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：(公社)日本整形外科学会  

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

症例は44歳女性で、胸部下部食道癌の右肺下葉浸潤により食道肺瘻を生じ、繰り返す肺炎のため頸部食道離断術および食道瘻、胃瘻造設がなされた。腫瘍切除に伴い右肺下葉切除後の気管支断端および下行大動脈留置ステントが露出予定となったため、再建目的に当科紹介となった。ステント露出部は広背筋弁で被覆し、右肺下葉気管支断端は縫合切離速度自動調整機能付き自動縫合器Signiaステープリングシステムで切離された後に、断端部を十分な面積の前鋸筋弁で被覆した。術後2日目に造影CTにて胸腔内所見および移植組織の血流が問題ないことを確認し、術後23日目には転院となった。移植組織は全生着し、術後のCTでは気管支断端とステント露出部は筋弁で適切に被覆されており、術後経過は良好であった。

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

Three-dimensional (3D) cell constructs comprising only tissue-specific cells and extracellular matrix secreted by them would be ideal transplants, but their fabrication in a cell aggregation manner without cell scaffolds relies on random cell self-aggregation, making the control of their size and shape difficult. In this study, we propose a method to fabricate band-shaped tissues by inducing the self-aggregation of cell sheets using the developed cell self-aggregation technique (CAT). Acting as cell aggregation stoppers, silicone semicircular pillars were attached to two positions equidistant from both short ends of the rounded rectangular culture groove and coated with a specifically charged biomimetic polymer as a CAT-inducing surface. Mesenchymal stem cells, chondrocytes, and skeletal myoblast cells seeded on the surface of the culture grooves formed band-shaped aggregates between the two aggregation stoppers following spontaneous detachment with aggregation of the cell sheet from the outer edge of the grooves during day one of culture. The aggregated chondrocyte band matured into a rigid cartilage plate with an abundant cartilage matrix while retaining its band shape after two weeks of chondrogenic cultivation. Additionally, the aggregates of mesenchymal stem cells and myoblast cell bands could patch the induced collagen membrane derived from rat subcutaneous tissue like a bandage immediately after their formation and successfully mature into fat and muscle tissues, respectively. These results indicate that, depending on the cell type, scaffold-free band-shaped cell aggregates produced by CAT have the potential to achieve tissue regeneration that follows the shape of the defect via in vitro maturation culture or in vivo organization.

DOI： 10.1088/1748-605X/ac9c7f

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00238-021-01905-2

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Other Link： https://link.springer.com/article/10.1007/s00238-021-01905-2/fulltext.html

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

The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify the morphological changes, long-term durability, and potential for secondary carcinogenesis in such tissues. In our single-center study, the rough morphological changes in 54 cases of intraoral and pharyngeal skin and mucosal flaps were evaluated more than 10 years after flap transfer. In addition, the literature on the development of second carcinomas from skin flaps was reviewed. The mean follow-up period for transferred flaps was 148 months. The reconstruction areas and the probability of morphological changes were significantly correlated (p=0.006), especially in cases with tongue, lower gingiva, and buccal mucosal reconstruction. Free jejunal flap surfaces were well maintained, whereas tubed skin flaps showed severe morphological changes in cases with pharyngeal reconstruction. None of the flaps in our series developed second primary carcinomas. Skin flaps generally had good durability for > 10 years in intraoral environments, while mucosal flaps had better durability for pharyngeal reconstruction. Second squamous carcinomas arising from skin flaps are extremely rare; however, surgeons should take this possibility into consideration and conduct meticulous and long-term follow-up.

DOI： 10.18926/AMO/62813

PubMed

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

BACKGROUND: The closure of palatal defects after tumor resection or irradiation is performed with either a prosthesis or autogenous tissue; however, there are no clear criteria regarding selection of the method. Thus, this study aimed to investigate the real-world situation and problems of palatal closure using prostheses, and examined patient opinion on how palatal closure using autogenous tissue improved their postoperative quality of life (QOL). METHODS: In 5 patients whose palatal defects resulted from treatment for head and neck cancer and were closed with a prosthesis, the palate was closed secondarily with autogenous tissue; a questionnaire on daily life was administered pre- and post-operatively. RESULTS: Functional improvements in terms of speech and eating were achieved in all and in 4 of 5 cases, respectively. In all cases, the QOL was better for palatal closure with autogenous tissue than with the prosthesis. CONCLUSIONS: As postoperative QOL was considered to be better when reconstructing the palate with autogenous tissue than with the prosthesis, we recommend to actively select autogenous tissue for palate reconstruction.

DOI： 10.1097/SCS.0000000000007969

PubMed

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Language：English  

Ventriculitis is a rare, serious complication of neurosurgery. A 59-year-old man who had undergone a craniotomy for a paranasal adenocarcinoma, developed a right frontal cystic lesion. We performed a bifrontal craniotomy to remove the lesion. The dura was repaired with non-vascularized free fascia lata in watertight fashion. Ventriculitis occurred 3 days postoperatively. Ventricular drainage, craniectomy, and endoscopic irrigation were undertaken to remove an abscess. The dura and the resection cavity were reconstructed using a vascularized anterolateral thigh adipofascial flap. His symptoms disappeared, indicating that endoscopic irrigation and reconstruction can effectively address ventriculitis even in patients in critical clinical condition.

