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


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


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


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


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.


A Clinico-statistical Investigation on Cleft Lip and/or Palate Patients during the Past 10 Years in the Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital

徳島大学病院矯正歯科における過去10年間の口唇裂・口蓋裂患者に関する実態調査．

A clinical-statistical investigation was carried out with cleft lip and/or palate patients in the Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, during the 10 years from April 2006 to March 2016.
1 The number of cleft lip and/or palate patients was 96, accounting for 6.2% of orthodontic patients during the 10 years. The patients consisted of 55 males and 41 females with a male to female ratio of 1:0.75.
2 The distribution of cleft type was as follows: cleft lip and palate 36.5%, cleft lip and alveolus 33.3%, cleft palate 19.8%, and cleft lip 10.4%. The unilateral cleft lip was more frequently seen on the left side than on the right side, and in males than in females.
3 The peak age of the first visit was 0 years (58.3%). As Hellman's dental developmental stage, the percentage of stage A was 44.8%.
4 As for the resident distribution, 87.5% patients came from Tokushima prefecture.
5 90.6% of patients were referred from the Department of Plastic and Reconstructive Surgery in Tokushima University Hospital.
6 By classification of crossbite, cases of type 4 (anterior crossbite) were most frequent, at 52.9%.

徳島大学病院矯正歯科に来院した口唇裂・口蓋裂患者の実態を把握する目的で，2006年4月から2016年3月までの10年間に当科を受診した口唇裂・口蓋裂患者を対象として臨床統計を行い，以下の結果を得た．
1．過去10年間の口唇裂・口蓋裂患者は96名であり，矯正歯科総患者数の6.16%を占めていた．男女比は1:0.75であった．
2．裂型分類では唇顎口蓋裂(36.5%)，口唇顎裂(33.3%)，口蓋裂(19.8%)，口唇裂(10.4%)であった．披裂部の側性は唇顎口蓋裂，口唇顎裂においては左側に，口唇裂では右側に高い割合でみられた．裂型別性差に関しては口唇裂，口唇顎裂，唇顎口蓋裂においては男子に，口蓋裂においては女子に高い割合で認められた．
3．初診時年齢は0歳(58.3%)が最も多く，次いで1歳(11.5%)，2歳(7.3%)と続いた．初診時におけるHellmanの咬合発育段階で分類すると，乳歯咬合完成前のⅠA期(44.8%)が最も多く，次にⅠC期(32.3)，ⅡA期(7.3%)と続いた．
4．患者の居住地の地域分布は徳島県が87.5%で最も多く認められた．
5．紹介元の医療施設においては，当院形成外科からの紹介が90.6%を占めていた．
6．交叉咬合の分類において，前歯のみが交叉咬合を呈するType 4が52.9%と最も高かった．

Journal fo Japanese Cleft Palate Association


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.


唇裂後変形に対する人工骨移植の小工夫

唇裂後変形に対する人工骨移植の小工夫

Journal of Japan Society of Plastic and Reconstructive Surgery


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.

The Journal of Medical Investigation : JMI


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.


Chronic inflammation and progressive calcification as a result of fat necrosis : the worst end in fat grafting.

Autologous fat injection into the breast has been performed widely for breast augmentation and reconstruction because of recent technical and scientific advancements. However, it is important to learn what occurs and how problematic it can be if fat grafting is not conducted appropriately. Oil cysts were explanted from three subjects who underwent cosmetic fat grafting to the breast 2, 4, and 6 years previously. The oil cyst samples were examined histopathologically. Computed tomographic, magnetic resonance imaging, and mammographic images obtained sequentially after fat grafting were also analyzed. The cyst wall consisted of innermost and outermost fibrous layers and intermediate tissue that contained the regular adipose portion, a degenerated adipose portion, and a fibrous area. Eggshell-like macrocalcifications were seen in the inner surface. Numerous inflammatory cells, mainly MAC2/CD206 anti-inflammatory M2 macrophages, were observed in the degenerated adipose portion. Oil cysts with a longer history showed more calcifications in the innermost layer and a larger fibrous area adjacent to the degenerated fat portion than those with a shorter history. These histopathologic findings and clinical computed tomographic images revealed that oil cysts continued to be inflammatory and calcifications continued to develop over several years. After fat necrosis, long-term chronic inflammation persists and calcification seems to progress without limits. Oil cysts are the worst outcome of fat grafting and must be avoided by standardizing meticulous injection techniques. Therapeutic, V.