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Araki J, Mori K, Yasunaga Y, Onitsuka T, Yurikusa T, Sakuraba M, Higashino T, Hashikawa K, Ishida K, Sarukawa S, Hamahata A, Kimata Y, Matsumoto H, Terao Y, Yokogawa H, Sekido M, Asato H, Miyamoto S, Hyodo I, Nakagawa M. First Impressions: Setting the Stage for Better Relationships. Plast Reconstr Surg 2023; 152:693-698. [PMID: 37768217 PMCID: PMC10521771 DOI: 10.1097/prs.0000000000010661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/11/2022] [Indexed: 09/29/2023]
Abstract
Background: There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction. Methods: This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence. Results: Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15. Conclusion: The authors’ risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
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Affiliation(s)
- Jun Araki
- From the Division of Plastic and Reconstructive Surgery
| | | | | | | | - Takashi Yurikusa
- Division of Dentistry and Oral Surgery, Shizuoka Cancer Center Hospital
| | - Minoru Sakuraba
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East
- Department of Plastic and Reconstructive Surgery, Iwate Medical University
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East
| | | | - Katsuhiro Ishida
- Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine
| | | | - Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Saitama Cancer Center
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital
| | - Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital
| | - Yasunobu Terao
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
| | - Hideki Yokogawa
- Department of Plastic and Reconstructive Surgery, Saitama Medical University International Medical Center
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University School of Medicine
| | - Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital
| | - Ikuo Hyodo
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital
| | - Masahiro Nakagawa
- From the Division of Plastic and Reconstructive Surgery
- Department of Plastic Reconstructive Surgery, Hamamatsu University School of Medicine
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Araki J, Mori K, Yasunaga Y, Onitsuka T, Yurikusa T, Sakuraba M, Higashino T, Hashikawa K, Ishida K, Sarukawa S, Hamahata A, Kimata Y, Matsumoto H, Terao Y, Yokogawa H, Sekido M, Asato H, Miyamoto S, Hyodo I, Nakagawa M. A Novel Risk Model for Predicting Dysphagia after Tongue Reconstruction: A Retrospective Multicenter Study in Japan. Plast Reconstr Surg 2023; 152:693e-706e. [PMID: 36942956 PMCID: PMC10521771 DOI: 10.1097/prs.0000000000010428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/11/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction. METHODS This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence. RESULTS Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15. CONCLUSION The authors' risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Jun Araki
- From the Division of Plastic and Reconstructive Surgery
| | | | | | | | - Takashi Yurikusa
- Division of Dentistry and Oral Surgery, Shizuoka Cancer Center Hospital
| | - Minoru Sakuraba
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East
- Department of Plastic and Reconstructive Surgery, Iwate Medical University
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East
| | | | - Katsuhiro Ishida
- Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine
| | | | - Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Saitama Cancer Center
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital
| | - Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital
| | - Yasunobu Terao
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
| | - Hideki Yokogawa
- Department of Plastic and Reconstructive Surgery, Saitama Medical University International Medical Center
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University School of Medicine
| | - Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital
| | - Ikuo Hyodo
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital
| | - Masahiro Nakagawa
- From the Division of Plastic and Reconstructive Surgery
- Department of Plastic Reconstructive Surgery, Hamamatsu University School of Medicine
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Nagoshi A, Kijima T, Suzuki I, Sakamoto K, Nozaki F, Fujisawa D, Sugawara N, Shimoda K, Asato H, Kamai T. A case of penile self‐mutilation during a suicidal attempt successfully treated using a multidisciplinary approach. IJU Case Rep 2022; 5:165-167. [PMID: 35509771 PMCID: PMC9057736 DOI: 10.1002/iju5.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Akihiko Nagoshi
- Department of UrologyDokkyo Medical University Shimotsuga TochigiJapan
| | - Toshiki Kijima
