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

Epiblepharon is an eyelid disease affecting 46-52.5% of Asian children. The Hotz procedure was commonly used for the treatment. However, the currently preferred technique is the rotating suture technique. This study aimed to report the recurrence rate and the complications of using the rotating suture technique combined with lid margin split and lower eyelid retractor (LER) disinsertion of epiblepharon. This was a retrospective study of the procedures performed between January 2017 and December 2020. This study included 64 eyelids of 37 patients who underwent the consecutive rotating suture technique, lid margin split, and LER disinsertion simultaneously for lower eyelid epiblepharon and were followed up for at least 6 months. The mean age of the patients who underwent surgery was 9.5 (5-28) years. The mean observation period was 8.3 (6-27) months. Recurrence was observed in one eyelid (1.6%). The complications included an ectopic eyelash on one eyelid (1.6%). LER disinsertion performed in this study had two advantages. First, the imbalance between the anterior and posterior lamellae was corrected. Disinserting the LER, the tarsal plate could be repositioned cranially, effectively addressing this imbalance. Second, LER disinsertion ensured direct exposure of the lower margin of the tarsal plate, facilitating the implementation of a reliable rotating suture. In conclusion, promising results were achieved by combining the rotating suture technique with LER disinsertion and lid margin splitting.

DOI： 10.1016/j.bjps.2023.11.001

PubMed

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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

Lower eyelid entropion is the second most common disease seen after ptosis in oculoplastic outpatients. In this study, we performed percutaneous and transconjunctival shortening of the anterior and posterior layers of the lower eyelid retractor (LER) to treat lower eyelid involutional entropion. This study aimed to examine the recurrence rate and complications of the percutaneous and transconjunctival approaches. This was a retrospective study of procedures conducted from January 2015 to June 2020. The LER shortening was performed for lower eyelid involutional entropion on 103 patients (116 eyelids). From January 2015 to December 2018, LER shortening using the percutaneous approach was implemented; from January 2019 to June 2020, the transconjunctival approach was used to shorten the LER. All patient charts and photographs were retrospectively reviewed. Recurrence occurred in 4 patients (4.3%) in the percutaneous approach. No recurrence was observed in any patient in the transconjunctival approach. Temporary ectropion occurred in 6 patients (7.6%) when the percutaneous approach was used; all cases healed within 3 months after surgery. The study did not reveal any statistically significant difference in recurrence rates between the percutaneous and transconjunctival approaches. We achieved results equal to or better than percutaneous LER shortening by combining transconjunctival LER shortening with horizontal laxity shortening, such as lateral tarsal strip, pentagonal resection, and orbicularis oculi muscle resection. However, it is necessary to be careful about temporary ectropion after surgery when percutaneous LER shortening alone is performed for lower eyelid entropion.

DOI： 10.1016/j.bjps.2023.04.045

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

OBJECTIVE: In a previous study, the authors showed that the migration of Schwann cells (SCs) through end-to-side (ETS) neurorrhaphy promotes axonal regrowth within an acellular nerve graft. In the present study, the authors investigated whether a similar strategy using an artificial nerve (AN) would allow reconstruction of a long nerve gap (20 mm) in rats. METHODS: Forty-eight 8- to 12-week-old Sprague Dawley rats were divided into control (AN) and experimental (SC migration-induced AN [SCiAN]) groups. Prior to the experiment, the ANs used in the SCiAN group were populated in vivo with SCs over a 4-week period by ETS neurorrhaphy onto the sciatic nerve. In both groups, a 20-mm sciatic nerve defect was reconstructed in an end-to-end fashion using 20-mm ANs. Sections from the nerve graft and distal sciatic nerve in both groups underwent assessments at 4 weeks for SC migration by immunohistochemical analysis and quantitative reverse transcription-polymerase chain reaction. At 16 weeks, axonal elongation was assessed by immunohistochemical analysis, histomorphometry, and electron microscopy. The number of myelinated fibers was counted, the g-ratio was calculated, and myelin sheath thickness and axon diameter were measured. Furthermore, functional recovery was evaluated at 16 weeks using the Von Frey filament test for sensory recovery and by calculating the muscle fiber area for motor recovery. RESULTS: The area occupied by SCs at 4 weeks and by axons at 16 weeks was significantly larger in the SCiAN group than in the AN group. Histomorphometric evaluation of the distal sciatic nerve revealed a significantly greater number of axons. At 16 weeks, plantar perception in the SCiAN group was significantly better, demonstrating improvement in sensory function. However, no tibialis anterior muscle motor improvement was observed in either group. CONCLUSIONS: The induction of SC migration into an AN by ETS neurorrhaphy is a useful technique for repairing 20-mm nerve defects in rats, with better nerve regeneration and sensory recovery. No motor recovery was observed in either group; however, motor recovery might require a longer period of time than the lifespan of the AN used in this study. Future studies should investigate whether structural and material reinforcement of the AN, to lower its decomposition rate, can improve functional recovery.

DOI： 10.3171/2023.3.JNS222419

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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

BACKGROUND Vaginal wall hemangiomas are extremely rare, benign, vascular tumors of the female genitalia. Most cases occur in childhood, but a few cases can be acquired; however, the mechanism of hemangioma formation remains unknown. Most hemangiomas involving female genital organs are small and asymptomatic. However, huge hemangiomas can cause irregular genital bleeding, infertility, and miscarriage. Surgical excision and embolization are the most common treatment options. We reveal that sclerotherapy achieved good outcomes in a patient with an intractable huge vaginal wall hemangioma. CASE REPORT A 71-year-old woman visited a local doctor with concerns of frequent urination. A ring pessary was inserted after a diagnosis of pelvic organ prolapse. However, symptoms did not improve, and the patient consulted another hospital. The previous physician diagnosed vaginal wall tumors and prolapse and performed a colporrhaphy. However, she was referred to our hospital with heavy intraoperative bleeding. Imaging examination revealed a huge hemangioma on the vaginal wall, which was histologically diagnosed as a cavernous hemangioma. Angiography revealed hemorrhage in the right peripheral vaginal artery. Owing to concerns regarding extensive vaginal wall necrosis caused by arterial embolization, sclerotherapy using monoethanolamine oleate was selected. Hemostasis was achieved 1 month after sclerotherapy, and postoperative imaging showed the lesion had shrunk in size. No recurrence of hemangioma was observed 19 months after surgery. CONCLUSIONS We report a case of a large vaginal wall intractable bleeding hemangioma. Sclerotherapy can be a suitable treatment option for large vaginal hemangiomas that are too extensive to be treated using surgery or arterial embolization.

DOI： 10.12659/AJCR.939474

PubMed

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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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：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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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：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Reconstruction of eyelid margin defects following resection of upper-eyelid skin malignancies is typically performed using a lower eyelid switch flap, including eyelash reconstruction. However, a subsequent procedure for flap separation, and prolonged swelling of the flap may occur as a complication. Objective: The authors performed anterior lamellar reconstruction using a sliding flap with excess upper eyelid skin, a procedure that is a less invasive and simpler. Materials and Methods: The authors performed anterior lamellar reconstruction using a sliding flap in 7 patients with full-thickness upper eyelid margin defect after skin cancer resection. The mean age of the patients was 76.0 years. The horizontal width of the defect in our cohort ranged from 11 to 25 mm and the vertical width ranged from 5 to 10 mm. Results: All the flaps and mucosal grafts were well taken, and none of the patients complained of lack of eyelash reconstruction. However, eyelid margin irregularity, possibly due to flap or mucosal graft contraction, was observed in 2 patients, and 1 patient developed keratoconjunctivitis. Conclusions: The sliding flap technique is a minimally invasive and simple procedure for wide eyelid margin reconstruction. However, 2 patients developed eyelid margin irregularities and 1 patient developed keratoconjunctivitis. Those complications might have occurred owing to the condition of posterior lamellar reconstruction. Therefore, for the successful use of a sliding flap for anterior lamellar reconstruction, the form of the eyelid edge and the choice of posterior lamellar reconstruction are key considerations. In future, we plan to establish a better reconstructive technique by accumulating more evidence.

DOI： 10.1097/SCS.0000000000008584

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(有)科学評論社  

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

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

BACKGROUND: Lengthening temporalis myoplasty (LTM) is a unique and definite facial reanimation procedure that involves inserting the whole temporal tendon directly into the nasolabial fold. However, the nasolabial fold incision remains one of the difficulties of this procedure, particularly in young or female patient. To avoid the need for this incision, the authors developed an intraoral approach to manipulate the temporal muscle tendon toward the nasolabial fold. in this study, we describe the details of this procedure. METHOD: The authors performed their intraoral approach procedure in 5 patients with established complete facial paralysis. instead of making an incision at the nasolabial fold to approach the coronoid process, the authors made the incision at the buccal mucosa. The results were evaluated both subjectively and objectively. RESULTS: The authors achieved facial reanimation without leaving any obvious scar on the face or neck and the effect of static reconstruction is obvious, even immediately after the surgery. All the patients obtained good facial movement within 4 months (2.5 months in average), and improved all evaluated parameters postoperatively. No infections or other major complications were reported following surgery; however, 1 patient developed a slight dimple that required revision. DISCUSSION: The authors could advance temporal tendon toward nasolabial fold firmly obtaining sufficient surgical field similar to that of nasolabial fold incision, and achieved fairly good results without an obvious scar on the face.Establishing LTM without nasolabial fold incision, we could expand the indication of LTM more widely, and it could be more familiar procedure for smile reanimation in all generation.

DOI： 10.1097/SCS.0000000000008207

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

症例は66歳女性。左鼠径部の皮下腫瘤と疼痛を主訴とした。画像診断および血液学的所見より、悪性リンパ腫も含めた腫瘤性病変と考えられた。部分生検を施行したところ、悪性黒色腫もしくは明細胞肉腫(CCS)が疑われた。その後腫瘤は増大し、造影MRIで不均一な造影像、周囲軟部組織や腹直筋筋膜に沿った浸潤像が認められた。腫瘤は鼠径靱帯上の孤立性病変で、大腿三角部のリンパ節腫脹は認められなかった。確定診断が困難であったため、広範切除と鼠径リンパ節郭清を行った。病理組織学的にCCSが疑われたが、免疫組織では確定診断を得ることができなかった。遺伝子解析にてV600Eを検出し、PD-L1発現を認めたため、悪性黒色腫の可能性が示唆された。EWSR1転座が陰性であったことからCCSは否定的であった。遺伝子パネル検査にて、悪性黒色腫関連の遺伝子が豊富に発現していたことから、原発不明悪性黒色腫と確定診断した。BRAF遺伝子変異およびリンパ節転移を認めたことからstageIIIと考え、ダブラフェニブとトラメチニブ併用療法に加療を開始した。術後は経過良好であった。

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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：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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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：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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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：克誠堂出版(株)  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00398&link_issn=&doc_id=20210929020002&doc_link_id=%2Fad3ksgke%2F2021%2F006410%2F004%2F1153-1161%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2021%2F006410%2F004%2F1153-1161%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

47歳男。右変形性肘関節症に対して鏡視下手術を施行され、術後に右手の痺れと肘痛、手指の動きづらさを自覚した。仕事ができず、術後1ヵ月時に当科を紹介受診した。諸検査の結果から右肘関節部の正中神経断裂と考え、手術を行った。肘前方から進入し正中神経を展開したところ、正中神経は肘関節部で断裂し断端神経腫を形成していた。正中神経遠位断端に約5cmの欠損があり、神経断端を新鮮化すると約7cmの神経欠損が生じた。正中神経近位断端で円回内筋(PT)への枝を確認し、剥離した。遠位でもPTの遠位断端を確認し、さらに、正中神経の後面から橈側へ分岐する前骨間神経(AIN)も確認し、分離した。次に外側で橈骨神経を展開し、短橈側手根伸筋への枝を確認した。枝は末梢で3本に分かれており、これを遠位で切離し、橈骨動脈の下を通してAINへの神経交差縫合を行った。続いて下腿から腓腹神経を24cm採取し、これを3本に分け、1本はPTへの枝へ神経移植、残る2本は正中神経にcable graftし、良好な結果が得られた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02567&link_issn=&doc_id=20210927330014&doc_link_id=10.11270%2Fjjsrm.34.162&url=https%3A%2F%2Fdoi.org%2F10.11270%2Fjjsrm.34.162&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本皮膚外科学会・日本臨床皮膚外科学会・Asian Congress of Dermatologic Surgery  

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Language：Japanese   Publisher：日本皮膚外科学会・日本臨床皮膚外科学会・Asian Congress of Dermatologic Surgery  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：English  

Adenoid cystic carcinoma (ACC) is a relatively rare malignant tumor. It is more common in women than in men and typically develops in the lacrimal, salivary, and breast glands. ACC of the external auditory canal (EAC) is exceedingly rare, and its invasion into the ear lobe is even more unusual. In this report, we present a case of ACC that presented as a mass on the surface of the ear lobe in a 28-year-old woman and was initially diagnosed as infected atheroma. For wide resection of the tumor, half of the entire auricula was resected and superficial parotidectomy was performed. After confirming no tumor cells on the surface of the facial nerve, the defect was reconstructed by the combination of platysma muscle flap to prevent Frey syndrome and free forearm flap for the ear lobe form. There was no recurrence or metastasis of the tumor, and Frey syndrome did not occur at 2 years and 8 months after surgery. The patient was satisfied with the result, oncologically and cosmetically. Even in young patients, comprehensive treatments (including diagnosis, resection, and reconstruction) are important in painful ear lobe masses.

DOI： 10.1097/GOX.0000000000003393

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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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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02567&link_issn=&doc_id=20210112340001&doc_link_id=10.11270%2Fjjsrm.33.182&url=https%3A%2F%2Fdoi.org%2F10.11270%2Fjjsrm.33.182&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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)日本皮膚外科学会  

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

DOI： 10.31662/jmaj.2020-0016

PubMed

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Language：Japanese   Publisher：日本末梢神経学会  

手術支援ロボットda Vinciが導入されて約20年の歳月が経過しようとしているが、本邦の手外科・末梢神経外科領域においては、いまだ臨床応用のめどが立っていない。da Vinciはさまざまな特性を有するが、手外科・末梢神経外科領域で使用するうえでの最大の利点は内視鏡下顕微鏡手術にある。これまでに経験したda Vinciを用いた内視鏡下顕微鏡手術の症例を報告するとともに、フランスでのRobotic Microsurgery Master Courseの研修内容を示す。また、本邦でも2019年8月より順天堂浦安病院手外科センターで定期的に開始しているシミュレータを用いた研修内容を報告する。最後に、世界のRobotic Microsurgeryの潮流についていくつかの提言を行う。(著者抄録)

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

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

DOI： 10.1111/1346-8138.15189

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

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

DOI： 10.1007/s11604-019-00885-5

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

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

DOI： 10.1111/ped.14077

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Language：English  

With consideration of the ongoing developments in treatment options for cutaneous melanoma, the Japanese Skin Cancer Society published the first guidelines for cutaneous melanoma in 2007 and later revised them in 2015. Here, we report on an English version of the 2019 Japanese Melanoma Guidelines. In this latest edition, all processes were carried out according to the Grading of Recommendations, Assessment, Development and Evaluation system. A comprehensive published work search, systematic review and determination of recommendations in each clinical question were performed by a multidisciplinary expert panel consisting of dermatologists, a plastic and reconstructive surgeon, and a radiation oncologist. The advent of novel agents, such as immune checkpoint inhibitors and molecular-targeted agents, has drastically changed the nature of treatment for adjuvant and advanced-stage diseases among melanoma patients worldwide. Additionally, recent reports of clinical trials regarding surgical procedures and a better understanding of molecular biology and tumor immunology in clinical types of melanoma have had an impact on clinical practise. Based on these viewpoints, eight relevant clinical questions were raised in this report that aim to help clinicians select the appropriate therapeutic approach.

DOI： 10.1111/1346-8138.15151

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Dermatofibrosarcoma protuberans (DFSP) is a slow-growing superficial sarcoma. Due to its high late local recurrence, thin skin graft is usually recommended for reconstruction after resection of the tumor. In this report, we present a case of giant DFSP in the groin region of young woman. Reconstruction of large groin defect after DFSP resection was performed by "split-skin paddle anterolateral thigh flap" instead of skin graft considering that the patient was a 29-year-old woman. This method enabled the primary closure of the donor site and provided the positive functional and esthetic outcomes. In the present case, the surgical scar is less conspicuous and the patient can climb and descend stairs without any trouble at 4 years after the surgery. With careful monitoring of the tumor recurrence, this technique may become a reliable reconstruction option for patients with large groin defect after resection of the malignant tumor.

DOI： 10.1097/GOX.0000000000002528

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Oncoplastic lower eyelid reconstruction is a challenging task due to the complicated structure of the eyelid and requirement of high operative accuracy. Poorly treated defects result in ectropion and ptosis which may lead to keratitis and corneal ulceration. Previous related studies do not include a detailed comparison of the common reconstructive methods of the lower eyelid in terms of results and complication rates.Objective: The authors aim to demonstrate whether the choice of reconstruction affects the aesthetic and functional outcome of oncoplastic lower eyelid reconstruction.Methods & Materials: The authors performed a 10-year retrospective review of all oncoplastic lower eyelid reconstructions carried out in our hospital. Information on patient background, diagnosis and the choice of reconstructive method were evaluated. Postoperative photographs of each patient were then subjectively evaluated for color match, cosmesis, quality of shape, symmetry, and overall appearance. The authors hypothesized that the outcome is related to the main trajectory of the flap. Patients treated with local flaps of horizontal and vertical trajectories were then compared in terms of outcome and complication rates.Results: Reconstructions based on a horizontal trajectory compared with a vertical trajectory resulted with lower rates of ectropion and ptosis occurrence. The results were statistically significant.

