Analysis of Characteristics and Outcomes of Multimodal Therapy for Soft Tissue Sarcoma

当科で治療した悪性軟部腫瘍の内容と予後および術後機能に関する分析

Journal of Japan Society of Plastic and Reconstructive Surgery


Cyclical Stretching Induces Excess Intracellular Ca2+ Influx in Human Keloid-Derived Fibroblasts In Vitro

The incidence of keloids is higher in the case of darker skin. It is more common in the parts exposed to stretching (thorax, abdomen, and joints). Cyclical stretching reportedly induced each Ca2+ spike through differential mechanosensitive channels in human synovial and dermal fibroblasts. Therefore, the authors hypothesized that cyclical stretching also induces a specific Ca2+ spike in keloid-derived fibroblasts. This in vitro study compared the intracellular calcium dynamics induced by cyclical stretching between control (human dermal fibroblasts) and keloid (human keloid-derived fibroblasts) groups. Each group was exposed to two-dimensional stretch using an originally developed stretch microdevice. Intracellular Ca2+ was observed for 5 minutes, including 30 seconds of baseline, under a fluorescent confocal laser microscope. The intracellular Ca2+ concentration was evaluated every 0.5 second using the fluorescence intensity ratio. A positive cellular response was defined as a rise of the ratio by greater than or equal to 20%. The normal response cutoff value was determined by receiver operating characteristic analysis. The keloid groups were significantly more responsive than the control groups (15.7% versus 8.2%; P = 0.029). In the cellular response-positive cells, the keloid groups reached significantly higher intracellular Ca2+ concentration peaks than the control groups (2.20 versus 1.26; P = 0.0022). The cutoff value was 1.77, and 10.4% of the keloid-derived fibroblasts exhibited a hyper-Ca2+ spike above the normal range. Keloid-derived fibroblasts with a hyper-Ca2+ spike might constitute a keloid-specific subpopulation. Hereafter, the authors will study whether the normalization of excessive intracellular Ca2+ concentration leads to keloid treatment in vivo. This study result provided a clue to the onset mechanism of keloids, which the authors hope will lead to the development of new therapy in the future.


四肢機能温存のために筋肉移植と関節包再建を行った症例の検討:最善の Orthoplastic Surgery を考える

第49回日本マイクロサージャリー学会学術集会

第49回日本マイクロサージャリー学会学術集会


第49回日本マイクロサージャリー学会学術集会

第49回日本マイクロサージャリー学会学術集会


BIA ALCLを疑い検査を施行した乳房インプラント破損の2症例

BIA ALCLを疑い検査を施行した乳房インプラント破損の2症例

第10回日本乳房オンコプラスティックサージャリー学会総会

第10回日本乳房オンコプラスティックサージャリー学会総会


Radiographic Study Evaluating Perforator Vessels in the Ischiorectal Fossa for Safe Elevation of Island Flaps

Perforator flaps based on the ischiorectal fossa (IRF) (ie, internal pudendal artery perforator flaps) are useful for perineal reconstruction. The three-dimensional characterization of perforator arteries in the IRF remains unclear, as the IRF contains thick adipose tissue as well as organs, such as the rectum, vagina, and urethra. This study aimed to evaluate perforators in the IRF to guide the safe elevation of skin flaps designed based on the IRF. IRF vessels were examined in 200 bilateral computed tomography angiography scans performed in 100 patients. We examined branching patterns arising from the internal iliac artery and the origins of the skin perforators in the IRF. The branching patterns of the internal iliac artery were divided into three groups: perforators derived exclusively from the internal pudendal artery (78%), perforators derived from the internal pudendal artery and the inferior gluteal artery (18%), and perforators derived exclusively from the inferior gluteal artery (4%). The average number of perforators in the IRF was 1.5 ± 0.7. The number of perforators was significantly higher in women than in men. The perforator arteries were found exclusively around the medial and dorsal sides of the ischial tuberosity. We found that perforators in the IRF were stable. All cases had more than one skin perforator, which was mainly derived from the internal pudendal artery. Although perforators cannot be identified during flap elevation because the fatty tissue in the IRF is very thick, physicians must focus on preserving the perforator-containing fatty tissue around the ischial tuberosity.

Plastic and Reconstructive Surgery. Global Open


One-Stage Perifascial Areolar Tissue and Skin Grafting Combined with Negative Pressure Wound Therapy for a Refractory Wound with an Exposed Elbow Joint and Extensive Skin Defect


褥瘡治療の基本マニュアル

褥瘡治療の基本マニュアル


Massive Weight Lossによる余剰皮膚切除後に膝部にリンパ漏を生じた1例

第45回日本美容形成外科学会総会・第145回学術集会

第45回日本美容形成外科学会総会・第145回学術集会


頚椎後方固定術後の離開創に対して異物除去を行わず僧帽筋皮弁による再建を施行した一例

第81回中国・四国形成外科学会学術集会

第81回中国・四国形成外科学会学術集会


下眼瞼欠損再建手術における術後変形に関する実態調査および内容についての全例前向き調査

第81回中国・四国形成外科学会学術集会

第81回中国・四国形成外科学会学術集会


LVAの吻合部決定に術前エコー検査が有用であった症例の検討

LVAの吻合部決定に術前エコー検査が有用であった症例の検討

第6回日本リンパ浮腫治療学会学術総会

第6回日本リンパ浮腫治療学会学術総会


Ischial and Sacral Pressure Ulcers A Review of Optimal Treatments, Historical Management, and Surveillance Studies of the Japanese Population

