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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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

Summary:

In head and neck reconstructions, venous anastomosis of the free flap to the internal jugular vein system is a common procedure. However, in some cases, postoperative complications such as internal jugular vein thrombosis can occur. In this report, we present a case where postoperative internal jugular vein thrombosis was identified after venous anastomosis of the free flap to the internal jugular vein system. In this case, preserving the external jugular vein allowed for retrograde flow of venous blood in the internal jugular vein to enter the external jugular vein, serving as an alternative drainage pathway. This finding highlights the potential benefits of preserving the external jugular vein in head and neck surgery involving free flap venous anastomosis to mitigate the adverse effects of internal jugular vein thrombosis. Further investigations are warranted to better understand the underlying mechanisms and optimize surgical approaches for improved patient outcomes.

DOI： 10.1097/gox.0000000000005501

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

生後4ヵ月、男児。出生後より左頭頂部に腫瘤が認められた。頭血腫として経過観察中であったが、今回、増大傾向を示したため当科へ紹介となった。初診時、左頭頂部に5×4cm大の骨様に硬い隆起がみられ、頭部CTでは骨皮質に覆われた隆起が認められるも、脳実質への圧迫は認められなかった。以上、これらの所見を踏まえて、本症例は頭蓋変形を伴う石灰化頭血腫と診断され、生後11ヵ月時に3Dモデルによる術前シミュレーションと術中ナビゲーションを併用して頭蓋形成術が施行された。その結果、術後1年経過現在、頭蓋骨形態は問題なく形成されており、外観上も目立たず、家族の満足度も高い。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01068&link_issn=&doc_id=20231027390006&doc_link_id=10.57414%2Fjjpnprs.43.10_606&url=https%3A%2F%2Fdoi.org%2F10.57414%2Fjjpnprs.43.10_606&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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

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

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Authorship：Last author   Language：Japanese  

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

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Language：Japanese   Publisher：新潟県医師会  

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

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

Summary:

Surgical invasion of the lymphatic system can lead to lymphorrhea. Lymphorrhea is first treated conservatively, but is often refractory and subsequently treated surgically. In surgery, it is difficult to identify the lymphatic leak points visually. In this study, we observed the schlieren phenomenon based on the difference in the refractive index between glucose solution and lymph fluid, and were able to easily identify the site of the lymphatic leakage in real time and treat lymphorrhea.

DOI： 10.1097/gox.0000000000004269

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

DOI： 10.1016/j.transproceed.2021.09.076

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Authorship：Lead author   Language：Japanese  

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

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

A 48-year-old female discovered a mass in her left axilla. A thorough examination resulted in a diagnosis of left invasive lobular carcinoma(ILC)of the accessory mammary gland with wide ductal spread. Considering the wide ductal spread, massive resection of the left axilla mass, left lymph node dissection, and a latissimus dorsi musculocutaneous flap procedure were performed. However, histological analysis revealed ILC measuring 80×50 mm with lymph node metastases(5/23)and extensive cancer spread, resulting in a positive surgical margin. It is important to recognize the characteristics of ILC, axillary accessory breast cancer, and the axilla in a treatment strategy.

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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  

口唇部の組織不足をきたしている症例に対して同時に真皮脂肪移植による修正を行ったので、その結果を報告した。唇顎口蓋裂術後の二次修正で、当科にて肋軟骨を移植した24例(男性8例、女性16例、平均23.06±13.05歳)のうち5例に対し、上口唇への真皮脂肪組織移植を同時に行った。片側唇顎口蓋裂3例、両側唇顎口蓋裂1例の術後変形に対しては、赤唇の厚さや突出度のボリュームを追加するために用い、片側唇裂1例には陥凹変形を認める人中稜の高さを出すために移植した。術後1年以上の経過では、1例で移植部位の不適切さもあり改善不足となったが、他の4例では移植部の再陥凹がないこと、対称性が得られていることから良好な形態と判断した。本法は、低侵襲かつ簡便な手技で良好な形態改善が得られ有用であった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01997&link_issn=&doc_id=20200722330004&doc_link_id=10.32154%2Fjjscmfs.36.2_63&url=https%3A%2F%2Fdoi.org%2F10.32154%2Fjjscmfs.36.2_63&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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

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

2011年4月～2019年1月に兵庫医科大学耳鼻咽喉科・頭頸部外科で顔面神経減荷術を施行された患者58例のうち後遺症の治療目的で本学形成外科に紹介された5例を対象とし、形成外科で施行された手術の内容を中心に調査した。5例はいずれも不全麻痺例であった。形成外科で計11件の手術が施行されており、内訳は眉毛挙上術2件、眼瞼手術6件、鼻唇溝手術3件であった。眼瞼手術6件の内訳は、軟骨移植等を含む兎眼矯正3件、眼瞼下垂に対する挙筋前転術3件であった。

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

Introduction: Triamcinolone acetonide (TA), a steroid, is often used clinically to prevent dysfunctions associated with fibrosis. The objective of this study was to examine whether TA can be suspended in a gelatin sheet for tissue engineering using a mouse skin wound model. Methods: TA was suspended in biodegradable gelatin and freeze-dried in a sheet form. The sheet was analyzed for homogeneity and controlled release of TA by high-performance liquid chromatography. We made two skin wounds on the dorsal side of mice. Gelatin sheets with TA (TA sheet) and without TA (control sheet) were attached to each skin wound. To determine the efficacy of the prepared TA sheet on the skin wounds, TA-sheet versus TA-injection experiments were conducted. Hematoxylin and eosin staining was performed to assess the grade of epithelialization and alpha smooth muscle actin (α-SMA) immunohistochemical staining was conducted to evaluate myofibroblast infiltration. Results: In the TA-release test in vitro, 7.7 ± 2.3% of TA was released from the sheet by 24 h. After replacing the initial phosphate-buffered saline (PBS) with collagenase PBS, the amount of released TA increased over time. The wound area/original skin wound area after 15 days with the TA sheet was significantly larger than that with the control sheet (26.9 ± 5.5% vs 10.7 ± 2.6%, p = 0.023). The α-SMA positive area/whole area with the TA sheet was significantly lower than that with the control sheet (4.65 ± 0.66% vs 7.24 ± 0.7%, p = 0.023). Furthermore, the α-SMA positive area/whole area with the TA sheet was significantly lower than that with TA injection (5.32 ± 0.45% vs 7.93 ± 0.75%, p = 0.013). Conclusions: We developed a TA sheet and confirmed both the homogeneity of the suspended TA and controlled-release of the TA in the presence of collagenase in vitro. The TA sheet caused less myofibroblast infiltration into the tissue than the control sheet or TA injection did.

DOI： 10.1016/j.reth.2019.04.001

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

四肢領域での運動神経再建と比較して顔面神経の再建では求められる筋力が小さく、比較的弱い神経再生、弱い筋力で目的を果たしうる。それ故に端側神経縫合の応用、二重支配double innervationの概念、それらを顔面表情筋や移植筋へと誘導するための端側神経縫合術や各種の神経移行術の導入など、現在に至るまで顔面神経領域に特有のコンセプトや術式バリエーションが数多く報告され、それらを裏づける基礎研究とともにその有用性が明らかになってきている。顔面神経再建の目的は自然な表情の再獲得であるが、そのための顔面表情筋の動きの「質」までも考慮した再建術が求められるようになってきている。(著者抄録)

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

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

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

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

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Language：Japanese   Publisher：医歯薬出版(株)  

顔面神経は茎乳突孔より頭蓋骨外に出た後、耳下腺内を走行しつつ多数に分枝し顔面各部位の表情筋に分布する。そのため、耳下腺悪性腫瘍などの切除に伴う広範な顔面神経欠損に対しては、1本の本幹から多数の枝を再建する必要がある。ループ型神経移植とは、顔面神経再建において1本の移植神経そのものの側面を神経縫合部位として利用することで、1本の本幹から多数の分枝を再建する術式である。また、舌下神経など顔面神経以外のneural sourceからの再生軸索を積極的に顔面表情筋に導入する際にも有用である。本法を用いることにより、少量の移植神経で多数の分枝を効率よく再建することが可能となる。本稿では動物モデルを用いた本術式の開発ならびに検証、臨床応用、その成績について解説する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J00060&link_issn=&doc_id=20190311030006&doc_link_id=%2Faa7ayuma%2F2019%2F026810%2F007%2F0849-0854%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2019%2F026810%2F007%2F0849-0854%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  

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

Nerve transfer involves the use of a portion of a healthy nerve to repair an injured nerve, and the process has been used to alleviate traumatic brachial plexus injuries in humans. Study of the neural mechanisms that occur during nerve transfer, however, requires the establishment of reliable experimental models. In this study, we developed an ulnar-musculocutaneous nerve-transfer model wherein the biceps muscle of a mouse was re-innervated using a donor ulnar nerve. Similar muscle action potentials were detected in both the end-to-end suture of the transected nerve (correctrepair) group and the ulnar-musculocutaneous nerve-transfer group. Also, re-innervated acetylcholine receptor (AChR) clusters and muscle spindles were observed in both procedures. There were fewer re-innervated AChR clusters in the nerve transfer group than in the correct repair group at 4 weeks, but the numbers were equal at 24 weeks following surgery. Thus, our ulnar-musculocutaneous nerve-transfer model allowed physiological and morphological evaluation for re-innervation process in mice and revealed the delay of this process during nerve transfer procedure. This model will provide great opportunities to study regeneration, re-innervation, and functional recovery induced via nerve transfer procedures.