DOI： 10.1097/SCS.0000000000005639

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Mammary analogue secretory carcinoma (MASC) of salivary glands is a newly recognized tumor entity. We report a child who was initially diagnosed with lymphangioma and referred to our institute for sclerotherapy, only to find out that the tumor was in fact MASC after excision. This case of MASC is in a 7-year-old boy, the youngest case so far reported. He referred to his primary care physician with a infra-auricular swelling, and it was diagnosed as lymphatic malformation he was referred to our institution for sclerotherapy. For Doppler and ultrasound magnetic resonance imaging, there was a distinct cystic lesion with a heterogeneous solid lesion inside. Minimally invasive treatment such as sclerotherapy was thought to be more desirable due to a pediatric case, the risk of postoperative facial paralysis and scar. However, even the successful treatment of cystic lesion with sclerotherapy, solid lesion of the tumor could be remained without pathological findings. Otolaryngologist also thought the importance of pathological diagnosis, and we finally chose surgical excision. The tumor was ultimately diagnosed as MASC considering histological and genetic findings. For child case, we tend to treat patient less invasively, and it might bring a risk of MASC being incorrectly treated nonsurgically such as with sclerotherapy. This could lead to tumor progression and wider radical excision at last. We believe that histological diagnosis should become the priority in similar cases of mixed solid and cystic tumors to avoid incorrect treatment, and we need to choose surgical excision by understanding the character of salivary gland tumor occurring in childhood.

DOI： 10.1097/GOX.0000000000002059

PubMed

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

DOI： 10.1097/DSS.0000000000001037

PubMed

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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

Autologous endothelial progenitor cell (EPC) therapy is commonly used to stimulate angiogenesis in ischemic repair and wound healing. However, low total numbers and functional deficits of EPCs make autologous EPC therapy ineffective in diabetes. Currently, no known ex vivo culture techniques can expand and/or ameliorate the functional deficits of EPCs for clinical usage. Recently, we showed that a quality-quantity culture (QQc) system restores the vasculogenic and wound-healing efficacy of murine diabetic EPCs. To validate these results and elucidate the mechanism in a translational study, we evaluated the efficacy of this QQc system to restore the vasculogenic potential of diabetic human peripheral blood (PB) CD34+ cells. CD34+ cells purified from PB of diabetic and healthy patients were subjected to QQc. Gene expression, vascular regeneration, and expression of cytokines and paracrine mediators were analyzed. Pre- or post-QQc diabetic human PB-CD34+ cells were transplanted into wounded BALB/c nude mice and streptozotocin-induced diabetic mice to assess functional efficacy. Post-QQc diabetic human PB-CD34+ cell therapy significantly accelerated wound closure, re-epithelialization, and angiogenesis. The higher therapeutic efficacy of post-QQc diabetic human PB-CD34+ cells was attributed to increased differentiation ability of diabetic CD34+ cells, direct vasculogenesis, and enhanced expression of angiogenic factors and wound-healing genes. Thus, QQc can significantly enhance the therapeutic efficacy of human PB-CD34+ cells in diabetic wounds, overcoming the inherent limitation of autologous cell therapy in diabetic patients, and could be useful for treatment of not only wounds but also other ischemic diseases. Stem Cells Translational Medicine 2018;7:428-438.

DOI： 10.1002/sctm.17-0043

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PURPOSE: Diffusional kurtosis imaging (DKI) enables sensitive measurement of tissue microstructure by quantifying the non-Gaussian diffusion of water. Although DKI is widely applied in many situations, histological correlation with DKI analysis is lacking. The purpose of this study was to determine the relationship between DKI metrics and neurite density measured using confocal microscopy of a cleared mouse brain. METHODS: One thy-1 yellow fluorescent protein 16 mouse was deeply anesthetized and perfusion fixation was performed. The brain was carefully dissected out and whole-brain MRI was performed using a 7T animal MRI system. DKI and diffusion tensor imaging (DTI) data were obtained. After the MRI scan, brain sections were prepared and then cleared using aminoalcohols (CUBIC). Confocal microscopy was performed using a two-photon confocal microscope with a laser. Forty-eight ROIs were set on the caudate putamen, seven ROIs on the anterior commissure, and seven ROIs on the ventral hippocampal commissure on the confocal microscopic image and a corresponding MR image. In each ROI, histological neurite density and the metrics of DKI and DTI were calculated. The correlations between diffusion metrics and neurite density were analyzed using Pearson correlation coefficient analysis. RESULTS: Mean kurtosis (MK) (P = 5.2 × 10-9, r = 0.73) and radial kurtosis (P = 2.3 × 10-9, r = 0.74) strongly correlated with neurite density in the caudate putamen. The correlation between fractional anisotropy (FA) and neurite density was moderate (P = 0.0030, r = 0.42). In the anterior commissure and the ventral hippocampal commissure, neurite density and FA are very strongly correlated (P = 1.3 × 10-5, r = 0.90). MK in these areas were very high value and showed no significant correlation (P = 0.48). CONCLUSION: DKI accurately reflected neurite density in the area with crossing fibers, potentially allowing evaluation of complex microstructures.

DOI： 10.2463/mrms.mp.2017-0031

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kokuseido Publishing Co. Ltd  

An arteriovenous malformation (AVM) is a fast-flow shunt resulting from erroneous development of the vascular system that sometimes occurs in the lips. The lip has a unique anatomical structure and plays an important role in both aesthetic and functional aspects of the face. When treating AVM of the lip, we need to carefully determine the appropriate treatment strategy to preserve the lip's distinctive features in each patient. In this report, we present our experience of treating an AVM of the upper lip in a young female patient. We applied a phased treatment with multiple sclerotherapies, followed by surgical excision. Even against the patient whose nidus almost occupied her entire upper lip, we could treat her region without creating any deficit on her lip. We chose each sclerosant depending on the area of the nidus that was treated, and took into consideration the balance between its efficacy and any adverse effects. However, aesthetic improvement after multiple sclerotherapies was limited, and surgical excision was essential to improve the final appearance of the lip. A proper combination of sclerotherapy and surgical excision is important to treat AVM. Although our phased treatment strategy required multiple treatment sessions, it enabled a less invasive and reliable treatment of AVM of the lip.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The risk of cancer is significantly increased in patients undergoing renal transplant surgery than in the general population. In particular, skin cancer is the most commonly occurring cancer in these patients.A 34-year-old man underwent living renal transplantation for focal segmental glomerulosclerosis. After 18 months, he developed a lesion on the nasal dorsum, approximately 1 cm in size, and the lesion rapidly expanded to cover the entire dorsum.Owing to its rapid expansion, the lesion was suspected to be a malignant tumor and wide excision was planned.We removed the lesion with a 6-mm margin. Squamous cell carcinoma was diagnosed through intraoperative rapid pathological examination. The nasal bone and septum were invaded by the tumor and, as a result, the entire external nose was removed. The patient's nose was subsequently reconstructed using a free forearm flap for lining, iliac bone graft for the nasal frame, and a scalping forehead flap for skin coverage.Selective target radiotherapy was administered at the closest margin around the lesion, and the dosage of immunosuppressants was reduced.At >2 years postoperatively, the patient showed good cosmetic results with no relapse or metastasis of the tumor.We report the unusual case of a young man who developed a rapidly progressing squamous cell carcinoma on his nasal dorsum after 18 months of immunosuppression. Squamous cell carcinoma in organ transplant recipients may be more aggressive and may progress differently than in regular patients. Therefore, special attention is required for patients who take immunosuppressive drugs after renal transplant surgery.

DOI： 10.1097/SCS.0000000000003548

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BACKGROUND: Infantile hemangioma (IH) is a benign neoplasm that causes scarring and cosmetic problems after spontaneous regression. Therefore, aggressive treatments such as laser irradiation and corticosteroid have been used; however, recently, the effect of propranolol has been widely noticed. In this study, the authors applied propranolol to low-birth-weight infants with IHs and evaluated its effect. METHODS: Four low-birth-weight infants having IH were selected, with birth weights ranging from 582 to 814 g (average 703 g). The administration of propranolol was started within 4 days of hospitalization. The dosage of propranolol was increased from 0.5 to 2.0 mg/kg/day step by step. Vital signs and blood sugar level were checked prior to every administration of the drug. Continuous monitoring of electrocardiography and arterial oxygen saturation were performed during entire hospitalization.The outcomes were assessed by the patient's family and 2 board-certified plastic surgeons based on 5 parameters pertaining to clinical findings, using a scale of 1 to 10. Reduction rate of the hemangioma was calculated at the end of treatment and compared with the size prior to treatment. RESULTS: The authors could administrate propranolol without any severe side effects in all patients. Infantile hemangiomas gradually shrank soon after the authors started the treatment. Reduction ratios were 22.1% to 100% (average 48.72%), and the comprehensive evaluation of treatment was 7.5 to 10 (average 8.55) on a 10-point scale. CONCLUSIONS: With careful monitoring of their vital signs, propranolol could be a good treatment option even for IH in low-birth-weight infants whose birth weights were less than 1000 g.

DOI： 10.1097/SCS.0000000000003542

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Facial scar revision is fundamental in plastic and reconstructive surgery, and the revision of eyelid scars is extremely important because the eyelids markedly affect facial appearance. The structure of the eyelids is unique, with thin skin, subcutaneous tissue, and a free edge. Because of these characteristics, eyelid scar contracture can easily result in an obvious deformity. The appropriate use of Z-plasty is essential for reconstructing linear eyelid scars. On the other hand, the indications for W-plasty are limited, and in cases in which a wide defect occurs after scar resection, a local flap or skin graft is necessary. Upper eyelid opening requires smooth movement, and the lower eyelid needs strong support to maintain its normal structure. Therefore, skin grafts are generally used for the reconstruction of upper eyelid scars
however, the area of the graft should be carefully chosen because replacing the entire eyelid unit may be required to obtain good results beyond the extent of the scar. Local flaps are usually used for wide eyelid scars, and horizontal advancement flaps are the first choice because of similar tissue characteristics. For the lower eyelid, combined eyelid support reconstruction is sometimes required
thus, the flap should be chosen with careful consideration of the condition of both the scar and adjacent tissue.

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The object of this report is to share our experience of conservative management of giant aplasia cutis congenita (ACC) of the scalp with the topical application of basic fibroblast growth factor (bFGF). Complete epithelialization of the 9 × 8 cm sized defect was achieved in 33 weeks. Careful conservative management could eliminate the requirement of surgery for giant ACC defects of the scalp with bone defects and should be tried if surgery is thought to be risky or has consecutive morbidity. Topical bFGF application seems to accelerate healing, also providing a better epithelium for later reconstructive treatments and its usage could be standardized in the future.

DOI： 10.1097/SCS.0000000000003347

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BACKGROUND: Lower eyelid reconstruction after tumor removal is always challenging, and full-thickness defects beyond half of the eyelid length require a flap from a part other than the remaining lower eyelid, such as the temporal area or the cheek. OBJECTIVE: We aimed to report our experience of applying Smith-modified Kuhnt-Szymanowski, one of the most popular procedures for paralytic ectropion, for reconstructing oblong full-thickness lower eyelid margin defect. MATERIALS AND METHODS: We performed Smith-modified Kuhnt-Szymanowski on 5 cases of oblong full-thickness lower eyelid margin defect after skin cancer removal. The mean age of patients was 80.0 years. The horizontal widths of the defects ranged from half to two-thirds of the lower eyelid length and the vertical width ranged from 5 to 9 mm. RESULTS: We obtained good functional and esthetic results in all cases. No patients developed ectropion or lower eyelid distortion, and all patients were satisfied with their results. CONCLUSIONS: We utilized the procedure for morphological revision as a reconstructive procedure for eyelid margin defect by considering the defect as a morphological deformity of the eyelid margin; thus, donor tissue was not required to fill the defect and we could accomplish the reconstruction simply, firmly, and less invasively.

DOI： 10.1097/GOX.0000000000001230

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

AIMS: The synthetic leukotriene B4 receptor type 2 (BLT2) agonist CAY10583 (CAY) accelerates wound healing in diabetic mice by promoting keratinocyte migration. However, its effects on fibroblast activity and granulation are unknown. We investigated the mechanisms by which CAY promotes wound healing. METHODS: CAY was applied to wounds on streptozotocin-induced diabetic rats, and wound closure, granulation thickness, and epithelialization gaps were analyzed. BLT2 expression was examined by RT-PCR. Migration and proliferation were studied by scratch assays and MTS assays. Keratinocyte supernatants with CAY were applied to fibroblasts, and cytokines were measured by enzyme-linked immunosorbent assays. RESULTS: CAY significantly accelerated wound healing in diabetic rats (CAY, 78.05±12.22% vs. control, 59.84±11.09%; p=0.0222), with increased re-epithelialization and granulation compared to controls. BLT2 was expressed in keratinocytes, but not in fibroblasts. Keratinocyte treatment with the CAY supernatant enhanced fibroblast proliferation and migration (fibroblast scratch closure: CAY, 75.95±4.09% vs. control, 49.69±4.49%; p<0.0001). CAY-treated keratinocytes exhibited increased TGF-β1 and bFGF expression. CONCLUSIONS: CAY directly promotes keratinocyte migration and indirectly enhances fibroblast proliferation by increasing keratinocyte production of TGF-β1 and bFGF, accelerating wound closure. CAY is a promising pharmaceutical agent for diabetic wounds.

DOI： 10.1016/j.jdiacomp.2016.09.002

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Persistent inflammatory environment and abnormal macrophage activation are characteristics of chronic diabetic wounds. Here, we attempted to characterize the differences in macrophage activation and temporal variations in cytokine expression in diabetic and non-diabetic wounds, with a focus on interleukin (IL)-6 mRNA expression and the p38 MAPK and PI3K/Akt signaling pathways. Cutaneous wound closure, CD68- and arginase-1 (Arg-1)-expressing macrophages, and cytokine mRNA expression were examined in non-diabetic and streptozotocin-induced type 1 diabetic mice at different time points after injury. The effect of IL-6 on p38 MAPK and Akt phosphorylation was investigated, and an in vitro scratch assay was performed to determine the role of IL-6 in primary skin fibroblast migration. Before injury, mRNA expression levels of the inflammatory markers iNOS, IL-6, and TNF-α were higher in diabetic mice; however, IL-6 expression was significantly lower 6 h post injury in diabetic wounds than that in non-diabetic wounds. Non-diabetic wounds exhibited increased p38 MAPK and Akt phosphorylation; however, no such increase was found in diabetic wounds. In fibroblasts from non-diabetic mice, IL-6 increased the phosphorylation of p38 MAPK and levels of its downstream factor CREB, and also significantly increased Akt phosphorylation and levels of its upstream factor P13K. These effects of IL-6 were not detected in fibroblasts derived from the diabetic mice. In scratch assays, IL-6 stimulated the migration of primary cultured skin fibroblasts from the non-diabetic mice, and the inhibition of p38 MAPK was found to markedly suppress IL-6-stimulated fibroblast migration. These findings underscore the critical differences between diabetic and non-diabetic wounds in terms of macrophage activation, cytokine mRNA expression profile, and involvement of the IL-6-stimulated p38 MAPK-Akt signaling pathway. Aberrant macrophage activation and abnormalities in the cytokine mRNA expression profile during different phases of wound healing should be addressed when designing effective therapeutic modalities for refractory diabetic wounds.

DOI： 10.1371/journal.pone.0178232

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DOI： 10.1097/GOX.0000000000000792

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INTRODUCTION: Lid loading using gold weights has been commonly used to treat paralytic lagophthalmos (PL); however, the procedure has a relatively high complication rate and the availability of these plates varies among social circumstances. We used a levator lengthening (LL) technique, which originally elongated the levator aponeurosis by inserting a fascia graft between the edge of the levator aponeurosis and the tarsal plate. However, because this procedure tends to result in a wide residual lagophthalmos, we changed the graft material from fascia to conchal cartilage. In this study, we describe in detail our experience with LL using the cartilage graft. METHODS: LL was performed in 18 patients with PL. Fascia grafts were used in seven patients and cartilage grafts in 11. Static reconstructions of the lower eyelid and eyebrow were also performed in most patients. Efficacy was evaluated from patient reports of ocular symptoms and by measuring the palpebral fissure width at opening and closing for both eyes. RESULTS: All patients experienced improved ophthalmological symptoms, which were more apparent in cartilage cases. The average palpebral fissure at eyelid closure was 1.8 mm in cartilage cases and 4.0 mm in fascia cases. In cases where an eyebrow lift was concurrently performed, the residual lagophthalmos became wider in fascia grafting but remained acceptable in cartilage grafting. DISCUSSION: LL is a simple and useful procedure for treating PL with higher efficacy when a cartilage graft is used. However, the level of the upper eyelid can be easily adjusted by changing the fixation position of the cartilage. Additional experience is required to obtain more consistent outcomes.

