1411200665

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Language：Japanese   Publisher：Regenerative Therapy  

Introduction: Several methods of nerve reconstruction for facial nerve palsy are known. Although the recently introduced method of "cross-linking" of the facial and hypoglossal nerves with a grafted nerve has proved efficacious, the underlying mechanism is unclear. Methods: In this study, we created an animal model with Wistar rats and analyzed the newly reconstructed neural circuit by anterograde and retrograde neural tracer methods. The saphenous nerve was harvested as a graft, and its double end-to-side neurorrhaphy with the facial and hypoglossal nerves with epineural windows was carried out under the microscope. After an appropriate interval, small amounts of fluoro-ruby or fluoro-emerald were injected into the animals and analyzed 5 days later by fluorescent microscopy (Anterograde experiment: fluoro-ruby into the hypoglossal nucleus at 5 weeks; retrograde experiment: fluoro-ruby into the distal facial nerve sheath and fluoro-emerald into the distal hypoglossal nerve sheath, both at two months.). Results: The labeled axons derived from the hypoglossal nucleus were observed passing through the grafted nerve to the facial nerve. On the other hand, retrogradely labeled neurons were observed at both the hypoglossal and facial nuclei with some double-labeled neurons, suggesting that collateral sprouting had occurred. Conclusions: We suggest that the newly constructed neural circuits we observed are conducive to the treatment of facial nerve palsy.

DOI： 10.1016/j.reth.2015.05.003

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

Negative pressure wound therapy (NPWT) has been introduced as a useful technique for wound treatment. However, some complications have been reported, such as infection, bleeding and pain, which make it impossible for patients to continue further treatment. Air leak is another problem, especially in hairy regions, such as the head and genital area. We have introduced a silicone gel adhesive dressing for NWPT, instead of using the film included in the original kit. The use of the silicone gel adhesive dressing greatly reduces pain, which was occurs when detaching the film. In addition, it plays a role in reducing air leak in hairy regions. Although there remains the problem of its high cost, silicone gel adhesive dressing for NPWT is quite useful.

DOI： 10.11310/jsswc.6.125

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Language：Japanese   Publisher：日本皮膚悪性腫瘍学会  

DOI： 10.5227/skincancer.30.157

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Language：Japanese   Publisher：Japanese Society of Reconstructive Microsurgery  

The goal for foot reconstruction is to restore the structure and walking function. To achieve this goal, it is important to assess precisely the defects in anatomical structure, residual function, reconstructive procedure, and postoperative therapy, including rehabilitation and fitting of braces or footwear. We experienced twelve free tissue transfers and thirteen pedicle skin flaps for foot reconstruction in our hospital or branch hospitals. In all cases, tailored braces or footwear were used postoperatively under advice from a prosthetist. The free flaps we selected were: one rectus abdominis musculo-cutaneous flap, six latissimus dorsi musculo-cutaneous flaps, three groin flaps, a free scalp flap, and a scapular flap. Two of the patients who underwent free latissimus dorsi musculo-cutaneous transfer had a failed procedure due to vascular thrombus. The pedicled flaps we used were: six distally based sural flaps, five medial plantar flaps, and two lateral calcaneal flaps. Partial flap necrosis was encountered in two of six distally based sural flaps. Ulceration developed in one flap due to bulkiness. As restoring foot contour is ideal for foot reconstruction, we conclude that using thin flaps or thinning of flaps avoids bulkiness. Subsequent footwear fitting is also very important.

DOI： 10.11270/jjsrm.27.79

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Language：Japanese   Publisher：Japanese Society of Reconstructive Microsurgery  

The development of microvascular surgery has been contributed the patients' quality of life after the expanded resection of malignant tumor or large tissue defect caused by trauma. On the other hand, vascular complication, such as thrombosis, relates to the flap necrosis and strict monitoring of flap condition is necessitated. We basically monitor the flap every 4 hours for 5 days by inspection or palpation. In addition, we have been introduced blood glucose measurement, regional oxygen saturation index ( rSO<SUB>2</SUB> ), pulse oximeter ( SpO<SUB>2</SUB> ) and indocyanine green fluorescent ( ICG ) imaging for flap auxiliary monitoring. Because each of those methods has advantage and disadvantage, understanding of characteristics of each methods may helps us the earlier detection of vascular trouble, which directly relate to the flap salvage rate.

DOI： 10.11270/jjsrm.27.72

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Language：Japanese   Publisher：Japanese Society of Oral Oncology  

DOI： 10.5843/jsot.26.53

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

In patients with critical limb ischemia ( CLI ) who have an intractable ulcer of the lower limbs, there is a higher level of need for an amputation due to severe infection after revascularization. Three out of the thirteen patients with CLI ended up with major amputations in the past five years. A comparative study was performed between these patients and those who were cured by only minor amputations. Patient factors in the comparative study included age, sex, medical history of diabetes and chronic kidney disease, diabetes medication, history of lower limb amputation on the other side, complement-reactive protein ( CRP ) levels before and after revascularization and in the early period after local surgery, and serum albumin ( Alb ) before local surgery. The patient risk factors of major amputation were late diabetic nephropathy, history of lower limb amputation on the other side and under-nutrition. There was a possibility of major amputations if patients had high CRP levels early after they completed local surgeries compared with those after revascularization. Perioperative CRP levels may be one of the indicators to use in order to avoid major amputations.

DOI： 10.11310/jsswc.5.189

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Language：Japanese   Publisher：Japanese Society of Oral and Maxillofacial Surgeons  

Necrotizing fasciitis is treated by incisional drainage or immediate debridement. Generally, an infected wound should not be sutured or closured, but should be allowed to secondarily heal as an open wound. Treatment of necrotizing fasciitis involving the neck or submandibular region requires careful attention to major blood vessels or nerves. We therefore could not perform debridement radically. The wound should be continuously irrigated or applied ointment, but the presence of a fistula sometimes leads to prolonged wound healing.<BR>We describe our experience with an uncontrollable fistula attributed to debridement of submandibular necrotizing fasciitis, although irrigation had been continued for 6 weeks. After performing Negative Pressure Wound Therapy, with a V.A.C.^® ATS system good granulation tissue proliferated in 3 days, and the fistula disappeared. The wound completely healed in 1 week. Furthermore, the clinical course has been good, with no recurrence of a fistula after 3 months. We report a case of early healing of an uncontrollable fistula treated by a V.A.C.^® ATS system.

DOI： 10.5794/jjoms.60.71

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Language：Japanese   Publisher：Japanese Society of Oral Oncology  

This article reports a new classification system and a practical theory in surgical reconstruction for segmental mandibular defects after oncological ablative surgery: the "CAT classification system" and the "CAT concept". The CAT classification system classifies a mandibular defect with three letters indicating reference points: "C" signifies loss of the condylar head of the mandible, "A" the mandibular angle and "T" the mental tubercle. For example, the defect is described as "A" when the mandibular angle is segmentally resected, as "CA" when the condylar head and the mandibular angle are resected, as "CAT" when the entire hemi-mandible is resected, as "ATT" when the angle and the bilateral mental tubercle are resected, as "body" when only the mandibular body is resected and the angle and the mental tubercle are preserved, and as "neck" when only the mandibular ramus is resected and the condylar head and the angle are preserved. The CAT concept is a theory that is necessary and sufficient to reconstruct three reference points of the CAT classification system ("C", "A" and "T") in order to reconstruct oncological segmental mandibular defects. Previous studies showed that the CAT system and CAT concept are highly practical and useful in the standardization of mandibular reconstructive surgery.

DOI： 10.5843/jsot.26.57

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

Toe amputation for chronic ulcers associated with osteomyelitis or malignant tumor requires additional metatarsal bone resection for covering the stump ; alternatively, the stump is kept raw and skin is grafted after the formation of granulation. The fillet toe flap is one of the options for primary coverage of the stump when the lesion is restricted to half the side of the toe and the digital artery is preserved after the lesion is resected. Minimization of the level of amputation is related to improvements in ADL after surgery. Moreover, because long rest causes disuse atrophy, early healing is desirable. Although the fillet toe flap is used only in special cases, it could be used as a sensory flap. We believe the use of the fillet toe flap deserves more widespread consideration in toe amputation.

DOI： 10.11310/jsswc.3.123

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Various grafts with autogenous bone, cartilage, and alloplastic substitutes have been used for orbital floor reconstruction in surgery of facial fractures. Nevertheless, none has been the gold standard of graft material. We have demonstrated good clinical results in cases of pure blowout fracture in which the orbital floor was reconstructed with iliac cancellous bone sheets used as graft material. Here, we detail our surgical technique for orbital floor reconstruction with iliac cancellous bone.<br> The outline of our procedure is as follows:<br> 1)to approach the orbital floor, mainly the subciliary incision is used,<br> 2)the orbital content herniating into the maxillary sinus is repositioned, and the fracture and defect site are exposed subperiosteally,<br> 3)a bone block, a few millimeters thick, is harvested from the inner aspect of the ileum,<br> 4)the cortical bone of the harvested block is burred away and thinned to about a 1 mm-thick cancellous bone sheet,<br> 5)the sheet can be adequately trimmed with surgical scissors,<br> 6)the sheet is placed onto the orbital floor to cover the defect, without any fixation.<br> The iliac cancellous bone graft is as pliable and flexible as to fit the delicate curve of the orbital floor, and as soft as to cut easily with surgical scissors. We consider it the most appropriate material for orbital reconstruction.

DOI： 10.11310/jsswc.2.97

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Language：English   Publisher：Japanese Society of Reconstructive Microsurgery  

Weakness, hypertonicity, loss of isolated control and/or synkinetic movement of the facial mimetic muscle are common sequelae after facial palsy, unlike disruption of nerve continuity as in Bell's palsy or Hunt's syndrome. Here we describe a surgical procedure and postsurgical rehabilitation for the treatment of such sequelae.<BR>The surgical procedure comprises facial and hypoglossal nerve cross-linking that connects the nerves by an interpositional nerve graft with end-to-side anastomosis. For postsurgical physical rehabilitation, patients are instructed in the following techniques for facial neuromuscular retraining: 1) to practice isolated facial motion in front of a mirror (mirror-biofeedback technique); 2) to avoid gross voluntary movement both during practice and in daily life; and 3) to frequently massage and stretch the affected facial muscle.<BR>Between December 2005 and May 2008, twenty patients with sequelae after facial palsy were treated by our rehabilitation technique. Sixteen patients showed improvement in abnormal facial movement, while four did not. None of the patients developed facial synkinesis associated with tongue motion. Our surgical procedure and postsurgical rehabilitation exercises are alternative techniques for the sequelae of facial palsy.

