Kyushu University Academic Staff Educational and Research Activities Database
List of Papers
HIDEKI KADOTA Last modified date:2021.06.02

Associate Professor / Plastic and Reconstructive Surgery / Kyushu University Hospital


Papers
1. Hideki Kadota, Kunihiro Ishida, Coaptation of Cutaneous Nerves for Intractable Stump Pain and Phantom Limb Pain after Upper Limb Amputation, Strategies Trauma Limb Reconstr , 10.5005/jp-journals-10080-1442., 2020.01.
2. Seita Fukushima, Noritaka Komune, Kenichi Kamizono, Nozomu Matsumoto, Kazutaka Takaiwa, Takashi Nakagawa, Hideki Kadota, Use of negative pressure wound therapy to treat a cochlear implant infection around the auricle: a case report, J Wound Care, 2020.10.
3. Ken-Ichi Kamizono, Sei Yoshida, Ryuji Yasumatsu, Hideki Kadota , Volumetric changes of transferred free anterolateral thigh flaps in head and neck lesions, Auris Nasus Larynx , 2021.01.
4. Hideki Kadota, Junichi Fukushima, Sei Yoshida, Kenichi Kamizono, Muneyuki Masuda, Satoshi Toh, Ryuji Yasumatsu, Torahiko Nakashima, Takashi Nakagawa, Larynx-preserving reconstruction after extended base of the tongue resection, Journal of Plastic, Reconstructive and Aesthetic Surgery, 10.1016/j.bjps.2019.11.018, 73, 4, 740-748, 2020.04, 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..
5. Atsushi Imaizumi, Hideki Kadota, Perforator Branch Flaps, Journal of Plastic, Reconstructive and Aesthetic Surgery, 10.1016/j.bjps.2019.09.036, 2020.01, 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..
6. Hideki Kadota, Atsushi Imaizumi, Kunihiro Ishida, Yasunori Sashida, Successful local use of heparin calcium for congested fingertip replants, Archives of Plastic Surgery, 10.5999/aps.2019.00815, 47, 1, 54-61, 2020.01, 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..
7. Yusuke Inatomi, Hideki Kadota, Sei Yoshida, Kenichi Kamizono, Ryo Shimamoto, Seita Fukushima, Kayo Miyashita, Mioko Matsuo, Ryuji Yasumatsu, Shunichiro Tanaka, Junichi Fukushima, Utility of negative-pressure wound therapy for orocutaneous and pharyngocutaneous fistula following head and neck surgery, Head and Neck, 10.1002/hed.25989, 42, 1, 103-110, 2020.01, 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..
8. Kana Hisanaga, Hideki Kadota, Seita Fukushima, Yusuke Inatomi, Ryo Shimamoto, Kenichi Kamizono, Masuo Hanada, Sei Yoshida, Toxic Shock Syndrome Caused by Staphylococcal Infection after Breast Implant Surgery
A Case Report and Literature Review, Annals of Plastic Surgery, 10.1097/SAP.0000000000001868, 83, 3, 359-362, 2019.09, 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..
9. Yusuke Inatomi, Hideki Kadota, Kenichi Kamizono, Masuo Hanada, Sei Yoshida, Securing split-thickness skin grafts using negative-pressure wound therapy without suture fixation, Journal of Wound Care, 10.12968/jowc.2019.28.Sup8.S16, 28, S16-S21, 2019.08, 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..
10. Hideki Kadota, Kenichi Kamizono, Sei Yoshida, Masuo Hanada, Yusuke Inatomi, Seita Fukushima, Torahiko Nakashima, Ryuji Yasumatsu, Takashi Nakagawa, Pharyngeal reconstruction by anterolateral thigh flap with vastus lateralis muscle transfer for effective swallowing after total glossolaryngectomy
A case report, Head and Neck, 10.1002/hed.25735, 41, 7, E120-E124, 2019.07, 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..
11. Hideki Kadota, Kenta Momii, Masuo Hanada, Kenichi Kamizono, Yusuke Inatomi, Kana Hisanaga, Sei Yoshida, Kippei Ogaki, Keijiro Kiyoshima, Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene
A case report, Microsurgery, 10.1002/micr.30409, 39, 3, 263-266, 2019.03, 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..
12. Masuo Hanada, Hideki Kadota, Sei Yoshida, Naohide Takeuchi, Takamitsu Okada, Yoshihiro Matsumoto, Yasuharu Nakashima, Large-defect Resurfacing
A comparison of skin graft results following sarcoma resection and traumatic injury repair, Wounds, 31, 7, 184-192, 2019.01, 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..
13. Yusuke Inatomi, Hideki Kadota, Keizo Kaku, Hiromichi Sonoda, Yoshihisa Tanoue, Akira Shiose, Omental and deep inferior epigastric artery perforator flap coverage after heart transplantation to manage wide left ventricular assist device exposure with pocket infection, Journal of Artificial Organs, 10.1007/s10047-018-1075-9, 21, 4, 466-470, 2018.12, 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..
