Publications by authors named "Takumi Yamamoto"

251 Publications

Lymphaticovenular Anastomosis in Breast Cancer Treatment-Related Lymphedema: A Short-Term Clinicopathological Analysis from Indonesia.

J Reconstr Microsurg 2021 Mar 1. Epub 2021 Mar 1.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Background:  Locally advanced breast cancer is commonly found in Indonesia. In this group of patients, aggressive treatment such as axillary lymph nodes dissection (ALND) with or without regional nodal irradiation (RNI) will increase the risk of breast cancer treatment-related lymphedema (BCRL) in our patients. Lymphaticovenular anastomosis (LVA) has been established as a minimally invasive approach in lymphedema surgery. In this study, we report our first experience of LVAs in BCRL patients.

Methods:  This was a cross-sectional study taken from breast cancer patients receiving ALND with or without RNI. From December 2018 until June 2020, we collected and described general patient information, tumor characteristics, diagnostic methods, and the outcome of LVA. Postoperative subjective symptoms scores (lymphedema quality-of-life score [LeQOLiS]) and lymphedematous volume (upper extremity lymphedema [UEL] index) were compared with preoperative ones.

Results:  Seventy patients experienced BCRL with the mean age of 54.8 (9.4) years and mean body mass index of 28.1 (4.5). ALND was performed in 66 (97.1%) cases and RNI was given in 58 (82.9%) patients. Thirty-one (44.3%) patients were in the International Society of Lymphology stage 1, 24 (34.3%) in stage 2A, and 15 (21.4%) in stage 2B. The mean lymphatic vessel diameter was 0.5 (0.26) mm and 0.80 (0.54) mm for the vein. Lymphosclerosis severity was 7 (4%) in S0 type, 129 (74.1%) in S1 type, 37 (21.3%) in S2 type, and 1 (0.6%) in S3 type. In histopathology examination, S1 types were in lower grade injury, while S2 and S3 types were in the higher grade. Seven (53.8%) cases of S2 type showed severe fibrosis from trichrome staining. Postoperative LeQOLiSs were significantly lower than preoperative ones (5.6 ± 2.4 vs. 3.7 ± 2.6;  = 0.000). With the mean follow-up of 7.4 (3.7) months, the overall UEL index reduction was 9.2%; mean -11 (16.8). Postoperative UEL index was significantly lower than preoperative ones (117.7 ± 26.5 vs. 106.9 ± 18.5;  = 0.000). No complications were observed during this period.

Conclusion:  LVA reduced the subjective symptoms and UEL index in BCRL cases. Future studies using updated imaging technologies of the lymphatic system and longer follow-up time are needed to confirm our results.
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http://dx.doi.org/10.1055/s-0041-1723940DOI Listing
March 2021

Subdermal Dissection for Elevation of Pure Skin Perforator Flaps and Superthin Flaps: The Dermis as a Landmark for the Most Superficial Dissection Plane.

Plast Reconstr Surg 2021 Mar;147(3):470-478

From the Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine; the Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital; and the Department of Plastic Surgery, Noda Hospital.

Background: Pure skin perforator and superthin flaps have been reported and are becoming popular, as they allow one-stage thin skin reconstruction even from a thick donor site. However, currently reported elevation procedures use proximal-to-distal dissection requiring free-style perforator selection and primary thinning procedures. With distal-to-proximal dissection using the dermis as a landmark for dissection plane, it is expected that elevation of pure skin perforator or superthin flaps can be simplified.

Methods: Patients who underwent pure skin perforator or superthin flap transfers with the subdermal dissection technique were included. Flaps were designed based on location of pure skin perforators visualized on color Doppler ultrasound, and elevated just below the dermis under an operating microscope. Medical charts were reviewed to obtain clinical and intraoperative findings. Characteristics of the patients, flaps, and postoperative courses were evaluated.

Results: Thirty-six flaps were transferred in 34 patients, all of which were elevated as true perforator flaps (superficial circumflex iliac artery perforator flap in 29 cases, other perforator flaps in seven cases). Mean ± SD flap thickness was 2.24 ± 0.77 mm (range, 1.0 to 4.0 mm). Skin flap size ranged from 3.5 × 2 cm to 27 × 8 cm. Time for flap elevation was 27.4 ± 11.6 minutes. All flaps survived without flap atrophy/contracture 6 months after surgery, except for two cases of partial necrosis.

Conclusion: The subdermal elevation technique allows straightforward and direct elevation of a pure skin perforator or superthin flap within 30 minutes on average without the necessity of primary thinning.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000007689DOI Listing
March 2021

Free tensor fascia lata true-perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol-induced Charcot foot: A case report and literature review.