DOI： 10.11270/jjsrm.24.267

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

<i>Background:</i> We have previously proposed the CAT classification system, a simple and clear-cut system for classifying segmental mandibular defects after oncological surgery: “C” refers to the loss of the condylar head of the mandible, “A” the mandibular angle and “T” the mental tubercle. Here, we report a statistical and mathematical taxonomical study on the validity and utility of the classification system.<br><i>Methods:</i> Data were collected from 17 medical institutions in Japan on 259 patients who had undergone surgical ablation and simultaneous microsurgical oromandibular reconstruction (osteocutaneous free flap or soft tissue free flap with reconstruction-plate) attributed to head and neck cancer. The mandibular defects were classified according to the CAT system and the two commonly used systems HCL and Urken, and the validity and utility of the CAT system were tested as follows: 1) the tendency among the numbers of the three reference points of the CAT system (C, A and T) and the esthetic outcome of each patient were analyzed by Jonckheere's trend test, 2) each of the classified patterns of the three systems was analyzed by cluster analysis based on the esthetic results using Ward's method.<br><i>Results:</i> 1) There was a statistically significant trend among the numbers of the three reference points in the CAT system and the esthetic outcome, 2) each of the grouped clusters in the CAT system was clinically explicable and demonstrated a significant difference in the esthetic outcome; the two other systems did not yield such information.<br><i>Conclusion:</i> The CAT classification system is valid and useful for oncological segmental mandibular defects.

DOI： 10.5981/jjhnc.36.309

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

In the treatment of secondary deformities of anophthalmic orbits after severe trauma, free flap transfer is adopted for patients with eyelid and / or orbital rim defects. For some, however, free flap transfer is a requisite although no such defects are present. Here, we retrospectively review cases for which free flap transfer was carried out for secondary deformities of post-traumatic anophthalmic orbits without eyelid / orbital bone defects. From 1999 to 2008, seven patients with secondary deformities of post-traumatic anophthalmic orbits without eyelid or orbital bone defects were treated at Kobe University Hospital. Of the seven, three were treated with free flap transfers: two with a free forearm flap because of the inability to wear an eye prosthesis subsequent to the sudden onset of severe contracture of the eye socket, and one with a denuded DIEP flap for upper eyelid depression attributed to severe lack of and contracture of subcutaneous tissue. Even when the eyelid and the orbital bone are not injured, progressive contraction of the eye socket and severe lack of subcutaneous tissue are indications for free flap transfer in the treatment of secondary deformities of post-traumatic anophthalmic orbits.

DOI： 10.11310/jsswc.1.119

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Language：Japanese   Publisher：Japanese Society of Oral and Maxillofacial Surgeons  

Low-grade myofibroblastic sarcoma is an uncommon neoplasm of atypical myofibroblasts with fibromatosis-like features. The lesion has only been characterized in the last two decades, and the concept of neoplastic myofibroblasts remains controversial. We encountered a patient with low-grade myofibroblastic sarcoma of the maxilla.<br>A 70-year-old woman was referred to our hospital because of swelling of the anterior maxilla. She had undergone repeated surgical procedures of the lesion at other hospitals. The tumor invaded the hard palate, nasal cavity, bilateral maxillary sinus, and cheek skin. The biopsy specimen showed a low-grade myofibroblastic sarcoma, and she underwent wide resection of the lesion and reconstructive surgery using a free forearm flap. Histologic examination revealed diffuse, fascicular proliferation of spindle cells with focal cellular atypia. The tumor cells showed positive reactions for α-SMA and vimentin, which indicated differentiation to myofibroblasts, and the lesion was diagnosed as a low-grade myofibroblastic sarcoma. The patient is free from tumor 13 months after surgery.

DOI： 10.5794/jjoms.55.184

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

Organs with important functions for daily life are concentrated in the head and neck area, and maintaining post-treatment Quality-of-Life (QOL) is also important when treating cancers of the head and neck, in addition to improving survival rate. Free flap reconstruction techniques are expected to contribute to maintaining post-treatment QOL, but these techniques have not been adequately evaluated in Japan. We performed a cross-sectional analysis of QOL, using the Japanese version of the UWQOL (version 4) from the University of Washington in the United States, with 202 patients from 10 institutions who had undergone reconstructive surgery for tongue cancer. In addition to the survey form, we collected clinical information (age, sex, time since surgery, flap donor site, whether radiotherapy was administered, and other factors), and analyzed whether differences in postoperative QOL were seen depending on each of these factors and the hospital at which the surgery was performed. Although a relationship was found between QOL following reconstructive surgery for tongue cancer and the extent of resection, age and whether radiotherapy was administered, fairly good QOL was maintained overall.

DOI： 10.5981/jjhnc.35.374

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We propose a new classification system for segmental mandibular defects after oncological ablative surgery. The system describes a mandibular defect with three letters - C, A and T -. “C” reflects loss of the condylar head of mandible, “A” the mandibular angle and “T” the mental tubercle. The defect is classified as “A” when the mandibular angle is segmentally resected, as “CA” when the condylar head and the mandibular angle are resected, as “CAT” when the entire hemi-mandible is resected, as “ATT” when the angle and the bilateral mental tubercle are resected, as “body” when only the mandibular body is resected and the angle and the mental tubercle are preserved, and as “neck” when only the mandibular ramus is resected and the condylar head and the angle are preserved. This CAT classification system is simple, clear-cut, and a new alternative for oncological mandibular defects.

DOI： 10.5981/jjhnc.34.412

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Language：Japanese   Publisher：Japan Society for Laser Surgery and Medicine  

Q-switched lasers, developed on the theory of selective photothermolysis, are effective in the treatment of dermal melanocytosis; however, any incidental complications can cause considerable anxiety.<BR>A retrospective study on hypopigmentation was carried out on 53 regions of 42 patients undergoing treatment for aberrant mongolian spots after Q-switched laser irradiation, between July 2000 and June 2006 at the Department of Plastic Surgery, Kobe University Graduate School of Medicine. The association between patient factors (age, gender; region of irradiation - trunk, extremity - type of laser, fluence of energy, and frequency of laser irradiation) and hypopigmentation after laser irradiation was examined by multiple logistic regression analysis. Twenty-four cases (45.3%) exhibited hypopigmentation. Treatment on the trunk was associated with a greater incidence of hypopigmentation than treatment at extremities (odds ratio: 16.257,[95%CI, 2.367-111.660],P=0.005). Patient factors of age, gender, type of laser, fluence of energy, and frequency of laser irradiation were not statistically significant. These results are worthy of discussion and need to be verified from multiple aspects.

DOI： 10.2530/jslsm.29.26

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Language：English   Publisher：Journal of Cranio-Maxillofacial Surgery  

Purpose: This paper presents surgical techniques for reconstruction of the cheek, oral commissure and vermillion in the repair of full-thickness cheek defects after resection of buccal-mucosal squamous cell carcinoma. Patients and Methods: Four reconstructions in one-stage surgery with either a free radial forearm flap or a rectus abdominis musculocutaneous flap for cheek and oral commissure were carried out. There were combined with a new approach for vermillion advancement flaps. Most challenging was the need not only for morphological reconstruction of the orifice, but also for physiological reestablishment of sphincteric and sensory functions in the vermillion. Results: Morphological and physiological reconstruction of the lip with sphincteric and sensory functions was attained. Conclusion: This valuable reconstruction technique was demonstrated in large, full thickness defects involving the cheek, oral commissure and vermilion. © 2001 European Association for Cranio-Maxillofacial Surgery.

DOI： 10.1054/jcms.2001.0249

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Laser Surgery and Medicine  

<p>About 3 decades have passed since the pulsed-dye laser for the treatment of capillary malformation (port-wine stain) has spread. At present, the long-pulsed pulse dye laser has become the first-choice treatment in Japan. Devices with less purpura formation have been available in recent years. Early irradiation for infants tends to be recommended, but redarkening is still a serious problem. The development of the adjunctive drug or therapy which raise the effect of the dye laser is expected</p>

DOI： 10.2530/jslsm.jslsm-42_0004

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DOI： 10.1016/j.anl.2019.04.005

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Cardiac metastasis from head and neck cancers are very rare. Metastases to heart are mostly diagnosed at autopsy, and seldom found while patients are alive. Patients with cardiac metastasis do not present with specific symptoms in the early stages, and diagnosis is often delayed until the disease has advanced significantly. Here, we report a 66-year-old lady who was diagnosed with cardiac metastasis 10 months after surgical resection of oral cancer. She died one month following the discovery of cardiac metastasis. Cardiac metastasis should be considered when unexplained and progressive decline of general health is observed, even in the absence of abnormalities on the electrocardiogram. Early diagnosis may be made by analyzing the chronological changes in the cardiac accumulation of fluorodeoxyglucose during positron emission tomography-computed tomography scan.

DOI： 10.1016/j.anl.2018.10.018

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Dental rehabilitation with osseointegrated implants in reconstructed mandibles is a common procedure, but the technique still requires improvement, especially in its reliability and technical simplification. We herein report dental rehabilitation of a free fibula-reconstructed mandible with scar contracture. A vestibuloplasty technique with application of a polyglycolic acid (PGA) sheet is described. The implants were inserted into a viable fibula flap with severe scar contracture of the overlying epithelium resulting from vascular instability in skin paddle. Only the fibula periosteum was sutured after implant insertion; exposed surfaces were covered with a combination of PGA sheet and fibrin sealant. The area with PGA sheet coverage gradually healed with moderate contracture. The epithelium around the almost implants became immobilized. The implant-supported removable partial denture with custom titanium bar was acceptable. Dental rehabilitation is possible for reconstructed mandibles with severe scar contracture. Application of a PGA sheet may be useful for vestibuloplasty in patients with reconstructed mandibles.

DOI： 10.3390/dj7030065

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OBJECTIVES: To evaluate the impact of retropharyngeal lymph node (RPLN) dissection in the surgical treatment of hypopharyngeal cancer. METHODS: Between 2007 and 2016, 98 previously untreated patients with pathological diagnosed hypopharyngeal squamous cell carcinoma underwent total pharyngolaryngectomy and bilateral neck dissection at Kobe University Hospital. Bilateral dissection of RPLN was simultaneously performed in all patients. Pharynx was reconstructed with free jejunal transfer in 94 patients and primarily closed in 4 patients. Postoperative chemoradiotherapy was performed in patients with high risk factors including metastasis to RPLN, multiple lymph node metastasis, extranodal invasion, and/or positive/close surgical margins. RESULTS: The median follow-up period was 25 months ranging from 1 to 105 months. RPLN adenopathy was preoperatively identified in 9 patients in FDG-positron emission tomography. All of them had pathologically diagnosed RPLN metastases, which had been controlled in all patients during the observation periods. Among the other 89 patients, 7 patients had RPLN metastasis. The 2-year overall survival rates of the patients with and without RPLN metastasis were 65.7% and 69.8% (P = .61), respectively. CONCLUSIONS: In the present study, patients with RPLN metastasis showed equally favorable oncological outcome compared with patients without RPLN metastasis. At least, ipsilateral RPLN dissection should be considered in the surgical treatment of advanced hypopharyngeal cancer and multiple neck lymph node metastasis regardless of primary subsite.