DOI： 10.1016/j.bjps.2016.01.010

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Background: Frey syndrome (FS) or depressive deformity (DD) occurring after parotidectomy significantly reduces a patient's quality of life. However, there seems to be no effective treatment strategy against these complications. In this study, we report our experience of using platysma muscle flap (PMF) to prevent the development of FS and DD after parotidectomy, and evaluate its effect subjectively and objectively.
Methods: Superficial parotidectomy was performed for eight cases of parotid gland tumor, and a PMF was transferred to cover the site. The incidence of FS and DD were evaluated subjectively, using a questionnaire to the patients and board-certified reconstructive surgeons, and objectively, using Minor's starch-iodine test.
Results: In seven patients, the defect could be completely covered with PMF, and none of them developed FS or obvious DD. However, in one patient, the defect could be only partially covered, and the patient developed complications in the exact site that the flap did not cover. Overall scores from the questionnaire were high in relation to both cosmetic and functional perspectives from most of the patients and all the surgeons. No patients had major postoperative complications requiring revision.
Conclusions: PMF can be useful to cover the defect and prevent complications after parotidectomy. PMF is relatively easy to perform with fewer complications; however, a complete coverage of the defect should be ensured to obtain optimal results. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2015.12.021

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BACKGROUND: Losing the ability to speak severely affects the quality of life, and patients who have undergone laryngectomy tend to become depressed, which may lead to social withdrawal. Recently, with advancements in chemoradiotherapy and with alternative perspectives on postoperative quality of life, larynx preservation has been pursued; however, the selection of candidates and the optimal reconstructive procedure remain controversial. In this study, we retrospectively reviewed our experience with free jejunal graft for larynx-preserving cervical esophagectomy (LPCE), focusing on microvascular reconstruction. METHODS: Seven patients underwent LPCE for cervical esophageal carcinoma, and defects were reconstructed by free jejunal transfer subsequently. We collected preoperative and postoperative data of the patients and assessed the importance of the procedure. RESULTS: We mostly used the transverse cervical artery as the recipient, and a longer operative time was required, particularly for the regrowth cases. The operative field for microvascular anastomosis was more limited and deeper than those in the laryngectomy cases. Two graft necrosis cases were confirmed at postoperative day 9 or 15, and vessels contralateral from the graft were chosen as recipients in both patients. CONCLUSIONS: Microvascular reconstruction for free jejunal graft in LPCE differed in several ways from the procedure combined with laryngectomy. Compression from the tracheal cartilage to the pedicle was suspected as the reason of the necrosis clinically and pathologically. Therefore, we should select recipient vessels from the ipsilateral side of the graft, and careful and extended monitoring of the flap should be considered to make this procedure successful.

DOI： 10.1097/GOX.0000000000000613

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Introduction: There are two main methods to treat lower-lip deformity (LLD) in facial paralysis. The first method is surgical intervention on the side of the paralysis, and the second involves denervating the depressor muscles on the healthy side. It is sometimes difficult for patients to ethically accept the denervating healthy tissue; therefore, we performed the T-shape double fascia graft (TSDFG), which reportedly restores symmetry.
In this study, we report our experience with TSDFG and evaluation of the outcomes including the patient questionnaires.
Methods: Two fascia strips from the thigh, 7 x 70 mm in size, were used; one was grafted horizontally at the lower lip to correct the static position, and the other was grafted obliquely at the lateral side by folding and crossing the horizontal fascia.
A total of nine patients were treated by this procedure; three procedures were performed individually and six were performed in combination with another static or reanimation procedure. A questionnaire containing a five-point scoring system for facial appearance in multiple situations and other problems was sent to each patient at least 6 months after the surgery.
Result: From the physicians' point of view, all patients achieved an improvement in symmetry of the lower lip, particularly when opening of the mouth; however, assessments from the patients demonstrated much less satisfaction. The main reason for the dissatisfaction was the slight bulkiness of the red lip. There was one comment that noted that with more treatment, the expectations were higher, and, as a result, the patient could not admit satisfaction at the end.
Discussion: TSDFG is a simple and effective procedure for LLD; however, slight modifications may be required. In addition, there were some gaps in the perception of the results between the physicians and patients, and we need to consider these when planning to treat LLD. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2015.10.032

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Aims: To investigate the role of Notch signaling pathway in vasculogenic dysfunction of diabetic EPCs (DM-EPCs).
Methods: The study was performed in mice and diabetes was induced with Streptozotocin. The functional consequences of Notch pathway modulation were studied by assessment of colony forming capacity (EPC colony forming assay), EPC differentiation capacity (% of definitive EPC-CFU (dEPC-CFU)), circulating EPCs (EPC culture assay) and migrated cells (migration assay); in the presence of Notch inhibitor (gamma-secretase inhibitors (GSI)) compared to control. Notch pathway and VEGF involvement in DM- EPCs were assessed by gene expression (RT-qPCR).
Results: DM demonstrated to increase Notch pathway expression in bone marrow (BM) EPCs followed by lower EPC-CFU number, EPCs differentiation capacity, number of circulating EPCs, migrated cells and VEGF expression compared to control (p &lt; 0.05). Inhibition of Notch pathway by GSI rescued vasculogenic dysfunction in DM-EPCs as represented by increase in EPC-CFU number, differentiation capacity and number of circulating EPCs (p &lt; 0.05).
Conclusion: Our findings indicate the involvement of Notch pathway in mediating DM-EPCs dysfunction including less number of EPC-CFU, circulating EPCs and migrated cell number compared to control. Further in vitro inhibition of Notch pathway by GSI rescued DM-EPC dysfunction. Therefore targeting Notch pathway in DM may provide a target to restore DM-EPC dysfunction. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jdiacomp.2015.09.015

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Axonal regeneration relies on support from proliferating host Schwann cells (SCs), and previous studies on acellular nerve allografts (ANGs) suggest that axons can regenerate into ANGs within a limited distance. Numerous studies have demonstrated that the supplementation of ANGs with exogenous factors, such as cultured SCs, stem cells, and growth factors, promote nerve regeneration in ANGs. However, there are several problems associated with their utilization. In this study, we investigated whether end-to-side (ETS) neurorrhaphy, which is an axonal provider, could be useful as an SC provider to support axonal elongation in ANGs. We found that ETS neurorrhaphy effectively promoted SC migration into ANGs when an epineurium window combined with partial neurectomy was performed, and the effectiveness increased when it was applied bilaterally. When we transplanted ANGs containing migrated SCs via ETS neurorrhaphy (hybrid ANGs) to the nerve gap, hybrid ANGs increased the number of regenerated axons and facilitated rapid axonal elongation, particularly when ETS neurorrhaphy was applied to both edges of the graft. This approach may represent a novel application of ETS neurorrhaphy and lead to the development of hybrid ANGs, making ANGs more practical in a clinical setting.

DOI： 10.1371/journal.pone.0167507

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During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths.
This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive.
The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region.
During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2015.08.018

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Soft tissue defects or skin ulcers associated with tendon or bone exposure located distally on the extremities are always difficult to treat. The introduction of the vacuum-assisted closure (VAC) and dermal templates has led to major changes in ulcer treatment strategies. However, it is necessary to find an alternative method to treat these defects when VAC is not available.
Perifascial areolar tissue (PAT) is the loose connective tissue on the deep fascia that could be a candidate for repairing soft tissue defects or skin ulcers. Grafting PAT on the exposed bone or tendon, including a wide coverage of well-vascularized tissue surrounding the granulation tissue, can prepare the wound to be subsequently closed by a skin graft.
In this study, the PAT was used in various situations and its optimal usage and outcomes were evaluated. A total of 13 PAT grafts were performed and were especially useful for covering narrow ulcers with narrow tendon exposure and filling fistula areas. In comparison to other cases, covering the exposed cortical bone ulcers seemed to be more difficult to perform. However, an option for these ulcers could be the exposure of bone marrow and usage of intraosseous blood flow. It was also possible for the simultaneous engraftment of PAT and skin in narrow areas and could be an alternative in cases of small concave ulcers or fistulae. The PAT graft is a simple and minimally invasive procedure that can be a good alternative when VAC is not available. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2015.08.008

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DOI： 10.1016/j.reth.2014.11.001

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Lengthening temporalis myoplasty, reported by Daniel Labbe in 1997, is a unique and definite facial reanimation procedure that involves moving the whole temporal muscle anteroinferiorly and inserting its tendon directly into the nasolabial fold. In the present article, we report our experience in the use of his modified method of the procedure, which preserves the zygomatic arch by transecting the coronoid process through the nasolabial fold incision. We also describe our cadaveric study that aimed to elucidate a secure approach for coronoid process transection.
We performed this procedure in five patients with permanent facial paralysis. To improve facial symmetry, we also performed several additional static reconstructions such as T-shaped double-sleeve fascia grafts for lower lip deformities.
We were successful in achieving considerable static improvement at rest, immediately after the surgery, and the recovery of facial movement was apparent approximately 3 months after the surgery.
With regard to the cadaveric study, we noted that the entry to the buccal fat region, which is also the pathway of the temporal fascia, was a narrow space, and a short transection of the medial upper edge of the masseter fascia would make it easy to locate the coronoid process. Therefore, for a safe and secure access to the coronoid process from the nasolabial fold, we believe that we should first expose the cranial side and continue to dissect along the side and lower edge of the maxilla to locate the medial upper edge of the masseter fascia. By transecting along its edge, we could easily access the coronoid process, located immediately behind it, and widen the pathway of the temporal fascia.
This modified method is less invasive and simpler compared to the original procedure, and understanding the detailed anatomy for dissection would help surgeons perform this procedure more confidently. (C) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2014.09.037

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Distally based radial artery perforator flap (DBRAPF) is useful for hand defects
however, the location of the perforator varies among individuals. Preoperative evaluation has been a problematic issue when performing this flap. A 64-year-old man developed squamous cell carcinoma on an old burn scar at the dorsal thumb and was referred to our clinic for further treatment. After wide resection of the tumor, including the long and short extensors of the thumb, we reconstructed the defect with DBRAPF. At that time, near-infrared fluorescence angiography with indocyanine green (ICG) was used to identify the position of the perforator. After injecting ICG intravenously, we could observe its uptake at approximately 5 cm proximal to the styloid process. We designed a 10 × 6 cm island flap with that uptake as pivot point. During flap elevation, the perforator could be confirmed at the point of uptake
the flap was then transferred to the defect by rotating the pedicle at the identified point. The vascularity of the flap could also be checked intraoperatively through ICG angiography. The tip of the flap that showed weak ICG fluorescence indicated epidermal necrosis. Nevertheless, the entire flap was viable and enabled good functionality without tumor recurrence and metastasis after 5 years. Using ICG angiography, DBRAPF could be performed smoothly, easily, and safely.

DOI： 10.1097/GOX.0000000000000281

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Conjunctival squamous cell carcinoma (SCC) arising from an anophthalmic socket is quite rare, with few reports in the English literature. A 59-year-old man who had used an ocular prosthesis for 40 years had not removed the ocular prosthesis at all during the last 5 years. He had developed a mass on his entire right upper eyelid, and biopsy revealed a moderately differentiated SCC. Orbital exenteration including the upper and lower eyelid skin was performed. The defect was reconstructed with a free forearm flap followed by the placement of a facial epithesis. The pathology revealed an intraepithelial carcinoma on the upper palpebral conjunctiva, which seemed to infiltrate exclusively from that site to the upper eyelid and into the orbit. Other risk factors were not detected
therefore, chronic irritation or microtrauma of the upper conjunctiva from the prosthesis due to persistent prosthesis placement could have been the main trigger for the development of SCC. In cases where the ocular prosthesis is not fitted properly or removed appropriately, clinicians should be aware of this possible long-term consequence.

DOI： 10.1097/GOX.0000000000000299

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Myoepithelial carcinoma is rare and mostly originates from the major salivary glands. Sometimes, it is difficult to differentiate the benign from the malignant histologically, and its clinical behavior and histological features may vary. Here, we describe the case of a 55-year-old woman who presented with a massive myoepithelial carcinoma, which hung like a temple bell from her right side of the jaw, and she refused to go to the hospital for 3 years. Based on its size and location, we initially thought that, before surgical resection, neoadjuvant therapy would be necessary to reduce the tumor volume. However, after careful evaluation of the tumor characteristics (low-grade histology with outward expansion and little invasion of the adjacent tissues) and imaging findings, we decided that excision was possible. The tumor was encapsulated and had a clear border
it weighed 10.5 kg. By setting the incision line posterior to the equatorial plane and using the lengthened skin posterior to the tumor as a large local flap for the skin defect, we successfully reconstructed the skin defect without harvesting additional flap from other areas. No additional treatment was administered because a sufficient surgical margin was maintained, pathologically. She regained her daily life without recurrence or distant metastasis for 2 years. When treating a massive tumor, careful consideration of its characteristics and location is important, and in this case, we were able to use a simpler and less invasive treatment than we initially envisioned.

DOI： 10.1097/GOX.0000000000000296

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

Madelung disease, also known as benign symmetrical lipomatosis, is a rare condition characterized by symmetrical diffuse adipose tissue in the neck, shoulders, and arms. The present report described the case of a 51-year-old man diagnosed with Madelung disease who presented with masses primarily in the neck. He had previously shown partial improvement after injection lipolysis and shoulder surgery. However, 4 years later, following corticosteroid administration for the treatment of acute deafness, cervical lipomatosis progressed to the extent that he was unable to fasten his shirt. The initial treatment plan involved bilateral surgical excision of the lipomatous masses of the neck and liposuction for those in the submental area. However, the lipomas were adherent to the surrounding tissue and were partially fibrosed, presumably due to the previous injection lipolysis
thus, liposuction was not possible, and all the masses around the neck were carefully excised using cervical lymph node dissection technique. Thirty-two months later, the patient showed good cosmetic results, with no recurrence of cervical lipomatosis. Radical resection of the lipomas using a cervical dissection technique is useful in the treatment of Madelung disease
however, clinicians must consider the potential for adhesions and plan a meticulous dissection in those who have undergone injection lipolysis before the surgery.

DOI： 10.1097/GOX.0000000000000337

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Kokuseido Publishing Co. Ltd  

Lagophthalmos in cases of facial paralysis is a clinically important condition requiring treatment, as prolonged corneal exposure results in ulceration. The upper eyelid is responsible for 85% of lid closure, and several techniques can improve the protective function of the upper eyelid. Lid loading using gold weight has been commonly used for achieving upper eyelid closure
however, alternative methods are required, since the rate of complications such as migration and exposure of the plate are relatively high, and use of the material is not covered by social insurance. Levator lengthening developed by Paul Tessier is a unique technique for elongating the levator aponeurosis by using an interpositional fascia graft. We had reported the usefulness of this technique and had obtained fairly good results. However, eyelid closure tends to be incomplete, and the width between the upper and lower eyelid after closing was wide, especially in cases where eyebrow lift was performed simultaneously. To solve these problems, we used an ear cartilage graft instead of a fascia graft, which seemed to provide steady elongation of the levator. By using a cartilage graft, we were able to achieve better closure of the upper eyelid overall
however, several cases required revision. Here, we describe in detail our experience with levator lengthening using a cartilage graft.

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Subcutaneous hematoma is commonly caused by trauma or surgery. Proper treatment of the condition is needed to avoid severe complications. The present paper introduces a simple technique of hematoma evacuation, called cylinder syringe suction (CSS). Experiments were also performed to determine the detailed mechanism underlying its effectiveness.
Methods: The CSS procedure was performed as follows. A cylindrical plastic cylinder syringe was used. Either a few stitches were removed or a very small incision was made on the site of the hematoma. The edge of the syringe was compressed to the skin, which was covered by a thin hydrocolloid dressing. Vacuum aspiration was enforced at the site of the wound or incision, and the hematoma was gradually aspirated.
For the experiment, house rabbits were used. Hematoma evacuation was performed in 4 different ways, including needle aspiration alone (group 1), needle puncture followed by CSS (group 2), and creation of a small wound (5 mm) followed by needle aspiration (group 3) or CSS (group 4). The amount of evacuated hematoma and the suction pressure created by each of the 4 methods were compared.
Results: Group 4 showed the highest suction pressure and the greatest evacuated amount of hematoma. High suction pressure was also obtained in group 1; however, the amount of evacuated hematoma was small as the other 2 groups.
Conclusion: The CSS technique becomes effective mainly by creating high suction pressure, and the opening of a small wound enables the viscous coagula to pass through the skin.

DOI： 10.1097/SCS.0b013e318287d0db

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER ASSOC NEUROLOGICAL SURGEONS  

Object. The authors have developed a technique for the treatment of facial paralysis that utilizes anastomosis of the split hypoglossal and facial nerve. Here, they document improvements in the procedure and experimental evidence supporting the approach.
Methods. They analyzed outcomes in 36 patients who underwent the procedure, all of whom had suffered from facial paralysis following the removal of large vestibular schwannomas. The average period of paralysis was 6.2 months. The authors used 5 different variations of a procedure for selecting the split nerve, including evaluation of the split nerve using recordings of evoked potentials in the tongue.
Results. Successful facial reanimation was achieved in 16 of 17 patients using the cephalad side of the split hypoglossal nerve and in 15 of 15 patients using the caudal side. The single unsuccessful case using the cephalad side of the split nerve resulted from severe infection of the cheek. Procedures using the ansa cervicalis branch yielded poor success rates (2 of 4 cases). Some tongue atrophy was observed in all variants of the procedure, with 17 cases of minimal atrophy and 14 cases of moderate atrophy. No procedure led to severe atrophy causing functional deficits of the tongue.
Conclusions. The split hypoglossal-facial nerve anastomosis procedure consistently leads to good facial reanimation, and the use of either half of the split hypoglossal nerve results in facial reanimation and moderate tongue atrophy. (http://thejns.org/doi/abs/10.3171/2012.9.JNS1270)

DOI： 10.3171/2012.9.JNS1270

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER ASSOC NEUROLOGICAL SURGEONS  

Object. The authors have developed a technique for the treatment of facial paralysis that utilizes anastomosis of the split hypoglossal and facial nerve. Here, they document improvements in the procedure and experimental evidence supporting the approach.
Methods. They analyzed outcomes in 36 patients who underwent the procedure, all of whom had suffered from facial paralysis following the removal of large vestibular schwannomas. The average period of paralysis was 6.2 months. The authors used 5 different variations of a procedure for selecting the split nerve, including evaluation of the split nerve using recordings of evoked potentials in the tongue.
Results. Successful facial reanimation was achieved in 16 of 17 patients using the cephalad side of the split hypoglossal nerve and in 15 of 15 patients using the caudal side. The single unsuccessful case using the cephalad side of the split nerve resulted from severe infection of the cheek. Procedures using the ansa cervicalis branch yielded poor success rates (2 of 4 cases).
Some tongue atrophy was observed in all variants of the procedure, with 17 cases of minimal atrophy and 14 cases of moderate atrophy. No procedure led to severe atrophy causing functional deficits of the tongue.
Conclusions. The split hypoglossal-facial nerve anastomosis procedure consistently leads to good facial reanimation, and the use of either half of the split hypoglossal nerve results in facial reanimation and moderate tongue atrophy. (http://thejns.org/doi/abs/10.3171/2012.9.JNS1270)

DOI： 10.3171/2012.9.JNS1270

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

Aggressive digital papillary adenocarcinoma (ADPA) is a rare neoplasm of eccrine sweat gland origin that typically presents as a mass on the distal extremities. It is associated with high rates of local recurrence and distal metastasis. Presented here is the case of a 61-year-old male who developed ADPA on his distal sole just above the head of the first metatarsal bone. Wide excision of the tumor involving a 3-cm skin margin from previous surgical scar of biopsy was performed, and sentinel lymph node biopsies were taken from the popliteal fossa and inguinal regions. During this wide excision surgery, the pedicle for the reverse medial plantar flap had to be removed along with the tumor. Reconstructive surgery was performed with a medial plantar flap that was vascularized with a lateral plantar artery in a reverse fashion. This flap successfully covered the defect and the patient can walk without any problems. However, the pedicle crossed the donor site somewhat tightly and the flap became congested for a while. Therefore, it is important to ensure careful handling of the donor site when performing this procedure.