Microsurgery 2021 Feb 17. Epub 2021 Feb 17.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Charcot foot is can result in bone deformities and soft tissue defects. We report a case of alcohol-induced Charcot (AIC) foot with soft tissue defect including the weight-bearing zone of the heel and osteomyelitis, which was successfully reconstructed with free tensor fascia lata true-perforator flap (TFLtp). A 56-year-old male suffered from AIC foot with an 18 × 6 cm defect. Based on the preoperative ultrasound, we identified the overlying upper thigh area offering one of the thickest dermis. A TFLtp flap was raised sparing the TFL muscle based on one perforator without including the main trunk of the transverse/ascending branch of the lateral femoral circumflex vessel. The TFLtp flap was transferred to the heel and anastomosed to the posterior tibial artery in an end-to-side fashion. The patient complained no postoperative discomfort of the donor site and was able to walk on his foot after 5 weeks. This case report highlights that the TFLtp flap may offer thick dermis, faster surgery due to perforator level dissection and a concealed donor site.
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http://dx.doi.org/10.1002/micr.30724DOI Listing
February 2021

Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction.

J Surg Oncol 2021 Apr 10;123(5):1232-1237. Epub 2021 Feb 10.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.

Background: The internal mammary artery/vein (IMA/V) are commonly used recipients for free flap breast reconstruction, but requires costal cartilage resection and limits future use of the IMA. This study aimed to evaluate the feasibility of the thoracoacromial artery/vein (TAA/V) as recipients for deep inferior epigastric artery perforator (DIEP) flap breast reconstruction compared with using the IMA/V.

Methods: Medical charts of patients who underwent free DIEP flap breast reconstruction using the TAA/V or the IMA/V as recipient vessels were reviewed. Patient and vessel characteristics, time for vessel preparation and anastomosis, and postoperative pain were compared between TAA/V and IMA/V groups.

Results: Thirty-four patients were included; 12 in TAA/V group, and 22 in IMA/V group. There was no flap failure in both groups. There were statistically significant differences between TAA/V and IMA/V groups in vessel preparation time (10.9 ± 3.7 min vs. 24.1 ± 6.0 min, p < .001), anastomosis time (31.2 ± 12.1 min vs. 42.1 ± 11.2 min, p = .017), and total dose of acetaminophen (4566.7 ± 1015.6 mg vs. 5436.4 ± 1323.3 mg, p = .041).

Conclusions: The TAA/V could be safely used as recipient vessels for DIEP flap breast reconstruction with shorter time and less postoperative pain.
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http://dx.doi.org/10.1002/jso.26421DOI Listing
April 2021

Oral administration of NSP-116, a free radical scavenger, suppresses the symptoms of retinal vein occlusion in the murine model.

Exp Eye Res 2021 Mar 24;204:108453. Epub 2021 Jan 24.

Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.

Retinal vein occlusion (RVO) is an intractable eye disease that results in reduced visual acuity, associated with retinal ischemia, hemorrhage, and edema. RVO results in excessive ROS production in the retina, causing inflammation and retinal edema. A free radical scavenger, 4-(4-acetylpiperazin-1-yl)-2-(1H-imidazole-1-yl) aniline (NSP-116), has been reported to demonstrate antioxidative effects and prevent ROS production in the retina. Therefore, NSP-116 may represent a useful drug for treating the pathological symptoms of RVO, such as retinal edema and ischemic symptoms. This study aimed to investigate the effects of NSP-116 in a murine model of RVO. We evaluated the thickness of the retinal layer and the size of the non-perfused area following the oral administration of NSP-116. Moreover, we used western blot analysis to examine the expression levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α, after NSP-116 administration, and examined the localization of 8-hydroxy-2'-deoxyguanosine (8-OHdG), by immunostaining. The findings indicate that NSP-116 suppressed retinal edema and expansion the non-perfused area by suppressing the increased expression of VEGF, TNF-α, and 8-OHdG in the murine RVO model. In conclusion, the oral administration of NSP-116 may serve as an effective pharmacological treatment for the pathological symptoms of RVO.
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http://dx.doi.org/10.1016/j.exer.2021.108453DOI Listing
March 2021

Excess adiponectin in eyes with progressive ocular vascular diseases.

FASEB J 2021 Feb;35(2):e21313

Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.

