Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

悪性軟部腫瘍切除術後に生じた皮膚欠損を縫縮できない場合には、植皮もしくは皮弁が必要となる。なかでも背部腫瘍切除後には、比較的浅い部位に存在する肩甲骨、肋骨、脊椎棘突起が露出しやすいため、植皮を行っても生着しないことがあり、皮弁あるいは筋皮弁による閉鎖の必要性が高くなる。広背筋皮弁は手技が単純で、大きな筋体を有するため閉鎖可能な範囲も広いが、腫瘍切除の際に広背筋が合併切除される場合もあり、また過去の手術で広背筋皮弁が使用された後の再発症例も存在することから、複数の皮弁オプションが必要である。今回、背部悪性軟部腫瘍広範切除術後の皮膚軟部組織欠損に対して、背側肋間動脈穿通枝皮弁で再建を行った症例を3例経験し、いずれも良好な結果が得られたので文献的考察を加えて報告した。

Language：Japanese   Publisher：(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。

Language：English   Publisher：Journal of Craniofacial Surgery  

The supraclavicular flap is a regional flap in the supraclavicular area nourished by the transverse cervical or supraclavicular arteries. This flap gained popularity in the 2000s as it requires less surgical time than free flap reconstruction and has minimal donor-site morbidity. However, a high rate of postoperative complications has been reported. Moreover, there is ongoing debate regarding the indications and limitations of this flap. In this study, we confined the flap design to the supraclavicular fossa, considering flap vascularity and in an effort to minimize donor site morbidity. Between 2014 and 2023, we performed supraclavicular flap reconstruction in 3 cases of cervical skin defects and 1 case of a pharyngeal mucosal defect. The average defect and flap sizes were 7×3.9 cm and 11.5×4.4 cm, respectively. The lower border of the flap remained above the clavicle, and the lateral border did not exceed the acromioclavicular joint. When the flaps were transferred using the transposition method, the angle of transposition was limited to <90 degrees. When the VY advancement or turnover method was selected, we paid attention to the tension-free flap inset. We successfully reconstructed the defects without flap-related complications, and donor site scars were inconspicuous in all patients. In conclusion, we believe that confining the flap design to the supraclavicular fossa, limiting the indications of this flap to the reconstruction of medium-sized defects, and using tension-free flap insets are important for the successful application of this flap.

DOI： 10.1097/SCS.0000000000010483

Scopus

PubMed

Language：English   Publisher：Journal of Craniofacial Surgery  

Orbital reconstruction after total maxillectomy is essential to maintain ocular function and facial contour. Free flap transfer with simultaneous orbital bone reconstruction is a straightforward approach; however, it is challenging in medically unstable patients with multimorbidity. The authors developed an easily harvested temporoparietal fascial flap combined with vascularized outer table calvarial bone and entire temporalis muscle. The authors applied this technique in an 81-year-old patient with multiple comorbidities who required orbital floor reconstruction following total maxillectomy. Intraoperative indocyanine green fluorescence imaging confirmed excellent perfusion of the temporoparietal fascia, entire temporalis muscle, and calvarial bone. Although the patient developed postoperative local wound infection, the vascularized bone graft resisted infection and preserved the orbital structure without bone exposure. Our technique is minimally invasive and results in a well-vascularized flap for orbital reconstruction after total maxillectomy involving the orbital bone, and particularly beneficial in patients with multimorbidity or at high risk of local infection.

DOI： 10.1097/SCS.0000000000010571

Web of Science

Scopus

PubMed

Language：English   Publisher：Japan Society of Plastic and Reconstructive Surgery  

<p><i>Objectives</i>: No detailed country-specific cross-sectional studies have been reported on endoscopic plastic surgery. For the first time, the Japan Society of Plastic and Reconstructive Surgery conducted a nationwide survey to ascertain the status of endoscopic procedures in plastic surgery in Japan. This article discusses the current situation based on this survey findings.</p><p><i>Methods</i>: A questionnaire survey was conducted among 566 Japan Society of Plastic and Reconstructive Surgery-certified training facilities regarding the status of endoscopic plastic surgery procedures completed between January 2020 and December 2021.</p><p><i>Results</i>: Of the 143 institutions, 33 conducted endoscopic plastic surgery operations during the period, for a total of 753 procedures. Two hundred sixty-two procedures were conducted in the craniomaxillofacial region at 19 institutions and 491 in the extremities and trunk region at 19 institutions. Five intraoperative accidents were recorded, but no cases were moved to traditional surgery based on intraoperative choices. Sixteen postoperative problems were reported, but there were no reports of fatalities.</p><p><i>Conclusions</i>: The number of endoscopic plastic surgery cases is anticipated to rise, and this nationwide survey will contribute to this by offering useful data and insights.</p>

DOI： 10.53045/jprs.2023-0040

Web of Science

PubMed

CiNii Research

Language：English   Publisher：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

Language：English   Publisher：Journal of Craniofacial Surgery  

This study was performed to clarify whether the superthin anterolateral thigh (ALT) flap is an appropriate choice for head and neck reconstructions requiring thinner and more pliable flaps. Data of patients who underwent head and neck reconstruction from January 2020 to December 2022 were retrospectively collected. Nine patients (4.2%) underwent reconstruction with a superthin ALT flap. All the flaps survived with no cases of total or partial necrosis. Six patients treated with superthin ALT flaps and 15 patients treated with conventional ALT flaps who underwent oral cavity reconstruction were compared. The mean body mass index was significantly higher in the superthin flap group than in the conventional ALT flap group (25.2 vs 21.2 kg/m2, respectively; P = 0.04). The rate of postoperative complications requiring debridement was 0% and 13% (P = 0.37). The mean postoperative Hirose score was 9.7 and 8.7 (P = 0.17). The mean postoperative Functional Oral Intake Scale score was 6.7 and 5.9 (P = 0.12). Secondary flap refinement surgery after facial skin reconstruction was performed in 0 of 2 patients (0.0%) in the superthin flap group and 4 of 52 patients (7.7%) in the conventional ALT flap group (P = 0.04). Oral cavity reconstruction with superthin ALT flaps did not increase the incidence of postoperative flap necrosis and resulted in comparable postoperative function. In addition, superthin ALT flaps did not require additional flap refinement surgeries after facial skin reconstruction. The superthin ALT flap is a safe and reliable choice for obese patients with thick thigh subcutaneous tissue.

DOI： 10.1097/SCS.0000000000010652

Scopus

PubMed

Language：English   Publisher：Journal of Craniofacial Surgery  

Rapid ossification due to a subperiosteal hematoma in extremities has occasionally been documented in patients with neurofibromatosis type 1, but it has not been reported in the maxillofacial region. The authors present the first case of a subperiosteal hematoma in the forehead. A 36-year-old man presented with a rapidly swelling firm, fixed, 8×10 cm forehead mass. It became evident shortly after a fine-needle aspiration biopsy. Computed tomography imaging 2 months after the biopsy showed a hematoma that was encapsulated by a surrounding layer of ossification. Magnetic resonance imaging displayed a fluid-fluid level under the ossified area. These characteristic images led us to diagnose this rare lesion as a subperiosteal hematoma with ossification. Rapid ossification is a characteristic imaging finding of subperiosteal hematoma, which makes definitive diagnosis easy. It becomes imperative to underscore the potential risks of fine-needle aspiration in proximity to the periosteum in patients with neurofibromatosis type 1.

