Publications by authors named "Yutaka Fukunaga"

23 Publications

  • Page 1 of 1

Surgical Outcome of Pharyngocutaneous Fistula After Total Laryngectomy: A Retrospective Study.

Ann Plast Surg 2021 Mar 4. Epub 2021 Mar 4.

From the Departments of Plastic and Reconstructive Surgery Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: The management of pharyngocutaneous fistula is challenging. We typically treat postlaryngectomy pharyngocutaneous fistulas with a pedicled pectoralis major flap transfer. This study analyzed the outcomes of our surgical treatments for pharyngocutaneous fistula to propose considerations for surgical strategies.

Methods: This retrospective review included all patients who underwent surgical repair of a postlaryngectomy pharyngocutaneous fistula at the National Cancer Center Hospital East in Kashiwa, Japan, from January 2005 to December 2019.

Results: The final analysis included 33 cases (median age, 71 years). Twenty-two cases had a history of radiotherapy to the head and neck region. Wound closures were performed with a pedicled pectoralis major musculocutaneous flap (n = 26) or pedicled pectoralis major muscle flap (n = 7). In 1 case, a deltopectoral flap was combined with the pectoralis major musculocutaneous flap. The median total operation time was 236 minutes, the median blood loss during surgery was 144 mL, and the median hospital stay after the reconstructive surgery was 39 days. Minor leakage occurred in 19 cases, and major leakage occurred in 2 cases. The fistula was finally cured successfully in 31 cases. We compared the outcomes in patients with leakage after surgical repair to those in patients without leakage after surgical repair to determine the risk factors for leakage after surgical repair of a pharyngocutaneous fistula. Five patients in the nonleakage group and 17 in the leakage group had a history of preoperative radiation (P = 0.052). The median preoperative blood values in the nonleakage and leakage groups were as follows: albumin, 3.6 and 3.2 g/dL (P = 0.061), and C-reactive protein, 2.36 and 6.77 mg/dL (P = 0.031), respectively. The time between the occurrence of the fistula and reconstructive surgery was 32 and 9 days in the nonleakage and leakage groups, respectively (P = 0.009).

Conclusions: Our surgical treatment for postlaryngectomy pharyngocutaneous fistula succeeded in 31 of 33 cases (94%). This study demonstrated that pedicled pectoralis major flap transfer is useful for the treatment of postlaryngectomy pharyngocutaneous fistula.
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http://dx.doi.org/10.1097/SAP.0000000000002769DOI Listing
March 2021

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

J Plast Reconstr Aesthet Surg 2020 Nov 1. Epub 2020 Nov 1.

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

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

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

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

Conclusion: Our surgical treatment for colorectal or urinary tract-related fistula succeeded in 31 of 38 cases. Thus, vascularized tissue transfer is useful for refractory colorectal or urinary tract-related fistula.
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http://dx.doi.org/10.1016/j.bjps.2020.10.046DOI Listing
November 2020

Combined use of ipsilateral latissimus dorsi flap and anterolateral thigh flap to reconstruct extensive trunk defects.

Microsurgery 2021 Feb 6;41(2):175-180. Epub 2020 Nov 6.

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

Reconstruction of a full-thickness trunk defect is challenging because of the complex nature of such defects, which include the chest wall, abdominal wall, and diaphragm. We herein describe three patients in whom extensive trunk defects after sarcoma resection were reconstructed with a latissimus dorsi flap and an anterolateral thigh flap. In two patients, the defect included both the chest wall and the abdominal wall. The other patient had an extensive full-thickness chest wall defect. The size of the anterolateral thigh flap for each patient was 34 × 10 cm, 26 × 15 cm, and 23 × 5 cm, respectively. Although one patient required take-back for additional venous drainage, all wounds healed with no other complications. No respiratory dysfunction or abdominal wall hernia occurred in any patients. The combined use of a latissimus dorsi flap and an anterolateral thigh flap may provide reliable coverage of an extensive trunk defect and robust support of the chest and abdominal walls. Additionally, the availability of a two-team approach without a positional change makes this combination a versatile reconstructive option.
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http://dx.doi.org/10.1002/micr.30679DOI Listing
February 2021

Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography.

J Plast Reconstr Aesthet Surg 2020 May 28;73(5):870-875. Epub 2019 Nov 28.

Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan. Electronic address:

Background: This study was performed to investigate the arterial and venous anatomy of superficial inferior epigastric artery (SIEA) flaps using multidetector-row computed tomography angiography (MDCTA). We hypothesized that applicability of the SIEA flap has been underestimated in previous studies.

Methods: We retrospectively analyzed the results of preoperative MDCTA of the bilateral lower abdominal walls in 72 consecutive patients. We assessed the presence and branching pattern of the superficial inferior epigastric artery, superficial inferior epigastric vein (SIEV), superficial circumflex iliac vein, and venae comitantes (VC) of the superficial inferior epigastric artery. We also assessed the internal diameter of the SIEA at its origin.

Results: The SIEA was present on 133 sides (92.4%), and the mean internal diameter was 2.0 mm. The internal diameter of the SIEA was ≥2.0 mm on 102 sides (70.8%). The VC drained into the superficial circumflex iliac vein on 68 sides (47.2%) and to the SIEV on 30 sides (20.8%).

Conclusions: An internal diameter of the SIEA of ≥2.0 mm at its origin on preoperative imaging can be a good criterion for exploring the artery during lower abdominal flap harvest. The VC is the dominant drainage vein over the SIEV in some patients, and it communicates with the superficial circumflex iliac vein in almost half of patients. These findings can increase the safety of breast reconstruction with an SIEA flap.
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http://dx.doi.org/10.1016/j.bjps.2019.11.028DOI Listing
May 2020

Large-to-Small End-to-Side Venous Anastomosis in Free Flap Transfer.

J Surg Res 2020 01 16;245:377-382. Epub 2019 Aug 16.

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

Background: Vessel size discrepancy is one of the major risk factors for anastomotic failure in free flap transfer. The situation becomes challenging for reconstructive microsurgeons when the recipient vein is much smaller than the flap vein. We investigated the feasibility of large-to-small end-to-side venous anastomosis for such cases.

Materials And Methods: The subjects were 16 consecutive patients who underwent a free flap transfer for oncologic defects with a large-to-small end-to-side venous anastomosis. The larger flap vein was anastomosed to the side slit of the smaller recipient vein under an operating microscope. Surgical details and postoperative outcome were investigated retrospectively.

Results: An anterolateral thigh flap was used in five patients, a superficial inferior epigastric artery flap in four, a thoracodorsal artery perforator flap in three, and a latissimus dorsi musculocutaneous flap and a fibular osteocutaneous flap in two patients each. The internal mammary vein and the anterior tibial vein were most frequently used as a recipient vein (four patients each), followed by the deep inferior epigastric vein (three patients). The extent of vessel size discrepancy ranged from 1.3- to 3.3-fold, and the mean discrepancy was 1.9-fold. No anastomotic failure occurred postoperatively, and the flap survived in all patients.

Conclusions: Large-to-small end-to-side venous anastomosis can be a versatile option when only a small vein is available as a recipient vein. Internal mammary, deep inferior epigastric, and anterior tibial veins are good candidates for this technique.
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http://dx.doi.org/10.1016/j.jss.2019.07.084DOI Listing
January 2020

Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction.

Plast Reconstr Surg Glob Open 2018 Nov 15;6(11):e2014. Epub 2018 Nov 15.

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

Reconstruction of a circumferential pharyngeal defect with a free jejunal flap is a well-established procedure. However, anastomotic leakage often occurs, which can lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. Previous reports have described covering the anastomotic site with a mesenteric flap to prevent anastomotic leakage. However, the mesentery is covered by a serosal membrane, which interferes with adhesion and vascular communication. Therefore, we stripped off the serosal membrane to accelerate adhesion to the anastomotic site. We retrospectively studied patients who had a history of radiotherapy and who had received a stripped mesenteric flap in a circumferential pharyngeal reconstruction procedure. We collected the following data: operative time, blood loss, postoperative complications, interval to resumption of oral intake, and duration of hospital stay. We obtained data for 11 patients. The jejunal flap failed in one patient because of arterial thrombosis. One of the other 10 patients developed anastomotic leakage caused by congested mucous membrane necrosis. The patient was treated conservatively and showed no clinical symptoms of infection or inflammation. The 9 remaining patients had no anastomotic leakage. In the present series, although anastomotic leakage was observed in one of 10 patients who underwent circumferential pharyngeal reconstruction using a stripped mesenteric flap, the severity of the leakage was minimized.
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http://dx.doi.org/10.1097/GOX.0000000000002014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414107PMC
November 2018

Septocutaneous thoracodorsal artery perforator flaps: a retrospective cohort study.