Anti-vascular endothelial growth factor (VEGF) therapies are now the first-line treatment for many ocular diseases, but some patients are non-responders to these therapies. The purpose of this study was to determine whether the level of adiponectin increased the pathogenesis of retinal edema and neovascularization in the retina of progressive ocular vascular diseases. We examined the role played by adiponectin in two types of cells and animal models which are retinal vein occlusion (RVO) and oxygen-induced retinopathy (OIR) mice. Our results showed that an injection of anti-adiponectin antibody ameliorated the retinal edema and ischemia through the depression of the expression level of VEGF-related factors and tight junction-related proteins in the retina of RVO mice. The intravitreal injection of anti-adiponectin antibody also decreased the degree of retinal neovascularization in an OIR mice. In addition, exposure of human retinal microvascular endothelial cells and human brain microvascular pericytes in culture to adiponectin increased both the vascular permeability and neovascularization through the increase of inflammatory factor and the dropout of the pericytes. These findings indicate that adiponectin plays a critical role in retinal edema and neovascularization, and adiponectin is a potential therapeutic target for the treatment of diabetic macular edema, proliferative diabetic retinopathy, and RVO.
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http://dx.doi.org/10.1096/fj.202001740RRDOI Listing
February 2021

Side-to-side supermicrosurgical anastomosis training using chicken wing model with V-shaped traction method.

Microsurgery 2021 03 22;41(3):300-301. Epub 2021 Jan 22.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

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http://dx.doi.org/10.1002/micr.30710DOI Listing
March 2021

Establishment of a pigmented murine model abundant with characteristics of retinal vein occlusion.

Exp Eye Res 2021 Mar 13;204:108441. Epub 2021 Jan 13.

Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan; Department of Biomedical Research, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan. Electronic address:

Retinal vein occlusion (RVO) is a vascular disease that represents characteristic retinal hemorrhage and dilated retinal veins. Despite its clinical importance, its pathogenesis remains largely unknown because of limited opportunities to acquire human retinal samples. Therefore, an animal model that reproduces the clinical features of RVO patients is required for further investigation. In this study, we established a pigmented murine RVO model that reproduced characteristic fundus appearances similar to human RVO findings. Retinal edema in this model was observed in both optical coherence tomography and histological analysis, which is a clinically important outcome. With quantitative real-time PCR analysis on retinal samples, we revealed that the mRNA level of vascular endothelial growth factor (VEGF) increased in the retina induced RVO. Moreover, this retinal edema was reduced by intravitreal injection of anti-VEGF antibody. These results were consistent with human clinical knowledge and suggested that this model could be a useful tool for research into new therapeutic approaches.
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http://dx.doi.org/10.1016/j.exer.2021.108441DOI Listing
March 2021

Use of the superficial circumflex iliac artery perforator flap for reconstruction after sarcoma resection.

J Surg Oncol 2021 Mar 11;123(4):1067-1080. Epub 2021 Jan 11.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.

Background: Postoperative complications after flap-coverage in sarcoma treatment can postpone postoperative adjunct treatments. Here, we present our experience with the use of the superficial circumflex iliac artery perforator (SCIP) flap after sarcoma resection.

Patients And Methods: Patients undergoing immediate reconstruction surgery with a flap after sarcoma resection at a single institution from February 2017 to April 2020 were identified. Patient demographics, tumor characteristics, surgical characteristics, and complications were examined.

Results: Thirty-five consecutive patients underwent reconstructions using a SCIP flap (34 free and one pedicled SCIP flaps). We also identified 47 consecutive patients who underwent reconstruction with other pedicled or free flaps over the same time period. No significant differences were found in patient age, gender, defect size, or operative time between these two groups. The incidences of overall complications (20/47 [42.6%] vs. 3/35 [8.5%], p < .001), flap dehiscence (7/47 [14.8%] vs. 0/35 [0%], p = .018), and total flap complications (15/47 [31.9%] vs. 2/35 [5.7%], p = .005) were statistically greater in the control group than in the SCIP group.

Conclusion: With its minimal postoperative complication rate both in the reconstruction site and the donor site, the SCIP flap can be considered an optimal reconstruction option after sarcoma resection.
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http://dx.doi.org/10.1002/jso.26364DOI Listing
March 2021

A triple-component deep inferior epigastric artery perforator chimeric free flap for three-dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis.

Microsurgery 2020 Dec 25. Epub 2020 Dec 25.

Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan.

