Faculty Profiles - NAMBA Yuzaburo

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Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions

Koshima, I, Y Nanba, T Tsutsui, Y Takahashi, A Watanabe, R Ishii

ANNALS OF PLASTIC SURGERY 51 ( 2 ) 194 - 199 2003.8

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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New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities

Koshima, I, Y Nanba, T Tsutsui, Y Takahashi

ANNALS OF PLASTIC SURGERY 51 ( 1 ) 30 - 36 2003.7

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

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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Vascularized femoral nerve graft with anterolateral thigh true perforator flap for massive defects after cancer ablation in the upper arm

Koshima, I, Y Nanba, T Tsutsui, Y Takahashi, A Kawai

JOURNAL OF RECONSTRUCTIVE MICROSURGERY 19 ( 5 ) 299 - 302 2003.7

Language：English Publisher：THIEME MEDICAL PUBL INC

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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Medial plantar perforator flaps with supermicrosurgery

Koshima, I, Y Nanba, T Tsutsui, Y Takahashi

CLINICS IN PLASTIC SURGERY 30 ( 3 ) 447 - + 2003.7

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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小児マイクロサージャリー患者91例の検討

難波祐三郎, 高橋義雄, 伊藤聖子, 筒井哲也, 月野暁彦, 大西文夫, 寺戸通久, 松本洋, 光嶋勲

日本マイクロサージャリー学会会誌 16 ( 2 ) 98 - 98 2003.6

当科における陰茎再建術特に虫垂を用いた尿道再建について

筒井哲也, 難波祐三郎, 伊藤聖子, 松本洋, 月野暁彦, 寺戸通久, 大西文夫, 光嶋勲

日本マイクロサージャリー学会会誌 16 ( 2 ) 124 - 124 2003.6

頭頸部再建外科における穿通枝皮弁の応用

光嶋勲, 藤津美佐子, 筒井哲也, 高橋義雄, 難波裕三郎

頭頚部腫瘍 29 ( 2 ) 258 - 258 2003.5

Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg

Koshima, I, Y Nanba, T Tsutsui, Y Takahashi, S Itoh

JOURNAL OF RECONSTRUCTIVE MICROSURGERY 19 ( 4 ) 209 - 215 2003.5

Language：English Publisher：THIEME MEDICAL PUBL INC

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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Dynamic reconstruction of large abdominal defects using a free rectus femoris musculocutaneous flap with normal motor function

Koshima, I, Y Nanba, T Tutsui, Y Takahashi, S Itoh, R Kobayashi

ANNALS OF PLASTIC SURGERY 50 ( 4 ) 420 - 424 2003.4

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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副神経麻痺に対する遊離神経移植による再建

筒井哲也, 難波祐三郎, 伊藤聖子, 松本洋, 月野暁彦, 寺戸通久, 大西文夫, 柳林聡, 光嶋勲

日本形成外科学会会誌 23 ( 4 ) 285 - 286 2003.4

腫瘍切除後の顔面神経機能即時再建の治療経験

筒井哲也, 難波祐三郎, 伊藤聖子, 松本洋, 月野暁彦, 寺戸通久, 大西文夫, 光嶋勲

日本頭蓋顎顔面外科学会誌 19 ( 1 ) 61 - 62 2003.4

血管柄付き遊離脂肪移植による再建術

松本洋, 難波祐三郎, 筒井哲也, 伊藤聖子, 月野暁彦, 大西文夫, 柳林聡, 寺戸通久, 光嶋勲

日本形成外科学会会誌 23 ( 4 ) 286 - 286 2003.4

Treatment of meralgia paresthetica with a deep inferior epigastric perforator adiposal flap: Case report

Y Namba, S Ito, T Tsutsui, Koshima, I

JOURNAL OF RECONSTRUCTIVE MICROSURGERY 19 ( 2 ) 69 - 71 2003.2

Language：English Publisher：THIEME MEDICAL PUBL INC

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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副神経損傷に対する遊離神経移植による再建

大西文夫, 難波祐三郎, 筒井哲也, 伊藤聖子, 松本洋, 月野暁彦, 寺戸通久, 柳林聡, 光嶋勲

岡山医学会雑誌 114 ( 3 ) 340 - 340 2003.1

切り落とした指はつなげられるか．

難波祐三郎, 光嶋勲

治療 2003

特集，子宮頚癌治療のcontroversy, 下肢リンパ浮腫の予防と治療．

光嶋勲, 伊藤聖子, 筒井哲也, 高橋義雄, 難波裕三郎

産科と婦人科 5,629-633 2003

下肢リンパ浮腫の予防と治療．

光嶋勲, 伊藤聖子, 筒井哲也, 高橋義雄, 難波祐三郎

産科と婦人科 2003

小児における遊離皮弁．

難波裕三郎, 筒井哲也, 光嶋勲

日本マイクロ会誌 16,231-237 2003

リンパ浮腫の治療．特にリンパ管細静脈吻合に関して．

光嶋勲, 藤津美佐子, 高橋義雄, 筒井哲也, 難波裕三郎

手術 57,1189-1192 2003

先端外科医療の最前線．超微小血管吻合術と低侵襲再建術-キメラ型組織移植術の開発-．

光嶋勲, 難波裕三郎

医学のあゆみ 205,728-832 2003

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