記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

国立がん研究センター東病院在籍時、遊離皮弁を用いた頭頸部再建における皮弁モニタリング法の有用性について、2012年に本学会誌に報告した。皮島の色調やcapillary refillingの観察およびpin prick testといった臨床的観察法によるモニタリングは、血流障害時の皮弁救済率は27.3%と低いものの、感度は100%と高く、偽陽性率が0.2%と低い有用な方法であった。10年を経た現在、勤務している九州大学病院では臨床的観察法にサウンドドプラを追加したモニタリング法を導入している。今回、その有用性について再建部位別に検討した。対象は2016～2021年に九州大学病院で遊離組織移植を行った562例で、再建部位の内訳は頭頸部495例、乳房・体幹25例、上肢16例、下肢26例であった。検討の結果、頭頸部については、遊離皮弁の成功率、皮弁救済率とも10年前の報告と同等であった。一方、下肢については、動脈攣縮や動脈血栓が多く、術後に皮島のわずかな色調変化を呈した際に適切・迅速な判断ができずに皮弁を救済できなかった。

記述言語：英語   出版者・発行元：Elsevier B.V.  

記述言語：英語   出版者・発行元：Auris Nasus Larynx  

Objective: Peritracheostomal pharyngocutaneous fistula (PCF), a direct connection between the PCF and tracheal stoma due to a skin defect, is among the most problematic complications after total laryngectomy or pharyngolaryngectomy. Peritracheostomal PCFs can cause lethal complications, including severe pneumonia or carotid blowout, secondary to salivary leakage directly into the tracheal stoma, and their management is challenging without early invasive surgical closure. We aimed to evaluate the utility of our novel and minimally invasive combined local skin flap placement and negative-pressure wound therapy (NPWT) method for the management and conservative closure of peritracheostomal PCFs. Methods: We retrospectively enrolled patients who developed a peritracheostomal PCF from July 2015 to September 2021 at our institution and affiliated hospitals. Postoperative PCFs were all initially managed with appropriate wound bed preparation. Subsequently, a small local flap of healthy, lower neck skin was elevated and transferred anterior to the PCF to replace the peritracheostomal skin defect. The flap served to provide a sufficient surface for film dressing attachment and facilitated airtight sealing during NPWT. We initiated NPWT after confirming the local skin flap was firmly sutured to the tracheal mucosa. A flexible hydrocolloid dressing was applied to the peritracheostomal skin flap, and a film dressing was placed on the flexible hydrocolloid dressing and surrounding cervical skin. We inserted the NPWT foam shallowly into the fistula tract and applied negative pressure (73.5–125 mmHg). NPWT was continued until the PCF was closed or became so small that salivary leakage was minimal and could be managed by conventional compression dressings. Results: We enrolled six patients [male, n = 6; mean age, 66.5 years (range, 57–80 years)]. NPWT was applied for an average of 18.2 days (range, 2–28 days). During NPWT, air leakage occurred once (2 cases), only a few times (2 cases), or not at all (2 cases). In all patients, complete fistula closure was achieved in an average of 28.2 days (range, 15–55 days) after the start of NPWT, and no patient required further surgical intervention. There were no lethal complications (e.g., severe pneumonia) during treatment. Conclusion: Our method of combined local flap placement and NPWT enabled effective management of salivary aspiration and accelerated wound healing, which allowed conservative fistula closure in all patients. We believe combined local flap placement and NPWT should be considered a first-line treatment for intractable peritracheostomal PCF.

DOI： 10.1016/j.anl.2024.09.008

Scopus

PubMed

記述言語：日本語   出版者・発行元：日本マイクロサージャリー学会  

<p>　In 2012, we reported on the clinical observation method following 544 free flap transfers for head and neck reconstruction. After 10 years, we reviewed the postoperative outcomes using the similar monitoring approach. The success rates of free flap transfer were 97.8% for 495 head and neck defects and 80.8% for 26 lower extremities defects. Compromised flaps were observed in 21 patients. Flap color change was identified as the first clinical sign of flap compromise in 14 out of 21 patients. Of the 14 head and neck cases, emergency salvage surgeries were performed in six cases, and three flaps were salvaged. The other eight flaps were observed conservatively, however, all of them suffered total necrosis. In the five cases of lower extremity reconstruction with flap compromise, one patient underwent salvage surgery; however, the flap could not be salvaged. The other four flaps that did not undergo salvage surgery developed total necrosis. The flap salvage rate using the clinical observation method was comparable to previously reported rates. To further improve the salvage rate, it is essential to inspect the anastomosis site directly and perform salvage surgery promptly upon recognizing subtle and characteristic color changes in the flap.</p>

DOI： 10.11270/jjsrm.37.137

CiNii Research

記述言語：英語   出版者・発行元：Plastic and Reconstructive Surgery  

Surgeons have traditionally believed that swallowing is mainly dependent on gravity after total glossolaryngectomy. However, swallowing function after total glossolaryngectomy varies widely among patients, and a thorough analysis is lacking. The authors aimed to clarify the swallowing function after total glossolaryngectomy and determine whether it is primarily dependent on gravity. The authors retrospectively analyzed videofluorographic examinations of patients who underwent total glossolaryngectomy and free or pedicle flap reconstruction. The authors enrolled 20 patients (12 male; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient's ability to swallow was dependent on gravity alone. Videofluorography showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3 percent of the patients with poor clearance showed adequate constriction, which was significantly different (p = 0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance (p = 0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to previous understanding, constriction of the remnant posterior pharyngeal wall played an important role in swallowing after total glossolaryngectomy, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after total glossolaryngectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

DOI： 10.1097/PRS.0000000000009639

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般社団法人日本頭蓋顎顔面外科学会  

<p>　　Problems of orbital fracture surgeries include the narrow and deep surgical field, the difficulty of detecting the correct position of deep fractures, and the insufficiency of methods of teaching young surgeons. To overcome these problems, we introduced a combination therapy consisting of transorbital endoscopy, image-guided navigation system, and a 3D model.<br>　　Using endoscopy to assist with surgery, all medical staff can share a clear and magnified surgical vision through the high-resolution monitor. Transorbital endoscopic surgeries facilitate finding the microfracture easily even in the deep part of the orbit; thus, the image-guided navigation system adds accuracy and objectiveness to endoscopic surgeries. By a combination of endoscopy and image-guided navigation, we can avoid inadequate reduction of deep orbital fractures, which make orbital surgeries safer and easier and shortens the learning curve of young surgeons. Furthermore, 3D modeling can replicate real orbital shape and facilitate preoperative training of orbital surgeries. Using a mirrored 3D model, a precisely shaped bone graft can be manufactured and placed to the orbital defect.<br>　　Combining endoscopy, image-guided navigation system, and 3D modeling can contribute to safe and accurate orbital surgeries.</p>

DOI： 10.32154/jjscmfs.38.4_113

CiNii Research

記述言語：日本語  

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記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語