Reconstruction of a complex knee defect is challenging, especially when complicated with osteomyelitis. Complex knee defect requires multi-component three-dimensional reconstruction using a chimeric flap. Although anterolateral thigh (ALT) flap is the most workhorse chimeric flap, another chimeric flap is required when ALT flap is not available. In this report, we present a case of complex knee defect successfully treated with a free triple-component chimeric deep inferior epigastric artery perforator (DIEP) flap transfer. A 36 year-old male sustained right above-knee amputation and Gustilo IIIB open fracture of the left patella after being run over by a train. Stump formation was performed for the right limb amputation, and the left knee wound resulted in skin necrosis complicated with patella osteomyelitis. After debridement, the left knee wound showed a 3 × 2 cm articular capsule defect, 5 × 2 cm exposed patella stump, and a 16 × 9 cm skin defect. A triple-component chimeric DIEP flap, containing a 7 × 3 cm rectus abdominis muscle (RAM), a 3 × 2 cm RAM's fascia, and a 23 × 10 cm skin was transferred. The RAM's fascia was used to reconstruct the joint, the RAM to cover the exposed patella's stump and the reconstructed joint, and the skin paddle to cover the skin defect. Six months after the surgery, the patient could walk without osteomyelitis recurrence, and there was no limitation in the left knee joint's range of motion. Although indication is limited, a multi-component chimeric DIEP flap may be an option for three-dimensional reconstruction of a complex defect.
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http://dx.doi.org/10.1002/micr.30698DOI Listing
December 2020

Nerve vascularity in free vascularized nerve flaps.

Glob Health Med 2020 Aug;2(4):263-264

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

The blood supply of peripheral nerves consists of a complex internal vessels' network, feeding external vessels and the interlinking vasa nervorum. Patients with nerve damage may require nerve substitution. While the commonly performed avascular nerve grafts obtain vascularization only from random and slow inosculation into the vasa nervorum, their insufficient revascularization causes loss of the graft's potential due to central necrosis. This gets more relevant with the larger diameter of nerves injured. Examples for neurovascular flaps are the lateral femoral cutaneous nerve vascularized the superficial circumflex iliac artery perforator (LFCN-SCIP) flap or the iliohypogastric nerve graft vascularized the superficial inferior epigastric artery (SIEA). LFCN-SCIP shows a well concealed donor scar site with a maintained vascularization and a minor donor site morbidity. Therefore, the guaranteed axial nerve vascularity in LFCN-SCIP makes it a preferred autologous vascularized nerve therapy for peripheral nerve defects. A further option example is the anterior lateral thigh (ALT) flap with the LFCN.
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http://dx.doi.org/10.35772/ghm.2020.01027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731066PMC
August 2020

Lymphedema secondary to melanoma treatments: diagnosis, evaluation, and treatments.

Glob Health Med 2020 Aug;2(4):227-234

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Approximately 300,000 new cases of melanoma are annually diagnosed in the world. Advanced stage melanomas require sentinel lymph node biopsy (SLNB), sometimes lymph node dissections (LND). The development rate of lower extremity lymphedema ranges from 7.6% to 35.1% after inguinal SLNB, and from 48.8% to 82.5% after inguinal LND. Development rate of upper extremity lymphedema ranges from 4.4% to 14.6% after axillary LND. Lymphedema management has constantly improved but effective evaluation and surgical management such as supermicrosurgical lymphaticovenular anastomosis (LVA) are becoming common as minimally invasive lymphatic surgery. Diagnosis and new classification using indocyanine green lymphography allowing pre-clinical secondary lymphedema stage management are improving effectiveness of supermicrosurgical LVA and vascularized lymph node transfer. Lymphatic transfer with lymph-interpositional-flap can restore lymph flow after large oncologic excision even without performing lymphatic anastomosis. Since lymphatic reconstructive surgery may affect local to systemic dissemination of remnant tumor cells, careful consideration is required to evaluate indication of surgical treatments.
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http://dx.doi.org/10.35772/ghm.2020.01022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731060PMC
August 2020

Technical pearls in lymphatic supermicrosurgery.

Glob Health Med 2020 Feb;2(1):29-32

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Lymphedema is becoming a major public issue with improvement of cancer survival rate, as the disease is incurable and progressive in nature, and the number of cancer survivor with lymphedema is increasing over time. Surgical treatment is recommended for progressive lymphedema, especially when conservative therapies are ineffective. Among various lymphedema surgeries, supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming popular with its effectiveness and least invasiveness. There are many technical knacks and pitfalls in LVA surgery. In preoperative evaluation, indocyanine green lymphography is recommended for considering indication and incision sites. Intraoperatively, intravascular stenting method, temporary lymphatic expansion maneuver, field-rotating retraction, and several navigation methods are useful. The most important postoperative care is immediate compression after LVA surgery. Compression is critical to keep lymphatic pressure higher than venous pressure, allowing continuous lymph-to-venous bypass flow. These technical pearls should be shared with lymphedema surgeons for better lymphedema management.
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http://dx.doi.org/10.35772/ghm.2019.01010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731411PMC
February 2020

Supermicrosurgery for oncologic reconstructions.

