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

BACKGROUND: Peputide receptor radionuclide therapy with 177Lu for midgut neuroendocrine metastasis has been clinically approved as a safe treatment. Unresectable metastases of olfactory neuroblastoma have shorter survival due to insufficient effective systemic treatment. CASE REPORT: Herein, we report a patient treated with peputide receptor radionuclide therapy for unresectable recurrent olfactory neusroblastoma following a rare cranial metastasectomy infection. A 50-year-old female patient with olfactory neuroblastoma of Kadish C was initially treated by skull base surgery plus postoperative radiotherapy following chemotherapy. Recurrent disease with neck and intracranial metastases was treated by four salvage surgeries. Surgical site infection following intracranial metastasectomy was treated with debridement and delayed cranioplasty. Peputide receptor radionuclide therapy was performed for unresectable multiple metastases after cranioplasty. Successful therapy using four cycles of peputide receptor radionuclide had neither grade 3 nor grade 4 adverse events. The patient was followed at an outpatient clinic. CONCLUSION: Further case accrual of peputide receptor radionuclide therapy is required to develop a treatment for unresectable olfactory neuroblastoma.

DOI： 10.21873/anticanres.16778

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

Abstract

Reanimating facial structures following paralysis and muscle loss is a surgical objective that would benefit from improved options for harvesting appropriately sized muscle flaps. The objective of this study is to apply electrohydrodynamic processing to generate a cellularized, elastic, biocomposite scaffold that could develop and mature as muscle in a prepared donor site in vivo, and then be transferred as a thin muscle flap with a vascular and neural pedicle. First, an effective extracellular matrix (ECM) gel type is selected for the biocomposite scaffold from three types of ECM combined with poly(ester urethane)urea microfibers and evaluated in rat abdominal wall defects. Next, two types of precursor cells (muscle‐derived and adipose‐derived) are compared in constructs placed in rat hind limb defects for muscle regeneration capacity. Finally, with a construct made from dermal ECM and muscle‐derived stem cells, protoflaps are implanted in one hindlimb for development and then microsurgically transferred as a free flap to the contralateral limb where stimulated muscle function is confirmed. This construct generation and in vivo incubation procedure may allow the generation of small‐scale muscle flaps appropriate for transfer to the face, offering a new strategy for facial reanimation.

DOI： 10.1002/adhm.202301335

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In lateral skull base reconstruction, it is necessary to seal the defect in the lateral skull base, fill the dead space, and, sometimes, reconstruct the facial nerve. However, this procedure is difficult to perform with a standard musculocutaneous flap. Therefore, for such cases, an omental flap is used in our hospital because of its flexibility. In this study, we report our experience with the procedure (lateral skull base reconstruction with a free omental flap) and its long-term outcome and facial nerve reconstruction, with special focus on facial nerve recovery. This study is a technical note and a retrospective review. It was conducted in Nagoya University Hospital. Overall, 16 patients (12 women and 4 men; mean age: 55.1 years) underwent lateral skull base reconstruction with a free omental flap after subtotal temporal bone resection or lateral temporal bone resection during 2005-2017. The main outcome measures were postoperative complications and facial nerve recovery: Yanagihara score and House-Brackmann grading system. Complications included partial necrosis and minor cerebrospinal fluid leakage in 2 patients. Facial nerve recovery could be observed more than 12 months after surgery, with a mean Yanagihara score of 19.6 and House-Brackmann grade of 3.60. The free omental flap is a reliable method for lateral skull base reconstruction, especially in cases where facial nerve reconstruction is needed. To the best of our knowledge, this is the first report on facial nerve recovery after lateral skull base reconstruction.

DOI： 10.18999/nagjms.85.2.255

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OBJECTIVE: Superior thyroid artery (SThA) is a common recipient artery in free tissue transfer even after total pharyngolaryngoesophagectomy (TPLE) with hemithyroidectomy. The aim of this study was to evaluate whether the use of SThA as a recipient vessel affect thyroid function in patients undergoing TPLE with hemithyroidectomy. METHODS: From 2011 to 2020, 91 patients who underwent free jejunum transfer after TPLE with hemithyroidectomy were divided into two groups. In Group1 (n = 47), the contralateral SThA was used for the anastomosis. In Group2 (n = 44), other vessels were used. Retrospective chart review was performed comparing postoperative thyroid function between two groups. RESULTS: In group1, 17 patients presented hypothyroidism, 21 presented latent hypothyroidism and 9 presented no thyroid dysfunction comparing 15, 19, and 10 respectively in group 2. There were no significant differences between the two groups. CONCLUSION: Even after hemithyroidectomy, with inferior thyroid arteries are preserved, the SThA can be used as a recipient vessel. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:557-561, 2023.

DOI： 10.1002/lary.30262

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UNLABELLED: The aim of this study was to evaluate whether the Nerbridge, an artificial polyglycolic acid conduit with collagen matrix, is comparable to direct nerve suture in a rat sciatic nerve injury model in a short-gap interposition (SGI) setting. METHODS: Sixty-six female Lewis rats were randomly divided into the sham group (n = 13); no reconstruction (no-recon) group (n = 13; rat model with 10 mm sciatic nerve defect); direct group (n = 20; rat sciatic nerve injury directly connected by 10-0 Nylon); and SGI group (n = 20; sciatic nerve injury repaired using 5-mm Nerbridge). Motor function and histological recovery were evaluated. The sciatic nerve and gastrocnemius muscle were harvested for quantification of the degree of nerve regeneration and muscle atrophy. RESULTS: The SGI and direct groups achieved equal recovery in both functional and histological outcomes. At weeks 3 and 8 postsurgery, there was a significant improvement in the sciatic functional index of the SGI group when compared with that of the no-recon group (P < 0.05). Furthermore, the direct and SGI groups had less muscle atrophy at 4 and 8 weeks postsurgery compared with the no-recon group (P < 0.05). The axon density and diameter at the distal site in the SGI group were significantly higher than that in the no-recon group and comparable to that in the direct and sham groups. CONCLUSION: An artificial nerve conduit has equal potential as direct suture in motor nerve reconstruction when used in the SGI setting.