DOI： 10.1055/s-0032-1315769

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2012.02.001

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A 71-year-old male who had been diagnosed with rheumatoid arthritis 3 years previously developed multiple subcutaneous cysts on his buttock, elbow, knee, hand and back. The diameters of the cysts were 10-15 cm. The characteristic fluid and pathology of the cysts led to the diagnosis of multiple rheumatoid bursal cyst (MRBC). The patient was keen to treat the cyst on his buttock as it hampered his sitting position. However, it resisted several kinds of sclerotherapies, including absolute alcohol, OK-432, minocycline and dexamethasone. When the cyst grew further, it was resected surgically; however, the cyst recurred immediately. It was finally brought under control by injecting it with OK-432.
The thick cyst wall, which resisted the various sclerotherapies, was removed surgically, and a new capsule developed inside the cavity; adding a sclerotant to newly made thin capsule made us possible to treat this resistant large bursal cyst. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2011.08.025

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER ASSOC NEUROLOGICAL SURGEONS  

Object. Glial cell line derived neurotrophic factor (GDNF) has potent survival effects on central and peripheral nerve populations. The authors examined the differential effects of GDNF following either a sciatic nerve crush injury in mice that overexpressed GDNF in the central or peripheral nervous systems (glial fibrillary acidic protein [GFAP]-GDNF) or in the muscle target (Myo-GDNF).
Methods. Adult mice (GFAP-GDNF, Myo-GDNF, or wild-type [WT] animals) underwent sciatic nerve crush and were evaluated using histomorphometry and muscle force and power testing. Uninjured WT animals served as controls.
Results. In the sciatic nerve crush, the Myo-GDNF mice demonstrated a higher number of nerve fibers, fiber density, and nerve percentage (p &lt; 0.05) at 2 weeks. The early regenerative response did not result in superlative functional recovery. At 3 weeks, GFAP-GDNF animals exhibit fewer nerve fibers, decreased fiber width, and decreased nerve percentage compared with WT and Myo-GDNF mice (p &lt; 0.05). By 6 weeks, there were no significant differences between groups.
Conclusions. Peripheral delivery of GDNF resulted in earlier regeneration following sciatic nerve crush injuries than that with central GDNF delivery. Treatment with neurotrophic factors such as GDNF may offer new possibilities for the treatment of peripheral nerve injury. (DOI: 10.3171/2009.10.JNS091092)

DOI： 10.3171/2009.10.JNS091092

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The supernumerary nostril is a very rare congenital nasal abnormality, and several cases have been reported in the literature since 1906 when the first case was reported by Lindsay. In the other previously reported cases, the supernumerary nostril typically could present unilaterally or bilaterally, and it was therefore called a double nose, with most reported cases being unilateral. At our institution, we encountered a patient with a supernumerary nostril that was located above the left nostril. We thus performed an operation on this supernumerary nostril and obtained good results and a successful postoperative course. We herein present our findings while also discussing the pertinent literature.

DOI： 10.1097/SCS.0b013e3181d879d8

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

We used peripheral nerve allografts, already employed clinically to reconstruct devastating peripheral nerve injuries, to study Schwann cell (SC) plasticity in adult mice. By modulating the allograft treatment modality we were able to study migratory, denervated, rejecting, and reinnervated phenotypes in transgenic mice whose SCs expressed GFP under regulatory elements of either the S100b (S100-GFP) or nestin (Nestin-GFP) promoters. Well-differentiated SCs strongly expressed S100-GFP, while Nestin-GFP expression was stimulated by denervation, and in some cases, axons were constitutively labeled with CFP to enable in vivo imaging. Serial imaging of these mice demonstrated that untreated allografts were rejected within 20 days. Cold preserved (CP) allografts required an initial phase of SC migration that preceded axonal regeneration thus delaying myelination and maturation of the SC phenotype. Mice immunosuppressed with FK506 demonstrated mild subacute rejection, but the most robust regeneration of myelinated and unmyelinated axons and motor endplate reinnervation. While characterized by fewer regenerating axons, mice treated with the co-stimulatory blockade (CSB) agents anti-CD40L mAb and CTLAlg-4 demonstrated virtually no graft rejection during the 28 day experiment, and had significant increases in myelination, connexin-32 expression, and Akt phosphorylation compared with any other group. These results indicate that even with SC rejection, nerve regeneration can occur to some degree, particularly with FK506 treatment. However, we found that co-stimulatory blockade facilitate optimal myelin formation and maturation of SCs as indicated by protein expression of myelin basic protein (MBP), connexin-32 and phospho-Akt. (C) 2008 Published by Elsevier Inc.

DOI： 10.1016/j.expneurol.2008.04.018

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Sensory nerve autografting is the standard of care for injuries resulting in a nerve gap. Recent work demonstrates superior regeneration with motor nerve grafts. Improved regeneration with motor grafting may be a result of the nerve's Schwann cell basal lamina tube size. Motor nerves have larger SC basal lamina tubes, which may allow More nerve fibers to cross a nerve graft repair. Architecture may partially explain the suboptimal clinical results seen with sensory nerve grafting techniques. To define the role of nerve architecture, we evaluated regeneration through acellular motor and sensory nerve grafts. Thirty-six Lewis rats underwent tibial nerve repairs with 5 mm double-cable motor or triple-cable sensory nerve isografts. Grafts were harvested and acellularized in University of Wisconsin solution. Control animals received fresh Motor or sensory cable isografts. Nerves were harvested after 4 weeks and histomorphometry was performed. In 6 animals per group from the fresh motor and sensory cable graft groups, weekly walking tracks and wet muscle mass ratios were performed at 7 weeks. Histomorphometry revealed more robust nerve regeneration in both acellular and cellular motor grafts. Sensory groups showed poor regeneration with significantly decreased percent nerve, fiber count, and density (p&lt;0.05). Walking tracks revealed a trend toward improved functional recovery in the motor group. Gastrocnemius wet muscle mass ratios show a significantly greater muscle mass recovery in the motor group (p&lt;0.05). Nerve architecture (size of SC basal lamina tubes) plays an important role in nerve regeneration in a mixed nerve gap model. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.expneurol.2008.04.012

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

End-to-side (ETS) nerve repair remains an area of intense scrutiny for peripheral nerve surgeon-scientists. In this technique, the transected end of an injured nerve, representing the "recipient" is sutured to the side of an uninjured "donor" nerve. Some works suggest that the recipient limb is repopulated with regenerating collateral axonal sprouts from the donor nerve that go on to form functional synapses. Significant, unresolved questions include whether the donor nerve needs to be injured to facilitate regeneration, and whether a single donor neuron is capable of projecting additional axons capable of differentially innervating disparate targets. We serially imaged living transgenic mice (n=66) expressing spectral variants of GFP in various neuronal subsets after undergoing previously described atraumatic, compressive, or epineurotomy forms of ETS repair (n=22 per group). To evaluate the source, and target innervation of these regenerating axons, nerve morphometry and retrograde labeling were further supplemented by confocal microscopy as well as Western blot analysis. Either compression or epineurotomy with inevitable axotomy were required to facilitate axonal regeneration into the recipient limb. Progressively more injurious models were associated with improved recipient nerve reinnervation (epineurotomy: 184 +/- 57.6 myelinated axons; compression: 78.9 +/- 13.8; atraumatic: 0), increased Schwann cell proliferation (epineurotomy: 72.2% increase; compression: 39% increase) and cAMP response-element binding protein expression at the expense of a net deficit in donor axon counts distal to the repair. These differences were manifest by 150 days, at which point quantitative evidence for pruning was obtained. We conclude that ETS repair relies upon injury to the donor nerve. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.expneurol.2008.02.031

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

Retrograde labeling has become an important method of evaluation for peripheral nerve regeneration after injury. We review the features of the commonly used retrograde tracers Fast Blue, Fluoro-Gold, and Fluoro Ruby in addition to the various application methods (conduit reservoir, intramuscular injection, and crystal powder application) and the techniques used to count stained neurons. Upon application of the staining techniques and dyes in a rat and mouse nerve injury model, Fluoro-Gold was found to stain the greatest number of neurons with all application methods. However, due to variability of staining intensity, neuron size, and background staining, it is difficult to count the stained neurons accurately. Fast Blue stains consistently using intramuscular injection in the mouse but fails to provide adequate staining using the muscle injection method in the rat model and shows high failure rates using the conduit reservoir technique. However, crystal dye application with Fast Blue to the cut nerve end provides excellent results. We believe that it is imperative to use the various tracers and application methods prior to their experimental use to develop a consistent standardized approach to retrograde labeling.

DOI： 10.1055/s-2007-992344

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objectives/Hypothesis: Anecdotal clinical findings suggest that denervated muscle may regain modest functional recovery via spontaneous collateral sprouts from intact adjacent nerve fibers. The current study evaluates the conditions needed for the denervated masseter muscle to induce axonal sprouting from the facial nerve. We hypothesize that epineurial injury is required to induce collateral sprouting toward a neighboring denervated muscle.
Study Design: Twelve thy1-yellow fluorescent protein-16 (thy1-YFP-16) transgenic mice whose axons express yellow fluorescent protein were allocated into six groups, with four degrees of facial nerve injury (intact, crush, transection, removed segment) with or without masseter denervation.
Methods: Animals underwent serial in vivo imaging analyses under the fluorescent microscope weekly for 5 or 7 weeks and were subsequently perfused for analysis. Masseter muscle acetylcholine receptors (AChRs) were stained with Alexa Fluor 594 conjugated a-bungarotoxin, and whole mounts were imaged with confocal microscopy.
Results: In groups with intact or crushed facial nerves, no evidence of collateral sprouting was demonstrated. Mice with transected facial nerve branches or removed segments demonstrated sprouting from the proximal stump into the denervated masseter. Staining of the AChRs confirmed that new neuromuscular junctions were established between the facial nerve and the denervated masseter.
Conclusions: This study suggests that epineurial injury is required to stimulate axonal sprouting into adjacent denervated muscle. Nerves with compromised epineurium may be useful in promoting neo-neurotization after muscle denervation.

DOI： 10.1097/MLG.0b013e31812383af

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

We propose that double-transgenic thy1-CFP(23)/S100-GFP mice whose Schwann cells constitutively express green fluorescent protein (GFP) and axons express cyan fluorescent protein (CFP) can be used to serially evaluate the temporal relationship between nerve regeneration and Scbwann cell migration through acellular nerve grafts. Thy1-CFP(23)/S100-GFP and S100-GFP mice received non-fluorescing cold preserved nerve allografts from immunologically disparate donors. In vivo fluorescent imaging of these grafts was then performed at multiple points. The transected sciatic nerve was reconstructed with a I-cm nerve allograft harvested from a Balb-C mouse and acellularized via 7 weeks of cold preservation prior to transplantation. The presence of regenerated axons and migrating Schwarm cells was confirmed with confocal and electron microscopy on fixed tissue. Schwarm cells migrated into the acellular graft (163 +/- 15 intensity units) from both proximal and distal stumps, and bridged the whole graft within 10 days (388 +/- 107 intensity units in the central 4-6 mm segment). Nerve regeneration lagged behind Schwarm cell migration with 5 or 6 axons imaged traversing the proximal 4 mm of the graft under confocal microcopy within 10 days, and up to 21 labeled axons crossing the distal coaptation site by 15 days. Corroborative electron and light microscopy 5 mm into the graft demonstrated relatively narrow diameter myelinated (431 +/- 31) and unmyelinated (64 9) axons by 28 but not 10 days. Live imaging of the double-transgenic thy1-CFP (23)/S100-GFP murine line enabled serial assessment of Schwarm cell-axonal relationships in traumatic nerve injuries reconstructed with acellular nerve allografts. (c) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.expneurol.2007.06.004

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Transgenic mice whose axons and Schwann cells express fluorescent chromophores enable new imaging techniques and augment concepts in developmental neurobiology. The utility of these tools in the study of traumatic nerve injury depends on employing nerve models that are amenable to microsurgical manipulation and gauging functional recovery. Motor recovery from sciatic nerve crush injury is studied here by evaluating motor endplates of the tibialis anterior muscle, which is innervated by the deep peroneal branch of the sciatic nerve. Following sciatic nerve crush, the deep surface of the tibialis anterior muscle is examined using whole mount confocal microscopy, and reinnervation is characterized by imaging fluorescent axons or Schwann cells (SCs). One week following sciatic crush injury, 100% of motor endplates are denervated with partial reinnervation at 2 weeks, hyperinnervation at 3 and 4 weeks, and restoration of a 1:1 axon to motor endplate relationship 6 weeks after injury. Walking track analysis reveals progressive recovery of sciatic nerve function by 6 weeks. SCs reveal reduced S100 expression within 2 weeks of denervation, correlating with regression to a more immature phenotype. Reinnervation of SCs restores S100 expression and a fully differentiated phenotype. Following denervation, there is altered morphology of circumscribed terminal Schwann cells demonstrating extensive process formation between adjacent motor endplates. The thin, uniformly innervated tibialis anterior muscle is well suited for studying motor reinnervation following sciatic nerve injury. Confocal microscopy may be performed coincident with other techniques of assessing nerve regeneration and functional recovery. (c) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.expneurol.2007.05.028

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Background: The technique chosen to reconstruct anterior lamellar defects of the upper eyelid requires careful consideration. We modified pre-existing techniques used to reconstruct anterior lamellar defects after tumour resection and have called this procedure a hemi-orbicularis ocuti switch flap.
Methods: This musculocutaneous flap is elevated with underlying orbicutaris and its base abuts the anterior (amettar defect. The flap, which is half the height of the defect, is elevated and inset to cover the defect. Then, taking into consideration the extensibility of upper eyelid skin, the remainder of the defect and the donor site are closed directly.
Results: Five patients with basal cell carcinoma, haemangioma, and xanthoma of the upper eyelid were treated by this method. All flaps survived and complications were minimal. Aesthetically and functionally good results were obtained by this method.
Conclusions: We have developed a surgical method for the reconstruction of anterior tametlar defects of the upper eyelid. The proposed method is technically simple and safe and provides consistent results for a potentially wide variety of upper eyelid turnours. (c) 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2006.11.017

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Language：English   Publisher：IOS PRESS  

End-to-side (ETS) nerve repair, in which the distal stump of a transected nerve is coapted to the side of an uninjured donor nerve, offers a technique for repair of peripheral nerve injuries where the proximal nerve stump is unavailable or a significant nerve gap exists. Details of animal models are explored including motor and sensory regeneration to further clarify the mechanism of collateral sprouting while eliminating false positive results from contaminating axons. Some experimental studies support the conclusion that sensory or motor reinnervation may be derived from collateral sprouting while others suggest that reinnervation requires an injury to the donor nerve. Clinical experience with ETS neurorrhaphy includes management of upper extremity nerve injury, facial reanimation, reconstruction following tumor ablation, and the prevention of neuroma formation. Our interpretation of the ETS literature suggests that sensory axons may sprout without deliberately attempting to injure them. while motor axons regenerate only in response to a deliberate injury. Experimental and clinical experience with ETS neurorrhaphy has rendered mixed results. Our interpretation of the literature suggests that the success of this technique is dependent upon axonal injury of motor and possibly sensory nerves. While continued clinical and laboratory experimentation with ETS nerve repair is warranted, it should not yet replace more established techniques of nerve repair.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Objective: Sensory nerve grafts are often used to reconstruct injured motor nerves, but the consequences of such motor/sensory mismatches are not well studied. Sensory nerves have more diverse fiber distributions than motor nerves and may possess phenotypically distinct Schwann cells. Putative differences in Schwann cell characteristics and pathway architecture may negatively affect the regeneration of motor neurons down sensory pathways. We hypothesized that sensory grafts impair motor target reinnervation, thereby contributing to suboptimal outcomes. This study investigated the effect of motor versus sensory grafts on nerve regeneration and functional recovery. Study Design: The authors conducted a prospective, randomized, controlled animal study. Methods: Fifty-six Lewis rats were randomized to seven groups of eight animals each. Five-millimeter tibial nerve defects were reconstructed with motor or sensory nerve grafts comprised of single, double, triple, or quadruple cables. Tibial nerve autografts served as positive controls. Three weeks after reconstruction, nerves were harvested for histologic examination and quantitative histomorphometric analysis. Wet muscle masses provided an index of functional recovery. Results: Nerve regeneration was significantly greater across motor versus sensory nerve grafts independent of graft cross-sectional area or cable number. Motor grafts demonstrated increased nerve density, percent nerve, and total fiber number (P &lt; .05). Normalized wet muscle masses trended toward improved recovery in motor versus sensory groups. Conclusions: Reconstruction of tibial nerve defects with nerve grafts of motor versus sensory origin enhanced nerve regeneration independent of cable number in a rodent model. Preferential nerve regeneration through motor nerve grafts may also promote functional recovery with potential implications for clinical nerve reconstruction.

