Publications by authors named "Takuya Iida"

166 Publications

Damage-free light-induced assembly of intestinal bacteria with a bubble-mimetic substrate.

Commun Biol 2021 03 22;4(1):385. Epub 2021 Mar 22.

Department of Physical Science, Graduate School of Science, Osaka Prefecture University, Osaka, Japan.

Rapid evaluation of functions in densely assembled bacteria is a crucial issue in the efficient study of symbiotic mechanisms. If the interaction between many living microbes can be controlled and accelerated via remote assembly, a cultivation process requiring a few days can be ommitted, thus leading to a reduction in the time needed to analyze the bacterial functions. Here, we show the rapid, damage-free, and extremely dense light-induced assembly of microbes over a submillimeter area with the "bubble-mimetic substrate (BMS)". In particular, we successfully assembled 10-10 cells of lactic acid bacteria (Lactobacillus casei), achieving a survival rate higher than 95% within a few minutes without cultivation process. This type of light-induced assembly on substrates like BMS, with the maintenance of the inherent functions of various biological samples, can pave the way for the development of innovative methods for rapid and highly efficient analysis of functions in a variety of microbes.
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http://dx.doi.org/10.1038/s42003-021-01807-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985151PMC
March 2021

Sacral defect reconstruction using a sensate superior gluteal artery perforator flap based on the superior cluneal nerves: A report of two cases.

Microsurgery 2021 Jul 2;41(5):468-472. Epub 2021 Feb 2.

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

The superior gluteal artery perforator (SGAP) flap is a widely used flap for sacral reconstruction. However, it is non-sensate flap and sensory loss is one of the most important risk factors for pressure ulcer development and recurrence; therefore, a sensate SGAP flap would be ideal for the reconstruction. Because the upper buttock is innervated by the superior cluneal nerves (SCNs) which originate from Th11 to L4, a sensate SGAP flap based on SCNs is anatomically possible. Herein, we present a novel sensate SGAP flap based on SCNs for reconstruction of sacral defects. Two patients with a sacral defect underwent reconstruction using a sensate SGAP flap (53 and 56 years old, both men). Diagnoses were sacral spindle cell sarcoma and sacral pressure ulcer. The defect sizes were 16 × 13 and 12 × 11 cm. The flap was designed based on the locations of SCNs which are commonly located at 6-8 cm lateral from the midline at the iliac crest. Flap sizes were 16 × 9 and 15 × 13 cm, respectively. The flaps survived completely in both cases. Flap sensation was observed immediately after surgery except in flap margins. However, sensory recovery occurred in these areas as well several months postoperatively. None of the patients developed postoperative pressure ulcers during the follow-up period of 37 and 13 months. This method may preserve flap sensation and therefore can contribute to reducing the risk of postoperative pressure ulcers and could be a useful option for sacral reconstruction.
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http://dx.doi.org/10.1002/micr.30714DOI Listing
July 2021

Silk fibroin vascular graft: a promising tissue-engineered scaffold material for abdominal venous system replacement.

Sci Rep 2020 12 3;10(1):21041. Epub 2020 Dec 3.

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

No alternative tissue-engineered vascular grafts for the abdominal venous system are reported. The present study focused on the development of new tissue-engineered vascular graft using a silk-based scaffold material for abdominal venous system replacement. A rat vein, the inferior vena cava, was replaced by a silk fibroin (SF, a biocompatible natural insoluble protein present in silk thread), tissue-engineered vascular graft (10 mm long, 3 mm diameter, n = 19, SF group). The 1 and 4 -week patency rates and histologic reactions were compared with those of expanded polytetrafluoroethylene vascular grafts (n = 10, ePTFE group). The patency rate at 1 and 4 weeks after replacement in the SF group was 100.0% and 94.7%, and that in the ePTFE group was 100.0% and 80.0%, respectively. There was no significant difference between groups (p = 0.36). Unlike the ePTFE graft, CD31-positive endothelial cells covered the whole luminal surface of the SF vascular graft at 4 weeks, indicating better endothelialization. SF vascular grafts may be a promising tissue-engineered scaffold material for abdominal venous system replacement.
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http://dx.doi.org/10.1038/s41598-020-78020-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713399PMC
December 2020

Near-field transmission and reflection spectroscopy for revealing absorption and scattering characteristics of single silver nanoplates.

J Chem Phys 2020 Oct;153(14):144703

Department of Chemistry and Biochemistry, School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo 169-8555, Japan.

Near-field optical microscopy visualizes spatial characteristics of elementary excitations induced in metal nanostructures. However, the microscopy is not able to reveal the absorption and scattering characteristics of the object simultaneously. In this study, we demonstrate a method for revealing the absorption and scattering characteristics of silver nanoplate by using near-field transmission and reflection spectroscopy. Near-field transmission and reflection images show characteristic spatial features attributable to the excited plasmon modes. The near-field refection image near the resonance shows a reversed contrast depending on the observed wavelength. Near-field reflection spectra show unique positive and negative resonant features. We reveal that the optical characteristics and the wavelength dependency of the optical contrast originate from the scattering and absorption properties of the plasmons, with the aid of the electromagnetic simulations.
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http://dx.doi.org/10.1063/5.0025328DOI Listing
October 2020

Superficial Circumflex Iliac Perforator-Osteocutaneous Flap for Reconstruction of Extensive Composite Defects in the Forefoot.

