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Narushima M, Shiraishi M, Banda CH, Ishiura R. Microsurgical Treatment for Arteriovenous Malformations in the Hand. Hand Clin 2024; 40:229-236. [PMID: 38553094 DOI: 10.1016/j.hcl.2023.12.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Vascular malformations in the extremities are a common site of occurrence; arteriovenous malformations (AVMs) are the least frequent of all vascular malformations, estimated at 5% to 20%. The first step in management is to perform a thorough clinical examination. Symptoms are assessed, and staging is performed using the Schobinger classification. Next, ultrasonography and contrast-enhanced computed tomography are used to confirm the diagnosis of AVM and to confirm the extent of the malformation. Surgery is the first-line treatment and reconstruction is performed. In cases where surgery is not feasible, embolization and sclerotherapy may be used to alleviate symptoms.
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Affiliation(s)
- Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174, Edobashi, Tsu514-8507, Japan.
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihena Hansini Banda
- Plastic and Reconstructive Surgery Unit, Department of Surgery, The University Teaching Hospital, Lusaka, Zambia
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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Mitsui K, Narushima M, Danno K, Ishiura R, Banda CH. Intra-lymphocele microsurgical identification of causative afferent vessels for effective lymphaticovenular anastomosis in lymphocele treatment: A case report. Microsurgery 2024; 44:e31002. [PMID: 36571804 DOI: 10.1002/micr.31002] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/29/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
Lymphoceles are an important complication of pelvic and abdominal surgery with a reported incidence of 11%-88%. Conventional treatment includes compression, puncture aspiration, sclerotherapy, and ligation but recurrence is not uncommon and is difficult to treat. Recently, microsurgical lymphaticolymphatic anastomosis, lymphaticovenular anastomosis (LVA) and reconstruction of lymphatic circulation with flaps are increasingly being utilized for lymphocele treatment. Effective microsurgical treatment requires precise identification of the causative afferent vessels for the most efficient circulatory by-pass. However, direct identification of these vessels using traditional lymphoscintigraphy and near infrared lymphography is challenging and often not possible. We report the case of a 55-year-old woman who presented with bilateral inguinal lymphoceles and lymphedema following pelvic surgery for vulvovaginal cancer. Bilateral multiple LVAs of the lower extremities were performed and the lower limb circumferences reduced postoperatively, however both lymphoceles still persisted. The patient was successfully treated by approaching the lymphoceles from inside the lymphocele cavity. The causative afferent lymph vessels were directly identified microsurgically by gentle pressure on the inner wall and causative afferent lymph vessel lymphaticovenular anastomosis was performed. The lymphoceles resolved promptly after surgery without complications, and no recurrence was observed on 5 years follow-up. This case report presents an innovative microsurgical approach to lymphocele treatment, including examination and techniques to identify the causative afferent lymphatic vessels for effective anastomosis. We report this case to demonstrate the importance of lymphatic vessel selection in the microsurgical treatment of lymphocele.
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Affiliation(s)
- Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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Yamagata K, Banda CH, Shiraishi M, Shimizu K, Okada Y, Mitsui K, Danno K, Ishiura R, Furukawa H, Narushima M. Anatomical external auricular muscle transposition with mini flap transfer for mild cryptotia: A case report. JPRAS Open 2023; 38:147-151. [PMID: 37929067 PMCID: PMC10623107 DOI: 10.1016/j.jpra.2023.09.004] [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: 05/11/2023] [Accepted: 09/17/2023] [Indexed: 11/07/2023] Open
Abstract
Cryptotia is a congenital ear deformity characterized by the upper helix buried under the skin of the temporal region. Recurrence and inadequate correction of ear position are major complications following auricle reconstruction. Abnormalities of the auricular muscles are closely associated with cryptotia and considered to be the main cause. However, current corrective procedures focus on provision of additional skin and abnormal auricular muscle correction is considered supplementary. We report a surgical approach focused on the anatomical repositioning of the external auricular muscle insertions and skin cover with a mini flap. Two consecutive patients aged 6 and 14 years with mild cryptotia (minimal auricular cartilage deformity) were treated using this technique with a follow-up duration of 12-25 months. The abnormal insertion of the superior auricular muscle (SAM) to the superior helix was repositioned to its correct anatomical position below the eminence of the triangular fossa, effectively moving the ear posterosuperiorly. No complications occurred postoperatively, the increase in vertical length of the superior helix to the superior ear attachment was 7.8 and 7.9 mm at 6months. Both patients could wear facemasks comfortably without them sliding off and were satisfied with the esthetic results. Total follow-up duration was 3 years in Case 1 and 4.4 years in Case 2. Primary correction of the SAM to its anatomical position may be a useful method for reducing the size of the skin flaps required with minimal donor site morbidity in reconstruction of mild cryptotia.
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Affiliation(s)
- Kosuke Yamagata
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Chihena H. Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kotaro Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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Banda CH, Shiraishi M, Mitsui K, Okada Y, Danno K, Ishiura R, Maemura K, Chiba C, Mizoguchi A, Imanaka-Yoshida K, Maruyama K, Narushima M. Structural and functional analysis of the newt lymphatic system. Sci Rep 2023; 13:6902. [PMID: 37106059 PMCID: PMC10140069 DOI: 10.1038/s41598-023-34169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
Regeneration competent vertebrates such as newts and salamanders possess a weakened adaptive immune system characterized by multiple connections between the lymphatic system and the blood vascular system called lymphatic hearts. The role of lymphatic vasculature and these lymphaticovenous connections in regeneration is unknown. We used in-vivo near-infrared lymphangiography, ultra-high frequency ultrasonography, micro-CT lymphangiography, and histological serial section 3-dimentional computer reconstruction to evaluate the lymphatic territories of Cynops pyrrhogaster. We used our model and supermicrosurgery to show that lymphatic hearts are not essential for lymphatic circulation and limb regeneration. Instead, newts possess a novel intraosseous network of lymphatics inside the bone expressing VEGFR-3, LYVE-1 and CD-31. However, we were unable to show Prox-1 expression by these vessels. We demonstrate that adult newt bone marrow functions as both a lymphatic drainage organ and fat reservoir. This study reveals the fundamental anatomical differences between the immune system of urodeles and mammals and provides a model for investigating lymphatics and regeneration.
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Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Kaho Maemura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Chikafumi Chiba
- Faculty of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Prefecture, 305-8571, Japan
| | - Akira Mizoguchi
- Department of Personalized Cancer Immunotherapy, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Kazuaki Maruyama
- Department of Pathology and Matrix Biology, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie Prefecture, 514-8507, Japan.
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Ishiura R, Mitsui K, Banda CH, Danno K, Narushima M. Lymphaticovenular anastomoses training model for multiple stages of lymphedema by using efferent lymphatic plexus of the mesenteric lymph node of rats. Microsurgery 2023; 43:261-265. [PMID: 36382665 DOI: 10.1002/micr.30986] [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] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/17/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lymphaticovenular anastomosis (LVA) has transformed lymphedema treatment and has become an important part of the surgical therapy. LVA requires supermicrosurgical skills and unique nontraumatic techniques as the lymphatic vessel diameter of varies with the progression of lymphedema from 0.3 to 0.8 mm. However, even though several supermicrosurgical vessel anastomosis training models have been reported, only few focus on LVA including both various sizes of lymphatic vessels and lymphatic dissection. We report the establishment of a novel in-vivo LVA training model using the rat efferent lymphatic plexus of the mesenteric lymph node. MATERIALS AND METHODS Lymphatic vessels in the efferent lymphatic plexus of the mesenteric lymph node and mesenteric veins of 10 male Wistar rats, 572-850 g, were used for LVA in an intima-to-intima coaptation manner using 12-0 nylon suture with 4-6 stitches in an end-to-end fashion. Postoperative patency was evaluated with indigo carmine blue after completion of anastomosis. Diameters of lymphatic vessels in the plexus and recipient veins were measured. RESULTS The diameters of lymphatic vessels in efferent lymphatic plexus of the mesenteric lymph nodes and mesenteric veins used as recipients were measured in all 10 male rats. The mean number of lymphatic vessels included in efferent lymphatic plexus of the mesenteric lymph nodes was 7.5 (range, 5-11) and the mean diameter of the lymphatic vessels was 0.34 mm (range, 0.1-1.2 mm). The mean diameter of lymphatic vessels used for LVA was 0.46 mm (range, 0.25-0.7 mm). The mean diameter of the recipient veins was 0.49 mm (range, 0.35-0.7 mm). The postoperative patency rate after LVA was 100% (10/10). CONCLUSION We reported the establishment of LVA model involving the use of the efferent lymphatic plexus of the mesenteric lymph node and mesenteric veins in rats.
