Publications by authors named "Minoru Sakuraba"

99 Publications

Protocol for a multicentre, prospective, cohort study to investigate patient satisfaction and quality of life after immediate breast reconstruction in Japan: the SAQLA study.

BMJ Open 2021 02 15;11(2):e042099. Epub 2021 Feb 15.

Department of Plastic and Reconstructive Surgery, Okayama University Hospital, Okayama, Japan.

Introduction: The aim of breast reconstruction (BR) is to improve patients' health-related quality of life (HRQOL). Therefore, measuring patient-reported outcomes (PROs) would clarify the value and impact of BR on a patient's life and thus would provide evidence-based information to help decision-making. The Satisfaction and Quality of Life After Immediate Breast Reconstruction study aimed to investigate satisfaction and HRQOL in Japanese patients with breast cancer who undergo immediate breast reconstruction (IBR).

Methods And Analysis: This ongoing prospective, observational multicentre study will assess 406 patients who had unilateral breast cancer and underwent mastectomy and IBR, and were recruited from April 2018 to July 2019. All participants were recruited from seven hospitals: Okayama University Hospital, Iwate Medical University Hospital, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Showa University Hospital, University of Tsukuba Hospital, Osaka University Hospital and Yokohama City University Medical Center. The patients will be followed up for 36 months postoperatively. The primary endpoint of this study will be the time-dependent changes in BREAST-Q satisfaction with breast subscale scores for 12 months after reconstructive surgery, which will be collected via an electronic PRO system.

Ethics And Dissemination: This study will be performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects published by Japan's Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare, the modified Act on the Protection of Personal Information and the Declaration of Helsinki. This study protocol was approved by the institutional ethics committee at the Okayama University Graduate School of Medicine, Dentistry, on 2 February 2018 (1801-039) and all other participating sites. The findings of this trial will be submitted to an international peer-reviewed journal.

Trial Registration Number: UMIN000032177.
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http://dx.doi.org/10.1136/bmjopen-2020-042099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887355PMC
February 2021

Surgical outcome for colorectal or urinary tract-related fistula: Usefulness of vascularized tissue transfer-a retrospective study.

J Plast Reconstr Aesthet Surg 2021 05 1;74(5):1041-1049. Epub 2020 Nov 1.

Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: It is challenging to manage colorectal or urinary tract-related fistula. We typically treat colorectal or urinary tract-related fistula with a vascularized tissue transfer. This study aimed to analyze the outcomes of our surgical treatments for colorectal or urinary tract-related fistula.

Methods: This retrospective review included all patients who underwent surgical repair of a colorectal or urinary tract-related fistula at our institution from October 2004 to September 2019. Patients whose surgical outcomes could not be evaluated were excluded. The primary outcome was the overall cure rate. We also evaluated the complication rate and compared the outcomes for rectovaginal fistula with those for urorectal fistula.

Results: The final analysis included 38 cases, of which 17 were rectovaginal fistula and 16 were urorectal fistula. The transperineal approach was used in 28 cases and transperineal and transabdominal combined in nine cases. A gracilis muscle flap was used in 19 cases and a gluteal fold flap in 13 cases. Although a major leak occurred in nine cases, the fistula was finally cured successfully in 31 cases. A comparison of the outcomes for rectovaginal fistula and urorectal fistula showed that complications occurred in 5/17 cases of rectovaginal fistula and 10/16 cases of urorectal fistula (p = 0.056). Fistulae were cured successfully in 13/17 cases of rectovaginal fistula and 14/16 cases of urorectal fistula (p = 0.656).

Conclusion: Our surgical treatment for colorectal or urinary tract-related fistula succeeded in 31 of 38 cases. Thus, vascularized tissue transfer is useful for refractory colorectal or urinary tract-related fistula.
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http://dx.doi.org/10.1016/j.bjps.2020.10.046DOI Listing
May 2021

Comparison of salvage surgery for recurrent or residual head and neck squamous cell carcinoma.

Jpn J Clin Oncol 2020 Mar;50(3):288-295

Departments of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Objective: Concomitant chemoradiation therapy is a standard treatment for head and neck cancer. Thus, salvage surgery has become a necessary treatment. The aim of the study was to evaluate the results of salvage surgery by each site of the head and neck, especially the oropharynx, hypopharynx and larynx.

Methods: This was a retrospective, single-institute study. The primary endpoint was overall survival. Secondary endpoints were disease-free survival, the locoregional control rate after salvage surgery, the indication rate for salvage surgery, the reasons for contraindications to salvage surgery, the post-operative complication rate and the predictors of survival.

Results: Three-year overall survival after salvage surgery was 58.8% in the salvage surgery group and 8.59% in the other treatment group (P < 0.0001). Regarding overall survival and disease-free survival after salvage surgery, there was no difference among sites. Regarding locoregional control rate among sites, there was no significant difference. The oropharyngeal cancer group had the lowest rate of salvage primary resection. Surgical margin and local and regional recurrence or residual disease were predictors on univariate and multivariate analyses.