DOI： 10.2220/biomedres.40.115

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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)日本美容外科学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)全日本病院出版会  

顔面神経麻痺後の病的共同運動・顔面拘縮に対する外科的治療はいまだ広く行われてはおらず、ボツリヌス毒素の使用、バイオフィードバック法を用いたリハビリテーションなどの非手術的治療と比較しても現時点では一般的な治療であるとは言い難いが、局所麻酔下に行える形成外科的手技(眉毛挙上術、上眼瞼形成術、挙筋前転術、眼輪筋減量術)を組み合わせることで効果的な治療を行うことができる。外科的治療を行うにあたっては完全麻痺例とは症状が異なること、そしてその症状に対して求められる手術が異なるということを十分に理解し、適切な術式を選択・組み合わせる必要がある。これらの外科的治療における自覚症状の改善率は高いが、その改善度をHouse-Brackmann法や柳原40点法、Sunnybrook法など、従来の顔面神経麻痺のスコアを用いて正しく評価することは困難である。新たな客観的・定量的評価法の確立が今後の課題である。(著者抄録)

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

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

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

The etiologies, symptoms, and prognosis of facial palsy vary. For example, the facial nerve reconstruction for congenital paralysis is different from that for acquired disease.<BR> Conditions of facial palsy include flaccid complete paralysis, incomplete paralysis, contracture, and mass movement.<BR> The social status and general condition of the patients should also be considered during the management of facial palsy.<BR> Surgical procedures for facial nerve reconstruction differ greatly, and there are numerous surgical options such as end-to-side neurorrhaphy, cross-facial nerve graft, hypoglossal or masseteric or accessory nerve cross-over, interpositional jump graft, babysitter procedure, cable graft and loop graft for defects in multiple branches of facial nerves, and neural signal augmentation in network type or cross-link surgeries.<BR> Nerve reconstruction for the respective periorbital and perioral regions is a useful option for both new and established facial palsy.<BR> Surgical procedures for facial nerve reconstruction are selected based on many factors.<BR> We here present our surgical algorithm for nerve reconstruction for facial palsy.

DOI： 10.32154/jjscmfs.34.1_9

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-16K11391/

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：克誠堂出版(株)  

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

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Language：Japanese   Publisher：(株)日本医事新報社  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Objective: This report evaluates the behavior of anastomosed vessels and transferred flaps after anastomosed site infection in head and neck reconstruction. Patients and methods: Eleven free-flap cases after infection at the vascular pedicle site were included, the patency of which was observed macroscopically after re-exploration and pus drainage. Location was in the tongue (5 cases), oropharynx (3 cases), mouth floor (1 case), mandible (1 case), and hypopharynx (1 case). Transferred flaps originated from rectus abdominis (3 cases), anterolateral thigh (3 cases), radial forearm (3 cases), jejunum (1 case), and latissimus dorsi (1 case). Days for infection found were ranged 3-14 days postoperatively. Causes of infection were the salivary fistula formation in 5 cases, and precise etiology was not defined in the other 6 cases. Results: Disruption of the vascular pedicles occurred with high frequency after infection. Disruption of vein occurred most frequently (5 cases), followed by both artery and vein (2 cases) and artery only (1 case). Of the eight flaps, two flaps failed, but the other six flaps survived despite pedicle disruption, indicating overall survival of nine flaps after pedicle site infection. Five of the nine survived cases were healed with simple washing and ointment application. However, the other four patients, whose cause of infection was a salivary fistula, needed second flap transfer to treat those fistulas. Conclusion: Disruption of anastomosed vessels can occur with high frequency after infection, causing subsequent flap loss. Therefore, surgeons need to deal with pedicle site infection to save the flap. (C) 2016 Wiley Periodicals, Inc.

DOI： 10.1002/micr.30025

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Language：Japanese   Publisher：(株)日本医事新報社  

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

悪性軟部腫瘍に対する最も有効な治療法は広範切除であり、その結果として大きな欠損を生じる症例は少なくない。欠損が大きく、単一の皮弁のみでの閉鎖が困難な場合には通常、皮弁採取部や移行部への植皮を併施して対処することが多い。しかし、背部に植皮を行った場合、他部位に比べて植皮片の固定が難しく、安静度の問題が生じるうえ、良好な生着が得られても高度の陥凹変形をきたす。そこで、背部悪性軟部腫瘍切除後の大きな欠損に対し、血行を考慮して拡大した大きな三角形の皮島を有する広背筋皮弁をV-Y前進皮弁として移行する方法を用いることで、植皮を併施しない再建を行うようにした。これまで4例に施行し、機能的にも整容的にも良好な成績が得られているので代表例を示しつつ報告した。

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Other Link： http://search.jamas.or.jp/link/ui/2016372923

Language：Japanese   Publisher：新潟県医師会  

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

Background: Multiple-branch reconstruction is required in order to attain facial reanimation for extensive facial nerve defects. We previously reported that end-to-side nerve grafting, with the use of a single nerve graft for defect reconstruction, was easy to perform. We have also demonstrated the efficacy of end-to-side nerve suture of the recipient nerve to the donor graft nerve, in experimental rat models and clinical cases. The regenerating axons, which extended into the nerve graft, were "distributed" to multiple recipient nerves via end-to-side nerve-suture sites.
Methods: Thirty-two patients who underwent facial nerve reconstruction (five to 10 branches) had a single sural nerve graft coapted to the proximal stump of the facial nerve in an end-to-end manner, followed by end-to-side nerve suture of the recipient nerve stumps to the side of the nerve graft. In 19 patients who were expected to undergo postoperative radiotherapy and/or chemotherapy, the distal end of the graft was connected to the side of the hypoglossal nerve for "axonal supercharging," to enhance the recovery of the facial muscles.
Results: Initial facial movements were noted at 5-12 months postoperatively, and good recovery (House-Brackmann grade III/IV) was observed during long-term follow-up in most patients.
Conclusion: End-to-side nerve suture of the recipient nerve stumps to the nerve graft requires less graft nerve material and less technical mastery to reconstruct multiple branches of the facial nerve. We also described the concept of "axonal supercharging," namely the connection of double-donor neural sources to the graft, and "axonal distribution," namely the reinnervation of multiple recipient nerve stumps connected to the graft in an end-to-side manner. This combination of axonal supercharging and distribution can be a useful option in facial nerve reconstruction. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2015.04.005

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

Local flaps and composite grafting are the procedures of choice for reconstructing relatively small soft tissue defects. However, despite their limited conveyable volume, local flaps sometimes require a wide dissection area and long new incisions. Composite grafts also have serious limitations and require a well-vascularized recipient bed. To overcome these limitations, we used a free vascularized perivascular tissue flap based on the descending branch of the lateral femoral circumflex artery. Using this method, we performed reconstructions for seven patients (four cases in head and neck region and three cases in lower limb) with various soft tissue defects (ranged from 4.0 cm(3) to 40.0 cm(3)). This flap was easily elevated, without the need for precise preoperative flap design, and the flap volume was adjustable regardless of whether deep fascia and muscle were included. The flap has a rich vascular supply, which allows bone and cartilage tissue to be combined with the transfer of soft tissue, and satisfactorily treats chronic wounds with poor blood supply. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2015.03.005

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

DOI： 10.1097/GOX.0000000000000441

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

Wound healing process is a complex and highly orchestrated process that ultimately results in the formation of scar tissue. Hypertrophic scar contracture is considered to be a pathologic and exaggerated wound healing response that is known to be triggered by repetitive mechanical forces. We now show that Transient Receptor Potential (TRP) C3 regulates the expression of fibronectin, a key regulatory molecule involved in the wound healing process, in response to mechanical strain via the NF kappa B pathway. TRPC3 is highly expressed in human hypertrophic scar tissue and mechanical stimuli are known to upregulate TRPC3 expression in human skin fibroblasts in vitro. TRPC3 overexpressing fibroblasts subjected to repetitive stretching forces showed robust expression levels of fibronectin. Furthermore, mechanical stretching of TRPC3 overexpressing fibroblasts induced the activation of nuclear factor-kappa B (NF kappa B), a regulator fibronectin expression, which was able to be attenuated by pharmacologic blockade of either TRPC3 or NF kappa B. Finally, transplantation of TRPC3 overexpressing fibroblasts into mice promoted wound contraction and increased fibronectin levels in vivo. These observations demonstrate that mechanical stretching drives fibronectin expression via the TRPC3-NF kappa B axis, leading to intractable wound contracture. This model explains how mechanical strain on cutaneous wounds might contribute to pathologic scarring.