DOI： 10.18926/AMO/61908

PubMed

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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

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

BACKGROUND: In surgical treatment for longstanding facial paralysis, muscle transplantation is considered a useful and important method. To obtain a spontaneous smile, the use of the facial nerve of the healthy side as a motor source is better, but use of the masseter nerve allows prompt reinnervation and powerful movement. However, in some patients in whom the masseter nerve is used, separating masticatory movement and commissure contraction is difficult. Solutions for such patients have not been determined. CASE HISTORY AND DISCUSSION: A 46-year-old female patient presented with longstanding complete facial paralysis after resection of a right acoustic neurinoma. As initial surgery, free gracilis transfer was performed on the cheek, but the patient experienced commissure movement during meals postsurgery. Secondary corrective surgery was performed to detach the motor nerve of the gracilis from the masseter nerve and suture it to the facial nerve of the healthy side via cross-face nerve graft. The symptom improved but partially recurred. Improvement in synkinetic movement can be obtained by performing cross-face nerve grafting and subsequent nerve switch.

DOI： 10.1097/SCS.0000000000004721

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Raoultella planticola, a Gram-negative, aerobic bacillus commonly isolated from soil and water, rarely causes invasive infections in humans. Septic shock from R. planticola after burn injury has not been previously reported. Case presentation: A 79-year-old male was admitted to the emergency intensive care unit after extensive flame burn injury. He accidently caught fire while burning trash and plunged into a nearby tank filled with contaminated rainwater to extinguish the fire. The patient developed septic shock on day 10. The blood culture detected R. planticola, which was identified using the VITEK-2 biochemical identification system. Although appropriate antibiotic treatment was continued, the patient died on day 12. Conclusions: Clinicians should be aware of fatal infections in patients with burn injury complicated by exposure to contaminated water.

DOI： 10.1186/s12941-018-0270-0

Scopus

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：THIEME MEDICAL PUBL INC  

Background The treatment of trauma to the lower extremities often carries a high risk of complications. To the best of our knowledge, no study has been published regarding the treatment of open lower-limb fractures using laser-assisted indocyanine green angiography (LA-ICG). Here we retrospectively evaluated LA-ICG based therapeutic interventions and reported the use of LA-ICG and its results in this application.
Patients and Methods Between January 2011 and December 2015, a total of 23 cases with Gustilo grade IIIB open lower-limb fractures were investigated. LA-ICG was used to demonstrate the presence of necrotic tissue and determine the range of debridement. We compared 13 patients treated using LA-ICG from 2013 to 2015 with 10 patients treated without LA-ICG from 2010 to 2013. We reviewed tissue necrosis and other outcomes of these patients.
Results The tissue necrosis rate in the LA-ICG used group was significantly lower than that in the LA-ICG free group. There were also significant differences in the average number of instances of tissue necrosis per patient, debridements, and deep-site infections. There was no flap loss.
Conclusion By using LA-ICG, not only plastic surgeons but also clinicians in all associated departments including orthopedics can perform early reliable debridement and share in trauma treatment planning. We will continue to accumulate similar cases and hope to further improve LA-ICG techniques.

DOI： 10.1055/s-0036-1593807

Web of Science

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：THIEME MEDICAL PUBL INC  

Background In this article, we reviewed the training results of medical students using the Microvascular Research Center Training Program (MRCP), and proposed an ideal microsurgical training program for all individuals by analyzing the training results of medical students who did not have any surgical experience.
Methods As of 2015, a total of 29 medical students completed the MRCP. In the most recent 12 medical students, the number of trials performed for each training stage and the number of rats needed to complete the training were recorded. Additionally, we measured the operating time upon finishing stage 5 for the recent six medical students after it became a current program.
Results The average operating time upon finishing stage 5 for the recent six medical students was 120 minutes 11 minutes (standard deviation [SD]). The average vascular anastomosis time (for the artery and-vein) was 52 minutes 2 minutes (SD). For the most recent 12 medical students, there was a negative correlation between the number of trials performed in the non-rat stages (stages 1-3) and the number of rats used in the rat stages (stages 4-5).
Conclusion Analysis of the training results of medical students suggests that performing microsurgery first on silicon tubes and chicken wings saves animals' lives later during the training program. We believe that any person can learn the technique of microsurgery by performing 7 to 8 hours of training per day over a period of 15 days within this program setting.

DOI： 10.1055/s-0035-1568884

Web of Science

PubMed

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

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J-GLOBAL

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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：(NPO)日本食道学会  

J-GLOBAL

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

症例は65歳男性で、両肩痛を主訴とした。血液検査では炎症反応の高値に加え、腎機能の増悪、筋逸脱酵素の上昇を認めた。CTおよびMRIにて両肩関節周囲の筋、皮下組織の炎症を認め、重症軟部組織感染症の疑いとしてaminobenzylpenicillin(ABPC) 2gおよびclindamycin(CLDM) 600mgの経静脈投与を開始し、緊急デブリードマンを行う方針となった。手術時、脂肪浅筋膜に沿った壊死を認め、同部の皮膚および皮下組織は切除した。また、両側の三角筋に一部壊死を認め、可及的に切除した。両肩関節も開放し、大量の生理食塩水にて洗浄を行った。血液培養にてStreptococcus pyogenesが検出されており、抗生剤はABPC 12g/day、CLDM 2400mg/dayを投与、またγグロブリンの大量投与も行った。初回デブリードマン後、炎症反応の改善を認め、術後9日目に追加のデブリードマンを施行した。以後、週2回程度の頻度で洗浄・デブリードマンを手術室にて行った。播種性血管内凝固症候群による出血傾向の遷延もあり、入院17日目に右上肢の温存は困難と判断し、右肩関節離断を行った。残存した上腕皮弁を用い肩関節の断端露出部を被覆し、周囲の残存した筋体上には分層網状植皮を行い創閉鎖した。入院50日目に左肩関節固定術および左有茎広背筋皮弁と分層植皮による再建を施行した。術後1年で潰瘍形成を認めず、経過良好である。

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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：(一社)日本頭頸部癌学会  

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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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