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Morihisa Y, Rikimaru-Nishi Y, Ohmaru Y, Ino K, Rikimaru H, Kiyokawa K. Scientific validation of clinical visual scales and Antera 3D™ consistency with derived measurements in the assessment of infantile haemangioma after laser therapy. J Plast Reconstr Aesthet Surg 2024; 91:47-55. [PMID: 38401278 DOI: 10.1016/j.bjps.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Laser therapy is a treatment for infantile haemangiomas. The efficacy of laser therapy for red lesions is determined by visual evaluation; however, this assessment is inaccurate and lacks objectivity. OBJECTIVE To scientifically validate the consistency between pre- and post-treatment visual assessment grades for infantile haemangioma treated with pulsed dye laser (PDL) and the values calculated from images obtained with Antera 3D™. METHODS This study involved 81 cases of infantile haemangiomas treated with PDL alone from 2012 to 2015 and with Antera 3D™ images of the lesions. Using images obtained before treatment and 4-6 weeks after the last treatment, the lesions were rated using a visual four-step scale. Ratings were categorised as Poor/Fair/Good/Excellent by the degree of improvement in the red colour tone. The red colour ratio was calculated using the haemoglobin distribution in the lesion and surrounding skin, and the improvement difference and improvement rate were then obtained. The correlation between the improvement difference and improvement rate, and visual evaluation was statistically analysed. RESULTS No serious adverse effects were observed, with an average of 4.3 treatments per patient; 60.1% of the patients achieved Good/Excellent results. There were statistically significant differences in the post-treatment red colour ratio and improvement ratio in each category after visual evaluation classification. The improvement rate and the four visual grades were statistically correlated. CONCLUSION This study confirmed the scientific validity of visual evaluation and the evaluation criteria calculated from Antera 3D™. This method could objectively determine treatment effectiveness.
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Affiliation(s)
- Yoichiro Morihisa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Department of Plastic Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Youkou Ohmaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kou Ino
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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Matsuura‐Midorikawa M, Rikimaru H, Rikimaru‐Nishi Y, Migita H, Tanaka H, Oyama M, Kiyokawa K. Indication for management of oropharyngocutaneous fistulas after head and neck reconstruction using a "stick-shaped platysma flap" technique. Clin Case Rep 2021; 9:e04135. [PMID: 34336209 PMCID: PMC8319381 DOI: 10.1002/ccr3.4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022] Open
Abstract
The main strength of the stick-shaped platysma flap technique is it provides adequate tissue volume, while being comparatively simple to perform. It is a highly efficient and straightforward method to close intractable fistulas with minimal morbidity.
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Affiliation(s)
- Mari Matsuura‐Midorikawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Yukiko Rikimaru‐Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
- Division of Microscopic and Developmental AnatomyDepartment of AnatomyKurume University School of MedicineKurumeJapan
| | - Hisashi Migita
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Hiroaki Tanaka
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Mai Oyama
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial SurgeryKurume University School of MedicineKurumeJapan
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Tanaka H, Rikimaru H, Rikimaru-Nishi Y, Muraoka N, Anegawa M, Ueki S, Oishi O, Kiyokawa K. Surgical Management of Deep Brain Stimulator Infection without Electrode Removal: Report of Two Cases. J Neurol Surg Rep 2020; 81:e15-e19. [PMID: 32257764 PMCID: PMC7108948 DOI: 10.1055/s-0039-3399569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/28/2019] [Indexed: 11/02/2022] Open
Abstract
Objective Stimulation of the subthalamic nucleus by implanted electrodes (deep brain stimulation [DBS]) is performed to suppress symptoms of Parkinson's disease. However, postoperative wound dehiscence and infection can require removal of the implanted electrode leads. This report describes treatment of intractable unilateral wound infection in two patients without removing the DBS device. Methods First, components of the DBS system were removed except for the electrode lead and thorough debridement of the infected wound was conducted. Second, the edges of the bone defect left by removal of DBS components were smoothed to eliminate dead space. Subsequently, the electrode lead was covered by using a pericranial-frontalis-muscle flap or a bi-pedicled-scalp flap with good blood supply. Closed intrawound continuous negative pressure and irrigation treatment was conducted for 1 week after the surgery, and then the drain was removed. Results We treated two patients with wound infection after implantation of DBS electrodes. Case 1 developed a cutaneous fistula and Case 2 had wound dehiscence. After treatment by the method described above, complete wound healing was achieved in both patients. Conclusion DBS is always associated with a risk of infection or exposure of components and treatment can be very difficult. We successfully managed intractable wound infection while leaving the electrode lead in situ, so that it was subsequently possible to continue DBS for Parkinson's disease.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan.,Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Norihiro Muraoka
- Department of Neurological Surgery, National Center Hospital of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan.,Department of Neurological Surgery, Takagi Hospital, Okawa-shi, Fukuoka, Japan
| | - Mina Anegawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Shoya Ueki
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Ou Oishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan.,Department of Plastic and Reconstructive Surgery, Takagi Hospital, Okawa-shi, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
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Rikimaru H, Rikimaru-Nishi Y, Yamauchi D, Ino K, Kiyokawa K. New Alternative Therapeutic Strategy for Gustilo Type IIIB Open Fractures, Using an Intra-Wound Continuous Negative Pressure Irrigation Treatment System. Kurume Med J 2019; 65:177-183. [PMID: 31723082 DOI: 10.2739/kurumemedj.ms654009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The treatment of Gustilo type IIIB and IIIC open fractures remains a challenging problem, because the infection rate is 15-45%. Infection can lead to serious complications such as osteomyelitis or amputation. The intra-wound continuous negative pressure and irrigation treatment (IW-CONPIT) was developed for infected wounds and intractable ulcers, and is very effective in suppressing infection and accelerating wound healing. Here the IW-CONPIT was applied to severe open fractures for the purpose of preventing infection. After thorough debridement and lavage of the wound, bony stabilization is performed by external fixation. Dermal matrix is grafted onto any areas where the bone or tendon is exposed. A sponge containing two tubes is placed over the entire surface of the wound including the dermal matrix. Then it is covered with a film dressing to make the wound completely airtight. A bottle of physiologic saline solution is attached to one tube, and a continuous aspirator is attached to the other. This system maintains negative pressure on the wound surface, which is continuously irrigated. Thirty-five patients were treated with this method. A superficial infection developed in two cases but was resolved by additional debridement and continued application of IW-CONPIT. Complete wound healing was obtained with split thickness skin graft in all cases. There were no complications such as osteomyelitis, delayed bone union or amputation. IW-CONPIT was able to definitively prevent wound infection in Gustilo type ⅢB open fractures. We believe this method will become a standard treatment option for this condition.