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Affiliation(s)
- Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, the University of Mie, Tsu, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, the University of Mie, Tsu, Japan
| | | | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, the University of Mie, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, the University of Mie, Tsu, Japan
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Imai S, Narushima M, Banda CH, Shiraishi M, Shimizu K, Okada Y, Mitsui K, Danno K, Ishiura R, Yuzuriha S, Ohmori K. Tsugishige Kondo, The Father of Japanese Surgery: Exploring the History of Hideyo Noguchi's Hand Reconstruction With a Forearm Flap Before the Establishment of Plastic Surgery in Japan. Ann Plast Surg 2023; 90:209-213. [PMID: 36796041 DOI: 10.1097/sap.0000000000003396] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/18/2023]
Abstract
ABSTRACT Hideyo Noguchi is one of the most famous scientists in Japan's history, and his portrait has adorned the ¥1,000 banknotes since 2004. He had a childhood burn injury resulting in severe hand scarring and contracture that plagued his early life and education.The resulting hand deformity required 3 separate reconstructions with the third and most complex surgery performed by Professor Tsugishige Kondo just before Noguchi's final medical doctor license examination in 1897. In this surgery, Kondo released the contractures using the first radial forearm flap performed in Japan long before the establishment of plastic surgery in the country.Reviewing the history of Kondo, we find that he likely learned the art of reconstructive surgery along with many other surgical techniques during his stay in Europe from 1891 to 1896 where he was mentored by 4 prominent surgeons of the era: Christian Albert Theodor Billroth, Vincenz Czerny, James Israel, and Carl Nicoladoni. During this period, Czerny reported performing the world's first breast reconstruction using lipoma transfer, and Nicoladoni performed the world's first thumb reconstruction with a chest flap and with toe-to-thumb transfer. Kondo may have watched these world's first operations and may have also been taught these innovative techniques including the forearm flap directly by these pioneers. He returned to Japan and successfully applied these reconstructive surgery methods in his practice and teaching, as evidenced by the landmark surgery of Hideyo Noguchi's hand, and laid the foundations for the development of plastic surgery in Japan.
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Affiliation(s)
- Shoichi Imai
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Mitsunaga Narushima
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Chihena H Banda
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Makoto Shiraishi
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Kotaro Shimizu
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Yoshimoto Okada
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Kohei Mitsui
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Kanako Danno
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Ryohei Ishiura
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Nagano
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Shiraishi M, Narushima M, Banda CH, Mitsui K, Danno K, Ishiura R, Kurita M, Yuzuriha S, Okazaki M. Safety of SARS-CoV-2 Vaccination in Patients with Vascular Malformations: Patient-Reported Adverse Vaccine Reactions. Ann Vasc Dis 2023. [DOI: 10.3400/avd.oa.22-00126] [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: 03/31/2023] Open
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Danno K, Narushima M, Banda CH, Okada Y, Mitsui K, Shimizu Y, Shiraishi M, Sugioka K, Yokota N, Yamamoto S, Ishiura R. Skin graft fixation with negative pressure wound therapy with instillation and dwelling (NPWTi-d) for contaminated complex wounds of the extremities. JPRAS Open 2022; 34:152-157. [PMID: 36304070 PMCID: PMC9593306 DOI: 10.1016/j.jpra.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Negative Pressure Wound Therapy (NPWT) is increasingly being used as a major method of skin graft dressing and fixation. Negative Pressure Wound Therapy with Instillation and Dwelling (NPWTi-d) further enhances wound care over regular NPWT. However, only a few reports have been made on its use for skin graft fixation due to concerns of graft maceration or detachment. We used NPWTi-d to fix skin grafts for 4 cases of severely contaminated complex posttraumatic wounds. Methods The age ranged from 37 to 72 years, and included trauma of the lower leg, forearm dog bite and incomplete amputations of the upper arm and hand respectively. The mean instillation saline volume per wound size was 0.21 ml/cm2 and the dwelling time reduced to 3 min. The NPWTi-d skin graft fixation was removed after about a week. Results All the grafts healed well and no complications such as infection or contracture were observed. Follow-up time was 1 -8 months. Conclusions NPWTi-d may be a useful option for fixing skin grafts particularly in contaminated wounds with a high risk of infection.
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Affiliation(s)
- Kanako Danno
- Department of Plastic and Reconstructive Surgery, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University, 2-174 Edobashi, Tsu, Mie,Corresponding author.
| | - Chihena H. Banda
- Department of Plastic and Reconstructive Surgery, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, Miyagi
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Yuta Shimizu
- Department of Plastic and Reconstructive Surgery, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo
| | - Kyoko Sugioka
- Department of Dermatology, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Naho Yokota
- Department of Dermatology, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Shinya Yamamoto
- Department of Dermatology, Mie University, 2-174 Edobashi, Tsu, Mie
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Mie University, 2-174 Edobashi, Tsu, Mie
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Banda CH, Wilson E, Malata CM, Narushima M, Ogawa T, Hassanein ZM, Shiraishi M, Okada Y, Ghorra DT, Ishiura R, Danno K, Mitsui K, Oni G. Clinical application and outcomes of reconstructive microsurgery in Africa: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2035-2048. [PMID: 35643598 DOI: 10.1016/j.bjps.2022.04.028] [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: 10/17/2021] [Revised: 02/20/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa. METHODS Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates. RESULTS Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84). CONCLUSION This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care. REVIEW REGISTRATION Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.
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Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan; Department of Surgery, Arthur Davison Children's Hospital, Ndola, Zambia.
| | - Emma Wilson
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, United Kingdom
| | - Charles M Malata
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Anglia Ruskin University, School of Medicine, Chelmsford, Cambridge, United Kingdom
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Tomoko Ogawa
- Department of Breast Surgery, Mie University, Tsu, Japan
| | - Zeinab M Hassanein
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, United Kingdom
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Dina T Ghorra
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Plastic and Reconstructive Surgery, Alexandria University, Alexandria, Egypt
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Georgette Oni
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Ishiura R, Shiraishi M, Okada Y, Mitsui K, Hansini Banda C, Danno K, Narushima M. Treatment of cold intolerance following finger pulp amputations: a case comparison between immediate finger replantation and delayed pulp and digital arterial arch reconstruction with flow-through free hypothenar flap. Case Reports Plast Surg Hand Surg 2022; 9:33-36. [PMID: 34993273 PMCID: PMC8725866 DOI: 10.1080/23320885.2021.2020656] [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] [Indexed: 11/05/2022]
Abstract
We report a unique case of cold intolerance following identical fingertip amputations of two fingers on the same hand. The index finger was replanted and the middle finger was reconstructed with a free flow-through hypothenar perforator flap to anatomically restore the digital arterial arch circulation and successfully treat cold intolerance.