DOI： 10.1097/SCS.0000000000010413

Scopus

PubMed

Publisher：克誠堂出版(株)  

DOI： 10.18916/keisei.2024060010

CiNii Research

Language：English   Publisher：Japan Society for Surgical Wound Care  

Lymphorrhea, which is a challenging disease to manage, can be treated using noninvasive or invasive procedures. We herein report a case of intractable lymphorrhea that did not respond to multimodal treatments, including direct suture after excision, lymphaticovenous anastomosis, and negative-pressure wound therapy; however, complete resolution was achieved by free flap transfer. A 47-year-old woman presented with severe lymphorrhea in her right upper arm due to repeated partial excision of a large lymphangioma extending from the upper arm to the cervicothoracic region. Despite multiple attempts to manage lymphorrhea using noninvasive procedures, she experienced persistent lymph leakage and recurrent cellulitis. Surgical interventions, including lymphaticovenous anastomosis, were tried but were ineffective, and negative-pressure wound therapy also did not show satisfactory outcomes. Free-flap transplantation was performed using an anterolateral thigh flap. Following anterolateral thigh flap transplantation, the patient experienced complete resolution of lymphatic leakage. There were no signs of lymphedema or cellulitis, indicating successful relief of these complex symptoms for six months postoperatively. This report highlights the successful treatment of intractable lymphorrhea with free anterolateral thigh flap transplantation. For refractory lymphatic leakage, a comprehensive approach that considers both lymphatic flow reduction and the promotion of wound healing around the fistula is crucial. In cases of uncontrolled lymphorrhea, an alternative option, such as free flap transfer, should be recommended as surgical intervention.

DOI： 10.36748/ijswc.5.2_46

CiNii Research

Language：English   Publisher：(一社)日本創傷外科学会  

Language：Japanese   Publisher：The Japan Broncho-esophagological Society  

DOI： 10.2468/jbes.75.102

CiNii Research

Language：English   Publisher：Annals of Plastic Surgery  

Klippel-Trenaunay syndrome (KTS) is characterized by port-wine stains, mixed vascular malformations, and soft tissue and bone hypertrophy. Klippel-Trenaunay syndrome is occasionally complicated by chyluria, for which there is no effective treatment currently. We report a case of KTS complicated by intractable chyluria and hematuria due to a lymphatic-ureteral fistula. The patient was successfully treated with multiple lymphaticovenular anastomoses (LVAs). A 66-year-old woman with an enlarged left lower extremity since childhood was diagnosed with KTS. At 60 years of age, she developed chyluria (urine albumin, 2224 μg/mL) and hematuria. Lymphoscintigraphy showed a lymphatic-ureteral fistula near the ureterovesical junction. Conservative treatment was ineffective. She also developed left lower extremity lymphedema, which gradually worsened. Leg cellulitis and purulent pericarditis developed because of hypoalbuminemia (minimum serum albumin level, 1.3 g/dL). We performed 14 LVAs in 2 surgeries to reduce lymphatic fluid flow through the lymphatic-ureteral fistula. The chyluria and hematuria resolved soon after the second operation, and the urine albumin level decreased (3 μg/mL). After 28 months, she had no chyluria or hematuria recurrence and her serum albumin level improved (3.9 g/dL). Multiple LVAs can definitively treat chyluria caused by a lymphatic-ureteral fistula in patients with KTS.

DOI： 10.1097/SAP.0000000000003744

Web of Science

Scopus

PubMed

Language：English   Publisher：Microsurgery  

Background: Concomitant resection of the sciatic nerve along with a malignant tumor is no longer a contraindication for limb-sparing surgery, as most of these patients remain ambulatory. However, sciatic nerve reconstruction after sarcoma resection is not commonly performed. Restoration of nerve function can improve patient quality of life. We describe our experience with four patients who underwent sciatic nerve reconstruction using an ipsilateral common peroneal nerve graft at the time of sarcoma resection. Methods: Because of the low chance of peroneal nerve recovery, the ipsilateral peroneal trunk was used as a graft to reconstruct the tibial trunk of the sciatic nerve. Two patients were men and two were women. Mean age was 45.3 years (range, 15–62). Mean sciatic nerve defect length was 9.4 cm (range, 8.5–12.0). Proximal thigh defects (three patients) were reconstructed with a double cable; the one patient with a distal thigh defect underwent single cable reconstruction. Mean operation time was 492 min (range, 428–682). Results: Mean length of the harvested peroneal trunks was 21 cm (range, 11–26). Mean graft length was 11.9 cm (range, 11–13). Postoperative course was uneventful in all four patients. One patient died of sarcoma lung metastasis and could not be evaluated. Three patients were followed for more than 2 years. Two patients achieved British Medical Research Council grade 4 plantar flexion; the remaining patient achieved grade 5 plantar flexion and grade 4 toe flexion. Semmes–Weinstein monofilament sensory testing showed loss of protective sensation on the plantar surface in all three. Musculoskeletal Tumor Society scores at last follow-up were 60.0%, 70.0%, and 43.3%, respectively. Conclusions: Immediate sciatic nerve reconstruction using an ipsilateral common peroneal nerve graft avoids reconstruction delay and scar tissue formation, which is advantageous for nerve recovery. This technique may be considered when sciatic nerve resection is anticipated during sarcoma resection.

DOI： 10.1002/micr.31034

Web of Science

Scopus

PubMed

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

Language：Japanese   Publisher：THE JAPAN LARYNGOLOGICAL ASSOCIATION  

<p>Postoperative pharyngocutaneous fistula after head and neck surgery is a devasting complication that increases hospitalization time and delays the initiation of oral intake and postoperative adjuvant therapy. Although it is commonly experienced, the treatment strategy differs greatly according to the size and site of the fistula and the preference of the surgeon, and a standard therapy remains to be established.</p><p>Since it was first reported in 1997, negative pressure wound therapy (NPWT) has been widely applied in the treatment of complicated intractable wounds all around the body. However, its use in the treatment of head and neck fistulas has been less frequent because of the numerous undulations of the skin on the surface of the head and neck, which make an airtight seal difficult to achieve. In addition, salivary contamination and possible air leakage from the fistula are major obstacles in applying NPWT to head and neck fistulas.</p><p>We have actively applied NPWT in the management of head and neck fistulas and have successfully treated these complicated wounds. Thorough wound bed preparation and the application of hydrocolloid materials around the wound edge have enabled the continuation of NPWT without leakage and infection. Incisional drainage performed a small distance from the location of the fistula was helpful for avoiding leakage during NPWT.</p><p>In this article, we present our current treatment strategy utilizing NPWT for head and neck fistulas and delineate the tips for avoiding leakage during NPWT.</p>

DOI： 10.5426/larynx.34.81

CiNii Research

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：English   Publisher：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

Language：Japanese   Publisher：(公財)日本眼科学会  

背景:炎症性筋線維芽細胞性腫瘍(IMT)は筋線維芽細胞の増殖と炎症細胞浸潤を特徴とする中間悪性腫瘍であり,肺,腹腔骨盤内,後腹膜に好発し,眼窩に発生することはまれである.今回,眼窩に発生したIMTの1例を経験したので報告する.症例:46歳,女性.複視を主訴に近医眼科を受診し,眼窩に腫瘍を指摘され九州大学病院眼科を紹介受診した.初診時に右眼球結膜下の赤色調腫瘤および画像診断で右眼窩内下方に35×20×15mmの紡錘形腫瘤を認め,眼球運動障害を来していた.結膜下の腫瘤を生検したところ,炎症細胞浸潤を伴った紡錘形細胞の増殖を認めた.免疫染色の結果,増殖細胞はanaplastic lymphoma kinase(ALK),α-平滑筋アクチン(α-SMA),desmin陽性であり,IMTと診断した.結膜切開および鼻内視鏡下にアプローチして全摘出し,術後24ヵ月の現在,再発は認めていない.結論:眼窩腫瘍で非上皮性腫瘍を疑う際はIMTの可能性も検討する必要がある.(著者抄録)

Publisher：克誠堂出版(株)  