International Journal of Surgical Wound Care


Treatment of Critical Limb Ischemia Using Microsurgery Techniques

マイクロサージャリーの技術を用いた重症下肢虚血治療とその成績

Journal of Japanese Society of Reconstructive Microsurgery

日本マイクロサージャリー学会会誌


頚椎後方固定術後の離開創に対して異物除去を行わず僧帽筋皮弁による再建を施行した1例

第26回徳島形成外科集談会

第26回徳島形成外科集談会


第26回徳島形成外科集談会

第26回徳島形成外科集談会


Relationship between fluctuations in skin perfusion pressure values and wound healing in patients with chronic limb-threatening ischemia undergoing hemodialysis

Background : Patients with chronic limb-threatening ischemia are often on hemodialysis. It is unclear which skin perfusion pressure (SPP) values, i.e., those measured immediately after hemodialysis on a hemodialysis day or those measured on a non-hemodialysis day, reflect the actual wound healing course in chronic limb-threatening ischemia. Methods : Eighteen patients undergoing hemodialysis (49 measurements) who were treated for leg ulcers due to critical limb ischemia were included in the study. The SPP values were divided into two groups : those measured immediately after hemodialysis (HD day group) and those measured on non-hemodialysis days (non-HD day group). The wound healing outcomes were investigated. The cutoff SPP value for predicting wound healing was set to ≥ 35 mmHg. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SPP in each group were measured. The relationship between SPP and blood pressure was analyzed by regression analysis. Results : Significant differences were observed in the positive predictive value (HD day : 100%, non-HD day : 50% ; P = 0.002), The correlation coefficient was 0.698 in the HD day group and 0.292 in the non-HD day group. Diastolic blood pressure had a significant effect on SPP (P = 0.039). Conclusions : The measurements are best taken immediately after hemodialysis for more accuracy. J. Med. Invest. 69 : 294-298, August, 2022.

The Journal of Medical Investigation : JMI


5G・ドコモオープンイノベーションクラウド™を用いた形成外科遠隔診療

5G・ドコモオープンイノベーションクラウド™を用いた形成外科遠隔診療

第265回徳島医学会学術集会

第265回徳島医学会学術集会


彫刻刀を用いた修正術が有効であったカリフラワー耳の2例

彫刻刀を用いた修正術が有効であったカリフラワー耳の2例

第14回日本創傷外科学会総会・学術集会

第14回日本創傷外科学会総会・学術集会


A Case of Macrodystrophia Lipomatosa of the Lower Extremity: An Effective Measuring of the Dynamic Plantar Pressure for Severe Congenital Deformity

Journal of Plastic and Reconstructive Surgery


舌再建後に脱上皮した皮島部の毛により難治性瘻孔を生じた 1 例

舌再建後に脱上皮した皮島部の毛により難治性瘻孔を生じた 1 例

第46回日本頭頸部癌学会

第46回日本頭頸部癌学会


耳下腺に浸潤した耳介部基底細胞癌の1例

耳下腺に浸潤した耳介部基底細胞癌の1例


褥瘡手術後の早期創離開の要因とリスク因子

褥瘡手術後の早期創離開の要因とリスク因子

第65回日本形成外科学会総会・学術集会

第65回日本形成外科学会総会・学術集会


坐骨部の褥瘡手術と周術期管理


Lateral Nasal Artery Perforator Flap for Nasal Reconstruction Clinical Applications and Risk Factors Associated With Nasal Deformities

Nasal reconstruction is challenging because of the difficulty in balancing superior aesthetic outcomes and less invasive surgery. The use of the lateral nasal artery (LNA) perforator flap has been reported for nasal reconstruction. However, few reports have described appropriate applications of nasal reconstruction and assessments of nasal deformity. This study aimed to quantify the aesthetic outcomes on using this flap and reveal the risk factors associated with nasal deformities. Twenty patients underwent nasal reconstruction using the LNA flap with a cranial perforator adjacent to the nasal defect. Postoperative protuberant deformities were scored by 2 independent plastic surgeons using a 5-point Likert scale and classified as excellent, good, or poor. The risk factors of deformities were identified using univariate analyses. A nasal alar deviation index was developed to analyze correlations with flap harvesting. The sensory function was assessed by the Semmes-Weinstein test. Flaps survived in 19 patients (95%), and 1 flap showed distal necrosis. All arterial perforators used remained within 5 mm lateral to the boundary between the cheek and nasal ala. The flaps were most often used to cover 2 subunits, including the nasal sidewall defects. Protuberant deformities in 6 (30%), 8 (40%), and 6 (30%) patients were classified as excellent, good, and poor, respectively. Nasal defects involving more than 3 subunits caused severe protuberant deformity. Only 2 patients (5%) in the good and fair groups underwent additional debulking surgery. Nasal alar deviation was not significantly correlated with flap harvesting, when the nasal alar deviation index before and after surgery were compared. Sensory function was retained in all patients. Aesthetic outcomes and sensory function were good on using the LNA perforator flap as a propeller flap having a wide arc of rotation. This flap is suitable for nasal reconstruction involving less than 2 nasal subunits without any severe nasal alar deviation deformity. In addition, this flap allows for better outcomes because it requires less invasive 1-stage surgery.