DOI： 10.1038/srep11620

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

The free groin flap results in less donor-site morbidity than other skin flaps and is suitable for use in children and adolescents. However, the vascular pedicle is relatively short and vessel diameter is small, which makes vascular anastomosis technically difficult. To overcome this limitation, we harvested vein and arterial grafts from the flap elevation area without placing additional skin incisions. Use of short (2–3 cm) vein/arterial grafts greatly simplified flap insetting and vascular anastomosis. This procedure may expand the indications for free groin flap transfer.

DOI： 10.1097/GOX.0000000000000379

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Severe donor shortage in Japan makes the waiting period for heart transplantation extremely long and the left ventricular assist devices (LVADs) are often used for bridge-to-transplant. We present three cases of infected and exposed DuraHeart(A (R)) LVAD system treated with free flaps. Four free flaps (two latissimus flaps and two anterolateral thigh flaps) were transferred using the right internal thoracic vessels or left deep inferior epigastric vessels as recipients. The potential significance of the continuous low pressure blood flow generated by the LVAD system on microvascular patency has not been previously reported. All flaps survived and worked efficiently to control the infection and cover the devices. Heart transplantation was conducted in the two of three patients. Free flap transfer is an efficient treatment for the patients with infected and exposed implantable LVAD.

DOI： 10.1007/s10047-014-0812-y

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Language：English   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/1346-8138.12816

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

Wide resection of malignant skin tumors in the upper orbital region often results in soft-tissue defects involving the eyebrow. We used composite skin grafts from the area around the sideburns for 1-stage reconstruction of skin and eyebrow defects. The results were aesthetically satisfying because the hair and shape of these regions were similar to those of the original eyebrow, and donor-site closure was easy with inconspicuous scar. The survival of full-thickness skin graft area of composite grafts from sideburn facilitates revascularization of thicker hair follicles in the graft and allows safe, natural eyebrow reconstruction.

DOI： 10.1097/GOX.0000000000000264

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

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

顔面神経麻痺に対し頭髪生え際皮膚切除による眉毛挙上術を行った6例について検討した。男性1例、女性5例で、平均年齢は58.2歳であった。5例は不全麻痺、1例は完全麻痺に伴う眉毛下垂であった。切除した生え際皮膚の幅は平均16.2mm、術後経過観察期間は平均7.0ヵ月であった。その結果、全例で術後は麻痺の改善を認め、良好な経過が得られた。

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

末梢神経研究の歴史は比較的浅く、19世紀後半のWallerの論文発表以来、神経生理について神経損傷後の変性と神経再生には時間がかかることが理解され、末梢神経修復術の検討が本格的に行われ始めた。大きな近年の戦争を契機に末梢神経損傷治療の進歩があった。断裂神経の修復は拡大視野下に、できるだけ早期に行い、緊張のない接合が可能であれば断端面の状態における神経束パターンや上膜上走行血管の状態などに注意し、断端面がマッチングするように神経上膜縫合を行う。緊張下の神経縫合は避けて10-15%余裕を持った自家神経移植で架橋することが重要で、フィブリン糊を用いた接合も積極的に考えてよい。前腕遠位、手関節付近では各種末梢神経幹内の神経束グループ走行パターンは一定化しているので解剖学的に適合するグループ間で端々縫合又は神経移植により架橋する事を考える。血管付き神経移植は血行の悪い母床、近位部で長めの欠損架橋に対して血管付き腓腹神経移植が、C8T1神経根引抜き損傷例では血管柄付き尺骨神経を用いて対側C7神経根に接合し、患側正中神経近位断端との間に架橋できる。神経交叉術、端側神経接合術も適応を選んで有用な神経再建法となっている。(著者抄録)

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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   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/1346-8138.12631

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

DOI： 10.1097/GOX.0000000000000210

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

Corrective surgery following breast-conserving surgery is generally challenging due to severe fibrosis induced by postoperative radiotherapy. Although use of the latissimus dorsi myocutaneous flap offers a safe and reliable option, exposure of the skin paddle to the skin surface is often inevitable to achieve correction of nipple-areola complex malposition, leaving conspicuous, patchwork-like scars on the breast. In this report, we describe a 2-stage procedure using a subcutaneous tissue expander and the latissimus dorsi myocutaneous flap for the correction of both nipple-areola complex malposition and breast volume without skin paddle exposure. Although careful observation is necessary during skin expansion, this technique could offer an alternative option for patients undergoing corrective surgery following breast-conserving surgery.

DOI： 10.1097/GOX.0000000000000200

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BACKGROUND: In a previous study, the authors outlined a technique for calculating the number of abnormal vascular loop structures described in 3-dimensional computed tomography angiography. To be developed into a quantitative evaluation method for soft-tissue arteriovenous malformations (AVMs), the concept needs assessment of validity. METHODS: Computed tomography angiography results of 19 soft-tissue AVMs and 18 control abdominal vessels are utilized. Enhanced vascular lumen regions over 120 HU were extracted by a region growing method and skeletonized into wire frame graph models. The number of vascular loop structures in graphs is calculated as 1 - [Number of nodes] + [Number of edges], and results are compared between AVM/control groups, pre-/postprogression, and pre-/posttreatment. RESULTS: Average vascular lumen capacity of AVMs was 57.5 ml/lesion, and average number of vascular loops was 548 loops/lesion. Loop density of AVMs (weighted average, 9.5 loops/ml) exhibited statistically significant (P < 0.001) greater value than normal abdominal blood vessels (weighted average, 1.3 loops/ml). In all 4 cases without treatment, number of loops and loop density both increased. Particularly, number of loops increased greatly by 2 times or more in 3 cases. In all 7 cases with treatment, number of loops and vascular lumen capacity significantly (P = 0.0156) decreased. Particularly, number of loops showed clearer decrease in cases with entire lesion treatment than partial treatment. CONCLUSIONS: Total number of described vascular loop structures and their density or volume well reflected the existence, progression, and remission of soft-tissue AVMs. Topological analysis can be expected to be developed into a quantitative evaluation for AVMs.

DOI： 10.1097/GOX.0000000000000151

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

BACKGROUND: Evaluating the progression of soft-tissue arteriovenous malformation (AVMs) is still problematic. To establish a quantitative method, we took a morphological approach. METHODS: Normal blood vessels in early-phase 3D-computed tomography angiography images are theoretically expected to be tree-like structures without loops, whereas AVM blood vessels are expected to be mesh-like structures with loops. Simplified to the utmost limit, these vascular structures can be symbolized with wire-frame models composed of nodes and connecting edges, in which making an extra loop always needs one more of edges than of nodes. RESULTS: TOTAL AMOUNT OF ABNORMAL VASCULAR STRUCTURES IS ESTIMATED FROM A SIMPLE EQUATION: Number of vascular loops = 1 - ([Number of nodes] - [Number of edges]). CONCLUSION: Abnormalities of AVM vascular structures can be mathematically quantified using computed tomography angiography images.

DOI： 10.1097/GOX.0000000000000163

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

42歳男。4年前の自殺企図にて両手ならびに頸部～顔面の熱傷を受傷した。うつ病のコントロールが良好となり、頸部～下顎縁～オトガイ部の肥厚性瘢痕の整容的改善を希望して受診した。第1回手術として、橈骨動脈を茎とした遊離前腕脂肪筋膜弁を上甲状腺動脈、顔面静脈、外頸静脈へおのおの血管吻合を行い移植、胸部皮下に留置したtissue expander(TE)上に留置した。術後3ヵ月間でfull expansionとした。第2回手術では移植したflapの橈骨動静脈を茎とした幅13cm×長さ30cmのDP flapを挙上し、TEを抜去した。血流良好かつ取り回しの容易な薄い皮弁の挙上とともにdonor siteの縫縮が可能であった。現在2年6ヵ月経過しているが、良好な結果を維持している。

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

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Other Link： http://search.jamas.or.jp/link/ui/2014288958

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: Oxidative stress has been suggested as a mechanism underlying skin aging, as it triggers apoptosis in various cell types, including fibroblasts, which play important roles in the preservation of healthy, youthful skin. Catechins, which are antioxidants contained in green tea, exert various actions such as anti-inflammatory, anti-bacterial, and anti-cancer actions. In this study, we investigated the effect of (+)-catechin on apoptosis induced by oxidative stress in fibroblasts.
Methods: Fibroblasts (NIH3T3) under oxidative stress induced by hydrogen peroxide (0.1 mM) were treated with either vehicle or (+)-catechin (0-100 mu M). The effect of (+)-catechin on cell viability, apoptosis, phosphorylation of c-Jun terminal kinases (JNK) and p38, and activation of caspase-3 in fibroblasts under oxidative stress were evaluated.
Results: Hydrogen peroxide induced apoptotic cell death in fibroblasts, accompanied by induction of phosphorylation of JNK and p38 and activation of caspase-3. Pretreatment of the fibroblasts with (+)-catechin inhibited hydrogen peroxide-induced apoptosis and reduced phosphorylation of JNK and p38 and activation of caspase-3.
Conclusion: (+)-Catechin protects against oxidative stress-induced cell death in fibroblasts, possibly by inhibiting phosphorylation of p38 and JNK. These results suggest that (+)-catechin has potential as a therapeutic agent for the prevention of skin aging.