DOI： 10.18916/j00398.2022224310

CiNii Research

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

Language：English   Publisher：Auris Nasus Larynx  

Objective: Concave deformities and gustatory sweating are the most common complications that cause substantial patient dissatisfaction after parotidectomy. Various surgical methods to prevent these complications have been described. However, effective techniques have not been established, especially in patients with medium- to large-sized parotidectomy defects. We evaluated the utility of infrahyoid myofascial flap reconstruction of parotidectomy defects for the prevention of these complications. Methods: We conducted a retrospective case series study in patients with a benign or malignant parotid tumor measuring over 4 cm who underwent immediate pedicle infrahyoid myofascial flap reconstruction after total or subtotal parotidectomy or total resection of either the superficial or deep parotid gland at our hospital. Subjective analyses of facial symmetry, postoperative concave deformities of the anterior neck, gustatory sweating, voice disorders, odynophagia, neck scarring in the parotid and anterior neck areas, sensory disorders, pain, and neck stiffness were performed using patient interview data. Objective evaluations of facial symmetry were made by the first or second author. Both analyses were performed after a follow-up of more than six months. Additionally, patient demographic data, clinicopathological factors, parotidectomy and skin incision types, flap survival, and postoperative complications were evaluated. Results: We included eight patients (male, n=5; mean age, 69.3 years [range, 37–93 years]). Procedures included total or subtotal parotidectomy (n=4), superficial lobe parotidectomy (n=2), and deep lobe parotidectomy with partial superficial lobe parotidectomy (n=2). Infrahyoid myofascial flaps reached the cranial tip of the parotid defect without tension, and their volume sufficiently filled the parotidectomy defect in all patients. There were no local signs of insufficient blood flow within the transferred flaps. Objective and subjective assessments were made after a mean duration of 1.2 years (range, 0.6-1.8). Postoperatively, no patient subjectively reported facial asymmetry. Objectively, facial symmetry was “good” in four patients and “fair” in four patients. No distinctly visible concave deformity in the parotid or anterior neck area occurred in any patient. Gustatory sweating occurred in one patient; this individual had the largest parotidectomy defect. Only one patient experienced donor site morbidity (mild anterior neck stiffness) related to infrahyoid myofascial flap elevation. Conclusion: Although complete prevention of gustatory sweating was unsuccessful, infrahyoid myofascial flap reconstruction of medium- to large-sized parotidectomy defects led to postoperative facial symmetry with minimal donor site morbidity.

DOI： 10.1016/j.anl.2021.10.012

Web of Science

Scopus

PubMed

Language：English   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

耳下腺切除術の術後合併症である陥凹変形と味覚性発汗の予防を目的に、切除による欠損を舌骨下筋筋膜皮弁(infrahyoid myofascial flap;IHM皮弁)で再建する方法の有用性を評価した。大きさが4cm超の良性・悪性の耳下腺腫瘍に対し、2009年5月～2010年12月に切除術と有茎IHM皮弁での即時再建術を施行した自験例8名(男性5名、年齢37～93歳)を後方視的に調査した。その耳下腺切除術が全摘・亜全摘であった症例は4名、浅葉切除は2名、浅葉の部分切除を伴う深葉切除は2名であった。どの再建例でもIHM皮弁は耳下腺欠損創の頭側端まで張力をかけなくても届き、その皮弁体積は欠損創を充填するのに十分であった。移行した皮弁で血流不足の局所徴候が観察された例も無かった。手術から平均で1.2年後に評価が行われたが、主観的に顔面非対称を訴えた患者はいなかった。客観的にも顔面の対称性は4名で良好、4名で可と判定された。耳下腺領域または前頸部に陥凹変形が肉眼的にはっきりと認められた患者はいなかった。味覚性発汗は1名でのみ発生したが、この患者は切除術で欠損が最も大きく生じていた症例であった。皮弁挙上に関連した合併症としては、軽度の前頸部硬直が1名のみ認められた。耳下腺切除術による欠損が中型以上の症例にIHM皮弁再建を行うことで顔面の対称性が達成され、移植部位の合併症は最小限に留まった。

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

Language：Japanese   Publisher：(一社)日本手外科学会  

上肢皮膚欠損6例に対し,薄層型浅腸骨回旋動脈穿通枝皮弁による再建を行った.術前カラードプラエコー検査で浅腸骨回旋動脈浅枝・深枝および浅下腹壁動脈について精査し,これらの栄養血管の中で良好に発達しているものを含めて皮島をデザインした.皮弁の剥離は浅筋膜に沿って行い,浅脂肪層のみを含めて皮弁を挙上した.皮島の大きさは平均15×6.7cm,厚さは平均4.5mmであった.栄養血管を浅枝のみとしたのが2例,浅枝と深枝の両方を含めたのが1例,浅枝と浅下腹壁動脈を含めたのが3例であった.全例で術後血栓や部分壊死等の周術期合併症を認めず,皮弁は全生着した.皮島の厚さは適度であり,経過観察期間中に皮弁のdefattingを目的として再手術を行った症例はなかった.上肢皮膚欠損の再建において薄層型浅腸骨回旋動脈穿通枝皮弁は皮弁の薄さ,安全性,低侵襲性の点で有用な選択肢であると考える.(著者抄録)

Language：English   Publisher：Japan Society of Plastic and Reconstructive Surgery  

<p><i>Objectives</i>: Fingertip injuries are common, and there are many techniques used for reconstruction. The authors reviewed the outcomes of fingertip reconstruction, including sensation and shape, using the combined technique of the adipofascial cross-finger flap and glabrous skin graft and defined the optimal dimensions of fingertip defect that is applicable to this technique.</p><p><i>Methods</i>: Between 2006 and 2016, 10 cases, aged 3-60 years (mean, 28.1 years), who had undergone fingertip reconstruction using a combination of the adipofascial cross-finger flap and glabrous skin graft were reviewed. The presence of fingertip and nail deformity and the results of the Semmes-Weinstein monofilament and static two-point discrimination tests were analyzed.</p><p><i>Results</i>: Fingertip deformity was noted in three cases where the defect was more than 50% of the Tamai zone I or extended to zone II. Mild nail plate deformity was found in three cases with more than 40% of the nail bed defect. Two of these three cases presented with partial phalangeal tuft defects. Eight fingers were examined using the Semmes-Weinstein test, and their scores were between 2.83 and 4.31 in five fingers and 4.56 in three fingers. Six were examined for static two-point discrimination, with 5 mm in three, 6 mm in one, and 10 mm in two. The color and contour of all donor fingers were almost typical.</p><p><i>Conclusions</i>: The combination of the adipofascial cross-finger flap and full-thickness glabrous skin graft is applicable to around 50% of fingertip defect within the Tamai zone I, achieving a satisfactory shape and regaining more than protective sensation.</p>

DOI： 10.53045/jprs.2021-0002

Web of Science

PubMed

CiNii Research

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

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

脂肪筋膜指交叉皮弁と無毛皮膚グラフトを用いて指尖部再建を行った10症例(平均28.1歳)について検討した。玉井分類zone Iの50%以上またはzone IIまで拡大した欠損の3例に指尖変形がみられた。爪床の40%以上が欠損した3例に軽度の爪甲変形がみられた。これら3例中2例に末節骨粗面の欠損がみられた。隣接指を皮弁ドナーとして再建術を行った。術後のフォローアップ期間の中央値は184.5日(範囲60～1533)であった。術後にモノフィラメント検査を用いて8指の触覚を調べた。その結果、スコアは5指で2.83～4.31、3指で4.56であった。6指に静的二点識別覚検査を行い、識別閾値5mmが3例、6mmが1例、10mmが2例であった。ドナー指の外形および色はほぼ正常であった。