DOI： 10.1097/GOX.0000000000004875

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BACKGROUND: The usefulness of closed incision negative pressure wound therapy (ciNPWT) has been well documented in many surgical sites, except for the donor site of the deep inferior epigastric artery perforator (DIEP) flap. The aim of this study was to evaluate the effect of ciNPWT on microsurgical breast reconstruction using a DIEP flap. METHODS: Fifty-six cases of breast reconstruction with DIEP flap were included and divided into two groups based on post-surgical wound management: the ciNPWT group received ciNPWT at the donor site, while the conventional group received conventional wound management. The primary outcomes were the incidence of seroma, wound dehiscence, and surgical site infection, and secondary outcomes were the time to drain removal and amount of drainage. The breast reconstruction risk assessment (BRA) score was used to evaluate the comprehensive risk in each case. RESULTS: Among the patient and surgical characteristics, only the BRA score (P=0.02) and the time to elevate the flap (P=0.02) were significantly higher and longer in the ciNPWT group, respectively. The incidence of seroma, dehiscence, and wound infection showed no significant difference between the two groups. In the subgroup analysis of patients with body mass index ≥ 25, the primary outcomes did not differ, while the secondary outcomes were significantly lower in the ciNPWT group (drainage volume, P = 0.04; time to drain removal, P = 0.04). CONCLUSION: ciNPWT can potentially reduce the incidence of donor site complications of DIEP flaps, especially if the comprehensive risk for post-surgical complications is considered.

DOI： 10.1016/j.jpra.2022.08.002

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BACKGROUND: The treatment of locally advanced colon cancer is challenging, particularly when there is invasion of the abdominal wall. In such cases, balancing the securing of margins and sufficiently repairing abdominal wall defects is important, but difficult when the extent of invasion is large. CASE PRESENTATION: A 34-year-old male was referred to our hospital with abdominal pain and diagnosed with obstructive transverse colon cancer. He had undergone ileo-sigmoid colostomy at his previous hospital. The tumor was massive and invaded the abdominal wall (maximum diameter: approximately 12 cm), and was accompanied by regional lymph node swelling. No distant metastasis was detected. We diagnosed the tumor as cT4bN2bM0 Stage IIIC locally advanced transverse colon cancer and planned neoadjuvant chemotherapy. After two courses of FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan), he developed an entero-cutaneous fistula due to tumor penetration and required emergency diverting ileostomy construction. After the procedure, contrast-enhanced computed tomography showed good tumor shrinkage. As a result, the planned chemotherapy was canceled and he underwent radical resection of the tumor. En bloc extended right hemicolectomy was performed with excision of the fistula, ensuring a sufficient margin. The post-excision defect at the anterior abdominal wall involved 11 × 16 cm of fascia and 6 × 9 cm of skin located in the middle of the abdomen. A free anterolateral thigh flap was harvested from the right thigh and vascular pedicle was anastomosed to the right gastroepiploic artery and vein. The fascia lata, which was included in the anterolateral thigh flap, was sutured onto the abdominal wall fascia as inlay fashion to reconstruct the abdominal wall defect. Histopathology revealed moderately differentiated adenocarcinoma of the colon with no tumor cells in the abdominal wall tissue [post-chemotherapeutic state, therapy effect: Grade 1b; Stage IIA (ypT3N0M0)]. All resected margins of the specimen were free from adenocarcinoma. He was discharged on postoperative day 16. CONCLUSION: We report a case of colon cancer extensively invading the abdominal wall, which was completely resected. The abdominal wall defect was reconstructed with a free anterolateral thigh flap after tumor shrinkage with neoadjuvant chemotherapy. We present an efficient strategy for managing locally advanced colon cancer with extensive abdominal wall invasion.

DOI： 10.1186/s40792-022-01515-5

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BACKGROUND: Hypertrophic scars and keloids tend to cause serious functional and cosmetic impediments to patients. As these scars are not life threatening, many patients do not seek proper treatment. Thus, educating physicians and patients regarding these scars is important. The authors aimed to develop an algorithm for a scar screening system and compare the accuracy of the system with that of physicians. This algorithm was designed to involve health care providers and patients. METHODS: Digital images were obtained from Google Images (Google LLC, Mountain View, Calif.), open access repositories, and patients in the authors' hospital. After preprocessing, 3768 images were uploaded to the Google Cloud AutoML Vision platform and labeled with one of the four diagnoses: immature scars, mature scars, hypertrophic scars, and keloid. A consensus label for each image was compared with the label provided by physicians. RESULTS: For all diagnoses, the average precision (positive predictive value) of the algorithm was 80.7 percent, the average recall (sensitivity) was 71 percent, and the area under the curve was 0.846. The algorithm afforded 77 correct diagnoses with an accuracy of 77 percent. Conversely, the average physician accuracy was 68.7 percent. The Cohen kappa coefficient of the algorithm was 0.69, while that of the physicians was 0.59. CONCLUSIONS: The authors developed a computer vision algorithm that can diagnose four scar types using automated machine learning. Future iterations of this algorithm, with more comprehensive accuracy, can be embedded in telehealth and digital imaging platforms used by patients and primary doctors. The scar screening system with machine learning may be a valuable support tool for physicians and patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

DOI： 10.1097/PRS.0000000000009312

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Superior vena cava (SVC) syndrome refers to a constellation of symptoms secondary to obstruction of blood flow through the SVC. In this condition, venous blood that usually drains into the SVC is diverted into the inferior vena cava (IVC) via collateral veins. Reconstructive surgery is challenging in such cases owing to the anomalous venous system. In this case report, we describe reconstructive surgery using a pedicled omental flap in a patient with upper thoracic empyema and concomitant SVC syndrome. A 68-year-old man underwent resection of malignant thymoma, the bilateral brachiocephalic veins, and a part of the right upper lobe, followed by polytetrafluoroethylene (PTFE) graft placement for venous system reconstruction, 2 years prior to presentation. He developed postoperative upper thoracic cavity empyema, which necessitated PTFE graft removal. Although the infection was controlled after 2 months, multiple right upper lobe pulmonary fistulas persisted, and the patient was referred to our department for further evaluation. Contrast-enhanced computed tomography revealed SVC syndrome characterized by SVC obstruction and consequent drainage of venous blood from the upper trunk into the IVC via collateral vessels. We debrided necrotic and infected tissues, and a pedicled omental flap was placed for upper lobe fistula coverage. The patient showed an uncomplicated postoperative course, and no recurrent empyema or pulmonary fistulas were observed 3 years postoperatively. Flaps associated with the SVC system show high venous pressures. The use of a pedicled omental flap was deemed feasible because this graft reaches the upper thorax even though it is associated with the IVC system.