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Affiliation(s)
- Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine.,Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Daisuke Yamauchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Koh Ino
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
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Sakamoto A, Rikimaru H, Rikimaru-Nishi Y, Watanabe K, Hashiguchi S, Kanazawa T, Nakamura KI, Kiyokawa K. Experimental study on maintaining the curvature of transplanted cartilage: Influence of the number of cartilage struts. J Plast Reconstr Aesthet Surg 2019; 72:1340-1346. [PMID: 31064705 DOI: 10.1016/j.bjps.2019.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND When auriculoplasty is performed for microtia, wire often becomes exposed during the long postoperative period. We have investigated other materials for fixing cartilage. We previously reported that absorbable sutures are more appropriate than wire. The present animal experiments investigated the reasons why fixation of transplanted cartilage is maintained when using absorbable sutures. METHODS The costal cartilages of Sprague-Dawley rats were harvested, and three cartilage transplant models were prepared. After bending a costal cartilage into a U-shape, it was fixed by using only absorbable sutures as the control or was fixed by suturing one or two cross struts of cartilage to the U-shaped graft. Then the cartilages were subcutaneously transplanted into the backs of the rats. They were removed 8 weeks later, and the return rate of the bent cartilages was assessed. RESULTS The return rate was 74.0%, in the suture-only group (control), 27.9% in the one-strut group, and 8.3% in the two-strut group. When the sites of contact between the U-shaped graft and the cartilage struts were observed by light microscopy, adhesion of the two cartilages by fibrous connective tissue was observed. CONCLUSION U-shaped cartilage grafts demonstrated a smaller return rate when there was a larger contact area with the cartilage struts. Each strut was fixed by fibrous connective tissue at the contact site, thereby maintaining the shape of the graft. Thus, when creating a cartilage framework, it is important to fix the bent cartilage to the cartilage struts with a sufficiently large contact area.
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Affiliation(s)
- Aritaka Sakamoto
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Koichi Watanabe
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Shinichiro Hashiguchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Tomonosin Kanazawa
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kei-Ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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Rikimaru-Nishi Y, Rikimaru H, Hashiguchi S, Kanazawa T, Ohta K, Nakamura KI, Kiyokawa K. Histological study of costal cartilage after transplantation and reasons for avoidance of postoperative resorption and retention of cartilage structure in rats. J Plast Surg Hand Surg 2018; 52:352-358. [PMID: 30286673 DOI: 10.1080/2000656x.2018.1505634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Limited information is available on the biological status of transplanted cartilage from which the perichondrium has been removed. This article describes the histological and three-dimensional structural picture of cartilage, using green fluorescent protein (GFP) transgenic rats and normal wild rats. METHODS Three sections of costal cartilage were harvested from 10-week-old wild rats. One section was used as a specimen while two were subcutaneously collected from the dorsal region of 10-week-old GFP rats at 4 and 8 weeks post-transplant. The experiment was performed in two randomized groups. The perichondrium was removed from transplanted cartilage in the first group and perichondrium of transplanted cartilage remained intact in the second group. Histology and focused ion beam/scanning electron microscope (FIB/SEM) tomography were used to evaluate the transplanted cartilage. RESULTS All 40 transplanted sections were harvested and no infections, exposure or qualitative change of cartilage matrix were seen following transplant. Histological analyses showed that the surface layer of the GFP-negative transplanted cartilage was replaced with GFP-positive chondrocytes 8 weeks post-transplant in the first group. A three-dimensional layer of perichondrium-like tissue reconstructed around the cartilage at 8 weeks was confirmed, resembling normal perichondrium. However, the GFP-positive chondrocytes were not replaced in the second group. CONCLUSIONS The cell renewal of chondrocytes is necessary for subcutaneously transplanted cartilage to maintain its tissue composition over a long period of time. The histological and ultrastructural analyses revealed that cells from recipient tissue generated new chondrocytes even when cartilage was implanted after removing the perichondrium.