Glob Health Med 2020 Feb;2(1):18-23

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

With advancement of microsurgical techniques, supermicrosurgery has been developed. Supermicrosurgery allows manipulation (dissection and anastomosis) of vessels and nerves with an external diameter of 0.5 mm or smaller. Because quality of life of cancer survivors is becoming a major issue, less invasive and functionally-better oncological reconstruction using supermicrosurgical techniques attracts attention. Conventional free flap reconstruction usually sacrifices major vessels and muscle functions, whereas supermicrosurgical free flaps can be transferred from anywhere using innominate vessels without sacrifice of major vessel/muscle. Since a 0.1-0.5 mm vessel can be anastomosed, patient-oriented least invasive reconstruction can be accomplished with supermicrosurgery. Another important technique is lymphatic anastomosis. Only with supermicrosurgery, lymph vessels can be securely anastomosed, because lymph vessel diameter is usually smaller than 0.5 mm. With clinical application of lymphatic supermicrosurgery, various least invasive lymphatic reconstruction has become possible. Lymphatic reconstruction plays an important role in prevention and treatment of lymphatic diseases following oncologic surgery such as lymphedema, lymphorrhea, and lymphocyst. With supermicrosurgery, various tissues such as skin/fat, fascia, bone, tendon, ligament, muscle, and nerves can be used in combination to reconstruct complicated defects; including 3-dimensional inset with multi-component tissue transfer.
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http://dx.doi.org/10.35772/ghm.2019.01019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731086PMC
February 2020

Definition of perforator flap: what does a "perforator" perforate?

Glob Health Med 2019 Dec;1(2):114-116

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Perforator flap concept plays an important role in reconstructive surgery, because it allows less invasive and more complex reconstruction by preserving major vessels and muscles with intramuscular vessel dissection. Originally "perforator" represents vessel perforating the muscle, then vessel perforating the deep fascia regardless of muscle perforation. With technical progress in reconstructive microsurgery, the previous definition becomes inappropriate for least invasive flaps, only requiring intra-adiposal vessel dissection, such as superficial circumflex iliac artery perforator flap. Based on our experience of various least invasive flap reconstructive surgeries, a new concept for perforator flap has been developed. The new definition of perforator is a vessel perforating an envelope of a targeted tissue to be transferred; the superficial fascia for skin, the periosteum for bone, the perineurium for nerve, and the deep fascia for muscle. According to the new definition, all flaps can be precisely classified based on the corresponding "perforator".
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http://dx.doi.org/10.35772/ghm.2019.01009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731185PMC
December 2019

Free superficial circumflex iliac artery perforator fascial flap for reconstruction of upper abdominal wall with extensive infected herniation: A case report.

Microsurgery 2021 Mar 14;41(3):270-275. Epub 2020 Dec 14.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Complex abdominal wall reconstruction is challenging, and vascularized fascia is preferred for active infection cases. Pedicled tensor fascia lata flap is commonly used for lower abdominal wall reconstruction, and free vascularized fascial flap based on the lateral circumflex femoral artery (LCFA) is used for upper abdominal wall reconstruction. However, LCFA-based flap transfer requires invasive and time-consuming muscle dissection and a large recipient vessel. The purpose of this report was to present a new application of superficial circumflex iliac artery (SCIA) perforator (SCIP)-based fascial flap for upper abdominal wall reconstruction. A 70-year-old male suffered from a long-lasting extensive abdominal wall herniation complicated with mesh infection and cutaneous fistulae following multiple herniation repair with synthetic mesh. After complete debridement of infected tissues, there was a 29 x 26 cm full-thickness abdominal wall defect. Components separation was performed to minimize the defect size, after which 12 x 7 cm defect remained in the upper abdominal wall. A 20 x 10 cm SCIP deep fascial flap was elevated based on the deep branch of the SCIA. The SCIP flap was transferred to the defect to reconstruct the upper abdominal wall. The SCIP was anastomosed to the deep inferior epigastric artery perforator with supermicrosurgical perforator-to-perforator anastomosis. Postoperative course was uneventful with good functional and esthetic results of the donor and recipient sites 11 months after the surgery. Although further studies are required, SCIP fascial flap may be an option for upper abdominal wall reconstruction.
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http://dx.doi.org/10.1002/micr.30693DOI Listing
March 2021

A Diarylacetonitrile as a Molecular Probe for the Detection of Polymeric Mechanoradicals in the Bulk State through a Radical Chain-Transfer Mechanism.