Sentinel lymph node biopsy for cutaneous malignant melanoma ; clinical significance

徳島大学病院で実施された皮膚悪性黒色腫に対するセンチネルリンパ節生検の臨床的意義について


Critical limb ischemia as a consequence of multiple spontaneous arteriovenous fistula and peripheral arterial disease.


Analysis of Risk Factors Associated With Drooping Deformity After Lower Eyelid Reconstruction

Lower eyelid reconstruction is challenging because of the risk of severe postreconstruction deformities of the lower eyelid, such as drooping, entropion, and ectropion. However, the risk factors for these postreconstruction deformities are unclear. The present study aimed to quantify the drooping deformity of the lower eyelid after reconstruction using a cheek rotation flap and to identify risk factors associated with postreconstruction deformities. Our study group included 28 patients who underwent full-thickness lower eyelid reconstruction using a cheek rotation flap for anterior lamella reconstruction. We developed the drooping index to classify postreconstruction outcomes as good (index <1.2), fair (index between 1.2 and 1.5), and poor (index >1.5). We identified risk factors for a drooping deformity using univariate analyses (Mann-Whitney U or Spearman rank correlation, depending on data distribution). Overall, the drooping index ranged between 1.0 and 2.11, with an average value of 1.3. A good outcome was obtained in 11, a fair outcome in 12, and a poor outcome in 5 patients. Clinically severe ectropion was observed in five of the 17 patients in the fair and poor outcome groups, with four of these patients requiring revision surgery. Risk factors for postreconstruction drooping deformity included medial location of the tumor, resection involving more than 50% of the horizontal width of the lower eyelid, and dissection of subcutaneous tissue of the cheek extending below the zygomatic arch. A cheek rotation flap provides satisfactory outcomes for full-thickness reconstruction of the lower eyelid. Extension of dissection of subcutaneous tissue of the cheek below the zygomatic arch increases the risk of postsurgical drooping deformity. Our drooping index provides a quantitative measure of drooping deformity and is clinically useful to classify outcomes.


Profile of Blood Glucose in Diabetic Patient Suffered from Diabetic Foot Osteomyelitis with Effective Low Carbohydrate Diet

The case was 52-year-old female with type 2 diabetes mellitus (T2DM) for 10-years. She complained of the decreased sensation of right lower foot, and revealed diabetic foot infection (DFI) and/or diabetic foot osteomyelitis (DFO) at right 1st proximal phalanx. Various data included body mass index (BMI) 33.3 kg/m2, HbA1c 11.4%, blood glucose 430 mg/dL, WBC 12100 /μL, C-reactive Protein (CRP) 13.5 mg/dL. On admission (day 1), she was started by 4 times of injection (Aspart and Glargin) with glucose profile 200-500 mg/dL. Surgical amputation of the right toe was performed between 1st metatarsal and proximal phalanx (day 17). Then, blood glucose profile decreased moderately. After discharge of the hospital, super-Low Carbohydrate Diet (LCD) was started without Aspart (day 37). Consequently, glucose profile was normalized with HbA1c 6.3% on (day 77). Consequently, LCD was evaluated to be effective for glucose variability in this case and some related discussion was described.


創内持続陰圧洗浄療法後に遊離前外側大腿皮弁で再建した膝蓋骨腱の露出を伴う膝関節部低温熱傷の1例


皮島の一部を脱上皮した遊離前外側大腿皮弁で腹壁を再建した臍部尿膜管癌の1例

皮島の一部を脱上皮した遊離前外側大腿皮弁で腹壁を再建した臍部尿膜管癌の1例

Journal of Japan Society of Plastic and Reconstructive Surgery


The perifascial areolar tissue and negative pressure wound therapy for one-stage skin grafting on exposed bone and tendon

Factors such as exposed bones or tendons can inhibit wound healing and make it a lengthy process unless aggressive debridement or vascularized flap surgery are performed. We have developed a new procedure involving simultaneous application of a skin graft and perifascial areolar tissue (PAT) and negative pressure wound therapy. Of 8 patients with wounds, bones, tendons, and thick fascia were exposed in 4, 2, and 2 cases, respectively. These wounds were adequately covered with PAT, and split-thickness skin grafts were applied simultaneously on the PAT with a VACsize 4.9 bigcirc size 3.5 back 115 up 4 roman R device. In 6 of 8 cases, the skin graft and PAT were successful, and epithelialization was achieved within 4 weeks. PAT adapted but skin graft was unsuccessful in one case, and both the skin graft and PAT failed to adapt of a pressure ulcer. Using the PAT to overlap more than 400% of the exposed areas resulted in better adaptation. This procedure contributed to reducing the burden on the patients because we were able to use a skin graft on the exposed areas, without the need for removal of bone or tendons. This potentially means patients avoid loss of function in the affected areas and achieve better outcomes. J. Med. Invest. 65:96-102, February, 2018.