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Affiliation(s)
- Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | | | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
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Goto H, Okada Y, Watanabe S, Danno K, Yamamoto S, Ishiura R, Nakayama Y, Mitsui K, Ueki A, Nakai Y, Narushima M, Yamanaka K. Successful Treatment of Ulcerative-Type Pyoderma Gangrenosum with a Combination Therapy of Oral Prednisolone, Vacuum-Assisted Closure, and Skin Grafting. Case Rep Dermatol 2021; 13:497-501. [PMID: 34899231 PMCID: PMC8613544 DOI: 10.1159/000519659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/07/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a relatively rare inflammatory skin disease that progressively causes necrotic ulceration mainly on the lower extremities and trunk. Systemic corticosteroid is considered a first-line treatment for PG as it facilitates wound healing; however, several cases where tumor necrosis factor-α inhibitors, adalimumab and infliximab, were administered showed good response. For intractable PG with a large ulcer or problematic epithelization, chemical or mechanical debridement of necrotic tissue in combination with skin grafting may be necessary to promote wound healing. Our report presents a case of intractable ulcerative PG requiring oral prednisolone and skin grafting. Although mechanical debridement was performed, granulation was poor; therefore, after the PG activity became quiescent, we utilized a vacuum-assisted closure (VAC) system to promote granulation and adaptation of the grafted skin. Although more cases are required for a definitive conclusion, the VAC system may be a choice for PG with large ulcers.
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Affiliation(s)
- Hiroyuki Goto
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
| | - Yoshimoto Okada
- Plastic and Reconstructive Surgery, Mie University Graduate School of medicine, Mie, Japan
| | - Seimi Watanabe
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
| | - Kanako Danno
- Plastic and Reconstructive Surgery, Mie University Graduate School of medicine, Mie, Japan
| | - Shinya Yamamoto
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
| | - Ryohei Ishiura
- Plastic and Reconstructive Surgery, Mie University Graduate School of medicine, Mie, Japan
| | - Yuichi Nakayama
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
| | - Kohei Mitsui
- Plastic and Reconstructive Surgery, Mie University Graduate School of medicine, Mie, Japan
| | - Ayaka Ueki
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
| | - Yasuo Nakai
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
| | - Mitsunaga Narushima
- Plastic and Reconstructive Surgery, Mie University Graduate School of medicine, Mie, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of medicine, Mie, Japan
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12
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Matsui C, Banda CH, Okada Y, Shiraishi M, Shimizu K, Mitsui K, Danno K, Ishiura R, Narushima M. Shaping the future of microsurgery: Combination of exoscope and smart glasses. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34852969 DOI: 10.1016/j.bjps.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Chiaki Matsui
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Yoshimoto Okada
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Kotaro Shimizu
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan.
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13
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Matsumoto T, Banda CH, Kondo E, Yoshida K, Hirata T, Ikeda T, Narushima M. Laparoscopic repair of segmental obturator nerve injury defect using an artificial nerve conduit: A case report. J Obstet Gynaecol Res 2021; 47:4118-4121. [PMID: 34263495 DOI: 10.1111/jog.14920] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/25/2021] [Accepted: 06/26/2021] [Indexed: 11/26/2022]
Abstract
Obturator nerve injury is an uncommon complication frequently associated with pelvic gynecologic or urologic cancer surgery. It can lead to disability or adversely affect quality of life. Large segmental defects are particularly difficult to manage as the limited mobility of the nerve prevents tension-free direct end-to-end anastomosis. A 36-year-old woman with cervical cancer underwent sentinel lymph node biopsy, laparoscopic radical hysterectomy, and bilateral adnexectomy. During the procedure, the sentinel lymph node (right obturator node) adherent to the obturator nerve was resected together with the nerve segment leaving a 3 cm defect. Immediate laparoscopic obturator nerve repair was performed using an artificial nerve conduit leading to successful recovery. We report this unique case due to rarity of large segmental obturator nerve defects and present laparoscopic nerve repair with artificial nerve conduits as a useful treatment alternative of these important injuries, without nerve donor site morbidity.
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Affiliation(s)
- Tsuyoshi Matsumoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Kenta Yoshida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Toru Hirata
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
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14
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Mitsui K, Narushima M, Ishiura R, Danno K, Sakakura Y, Banda CH. Dual imaging lymphangiography guided treatment of infantile chylothorax. J Vasc Surg Cases Innov Tech 2021; 7:492-495. [PMID: 34386679 PMCID: PMC8346552 DOI: 10.1016/j.jvscit.2021.06.007] [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: 04/13/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
Chylothorax is a potentially fatal postoperative complication of neck, thoracic, and abdominal surgery in children. We report the case of a 3-month-old infant who developed persistent chylothorax with respiratory insufficiency successfully managed using a microsurgical technique and intraoperative embolotherapy. This was achieved using a combination of intermittent digital X rays and live near-infrared fluorescence imaging we have termed "dual imaging lymphangiography" to guide therapy in real time. The chylothorax resolved and the patient returned to normal diet without recurrence. This microsurgical approach with dual imaging lymphangiography provides a useful tool for intraoperative visualization and treatment of complicated chylothoraces.
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Affiliation(s)
- Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan.,Department of Plastic and Reconstructive Surgery, Aichi Medical University, Nagakute, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yosuke Sakakura
- Department of Clinical Anesthesiology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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15
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Banda CH, Narushima M, Mitsui K, Danno K, Fujita M, Furuya M, Karakawa R, Ogishima S, Ishiura R. Donor site morbidity of postauricular free flaps and full thickness skin grafts. J Plast Reconstr Aesthet Surg 2021; 74:2392-2442. [PMID: 33811010 DOI: 10.1016/j.bjps.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan.
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Minami Fujita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Megumi Furuya
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Ogishima
- Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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16
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Banda CH, Narushima M, Mitsui K, Danno K, Fujita M, Furuya M, Karakawa R, Ogishima S, Ishiura R. Posterior auricular artery free flap reconstruction of the retroauricular sulcus in microtia repair. J Plast Reconstr Aesthet Surg 2020; 74:2349-2357. [PMID: 33518502 DOI: 10.1016/j.bjps.2020.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/18/2020] [Revised: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Autologous repair using costal cartilage grafts remains the most widely accepted method of microtia reconstruction. A major complication of current techniques is loss of ear shape caused by scarring, contracture and cartilage absorption. We present a new surgical technique utilizing the posterior auricular artery free flap in microsurgical reconstruction of the retroauricular sulcus in microtia. METHOD Reconstruction is performed in two stages. In the first stage, a fabricated costal cartilage framework is inserted into a skin pocket as described by Nagata. In the second stage, the ear framework is elevated from the scalp and held by an additional cartilage wedge. Following indocyanine green angiography perforator mapping, a posterior auricular artery perforator flap is harvested from the contralateral (normal) ear and used to reconstruct the posterior auricular sulcus covering the cartilage framework and elevating wedge. RESULTS The technique was applied to three patients aged 11-15 years with a follow-up time of 8 months to 3 years. The average flap artery diameter was 0.73 mm and the vein was 0.7 mm. Venous congestion occurred in one case and was resolved with a vein graft leading to complete flap recovery. Good ear shape, elevation, projection, skin color and texture were achieved in all the cases. CONCLUSION Posterior auricular artery flap reconstruction of the retroauricular sulcus in microtia repair is a useful alternative to the current skin graft and tissue expander-based techniques. It provides the ideal skin color and texture match and may improve the overall results of microtia reconstruction by enhancing vascularity.
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Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan.