Conclusions: Salvage surgery is effective for recurrent or residual cases after concomitant chemoradiation therapy. For oropharyngeal cancer, local control is important, and for oropharyngeal cancer and hypopharyngeal cancer, distant metastasis is important.
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http://dx.doi.org/10.1093/jjco/hyz176DOI Listing
March 2020

Clavien-Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer.

PLoS One 2019 12;14(9):e0222570. Epub 2019 Sep 12.

Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: The frequency of postoperative complications is used as an indicator of surgical quality; however, comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. A standard grading system for surgical complications is necessary to improve the quality of clinical research and reporting in head and neck reconstruction.

Methods: The aim of this study was to compare postoperative morbidity after microvascular head and neck reconstruction between patients with versus without a history of prior radiation therapy (RT) by using the Clavien-Dindo classification. A group of 274 patients was divided into two cohorts based on the history of prior RT: the RT group included 79 patients and the non-RT group included 195 patients. Postoperative (30-day) complications were compared between the groups with a nonstandardized evaluation system and the Clavien-Dindo classification.

Results: The grades of complications according to the Clavien-Dindo classification were significantly higher in the RT group than in the non-RT group. The frequency of postoperative complications did not differ significantly between the groups according to the nonstandardized evaluation system.

Conclusions: The Clavien-Dindo classification could serve as a useful, highly objective tool for grading operative morbidity after microvascular head and neck reconstruction when comparing similar defects and methods of reconstruction. Widespread use of the Clavien-Dindo classification system would allow adequate comparisons of surgical outcomes among different surgeons, centers, and therapies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222570PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742376PMC
March 2020

Free flap reconstruction of Achilles tendon and overlying skin defect using ALT and TFL fabricated chimeric flap.

Case Reports Plast Surg Hand Surg 2019 4;6(1):82-85. Epub 2019 Jul 4.

Department of Plastic and Reconstructive Surgery, Iwate Medical University Hospital, Morioka, Japan.

A 33-year-old man developed a left Achilles tendon rupture and skin necrosis. We reconstructed the defect using an anterolateral thigh flap and a tensor fasciae lata muscle flap in a chimeric fashion. he was able to stand on a toe of the operated foot without help 6 months postoperatively.
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http://dx.doi.org/10.1080/23320885.2019.1635023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609348PMC
July 2019

Mandibular reconstruction in elderly patients.

J Surg Oncol 2018 Jun 14;117(8):1744-1751. Epub 2018 May 14.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background And Objectives: The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients.

Methods: We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft (n = 49), mandibular reconstruction plate and soft tissue flap (n = 22), and soft-tissue flap (n = 50). We compared perioperative outcomes among groups and investigated factors affecting the choice of reconstructive technique.

Results: Rates of postoperative complications did not differ significantly among groups. Mandibular reconstruction plate was indicated only for anterior mandibular defects. Soft-tissue flap was indicated for posterior mandibular defects in patients aged ≥75 years or with a poor postoperative Eichner index.

Conclusions: Mandibular reconstruction plate and soft-tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.
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http://dx.doi.org/10.1002/jso.25059DOI Listing
June 2018

Swallowing disorder following salvage total pharyngo-laryngo-esophagectomy with free jejunum reconstruction.

Oncol Lett 2018 May 8;15(5):7355-7361. Epub 2018 Mar 8.

Department of Head and Neck Surgery, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan.

For recurrent cases or residual cases following concomitant chemo-radiation therapy (CCRT), salvage surgery is a frequently used treatment options. A swallowing disorder is one of the major complications of CCRT. The purpose of the present study was to evaluate the effect of CCRT on swallowing function in patients who underwent salvage total pharyngo-laryngo-esophagectomy (TPLE), and to evaluate the importance of pharyngeal constriction in patients who underwent TPLE. Between 2008 January and 2014 May, 54 patients were treated with salvage TPLE following CCRT or TPLE at the National Cancer Center Hospital East, Chiba, Japan and were included in the present study. A total of 14 patients underwent salvage TPLE following CCRT for recurrence or residual tumor (the salvage TPLE group), and 40 patients underwent TPLE as initial treatment (the TPLE group). The pharyngeal constriction score and the post-swallowing oropharyngeal residue rate were evaluated, and inadequate velopharyngeal closure was assessed by videofluorography. The pharyngeal constriction score of the salvage TPLE group was poorer than that of the TPLE group (P<0.05). The bolus residue in the oropharynx was significantly larger in the salvage TPLE group than in the TPLE group (P<0.05). With regards to inadequate velopharyngeal closure, there was no significant difference between the TPLE group and the salvage TPLE group (P>0.99). The results of the present study indicate that the swallowing function of patients who undergo salvage TPLE may be affected by CCRT.
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http://dx.doi.org/10.3892/ol.2018.8213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920806PMC
May 2018

Efficacy of Tensed and Straight Free Jejunum Transfer for the Reduction of Postoperative Dysphagia.