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Affiliation(s)
- Yukiko Rikimaru-Nishi
- a Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery , Kurume , Japan.,b Division of Microscopic and Developmental Anatomy , Kurume University School of Medicine , Kurume , Japan
| | - Hideaki Rikimaru
- a Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery , Kurume , Japan
| | - Shinichiro Hashiguchi
- a Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery , Kurume , Japan
| | - Tomonoshin Kanazawa
- b Division of Microscopic and Developmental Anatomy , Kurume University School of Medicine , Kurume , Japan
| | - Keisuke Ohta
- b Division of Microscopic and Developmental Anatomy , Kurume University School of Medicine , Kurume , Japan
| | - Kei-Ichiro Nakamura
- b Division of Microscopic and Developmental Anatomy , Kurume University School of Medicine , Kurume , Japan
| | - Kensuke Kiyokawa
- a Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery , Kurume , Japan
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Tateyama M, Konno M, Takano R, Chida K, Rikimaru H, Chida K. Incidence of a dangerous misalignment of tracheostomy tubes in patients with advanced neuromuscular disorders. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ohmaru Y, Sakata K, Hashiguchi SI, Tanaka H, Rikimaru H, Kiyokawa K. A new modified Pudendal Thigh Flap of vaginoplasty including reconstruction of vaginal vestibule. Case Reports Plast Surg Hand Surg 2017; 4:21-26. [PMID: 28470030 PMCID: PMC5404652 DOI: 10.1080/23320885.2017.1296363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 02/12/2017] [Indexed: 11/21/2022]
Abstract
We modified the conventional Pudendal Thigh Flap (PTF) on the vaginoplasty including reconstruction of vaginal vestibule. After the operation, no stenosis of the vaginal vestibule and opening of the vagina was observed. It is believed that our technique is cosmetically and functionally possible and a useful method.
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Affiliation(s)
- Youkou Ohmaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University, Fukuoka, Japan
| | - Kensuke Sakata
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University, Fukuoka, Japan
| | - Shin-Ichiro Hashiguchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University, Fukuoka, Japan
| | - Hiroaki Tanaka
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University, Fukuoka, Japan
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Ono T, Tanaka N, Umeno H, Sakata K, Morioka M, Ohmaru Y, Rikimaru H, Koga N, Kiyokawa K, Chitose SI, Shin B, Aso T, Etoh H, Abe T. Treatment Outcomes of Locally Advanced Squamous Cell Carcinoma of the Ethmoid Sinus Treated with Anterior Craniofacial Resection or Chemoradiotherapy. Case Rep Oncol 2017; 10:339-349. [PMID: 28559817 PMCID: PMC5436010 DOI: 10.1159/000470834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 11/19/2022] Open
Abstract
We retrospectively analyzed 14 patients with locally advanced squamous cell carcinoma of ethmoid sinus (LASCC-ES) for the feasibility of anterior craniofacial resection (ACFR). Ethmoid cancer treatment comprised alternating chemoradiotherapy (ALCRT; n = 1), concomitant radiotherapy and intra-arterial cisplatin (RADPLAT; n = 4) and ACFR (n = 9). The 3- and 5-year overall survival (OS) rates of patients were 47.6 and 39.6%, respectively. The 3-year local control (LC) rates of chemoradiotherapy (CRT; ALCRT and RADPLAT) (n = 5) and ACFR (n = 9) groups were 0 and 66.7% (p = 0.012), respectively. The 3-year progression-free survival (PFS) rate of the CRT and ACFR groups were 0 and 55.6% (p = 0.018), respectively. The 3-year OS rate of the CRT and ACFR groups were 0 and 76.2% (p = 0.005), respectively. Postoperative pathological examinations confirmed positive margins in 3 (33%) of 9 cases. The 3-year LC and PFS rates of cases (n = 3) with positive surgical margins were significantly poorer than those of cases (n = 6) with negative surgical margins. Although ACFR for LASCC-ES is a feasible treatment, cases with positive surgical margins were more prone to local relapse. Therefore, surgical safety margins should be thoroughly assessed.
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Affiliation(s)
- Takeharu Ono
- aDepartment of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Norimitsu Tanaka
- bDepartment of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Hirohito Umeno
- aDepartment of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kiyohiko Sakata
- cDepartment of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Motohiro Morioka
- cDepartment of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoko Ohmaru
- dDepartment of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hideaki Rikimaru
- dDepartment of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Noriyuki Koga
- dDepartment of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kensuke Kiyokawa
- dDepartment of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shun-Ichi Chitose
- aDepartment of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Buichiro Shin
- aDepartment of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takeichiro Aso
- aDepartment of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hidehiro Etoh
- bDepartment of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- bDepartment of Radiology, Kurume University School of Medicine, Kurume, Japan
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Abstract
Quantification of the overall activity of every masticatory muscle is requisite for the analysis of stomatognathic function, which has not been accomplished by conventional electromyography. We used positron emission tomography and 18F-fluoro-deoxy-glucose to quantify the overall activity of every masticatory muscle during lateral excursion, and to evaluate the relative contribution of each masticatory muscle to lateral excursion. The present study suggested that lateral and medial pterygoid muscles are more responsible for lateral excursion than are masseter and temporal muscles. In particular, the contralateral lateral pterygoid muscle plays a major role, followed by the contralateral medial pterygoid muscle.