DOI： 10.18999/nagjms.84.3.648

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Objective  Craniofacial resection (CFR) and temporal bone resection (TBR) on malignant head and neck tumors (MHNTs) invading skull base require accurate and precise determination of the tumor invasion. We investigated tumor skull base invasion patterns and surgical results in CFR and TBR cases. Methods  We performed either CFR or TBR for 75 selected patients with the possibility of en bloc resection over the period between 2011 and 2018. The medical charts of the selected patients were reviewed. Results  Primary tumor onset site (TOS) groups were: (1) nasal cavity/ethmoid sinus, 20 cases; (2) orbit, 10 cases; (3) maxillary sinus, 28 cases; and (4) external ear/temporomandibular joint, 17 cases. Grades for tumor invasion depth (TID) included: (I) extracranial invasion and skull base bone invasion; (II) extradural invasion; or (III) intradural invasion. Patients in groups 1 and 2 had a significantly higher frequency of grade II and III invasions than patients in groups 3 and 4. The main invasion site was nasal cavity superior wall and ethmoid sinus superior wall for group 1 tumors, orbit superior wall, and lateral skull base sphenoid bone for group 2 and 3 tumors, and lateral skull base temporal bone for group 4 tumors. Positive resection margins represented a significant negative prognostic factor. TID and TOS did not affect skull base margin status. Conclusion  Skull base invasion of MHNTs exhibits certain fixed patterns in sites susceptible to invasion based on the TOS. The frequencies of extradural and intradural invasions differed, indicating the importance for accurate preoperative tumor evaluation.

DOI： 10.1055/s-0039-3402034

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OBJECTIVE: To review the authors' surgical experience with radical temporal bone resection (TBR) with an emphasis on the classification of skull base osteotomy and transcranial tympanotomy (TCT) that is required for middle ear transection. METHODS: We reviewed the records of 25 patients who underwent radical TBR at our facilities between 2011 and 2020. RESULTS: The osteotomy line of radical TBR was divided into 3 segments: anterior (A), medial (M), and posterior (P). Each segment was further classified as follows: A1, through the glenoid fossa (1 patient); A2, in front of the glenoid fossa (23 patients); A3, through the greater wing of the sphenoid bone (1 patient); M1, through the middle ear (16 patients); M2, through the inner ear (9 patients); P1, through the mastoid (9 patients); and P2, through the posterior cranial fossa (16 patients). The M segment was significantly associated with operation time and intraoperative blood loss. In all patients with M1 osteotomy, TCT was performed; TCT was classified into superior and far posterior approaches. A superior approach was performed in all 16 patients, whereas the far posterior approach was performed in only 7 patients with both M1 and P2 osteotomy. CONCLUSIONS: Our newly proposed osteotomy classification of radical TBR is suitable for minute but clinically important adjustment of the osteotomy line. TCT is an indispensable technique for M1 osteotomy; our newly proposed classification expands our understanding of TCT and how to incorporate this technique into radical TBR.

DOI： 10.1016/j.wneu.2021.04.002

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DOI： 10.1016/j.ijom.2020.07.025

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OBJECTIVE: To assess the characteristics of adipose-derived regenerative cells, and provide supportive data explaining the mechanism of efficacy observed for the use of these cells in the treatment of stress urinary incontinence. METHODS: Adipose tissues were harvested by abdominal liposuction from healthy donors and patients with stress urinary incontinence. Adipose-derived regenerative cells were isolated from tissues using the Celution system, and assessed for their characteristics and ability to differentiate into smooth muscle cells. RESULTS: Adipose-derived regenerative cells isolated by the Celution system developed into fibroblastic colonies. Flow cytometric analysis of adipose-derived stem cell markers showed that adipose-derived regenerative cells were positive for CD34 and CD44, and negative for CD31. Immunofluorescence staining after differentiation showed that colony-forming cells were positive for alpha-smooth muscle actin, calponin and desmin, which are smooth muscle cell markers. A cytokine release assay showed that adherent cells secreted cytokines associated with angiogenesis, including vascular endothelial growth factor-A, angiopoietin-2 and placental growth factor. CONCLUSIONS: Adipose-derived regenerative cells collected by the Celution system might have clonogenic capacity and an angiogenetic function. These properties might contribute to the mechanisms through which regenerative cell therapy by periurethral injection of autologous adipose-derived regenerative cells ameliorates stress urinary incontinence.