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Minami Fujita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Megumi Furuya
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Ogishima
- Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
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17
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Jpn J Radiol 2020; 38:287-342. [PMID: 32207066 PMCID: PMC7150662 DOI: 10.1007/s11604-019-00885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke’s International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke’s International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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18
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Ishiura R, Mitsui K, Danno K, Banda CH, Inoue M, Narushima M. Successful treatment of large abdominal lymphatic malformations and chylous ascites with intra-abdominal lymphovenous anastomosis. J Vasc Surg Venous Lymphat Disord 2020; 9:499-503. [PMID: 32505686 DOI: 10.1016/j.jvsv.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/31/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
Large abdominal lymphatic malformations (LMs) are rare and may occasionally cause life-threatening illness, especially when they involve the central lymphatic system, lumbar trunks, cisterna chyli, thoracic duct, and their major tributaries, forming complex lymphatic anomalies. These LMs are often accompanied by chylous leak in various locations, and treatment remains challenging. We report a case of large abdominal LM with chylous ascites, protein-losing enteropathy, vaginal chylous leak, and lower limb lymphedema successfully treated with microsurgical intra-abdominal lymphovenous anastomosis and discuss the technical details of the procedure.
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Affiliation(s)
- Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan.
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Chihena Hansini Banda
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
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19
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese Clinical Practice Guidelines for Vascular Anomalies 2017. J Dermatol 2020; 47:e138-e183. [PMID: 32200557 PMCID: PMC7317503 DOI: 10.1111/1346-8138.15189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence‐based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Iruma-gun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Pediatr Int 2020; 62:257-304. [PMID: 32202048 PMCID: PMC7232443 DOI: 10.1111/ped.14077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Banda CH, Mitsui K, Ishiura R, Danno K, Narushima M. A supermicrosurgery pig foot training model for practice of lymphaticovenular anastomosis. Microsurgery 2019; 40:91-92. [DOI: 10.1002/micr.30521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Chihena H. Banda
- Department of Plastic and Reconstructive SurgeryGraduate School of Medicine, Mie University Mie Prefecture Japan
| | - Kohei Mitsui
- Department of Plastic and Reconstructive SurgeryGraduate School of Medicine, Mie University Mie Prefecture Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive SurgeryGraduate School of Medicine, Mie University Mie Prefecture Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive SurgeryGraduate School of Medicine, Mie University Mie Prefecture Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive SurgeryGraduate School of Medicine, Mie University Mie Prefecture Japan
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Yoshimatsu H, Yamamoto T, Hayashi A, Fuse Y, Karakawa R, Iida T, Narushima M, Tanakura K, Weninger WJ, Tzou CHJ. Use of the transverse branch of the superficial circumflex iliac artery as a landmark facilitating identification and dissection of the deep branch of the superficial circumflex iliac artery for free flap pedicle: Anatomical study and clinical applications. Microsurgery 2019; 39:721-729. [PMID: 31591765 DOI: 10.1002/micr.30518] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The deep branch of the superficial circumflex iliac artery (SCIA) should be included when a large superficial circumflex iliac artery perforator (SCIP) flap is necessary, or when anatomical structures perfused by the deep branch are procured. The aim of this study was first to describe the anatomical features of the "transverse branch" of the deep branch of the SCIA in cadavers, and then to assess the efficacy of its use as a landmark for identification and dissection of the deep branch of the SCIA through clinical applications. METHODS Twenty groin regions from 10 cadavers were dissected. The course and the takeoff point of the transverse branch were documented. With the transverse branch used as a landmark for pedicle dissection, 27 patients (16 males and 11 females) with an average age of 51.7 years underwent reconstructions that used vascularized structures nourished by the deep branch of the SCIA. Aside from the skin paddle, an iliac bone flap was used in 10 cases, a lateral femoral cutaneous nerve flap in four cases, and a sartorius muscle flap in three cases. The defect locations included the head (seven cases), the foot (six cases), the hand (six cases), the arm (five cases), and the leg (three cases). The causes of reconstruction were tumors in 13 patients, trauma in six patients, infection in four patients, surgical procedures in three patients, and refractory ulcer in one patient. RESULTS In all specimens, the transverse branch was found underneath the deep fascia caudal to the anterior superior iliac spine (ASIS). The average distance from the ASIS to the transverse branch was 25.5 ± 13.0 mm (range, 5-50 mm). The average dimension of the flap was 13.1 × 5.9 cm2 . All the flaps survived completely after the surgery; lymphorrhea was seen in one patient at the donor site. The average follow-up period was 12.9 months (range, from 2 to 42 months), and all patients had good functional recovery with satisfactory esthetic results. CONCLUSIONS The transverse branch was found in all specimens, branching from the deep branch of the SCIA. Successful results were achieved by using it as the landmark for identification and dissection of the deep branch of the SCIA. This method allows safe elevation of a large SCIP flap or a chimeric SCIP flap.
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Affiliation(s)
- Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
| | - Akitatsu Hayashi
- Department of Breast Center, Kameda Medical Center, Chiba, Japan
| | - Yuma Fuse
- Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Mie, Mie, Japan
| | - Kenta Tanakura
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Wolfgang J Weninger
- Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Chieh Han John Tzou
- Department of Plastic and Reconstructive Surgery, Hospital of the Divine Saviour (Krankenhaus Goettlicher Heiland), Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
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Yoshida S, Koshima I, Narushima M, Nagamatsu S, Yokota K, Yamashita S, Harima M. Usefulness of ectopic implantation in multiple finger amputation injury. Clin Case Rep 2019; 7:546-549. [PMID: 30899491 PMCID: PMC6406161 DOI: 10.1002/ccr3.2040] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/22/2022] Open
Abstract
Replantation combined with simultaneous ectopic implantation can be considered in patients with multiple finger amputation injury. This technique has the advantages of reducing the operating time and optimizing hemodynamic stability. However, it is only possible when multiple hand and microsurgery team can be organized at short notice.
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Affiliation(s)
| | - Isao Koshima
- International Center for Lymphedema (ICL)HiroshimaJapan
| | | | - Shogo Nagamatsu
- Plastic and Reconstructive SurgeryHiroshima University HospitalHiroshimaJapan
| | - Kazunori Yokota
- Plastic and Reconstructive SurgeryHiroshima University HospitalHiroshimaJapan
| | - Shuji Yamashita
- Department of Plastic and Reconstructive SurgeryGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Mitsunobu Harima
- Department of Plastic and Reconstructive SurgeryGraduate School of MedicineThe University of TokyoTokyoJapan
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24
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Banda CH, Georgios P, Narushima M, Ishiura R, Fujita M, Goran J. Challenges in global reconstructive microsurgery: The sub-Saharan african surgeons' perspective. JPRAS Open 2019; 20:19-26. [PMID: 32158868 PMCID: PMC7061683 DOI: 10.1016/j.jpra.2019.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/20/2018] [Accepted: 01/20/2019] [Indexed: 01/07/2023] Open
Abstract
Background Microsurgery is an essential element of plastic surgery practice. However, it remains unavailable or rudimentary in several developing countries, especially in sub-Saharan Africa. This study presents the local plastic surgeons experience, while focusing on specific challenges encountered and methods to improve the sub-Saharan global microsurgery practice. Methodology An online survey was sent to all plastic surgeons registered with the College of Surgeons East Central and Southern Africa and respective national plastic surgical societies in the east central and southern Africa regional community. A total of 57 questionnaires were sent. Surgeons' country of practice, years of experience and rate of performing microsurgical procedures were considered. Results The survey response rate was 56% (n = 32). Most participants believed microsurgery was essential in the region. The leading challenge was inadequate perioperative care, mainly attributed to shortage of support staff (n = 29, 91%). Others were lack of surgical expertise and resources. Interestingly, public unawareness of the benefits of microsurgery was also noted as a critical hindrance. The foremost suggestion on improvement (n = 19, 59%) was to enhance training with a multidisciplinary team-building approach. Others included increased advocacy, publications and funding. Conclusion The Plastic surgeons' perspective recognizes the needs of Global Reconstructive Microsurgery in sub-Saharan Africa. However, inadequate perioperative care, insufficient expertise, lack of equipment and lack of public awareness were major hindrances. Finally, there is a need to improve microsurgery in the region through advocacy, training and multidisciplinary team building.
