Publications by authors named "Kenji Hayashida"

91 Publications

Triple-Row Technique Confers a Lower Re-tear Rate than Standard Suture Bridge Technique in Arthroscopic Rotator Cuff Repairs.

Arthroscopy 2021 May 3. Epub 2021 May 3.

Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan.

Purpose: The purpose of the study is to compare the structural and clinical results between the knotless suture bridge (SB) and triple-row (TR) techniques.

Methods: This study is a retrospective study and included 212 shoulders with repairable rotator cuff tears treated with the SB technique and 206 shoulders treated with the TR technique. In the TR technique, medial and lateral anchors were placed as they would be for the SB technique, with a middle row anchor was added on the edge of footprint to reduce the torn tendons. All patients underwent primary arthroscopic rotator cuff repair and had magnetic resonance imaging (MRIs) 6 months postoperatively to evaluate for re-tear. Sugaya's classification was used to classify the re-tear pattern. The function of all patients preoperatively and 2 years postoperatively were assessed by the American Shoulder and Elbow Surgeons (ASES) shoulder index and the University of California at Los Angeles rating scale (UCLA).

Results: According to Sugaya's classification, 24 (11.3%), 6 (2.8%), and 20 (9.4%) in SB-treated shoulders and 16 (7.8%), 12 (5.8%), and 8 (3.9%) in TR-treated shoulders, respectively had types 3, 4, and 5. There was a statistically significant higher type 5 re-tear in SB-treated shoulders (p=0.038) than in TR-treated shoulders. The average clinical outcome scores at the final follow-up improved significantly relative to those before the surgeries in both groups. There were no statistical differences in the clinical outcome scores at the final follow-up between SB and TR groups.

Conclusions: The use of the TR technique in ARCR resulted in a lower large-size re-tear rate when compared with the use of the SB technique. No clinical differences were noted in the outcomes between the 2 groups.
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http://dx.doi.org/10.1016/j.arthro.2021.04.045DOI Listing
May 2021

Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty.

Arch Orthop Trauma Surg 2021 Apr 30. Epub 2021 Apr 30.

Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan.

Introduction: In total hip arthroplasty (THA), improper cup orientation can result in dislocation, early excessive polyethylene wear, and pain following THA. The supine position during THA provides a more reproducible functional pelvic position than the lateral decubitus position and may allow freehand cup placement as reliable as that obtained by computer navigation. The purpose of this study was to investigate the accuracy of freehand cup placement through a supine direct anterior approach (DAA) compared with computed tomography (CT)-based navigation.

Materials And Methods: The same surgeon performed primary cementless THA through the DAA in 144 supine patients. Seventy-two patients underwent freehand cup placement with standard mechanical guidance-oriented radiographic target cup positioning, and 72 underwent placement with CT-based navigation guidance. Using three-dimensional templating software, the study group calculated cup inclination and anteversion on postoperative CT scans.

Results: The navigation method resulted in a significantly smaller deviation of inclination from the target (p < 0.05); the difference in anteversion was not significant. In addition, the navigation method resulted in significantly fewer cups placed ± 10° outside the target position (0% for inclination, 0% for anteversion) than did the freehand procedure (26% for inclination, 25% for anteversion) (p < 0.0001).

Conclusions: Freehand cup placement is less reliable even in the supine position. Use of a CT-based navigation system can significantly improve cup positioning in THA through the DAA by reducing the incidence of outliers.
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http://dx.doi.org/10.1007/s00402-021-03920-1DOI Listing
April 2021

Fournier's Gangrene With Subcutaneous Emphysema of the Thigh Caused by Air Inflow Associated With a Rectovaginal Fistula: A Case Report of Pseudo-gas Gangrene.

Wounds 2021 Jan;33(1):E10-E13

Shimane University, Shimane, Japan.

Introduction: Rectovaginal fistulas (RVFs) are abnormal connections between the rectum and vagina.

Case Report: A 61-year-old female patient was admitted to the authors' hospital with swelling, extending from the left thigh to the left lower abdomen and crepitus. An axial computed tomography scan showed air in the soft tissue of the left thigh, left buttock, perineal region, and left lower abdomen. Gas gangrene was suspected. Accordingly, the patient was administered meropenem, clindamycin, and vancomycin and underwent emergency debridement. An intraoperative examination revealed necrotizing fasciitis in the left buttock but no inflammatory signs in the thigh. On postoperative day 8, fecal matter was discharged from the patient's vagina, and an RVF was detected by colon fiberscopy. The patient underwent resurfacing surgery with a free skin graft, and a colon stoma was fashioned 15 days after the primary surgery. The patient was discharged on day 14 following surgery with wound healing.

Conclusion: The existence of free air in subcutaneous tissue combined with an infection, particularly in the extremities, is generally suggestive of gas gangrene. In the present case, subcutaneous gas was not caused by gas gangrene but rather by air inflow from an RVF. Appropriate treatment of the RVF was necessary to avoid the exacerbation of Fournier's gangrene and prevent necrosis spreading to the thigh.
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January 2021

Safety and efficacy of secondary mandibular reconstruction using a free osteo-cutaneous fibula flap after segmental mandibular resection: a retrospective case-control study.

BMC Surg 2021 Apr 9;21(1):189. Epub 2021 Apr 9.

Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.

Background: Free osteocutaneous fibula flap (FFF) is currently considered the best option for segmental mandibular reconstruction; however, there are only a few reports comparing secondary with primary reconstructions using FFF. This study aimed to evaluate the safety and efficacy of secondary mandibular reconstruction using FFF when compared with primary mandibular reconstruction.