Plast Reconstr Surg Glob Open 2020 Aug 25;8(8):e3076. Epub 2020 Aug 25.

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

Although the great toe plays important roles in walking, loading, and maintaining balance when compared with other toes, there are few reports on great toe reconstruction, including the reconstruction of distal phalanx. This report aims to describe the use of a superficial circumflex iliac artery perforator (SCIP)-osteocutaneous flap for reconstructing a complex tissue defect of the great toe. A 62-year-old man presented with a crush injury to the forefoot. Because the great toe was severely crushed, the defect distal to the proximal phalanx of the great toe was reconstructed using a SCIP-osteocutaneous flap. The immediate postoperative course was uneventful; however, surgical revision was necessary. Signs of osseous union could be observed on radiographic images taken 2 months after the initial surgery. Twenty-four months after surgery, the patient could freely walk without resorption of the transferred bone. We demonstrated that SCIP-osteocutaneous flaps may be promising free flaps in complex tissue defect reconstruction of the great toe.
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http://dx.doi.org/10.1097/GOX.0000000000003076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489706PMC
August 2020

Resection and Reconstruction of Giant Abdominoscrotal Arteriovenous Malformation.

Plast Reconstr Surg Glob Open 2020 Mar 27;8(3):e2725. Epub 2020 Mar 27.

Department of Radiology, University of Tokyo, Tokyo, Japan.

Genital arteriovenous malformations are rare and present unique surgical challenges in preserving urogenital function, abdominal wall integrity, and lower limb perfusion. A 32-year-old man with a giant abdominoscrotal arteriovenous malformation presented with recurrent heavy bleeding. Due to the high risk of rebleeding and fatal hemorrhage, surgery with curative intent was proposed and the patient was counseled on the risks of ischemia to the lower limb, testes, and penis. Preoperative embolization of the feeding vessels was performed. Three days later, surgical excision of the mass with the affected scrotum, left rectus muscle, sheath, and overlying abdominal skin followed. The testes were dissected from the malformation and preserved along with the right internal pudendal artery. The left thigh skin was advanced to the scrotal remnants and a neoscrotum created. The resulting large abdominal wall defect was reconstructed in layers with a pedicled anterolateral thigh flap, including innervated vastus lateralis muscle, to prevent herniation. Recovery was uneventful, and a 4-year follow-up revealed no significant clinical or radiological recurrence with recovery of flap sensation, retained erectile function, and no herniation. We report this case due to rarity of giant abdominoscrotal arteriovenous malformations and present preoperative embolization, surgical resection, and functional anterolateral thigh flap reconstruction as a valuable treatment option of this life-threatening illness.
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http://dx.doi.org/10.1097/GOX.0000000000002725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253270PMC
March 2020

Effective Secondary Reconstruction of Refractory Urethrocutaneous Fistula after Metoidioplasty Using Folded Superficial Circumflex Iliac Artery Perforator Flap.

Plast Reconstr Surg Glob Open 2020 Mar 25;8(3):e2716. Epub 2020 Mar 25.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.

One of the primary goals of penile reconstruction for female-to-male transsexuals is to enable voiding while standing. Metoidioplasty represents a viable option, but it is associated with a high rate of postoperative fistula formation and recurrence, which affects the aesthetic and functional outcomes. Subsequent surgical repair using scarred and inadequate local tissue may contribute to fistula recurrence. The folded superficial circumflex iliac artery perforator (SCIP) island flap offers sufficient well-vascularized tissue and skin envelope for the reconstruction of the urethra and outer skin after failed metoidioplasty. The SCIP flap can be elevated as a hairless thin flap, making it useful in urethral reconstruction even when it is folded. We describe a case of a 44-year-old female-to-male transsexual patient who developed a refractory urethrocutaneous fistula after metoidioplasty. Surgical repairs were attempted using local tissue 4 times without success. The patient presented to our hospital, and we performed urethral reconstruction using a folded, pedicled SCIP flap for both urethra and skin augmentation. The postoperative course was uneventful, with satisfactory functional results and low donor-site morbidity. No fistula recurrence was observed during the 2 years of follow-up. This novel procedure offers a viable alternative technique for refractory urethrocutaneous fistula repair.
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http://dx.doi.org/10.1097/GOX.0000000000002716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253264PMC
March 2020

Superthin Thoracodorsal Artery Perforator Flap for the Reconstruction of Palmar Burn Contracture.

Plast Reconstr Surg Glob Open 2020 Mar 11;8(3):e2695. Epub 2020 Mar 11.

Department of Plastic Surgery, Kanto Central Hospital, Tokyo, Japan.