DOI： 10.1186/1472-6882-14-133

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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)  

顔面神経麻痺に伴う眉毛下垂症例9例(男性2名、女性7名:手術時平均年齢72.4歳)に対して眉毛上皮膚切除時にMitek suture anchor systemを用いて前頭骨に固定する方法(本法)を行い、後戻りと併施した術式について検討した。健側の眼瞼皮膚弛緩症や眼瞼下垂を認める場合は同時に両側の眼瞼形成術を行った。評価はeyebrow ptosis scale(EPS)を用い、平均経過観察期間は10.3ヵ月である。その結果、平均EPSは術後1年以上経過症例7例で101.6%、術後1ヵ月で106.3%であった。後戻りは全症例で認め、平均EPSは10.1%であった。併施の術式は、眉毛下垂が比較的軽度の6例は上眼瞼余剰皮膚切除術、2筋移行術のうちの1例と口角挙上術1例は上眼瞼余剰皮膚切除術を追加した。合併症は1例で感染を認めた。本法は強固な固定が可能で後戻りが少なく、良好な結果を得られた。

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Other Link： http://search.jamas.or.jp/link/ui/2014157828

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OBJECTIVE: We present a case of exposure of a microvascular anastomotic coupler. METHODS: We performed venous anastomoses using microvascular anastomotic couplers in head and neck reconstruction. RESULTS: A microvascular anastomotic coupler was exposed in the seventh month postoperation, and an anastomosed vein was disrupted. CONCLUSIONS: Although the usefulness of the microvascular anastomotic coupler in microsurgical flap reconstruction is not in doubt, as described previously, we believe that it is necessary to remember that use of a microvascular anastomotic coupler involves potential risks of exposure and anastomosed vessel disruption.

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A patient with complex regional pain syndrome type II was successfully treated using free anterolateral thigh flap transfer with digital nerve coaptation to the cutaneous nerve of the flap. Release of the scarred tissue and soft tissue coverage with targeted sensory nerve coaptation were useful in relieving severe pain.

DOI： 10.3109/23320885.2014.966106

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

顔面神経再建における移植神経の端側神経縫合の手技を紹介し、顔面神経再建26例(男14例、女12例、平均48.1歳)の成績を報告した。原疾患は耳下腺悪性腫瘍17例、外傷3例、脳血管障害2例、顔面神経鞘腫、脳腫瘍、ベル麻痺、先天性顔面神経麻痺各1例であった。再建術式は従来型の端々縫合が5例で、分枝利用2例、神経端々縫合、舌下神経移行、顔面交叉神経移植各1例であった。端側神経縫合21例はループ型10例、分枝利用3例、顔面交叉神経移植1例、ネットワーク型7例で、ネットワーク型の内訳はクロスリンク型2例、ループ型と舌下神経移行併用3例、顔面交叉神経移植と舌下神経移行1例であった。耳下腺悪性腫瘍切除後の即時再建14例のうち端側縫合は11例(ループ型9例、分枝利用2例)で、観察期間2ヵ月〜11年3ヵ月のハウスブラックマン分類による成績はグレードIIが4例、IIIが6例、IVが1例と概ね良好であった。

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

比較的小範囲の軟部組織欠損の再建に対して、しばしば局所皮弁や複合組織移植が用いられる。しかしながら局所皮弁では十分な組織や移動距離が得られない、複合組織移植では移植できる組織量に限りがある、などの欠点がある。これらの欠点を回避するため、われわれは外側大腿回旋動脈下行枝周囲の軟部組織をfree flapとして用いた軟部組織再建を行った。対象は、踵(非荷重部)部潰瘍の再建2例、眼窩上壁・前頭蓋底の再建1例、下眼瞼全層欠損の再建1例であった。本法は術前の綿密なデザインが不要であり、挙上においては手技的に簡便であり、組織は必要に応じて筋、筋膜、皮下脂肪を含めて採取できる。一方、豊富な血流を有するため皮膚、軟骨、骨の遊離移植と併用しやすく、血流不全を伴う難治性潰瘍にもよい適応と考えられる。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MARY ANN LIEBERT INC  

Adult mesenchymal stem cells secrete a variety of angiogenic cytokines and growth factors, so we proposed that these paracrine mechanisms may be used to promote vascularization and growth for tissue engineering in vivo. We tested whether or not human adipose-derived stem cells (ASCs) promote tissue formation in rats. ASCs were evaluated in vitro for mRNA expression of angiogenic factors, including the vascular endothelial growth factor, basic fibroblast growth factor, interleukin-8 (IL-8), and stromal cell-derived factor-1 (SDF-1) and proliferative activity on human microvascular endothelial cells. For in vivo analysis, CM-DiI-labeled ASCs were implanted with a rat cardiac extracellular matrix (ECM) extract-derived hydrogel into a chamber with a femoral arteriovenous loop in the groin of male nude rats for 7 days. Vascularization in newly generated tissue was estimated by histomorphometry after endothelial nitric oxide synthase (eNOS) immunostaining. ASCs expressed growth factor mRNA and produced an angiogenic activity in vitro. After implantation, ASCs survived, but remained suspended in the ECM and relatively few were incorporated into the newly formed tissue. The volume of newly generated tissue was significantly higher in chambers containing ASCs and it was enriched with vasculature when compared with the ECM alone. We conclude that human ASCs promote tissue growth and angiogenesis in the rat vascularized chamber, thereby showing promise for tissue-engineering applications for regenerative therapy.

DOI： 10.1089/ten.tea.2012.0391

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

37歳女。7歳時に右顔面神経麻痺を発症し、耳鼻咽喉科で加療されたが改善せず、完全麻痺となった。今回、遊離広背筋移植による笑いの再建術を行い、その際、健側顔面神経からの神経再生を確保しつつ、移植筋へのより強力な神経支配を図るために、胸背神経側面へ神経移植を介して患側の顔面神経と舌下神経を付加するかたちで用い、良好な結果が得られた。麻痺発症後長期経過していても患側顔面神経内には軸索が少量ながら存在していることから、神経付加として患側顔面神経を用いることは可能であると考えられた。

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

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

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BACKGROUND: Local re-recurrence after R0 resection of local recurrence of rectal cancer (LRRC) is not rare. The purpose of this study was to examine the pathological features of LRRC and determine the prognostic factors. METHODS: Twenty-one patients underwent R0 resection of LRRC without preoperative therapy from 2000 to 2008. Tumor progression patterns were classified into three types: A, expanding type; B, infiltrating type; and C, intermediate type. Distant isolated cancer cells (DICCs) were defined as cancer cells present in isolation and at a distance (>1 mm) from the tumor edge. RESULTS: Venous invasion was identified in all but one patient (95%). DICCs were observed in 11 of 21 cases. Type A patients had a significantly lower local re-recurrence rate (0/5) compared with type B and/or C patients (11/16, P = 0.012) and a significantly lower incidence of distant metastasis compared with type B and C patients (0/5 vs. 13/16, respectively; P = 0.0028). Multivariate regression analysis identified venous invasion of the primary lesion (P = 0.027) and tumor progression patterns (P = 0.039) as independent predictors of local re-recurrence. CONCLUSIONS: The main features of LRRC were infiltrating growth, venous invasion, and DICCs. Tumor progression patterns correlated with local re-recurrence and distant metastasis. Preoperative adjuvant therapy to terminate peri-tumor cancer cells may be required for better tumor control.

