Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Publishing type：Research paper (scientific journal)   Publisher：Informa UK Limited  

DOI： 10.1080/2000656x.2022.2032107

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Publishing type：Research paper (scientific journal)   Publisher：Japan Society of Plastic and Reconstructive Surgery  

DOI： 10.53045/jprs.2022-0020

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   Publisher：Georg Thieme Verlag KG  

<title>Abstract</title>
Background Various phalloplasty methods have been reported; however, a consensus has not been reached. Therefore, we suggest an alternative algorithm for an ideal phalloplasty considering the factors that affect flap selection.


Methods We retrospectively examined 32 phalloplasty cases of female-to-male transgender. Flaps used for phalloplasty were classified into three groups as follows: (1) radial forearm (RF) group, (2) anterolateral thigh (ALT) group, and (3) flap combination (FC) group. Statistical analyses were performed to determine the significance of age and body mass index (BMI) as well as differences in the rates of postoperative complication, reoperation, esthetic acceptability, tactile or erogenous sensibility, and the ability to urinate while standing.


Results Ten cases were included in the RF group and 7 and 15 cases in the ALT and FC groups, respectively. With respect to BMI, the RF group (mean [standard deviation (SD)] = 25.9 [3.3]) showed significantly higher BMI than the ALT (21.7 [0.9]) or FC group (22.2 [4.5]). The RF (mean [SD] = 3.7 [0.4]) and ALT groups (3.5 [0.9]) had significantly higher esthetic acceptability evaluation scores (from 1 to 4) than the FC group (2.5 [1.2]). Moreover, the RF and ALT groups were superior than the FC group in terms of tactile or erogenous sensibility rates.


Conclusion BMI effected flap choices for phalloplasty because of the correlation between BMI and skin thickness. FC becomes an option between ALT flap and RF flap in terms of flap choice based on BMI. Our alternative algorithm for an ideal phalloplasty based on BMI will be useful for objective flap choices.

DOI： 10.1055/s-0041-1732373

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：克誠堂出版(株)  

性同一性障害(GID)のfemale-to-male(FTM)に対し、乳輪下半周切開法による乳房切除術と乳頭縮小術を一期的に行った94例188乳房を対象に、手術記録とカルテを用いて、術後経過を調査した。また、術後1ヵ月の記録写真を用いて術後の乳頭の状態を評価した。その結果、術後に乳頭壊死を認めた症例はなかった。乳頭の表皮壊死を3例3乳頭(1.6%)、乳頭の埋没を2例2乳頭(1.1%)に認め、表皮壊死は保存的治療で治癒した。乳頭の埋没で追加治療の希望はなく、経過観察となった。後に余剰皮膚切除などの修復術を追加した症例は6例12乳房であった。術後に血腫が原因で緊急手術となったのは6例6乳房で、いずれも乳頭の合併症(乳頭表皮壊死、乳頭埋没)は認めなかった。合併症の発症率と、年齢、ホルモン治療歴、喫煙歴、BMIの関連は、合併症例が少なく、統計学的に指摘できなかった。GID・FTMに対する乳房切除術と乳頭縮小術の一期的手術は有用と考えられた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00398&link_issn=&doc_id=20210225230010&doc_link_id=%2Fad3ksgke%2F2021%2F006403%2F015%2F0310b0316%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2021%2F006403%2F015%2F0310b0316%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

Language：Japanese   Publisher：克誠堂出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00398&link_issn=&doc_id=20200831110010&doc_link_id=%2Fad3ksgke%2F2020%2F006309%2F016%2F1159-1165%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2020%2F006309%2F016%2F1159-1165%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English  

Mastectomy is usually the first and most important surgical procedure in female-to-male (FTM) individuals with gender identity disorder. Nipple reduction is also important in the process of reconstructing the chest wall for a more male appearance. If the nipples remain large after a mastectomy, the results may be disappointing to many FTM transsexuals. Nipple reduction enables these individuals to go to the beach or Japanese public baths, where they may go topless in public. We therefore consider that nipple reduction is indicated for all FTM transsexuals who desire it. There are a variety of methods for the reduction of enlarged nipples for women or non-FTM patients, but only a few reports have described the process used to create masculine-appearing nipples for FTM transsexuals. We developed a novel technique called the Eryngii method for creating male-like nipples using a 4-mm diameter dermal punch knife. The name of the method refers to the Eryngii king trumpet mushroom, which the nipple resembles after the surgical process. The main strength of this method is that it permits the creation of ideal nipples without difficulty. Here we introduce the technique and discuss our history of surgical methods for nipple reduction, including improvements and elaborations.