Methods: From October 2018 to February 2020, patients who underwent mandibular reconstruction using FFF after segmental mandibulectomy were retrospectively reviewed. The size and location of the mandibular defect, the segment length and number of osteotomies in the fibula, types of the mandibular plating system, kinds and laterality of the recipient vessels were recorded from the surgical notes. Flap survival, duration of nasogastric tube use, and implant installation after reconstruction were recorded as postoperative evaluation indices.

Results: Twelve patients underwent mandibular reconstruction using FFF during the study period. There were no significant differences in demographic characteristics other than body mass index between the primary (n = 8) and secondary (n = 4) reconstruction groups. No significant differences were observed in the size and location of defects, the segment length and number of osteotomies in the fibula, and the types of mandibular plating system. There was no significant difference in the kinds of recipient vessels; however, the laterality of recipient vessels was ipsilateral in all cases of primary reconstructions and contralateral in all cases of secondary reconstructions. Three out of eight patients with primary FFF reconstruction developed partial flap necrosis. Four patients in the secondary FFF reconstruction group achieved complete flap survival. The duration of use of the nasogastric tube and implant installation after reconstruction was comparable between the two groups.

Conclusion: Safe and effective secondary mandibular reconstruction can be performed in this clinical case study using FFF.
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http://dx.doi.org/10.1186/s12893-021-01194-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035737PMC
April 2021

Treatment of acromioclavicular joint separations in Japan: a survey.

JSES Int 2021 Jan 31;5(1):51-55. Epub 2020 Oct 31.

Scientific Research Project Committee, Japan Shoulder Society, Tokyo, Japan.

Background: Treatment options for acromioclavicular joint (ACJ) separations are highly dependent on severity, as well as the patient's background. Furthermore, some patients can be switched from conservative to surgical treatment. In this study, we conducted a mail-based questionnaire survey of members of the Japan Shoulder Society on the administration of treatments for ACJ separations.

Methods: A questionnaire survey with 5 categories was mailed to all 1655 members of the Japan Shoulder Society (including 59 councilors): initial treatment, whether surgery was performed, indications for surgery based on severity, switching from conservative to surgical treatment, and surgical methods.

Results: Altogether, 183 members, including 56 councilors, responded. Regarding the initial treatment, 17 respondents opted for treatment without immobilization or fixation and 166 opted for immobilization or fixation. Of the members, 11 opted for only conservative treatment whereas 172 chose surgery depending on the case; of the latter, 9 considered it for patients with a Rockwood classification of type 2 or higher; 120, for patients with type 3 or higher; and 172, for patients with types 4-6. Furthermore, 75 of 172 members had experience switching to surgical treatment during conservative treatment. For 64 of 172 members, the modified Cadenat method was the most common surgical method.

Conclusions: Only 11 members opted for conservative treatment of ACJ separations, and approximately 95% of physicians chose surgery. Furthermore, >70% of physicians considered surgery for an injury classified as type 3 or higher, and 37% of members performed the modified Cadenat method. However, the popularization of arthroscopic surgery may affect the selection of surgical methods in the future.
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http://dx.doi.org/10.1016/j.jseint.2020.09.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846705PMC
January 2021

[A Case of Early Detection and Treatment Applicable to Squamous Cell Carcinoma of the Palate Detected by Oral Cancer Mass Screening in Izumo 2019].

Gan To Kagaku Ryoho 2020 Dec;47(13):1774-1776

Dept. of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine.

Treatment of oral cancer is based on radical resection and reconstructive surgery. Surgery causes impairment of maxillofacial morphology and function, including chewing and eating difficulties, and dysarthria. It is necessary to restore the maxillofacial morphology and function by reconstructive surgery and use of prostheses. Therefore, early detection and treatment are required to reduce these disabilities associated with oral cancers. Here, we report a case of oral cancer that was detected early by our oral cancer mass screening program in Izumo, Japan, in 2019. A 73-year-old woman presented with a reddish ulcerative region in the palate. Cytological screening indicated positive-suspected low squamous intraepithelial neoplasia (LSIL). The patient was diagnosed as squamous cell carcinoma of the palate(cT1N0M0, StageⅠ)in our hospital. We performed radical resection of the palate tumor and immediate reconstruction using a vascularized radial forearm flap. The clinical course was good and oral function was fully restored. It is important for oral surgeons to publicize and raise awareness of oral cancer, and to continue oral cancer mass screening programs.
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December 2020

Low Serum Levels of Fibroblast Growth Factor 2 in Gunn Rats: A Hyperbilirubinemia Animal Model of Schizophrenic Symptoms.

CNS Neurol Disord Drug Targets 2020 ;19(7):503-508

Department of Dermatology, Faculty of Medicine, Shimane University, Matsue, Japan.

Background: Fibroblast Growth Factor (FGF) 2 (also referred to as basic FGF) is a multifunctional growth factor that plays a pivotal role in the pro-survival, pro-migration and prodifferentiation of neurons.

Method: Because alterations in FGF2 levels are suggested to contribute to the pathogenesis of schizophrenia, we investigated serum levels of FGF2 in the Gunn rat, a hyperbilirubinemia animal model of schizophrenic symptoms.

Results: The enzyme-linked immunosorbent assay showed that the serum levels of FGF2 in Gunn rats were 5.09 ± 0.236 pg/mL, while those in the normal strain Wistar rats, serum levels were 11.90 ± 2.142 pg/mL. The serum FGF2 levels in Gunn rats were significantly lower than those in Wistar rats. We also measured serum levels of Unconjugated Bilirubin (UCB) and found a significant negative correlation between UCB and FGF2 in terms of serum levels in all the rats studied.