DOI： 10.1111/iju.14408

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Lippincott Williams and Wilkins  

DOI： 10.1097/GOX.0000000000003525

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Objective  This study was aimed to evaluate health-related quality of life in patients undergoing anterolateral craniofacial resection (AL-CFR) with orbital exenteration (OE) for malignant skull base tumors and to investigate the effects of early psychiatric intervention. Design  Present study is a prospective, observational study. Setting  The study took place at the hospital department. Participants  Twenty-six consecutive patients were selected who underwent AL-CFR with OE at our hospital between 2005 and 2015. Main Outcome Measures  Health-related quality of life was assessed preoperatively and 3, 6, 12, and 24 months after surgery using the Hospital Anxiety and Depression Scale (HADS) and medical outcomes study 8-items Short Form health survey (SF-8). In all cases, psychiatric intervention was organized by the consultation liaison psychiatry team preoperatively and postoperatively. Results  Ten (38.0%) of the 26 patients died and 16 (62.0%) were alive and disease-free at the end of the study. The 3-year overall and disease-free survival rates were 64.9% and 53.3%, respectively. Twenty-one patients (80.8%) developed psychiatric complications after surgery and needed treatment with psychotropic medication. Before surgery, 28% of patients had HADS scores ≥8 for anxiety and 20% had scores ≥8 for depression. Seven of the eight items in the SF-8 were significantly lower than those for the general Japanese population. However, scores for all the SF-8 items gradually improved during postoperative follow-up, reaching approximately 50 points, which is the national standard value, at 2 years after surgery. Conclusions  Craniofacial resection with OE was feasible and well tolerated in patients with malignant skull base tumors who received early psychiatric intervention to decrease the considerable psychological impact of this procedure.

DOI： 10.1055/s-0039-1694010

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Adipose-derived regenerative cell (ADRC) is a promising alternative source of autologous somatic stem cells for the repair of damaged tissue. This study aimed to assess the safety and feasibility of autologous ADRC implantation for therapeutic angiogenesis in patients with critical limb ischaemia (CLI). A clinical pilot study-Therapeutic Angiogenesis by Cell Transplantation using ADRCs (TACT-ADRC) study-was initiated in Japan. Adipose tissue was obtained by ordinary liposuction method. Isolated ADRCs were injected into the ischaemic limb. We performed TACT-ADRC procedure in five patients with CLI. At 6 months, no adverse events related to the TACT-ADRC were observed. No patients required major limb amputation, and ischaemic ulcers were partly or completely healed during the 6-month follow-up. In all cases, significant clinical improvements were seen in terms of rest pain and 6-min walking distance. Numbers of circulating CD34+ and CD133+ cells markers of progenitor cell persistently increased after ADRC implantation. The ratio of VEGF-A165b (an anti-angiogenic isoform of VEGF) to total VEGF-A in plasma significantly decreased after ADRC implantation. In vitro experiments, cultured with ADRC-conditioned media (CM) resulted in increased total VEGF-A and decreased VEGF-A165b in C2C12 cells, but not in macrophages. ADRC-CM also increased CD206+ cells expression and decreased TNF-α in macrophages. Autologous ADRC implantation was safe and effective in patients with CLI and could repair damaged tissue via its ability to promote angiogenesis and suppress tissue inflammation.

DOI： 10.1038/s41598-020-73096-y

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DOI： 10.1016/j.bjps.2020.08.060

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press  

DOI： 10.1093/jjco/hyaa039

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The purpose of this study was to assess the correlation between tissue volume and blood flow of the flap in an animal model. Using animal model, tissue volume can be attenuated, and precise change of blood flow could be evaluated. We further investigate the relationship between blood flow and vascular density in the tissue. In this study, we assessed flap conductance (ml/min/mm Hg) as to evaluate the conductivity of blood flow into the flap. Japanese white rabbit was used (n = 7) for this study. The amount of blood flow of jejunal and latissimus dorsi muscle (LD) flaps was measured while removing the distal portion of the flap sequentially. Conductance at each time was calculated from blood pressure and blood flow volume. The tissue volume at each time was also measured. The correlation between conductance and volume was analyzed using a linear mixed model. Immunohistochemical evaluation of microvessel densities (MVD) in these tissues was also performed for CD31/PECAM1 positive area. Conductance and tissue volume were significantly correlated in both jejunal and LD flaps. As the volume increases by 1 cm3, the conductance increased significantly by 0.012 ml/min/mm Hg in jejunum, and by 0.0047 ml/min/mm Hg in LD. Mean MVD was 1.15 ± 0.52% in the jejunum and 0.37 ± 0.29% in the LD muscle. In this study, we revealed that flap conductance is proportional to volume and proportional constant is different between the type of tissue. It suggests that the difference of MVD creates the unique conductance of each tissue.

DOI： 10.18999/nagjms.82.2.291

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[This corrects the article DOI: 10.1055/s-0038-1676777.].

DOI： 10.1055/s-0039-1692394

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nagoya University  

DOI： 10.18999/nagjms.82.1.123

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Lippincott Williams and Wilkins  

DOI： 10.1097/GOX.0000000000002872

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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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BACKGROUND: The aim of this study was to demonstrate the feasibility and safety of the Nuss procedure for patients with pectus excavatum (PE) with a history of intrathoracic surgery. PATIENTS: From April 2010 to December 2013, we performed 6 cases of PE repair in patients with a history of intrathoracic surgery. The causes of previous operations were congenital cystic adenomatoid malformation in 4 patients and congenital diaphragmatic hernia in 2. The patients' median age was 5 years (range, 4-9 years) and median preoperative pectus severity index was 4.63 (range, 3.42-10.03). Their intraoperative and postoperative courses were reviewed retrospectively. RESULTS: The mean overall operation time was 127.5 ± 17.0 minutes, and the mean operation time for endoscopic pneumolysis was 28.8 ± 12.3 minutes. Intraoperative exploration for pleural adhesion revealed that the endoscopic approach in the previous operation was associated with low pleural adhesion, and the open thoracotomy or laparotomy approach was associated with low to high pleural adhesion. One patient developed a pneumothorax on the first postoperative day. All the other patients had uneventful postoperative courses. All the patients received bar removal 2-3 years after bar insertion. One patient developed atelectasis after bar removal. All the other patients had an uneventful postoperative course. The mean postoperative follow-up time after bar removal was 20.1 ± 14.7 months. CONCLUSIONS: History of intrathoracic surgery seems not a contraindication for the Nuss procedure. However, perioperative complications should be carefully monitored in both the bar insertion and removal operations.