DOI： 10.1245/s10434-010-1435-z

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

耳下腺悪性腫瘍切除後の広範な顔面神経欠損に対する一期的複数枝再建を容易・確実かつ、より少量の移植神経で行うために、著者等は端側縫合を用いた神経移植法について検討し実施してきた。最近では、一本の移植神経への双方向からの再生を期待するbi-directional nerve graftの考え方を応用し、移植神経遠位端の舌下神経への端側縫合を追加している。その手術方法を紹介し、動物モデルによる実験の結果と、臨床例に施行した結果を報告した。これまで臨床例6例に施行し、全例腓腹神経移植を行い、再建枝数は4〜7本であった。術後長期の経過を観察しえた症例では術後6ヵ月頃より下顎縁枝からの回復がみられ、舌下神経からの回復が起こっているものと考えられた。一方で、回復が思わしくなく、muscle bow traction法を追加して口角挙上を図った症例もあった。代表例として、柳原40点法の表情筋運動スコアが術前の10点から術後18点に改善した1例を提示した。

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神経端側縫合を応用した自家神経バイパスグラフト(BG)の有用性を検討するため、ラット神経腫モデルを用いて実験を行った。実験群は総腓骨神経を単純切除後即時縫合した群(対照群)、神経腫モデル作成と同時にBG施行した群(即時BG群)、モデル作成後3週間目にBG施行した群(二期的BG群)、モデル作成のみBGなし群(非BG群)とした。足跡分析によるperoneal functional index(PFI)は、全群で術後低下を認めたが、対照群および即時BG群は徐々に増加して5週目以降に、二期的BG群は8週目以降に非BG群と比較して有意に高値となった。10週目においては対照群、即時BG群、二期的BG群の間でPFIに有意差はなく、運動神経伝達速度、脛骨筋重量の回復にも有意差はなかった。神経短軸方向切片のトルイジンブルー染色による形態学的評価では、BG内にミエリン化した再生軸索を認め、全軸索数は二期的BG群で、軸索密度は即時BG群および二期的BG群で他群に比較して有意に高値であった。

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

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Other Link： http://search.jamas.or.jp/link/ui/2010260930

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MARY ANN LIEBERT, INC  

We have previously established a chamber model of tissue engineering that promotes de novo angiogenesis and vascularization of engrafted cells and tissues when combined with an extracellular matrix. Here we demonstrate that the mouse chamber ( MC) model can sustain ectopic grafts of murine fetal thymus lobes and, to a limited degree, human pediatric thymus tissue, resulting in de novo T-cell production. Silicone chambers containing Matrigel (R) and thymus tissues were placed around exposed epigastric vessels and the ends sealed with bone wax, before implantation into the inguinal fat pad of athymic Balb/c(nu/nu) ( nude) mice. Murine, embryonic day 15 (E15) thymus grafts were found to be well vascularized and viable within the MC upon harvest at week 11. In contrast, engraftment of both adult murine and pediatric human thymus tissue was limited, with only one out of the seven human thymus grafts sustaining mature, murine-derived T-cell development. Increased CD4+ and CD8(+) T-cell numbers were observed in the peripheral blood of nude mice within 2 weeks after E15 thymus-MC grafts (n = 8), compared with nude control mice. Peripheral blood T-cell percentage and subset distribution were comparable to mice receiving conventional thymus kidney capsule grafts. T-cell function of both kidney capsule- and MC-E15 thymus grafts was established via successful rejection of major histocompatibility complex (MHC)-mismatched skin grafts. Sustained growth of fetal thymus tissue in the MC provides an alternative model for the study of thymopoiesis and related applications of T-cell-mediated immunity.

DOI： 10.1089/ten.tec.2009.0135

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

Manganese-enhanced magnetic resonance imaging (MEMRI) was used to investigate retrograde axonal tracing in the rat sciatic nerve model to assess its potential to examine peripheral nerve injury. The right sciatic nerve was exposed and crushed. After each recovery period, the distal part of the right sciatic nerve was injected with manganese (400 mM, 15 mu l). After allowing 3 days for manganese transport the animals were subsequently scanned to visualize the sciatic nerve and its corresponding spinal cord and dorsal root ganglia with T1-weighted MRI. Thirty-four animals were randomly divided into 4 experimental groups according to their recovery period post-crush injury: 3 days (n = 6), 2 weeks (n = 6), 4 weeks (n = 6) and 12 weeks (n = 6); and two control groups: a non-crushed group (n = 6) and a nerve cut group (n = 4). In the no-injury group, the right sciatic nerve tract including its corresponding spinal cord and dorsal root ganglia showed significant T1 signal enhancement. In the animals with crush injury, the MR signal intensity was significantly reduced proximal to the injured site but gradually reappeared with increasing recovery period. The signal intensity of the sciatic tract was compared to the results of behavioral functional testing, retrograde axonal tracing with neural tracer fluorogold and histomorphometric analysis of the distal nerve. Significant correlations were observed between the MR signal intensity and the behavioral functional test (r=0.50, p&lt;0.05), and the retrograde axonal tracing (r=0.88; p&lt;0.05). Retrograde neuronal tract tracing with MEMRI can be used for the assessment of peripheral nerve damage and regeneration. (C) 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.neuroimage.2010.01.008

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

Cardiac tissue engineering offers promise as a surgical approach to cardiac repair, but requires an adequate source of cardiomyocytes. Here we evaluate the potential for generating human cardiac muscle cells in vivo from adipose-derived stem cells (ASC) by co-implanting in a vascularised tissue engineering chamber with inducing rat cardiomyocytes (rCM). Co-implantation (ASC-rCM) was compared with rCM or ASC controls alone after 6 weeks. Immunostaining using human nucleus specific antibody and cardiac markers revealed several fates for ASC in the chamber; (1) differentiation into cardiomyocytes and integration with co-implanted rCM; (2) differentiation into smooth muscle cells and recruitment into vascular structures; (3) adipogenic differentiation. ASC-rCM and ASC groups grew larger tissue constructs than rCM alone (212 +/- 25 mu l, 171 +/- 16 mu l vs. 137 +/- 15 mu l). ASC-rCM and rCM groups contracted spontaneously at up to 140 bpm and generated a 10-15-fold larger volume of cardiac muscle (14.5 +/- 4.8 mu l and 18.5 +/- 2.6 mu l) than ASC alone group (1.3 +/- 0.5 mu l). Vascular volume in ASC-rCM group was twice that of the rCM group (28.7 +/- 5.0 mu l vs. 14.8 +/- 1.8 mu l). The cardiac tissue engineered by co-implanting human ASC with neonatal rCM showed in vivo plasticity of ASC and their cardiomyogenic potential in tissue engineering. ASC contribution to vascularisation also promoted the growth of engineered tissue, confirming their utility in this setting. (C) 2009 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.biomaterials.2009.11.097

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

顔面神経再建にあたり、顔面神経の中枢側の断端に縫合した移植神経に対して末梢側の各分枝を端側吻合することで再建を効率よく行える術式を開発した。端側型神経移植では採取された移植神経の状態、再建すべき分枝の位置や本数に関わらず、様々なバリエーションの神経移植方法を駆使して無理なく確実に再建することが可能である。2000年7月から2007年2月までに耳下腺悪性腫瘍切除による顔面神経欠損例6症例に対して本法を行った結果、4例中2例では側頭枝および下顎縁枝の回復は認めなかったが、他の分枝の支配する表情筋の運動は全症例で回復した。本法は手術手技も煩雑とならず、効率のよい軸索再生も期待され、必要な移植神経の長さも節約される利点があり、顔面神経の複数の分枝を効率よく再建するために有用と思われた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J01922&link_issn=&doc_id=20100301480031&doc_link_id=%2Fcu1facia%2F2009%2F002900%2F032%2F0101-0104%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcu1facia%2F2009%2F002900%2F032%2F0101-0104%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

Objective: The superior orbital fissure syndrome results from damage to the nerves passing through the superior orbital fissure. In the present case, the superior orbital fissure syndrome developed after repair of facial bone fractures, although the symptoms were not observed before surgery and no obvious cause was found. To investigate the aetiology of this syndrome, we examined the superior orbital fissure anatomically.
Methods: We measured the width of superior orbital fissure on the horizontal plane including the optic canal using the computed tomography (CT) scans of other patients and cadavers.
Results: The results indicated that the width was 3.73 +/- 1.64 mm in the CT scans of patients and 3.21 +/- 1.09 mm in the cadavers. There was no significant difference between the width in the CT scans and cadavers. The width in the present patient on the affected side was 1.6 mm, that is relatively narrow.
Conclusion: After operation, narrow superior orbital fissure may reduce the tolerance to compression of the nerves by oedema. We consider the narrow superior orbital fissure as a risk factor for superior orbital fissure syndrome. When the superior orbital fissure is congenitally narrow, the surgeons should try to avoid excessive pulling of the bone fragment and compression of the orbital tissue during repair of the facial bone fractures. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2008.11.052

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

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

Background: The effectiveness of end-to-side nerve graft for multiple branch reconstruction was confirmed using a new rat four-branch facial nerve reconstruction model with end-to-side cross-face nerve graft.
Methods: Forty Lewis rats were randomly divided into four groups with different reconstruction methods for four branches (bilateral buccal. and marginal branches) of the bilateral facial nerves as follows: group I In = 12), single sciatic nerve graft with end-to-side neurorrhaphy; group 11 (n = 12), four cable grafts using two sciatic and two ulnar nerves with end-to-end neurorrhaphy; group III (n = 8), no repair; and group IV (n = 8), sham operation. The four groups were compared with double retrograde tracing of the facial nucleus, electrophysiological and histomorphometrical assessment of the reconstructed facial nerve.
Results: Although there were no significant differences between groups I and 11 in the electro-physiological. tests, group I showed more uniform and better reinnervation in the histomorphometrical assessment. Retrograde tracing of facial nucleus revealed significantly higher number of double-labeled neurons in group I although the total number of labeled neurons was not different between the two groups.
Conclusions: End-to-side nerve graft shows a good functional recovery, requires less graft, and is easy to perform. With the availability of the side of the nerve graft itself as a nerve coaptation site, it can be an effective alternative in facial nerve reconstruction and be of great value in various kinds of peripheral nerve surgery. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2008.04.013

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

The purpose of this study was to determine whether sensory reinnervation with end-to-side neurorrhaphy preserves muscle mass in pedicled muscle flaps. A new muscle flap model innervated by the common peroneal nerve (CPN) was tested in rats. Animals were divided into group 1 (CPN transected without repair), group 2 (CPN transected and immediately repaired by end-to-end neurorrhaphy), and groups 3A and 3B (CPN transected and repaired with the sural nerve, by end-to-end and end-to-side neurorrhaphy, respectively). We evaluated the muscle-preserving effect by measuring muscle weight and performed histological and morphometric analyses 3 months after the procedure. Sensory reinnervation significantly preserved the muscle mass, although less than motor reinnervation. There was no significant difference between the end-to-end and end-to-side procedures. Results of morphometric analysis in each group paralleled those of mean muscle weight. Sensory reinnervation with end-to-side neurorrhaphy appears to be useful in the preservation of muscle flap mass.