DOI： 10.18926/AMO/57958

PubMed

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Language：Japanese   Publisher：GID(性同一性障害)学会  

性同一性障害に対する身体的治療に関しては保険収載されておらず自費診療のため大きな負担となっていたが、ついに2018年4月より性別適合手術に対する健康保険の適用が開始された。しかし、ホルモン療法が自費診療のため、混合診療の観点からホルモン治療済み患者は対象とならず、実際にはホルモン未治療の患者の乳房切除のみ保険適用で手術可能となっている。性別適合手術の保険適用が開始されたことによるこの1年の動向を乳房切除の費用面を中心に自費診療と保険診療で比較した。当院では乳房切除術においてクリニカルパスを導入しているため、手術手技および入院による術後管理には大きな変化はない。費用面では保険診療による施行が19例で総支払額の平均は190,860円、自費診療による施行が18例で総支払額の平均は631,685円であった。ホルモン治療はガイドラインに沿った治療であるにも関わらず、ホルモン投与の有無によって費用面で大きな差が生じており、混合診療問題の早期解決が望まれる。(著者抄録)

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Authorship：Last author   Language：English  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Intestinal vaginoplasty has several advantageous features, such as scarless surgery, low incidence of contraction of the reconstructed vagina, maintenance of vaginal depth, spontaneous mucus production, and a low rate of complications. Therefore, this technique is becoming popular in many countries. Following the global trend, the demand for intestinal vaginoplasty for transsexuals is also increasing in Japan. However, there are few reports on intestinal vaginoplasty in Japan. In this study, we examined the safety and effectiveness of rectosigmoid colon vaginoplasty in the Japanese population. We retrospectively surveyed 18 male-to-female transsexuals who underwent laparoscopic rectosigmoid colon vaginoplasty at the Okayama University Hospital Gender Center between October 2012 and December 2017. One patient had developed an anastomotic leak and 2 patients experienced vaginal prolapse, which needed revision surgery. Both adverse outcomes were comparable with those from previous studies. The anastomotic leak was managed adequately with conservative treatment. To avoid vaginal prolapse, it is important to decide the length of the rectosigmoid segment so that a pull on it does not cause it to become lax, while excessive stress on the feeder vessels is avoided. Based on our study, we concluded that rectosigmoid vaginoplasty was a reliable technique in the Japanese population.

DOI： 10.18926/AMO/56862

PubMed

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Authorship：Lead author   Language：Japanese  

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

男性から女性への性転換患者(42歳、性同一性障害)で、性別適合手術(直腸-S状結腸造腟術)を施行後、4日目に下腹部痛を認め、腸管縫合不全をきたした症例について報告した。本症例では、腸管背側に縫合不全が生じ限局性の膿瘍腔が形成され、患者からも整容面の希望があったことから、総合的に判断して傍仙骨ドレナージによる治療を選択し、治癒に至った。直腸-S状結腸造腟術は性同一性障害以外に先天性腟欠損症などの患者にも施行されており、一定の確率で縫合不全が起こりえるが、縫合不全によって生じた膿瘍が腸管背側に限局していれば保存的治療により治癒する可能性があることが示唆された。

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

知覚神経付き遊離前外側大腿皮弁による足底再建について検討した。足底部再建を知覚神経付き遊離前外側大腿皮弁で行った4例(男性、24〜66歳)を対象とした。知覚神経は4例とも外側大腿皮神経を皮弁に含めて採取した。全例部分壊死や術後感染などは認めず完全生着した。術後3週目からは弾性ストッキングによる圧迫を行い、術後8週目から荷重を開始した。Tinel signは4例で術後2週目から認めた。2例は、術後4週目から抗癌剤投与を開始し、投与期間中にはTinel signの消失を認めたが、投与終了後2週目から再度Tinel signを認めた。術後4週目のS-W testによる皮弁内知覚は4例ともRed 6.45であった。術後2ヵ月月でのS-W testでは、抗癌剤投与中の2例ではTinel signが消失しており、測定不能6.65であったが、残りの2例はRed 4.74、Red 5.88まで回復した。術後経過観察で、4例とも杖なしでの独歩と、術前使用していた靴での歩行が可能であり、皮弁の傷、靴擦れ、胼胝腫の発症は認めていない。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02567&link_issn=&doc_id=20161031340004&doc_link_id=10.11270%2Fjjsrm.29.150&url=https%3A%2F%2Fdoi.org%2F10.11270%2Fjjsrm.29.150&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本性科学会  

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Language：Japanese   Publisher：日本性科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Since 2001, we have been performing phalloplasty with a radial forearm free flap as the flap of first choice in female-to-male transsexuals (FTMTS). In the present case, a 22-year-old FTMTS with a negative Allen test, we achieved good results by performing phalloplasty with an innervated island pedicled anterolateral thigh flap using the "tube within a tube" technique, in which the penis and urethra are constructed with a single flap. As compared to a forearm flap, use of an innervated island-pedicled flap may have the following advantages in phalloplasty: 1) no need for a microsurgical technique; 2) no scars at noticeable sites; 3) small functional loss in the flap donor area; 4) no sacrifice of major blood vessels. Thus, this technique seems to be a useful clinical alternative for phallic reconstruction.