Treating burn scar contractures is challenging. Although free flap transfer is an effective tool for hand reconstruction, free flaps are often bulky, causing functional disturbance and poor cosmetic appearance. Secondary debulking operations are required, resulting in a prolonged total treatment period and delayed return to daily life and work for the patient. Therefore, 1-stage reconstruction using a thin and pliable flap is ideal. In this report, we present the superthin TDAP flap as an option for the reconstruction of postburn palmar contracture. During TDAP flap elevation, the thoracodorsal artery perforator was identified and traced distally until its penetration into the dermis. Subsequently, the subdermal tissue was removed and a uniformly superthin TDAP flap was elevated. Postoperatively, early functional recovery was achieved with excellent palmar contour and texture. No revision surgery was required and no recurrence of contractures occurred during the 6-month follow-up. This procedure is useful in elevating a superthin TDAP flap and is a feasible option for the reconstruction of working surfaces, such as the palm.
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http://dx.doi.org/10.1097/GOX.0000000000002695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253288PMC
March 2020

Two-stage Reconstruction Using a Free Jejunum/Ileum Flap After Total Esophagectomy.

Ann Plast Surg 2020 12;85(6):638-644

From the Department of Plastic and Reconstructive Surgery, The University of Tokyo, Bunkyo-ku.

Background: Reconstruction after esophagectomy is conventionally performed with a gastric conduit. However, in cases where a gastric conduit is unavailable, reconstructive procedures vary in terms of flap type, operative timing, and conduit route. Single-stage surgery is associated with a long operation time and high surgical stress, resulting in perioperative mortality. Recent advances in reconstructive microsurgery have made free intestinal flap transfer safe and reliable. Therefore, to overcome the shortcomings with previous methods, we performed 2-stage surgery involving free jejunum/ileum transfer for reconstruction after esophagectomy.

Patients And Methods: From 2010 to 2018, 42 free jejunum/ileum flaps were transferred for reconstruction after esophagectomy in 41 patients. The diagnosis was esophageal cancer in 38 patients. All operations were performed in 2 stages. In most cases, total esophagectomy was performed in the first operation. The cervical stump of the esophagus was sutured to the cervical skin, creating an esophagostomy in the left neck. About 4 to 7 weeks after the first operation, the second operation was performed. The free jejunum/ileum flap was transferred through the subcutaneous route. Microvascular anastomosis was performed with the internal mammary artery and internal mammary vein, transverse cervical artery, internal and external jugular veins (internal jugular vein and EJV, respectively), and cephalic vein. The mean follow-up duration was 20 months.

Results: Free jejunum/ileum transfer was performed as the first operation in 4 cases and as the second operation in 38 cases. A free jejunal flap was used in 36 cases and free ileal flap was used in 6 cases. The recipient arteries were the internal mammary artery in 38 cases and transverse cervical artery in 4 cases. The recipient veins were the internal mammary vein in 15 cases, cephalic vein in 13 cases, EJV in 10 cases, and internal jugular vein in 10 cases. The flaps survived in all cases, except 1 case (41/42, 97.6%). The complications were anastomotic leakage of the flap in 9 cases, respiratory complications in 10 cases, and ileus in 2 cases. Perioperative mortality was not noted.

Conclusions: Two-stage surgery using free jejunum/ileum flap transfer is a safe and reliable option for esophageal reconstruction in cases where gastric pull-up is unavailable.
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http://dx.doi.org/10.1097/SAP.0000000000002421DOI Listing
December 2020

Light-induced assembly of living bacteria with honeycomb substrate.

Sci Adv 2020 02 28;6(9):eaaz5757. Epub 2020 Feb 28.

Research Institute for Light-induced Acceleration System, Osaka Prefecture University, Sakai 599-8570, Japan.

Some bacteria are recognized to produce useful substances and electric currents, offering a promising solution to environmental and energy problems. However, applications of high-performance microbial devices require a method to accumulate living bacteria into a higher-density condition in larger substrates. Here, we propose a method for the high-density assembly of bacteria (10 to 10 cells/cm) with a high survival rate of 80 to 90% using laser-induced convection onto a self-organized honeycomb-like photothermal film. Furthermore, the electricity-producing bacteria can be optically assembled, and the electrical current can be increased by one to two orders of magnitude simply by increasing the number of laser irradiations. This concept can facilitate the development of high-density microbial energy conversion devices and provide new platforms for unconventional environmental technology.
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http://dx.doi.org/10.1126/sciadv.aaz5757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048417PMC
February 2020

Neuroma formation following fascicular turnover flap nerve repair.

J Plast Reconstr Aesthet Surg 2020 05 20;73(5):983-1007. Epub 2020 Jan 20.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

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http://dx.doi.org/10.1016/j.bjps.2020.01.006DOI Listing
May 2020

Functional and Aesthetic Reconstruction for Microtia Using the Combination of Superficial Circumflex Iliac Artery Perforator Superthin Flap Transfer and Skin Grafting.

Plast Reconstr Surg Glob Open 2019 Jul 5;7(7):e2312. Epub 2019 Jul 5.

Department of Otolaryngology, The University of Tokyo, Tokyo, Japan.

Microtia with congenital aural atresia is challenging to achieve aesthetically and functionally good results. We herein present a case where a vascularized superthin superficial circumflex iliac artery perforator (SCIP) flap was used for reconstruction of the external auditory canal (EAC) and a full-thickness skin graft was used for reconstruction of the postauricular region for a 10-year-old male who suffered from microtia with congenital aural atresia. After costal cartilage grafting (the first operation), EAC reconstruction and auricle elevation (the second surgery) was performed. After the atticoantrostomy, a superthin SCIP flap was rolled up in a sac and was inset to the newly created EAC. The postauricular skin defect was covered with full-thickness skin graft. The SCIP flap survived completely and good patency of the reconstructed EAC was accomplished, which results in an improvement of previous hearing loss. The skin graft survived completely, which eventually demonstrated aesthetically satisfactory results.
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http://dx.doi.org/10.1097/GOX.0000000000002312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952158PMC
July 2019

Flow-oriented Venous Anastomosis to Control Lymph Flow of Lymphatic Malformation.