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Affiliation(s)
- S Yamaguchi
- Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
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Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M. Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management. World Neurosurg 2016; 89:240-54. [PMID: 26875653 DOI: 10.1016/j.wneu.2016.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Craniofacial resection (CFR) for advanced sinonasal malignant tumors (SNMTs) is mandatory for radical resection. Surgeons must be aware of perioperative complications and long-term outcome because this procedure is extremely invasive, especially when the tumor involves the anterior skull base. METHODS Thirty-eight consecutive surgical patients with advanced SNMT of T4 stage or Kadish stage C (31 men and 7 women; mean age, 55 years; range: 19-76 years) treated with CFR in the past 28 years were followed up for 59.4 months. In cases of unilateral orbital extension, en-bloc resection was achieved using several neurosurgical techniques (extended CFR) from 2005 onwards. Herein, we evaluated the safety and effectiveness of surgery by comparing survival data between 2 time periods (first stage: 1984-2004, second stage: 2005-2012). RESULTS Squamous cell carcinoma was the most common histological type observed (65.8%), followed by esthesioneuroblastoma (15.8%). Using a combination of adjuvant radiation therapy, the 5-year overall survival and the 5-year disease-specific survival rates were 55.5% and 59.4%, respectively. Sarcomatous histology was a poor prognostic factor. The 5-year disease-specific survival rate was 48.9% in the first stage and improved to 82.1% in the second stage (P = 0.057); this was related to improvements in local control rate. CONCLUSIONS CFR and postoperative radiotherapy are safe and effective for treating advanced SNMTs. Extended CFR, including radical orbital exenteration, may contribute to good long-term outcomes. A diverse surgical team may help perform radical resection and reconstruction in patients with advanced tumors.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
| | - Akiteru Maeda
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Noriyuki Koga
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Hirohito Umeno
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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Tsukita K, Chiba T, Rikimaru H, Kurihara N, Tano O, Miura E, Ando D, Suzuki Y. Usefulness of neck mra source images for rapid screening for spontaneous cervical epidural hematoma: a case report and literature review. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Watanabe K, Takahashi N, Morihisa Y, Ikejiri M, Koga N, Rikimaru H, Kiyokawa K. Maxillary reconstruction using chimeric flaps of the subscapular artery system without vein grafts and the novel usage of chimeric flaps. J Reconstr Microsurg 2013; 29:601-6. [PMID: 24022603 DOI: 10.1055/s-0033-1354736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to overcome the disadvantages associated with the shortness of the vascular pedicle of subscapular system combined flaps when performing the maxillary reconstruction procedure. Combined flaps of the subscapular artery system were used for maxillary reconstruction. A latissimus dorsi myocutaneous flap, a scapular fasciocutaneous flap, and two kinds of scapular bone flaps were elevated as combined flaps. Next, the circumflex scapular artery (CS) and vein were cut off from the combined flaps and anastomosed to the serratus anterior branch, thereby establishing chimeric flaps. Then, maxillary reconstruction was performed using these flaps. We encountered two patients who underwent maxillectomy for maxillary cancer. Satisfactory improvements in facial shape were obtained in both cases. In cases in which combined flaps of the subscapular artery system are used for maxillary reconstruction, the biggest problem is that the vascular pedicle does not reach the recipient vessel in the neck due to the shortness of the CS. Therefore, vein grafts are generally performed to extend the flaps to the maxilla. Our novel procedure has the great advantages of long vascular pedicles and high flexibility in setting the flaps without the use of vein grafts.
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Affiliation(s)
- Koichi Watanabe
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
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Morinaga K, Kiyokawa K, Rikimaru H, Aoyagi S, Tayama K, Akashi H. Results of intra-wound continuous negative pressure irrigation treatment for mediastinitis. J Plast Surg Hand Surg 2013; 47:297-302. [DOI: 10.3109/2000656x.2013.765885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Koga N, Kiyokawa K, Rikimaru H, Inoue Y. Surgical correction of extensive scarring of the limbs with an unfolded cube advancement flap. J Plast Surg Hand Surg 2012; 46:283-7. [PMID: 22784222 DOI: 10.3109/2000656x.2012.700033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We devised a cube advancement flap and reported its usefulness for treating defects of the face. Here we report its use to treat five cases of extensive scarring of the limbs with similar satisfactory results.
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Affiliation(s)
- Noriyuki Koga
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
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Watanabe K, Takahashi N, Morihisa Y, Ino K, Rikimaru H, Koga N, Kiyokawa K. A method for accurately designing flaps for use in reconstructive surgery of the oral and oropharyngeal region using surgical wire. J Plast Reconstr Aesthet Surg 2011; 65:536-8. [PMID: 22154713 DOI: 10.1016/j.bjps.2011.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/13/2011] [Accepted: 09/23/2011] [Indexed: 11/26/2022]
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Sakamoto A, Kiyokawa K, Rikimaru H, Watanabe K, Nishi Y. An investigation of the fixation materials for cartilage frames in microtia. J Plast Reconstr Aesthet Surg 2011; 65:584-9. [PMID: 22137825 DOI: 10.1016/j.bjps.2011.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/08/2011] [Accepted: 10/13/2011] [Indexed: 11/26/2022]
Abstract
UNLABELLED When performing auriculoplasty for microtia surgery, wires are typically used to fix the costal cartilage frames. However, cases in which such wires become exposed during a long-term follow-up were frequently observed at our facility. Hence, using various materials, we conducted an investigation of the materials most suitable for fixation. METHOD The subjects consisted of 122 cases in which auriculoplasty by costal cartilage graft surgery was performed and the postoperative course was traceable, within approximately 24 years from January 1984 to March 2007. Regarding the fixation materials used in the 84 cases in which wire was used, 5 cases used monofilament non-absorbable sutures (Nylon(®)), 5 cases used monofilament absorbable sutures (PDS(®)), and 28 cases used braided absorbable sutures(VICRYL(®)).Their postoperative course was investigated, and the presence of auricular deformities caused by a loosening of the fixation materials and the exposure of the fixation materials was examined. RESULTS An exposure of the wire was observed in 19 cases (22.6%) of the 84 cases that used wires. An exposure of nylon was observed in 2 (40%) of 5 the cases that used nylon, and of those, a mild deformation was observed in the lower helix in one case that was suspected to have been caused by a loosening of the surgical suture. Regarding the 33 cases in which absorbable sutures were used (5 cases used monofilament absorbable sutures and 28 cases used braided absorbable sutures), neither any auricular deformities nor exposure of the fixation materials was observed in any of the cases. CONCLUSION Whether using monofilament or braided sutures, absorbable sutures are therefore believed to be the most suitable material for the fixation of cartilage.