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Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan.,Department of Surgery, Arthur Davison Children's Hospital, Ndola, Zambia
| | - Pafitanis Georgios
- Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Minami Fujita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Jovic Goran
- Department of Surgery, The University Teaching Hospital, Lusaka, Zambia
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26
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Pafitanis G, Narushima M, Yamamoto T, Miller R, Koshima I. Insights to establish early learning curve in clinical supermicrosurgery. Microsurgery 2018; 39:100-101. [PMID: 30561056 DOI: 10.1002/micr.30401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Georgios Pafitanis
- The Royal London Hospital, Barts Health NHS Trust, Academic Plastic Surgery Group, Queen Mary University of London, London, United Kingdom
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Robert Miller
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Isao Koshima
- International Centre for Lympedema, Hiroshima University Hospital, Hiroshima, Japan
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27
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Ishiura R, Fujita M, Furuya M, Banda C, Narushima M. Skin perforator mapping method for anterolateral thigh flap using indocyanine green angiography. J Plast Reconstr Aesthet Surg 2018; 71:e64. [DOI: 10.1016/j.bjps.2018.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
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28
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Jing W, Narushima M. Half-transection method combined with intravascular stent for supermicrosurgical lymphaticovenular anastomosis. J Plast Reconstr Aesthet Surg 2018; 71:1816-1834. [PMID: 30122599 DOI: 10.1016/j.bjps.2018.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/29/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Wang Jing
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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29
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Pafitanis G, Narushima M, Yamamoto T, Raveendran M, Veljanoski D, Ghanem AM, Myers S, Koshima I. Evolution of an evidence-based supermicrosurgery simulation training curriculum: A systematic review. J Plast Reconstr Aesthet Surg 2018; 71:976-988. [PMID: 29773411 DOI: 10.1016/j.bjps.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/08/2017] [Accepted: 04/02/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Supermicrosurgery (SM) involves operating on vessels with calibers from 0.3-0.8 mm. SM requires skills beyond those of conventional microsurgery. Current microsurgery courses do not prepare a junior surgeon for such a challenge. Several models have been developed to assist in the early learning curve, but their true purpose, benefit, and validation have not been addressed. This systematic literature review summarizes the existing SM simulation models, and their likely impact on microsurgery training for small-caliber vessel-based procedures is assessed. METHODS An electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From the literature search, 90 potential articles from MEDLINE and 300 articles from other databases were identified and screened. Twenty-five studies were screened against the inclusion criteria by two independent reviewers for a final critical analysis. RESULTS Thirty-six articles were included in the reviewing process, and 15 SM simulation training models were identified. The simulation models were classified as nonbiological or biological and as ex vivo or in vivo. None of these models demonstrated validity. However, critical analysis of the full-text articles established the clinical correlation of each model along with the specific skill demonstrated. A novel ladder-based curriculum was established. Further, an expert's questionnaire generated a Likert scale and the clinical impact of each SM simulation training model. CONCLUSION This is the first review to highlight the clinical relevance of SM models and the need for validation. Currently, a variety of training models in SM appear to enable the acquisition of specific skills, and the clinical impact of a selection is recognized in a proposed SM simulation training curriculum.
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Affiliation(s)
- Georgios Pafitanis
- Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, The Blizard Institute, Queen Mary University of London, 4 Newark Street, Whitechapel, E1 2AT, London, UK.
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takumi Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-0033, Japan
| | - Maria Raveendran
- Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, The Blizard Institute, Queen Mary University of London, 4 Newark Street, Whitechapel, E1 2AT, London, UK; University of Toronto, Toronto, Canada
| | - Damjan Veljanoski
- Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, Whitechapel, E1 2AT, London, UK
| | - Ali M Ghanem
- Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, The Blizard Institute, Queen Mary University of London, 4 Newark Street, Whitechapel, E1 2AT, London, UK
| | - Simon Myers
- Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, The Blizard Institute, Queen Mary University of London, 4 Newark Street, Whitechapel, E1 2AT, London, UK
| | - Isao Koshima
- International Centre for Lympedema, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
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Yamamoto T, Narushima M, Koshima I. Lymphatic vessel diameter in female pelvic cancer-related lower extremity lymphedematous limbs. J Surg Oncol 2018; 117:1157-1163. [DOI: 10.1002/jso.24974] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/08/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery; National Center for Global Health and Medicine; Tokyo Japan
- Department of Plastic and Reconstructive Surgery; The University of Tokyo Hospital; Tokyo Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery; The University of Tokyo Hospital; Tokyo Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery; The University of Tokyo Hospital; Tokyo Japan
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Karakawa R, Narushima M, Ogishima S, Hara H, Karino S, Iida T, Kakigi A, Koshima I. Free anterolateral thigh full-thickness skin flap with vascularized lateral femoral cutaneous nerve for the reconstruction of facial nerve and external auditory canal after the resection of facial nerve schwannoma. SAGE Open Med Case Rep 2017; 5:2050313X17741825. [PMID: 29201373 PMCID: PMC5697583 DOI: 10.1177/2050313x17741825] [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: 05/09/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022] Open
Abstract
The complex reconstruction of nerves and soft tissue in the head and neck region is still challenging, especially in cases requiring external auditory canal reconstruction with facial nerve reconstruction. We report a case of left facial schwannoma extending into the external auditory canal beyond the tympanic membrane with facial paralysis in which the reconstruction of both the facial nerve and external auditory canal was successfully performed using an anterolateral thigh flap as a super-thin full-thickness skin flap, including vascularized lateral femoral cutaneous nerve. Resection of 20 mm × 46 mm facial schwannoma, including the skin of the external auditory canal, tympanic membrane, incus and malleus, was performed. The 8-cm nerve gap was repaired using a vascularized lateral femoral cutaneous nerve included in the anterolateral thigh flap. An 8 cm × 2 cm super-thin, free anterolateral thigh flap was then rolled up as a sac (diameter of 2 cm, height of 2 cm) and inset to the external auditory canal defect. The postoperative course was uneventful, and the flap survived completely. One year and nine months after the surgery, the patient’s facial movement has improved to the pre-surgery level.
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Affiliation(s)
- Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The Mie University, Mie, Japan
| | - Shinya Ogishima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - Hisako Hara
- Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Shotaro Karino
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - Akinobu Kakigi
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
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Song D, Pafitanis G, Yang P, Narushima M, Li Z, Liu L, Wang Z. Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique. J Plast Reconstr Aesthet Surg 2017; 70:1001-1008. [PMID: 28601599 DOI: 10.1016/j.bjps.2017.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/21/2016] [Revised: 05/14/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study demonstrates the use of a modified free innervated DRAP flap utilizing the supermicrosurgery technique for fingertip reconstruction. MATERIALS AND METHODS From January 2010 to February 2014, 20 cases of fingertip reconstruction were performed using a short pedicle mini innervated transverse DRAP flap. The patients demographics, the mechanism of injury, the defect size and anatomical location, the source of pedicle vessels, the recipient vessels, the nerve branch used for innervation, the follow-up and sensation outcomes are reported. Three cases are presented demonstrating different anatomical fingertip injury reconstructions. RESULTS 20 consecutive traumatic fingertip injuries (M:F-14:6) were reconstructed with a free DRAP flap from the same hand. 6 index, 6 middle, 5 ring and 3 little finger defects were included in this study. All procedures were performed under regional anaesthesia and sedation. There were no intra- or post-operative complications. The average operative time was 105 (85-120) minutes. Each flap size was matching the size of the defects. All donor sites achieved primary closure and good cosmesis. The average follow-up was 12.8 (6-28) months. Follow-up demonstrated a static two-point discrimination of the flaps with an average distance of 5.5 (4-7) mm. CONCLUSION The innervated DRAP flap has proven to be an easy, reliable and effective sensate fingertip reconstruction option, utilizing the supermicrosurgery technique. LEVEL OF EVIDENCE Level IV, retrospective series.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410000, China.
| | - Georgios Pafitanis
- The Royal London Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK.
| | - Peng Yang
- Department of Orthopedics Trauma Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200000, China.