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Language：English   Publisher：Okayama University Medical School  

DOI： 10.18926/AMO/52660

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Other Link： http://search.jamas.or.jp/link/ui/2015033840

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Since 2001, we have been performing phalloplasty with a radial forearm free flap as the flap of first choice in female-to-male transsexuals (FTMTS). In the present case, a 22-year-old FTMTS with a negative Allen test, we achieved good results by performing phalloplasty with an innervated island pedicled anterolateral thigh flap using the "tube within a tube" technique, in which the penis and urethra are constructed with a single flap. While phalloplasty with an island-pedicled or free anterolateral thigh flap has been reported previously, the present case seems to be the first of phalloplasty with an innervated island-pedicled anterolateral thigh flap using the "tube within a tube" technique. As compared to a forearm flap, use of an innervated island-pedicled flap may have the following advantages in phalloplasty: 1) no need for a microsurgical technique; 2) no scars at noticeable sites; 3) small functional loss in the flap donor area; 4) no sacrifice of major blood vessels. Thus, this technique seems to be a useful clinical alternative for phallic reconstruction.

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：GID(性同一性障害)学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.97.344_1

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Total pages：381   Responsible for pages：14   Language：Japanese Book type：Scholarly book

Total pages：279   Responsible for pages：8   Language：Japanese Book type：Scholarly book

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Other Link： http://search.jamas.or.jp/link/ui/2014335653

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Language：English   Publisher：Okayama University Medical School  

DOI： 10.18926/AMO/52013

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Other Link： http://search.jamas.or.jp/link/ui/2015047271

Language：English   Publisher：Okayama University Medical School  

DOI： 10.18926/AMO/51073

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Other Link： http://search.jamas.or.jp/link/ui/2014082882

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Other Link： http://search.jamas.or.jp/link/ui/2012271239

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Language：English   Publisher：THIEME MEDICAL PUBL INC  

Multidetector-row computed tomography angiography (MDCTA) can be used to visualize small vessels and has been used to search for perforators in deep inferior epigastric artery perforator flaps and anterolateral thigh flaps. Fibula osteocutaneous flaps are often used for mandibular reconstruction, but questions remain about the reliability of these flaps and the variety of their perforators. Eight patients who were candidates for mandibular or pedal reconstruction with a fibula osteocutaneous flap were prospectively evaluated with MDCTA and Doppler sonography. We evaluated the number, position, and course of perforators with MDCTA. The perforators were classified, and intraoperative findings were compared with those of Doppler sonography and MDCTA. MDCTA accurately identified the perforators and showed a satisfactory concordance with intraoperative findings. The high spatial resolution of MDCTA allows the perforators&apos; origin, course, and type to be precisely described. Eighteen vessels were identified with MDCTA, and on average, 2.3 vessels were identified in the leg of each patient. The rate of concordance with operative findings was 87.5% for MDCTA. With MDCTA, flap perforators can be accurately evaluated before surgery in a manner not possible with traditional angiography or Doppler sonography. Reliable perforators can be chosen, and detailed operative plans can be made.

DOI： 10.1055/s-0030-1267380

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DOI： 10.11477/mf.1405101948

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Language：Japanese   Publisher：全日本病院出版会  

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Other Link： http://search.jamas.or.jp/link/ui/2012006071

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DOI： 10.11477/mf.1413102540

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Other Link： http://search.jamas.or.jp/link/ui/2012040977

Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：Japan Surgical Society (JSS)  

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Other Link： http://search.jamas.or.jp/link/ui/2010261803

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Other Link： http://search.jamas.or.jp/link/ui/2010244382

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2009.06.018

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

The goals of head and neck reconstruction after malignant tumor resection include obtaining good postoperative function and appearance and minimizing operative invasiveness. However, the most important goals are reducing local postoperative complications and discharging the patient early, because patients requiring head and neck reconstruction tend to have poorer prognoses. Local complications delay wound healing, postoperative treatment, and postoperative recovery of eating and speech functions. Thus, when shown to be necessary by clinical observation and imaging findings, we open the wound area promptly and attempt to diagnose the complication. In this way, we can discover cervical infections and minimize wound contamination before more serious complications, such as total flap necrosis, develop. We review measures for preventing local complications in patients undergoing head and neck reconstruction at our institution and divide them into preoperative, intraoperative, and postoperative measures.

DOI： 10.5981/jjhnc.36.369

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Other Link： http://search.jamas.or.jp/link/ui/2011048374

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Language：English   Publishing type：Book review, literature introduction, etc.   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

To investigate the biological mechanism of gender identity disorder (GID), five candidate sex hormone-related genes, encoding androgen receptor (AR), estrogen receptors alpha (ER alpha) and beta (ER beta), aromatase (CYP19), and progesterone receptor (PGR) were analyzed by a case-control association study. Subjects were 242 transsexuals (74 male-to-female patients (MTF) and 168 female-to-male patients (FTM)), and 275 healthy age- and geographical origin-matched controls (106 males and 169 females). The distributions of CAG repeat numbers in exon 1 of AR, TA repeat numbers in the promoter region of ER alpha CA repeat numbers in intron 5 of ER beta, TTTA repeat numbers in intron 4 of CYP19, and six polymorphisms (rs2008112, rs508653, V660L, H770H, rs572698 and PROGINS) of PGR were analyzed. No significant difference in allelic or genotypic distribution of any gene examined was found between MTFs and control males or between FTMs and control females. The present findings do not provide any evidence that genetic variants of sex hormone-related genes confer individual susceptibility to MTF or FTM transsexualism. (C) 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.pnpbp.2009.07.008