Plast Reconstr Surg Glob Open 2017 Dec 28;5(12):e1599. Epub 2017 Dec 28.

Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and reconstructive surgery, Miyagi Cancer Center, Natori, Japan; Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan; and Juntendo University Graduate School of Medicine, Advanced Clinical Research of Cancer, Tokyo, Japan.

Background: Free jejunal transfer (FJT) is a standard method of reconstruction after total pharyngo-laryngo-cervical esophagectomy (TPLE) in patients with advanced head and neck cancer. However, it is related to various degrees of postoperative swallowing dysfunction. This study aimed to assess whether the tensed and straight FJT method results in a reduced rate of postoperative dysphagia compared with historical controls.

Methods: Patients who were undergoing FJT after TPLE for squamous cell carcinoma of the hypopharynx or cervical esophagus were enrolled. The primary endpoint was the rate of not developing dysphagia within 6 months of the surgery, and we compared this value with that obtained from historical data of patients who underwent FJT. The secondary endpoint was the rate of developing surgical complications.

Results: Although 128 patients were registered between August 2012 and July 2015, 7 were excluded based on the exclusion criteria. Of the remaining 121 patients, FJT with the craniocaudally tensed and straight method was performed in all patients. The rate of not developing dysphagia and its 95% confidence interval (CI) were 66.1% and 57.0-74.5%, respectively. The lower limit of the CI was higher than the prespecified threshold value of 50.0%. The rate of developing complications of total necrosis of the jejunum was 3.3%, cervical infection was 9.9%, and major anastomotic leakage was 4.1%.

Conclusions: Our findings revealed that the proportion of postoperative dysphagia decreased in patients who underwent tensed and straight FJT. This method may become the standard surgical method in reconstruction of defects after TPLE.
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http://dx.doi.org/10.1097/GOX.0000000000001599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889443PMC
December 2017

Analysis of cancer-associated fibroblasts and the epithelial-mesenchymal transition in cutaneous basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Hum Pathol 2018 09 16;79:1-8. Epub 2018 Mar 16.

Department of Plastic Surgery, School of Medicine, Iwate Medical University, Morioka 020-8505, Japan.

Activated cancer-associated fibroblasts (CAFs) and fibroblasts that have undergone the epithelial-mesenchymal transition (EMT) in cancer stroma contribute to tumor progression and metastasis. However, no reports have investigated the CAF phenotype and its clinicopathological relevance in cutaneous malignant tumors, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Here, we investigated the CAF phenotype in cutaneous malignant tumors based on their histology and immunohistochemical expression of CAF-related markers, including adipocyte enhancer-binding protein 1 (AEBP1), podoplanin, platelet-derived growth factor receptor α (PDGFRα), PDGFRβ, fibroblast activating protein (FAP), CD10, S100A4, α-smooth muscle actin (α-SMA), and EMT-related markers (Zeb1, Slug, and Twist). In addition, we assessed the role of the CAF phenotype in cutaneous malignant cancers using hierarchical cluster analysis. Consequently, 3 subgroups were stratified based on the expression pattern of CAF- and EMT-related markers. Subgroup 1 was characterized by low expression of AEBP1, PDGFRα, PDGFRβ, FAP and Slug, whereas subgroup 2 was closely associated with high expression of PDGFRβ, S100A4 and Twist. In addition, high expression levels of podoplanin, PDGFRβ, CD10, S100A4, α-SMA, Zeb1, Slug and Twist were observed in subgroup 3. High expression of CD10 was commonly found in all 3 subgroups. These subgroups were correlated with histologic subtypes, that is, subgroup 1, MM; subgroup 2, BCC; and subgroup 3, SCC. We suggest that the expression pattern of CAF- and EMT-related proteins plays crucial roles in the progression of BCC, SCC, and MM.
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http://dx.doi.org/10.1016/j.humpath.2018.03.006DOI Listing
September 2018

Repairing Bronchoesophageal Tube Fistula Using A Contralateral Latissimus Dorsi Musculocutaneous Flap.

Plast Reconstr Surg Glob Open 2017 Sep 26;5(9):e1484. Epub 2017 Sep 26.

Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan; and Department of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan.

A postoperative aerodigestive fistula is one of the rare but critical complications after esophagectomy, and management is challenging. The essential keys to successful treatment of these fistula are thorough debridement and complete closure followed by separation of the respiratory and digestive tract. We present a case of a recurrent bronchoesophageal fistula between the left main bronchus and neo esophagus, which was successfully treated through a contralateral approach. The fistula was debrided and closed primarily through a right thoracotomy, and the interposition of a pedicled latissimus dorsi musculocutaneous flap from the right side was carried out. The patient was able to resume oral feeding at 16th postoperative day.
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http://dx.doi.org/10.1097/GOX.0000000000001484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640357PMC
September 2017

Comparison of Donor Site Drainage Duration and Seroma Rate Between Latissimus Dorsi Musculocutaneous Flaps and Thoracodorsal Artery Perforator Flaps.