DOI： 10.1016/j.bjps.2018.12.027

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

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Objectives: Liposuction is now applied to harvest autologous adipose-derived regenerative cells in the regenerative medicine. Although liposuction is highly safe for females who generally have larger fat deposits, liposuction has some potential risks for donor-site complications in the case of aged male patients. The purpose of our study was to review the complications of liposuction of the aged male patients who have undergone cell therapy for stress urinary incontinence. Methods: Sixteen male patients (mean age, 74 years old) with persistent stress urinary incontinence were included in this study. Approximately 250 mL of adipose tissue was harvested using a syringe attached to the cannula. Postoperative complications were recorded and graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Results: Average liposuction time was 57.4 min. No major complications were observed. However, there were some minor complications: bruising, numbness, contour irregularities, firmness, and scarring. These complications were CTCAE Grade 1 in all cases. The complications, except for the scarring, became unnoticeable within 6 months in all cases. Conclusion: Liposuction takes time and has some minor donor-site complications for stem cell therapy in aged male stress urinary incontinence patients.

DOI： 10.1016/j.jpra.2019.01.003

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OBJECTIVEAlthough sphenoidotomy is more commonly performed via the transnasal approach than via the transcranial approach, transcranial sphenoidotomy (TCS) remains indispensable for en bloc resection of locally advanced sinonasal malignant tumors (SNMTs) extending to the skull base. TCS also enables transsphenoidal transposition of the temporoparietal galeal flap (TPGF) to compensate for the lack of vascularized reconstructive tissue after endoscopic transnasal skull base surgery. The objective of this study was to review the authors' surgical experience using TCS with an emphasis on the surgical anatomy of the sphenoid sinus and on the purpose of TCS. Relevant anatomy is further illustrated through cadaveric dissection and photo documentation.METHODSThe authors reviewed the records of 50 patients who underwent TCS at the Nagoya University Hospital, Fukushima Medical University Hospital, or Aichi Medical University Hospital over the course of 7 years (between January 2011 and November 2017). The authors also performed cadaveric dissection in 2 adult cadaveric skull base specimens.RESULTSOf the 50 patients included in this study, 44 underwent craniofacial resection (CFR) for en bloc resection of SNMTs involving the anterior and/or lateral skull base, and 6 underwent transsphenoidal transposition of the TPGF flap. The authors categorized the TCS procedures according to the portion of the sphenoid sinus wall involved (i.e., superior, lateral, and superolateral). Superior sphenoidotomy was used in patients requiring anterior CFR. Lateral sphenoidotomy was further divided into 2 subtypes, with type 1 procedures performed for the transsphenoidal transpositioning of the TPGF, and type 2 procedures used in patients requiring lateral CFR. Superolateral sphenoidotomy was used in anterolateral CFR.CONCLUSIONSTCS still represents a useful tool in the armamentarium of neurosurgeons treating central skull base lesions. The newly proposed surgical classification facilitates a profound understanding of TCS and how to incorporate this technique into clinical practice.

DOI： 10.3171/2018.6.JNS181013

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

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Some patients undergo postoperative chemotherapy despite showing impaired wound healing after a major surgery. We speculated that postoperative chemotherapy further delays wound healing in these patients. This study aimed to compare the effects of doxorubicin (DXR) in ischemic skin flap and normal incisional wound models after surgery. A 2-cm incisional wound was made in group 1 rats, and saline was injected intravenously, following surgery on the same day. Incisional wound was made in group 2-5 rats, and 8 mg/kg DXR was injected intravenously, following surgery on the same day and after 7, 14, and 21 days respectively. H-shaped double flaps were made in group 6 rats, and saline was injected intravenously, following surgery on the same day. Flaps were made in group 7-10 rats, and 8 mg/kg DXR was injected intravenously, following surgery on the same day and after 7, 14, and 21 days respectively. On days 7, 14, 21, and 28 after surgery, the suture wounds were removed, tensile wound strengths were measured, and tissue samples were collected for histopathological evaluation. The tensile strength was significantly lower in the DXR-treated groups than in the control groups for both ischemic skin flaps and incision wounds. Additionally, the cross effect between DXR and ischemia was not significant. On pathological examination, DXR showed atrophic skin changes and degeneration of skin appendages on days 14-21 after the surgery in both the models. DXR decreased the wound tensile strength and caused an atrophic change in the ischemic wound.

DOI： 10.18999/nagjms.80.3.357

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DOI： 10.18999/nagjms.80.3.357

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Churchill Livingstone  

DOI： 10.1016/j.bjps.2017.11.021

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Objective: To perform a quantitative computed tomography (CT) assessment of short- and long-term outcomes of autologous fat injection augmentation in patients with unilateral vocal fold paralysis. Study Design: Retrospective case series. Methods: Twelve patients who had undergone autologous fat injection augmentation for unilateral vocal fold paralysis in our hospital between 2011 and 2015 were enrolled in this study. The autologous fat for injection was acquired from periumbilical subcutaneous tissue and was injected orally using a special-purpose laryngeal injection needle. To evaluate the injected fat at the follow-up assessments, CT was performed at several times after surgery in clinical practice. All thin-section CT images were transferred to a workstation, and the volume of the injected fat was calculated. Results: Patients comprised 6 men and 6 women with a mean age at the time of surgery of 62.9 years (range, 46-82 years). The actual injected fat volume was 1.1-2.5 ml (mean, 1.6 ml). In seven patients assessed by CT two days after surgery, the average residual rate of the injected fat was 63.9%. The mean residual rates of the injected fat were 30.0% at 3 months, 33.7% at 6 months, 29.2% at 12 months, and 32.0% at 24 months. Conclusions: Although the injected fat volume decreased within the first three months and the residual rate of the injected fat was 30.0% at three months after injection, the residual fat volume remained at the same level for 24 months after injection. Level of Evidence: 4.