Plast Reconstr Surg Glob Open 2019 Jul 29;7(7):e2199. Epub 2019 Jul 29.

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

Less-invasive surgeries, such as lymphaticovenular anastomosis (LVA), are the widely accepted intervention for lymphedema. This study aimed to assess the outcomes of flow-oriented LVA modification on lymphatic malformation (LM).

Methods: We included 19 patients diagnosed with LM mixed type or microcystic type, who came to our clinic from June 2015 to December 2017. Under general anesthesia, all patients were administered an indocyanine green lymphography injection subcutaneously. In the case of a strong inflow, the patient underwent afferent lymph vessel of LM to venous anastomosis (LMVA). Otherwise, the side wall of LMVA was performed to the cysts. Outcomes were classified into the following groups based on the size changes: treatment effect (TE) 4 = >80% reduction rate; TE 3 = 50%-80% reduction rate; TE 2 = 20%-50% reduction rate; and TE 1 = 0%-20% reduction rate.

Results: All cases underwent surgery, with no case having an increased size. The results were as follows: TE 4 = 4 (21%) patients; TE 3 = 6 (32%) patients; TE 2 = 5 (26%) patients; and TE 1 = 4 (21%) patients. No case required study termination due to disease progression. Minor complication occurred in 3 cases. One vesicle increased at the labial mucosa and one wound dehiscence that epithelized within 1 month.

Conclusion: LMVA could be a novel, minimally invasive lymph flow-oriented surgical method for intractable LM.
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http://dx.doi.org/10.1097/GOX.0000000000002199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952148PMC
July 2019

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

Additional venous anastomosis in free profunda artery perforator flap transfer using the posterior accessory saphenous vein.

J Plast Reconstr Aesthet Surg 2019 Dec 24;72(12):1936-1941. Epub 2019 Sep 24.

Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan.

Background: The profunda artery perforator (PAP) flap has recently been widely used for head and neck as well as breast reconstruction. Although this flap has various advantages, its vascular pedicle is relatively smaller and shorter than that of other workhorse flaps such as the anterolateral thigh flap. The posterior accessory saphenous vein (pASV) is a branch of the great saphenous vein, which runs in the posteromedial aspect of the thigh and can be included in the PAP flap. Here, we present the anatomical characteristics of the pASV and feasibility of its use in PAP flap transfers.

Patients And Methods: An anatomical study of the pASV was conducted in nine lower extremities of five patients using ultrasonography. Several landmarks such as point A (the point where the pASV crosses the posterior border of the adductor longus muscle), point B (the point where the pASV merges with the great saphenous vein) and the inguinal crease, were marked. Distribution of the pASV was plotted, and several distances were measured. On the basis of the anatomical study, nine free PAP flap transfers were performed.

Results: In the anatomical study, the mean diameter of the pASV was 3.4 and 4.9 mm at points A and B, respectively. The mean available length of the pASV was 9.4 cm. In clinical cases, all flaps completely survived. No flap-related complication was observed. The pASV was included in the PAP flap in eight cases. The mean length of the harvested pASV was 8.6 cm, and the mean diameter was 3.3 mm. Indocyanine green angiography showed effective drainage using the pASV alone.

Conclusions: The use of the pASV can be an effective option, particularly for head and neck reconstruction, and its application in various types of reconstructive surgery can be widened.
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http://dx.doi.org/10.1016/j.bjps.2019.09.013DOI Listing
December 2019

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

A Simple Skin Incision Design for Pediatric Superficial Branch of Superficial Circumflex Iliac Artery.

Plast Reconstr Surg Glob Open 2019 Apr 2;7(4):e2159. Epub 2019 Apr 2.

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

Background: Superficial circumflex iliac artery (SCIA) perforator flap is one of the demanding flaps. However, little is known about SCIA anatomy, which is crucial for successful SCIA perforator flap elevation, in children. We assessed the efficacy of our incision design to detect the superficial branch of the SCIA in vivo.

Methods: Eleven consecutive pediatric patients who required harvesting (eg, skin grafts or vascularized lymph node transfer) were assessed. All possible congenital vascular malformation cases were excluded. To reduce potential bias, all groin procedures were performed on the contralateral side of malformations. After inguinal area mapping, 1.5-cm skin incision was made. From the window opened by the skin incision, tiny perforation to the skin surface was detected for further dissection. Following the tiny branch, the main trunk of the superficial circumflex vascular bundle was dissected. The whole vascular bundle, artery, and major vein from the bundle were dissected and their sizes were measured.

Results: Of the 11 patients, 4 were boys; the age range was 5 months to 14 years (mean age: 3.2 years). Vessel bundle size was 0.7-1.5 (mean: 1.1 mm). In all cases, the bundle was detected within 5 min (1-5, mean: 2.5 min). No vascular damage was observed, and all arteries pulsated well, without requiring additional skin incision. The superficial branch of the SCIA was mainly detected right below the initial skin incision.