DOI： 10.1002/hed.25608

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Publisher：Journal of Reconstructive Microsurgery  

DOI： 10.1055/s-0038-1672134

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Congenital entropion is an ocular condition involving malpositioning of the eyelid, which can result in ocular pain, conjunctival epiphora, or photophobia. Noninvasive treatment is effective in some cases; however, surgical treatment is indicated when keratitis and ocular irritating symptoms occur. There is no consensus regarding the most appropriate surgical technique. Moreover, some patients complain of changes in their appearance or unwanted incision scars after surgery. In particular, individuals with certain types of Asian heritage exhibit a lower eyelid morphology that differs from that of white individuals, caused by orbital fat locational difference. Subciliary muscle bulges cause swelling in the lower eyelid called Namidabuluro and are considered to create a youthful and beautiful appearance in Asians. Accordingly, some Asian individuals tend to be sensitive about changes to the appearance of the lower eyelid. To our knowledge, no report has yet described changes to Namidabukuro during congenital entropion repair in Asians. We describe a novel surgical technique for congenital entropion repair with the creation of cosmetically natural Namidabuluro in an East Asian cohort. The study included 8 lower eyelids of 4 Japanese female patients. Scarring was not noticeable in any of the 4 cases. Eversion of the cilia and the creation of cosmetically natural Namidabuluro were accomplished in all cases. There has been no case of recurrence yet. The novel surgical technique we developed enables not only the treatment of congenital entropion but also the creation of cosmetically acceptable Namidabuluro, resulting in increased patient satisfaction.

DOI： 10.1097/GOX.0000000000002122

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Publisher：International Journal of Surgery Case Reports  

DOI： 10.1016/j.ijscr.2019.01.018

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Language：Japanese   Publisher：日本皮膚悪性腫瘍学会  

DOI： 10.5227/skincancer.34.78

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Mosby Inc.  

Objective: Pain is one of the most problematic symptoms in patients with osteoradionecrosis of the jaws. This study investigated the associations between pain severity and morphologic alterations of the mandibular canal and inferior alveolar nerve, in respective computerized tomography images and resected specimens of mandibular osteoradionecrosis. Study Design: We assessed 14 lesions in 13 patients who underwent segmental mandibulectomy for surgical debridement and simultaneous reconstruction with free fibula flap (1 patient exhibited bilateral lesions). The extent of the mandibular canal bone defect on preoperative coronal computerized tomography images and the number of inferior alveolar nerve fascicles in resected specimens were evaluated. Comparisons were made between the slight pain and extreme pain groups. In most of the patients in the extreme pain group, either mandibular canal bone defects were absent or entire circumferential defects were present
inferior alveolar nerve fascicles were either distinguishable or completely absent in the resected specimens. Results: Although there was no statistically significant association between extreme pain and computerized tomography or histopathologic findings, the histopathologically indistinguishable inferior alveolar nerve fascicles was significantly associated with slight pain. Conclusions: The degree of degeneration of mandibular canal and inferior alveolar nerve may be associated with pain severity in patients with mandibular osteoradionecrosis.

DOI： 10.1016/j.oooo.2018.03.017

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Objective  Nasal and paranasal malignant tumors invading the skull base are rare and poorly studied. We evaluated postoperative complications in patients undergoing salvage surgery for such tumors. Design  Retrospective study. Setting  Kobe University Hospital. Participants  Among 48 patients who underwent surgery for tumors involving the skull base between 1993 and 2015, 21 patients had squamous cell carcinoma, 13 had olfactory neuroblastoma, 5 had adenocarcinoma, 2 had sarcoma, 2 had adenoid cystic carcinoma, and 1 each had malignant melanoma, poorly differentiated carcinoma, undifferentiated carcinoma, myoepithelial carcinoma, and malignant peripheral nerve sheath tumor. Prior to skull base surgery, radiotherapy, chemoradiotherapy (CRT), particle radiotherapy, chemotherapy, or surgery were applied in 3, 15, 4, 5, and 3 patients, respectively. Main Outcome Measures  Main outcome measures were postoperative complications in patients who underwent skull base surgery after concomitant CRT and/or particle therapy. Results  Major postoperative complications were observed in 14 surgical procedures (29%; 2 patients with cerebral herniation, 3 with cerebrospinal fluid leakages, 3 with meningitis, 1 with hydrocephalus, 6 with epidural abscesses, 2 with local infections, and 2 with partial flap necrosis). Four patients developed ≥2 complications. One patient died of postoperative lung infarction. Three (16.7%) of 18 patients without prior treatment and 9 (50%) of 18 patients who underwent preoperative radiotherapy/CRT had severe postoperative complications. Two (50%) of four patients treated with particle radiotherapy had postoperative complications. Conclusions  CRT or particle radiotherapy were significantly associated with a high risk of severe postoperative complications after skull base surgery. Meticulous care should be taken in patients treated with radiotherapy/particle therapy prior to skull base surgery.

DOI： 10.1055/s-0037-1606382

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Publisher：Lymphatic Research and Biology  

DOI： 10.1089/lrb.2016.0063

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Publisher：Plastic and Reconstructive Surgery - Global Open  

DOI： 10.1097/GOX.0000000000001776

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DOI： 10.3892/mco.2017.1477

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

Objective: Few studies evaluate condylar movement following mandibular reconstruction. The main objective of this study was to show that axial four-dimensional computed tomography (4DCT) could visualize bilateral protrusive condylar movement directly. We used axial 4DCT images to assess condylar protrusion in patients who underwent mandibular reconstruction.
Methods: We enrolled seven healthy volunteers (median age 30 years, range 27-38 years) and seven patients (median age 65 years, range 52-80 years), who underwent mandibulectomy (segmental in five, hemi in one, marginal in one) and free flap reconstruction (using the fibula in six and the radial forearm in one). Six study subjects were instructed to masticate a cookie during the 4DCT scan (the seventh made chewing motions). The distance between the most anterior and posterior positions of the bilateral condyles on 4DCT (axial view) images was then measured and compared between controls and patients using the Manne-Whitney U-test.
Results: The crosswise difference in the distances of condylar protrusion was significantly greater in patients than in the controls.
Conclusion: Axial 4DCT images can visualize a bilateral condylar protrusive path. Axial 4DCT images for patients who have undergone mandibulectomy and reconstruction may be useful for evaluation of functional movement of condyles. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jcms.2017.08.025

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Language：English   Publisher：MARY ANN LIEBERT, INC  

Background: The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction.
Methods: A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infectionhead neck," "surgical site infectionoral cancer," "antibiotic prophylaxishead neck," and "surgical site infectionoral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded.
Results: The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection.
Conclusion: Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery.

DOI： 10.1089/sur.2017.101

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc  

Nasal polyps are inflammatory proliferative tumors arising from the mucosa of the nasal cavity and paranasal sinuses. Although many cases concerning nasal polyps have been reported, those involving external nasal deformities are rare. We report a case of nasal polyposis filling the nasal cavity and paranasal sinuses, leading to external nasal and facial deformities. The condition above is known as Woakes’ syndrome, which is characterized by severe recurrent nasal polyps with deformity of the nasal pyramid, leading to broadening of the nose. We performed nasal osteotomy and facial bone-shaving via the midface degloving approach, which improved the patient's facial appearance.

DOI： 10.1016/j.omsc.2017.05.001

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Objectives
Transient receptor potential cation channel (subfamily V, members 1-4) (TRPV1-4) are expressed in skin and neurons and activated by external stimuli in normal mucosae of all oral cavity sites. The oral cavity is exposed to various stimuli, including temperature, mechanical stimuli, chemical substances, and changes in pH, and, notably, the risk factors for oncogenic transformation in oral squamous epithelium are the same as the external stimuli received by TRPV1-4 receptors. Hence, we examined the relationship between oral squamous cell carcinoma (SCC) and TRPV1-4 expression.
Materials and Methods
Oral SCC patients (n = 37) who underwent surgical resection were included in this study. We investigated the expression of TRPV1-4 by immunohistochemical staining and quantification of TRPV1-4 mRNA in human oral mucosa. In addition, we compared the TRPV1-4 levels in mucosa from patients with SCC to those in normal oral mucosa.
Results
The receptors were expressed in oral mucosa at all sites (tongue, buccal mucosa, gingiva, and oral floor) and the expression was stronger in epithelia from patients with SCC than in normal epithelia. Furthermore, alcohol consumption and tobacco use were strongly associated with the occurrence of oral cancer and were found to have a remarkable influence on TRPV1-4 receptor expression in normal oral mucosa. In particular, patients with a history of alcohol consumption demonstrated significantly higher expression levels.
Conclusion
Various external stimuli may influence the behavior of cancer cells. Overexpression of TRPV1-4 is likely to be a factor in enhanced sensitivity to external stimuli. These findings could contribute to the establishment of novel strategies for cancer therapy or prevention.

DOI： 10.1371/journal.pone.0169723

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Objective: Myxofibrosarcoma (MFS) is a relatively rare tumor that is histologically characterized by myxoid stroma and spindle cell proliferation. This tumor most commonly arises as a slow growing, enlarging painless mass in the extremities of elderly patients. Methods: We report a case of a primary, low-grade MFS in the rectus abdominis muscle infiltrating the abdominal cavity of a 75-year-old man. Results: The patient underwent a wide excision of the right abdominal wall mass with a 3-cm surgical margin from the scar due to a biopsy. The tumor infiltrated the urinary bladder, peritoneum, and external iliac vessels. Twenty-six months after the initial operation, he had recurrences in his abdominal wall, urinary bladder, and right iliac vessels. Conclusions: To our knowledge, primary MFS of the muscle in the abdomen has not been documented previously. Although this case was histopathologically classified as a low-grade tumor, it infiltrated the abdominal cavity. The tumor is suspected to have penetrated the abdominal cavity below the linea arcuata, which lacks the posterior sheath of the rectus abdominis muscle; from there, it could easily spread without being blocked by any biological barriers.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：HINDAWI LTD  

Background. This study aimed to analyze differences in necrotic changes between cortical and cancellous bone in resection margins after segmental mandibulectomy for advanced mandibular osteoradionecrosis. Methods. Anteroposterior bone specimens from eleven patients who underwent segmental mandibulectomy with simultaneous free fibula flap reconstruction for advanced osteoradionecrosis were analyzed histopathologically for the presence of necrotic bone based on the presence of blood vessels within Haversian canals. Results. Ten of eleven (91%) cortices near the inferior border of the mandible at the anterior margins were necrotic. All cancellous bones at the anterior margins were viable. Seven of eleven (64%) cortices near the inferior border of the mandible at the posterior margins were necrotic. Three of eleven (27%) cancellous bones at the posterior margins were necrotic. Conclusion. Necrotic changes are more prevalent in cortices than in cancellous bones in mandibular osteoradionecrosis, probably due to a decrease of periosteal blood supply caused by radiotherapy.

DOI： 10.1155/2017/3125842

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Background. Extirpation of tumors arising in the pterygopalatine fossa is challenging because of its anatomic complexity.
Methods and Results. A 67-year-old man was referred to our department with a diagnosis of a tumor in his left pterygoid fossa. An incisional biopsy through the canine fossa was diagnosed as myxofibrosarcoma. The upper part of the maxilla was swung laterally to remove the tumor while the hard plate was preserved. The defect was reconstructed using rectus abdominis musculocutaneous free and ipsilateral temporal. The postoperative course was uneventful, without facial palsy or mastication disorders.
Conclusion. Our experience with this case suggests that the modified partial maxillary swing approach with preservation of the hard palate and orbital floor in combination with infratemporal and cervical approaches is useful for lesions in the pterygoid process without causing severe complications. (C) 2016 Wiley Periodicals, Inc.