- Department of UrologyDokkyo Medical University Shimotsuga TochigiJapan
| | - Issei Suzuki
- Department of UrologyDokkyo Medical University Shimotsuga TochigiJapan
| | - Kazumasa Sakamoto
- Department of UrologyDokkyo Medical University Shimotsuga TochigiJapan
| | - Fuyo Nozaki
- Department of Plastic and Reconstructive Surgery Dokkyo Medical UniversityShimotsuga TochigiJapan
| | - Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery Dokkyo Medical UniversityShimotsuga TochigiJapan
| | - Norio Sugawara
- Department of Psychiatry Dokkyo Medical University Shimotsuga Tochigi Japan
| | - Kazutaka Shimoda
- Department of Psychiatry Dokkyo Medical University Shimotsuga Tochigi Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery Dokkyo Medical UniversityShimotsuga TochigiJapan
| | - Takao Kamai
- Department of UrologyDokkyo Medical University Shimotsuga TochigiJapan
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Kurabayashi T, Suzuki Y, Asato H. Extensor tendon repairing with a rolled deep temporal fascial graft and a free temporoparietal fascial flap as a gliding bed: A case report. JPRAS Open 2020; 23:75-79. [PMID: 32158909 PMCID: PMC7061604 DOI: 10.1016/j.jpra.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022] Open
Abstract
Reconstruction of combined skin and tendon loss in an injury of the dorsum of the hand is a challenging problem because it is required to achieve adequate excursion of the tendon. We herein report our case of extensor tendon repair for a dorsal hand injury using a rolled deep temporal fascial (DTF) graft and a free temporoparietal fascial flap. The patient regained satisfactory hand function with minimal donor site morbidity. DTF utilization as tendon grafts spares another incision for tendon grafting. Furthermore, one can integrate all the donor sites into the temporal region by choosing the scalp as a donor site for skin grafting. Patients can benefit from this procedure, which provides a functional reconstruction of the hand and leaves only inconspicuous donor site scars.
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Affiliation(s)
- Takashi Kurabayashi
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Yasutoshi Suzuki
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
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Fujisawa D, Asato H, Tanaka K, Itokazu T, Kojya S. Reconstruction of esophageal stenosis that had persisted for 40 years using a free jejunal patch graft with virtual endoscopy assistance: A case report. Arch Plast Surg 2019; 47:178-181. [PMID: 31018631 PMCID: PMC7093279 DOI: 10.5999/aps.2019.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.
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Affiliation(s)
- Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Katsunori Tanaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Tetsuo Itokazu
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Shizuo Kojya
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
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Matsumoto T, Kubota K, Aoki T, Shimizu T, Mori S, Kato M, Asato H. A Novel Approach for Hepatic Arterial Reconstruction after Total Pancreatectomy with Common Hepatic Artery Resection Using Inferior Phrenic Artery. Dig Surg 2018; 36:99-103. [PMID: 29414805 DOI: 10.1159/000486630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Because of the anatomical characteristics, pancreatic cancers (PC) can easily invade to visceral vessels such as celiac artery, superior mesenteric artery, common hepatic artery (CHA) and portal vein, which makes curative resection difficult. In this study, we report an R0 resection for locally advanced PC by total pancreatectomy, combined resection of CHA, and reconstruction of hepatic artery using autologous left inferior phrenic artery (IPA). METHODS A 47-year-old woman with complaints of low back pain was referred to our department. Contrast-enhanced computed tomography revealed a hypo-attenuation tumor of the pancreatic body measuring 70 mm, which completely encased the CHA. When unresectable locally advanced PC was diagnosed, systematic chemotherapy was administrated. After downstaging, she underwent surgery with curative intent. The tumor completely infiltrated the peripheral part of the CHA and gastroduodenal artery. As the tumor also extended to the head of the pancreas, total pancreatectomy and combined resection of CHA were performed. Then the exposed left IPA and proper hepatic artery were anastomosed with a microvascular technique. RESULTS R0 resection was performed for restoring hepatic arterial flow and the postoperative course was uneventful without any postoperative morbidity. CONCLUSION Hepatic artery reconstruction using IPA is a simple and safe procedure in selected patients.