DOI： 10.1055/s-0028-1088229

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

耳下腺悪性腫瘍切除術に伴う顔面神経の複数分枝欠損患者6例(男3例・女3例・平均51.3歳)に対し、移植神経への端側神経縫合を用いた再建術を施行した。移植神経は顔面神経本幹または中枢側の分枝の断端と端々縫合した後、各分枝の断端付近を通過するように配置し、それぞれの分枝と端側縫合し、移植神経の末梢断と再度の分枝を端々縫合した。神経再建の対象となる側頭枝、頬骨枝、頬筋枝、下顎縁枝のすべてを再建したのが3例、3分枝が1例、2分枝が2例で、採取した神経は腓腹神経3例、大耳介神経2例、その他の頸神経1例であった。吻合形態は枝分かれのない移植神経を用いたloop型が4例、枝分かれを利用したbranchが型1例、loop型と従来の端々吻合cable型との組み合わせが1例であった。術後経過観察期間1年3ヵ月〜7年11ヵ月で、すべての例において表情筋運動の回復が得られ、眼瞼、口角挙上も改善したが、全4分枝再建の3例中2例は側頭枝と下顎縁枝の回復が確認されなかった。

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

ラット坐骨神経欠損モデルを用い、移植した正中神経の側面に腓骨神経の断端を縫合した端側縫合群と、正中神経および尺骨神経に脛骨神経、腓骨神経を端々縫合した群で再建効果を比較した。両群間で経時的機能回復評価に有意差はなく、再生軸索の連続性を評価する逆行性トレーサーを用いた検討でも有意差はなかった。前頸骨筋および腓骨神経の組織像にも有意差はなく、端側縫合は端々縫合と同等の効果が得られた。次に、神経の損傷部位より末梢側の側面に他の神経の近位端を端側縫合付加する方法(axonal supercharging tecnique)について検討した。縫合付加群は術後30日以降で付加なしの対照群と比較して有意に優れた知覚回復を認め、支配筋重量も有意に回復していた。また逆行性トレーサーを用いた検討では再生軸索の進入が確認され、組織像でも神経再生促進が示唆された。神経端側縫合付加は神経損傷後の機能回復促進に有効と考えられた。

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

With the recent advances in oncologic breast surgery breast reconstruction with the latissimus dorsi myocutaneous (LDM) flap without an implant has become a good option among other autologous tissue reconstructions available. However, only a few large-scale studies have so far evaluated the critical factors affecting its esthetic outcomes. We retrospectively reviewed 97 consecutive patients who underwent breast reconstruction with the LDM flap between 2001 and 2005 at our institution. The esthetic outcome in comparison with the normal breast was evaluated by means of observer assessment consisting of 7 criteria. A stratified analysis was performed to determine the factors affecting the esthetic outcomes after the breast-conservative surgery and skin-sparing mastectomy. We found that reconstruction of the lower half of the breast and exposure of the skin paddle resulted in poor esthetic outcomes after breast-conservative surgery. Large preoperative brassiere cup size, radiation history, axillary node dissection, and exposure of the skin paddle were the factors which negatively affected the overall outcomes after skin-sparing mastectomy. Age, body mass index, presence of nipple areola-complex defect, or design of skin paddle did not affect the esthetic outcomes. On the basis of these critical factors, we could determine the indications and limitations of breast reconstruction with LDM flap. In some cases, further technical modifications are still warranted, and we believe that these modifications will optimize the use of this flap in breast reconstruction.

DOI： 10.1097/SAP.0b013e318156a1cf

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

症例は生後4ヵ月の女児で、患児の啼泣に気づいた母親がみると犬の毛が右第4趾周囲に巻きつき足趾先端部が腫脹しており、近医にて犬の毛が可及的に除去されたが腫脹は軽快せず、創部から不良肉芽の増生を認め紹介来院となった。初診時、右第4趾は腫脹・発赤し、肉眼的には毛の残存やX線像上で骨折も認めず、1週間後に全身麻酔下に手術を施行、顕微鏡下に患部を注意深く観察したところ、創深部に残存した犬の体毛と思われる糸状の異物を数本確認した。一部の毛は全周性に巻きつき、骨に達するまでくい込んで軟部組織はほぼ全周性に切断されており、犬の体毛と思われる異物を顕微鏡下に完全に除去した。足底面には肉芽組織が形成され、足趾先端への血流がこれにより補われている可能性があったため、肉芽は一部を焼灼した以外はそのまま残し足背部の皮膚のみ縫合した。術後経過は良好で、足底面の肉芽は術後急速に縮小し、術後3週間で完全に消失し、術後2ヵ月には足趾はほぼ正常な状態まで治癒した。以上より、本症の取り扱いに際しては、虐待の可能性も視野に含めて、時には児童相談所などへの通告が必要となる場合があり、注意を要すると考えられた。

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

This report describes an effective technique of using a total leg flap for treating a 57-year-old male paraplegic patient with intractable sacral pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus. Spondylitis was accompanied by severe instability of the lumbosacral area, a large lumbosacral ulcer, and a large bone and muscle defect, which made it difficult for the patient to maintain a sitting position. A total leg flap procedure, a modification of the total thigh flap procedure, was performed as a I-stage salvage surgery. The vascularized tibia and fibula were grafted between the lumbar and sacral vertebrae, and a musculocutaneous flap was used to cover the extensive ulceration in the lumbosacral skin defect. The intractable lesion of the lumbosacral spine, which had not been cured for more than 2 years despite repeated debridement, intravenous antibiotic injections, sugar treatment, pyoktanin treatment, and hyperbaric 0, treatment, subsided and stabilized within I year of surgery. The patient returned to activities of daily living using a wheelchair, and was very satisfied with the results. Use of a total leg flap with a vascularized tibia graft is an effective treatment for intractable pyogenic spondylitis accompanied by a large bone defect and large lumbosacral ulcers.

DOI： 10.3171/SPI/2008/8/5/468

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

The mature peripheral nervous system (PNS) generally shows better regeneration of injured axons as opposed to the central nervous system (CNS). However, complete functional recovery is rarely achieved even in the PNS although morphologically good axonal regeneration often occurs. This mainly results from aberrant reinnervation due to extensive branching of cut axons with consequent failure of synchronized movements of the muscles. Myelin-associated glycoprotein (MAG), a well-characterized molecule existing both in the CNS and PNS myelin, is considered to be a potent inhibitor of axonal regeneration especially in the CNS. In the present study, we investigated whether MAG has any effects not only on axonal elongation, but also on axonal branching. We show herein that MAG minimized branching of the peripheral axons both in vitro and in vivo via activation of RhoA. Furthermore, after sciatic nerve transection in rats, focal and temporary application of MAG to the lesion dramatically enhanced the functional recovery. Using double retrograde labeling and preoperative/postoperative labeling of spinal neurons, reduced hyperinnervation and improved accuracy of target reinnervation was confirmed, respectively. In conclusion, as MAG significantly improves the quality of axonal regeneration, it can be used as a new therapeutic approach for peripheral nerve repair with possible focal and temporary application. (C) 2007 Wiley-Liss, Inc.

DOI： 10.1002/glia.20566

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

Object. In an attempt to improve peripheral nerve repair, the influence of the addition of reverse end-to-side neurorrhaphy for an injured peripheral nerve was investigated in the rat sciatic nerve transection model.
Methods. Twelve Sprague-Dawley rats were divided into two groups (six rats in each group). In Group 1, the right sciatic nerve was cut at a point distal to the gluteal notch and repaired using end-to-end neurorrhaphy with four 10-0 nylon epineurial sutures. In Group It, after performing the same procedure as in Group I, the left sciatic nerve was cut distally and passed through a subcutaneous tunnel to the right side. The proximal stump of the left sciatic nerve was co-apted to the epineurial window of the right sciatic nerve distal to the injured point in an end-to-side fashion using 10-0 nylon epineurial sutures. The effects were evaluated using analgesimeter recordings for the hind paw, electrophysiological tests, measurement of the muscle contraction force, a double-labeling technique, weight measurement and histological examination of the gastrocnemius muscle, histological examination of the bilateral sciatic nerves, and immunofluorescent staining.
Results. Results from the many tests used to evaluate the reverse end-to-side neurorrhaphy technique indicated that functional recovery of the denervated target organs was promoted by axonal augmentation.
Conclusions. The reverse end-to-side neurorrhaphy technique could be useful in peripheral nerve repair.