Ann Plast Surg 2017 Aug;79(2):183-185

From the *Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and †Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Introduction: Donor site seroma formation and prolonged drainage duration are common complications of using latissimus dorsi musculocutaneous (LDMC) flaps. The present retrospective study aimed to investigate the effect of types of back flap harvest on drainage duration and seroma formation rates.

Methods: Adult patients (n = 155) who underwent reconstruction with a latissimus dorsi flap from January 2010 to October 2015 were included in the study, of which 54 patients underwent breast reconstruction with a pedicled LDMC flap (LD breast group), 80 patients underwent an LDMC flap transfer for purposes other than breast reconstruction (LD nonbreast group), and 21 patients underwent soft tissue reconstruction with a thoracodorsal artery perforator (TAP) flap (TAP group). Flap size, drainage durations, and seroma formation rates at donor sites were compared among the 3 groups.

Results: Flap sizes significantly differed between the LD nonbreast group (median value, 185.5 cm) and the other 2 groups (119 cm in the LD breast group. 127.5 cm in the TAP group), with no significant difference observed between the LD breast and TAP groups. The mean drainage duration was 11.6 days for the LD breast group. 9.82 days for the LD nonbreast group, and 4.81 days for the TAP group. Drainage durations significantly differed among the groups. Seroma formation rate of the LD breast group (42.6%) was significantly higher than those of the other groups.

Conclusions: The type of back flap harvest used significantly affected drainage duration and seroma formation rate in the present study. Lumbar fat extension with the use of a LDMC flap for breast reconstruction may lead to seroma formation. Thoracodorsal artery perforator flaps are associated with minimal risks of seroma formation and significantly shortened drainage duration compared with LDMC flaps.
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http://dx.doi.org/10.1097/SAP.0000000000001077DOI Listing
August 2017

Analysis of a Surgical Treatment for Persistent Urorectal Fistulas after Radical Cancer Surgery: A Comparison of Prostate Cancer and Rectal Cancer.

Urol Int 2017 24;99(1):56-62. Epub 2017 Feb 24.

Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan.

Introduction: The study aimed to present our experience of surgical treatment for urorectal fistulas (URF) that develop after cancer surgery.

Materials And Methods: Fourteen patients with URF who were treated at our institution from 2005 through 2015 were retrospectively analyzed. Among these, 7 patients had previous surgical treatment of prostate cancer (PC) and the other 7 had been treated for rectal cancer (RC). The fistula was resected through a perineal incision, and the urinary and fecal defects were separately closed with the hinge flap method followed by interposition of a muscle flap transfer.

Results: The overall fistula closure rate was 79%. Although the closure rate of the URF was lower in patients with previous RC surgery compared to the PC patients (57 vs. 100%), it did not reach statistical significance.

Conclusions: URF treatment using an interposition muscle flap offers a high success rate of fistula closure. However, complicated fistulas occurring after RC surgery involving the prostate or the seminal vesicle might be difficult to repair by this surgery alone.
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http://dx.doi.org/10.1159/000457835DOI Listing
May 2018

Reconstructive Surgery for Bronchopleural Fistula and Empyema: New Application of Free Fascial Patch Graft Combined with Free Flap.

Plast Reconstr Surg Glob Open 2017 Jan 17;5(1):e1199. Epub 2017 Jan 17.

Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: Postoperative bronchopleural fistula (BPF) and empyema are not uncommon after lung cancer surgery. Some patients require reconstructive surgery to achieve wound healing. In this report, we describe a novel method of reconstructive surgery for BPF and empyema.

Methods: From 1996 through 2014, we performed reconstructive surgery for the treatment of BPF and empyema in 13 cases. BPF or a pulmonary fistula was present in 11 patients at the time of reconstruction. Of these, a free fascial patch graft combined with a free soft tissue flap was used to close the fistula in 6 cases. In the other 5 cases, primary fistula closure or direct coverage of the fistula with a transferred flap was performed. Medical records were retrospectively reviewed, and postoperative results were compared for these methods.

Results: All the flaps were transferred successfully except in 1 case. Although postoperative air leakage was observed in 5 cases, most of these healed with conservative management. Of 11 fistulas, 8 were successfully controlled. Although differences were not statistically significant, a higher success rate of fistula closure was obtained in patients with a fascial patch graft (100% vs 40%). As a result, 9 patients could be discharged from the hospital, but 4 died during their hospital stay.

Conclusion: Although the incidence of in-hospital mortality was high, fistula closure with a fascial patch graft combined with free flap transfer was effective for the treatment of BPF and empyema, compared with other procedures.
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http://dx.doi.org/10.1097/GOX.0000000000001199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293298PMC
January 2017

Reconstruction of Complex Groin Defects After Sarcoma Resection.

Ann Plast Surg 2017 Apr;78(4):443-447

From the *Department of Plastic and Reconstructive Surgery, and †Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo; ‡Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: Complex groin defects after sarcoma resection require reconstruction of multiple vital structures that can include the major vessels, the overlying skin, the abdominal wall, and the hip joint. We investigated the feasibility of limb preservation after complex groin reconstruction.