Conclusion: Since it is known that FGF2 regulates dopaminergic neurons and have antineuroinflammatory effects, our finding suggests that low FGF2 levels may contribute to the pathogenesis of schizophrenia, in which imbalanced dopamin-ergic signaling and neuroinflammation are supposed to play certain roles.
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http://dx.doi.org/10.2174/1871527319999200729153907DOI Listing
January 2020

Antiodor Effects of Rice Bran Sheets in Patients with Malodorous Wounds.

J Palliat Med 2020 06;23(6):750-751

Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, Izumo, Japan.

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http://dx.doi.org/10.1089/jpm.2019.0693DOI Listing
June 2020

Methods used to assess the severity of acromioclavicular joint separations in Japan: a survey.

JSES Int 2020 Jun 13;4(2):242-245. Epub 2020 Feb 13.

Scientific Research Project Committee of the Japan Shoulder Society, Tokyo, Japan.

Background: In acromioclavicular joint (ACJ) separations, patient characteristics determine the indications for surgery. However, in Japan, classification methods used to assess the severity of ACJ separations differ between institutions, and even within a classification method, different interpretations can lead to different assessments of severity. Therefore, in this study, we conducted an email survey of Japan Shoulder Society (JSS) members regarding their assessment methods for ACJ separation severity.

Methods: A questionnaire about methods for assessing the severity of ACJ separations was emailed to JSS members (1655) including 59 JSS councilors. The survey focused on diagnostic imaging methods, classifications of severity assessments, and methods of assessing severity.

Results: In total, 183 responses were received. All respondents used an anteroposterior view of the ACJ. Severity assessments were classified by the Tossy classification (57 respondents), Rockwood classification (141 respondents), and other classifications (7 respondents) including duplication. Of the 141 respondents using the Rockwood classification, 119 diagnosed type III as ACJ dislocation when the inferior clavicle border translated above the superior acromial border, whereas 56 used the coracoclavicular distance. However, to diagnose type V, 118 respondents used the coracoclavicular distance whereas 38 used palpation. To diagnose type IV, 57 respondents considered all cases in which the clavicle translated posterior to the acromion, even when vertical ACJ dislocation occurred simultaneously. However, 88 respondents did so in the presence of posterior clavicle displacement and ACJ subluxation.

Conclusion: The Rockwood classification is commonly used for severity assessments in Japan; however, there is some disagreement regarding the assessment for the diagnosis of type IV. Methods to diagnose both superior and posterior translation of the clavicle need further debate.
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http://dx.doi.org/10.1016/j.jseint.2019.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256793PMC
June 2020

Adipose-Derived Stem Cells Promote Intussusceptive Lymphangiogenesis by Restricting Dermal Fibrosis in Irradiated Tissue of Mice.

Int J Mol Sci 2020 May 29;21(11). Epub 2020 May 29.

Department of Dermatology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.

Currently, there is no definitive treatment for lymphatic disorders. Adipose-derived stem cells (ADSCs) have been reported to promote lymphatic regeneration in lymphedema models, but the mechanisms underlying the therapeutic effects remain unclear. Here, we tested the therapeutic effects of ADSC transplantation on lymphedema using a secondary lymphedema mouse model. The model was established in C57BL/6J mice by x-irradiation and surgical removal of the lymphatic system in situ. The number of lymphatic vessels with anti-lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1) immunoreactivity increased significantly in mice subjected to transplantation of 7.5 × 10 ADSCs. X-irradiation suppressed lymphatic vessel dilation, which ADSC transplantation could mitigate. Proliferative cell nuclear antigen staining showed increased lymphatic endothelial cell (LEC) and extracellular matrix proliferation. Picrosirius red staining revealed normal collagen fiber orientation in the dermal tissue after ADSC transplantation. These therapeutic effects were not related to vascular endothelial growth factor (VEGF)-C expression. Scanning electron microscopy revealed structures similar to the intraluminal pillar during intussusceptive angiogenesis on the inside of dilated lymphatic vessels. We predicted that intussusceptive lymphangiogenesis occurred in lymphedema. Our findings indicate that ADSC transplantation contributes to lymphedema reduction by promoting LEC proliferation, improving fibrosis and dilation capacity of lymphatic vessels, and increasing the number of lymphatic vessels via intussusceptive lymphangiogenesis.
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http://dx.doi.org/10.3390/ijms21113885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312745PMC
May 2020

Strategies to prevent hypertrophic scar formation: a review of therapeutic interventions based on molecular evidence.

Burns Trauma 2020 27;8:tkz003. Epub 2020 Jan 27.

Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.

Once scar tissues mature, it is impossible for the surrounding tissue to regenerate normal dermal tissue. Therefore, it is essential to understand the fundamental mechanisms and establish effective strategies to inhibit aberrant scar formation. Hypertrophic scar formation is considered a result of the imbalance between extracellular matrix synthesis and degradation during wound healing. However, the underlying mechanisms of hypertrophic scar development are poorly understood. The purpose of this review was to outline the management in the early stage after wound healing to prevent hypertrophic scar formation, focusing on strategies excluding therapeutic agents of internal use. Treatment aimed at molecular targets, including cytokines, will be future options to prevent and treat hypertrophic scars. More basic studies and clinical trials, including combination therapy, are required to investigate the mechanisms and prevent hypertrophic scar formation.
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http://dx.doi.org/10.1093/burnst/tkz003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175766PMC
January 2020

Progression of Erosive Changes of Glenoid Rim After Arthroscopic Bankart Repair.

Arthroscopy 2020 01 7;36(1):44-53. Epub 2019 Nov 7.

Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan.

Purpose: To evaluate changes of the glenoid after arthroscopic Bankart repair (ABR) in patients with different preoperative glenoid structures.