DOI： 10.1002/hed.24558

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (other academic)  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Verlag  

Purpose: This study aimed to compare the size of skin paddles, the postoperative course, and donor site complications between primary closure and skin grafts of the free fibula flap donor site. Methods: Thirty-five consecutive patients were enrolled. Medical records were retrospectively reviewed for risk factors for delayed healing, size of skin paddles, time to resumption of gait with a mobility aid and self-ambulation, early donor site morbidity, and late donor site complaints. Results: The harvested skin paddles were significantly wider in the skin graft group than in the primary closure group (P = 0.02), with no difference in length (P = 0.1). The difference in time to resuming gait with a mobility aid was also significant (P = 0.01), but not the time to self-ambulation (P = 0.9). Two early donor site morbidities (5.7 %) and 12 late donor site complaints (34.3 %) were found. No significant difference in the incidence of early donor site morbidity was observed between two groups. Occurrence of late donor site complaints was not affected by any risk factors. Conclusions: The width of the harvested skin paddle, but not the length, is one of factors involved in donor site closure. Resumption of gait with a mobility aid, but not self-ambulation, may be delayed in skin graft patients.

DOI： 10.1007/s10006-016-0556-3

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

Recent advances in microsurgery have enabled surgical anastomosis of small vessels with calibers less than 1 mm. An anastomosis of a small vein and a lymphatic vessel, lymphaticovenous anastomosis (LVA), is an effective surgical treatment for lymphedema. However, because of the particularities of lymphatic vessels such as their small caliber and thin vessel wall, LVA is a difficult treatment to perform. This report presents the usefulness of a surgical suture attached with a straight needle in LVA. Fifty cases where LVAs were carried out with the technique were retrospectively reviewed based on technical viewpoints with medical records including operative reports and videos. The gages of threads used in the procedure were 11-0 and 12-0, and all were made of monofilament nylon. The diameters of the needles were 40um, 50um, 60um and 80um. and the lengths of needles were 3 mm, 4 mm and 5 mm. The calibers of the anastomosed lymphatic vessels were 0.2 mm to 1.0 mm. Both end-to-end and end-to-side anastomoses were performed. All the patients developed no postoperative complications related to the procedure. The review of the cases showed: (1) a back-wall first technique was useful for the anastomosis of vessels with calibers of less than 1 mm; (2) a straight needle was useful for a posterior vessel wall; (3) in particular, direction was easy to control when stabbing a vessel wall with a straight needle; (4) an anterior wall was difficult to stab with a straight needle when the wall was very thick, which was much less frequent in LVA. Some technical refinements are necessary for a reliable procedure in lymphatic microsurgery. The combination of a usual back-wall first technique and a straight needle is an effective alternative in LVA.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Churchill Livingstone  

Purpose The purpose of this study was to analyze jaw movement during mastication in patients who underwent mandibular reconstruction following segmental mandibulectomy, including mouth opening and mastication time, based on four-dimensional computed tomography (4D CT) images. Material and methods This study included six surgical patients, who underwent segmental mandibulectomy and simultaneous reconstruction with a free fibula osteocutaneous flap, and four controls. 4D CT was performed during mastication of a cookie to evaluate the movement of the jaw during natural function. The maximum mouth opening, mastication time, and movement of the mandibular angle during mastication were evaluated from the 4D CT images. Results 4D CT images enabled visualization of jaw movement during mastication. When compared with the controls, the maximum mouth opening during mastication and excursion of the mandibular angle, especially on the diseased side, tended to decrease in surgical patients
however, this did not occur with mastication time. The numerical differences between the diseased and nondiseased side in surgical patients tended to be higher than the crosswise differences in controls. Conclusion 4D CT images revealed differences in jaw function between patients who underwent mandibular reconstruction and controls. 4D CT could be used to evaluate postoperative outcomes following mandibular reconstruction.

DOI： 10.1016/j.jcms.2016.01.027

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Language：Japanese   Publishing type：Research paper (scientific journal)  

BACKGROUND: The purpose of this study was to analyze outcomes for the treatment of locally advanced temporal bone cancer by means of concomitant chemoradiotherapy (CCRT) with a combination of cisplatin (CDDP), 5-fluorouracil (5-FU), and docetaxel (TPF). METHODS: Between 2006 and 2011, 34 patients with squamous cell carcinoma of the temporal bone were treated at Kobe University Hospital. Medical records were retrospectively reviewed to obtain information concerning patient characteristics, extent of disease, treatment, adverse events, and oncologic results. RESULTS: Ten patients were treated with CCRT using TPF regimen. The 5-year overall survival rate and disease-free survival rate were both 60%. Of special interest is that even for patients with unresectable T4 disease, the 5-year overall survival rate was 56%. CONCLUSION: The results of our study indicate that CCRT with TPF for locally advanced temporal bone cancer is an effective and promising regimen. © 2015 Wiley Periodicals, Inc. Head Neck 38: E949-E953, 2016.

DOI： 10.1002/hed.24133

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ajoms.2015.08.007

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Oncoplastic Breast Surgery Society  

<p>　In this article, we present data on immediate breast reconstruction at two hospitals without a full-time plastic surgeon, performing a retrospective chart review of patients. A reconstructive surgeon performed physical examinations on all patients and obtained their informed consent preoperatively. We explained to the patients about the limitations of reconstructive methods, for example, that free deep inferior epigastric artery flap transfer and primary silicone breast implant reconstruction were unavailable. From October 2012 to January 2016, we performed 30 immediate breast reconstructions (28 patients, 30 sites) in these hospitals ; 19 sites with autologous breast reconstruction by pedicled flap (latissimus dorsi musculocutaneous flap 18, rectus abdominis musculocutaneous flap 1) and, 11 sites (9 patients) with the tissue expander. The average length from consulting a plastic surgeon to the operation date was 26.0±14.9 days. As reconstructive methods are limited in our collaborations, this limitation was explained to the patients. Therefore, it was necessary for the reconstructive surgeon to perform a physical examination preoperatively.</p>

DOI： 10.20699/jopbs.1.2_82

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

In the treatment of the soft tissue defect of the elbow, flap reconstruction is necessitated in many cases because of thinness of soft tissue at this region. In addition, reacquirement of tactile sensation is desirable because of the anatomical and specific functions of the elbow. Of three cases treated for elbow defects, one was reconstructed with a pedicled island forearm flap containing the lateral cutaneous nerve of the forearm, another was reconstructed with a venoneuro-accompanying artery fasciocutaneous flap (VNAF flap) containing the basilic vein, and the third with the VNAF flap containing the cephalic vein. The three cases demonstrated a sudden change of sensory territory 4 to 6 months after surgery, which was confirmed by touching the reconstructed region with patients' eye-closed: from its original territory to the elbow in a "switching"-like action. Here we describe and discuss the concept of "sensory switching".

DOI： 10.1055/s-0035-1549369

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background:Dental rehabilitation with osseointegrated implants in reconstructed mandibles remains one of the most challenging procedures for oral and maxillofacial surgeons. Satisfactory outcome requires appropriate assessment of graft morphology. There are few analyses of the morphology of fibulae in reconstructed mandibles, although cadaver studies on fibular shape have been performed.Materials and Methods:In this study, we used postoperative computed tomography to retrospectively evaluate the shape, height, and orientation of fibulae transferred after mandibulectomy in 19 patients.Results:The average height of transferred fibulae was 14.3 mm (range, 10.8-20.5 mm). The cross-sectional morphology of transferred fibulae could be classified into 2 types: apex and nonapex. The former type included knife-edged and triangular shapes; the latter included square and circular shapes.Conclusion:When implant insertion is planned in a reconstructed mandible, the orientation of the apex of transferred fibula should be evaluated preoperatively to allow for adjustments in implant procedure because the ridge at the apex of the fibula is narrow.

DOI： 10.1097/ID.0000000000000290

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

The purpose of this study was to sequentially evaluate bone union of fibular grafts in mandibular reconstruction. Patients who underwent routine follow-up computed tomography (CT) and panoramic X-ray imaging during a period of &gt;= 2 years were enrolled. On panoramic X-ray images, bone union was scored as 0 (absent callus formation) or 1 (complete callus formation). On CT images, a scale of 0 to 2 was used (0, absent callus formation; 1, complete callus formation only on the labial side; 2, complete callus formation on both the labial and lingual side). A total of 56 bone junctions were evaluated in 20 patients. Five of 56 junctions (9%) in four of 20 patients (20%) showed radiological non-union (panoramic X-ray score = 0, CT score = 0 or 1) at 2 years after surgery. All bone junctions with radiological nonunion were located at the mandibular angle. No categorical values, including diabetes mellitus and radiation therapy, were significantly associated with radiological non-union. In conclusion, assessing at least two sides (i.e. labial and lingual sides) on CT images is adequate to evaluate bone union in transferred fibula flaps. Careful fixation at the mandibular angle may improve the rate of bone union.

DOI： 10.1016/j.ijom.2015.04.014

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Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Purpose: Tissue that is resected for the treatment of oral tumors often includes salivary gland ducts. At their institution, the authors conserve and transfer as much of the salivary duct as possible during these procedures to avoid obstructive complications. Differentiating these obstructive complications from a metastatic node can be challenging and can confound subsequent oncologic management. This study compared and examined the effectiveness of salivary duct repositioning in decreasing the incidence of obstructive complications.
Materials and Methods: Cases of oromandibular disease treated with salivary duct resection at Kobe University Graduate School of Medicine from 2008 to 2013 were retrospectively analyzed. Thirty-two cases (25 patients) of Wharton duct resection and 31 cases (31 patients) of Stensen duct resection were included. The incidence of complications after salivary duct repositioning, duct ligation, and retention of the sublingual gland around the Wharton duct was compared.
Results: Wharton ducts were repositioned in 30 cases and ligated in 2 cases. Complications, including oral swelling at the Wharton duct, were observed in 5 cases of repositioning and 2 cases of ligation. Stensen ducts were repositioned in 9 cases and ligated in 22 cases. The only complication reported was a single case of salivary fistula after ligation.
Conclusions: Salivary duct repositioning is performed to prevent blockage of physiologic salivary discharge. Complications were more frequently associated with Wharton ducts than with Stensen ducts because of the unique physiologic and anatomic characteristics of the Wharton duct. Repositioning of the salivary duct is a suitable method for preventing complications associated with the Wharton duct. (c) 2015 American Association of Oral and Maxillofacial Surgeons

DOI： 10.1016/j.joms.2014.12.006

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Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Publisher：The Journal of craniofacial surgery  

DOI： 10.1097/SCS.0000000000001509

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：THIEME MEDICAL PUBL INC  

Background Most free flap reconstruction complications involve vascular compromise. Evaluation of vascular anatomy provides considerable information that can potentially minimize these complications. Previous reports have shown that contrast-enhanced computed tomography is effective for understanding three-dimensional arterial anatomy. However, most vascular complications result from venous thromboses, making imaging of venous anatomy highly desirable.
Methods The phase-lag computed tomography angiography (pl-CTA) technique involves 64-channel (virtually, 128-channel) multidetector CT and is used to acquire arterial images using conventional CTA. Venous images are three-dimensionally reconstructed using a subtraction technique involving combined venous phase and arterial phase images, using a computer workstation.
Results This technique was used to examine 48 patients (12 lower leg reconstructions, 34 head and neck reconstructions, and 2 upper extremity reconstructions) without complications. The pl-CTA technique can be used for three-dimensional visualization of peripheral veins measuring approximately 1 mm in diameter.
Conclusion The pl-CTA information was especially helpful for secondary free flap reconstructions in the head and neck region after malignant tumor recurrence. In such cases, radical dissection of the neck was performed as part of the first operation, and many vessels, including veins, were resected and used in the first free-tissue transfer. The pl-CTA images also allowed visualization of varicose changes in the lower leg region and helped us avoid selecting those vessels for anastomosis. Thus, the pl-CTA-derived venous anatomy information was useful for exact evaluations during the planning of free-tissue transfers.