Risk factors for delayed healing at the free anterolateral thigh flap donor site

The free anterolateral thigh (ALT) flap has been widely used for various kinds of reconstructions. However, delayed healing at the donor site occasionally occurs due to wound dehiscence or the partial loss of grafted skin at the donor site. The aim of the present study was to identify reliable predictive factors for delayed healing at the donor site after the harvest of a free ALT flap. This study included 52 patients who underwent reconstructive procedures using free ALT flaps. The delayed healing group included patients with wounds at the donor site that had not healed over 3 weeks after surgery, and the normal healing group included patients who showed wound healing within 3 weeks after surgery. Multivariate logistic regression models were created to identify the risk factors for delayed healing at the ALT flap donor site. Among the 52 patients, 24 (46.2%) showed delayed healing at the donor site, and 6 patients required additional operative treatment. A high preoperative body mass index (BMI), smoking, and skin grafting were found to be significantly associated with delayed healing at the ALT donor site. Of the 37 patients who underwent skin grafting, 23 (62%) experienced delayed healing at the donor site. A high preoperative BMI, smoking, and skin grafting were risk factors for delayed healing at the free ALT donor site. Skin grafting at the ALT donor site should be avoided in patients with a high BMI or a habit of smoking.


Topical Application of Nitrosonifedipine, a Novel Radical Scavenger, Ameliorates Ischemic Skin Flap Necrosis in a Mouse Model.

Ischemic skin flap necrosis can occur in random pattern flaps. An excess amount of reactive oxygen species is generated and causes necrosis in the ischemic tissue. Nitrosonifedipine (NO-NIF) has been demonstrated to possess potent radical scavenging ability. However, there has been no study on the effects of NO-NIF on ischemic skin flap necrosis. Therefore, they evaluated the potential of NO-NIF in ameliorating ischemic skin flap necrosis in a mouse model. A random pattern skin flap (1.0 × 3.0 cm) was elevated on the dorsum of C57BL/6 mice. NO-NIF was administered by topical injection immediately after surgery and every 24 hours thereafter. Flap survival was evaluated on postoperative day 7. Tissue samples from the skin flaps were harvested on postoperative days 1 and 3 to analyze oxidative stress, apoptosis and endothelial dysfunction. The viable area of the flap in the NO-NIF group was significantly increased (78.30 ± 7.041%) compared with that of the control group (47.77 ± 6.549%, p < 0.01). NO-NIF reduced oxidative stress, apoptosis and endothelial dysfunction, which were evidenced by the decrease of malondialdehyde, p22phox protein expression, number of apoptotic cells, phosphorylated p38 MAPK protein expression, and vascular cell adhesion molecule-1 protein expression while endothelial nitric oxide synthase protein expression was increased. In conclusion, they demonstrated that NO-NIF ameliorated ischemic skin flap necrosis by reducing oxidative stress, apoptosis, and endothelial dysfunction. NO-NIF is considered to be a candidate for the treatment of ischemic flap necrosis.


Proximal nail fold flap for digital mucous cyst excision

The skin covering a digital mucous cyst is often very thin and is often excised with the cyst. Thus, transfer of a skin flap is needed for the defect. We have developed a proximal nail fold flap technique by which the thin skin covering the cyst can be preserved. We conducted a retrospective study to assess the effectiveness and reliability of this technique for digital mucous cyst excision. The study group comprised 26 patients treated for 28 digital mucous cysts. The flap was elevated on the nail matrix to expose the distal interphalangeal joint capsule. To preserve the skin in cases in which the skin covering the cyst was exceptionally thin, we did not excise the upper part of the cyst wall. Excision of the cyst and stalk was successful in all cases. Additional excision of the joint capsule or osteophyte(s) was achieved in 20 cases and 5 cases, respectively. No flap necrosis, skin defect or nail deformity resulted. Three of the cysts recurred and were treated successfully by reoperation involving the same flap elevation technique. We conclude that the proximal nail fold flap is useful for excision and reliable for wound coverage after digital mucous cyst excision. J. Med. Invest. 63: 278-280, August, 2016.

The Journal of Medical Investigation : JMI


Reduction mammaplasty and mastopexy for the contralateral breast after reconstruction surgery following canser resection : A report of 3 cases

Breast reconstruction generally involves autologous tissue transplantation and placement of a mammary prosthesis. When the patient's breasts are extremely large and ptotic, breast reconstruction often results in significantly asymmetrical appearance. However, a good aesthetic outcome after reconstruction surgery following cancer resection is an important quality-of-life factor. We evaluated the efficacy of touch-up surgery, either reduction mammaplasty or mastopexy, performed on the contralateral breast for symmetrization. Reduction mammaplasty was performed on the contralateral breast in 2 patients and mastopexy was performed on the contralateral breast in 1 patient after reconstruction surgery following cancer resection, between 2008 and 2014. We reviewed each patient's medical record for general clinical information and for the methods of breast cancer resection and breast reconstruction used, wait time between breast cancer resection and touch-up surgery, preservation of the sensitivity of the nipple-areola complex after the touch-up surgery, and aesthetic outcome (based on visual analog scale score). Wait times in the 3 cases were 4, 9, and 18 months. Nipple-areolar sensitivity was well preserved in all 3 cases. Aesthetic outcomes were judged "excellent" or "very good." Revision surgery on the contralateral breast 4 to 18 months after breast reconstruction substantially improves the aesthetic outcome. J. Med. Invest. 63: 281-285, August, 2016.