Methods: Patients who underwent ABR for traumatic anterior shoulder instability were retrospectively investigated. They were divided into 3 groups on the basis of preoperative glenoid structure by computed tomography (CT): normal glenoid (group N), glenoid erosion (group E), or glenoid defect associated with a bony Bankart lesion (group B). Shoulders in group B were also stratified according to the postoperative status of the bone fragment (union, nonunion, or resorbed). Postoperative changes of glenoid width (Δ) (increase: Δ ≥5%, stable: Δ >-5% to <5%, decrease: Δ ≤-5%) and the extent of glenoid bone loss were investigated by 3-dimensional CT.

Results: A total of 186 shoulders were divided into 3 groups: group N (n = 61), group E (n = 46), and group B (n = 79). At initial postoperative CT, the glenoid width was decreased in 41 shoulders, stable in 20 shoulders, and increased in no shoulders from group N. The respective numbers were 27, 18, and 1 in group E, and 50, 22, and 7 in group B. The glenoid width was reduced in all groups (mean percent change: -8.8%, -5.9%, and -6.1%, respectively). In group B, glenoid width decreased in most of the shoulders without bone union. The glenoid bone loss on the preoperative and postoperative final CT was, respectively, 0% and 8.6% in group N (P < .0001), 9.9% and 12.4% in group E (P = .03), and 10.4% and 7.2% in group B (P = .01). Final glenoid bone loss >13.5% was recognized in 18.2% of group N, 35.7% of group E, and 21.8% of group B.

Conclusions: Glenoid width often decreased after ABR because of anterior glenoid rim erosion, and this change was frequent in patients with preoperative normal glenoid, glenoid erosion, or without postoperative union of a bony Bankart lesion.

Level Of Evidence: Level 3, Case-control study.
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http://dx.doi.org/10.1016/j.arthro.2019.07.019DOI Listing
January 2020

Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant: A case report.

Medicine (Baltimore) 2019 Oct;98(43):e17575

Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.

Rationale: Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA).

Patient Concerns: We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies.

Diagnosis: The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema.

Interventions: LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm.

Outcomes: Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required.

Lessons: LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.
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http://dx.doi.org/10.1097/MD.0000000000017575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824808PMC
October 2019

Shoulder and elbow evaluation of pitchers in National High School Baseball Invitational Tournaments and National High School Baseball Championships from 1993 to 2016 in Japan.

J Orthop Sci 2020 May 27;25(3):423-427. Epub 2019 Jun 27.

Medical Science Committee, The Japan High School Baseball Federation, 1-22-25 Edobori Nishiku, Osaka, Osaka, 550-0002, Japan.

Background: Shoulder and elbow examinations for pitchers have been performed in Japan's National High School Baseball Invitational Tournaments (NHSBITs) and National High School Baseball Championships (NHSBCs) since 1993. However, for years the results have not been analyzed. The purpose of this study was to evaluate changes in the condition of shoulders and/or elbows of pitchers from 1993 to 2016.

Materials And Methods: Pitchers in NHSBITs and NHSBCs, 1994-2016, were examined together with those who received a trial examination (Trial) in the NHSBC 1993. Shoulder and elbow symptoms were comprehensively graded into five categories; none, mild, moderate, severe and dysfunction. Standard plain radiographs of the shoulder and elbow were obtained. Average Annual Percent Changes (AAPCs) in the percentages of pitchers with symptoms and positive radiographic findings were analyzed.

Results: The percentages of pitchers with moderate or worse symptoms in the shoulder or elbow were 14.6% and 13.8%, respectively, in the Trial, 1.1% and 1.1% in NHSBITs and 1.3% and 2.0% in NHSBCs. The AAPC of pitchers with a symptomatic shoulder in NHSBITs was reduced over the study period, at -3.36% (P < 0.05), but that in NHSBCs was unchanged at -1.01%. The AAPCs of pitchers with a symptomatic elbow in NHSBITs and in NHSBCs decreased, at -3.13% and -3.33%, respectively (P < 0.05), while that of pitchers with residual apophyseal fragmentation at the ulnar collateral ligament insertion increased at +2.79% (P < 0.05). The decreased percentages of symptomatic pitchers suggest that joint condition is well controlled in high school days; however, the increased frequency of radiographic findings suggests the necessity of protection against overuse in younger players.

Conclusions: The percentages of pitchers with symptomatic shoulders and elbows in NHSBITs and those with symptomatic elbows in NHSBCs have decreased over the 23 years. However, the increased frequency of residual medial humeral epicondyle apophyseopathy should be noted.
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http://dx.doi.org/10.1016/j.jos.2019.06.006DOI Listing
May 2020

Advances in surgical applications of growth factors for wound healing.

Burns Trauma 2019 5;7:10. Epub 2019 Apr 5.

Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan.

Growth factors have recently gained clinical importance for wound management. Application of recombinant growth factors has been shown to mimic cell migration, proliferation, and differentiation , allowing for external modulation of the healing process. Perioperative drug delivery systems can enhance the biological activity of these growth factors, which have a very short half-life after topical administration. Although the basic mechanisms of these growth factors are well understood, most have yet to demonstrate a significant impact in animal studies or small-sized clinical trials. In this review, we emphasized currently approved growth factor therapies, including a sustained release system for growth factors, emerging therapies, and future research possibilities combined with surgical procedures. Approaches seeking to understand wound healing at a systemic level are currently ongoing. However, further research and consideration in surgery will be needed to provide definitive confirmation of the efficacy of growth factor therapies for intractable wounds.
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http://dx.doi.org/10.1186/s41038-019-0148-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450003PMC
April 2019

Representative survey of frozen shoulder questionnaire responses from the Japan Shoulder Society: What are the appropriate diagnostic terms for primary idiopathic frozen shoulder, stiff shoulder or frozen shoulder?