DOI： 10.1055/s-0034-1400070

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: C-reactive protein (CRP) screening has been reported to be reliable for detection of infectious complications. Postoperative abnormal response of CRP can predict wound infection in colorectal surgery. This study aimed to determine the efficacy of CRP monitoring to detect infectious complications in oral oncologic surgery.
Methods: One hundred patients who underwent oral cancer resection with primary reconstruction were enrolled. Postoperative kinetics of CRP were classified into a normal or abnormal response.
Results: A normal CRP response after surgery was observed in 61 patients and an abnormal response was observed in 39. There were postoperative infectious complications in 21 patients, with surgical site infections in 13 patients (early onset in six and late onset in seven). Non-wound infections were found in nine patients. Sensitivity, specificity, the positive predictive value, and the negative predictive value for abnormal CRP response as a predictor for early infectious complications were 100%, 70.1%, 35.9%, and 100%, respectively.
Conclusion: Postoperative serial CRP screening is a useful test as an indicator of infectious complications in oral oncologic surgery. Normal CRP responses can rule out almost all early infectious complications.

DOI： 10.1186/s40463-015-0066-6

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Previous studies on postoperative long-term results in patients who underwent reconstructive free flap transfer following hemiglossectomy had some issues, including the heterogeneity of the patient population and the observation period. The present study aimed to evaluate changes of reconstructed tongues in patients who underwent radial forearmfree flap (RFFF) after hemiglossectomy with long-term follow-up. We enrolled 23 patients who underwent RFFFafter hemiglossectomy with a postoperative follow-up of 5 years or more. Postoperative status (eating, speech, sensation function) was assessed by concisemedical inquiries. Morphological changes of flaps were evaluated by reviewing clinical photographs. Hemiglossectomy involving the base of the tongue was performed in 4 cases (17.4%) and was limited to the mobile tongue in 19 cases (82.6%). The mean follow-up was 85.4 months (range, 60-122 months). All patients experienced gradually improved postoperative status. The most significant improvement was found between 1 and 5 years after surgery (P = 0.007), but not between 1 and 3 years (P = 0.075) or between 3 and 5 years (P = 0.530). In almost all of the flaps, there were few morphological changes throughout the follow-up period. Postoperative status in patients who underwent reconstructive RFFF following hemiglossectomy improved sequentially.

DOI： 10.1097/SCS.0000000000001176

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Oral Oncology  

We have classified maxillofacial asymmetry from two viewpoints: the fact that all humans have an asymmetrical face, regardless of whether it appears to be normal and symmetrical, and the ability of humans to visually perceive asymmetry. In this study, based on this classification, we investigated skeletal factors influencing self-recognition after surgery in maxillofacial asymmetry patients, and attempted to apply the factors for mandibular reconstruction. We also investigated the limitation of the fibula with regard to these factors and grafted bone resorption and absolute indications. It was suggested that the positional adjustment of the chin (C: center of the mandible) is important, and that changes in the mandibular angle (A) markedly influence self-recognition of asymmetry in patients of mandibular reconstruction. Considering postoperative recognition of asymmetry, grafted fibular bone resorption, and the importance of preserving the peroneal artery for patients and prepositions towards peripheral arterial disease (PAD), the indication of mandibular reconstruction with a free fibular bone flap should be limited to the mandibular straight-line region (B: body of the mandible) not requiring osteotomy with a conserved mandibular angle.

DOI： 10.5843/jsot.27.49

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：WICHTIG EDITORE  

Purpose: Acellular nerves are a reconstruction material and provide scaffolds for nerve regeneration. Numerous methods to develop acellular nerves have been described. However, these methods pose problems that can be attributed to incomplete acellular processing and destruction of the extracellular matrix (ECM); the former may lead to rejection response, while the latter may damage the scaffold. In order to overcome problems associated with the above-mentioned methods, we developed a novel method that employs a hypertonic sodium chloride solution to decellularize nerve graft material.
Methods: Rat sciatic nerves were harvested, dipped in hypertonic sodium chloride solution (1 M), and shaken for 24 h. We then washed the nerves in phosphate-buffered saline for 7 days with shaking and evaluated the acellular nerves by hematoxylin-eosin (H-E) staining, immunostaining, and electron microscopy. We then transplanted the grafts to the sciatic nerve of another rat and evaluated the outcomes by H-E staining, immunostaining (anti-neurofilament antibody, anti-S-100 antibody), anterograde nerve tracing, and electron microscopy.
Results: We found that our method successfully decellularized the grafts, but was mild enough to leave the ECM intact. Two months after transplantation, immunostaining and anterograde nerve tracing confirmed that Schwann cells infiltrated the grafts and induced neurofilament extension.
Conclusions: Our methodology preserves the ECM, is simple to develop, and does not involve substances that harm biogenic tissue. Acellular nerve tissue processed in this way could become a substitute material for bridging nerve gaps. Our method could also aid in the development of other acellular tissues.

DOI： 10.5301/ijao.5000365

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS INC  

Diabetics with foot-related problems might eventually need to undergo major or minor amputation because of infection or cellulites. It has been suggested that immobilization of the ankle and the metatarsophalangeal joint suppresses the spread of infection; however, there is no evidence to support this inference. Here, we demonstrate by histological analysis how the immobilization works. The tendon from the amputated toe is harvested, and a hematoxylin-eosin stained paraffin-embedded section is prepared and analyzed. Necrosis occurred in only a single fiber of the tendon, and intact and necrotic or infected tendon fibers were found intermingled. The reciprocal movements of the tendon and the joint (extension and flexion) may be the pathogenic cause of cellulites and infection, leading to the massage effect and the spread of bacteria along the tendon itself. We suggest that immobilizing the ankle and the metatarsophalangeal joint with a removable contacting cast would suppress the spread of infection in foot ulcers.

DOI： 10.1177/1534734614545873

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

This study aims at the evaluation of blood vessel reconstruction process of decellularized small diameter vessels prepared by a hyperosmotic electrolyte solution treatment not only histologically but also physiologically in rat transplantation model. Complete cell removal by a hyperosmotic electrolyte solution treatment was confirmed by hematoxylin/eosin staining and scanning electron microscopic observation. All acellular vessels transplanted into the rat abdominal aorta were patent up to 14 months. One week post-transplantation, the vWF-positive cells were observed on the luminal surface but the layer formation did not complete. Five weeks following transplantation, the vWF-positive endothelial cells were located on the intima consistent with intact endothelial cells. Beneath the endothelial cells, alpha-SMA-positive smooth muscle cells were distributed. The harvested vessels displayed formation of tunica intima (endothelial cells) and tunica medulla (smooth muscle cell) layers. We also examined the physiological properties of the vessels 12 months post-transplantation using a wire myograph system. The transplanted vessels contracted upon addition of norepinephrine and relaxed upon addition of sodium nitroprusside as well as the native vessels. In conclusion, the acellular vessels prepared with hyperosmotic electrolytic solution showed excellent and long-term patency, which may be related to the successful preservation of vascular ECM. In addition, the acellular vessels revealed the intima/medulla regeneration with the physiological contraction-relaxation functions in response to the each substance.

DOI： 10.1007/s10047-014-0760-6

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

DOI： 10.1155/2014/893746

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

BackgroundTumor thickness and relative depth of invasion are prognostic parameters considered when developing treatment plans for malignant skin tumors. Although conventional magnetic resonance (MR) imaging techniques cannot identify small tumors, use of microscopy coils considerably improves spatial resolution. Some studies have shown that this technique is efficacious in preoperative assessment of relative depth of invasion; however, its ability to provide accurate measurements of tumor thickness remains unconfirmed.
ObjectiveThe purpose of this pilot study was to evaluate the usefulness of preoperative MR-microscopy in determining tumor thickness and relative depth of invasion of malignant skin tumors.
Methods and MaterialsMagnetic resonance images of malignant skin tumors in seven female patients (six with basal cell carcinoma and one with malignant melanoma) were obtained using a 1.5 T system and a 47-mm or 23-mm microscopy coil. Tumors were then excised, fixed, dehydrated, embedded, and stained with hematoxylin and eosin. We then compared MR-microscopy and pathology values for thickness and relative depth of invasion of each tumor.
ResultsBoth techniques produced similar measurements of tumor thickness and relative depth of invasion.
ConclusionsMR-microscopy is very useful for accurate preoperative estimation of not only relative depth of invasion, but also thickness of malignant skin tumors.

DOI： 10.1111/dsu.12371

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Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

Three-dimensional imaging with multidetector-row computed tomography (MDCT) provides useful information for the evaluation of arteries before an operation. However, the obtained information has been restricted only to arteries. We developed a phase lag-CT angiography (pl-CTA) method that allows three-dimensional visualization of the venous anatomy. The principle of pl-CTA is simple and consists of a phase lag and subtraction of images using a workstation. pl-CTA provides a greater amount of venous anatomical information compared to that obtained by the usual CTA.