14. Hideki Kadota, Jyunichi Fukushima, Clinical application of reconstructive surgeries for the patients with facial nerve palsy, Otolaryngology - Head and Neck Surgery (Japan), 90, 9, 758-764, 2018.08.
15. Yusuke Inatomi, Sei Yoshida, Kenichi Kamizono, Masuo Hanada, Ryuji Yasumatsu, Hideki Kadota, Successful treatment of severe facial lymphedema by lymphovenous anastomosis, Head and Neck, 10.1002/hed.25206, 40, 7, E73-E76, 2018.07, 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..
16. Mitsuhiro Fukata, Takeshi Arita, Hideki Kadota, Keita Odashiro, Toru Maruyama, Koichi Akashi, Successful management of wound dehiscence after implantation of a subcutaneous implantable cardioverter-defibrillator without device removal, HeartRhythm Case Reports, 10.1016/j.hrcr.2017.06.006, 3, 9, 415-417, 2017.09.
17. Hideki Kadota, Sei Yoshida, Masuo Hanada, Kenichi Kamizono, Yusuke Inatomi, Seita Fukushima, Kana Hisanaga, Jyunichi Fukushima, An attempt to achieve "functional swallow" after total glossectomy with laryngectomy, Japanese Journal of Plastic Surgery, 60, 4, 392-400, 2017.04, 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..
18. Hideki Kadota, Opinions from next generation of plastic surgeons; haunting lines, Japanese Journal of Plastic Surgery, 59, 11, 1206-1207, 2016.11.
19. Atsushi Imaizumi, Hideki Kadota, Kunihiro Ishida, Extensor hallucis brevis tendon transfer for the correction of drop toe deformity after dorsalis pedis tendocutaneous free flap harvest, Annals of Plastic Surgery, 10.1097/SAP.0000000000000411, 76, 3, 327-331, 2016.01, 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..
20. Kenichi Kamizono, Sei Yoshida, Hideki Kadota, Makoto Yamashita, Byunghyun Cho, Makoto Hashizume, Motohiro Sawatsubashi, Nozomu Matsumoto, Quantitative assessment of contouring for fibro-osseous lesions in the orbital area using navigation system 3D (Three dimensions) resection rate, Oto-Rhino-Laryngology Tokyo, 10.11453/orltokyo.59.6_354, 59, 6, 354-359, 2016.01, 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..
21. Masuo Hanada, H. Kadota, T. Matsunobu, E. Shimada, Y. Iwamoto, Non-anatomical reconstruction of lateral ulnar collateral ligament of the elbow after tumor resection, Strategies in Trauma and Limb Reconstruction, 10.1007/s11751-015-0235-1, 10, 3, 195-199, 2015.11, 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..
22. Hideki Kadota, Junichi Fukushima, Kenichi Kamizono, Muneyuki Masuda, Shunichiro Tanaka, Takamasa Yoshida, Torahiko Nakashima, Shizuo Komune, A minimally invasive method to prevent postlaryngectomy major pharyngocutaneous fistula using infrahyoid myofascial flap, Journal of Plastic, Reconstructive and Aesthetic Surgery, 10.1016/j.bjps.2013.03.033, 66, 7, 906-911, 2013.07, 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..
23. Kadota H, Fukushima J, Yoshida S, Kamizono K, Kumamoto Y, Masuda M, Nakashima T, Yasumatsu R, Komune S., Microsurgical free flap transfer in previously irradiated and operated necks: feasibility and safety., Auris Nasus Larynx., 39, 5, 496-501, 2012.10.
24. Hideki Kadota, Junichi Fukushima, Sei Yoshida, Kenichi Kamizono, Yoshihiko Kumamoto, Muneyuki Masuda, Torahiko Nakashima, Ryuji Yasumatsu, Shizuo Komune, Microsurgical free flap transfer in previously irradiated and operated necks
Feasibility and safety, Auris Nasus Larynx, 10.1016/j.anl.2011.09.006, 39, 5, 496-501, 2012.10, 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..
25. Kadota H, Kakiuchi Y, Yoshida T., Management of chylous fistula after neck dissection using negative-pressure wound therapy: A preliminary report., Laryngoscope, 10.1002/lary.23216, 122, 5, 997-999, 2012.05.
26. Ryuji Yasumatsu, Junichi Fukushima, Torahiko Nakashima, Hideki Kadota, Yuichi Segawa, Akihiro Tamae, Masato Kato, Shizuo Komune, Surgical management of malignant tumors of the trachea
Report of two cases and review of literature, Case Reports in Oncology, 10.1159/000339408, 5, 2, 302-307, 2012.05, 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..
27. Muneyuki Masuda, Kenichi Kamizono, Masayoshi Ejima, Akiko Fujimura, Hideoki Uryu, Hideki Kadota, Tracheal reconstruction with a modified infrahyoid myocutaneous flap, Laryngoscope, 10.1002/lary.23194, 122, 5, 992-996, 2012.05, 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..
28. Kadota H, Fukushima J, Kamizono K, Umeno Y, Nakashima T, Yasumatsu R, Komune S., Selective epithelial ischemia of transferred free jejunum after late loss of its vascular pedicle., Ann Plast Surg, 6, 67, 612-614, 2011.12.