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Language：English   Publisher：SPRINGER  

The aim of this study is to describe the effect of transarterial embolization from the ophthalmic artery as a pretreatment for orbital exenteration. A 75-year-old Chinese man with a 7-year history of gradual increase of the left eye swelling showed a massive conjunctival tumor growing outwardly from the interpalpebral fissure and had no light perception in the left eye. Magnetic resonance imaging showed orbital invasion of the tumor around the left eyeglobe. The initial surgery for the planned orbital exenteration was discontinued after skin incision around the orbital margin due to massive hemorrhage. The patient underwent transarterial embolization with gelatin sponge (Spongel) of the feeding arteries from the left ophthalmic artery and, the next day, had orbital exenteration with well-controllable bleeding and reconstruction with free vascularized anterolateral thigh cutaneous flap transfer. Pathologically, well-differentiated squamous cell carcinoma proliferated in exophytic, papillary, and nested fashions, arising from the bulbar conjunctiva. Tumor cells were also found in the conjunctival stroma around the vessels. The sclera at the equator had a perforated site with tumor cell invasion, but no intraocular invasion was found. Hematoxylin-positive gelatin sponges were found inside the orbital vessels and large choroidal vessels. In conclusion, transarterial embolization of feeding arteries arising from the ophthalmic artery is a useful pretreatment to control bleeding at orbital exenteration for malignancy.

DOI： 10.1007/s00270-008-9413-6

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DOI： 10.18926/AMO/31841

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Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

We treated 2 different types of intersexual patients who underwent a vaginoplasty with the pudendal-thigh flap. One was a female with testicular feminization syndrome for whom we reconstructed the total vagina with a pudendal-thigh flap, and the other was a female with an adrenogenital syndrome for whom we enlarged the introitus of the vagina with the same approach. There were no complications such as a flap necrosis. In addition, there was no stricture of the neo-vagina and no urinary problem.

DOI： 10.18926/AMO/30948

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Language：English   Publisher：THIEME MEDICAL PUBL INC  

The purpose of this study was to determine the usefulness of a new flap model, the superficial inferior epigastric artery (SIEA) flap for supermicrosurgical training. Experimental groups were randomly divided into three groups of 10 rats each. In each group REA flaps were elevated and then returned to their original locations with or without vascular anastomosis of the superficial inferior epigastric vessels. Group 1: free SIEA flap, group 2: free SIEA flap with 1 hour ischemia time, group 3: free SIEA flap with 4 hours ischemia time, group 4: SIEA flap without vascular anastomosis. The viability rate was 80% with group 1, 50% with group 2, and 40% with group 3. All nonvascularized flaps (group 4) underwent complete necrosis. These findings suggest that preservation of blood flow in a flap has a beneficial effect on the prevention of microthrombosis in the subcutaneous capillary network of the skin and increases the flap survival rate. The SIEA flap with preserved circulation is an ideal model for developing supermicrosurgical skills.

DOI： 10.1055/s-0028-1088226

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Language：English   Publisher：OKAYAMA UNIV MED SCHOOL  

Between January 2001 and December 2007, we performed vaginoplasty as sex reassignment surgery in a total of 14 male-to-female transsexual (MTFTS) patients [1]. Several complications occurred such as partial flap necrosis, rectovaginal fistula formation and hypersensitivity of the neoclitoris. just after the operation, some patients feel that their penises still exist, but by several weeks postoperatively, this sensation has disappeared. Herein we report a case of MTFTS in whom the sensation of a phantom erectile penis persisted for much longer.

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To date, many techniques have been reported for vaginoplasty in male-to-female trans-sexual (MTFTS) patients, such as the use of a rectum transfer, a penile-scrotal flap and a reversed penile flap. However, none of these procedures is without its disadvantages. We developed a newly kind of flap for vaginoplasty, the M-shaped perineo-scrotal flap (M-shaped flap), using skin from both sides of the scrotum, shorn of hair by preoperative laser treatment. We applied this new type of flap in 7 MTFTS patients between January 2006 and January 2007. None of the flaps developed necrosis, and the patients could engage in sexual activity within 3 months of the operation. The M-shaped flap has numerous advantages: it can be elevated safely while retaining good vascularity, it provides for the construction of a sufficient deep vagina without a skin graft, the size of the flap is not influenced entirely by the length of the penis, and it utilizes skin from both sides of the scrotal area, which is usually excised.