Methods: The subjects were 12 consecutive patients who underwent complex groin reconstruction after sarcoma resection. In all patients, the defect included a major artery (external iliac or femoral) and overlying skin. The defect included the abdominal wall in 5 patients and the hip joint in 2. Arterial reconstruction was performed with an autologous vein graft in 9 patients and with an expanded polytetrafluoroethylene graft in 3. Soft-tissue coverage was performed with a pedicled rectus abdominis musculocutaneous flap in 7 patients, a free latissimus dorsi musculocutaneous flap in three, and a free anterolateral thigh flap in 2.

Results: Postoperative complications occurred in 7 patients (58.3%). Limb salvage was possible in 8 patients (66.7%) with 39 months' median follow-up. Two patients required amputation because of wound problems, and 2 required amputation because of local recurrence of the tumor.

Conclusions: Limb salvage is possible even after extensive resection of groin sarcoma, although the rate of postoperative wound complications is substantial. Proper selection of the arterial conduit and the soft-tissue flap, depending on the components of the defect, are mandatory for successful reconstruction.
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http://dx.doi.org/10.1097/SAP.0000000000000902DOI Listing
April 2017

Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

Clin Plast Surg 2016 Oct 21;43(4):729-37. Epub 2016 Jul 21.

Division of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.

The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods.
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http://dx.doi.org/10.1016/j.cps.2016.05.002DOI Listing
October 2016

Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer.

Jpn J Clin Oncol 2016 Oct 10;46(10):919-927. Epub 2016 Aug 10.

Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.

Objective: To evaluate the feasibility of postoperative intensity-modulated radiotherapy for head and neck cancer by investigating the patterns of failure after this therapy.

Methods: A retrospective chart review was performed.

Results: Between March 2006 and December 2013, 122 consecutive patients with head and neck squamous cell carcinoma were treated by surgery followed by postoperative intensity-modulated radiotherapy. In regard to the site of the primary tumor, 59 (48%) patients had cancer of the oral cavity, 31 (26%) patients had cancer of the hypopharynx, 14 (11%) patients had cancer of the oropharynx, 10 (8%) patients had cancer of the larynx and 8 (7%) patients had cancer of unknown primary. The median follow-up period of the surviving patients was 54 months (range, 25-115). Concurrent chemotherapy was administered in 76 patients (62%). The median prescribed radiation dose was 66 Gy. The 3-year overall survival, progression-free survival, distant metastasis free survival and loco-regional control rates were 59%, 48%, 52.4% and 71%, respectively. Of the 122 patients, 32 developed loco-regional recurrence as the initial recurrence, including in-field recurrence in 26 patients, marginal recurrence in five patients and out-field recurrence in seven patients. Of the five patients with marginal recurrence, four have had two or more surgeries before the intensity-modulated radiotherapy and three had oral cavity cancer. Severe adverse events were not frequent, occurring at a frequency of <5%, except for mucositis. No severe toxicities associated with the flap reconstruction were observed either.

Conclusion: Postoperative intensity-modulated radiotherapy appears to be effective and feasible for patients with head and neck squamous cell carcinoma.
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http://dx.doi.org/10.1093/jjco/hyw095DOI Listing
October 2016

Combined salivary duct carcinoma and squamous cell carcinoma suspected of carcinoma ex pleomorphic adenoma.

Pathol Int 2016 Aug 19;66(8):460-5. Epub 2016 Jul 19.

Head and Neck Surgery Division, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan.

A 76-year-old Japanese woman had noticed an asymptomatic and palpable mass in her left parotid gland region for 20 years. The tumor had showed rapid growth during the last two months. Therefore, the tumor was clinically suspected of being a malignant tumor and was surgically resected. A histopathological examination revealed that the tumor consisted of two different histopathological neoplastic components accompanied by hyalinized fibrosis at the center of the tumor. The two-neoplastic components were squamous cell carcinoma and salivary duct carcinoma. The tumor was suspected to be a carcinoma ex pleomorphic adenoma after considering the clinical course and the histopathological findings, such as hyalinized fibrosis at the center of the tumor. There was no evidence of recurrence at 30 months after the surgical resection.
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http://dx.doi.org/10.1111/pin.12429DOI Listing
August 2016

Single venous anastomosis versus dual venous anastomoses in free anterolateral thigh flap transfer: A cohort study.

J Plast Reconstr Aesthet Surg 2016 Sep 2;69(9):1313-5. Epub 2016 Jul 2.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.

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http://dx.doi.org/10.1016/j.bjps.2016.06.023DOI Listing
September 2016

Early detection of local recurrence after soft tissue sarcoma resection and flap reconstruction.

Int Orthop 2016 Sep 17;40(9):1975-80. Epub 2016 May 17.

Division of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.