Conclusions: Our skin incision design can effectively detect the SCIA in pediatric patients and may be used in adult patients.
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http://dx.doi.org/10.1097/GOX.0000000000002159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554152PMC
April 2019

Interparticle-Interaction-Mediated Anomalous Acceleration of Nanoparticles under Light-Field with Coupled Orbital and Spin Angular Momentum.

Nano Lett 2019 Aug 4;19(8):4873-4878. Epub 2019 Jul 4.

Graduate School of Science , Osaka Prefecture University , 1-2, Gakuen-cho , Naka-ku, Sakai , Osaka 599-8570 , Japan.

Spin-orbit interaction is a crucial issue in the field of nanoscale physics and chemistry. Here, we theoretically demonstrate that the spin angular momentum (SAM) can accelerate and decelerate the orbital motion of nanoparticles (NPs) via light-induced interparticle interactions by a circularly polarized optical vortex. The Laguerre-Gaussian beam as a conventional optical vortex with orbital angular momentum (OAM) induces the orbital and spinning motion of a trapped object depending on the spatial configuration. On the contrary, it is not clear whether circularly polarized light induces the orbital motion for the particles trapped off-axis. The present study reveals that the interparticle light-induced force due to the SAM enhances or weakens the orbital torque and modulates rotational dynamics depending on the number of NPs, where the rotation speed of NPs in the optical field with both positive SAM and OAM can be 4 times faster than that in the optical field with negative SAM and positive OAM. The obtained results will not only clarify the principle for the control of NPs based on OAM-SAM coupling via light-matter interaction but also contribute to the unconventional laser processing technique for nanostructures with various chiral symmetries.
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http://dx.doi.org/10.1021/acs.nanolett.9b00332DOI Listing
August 2019

Treating Pulsatile Exophthalmos in Child with Minimally Invasive Approach and Custom-made Titanium Mesh Plate.

Plast Reconstr Surg Glob Open 2019 Feb 11;7(2):e2070. Epub 2019 Feb 11.

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

Orbital roof fracture is a relatively rare trauma. In most cases, surgical intervention is not needed since the fracture is slight. However, invasive surgical procedures are inevitable once pulsatile exophthalmos occurs if vision impairment is to be avoided. We report our rare experience of orbital roof fracture in a child with pulsatile exophthalmos. Good reconstruction of the anterior cranial base was achieved using a custom-made titanium mesh and a minimally invasive approach. A 3-year-old girl who had been diagnosed with subdural hematoma, brain contusion, and fracture of the right orbital roof caused by facial bruising underwent emergent external decompression by coronal skin incision and a transcranial approach on the same day as the trauma. Cranioplasty using autologous frozen bone in the same approach was performed 103 days posttrauma, but this was followed by pulsatile exophthalmos. After recovering from critical stage, the girl was brought to our department for reconstruction of the anterior base. Risk of vision impairment was also one reason for reconstruction, but the neurosurgeon hesitated to approach the region using a coronal approach considering the possibility of infection in the frozen autologous bone. Through cross-team discussion, reconstruction using a subeyebrow incision was performed with a custom-made titanium mesh plate. Pulsatile exophthalmos completely disappeared. Pulsatile exophthalmos is a very rare but serious complication that carries a risk of vision impairment. By applying a custom-made titanium mesh plate, precise reconstruction was enabled with minimal invasiveness and low risk.
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http://dx.doi.org/10.1097/GOX.0000000000002070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416129PMC
February 2019

Use of the Distal Facial Artery (Angular Artery) for Supermicrosurgical Midface Reconstruction.

Plast Reconstr Surg Glob Open 2019 Feb 5;7(2):e1978. Epub 2019 Feb 5.

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

Background: In free-flap reconstruction of the midface, options for the recipient artery are quite limited; the superficial temporal artery and the facial artery are the most commonly used arteries. We report our approach for the use of the angular artery (the terminal branch of the facial artery) as the recipient artery in free-flap reconstruction of the midface.

Methods: Nine patients with midface defects underwent free-flap reconstructions using the angular artery as the recipient artery. Identification and marking of the facial artery were performed preoperatively using handheld Doppler ultrasound. The angular artery was located through an incision made on the side of the nose. When present, a vena comitans of the facial artery or any subcutaneous vein in the vicinity of the defect was used as the recipient vein. In other cases, the facial vein in the submandibular region was chosen as the recipient vein, using a vein graft.

Results: The average diameter of the angular artery was 0.9 mm (range, 0.7-1.0 mm). In all cases, arterial anastomosis was performed in an end-to-end fashion, and flaps survived completely. In 4 cases, a vein graft was used to bridge the pedicle vein and the facial vein.

Conclusions: Although supermicrosurgical skills may be required for its anastomosis, the angular artery is an anatomically consistent artery, which is suitable for use as the recipient artery in free-flap reconstruction of the midface. Use of the angular artery as the recipient artery allows shorter flap pedicles and decreases the number of vein grafts necessary.
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http://dx.doi.org/10.1097/GOX.0000000000001978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416107PMC
February 2019

Flow Pattern Classification in Lymphatic Malformations by Indocyanine Green Lymphography.