Language：Japanese   Publisher：Japan Society of Cranio-Maxillo-Facial Surgery  

<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

Language：Japanese   Publisher：Japanese Society of Reconstructive Microsurgery  

<p>  Presently, robotic surgeries are increasing rapidly in the fields of urologic and general surgery. Surgical robots can reduce surgeon’s finger tremors and facilitate precise maneuvers, which are advantageous in microsurgery. In Europe, two types of surgical robotic systems were created for microsurgery, and they have begun to be used in clinical practice.　<BR>  We have been working on the development of a new surgical robot specialized for microsurgery since 2017. Our goal was to make robotic hands with following accuracy of less than±0.01 mm and use a 3D monitor with 8K resolution in place of the surgeon’s eyes. In 2021, we succeeded in anasto-mosing an artificial vessel of less than 1 mm in diameter using our test model. We are aiming to complete the final product, which will be used to suture lymphatic vessels of less than 1 mm, by 2024.　<BR>  The exoscope has begun to be introduced in the field of microsurgery as another option to the surgical microscope. By using the exoscope, surgeons can perform microsurgery with a wide working space and relaxed posture, which reduce the physical burden on microsurgeons.　<BR>  The latest information and the pros and cons of these new devices are reviewed in this article.</p>

DOI： 10.11270/jjsrm.35.74

CiNii Research

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

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

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

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

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

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

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

Background: As the base of the tongue (BOT) plays essential roles in speech and swallowing, surgical resection of BOT cancer is typically avoided. Moreover, standard reconstructive procedures for larynx-preserving BOT defects have not yet been established. We performed immediate flap reconstruction after wide resection of BOT cancer with laryngeal preservation. Herein, the functional and oncological results of our strategy were analysed. Methods: We retrospectively evaluated patients who underwent extended BOT resection (including the oral tongue, upper/lateral oropharyngeal wall, epiglottis and false vocal cord) with laryngeal preservation between April 2006 and April 2016. We classified defects involving the oral tongue or upper/lateral oropharyngeal wall as the lateral extension type and those involving the epiglottis or false vocal cord as the laryngeal extension type. Lateral extension-type defects were closed primarily and filled with a deepithelialised skin or muscle flap. Laryngeal extension-type defects were reconstructed using a bulky skin flap plus hyo-thyroid-pexy to create a neo-epiglottis. Postoperative functional and oncologic outcomes were assessed. Results: We enrolled 18 patients with extended BOT defects. Of them, 11 had a history of irradiation. The tracheal cannula was removed in all cases, although laryngeal extension defects were associated with a longer duration to removal. All patients achieved complete oral intake and retained intelligible speech, with preservation of laryngeal function. There was no local recurrence, and the 5-year overall survival was 88.9%. Conclusions: Following wide BOT resection, reconstruction with laryngeal preservation is feasible even in cases involving irradiated tumours with laryngeal extension.

DOI： 10.1016/j.bjps.2019.11.018

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

DOI： 10.5005/jp-journals-10080-1442.

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

Background: Because of the difficulty of airtight sealing and risk of salivary contamination, negative-pressure wound therapy (NPWT) has rarely been applied for postoperative fistula following head and neck surgery; thus, its utility remains unclear. Methods: We applied NPWT in 34 patients who developed orocutaneous and pharyngocutaneous fistula after head and neck surgery. Here we retrospectively analyzed the utility of NPWT for managing those fistulas. Results: Thirty-two patients (94.1%) underwent NPWT as scheduled without adverse events. In 28 patients (82.4%), fistula closure was completed only by NPWT, and the mean period to fistula closure was 30.4 days. The mean period to closure did not differ significantly between fistulas with (21.7 days) and without (39.1 days) previous irradiation. Conclusions: Airtight sealing can be maintained and postoperative fistula can be closed by NPWT with a high success rate, even after previous irradiation. NPWT is an effective and minimally invasive treatment for postoperative fistula.

DOI： 10.1002/hed.25989

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

Background Conventional methods of external bleeding for congested fingertip replants exhibit notable problems, including uncontrollable bleeding and unpredictable survival of the replant. We have added a local injection of heparin calcium to the routine use of systemic heparinization for inducing external bleeding. We retrospectively examined patients who underwent external bleeding using our method. Methods Local subcutaneous injections of heparin calcium were made in 15 congested replants in addition to systemic heparinization. Each injection ranged from 500 to 5,000 U. The average duration of the injections was 4.1 days. Surgical outcomes were analyzed and compared with a control group of patients who underwent external bleeding without heparin calcium. Results The overall survival rate was 93.3%, which was higher than that of the control group (83.3%), but the difference was not statistically significant (P= 0.569). The survival rate for subzones I and II by the Ishikawa subzone classification was 100%, whereas it was 87.5% in subzones III and IV. No statistically significant difference was observed. The rate of partial necrosis was 0% in subzones I and II, whereas it was significantly higher (66.7%) in subzones III and IV (P=0.015). The mean total blood loss via external bleeding was 588 g in 10 fingers. No patients required blood transfusion. Conclusions Congestion of a replanted fingertip can be successfully managed without blood transfusion by our method. Although complete relief from congestion in replants in subzones I and II is achievable, there is a higher risk of partial necrosis in subzones III and IV.

DOI： 10.5999/aps.2019.00815

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

Background: Modern microsurgical reconstruction aims to achieve functional and satisfactory esthetic outcome and the primary thinning procedure results in one-stage reconstruction. However, current techniques are lacking preoperative knowledge of the peripheral perforator in the adipose layer. We hypothesized that the combination of the knowledge of microvasculature and visualization of such small vessels in the adipose layer by Color Doppler ultrasonography (CDU) will make the dissection of these vessels with simultaneous flap thinning of the perforator branch flap technique feasible and provide consistent results in variety of flaps. Methods: Retrospective chart review of consecutive cases in which perforator branch flap technique was used from 2011 to 2019 was conducted. Entire course of branch of the perforator in the adipose layer were traced up to the dermis by CDU, and marked on the skin surface. Based on CDU finding, perforator branches were dissected in the adipose layer simultaneously with the primary thinning of the skin flap. Results: Thirty perforator branch flaps in 28 cases were elevated. Courses of the perforator branches detected by CDU accurately corresponded to surgical findings in all cases. There was no total flap loss in any of the cases and partial necrosis in one case. In five flaps, a secondary debulking procedure was needed. Conclusions: The combination of knowledge of microvasculature with CDU guidance has made the perforator branch technique possible and allowed to safely transfer the skin flap from various body areas to the defect, thereby, achieving “like with like” reconstruction in one-stage.

DOI： 10.1016/j.bjps.2019.09.036

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

Toxic shock syndrome is a rare but life-threatening complication after breast implant surgery. We describe a 77-year-old woman who developed toxic shock syndrome caused by methicillin-resistant Staphylococcus aureus after breast implant reconstruction. Despite a high fever and markedly increased white blood cell count, suggesting severe infection, she initially had no symptoms of local findings, such as wound swelling and redness of the breast. Soon after diagnosis of toxic shock syndrome and removal of her breast implant, she was recovered from the shock state. To date, 16 cases of toxic shock syndrome have been reported, including this case, and they were related to breast implants or tissue expander surgery. The common and noteworthy characteristic of these cases was the lack of local findings, such as swelling or redness, which suggests infection. Therefore, early diagnosis is generally difficult, and the initiation of proper treatment can be delayed without knowledge of this characteristic. Toxic shock syndrome requires early diagnosis and treatment. If the patient has a deteriorated vital sign after breast implant surgery or tissue expander breast reconstruction, toxic shock syndrome should be suspected, even if there are no local signs of infection, and removal of the artifact should be considered as soon as possible.