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan.
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410000, China.
| | - Linfeng Liu
- Department of Hand and Foot Surgery, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China.
| | - Zengtao Wang
- Hand and Foot Surgical Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250000, China.
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Yamamoto T, Yamamoto N, Yoshimatsu H, Narushima M, Koshima I. Factors Associated with Lower Extremity Dysmorphia Caused by Lower Extremity Lymphoedema. Eur J Vasc Endovasc Surg 2017; 54:69-77. [PMID: 28392114 DOI: 10.1016/j.ejvs.2017.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/04/2016] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Indocyanine green (ICG) lymphography has been reported to be useful for the early diagnosis of lymphoedema. However, no study has reported the usefulness of ICG lymphography for evaluation of lymphoedema with lower extremity dysmorphia (LED). This study aimed to elucidate independent factors associated with LED in secondary lower extremity lymphoedema (LEL) patients. METHODS This was a retrospective observational study of 268 legs of 134 secondary LEL patients. The medical charts were reviewed to obtain data of clinical demographics and ICG lymphography based severity stage (leg dermal backflow [LDB] stage). LED was defined as a leg with a LEL index of 250 or higher. Logistic regression analysis was used to identify independent factors associated with LED. RESULTS LED was observed in 106 legs (39.6%). Multivariate analysis revealed that independent factors associated with LED were higher LDB stages compared with LDB stage 0 (LDB stage III; OR 17.586; 95% CI 2.055-150.482; p = .009) (LDB stage IV; OR 76.794; 95% CI 8.132-725.199; p < .001) (LDB stage V; OR 47.423; 95% CI 3.704-607.192; p = .003). On the other hand, inverse associations were observed in higher age (65 years or older; OR 0.409; 95% CI 0.190-0.881; p = .022) and higher body mass index (25 kg/m2 or higher; OR 0.408; 95% CI 0.176-0.946; p = .037). CONCLUSIONS Independent factors associated with LED were elucidated. ICG lymphography based severity stage showed the strongest association with LED, and was useful for evaluation of progressed LEL with LED.
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Affiliation(s)
- T Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
| | - N Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - H Yoshimatsu
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - M Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - I Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
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Tashiro K, Feng J, Wu SH, Mashiko T, Kanayama K, Narushima M, Uda H, Miyamoto S, Koshima I, Yoshimura K. Pathological changes of adipose tissue in secondary lymphoedema. Br J Dermatol 2017; 177:158-167. [PMID: 28000916 DOI: 10.1111/bjd.15238] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The pathophysiology of lymphoedema is poorly understood. Current treatment options include compression therapy, resection, liposuction and lymphatic microsurgery, but determining the optimal treatment approach for each patient remains challenging. OBJECTIVES We characterized skin and adipose tissue alterations in the setting of secondary lymphoedema. METHODS Morphological and histopathological evaluations were conducted for 70 specimens collected from 26 female patients with lower-extremity secondary lymphoedema following surgical intervention for gynaecological cancers. Indocyanine green lymphography was performed for each patient to assess lymphoedema severity. RESULTS Macroscopic and ultrasound findings revealed that lymphoedema adipose tissue had larger lobules of adipose tissue, with these lobules surrounded by thick collagen fibres and interstitial lymphatic fluid. In lymphoedema specimens, adipocytes displayed hypertrophic changes and more collagen fibre deposits when examined using electron microscopy, whole-mount staining and immunohistochemistry. The number of capillary lymphatic channels was also found to be increased in the dermis of lymphoedema limbs. Crown-like structures (dead adipocytes surrounded by M1 macrophages) were less frequently seen in lymphoedema samples. Flow cytometry revealed that, among the cellular components of adipose tissue, adipose-derived stem/stromal cells and M2 macrophages were decreased in number in lymphoedema adipose tissue compared with normal controls. CONCLUSIONS These findings suggest that long-term lymphatic volume overload can induce chronic tissue inflammation, progressive fibrosis, impaired homeostasis, altered remodelling of adipose tissue, impaired regenerative capacity and immunological dysfunction. Further elucidation of the pathophysiological mechanisms underlying lymphoedema will lead to more reliable therapeutic strategies.
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Affiliation(s)
- K Tashiro
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.,Department of Plastic Surgery, National Cancer Center, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - J Feng
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.,Department of Plastic Surgery, Southern Medical University Nanfang Hospital, 1838 Guangzhou South Ave., Guangzhou, 510515, China
| | - S-H Wu
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - T Mashiko
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - K Kanayama
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - M Narushima
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - H Uda
- Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - S Miyamoto
- Department of Plastic Surgery, National Cancer Center, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - I Koshima
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - K Yoshimura
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.,Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Hara H, Mihara M, Anan T, Fukumoto T, Narushima M, Iida T, Koshima I. Pathological Investigation of Acquired Lymphangiectasia Accompanied by Lower Limb Lymphedema: Lymphocyte Infiltration in the Dermis and Epidermis. Lymphat Res Biol 2016; 14:172-80. [DOI: 10.1089/lrb.2016.0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Hisako Hara
- Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Mihara
- Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Takashi Anan
- Sapporo Dermatopathology Institute, Hokkaido, Japan
| | | | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Hayashi A, Kaji N, Morikawa T, Ishiura R, Yokoyama A, Mashiko T, Yamamoto T, Yoshimatsu H, Hara H, Yamashita S, Iida T, Koshima I, Narushima M. Surgical Treatment and Pathological Findings of Venous Malformations Involving a Nerve. J Reconstr Microsurg Open 2016. [DOI: 10.1055/s-0036-1587340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Akitatsu Hayashi
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Nobuyuki Kaji
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Teppei Morikawa
- Department of Pathology, University of Tokyo Hospital, Tokyo, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Ai Yokoyama
- Department of Plastic and Reconstructive Surgery, Japanese Red Cross Ashikaga Hospital, Ashikaga, Tochigi, Japan
| | - Takanobu Mashiko
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Shuji Yamashita
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, University of Tokyo School of Medicine, Tokyo, Japan
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Narushima M, Iida T, Kaji N, Yamamoto T, Yoshimatsu H, Hara H, Kikuchi K, Araki J, Yamashita S, Koshima I. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthet Surg 2016; 69:827-834. [PMID: 27085610 DOI: 10.1016/j.bjps.2016.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 11/06/2015] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 11/25/2022]
Abstract
For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of the surgical options used for large defects. However, a flap containing the fat layer is bulky. Several debulking surgeries are often needed for aesthetic and functional purposes. To overcome this disadvantage, we herein report our experience of six cases of hand and finger reconstruction using a pure skin perforator (PSP) flap concept. A PSP flap is a thin skin flap that is vascularized by a perforator branch penetrating the dermis. The thickness of the PSP flap could be approximately ≤2 mm as needed. The superficial circumflex iliac artery and superficial inferior epigastric artery were used as a flap pedicle. Secondary defatting operations were not required. For the success of PSP flap elevation, we applied three techniques: the microdissection technique for vessel separation, thin flap elevation at the superficial fascial layer, and the temporary clamping method. Temporary clamping was applied for the main trunk of pedicle vessels during debulking to prevent unwanted bleeding, which allowed us to freely perform three-dimensional defatting. Using these three techniques, the PSP flap can be elevated and adjusted for complex contouring of the hand and finger. Although the use of the PSP flap requires further study, the PSP flap is an effective, superthin flap with the advantages of both skin graft and perforator flaps.