J Plast Reconstr Aesthet Surg 2019 Jan 5;72(1):78-84. Epub 2018 Sep 5.

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

Background: This study aimed to investigate the versatility of septocutaneous thoracodorsal artery perforator (TDAP-sc) flaps in various areas in the body and the running pattern of septocutaneous perforators.

Methods: This retrospective cohort study included 20 consecutive patients who underwent reconstruction of an oncological defect with a TDAP-sc flap from May 2014 to January 2018. Fifteen flaps were free, and the remaining five were pedicled. Surgical details and postoperative complications were investigated.

Results: The flap size ranged from 13 × 6.5 to 22 × 15 cm. The defect location was the upper extremity in eight patients, the head and neck in six, the lower extremity in four, and the trunk in two. The septocutaneous perforator arose from the thoracodorsal vessels proximal to the serratus anterior branch in 10 (50.0%) patients, from the thoracodorsal vessels distal to the serratus anterior branch in six (30.0%), and from the serratus anterior branch in four (20.0%). All flaps completely survived, except the one with partial necrosis. The scapula was simultaneously harvested based on the angular branch in three patients who underwent mandibular reconstruction.

Conclusions: The TDAP-sc flap can be a versatile option for various types of reconstruction if a dominant septocutaneous perforator is present. Prevalence of a dominant TDAP-sc is estimated at approximately 50%. However, this flap can be harvested without tedious intramuscular dissection, and the two-team approach is possible during tumor resection. The presence of a dominant septocutaneous perforator can expand indication of the TDAP flap.
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http://dx.doi.org/10.1016/j.bjps.2018.08.026DOI Listing
January 2019

Free latissimus dorsi musculocutaneous flap for external hemipelvectomy reconstruction.

Microsurgery 2019 Feb 6;39(2):138-143. Epub 2018 Sep 6.

Department of Plastic and Reconstructive Surgery, National Cancer Center, Tokyo, Japan.

Introduction: External hemipelvectomy is one of the most extensive surgical procedures for locally advanced pelvic tumors. Stump coverage with the local tissues can be difficult in recurrent cases. Herein, we report our experience with immediate stump coverage using a free latissimus dorsi musculocutaneous (LDMC) flap after external hemipelvectomy for recurrent pelvic malignancies.

Methods: Six patients underwent external hemipelvectomy and immediate reconstruction using a free LDMC flap between November 2012 and June 2017. The mean age of the patients was 65 years (range: 63-69 years). The primary tumors were myxoid liposarcoma, chondrosarcoma, osteosarcoma, squamous cell carcinoma, and pleomorphic liposarcoma. A free LDMC flap was harvested from the ipsilateral back and transferred to the defect. When an intercostal nerve was found at the recipient site, the thoracodorsal nerve was coaptated with the intercostal nerve to reinnervate the muscle.

Results: The mean flap size was 23 × 10 cm and the range was 20 × 8-27 × 13.5 cm. The contralateral deep inferior epigastric vessels were used as recipient vessels in all patients. Thoracodorsal-intercostal nerve coaptation was performed in 2 patients. The flap survived in all patients. Three patients had complications of abscess formation. No patient developed postoperative hernia.

Conclusion: Although it is challenging to do reconstruction after external hemipelvectomy, a free LDMC flap has several advantages, including a large coverage area, stability of circulation, ease of elevation, and preservation of the strength of the remaining abdominal wall. Technical tips for selecting anastomosis vessels are important and nerve coaptation could be effective.
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http://dx.doi.org/10.1002/micr.30373DOI Listing
February 2019

Topical application of nitrosonifedipine, a novel radical scavenger, ameliorates ischemic skin flap necrosis in a mouse model.

Wound Repair Regen 2017 04 13;25(2):217-223. Epub 2017 Feb 13.

Department of Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School.