DOI： 10.1097/01.mlg.0000229469.31749.91

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

We treated four patients with scaphocephaly using a combination of distraction and contraction techniques and achieved satisfactory results. Radial osteotomies in the frontal and occipital bones flattened these abnormal bossing bones and accelerated the disappearance of bony bumps created by distraction. This technique facilitates the achievement of the desired shape of the skull through fine adjustments of the distraction and contraction devices. (C) 2004 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2004.06.034

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Reconstruction for polysyndactyly of the toes aims at cosmetic improvement. A previous method that uses a skin graft has inherent disadvantages of mismatched pigmentation between the graft and the surrounding skin and scar formation at the donor site. The authors' new improved surgical technique for the treatment of polysyndactyly of the toes does not require a skin graft and therefore avoids these problems. The authors designed a subcutaneous flap from the distal portion of a rectangular flap of skin from the dorsal side of the interdigital webbing and moved the former flap to the sidewall of the base of a toe. Both flaps are the same size; therefore, an interdigital space had to be of sufficient size to accommodate both of them. To ensure an adequate blood supply to the flap, careful handling of the subcutaneous flap is essential for success. This procedure can apply to polysyndactyly of the fourth, fifth, and sixth toes when the fourth and fifth toes adhere over the distal side of the distal interphalangeal-joint and when the skin on the dorsal side of the fifth toe, regarded as the excessive one, is at lease twice the size of the dorsal rectangular flap. Ten patients with polysyndactyly of the toe were treated with this method. Aesthetically good results were obtained.

DOI： 10.1097/01.PRS.0000131882.19567.65

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The accurate diagnosis and treatment of posterior plagiocephaly have been a source of controversy. The unilateral lambdoid synostosis that is characterized by flattening of ipsilateral occipital bone is a rare type of craniosynostosis. An 8-month-old infant with unilateral lambdoid synostosis is reported. The patient exhibited right occipital flattening, mastoid bulge, and right frontal bone prominence, with the right auricle displaced anteroinferiorly on gross examination. A Towne projection radiograph of the skull and three-dimensional computed tomography scans revealed that the right lambdoid suture was prematurely fused. Correction of the cranial shape was performed using distraction osteogenesis combined with a barrel stave osteotomy. Significant improvement in the skull was observed 1 year after surgery.

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Recent evidence supports the use of end-to-side neurorrhaphy for the treatment of certain peripheral nerve disorders. However, the mechanism by which nerves regenerate following this procedure is still unclear. To address this question, the authors designed a new end-to-side coaptation model in rats in which the donor nerves were uninjured. The regenerated axons at the coaptation site were observed directly using fluorescent dye as the neural tracer. The sciatic nerve from adult Wistar rats was transplanted between the left and right median nerves. Fifteen rats were divided into three groups. In group I, the donor (right median) nerve was sutured end to side to the divided grafted nerve using a noninjury technique. In group II, the aponeurosis of the spinal muscles was harvested and the sciatic and right median nerves were coapted end to side noninjuriously by wrapping them in the excised aponeurosis. In group III, a perineurial window was created and a partial neurectomy was carried out at the suture site, after which the sciatic and right median nerves were sutured end to side. Sixty days after the operation, nerve regeneration was evaluated by recording action potentials in the grafted nerve, by performing electromyography in the flexor muscles in the forearm, and by histological examination. The grafted nerves were fixed and sectioned, the number of regenerated nerve fibers was counted, and axonal diameters were measured. Fluorescent dye crystal was used, in conjunction with confocal microscopy, to observe the regenerated axons at the coaptation site. The results showed that nerve regeneration had occurred in the animals, as determined electrophysiologically and histologically. Both the right and left flexor muscles of the forearm contracted simultaneously as a result of indirect electric stimulation of the grafted nerve, which suggests that the regenerated nerve was physiologically connected with the donor nerve. Nerve fiber counts did not show any differences among groups (p &gt; 0.05), but axonal diameters were significantly greater in group III than in the other two groups. Fluorescent dye staining revealed the presence of regenerated nerve fibers beyond the coaptation site. In group III, the regenerating nerves were observed within the whole section of the coaptation site and collateral sprouting was found to occur even at a site distal to the suture. From these results, the authors conclude that in end-to-side neurorrhaphy, nerve regeneration occurs by collateral sprouting from the donor nerve.

DOI： 10.1097/01.PRS.0000129075.96217.92

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：MEDIMOND S R L  

We treated seven patients with scaphocephaly by distraction osteogenesis with radial osteotomy. Modified Pi. osteotomy was performed; however osteotomizcd bone was not detached from underlying dura. Two distraction devices were placed in the parasagittal region bilaterally to expand skull width. In five patients out of seven reverse-distraction devices also were applied in the removed coronal suture to reduce in anteroposterior skull length. and achieved satisfactory results. Radial osteotomies in the frontal and occipital bones flattened these abnormal bossing bones and accelerated the disappearance of bony bumps created by distraction. This technique facilitates the achievement of the desired shape of the skull through fine adjustments of the distraction and contraction devices.

Web of Science

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Total pages：217p   Language：Japanese  

CiNii Books

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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：克誠堂出版(株)  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00398&link_issn=&doc_id=20230901080003&doc_link_id=%2Fad3ksgke%2F2023%2F006609%2F005%2F1020b1028%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2023%2F006609%2F005%2F1020b1028%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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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

皮膚悪性腫瘍に対する治療は形成外科の分野において最も重要な分野の1つとも考えられる.顔面に生じた悪性腫瘍については,その診断や切除,再建に至るまで質の高い治療を提供していくことが不可欠である.皮膚悪性腫瘍の切除は,腫瘍性状や発生部位に応じた検討は必須で,個々の症例に応じて再建法も異なる.再建法はUnit原理を背景にした術式選択が基本となるが,眼瞼や口唇といった遊離縁を有する部位では,その部位特有の再建法の選択も必要になる.今回は,顔面に生じる基底細胞癌や有棘細胞癌,悪性黒色腫といった代表的皮膚悪性腫瘍について,それぞれの診断法や術前検査,切除法や再建,術後の留意点など,術前・術中・術後の3つの観点からまとめた.(著者抄録)

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

80歳女性。心臓カテーテル治療後に腰部に紅斑が出現し、近医の皮膚科でステロイド外用剤による治療を受けるも改善せず、当科へ紹介となった。初診時、腰部正中のやや左側よりに80×75mm大の潰瘍が認められた。臨床経過や既往歴より患者は8年前に腰部脊柱管狭窄症に対する手術歴を有し、3年前からは複数回の心臓カテーテル治療が行われていたことが判明した。また、冠動脈病変の状況からRAO cranialでの放射線照射の時間が長い状況であったことも確認された。以上、これらの所見を踏まえて、本症例は放射線潰瘍と診断され、デブリードマンおよび潰瘍切除術を行い、術後6週で皮弁移植による再建術が施行された。だが、潰瘍は改善せず、2回目手術から6週間後に回転皮弁による再建術を追加した。その結果、術後は皮弁下の漿液腫が生じたが、OK-432局所注入を3回実施することで創の完全閉鎖が得られた。術後5年経過現在、潰瘍の再発はみられていない。

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Language：Japanese   Publisher：(株)メディカ出版  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J05810&link_issn=&doc_id=20220324140008&doc_link_id=issn%3D2185-7733%26volume%3D12%26issue%3D2%26spage%3D199&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D2185-7733%26volume%3D12%26issue%3D2%26spage%3D199&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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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)日本美容皮膚科学会  

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Language：Japanese   Publisher：日本末梢神経学会  

手術支援ロボットda Vinciが導入されて約20年の歳月が経過しようとしているが、本邦の手外科・末梢神経外科領域においては、いまだ臨床応用のめどが立っていない。da Vinciはさまざまな特性を有するが、手外科・末梢神経外科領域で使用するうえでの最大の利点は内視鏡下顕微鏡手術にある。これまでに経験したda Vinciを用いた内視鏡下顕微鏡手術の症例を報告するとともに、フランスでのRobotic Microsurgery Master Courseの研修内容を示す。また、本邦でも2019年8月より順天堂浦安病院手外科センターで定期的に開始しているシミュレータを用いた研修内容を報告する。最後に、世界のRobotic Microsurgeryの潮流についていくつかの提言を行う。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

皮膚悪性腫瘍の手術は、高齢化社会を迎えた現代において、形成外科の日常診療で最も重要な分野の1つと考えられる。とりわけ形成外科の主要臓器とも言える顔面に生じた悪性腫瘍については、質の高い診療を提供していくことが形成外科医に課せられた使命とも言える。皮膚悪性腫瘍の切除は、診療ガイドラインの充実で画一的な実施が可能になってきているものの、腫瘍性状に応じた検討は必須で、その理解は再建法にも繋がる。再建法はUnit原理を背景にした術式選択が基本となるが、眼瞼や口唇といった遊離縁を有する部位では、その部位特有の再建法の選択も必要になる。また、低侵襲治療を目指し独自の再建術式も考案している。今回は、顔面に生じる基底細胞癌や有棘細胞癌、悪性黒色腫といった代表的皮膚悪性腫瘍について、その診断に関する一般事項から切除・再建といった外科的治療の考え方について、自験例を提示しながらまとめた。今後の悪性腫瘍診療の一助になれば幸いである。(著者抄録)

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Language：Japanese   Publisher：日本顔面神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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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)日本皮膚外科学会  

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

基底細胞癌(BCC)は外鼻に最も多く発生することが知られているが、様々な組織型があることや局所破壊性、さらに外鼻という特有の形態構造の点から、切除マージンについては種々の報告がある。特にmorphea type BCCについては水平・垂直方向ともに浸潤性が強く、十分なマージンをもって切除を施行しても断端陽性となり、追加切除を要することが多い。また、外鼻は皮膚、軟骨・筋肉、粘膜が互いに隣接しながら3層構造を呈していることから、それぞれの部位や欠損に応じた切除ならびに再建術が必要となる。今回我々は、外鼻に生じた毛細血管拡張を主体としたmorphea type BCCにおいて、複数回の切除術の末に全層欠損を生じ、広範囲な外鼻再建を要した症例を経験した。症例提示を行いつつ、外鼻BCCに対するoncoplastic surgeryについて、morphea type BCCや外鼻再建を中心に報告する。(著者抄録)

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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=2019&ichushi_jid=J00398&link_issn=&doc_id=20190704190001&doc_link_id=%2Fad3ksgke%2F2019%2F006207%2F003%2F0709-0715%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2019%2F006207%2F003%2F0709-0715%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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

耳下腺腫瘍に対して耳下腺浅葉切除術と有茎広頸筋弁移植による耳下腺露出部の被覆を行い、術後2年以上経過した11例(男4例、女7例)を対象として、自覚症状の評価と頬部ならびに頸部の形態的評価を行った。手術時年齢は22〜73歳、腫瘍の最大径は20〜57mmであり、耳下腺欠損部を完全に被覆できた10例(90.9%)では、術後長期間が経過してもFrey症候群の発生はなく良好な形態が保たれ、非常に高い評価が得られた。一方、耳下腺欠損部を完全に被覆できなかった1例(9.1%)はFrey症候群と陥凹変形が生じ、長期的にも症状が変わることはなかった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00398&link_issn=&doc_id=20190403130008&doc_link_id=%2Fad3ksgke%2F2019%2F006204%2F012%2F0414-0421%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2019%2F006204%2F012%2F0414-0421%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本顔面神経学会  

顔面神経麻痺に対する動的再建法の一つに、側頭筋全体を前下方に前進させ鼻唇溝部に直接作用させるLengthening Temporalis Myoplasty法があり、同法は様々な利点を有するが、筋突起離断を要するなど、ある程度の侵襲を伴う。一方、Viterboらが報告したOrthodromic Temporal Flap(OTF)法は、筋突起を離断せずに側頭筋腱膜を外し、鼻唇溝との間に大腿筋膜を移植して笑いの再建を行う方法であり、低侵襲な手技と考えられる。今回、高齢の陳旧性顔面神経麻痺患者に対してOTF法を施行するとともに、Anderson法に準じた下眼瞼外反の再建(側頭筋の一部を下眼瞼縁に移行)も行い、良好な結果が得られたので報告した。

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Language：Japanese   Publisher：日本末梢神経学会  

形成外科は様々な末梢神経損傷の治療に携わるが、その中で最も大きな分野となるのが、顔面神経麻痺への再建術である。中でも、動的再建術は急性期〜亜急性期に施行する神経移植並びに神経移行術と陳旧例に施行する遊離筋肉移植並びに筋肉移行術に大きく分けられるが、単一motor sourceによる画一的な再建から、複数motor sourceの有効活用へと、その治療コンセプトも大きな変革を遂げている。顔面神経麻痺の再建が、四肢骨格筋の再建と異なった形で発展し得る背景には、顔面表情筋や顔面神経固有の特性が挙げられ、四肢では殆ど使用されない端側神経縫合が新たな術式の根幹となったり、複数のmotor sourceによる多重神経支配が同一部位の再建に利用可能といった大きな特徴を生じ、さらなる術式の発展をもたらしている。これらの発展は、Donor nerveへの侵襲の軽減とともに、動きの質の向上といったより良い結果を生み出すしているが、どのような表情が得られるかを予測することは未だ困難で課題も多い。今回は、顔面神経麻痺再建の現状と展望についてまとめ報告を行う。その特徴が他領域の発展にも繋がりゆくことを願って。(著者抄録)

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

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Language：Japanese   Publisher：日本美容皮膚科学会  

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

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Language：Japanese   Publisher：エーザイ(株)  

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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：日本顔面神経学会  

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

80歳男。30年前より左側腹部に黒褐色局面を認めるも放置し、数年前より徐々に増大してびらん、疼痛を伴うようになった。初診時、左側腹部に90×60mm、軽度隆起した境界明瞭、不整形な黒褐色の角化性腫瘤を認め、内部に40×30mmのびらんを伴っていた。生検で高分化型の有棘細胞癌が考えられたため、肉眼的腫瘍辺縁から10mmのマージンを確保し、潰瘍部直下は外腹斜筋筋膜下、その他は外腹斜筋筋膜上で切除した。病理所見では隆起した脂漏性角化症の最表層の基底層にBowen病の存在を認め、深層は脂漏性角化症が残存していた。脂漏性角化症に連続して比較的胞体の明るい細胞を所々に認め、上皮腫瘍様の増殖を示していた。その部分には核分裂像が散見された。脂漏性角化症の存在する部位はズボンのベルトが当たる位置であり、ベルト装着による慢性の機械的刺激が要因で上皮性腫瘍様の増殖が起こり、更に形質転換が生じBowen病が発症したと考えられた。経過は良好で、術後1年で再発は認めなかった。

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Language：Japanese   Publisher：日本末梢神経学会  

人工神経や無細胞化同種神経移植などの移植材料が、末梢神経外科の新たな手法として大きな注目を集める一方、それらの無細胞な移植材料に、いかに軸索伸張に必要なSchwann細胞(SC)や神経栄養因子を付加するかが今後の大きな課題となっている。今回我々は、端側神経縫合の手法を、無細胞神経に対するSCの供給手技として応用出来ないかと考え、2つの実験を施行した。一つ目の実験として、どのような端側神経縫合法が無細胞化神経に対する有効なSC細胞供給法になり得るかを検討した。また、二つ目の実験として、端側神経縫合を用いて無細胞化神経にSC細胞を遊走させたハイブリッド型神経が、移植神経としてどの程度有用かを検討した。その結果、無細胞化神経へのSCの遊走には、端側縫合時の神経上膜開窓が必要で、移植神経片側よりも両側へ端側神経縫合を行った方が、より効果的であった。また、効果的な遊走が可能であった両側端側縫合群による移植神経で、最も多くの再生軸索を得ることが出来た。端側神経縫合は無細胞化神経へのSC遊走手段として有用と考えられ、より多くのSC細胞の遊走が、無細胞神経の可能性をさらに拡げると考えられた。(著者抄録)

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

皮膚腫瘍切除後の欠損については、通常単純縫縮による創閉鎖が行われる。しかし、無理な縫縮で引きつれや拘縮を生じる場合や欠損が大きい場合には、局所の皮弁移植が適応となる。高齢者の増加により全身麻酔や入院を避ける場面もしばしばで、その場合には外来通院での施行が必要となる。外来での施行が可能な皮弁移植は、移動形態が比較的単純で、表層での操作により施行可能な局所皮弁が主となる。回転皮弁や伸展皮弁、皮下茎皮弁などが挙げられ、縫合創の方向によってはZ形成術を考慮する場合もある。回転皮弁や伸展皮弁では切開線がユニットの境界線に沿うなど、そのデザインが重要となる一方、VY皮弁の形態で主に施行される皮下茎皮弁では、その茎のとり方も施行の重要な要素となる。外来手術においても、皮弁移植の適切な施行がよりよい結果を生む一方、その選択には慎重な検討が必要で、単純縫縮や植皮との比較を念頭に置きながら、適応を決定していくことが重要である。(著者抄録)