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Affiliation(s)
- Mitsunaga Narushima
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takuya Iida
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Nobuyuki Kaji
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takumi Yamamoto
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hidehiko Yoshimatsu
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hisako Hara
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuki Kikuchi
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Jun Araki
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shuji Yamashita
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Isao Koshima
- Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Tashiro K, Yamashita S, Araki J, Narushima M, Iida T, Koshima I. Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators. J Plast Reconstr Aesthet Surg 2016; 69:346-50. [DOI: 10.1016/j.bjps.2015.10.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022]
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Visconti G, Hayashi A, Salgarello M, Narushima M, Koshima I, Yamamoto T. Supermicrosurgical T-shaped lymphaticovenular anastomosis for the treatment of peripheral lymphedema: Bypassing lymph fluid maximizing lymphatic collector continuity. Microsurgery 2016; 36:714-715. [PMID: 26728153 DOI: 10.1002/micr.30019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Visconti
- Department of Plastic and Reconstructive Surgery, Università Cattolica Del "Sacro Cuore"-University Hospital "a. Gemelli", Rome, Italy
| | - Akitatsu Hayashi
- Department of Plastic and Reconstructive Surgery, The Tokyo University Hospital, Bunkyo, Tokyo, Japan
| | - Marzia Salgarello
- Department of Plastic and Reconstructive Surgery, Università Cattolica Del "Sacro Cuore"-University Hospital "a. Gemelli", Rome, Italy
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The Tokyo University Hospital, Bunkyo, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, The Tokyo University Hospital, Bunkyo, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, The Tokyo University Hospital, Bunkyo, Tokyo, Japan
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Abstract
BACKGROUND AND METHODS Indocyanine green (ICG) lymphography is one of several methods of lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display. RESULTS ICG lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area. CONCLUSION In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.
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Affiliation(s)
- Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Fusa Ogata
- Department of Cardiovascular Medicine, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Makoto Mihara
- Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
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Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Hayashi A, Koshima I. Indocyanine Green Lymphography Findings in Primary Leg Lymphedema. Eur J Vasc Endovasc Surg 2015; 49:95-102. [PMID: 25488514 DOI: 10.1016/j.ejvs.2014.10.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/29/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Indocyanine green (ICG) lymphography has been reported to be useful for the evaluation of secondary lymphedema, but no study has reported characteristic findings of ICG lymphography in primary lymphedema. This study aimed to classify characteristic ICG lymphography patterns in primary lymphedema. METHODS The study was a retrospective observational study. Thirty one primary lower extremity lymphedema (LEL) patients with a total of 62 legs were studied. ICG lymphography patterns were categorized according to the visibility of lymphatics and dermal backflow (DB) extension. Clinical demographics were compared with categorized ICG lymphography patterns. RESULTS All symptomatic legs showed abnormal patterns, and all asymptomatic legs showed normal patterns on ICG lymphography. Abnormal lymphographic patterns could be classified into proximal DB (PDB), distal DB (DDB), less enhancement (LE), and no enhancement (NE) patterns. There were significant differences between PDB (16 patients), DDB (6 patients), LE (4 patients), and NE patterns (5 patients) in age (37.3 ± 18.3 vs. 61.8 ± 19.2 vs. 50.8 ± 27.7 vs. 29.2 ± 18.0 years, p = .035), onset of edema (23.9 ± 19.4 vs. 46.8 ± 27.0 vs. 43.0 ± 31.3 vs. 6.6 ± 14.2 years, p = .020), laterality (bilateral; 18.8% vs. 66.7% vs. 75.0% vs. 0%, p ¼ .016), cellulitis history(56.3% vs. 100% vs. 25.0% vs. 0%, p ¼ .007), and LEL index (292.2 ± 32.8 vs. 254.2 ± 28.6 vs. 243.3 ± 9.4 vs. 295.2 ± 44.8, p = .016). CONCLUSIONS ICG lymphography findings in primary lymphedema could be classified into four patterns withdifferent patient characteristics.
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Koshima I, Narushima M, Mihara M, Yamamoto T, Hara H, Ohshima A, Kikuchi K, Todokoro K, Seki Y, Iida T, Nakagawa M. Lymphadiposal Flaps and Lymphaticovenular Anastomoses for Severe Leg Edema: Functional Reconstruction for Lymph Drainage System. J Reconstr Microsurg 2015; 32:50-5. [PMID: 26258914 DOI: 10.1055/s-0035-1554935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Collecting lymphatics have lymph-drainage function with contraction of smooth muscle cells. Patients with edema have lost this drainage function due to degeneration of smooth muscle cells. Lymphaticovenular (LV) anastomosis salvages smooth muscle cells from reversible degeneration (mild edema), but muscle cells cannot be recovered from irreversible degeneration (severe edema). Therefore, in severe edema, LV anastomoses cannot reestablish the drainage function of the lymphatic system.To overcome this weakness of LV bypass methods for severe edema, new methods were instituted for repair of this missing drainage function using a lymphadiposal flap from the contralateral foot for hemilateral edema, or transfer of lateral thoracic lymph nodes for bilateral edema. METHODS A total of 13 cases were repaired with lymphadiposal flaps and additional LV anastomoses. These cases have frequent phlegmon or cellulitis or resisted to previous LV anastomoses and/or compression therapy. The ages ranged from 15 to 75 years. There were four cases of primary edema and nine cases of secondary edema. RESULTS Regarding the lymphadiposal flap (n = 8), three cases showed an excellent response (37.5%; no need for compression therapy), four cases had a good response (50%; improvement with compression), one case showed no change (12.5%; no improvement), and there were no cases of deterioration. Regarding the lateral thoracic lymph nodes transfer (n = 5), two cases had a good response (40%), three showed no improvement (60%), and there were no cases of deterioration. CONCLUSION It is concluded that lymphadiposal flap or lymph nodes transfer is suitable for severe edema having frequent cellulitis in unilateral or bilateral lower extremities resisting previous LV anastomoses and/or compression therapy.
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Affiliation(s)
- Isao Koshima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Mihara
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Azusa Ohshima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuki Kikuchi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Todokoro
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Seki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Yoshimatsu H, Yamamoto T, Iwamoto T, Haragi M, Narushima M, Iida T, Koshima I. Pedicle-in-a-trench technique for lower extremity reconstruction. J Plast Reconstr Aesthet Surg 2015; 68:1318-9. [PMID: 26037221 DOI: 10.1016/j.bjps.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 04/29/2015] [Accepted: 05/03/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Taku Iwamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makiko Haragi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Tashiro K, Harima M, Mito D, Shibata T, Furuya M, Kato M, Yamamoto T, Yamashita S, Narushima M, Iida T, Koshima I. Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern. J Plast Reconstr Aesthet Surg 2015; 68:e120-5. [DOI: 10.1016/j.bjps.2015.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
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Negoro T, Shimizu S, Narushima M, Banham AH, Wakabayashi H, Takayanagi R, Hagiwara T, Roncador G, Osabe T, Yanai T, Kin M, Ikeda K, Endo A, Akiyama H, Nakano Y. Elevated receptor for activated C kinase 1 expression is involved in intracellular Ca2+ influx and potentially associated with compromised regulatory T cell function in patients with asthma. Clin Exp Allergy 2015; 44:1154-69. [PMID: 25048599 DOI: 10.1111/cea.12375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 05/09/2014] [Accepted: 07/02/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Regulatory T cells (T(regs)) are activated during anergy in response to T cell receptor (TCR) activation and functional immune suppression. Anergy of paediatric T(regs) is partially dependent on intracellular calcium mobility; following TCR activation, T(regs) do not exhibit increased intracellular Ca(2+) concentration ([Ca(2+) ](i)). OBJECTIVE We determined whether [Ca(2+) ](i) in adult T(regs) defined their anergy, if intracellular Ca(2+) movement was linked to regulatory functions, whether [Ca(2+)](i) was indicative of asthma pathology, and the potential molecular mechanism responsible for Ca(2+) movement in T(regs). METHODS T(regs) were purified by the magnetic bead method, and their regulatory functions were assessed by monitoring carboxyfluorescein succinimidyl ester-labelled responder T cell proliferation. The Ca(2+) response of Fura-2-labelled cells was measured using a video image analysis system. To analyse the functions of T(regs) at the molecular level, we generated Jurkat Tet-On(®) clones with doxycycline (Dox)-induced forkhead box P3 (FOXP3) protein expression. RESULTS CD4(+) CD25(+) CD127(-/low) T(regs) from participants without asthma did not elicit Ca(2+) influx in response to TCR activation, exhibited little proliferation and suppressed proliferation of CD4(+) CD25(-) T cells. In contrast, under similar conditions, T(regs) from patients with asthma exhibited increased [Ca(2+)](i) and robust proliferation with partial loss of regulatory functions. FOXP3 protein levels in Tet-On(®) clones were high after both 2- and 5-day Dox treatment; however, 5-day cells were comparable with T(regs) from patients with asthma, whereas 2-day cells were similar to T(regs) from participants without asthma. Increasing [Ca(2+)](i) induced a high level of receptor for activated C kinase 1 (RACK1) expression in 5-day cells. CONCLUSIONS AND CLINICAL RELEVANCE We confirmed that T(regs) in patients with asthma are functionally impaired and that the abnormal regulatory functions of these cells can be analysed by [Ca(2+)](i) following TCR engagement. Furthermore, the impaired functioning of T(regs) evident in patients with asthma may be due to a high level of RACK1.