Angew Chem Int Ed Engl 2021 Feb 1;60(5):2680-2683. Epub 2020 Dec 1.

Department of Chemical Science and Engineering, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo, 152-8550, Japan.

Since the beginning of polymer science, understanding the influence of mechanical stress on polymer chains has been a fundamental and important research topic. The detection of mechanoradicals generated by homolytic cleavage of the polymer chains in solution has been studied in many cases. However, the detection of mechanoradicals in the bulk is still limited owing to their high reactivity. Herein, we propose an innovative strategy to detect mechanoradicals visually and quantitatively using a chain-transfer agent that generates relatively stable fluorescent radicals as a molecular probe. Mechanoradicals generated by ball milling of polystyrene samples were successfully detected by using a diarylacetonitrile compound as a fluorescent molecular probe through this radical chain-transfer mechanism. This probe enables the visualization and quantitative evaluation of mechanoradicals generated by polymer-chain scission.
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http://dx.doi.org/10.1002/anie.202013180DOI Listing
February 2021

Intraoperative Real-Time Visualization of the Lymphatic Vessels Using Microscope-Integrated Laser Tomography.

J Reconstr Microsurg 2020 Oct 14. Epub 2020 Oct 14.

Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background:  Detection and selection of the lymphatic vessels are important for maximizing therapeutic efficacy of lymphaticovenular anastomosis (LVA). Some imaging modalities have been reported to be useful for intraoperative identification of the lymphatic vessels, but they have limitations. In this article, we present new capabilities of intraoperative laser tomography, which was used to evaluate the lumen of the lymphatic vessel and to validate the patency of anastomosis.

Patients And Methods:  Fifty-two patients with upper extremity lymphedema secondary to breast cancer treatment underwent indocyanine green (ICG) lymphography and real-time laser tomography imaging of ICG-enhanced lymphatic vessels intraoperatively before transecting the vessels during LVA. The imaging findings of the lymphatic vessels in laser tomography were investigated. Time required for scanning of the lymphatic vessels was compared between laser tomography and ultrasonography. The correlation between the thickness of the lymphatic vessel wall measured with laser tomographic imaging and the histologically measured thickness of the lymphatic vessel wall was examined. The patency of anastomosis sites was determined based on the image using laser tomography immediately after establishment of LVA.

Results:  A total of 132 ICG-enhanced lymphatic vessels were scanned with laser tomography showing clear lumen with surrounding vessel wall. The required time for lymphatic vessel scanning was significantly shorter with laser tomography than with ultrasonography (1.6 ± 0.3 vs. 4.8 ± 1.2 minutes;  = 0.016). Strong correlation was seen between the thickness of the lymphatic vessels wall measured using laser tomography and the histologically measured thickness of the lymphatic vessel wall ( = 0.977, 95% confidence interval: 0.897-0.992,  < 0.001). The quality of patency was evaluated immediately after anastomosis, which assisted in deciding whether reanastomosis was needed.

Conclusion:  Microscope-integrated laser tomography provides real-time images of the lymphatic vessels in extremely high resolution and enables evaluation of lymphatic lumen condition and objective post-LVA anastomosis status.
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http://dx.doi.org/10.1055/s-0040-1718549DOI Listing
October 2020

Ulnar artery concomitant veins of the chicken wing for advanced supermicrosurgery training.

Microsurgery 2021 01 26;41(1):102-103. Epub 2020 Aug 26.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

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http://dx.doi.org/10.1002/micr.30643DOI Listing
January 2021

Clarifying the structure of serious head and spine injury in youth Rugby Union players.

PLoS One 2020 15;15(7):e0235035. Epub 2020 Jul 15.

2019 Rugby World Cup Organizing Committee, Tokyo, Japan.

This study aimed to clarify the cause of rugby head and spinal cord injuries through a network centrality analysis of 14-year (2004-2018) longitudinal data in Japan. The study hypothesis is that understanding the causal relationship among the occurrence of serious injuries, the quality of player experience and play situation as a network structure could be possible to obtain practical knowledge on injury prevention. In this study, bipartite graphs are used to make it easier to understand the situation of players and injuries. This would also help to elucidate more characteristic subgroup. A network bipartite graph and subgroup (cluster) analyses were performed to clarify the injured players' experience and the cause of injury. We used the algorithm of R program, IGRAPH, clustering edge betweenness. For subgroup extraction, the modularity Q value was used to determine which step to cut. The Japanese rugby population was 93,873 (2014-2018 average), and 27% were high school students. The data showed that careful attention would be particularly needed for groups of inexperienced Japanese high school players. Our study suggests that we should consider introducing rules that prohibit "head-on collisions" in youth rugby.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235035PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363091PMC
September 2020

Comparison of Outcomes between Side-to-End and End-to-End Lymphovenous Anastomoses for Early-Grade Extremity Lymphedema.