DOI： 10.1002/lio2.125

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DOI： 10.1186/s12894-017-0282-7

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DOI： 10.1016/j.jss.2016.11.052

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DOI： 10.1002/hed.24653

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DOI： 10.1016/j.biomaterials.2016.10.029

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DOI： 10.1055/s-0036-1588004

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DOI： 10.1017/S0022215116008707

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DOI： 10.1002/term.1834

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Language：Japanese   Publisher：Japanese Society of Reconstructive Microsurgery  

In gastric tube reconstruction for esophagectomy, the blood flow to the gastric tube is mainly supplied by the gastroduodenal artery ( GDA ) via the right gastroepiploic artery ( RGEA ) . Ablation of RGEA in pylorus-preserving pancreaticoduodenectomy ( PPPD ) for pancreatic head cancer may cause ischemia of the gastric tube. The middle colic artery ( MCA ), splenic artery and jejunal artery are potential choices of donor vessel to reconstruct RGEA. We report a case of microsurgical reconstruction of RGEA with MCA, which was ligated during the operation for preservation of the gastric tube. The postoperative course was uneventful and the flow of RGEA was confirmed by CT angiography on the eighth postoperative day. It seemed reasonable to use MCA for the reconstruction of RGEA in that the positions of donor and recipient vessels are close and the sacrifice of blood flow to other organs is limited.

DOI： 10.11270/jjsrm.29.47

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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：日本レックリングハウゼン病学会  

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DOI： 10.1016/j.jpra.2015.05.003

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DOI： 10.1016/j.ijsu.2015.03.022

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DOI： 10.1097/SAP.0b013e318268a8b1

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

Tissue expansion allows highly esthetic reconstruction by the use of expanded adjacent tissue to reconstruct a defect after excision of tumors and scar. We retrospectively reviewed data on 49 expanded flap reconstructions performed in 39 patients during the period 2006 - 2013. <BR> Location, disease, reconstruction methods, and complications were collected. A total of 39 patients ( mean age of 32 years ) underwent reconstruction by insertion of a tissue expander in the trunk ( n = 15 ), the head and neck ( n = 7 ), and the back ( n = 4 ). The indications for tissue expansion were breast reconstruction ( n = 14 ), scar ( n = 12 ), and giant nevi ( n = 7 ). Complications included extrusion in 5 patients infection in 2, poor fixation of the port in 2, and impairment of the port in 1. Our modifications were: healthy skin incision, pocket dissections larger than the expander size, slow expansion to avoid exposure, another incision in the nevi, and reliable fixation of the port to avoid its migration.

DOI： 10.11310/jsswc.5.166

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DOI： 10.1016/j.biomaterials.2013.06.020

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The evaluation of candidate materials and designs for soft tissue scaffolds would benefit from the ability to monitor the mechanical remodeling of the implant site without the need for periodic animal sacrifice and explant analysis. Toward this end, the ability of non-invasive ultrasound elasticity imaging (UEI) to assess temporal mechanical property changes in three different types of porous, biodegradable polyurethane scaffolds was evaluated in a rat abdominal wall repair model. The polymers utilized were salt-leached scaffolds of poly(carbonate urethane) urea, poly(ester urethane) urea and poly(ether ester urethane) urea at 85% porosity. A total of 60 scaffolds (20 each type) were implanted in a full thickness muscle wall replacement in the abdomens of 30 rats. The constructs were ultrasonically scanned every 2 weeks and harvested at weeks 4, 8 and 12 for compression testing or histological analysis. UEI demonstrated different temporal stiffness trends among the different scaffold types, while the stiffness of the surrounding native tissue remained unchanged. The changes in average normalized strains developed in the constructs from UEI compared well with the changes of mean compliance from compression tests and histology. The average normalized strains and the compliance for the same sample exhibited a strong linear relationship. The ability of UEI to identify herniation and to characterize the distribution of local tissue in-growth with high resolution was also investigated. In summary, the reported data indicate that UEI may allow tissue engineers to sequentially evaluate the progress of tissue construct mechanical behavior in vivo and in some cases may reduce the need for interim time point animal sacrifice.

DOI： 10.1016/j.biomaterials.2013.01.036

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Language：Japanese   Publisher：Japanese Society of Reconstructive Microsurgery  

From an esthetic perspective, we need to choose color-matched and texture-matched flaps for reconstruction of exposed parts. We reviewed flap surgical procedures and evaluated the final appearance in free flap reconstruction of exposed parts over the last decade.<BR>Sixty patients with lesions of exposed parts underwent free flap reconstructions between 2002 and 2011. There were 32 males and 28 females. The average age was 40 years. The lesions were located in fifteen head and neck parts, eleven lower thigh parts, and nine foot parts, among others. Thirty patients received free latissimus dorsi flaps, ten free fibula flaps, and nine free anterolateral thigh flaps, among others. Average follow-up period was 50 months. Final appearances were scored out of four in terms of meshed skin graft, unevenness, and color match, and finally classified into four grades: excellent, good, fair, and poor.<BR>The survival rate of free flaps was 93.5%. Twenty-four patients required additional surgical procedures, such as defatting and scar revision. Esthetic results were excellent in eight, good in sixteen, fair in twelve, and poor in five.<BR>The final appearance was quite good, as the percentage of excellent and good results was approximately 60%. However, we need to continue to improve the esthetic results.

DOI： 10.11270/jjsrm.26.134

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DOI： 10.1002/term.1834.

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DOI： 10.1016/j.cardfail.2012.05.006

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DOI： 10.1089/ten.tec.2011.0295

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DOI： 10.1097/SAP.0b013e31820456fe

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DOI： 10.1016/j.biomaterials.2011.01.025

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In surgical treatment of tumors, including facial nerve resection, it is necessary not only to reconstruct the facial nerve but to fill the complex defect. We report here a new surgical procedure using nerve grafts and free omental flap for facial nerve reconstruction. Between January 2004 and December 2008, we performed facial nerve reconstruction using nerve grafts and free flap transfer in 8 cases (3 were male and 5 were female, with an average age of 39.3years). We evaluated the results using Yanagihara's 40-point grading system. All free omental flaps were successfully transferred. Post operative facial nerves were 29.0. The omental flap has a long pedicle and flexibility. These properties of the omental flap make it useful for filling the complex defect and covering the reconstructed facial nerve. We consider that nerve grafts with a free omental flap transfer are useful for reconstruction of the facial nerves.