DOI： 10.1097/SAP.0000000000001868

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

Objective: Negative-pressure wound therapy (NPWT) is generally applied as a bolster for split-thickness skin grafts (STSG) after the graft has been secured with sutures or skin staples. In this study, NPWT was applied to secure STSGs without any sutures or staples. Surgical outcomes of using NPWT without sutures was compared with a control group. Methods: Patients with STSGs were divided into two groups: a 'no suture' group using only NPWT, and a control group using conventional fixings. In the no suture group, the grafts were covered with meshed wound dressing and ointment. The NPWT foam was placed over the STSG and negative pressure applied. In the control group, grafts were fixed in place using tie-over bolster, securing with fibrin glue, or NPWT after sutures. Results: A total of 30 patients with 35 graft sites participated in the study. The mean rate of graft take in the no suture group was 95.1%, compared with 93.3% in the control group, with no significant difference between them. No graft shearing occurred in the no suture group. Although the difference did not reach statistical significance, mean surgical time in the no suture group (31.5 minutes) tended to be shorter than that in the control group (55.7 minutes). Conclusion: By eliminating sutures, the operation time tended to be shorter, suturing was avoided and suture removal was not required meaning that patients could avoid the pain associated with this procedure. Furthermore, the potential for staple retention and its associated complications was avoided, making this method potentially beneficial for both medical staff and patients. Declaration of interest: The authors report no conflicts of interest.

DOI： 10.12968/jowc.2019.28.Sup8.S16

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

Background: We report a novel reconstruction technique that maintained effective swallowing after total glossolaryngectomy (TGL) by restoring pharyngeal constriction using a vascularized vastus lateralis muscle transfer. Methods: A 65-year-old male with recurrent tongue cancer underwent TGL and anterolateral thigh flap reconstruction with the vastus lateralis muscle. The bilateral cut ends of the remaining posterior pharyngeal wall constrictor muscle were sutured to the transferred vastus lateralis muscle so that the two muscles encircled the reconstructed pharynx. The femoral nerve of the vastus lateralis muscle was coapted to the hypoglossal nerve. Results: Videofluorographic examination showed the contrast bolus flowing smoothly with little assistance from gravity. Laryngoscopic examination showed circumferential constriction of the reconstructed pharynx. The patient could swallow soft food without placing the bolus in his posterior oral cavity or drinking simultaneously. Conclusion: The restoration of pharyngeal constriction introduces the possibility of functional swallowing in patients after TGL.

DOI： 10.1002/hed.25735

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

Fournier's gangrene is lethal necrotizing fasciitis that involves the perineum and external genitalia. We describe the case of a 52-year-old man with Fournier's gangrene who underwent reconstruction of an extensive perineoscrotal defect using three pedicled perforator flaps. Three debridement procedures resulted in a skin and soft tissue defect of 36 × 18 cm involving the perineum, scrotum, groin, medial thigh, buttocks, and circumferential perianal area and left the perforating arteries originating from these locations unavailable for reconstruction. We repaired the defect using left deep inferior epigastric artery perforator (DIEP) (29 × 8 cm) and bilateral anterolateral thigh perforator (ALT) flaps (35 × 8 cm and 22 × 7 cm). The flaps reached the defect without tension, and the defect was successfully covered without a skin graft. No postoperative complications occurred except for epidermal necrosis involving a tiny part of the DIEP flap tip. Nine months postoperatively, the patient experienced no impairment of bowel function or hip joint movement. There was also no avulsion or ulceration of the reconstructed perineal skin, and the cosmetic appearances of the healed wound and donor site were satisfactory. The combination of these three perforator flaps enabled us to achieve a satisfactory outcome while avoiding skin grafts.

DOI： 10.1002/micr.30409

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

Introduction. Soft tissue sarcomas are rare neoplasms, and most plastic surgeons do not commonly resurface large tissue defects after a wide resection of these tumors. Objective. The purpose of this study is to elucidate the clinical results of large skin grafts after wide sarcoma resection by comparison with grafts for traumatic skin defects. Materials and Methods. A retrospective review was performed of patients who received skin grafts > 50 cm² after traumatic injury or wide sarcoma resection from 2014 to 2016. Patient medical records were reviewed; graft take rate, graft loss, and days to complete epithelialization were compared between the 2 groups. Results. In the sarcoma group (n = 8), 5 grafts were partially lost; the sarcoma group mean graft take rate of 67.5% ± 30.0% was significantly lower than that of the trauma group (n = 7) at 99.6% ± 1.1%. The mean time to complete epithelialization from the skin graft placement in the sarcoma group was 113.3 ± 66.0 days, which was significantly longer than that of the trauma group (40.3 ± 38.0 days). Wounds located around the shoulder joint in 2 sarcoma group patients did not heal even after 300 days of conservative treatment; 1 required a secondary flap. Conclusions. The results of skin grafting for resurfacing large defects after sarcoma resection are inferior to those for traumatic injury repair. Skin grafts may fail because the blood supply for the wound bed is impaired during resection. Furthermore, due to the wound bed movement, epithelialization over muscles of the shoulder joint is difficult to achieve, and skin grafts in this region will likely fail.

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

Infection is a serious potential complication after left ventricular assist device (LVAD) implantation. In general, infection of the device pocket, with device exposure, should be managed by early device removal and heart transplantation. However, because of the small number of donors in Japan, accelerating access to heart transplantation is often difficult and the LVAD can be widely exposed during the waiting period. We report our experience of successful heart transplantation in a patient with a widely exposed LVAD with pocket infection. A 48-year-old man suffered from heart failure due to idiopathic dilated cardiomyopathy. An LVAD was implanted, but postoperative infection led to blood pump exposure. Heart transplantation was performed 4 months after LVAD exposure, at which time the epigastric skin defect measured 14 × 8 cm. The skin defect could not be closed after heart transplantation, so it was covered by an omental flap with split-thickness skin grafts. 7 days postoperatively, the peritoneal suture broke and the intestinal tract prolapsed outside the body. Reintroduction of the prolapsed intestinal tract and deep inferior epigastric artery perforator (DIEP) flap coverage of the omental flap were performed. The postoperative course was uneventful. There have been no reports of the management of wide skin defects in the presence of infection when heart transplantation is performed. Omental flap placement was useful for controlling long-lasting infection. An omental flap placed in a patient with a wide epigastric skin defect should be covered by durable skin flap, such as a DIEP flap, to avoid intestinal prolapse.

DOI： 10.1007/s10047-018-1075-9

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

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

Background: Facial edema is a common complication after neck dissection and/or chemoradiotherapy for head and neck cancer. Edema subsides spontaneously in most cases but sometimes persists, in which case surgical intervention is required. We report a case of severe facial edema that showed significant improvement upon lymphovenous anastomosis (LVA). Methods: A 66-year-old man with oral floor cancer developed progressive facial lymphedema after tumor resection, bilateral neck dissections, chemoradiotherapy, and fibular and rectus abdominis musculocutaneous flap transfer. His eyesight was completely disturbed due to severe eyelid edema. The LVAs were performed in the bilateral preauricular area. Surgical findings showed stagnation of the lymphatic fluids in dilated lymphatic vessels, which were drained to the superficial temporal veins by LVA. Results: The edema subsided rapidly and the patient's eyesight returned as soon as 4 days postoperatively. Conclusion: Using LVA in the preauricular region can be a choice of surgical treatment for severe facial edema.