Ischemic skin flap necrosis can occur in random pattern flaps. An excess amount of reactive oxygen species is generated and causes necrosis in the ischemic tissue. Nitrosonifedipine (NO-NIF) has been demonstrated to possess potent radical scavenging ability. However, there has been no study on the effects of NO-NIF on ischemic skin flap necrosis. Therefore, they evaluated the potential of NO-NIF in ameliorating ischemic skin flap necrosis in a mouse model. A random pattern skin flap (1.0 × 3.0 cm) was elevated on the dorsum of C57BL/6 mice. NO-NIF was administered by topical injection immediately after surgery and every 24 hours thereafter. Flap survival was evaluated on postoperative day 7. Tissue samples from the skin flaps were harvested on postoperative days 1 and 3 to analyze oxidative stress, apoptosis and endothelial dysfunction. The viable area of the flap in the NO-NIF group was significantly increased (78.30 ± 7.041%) compared with that of the control group (47.77 ± 6.549%, p < 0.01). NO-NIF reduced oxidative stress, apoptosis and endothelial dysfunction, which were evidenced by the decrease of malondialdehyde, p22phox protein expression, number of apoptotic cells, phosphorylated p38 MAPK protein expression, and vascular cell adhesion molecule-1 protein expression while endothelial nitric oxide synthase protein expression was increased. In conclusion, they demonstrated that NO-NIF ameliorated ischemic skin flap necrosis by reducing oxidative stress, apoptosis, and endothelial dysfunction. NO-NIF is considered to be a candidate for the treatment of ischemic flap necrosis.
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http://dx.doi.org/10.1111/wrr.12510DOI Listing
April 2017

Reduction mammaplasty and mastopexy for the contralateral breast after reconstruction surgery following cancer resection: A report of 3 cases.

J Med Invest 2016 ;63(3-4):281-5

Department of Plastic and Reconstructive Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School.

Background: Breast reconstruction generally involves autologous tissue transplantation and placement of a mammary prosthesis. When the patient's breasts are extremely large and ptotic, breast reconstruction often results in significantly asymmetrical appearance. However, a good aesthetic outcome after reconstruction surgery following cancer resection is an important quality-of-life factor. We evaluated the efficacy of touch-up surgery, either reduction mammaplasty or mastopexy, performed on the contralateral breast for symmetrization.

Methods: Reduction mammaplasty was performed on the contralateral breast in 2 patients and mastopexy was performed on the contralateral breast in 1 patient after reconstruction surgery following cancer resection, between 2008 and 2014. We reviewed each patient's medical record for general clinical information and for the methods of breast cancer resection and breast reconstruction used, wait time between breast cancer resection and touch-up surgery, preservation of the sensitivity of the nipple-areola complex after the touch-up surgery, and aesthetic outcome (based on visual analog scale score).

Results: Wait times in the 3 cases were 4, 9, and 18 months. Nipple-areolar sensitivity was well preserved in all 3 cases. Aesthetic outcomes were judged "excellent" or "very good."

Conclusion: Revision surgery on the contralateral breast 4 to 18 months after breast reconstruction substantially improves the aesthetic outcome. J. Med. Invest. 63: 281-285, August, 2016.
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http://dx.doi.org/10.2152/jmi.63.281DOI Listing
June 2017

Development of Skin Flaps for Reconstructive Surgery: Random Pattern Flap to Perforator Flap.

J Med Invest 2016 ;63(3-4):159-62

Department of Plastic and Reconstructive Surgery, Tokushima University Graduate School of Medical Science.

Flap transplantation has been an important procedure in plastic and reconstructive surgery to cover and fill various defects. Flap necrosis due to blood circulation failure leads to severe complications, especially in a patient undergoing reconstruction concerning the body cavity after tumor ablation. Surgical procedures for flap transplantation have been further improved and developed. We have reviewed from the random pattern flap to the newest procedure, the perforator flap. Perforator vessels were investigated in the process of development of the fasciocutaneous flap and have become important for blood supply of the skin flap. Blood circulation of the flap has become more stable and reliable than ever with the development and findings of the perforator vessels. Further development of a skin flap will be based on the perforasome concept, which involves the study of the territory and linking of perforator vessels. J. Med. Invest. 63: 159-162, August, 2016.
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http://dx.doi.org/10.2152/jmi.63.159DOI Listing
June 2017

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

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

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

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

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

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

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

Y-shaped flow-through anastomosis during a flow-through flap transfer.