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Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

Intractable cutaneous ulcers on the fingers are a common complication of systemic sclerosis (SSc). These are associated with pain and require daily treatment, which may decrease the quality of life of the patients. Digital ulcers (DUs) in the Proximal interphalangeal (PIP) joints can become intractable because the bone protrudes toward the dorsal side owing to joint flexion contracture, which induces poor circulation and persistently exerts pressure on the atrophic skin and subcutaneous tissues. In ulcers associated with a pocket, the shearing force of the joint movement, as in the case of decubitus ulcers, can also cause the ulcers to become intractable. Various treatment methods are available for vascular compromise, including pharmacotherapy, surgical revascularization, and local treatment in a moist environment; however, there are few reports of specific techniques to address the bony prominences and the shearing force. We performed fixation with a long-term-use, removable custom-made device on the palmar surfaces of the fingers, for (1) decompression of the dorsal subcutaneous tissues, (2) prevention of deviation due to joint stabilization, and (3) prevention of further flexion contractures. Herein, we report two cases of DU on the dorsal side of the PIP joint that was complicated with SSc, both of which had excellent outcomes following the use of this procedure.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Introduction: Magnetic resonance angiography (MRA) is currently considered the most useful test to evaluate the vascular anatomy of the lower leg prior to free fibula osteocutaneous flap transfer. This study aimed to confirm the validity of preoperative MRA. Methods: In 19 patients underwent free fibula osteocutaneous flap transfer for maxillary and mandibular reconstruction, the MRA and intraoperative findings and the postoperative complications were retrospectively analyzed. The location and number of distal septocutaneous perforators (dSCPs) that were preoperatively identified and harvested with flaps were documented. Results: Preoperative MRA detected dSCPs with 100 % sensitivity. MRA findings also revealed the diversity of vascular structures, such as the tibio-peroneal bifurcation location and the anatomical relationship between the peroneal vessels and the fibula. No patients suffered postoperative ischemic complications in the donor leg. The total flap survival rate was 95 %. Conclusions: Preoperative MRA effectively excluded large vessel anomalies and peripheral vascular disease, and precisely identified the septocutaneous perforators. Additionally, preoperative MRA contributed to a safer fibular osteotomy by predicting the anatomical relationship between the peroneal vessels and the fibula. (c) 2013 Wiley Periodicals, Inc.

DOI： 10.1002/micr.22128

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Umbilical reconstruction after total excision of the umbilicus represents a challenging problem for reconstructive surgeons. We describe herein a new method for one-stage umbilical reconstruction after resection of a urachal cyst. This case series included 6 patients, with laparoscopic urachal cyst removal in 5 and conventional transcutaneous surgery in 1. One-stage umbilical reconstruction was performed in all cases. When a conventional transcutaneous approach is indicated, umbilical reconstruction can be undertaken through the same skin incision used for total resection of the urachal cyst. Two triangular flaps were designed just below the umbilical defect. Flaps were rotated 180 degrees and sutured together to form one big triangular flap. This flap was then folded to create the new umbilicus. A deep umbilicus with good shape was constructed in all cases, and all patients were satisfied with the outcome. This method is simple, easy, and produces a natural-looking umbilicus.

DOI： 10.1097/SAP.0b013e318248b830

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Publisher：Journal of Craniofacial Surgery  

DOI： 10.1097/SCS.0b013e3182953a0b

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Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publishing type：Research paper (other academic)  

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Publisher：Journal of Craniofacial Surgery  

DOI： 10.1097/SCS.0b013e3182801898

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Language：English   Publishing type：Research paper (scientific journal)  

Ameloblastic carcinoma is a very rare malignant odontogenic tumor. We report a case of secondary-type ameloblastic carcinoma that extended transversally over almost half of the side of the face. Malignant transformation and identification of the malignant region in the large tumor were achieved using L-3-[F]fluoro-α-methyltyrosine (FAMT)-positron emission tomography (PET)
FAMT is transported into cancer cells by L-type amino acid transporter 1 and shows high specificity for malignant tumors. The malignant region determined by microscopic evaluation of resected samples was similar to the region showing high FAMT uptake in PET. Using preoperative FAMT-PET and magnetic resonance imaging, we were able to achieve total resection of the very large tumor, while avoiding excessive resection that could cause severe functional loss or a poor aesthetic facial appearance. We used a modified Weber-Fergusson incision along the nasolabial fold to the labiajugal fold and reconstruction with a pectoralis major muscle flap, and this gave a good aesthetic outcome. Safe surgical resection was possible because preoperative three-dimensional computed tomography angiography was used to identify the position of the main trunk of the external carotid artery, which was closely aligned with the tumor in a posterior direction in the infratemporal fossa region. Copyright © 2013 by Mutaz B. Habal, MD.

DOI： 10.1097/SCS.0b013e3182710311

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Prevention of the atrophy of denervated muscles is essential for a good outcome in facial contouring and oral reconstruction. In this study, we compared the effectiveness of end-to-end and end-to-side neurorrhaphy of the motor nerve, and end-to-end neurorrhaphy of the sensory nerve, all of which are frequently used in such reconstruction for the prevention of muscle atrophy.
Wistar rats were divided into four groups: group 1, motor nerve division of semimembranosus without repair; group 2, motor nerve division and end-to-end coaptation to the saphenous nerve; group 3, motor nerve division and end-to-side coaptation to the sciatic nerve; and group 4, motor nerve division and end-to-end repair.
Measurement of semi-membranosus volume, histological evaluation and staining of neuromuscular junctions that were carried out 3 months postoperatively revealed that muscle volume preservation was larger in groups 3 and 4 than in the other two groups (p &lt; 0.05), but slightly superior in group 4 (p &lt; 0.05). There was no statistical difference between groups 2 and 1; histologically, muscle architecture was better preserved in group 2 than in group 1; reactivation of the neuromuscular junctions was observed in all except group 1.
End-to-side repair of motor nerves is one of the better options for the preservation of muscle volume when end-to-end nerve repair is not indicated. Sensory protection may also provide some advantages in the preservation of muscle volume. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2012.01.018

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

Ion beam therapy has lately attracted considerable attention as an effective means for beating cancers. Ion beam experts say that it produces less harmful side effects than regular radiation because of its physical features. Sometimes, however, it induces severe skin damage as a side effect. We experienced seven cases of intractable ulcerations associated with ion beam therapy. Original diseases of our cases are composed of three hepatocellular carcinomas, three soft tissue sarcomas, one squamous cell carcinoma in the head and neck region. From these seven cases, we found two important clinical features of the ulcerations due to ion beam. First, severe skin necrosis or ulcerations occur frequently when cancers are located shallowly in the body, for instance hepatocellular carcinoma and soft tissue sarcomas in the extremities. Second, the outbreak of ulceration after ion beam therapy is much earlier than that of chronic ulcerations after regular radiation therapy. Conservative therapy is not effective to cure the ulcerations. We should achieve sufficiently deep debridement and reconstruct the defect by a flap rich in blood supply.

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Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (other academic)  

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Language：Japanese   Publishing type：Research paper (other academic)  

Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：WILEY-BLACKWELL  

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Language：English   Publisher：Japan Society for Head and Neck Cancer  

&lt;p&gt;We propose the &quot;CAT concept&quot;, a new theory for surgical reconstruction after oncological segmental mandibulectomy. The essence of the theory is to reconstruct three reference points on the mandible - &quot;C&quot; (condylar head) &quot;A&quot; (mandibular angle) and &quot;T&quot; - necessary and sufficient for its surgical reconstruction. An anthropometric analysis of the mandible of ten preserved human cadavers showed that the mandibular contour can be made merely 3 to 7 mm smaller than the original when the CAT concept is adopted, suggesting that the concept sufficiently satisfies the condition for surgical reconstruction of the mandible. A review of our 45 clinical cases of mandibular reconstruction after oncological ablation demonstrated a positive trend between the number of reconstructed or non-resected reference points of the CAT concept and the esthetic outcome of each patient (Fisher&#039;s exact test, p&lt;0.01), suggesting that the concept satisfies the necessary condition. Given these results, we concluded that the CAT concept is a highly practical theory for the surgical reconstruction of segmental mandibular defects.&lt;/p&gt;

DOI： 10.5981/jjhnc.38.84

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CiNii Research

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Language：Japanese   Publisher：北関東医学会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J03107&link_issn=&doc_id=20110825450129&doc_link_id=%2Fde3kitak%2F2011%2F006103%2F132%2F0462-0462%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fde3kitak%2F2011%2F006103%2F132%2F0462-0462%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Candida species inhabit the mucosal surfaces of healthy individuals. Major forms of oral candidiasis are pseudomembranous and atrophic form, but chronic hyperplastic candidiasis (CHC) is rarely seen. We encountered a nodule caused by candidal infection on a forearm flap in the oral cavity mimicking a recurrent tongue cancer, which revealed as CHC by histopathological examination. Like other forms of oral candidiasis, the nodule well responded to the treatment of antifungal agents and eventually disappeared: When an intraoral nodule is observed, the possibility of CHC should be taken into consideration. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.anl.2010.11.007

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

The incidence of the diabetic foot is increasing worldwide. Because evidence has shown that transmetatarsal amputation is associated with fewer failures in amputations of the diabetic foot with or without peripheral arterial disease, improving its management and surgical technique is a mission for the surgeon. Conventional transmetatarsal amputation has held firm, however, for more than 150 years. With a new concept for the transmetatarsal amputation method aimed at a better outcome, we propose a modified procedure for preserving the soft tissue between the metatarsal bones (the vasculature complex with the muscles, periostea, and vessels) and applying it to the distal bone stumps. The purpose of this method is to secure a functional foot by preserving the longitudinal arch. The new method was applied to 11 patients with diabetes mellitus or peripheral arterial disease, or both. All wounds closed successfully. Of the 11 patients, 8 were still alive with no complications. Of these 8 patients, 6 were able to ambulate with a custom-made shoe and 2 used a wheelchair, just as preoperatively. Of the 3 patients who died, 1 died a natural death, 1 died of sepsis, and 1 of cerebral infarction. We believe that the modified transmetatarsal amputation that we have described in this report is a potential breakthrough in the care of patients with forefoot gangrene and may gain acceptance over time. (C) 2011 by the American College of Foot and Ankle Surgeons. All rights reserved.

DOI： 10.1053/j.jfas.2011.03.018

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   Publisher：THIEME MEDICAL PUBL INC  

DOI： 10.1055/s-0030-1251562

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BACKGROUND: Our objective was to evaluate the value of the blowing test to measure the speech and swallowing function after resection of oral or oropharyngeal cancer. METHODS: Speech and swallowing functions of the patients after surgical resection of oral or oropharyngeal cancer were assessed by a speech intelligibility test, blowing time, questionnaires, and oropharyngeal pressures. Blowing time (pressure) ratio was determined by dividing blowing time (pressure) with open nose by blowing time (pressure) with closed nose. RESULTS: Blowing time ratio had significant correlation with blowing pressure ratio (p = .014), score of speech intelligibility test (p = .0014), questionnaire for aspiration (p = .029), nasopharyngeal backflow (CC = 0.676, p = .032), amount of food to swallow (p = .037), and oropharyngeal pressure during swallowing (p = .024). CONCLUSION: The present results demonstrated the value of blowing time ratio as a simple objective tool for speech and swallowing ability related to velopharyngeal function after resection of oral and oropharyngeal cancers.