CiNii Books

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

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

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

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

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

上口唇部動静脈奇形の小児3例と若年女性2例の計5例(3〜30歳)を対象に、塞栓硬化療法を行った後、必要に応じて外科的切除術を行う段階的治療を施行した。硬化療法は4〜7ヵ月の間隔で1〜3回施行(平均2.0回)し、nidusを消失または僅かな範囲に限局させることができた。硬化療法による全身的な合併症はなく、エタノールの使用による赤唇部wet lipの壊死を2例に認めた。2例のうち成人例の1例で、やや横長の壊死を生じ潰瘍化したが、保存的治療で軽快した。最終の硬化療法から5〜7ヵ月後に外科的切除術を行い、切除術まで至ったのは4例であった。手術による粘膜壊死等の大きな合併症はなかったが、赤唇部の知覚鈍麻を成人の2例に認めた。4例全例で口唇の形態改善が得られ、整容面の満足度は高かった。しかし、2例が再発し、うち1例(成人例)に約2〜3年の間隔で2回の硬化療法を追加した。

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017353244

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

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

末梢神経の縫合は、外傷や再建時の手技として非常に重要で、本邦における人工神経の実用化は、神経再建の幅をより興味深いものへと発展させている。神経縫合の手技には、適切な術野展開と損傷神経の同定、断端の新鮮化、神経上膜縫合を中心とした適切な顕微鏡下での縫合操作、後療法といった一連の流れがあり、それら1つ1つをしっかりと実践することが重要になる。また、端側神経縫合や神経移植といった手技についても、各々の軸索再生機序や適応に関する十分な理解が必要で、顔面神経麻痺再建においては端側神経縫合を様々な形で応用することにより、近年大きな発展を遂げている。本稿では、神経再生に関する基礎研究も含め、端々縫合、端側神経縫合、神経移植とそれぞれの縫合手技について、基礎的事項を中心に私見も交え解説した。神経縫合は日常診療の中で、既に確立された手技であるが、今後の手技施行にあたり、参考になる事項があれば幸いである。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017187080

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

CiNii Books

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Language：Japanese   Publisher：日本顔面神経学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

皮膚腫瘍診療において、適切な診断を行うための検査・手技手順は、最適な治療を導く道筋にもなるため非常に重要である。今回は、日常診療における診断過程ならびに必要となる検査・手技を段階的stepとしてまとめることで、より系統的に腫瘍診断に取り組むことが出来るのではないかと考えた。Step 1として、五感を用いた問診・視診・触診といった診察から始まり、step 2には局所診断を行う超音波・MRI・CT・ダーモスコピーといった検査をまとめた。Step 3には腫瘍に直接手を加える穿刺や生検といった手技が考えられ、step 4として最終的に治療を進める上で確認や精査が必要と考えられる病期分類のための検査や術前全身検査のポイントをまとめた。各々のstepを確認しながら、気をつけるべきポイントを整理して捉えることが重要で、より質の高い皮膚腫瘍診療を実現していくための1つのきっかけになればと考える。(著者抄録)

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

当施設で過去10年間に経験した上眼瞼皮膚悪性腫瘍切除後の再建術に関して調査を行った。2004年1月から2014年12月までを対象とし、症例は25例(男性10例、女性15例)、総手術件数27件、年齢は8歳〜88歳(平均67.8歳)であった。前葉の再建方法は単純縫縮9件、前額皮弁1件、V-Y皮弁1件、transposition flap 2件、sliding flap 6件、hemi-orbicularis oculi switch flap(HOOSF)4件、下眼瞼からのswitch flap 4件であった。単純縫縮、sliding flap、HOOSFによる再建において術後評価が高く、前額皮弁、transposition flapでそれぞれ1件ずつ整容面での修正術を要した。近年ではlateral canthotomyを併用した縫縮に加えHOOSFやsliding flapなど眼瞼への侵襲の少ない術式を積極的に用いており、術後の腫脹も軽微で、整容的にも良好な結果を得られている。(著者抄録)

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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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)日本皮膚悪性腫瘍学会  

46歳、男性。1年前より拡大する左耳介部の暗赤色、痂皮を伴う4.5×3.0cmの充実性腫瘤。病理組織は真皮に粘液湖が形成され、adenocarcinomaの乳頭状集塊が浮遊。免疫染色でCK7、CK20、GCDFP-15が陽性。CK5/6、Synaptophysin、Chromogranin Aは陰性。全身検索で他内臓悪性腫瘍はみられず、皮膚原発粘液癌と診断した。耳介の発症は稀。腫瘍切除および欠損耳介部の再建術を二期的に施行した。(著者抄録)

DOI： 10.5227/skincancer.31.168

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

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

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Language：Japanese   Publisher：日本レーザー治療学会  

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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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：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：日本顔面神経学会  

Lengthening Temporalis Myoplasty法(LTM法)は、側頭筋全体の神経支配を温存したまま有茎弁として前下方に前進させ、鼻唇溝部に直接作用させる顔面神経麻痺動的再建法である。症例は26歳女性で、3年前の妊娠初期にBell麻痺が生じ、薬物療法は見送られ、頬部の完全麻痺が残存した。柳原40点法では16/40点、House-Brackmann gradeはIV〜Vと考えられ、閉瞼機能は保たれているものの鼻唇溝部の動きは全く認めなかった。陳旧性麻痺に即した外科的治療の適応と考え、LTM法を施行した。アプローチは鼻唇溝切開を回避し、口腔内切開にて試みた。術後創部の経過は良好で、術直後から良好な形態改善が得られ、静的再建としての効果も高かった。また、顔の露出部分に瘢痕を残さないため、高い満足度が得られた。術後1年を経過し、静止時の良好な顔面形態が保持され、笑顔時の形態も良好である。

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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)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

今回我々は、縦隔内転移を生じた未分化多形型肉腫(undifferentiated pleomorphic sarcoma:UPS)、いわゆる悪性線維性組織球腫(MFH)の1例を経験した。症例は57歳、男性。52歳時に右大腿外側部に約13cm大の軟部肉腫を生じ、拡大切除術を施行した。しかし、術後1年半で右肺上葉に転移を生じ、右上葉部分切除術およびMAIDでの化学療法を施行するも、約半年後に転移巣の再発を認め、再び上葉部分切除術を施行。ICEでの化学療法を追加するも8ヵ月後に再発巣を認め、右肺上葉切除と縦隔リンパ節郭清術に加え術後放射線療法を施行。しかし、術後約1年で縦隔リンパ節への転移を認め、郭清術とともにカフェインでの化学療法を行うも、7ヵ月後に縦隔リンパ節腫脹から上大静脈症候群を生じ、3ヵ月後には心筋前壁への転移を認めた。様々な治療を行うも再発を繰り返し、最終的に縦隔内の心筋にまで転移を生じたが、軟部肉腫の縦隔内転移は稀であり、その経過や機序について文献的考察を加え報告を行う。(著者抄録)

DOI： 10.5227/skincancer.30.16

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Other Link： http://search.jamas.or.jp/link/ui/2015291551

Language：Japanese   Publisher：金原出版(株)  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2015287608

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

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Language：Japanese   Publisher：日本レックリングハウゼン病学会  

びまん性神経線維腫は血管に富み、血管壁とその支持組織が脆弱なため術中術後に出血量の多い腫瘍として知られている。今回我々は腰臀部に生じた巨大なびまん性神経線維腫の手術に際し、選択的動脈塞栓術(TAE)を含む種々の方法を併用して臨んだが、手技に不慣れな点があり、相当量の出血を余儀なくされた。この点を踏まえて第2回目の手術に際して、術前のTAEのあとに再度、追加のTAEを実施した。これによって、術中の出血量を大きく減少させることができたので報告する。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

＜ポイント＞1)皮膚軟部腫瘍におけるCT検査は、局所では骨への浸潤程度、全身的にはリンパ節や主要臓器への転移に対する評価に有用で、腫瘍の診断や術前精査には、各々の画像検査(超音波やMRIなど)の特性を踏まえた施行が必要である。2)術後経過観察としての画一的な画像検査の施行はCTも含め推奨されず、症例に応じた十分な検討が必要である。3)FDG-PETならびにPET/CTは、腫瘍の局在に加え、腫瘍の悪性度や治療効果の判定など他の画像検査では難しい腫瘍の質的診断が可能で、病期診断についても高い診断能を有するため、有効な使用を行っていく必要がある。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2015208412

Language：Japanese   Publisher：(株)全日本病院出版会  

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

1歳男児。左下肢奇形を主訴とした。出生時より多発奇形を認め、左下肢は左大腿基部と踵部の間で翼状片を呈し下肢の伸展は困難であった。下肢X線写真にて両側股関節の脱臼と左股関節形成不全、左腓骨および踵骨欠損を認めた。MRIでは坐骨神経様索状物が極度に短縮し、CT血管造影では左大腿動脈が膝関節部で途絶し下腿と足趾へは内腸骨動脈からの分枝で栄養されていた。1歳時に連続Z形成術を用いた翼状片解除術を施行した。手術には連続Z形成術よる皮膚の延長に加え、索状物と神経血管の十分な剥離操作を必要とした。脈管同定には赤外線観察カメラを用いたインドシアニングリーン蛍光法が有用であった。脈管系の剥離操作とともに下腿後面から足関節部に存在下強固な線維性癒合を解除することで、大腿から足関節部の距離は延長し翼状片の角度も改善した。術後の拘縮はなく、座位の保持とともにベビーカーの乗車が可能となって活動範囲を広げることができた。

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

4ヵ月男児。生下時より臀部に2cm大の赤色隆起性腫瘤を認め、近医皮膚科にて真皮内母斑疑いで経過観察となったが、腫瘤は増大し、出血を認めるようになったため、当科を紹介受診した。初診時、臀部正中に5×7cm、赤褐色の有茎性腫瘤を認め、表在超音波では腫瘍内部に高流速の樹枝状の血管網を認めた。先天性血管腫または乳児血管腫を考え、生後8ヵ月よりプロプラノロール内服およびドライアイス圧抵を行った。治療初期には腫瘍の縮小傾向を認めたが、その後の持続的な縮小はわずかで、大きさの変化も軽微であった。一方、体の大きさは成長し、相対的には縮小しているとも考えられたが、家族からは手術の希望が強く、最終的に切除術を行った。病理組織学的にBednar腫瘍と診断され、拡大切除を追加した。術後1年半の時点で再発は認めず、良好に経過している。

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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

急性期顔面神経麻痺に対し、われわれは舌下神経縦二分割移行法を考案し、その有用性について基礎的研究も加え検討を重ねてきたので報告を行う。症例はほとんどが聴神経腫瘍切除後の完全麻痺例で、麻痺出現後平均6.2ヵ月にて本手術を施行、8ヵ月以上の経過観察を行った36例について検討した。分割した舌下神経の選択は第1〜5期に分け誘発筋電図を用いるなどさまざまな選択法を試みたが、最終的な表情筋の回復は頭側で17例中16例、尾側で15例中15例と、頭尾側で有意差を認めず、回復しなかった1例は感染例であった。また、ansa cervicalisの使用例は回復が4例中2例と悪かった。舌萎縮についてはminimalが17例、moderateが14例と、ある程度の舌萎縮は生じたが、高度な舌の機能障害を生じた症例はなかった。このように、本術式は確実な表情筋の回復を得ることができ、分割したどちらの神経を利用しても差を生じないと考えられた。(著者抄録)

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

近年、鼻骨骨折整復術における術中超音波検査の有用性が報告されている。しかし、操作性に適したプローブに関して現在確立した見解は得られていない。今回われわれは、鼻骨骨折整復術時における術中の整復状態の評価にL字型プローブを用いて、術中超音波検査を連続した14症例に行った。結果は、全症例において短時間で正確な評価を行うことができ、手術時間の延長なく、鼻骨骨折後の腫脹した状態で視診や触診では評価が困難な症例においても良好な整復を確認することが可能であった。使用したL字型プローブは先端がきわめて小さく、鼻骨のような体表面に近い凹凸のある骨病変の描出にも優れており、整復後の状態を客観的にかつ、簡便に画像評価可能な方法として有用であると考えた。(著者抄録)

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Language：Japanese   Publisher：日本顔面神経学会  

顔面神経麻痺後10ヵ月以上経過して舌下神経縦二分割移行術(本術式)を行った3例の経過を紹介した。症例1は40歳男で、麻痺後10ヵ月に本術式を施行した。術直後からリハビリテーション(リハ)を開始し、術後9ヵ月時点で静止時の対称性並びに舌の動きに合わせた鼻唇溝部の動きを認め、術後2年でさらに良好な動きが認められた。症例2は54歳女で、麻痺後11ヵ月に本術式を施行した。術後1年で舌の動きに合わせた鼻唇溝部の動きを認めたが、術後3年以上経過後にリハを開始し、術後6年半経過時点で静止時の頬部の非対称性と下眼瞼の外反が残存した。症例3は34歳男で、麻痺後15ヵ月に本術式を施行した。専門医によるリハ科への通院が困難であり、術後11年後現在、静止時の左右非対称性は残存し、頻繁に流涙を認め、話しながら表情筋を動かすことは難しい状態である。

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Language：Japanese   Publisher：日本顔面神経学会  

顔面神経麻痺の再建に咬筋神経と舌下神経を併用した3例について検討した。2例は耳下腺癌の耳下腺全摘に対する即時再建例、1例は聴神経腫瘍術後の麻痺出現1年2ヵ月後の再建例であった。平均年齢は61.7歳、術後経過観察期間は平均36ヵ月であった。即時再建例では、いずれも咬筋神経を頬骨枝へ移行したが、術後3〜4ヵ月で強力な咬筋神経由来の随意運動を口角も含めた顔面全体に認められた。麻痺後1年2ヵ月の再腱例では咬筋神経を頬筋枝に移行したが、術後10ヵ月で有意な頬部の随意運動が認められた。しかし、いずれの症例も静止時の形態は改善されず、咬筋神経由来の動きが1年以上経過してもその傾向は変化しなかった。一方、舌下神経由来の動きは、即時再建例も含め術後1年8ヵ月〜2年と長期経過してから明らかとなり、静止時の対称性は舌下神経の再生が顕著になってから改善する傾向を示した。

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

顔面神経麻痺に対する神経再建術は、端側神経縫合の有用性が再評価されて以来、多くの新たな術式やコンセプト、さらに神経再建用語を生み出し多様化し続けている。多くの術式や研究が日本の形成外科から発信され、この分野での創造性の高さを示す一方、その妥当性や適正な使用法について統一的な見解を示す必要があると考えられた。今回われわれは、「端側神経縫合」、「縫合」と「吻合」、「流入型端側神経縫合」、「ネットワーク型神経再建」、「クロスリンク手術」、「ループ型神経移植」、「neural signal augmentation/axonal supercharge」、「bi-directional nerve regeneration」、「neurotization」といった神経再建の骨幹となる神経再建用語やコンセプトについて検討を加え、それらに対する確認や定義づけを行った。われわれの考える統一的な見解を「Fukushima提言」とし、ここに記す。(著者抄録)

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

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

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Language：Japanese   Publisher：(株)全日本病院出版会  

麻痺性兎眼に対する上下眼瞼への静的再建術について、上眼瞼Levator lengthening法(LL法)を中心に、その手法の実際や注意点、施行のコツなどをまとめた。LL法は、挙筋腱膜を筋膜移植により延長して閉瞼しやすくする手法だが、移植材料に軟骨を用いることで、より良好な結果が得られている、ただし、軟骨の止め方一つで結果が左右されるなど、手術操作そのもので得られる効果が異なるため、症例毎の検討が必要と思われた。ゴールドプレートについては、長期埋入例における露出や形態の顕在化例をLL法施行例中にも経験し、今後混合医療の導入が進んだとしても、合併症を踏まえた使用法を検討すべきと思われた。下眼瞼変形に対する修正については主にKS法を施行してきたが、上眼瞼よりも下眼瞼への修正がより重要となることもしばしばで、上下眼瞼を合わせた系統的な手術適応の検討を今後行っていく必要があるのではないかと思われた。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014336656

Language：Japanese   Publisher：金原出版(株)  

症例は86歳女性で、1ヵ月前より右下腿に皮下結節が出現し、徐々に増大したため、当科を受診した。受診時、右下腿後面に径1cm、表面常色でドーム状に隆起した皮下結節を二つ触知し、右側の結節を全切除生検し、病理組織学的に粘液線維肉腫と診断した。前回の切除瘢痕と左側の結節の辺縁からそれぞれ2cm離し、脂肪織全層で一塊にして拡大切除したが、断端陽性であったため、計3回の追加切除を要した。術後は筋皮弁移植部の壊死および足趾、足外側の阻血性変化を生じ、下肢動脈造影にて大腿動脈の血栓による完全閉塞を認めたため、Fogartyカテーテルによる血栓除去術を施行して膝窩動脈まで血行再建を行った後、下腿切断術を施行した。切断肢断端の腫瘍細胞は陰性で、切断術後3ヵ月経過した現在、再発・転移は認めない。

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014353915

Language：Japanese   Publisher：(株)全日本病院出版会  

J-GLOBAL

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

顔面神経麻痺性兎眼の10例に対し移植材料を軟骨に変更したlevator lengthening法を施行した。手術は他部位への手術を同時施行したものが多く、併用手術は眉毛挙上術が6例、下眼瞼変形の修正が7例に行われ、眉毛挙上+下眼瞼修正の両方を行ったのは6例であった。全例で目の乾燥症状や疼痛などの症状改善を認め、角膜の露出を生じない程度の閉瞼を得ることができた。開瞼時の瞼裂高(上下目瞼縁間の距離)は、患側が若干下垂気味になる傾向があったが、修正を要した2例を除き、気になるとの訴えはなかった。閉瞼時に残存する開瞼幅は平均1.8mm、開瞼時の瞼裂高の左右差は平均1.5mmで、眉毛挙上+下眼瞼修正例では各々2.0mm、1.8mm、単独施行例では1.3mm、1.0mmであった。移植軟骨の位置修正を要したのは4例であった。術後感染、移植軟骨の違和感などの合併症はなく、ゴールドプレートの露出・摘出例においても感染はなく、重瞼線の再建も可能であり満足度は高かった。