DOI： 10.3171/JNS-07/10/0821

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

The function of the p75(NTR) neurotrophin receptor (p75(NTR)) in nervous system regeneration is still controversial. Part of that controversy may be due to the fact that p75(NTR) is expressed by both neuronal and glial cell types and may have very distinct and even contradictory roles in each population. In this study, to elucidate the in vivo function of p75(NTR) in Schwann cells during remyelination after peripheral nerve injury, we established a new animal model for p75(NTR)-deficient Schwann cell transplantation in nude mice. We performed quantitative assessments of the functional, histological, and electro physiological recovery after sciatic nerve injury, and compared them with those of the P75(NTR)(+1+) Schwann cell transplanted animals. At 710 weeks after injury, the motor recovery in the p75(NTR)(-/-) Schwann cell transplanted animals was significantly impaired compared with that in the p75(NTR)(+/+) Schwann cell transplanted animals. The lower number of the retrogradely labeled motoneurons and the hypomyelination in the p75(NTR)(-/-) Schwann cell transplanted animals were evident at 6 and 10 weeks after injury. At 10 weeks after injury, the radial growth in the axon caliber was also impaired in NTR the P75(NTR)(-/-) Schwann. cell transplanted animals. Measurement of the amount of myelin proteins and the nerve conduction velocity at 10 weeks after injury reflected these results. In summary, the p75(NTR) expression in Schwann cells is important for remyelination process, and the motor recovery after injury is impaired due to impaired axonal growth, remyelination, and radial growth in the axon calibers. (C) 2007 Wiley-Liss, Inc.

DOI： 10.1002/glia.20533

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

The latissimus dorsi flap has been widely used in breast reconstruction surgery. Despite its potential advantages such as low donor morbidity and vascular reliability, the complication of donor-site seroma fort-nation frequently occurs. Consecutive 174 patients who underwent breast reconstruction with the latissimus dorsi flap from 2001 to 2006 were retrospectively reviewed. The age, body mass index (BMI), smoking history, timing of reconstruction, type of breast surgery and nodal dissection, and several other intraoperative data were analyzed. The overall incidence of postoperative seroma was 21%. Increased age (&gt;50 years) and obesity (BMI &gt;23 kg/m(2)) were significant risk factors for seroma formation (P = 0.02 and 0.004, respectively). The patients who underwent skin-sparing mastectomy or modified radical mastectomy had higher incidence of seroma formation (28% and 33%, respectively) as compared with those who had breast-conservative surgery (11%). A significant correlation was found between the type of breast surgery and the incidence of seroma (P = 0.04). The type of nodal dissection did not affect the incidence of postoperative seroma (P = 0.66). We concluded that increased age, obesity, and invasive breast surgery are risk factors for donor-site seroma formation after breast reconstruction with the latissimus dorsi flap. Close attention should be paid to prevent development of postoperative seroma when operating on such high-risk patients.

DOI： 10.1097/SAP.0b013e31802c54ef

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

The treatment of neuroma-in-continuity is controversial. To bypass neuroma-in-continuity with a nerve graft using end-to-side neurorrhaphy is considered to be theoretically a good option. To test this therapeutic modality, we performed a nerve bypass graft in a neuroma-in-continuity rat model. An obstructive neuroma-in-continuity was created in a transected peroneal nerve by interposition using the aponeurosis of the spinal muscles. In the experimental animals, (1) immediate, (2) 3-week delayed, or (3) no ulnar nerve bypass graft was performed. The peroneal functional index (PFI), conduction velocity, tibialis anterior muscle weight, and histomorphometric analyses were performed and compared with control (simply cut and repair) animals. On postoperative day 70, the recoveries of the PFI values, conduction velocity, and tibialis anterior muscle weight in the bypassed animals showed no significant differences as compared with the control animals, and the extent of these recoveries in the bypassed animals were significantly superior to those in the no-graft animals. In the histomorphometric analysis, the mean percent nerve in the bypassed animals was significantly larger than that in the no-graft animals. In conclusion, this technique may be a good alternative to the current therapeutic techniques for neuroma-in-continuity when there is a significant retained function.

DOI： 10.1055/s-2007-974652

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

Background: The Rho family of small GTPases is responsible for various processes involving actin cytoskeleton in eukaryotic cells, including neurite outgrowth. Several substances found at the peripheral nerve injury site were shown to activate one member of this family, Rho. The activation of Rho leads to neurite outgrowth inhibition and the development of posttraumatic neuropathic pain. The authors used the clinically tested Rho-associated kinase inhibitor fasudil hydrochloride to enhance the functional recovery of the peripheral nerve in the rat.
Methods: In the peroneal nerve interpositional graft model, the authors administered fasudil (experimental groups) or saline (control groups) (1) intraperitoneally and (2) directly into the graft by microinjection (n = 6 animals per experimental condition). Neural recovery was assessed during postoperative follow-up lasting 80 days by peroneal functional index, electrophysiologic, and histomorphometric analyses.
Results: The peroneal functional index returned to values not significantly different from preoperative values on days 55 (fasudil injected into the graft) and 60 (fasudil injected intraperitoneally) in the experimental groups. In the control groups, this took 70 (saline injected intraperitoneally) and 75 days (saline injected into the graft). These results are supported by electrophysiologic and histomorphologic assessments.
Conclusions: The authors determined that fasudil hydrochloride was capable of accelerating the functional regeneration after peripheral nerve axotomy, which is consistent with the results of reports about Rho cascade disruption in the central nervous system. Because fasudil hydrochloride is a clinically tested drug, it could be used to enhance neural regeneration in human patients as well.

DOI： 10.1097/01.prs.0000246380.40596.29

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

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

Platelet-rich plasma (PRP) has attracted attention as a safe and cost-effective source of growth factors that stimulate cells to regenerate tissue. Bone marrow aspirate was processed with the same protocol to obtain PRP from peripheral blood. This concentrate contained condensed nucleated bone marrow cells, which are useful for regenerative medicine, as well as condensed platelets. In PRP derived from bone marrow aspirate, the density of platelets and levels of growth factors (platelet-derived growth factor and transforming growth factor-beta) were the same as in PRP derived from peripheral blood. Condensation of nucleated cells, especially small-sized cells, was confirmed. With a simple and cost-effective technique, source cells and growth factors can be obtained at the same time. This simultaneous concentration of platelets and bone marrow cells has great potential as a source of materials for regenerative medicine.

DOI： 10.1111/j.1524-475X.2006.00196.x

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

症例は48歳女性で、2年前頃より右乳頭部発赤が出現し、近医にてPaget病と診断された。右乳輪乳頭部にはびらんがあり、乳腺超音波やマンモグラフィーでは右乳房C領域に8×8×7mmの形状不整、辺縁やや粗雑のLow echoic lesionを認め、乳腺内部には石灰化像がみられた。腫瘤は、穿刺細胞診でClass Vであった。センチネルリンパ節に腫瘍細胞はみられなかったため、全乳腺切除を行った。病理組織学的所見は、腫瘤部には乳管内の増殖像、線維増生を伴った湿潤癌像がみられ、腺腔形成傾向が目立ち、浸潤性乳管癌、乳頭腺管癌と診断した。乳頭部は表皮内に大型の明るい泡沫状の細胞質と、表皮が一部菲薄化し、好中球浸潤、痂皮形成、膿瘍形成も認めた。続いて、下腹壁動脈穿通枝皮弁による乳房再建術を行った。術後経過は良好で、術後2年現在、局所再発、転移は認められない。また、腹部の瘢痕も目立たず、再建乳房はほぼ対称的である。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

After peripheral nerve injury, minimizing axonal misdirection has been a matter of importance to obtain good functional outcomes. In general, it becomes more challenging as the nerve defect length is longer. As previous works suggested that a conduit repair leaving a short gap could induce some target-specific reinnervation, we expected that a distally placed conduit combined with nerve graft would enhance the specificity of reinnervation, especially in dealing with a long gap. To test this, a 14-mm-long gap was created in the rat sciatic nerves and repaired with either 1) whole nerve graft (WG), 2) interfascicular nerve grafts (FG), or 3) whole nerve graft combined with distally placed silicone tube leaving a 5-mm gap (TUBG). At the end of follow up, the extent of target specific reinnervation (measurement of the compound muscle action potentials evoked by stimulation of the sciatic nerve and its tibial and common peroneal fascicles) and the accuracy of motoneuronal projection (sequential retrograde labeling of the common peroneal motor pool) were assessed. Both assessments revealed that groups FG and TUBG had a similar selectivity, which was significantly higher than in group WG. Consistent with these results, the functional recovery as assessed by walking track analysis showed no significant difference between groups FG and TUBG, whereas those were significantly superior to group WG. In contrast, histomorphometric assessment of the regenerating axons and wet muscle weight showed no significant difference among the three groups. In conclusion, conduit repair would have some effects on reducing motor axonal misdirection, and it might be more effective when used in the management of a large defect in combination with nerve graft. (C) 2007 Wiley-Liss, Inc.