DOI： 10.1002/hed.21283

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Harvesting the radial forearm flap may cause circulatory problems in the donor arm. To investigate the influence on donor hands after radial forearm flap harvesting, we assessed the process of circulatory changes prospectively by measuring skin perfusion pressure (SPP) that is clinically useful in detecting vascular lesions.
The records of 17 patients (14 men and 3 women aged 59.7 +/- 11.8 years) who had undergone free radial forearm flap transfer for head and neck reconstruction, between December 2005 and April 2007, were analysed. SPP in the thumb (finger I), the middle finger (III) and the little finger (V) was measured in the 17 patients preoperatively and 1 month and 3, 6, 9 and 12 months postoperatively. All statistical tests were two sided, with a significance level defined as p &lt; 0.05.
Preoperatively, baseline SPP was more dominant in finger I than in finger V. Postoperatively, SPP changed significantly in both fingers, while it showed no change in finger III and tended to be higher in finger I than in the other two.
Harvesting the free radial forearm flap reduces skin perfusion in the fingers of the donor arm and, we assume, leads to a re-distribution of blood flow to the fingers, with the residual ulnar artery still supplying more blood flow to finger I than to finger V. This suggests the presence of an autoregulating mechanism whereby blood perfusion to the fingers is controlled by the physiological demands of individual fingers. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2008.11.068

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

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Language：Japanese   Publisher：(株)全日本病院出版会  

縫合糸や皮膚閉鎖に用いる材料の特性を十分に理解することは'キズアトをきれいにする'ために重要である。たとえ縫合技術が一流であっても、材料に対する理解が不十分であれば良好な結果を得ることはできない。瘢痕形成を考慮すると、組織反応が少なく、抗張力の持続するモノフィラミント合成非吸収糸であるナイロン糸を用いた真皮縫合が主流であった。しかし近年、長期間抗張力を維持する吸収糸が開発され、真皮縫合に使用される機会が増えてきた。長期的な縫合糸膿瘍、糸露出の危険性を考慮すると、PDS IIなどの抗張力の持続するモノフィラメントの合成吸収糸は有用である。真皮縫合の後、創縁の微妙な修正やズレの防止のために、縫合糸を用いた表皮縫合を行う。皮下縫合、真皮縫合で創縁がしっかりと外反、密着している状態では、表皮縫合をせずに皮膚表面接着剤、サージカルテープや半透過性透明フイルムも(1)抜糸の必要がない、(2)針糸刺入による組織損傷がない、(3)手術時間の短縮が可能、(4)縫合糸痕の心配がない、という点で有用な皮膚閉鎖法である。本稿では、真皮縫合に用いる縫合糸の選択および表皮縫合の方法について詳述する。(著者抄録)

Language：Japanese   Publishing type：Research paper (international conference proceedings)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Purpose: Various autografts and synthetic materials such as titanium plates have been used for orbital floor reconstruction; however, no consensus on reconstruction methods has been reached. We have used iliac cancellous bone for this reconstruction with good results.
Patients and Methods: Patients (n = 101) enrolled in this study underwent orbital floor reconstruction of pure blowout fracture with an approximate I mm thinned and trimmed iliac cancellous bone without fixation of the graft. The results were assessed by CT; diplopia exceeding an angle of 45 degrees was evaluated as a poor outcome.
Results: Postoperatively, diplopia appeared in 15 patients and disappeared in 86 patients. At 6-month follow-up, CT showed that the morphology of the orbit was well maintained and no shedding or improper positioning of the grafted bone was observed in any of the patients. Moreover, CT images demonstrated ossification of the transplanted bone graft.
Conclusions: The method encompassing the use of the medulla of the iliac bone has several merits: 1) the graft bone is sufficiently pliable and flexible to fit the gently curving orbital floor; 2) being soft, it is easy to cut. Furthermore, no complication attributable to its fragility is observed at short- and long-term follow-up. The I mm thin medullar bone graft derives its robustness from its beamed structure. We consider the medulla of the iliac bone fitting autosomal material for the reconstruction of the orbital floor. (C) 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:957-961, 2009

DOI： 10.1016/j.joms.2008.08.014

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

The process of the ischium may be a risk factor for intractable pressure ulcers, as is the process of the sacrum. How the ischium affects pressure ulcers is the subject of controversy, however, because little is known about the shapes of ischia with pressure ulcers. With 3-dimensional computed tomography (3D-CT), we assessed the extent of the prominence of the ischium and free bone fragments of eight patients with ischial ulcers who required surgery. In 6 out of 9 patients (67 %) the ischia of the side with pressure ulcers were less prominent than, and in 3 patients ischial bones of the side with pressure ulcers were as prominent as, the other side, demonstrating that in no case is the ischium of the side with the pressure ulcer more prominent than the other side. In the sitting position, the pelvis tends to lean toward the side of the less prominent ischium. Ischial pressure ulcers may be intractable because of the leaning, which increases interface pressure on the side of the pressure ulcer.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

When a surgeon treats a distal foot ulcer accompanying exposure of the bone or joint, reverse flow flap from the dorsal foot is a useful maneuver to employ. Reverse flow flaps are very useful for the reconstruction of distal extremities; however, venous congestion of the flap may occur. Although various theories of reverse venous drainage have been reported, the safety and certainty of reverse flow flap have not been verified. In this report, we use the reverse flow flap from the dorsal foot to treat distal foot ulcers. We performed venous anastomosis to persuade postoperative venous drainage antegradely. We present two case reports and discuss the reliability of venous anastomosis in reverse flow flap surgery.

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Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

We have to reconsider the selection of operative methods for decubitus on calcaneal regions, unlike the reconstructive operative methods for the loading region on feet. This is because it depends upon the pathogenesis of decubitus, sensory level, and/or ambulatory condition whether the wound has the operative indication. We here classify the decubitus on calcaneal region into three patterns. 1. Bedfast patient 2. Diabetes mellitus (DM) and/or peripheral arterial disease (PAD) 3. Ambulatory paralytic patient.

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Language：Japanese   Publisher：Japanese Journal of Plastic Surgery  

Sclerotherapy for venous malformation is thought to be a simple, relatively safe, minimally invasive treatment that leaves no scars. Its effectiveness has often been reported, and it is the standard treatment in Japan. Here, we investigated the usefulness of simulation cavernography and sclerotherapy for venous malformation. We retrospectively analyzed 80 sclerotherapy sessions of 42 patients diagnosed with venous malformation and treated by sclerotherapy at Kobe University Hospital and in the Division of Plastic Surgery, National Hospital Organization Himeji Medical Center, from April 2000 to October 2006. The results of fluoroscopy were classified into four types according to the following procedures. Type I : Pooling of contrast medium in the cavity of the venous malformation was confirmed, and sclerotherapy was conducted continuously (50 sessions, 62.5%). Type II : A thick drainage vein was confirmed, another part was punctured, and sclerotherapy was conducted continuously (8 sessions, 10.0%). Type IIIa : A thick drainage vein was confirmed, and sclerotherapy was carried out by manually pressing the vein to prevent the sclerosant from flowing into the drainage vein (21 sessions, 26.3%). Type IIIb : A thick drainage vein was confirmed, another part was punctured, but sclerotherapy was discontinued (1 session, 1.25%). Had we carried out sclerotherapy without simulation cavernography, some side effects would probably have ensued in 37.5% of the cases. The results suggest that simulation cavernography and sclerotherapy are useful in the treatment of venous malformation.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：THIEME MEDICAL PUBL INC  

Regions of oropharyngeal cancer, hypopharyngeal cancer, and cervical esophageal cancer in a 70-year-old man were surgically resected and reconstructed with a free jejunal flap. Postoperatively the patient showed severe dysphagia and a chimneylike protrusion in the oral cavity. In a second operation, a dorsal, longitudinal incision for phimosis was made to release the stenosis; however, the dysphagia persisted, and peristalis seemed to interfere with deglutition. Here, we discuss the cause of the dysphagia, a complication of total reconstruction of oroesophageal defects with a single free jejunal flap, and the procedures of reconstruction.

DOI： 10.1055/s-2008-1076092

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Language：Japanese   Publisher：日本シミュレーション外科学会  

血管奇形に対する硬化療法に術中シミュレーションを導入し、その成績を報告した。対象は静脈奇形に対して硬化療法を施行し、造影記録を確認できた15症例(男性7名、女性8名)で、これらの症例に対して合計33回の治療を行った。術中シミュレーションの結果は以下の4タイプに分類した。造影剤が病変内に留まり、そのまま硬化療法を施行した症例(タイプ1,82%)。太い流出静脈や主要血管への流出が確認され、穿刺部位を変えて硬化療法を施行した症例(タイプ2,15%)。用手的圧迫で病変内に留まり、硬化療法を施行した症例(タイプ3a,0%)。用手的圧迫でも病変内に留まらず、硬化療法を断念した症例(タイプ3b,3%)。タイプ3aは硬化療法施行時にしばしば経験するが、今回の症例中では見られなかった。タイプ2と3bを併せると18%の症例で流出静脈を認めたが、いずれの症例も重篤な合併症は見られず、経過は良好であった。

Language：English   Publisher：BLACKWELL PUBLISHING  

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Language：Japanese   Publisher：Japanese Journal of Plastic and Reconstructive Surgery  

We describe two cases of hemilateral lower lid retraction in thyroid ophthalmopathy surgically treated with comprehensive lid interlining cartilage (CLIC) grafts, whereby the total lower lid is supported by 4.5×1 cm auricular cartilage. Case 1 : A 74-year-old man visited our department presenting with right lower lid retraction (4 mm lower than the contralateral side), The patient had three months earlier undergone right inferior rectus muscle recession to treat double vision. A CLIC graft to his right lower lid was carried out under local anesthesia. Case 2 : A 44-year-old man with right lower lid retraction (3 mm lower than the contralateral side) had 12 months earlier undergone right inferior rectus muscle recession. The patient underwent a CLIC graft under general anesthesia. In both cases, the retracted lower lid was corrected and restored to the level of the contralateral side I also, a natural symmetrical appearance of the mid-face was attained. CLIC grafting is an effective alternative treatment for lower lid retraction in thyroid ophthalmopathy patients.

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING  

DOI： 10.1111/j.1524-4725.2007.33294.x

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING  

DOI： 10.1111/j.1524-4725.2007.33202.x

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Language：Japanese   Publishing type：Research paper (international conference proceedings)  

Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: In treating patients with anophthalmic orbits, it is essential to achieve a long-lasting natural appearance and comfortable retention of eye prostheses. In 1992, the authors developed a therapeutic strategy based on a simple algorithm for treating the three common symptoms of acquired anophthalmic orbit: severe eye socket contracture is surgically treated with a radial forearm free flap transfer, upper lid depression is treated with lipoinjection, and lower lid retraction is treated with an auricular cartilage graft.
Methods: From 1992 to 2004, 18 acquired anophthalmic orbits (I I enucleated and seven exenterated) were treated at Kobe University Hospital based on the authors' therapeutic strategy. Aesthetic outcomes were evaluated according to patient and surgeon satisfaction.
Results: Sixteen patients underwent auricular cartilage grafts, eight received radial forearm free flap transfers, and seven were treated with lipoinjection. Optional revisional surgery was carried out in four cases. The aesthetic outcome was assessed as good in six patients, moderate in eight patients, and poor in four patients; the last four had undergone total maxillectomy with orbital exenteration or had eyelid defects because of previous cancer surgery.
Conclusions: The authors' therapeutic strategy for acquired anophthalmic orbit is simple and, with slight modification, fitting for most cases, although it necessitates innovative surgery in cases with orbital rim and/or eyelid defects.