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Affiliation(s)
- Aritaka Sakamoto
- Saiseikai Fukuoka General Hospital, Department of Plastic Surgery, Fukuoka, Japan
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Kiyokawa K, Tai Y, Inoue Y, Yanaga H, Rikimaru H, Shigemori M. Surgical treatment for epidural abscess in the posterior cranial fossa using trapezius muscle or musculocutaneous flap. Skull Base Surg 2011; 10:173-7. [PMID: 17171144 PMCID: PMC1656875 DOI: 10.1055/s-2000-9333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Two patients developed an epidural abscess in the posterior cranial fossa following tumor dissection from the occipital region of the head and underwent surgical treatment. After debridement of necrotic and infectious tissues inside the abscess was performed, the empty cavity was filled and the tissue defect was reconstructed by using a trapezius muscle flap or a trapezius musculocutaneous flap. Both patients had good clinical results, and their abscesses were healed. The trapezius muscle flap and trapezius musculocutaneous flap were quite useful in the treatment for epidural abscess in the posterior cranial fossa.
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Watanabe K, Kiyokawa K, Ino K, Nishi Y, Rikimaru H, Inoue Y. Treatment strategies for refractory pulmonary fistulae using a latissimus dorsi muscle flap. J Plast Reconstr Aesthet Surg 2011; 64:1014-21. [PMID: 21396896 DOI: 10.1016/j.bjps.2011.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/26/2011] [Accepted: 02/09/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND As a common treatment for pulmonary fistula, pleurosclerosis is performed. However, in the case of pulmonary fistula with empyema, it is difficult to develop adhesion through pleurosclerosis. Therefore, it is necessary to fill the dead space with a tissue graft. METHOD This surgical procedure is performed in two stages. In the first-stage surgery, the thoracic empyema cavity is opened widely, and sufficient drainage and debridement are performed within the thoracic empyema cavity. After the surgery, the wound is washed every day to suppress infection and promote the proliferation of benign granulation tissue (wound bed preparation). In the following second-stage surgery, a graft of latissimus dorsi muscle flap is performed to fill the dead space and close the fistula. In this case, a negative pressure drain is placed around the fistula to reliably drain air leaks from the pulmonary fistula, and thus the latissimus dorsi muscle flap and the tissue surrounding the pulmonary fistula can reliably adhere to the site. CASES AND RESULTS: Treatment with this method was performed in five cases, all of which successfully healed with no complications or recurrence. CONCLUSION When treating pulmonary fistula that has developed into thoracic empyema, it is believed that the following three points are important: (1) wound bed preparation around the pulmonary fistula, (2) inserting a latissimus dorsi muscle flap having a high wound-healing capacity and (3) promoting strong adhesion of the muscle flap and tissue surrounding the pulmonary fistula by reliably draining air leaks from the pulmonary fistula with a negative pressure drain.
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Affiliation(s)
- Koichi Watanabe
- Department of Plastic and Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka Prefecture 830-0011, Japan
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Yamauchi T, Kiyokawa K, Inoue Y, Rikimaru H. V-Y fasciocutaneous flap of the medial thigh including the long saphenous vein for reconstruction of intrapelvic dead space. ACTA ACUST UNITED AC 2009; 43:142-7. [PMID: 19401944 DOI: 10.1080/02844310902771657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Some patients develop an intrapelvic infection and fistula caused by the presence of intrapelvic dead space after the resection of rectal cancer, and the treatment is sometimes quite difficult. We have developed a new surgical technique for the treatment and prevention of such fistulas that uses a fasciocutaneous flap from the medial thigh. A V-shaped fasciocutaneous flap with a pedicle on the anterior side of the thigh is designed on the medial thigh and gluteal region. After raising the fasciocutaneous flap that contains the long saphenous vein, the gluteal section including a thick layer of fatty tissue is de-epithelialised, and the flap is rotated and advanced towards the dead space to fill it. Four patients were operated on using our technique. One was a secondary reconstruction: the patient had developed a small fistula after reconstructive surgery, but it healed with conservative treatment. As a result, all four patients achieved satisfactory outcomes. The advantages of our technique include: no change in the position of the body is required for reconstruction; operations are simple; sufficient volume of tissue is obtained from the thick fatty tissues of the gluteal region; and the fasciocutaneous flap contains the long saphenous vein and has good venous circulation. We consider this technique useful for the reconstruction of intrapelvic dead space.