Purpose: Flap reconstruction has become an essential component in soft tissue sarcoma treatment. However, the clinical features of local recurrence after soft tissue sarcoma resection and flap reconstruction remain unclear. The present study aimed to establish effective follow-up strategies after soft tissue sarcoma resection and flap reconstruction.

Methods: Data from patients who underwent soft tissue sarcoma resection and immediate flap reconstruction were retrospectively reviewed. Follow-up after surgery included history taking and physical examination during every visit to the hospital. Magnetic resonance imaging to evaluate the primary site was performed six months after the end of treatment then annually for ten years. The methods of detection of local recurrence were assessed.

Results: A total of 229 consecutive patients were included in the present study. During a median follow-up period of 40 months, 33 patients (14.4%) developed local recurrence. Twenty-three recurrences that occurred on the margin of the transferred flap were detected as palpable mass prior to radiological assessment; among the remaining ten recurrences that occurred in the deep layer of the transferred flap, six were detected by abnormal clinical findings and four were clinically occult and detected by surveillance radiological assessment.

Conclusions: Surveillance radiological assessment has an important role in early detection of local recurrence that develops in the deep layer of the transferred flap. Therefore, meticulous clinical assessment combined with routine radiological study should be performed during follow-up evaluation for local recurrence after soft tissue sarcoma resection and flap reconstruction.
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http://dx.doi.org/10.1007/s00264-016-3219-yDOI Listing
September 2016

The Superior Rectal Artery as a Recipient Vessel for Free Flap Transfer After Partial Sacrectomy in Patients With Chordoma.

Ann Plast Surg 2016 Mar;76(3):315-7

From the *Division of Plastic and Reconstructive Surgery, †Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan; and ‡Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Free flaps have rarely been used to reconstruct lumbosacral defects, primarily because of the lack of suitable recipient vessels in this region. We propose the novel use of the superior rectal artery as a recipient vessel for free flap transfer after partial or total sacrectomy. We transferred free flow-through latissimus dorsi musculocutaneous flaps, with the superior rectal vessels as recipient vessels, to reconstruct defects after partial sacrectomy in 2 patients with sacral chordoma. The flaps survived completely, and the wounds healed uneventfully in both patients. The superior rectal artery is easier to dissect and anastomose than are gluteal vessels and is less affected by patients' postoperative postural change than are extraperitoneal vessels. We believe that the superior rectal artery is a versatile recipient vessel for free flap transfer to reconstruct sacrectomy defects.
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http://dx.doi.org/10.1097/SAP.0000000000000493DOI Listing
March 2016

Predictive factors of dysphagia after lateral and superior oropharyngeal reconstruction with free flap transfer.

J Surg Oncol 2016 Feb 12;113(2):240-3. Epub 2016 Jan 12.

Division of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.

Background And Objectives: Lateral and superior oropharyngeal reconstruction is technically challenging and can be complicated by postoperative dysphagia. The aim of this retrospective study was to identify the predictive factors of dysphagia after lateral and superior oropharyngeal reconstruction with free flap transfer and to establish better management for cases with these predictive factors.

Methods: We performed a retrospective chart review of 109 patients who had undergone lateral and superior oropharyngeal reconstruction with free flap transfer for oropharyngeal cancer. Preoperative, operative, and postoperative variables were examined, and possible predicative factors for dysphagia were subjected to univariate analysis and multivariate logistic regression analysis.

Results: Dysphagia occurred in 16 patients (14.7%). Multivariate logistic regression analysis identified extensive tongue base resection, postoperative radiotherapy, and history of radiotherapy to the head and neck region as independent factors contributing to dysphagia after lateral and superior oropharyngeal reconstruction. Of these factors, extensive tongue base resection was the most important.

Conclusions: Early intervention to minimize the risk of dysphagia should be performed for patients identified with these predictive factors.
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http://dx.doi.org/10.1002/jso.24105DOI Listing
February 2016

Combined Use of Anterolateral Thigh and Gluteal Fold Flaps for Complex Groin Reconstruction.

Plast Reconstr Surg Glob Open 2015 Oct 20;3(10):e541. Epub 2015 Oct 20.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

We present a case of an epithelioid sarcoma of the right groin in which wide resection resulted in a complex groin defect involving the full thickness of the abdominal wall and the perineum. We reconstructed the defect using a combination of pedicled anterolateral thigh (ALT) flap and gluteal fold flap. The functional and aesthetic results were satisfactory. The ALT flap with a robust iliotibial tract is the flap of choice for abdominal wall reconstruction; however, the area covered by the skin island of the flap is restricted because the skin island is tethered to the iliotibial tract. In such cases, a gluteal fold flap is ideal for an ALT flap. Therefore, using a combination of a pedicled ALT flap and a gluteal fold flap could be a reliable option for the reconstruction of a complex groin defect.
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http://dx.doi.org/10.1097/GOX.0000000000000525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634178PMC
October 2015

Anterolateral thigh flap for axillary reconstruction after sarcoma resection.