J Orthop Sci 2019 Jul 11;24(4):631-635. Epub 2019 Jan 11.

Scientific Research Project Committee of Japan Shoulder Society, Tokyo, Japan.

Background: Primary frozen shoulder has unknown etiology and significant restriction of active and passive motion. The distinction between frozen shoulder and stiff shoulder has been unclear. Therefore, the purposes of this study were to perform a survey regarding definition and classification of frozen shoulder proposed by the American Academy of Orthopedic Surgeons (AAOS) among the members of the Japan Shoulder Society (JSS) and to compare the results with those obtained among the members of the American Shoulder and Elbow Surgeons (ASES).

Methods: The Scientific Research Project Committee of the JSS prepared the questionnaire for frozen shoulder and stiff shoulder. Surveys were sent by e-mail on Jan 14, 2016 to JSS registered members and the response dead-line was set on March 13, 2016.

Results: The number of respondents was 230, including all directors, councilors, and senior doctors. Agreement with the definition of primary frozen shoulder was 67%, the classification of primary or secondary frozen shoulder was 53%, and the 3 divisions of secondary frozen shoulder was 53%. Diagnostic terms for the cases of shoulder stiffness with unknown etiology were as follows: frozen shoulder (31%), stiff shoulder (22%), periarthritis scapulohumeralis (16%), so called "Gojukata" in Japan, which means shoulder problems in their fifties (16%), idiopathic frozen shoulder (6%), primary frozen shoulder (4%), adhesive capsulitis (3%), others (2%).

Conclusion: The survey shows lower rates of agreement among the JSS members than the ASES members for the definition of primary frozen shoulder, the classification of primary and secondary frozen shoulder, and the divisions of secondary frozen shoulder. To avoid confusion between stiff shoulder and frozen shoulder, the committee agrees to the ISAKOS recommendation that the term "frozen shoulder" should be used exclusively for primary idiopathic stiff shoulder.
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http://dx.doi.org/10.1016/j.jos.2018.12.012DOI Listing
July 2019

Foot reconstruction with the superficial circumflex iliac artery perforator flap under local anesthesia: Two case reports.

Medicine (Baltimore) 2019 Jan;98(2):e13888

Division of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Japan.

Rationale: The superficial circumflex iliac artery perforator (SCIP) free flap is a popular method used in foot reconstruction. Although the SCIP flap has a relatively short pedicle and does not require intramuscular dissection, general anesthesia is largely preferred for SCIP flap reconstruction. We report 2 cases with the free SCIP flap for skin and soft tissue reconstruction of the foot under local anesthesia.

Patient Concerns: Case 1 was a 34-year-old man sustained a crush injury to the dorsal foot, resulting in a soft tissue defect with bone and tendon exposure. Case 2 was a 41-year-old man with type 2 diabetes was referred to our division for an intractable ankle wound after surgery for a calcaneal bone fracture.

Diagnosis: The diagnosis was intractable wounds on feet caused by trauma and surgery. Patients were unable to receive general anesthesia because of asthma or elevated liver enzymes.

Interventions: Two patients with tissue defects on their feet were treated with SCIP flaps under local anesthesia. Fifteen milliliter of 0.5% bupivacaine was injected for ankle block. SCIP flaps were harvested after injecting 10 to 15 mL of 1% lidocaine combined with epinephrine around the flap incisions.

Outcomes: No complications related to the use of local anesthesia developed during the operation or postoperatively. Two flaps survived and fully took without complications.

Lessons: With proper local anesthesia, successful foot reconstruction with a free SCIP flap was possible. This method can be considered a sufficient option for foot reconstruction for patients unable to receive general anesthesia.
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http://dx.doi.org/10.1097/MD.0000000000013888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336647PMC
January 2019

An intraspinal extradural lipoma with spinal epidural lipomatosis: A case report and a review of literature.

Surg Neurol Int 2018 23;9:212. Epub 2018 Oct 23.

Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka 543-0035, Japan.

Background: Intraspinal extradural lipomas are very rare and should be differentiated from spinal epidural lipomatosis (SEL) and/or angiolipomas.

Case Description: A 76-year-old male presented with left lower extremity radiculopathy. The magnetic resonance imaging (MRI) revealed hyperplasia of epidural fat at the L2-3 and L3-4 levels accompanied by a lipomatous L4-5 mass. Following resection of this mass and hyperplastic epidural fat, the histological examination was consistent with an intraspinal extradural lipoma and SEL.

Conclusion: This case indicates that asymmetrical compression of the dural sac may be attributed to an intraspinal extradural lipoma vs. just SEL and/or an angiolipoma.
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http://dx.doi.org/10.4103/sni.sni_280_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213804PMC
October 2018

Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System.

Orthop J Sports Med 2018 Jul 9;6(7):2325967118782420. Epub 2018 Jul 9.

Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan.

Background: The combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed "bipolar bone loss," but the prevalence and influence of this condition on postoperative recurrence after arthroscopic Bankart repair are still unclear.

Purpose: To investigate bipolar bone loss in male athletes using a new scoring system and to evaluate its efficacy by comparing it with the glenoid track concept.

Study Design: Case-control study; Level of evidence, 3.