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Affiliation(s)
- T Negoro
- Department of Pharmacogenomics, Showa University School of Pharmacy, Shinagawa-ku, Tokyo, Japan
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Hayashi A, Yamamoto T, Yoshimatsu H, Hayashi N, Furuya M, Harima M, Narushima M, Koshima I. Ultrasound visualization of the lymphatic vessels in the lower leg. Microsurgery 2015; 36:397-401. [DOI: 10.1002/micr.22414] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 03/12/2015] [Accepted: 03/19/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Akitatsu Hayashi
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Nobuko Hayashi
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Megumi Furuya
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Mitsunobu Harima
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; 7-3-1 Hongo Bunkyo-Ku Tokyo Japan
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Otake K, Uchida K, Inoue M, Koike Y, Narushima M, Kusunoki M. Use of computed tomography-lymphangiography with direct injection of water-soluble contrast medium to identify the origin of chylous ascites. J Vasc Surg Venous Lymphat Disord 2015; 3:90-3. [PMID: 26993687 DOI: 10.1016/j.jvsv.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/23/2014] [Indexed: 12/23/2022]
Abstract
Contrast lymphangiography is a useful technique to determine the site of lymphatic leakage in the patient with chylous ascites. Conventional lymphangiography with lipid-soluble contrast material carries the disadvantage of complications, such as oil emboli and lymphedema. The authors report a successful case of computed tomography (CT)-lymphangiography with direct injection of water-soluble contrast medium into a lower limb lymphatic vessel to determine the site of lymphatic leakage in a pediatric patient with refractory primary chylous ascites. The patient subsequently underwent laparoscopic ligation of the leaking site and recovered well. This novel technique offers superior potential for preoperative assessment and the planning of laparoscopic repair.
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Affiliation(s)
- Kohei Otake
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
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Yonezawa I, Waki M, Tamura Y, Onoda R, Narushima M, Ishizuka T, Tajima S. Gemcitabine-based regimen for primary ovarian angiosarcoma with MYC amplification. ACTA ACUST UNITED AC 2014; 21:e782-9. [PMID: 25489268 DOI: 10.3747/co.21.2144] [Citation(s) in RCA: 6] [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: 11/15/2022]
Abstract
Angiosarcoma is a rare and aggressive type of sarcoma, and primary angiosarcoma of the ovary is extremely rare. We report the case of a 29-year-old woman who was diagnosed with ovarian angiosarcoma and possible bone metastases. We treated this patient with a gemcitabine-based regimen as postoperative adjuvant chemotherapy, after which she achieved at least 7 years of progression-free survival, an extremely long duration given the aggressive features of this tumour. We retrospectively performed immunohistochemical analyses and fluorescence in situ hybridization to make a pathology diagnosis and to investigate the tumour features. MYC amplification and c-Myc protein overexpression were positively detected. It might be possible to correlate the effectiveness of the gemcitabine-based chemotherapeutic regimen with MYC gene amplification and c-Myc protein overexpression.
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Affiliation(s)
- I Yonezawa
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - M Waki
- Cell Biology and Anatomy, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Y Tamura
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - R Onoda
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - M Narushima
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - T Ishizuka
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - S Tajima
- Pathology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
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Iida T, Yoshimatsu H, Tashiro K, Hara H, Yamamoto T, Narushima M, Koshima I. Reconstruction of a full-thickness, complex nasal defect that includes the nasal septum using a free, thin superficial inferior epigastric artery flap. Microsurgery 2014; 36:66-9. [PMID: 25471263 DOI: 10.1002/micr.22363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/25/2014] [Accepted: 11/21/2014] [Indexed: 12/19/2022]
Abstract
Complex nasal defects present a surgical challenge, particularly in cases with a full-thickness defect that extends into the nasal septum. Although the superficial inferior epigastric artery (SIEA) flap has been widely used as a bulky flap for soft tissue augmentation, reports on its use as a thin flap are limited. We present a case of complex nasal defect reconstruction using a free, thin SIEA flap. A 65-year-old man with a recurrent malignant peripheral nerve sheath tumor around the left nose and cheek underwent wide tumor resection, leaving a full-thickness nasal defect that included portions of the nasal septum, nasal bone, and maxilla. A free, thin SIEA flap was elevated and primarily thinned by microdissecting the pedicle distally. The flap was then folded and inset to close the nasal septum and skin. The flap survived completely and complete closure of the nasal septum was observed. As the SIEA runs toward superficial layers as it is traced distally, primary thinning of the flap is possible. We believe that this method may represent an alternative to the superficial circumflex iliac artery perforator flap in cases in which the superficial circumflex iliac artery system is hypoplastic.
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Affiliation(s)
- Takuya Iida
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kensuke Tashiro
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Yoshimatsu H, Yamamoto T, Iwamoto T, Hayashi A, Narushima M, Iida T, Koshima I. The role of non-enhanced angiography in toe tip transfer with small diameter pedicle. Microsurgery 2014; 35:364-9. [PMID: 25382745 DOI: 10.1002/micr.22353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Toe tip transfer allows functional and esthetic reconstruction of the lost fingertip, but it is still uncommon because identification and dissection of donor and recipient veins can be challenging. Nonenhanced angiography (NEA) is a device that emits infrared light at a wavelength of 850 nm, which is exclusively absorbed by hemoglobin. The light penetrates the bones and other soft tissues, effectively visualizing veins in real time. The aim of this report is to present the experience on the preoperative use of nonenhanced angiography for visualization of donor and recipient veins in toe tip transfers in a series of patients. PATIENTS AND METHODS Four cases of toe tip transfer and one case of free nail flap were performed for reconstruction of the tips of thumb and finger with preoperative examination using NEA. Patients' age ranged from 29 to 52 years old (average, 29.2 years old). Before the operation, the veins in the donor and recipient sites were marked using NEA, and the blood flow of the veins in the recipient site was confirmed. RESULTS Pedicles in all transferred toe tips were less than 2 cm in length, with diameters smaller than 0.8 mm. The postoperative courses were uneventful, and all transferred toe tips survived completely, with satisfying functional and aesthetic results. CONCLUSIONS NEA may facilitate venous dissection of the donor and the recipient sites, allowing safe and efficient toe tip transfer with a small pedicle.
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Affiliation(s)
- Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taku Iwamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akitatsu Hayashi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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