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Affiliation(s)
- Toshihiko Yamauchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
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Kiyokawa K, Takahashi N, Rikimaru H, Yamauchi T, Inoue Y. New Continuous Negative-Pressure and Irrigation Treatment for Infected Wounds and Intractable Ulcers. Plast Reconstr Surg 2007; 120:1257-1265. [PMID: 17898598 DOI: 10.1097/01.prs.0000279332.27374.69] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Continuous irrigation and the vacuum-assisted closure system are effective methods for the treatment of infected wounds and intractable ulcers. The objective of this study was to simultaneously use both of the above methods as a new approach for obtaining more satisfactory, accelerated wound healing. METHODS After debridement of the wound, indwelling irrigation and aspiration tubes are placed in the wounds that have been sutured closed. With open wounds, a sponge with the same shape as the wound is placed directly onto the wound surface, and after the two tubes are inserted in the sponge, the wound is covered with film dressing to make the wound completely airtight. A bottle of physiologic saline solution is then attached to the irrigation tube, and a continuous aspirator (Mera Sacume) is attached to the aspiration tube. The bottle of physiologic saline solution is placed at the same height as the wound, and with a pressure gradient between the two of 0, continuous aspiration is applied. RESULTS All nine cases treated as closed air cavity wounds with this method healed after 2 to 3 weeks. In eight cases of open wound, recurrence of infection was observed in only one case. CONCLUSIONS The two treatments of continuous irrigation and negative pressure were observed to have an additive and synergistic effect for earlier wound healing. Furthermore, the present method can dramatically reduce the number of dressing changes required, patient pain, psychological stress, and treatment cost.
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Affiliation(s)
- Kensuke Kiyokawa
- Kurume City, Japan From the Department of Plastic and Reconstructive Surgery, Kurume University School of Medicine
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Abstract
Congenital pharyngeal atresia is a very rare gastrointestinal anomaly, with only seven cases of complete pharyngeal atresia having been reported. Five of these cases were autopsy reports and success in surgery to enable oral ingestion was not reported even for the two surviving cases. This is a report of a 1.5-year-old boy with complete congenital pharyngeal atresia who was saved by an emergency tracheostomy directly after birth, and on whom we performed surgery to reconstruct the pharyngeal cavity and prevent re-occlusion and restonosis. Approximately four years after the surgery, no restenosis of the pharyngeal cavity has been observed, and the patient is capable of orally ingesting ordinary meals and breathing and vocalizing by closing the tracheal lumen for nearly satisfactory results.
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Affiliation(s)
- Nagahiro Takahashi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
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Nishi Y, Kiyokawa K, Watanabe K, Rikimaru H, Yamauchi T. A Surgical Treatment of Severe Late Posttraumatic Enophthalmos Using Sliced Costal Cartilage Chip Grafts. J Craniofac Surg 2006; 17:673-9. [PMID: 16877913 DOI: 10.1097/00001665-200607000-00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The efficacy of sliced costal cartilage chip grafts for the treatment of late posttraumatic enophthalmos was investigated. Surgery was conducted based on the method reported by Matsuo et al. in 1989. After making an incision in the lower eyelid, dissecting the subperiosteum of the medial orbital wall, orbital floor and lateral orbital wall was performed to the posterior of the orbit, and then costal cartilage chips were gradually grafted in a step-like configuration to the subperiosteum from a location posterior to the equatorial plane of the eyeball. At this time, as well as to the area of concave depression in the orbital bone caused by the fracture, grafts were made to the subperiosteum of the non-deformed medial and lateral orbital wall, to move all of the orbital tissue, including the eyeball, forward. This was performed for five cases of severe late posttraumatic enophthalmos. Among the five cases, there were four cases of severe orbital fracture and one case for which malignant orbital tumor extirpation and radiation therapy had been performed. Following surgery, although mild enophthalmos remained in three of the five cases, esthetically satisfactory results were obtained for all cases. Costal cartilage chip grafts were shown to be an effective method for the treatment of late posttraumatic enophthalmos.
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Affiliation(s)
- Yukiko Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
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Takagi M, Kiyokawa K, Sakamoto A, Watanabe K, Rikimaru H, Inoue Y, Shirouzu T. Two-Stage Reconstructive Surgery of a Patient with Head Trauma Resulting in Extensive Cranial Bone and Dura Mater Loss Caused by Postoperative Infection. J Craniofac Surg 2006; 17:584-90. [PMID: 16770204 DOI: 10.1097/00001665-200605000-00035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
After external decompression for a case of head trauma, epidural abscess formation resulted in extensive cranial bone and dura mater loss, for which two-stage reconstructive surgery was conducted. In the first operation, after thorough debridement of the infected wound, the dura mater was reconstructed using a bipedicle pericranial flap with posterior and anterior pedicles. After the infection had completely subsided, the second operation was performed, reconstructing the cranium with grafted outer-table calvarial bone and cutting bone to reposition an old zygomatic fracture. At this point, the pericranial flap used for dura mater reconstruction in the first operation became a satisfactory graft bed for the grafted bone. The postoperative course was satisfactory, and there was no cranial bone absorption after roughly 2 year, and a favorable shape has been maintained for an extremely satisfying result.