DOI： 10.18926/AMO/32875

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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We treated a case with left tibial adamantinoma by use of a contralateral. fibular osteoadiposal flap. The donor site of conventional fibular osteocutaneous flap must be covered with a skin graft because if we close the donor skin defect directly, compartment syndrome might occur. We were able to close the donor skin defect because this combined type flap included only a small monitoring skin paddle. We present herein the utility of the osteoadiposal flap and show the value of a skin-sparing approach with a minimal aesthetic defect.

DOI： 10.18926/AMO/30718

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The free radial forearm flap is a very common material for penile reconstruction. Its major problems are donor-site morbidity with large depressive scar after Skin grafting, urethra] fistula due to insufficiency of suture line for the urethra, and need for microvascular anastomosis. A new method using combined bilateral island SCIP flaps for the urethra and penis is developed for gender identity disorder (GID) patients. The advantages of this method are minimal donor-site morbidity with a concealed donor scar, and possible one-stage reconstruction for a longer urethra of 22 cm in length without insufficiency, even for GID female-to-male patients. A disadvantage is poor sensory recovery.

DOI： 10.1055/s-2006-939957

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The first case of sex reassignment surgery (SRS) in our hospital was performed in January 2001; as of February, 2005, 4 cases of MTF-SRS had been performed. In the 2 most recent cases, we used penile and scrotal skin flaps to avoid complications. The depth and width of the new vagina was made to be adequate for sexual intercourse. Future attention should be focused on devising a surgical technique that will help prevent the complications of partial necrosis of the epidermal skin and wound dehiscence. Although ours is only an initial experience, we describe our surgical technique herein.

DOI： 10.18926/AMO/31976

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Language：English   Publishing type：Book review, literature introduction, etc.  

With the development of various reconstructive procedures, most patients who have undergone ablative surgery for oropharyngeal cancer have obtained satisfactory functional results and good quality of life. However, many questions remain concerning methods of obtaining optimal postoperative oral and pharyngeal functions, especially after glossectomy. This review focuses on reconstructive methods after partial glossectomy, hemiglossectomy, and subtotal or total glossectomy and discusses current problems and the possibility of sensory and dynamic reconstruction. © The Japan Society of Clinical Oncology 2005.

DOI： 10.1007/s10147-005-0500-2

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DOI： 10.5981/jjhnc.31.313

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The authors describe, in the first report of this type of replantation surgery, a high success rate using delayed venous anastomosis in 16 consecutive distal phalangeal replantations under digital block. Among these replantations, seven fingers (43.8 percent) showed postoperative venous congestion and five fingers were reoperated on with delayed venous drainage under digital block. All the reoperated fingers were successfully drained by additional single or double venous drainage with a vein graft. As a result, 13 fingers survived (81.3 percent success rate). All operations were performed under a digital block.

DOI： 10.1097/01.PRS.0000146869.92997.F3

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The authors describe, in the first report of this type of replantation surgery, a high success rate using delayed venous anastomosis in 16 consecutive distal phalangeal replantations under digital block. Among these replantations, seven fingers (43.8 percent) showed postoperative venous congestion and five fingers were reoperated on with delayed venous drainage under digital block. All the reoperated fingers were successfully drained by additional single or double venous drainage with a vein graft. As a result, 13 fingers survived (81.3 percent success rate). All operations were performed under a digital block.

DOI： 10.1097/01.PRS.0000146869.92997.F3

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This is the first report on the effectiveness of minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema. Fifty-two patients (age: 15 to 78 years old; 8 males, 44 females) were treated with lymphaticovenular anastomoses under local anesthesia and by postoperative compression using elastic stockings. The average duration of edema of these patients before treatment was 5.3 +/- 5.0 years. The average number of anastomosis in each patient was 2.1 +/- 1.2 (1-5). The patients were followed for an average of 14.5 +/- 10.2 months, and the result were considered effective (82.5%) even for the patients with stage III (progressive edema with acute lymphangitis) and IV (fibrolymphedema), but others showed no improvement. Among these cases, 17 patients showed reduction of over 4 cm in the circumference of the lower leg. The average decrease in the circumference excluding edema in bilateral legs was 41.8 +/- 31.2% of the preoperative excess length. These results indicate that minimal invasive lymphaticovenular anastomosis under a local anesthesia is valuable instead of general anesthesia.

DOI： 10.1097/01.sap.0000120319.89926.07

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A new one-stage nerve pedicle grafting technique, employing a vascularized great auricular nerve graft, was used to repair a facial nerve defect. The facial nerve of a 39-year-old woman with facial schwannoma was resected, and an island vascularized great auricular nerve graft from the ipsilateral side was transferred to bridge a 4 cm long defect of the buccal branch. Postoperatively, rapid nerve sprouting through the vascularized nerve graft and excellent facial reamination were obtained within 6 months after surgery. This method in one-stage using a vascularized nerve graft is technically easy, requires a short operating time, has minimal donor-site morbidity, and leads to successful nerve regeneration postoperatively.