Microsurgery 2016 Jul 5;36(5):378-383. Epub 2015 Nov 5.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: Reconstruction of extensive axillary defects after sarcoma resection presents a challenging problem in reconstructive microsurgery. The purpose of this report was to investigate the feasibility of the free anterolateral thigh (ALT) flap for oncologic axillary reconstruction.

Methods: The extensive axillary defects in six patients with sarcoma was reconstructed using a free ALT flap. The defect size ranged from 15 × 11 to 28 × 25 cm . Five patients had recurrent cases and the ipsilateral latissimus dorsi flap had been already used in three patients. Two patients with a full-thickness defect underwent chest wall reconstruction with the iliotibial tract.

Results: All flaps survived completely and the wounds healed without complications in all patients.

Conclusions: The free ALT flap is an ideal flap for axillary reconstruction after extensive sarcoma resection. It can be tailored to the requirements of the individual's defect and provides durable coverage for the axillary neurovascular bundle and intrathoracic structures. Flap harvesting in the lateral decubitus position enables a two-team approach. © 2015 Wiley Periodicals, Inc. Microsurgery 36:378-383, 2016.
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http://dx.doi.org/10.1002/micr.22529DOI Listing
July 2016

Combined use of anterolateral thigh flap and pharyngeal flap for reconstruction of extensive soft-palate defects.

Microsurgery 2016 May 30;36(4):291-6. Epub 2015 Sep 30.

Division of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: Functional reconstruction of extensive soft-palate defects is challenging for microsurgeons. The versatility of the combination of a free anterolateral thigh flap and a superiorly based pharyngeal flap for oncologic soft-palate reconstruction was investigated.

Methods: The combination of flaps was used for immediate reconstruction after total or subtotal resection of the soft palate in five consecutive patients from 2006 to 2011.

Results: All flaps survived completely. Palatal fistula and miniplate infection each developed in one patient but healed conservatively. Follow-up period ranged from 21 to 66 months. All patients tolerated a regular diet without significant aspiration or nasal regurgitation. Speech intelligibility was excellent in all patients, and none required a palatal prosthesis.

Conclusions: The combination of an anterolateral thigh flap and a superiorly based pharyngeal flap is a versatile option for reconstructing extensive soft-plate defects. This method is simple and achieves reproducible results with limited donor-site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery 36:291-296, 2016.
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http://dx.doi.org/10.1002/micr.22507DOI Listing
May 2016

Flow-through anastomosis for both the artery and vein in leg free flap transfer.

Microsurgery 2015 Oct 25;35(7):536-40. Epub 2015 Aug 25.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.

Objective: Free flap transfer is an essential part of limb-sparing surgery for leg sarcoma; however, this procedure is associated with a high failure rate. The aim of this study was to identify factors that contribute to microvascular compromise and flap failure for leg free flap transfer, while focusing on anastomotic techniques (end-to-end, end-to-side, and flow-through anastomoses).

Patients And Methods: Data from 56 consecutive patients who underwent leg free flap transfer after oncologic resection were retrospectively reviewed. Of these patients, flow-through anastomosis was performed with the artery in 29 and the vein in 24, whereas conventional techniques were performed in others. The variables contributing to microvascular compromise and flap failure were statistically analyzed.

Results: Venous thrombosis (four patients, 7.1%) was more frequent than arterial thrombosis (one patient, 1.8%) and (4 patients, 7.1%) resulted in flap loss. All anastomotic failures occurred in end-to-end anastomoses. All flow-through anastomoses achieved patency both for the artery and vein. No anastomotic failure or flap loss occurred in 22 flaps which were transferred with flow-through anastomosis for both the artery and vein. Flow-through venous anastomosis tended to have a lower rate of microvascular compromise and flap loss than conventional techniques (P = 0.13 and 0.25, respectively).

Conclusion: The key to successful leg free flap transfer is to prevent venous failure; thus, flow-through venous anastomosis may be a breakthrough solution. Preferential use of flow-through anastomosis for both the artery and vein can provide predictable results in leg free flap transfer.
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http://dx.doi.org/10.1002/micr.22476DOI Listing
October 2015

Clinical analysis of 33 flow-through latissimus dorsi flaps.

J Plast Reconstr Aesthet Surg 2015 Oct 14;68(10):1425-31. Epub 2015 Jun 14.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kawahiwa, Chiba 277-8577, Japan.

Introduction: Indications for flow-through latissimus dorsi (LD) flaps have been limited for reconstructing distal extremities. In addition, there has been little discussion in regard to the question of which branch is most suitable as a distal runoff of the flow-through anastomosis. The aims of this study were to investigate the feasibility of flow-through LD flaps in various areas in the body and the rationale for branch selection for the distal runoff vessel.

Methods: This retrospective study included 33 patients who underwent reconstruction of an oncology-related defect with a free flow-through LD flap. Defect locations, branches used for the distal runoff, and postoperative complications were investigated.