Methods: The sizes of both lesions were evaluated retrospectively in 80 male athletes (85 shoulders) using computed tomography. The glenoid defects and the length, width, and depth of the Hill-Sachs lesions were classified into 5 size categories and were allocated scores from "0" for no defect to "4" for the largest defect. Patients were then classified into 5 classes according to the total score for both lesions: class 1, 0-1 point; class 2, 2 points; class 3, 3 points; class 4, 4 points; and class 5, ≥5 points. The prevalence of bipolar bone loss and postoperative recurrence rates for patients with at least 2 years of follow-up were compared among the classes. The recurrence rate for each class was also compared between shoulders with an off-track lesion and shoulders with an on-track lesion as well as among 3 sporting categories: rugby, American football, and other sports.

Results: Based on the combination of glenoid defect size and Hill-Sachs lesion length, the postoperative recurrence rate was 0% for shoulders in class 1, 12.5% for class 2, 33.3% for class 3, 28.6% for class 4, and 31.3% for class 5, while the recurrence rates were 0%, 16.7%, 28.6%, 27.3%, and 31.6%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion width and 0%, 8.3%, 26.7%, 28.6%, and 35.3%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion depth. Postoperative recurrence was frequently recognized regardless of the presence of off-track Hill-Sachs lesions. No recurrence was recognized in class 1 shoulders among rugby players, in classes 1 and 2 among American football players, and in classes 1 through 3 among other athletes based on the combination of glenoid defect size and Hill-Sachs lesion size.

Conclusion: Our scoring system for bipolar bone loss was useful to evaluate the influence on postoperative recurrence in male athletes. The postoperative recurrence rate was influenced by the extent of bipolar bone loss and the sporting category regardless of the presence of off-track lesions.
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http://dx.doi.org/10.1177/2325967118782420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055304PMC
July 2018

Intradural Disk Herniation Mimicking a Spinal Tumor: Radiologic Imaging, Pathogenesis, and Operative Management.

Case Rep Orthop 2018 29;2018:9810762. Epub 2018 Apr 29.

Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan.

Intradural disk herniation (IDH) is a rare condition, occurring more often at the L4-5 level. We examined a case of an IDH at the L1-2 level mimicking an intradural spinal tumor. A 71-year-old woman with a long history of backache and pain radiating down the left leg was admitted to our hospital with the worsening of these symptoms. Magnetic resonance imaging and computed tomographic myelography demonstrated an intradural mass at the L1-2 level. Given the radiologic findings and the location of the mass, the preoperative differential diagnosis centered on intradural spinal tumors. Dural incision was performed using a surgical microscope to resect the mass. Contrary to our expectation, the diagnosis made during the surgery was IDH. Despite advances in imaging techniques, IDH could not be definitively diagnosed preoperatively. The pathogenesis of IDH remains unclear. In our patient, the ventral dural defect was smooth and round, and the dural tissue around the defect was thickened. These intraoperative findings suggested that the patient's IDH resulted not from an acute new event but from a chronic process. We recommend dural incision using a surgical microscope for treating IDH because it provides a clear visual field.
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http://dx.doi.org/10.1155/2018/9810762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949157PMC
April 2018

Successful reconstruction of congenital perineal skin defect using gluteal-fold bilobed perforator flap.

Afr J Paediatr Surg 2017 Jan-Mar;14(1):15-17

Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.

Perineovaginorectal defect usually requires surgical repair; however, direct closure often leads to dehiscence. We present two patients with a congenital perineal skin defect who were successfully treated using a gluteal-fold bilobed perforator flap. This flap facilitates esthetic restoration and a more natural perineovaginorectal appearance, using only a one-stage procedure. This technique may be a favorable option for perineal and genital repair.
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http://dx.doi.org/10.4103/ajps.AJPS_29_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853016PMC
June 2018

Novel Application of Cultured Epithelial Autografts (CEA) with Expanded Mesh Skin Grafting Over an Artificial Dermis or Dermal Wound Bed Preparation.

Int J Mol Sci 2017 Dec 25;19(1). Epub 2017 Dec 25.

Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan.

Cultured epithelial autografts (CEA) with highly expanded mesh skin grafts were used for extensive adult burns covering more than 30% of the total body surface area. A prospective study on eight patients assessed subjective and objective findings up to a 12-month follow-up. The results of wound healing for over 1:6 mesh plus CEA, gap 1:6 mesh plus CEA, and 1:3 mesh were compared at 3, 6, and 12 months using extensibility, viscoelasticity, color, and transepidermal water loss by a generalized estimating equation (GEE) or generalized linear mixed model (GLMM). No significant differences were observed among the paired treatments at any time point. At 6 and 12 months, over 1:6 mesh plus CEA achieved significantly better expert evaluation scores by the Vancouver and Manchester Scar Scales ( < 0.01). Extended skin grafting plus CEA minimizes donor resources and the quality of scars is equal or similar to that with conventional low extended mesh slit-thickness skin grafting such as 1:3 mesh. A longitudinal analysis of scars may further clarify the molecular changes of scar formation and pathogenesis.
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http://dx.doi.org/10.3390/ijms19010057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796007PMC
December 2017

The neck burn scar contracture: a concept of effective treatment.

Burns Trauma 2017 13;5:22. Epub 2017 Jul 13.

Department of Plastic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan.