DOI： 10.11270/jjsrm.24.383

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Language：Japanese   Publisher：(一社)日本創傷外科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J05739&link_issn=&doc_id=20110331350006&doc_link_id=10.11310%2Fjsswc.1.88&url=https%3A%2F%2Fdoi.org%2F10.11310%2Fjsswc.1.88&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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DOI： 10.1016/j.athoracsur.2009.02.094

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

Recently omental flaps have widely been used in clinical practice. A few experimental studies, however, have examined the effect of omental flaps in wound healing. We examined its effect using a gastric wall defect model. We created an omental flap lining a 2.0-mm defect perforating a rat stomach and created a silicon sheet lining as a control. We examined the tissue response during gastric wall regeneration on postoperative days. Immunohistochemical study was also performed using proliferating cell nuclear antigen (PCNA) and fibroblast growth factor-2 (FGF-2). In the omental group, granulation tissue proliferated by day 3 and stratified villi completely covered the defect by day 7. In the control group, little granulation tissue was observed and the defect had not yet been covered by day 10. In the control group, some PCNA- and FGF-2-positive cells were observed on the edges of the epithelium. In the omental group, many PCNA- and FGF-2-positive cells were observed in the granulation tissue near wound edges and in the center of the omental granulation as well as the edges of the epithelium.<BR> This study confirmed that the omental flap accelerated gastric wall wound healing by cell proliferation.

DOI： 10.11310/jsswc.1.88

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DOI： 10.1055/s-0028-1090607

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Other Link： http://search.jamas.or.jp/link/ui/2008165238

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本整形外科学会  

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Other Link： https://search.jamas.or.jp/link/ui/2020110557

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

DOI： 10.18999/nagjms.80.3.357

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：Churchill Livingstone  

DOI： 10.1016/j.bjps.2017.11.021

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Objective: To perform a quantitative computed tomography (CT) assessment of short- and long-term outcomes of autologous fat injection augmentation in patients with unilateral vocal fold paralysis. Study Design: Retrospective case series. Methods: Twelve patients who had undergone autologous fat injection augmentation for unilateral vocal fold paralysis in our hospital between 2011 and 2015 were enrolled in this study. The autologous fat for injection was acquired from periumbilical subcutaneous tissue and was injected orally using a special-purpose laryngeal injection needle. To evaluate the injected fat at the follow-up assessments, CT was performed at several times after surgery in clinical practice. All thin-section CT images were transferred to a workstation, and the volume of the injected fat was calculated. Results: Patients comprised 6 men and 6 women with a mean age at the time of surgery of 62.9 years (range, 46-82 years). The actual injected fat volume was 1.1-2.5 ml (mean, 1.6 ml). In seven patients assessed by CT two days after surgery, the average residual rate of the injected fat was 63.9%. The mean residual rates of the injected fat were 30.0% at 3 months, 33.7% at 6 months, 29.2% at 12 months, and 32.0% at 24 months. Conclusions: Although the injected fat volume decreased within the first three months and the residual rate of the injected fat was 30.0% at three months after injection, the residual fat volume remained at the same level for 24 months after injection. Level of Evidence: 4.

DOI： 10.1002/lio2.125

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Language：Japanese   Publisher：日本シミュレーション外科学会  

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DOI： 10.1186/s12894-017-0282-7

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DOI： 10.1016/j.jss.2016.11.052

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Language：Japanese   Publisher：(NPO)日本皮膚外科学会  

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DOI： 10.1002/hed.24653

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DOI： 10.1016/j.biomaterials.2016.10.029

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DOI： 10.1055/s-0036-1588004

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BACKGROUND: Although we have seen tremendous advancement in microsurgery over the last 2 decades and free tissue transfer has become standard for head and neck reconstruction, surgeons still struggle to prevent postoperative complications. We examined the relationship between body mass index (BMI) and postoperative complications in patients undergoing rectus abdominis free flap transfer after anterolateral craniofacial resection. METHODS: This was a retrospective review of reconstructive surgery using rectus abdominis musculocutaneous free flap in patients with locally advanced maxillary sinus carcinoma from 2003 to 2014 (n = 35, 27 men and 8 women; average age, 60.9 ± 7.8 years). All patients underwent craniofacial reconstruction after anterior and middle cranial fossa skull base resection and maxillectomy (class IV, subtype a) with palatal resection. Patients were categorized based on sex, BMI, and other parameters. RESULTS: Recipient-site infection occurred in 11 patients (31.4%), cerebrospinal fluid leakage in 6 (17.1%), partial flap necrosis in 2 (5.7%), total flap necrosis in 1 (2.9%), and facial fistula in 4 (11.4%). Women showed partial flap necrosis significantly more frequently (P = 0.047), probably owing to poor vascular supply of the subcutaneous fat layer. Patients with low BMI (<20 kg/m(2)) showed recipient-site infection (P = 0.02) and facial fistula (P = 0.01) significantly more frequently owing to insufficient tissue volume and poor vascular supply. CONCLUSION: Postoperative recipient-site infection and facial fistula occurred mainly in low-BMI patients. Surgeons should take care to achieve sufficient donor tissue on low-BMI patients. Using a prosthetic obturator in low-BMI patients for craniofacial reconstruction can be a good alternative option to reduce postoperative complications due to insufficient donor tissue volume.