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Affiliation(s)
| | - Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan
| | - Taku Aoki
- Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan
| | - Takayuki Shimizu
- Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan
| | - Shozo Mori
- Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan
| | - Masato Kato
- Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Japan
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Takahashi T, Ogasawara T, Kishimoto J, Liu G, Asato H, Nakatsuka T, Uchinuma E, Nakamura K, Kawaguchi H, Takato T, Hoshi K. Synergistic Effects of FGF-2 with Insulin or IGF-I on the Proliferation of Human Auricular Chondrocytes. Cell Transplant 2017; 14:683-693. [DOI: 10.3727/000000005783982675] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chondrocyte preparation with the safety and efficiency is the first step in cartilage regenerative medicine. To prepare a chondrocyte proliferation medium that does not contain fetal bovine serum (FBS) and that provides more than a 1000-fold increase in cell numbers within approximately 1 month, we attempted to use the medium containing 5% human serum (HS), but it exerted no more than twofold increase in 2 weeks. To compensate for the limited proliferation ability in HS, we investigated the combinational effects of 12 factors [i.e., fibroblast growth factor(FGF)-2, insulin-like growth factor(IGF)-I, insulin, bone morphogenetic protein-2, parathyroid hormone, growth hormone, dexamethasone, 1α25-dihydroxy vitamin D3, L-3,3′,5′-triodothyronine, interleukine-1 receptor antagonist, 17β-estradiol, and testosterone] on the proliferation of human auricular chondrocytes by analysis of variance in fractional factorial design. As a result, FGF-2, dexamethasone, insulin, and IGF-I possessed promotional effects on proliferation, while the combination of FGF-2 with insulin or IGF-I synergistically enhanced the proliferation. Actually, the chondrocytes increased 7.5-fold in number in 2 weeks in a medium containing 5% HS with 10 ng/ml FGF-2, while the cell number synergistically gained a 10–12-fold increase with 5 μg/ml insulin or 100 ng/ml IGF-I in the same period. The proliferation effects were more enhanced at a concentration of 100 ng/ml for FGF-2, and especially for the combination of 100 ng/ml FGF-2 and 5 μg/ml insulin (approximately 16-fold within 2 weeks). In the long-term culture with repeated passaging, this combination provided more than 10,000-fold within 8 weeks (i.e., passage 4). Thus, we concluded that such a combination of FGF-2 with insulin or IGF-I may be useful for promotion of auricular chondrocyte proliferation in a clinical application for cartilage regeneration.
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Affiliation(s)
- Tsuguharu Takahashi
- Department of MENICON Cartilage & Bone Regeneration, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
- Division of Tissue Engineering, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Toru Ogasawara
- Department of MENICON Cartilage & Bone Regeneration, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
- Department of Oral & Maxillofacial Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Junji Kishimoto
- Department of Clinical Bioinformatics, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Guangyao Liu
- Department of MENICON Cartilage & Bone Regeneration, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
- Department of Orthopaedics Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Hirotaka Asato
- Department of Plastic & Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Takashi Nakatsuka
- Department of Plastic & Reconstructive Surgery, Saitama Medical School, Kerohongo 38, keroyama-cho, Iruma, Saitama 350–0495, Japan
| | - Eijyu Uchinuma
- Department of Plastic & Reconstructive Surgery, Kitasato University, Kitasato 1–15–1, Sagamihara, Kanagawa 228–8555, Japan
| | - Kozo Nakamura
- Department of Clinical Bioinformatics, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Hiroshi Kawaguchi
- Department of Clinical Bioinformatics, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Tsuyoshi Takato
- Division of Tissue Engineering, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
- Department of Oral & Maxillofacial Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
| | - Kazuto Hoshi
- Department of MENICON Cartilage & Bone Regeneration, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
- Division of Tissue Engineering, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Hongo 7–3–1, Bunkyo-Ku, Tokyo 113–0033, Japan
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Kaga K, Asato H. Sound lateralization ability of patients with bilateral microtia and atresia after bilateral reconstruction of auricles and external auditory canals and fitting of new canal-type hearing aids to replace a bone conduction hearing aid. Acta Otolaryngol 2017; 137:370-374. [PMID: 27834100 DOI: 10.1080/00016489.2016.1249947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION Each of eight patients with bilateral microtia and atresia underwent bilateral reconstruction of the auricles and external auditory canals and were fitted bilateral canal-type hearing aids in the operated ears to replace a bone conduction hearing aid. The ability to discriminate inter-aural intensity difference (IID) and even inter-aural time difference (ITD) was retained in all these patients. OBJECTIVE This study studied the post-operative sound lateralization ability of patients with bilateral microtia and atresia after total reconstruction of both auricles and external auditory canals, followed by fitting of bilateral canal-type hearing aids. METHODS Eight patients with bilateral microtia and atresia ranging in age from 13-43 years were recruited in this study. Each of them underwent bilateral reconstruction of the auricles and external auditory canals and were fitted canal-type hearing aids in both the operated ears to replace a bone conduction hearing aid. A sound lateralization test was conducted to determine IID and ITD discrimination ability thresholds. RESULTS In all the patients, the IID discrimination ability thresholds of the patients were more than 3-fold those of the controls, the ITD discrimination ability threshold was more than 5-fold those of controls, and binaural hearing was retained.