Microsurgery 2016 Jan 8;36(1):89-90. Epub 2015 Jan 8.

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

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http://dx.doi.org/10.1002/micr.22374DOI Listing
January 2016

Technical tips to trim the stump of a nonspurting recipient artery.

Plast Reconstr Surg Glob Open 2014 Nov 5;2(11):e248. Epub 2014 Dec 5.

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

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http://dx.doi.org/10.1097/GOX.0000000000000174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255891PMC
November 2014

T-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of an Extensive Circumferential Pharyngeal Defect.

Plast Reconstr Surg Glob Open 2014 Apr 7;2(4):e129. Epub 2014 May 7.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Summary: In the era of free-flap transfer, the pectoralis major musculocutaneous flap still plays a unique role in head and neck reconstruction. We report on a patient with a recurrent hypopharyngeal carcinoma after total pharyngolaryngectomy and adjuvant chemoradiotherapy in whom defects included a circumferential defect of the oropharynx and the entire tongue. The defects were successfully reconstructed with a T-shaped pectoralis major musculocutaneous flap whose skin island included multiple intercostal perforators from the internal mammary vessels. This flap design is effective for reconstructing circumferential pharyngeal defects in vessel-depleted neck.
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http://dx.doi.org/10.1097/GOX.0000000000000074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174203PMC
April 2014

Accompanying artery of sciatic nerve as recipient vessel for free-flap transfer: a computed tomographic angiography study and case reports.

Microsurgery 2015 May 8;35(4):284-9. Epub 2014 Sep 8.

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

Suitable recipient vessels for free-flap transfer are hard to find in the posterior thigh. To investigate the versatility of accompanying artery of sciatic nerve as a recipient vessel in this region, we performed computed tomographic angiographic study of 20 consecutive healthy thighs in 10 patients. The presence and internal diameter of the accompanying artery were studied. The accompanying artery of the sciatic nerve was present in 11 thighs (55%) and the internal diameter of the artery at the mid-thigh level ranged from 2.1 to 3.2 mm. We used this artery as a recipient vessel for free flaps transferred to reconstruct extensive thigh defects in three patients with sarcomas. In all patients the flaps survived without vascular compromise. No sensory or motor dysfunction in the sciatic nerve distribution occurred in any patients. We believe that the accompanying artery of the sciatic nerve may be a recipient vessel for free-flap transfer in selected patients.
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http://dx.doi.org/10.1002/micr.22324DOI Listing
May 2015

Venous-supercharged freestyle posterior thigh flap without a descending branch of the inferior gluteal artery for reconstruction in the infragluteal region.

J Plast Reconstr Aesthet Surg 2014 Dec 14;67(12):1740-3. Epub 2014 Aug 14.

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

The posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer.
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http://dx.doi.org/10.1016/j.bjps.2014.08.005DOI Listing
December 2014

One-stage reconstruction of a tracheal defect with a free radial forearm flap and free costal cartilage grafts.

J Plast Reconstr Aesthet Surg 2014 Jun 8;67(6):857-9. Epub 2014 Jan 8.

Department of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.

Reconstructing the trachea is challenging because of its multilayer structure and airway function; multiple procedures are often required. We report a case of one-stage reconstruction for a tracheal defect. The surgery was performed with a free radial forearm flap and free costal cartilage grafts. Air leakage occurred postoperatively but healed without additional surgery. The reconstructed trachea has retained its shape, diameter and airway function for 14 months despite the patient's history of radiotherapy. This one-stage procedure with well-vascularised tissue was successfully used to reconstruct a stable, well-functioning trachea.
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http://dx.doi.org/10.1016/j.bjps.2013.12.053DOI Listing
June 2014

Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects.

Microsurgery 2014 Sep 16;34(6):470-4. Epub 2014 Jan 16.

Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, 104-0045, Japan.