Results: The defect location was in the lower extremity in 13 patients, the scalp in seven, the upper extremity in six, the pelvis in six, and the chest in one. In 19 of the 33 patients, the defects were located in areas other than the distal extremities. The circumflex scapular artery (CSA) was most frequently used as the distal runoff vessel (24 patients) followed by the serratus anterior branch (SAB) (five patients). All flaps were transferred successfully without anastomotic failure.

Conclusions: The flow-through LD flap is a reliable option for reconstruction in many areas of the body. It can provide high success rates not only for extremity reconstruction but also for scalp and pelvic reconstruction. The CSA matches well with the workhorse recipient vessels. The SAB is suitable when there is a vascular defect of the recipient artery.
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http://dx.doi.org/10.1016/j.bjps.2015.05.038DOI Listing
October 2015

Analysis of functional outcomes in patients with mandible reconstruction using vascularized fibular grafts.

Microsurgery 2017 Feb 6;37(2):101-104. Epub 2015 Jun 6.

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Backgrounds: Although a vascularized fibular graft (VFG) is the favored method for mandible reconstruction, only few functional reports have been published. In this study, surgical outcomes and functional results after mandible reconstruction were analyzed.

Patients And Methods: From 1999 through 2010, oromandibular defects after segmental mandibulectomy were reconstructed with VFG in 101 patients. Operative outcomes and subjective functional evaluation was performed. Of these, 44 patients could be evaluated for functional outcomes, and bite force was measured with an occlusal force meter in 24 patients.

Results: Major surgical complications required secondary revisional surgery developed in four patients. A normal diet was possible in 37 patients (84.1%), and a soft diet was possible in 7 patients (15.9%). Conversational ability was rated as excellent in 42 patients (95.5%). The mean bite force on the nonaffected side of the mandible was 187.7 N, and bite force decreased as the number of osteotomies in the VFG increased. Furthermore, bite force was significantly lower (P = 0.001) on the affected side (58.2 N), compared to nonaffected side (191.9 N).

Conclusions: Although masticatory force decreases as the number of osteotomies increases, oral function after mandible reconstruction is satisfactory in most cases. Transfer of a VFG is a safe and reliable method for functional mandible reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery 37:101-104, 2017.
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http://dx.doi.org/10.1002/micr.22433DOI Listing
February 2017

Rotationplasty with vascular reconstruction for prosthetic knee joint infection.

Case Rep Orthop 2015 30;2015:241405. Epub 2015 Mar 30.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba 277-8577, Japan.

Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.
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http://dx.doi.org/10.1155/2015/241405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396166PMC
April 2015

Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery.

Microsurgery 2015 Sep 25;35(6):485-8. Epub 2015 Apr 25.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Reconstruction of complex knee defects including the popliteal artery presents a challenging problem in reconstructive microsurgery. Reconstruction of the popliteal artery and soft-tissue coverage should be performed simultaneously for limb salvage. We present the one-stage reconstruction of a complex knee defect including the popliteal artery using a free flow-through anterolateral thigh (ALT) flap as a bypass flap in two patients with sarcomas. In both patients, the popliteal artery and vein were reconstructed using branches of the lateral circumflex femoral arterial system. The flaps survived without vascular compromise and the limbs were preserved successfully. Free flow-through ALT flap enables simultaneous leg revascularization and soft-tissue coverage with a single free flap. The lateral circumflex femoral arterial system has many branches with large diameters, making it suitable for reconstruction of multiple infrapopliteal arteries.
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http://dx.doi.org/10.1002/micr.22421DOI Listing
September 2015

Evaluation of routine contrast swallow following total pharyngolaryngectomy and free jejunal transfer.

Laryngoscope 2015 Oct 17;125(10):2280-3. Epub 2015 Apr 17.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan.

Objective: Anastomotic leakage is a serious complication following total pharyngolaryngectomy (TPL) and free jejunal transfer (FJT). Although routine radiological assessment using contrast swallow is widely performed postoperatively for the detection of anastomotic leakage before oral intake, the accuracy remains unclear. We evaluated the clinical usefulness of routine contrast swallow for screening of anastomotic leakage.

Study Design: Retrospective chart review.

Methods: We retrospectively reviewed 232 patients who had undergone TPL and FJT from 2009 to 2013. Initial contrast swallow was performed near the seventh postoperative day in patients without a history of radiation for head and neck region preoperatively and near the 14th postoperative day in patients with a history. The accuracy of routine contrast swallow was calculated.

Results: Clinical anastomotic leakage occurred in 12 patients (5.2%); of these, anastomotic leakage was detected by initial contrast swallow in six patients. The sensitivity and specificity of contrast swallow were 50.0% and 99.1%, respectively.

Conclusion: Contrast swallow has low sensitivity and a high false-negative rate for the diagnosis of clinical leakage after TPL and FJT, and routine contrast swallow was insufficient for the screening of anastomotic leakage. Therefore, contrast swallow should be performed in a targeted fashion for patients with clinical signs of anastomotic leakage.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lary.25302DOI Listing
October 2015