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Affiliation(s)
- Kimitaka Kaga
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
| | - Hirotaka Asato
- Department of Plastic Surgery, Dokkyo Medical University, Tochigi, Japan
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Abstract
BACKGROUND Adhesion occurs as a part of the wound healing process, but it sometimes compromises patients' daily activities. The authors were looking for materials and methods that could prevent adhesion, and noticed that the costal cartilage has possibility. The anti-adhesive property of the costal cartilage was examined histologically. METHODS Thirty-five patients with microtia who provided consent for participating in this study were enrolled between April 2008 and March 2015. In the first stage of microtia reconstruction surgery, the excess cartilage was used to create these three types of specimens: (A) a piece of cartilage retaining the perichondrium on one side, (B) a piece of only cartilage parenchyma sliced with a plane parallel to the long axis of costal cartilage, and (C) the costal cartilage in a plane perpendicular to the long axis sliced pieces. These specimens were implanted into the subcutaneous fat of the chest. After at least 6 months in the second stage of surgery (i.e. auricular elevation), these specimens, wearing a little around the adipose tissue, we removed and examined histologically. RESULT A fibrosis formation of the perichondrium side of Specimen A was thicker significantly than that of the cartilage side. A fibrosis formation of Specimen B was thicker significantly than that of the cartilage side of Specimen A. CONCLUSION It was suggested that, if there is perichondrium, the costal cartilage parenchyma surface makes less adhesion with surrounding tissues. Costal cartilage with unilateral perichondrium is likely to be an effective surgical material for adhesion prevention.
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Affiliation(s)
- Norio Fukuda
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Tochigi , Japan
| | - Hirotaka Asato
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Tochigi , Japan
| | - Kohei Umekawa
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Tochigi , Japan
| | - Goro Takada
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Tochigi , Japan
| | - Takeshi Kan
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Tochigi , Japan
| | - Shoichi Sasaki
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Tochigi , Japan
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Kaga K, Asato H. Sound lateralization test in patients with unilateral microtia and atresia after reconstruction of the auricle and external canal and fitting of canal-type hearing aids. Acta Otolaryngol 2016; 136:368-72. [PMID: 27049537 DOI: 10.3109/00016489.2015.1103900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION In patients with unilateral microtia and atresia after reconstruction of the auricle and external canal and fitting of a canal-type hearing aid for the operated ear, the ability to discriminate the inter-aural intensity difference (IID) was acquired in all of the patients, whereas that to discriminate inter-aural time difference (ITD) was acquired in one-half of the patients. OBJECTIVE To study the post-operative sound lateralization ability in patients with unilateral microtia and atresia after reconstruction surgery of the auricle and external canal and fitting of a canal-type hearing aid of the operated ear. METHODS Eighteen patients with unilateral microtia and atresia ranging from 13-24 years of age were recruited in this study. All of them underwent reconstruction of the auricle and external canal and were fitted a canal-type hearing aid for the operated ear. The sound lateralization test was conducted to determine IID and ITD using a self-recording apparatus. The test stimulus was a continuous narrow-band noise at 500 Hz and 50 dBHL presented to the right and left ears through the air conduction receivers. RESULTS IID could be measured in all of the patients, whereas ITD could be measured in only nine out of the 18 patients. Post-operative binaural hearing could be acquired in all the patients.