DOI： 10.1055/s-2004-829998

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The superficial circumflex iliac artery perforator (SCIP) flap differs from the established groin flap in that it is nourished by only a perforator of the superficial circumflex iliac system and has a short segment (3 to 4 cm in length) of this vascular system. Three cases in which free superficial circumflex iliac artery perforator flaps were successfully transferred for coverage of soft-tissue defects in the limb are described in this article. The advantages of this flap are as follows: no need for deeper and longer dissection for the pedicle vessel, a shorter flap elevation time, possible thinning of the flap with primary defatting, the possibility of an adiposal flap with customized thickness for tissue augmentation, a concealed donor site, minimal donor-site morbidity, and the availability of a large cutaneous vein as a venous drainage system. The disadvantages are the need for dissection for a smaller perforator and an anastomosing technique for small-caliber vessels of less than 1.0 mm.

DOI： 10.1097/01.PRS.0000095948.03605.20

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The major problems in dealing with established mandibular loss are severe soft-tissue contracture and a limited number of recipient vessels. The skin portion of the iliac osteocutaneous flap often necrotizes in cases without perforators of the deep circumflex iliac vessel. To overcome these problems, eight patients with established mandibular loss and no skin perforators of the deep circumflex iliac vessel were treated with a sequential vascularized iliac bone graft and a superficial circumflex iliac perforator flap with a single recipient vessel. Regarding the recipient vessels, the ipsilateral cervical vessels were used for four patients, and the contralateral facial and ipsilateral superficial temporal vessels were used for two cases each. The superficial circumflex iliac perforator flaps were 7 to 28 cm in length and 3 to 15 cm in width. The iliac bone grafts ranged from 7 to 13 cm in length, and three cases were repaired with the inner cortex of the iliac bone. There were no serious complications, such as flap necrosis or bone infection and resulting absorption. The advantages of this method are that both pedicles are very close to each other and of suitable diameter for anastomosis. Simultaneous flap elevation and preparation for the recipient site is possible. The skin flap and vascularized bone graft can be obtained from the same donor site. A single source vessel can nourish both the large skin area and bone sequentially. Longer dissection of the superficial circumflex iliac system to the proximal femoral division is unnecessary. A large flap can survive with a short segment of the superficial circumflex iliac system. Only the vascularized inner cortex of the iliac bone needs to be used, and the outer iliac cortex can be preserved, which results in less morbidity at the donor site.

DOI： 10.1097/01.PRS.0000090725.89401.DE

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Language：Japanese   Publisher：現代医療社  

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Other Link： http://search.jamas.or.jp/link/ui/2004180076

Language：Japanese   Publisher：岡山医学会  

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Reconstruction for defects around the ankle continues to be challenging. Repairs have been effected with the dorsalis pedis flap, the medial plantar flap, and with reverse-flow island flaps using the anterior and posterior tibial systems and the peroneal system. However, sacrifice of the major vessels of the lower leg and wide and long seats at the donor site are disadvantages of these flaps. To overcome these disadvantages, the authors developed island lateral and medial malleolar flaps with the perforators located close to the ankle. These flaps are easy to elevate, involve a short operating time, require no sacrifice of major vessels or muscles of the lower legs, and the use of these adipofascial flaps makes donor scars more acceptable. Malleolar perforator flaps are suitable for the repair of small ankle defects.

DOI： 10.1097/01.sap.0000095654.07024.65

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The authors present two cases in which the venous drainage of transferred flaps was compromised and the flaps were salvaged by vein grafts. Traditionally, once transferred free flaps had become congestive, surgeons would re-anastomose the thrombosed veins, and administer anticoagulants or carry out peripheral vessel dilation. These authors recommend not only re-anastomosis of veins, but also additional venous drainage, with or without vein grafts.

DOI： 10.1055/s-2004-815639

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Patients with established or irreversible plantar sensory loss often have normal sensation on the dorsal aspect of the foot, due to an intact deep peroneal nerve. A new method of deep peroneal nerve transfer is proposed for repair of plantar sensory loss caused by extensive nerve gaps or high-level lesions of the posterior tibial nerve. Two cases in which this technique was used are described. The surgical technique is relatively easy, with a short operating time, rapid nerve regeneration after surgery, accurate sensory recovery, and minimal donor-site morbidity with sensory loss only on the first web space of the foot.

DOI： 10.1055/s-2003-44632

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Language：Japanese   Publisher：岡山医学会  

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The introduction of supermicrosurgery has led to the development of a new gluteal perforator flap nourished only by a musculocutaneous perforator of the superficial gluteal artery system. This flap has a perforator that is short (3-4 cm in length) and small (less than 1 mm). The successful transference of a free gluteal perforator flap for the coverage of soft-tissue defects in the foot and face in two patients is described in this article. With this flap, deeper and longer dissection for a pedicle vessel is unnecessary, flap elevation time is shorter, thinning of the flap with primary defatting and creation of an adiposal flap with customized thickness for tissue augmentation are possible, the donor site is in a concealed area with minimal donor site morbidity, and application of the flap as a scarred flap for previous operations in the gluteal region is possible. The disadvantages of this flap are necessity of dissection for a smaller perforator and of anastomosis of small-caliber vessels of less than 1.0 mm.