Development of Skin Flaps for Reconstructive Surgery:Random Pattern Flap to Perforator Flap

Flap transplantation has been an important procedure in plastic and reconstructive surgery to cover and fill various defects. Flap necrosis due to blood circulation failure leads to severe complications, especially in a patient undergoing reconstruction concerning the body cavity after tumor ablation. Surgical procedures for flap transplantation have been further improved and developed. We have reviewed from the random pattern flap to the newest procedure, the perforator flap. Perforator vessels were investigated in the process of development of the fasciocutaneous flap and have become important for blood supply of the skin flap. Blood circulation of the flap has become more stable and reliable than ever with the development and findings of the perforator vessels. Further development of a skin flap will be based on the perforasome concept, which involves the study of the territory and linking of perforator vessels. J. Med. Invest. 63: 159-162, August, 2016.


Predictability of Pressure Ulcers Based on Operation Duration, Transfer Activity, and Body Mass Index Through the Use of an Alternating Decision Tree

To develop a prediction model for pressure ulcer cases that continue to occur at an acute care hospital with a low occurrence rate of pressure ulcers. Analyzing data were collected from patients hospitalized at Tokushima University Hospital during 2012 using an alternating decision tree (ADT) data mining method. The ADT-based analysis revealed transfer activity, operation time, and low body mass index (BMI) as important factors for predicting pressure ulcer development. Among the factors identified, only "transfer activity" can be modified by nursing intervention. While shear force and friction are known to lead to pressure ulcers, transfer activity has not been identified as such. Our results suggest that transfer activities creating shear force and friction correlate with pressure ulcer development. The ADT algorithm was effective in determining prediction factors, especially for highly imbalanced data. Our three stumps ADT yielded accuracy, sensitivity, and specificity values of 72.1%±3.7%, 79.3%±18.1%, and 72.1%±3.8%, respectively. Transfer activity, identified as an interventional factor, can be modified through nursing interventions to prevent pressure ulcer formation. The ADT method was effective in identifying factors within largely imbalanced data. J. Med. Invest. 63: 248-255, August, 2016.


On-Admission Pressure Ulcer Prediction Using the Nursing Needs Score

Pressure ulcers (PUs) are considered a serious problem in nursing care and require preventive measures. Many risk assessment methods are currently being used, but most require the collection of data not available on admission. Although nurses assess the Nursing Needs Score (NNS) on a daily basis in Japanese acute care hospitals, these data are primarily used to standardize the cost of nursing care in the public insurance system for appropriate nurse staffing, and have never been used for PU risk assessment. The objective of this study was to predict the risk of PU development using only data available on admission, including the on-admission NNS score. Logistic regression was used to generate a prediction model for the risk of developing PUs after admission. A random undersampling procedure was used to overcome the problem of imbalanced data. A combination of gender, age, surgical duration, and on-admission total NNS score (NNS group B; NNS-B) was the best predictor with an average sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of 69.2% (6920/100), 82.8% (8280/100), and 84.0% (8400/100), respectively. The model with the median AUC achieved 80% (4/5) sensitivity, 81.3% (669/823) specificity, and 84.3% AUC. We developed a model for predicting PU development using gender, age, surgical duration, and on-admission total NNS-B score. These results can be used to improve the efficiency of nurses and reduce the number of PU cases by identifying patients who require further examination.


母指IP関節に生じた化膿性関節炎・骨髄炎に対して血管柄付第Ⅱ趾PIP関節移植を用いた治療経験

Journal of Japan Society of Plastic and Reconstructive Surgery


〈症例〉巨大化するまで放置された大腿部脂肪肉腫に対する姑息的遊離皮弁移植術

〈症例〉巨大化するまで放置された大腿部脂肪肉腫に対する姑息的遊離皮弁移植術

日本マイクロサージャリー学会会誌

日本マイクロサージャリー学会会誌


Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients : a retrospective study

The aim of this retrospective study was to examine whether serum albumin levels offer a good marker of nutritional status in patients with burns. Serum albumin levels have been used to evaluate nutritional status in burns patients, even though these levels are affected by various factors and are not specific to malnutrition. To clarify whether provision of nutrition or presence of inflammation affects serum albumin levels, we studied serum albumin levels, C-reactive protein (CRP) levels and caloric intake over time in 30 patients with burns. Serum albumin levels did not respond to provision of nutrition, but correlated negatively with CRP levels, suggesting that serum albumin levels are more closely associated with inflammation than nutrition. This study also suggests that hypoalbuminemia is a good indicator of the severity of burns or associated complications. We conclude that serum albumin levels do not offer a good nutritional marker in burns patients.