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014377430

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

当科にて過去15年間で施行した顔面神経麻痺静的再建術の統計的な検討を行った。1998年1月から2012年12月までを対象とし、症例は男性79例、女性87例の合計166例で、総手術件数は188例、年齢は9〜92歳(平均年齢60.4歳)であった。手術術式は眉毛挙上術108例、上眼瞼形成術81例、下眼瞼形成術62例、口角・下口唇形成術32例であった。眉毛挙上術では骨膜固定法への付加的手技の追加により再発までの期間が延長された。上眼瞼形成ではゴールドプレート埋入術が2007年まで施行され、合併症は50.7%と高率であった。下眼瞼形成では再手術となった症例は少数だったが、それらの症例には複数回の手術が必要となった。また、頬部の静的再建では症例数は限られていたが、静止時の対称性は経年的にも保たれていた。下口唇変形に対して近年になってDouble fascia graftが行われ一定の効果が得られていた。(著者抄録)

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Language：Japanese   Publisher：(株)学研メディカル秀潤社  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本顔面神経学会  

移植材料を軟骨にして眼瞼挙筋の延長をはかるLevator lengthening法を施行し、眉毛挙上術の同時施行例について検討を行った。対象は顔面神経麻痺性兎眼の4例で、全て麻痺後5年以上の陳旧例で、ゴールドプレートの露出を1例に認めた。全例に下眼瞼に対する外反修正を施行し、2例に頬部の動的再建としてTemporal Myoplastyを同時施行したが、それらの症例については、Anchoring Suture法を用いた眉毛挙上術となった。その結果、4例全てで角膜の露出を生じない程度の閉瞼が得られた。開瞼時の瞼裂高の左右差は、患側が若干下垂気味で、疼痛や角膜刺激症状といった症状は全例で改善したが、1例で流涙の残存が認められた。また、眉毛挙上を併用することで、経時的に改善するものの重瞼線の幅が術後広くなる印象があった。手術による瘢痕拘縮や移植軟骨の変形に伴って生じる可能性のある経時的な眼瞼位置の変化は特に認められなかった。

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Language：Japanese   Publisher：日本顔面神経学会  

過去10年間に当科で顔面神経麻痺に対し神経移行術ならびに交差神経移植術を行った17例について検討した。手術時年齢は平均54.1歳で、60代でピークを示した。原因疾患は聴神経鞘腫が全体の58.8%を占めた。年代ごとの神経移行術の傾向としては、2007年以前は舌下神経縦型二分割移行術を主に施行されており、2008年以降はクロスリンク型神経移植術、2009年以降はjump graftや咬筋神経移行術など舌下神経縦二分割移行術以外の神経移行術が行われていた。主な合併症として、舌下神経縦二分割移行術では軽度から中等度の舌萎縮を認めたが、嚥下や構音障害といった舌の機能障害はみられなかった。一方、jump graftやクロスリンク型神経移植術では舌萎縮を認めなかった。知覚神経採取例では術直後は支配領域の知覚障害や歩行障害を認めたが、長期経過中に知覚障害や歩行障害の改善がみられた。

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Language：Japanese   Publisher：日本顔面神経学会  

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Language：Japanese   Publisher：日本顔面神経学会  

過去10年間に当科で施行した眼瞼周囲の顔面神経静的再建術115例について検討した。その結果、平均年齢は61.8歳で、男女差はなかった。疾患は頭蓋内腫瘍と耳下腺悪性腫瘍で45%を占め、突発性およびウイルス性は16%にとどまった。眉毛部では骨膜固定に対する付加的手技の追加により再発までの期間の延長がみられ、その有用性が示唆された、上眼瞼ではGold plate挿入術の合併症は43.3%と、過去の報告と同様に高率であった。下眼瞼ではK-S法のみで多くの症例で改善がみられ、再手術を要したのは11.4%と少なかったが、再手術例では複数回の手術が必要となる傾向が示された。

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Language：Japanese   Publisher：日本末梢神経学会  

顔面神経麻痺に対する動的再建術は、急性期〜亜急性期例に対する神経移植や神経移行術並びに陳旧例に対する筋肉移植や移行術に分けられ、古くから様々な術式が考案されてきた。当科では、急性期並びに亜急性期の症例に対し、舌下神経縦二分割移行術を考案し術式の変遷を重ねながら施行してきた。さらに、端側神経縫合について様々な基礎的研究を行い、近年の顔面神経再建に応用している。当科で施行してきた神経移行術をまとめると、顔面神経本幹を切断した上での舌下神経縦二分割移行術から、近年では端側神経縫合のコンセプトを取り入れたJump graftや新たなNeural sourceとしての咬筋神経の移行、さらに末梢枝への神経移行の試みなど様々な術式をとり入れ多様化してきた。一方、陳旧例に対しては、以前から遊離筋肉移植術を施行してきたが、近年では側頭筋全体を前方移動して直接鼻唇溝部に作用させるTemporal myoplastyを用いる様になり、良好な結果を得ている。今回我々は、当科で施行してきた顔面神経麻痺動的再建術の歩みを振り返るとともに、各々の結果や問題点、そして今後の展望などについてまとめ報告を行う。(著者抄録)

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

63歳女。主訴は左上眼瞼腫脹であった。MRIでは左上眼瞼皮下全体にT1強調像で低信号・T2強調像で中等度信号の病変を認め、境界は不明瞭で眼窩内および涙腺におよぶ腫瘤を認めた。生検では黄色腫の診断で、全身麻酔下に左眼瞼部の腫瘍摘出術を施行し、挙筋腱膜上で可及的に摘出したが残存した。徐々に再発を認め術後1年には左上眼瞼の腫脹が著明となり右眼瞼の腫脹も認めたため、再度手術を施行し腫瘍切除および右上眼瞼の挙筋短縮術を施行した。病理組織学的所見では最終的に黄色肉芽腫の診断となった。2回目の手術後も徐々に再発を認めたため、トリアムシノロン局注2〜12mg/回を計6回上下眼瞼腫瘤部に施行した結果奏功し、11ヵ月後に病変はほぼ消失した。最終局注から1年半経過して再発は認めていない。

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Language：Japanese   Publisher：(一社)日本手外科学会  

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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)日本マイクロサージャリー学会  

急性期顔面神経麻痺に対する舌下神経縦二分割移行術について検討した。手術を施行したのは、脳腫瘍切除後に顔面神経の完全麻痺となり、自然回復が期待できないと判断した37例を対象とした。手術は舌下神経縦二分割移行術に加え、麻痺出現後半年以内の症例を中心に25例に腓腹神経を朋いた顔面交叉神経移植術も同時施行した。舌下神経とAnsa cervicalisはそれぞれ、33例と4例で用いられた。舌下神経を用いた症例では32例と、ほぼすべての症例で表情筋の回復を得ることができた。移行した舌下神経の頭尾側選択に伴う回復率は、頭側で16/17、尾側で16/16と、頭尾側とも差を認めなかった。ただし、Ansa cervicalisを使用した4例は2/4と回復率は良好といえなかった。高度の嚥下・構音障害をきたしたSevere atrophyは認めなかった。

DOI： 10.11270/jjsrm.26.61

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

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Language：Japanese   Publisher：(株)全日本病院出版会  

内眼角部は、内眥靱帯や涙道機構といった特殊な構造を有し、先端が突出し周囲に円形の陥凹を呈するといった特徴的な形態を有する。基底細胞癌をはじめ様々な皮膚腫瘍が良悪性を問わず好発する部位であるが、顔面の中央で眼瞼特有の薄い皮膚を有し、余剰皮膚も少なく、無理な縫縮は変形や兎眼などの醜形を生じることもある。そのため、生じた腫瘍をどのような方法および範囲で切除を行い、形態や構造をふまえた上でどのように再建するかの決定ならびに実践には、十分な理解と経験が必要と考えられる。今回我々は、内眼角部に生じた皮膚腫瘍の中から、当院で手術を行い検討を要したいくつかの症例を呈示するとともに、内眼角部に好発する基底細胞癌などに対するoncologicalな側面と各々の構造に応じた再建に関するreconstructiveな側面についてまとめたので報告を行う。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2013222882

Language：Japanese   Publisher：(株)全日本病院出版会  

皮膚外科手術の基本手技は、皮切デザイン、局所麻酔、皮膚切開、腫瘍切除、縫合閉創といくつかのステップに分けられ、各々にだれもが知るべき基本的事項とともに、経験に基づくコツや暗黙知的な感覚も存在する。皮切デザインでは、切開線の基本となるrelaxed skin tension line(RSTL)よりも、aesthetic unitに沿って行うほうがよいと考えられる部位が顔面には存在したり、縫合閉鎖では、真皮縫合の必要性やopen treatmentの適応など、状況に応じた総合的な判断が必要になる。本稿では、特に皮膚外科手術にこれから積極的に取り組もうとする医師に対して、筆者自身が重要と考えるポイントや大切にしているコツなどについて、各々のステップごとに具体的に呈示し、スキルアップポイントとしてまとめたので報告を行う。(著者抄録)

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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)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

DOI： 10.5227/skincancer.27.275

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

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2013132011

Language：Japanese   Publisher：日本顔面神経学会  

顔面神経の走行には個人差があり、手術時に顔面神経を同定することが困難なケースもしばしばある。今回著者等は、術前に顔面神経の走行評価が必要と判断された症例12例に対し、経皮的神経刺激装置(以下A)を用いて同評価を行った。12例の内訳は、耳下腺腫瘍4例、皮下腫瘍3例、下顎骨骨折2例、表皮母斑1例、先天性顔面神経不全麻痺1例、皮膚悪性腫瘍1例であった。評価の結果、Aを用いたことにより全例で目的とする神経の走行を予測でき、術中に神経の確認が行えた症例では術前のマーキング直下で神経を同定することができ、術前予測と実際の神経位置との誤差はほとんどなかった。術前に顔面神経の位置を同定することは顔面神経再建や腫瘍切除時のプランニングにおいて非常に重要であり、円滑な手術や合併症の軽減につながると考えられた。

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Language：Japanese   Publisher：日本顔面神経学会  

陳旧性顔面神経麻痺における笑いの動的再建法の一つに、側頭筋全体を脱神経せずに有茎弁として口唇部に直接作用させるTemporal Myoplasty法(以下TM法)があり、様々な利点から本邦でも注目を集めているが、頬骨弓の離断や筋膜の届きにくさといった手技上の煩雑さから未だ一般的にはなっていない。著者等はTM法の変法として、鼻唇溝部の切開により筋突起の切断を行う方法を考案し、従来法よりも低侵襲な手法となったが、本術式の安全かつ円滑な施行にはさらなる検討が必要と思われる。そこで今回、屍体解剖を通してTM変法のポイントを明瞭化することを試み、以下の示唆を得た。1)側頭筋膜の牽引する入り口は限られたスペースであり、鼻唇溝から筋突起への距離を考えると、側頭筋を充分に挙上するだけでなく、側頭筋自体を引き伸ばす伸展手技が必要不可欠である。2)鼻唇溝からの展開については、筋突起が咬筋起始部前縁の後方に隠れるように存在することから、皮下浅層の剥離を頭側中心に行い、咬筋筋膜の付着する頬骨突起下縁に沿って剥離を進め、咬筋起始部前縁の筋膜を1cm程度切開することで、筋突起の同定が容易になる。

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Language：Japanese   Publisher：日本顔面神経学会  

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Language：Japanese   Publisher：日本顔面神経学会  

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Language：Japanese   Publisher：日本顔面神経学会  

当院では下口唇変形の陳旧例に対する治療法として、Udagawaらが報告した2本の筋膜移植による静的再建術を施行している。今回、その手術手技について紹介するとともに、本法を施行した患者5名にアンケートを行い、手術に対する満足度などについて調査した結果を報告した。アンケートの内容は、開口時・静止時・笑顔時の下口唇形態と、下口唇そのものの固さや違和感、赤唇部の形態などについて、「大変満足」を5点、「やや満足」を4点、「満足」を3点、「やや不満」を2点、「とても不満」を1点とする5段階評定で回答してもらうとともに、その他コメントなどについても記載してもらった。結果、下口唇形態についての評価は開口時が平均3.2点とわずかに「満足」以上となったが、静止時と笑顔時の評価はそれぞれ平均2.4点、2.6点にとどまった。赤唇部の形態は平均2.25点で最も低い評価となり、下口唇の厚みが「手術側で厚い」と訴えた人が3名(60%)いた。また、「大きな口が開けられない」「治療しているとさらに欲が出るのでなかなか満足とはいえない」などのコメントもあり、良好な満足度を得る難しさを改めて感じさせられた。

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

症例は55歳男性で、12年前からあった右大腿後面の腫瘤が増大傾向となって受診した。同部に9×5cm大で皮膚との可動性は良好だが、下床との可動性が乏しい弾性軟の皮下腫瘤を触知した。MRIで右大腿二頭筋・半膜様筋の筋間から筋内に9×5×4cmの多結節状で境界明瞭な腫瘤を認め、T1強調で筋と等信号、辺縁に一部脂肪信号を呈し、T2強調で高信号、内部に索状構造を認め、腫瘤内部に強い造影効果が認められた。生検で成熟脂肪細胞の増生を主体に粘液腫状変性を伴い、間質に毛細血管の増加を認め、粘液変性を伴った脂肪腫の診断で摘出術を行った。摘出標本は9×5×4cm大の表面平滑、黄色調、充実性の弾性やや軟な脂肪様組織であった。病理所見では、成熟脂肪細胞の増殖を主体に、粘液状基質内に紡錘形細胞の増殖を認め、CD34染色陽性からSpindle Cell Lipomaと診断された。術後6ヵ月経過で再発は認めていない。

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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  

症例は1歳10ヵ月女児で、生下時より胸腰椎型脊髄髄膜瘤を認め、脳神経外科で硬膜の再建を行い、直径45mmの皮膚欠損に対し形成外科で閉鎖術を受け、再建はV-Y前進皮弁と縦型双茎皮弁の複合皮弁を用いた。患児の麻痺レベルはTh12で、Sharrardの1群に相当し、両下肢運動障害と直腸膀胱障害を認めていた。術後経過良好であったが、感冒による脱水と長時間の臥床による脊椎突出部への圧迫のため、皮弁正中手術瘢痕部に骨露出を伴う直径30mmの褥瘡が発生した。全身状態の改善を待ち、潰瘍発見22日目にデブリードマンと突出した脊椎の除去を行った後、生じた50×38mmの皮膚欠損に対し、前回同様の複合皮弁による再建術を施行した。前回の切開創痕を皮膚切開し、穿通枝を温存しつつ広背筋筋膜下で皮弁を剥離挙上し、皮膚欠損を閉鎖した。術後正中縫合部に縫合不全を僅かに生じたが、約2週間で保存的に治癒した。術後2年経過し、再発はない。

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Language：Japanese   Publisher：静岡県整形外科医会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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

症例は49歳女性で、左後頭部にある直径1cm大の皮下腫瘍に対し、切除術を受け、結節性筋膜炎と診断された。その後、再発し、増大傾向を認めたため受診した。左後頭部に15×15mm大の弾性硬、境界明瞭な下床との癒着を認めない可動性良好な皮下腫瘍が認められた。CTで一部に毛羽立ち様の濃度上昇を伴った22×17mmの皮下腫瘍を認め、MRIで皮下脂肪層にT1強調画像で低輝度、T2強調画像で等輝度を呈す境界明瞭な腫瘍像が認められた。結節性筋膜炎の再発を疑ったため、単純切除し確定診断することとした。全身麻酔下に前回の手術痕を含むように皮膚と共に腫瘍の単純切除術を行った。頭皮直下に周囲組織と癒着のない境界明瞭な30×20×15mmの弾性硬で黄色多房性の皮下腫瘍が認められた。病理診断の結果、紡錘形の腫瘍細胞の核は腫大し、楕円形で、極めて多くの核分裂像を認め、一部では異型核分裂がみられた。各種抗体を用いた免疫染色でアクチン染色が陽性で、c-kit recepter、S-100・デスミン、ケラチン、CD34が陰性であった。以上より、表在性の平滑筋肉腫と診断した。筋膜ないし瘢痕性に癒着の強い大後頭隆起周辺で骨膜も一部含め拡大切除を行った。二期的に分層植皮で再建を行った。術後9ヵ月経過したが腫瘍の局所再発や遠隔転移は認めていない。

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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Language：Japanese   Publisher：日本顔面神経学会  

48歳女。約11年前に聴神経腫瘍切除術後に左顔面神経麻痺となり、すぐにGold plateによるLid loadingを施行した。徐々にGold plateの形態が目立つ様になり、約2年前の再診時には、一部が突出し露出しかけた状態で角膜刺激症状も強かった。そこで、側頭筋膜を用いたLevator lengthening法での修正を施行して経過良好であったため、完全麻痺となっている頬部の笑いの再建も希望した。術後創部の経過は良好で、頬部の腫脹も強くなく、鼻唇溝から鼻翼までの良好な静止時の形態を保つことが出来、術直後から静的再建としての改善が得られた。術後2ヵ月頃から側頭筋の収縮を認め、術後4ヵ月でその動きは顕著になった。口角下制筋麻痺の再建を施行した。その後の経過は良好で、術後すぐに側頭筋の収縮を認め、下口唇の形態改善に伴いバランスの良い表情が再建出来た。

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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

43歳女。18年前に交通事故にて頸椎損傷を受傷し対麻痺となり、車椅子を用いて日常生活を送っていた。6年ほど前から左坐骨部に褥瘡を生じ、保存的加療を続けていたが、感染を生じ急速に増悪し難治であった。全身麻酔下に坐骨結節の平坦化も含めたデブリードマンおよび後大腿皮弁の移植を行った。創部にリモイスパッドを貼付し保護したうえで、術後4週から車椅子の騎乗を可とした。しかし、車椅子騎乗再開後1週で、創部の皮弁縫合部の尾側端および内側に約1cmのし開を生じた。局所麻酔下に創閉鎖を行うも、術後1週ですぐに創離開が再発し、再縫合が必要となった。車椅子への移乗法を再騎乗の前に確認した。非常に大きな剪断応力が手術創にかかり、創離開・再発の明らかな原因と考えた。独自に移乗板の作製を行った。独自の移乗板を用いたプッシュアップ移乗を練習しながらリハビリを進め、2週後も創部に問題ないことを確認して、退院した。