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Affiliation(s)
- Kimitaka Kaga
- a National Institute of Sensory Organs, National Tokyo Medical Center , Tokyo Japan
| | - Hirotaka Asato
- b Department of Plastic Surgery , Dokkyo Medical University , Tochigi , Japan
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Abstract
OBJECTIVE According to previous reports, remote ischaemic preconditioning (RIPC) is a "delay" procedure that is highly likely to be useful for preventing skin flap necrosis. Differences in the extent of necrosis in rat dorsal skin flaps when different clamping times were used in RIPC were compared among the four groups described below. METHODS Group A was a control group in which no prior ischaemic area was created, and both back legs were devascularised for 15 min in Group B, 30 min in Group C, and 60 min in Group D. The experiments were performed on 10 rats in each group, and the surviving area was measured. One-way analysis of variance (ANOVA) and Tukey's multiple comparison test were used for analysis, with p < 0.05 regarded as significant. RESULTS The surviving area of the skin flap was 15.4 ± 1.8 cm(2) in Group A, 15.4 ± 2.0 cm(2) in Group B, 17.9 ± 2.0 cm(2) in Group C, and 19.2 ± 3.4 cm(2) in Group D, with significant differences between Groups A and D and between Groups B and D. CONCLUSIONS RIPC consisting of 60 min of ischaemic preconditioning may be clinically useful as a method of preventing skin flap necrosis.
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Affiliation(s)
- Kosuke Masaoka
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Shimotsuga, Tochigi , Japan
| | - Hirotaka Asato
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Shimotsuga, Tochigi , Japan
| | - Kohei Umekawa
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Shimotsuga, Tochigi , Japan
| | - Masaya Imanishi
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Shimotsuga, Tochigi , Japan
| | - Ayako Suzuki
- a Department of Plastic and Reconstructive Surgery , Dokkyo Medical University , Shimotsuga, Tochigi , Japan
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Imanishi M, Asato H. Joint surgery for elevation of the auricle and construction of the EAC. Adv Otorhinolaryngol 2013; 75:76-86. [PMID: 24135355 DOI: 10.1159/000350620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Masaya Imanishi
- Department of Plastic Surgery, Dokkyo Medical University, Tochigi, Japan
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Asato H. [Plastic surgery to head and neck area]. Nihon Jibiinkoka Gakkai Kaiho 2013; 116:636-9. [PMID: 24024277 DOI: 10.3950/jibiinkoka.116.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Takushima A, Harii K, Asato H, Kurita M, Shiraishi T. Fifteen-year survey of one-stage latissimus dorsi muscle transfer for treatment of longstanding facial paralysis. J Plast Reconstr Aesthet Surg 2012; 66:29-36. [PMID: 22960057 DOI: 10.1016/j.bjps.2012.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 07/30/2012] [Accepted: 08/03/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neurovascular free muscle transfer is one of the main reconstructive options for established or long-standing facial paralysis. The two-stage gracilis muscle transfer combined with the cross-face nerve graft (two-stage method) has been supplanted by one-stage reconstruction using the latissimus dorsi muscle (LD) at our institution. This study retrospectively evaluated the results of one-stage LD transfer. METHODS Between September 1993 and December 2008, 344 patients (133 males, 211 females; age range, 5-75 years) with unilateral facial paralysis underwent 351 one-stage LD transfers. Patients were evaluated with a custom grading scale. Differences in grading scale score were compared according to age, past surgical history and the duration from operation to neuromuscular recovery. RESULTS Contraction of the transferred muscle was recognised in 305 (87.0%) transfers. The duration until neuromuscular recovery ranged from 3 to 16 months (average ± standard deviation: 6.48 ± 1.92 months). The grading scale was significantly lower in middle-age group than in younger and elder groups (P < 0.01). Duration until neuromuscular recovery was significantly different when comparing the younger group and the oldest group. There was no difference in grading scale score or in duration until neuromuscular recovery when comparing the patients with a past surgical history and those without. The grading scale negatively correlated with the duration until neuromuscular recovery. CONCLUSIONS The results are consistent and statistical analysis revealed the versatility of the one-stage LD transfer. Although we believe the two-stage method is still a good option for facial reanimation, the one-stage method is advantageous regarding the shorter period of recovery and little donor-site morbidity.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
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Okochi M, Okazaki M, Asato H. Oral antithrombotic treatment and postoperative thrombotic complications after head and neck reconstruction using free flaps. J Plast Surg Hand Surg 2012; 46:163-6. [DOI: 10.3109/2000656x.2012.697374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miyamoto S, Takushima A, Okazaki M, Momosawa A, Asato H, Harii K. Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos. J Plast Reconstr Aesthet Surg 2009; 62:1187-95. [DOI: 10.1016/j.bjps.2007.12.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 10/26/2007] [Accepted: 12/18/2007] [Indexed: 11/30/2022]
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Sarukawa S, Asato H, Okazaki M, Nakatsuka T, Takushima A, Harii K. Clinical evaluation and morbidity of 201 free jejunal transfers for oesophagopharyngeal reconstruction during the 20 years 1984–2003. ACTA ACUST UNITED AC 2009; 40:148-52. [PMID: 16687334 DOI: 10.1080/02844310600652894] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated 192 patients who had 201 free jejunal transfers for oesophagopharyngeal reconstruction during the 20 years 1984-2003. The main postoperative complications were thrombosis, leaks, and stenosis. In this series, the rate of thrombosis was 7/201 (3.5%), that of leaks was 17/201 (8.5%), and that of stenosis was 25/201 (13.0%). When we assessed the relation between pre-existing conditions, surgical techniques, and these complications, we found only one significant difference: a history of alcohol misuse was associated with a reduction in the incidence of thrombosis. The surgical techniques did not affect the development of leaks or stenosis, which means that a complicated surgical technique is unnecessary.