Plast Reconstr Surg 2020 06;145(6):1112e-1113e

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

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http://dx.doi.org/10.1097/PRS.0000000000006856DOI Listing
June 2020

Distinction between the lymph vessel and the vein on ICG lymphography: Intradermal or subcutaneous ICG injection also enhances the vein.

J Plast Reconstr Aesthet Surg 2020 10 5;73(10):1897-1916. Epub 2020 May 5.

Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2020.03.031DOI Listing
October 2020

Microsurgical Strategies for Prophylaxis of Cancer-Related Extremity Lymphedema: A Comprehensive Review of the Literature.

J Reconstr Microsurg 2020 Sep 29;36(7):471-479. Epub 2020 Apr 29.

Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan.

Background:  Cancer-related lymphedema represents the first cause of noninfectious secondary extremity lymphedema. This entity is a progressive and debilitating disease with no curative treatment available. With the advent of lymphedema microsurgery, focus has turned into risk reduction and prevention of the disease progression.

Methods:  Literature review was conducted to clarify current microsurgical approach to prophylaxis of cancer treatment-related extremity lymphedema.

Results:  Prophylactic approach could be classified into primary and secondary prevention; microsurgical procedures were performed simultaneously with cancer ablation in primary prevention, and secondary prevention was performed secondarily after cancer treatment for selected high-risk subclinical cases. Indocyanine green lymphography was the most useful method for lymphedema screening after cancer treatment and to diagnose subclinical lymphedema. Several lymphovenous shunt operations were performed as prophylactic procedures, and classified into microsurgical lymphovenous implantation and supermicrosurgical lymphovenous intima-to-intima coaptation. Both showed clinically significant prophylactic effects.

Conclusion:  This review provides a comprehensive overview of the literature regarding microsurgical interventions for the prevention of cancer-related extremity lymphedema. There are several methods for lymphedema prophylaxis and further studies are required to clarify indication of each method.
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http://dx.doi.org/10.1055/s-0040-1710047DOI Listing
September 2020

Recipient vein funnelization for supermicrosurgical lymphaticovenular anastomosis.

Microsurgery 2020 07 7;40(5):618-619. Epub 2020 Apr 7.

Department of Plastic and Reconstructive Surgery, University of Tokyo, Japan.

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http://dx.doi.org/10.1002/micr.30586DOI Listing
July 2020

Bedside 3D Visualization of Lymphatic Vessels with a Handheld Multispectral Optoacoustic Tomography Device.

J Clin Med 2020 Mar 17;9(3). Epub 2020 Mar 17.

Department of Breast Center, Kameda Medical Center, Chiba 296-8602, Japan.

Identification of lymphatics by Indocyanine Green (ICG) lymphography in patients with severe lymphedema is limited due to the overlying dermal backflow. Nor can the method detect deep and/or small vessels. Multispectral optoacoustic tomography (MSOT), a real-time three- dimensional (3D) imaging modality which allows exact spatial identification of absorbers in tissue such as blood and injected dyes can overcome these hurdles. However, MSOT with a handheld probe has not been performed yet in lymphedema patients. We conducted a pilot study in 11 patients with primary and secondary lymphedema to test whether lymphatic vessels could be detected with a handheld MSOT device. In eight patients, we could not only identify lymphatics and veins but also visualize their position and contractility. Furthermore, deep lymphatic vessels not traceable by ICG lymphography and lymphatics covered by severe dermal backflow, could be clearly identified by MSOT. In three patients, two of which had advanced stage lymphedema, only veins but no lymphatic vessels could be identified. We found that MSOT can identify and image lymphatics and veins in real-time and beyond the limits of near-infrared technology during a single bedside examination. Given its easy use and high accuracy, the handheld MSOT device is a promising tool in lymphatic surgery.
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http://dx.doi.org/10.3390/jcm9030815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141284PMC
March 2020

Buffalo skull-shaped supermicrosurgical lymphaticovenular anastomosis.

J Plast Reconstr Aesthet Surg 2020 06 20;73(6):1174-1205. Epub 2020 Feb 20.

Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2020.02.008DOI Listing
June 2020

Visualization of the "Intradermal Plexus" Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps.