DOI： 10.1002/hed.25206

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

DOI： 10.1016/j.hrcr.2017.06.006

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

Between April 2006 and January 2016, 18 patients underwent total glossectomy with laryngec-tomy and free or pedicle flap reconstruction. Postoperative videofluorography was performed in all 18 patients and the results analyzed. Fourteen patients (77.8%) achieved complete oral intake without the aid of gastric tube feeding. In 7 patients (38.9%), clearance of the pharynx was excellent and the contrast medium entered the esophagus within a few minutes of swallowing. These patients were able to take the contrast medium smoothly into the esophagus of their own volition, without the help of gravity. Their method of swallowing was defined in this study as acquiring "functional swallow", while in 11 patients who did not acquire "functional swallow", clearance of the pharynx was poor and the contrast medium did not enter the esophagus despite repeated swallowing. This was caused mainly by optional contraction of the remnant posterior pharyngeal wall ; contraction of the remnant posterior pharyngeal wall was very weak, and the passage of the contrast medium was partly dependent on gravity. These patients were thus taking contrast medium into the esophagus with the help of gravity. Statistical analyses were performed to compare those patients who acquired "functional swallow" with those who did not: the parameters included age, radiotherapy dose, neck dissection, lip closure, velopharyngeal competence, constriction of the poste-rior pharyngeal wall, reconstructed pharyngeal shape, and the type of flap used. Strong contraction of the remnant posterior pharyngeal wall, the ability to close the lips, and velopharyngeal competence showed statistically significant differences. To achieve "functional swallow" after total glossectomy with laryngectomy, not only is strong contraction of the remnant pharyngeal constrictor muscle considered necessary, but also the ability to close the lips and the presence of velopharyngeal competence. In patients who have strong pharyngeal constrictor muscle power, but without lip insufficiency and velopharyngeal incompetence, the pharyngeal space could be reconstructed slightly narrower, not "funnel-shaped", in order to create strong swallowing pressure.

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

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

Background : Bone contouring is currently the best treatment for fibro-osseous lesions after bone growth arrest. Navigation systems available for this surgery allow intra-operative visualization. However, assessment after contouring surgery with the navigation system has rarely been reported. Method : To assess the utility of this surgery we used a 3D (three dimensions) resection rate. This is defined as real contoured volume measured with postoperative CT data divided by planned volume to contour preoperatively. Result : We used this method to contour fibro-osseous lesions in five patients. 3D resection volume was 8114.9mm3 (3109mmM9779mm3) in average. 3D resection rate was 63.9% (50.6%-87.7%) in average. These data present reasonable resection rate compared with other reports. All patients achieved acceptable facial contour line and improvement in symptoms. Conclusions : 3D resection rate is a new quantitative method measuring the rate of resected area for a targeted bulging bone. This rate presents a simple and easy assessment for surgical contouring of the orbital fi-bro-osseous lesions.

DOI： 10.11453/orltokyo.59.6_354

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

The dorsalis pedis tendocutaneous (DPTC) free flap is an ideal option for the reconstruction of the combined defect of the dorsal hand skin andmultiple extensor tendons, whereas it possess not only soft tissue problems, but also symptomatic drop toe deformity in the donor site. We have corrected this drop toe deformity with a tendon transfer technique, using the extensor hallucis brevis muscle, which was preserved during the DPTC free flap harvest. The donor site exposing the transferred tendons was covered with another thin free flap. Two cases that underwent this technique exhibited satisfactory alignment and active extension of the toes. This tendon transfer technique combined with free flap coverage overcomes almost all the problems in the donor site of the DPTC free flap, achieving excellent contours of both the dorsal hand and the foot.

DOI： 10.1097/SAP.0000000000000411

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

We present the case of an 80-year-old man with a tumor recurrence on his right arm 6 years after initial treatment. The lateral aspect of the elbow joint, involving overlaying skin, muscles, tendons, joint capsule, lateral collateral ligament complex, the lateral 1/3 of the capitellum, and lateral epicondyle of humerus were excised in the tumor resection. Intraoperative assessment revealed multidirectional instability of the elbow, and joint stabilization was needed. Because the lateral epicondyle was resected, graft placement in an anatomical position was impossible to carry out. Therefore, non-anatomical reconstruction of lateral ulnar collateral ligament with palmaris longus tendon graft was performed. The skin was reconstructed using an antegrade pedicled radial forearm flap. For wrist extension reconstruction, the pronator quadratus tendon was transferred to the extensor carpi radialis brevis tendon. One year after the operation, elbow range of motion was 5–130°. The patient remains symptom free. The Mayo elbow performance score is good. The Musculoskeletal Tumor Society rating score is excellent. To our knowledge, this is the first report of an elbow lateral ulnar collateral ligament reconstruction after tumor resection.

DOI： 10.1007/s11751-015-0235-1

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

Introduction To prevent postoperative pharyngocutaneous fistula (PCF) after total (pharyngo)laryngectomy, simultaneous coverage of pharyngeal anastomosis with vascularised flaps such as pectoralis major muscle, anterolateral thigh or radial forearm, has been reported to be effective. As an alternative to the invasive methods using distant flaps, we used the infrahyoid myofascial flap (IHMFF), which was harvested from the same operation field of (pharyngo)laryngectomy, for covering the site of pharyngeal anastomosis. Herein, we describe the safety and effectiveness of our minimally invasive method for preventing PCF. Methods Eleven patients who were at a high risk of developing PCF due to previous chemoradiotherapy underwent simultaneous coverage of pharyngeal anastomosis with IHMFF after total (pharyngo)laryngectomy. The incidence of PCF and the rate of major fistula requiring surgical closure were determined, and the results were compared with the control group (23 patients without IHMFF cover after laryngectomy). Results PCF developed in 2 of the 11 patients (18.2%). The fistulae of these two patients were closed conservatively and did not require additional surgery. PCF developed in 6 of 23 patients (26.1%) in patients without IHMFF cover. All the six patients with fistula required additional closure surgery. The incidence of PCF did not differ in patients with or without IHMFF cover (Fisher's exact probability test; p = 0.939, NS). However, the rate of major PCF requiring surgical closure was significantly lower in patients with IHMFF cover (Fisher's exact probability test; p = 0.036 <0.05). Conclusions For (pharyngo)laryngectomy patients, IHMFF cover is a minimally invasive method that can prevent major PCF.

DOI： 10.1016/j.bjps.2013.03.033

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

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

Objectives: Microsurgery is difficult to perform in necks that have been previously irradiated and operated upon because of the limited availability of recipient vessels. The objective of this study was to clarify the feasibility and safety of performing microsurgery in necks that are scarred and fibrous owing to previous treatment. Methods: Twenty patients whose necks were previously irradiated and operated upon and who underwent free tissue transfer were included in this study. All patients had been previously administered an average of 60.7 (range, 30-95). Gy of radiotherapy. Thirteen patients had undergone hemilateral neck dissections, 5 patients had undergone bilateral neck dissections, 8 patients had undergone (pharyngo)laryngectomies, and 10 patients had undergone prior flap transfer. The success rate of microsurgery and the selection of recipient vessels were examined. Results: All recipient vessels could be adopted in the neck field without vessel grafting. One patient developed necrosis of the flap, which was salvaged with retransfer of another flap after trimming the same cervical vessels. For the remaining 19 patients, free tissue transfers were successful. Conclusions: Suitable recipient vessels are residual and available even in the previously irradiated and operated neck field. When performed properly, free tissue transfer in the previously treated neck is not as risky a surgery as was generally believed.

DOI： 10.1016/j.anl.2011.09.006

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

Reconstruction of a tracheal defect is a challenge because it often requires invasive surgery associated with relatively high morbidity. We recently invented a less-invasive method using a modified infrahyoid myocutaneous (IHMC) flap for the reconstruction of a tracheal defect in an 83-year-old male. A tracheal defect, the right half of the cricoid cartilage plus the right three quarters of the I-IV tracheal cartilage (about 3 × 4 cm), was reconstructed with a modified IHMC flap composed of the sternohyoid and platysma muscles and a skin pedicle. Considering the age of patient, we avoided rigid reconstruction and used a soft silicone tracheal opening retainer (Koken Co., Ltd., Tokyo, Japan) as an anterior wall dilator after surgery and waited for the scarring of the flap until it become rigid enough. The postoperative course was uneventful and the trachea was reconstructed safely. Tracheal reconstruction with an IHMC flap is a useful and less-invasive alternative compared to end-to-end anastomosis or reconstruction with a forearm flap, which is currently used as a mainstay.