Plast Reconstr Surg 2019 03;143(3):558e-564e

From the Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center; the Lymph Clinic, Children's Medical Center; and the Department of Plastic and Reconstructive Surgery, University of Tokyo.

Background: Lymphatic malformation is a congenital lymphatic disorder. Although a few lymphangiographic and lymphoscintigraphic studies of lymphatic malformation exist, its lymphatic flow has not been fully assessed, and a classification system has not yet been established. However, indocyanine green lymphography has been developed to safely provide a fine assessment of lymph flow in the treatment of lymphedema. In addition, indocyanine green lymphography has been shown to be helpful in detecting the lymphatic malformation inflow for the treatment of refractory microcystic type lymphatic malformation using the venous anastomosis technique. Therefore, the authors aimed to reveal the in vivo lymph flow around the lymphatic malformation using indocyanine green lymphography, and to design a classification system according to the observed patterns.

Methods: Indocyanine green lymphography was performed in 20 sequential pediatric patients with lymphatic malformation (aged 11 months to 10 years). Most of the cases were intractable, with microcystic or mixed-type lymphatic malformation.

Results: All patients successfully completed lymphography with clear observations. The flow patterns were classified into four types: type 1 had a strong detectable inflow; type 2 had multiple small observable inflows; type 3 had a superficial lymph flow over the lesion; and type 4 had a flow around the lymphatic malformation, without any connections to the lesion.

Conclusion: The proposed classification system may aid in the further development of surgical treatments for lymphatic malformation.
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http://dx.doi.org/10.1097/PRS.0000000000005362DOI Listing
March 2019

Mechanical versus Hand-Sewn Venous Anastomoses in Free Flap Reconstruction: A Systematic Review and Meta-Analysis.

Plast Reconstr Surg 2019 02;143(2):441e-442e

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

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http://dx.doi.org/10.1097/PRS.0000000000005238DOI Listing
February 2019

Feasibility and reliability of supermicrosurgical vasa recta anastomosis for double-pedicled free jejunum transfer.

JPRAS Open 2019 Mar 12;19:125-134. Epub 2019 Jan 12.

Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

Background: Although free jejunal transfer is an established and reliable procedure for reconstruction after total pharyngolaryngectomy (TPL), vascular thrombosis remains a surgical challenge. To reduce the risk, a double-pedicled free jejunal flap transfer has been attempted using a root jejunal artery and an arcade artery, although several drawbacks exist. The vasa recta are terminal straight vessels that arborize from an arcade artery without branching. We present a novel double-pedicled free jejunum transfer using vasa recta anastomosis.

Methods: Between 2011 and 2015, we performed 14 double-pedicled free jejunal flap transfers for reconstruction after TPL. Vasa recta were used for second arterial anastomosis in 5 out of 14 patients. Others include a root artery in three patients and an arcade artery in six patients. Indocyanine green (ICG) angiography was performed to confirm the patency and perfusion of the entire flap by the second artery alone.

Results: The flaps survived completely in all cases. The vasa recta (average diameter; 0.8 mm) were anastomosed to the superior thyroid artery and transverse cervical artery in four and one cases, respectively. Supramicrosurgical end-to-side anastomosis was performed in two cases. ICG angiography showed sufficient perfusion of the entire flap with the second artery alone in all cases.

Conclusion: As vasa recta were confirmed as being capable of perfusing the entire flap up to 25 cm, the double-pedicle method using vasa recta might be an option to reduce the risk of flap necrosis, particularly in high-risk patients.
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http://dx.doi.org/10.1016/j.jpra.2019.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061654PMC
March 2019

Anatomical Study and Clinical Application of Free Thoracoacromial Artery True-Perforator Flap for Reconstruction of the Face.

J Craniofac Surg 2019 Jan;30(1):205-207

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

Introduction: The clavicular region is acknowledged as one of the most suitable donor sites for reconstruction of the face or neck. Recently, a free thoracoacromial artery (TAA) perforator (TAAP) flap was reported as a new option for reconstruction of the face. However, the TAAP flap has several drawbacks including tedious intramuscular dissection of the pedicle and loss of availability of a pectoralis major flap as a bailout option in case of cancer recurrence. We performed an anatomical study of the TAAP and developed a novel TAA "true-perforator" flap, in which we can preserve the main trunk of the TAA.

Patients And Methods: Anatomical study of the TAAPs was performed in 6 patients while elevating a deltopectoral flap or a pedicled TAAP flap. Location and diameter of the perforators were recorded. Based on these anatomical findings, we developed a novel free TAA true-perforator flap, which we used for the reconstruction of a facial defect after cancer resection.

Results: The most dominant TAAP was identified 4.8-cm (4 to 7-cm) caudally from the upper border of the deltopectoral triangle along the cephalic vein and 1.7-cm (0.5 to 2-cm) medially from the cephalic vein. The diameter of the TAAPs at the level of fascial penetration was 0.78-mm (0.6 to 1.0-mm). The pedicle could be elongated up to 3-cm with proximal dissection. Clinical case showed a satisfactory aesthetic result with minimal donor-site morbidity.

Conclusions: A free TAA true-perforator flap can be a new option for the reconstruction of the face with many advantages including reduced donor-site morbidity and satisfactory aesthetic outcome.
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http://dx.doi.org/10.1097/SCS.0000000000004968DOI Listing
January 2019

Use of Laser Speckle Contrast Imaging for Successful Fingertip Replantation.