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Affiliation(s)
- Mikako Takagi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
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Rikimaru H, Kiyokawa K, Inoue Y, Tai Y. Three-Dimensional Anatomical Vascular Distribution in the Pectoralis Major Myocutaneous Flap. Plast Reconstr Surg 2005; 115:1342-52; discussion 1353-4. [PMID: 15809597 DOI: 10.1097/01.prs.0000156972.66044.5c] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In head and neck reconstruction, the pectoralis major myocutaneous flap, located adjacent to the area of reconstruction, is a very useful and easy-to-prepare flap. However, it is reported to have an unstable blood circulation that could result in partial necrosis of the skin island. The current study investigated the detailed three-dimensional vascular network in the flap to establish a method of preparation with a stable circulation. METHODS The pectoralis major muscle and the anterior chest skin on 12 sides of eight fresh cadavers were subjected to angiographic procedures in which contrast medium was injected selectively to the internal thoracic artery and the thoracoacromial artery. On another fresh cadaver, resin was injected in the same manner, and a clear specimen of the pectoralis major myocutaneous flap was prepared. RESULTS The pectoralis major muscle consists of two anatomical vascular territories that the choke vessels in the muscle at the level of the fourth costal cartilage divide into cranial and caudal sides. The chest skin area on the caudal side where the skin island of the flap is prepared receives its blood supply from a dense anastomotic network formed by the fourth, fifth, and sixth intercostal perforating branches. CONCLUSIONS The blood flow in the pectoral branch of the thoracoacromial artery runs through the choke vessels that dilate at the elevation of the pectoralis major myocutaneous flap, first into the fourth intercostal perforating branches; then to the anastomotic vascular network of the fourth, fifth, and sixth intercostal perforating branches; and finally to reach the periphery of the skin island.
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Affiliation(s)
- Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery-Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan.
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Abstract
Brain-gut interaction is considered to be a major factor in the pathophysiology of irritable bowel syndrome. However, only limited information has been provided on the influence of gastrointestinal tract stimulation on the brain. Our aim in this study was to determine the specific regions of the brain that are responsible for visceral perception and emotion provoked by distention of the descending colon in humans. Fifteen healthy males aged 22 +/- 1 participated in this study. Using a colonoscope, a balloon was inserted into the descending colon of each subject. After sham stimulation, the colon was randomly stimulated with bag pressures of 20 and 40 mmHg, and regional cerebral blood flow was measured by [(15)O] positron emission tomography. The subjects were asked to report visceral perception and emotion using an ordinate scale of 0-10. Colonic distention pressure dependently induced visceral perception and emotion, which significantly correlated with activation of specific regions of the brain including the prefrontal, anterior cingulate, parietal cortices, insula, pons, and the cerebellum. In conclusion, distention of the descending colon induces visceral perception and emotion. These changes significantly correlate with activation of specific regions in the brain including the limbic system and the association cortex, especially the prefrontal cortex.
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Affiliation(s)
- T Hamaguchi
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Aoba, Sendai, Japan
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Kiyokawa K, Rikimaru H, Inoue Y, Tai Y. A New Concept and Technique for Reconstructing Skin Defects in the Cheek Region: An Unfolded Cube Advancement Flap. Plast Reconstr Surg 2004; 113:985-91. [PMID: 15108895 DOI: 10.1097/01.prs.0000105045.57704.44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Japan.
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Abstract
Investigators have used positron emission tomography with 18F-fluoro-D-deoxyglucose to obtain information not only for the diagnosis of cancers, but also for researching physiology in skeletal muscles. The aim of this study was to evaluate the activities of the jaw and tongue muscles during gum-chewing. Five volunteers aged 32-61 years were studied by positron emission tomography. They were requested to chew two pieces of chewing gum for 30 min after intravenous injection of 18F-fluoro-D-deoxyglucose. 18F-fluoro-D-deoxyglucose uptake in the intrinsic tongue muscle was significantly (p < 0.05) higher than that in the masseter, temporal, and medial pterygoid muscles. Heterogeneous uptake of 18F-fluoro-D-deoxyglucose was observed in the masticatory muscles. In addition, the tongue exhibited higher activity than the masticatory muscles. In conclusion, positron emission tomography with 18F-fluoro-D-deoxyglucose appeared to be a useful technique for investigating the physiologic activities of the skeletal muscles, which have been difficult to examine by conventional methods.
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Affiliation(s)
- H Rikimaru
- Division of Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
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Kiyokawa K, Tai Y, Inoue Y, Yanaga H, Rikimaru H, Mori K, Nakashima T, Kameyama T. Reliable, minimally invasive oromandibular reconstruction using metal plate rolled with pectoralis major myocutaneous flap. J Craniofac Surg 2001; 12:326-36. [PMID: 11482617 DOI: 10.1097/00001665-200107000-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to minimize the surgical invasiveness to the donor site and the amount of the primary reconstruction time after oromandibular tumor resection. Oromandibular reconstruction was performed only using a pectoralis major myocutaneous flap and a metal plate. The pectoralis major myocutaneous flap was grafted to the oral cavity defect by rolling and wrapping around the metal plate with the muscle of the flap. No early postoperative complications have been noted in all seven patients. An average of 2 years and 1 month has past since surgery, and to date no infections, plate exposure, or plate breakage have been observed in any of the patients. The safety of the oromandibular reconstruction using a metal plate was improved by rolling the muscle of the pectoralis major myocutaneous flap around the metal plate. The present method was shown to be a rational technique that allowed primary reconstruction of the oral cavity and mandible in a minimally invasive manner in a short time.
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Affiliation(s)
- K Kiyokawa
- Department of Plastic and Reconstructive Surgery, Kurume University School of Medicine, Fukuoka, Japan
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Rikimaru H, Sato A, Hashizume E, Sasaki S, Watanabe T, Takada S, Kamata K, Tanabe S, Satomi S, Ishibashi T. Saccular renal artery aneurysm treated with an autologous vein-covered stent. J Vasc Surg 2001; 34:169-71. [PMID: 11436092 DOI: 10.1067/mva.2001.115798] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A 32-year-old woman underwent an autologous saphenous vein-covered stent deployment for the treatment of a saccular aneurysm on the distal renal artery. Complete exclusion of the aneurysm was immediately obtained. One year after the treatment, remarkable shrinkage of the aneurysm was demonstrated by means of computed tomography, and wide patency of the renal artery and the stent was shown by means of angiography.