DOI： 10.1002/lary.23194

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

Malignant neoplasms occurring from the trachea are extremely rare. Therefore, their clinical characteristics and surgical results have not been thoroughly discussed. These tumors are often misdiagnosed and treated as bronchial asthma or chronic obstructive pulmonary disease. It is critically important to probe the cause-effect relationship between the medical presentations and the clinical diagnosis. In this report, two cases of tracheal malignancy suffering from dyspnea due to obstruction of the proximal trachea are described, and a review of the literature is presented.

DOI： 10.1159/000339408

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

DOI： 10.1002/lary.23216

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

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

Pharyngocutaneous fistula (PCF) is one of the most troublesome postoperative complications after head and neck cancer surgery, such as total laryngectomy, and especially in patients with previous radiotherapy, it takes longer to be completely cured. Generally, PCF is treated with adequate drainage, neck compression and frequent dressings. When spontaneous closure is not achieved with these conservative treatments, surgical closure with free or local flap is needed. In this report, we review two cases of postoperative PCF treated with Negative Pressure Wound Therapy (NPWT). NPWT is a relatively new method which is thought to promote healing of complicated wounds by utilizing topical negative pressure. Initially, there was concern that NPWT for PCF may promote salivary leak or air leak which would inhibit wound healing. However, in both of our cases, excellent wound healing was obtained and the fistula was successfully closed without surgical procedure. In addition to the effect of promoting healing, NPWT could save the time and effort of medical staff for performing frequent dressings. We consider that NPWT is a useful option for the treatment of postoperative PCFs.

DOI： 10.5981/jjhnc.37.439

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

Free flaps are considered to revascularize from the surrounding tissue and survive without their original pedicle flow after a certain period postoperatively. We report 2 patients who developed mucosal ischemia of the transferred jejunum by ligation of its vascular pedicle 10 and 25 months after microvascular free jejunal transfer. Both patients had a history of heavy smoking, and had undergone definitive radiotherapy and previous surgery to the recipient bed. Both were treated conservatively; however, a stenotic change of the transferred jejunum remained in 1 patient. If poorly revascularized flaps, such as jejunal flaps, were transferred to the irradiated and scarred recipient bed, revascularization might never reach completion. If pedicle division is required in such cases, reanastomosis of the pedicle would be ideal regardless of the time after the transfer.

DOI： 10.1097/SAP.0b013e3181fe32cc

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

We reviewed seven patients who underwent reconstruction using an infrahyoid myocutaneous flap after ablative surgery for head and neck cancers, and examined the safety and eligibility of using this flap. Although one patient developed partial necrosis of the skin island, the other six patients showed total survival of the flap. The patient with partial flap loss developed a small pharyngocutaneous fistula, and two other patients developed local wound infection without fistula, but those complications healed conservatively. The time taken till starting oral intake ranged from 5 to 20 days after surgery (mean: 9 days), and all patients finally regained oral intake without tube feeding. Because the skin island and the feeding vessels of the infrahyoid myocutaneous flap are included in the neck and the flap is technically easy to harvest, using this flap is minimally invasive for head and neck cancer patients. However, the flap is not indicated for some patients due to the size and position of the primary tumor and neck lymph node metastases. If eligible patients are properly selected, the infrahyoid myocutaneous flap provides a safe and useful option in head and neck reconstruction.

DOI： 10.5981/jjhnc.37.126

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

Objective: Through our experiences in the parapharyngeal space (PPS) surgery, we have learned that it is possible to gain wide exposure of the PPS near to the skull base with a transcervical approach alone. Thus, we presumed that if this type of transcervical approach would be combined with a transoral approach, a less invasive oropharyngectomy without mandibulotomy and lip-splitting might be feasible for the resection of advanced oropharyngeal cancer, sparing the morbidities associated with conventional mandibular swing approach or its modified procedures. We termed this method as a mandible preserving pull-through oropharyngectomy (MPPO) and evaluated its feasibility and efficacy in this pilot study. Materials and methods: MPPO was applied for a series of 7 patients with advanced lateral and/or upper oropharyngeal cancer including 2 patients with T4 stage. Our current application of MPPO excludes tumors, which involves mandibular bone, the higher part of the medial pterygoid muscle, and the lateral pterygoid muscle. Results: Safe and sufficient excision of tumors was feasible by MPPO avoiding morbidities associated with mandibulotomy or lip-splitting without compromising oncological outcomes. Conclusions: Although preliminary, our favorable outcomes indicate that MPPO might be a useful alternative to conventional mandibular swing approach or its modified procedures for selected cases with advanced oropharyngeal cancer. Further accumulation of data is encouraged.

DOI： 10.1016/j.anl.2010.08.010

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

Thymidylate synthase (TS) is a major target of 5-fluorouracil (5-FU) and dihydropyrimidine dehydrogenase (DPD) is a rate-limiting enzyme in the degradation of 5-FU. There are no studies investigating the comparison of TS and DPD mRNA expressions in oral tongue SCC (OSCC) and nontumor tissues obtained from the same patients. In addition, increased interest has been focused on the biological roles of TS and DPD as the independent prognostic factors as well as responsive determinants for cancer patients with 5-FU based therapy. We determined the expression levels of TS and DPD in tumor (T) and nontumor squamous epithelial tissues (N) of OSCC using real-time reverse transcription-polymerase chain reaction and evaluated whether the T/N ratio would correlate with clinicopathological factors. The mRNA expressions of TS and DPD were significantly higher in tumor areas than in nontumor areas. No correlation was found between the T/N ratio of each mRNA expression and gender, clinical stage, T classification, N classification or differentiation. The T/N ratio of TS in patients that died of disease was significantly higher than in patients with free of disease, whereas there were no relationships between The T/N ratio of DPD and disease status. Clinical follow-up data showed shorter overall survival periods for cases with high T/N ratio of TS than for cases with low T/N ratio of TS with the statistically significant. Our study showed that TS but not DPD seems to have prognostic value in OSCC. These findings suggest that the assessment of TS activity may be useful both in the management and in the treatment of OSCC.

DOI： 10.1007/s00405-009-1062-0

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

Objectives/Hypothesis: To examine the efficacy and safety of free jejunal transfer after larynx-preserving esophagectomy in patients with cervical esophageal carcinoma, especially with a high tumor involving the hypopharynx. Study Design: A retrospective analysis of patients with cervical esophageal carcinoma who underwent free jejunal transfer after larynx-preserving esophagectomy. Methods: The subjects were 32 patients who underwent larynx-preserving cervical esophagectomy and microvascular jejunal transfer. Fifteen patients had a high cervical esophageal carcinoma that involved the hypopharynx (high-tumor group), and 17 patients had a low cervical esophageal carcinoma that did not involve the hypopharynx (low-tumor group). For each group, mortality, morbidity (anastomotic leakage, wound infection, stricture, and recurrent laryngeal nerve palsy), functional outcomes (time to start oral intake, achieve complete oral intake, decannulation, and rate of larynx preservation), and oncologic outcomes (survival and local control rate) were reviewed and compared. Results: No perioperative deaths occurred in either group. The incidence of postoperative complications did not differ between the groups. Oral intake started significantly later in the high-tumor group (14.9 days) than in the low-tumor group (10.4 days), but all patients in the high-tumor group could finally achieve oral intake without aspiration. Decannulation was possible in patients who underwent tracheostomy, and laryngeal function was completely preserved in the high-tumor group. Both survival and local control rate did not differ between the groups. Conclusions: Free jejunal grafts in larynx-preserving surgery can be performed safely and reliably in patients with low cervical esophageal carcinomas and in selected patients with high tumors involving the hypopharynx.