A neck scar contracture can severely and negatively affect the function of mastication, phonic, or breathing and result in neck pain and issues with esthetics. The best way is of course to avoid such contracture by means of non-surgical treatment such as use of a growth factor. The basic fibroblastic growth factor is clinically well proven in decreasing scar formation and improving healing. There are numerous reconstructive methods for neck contracture, especially when the lesions are relatively limited in part of the neck. However, a very severe and full circumferential scar contracture requires extensive reconstruction. The thin groin flap is one of the answers and well matches with the tissue texture and maintains the flexibility. Even with extensive burns and delayed reconstructions due to resuscitation first, the groin area is well preserved and can be safely harvested by dual vasculature systems of the superficial circumflex iliac artery and superficial epigastric artery, which warrant more reliability compared to the perforator flaps in this area. More demanding and stringent forms of the neck burn scar contracture are the sequelae of radiation. A radiation burn or radiation injury can be progressing and hard to heal. Adipose-derived stem cells can reverse the scar contracture as the surrounding tissue is softened and can accelerate wound healing. In this review, different types of neck burn scar contracture and reconstructive methods are summarized, including innovative use of bFGF and ADSCs in the management of difficult wound healing and scar contracture.
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http://dx.doi.org/10.1186/s41038-017-0086-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508764PMC
July 2017

The thymus and activation-regulated chemokine (TARC) level in serum at an early stage of a drug eruption is a prognostic biomarker of severity of systemic inflammation.

Allergol Int 2018 Jan 22;67(1):90-95. Epub 2017 Jun 22.

Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan. Electronic address:

Background: In severe drug eruptions, precise evaluation of disease severity at an early stage is needed to start appropriate treatment. It is not always easy to diagnose these conditions at their early stage. In addition, there are no reported prognostic biomarkers of disease severity in drug eruptions. The aim of this study was to test whether the thymus and activation-regulated chemokine (TARC) level in serum at an early stage of a drug eruption can serve as a prognostic biomarker of systemic inflammation.

Methods: Study participants included 76 patients who received a diagnosis of a drug eruption, one of the following: drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome, maculopapular exanthema, and erythema multiforme. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) was eliminated in this study because scoring system for evaluating the severity was established. Correlation coefficients between serum TARC levels and indicators of systemic inflammation, including the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, modified systemic inflammatory response syndrome (mSIRS) score, and C-reactive protein in serum were evaluated.

Results: Serum TARC levels positively correlated with the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, mSIRS score, C-reactive protein, albumin, white blood cell count, body temperature, and pulse rate. TARC levels negatively correlated with systolic blood pressure. Among these parameters, the mSIRS score showed strong correlation (correlation coefficient: 0.68).

Conclusions: Serum TARC levels correlate well with indicators of systemic inflammation and of disease severity among patients with a drug eruption except SJS/TEN. Serum TARC may be a prognostic biomarker of severity of inflammation in drug eruptions.
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http://dx.doi.org/10.1016/j.alit.2017.06.001DOI Listing
January 2018

Surgical treatment algorithms for post-burn contractures.

Burns Trauma 2017 14;5. Epub 2017 Mar 14.

Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, Fukuoka, Japan.

Burn contractures produce restrictions in motion and unacceptable aesthetic results, frequently with persistent wounds. Proper planning and tissue selection are essential to minimize donor site morbidity optimizing outcomes. The principle of burn reconstructive surgery requires that the defects after release should be replaced with donor tissues which have matching texture and color as well as enough pliability. Autologous skin grafting or flap surgeries meet these criteria to replace scar tissues and resurface the subsequent to post-released scar defects. Despite the benefits, the use of flaps is often limited in burn patients for many reasons. If a surgeon intends to release completely and reconstruct in one-stage operation, a large defect may result in large donor site morbidity, necessitating flap surgery including free flap surgery. A lot of different methods and procedures are available for resurfacing the defects, and these are reviewed. In this article, algorithms for the release of burn contractures and reconstructive methods are presented. These treatment algorithms should aid in achieving significant improvement in both joint motions and aesthetic deformities.
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http://dx.doi.org/10.1186/s41038-017-0074-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348756PMC
March 2017

Adipose-Derived Stem Cells and Vascularized Lymph Node Transfers Successfully Treat Mouse Hindlimb Secondary Lymphedema by Early Reconnection of the Lymphatic System and Lymphangiogenesis.

Plast Reconstr Surg 2017 Mar;139(3):639-651

Nagasaki and Oita, Japan.

Background: Secondary lymphedema is often observed in postmalignancy treatment of the breast and the gynecologic organs, but effective therapies have not been established in chronic cases even with advanced physiologic operations. Currently, reconstructive surgery with novel approaches has been attempted.

Methods: The hindlimbs of 10-week-old male C57BL/6J mice, after 30-Gy x-irradiation, surgical lymph node dissection, and 5-mm gap creation, were divided into four groups, with vascularized lymph node transfer abdominal flap and 1.0 × 10 adipose-derived stem cells. Lymphatic flow assessment, a water-displacement plethysmometer paw volumetry test, tissue quantification of lymphatic vessels, and functional analysis of lymphatic vessels and nodes were performed.

Results: Photodynamic Eye images, using indocyanine green fluorescence, demonstrated immediate staining in subiliac lymph nodes, and linear pattern imaging of the proximal region was observed with the combined treatment of adipose-derived stem cells and vascularized lymph node transfer. Both percentage improvement and percentage deterioration with the combined treatment of adipose-derived stem cells and vascularized lymph node transfer were significantly better than with other treatments (p < 0.05). The numbers of lymphatic vessels with LYVE-1 immunoreactivity significantly increased in mice treated with adipose-derived stem cells (p < 0.05), and B16 melanoma cells were metastasized in groups treated with vascularized lymph node transfers by day 28.

Conclusions: Adipose-derived stem cells increase the number of lymphatic vessels and vascularized lymph node transfers induce the lymphatic flow drainage to the circulatory system. Combined adipose-derived stem cell and vascularized lymph node transfer treatment in secondary lymphedema may effectively decrease edema volume and restore lymphatic function by lymphangiogenesis and the lymphatic-to-venous circulation route.
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http://dx.doi.org/10.1097/PRS.0000000000003110DOI Listing
March 2017

Silver Sulfadiazine-Impregnated Hydrocolloid Dressing Is Beneficial in Split-Thickness Skin-Graft Donor Wound Healing in a Small Randomized Controlled Study.