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Affiliation(s)
- H Rikimaru
- Second Department of Surgery, Tohoku University School of Medicine, Sendai, Japan
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Masud M, Yamaguchi K, Rikimaru H, Tashiro M, Ozaki K, Watanuki S, Miyake M, Ido T, Itoh M. Evaluation of resting brain conditions measured by two different methods (i.v. and oral administration) with18F-FDG-PET. Ann Nucl Med 2001; 15:69-73. [PMID: 11355787 DOI: 10.1007/bf03012136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our aim was to evaluate regional differences between brain activity in two resting control conditions measured by 3D PET after administration of FDG through either the intravenous (i.v.) or the oral route. Ten healthy male volunteers engaged in the study as the i.v. group (mean age, 26 +/- 9.3 years, +/- S.D.) who received FDG intravenously and another 10 volunteers as the oral group (mean age, 27.9 +/- 11.3 years, +/- S.D.) who received FDG per os. A set of 3D-PET scans (emission and transmission scans) were performed in both groups. To explore possible functional differences between the brains of the two groups, the SPM-96 software was used for statistical analysis. The results revealed that glucose metabolism was significantly higher in the superior frontal gyrus, superior parietal lobule, lingual gyrus and left cerebellar hemisphere in the i.v. group than in the oral group. Metabolically active areas were found in the superior, middle and inferior temporal gyrus, parahippocampal gyrus, amygdaloid nucleus, pons and cerebellum in the oral group when compared with the i.v. group. These differences were presumably induced by differences between FDG kinetics and/or time-weighted behavioral effects in the two studies. This study suggests the need for extreme caution when selecting a pooled control population for designated activation studies.
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Affiliation(s)
- M Masud
- Division of Nuclear Medicine, Cyclotron Radioisotope Center, Tohoku University, Japan.
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Yanaga H, Tai Y, Kiyokawa K, Inoue Y, Rikimaru H. An ipsilateral superdrainaged transverse rectus abdominis myocutaneous flap for breast reconstruction. Plast Reconstr Surg 1999; 103:465-72. [PMID: 9950532 DOI: 10.1097/00006534-199902000-00015] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A conventional single pedicled TRAM (transverse rectus abdominis myocutaneous) flap is a musculocutaneous flap widely used for breast reconstruction. However, complications such as partial flap necrosis, fat necrosis, and fatty induration may occur as a result of unstable blood flow circulation to the flap. One major factor is venous congestion in the flap. In an effort to obtain more stable TRAM flap blood circulation, we anastomosed the ipsilateral deep inferior epigastric vein of a pedicled TRAM flap to the thoracodorsal vein. This procedure provides superdrainage by means of enhanced venous perfusion. This flap with superdrainage augmentation is referred to as a superdrainaged TRAM flap (12 patients). Changes in cutaneous blood flow were also assessed by measurement of cutaneous blood flow in zone IV using a laser blood flow meter (8 patients). The patients who underwent breast reconstructive surgery using this technique showed no evidence of postoperative complications such as flap necrosis, fat necrosis, or fatty induration. Satisfactory results were obtained during breast reconstruction in patients who had previously undergone a radical mastectomy with resultant large areas of tissue defects. In addition, the two patient groups, 12 patients with superdrainaged TRAM flap and 20 patients with single pedicled TRAM flap, were compared to assess differences in complications. The incidence of partial flap necrosis, fat necrosis, and fatty induration was lower among patients with superdrainaged flap than those with single pedicled flap.
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Affiliation(s)
- H Yanaga
- Department of Plastic and Reconstructive Surgery at the Kurume University School of Medicine, Kurume City, Japan
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Kiyokawa K, Tai Y, Tanabe HY, Inoue Y, Yamauchi T, Rikimaru H, Mori K, Nakashima T. A method that preserves circulation during preparation of the pectoralis major myocutaneous flap in head and neck reconstruction. Plast Reconstr Surg 1998; 102:2336-45. [PMID: 9858167 DOI: 10.1097/00006534-199812000-00010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present article describes a method that preserves circulation during the preparation of the pectoralis major myocutaneous flap used in head and neck reconstruction. The major disadvantage of this flap is its poor circulation and consequent partial necrosis. To solve this problem, we analyzed the circulation and hemodynamics of the pectoralis major myocutaneous flap (the perforator of the anterior intercostal branch located about 1 to 2 cm medial to the areola in the fourth intercostal space is important), evaluated the safe donor sites in the chest wall for a skin island (the perforator is included on the skin island's central axis), improved the surgical procedure for elevating flaps (for preventing perforator injuries), and devised a means to transfer flaps, thereby increasing the range of the flaps (the transfer route is under the clavicle). Using this technique, head and neck reconstruction was performed on 62 patients. The diagnosis included oral cancer (21), oropharyngeal carcinoma (10), parotid carcinoma (10), hypopharyngeal carcinoma (9), and other head and neck malignant tumors (12). Of these, partial or marginal necrosis of the flap caused by circulatory problems was detected in three patients (5 percent). Using our method, the problems associated with inadequate circulation in the pectoralis major myocutaneous flap were greatly alleviated, thus reconfirming the usefulness of this flap in head and neck reconstruction.
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Affiliation(s)
- K Kiyokawa
- Department of Plastic and Reconstructive Surgery, Kurume University School of Medicine, Kuruoka, Japan
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