Plast Reconstr Surg Glob Open 2018 Sep 5;6(9):e1924. Epub 2018 Sep 5.

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

Fingertip replantation is a technical challenge for microsurgeons. For successful fingertip replantation, it is important to monitor the replanted fingertip vascularity for the early detection and revision of vascular compromise. Laser speckle contrast imaging (LSCI) is a camera-based technique that measures the perfusion by illuminating the tissue with a 785-nm-wavelength divergent laser beam. This creates a speckle pattern over the illuminated area. We present a case in which postoperative monitoring of the replanted fingertip microcirculation using LSCI allowed for successful Tamai zone I fingertip replantation. Postoperative monitoring using LSCI has 3 main advantages. First, this method is harmless to the patient and the replanted fingertip. A camera-based technique enables microcirculation monitoring without touching the patient or the replanted fingertip. Second, tissue perfusion is measured in real time and recorded continuously, allowing for the rapid response to the arterial or venous occlusion to be observed. Third, using LSCI, the skin perfusion can be measured quantitatively. Although further clinical investigations will be required to confirm its efficacy, LSCI has the potential to be a useful monitoring device.
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http://dx.doi.org/10.1097/GOX.0000000000001924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191215PMC
September 2018

Ratio of Blood Glucose Level Change Measurement for Flap Monitoring.

Plast Reconstr Surg Glob Open 2018 Jul 16;6(7):e1851. Epub 2018 Jul 16.

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

Background: In a setting of flap congestion, early detection and rapid reexploration are important. Some studies described the efficacy of blood glucose measurement for flap monitoring. However, the sensitivity and specificity of this method were not high enough to determine whether reexploration should be done or not. The purpose of this study was to evaluate and establish a method using the ratio of blood glucose level change (RBGC) measurement for detecting venous thrombosis and to propose an algorithm for flap salvage after congestion.

Methods: Blood glucose level was measured in 36 free tissue transfers over time postoperatively and RBGC was calculated. When flap congestion was suspected, frequent blood glucose measurement and some countermeasures were performed complying with an algorithm. If the venous thrombus was suspected, the reexploration was performed. The RBGCs at the points in time when the venous thrombosis was detected were compared with those at the points in time when the flap demonstrated no venous thrombosis.

Results: Of the 36 flaps, 30 flaps demonstrated no venous thrombosis and 6 flaps demonstrated venous thrombosis. Four flaps demonstrated signs of congestion but improved after the reexploration. The mean RBGCs at the points in time when the venous thrombosis was detected was -7.61 mg/dl h and those at times when the flap demonstrated no venous thrombosis was 0.10 mg/dl h, the former being significantly lower than the latter.

Conclusion: Using the flap monitoring method using RBGC measurement, we could salvage some flaps from the congestion due to the venous thrombosis without unnecessary reexploration.
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http://dx.doi.org/10.1097/GOX.0000000000001851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110689PMC
July 2018

Pure Skin Perforator Flaps: The Anatomical Vascularity of the Superthin Flap.

Plast Reconstr Surg 2018 09;142(3):351e-360e

From the Department of Plastic and Reconstructive Surgery, Mie University, School of Medicine; the Departments of Plastic and Reconstructive Surgery and Otorhinolaryngology, Tokyo University, School of Medicine; the Department of Plastic Surgery, Tan Tock Seng Hospital; and the Academic Plastic Surgery Group, Queen Mary University of London.

Background: Recently, a superthin "pure skin perforator" flap without any subcutaneous tissue was proposed, but the vascularity is still unclear. The authors therefore investigated the vascularity of the proposed superficial circumflex iliac artery-pure skin perforator along with its clinical applications and findings on indocyanine green imaging.

Methods: The locations and dimension of 70 pure skin perforators on 40 flaps were investigated and classified into central-peripheral and mediolateral parts. Indocyanine green angiography was used to analyze the patterns of the vascular anatomy.

Results: Twenty-seven of 29 cases (93.1 percent) presented with pure skin perforator vessels within the area 5 cm above and 1 cm below the inguinal ligament and 4 cm medial and 2 cm lateral from the anterior superior iliac spine. The total flap size averaged 39 ± 22 cm(2) (range, 3 to 90 cm(2)). A subanalysis of the relationship between the flap size and location of pure skin perforators within the single, double, and triple pure skin perforator flap subgroups did not reveal any significance. Indocyanine green angiography revealed three interesting perfusion patterns of pure skin perforator flap: a radial diffusion pattern, direct linking vessels in the intradermal layer, and intradermal arteriovenous shunts.

Conclusions: The location number of the pure skin perforators within the flap was not considered to be a crucial factor in the flap design and size in this study. This new knowledge regarding the pure skin perforator concept will allow surgeons to elevate a full-thickness skin flap safely.
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http://dx.doi.org/10.1097/PRS.0000000000004698DOI Listing
September 2018

Macroscopically Anisotropic Structures Produced by Light-induced Solvothermal Assembly of Porphyrin Dimers.

Sci Rep 2018 07 23;8(1):11108. Epub 2018 Jul 23.