Int J Low Extrem Wounds 2016 Dec 29;15(4):338-343. Epub 2016 Nov 29.

1 Nagasaki University, Nagasaki, Japan.

Donor-site wound healing was tested with a silver sulfadiazine (SSD)-impregnated hydrocolloid dressing and hydrocolloid dressing applied manually by a physician on site. A total of 14 patients, 5 woman and 9 men (23-89 years old, average = 61.6 ± 18.70 years), were enrolled in this prospective controlled study. The degree of bleeding was significantly less with the SSD-impregnated than with the hydrocolloid dressing (P < .01). In the moisture meter analysis, the values of the effective contact coefficient and corneal thickness were significantly smaller with the SSD-impregnated dressing (P < .05). In the color analysis, the clarity was significantly lower with the hydrocolloid dressing after 3 months than that of intact neighboring skin (P < .01). Regarding red-green color, SSD-impregnated and hydrocolloid values were significantly greater than the intact skin value immediately after and at 3 months, and the hydrocolloid value was significantly greater than intact at 6 months (P < .01 immediately; P < .01 at 3 months and intact at 6 months) in redness. Regarding yellow-blue color, the hydrocolloid value was significantly lower than the intact skin value at 3 months (P < .05 and intact) in yellow. The extensibility was significantly lower with the hydrocolloid dressing than in intact skin immediately (P < .01), and viscoelasticity was significantly lower with the hydrocolloid dressing than in intact skin immediately and after 3 and 6 months (P < .01 immediately and at 6 months and P < .05 at 3 months). The SSD-impregnated hydrocolloid dressing led to superior wound healing, decreased the degree of bleeding, and demonstrated better corneal barrier function, clarity, color matching, and viscoelasticity in split-thickness donors.
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http://dx.doi.org/10.1177/1534734616670988DOI Listing
December 2016

Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report.

Microsurgery 2018 Jan 4;38(1):85-88. Epub 2016 Sep 4.

Division of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Nagasaki, 856-8562, Japan.

We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43-year-old man had his left arm caught in a conveyor belt resulting in a large soft-tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow-through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow-up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects.
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http://dx.doi.org/10.1002/micr.30104DOI Listing
January 2018

Effectiveness of basic fibroblast growth factor for pediatric hand burns.

J Tissue Viability 2016 Nov 29;25(4):220-224. Epub 2016 Jun 29.

Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan.

Aim Of The Study: Pediatric hand deep dermal and deep burns may lead to serious hand deformity with functional impairment and result in an esthetically unfavorable outcome. Since there is no guideline regarding the use of growth factors for pediatric hand burns, we sought to investigate the effectiveness of an angiogenic and regenerative growth factor, basic fibroblast growth factor (bFGF).

Methods: Consecutive series of second degree or third degree palmer burns at less than 3 years of age seen from January 2010 to June 2014 were included for evaluation at 6 months post-wound healing. The bFGF treatment started from just after injury and continued up to 21 days. Each patient had their scars scored using the Vancouver Scar Scale (VSS) at 6 months after wound healing.

Results: There were 34 children with 49 acute palmar burns. The mean healing period was 13.5 ± 4.3 days (7-44 days) and 43 wounds healed within 21 days. There was no need of additional surgery in the 43 wounds, healed within 21 days. In comparison to the wounds for which healing took more than 21 days, the wounds that healed within 21 days demonstrated significantly better pigmentation, pliability, and height according to the VSS (p < 0.05), as well as no scar contracture or hypertrophic scars.

Conclusion: bFGF treatment was effective in cases that healed within 21 days, avoiding scar contractures and hypertrophic scars. Our methods using bFGF to complete wound healing are less invasive and produce better results in pediatric palmer burns.
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http://dx.doi.org/10.1016/j.jtv.2016.06.007DOI Listing
November 2016

Proximal interphalangeal replantation with arthrodesis facilitates favorable esthetics and functional outcome.

J Trauma Manag Outcomes 2015 27;9. Epub 2015 Oct 27.

Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, 1001-1 Kubara 2, 856-8562 Ohmura City, Japan.

Purpose: Management of finger amputations of the proximal interphalangeal (PIP) joint is still controversial. Regrettably, injured PIP joints seldom regain normal active motion; thus, many investigators recommend revision amputation with skeletal injury at or proximal to the PIP joint. We report the functional outcome of patients with replantation or revascularization following complete or incomplete amputations of the PIP joint.

Methods: A total of 15 digital replantations or revascularization were performed on 11 patients (9 males and 2 females, age, 26-69 years) with severe finger injuries at the PIP joint at our Medical Center from 2010 through 2012. Seven patients with 10 complete amputations underwent replantations, and 4 with 5 incomplete avulsion amputations underwent revascularization. PIP arthrodesis was performed in all cases. Routine postoperative evaluation was performed in 13 successfully treated patients.

Results: The 13 successfully treated cases were tracked over a follow-up of 12 to 55 months. Arthrodesis of PIP caused significantly lower total active range of motion (TAM; 85-120°). The mean DASH score was 37/100 (range: 10-64 points). Although mobility is poorer in PIP replantations, adequate PIP joint fixation improves DASH score and hand function.

Conclusions: PIP replantation along with arthrodesis at a functional position for a finger amputation should be performed when the patient wishes to undergo replantation, which facilitates patient satisfaction.
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http://dx.doi.org/10.1186/s13032-015-0028-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624359PMC
October 2015