DOI： 10.1097/01.SAP.0000044139.78441.53

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The authors report two cases of huge arteriovenous malformations in the head and neck regions treated successfully with preoperative superselective transarterial embolization and resection followed by a free perforator flap transfer. Based on the authors, previous cases, en block mass resection of the malformation was possible with bleeding of less than 150 ml. The massive defects could be repaired with free perforator flaps using an anterolateral thigh flap and a deep inferior epigastric artery perforator flap. One patient who lost facial muscle underwent reconstruction by simultaneous muscle transfer, and both patients regained accept- able cosmetic appearance and dynamic facial function. Now, more than 4 to 7 years after surgery, the patients have shown no reexpansion of the malformation. The important points of this treatment are complete embolization to accomplish total resection with minimal bleeding, free flap transfer to prevent postoperative reexpansion or recurrence of arteriovenous malformations, and the selection of recipient vessels because of arterial embolization in part of the lesion.

DOI： 10.1097/01.SAP.0000044706.58478.73

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Three cases of successful transfer of a new free anterolateral thigh (ALT) perforator flap for coverage of soft-tissue defects in the hand and upper arm are described. This new flap has a thin superficial fatty layer, no fascial component, and is vascularized with a perforator of the descending branch of the lateral circumflex femoral system. The free flap is nourished by anastomosing of the perforator or the proximal small segment of the descending branch. The advantages of this flap are no need for deep dissection, minimal time for flap elevation, minimal donor site morbidity, preservation of the main trunk of the lateral circumflex femoral system, possible thinning of the flap with primary defatting, possible application as a flow-through flap, and a concealed donor scar. This flap is suitable for coverage of defects in the fingers, hands, and arms.

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Massive resection of soft-tissue sarcoma in the elbow region often results in loss of long segments of the brachial artery and median nerve, as well as a wide soft-tissue defect. With conventional nerve grafts and revascularization of the arm, forearm and hand function is poor because nerves cannot be regenerated over the long nerve gap in the high elbow region. The authors used a long vascularized nerve graft and found it effective for reconstruction of upper arm function. This paper describes the first application of a free vascularized femoral nerve graft and a free anterolateral thigh true perforator flap based on the lateral circumflex femoral system, to repair elbow and forearm function. Long vascularized femoral nerve grafts of over 12 cm can be obtained, and an anterolateral thigh flap can be harvested from the same donor area.

DOI： 10.1055/s-2003-42498

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Language：English   Publisher：W B SAUNDERS CO  

Since the 1980s, the concept of the perforator flap has been modified to include new perforator flaps. A medial plantar perforator flap, which has no fascial component and is nourished only with perforators of the medial plantar vessel and a cutaneous vein, or with a small segment of the medial plantar vessel, was developed. A free medial plantar perforator flap was successfully transferred for coverage of a soft-tissue defect in the finger. The advantages of this flap are minimum donor site morbidity, minimum damage to the posterior tibial and medial plantar systems, no need for deep dissection, possible thinning of the flap with primary defatting, a short time for flap elevation, use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, a concealed donor scar, and possible application as a flow-through flap as a free flap and an island perforator flap for plantar weight-bearing defects.

DOI： 10.1016/S0094-1298(03)00044-0

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Over the last 9 years, the authors analyzed lymphedema of the lower extremity in a total of 25 patients, comparing the use of supermicrosurgical lymphaticovenular anastomosis and/or conservative treatment. The most common cause of edema was hysterectomy, with or without subsequent radiation therapy for uterine cancer. Among 12 cases that underwent only conservative treatment, only one case showed a decrease of over 4 cm in the circumference of the lower leg. The average period for conservative treatment was 1.5 years,and the average decreased circumference was 0.6 cm (8 percent of the preoperative excess). Thirteen patients were followed after lymphaticovenular anastomoses, as well as pre- and postoperative conservative treatment. The average follow-up after surgery was 3.3 years, and eight patients showed a reduction of over 4 cm in the circumference of the lower leg. The average decrease in the circumference, excluding edema in the bilateral leg, was 4.7 cm (55.6 percent of the preoperative excess). These results indicate that supermicrosurgical lymphaticovenular anastomosis has a valuable place in the treatment of lymphedema.

DOI： 10.1055/s-2003-40575

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Reconstruction of large abdominal wall defects with conventional reconstruction including the component separation technique is difficult because of strong transverse tension and loss or weakness of the rectus abdominis muscle. To overcome this problem, dynamic reconstruction of the abdominal wall using a free innervated rectus femoris musculocutaneous flap was performed for large defects with separation of the bilateral rectus abdominis muscles. The intact motor nerve of the rectus femoris muscle was transferred without transection, and only the pedicle vessels were anastomosed to the omental vessels. Four and one-half years after surgery, the rectus femoris muscle had voluntary strong muscle contraction and there was no abdominal protrusion, herniation, or donor morbidity. This new method with dynamic function can replace conventional techniques for large abdominal defects without rectus muscle function.