Limb salvage and vascular augmentation by microsurgical free flap transfer for treatment of neuropathic diabetic foot ulcers

Neuropathic diabetic foot ulcers are generally deep and infectious wounds extending to the bone or joint. We performed microsurgical free flap transfer for limb salvage and vascular augmentation of feet with diabetic neuropathy. Angiography was performed to identify any significant arterial disease. The free flaps were transplanted after resection of the damaged skin and infected bone. Flow-through or end-to-side anastomosis to the dorsalis pedis artery was performed to preserve the arterial blood flow to the residual foot. An anterolateral thigh flap and free flaps based on the subscapular artery system were transplanted in 1 and 10 patients, respectively. All flaps survived. Arterial flow on the distal side of the anastomosis was postoperatively confirmed in all patients. During a mean follow-up period of 52 months, the long-term complications observed were recurrent ulcers in 4 patients. The limb salvage rate was 100%, and 82% of patients achieved functional ambulation. Microsurgical flap transplantation is a safe and useful technique for minimal amputation of a diabetic neuropathic foot. Postoperative protection of the feet is important in order to avoid recurrence of foot ulceration. The use of protective footwear custom-tailored for each patient is strongly recommended.


Three-dimensional sodium chloride (NaCI) model for simulated mandibular reconstruction surgery : a new environmentally friendly material

Mandibular reconstruction using a fibular graft is a difficult procedure that requires technical expertise to enable adequate occlusal function and restore an aesthetic appearance. Here we used three-dimensional (3D) sodium chloride (NaCl) models for simulated mandibular reconstruction surgery. This study aimed to reveal the accuracy of mandibular reconstruction with fibular grafts using this model. Mandibular reconstructions using 3D NaCl models were performed in 5 cases. The maxilla, mandible, and fibular models were developed using computed tomography (CT) data. We performed preoperative cutting and simulation surgery using this model. Angles between the body of the corpus and symphysis were measured from the axial view (n = 4). Angles between the ramus and the body of the corpus were measured from the lateral and axial views (n = 6). These angles were measured on simulated models and postoperative CT images were compared. Differences between the angles measured on the simulated models and postoperative CT images were 0-5° (mean, 1.9°). We were able to reproduce the neomandibles with precise osteotomies using the 3D NaCl models. We believe that simulated mandibular reconstruction surgery using this model might help reduce the number of intraoperative neomandibular segment adjustments.

The Journal of Medical Investigation : JMI


Risk factors for complications after reconstructive surgery for sternal would infection


The Internal Pudendal Artery Perforator Thigh Flap : A New Free Style Pedicle Flap for the Ischial would infection

Recurrence and complication rates of pressure sores are highest in the ischial region, and other donor sites are needed for recurrent pressure sores. The potential of a new freestyle pedicle flap for ischial lesions, an internal pudendal artery perforator (iPap) thigh flap, was examined through anatomical and theoretical analyses and a case series using computed tomography angiography. The skin flap was designed in the thigh region based on an iPap. The skin perforators were marked with a Doppler probe. One patient underwent computed tomography angiography with fistulography to identify the damage to or effects on the pedicle vessels of the flap. Debridement of ischial lesions and flap elevation were performed in the jackknife position. The iPap thigh flaps were performed in 5 patients, 4 with ischial pressure sores and 1 with calcinosis cutis of the ischial region. The width and length of the flaps ranged from 5 to 8 cm (mean, 6.6 cm) and 10 to 17 cm (mean, 12.6 cm), respectively. Three patients underwent partial osteotomy of the ischial bone. No complications, including flap necrosis or wound dehiscence of the donor and reconstructed sites, were observed. The perforator vessels of the internal pudendal artery are very close to the ischial tuberosity. Blood flow to the flap is reliable when careful debridement of the pressure sore is performed. The iPap thigh flap is a new option for soft-tissue defects in the ischial region, including ischial pressure sores.

Plastic and Reconstructive Surgery. Global Open


The Internal Pudendal Artery Perforator Flap : Free-style Pedicle Perforator Flaps for Vulva, Vagina, and Buttock Reconstruction

Reconstruction of the vulva, vagina, and buttocks following cancer ablation is challenging. Restoring the shape, volume, and function is the key to the best reconstruction for these regions. Perineal reconstruction with a free-style flap based on skin perforators from the internal pudendal artery was evaluated. The internal pudendal artery perforator flap was designed based on information about the skin perforators. The flap base contained the arterial sounds, which were identified by a handheld Doppler device, on and around the ischiorectal fossa. Types of flaps used included propeller flaps, traditional transposition flaps, and V-Y advancement flaps. Seventy-one flaps were transplanted in 45 cases. The reconstructed regions included vulvar skin in 36 cases, buttock skin in 10 cases, vagina in nine cases, anus in six cases, and pelvic cavity in six cases. The flaps were transplanted in the lithotomy or prone position. Sixty-seven of these flaps survived completely. Four flaps showed partial necrosis, but no total flap failures occurred. Thinning of the fatty tissue of the flap was performed in all cases except pelvic cavity reconstruction. An additional operation to remove bulkiness of the flaps following the initial reconstruction was required in one case. Propeller flaps, transposition flaps, and V-Y flaps were used in 35, three, and seven cases, respectively. This study revealed that the blood circulation of this flap is reliable and that it offers suitable volume not only for vulvar, vaginal, and anal reconstruction, which requires a thin flap, but also for pelvic floor reconstruction, which requires flap volume. Therapeutic, IV.