Department of Physics, Graduate School of Science, Osaka Prefecture University, 1-1 Gakuencho, Naka-ku, Sakai, Osaka, 599-8531, Japan.

Porphyrin-based molecules play an important role in natural biological systems such as photosynthetic antennae and haemoglobin. Recent organic chemistry provides artificial porphyrin-based molecules having unique electronic and optical properties, which leads to wide applications in material science. Here, we successfully produced many macroscopically anisotropic structures consisting of porphyrin dimers by light-induced solvothermal assembly with smooth evaporation in a confined volatile organic solvent. Light-induced fluid flow around a bubble on a gold nanofilm generated a sub-millimetre radial assembly of the tens-micrometre-sized petal-like structures. The optical properties of the petal-like structures depend on the relative angle between their growth direction and light polarisation, as confirmed by UV-visible extinction and the Raman scattering spectroscopy analyses, being dramatically different from those of structures obtained by natural drying. Thus, our findings pave the way to the production of structures and polycrystals with unique characteristics from various organic molecules.
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http://dx.doi.org/10.1038/s41598-018-28311-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056561PMC
July 2018

Lymph Flow Restoration after Tissue Replantation and Transfer: Importance of Lymph Axiality and Possibility of Lymph Flow Reconstruction without Lymph Node Transfer or Lymphatic Anastomosis.

Plast Reconstr Surg 2018 09;142(3):796-804

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

Background: The lymph system plays important roles in maintaining fluid balances, the immune system, and lipid metabolism. After tissue replantation or transfer, some cases suffer long-lasting edema or lymphedema caused by interruption of main lymph flows; however, this mechanism has yet to be clarified.

Methods: The medical charts of 38 patients who underwent indocyanine green lymphography after tissue replantation or free flap transfer were reviewed to obtain data regarding clinical demographics, intraoperative findings, and postoperative indocyanine green lymphographic findings. Postoperative lymph flow restoration based on indocyanine green lymphographic findings was evaluated according to intraoperative findings, including raw surface in lymph axiality and compatible lymph axiality.

Results: Lymph flow restoration was observed in 24 cases (63 percent). There were significant differences in positive lymph flow restoration with regard to sex (male, 78 percent; female, 40 percent; p = 0.017), cause of defect (trauma, 83 percent; others, 33 percent; p = 0.002), type of operation (replantation, 94 percent; free flap, 41 percent; p = 0.001), and compatible lymph axiality (positive, 96 percent; negative, 0 percent; p < 0.001). Based on lymph axiality, the raw surface in lymph axiality-negative and compatible lymph axiality-positive condition was completely matched with lymph flow restoration positivity; 100 percent accuracy to predict postoperative lymph flow restoration was observed.

Conclusions: Lymph flow can be restored after tissue replantation or free flap transfer without lymph node or supermicrosurgical lymphatic anastomosis. The raw surface in lymph axiality-negative and compatible lymph axiality-positive condition is considered a key for restoring lymph flows after surgery affecting the main lymph pathway.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000004694DOI Listing
September 2018

Superficial Circumflex Iliac Artery-Based Iliac Bone Flap Transfer for Reconstruction of Bony Defects.

J Reconstr Microsurg 2018 Nov 12;34(9):719-728. Epub 2018 May 12.

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

Background:  The superficial circumflex iliac artery (SCIA)-based iliac bone flap has yet to be widely used. The purpose of this article is to validate the feasibility of SCIA-based iliac bone flap transfers for reconstruction of small to moderate-sized bony defects. Retrospective outcome comparisons between SCIA-based iliac bone flaps and fibula flaps were made.

Methods:  Twenty-six patients with bony tissue defects underwent reconstructions using either free SCIA-based iliac bone flaps (13) or fibula flaps (13). Outcomes were evaluated 9 months after the reconstruction on the following basis: bone length, pedicle length, skin paddle area, bone union, donor-site complications, skin paddle survival, and complications at the reconstructed site.

Results:  There was no statistically significant difference in pedicle length (iliac bone vs. fibula; 5.5 ± 1.8 vs. 4.1 ± 1.5 cm;  = 0.181), in bone union rate (iliac bone vs. fibula; 100 vs 92.3%;  = 0.308), in donor-site complication rate (iliac bone vs. fibula; 0 vs. 7.7%;  = 0.308), or in skin paddle complete survival rate (iliac bone vs. fibula; 100 vs. 83.3%;  = 0.125). Statistically significant differences were observed in bone flap length (iliac bone vs. fibula; 4.8 ± 2.2 vs. 11.1 ± 4.8 cm;  = 0.0005), in skin paddle area (superficial circumflex iliac artery perforator flap vs. peroneal artery perforator flap; 58.8 ± 35.6 vs. 27.7 ± 17.5 cm;  = 0.0343), and in reconstructed site complication rate (iliac bone vs. fibula; 0 vs. 30.8%;  = 0.030).

Conclusion:  In our series of SCIA-based iliac bone flap transfers, up to 8 × 3 cm could be procured along the iliac crest. When compared with fibula flap transfers, there were no significant statistical differences in pedicle length or in bone union rate; the SCIA-based iliac bone flap may be a feasible option for bony defects of small to moderate size.
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http://dx.doi.org/10.1055/s-0038-1651489DOI Listing
November 2018
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