DOI： 10.1097/01.prs.0000260706.07368.f1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING  

There have been few reports about the characteristics of the pigmentary arrangement of congenital melanocytic nevi (CMN) and nevus spilus (NS). Though the lines of Blaschko, which don't correspond to other lines such as Langer's lines and skin dermatomes, are well known to be followed by some rare pigmentary disorders, the relationship between these two disorders and the lines of Blaschko has not been discussed. Therefore, through an examination of 200 cases, we investigated whether or not the arrangement of CMN and NS follow the lines of Blaschko. Thirty-nine out of 92 cases (42.4%) of CMN and 67 out of 108 cases (62.0%) of NS were considered to follow the lines of Blaschko. Today, the idea is widely accepted that two functionally different cells proliferate during early embryogenesis of the skin which is caused from mosaicism and, as a result, the lines of Blaschko appear visually. In our results, we found that there were some cases of CMN and NS which showed a relationship with the lines of Blaschko, which is meaningful considering that the lesions and the lines are both related to pigmentary gene anomalies. The result was compared with CMN and NS by the chi(2) test. NS showed a predominant tendency to follow the lines with a significant difference (P = 0.0055). This may indicate that the lines of Blaschko reflect more clearly the proliferation of the epidermal cells than other cells in growth of the skin of the embryo. Further studies are required to elucidate the reason why some cases follow these lines and others do not.

DOI： 10.1111/j.1346-8138.2007.00242.x

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Background: In patients with perianal extramammary Paget's disease, wide local A excision is recommended. In the reconstruction of the resulting large defects not only the closure of the defect but also the preservation of anogenital function need to be considered.
Methods: We used bilateral V-Y advancement posterior thigh fasciocutaneous flaps for reconstructing three large anogenital defects, including the total anal canal, resulting from wide tocal excisions attributed to extramammary Paget's disease. A temporary anus was constructed at the same time to allow the wound of the reconstructed anus to heal. After the surgery, the course of bowel function was followed up through interviews and manometric examinations.
Results: All defects were successfully reconstructed with the flaps, and bowel function recovered satisfactorily. Manometric examinations were carried out in two cases; anal pressures were recorded regularly and used as parameters of the recovery of bowel function before closing the artificial anus. Eventually, the patients recovered the function of defecation.
Conclusions: We recommend the bilateral V-Y advancement posterior thigh fasciocutaneous flaps together with manometric studies as one of the most effective techniques for managing large anogenital defects. The use of sensate flaps, the restoration of original structures and manometric studies are conducive to successful outcomes. (C) 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2007.02.005

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：Kobe Journal of Medical Sciences  

Old malunited jaw fractures of nine patients who underwent orthognathic surgery for occlusal reconstruction were clinically evaluated. Early surgery on fractures of the jaw is the optimal treatment when due attention must be paid to occlusion. Since occlusal revision surgery subsequent to inaccurate diagnosis and inappropriate surgery is certainly very difficult and often unsuccessful, surgeons need to pay special attention to this situation.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/01.prs.0000200623.91956.66

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PubMed

Publisher：神戸大学  

Old malunited jaw fractures of nine patients who underwent orthognathic surgeryfor occlusal reconstruction were clinically evaluated. Early surgery on fractures of thejaw is the optimal treatment when due attention must be paid to occlusion. Sinceocclusal revision surgery subsequent to inaccurate diagnosis and inappropriate surgeryis certainly very difficult and often unsuccessful, surgeons need to pay special attentionto this situation.

PubMed

Publisher：Japan Society for Head and Neck Cancer  

We have carried out about 600 head and neck reconstructions with radial forearm free flap transfer and basic/clinical studies on flap circulation and surgical procedures. Knowledge obtained and refinement of surgical procedures in flap elevation, venous anastomosis and donor site coverage introduced at Kobe University Hospital are as follows:<BR>1) Deep and superficial venous systems of the flap are connected by including the cubital perforating vein in the venous pedicle.<BR>2) Our studies have revealed that the deep venous system has dominant blood flow compared with the superficial system. Consequently, drainage of the former system is crucial in reducing venous disturbance of the flap.<BR>3) &ldquo;Network venous anastomosis&rdquo;, where the two separate venous systems of the flap are anastomosed with the two venous systems of the neck (the internal and external jugular veins) including their connecting perforating vein, imitates the anatomical venous drainage in the forearm, providing a reliable, fail-safe drainage system.<BR>4) Skin grafts preserving subdermal vascular networks provide aesthetically more optimal results in covering the donor site of the flap.<BR>5) Fixation of skin grafts to the donor site of the flap with polyurethane foam and film without using the tie-over procedure is an easy and time-saving method requiring no assistants.

DOI： 10.5981/jjhnc.32.247

Publisher：Plastic and Reconstructive Surgery  

DOI： 10.1097/01.PRS.0000153233.87258.5D

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DOI： 10.1097/01.PRS.0000148447.33144.14

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nihon University School of Dentistry  

This study reviews reconstruction of complex three-dimensional oral and maxillofacial defects using the <i>single</i> free radial forearm flap or the <i>single</i> free rectus abdominis musculocutaneous flap. Between 1996 and 2003, 124 patients underwent oral and maxillofacial reconstruction in the Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine. Outcomes for 22 patients who underwent three-dimensional reconstruction of multiple surfaces were evaluated. Reconstruction was performed after resection of malignant tumors in all 22 patients. <i>Single</i> FAFs were utilized for 11 patients and single RAMs for the remaining 11. Flap survival rate was 100%. No major donor morbidity was observed, and all surviving patients (20/22) were able to perform normal daily living activities. <i>Single</i> FAF and RAM are useful materials for one-stage reconstruction of complex three-dimensional oral and maxillofacial defects requiring replacement of skin, mucosa, and intervening soft tissues. Good to excellent aesthetic results can be attained in most patients. (J. Oral Sci. 46, 65-70, 2004)

DOI： 10.2334/josnusd.46.65

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CiNii Research

Language：Japanese   Publisher：Annals of Plastic Surgery  

Whether or not multiple venous anastomoses reduce the risk of free-flap failure is a subject of controversy. We report here, for the first time, on the importance of selecting 2 separate venous systems of the flap for dual anastomoses. The efficacy of multiple anastomoses was verified through a retrospective review of 310 cases of the free radial forearm flap transfer. Dual anastomoses of separate venous systems (the superficial and the deep) showed a lower incidence of venous insufficiency than single anastomosis did (0.7% versus 7.5%; P < 0.05). On the other hand, dual anastomoses of a sole venous system showed no significant difference in the incidence of venous insufficiency compared with single anastomosis (11.5% versus 7.5%; P = 0.48). Our results suggest that dual venous anastomoses of separate venous systems is conducive to reduced risk of flap failure and affords protection against venous catastrophe through a self-compensating mechanism that obviates thrombosis of either anastomosis.

DOI： 10.1097/01.sap.0000096425.18223.60

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/S0266-4356(03)00170-0

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Language：Japanese   Publisher：Plastic and Reconstructive Surgery  

Endoscopic endonasal reductions have been addressed in 63 patients with blowout fracture of the medial orbital wall since 1992. The operations were carried out under general anesthesia with a magnified operative space projected on a television monitor by a charge coupled device video camera attached to the endoscope. The middle nasal turbinate was fractured toward the nasal septum, the uncinate process was cut off, and the bulla was opened. The ethmoidal bony partition and the mucous membrane were removed; however, the fractured bone chips of the medial orbital wall were preserved. The herniated orbital contents were pressed back into the orbital cavity, and the medial wall was set with 2-mm-thick bent silicone plates placed in the ethmoidal sinus. The plates were removed in the outpatient clinic 2 months after the operation. The surgical results of 21 patients treated with endoscopic reduction were compared with those of four patients treated with transfacial reduction with an iliac bone graft. All of the patients had isolated medial wall fracture and became aware of diplopia within 15 degrees in any direction from the primary position (straight gaze) before the operation; the follow-up period covered 6 months. The patients were classified into two categories according to postoperative double vision: "good," indicating no double vision or diplopia of more than 45 degrees, and "poor," diplopia of less than 45 degrees. Improvement of diplopia was observed in all patients without any complication. Of the 21 patients who underwent endoscopic reductions, 17 were classified as "good" and four as "poor." On the other hand, of the four patients who underwent transfacial reductions, three were classified as "good" and one as "poor." Significant differences were not observed between the surgical results of our two methods. Endoscopic endonasal reduction showed greater aesthetic advantages and, moreover, required no grafting. This technique is suggested as one of the most reasonable treatments of medial orbital wall fractures.

DOI： 10.1097/01.PRS.0000080723.29129.64

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/S1010-5182(02)00183-X

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PubMed

DOI： 10.1080/-2844310310007746

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PubMed

Language：Japanese   Publisher：Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery  

The free radial forearm flap has two drainage veins, the cutaneous and the deep, but no established consensus has been reached on the selection of the drainage pedicle. In our study, the flow volumes of the veins were examined by colour Doppler ultrasonography after 20 forearm flaps had been raised. The volume through the deep vein was significantly higher than that through the cutaneous vein (p < 0.01). In comparing the total flow (both veins open), the flow rate through the deep vein alone (cutaneous vein occluded) was over 80% in 13 cases, 60%-80% in seven, and under 60% in none; that through the cutaneous vein alone (deep vein occluded) was 60%-80% in eight, 40%-60% in eight, under 40% in four, and over 80% in none. Our results show the importance of the deep vein, as indicated by its high drainage capacity from the early stages of flap transfer.

DOI： 10.1080/2844310310007746

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Language：Japanese   Publisher：Aesthetic Plastic Surgery  

Some techniques for the treatment of mandibular protrusion with consideration for aesthetic improvement of the face as a whole are described. The aesthetic inferiority complex in the mind of patients with masticatory disorders as the chief complaint should not be underestimated. Three techniques were used in this study; preoperative orthodontic treatment, preservation of the patient's self-image, and maintenance of beautiful relationship between the midfacial line and the nasolabial fold as well as the nasal ala.

DOI： 10.1007/s00266-002-2036-4

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Language：Japanese   Publisher：British Journal of Oral and Maxillofacial Surgery  

The mobile tongue and the suprahyoid muscles were reconstructed in a man who had had a total resection of the mobile tongue with the oral floor and bilateral radical neck dissection (extensive resection of the bilateral suprahyoid muscles) for cancer of the tongue. A rectus abdominis musculocutaneous flap with the tenth intercostal nerve anastomosed to the remaining hypoglossal nerve was used for the reconstruction. The rectus abdominis muscle was inserted between the mandible and the hyoid bone, taking account of the anatomical positions of the tongue and suprahyoid muscles; the rectus sheath was then firmly sutured to the mandible and hyoid bone. This procedure created firm tendinous insertions between the mandible and hyoid bone. After the operation, the reconstructed tongue showed no sign of atrophy, and the reconstructed suprahyoid muscles (rectus abdominis muscle) could be moved, and the hyoid bone could be raised. © 2001 The British Association of Oral and Maxillofacial Surgeons.

DOI： 10.1054/bjom.2001.0636

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