Faculty Profiles - HASHIKAWA Kazunobu

Postoperative abnormal response of C-reactive protein as an indicator for infectious complications after oral oncologic surgery with primary reconstruction Reviewed

Masaya Akashi, Shungo Furudoi, Kazunobu Hashikawa, Akiko Sakakibara, Takumi Hasegawa, Takashi Shigeta, Tsutomu Minamikawa, Takahide Komori

JOURNAL OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Vol. 44 ( 1 ) page： 13 2015.4

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

Long-term Follow-up Study of Radial Forearm Free Flap Reconstruction After Hemiglossectomy Reviewed

Masaya Akashi, Kazunobu Hashikawa, Akiko Sakakibara, Takahide Komori, Hiroto Terashi

JOURNAL OF CRANIOFACIAL SURGERY Vol. 26 ( 1 ) page： 48 - 51 2015.1

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

下顎再建における血管柄付き遊離腓骨皮弁の限界ー骨吸収、整容性、末梢動脈疾患の観点からー Reviewed

Necessity of Distinguishing Verrucous Carcinoma From Verrucous Skin Lesion Overlaying Residual Skin Staples in an Area of Sensory Loss: A Case Report.

Sakakibara S, Tokiyoshi T, Hashikawa K, Terashi H

Eplasty Vol. 15 page： e23 2015

横尾聡, 橋川和信, 宮崎英隆, 牧口貴哉, Komori Takahide

口腔腫瘍 Vol. 27 ( 3 ) page： 49 - 56 2015

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

開頭術後頭部皮膚潰瘍の原因に関する検討とその対策死腔形成と脳室-腹腔シャントが及ぼす影響について Reviewed

Nomura Tadashi, Hashikawa Kazunobu, 榊原俊介, 高須啓之, 寺師浩人

日本頭蓋顎顔面外科学会誌 Vol. 30 ( 4号 ) page： 171 - 178 2014.12

Development of a novel method for decellularizing a nerve graft using a hypertonic sodium chloride solution Reviewed

Yasuhisa Ishida, Shuhsuke Sakakibara, Hiroto Terashi, Kazunobu Hashikawa, Tetsuji Yamaoka

INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS Vol. 37 ( 11 ) page： 854 - 860 2014.11

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

Is Immobilization of the Ankle and Metatarsophalangeal Joint Effective in Suppressing the Spread of Infection in Diabetic Foot Ulcers? Reviewed

Shunsuke Sakakibara, Yoriko Tsuji, Kazunobu Hashikawa, Hiroto Terashi

INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS Vol. 13 ( 3 ) page： 226 - 229 2014.9

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

Intima/medulla reconstruction and vascular contraction-relaxation recovery for acellular small diameter vessels prepared by hyperosmotic electrolyte solution treatment Reviewed

両側pure type眼窩ブローアウト骨折症例の検討 Reviewed

高須啓之, Hashikawa Kazunobu, Sakakibara Shunsuke, 寺師浩人

日本頭蓋顎顔面外科学会誌 Vol. 30 ( 3号 ) page： 147 - 153 2014.9

Shunsuke Sakakibara, Yasuhisa Ishida, Kazunobu Hashikawa, Tetsuji Yamaoka, Hiroto Terashi

JOURNAL OF ARTIFICIAL ORGANS Vol. 17 ( 2 ) page： 169 - 177 2014.6

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

Comparison of Malignant Skin Tumor Thickness and Relative Depth of Invasion Estimates from Preoperative MR-Microscopy and Pathological Evaluation Reviewed

ビデオで伝えたい私の手術ビデオで伝えたい遊離前腕皮弁の挙上方法

Nomura Tadashi, 榊原俊介, 高須啓之, 橋川和信, 寺師浩人, 明石昌也, 田原真也

日本形成外科学会会誌 Vol. 34 ( 5号 ) page： 394 2014.5

顎下部壊死性筋膜炎に伴う切開排膿後の難治性瘻孔にV.A.C. ATS治療システムによる局所陰圧閉鎖療法を用いた1例 Reviewed

榊原晶子, Sakakibara Shunsuke, Minamikawa Tsutomu, 重田崇至, Hashikawa Kazunobu, Komori Takahide

日本口腔外科学会雑誌 Vol. 60 ( 2号 ) page： 71 - 75 2014.2

Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study Reviewed

Sakakibara A, Hashikawa Kazunobu, Yokoo S, Sakakibara Shunsuke, Komori Takahide, Tahara S

Plast Surg Int Vol. 2014 page： 893746 2014

Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S

Plastic surgery international Vol. 2014 page： 893746 2014

Reiko Nakayama-Takeda, Shunsuke Sakakibara, Masato Kurokawa, Kazunobu Hashikawa, Hiroto Terashi

DERMATOLOGIC SURGERY Vol. 39 ( 12 ) page： 1767 - 1773 2013.12

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

Evaluation of venous anatomy with phase-lag CTA (pl-CTA)

Sakakibara S., Onishi H., Nomura T., Hashikawa K., Terashi H.

Japanese Journal of Plastic Surgery Vol. 56 ( 12 ) page： 1271 - 1280 2013.12

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.

Utility of fixation with a custom-made device for intractable digital ulcers in the proximal interphalangeal joints associated with systemic sclerosis; report of two cases

Makiguchi T., Terashi H., Hashikawa K., Yokoo S., Tsuji Y., Tahara S.

Japanese Journal of Plastic Surgery Vol. 56 ( 12 ) page： 1313 - 1318 2013.12

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.