DOI： 10.1097/GOX.0000000000000645

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Language：Japanese   Publisher：克誠堂出版  

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Other Link： https://search.jamas.or.jp/link/ui/2016090012

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OBJECT: Intracranial revascularization surgeries are an effective treatment for moyamoya disease and other intracranial vascular obliterative diseases. However, in some cases, wound-related complications develop after surgery. Although the incidence of wound complication is supposed to be higher than that with a usual craniotomy, this complication has rarely been the focus of studies in the literature that report the outcomes of revascularization surgeries. Here, the relationship between intracranial revascularization surgeries and their complications is statistically assessed. METHODS: Between October 2004 and February 2010, 71 patients were treated using cerebral revascularization surgeries on 98 sides of the head. The relationship between wound complications and operative technique was retrospectively assessed. Multivariate logistic regression analysis was performed to identify the risk factors of wound complication, including operative technique, age, sex, diabetes mellitus (DM), hypertension, hyperlipidemia, and smoking history. RESULTS: In total, there were 21 (21.4%) operative wound complications. Of these 21 complications, there were 14 (66.7%) minor complications and 7 (33.3%) major complications. No statistically significant relationship was found between wound complications and any surgical procedure. A trend toward severer complications was demonstrated for the procedures that used both STA branches ("double" procedures) in comparison with the procedures that used only 1 STA branch ("single" procedures, p=0.016, Cochran-Armitage trend test). Multivariate logistic regression analysis also revealed that double procedures demonstrated a significantly higher incidence of wound complications than single procedures (OR 3.087, p=0.048). DM was found to be a risk factor for wound complication (OR 9.42, p=0.02), but age, sex, hypertension, and hyperlipidemia were not associated with the incidence of complications. Even though the blood supply to the scalp is abundant due to 5 arteriovenous systems, sometimes cutaneous necrosis develops after intracranial revascularization surgeries. The galeal blood supply is thought to be crucial for preventing wound-related complications. Special care is also thought to be required for DM patients. CONCLUSIONS: Revascularization surgeries seemed to demonstrate a higher risk of wound-related complications. Double-type procedures, which use both branches of the STA, and a history of DM were found to be risk factors for wound-related complications. Attention should be paid to the design of the galeal incision and vessel harvest line. Also, special attention should be paid to patients with DM.

DOI： 10.3171/2014.12.JNS132602

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

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Other Link： https://search.jamas.or.jp/link/ui/2015002983

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BACKGROUND: Impaired wound healing as one of the complications arising from diabetes mellitus is a serious clinical issue. Recently, various cell therapies have been reported for promotion of wound healing. Skin-derived precursor cells (SKPs) are multipotent adult stem cells with the tendency to differentiate into neurons. We investigated the potency of promoting diabetic wound healing by the application of SKPs. METHODS: Skin-derived precursor cells isolated from diabetic murine skin were cultured in sphere formation medium. At passage 2, they were suspended in phosphate-buffered saline (PBS), and applied topically to full-thickness excisional cutaneous wounds in diabetic mice. Application of PBS served as controls (n = 21 for each group; n = 42 total). Time to closure and percentage closure were calculated by morphometry. Wounds were harvested at 10 and 28 days and then processed, sectioned, and stained (CD31, α-smooth muscle actin, and neurofilament heavy chain) to quantify vascularity and neurofilaments. RESULTS: Wounds treated with SKPs demonstrated a significantly decreased time to closure (18.63 days) compared with PBS-control wounds (21.72 days, P < 0.01), and a significant improvement in percentage closure at 7, 10, 14, and 18 days compared with PBS-control wounds (P < 0.01). Histological analysis showed that the Capillary Score (the number of vessels/mm2) was significantly higher in SKP-treated wounds at day 10 but not at day 28. Nerve Density (the number of neurofilaments/mm2) had increased significantly in SKP-treated wounds at day 28 compared with control group. Some applied SKPs were stained by neurofilament heavy chain, which demonstrates that SKPs directly differentiated into neurons. CONCLUSIONS: Skin-derived precursor cells promoted diabetic wound healings through vasculogenesis at the early stage of wound healing. Skin-derived precursor cells are a possible therapeutic tool for diabetic impaired wound healing.

DOI： 10.1097/SAP.0000000000000342

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DOI： 10.1002/term.1834.

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DOI： 10.1016/j.athoracsur.2009.02.094

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DOI： 10.1055/s-0028-1090607

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Free flaps are used increasingly in reconstructive surgery. However, many patients lack a satisfactory recipient vessel near the defect, because of radiotherapy, posttraumatic infection, or treatment for recurrent tumor. We usually use a venous graft in such cases, but when both long arterial and venous segments are needed, we use the gastroepiploic vessels because they include extensive, viable arterial and venous segments. Between 1998 and 2006 we used gastroepiploic vessels as grafts in the 13 cases analyzed here. All defects lacked satisfactory recipient vessels nearby. Patients included 10 men and 3 women; mean age was 51.2 years (range, 14 to 82). Demographic and clinical backgrand, results, and complications were analyzed retrospectively. Mean length of gastroepiploic vessels was 13.3 cm (range, 10 to 17). All outcomes were satisfactory. A complication, abdominal wound infection secondary to harvesting of the gastroepiploic vessels, occurred in 1 case. Although the number of gastroepiploic vessels used as grafts analyzed here is relatively small, this experience confirms their clinical utility.

DOI： 10.1055/s-0028-1088234

PubMed

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Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

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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  

researchmap

Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

Hepatic artery reconstruction is the most difficult and most important procedure in liver transplantation and locally advanced hilar cholangiocarcinoma. In this paper, we describe our microsurgical technique for hepatic artery anastomosis.<br />
Between 1999 and 2006, we performed 102 hepatic artery reconstruction at our hospital. The indication for hepatic artery reconstruction was liver transplantation, n=89; locally advanced hilar cholangioma, n=12; and pancreatic cancer, n=1. The average age was 52.5 years, (range, 6 months to 79 years ).Twenty-three cases were children. All patients underwent Doppler ultrasound for evaluation. There was no thrombosis in any patient.<br />
In cases in which the diameter of the recipient artery differs from that of the donor hepatic artery, we use a fish-mouth incision and funnelization technique. When the given artery is short, we use a back wall technique without turning the vessel over. Appropriate setting of reconstructed artery produces fine results.<br />
Reconstruction of hepatic artery is very difficult because these arteries are short and small, and because the surgical field is deep and mobile. Therefore, thrombosis of the reconstructed hepatic artery

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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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