DOI： 10.1002/lary.20493

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

Objectives/Hypothesis: Salvage surgery after definitive chemoradiotherapy is often associated with a higher rate of perioperative complications and poor prognosis. The objective of this study is to examine the safety and efficacy of free jejunal transfer after salvage pharyngolaryngectomy for patients with locally recurrent hypopharyngeal carcinoma after definitive chemoradiotherapy. Study Design: A retrospective analysis of patients with advanced hypopharyngeal carcinoma who underwent pharyngolaryngectomy and reconstruction using free jejunum. Methods: Forty patients who underwent pharyngolaryngectomy with jejunal transfer were included in this study. Fourteen patients underwent surgery after definitive chemoradiotherapy (the salvage-surgery group), whereas 26 patients underwent surgery after planned preoperative chemoradiotherapy (the planned-surgery group). The perioperative conditions, mortality, morbidity, functional outcomes, and oncologic outcomes in each group were compared. Results: The patients in the salvage-surgery group lost an average of 9 kg in weight before surgery, which thus indicated a malnourished condition. However, the incidence of all perioperative complications did not differ significantly between the groups. All patients in both groups achieved oral intake without tube feeding, and the intervals to start oral intake were 12.8 days in the salvage-surgery group and 15.6 days in the planned-surgery group, which was not significantly different. The 5-year diseasefree survival was 57.1% in the salvage-surgery group and 50.4% in the planned-surgery group, which was not significantly different. Conclusions: Salvage pharyngolaryngectomy and jejunal transfer can be performed safely and reliably for patients with locally recurrent hypopharyngeal carcinoma, and it is an excellent option after a failure of definitive chemoradiotherapy.

DOI： 10.1002/lary.20887

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

Background. Because of the low incidence of late thrombosis in free flaps used for head and neck reconstruction, the risk factors, prognosis, and the optimal method of treatment are unclear. Methods. The timing of thrombosis, types of flaps, occluded vessels, causative factors, previous irradiation, and salvage rates were reviewed and compared between 79 patients who had thrombosis on postoperative day 4 or earlier (early-thrombosis group) and 24 patients who had thrombosis on postoperative day 5 or later (late-thrombosis group). Results. The main causative factor for thrombosis in the late-thrombosis group was wound infection (54%), whereas wound infection was present in only 1% of cases of thrombosis in the early-thrombosis group. None of the flaps could be salvaged in the late-thrombosis group. Conclusion. Poor salvage rate in the late-thrombosis group is the most serious problem. Prevention, early detection, and appropriate management of wound infection are essential for avoiding late thrombosis.

DOI： 10.1002/hed.21021

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

Postoperative oral functions after subtotal or total glossectomy are closely related to the shape of the reconstructed tongue. Although wider and thicker flaps are recommended to ensure that the reconstructed tongue has a protuberant shape, obtaining flaps of sufficient volume in thin patients is difficult. Therefore, a new flap design should be considered for such patients. In this article we report our experiences with tongue reconstruction after subtotal or total glossectomy in thin patients. From 1997 through 2002, 11 thin patients (mean body mass index, 18.1 kg/m2) underwent subtotal or total glossectomy followed by immediate microsurgical reconstruction. The protuberant shape of the reconstructed tongue was created with a free two-island rectus abdominis musculocutaneous flap. The first skin island is used to reconstruct the surface of the tongue, and the second skin island is de-epithelized and inserted beneath the first to obtain a protuberant shape. Although flaps were transferred successfully in all 11 patients (mean skin island thickness. 6 mm), the larynx could not be preserved in 3 patients owing to aspiration pneumonia. After reconstruction, most patients could tolerate more than a soft diet and could engage in conversation. Our method is simple, less invasive than other methods, and useful for reconstructing defects after ablation of large tongue tumors in thin patients. However, patients in whom laryngeal preservation is possible after subtotal or total glossectomy must be chosen carefully.

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

Severe systemic complications developed in 48 of 2,426 patients undergoing reconstruction after resection of head and neck cancers at the East and Tokyo hospitals of the National Cancer Center, Japan, from June 1980 through December 2003. To identify causative factors, we reviewed 11 cases of upper airway obstruction, 8 cases of brain infarction, 5 cases of gastrointestinal hemorrhage, and 2 cases of pulmonary thromboembolism. We identified many possible causes of upper airway obstruction; tracheostomy should be performed when defects are large, when bilateral neck dissection has been done, and when patients are elderly. Most patients with brain infarction had a history of hypertension poorly controlled despite treatment with multiple agents. Appropriate blood pressures should be maintained during and after surgery in all patients. The stress of re-operation and treatment with nonsteroidal anti-inflammatory agents were believed to be the main causes of gastrointestinal hemorrhage. Although the incidence of pulmonary thromboembolism after head and neck reconstruction is low (0.08%), anticoagulants are indicated, especially for obese patients.

DOI： 10.5981/jjhnc.31.570

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

We report a patient with subglottic stenosis who required insertion of the Montgomery T-tube. During the operation, we could keep stable anaesthesia and adequate ventilation under general anaesthesia using continuous intravenous infusion of propofol with laryngeal mask airway (LMA).

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

Team care in the management of head and neck tumors at the National Cancer Center Hospital involves a diverse range of medical staff whose main subject is the head and neck area. The staff include head and neck surgeons, radiotherapists, radiodiagnosticians, medical oncologists, reconstructive surgeons, dentists, and nurses. An important advantage of team care at our hospital is the psychological and palliative care provided by psycho-oncologists, clinical psychologists, and palliative physicians. In this paper we report on the status of team care at our hospital throughout the management of head and neck tumors and discuss several problems and difficulties that must still be resolved.

DOI： 10.5981/jjhnc.30.401

Event date： 2021.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜   Country：Japan  

Event date： 2021.4

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：長崎   Country：Japan  

Event date： 2020.9

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜   Country：Japan  

Event date： 2019.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2023.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡   Country：Japan  

Event date： 2023.7

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京   Country：Japan  

Event date： 2023.3

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：名古屋   Country：Japan  

Event date： 2022.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：静岡   Country：Japan  

Event date： 2022.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：静岡   Country：Japan  

Event date： 2022.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山   Country：Japan  

Event date： 2022.4

Language：English  

Venue：Seoul(Web開催)   Country：Japan  

Event date： 2022.4

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡   Country：Japan  

Event date： 2022.3

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2021.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：筑波   Country：Japan  

Event date： 2021.11 - 2011.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2021.6

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京   Country：Japan  

Event date： 2021.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：長崎   Country：Japan  

Event date： 2020.11

Language：Japanese  

Venue：web開催   Country：Japan  

Event date： 2019.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：Bologna   Country：Italy  

Event date： 2019.5

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2019.5

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Country：Japan  

Event date： 2018.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：大阪   Country：Japan  

Event date： 2018.11

Language：English   Presentation type：Oral presentation (general)  

Venue：Seoul   Country：Korea, Republic of  

Event date： 2018.7

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：埼玉   Country：Japan  

Event date： 2018.6 - 2019.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜   Country：Japan  

Event date： 2014.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：京都   Country：Japan  

Event date： 2014.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：東京   Country：Japan  

Event date： 2014.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：長崎   Country：Japan  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

Language：Japanese   Publisher：日本喉頭科学会  

Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

Language：Japanese   Publisher：克誠堂出版(株)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：7

Number of peer-reviewed articles in Japanese journals：2

Type：Competition, symposium, etc. 

Number of participants：120

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：2

Number of peer-reviewed articles in Japanese journals：2

Type：Competition, symposium, etc. 

Number of participants：100