Effect of the Biopsy Technique on the Survival Rate of Malignant Melanoma Patients

Cutaneous malignant melanoma has a poor prognosis. The detrimental effect of incisional biopsies on the outcome of malignant melanoma has been debated. The aim of this study was to determine the effect of the presence and type of biopsy on the prognosis of malignant melanoma. The medical records of 109 malignant melanoma patients treated at Tokushima University Hospital from 1983 to 2007 were reviewed. After excluding 28 cases with stage 0 disease or incomplete data, 81 cases were analyzed in detail with respect to patient sex, age, tumor site, clinical stage at diagnosis, presence of ulceration or lymph node metastasis, and prognosis. The five-year survival and five-year disease-free survival rates of patients who underwent incisional or excisional biopsies were compared with those who did not undergo a biopsy. The male-to-female ratio was 1:1.19. The mean age was 61.3 years (range, 19-93 years). The most common site was a lower extremity, and the most common clinical stage was stage II. No significant differences in clinicopathological features, five-year survival rates, and five-year disease-free survival rates were observed among the three groups. The presence and type of biopsy neither affected the metastatic rate nor the prognosis of malignant melanoma. The use of incisional biopsies is not encouraged because tumor thickness cannot be measured accurately. However, they may be helpful for confirming the diagnosis if an excisional biopsy cannot be performed.


〈症例報告〉逆行性外側上腕皮弁で再建した Angiomatoid Fibrous Histiocytoma の1例

Journal of Japan Society of Plastic and Reconstructive Surgery


Extended Hair-bearing Lateral Orbital Flap for Simultaneous Reconstruction of Eyebrow and Eyelid

When a tumor in the lateral eyebrow region is resected, reconstruction of the eyebrow and upper eyelid defects is necessary. We perform simultaneous reconstruction of such defects; sideburn hair is included on an extended lateral orbital flap. We describe our method and results of a retrospective evaluation. We treated 6 patients with partial eyebrow and upper eyelid defects. An extended lateral orbital flap was designed on the lateral region of the lateral canthus including sideburn hair and was elevated with a pedicle of the orbicularis oculi muscle. Flap size, surgical outcomes, and reconstructed eyebrow morphology were evaluated. Mean flap size was 2.7 × 4.1 cm, with a maximum width and length of 3.5 and 5.1 cm, respectively. The mean hair-bearing region was 1.4 × 0.9 cm, with a maximum width and length of 1.8 and 1.3 cm, respectively. Total flap survival and hair growth were confirmed in all patients. The reconstructed eyebrow and eyelid were aesthetically satisfactory. The new eyebrow hair grew long and was directed upward but considered acceptable. No additional surgery was performed for any patient. The donor site scar was acceptable because it followed the wrinkles of the lateral eyelid. No paralysis of the temporal branch of the facial nerve resulted. The procedure for raising an extended hair-bearing lateral orbital flap is relatively easy, although attention must be paid to the temporal facial nerve. This flap is useful for simultaneously reconstructing defects of the upper eyelid and lateral eyebrow.


Relation between the serum albumin level and nutrition supply in patients with pressure ulcers : retrospective study in an acute care setting

This retrospective study examined the validity of the commonly used serum albumin level as an indicator of nutrition status of patients with pressure ulcer(s), particularly because the serum albumin level is affected by various factors and may not be specific to malnutrition. Specifically, we investigated whether nutrition supply or inflammation affects the serum albumin level in 82 patients with pressure ulcers(s) (29 in whom pressure ulcer was present upon admission and 53 in whom pressure ulcer developed after hospital admission). Serum albumin levels, blood test including C-reactive protein (CRP) levels and blood count, caloric intake, and depth and healing of pressure ulcers were compared between various subgroups of patients. Serum albumin levels correlated with red blood cell counts and hemoglobin and CRP levels but not with caloric intake. The correlation with CRP before and after several weeks of pressure ulcer treatment was negative. The serum albumin level upon admission was higher in patients in whom the ulcer healed than in those in whom it did not heal as well as in patients who were discharged than in those who died in the hospital. The serum albumin level appears to reflect inflammation, wound healing, and disease severity rather than nutrition supply in patients with pressure ulcer. J. Med. Invest. 61: 15-21, February, 2014.

The Journal of Medical Investigation : JMI


Two-Stage Surgery for Hidradenitis Suppurativa : Staged Artificial Dermis and Skin Grafting

Hidradenitis suppurativa is a chronic and often refractory skin disease that can require radical excision of the full layer of fatty tissue under the lesion. Closure using a split-thickness skin graft often results in depression deformity and lack of tissue flexibility. We have developed a two-stage procedure to preserve fatty tissue during radical excision and apply an artificial dermis graft, and we have performed this procedure in 18 patients (33 lesions). To describe our two-stage procedure and report results of the procedure in our patient series. In the first step, all diseased skin including the superficial subcutaneous fatty tissue is excised; normal deep subcutaneous fatty tissue is preserved. Artificial dermis is then grafted to the preserved fatty tissue. Two weeks later, split-thickness skin grafts are applied to the skin defects. We evaluated graft success, any recurrence, and postoperative appearance in our patients, who were followed up for 8 to 36 months. All 32 skin grafts were successful. There was only one recurrence, which was treated using reoperation, and postoperative appearances were good. Our new procedure incorporating artificial dermis appears to be a good treatment option for advanced hidradenitis suppurativa.