29. Hideki Kadota, Jyunichi Fukushima, Muneyuki Masuda, Kenichi Kamizono, Takamasa Yoshida, Shunichiro Tanaka, Yoichi Toriya, Head and neck reconstruction using infrahyoid myocutaneous flap, Japanese Journal of Head and Neck Cancer, 10.5981/jjhnc.37.126, 37, 1, 126-131, 2011.12, 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..
30. Hideki Kadota, Junichi Fukushima, Kenichi Kamizono, Yoshihiro Umeno, Torahiko Nakashima, Ryuji Yasumatsu, Shizuo Komune, Selective epithelial ischemia of transferred free jejunum after late loss of its vascular pedicle, Annals of Plastic Surgery, 10.1097/SAP.0b013e3181fe32cc, 67, 6, 612-614, 2011.12, 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..
31. Takamasa Yoshida, Hideki Kadota, Junichi Fukushima, Torahiko Nakashima, Shizuo Komune, Two cases of postoperative pharyngocutaneous fistula treated with Negative Wound Pressure Therapy (NPWT), Japanese Journal of Head and Neck Cancer, 10.5981/jjhnc.37.439, 37, 3, 439-443, 2011.12, 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..
32. Muneyuki Masuda, Junichi Fukushima, Hideki Kadota, Kenichi Kamizono, Masayoshi Ejima, Masahiko Taura, Mandible preserving pull-through oropharyngectomy for advanced oropharyngeal cancer
A pilot study, Auris Nasus Larynx, 10.1016/j.anl.2010.08.010, 38, 3, 392-397, 2011.06, 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..
33. Ryuji Yasumatsu, Torahiko Nakashima, Takahiro Wakasaki, Toranoshin Ayada, Hideki Kadota, Muneyuki Masuda, Satoshi Toh, Hideki Shiratsuchi, Shizuo Komune, Relative level of thymidylate synthase mRNA expression in primary tumors and normal tissues predicts survival of patients with oral tongue squamous cell carcinoma, European Archives of Oto-Rhino-Laryngology, 10.1007/s00405-009-1062-0, 267, 4, 581-586, 2010.04, 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..
34. Hideki Kadota, Minoru Sakuraba, Yoshihiro Kimata, Ryuichi Hayashi, Satoshi Ebihara, Hoichi Kato, Larynx-preserving esophagectomy and jejunal transfer for cervical esophageal carcinoma, Laryngoscope, 10.1002/lary.20493, 119, 7, 1274-1280, 2009.07, 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..
35. Hideki Kadota, Junichi Fukushima, Torahiko Nakashima, Yoshihiko Kumamoto, Sei Yoshida, Ryuji Yasumatsu, Hideki Shiratsuchi, Masaru Morita, Shizuo Komume, Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy, Laryngoscope, 10.1002/lary.20887, 120, 6, 1103-1108, 2009.06, 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..
36. Minoru Sakuraba, Yoshihiro Kimata, Gentarou Uchida, Hideki Kadota, Tomoyuki Yano, Ryuichi Hayashi, Satoshi Ebihara, Tongue reconstruction with a free two-island rectus abdominis musculocutaneous flap after subtotal or total glossectomy, Japanese Journal of Plastic and Reconstructive Surgery, 48, 5, 549-554, 2005.05, 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..
37. Hideki Kadota, Yoshihiro Kimata, Minoru Sakuraba, Katsuhiro Ishida, Ryuichi Hayashi, Mitsuo Yamazaki, Nobuya Monden, Masakazu Miyazaki, Satoshi Ebihara, Waichiro Oyama, Systemic complications after reconstruction for head and neck cancer
Factors contributing to upper airway obstruction, brain infarction, gastrointestinal hemorrhage, and pulmonary thromboembolism, Toukeibu Gan, 10.5981/jjhnc.31.570, 31, 4, 570-575, 2005.01, 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..
38. Hideki Kadota, Akira Kochi, Manabu Hashimoto, Yoshihiro Kimata, Anaesthetic management for insertion of the montgomery T-tube in a patient with subglottic stenosis, Japanese Journal of Anesthesiology, 53, 11, 1297-1299, 2004.11, 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)..
39. Yoshihiro Kimata, Katsuhiro Ishida, Hideki Kadota, Tomoyuki Yano, Minoru Sakuraba, Ryuichi Hayashi, Kazuto Matsuura, Mitsuo Yamazaki, Shinya Monden, Satoshi Ebihara, Hiroshi Tashiro, Team care approach for head and neck cancer in national cancer center hospital east, Toukeibu Gan, 10.5981/jjhnc.30.401, 30, 3, 401-406, 2004.01, 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..
40. Hideki Kadota, Minoru Sakuraba, Yoshihiro Kimata, Tomoyuki Yano, Ryuichi Hayashi, Analysis of thrombosis on postoperative day 5 or later after microvascular reconstruction for head and neck cancers, Head and Neck, 10.1002/hed.21021, 31, 5, 635-641, 2009.05, 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..