DOI： 10.1002/micr.20394

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BACKGROUND: Skin-sparing mastectomy (SSM) is a type of breast cancer surgery presupposed as breast reconstruction surgery. Cosmetically, it is an extremely effective breast cancer operation because the greater part of the breast's native skin and infra-mammary fold are conserved. All cases of SSM and immediate breast reconstruction performed by the senior author during the last five years were reviewed. METHODS: There are three implant options for breast reconstruction, namely, deep inferior epigastric perforator (DIEP) flap, latissimus dorsi myocutaneous (LDM) flap, and breast implant, and one of these was used for reconstruction after comprehensive evaluation. RESULTS: From 2001 to 2005, immediate reconstructions following SSM were performed on 124 cases (128 breasts) by the same surgeon. Partial necrosis of the breast skin occurred in 4 cases of SSM. The mean follow-up was 33.6 months. During the follow-up, there was local recurrence following surgery in 3 cases. The overall aesthetic results of immediate breast reconstruction after SSM are better than those after non-SSM. CONCLUSION: SSM preserves the native breast skin and infra-mammary fold, and is an extremely useful breast cancer surgery for breast reconstruction. SSM is an excellent breast cancer surgical technique. We think this procedure should be considered in more facilities conducting breast reconstruction in Japan.

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

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

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

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

Recent studies have provided evidence that p21(Cip1/WAF1) has not only cell cycle-associated activities but also other biological activities like neurite elongation. To investigate the role of p21(Cip1/WAF1) in the in vivo axonal regeneration in the peripheral nervous system, we developed a p21(Cip1/WAF1) knockout (KO) mice sciatic nerve injury model. We performed quantitative assessments of the functional, histological, and electrophysiological recoveries after sciatic nerve injury in p21(Cip1/WAF1) KO mice and compared the results with those of the wild-type mice. p21(Cip1/WAF1) KO mice showed a significant delay of the motor functional recovery between 21 and 42 days after sciatic nerve injury. The values of motor conduction velocity in p21(CiP1/WAF1) KO mice were significantly lower than those in the wild-type mice on postoperative day 28. The mean percent neural tissue and the mean nerve axon width of p21(Cip1/WAF1) KO mice were significantly less than those of the wild-type mice, which was caused by hyperphosphorylation of neurofilaments. Therefore, p21(Cip1/WAF1) was considered to be involved in radial axon growth and to be essential for the motor functional recovery following peripheral nervous system injury. (c) 2006 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2006.01.120

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PubMed

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

The effectiveness of the end-to-side nerve graft in comparison with the end-to-end cable-graft was determined in rat sciatic nerve transection models. Sixty Sprague Dawley rats were randomly divided into four groups with different reconstructive methods for two branches of the sciatic nerve: Group I, median nerve graft with end-to-side neurorrhaphy; Group II, median and ulnar nerve grafts with end-to-end neurorrhaphy; Group III, no repair; and Group IV, sham operation. Between Groups I and II, there were no significant differences in the functional, electrophysiologic, and histologic evaluations. In retrograde tracing of the spinal cord and dorsal root ganglia, the number of double-labeled neurons was significantly higher in Group I. End-to-side nerve grafts show good functional recovery, require less graft, and are easy to perform. The authors find this method to be an effective alternative in facial nerve reconstruction and of great value in various kinds of peripheral nerve surgery.

DOI： 10.1055/s-2005-922439

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE DERMATOLGICAL ASSOC  

A 53-year-old woman had had a pale-brown lesion on her right cheek and neck from birth. Since she was about 40 years old, part of the lesion had gradually elevated and increased in size. At the first examination, there was a huge mass measuring 110 x 70 x 35 mm on the right cheek. A wide local excision of the area including a superficial parotidectomy and submandibular lymph node dissection was performed, followed by full thickness skin grafting. Histological examination of the tumor revealed an invasive dermal neoplasm characterized by lobes that were composed of foamy cells stained with Sudan-IV mixed with many atypical cells showing remarkable variation in the shapes and sizes of their nuclei. The surrounding epithelial changes were consistent with nevus sebaceus. From these findings, the gigantic tumor was diagnosed as a sebaceous carcinoma arising in nevus sebaceus.

DOI： 10.1111/j.1346-8138.2005.tb00814.x

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.PRS.0000157613.93879.FF

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

Reconstruction of multiple branches of the facial nerve by sural nerve graft using end-to-side nerve suture was performed successfully on a patient with advanced parotid tumor. In this technique, one end of the grafted nerve is sutured with the stump of the facial nerve trunk in an end-to-end manner. Epineural windows are made on the nerve graft, and the distal stumps of the facial nerve branches (temporal, zygomatic, and buccal branches) are sutured with the graft in an end-to-side manner. Functional recovery of all branches and satisfactory facial expression were obtained within 2 years postoperatively. Axonal regeneration through the graft was confirmed by electrodiagnosis. Regeneration through the anastomosis at the stump of the facial nerve trunk using this technique is more efficient than conventional cable grafting, and the length of the nerve required is minimal. This technique may be a useful option for facial nerve reconstruction managing multiple branches.

DOI： 10.1097/01.sap.0000116283.76872.de

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

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

An 8-month-old girl presented with a painless mass on her left shoulder that was noticed by her mother. Ultrasonography and magnetic resonance imaging (MRI) showed a well-defined subcutaneous cystic mass. The excised cyst was lined with ciliated pseudostratified columnar epithelium with occasional goblet cells and diagnosed as a bronchogenic cyst. She made a good recovery.

DOI： 10.1080/02844310410031621

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Language：Japanese   Publisher：(独)労働者健康安全機構大阪労災病院  

症例1:61歳女,症例2:53歳女で,各々脂腺母斑から生じた基底細胞癌basal cell carcinoma,脂腺癌sebaceous carcinomaであった.いずれの症例においても拡大切除を施行し,症例2においては耳下腺浅葉切除,顎下リンパ節郭清を施行した.現在,いずれの症例においても再発を認めていない.脂腺母斑においては低い頻度ではあるものの悪性腫瘍発生の可能性があるため,予防的切除が望ましいと考えられた

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/00006534-200302000-00099

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

眼窩底,頬骨骨折の整復術における,lateral paracanthal incision法の有用性について検討した.整容面に優れ,かつ良好な視野が得られる本法は頬骨骨折や眼窩底骨折の整復術をはじめ,種々の顎顔面手術における選択肢の一つとなり得ると考えられる.下眼瞼の全層切開により皮膚側にわずかな創が残るものの,大部分の創は結膜面にあり,睫毛下切開法に比べて整容面で優れており,視野に関しても単純な経結膜切開法に比べてはるかに良好で,睫毛下切開法と比較しても遜色ないと考えられた

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Other Link： http://search.jamas.or.jp/link/ui/2003080675

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

DOI： 10.1097/00006534-200111000-00037

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Language：Japanese   Publisher：(一財)住友病院  

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Total pages：xii, 258p   Language：Japanese

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Total pages：v, 223p   Language：Japanese

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Total pages：viii, 302p   Language：Japanese

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Total pages：xii, 120p   Language：Japanese

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Total pages：xi, 555p   Language：Japanese

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Total pages：215  

ASIN

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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：(株)全日本病院出版会  

血管吻合に用いる器械や物品には様々な形状のものがあり、吻合する血管の径や位置、吻合方法、術者の好みなどにより適したものを選択する。また、吻合血管の深さや位置関係、口径差の有無によって、選択すべき吻合法も異なる。様々な血管吻合の技術を習得することで、各条件に対応した適切な血管吻合を行うことが可能となる。より高い組織生着率のためには正しい機器と吻合法の選択ならびに正確な手技が要求される。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2017187079

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：全日本病院出版会  

本稿では顔面神経再建において、多数の分枝を少量の移植神経で、効率よく再建するために、1本の移植神経の側面を神経縫合部位として利用するループ型神経移植法について解説する。通常の端側神経縫合と異なり、本法では移植神経側面への端側神経縫合は再生軸索の経路となる移植神経に分岐点を作成するために用いられており、中枢断端から移植神経内へと伸張した再生軸索は複数の末梢枝に「分配」(axonal distribution)されることになる。また、術前からの麻痺が存在していたり、術後放射線療法や化学療法が予定されているなど、術後の顔面表情筋回復が不良と思われる症例に対しては1本の移植神経への双方向からの再生を期待するbi-directional nerve graftの考え方を応用し、移植神経遠位端の舌下神経への端側縫合を追加し、再生軸索の付加(axonal supercharging)を図っている。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2014336652

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)日本頭蓋顎顔面外科学会  

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

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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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