Analysis of the Correlation between Wound Contraction Ratio and Therapeutic Duration Using V.A.C. ATS Therapy System for 34 Cases

V.A.C. ATS治療システムを使用した創傷34例の検討ー創の収縮率とV.A.C.使用期間に関する検討ー


Transcutaneous PCO2 Measurement at Low Temperature for Reliable and Continuous Free Flap Monitoring: Experimental and Clinical Study

Measurement of transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) has been used for free flap monitoring. Because these values are obtained with sensor probes heated to 44°C, there is potential for low-temperature burns on skin flaps. We measured TcPO2 and TcPCO2 at 37°C in both animals and humans to determine the feasibility and safety of the procedure as a postoperative flap monitoring method. Twelve epigastric island flaps were elevated in rabbits, and TcPO2 and TcPCO2 were measured at 37°C before and after ligation of the pedicles. In addition, TcPO2 and TcPCO2 at 37°C were measured in healthy men. Subsequently, the method was applied to postoperative monitoring of free flaps in 49 clinical cases. TcPO2 and TcPCO2 values were significantly affected by the experimental flap elevation. A rapid increase in TcPCO2 was observed with both arterial and venous occlusion. In the healthy men, TcPO2 and TcPCO2 were measurable at all skin surface sites. In the clinical cases of free flap transfer, TcPO2 values remained very low for at least 72 hours. TcPCO2 values ranged from 40 to 70 mm Hg for 72 hours in more than 80% of cases. In 2 cases, TcPCO2 values increased to more than 90 mm Hg, and exploration surgery was performed. These compromised flaps were saved by reanastomosis of the veins. Continuous monitoring of TcPCO2 at 37°C can provide objective information and alert doctors and nurses to the need for checking the free flap.


A Case of Nodular Fasciitis with Retraction of the Overlying Skin of the Cheek

頬部陥凹を呈した頬部結節性筋膜炎の1例

Journal of the Japan Society of Cranio-Maxillo-Facial Surgery

日本頭蓋顎顔面外科学会誌


Recurring facial low-grad fibro myxoid Sarcoma in an elderly patient : A cace report

Low-grade fibromyxoid sarcoma (LGFMS) is a rare type of sarcoma that is characterized by benign-appearing histologic features but a paradoxically aggressive clinical course. These tumors generally occur in young to middle-aged adults, sometimes in children, but rarely in high-aged adults. LGFMS typically affects the deep soft tissues of the trunk or lower extremities; however, it is rarely seen in the face. We here describe a case of LGFMS on the right forehead of an 84-year-old woman. After resection with a 1-cm skin margin, recurrence occurred at 15 months postoperatively. Additional wide excision was subsequently performed with a 2-cm skin margin. Recurrence and metastasis have not been observed for 1 year after the second excision. A wide surgical margin should be considered in cases of LGFMS.

The Journal of Medical Investigation : JMI


下殿動静脈を移植床血管とし遊離広背筋皮弁で再建した仙腸関節部放射線潰瘍の1例

下殿動静脈を移植床血管とし遊離広背筋皮弁で再建した仙腸関節部放射線潰瘍の1例

日本マイクロサージャリー学会会誌

日本マイクロサージャリー学会会誌


<原著>下顎プレート再建術における外側広筋と大腿筋膜を付着させた遊離前外大腿連合皮弁の有用性

日本頭蓋顎顔面外科学会誌


Usefulness in combined free anterolateral thigh and vastus lateralis muscle flaps


原発性リンパ浮腫診断治療指針2012年版9.リンパ原発性リンパ浮腫:その他の侵襲的治療9-2リンパ誘導術 2)遊離筋皮弁


Pencil-core granulome of the face:Report of two rare cases

Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS


糖尿病性足潰瘍瘍(神経障害型)に対する遊離皮弁移植による患肢温存法

糖尿病性足潰瘍瘍(神経障害型)に対する遊離皮弁移植による患肢温存法

日本マイクロサージャリ―学会会誌

日本マイクロサージャリ―学会会誌


特集/体表悪性腫瘍の部位別治療戦略 外陰殿部癌

特集/体表悪性腫瘍の部位別治療戦略 外陰殿部癌


Free Flap Transfer to Foot Ulcer Based on Diabetic Neuropathy Using Flow-through Type Anastomosis

神経障害型糖尿病足潰瘍に対する患肢温存と血流付加のための遊離皮弁移植術

日本マイクロサージャリー学会会誌

日本マイクロサージャリー学会会誌


顔面に発生したきわめて巨大な基底細胞癌の1例

顔面に発生したきわめて巨大な基底細胞癌の1例

Journal of Japan Society of Plastic and Reconstructive Surgery


特集臨床医学の展望2008-診断および治療上の進歩[4]形成外科学

特集臨床医学の展望2008-診断および治療上の進歩[4]形成外科学


手関節部に発生したびまん型関節外腱鞘巨細胞腫の1例

手関節部に発生したびまん型関節外腱鞘巨細胞腫の1例