Plast Reconstr Surg Glob Open 2019 Nov 14;7(11):e2411. Epub 2019 Nov 14.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Free flaps have evolved from musculocutaneous flaps to perforator-based cutaneous flaps. The subdermal plexus is now thought to play a significant role in skin paddle perfusion. We propose a new concept, the "intradermal plexus," allowing survival of dermis flaps, according to our study.

Methods: A dermis flap was used in 6 cases to reconstruct small defects. The superficial branch of the superficial circumflex iliac artery was traced distally using an ultrasound device with a 70-MHz linear array transducer until the artery's branch entered the dermis. The location of the dermis entry site was marked and the vessels running inside the dermis were observed and video-recorded. A flap was elevated above the superficial fascia, and the adipose tissue was removed using scissors after confirmation of the vessels' dermis entry point.

Results: The use of 70-MHz ultrasonography permitted observation in all patients of small arteries entering the dermis layer. The artery was observed to give off branches after entering the dermis, in effect constituting an "intradermal plexus." Small veins entering the dermis were similarly visualized using 70 MHz ultrasonography. All flaps survived completely.

Conclusions: Small arteries and veins entering and running inside the dermis were visualized for the first time with 70 MHz real-time ultrasonography. Knowledge of the existence of this "intradermal plexus" made it possible to discard nearly all subdermal adipose tissue quickly and safely, without resorting to the elaborate measures described in previous reports.
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http://dx.doi.org/10.1097/GOX.0000000000002411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908357PMC
November 2019

Preoperative planning of lymphaticovenular anastomosis in patients with iodine allergy: A multicentric experience.

J Plast Reconstr Aesthet Surg 2020 04 29;73(4):783-808. Epub 2019 Nov 29.

Centre for Surgical Treatment of Lymphedema, Dipartimento Salute della Donna, del Bambino e di Sanità Pubblica, UOC Chirurgia Plastica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Agostino Gemelli, 8, 00169 Rome, Italy.

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http://dx.doi.org/10.1016/j.bjps.2019.11.020DOI Listing
April 2020

Use of the transverse branch of the superficial circumflex iliac artery as a landmark facilitating identification and dissection of the deep branch of the superficial circumflex iliac artery for free flap pedicle: Anatomical study and clinical applications.

Microsurgery 2019 Nov 8;39(8):721-729. Epub 2019 Oct 8.

Department of Plastic and Reconstructive Surgery, Hospital of the Divine Saviour (Krankenhaus Goettlicher Heiland), Vienna, Austria.

Background: The deep branch of the superficial circumflex iliac artery (SCIA) should be included when a large superficial circumflex iliac artery perforator (SCIP) flap is necessary, or when anatomical structures perfused by the deep branch are procured. The aim of this study was first to describe the anatomical features of the "transverse branch" of the deep branch of the SCIA in cadavers, and then to assess the efficacy of its use as a landmark for identification and dissection of the deep branch of the SCIA through clinical applications.

Methods: Twenty groin regions from 10 cadavers were dissected. The course and the takeoff point of the transverse branch were documented. With the transverse branch used as a landmark for pedicle dissection, 27 patients (16 males and 11 females) with an average age of 51.7 years underwent reconstructions that used vascularized structures nourished by the deep branch of the SCIA. Aside from the skin paddle, an iliac bone flap was used in 10 cases, a lateral femoral cutaneous nerve flap in four cases, and a sartorius muscle flap in three cases. The defect locations included the head (seven cases), the foot (six cases), the hand (six cases), the arm (five cases), and the leg (three cases). The causes of reconstruction were tumors in 13 patients, trauma in six patients, infection in four patients, surgical procedures in three patients, and refractory ulcer in one patient.

Results: In all specimens, the transverse branch was found underneath the deep fascia caudal to the anterior superior iliac spine (ASIS). The average distance from the ASIS to the transverse branch was 25.5 ± 13.0 mm (range, 5-50 mm). The average dimension of the flap was 13.1 × 5.9 cm . All the flaps survived completely after the surgery; lymphorrhea was seen in one patient at the donor site. The average follow-up period was 12.9 months (range, from 2 to 42 months), and all patients had good functional recovery with satisfactory esthetic results.

Conclusions: The transverse branch was found in all specimens, branching from the deep branch of the SCIA. Successful results were achieved by using it as the landmark for identification and dissection of the deep branch of the SCIA. This method allows safe elevation of a large SCIP flap or a chimeric SCIP flap.
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http://dx.doi.org/10.1002/micr.30518DOI Listing
November 2019

Absorbable Plating of Nasoorbitoethmoid Fractures for Adults.

J Craniofac Surg 2019 10;30(7):2297-2298

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

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http://dx.doi.org/10.1097/SCS.0000000000005991DOI Listing
October 2019