DOI： 10.1097/01.SAP.0000032304.45784.F6

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A case of a 40-year-old female with meralgia paresthetica after malignant tumor resection in the right inguinal. region is reported. Traditionally, meralgia paresthetica is treated with neurotransection or neurolysis. The therapeutic strategy using neurolysis, and the use of a deep inferior epigastric perforator adiposal flap wrapping as a prophylactic procedure against reentrapment is discussed.

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：医歯薬出版  

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Other Link： http://search.jamas.or.jp/link/ui/2003025228

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Perforator flaps are defined as skin flap without fascia or muscle and they are nourished by one or more perforating vessels perforating the fascia, muscle, or intermuscular septum. As early as 1985 in Japan, we proposed this concept over that of the fasciocutaneous flap, which was believed to be nourished by fascial plexus. The pedicle perforators are classified as septocutaneous, musclular (intermuscular), periosteal, and intertendinous perforators. As useful perforator flaps in the lower extremity, posterior tibial perforator island flaps, saphenous island flaps, peroneal island flaps, malleolar island perforator flaps, deep inferior epigastric perforator free flap (DIEP flap), anterolateral thigh free flap (ALT flap), and latissimus dorsi muscle free perforator flap (thoracodorsal artery perforator flap, T-DAP or TAP flap) were described. These flaps have the advantage of minimal donor-site morbidity, relatively rapid dissection and flap elevation, and reliable skin territory.

DOI： 10.1055/s-2002-36291

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Vascularized toenail grafts with long vascular pedicles have usually been transferred under general anesthesia. In this paper, a minimally invasive vascularized nail graft with a short pedicle and small cutaneous flap, which was successfully transferred under digital block of the finger and toe, is described.

DOI： 10.1055/s-2001-18813

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Language：Japanese   Publisher：文光堂  

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Between June 1989 and December 1996, the flashlamp pumped pulsed dye laser was used to treat port wine stains (PWS) in 644 patients, age, range 3 months-93 years (mean 21). The efficacy of the treatment was assessed after more than one year of follow-up. Each factor that might affect the efficacy was then evaluated statistically. Broad lesions required more laser treatments than narrow lesions and clearing tended to start from the periphery of the lesion, indicating the three-dimensional depth of the broader PWS. Patients who had been given previous treatments such as argon laser required about two more laser treatments than those who had not, but there were no clear differences in the efficacy of dye laser treatment between the two groups.

DOI： 10.1080/028443101300165345

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Language：Japanese   Publisher：The Japanese Skin Cancer Society  

A-68-year-old man had a tumor on the thoracic wall for two years. It had a diameter of 10cm, and was elastically hard. Histopathological findings showed fibrous tissue made of compact and mature fibroblasts and collagen fibers. Fbbroblasts are small, slender nuclei with rare mitotic figures. We diagnosed that tumor as a desmoid tumor. Tumor resection was performed; a large defect (20×20cm) in the trunk had to be reconstructed. We showed a new strategy of repairing soft-tissue defects in the thoracic wall. We utilized two flaps, which are both pedicled latissimus dorsi muscle perforator flaps. One is perforated from the circumflex scapular artery, which we call a scapular flap, and the other is perforated from the intercostal artery. We propose these flaps latissimus dorsi perforator flaps and demonstrated some points of technique for the repairing of soft-tissue defects in the thoracic wall and rising musculocutaneous flaps. [Skin Cancer (Japan) 2001; 16: 305-309]

DOI： 10.5227/skincancer.16.305

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DOI： 10.4044/joma1947.113.3_279

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Lumbosacral defects on 20 patients were covered with a perforator-based flap. Cutaneous perforators derived from the 9th and loth intercostal arteries, the 4th lumbar artery, and multiple gluteal perforators that penetrate the gluteus maximus muscle were used as vascular pedicles. Minor complications occurred in five cases. Using this method, minimal morbidity of the donor site is expected because the gluteus maximus need not be sacrificed. Accordingly, perforator-based flaps are especially indicated for ambulatory patients, but for paraplegic patients as well. Even in the event of recurrence, another perforator-based or musculocutaneous flap can be elevated from the ipsilateral side because of the presence of multiple perforators in the lumbosacral and gluteal regions.

DOI： 10.1097/00006534-199804040-00015

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Language：English  

Lumbosacral defects on 20 patients were covered with a perforator-based flap. Cutaneous perforators derived from the 9th and loth intercostal arteries, the 4th lumbar artery, and multiple gluteal perforators that penetrate the gluteus maximus muscle were used as vascular pedicles. Minor complications occurred in five cases. Using this method, minimal morbidity of the donor site is expected because the gluteus maximus need not be sacrificed. Accordingly, perforator-based flaps are especially indicated for ambulatory patients, but for paraplegic patients as well. Even in the event of recurrence, another perforator-based or musculocutaneous flap can be elevated from the ipsilateral side because of the presence of multiple perforators in the lumbosacral and gluteal regions.

DOI： 10.1097/00006534-199804040-00015

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Author：Myself 

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Author：Myself 

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Author：Myself 

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