Soft-tissue defects after wide resection of groin sarcomas have been reconstructed with well-characterized flaps, such as rectus abdominis, gracilis, and anterolateral thigh flaps. To our knowledge, the use of superficial femoral artery perforator (S-FAP) flaps for this purpose has not been reported. We report on three female patients in whom groin defects after sarcoma resection were reconstructed with pedicled S-FAP flaps. The dimensions of the skin defects ranged from 13.5 × 11 to 16 × 14.5 cm. Sizable perforators from the superficial femoral arteries were identified preoperatively around the apex of the femoral triangle with computed tomographic angiography or color Doppler ultrasonography. The lengths of the flaps ranged from 17 to 19 cm. The main perforator penetrated the sartorius muscle in two patients and emerged between the sartorius and the adductor longus muscles in the other patient. The postoperative course was uneventful, and results were satisfactory in all patients. The main advantages of the S-FAP flap over more commonly used flaps are that it is easier to harvest and is associated with less donor-site morbidity. We believe that the S-FAP flap may be a versatile option for the coverage of groin defects.
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http://dx.doi.org/10.1002/micr.22226DOI Listing
September 2014

Flow-through divided latissimus dorsi musculocutaneous flap for large extremity defects.

Ann Plast Surg 2015 Feb;74(2):199-203

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

Reconstructing large defects of the extremities is a challenging problem for reconstructive microsurgeons. The latissimus dorsi musculocutaneous flap (LDMCF) is widely used for this purpose, but a skin graft is needed when the defect is wider than available flaps. We used flow-through divided LDMCFs to reconstruct large defects of the extremities in 5 consecutive patients from 2010 through 2012. The semicircular skin island was split longitudinally, and 1 skin island was advanced over the other to close a round or oval defect without a skin graft. Postoperatively, all flaps survived completely, and the mean Enneking score was 90.0%. The flow-through divided LDMCF is a reliable and versatile option for reconstructing large defects of the extremities.
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http://dx.doi.org/10.1097/SAP.0b013e3182996eaaDOI Listing
February 2015

Reconstruction of metatarsal bone defects with a free fibular osteomyocutaneous flap incorporating soleus muscle.

J Plast Reconstr Aesthet Surg 2013 Feb 21;66(2):277-80. Epub 2012 Aug 21.

Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School, Kuramoto-cho, Tokushima, Japan.

Severe traumatic bone and soft-tissue defects are often treated by lower leg amputation. The amputation level becomes a very important factor with respect to the patient's basic daily activities. We report the case of a 51-year-old man who was referred to us with severe traumatic metatarsal bone and dorsum pedis skin and soft-tissue defects. To avoid amputation, a free fibular osteomyocutaneous flap incorporating the soleus muscle was used to reconstruct the second and third metatarsal bones and the soft-tissue defect, respectively. Now, 2 years after the procedure, the patient is able to walk independently. To the best of our knowledge, this is the first report of use of such a composite transfer for a complex midfoot defect.
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http://dx.doi.org/10.1016/j.bjps.2012.07.029DOI Listing
February 2013

A patient who developed toe necrosis due to poor blood circulation after an interdigital tick bite.

J Cardiol Cases 2011 Oct 27;4(2):e106-e109. Epub 2011 Jul 27.

Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan.

A 71-year-old female had worked on a farm in the mountains and noticed itching of the left 3rd toe. She visited a local hospital due to a color change to purple in this area. Attachment of a tick was observed between the left 2nd and 3rd toes, and it was extracted. However, due to persistent pain, she was referred to our department of cardiovascular medicine for close examination and treatment. Lower extremity angiography showed that vascular visualization was poor in the area supplied by the arteries distal to the tick bite site, but the other blood vessels of the toe were clearly visualized. Toe amputation was performed and pathological examination of a surgical specimen revealed that most blood vessels near the necrosis were occluded by thrombi. We speculated that tick bite reactions were associated with thrombogenic vasculopathy. This report shows a patient who developed toe necrosis due to poor blood circulation after an interdigital tick bite.
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http://dx.doi.org/10.1016/j.jccase.2011.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265032PMC
October 2011

Pencil-core granuloma of the face: report of two rare cases.

J Plast Reconstr Aesthet Surg 2011 Sep 20;64(9):1235-7. Epub 2011 Feb 20.

Department of Plastic and Reconstructive Surgery, The University of Tokushima, Kuramoto, Tokushima, Japan.

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http://dx.doi.org/10.1016/j.bjps.2011.01.017DOI Listing
September 2011