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Language：Japanese   Publisher：(株)中外医学社  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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

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Language：Japanese   Publisher：順天堂医学会  

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

21歳男。幼少期から自身の左下腿に「膝までで完成している足に余分なものがついている」ような違和感、また四肢切断者に対する羨望意識があり、メンタルクリニック科で身体完全同一性障害と診断されていた。今回、自身の左踵部に約6時間ドライアイスを当て続けて凍傷を受傷し、保存的治療に抵抗性のため当科紹介となった。患者は治療に協力的であったが、左足関節からの切断、義足による歩行機能再獲得を希望した。家族は患肢温存を希望し、倫理的観点からも温存の方針として患者本人にインフォームドコンセントを行い、了承を得て手術を行った。初回手術としてデブリードマンを行い、広範な皮膚欠損と踵骨荷重部およびアキレス腱の踵骨付着部の欠損が生じたため、創部の清浄化を図った上で二期的に逆行性腓腹皮弁による踵部再建を行った。術後6ヵ月経過し、足関節可動域はほぼ正常で、足底板を用いた自立歩行が可能である。なお、自身の下腿に対する違和感は変化していないが、再度の自傷行為は希望していない。

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：日本顔面神経学会  

顔面神経麻痺性兎眼に対する代表的な治療法としてゴールドプレートによるLid loading法があるが、本法はプレートの露出や形態の透過といった材料に起因する合併症や、自費材料の扱いによる混合医療の問題から、その代替となる手術が待ち望まれている。今回著者等は、フランスのPaul Tessierによって1969年に考案されたLevator lengthening法(挙筋腱膜を筋膜移植することで延長し、上眼瞼の閉瞼を容易にする方法)を7例に施行し良好な結果が得られたので、手術方法を紹介し、代表例を提示した。本法は低侵襲で簡便であり、有用な方法と考えられたが、完全閉瞼を得ることは難しく、角膜が覆われる程度の閉瞼にとどまることもあるため、下眼瞼の外反がある場合にはその修正が必須であり、点眼薬の継続も必要と思われた。

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

63歳男。右眼瞼周囲の疼痛を自覚し、39℃の発熱と著明な炎症反応を認め、それに伴い既往の心不全が増悪したため循環器内科に入院となった。入院4日目より右上下眼瞼の急速な発赤、腫脹が出現し、培養検査でA群β溶連菌が検出された。創部は発赤・腫脹が強く、筋膜の壊死が正常皮膚を越えるよう進展し、排膿も認めた。壊死性筋膜炎を疑い、壊死組織を可及的に除去してデブリードマンを開始した。以後全身状態の改善が得られ、受診3ヵ月後には良好な肉芽形成も認めた。再建は、まず局所麻酔下に眼瞼周囲、頬部と耳前部に植皮術を計2回行った。その後、全身麻酔下に正中前額皮弁を下眼瞼に移植した。生着は良好であったが、完全閉瞼は困難で、下眼瞼の外反も認め、上眼瞼への正中前額皮弁移植と下眼瞼への耳介軟骨移植を行った。皮弁の遷延術、切り離しを含め計7回の手術を行い、植皮、皮弁とも生着は良好であった。術後7ヵ月で完全閉瞼は困難であるが、経過は良好である。

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

重症虚血肢に発生する難治性創傷は,通常の植皮術や皮弁移植術のみでは対応困難なことが多い。われわれは,現行の治療法では治療不能とされてきた最重症例に対し,種々の再生治療を応用した創傷治療を実施し良好な結果を得てきたので自験例を紹介しつつ,難治性創傷治療に果たす形成外科の今後の役割について述べる。現行の治療手段では救肢困難な虚血性下肢難治性潰瘍患者を対象に,自家骨髄細胞ないしは徐放型塩基性線維芽細胞増殖因子を用いて血管再生治療および創傷再生治療を実施した。創傷の閉鎖は自然な創収縮や上皮化を期待するか,追加植皮を行った。その結果,多くの症例で創閉鎖および自立歩行による退院を達成した。われわれの経験した治療手法は救肢率の向上に寄与していることが分かったが,これらを達成するためには他科との連携した集学的治療を実践するとともに,形成外科医も手術のみならず種々の治療手段を動員することが今後重要になると思われた。(著者抄録)

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

腋臭症手術において、イソギンチャク型タイオーバー固定法と命名した、覆布テープを用いたタイオーバーによる独自の固定法を考案し、その経験を報告した。腋臭症患者18例36部位を対象とし、全症例にイソギンチャク型タイオーバー固定法を施行した。合併症として軽度の血腫、膿瘍が1例(同一症例の片側)に生じたが、外用療法のみで術後2ヵ月で上皮化は完了し瘢痕は残らなかった。その他、皮弁部分壊死、テープによる接触性皮膚炎(発赤、そう痒、水疱)をきたした症例はなく、再縫合や植皮などの二期的手術は不要で、合併症を最小限に抑えることができた。

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Other Link： http://search.jamas.or.jp/link/ui/2010321721

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

深部脳刺激電極埋め込み術における皮膚合併症について検討した。パーキンソン病で深部脳刺激療法(DBS)を行った28例中、皮膚合併症を起こした4例(143%)を対象とした。手術は、頭部皮膚潰瘍に対してはデブリードマン、リード線の固定、創部の単純縫合または局所皮弁による閉創を行った。また、前胸部皮膚潰瘍に対しては、刺激装置の挿入部位を皮下から大胸筋膜下、または大胸筋下として再挿入を行った。4例中3例では術後皮膚潰瘍の再発はなく経過良好であるが、1例は頭部皮膚潰瘍再発に対し6回の手術を行ったが治癒は得られず、DBS挿入術後22ヵ月で片側のシステムを抜去した。全例においてDBSの効果は皮膚合併症治療後も良好であった。

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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)日本形成外科学会  

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

シリンジ陰圧法による血腫除去の有用な使用法とその作用機序について検討した。家兎を用いて、ケタミンとキシラジンの混合麻酔による全身麻酔下に、手術手技および血腫除去を施行した。吸引法により、血腫部を18G注射針で吸引したものをI群、18G注射針で穿刺し穴を開けたのちにシリンジ陰圧法を行ったものをII群、血腫部皮膚に5mmの割を入れ18G注射針で吸引したものをIII群、血腫部皮膚に5mmの割を入れシリンジ陰圧法で吸引したものをIV群とした。I群では少量の血腫が吸引できたのみで、III群では陰圧を生じなかった。IV群では、吸引できた血腫量が圧倒的に多く、吸引圧も高かった。シリンジ陰圧法の有用性が改めて確認し、小開創によりゲル化した血腫が通過する内腔の確保と最大吸引圧の大きさがそのおもな作用機序であると考えられた。

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Language：Japanese   Publisher：順天堂医学会  

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：順天堂医学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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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)日本頭蓋顎顔面外科学会  

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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)日本マイクロサージャリー学会  

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

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2009185935

Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

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

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2008351955

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)日本手外科学会  

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Language：Japanese   Publisher：順天堂医学会  

目的:端側神経縫合によって二つのルートからの再生神経を促すモデルにおいて、二重神経支配の可能性について検討した。対象:体重350〜450gのウイスター系ラット雄を10匹用いた。また今回の実験の実験動物は『順天堂大学医学部動物実験に関する指針』に従った。方法:ラットの坐骨神経を採取し、右正中神経から左正中神経に交叉神経移植を行なった。左右の正中神経とは端側縫合を行い、左正中神経は端側縫合部より近位で切断した。ここで、左正中神経を切断したままの群(I群)と直ちに再縫合を行う群(II群)に分けた。乾燥筋重量の比較、電気生理学的検査、組織学的検査、神経トレーサーを用いた縫合部の観察等を行い検討した。結果:乾燥筋重量、左正中神経遠位部の神経線維数は両群に有意差を認めなかった。電気生理学的検査ではII群における二重神経支配が示唆された。また、縫合部における両ルートからの再生神経を観察しえた。考察:個々の筋線維においては末だ検討を要するが、神経移植による、筋肉への二重神経支配の存在が示唆された。(著者抄録)

DOI： 10.14789/pjmj.53.89

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Language：English   Publisher：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2006.11.017

Web of Science

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Language：Japanese   Publisher：順天堂医学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

48歳男。発熱、左坐骨部褥瘡を主訴とした。9年前に転落事故で脊髄を損傷して下半身麻痺となり、以後車椅子で生活していた。1998年頃から坐骨部に褥瘡が生じ、保存的加療を行ったが、軽快増悪を繰返していた。2004年、褥瘡部底面は壊死となり、著明な感染を生じた。入院後の保存的加療で創の状態は改善したが、巨大な潰瘍治癒には保存的加療では年単位の時間が必要と思われ、皮弁移植による手術が必要と考えられた。しかし、患者の理解力が乏しく術後の体位保持等の管理が困難と予想された。そこで麻酔科、メンタルクリニック医師とともに検討を重ね、人工呼吸管理による鎮静と術後体位保持を行うことで皮弁の生着が得られた。人工呼吸器管理は9日間であったが、声帯閉鎖不全や上肢の筋力低下を認め、自力での車椅子移乗にリハビリが必要であった。術後リハビリや人工呼吸器による合併症を考慮すると、人工呼吸器で鎮静を行う適応は慎重にすべきと考えられた。

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Language：Japanese   Publisher：(一社)日本手外科学会  

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

76歳,女.右上肢の隆起性腫瘍および紅斑を主訴とした.右乳癌術および放射線療法後より右上肢のリンパ浮腫を認めた.術後5年より慢性腎不全で透析が施行され,右前腕部にシャントを造設した.その5年後にシャント閉鎖術が施行されたが,右前腕部に皮膚腫瘤を呈するようになった.その後,大腸癌手術を受け,上肢の腫瘤は急速に増大した.当科受診時,右上肢全体にリンパ浮腫を認め,前腕部にびまん性に浸潤する暗褐色斑,硬結,散在多発する結節腫瘤を認めた.腫瘤先端からは持続性出血を,上腕には一部毛細血管拡張像を認めた.右上肢MRIでは腫瘍は皮下組織全層に連続し骨周囲まで達していた.血管造影にて前腕部全体にびまん性濃染像を認め,腫瘍部で増強していた.生検の病理組織像は血管肉腫であった.Stewart-Treves症候群と診断し,出血が増悪したため肩甲帯離断術による拡大手術を行った.術後1週から切断端周囲全体にIL-2を局注したが,術後70日に左腰背部から大腿への疼痛,貧血進行を認めた.CTにて左後腹膜腔への出血を,MRIにて腰椎と腸腰筋の転移を認めた.転移は急速に進展し,全身状態悪化,透析困難症となり術後104日に死亡した

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

18歳,女.顔面および四肢の軟部皮下腫瘍を主訴とした.2歳時に右内眼角部を強打し,3歳時の初診時には両側内眼角部,顔面,四肢に多発する皮下腫瘤,歯肉肥厚を認めた.腫瘍切除術を施行し,病理診断は乳児筋線維腫症であった.術後数ヵ月で腫瘍は再発し,4歳時に頭部,右前腕,下顎,上下歯肉部の腫瘍切除術を施行した.6歳時に3回目の腫瘍切除術を行った.病理組織学的にヒアリン物質中に紡錘形あるいは類円形核を有する細胞が細い細胞索を形成して増殖し,基質と細胞核との間にshrinkage spaceを認めた.若年性ヒアリン線維腫症と診断した.その後も腫瘍は顔面・四肢に出現を繰り返し,18歳の現在まで10回,61個の腫瘍切除術を施行した.摘出腫瘍はいずれも皮膚直下に存在し,灰白色〜灰褐色の充実性であった.X線では9歳時から母指中手骨などに骨吸収像を,15歳時から膝関節痛と両膝の骨吸収像を認めた.現在,経過観察中である

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Language：Japanese   Publisher：日本末梢神経学会  

顔面神経麻痺の再建法の一つとして,近位・遠位ともに端側神経縫合を用いた神経移植により神経再生が可能か,またその再生神経を得た時,元のルートからの神経の回復があった時の二重神経支配の可能性について実験的に検証した.ウィスター系ラットを用いた.左正中神経の近位部の扱いで,左正中神経を切断したままのI群,左正中神経切断後,直ちに再縫合を行うII群に分けた.乾燥筋重量の患側/健側比は,I群とII群で有意差を認めなかった.S3→S2の刺激でI群とII群の全例で活動電位を認めた.II群においても左正中神経遠位に神経再生を認め,その際の移植神経と左正中神経近位部の両方に神経再生を認めた.左正中神経遠位部での神経線維数の計測を行い,I群とII群で有意差を認めなかった.II群の遠位端側神経縫合部で二つのルートからの神経再生が左正中神経遠位部に向かっている様を観察した

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

DOI： 10.1097/01.prs.0000184341.22692.8f

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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

49歳女性.患者は43歳時より背部,膝部,臀部,肘部の皮下,手指の硬化を自覚し,近医で皮下の石灰化と診断されたが放置していた.今回,左上肢の筋力低下を主訴に入院となった.所見では,全身の皮膚硬化と色素沈着,背部・膝部・臀部・肘部に1〜5cmまでの皮下腫瘍を認め,いずれも石灰化様の硬さであり,特に背部の腫瘍は巨大で圧迫症状と前後屈とも15度と制限を認めた.X線では腹部と両膝の皮下に石灰化陰影を認め,CTでは背部に高吸収域を,MRIでは背部にT1,T2強調像ともに低信号域が認められた.更に骨シンチグラムで腰背部に集積像を認め,全身性強皮症と診断された.背部腫瘍の摘出術を行なうことで術直後より前後屈制限は改善され,摘出標本の肉眼像では,腫瘍は硬い被膜様のもので覆われ,内部均一でチョーク様物質に満たされ,弱拡大像では内部は顆粒状の石灰化像を示し,周囲の被膜は骨化していた

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

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Language：Japanese   Publisher：順天堂医学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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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)日本集中治療医学会  

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

頭蓋縫合早期癒合症手術におけるmodified prone positionの有用性について検討した.術前には頭蓋・頸部の単純X線・CT所見から頸椎癒合などの異常がなくMRI所見でchronic tonsillar herniationがないことを確認し,手術では馬蹄型ヘッドレスト(メイフィールド型)にポリマー性パッドを巻いたものを用意し,まず仰臥位で経鼻気管内挿管を行い挿管チューブは鼻中隔に針糸固定する.次に腹臥位として頸部を後屈させて頭部を馬蹄型ヘッドレストにのせ,荷重は下顎部・頬部で受けるようにして,圧が1箇所にかからないようにスポンジを挿入して微調節するが,その際眼球に圧がかからないように注意する.この体位で両側冠状切開を加えることで前方は眼窩上縁,後方は大後頭孔までの展開が可能となる.以上より,本体位では全体像を鳥瞰的にみることができるので,全頭蓋形成に必要な舟状頭蓋・短頭・尖頭などの手術に有用であるものと考えられた

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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：(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)日本形成外科学会  

坐骨神経を左右正中神経間に交叉神経移植する実験モデルを作成し,端側縫合を受ける側神経の無損傷な群と上膜開窓を行う群の2群に分けて,カルボシアニン蛍光色素(DiI)をNeural tracerとして用い,端側神経縫合部での再生軸索を直接的に観察した.30日後に活動電位,筋電図および組織像により神経再生の有無を確認し,端側神経縫合部は固定後DiIの結晶を貼付して約4週間保存し,その縦断面の観察を行った.その結果,両群に再生神経を認め,DiIにより,そのラベルが可能であった.側神経から再生神経が発芽し移植神経に向かって枝分かれをしている様子を確認することもでき,端側神経縫合における神経再生は側神経から再生神経が発芽し移植神経へ誘導されて生じるものと思われた

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

側神経に損傷を全く加えない端側神経縫合法を独自に考案し,その方法を用いて側神経の損傷の有無と神経再生についてラットを用いた実験により検討を行った.15匹の雄のラットを用い,採取した坐骨神経を左右の正中神経の間に交叉移植した.右正中神経縫合の際に考案した端側縫合を用い,縫合を受ける右正中神経が完全に損傷のない群を作成した.作成から60日目に活動電位,誘発筋電図の測定を行い,神経再生の有無を確かめた.更に,神経組織を摘出し,形態学的な差異を比較した.その結果,側神経が全く損傷がない端側縫合を行った群であっても電気生理学的及び形態学的に神経の再生が認められ,神経線維の枝が分化誘導されて神経の再生が生じる可能性が示唆された

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Language：Japanese   Publisher：順天堂医学会  

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

植皮を行わず,皮下茎皮弁を用いた局所皮弁で指間形成行う術式を考案し,良好な結果が得られた.術式は趾間形成用背側矩形皮弁の遠位側に皮下茎皮弁を作成し,植皮によって被覆されていた部位に皮弁を用いるものであり,適応は,切除する過剰趾背側及び合趾部分に矩形皮弁2枚分の皮膚成分が存在する場合であり,小趾列多合趾症の場合には切除する過剰趾が内側趾となる場合であった.足趾小趾列多合趾症5例(6ヵ月〜6歳)に対し,本法を用いた趾間形成術を行った.2例は合趾の癒合がDIP関節まで達していた.皮下茎皮弁の血行が不安定な場合があることが欠点だが,合趾の癒合がDIP関節をこえる高度な例でも施行可能で,整容的にも良好な結果を得ることができた

CiNii Books

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Language：Japanese   Publisher：順天堂医学会  

CiNii Books

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