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Affiliation(s)
- Shunji Sarukawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo.
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Abstract
A distally-based sural flap was used in four patients with soft-tissue defects in the lower leg and foot. All flaps survived completely without venous congestion. To make safe use of this flap it is important to include both the sural nerve and the lesser saphenous vein in the flap. It also seems to be important to include the surrounding fatty tissues in the pedicle and to avoid compression at the point of its angulation. This flap has the advantages that it is quick and easy to raise, and the reconstruction can be done in a single operation. It is unnecessary to sacrifice the major arteries in the leg, although the sural nerve must be sacrificed. In general this type of reconstruction of the lower leg and foot is beneficial in cases similar to those presented here.
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Affiliation(s)
- Hirotaka Suga
- Department of Plastic and Reconstructive Surgery, Jichi Medical School, Tochigi, Japan.
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Takushima A, Harii K, Okazaki M, Ohura N, Momosawa A, Asato H. Reconstruction of maxillectomy defects with free flaps - comparison of immediate and delayed reconstruction: A retrospective analysis of 51 cases. ACTA ACUST UNITED AC 2009; 41:14-21. [PMID: 17484180 DOI: 10.1080/02844310601088262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To establish a standard reconstructive material we compared outcomes after immediate and delayed reconstruction. Of the 21 patients who had immediate reconstruction, six patients had upper horizontal plane reconstruction. All bone grafts survived without infection or absorption. Of the 30 patients who had delayed reconstruction, 22 patients had upper horizontal plane reconstruction, with vascularised bone in 14 patients, non-vascularised bone or cartilage in five patients, and hydroxyapatite bone block in three. Postoperative infections developed in three of four patients for whom costal cartilage was used, and in all three patients for whom hydroxyapatite blocks were used. Non-vascularised bone or cartilage grafts are preferable for immediate reconstruction because of their technical simplicity. Vascularised bone grafts or osteocutaneous flaps are preferable for delayed reconstruction, however, as in most cases the operating field is contaminated by bacterial.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
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Oki M, Asato H, Suzuki Y, Umekawa K, Takushima A, Okazaki M, Harii K. Salvage reconstruction of the oesophagus: a retrospective study of 15 cases. J Plast Reconstr Aesthet Surg 2009; 63:589-97. [PMID: 19303831 DOI: 10.1016/j.bjps.2009.01.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 12/15/2008] [Accepted: 01/11/2009] [Indexed: 01/30/2023]
Abstract
Salvage reconstruction of the oesophagus is still considered a challenging procedure for all head and neck surgeons. The risk of postoperative infection and delayed wound healing is high because of thick scar formation and persistent inflammation. Furthermore, recipient vessels for free tissue transfer or vascular supercharge are not always available. Alimentary tract reconstruction with skin or musculocutaneous flap may be necessary, but this method is susceptible to fistula formation.[Nakatsuka T, Harii K, Asato H, et al. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience. Scand J Plast Reconstr Surg Hand Surg 1998; 32: 307-10] In the past 10 years, we have experienced 15 cases of salvage reconstruction of the oesophagus after prior cancer treatment or aorto-oesophageal fistula; the cervical oesophagus was reconstructed in five cases and the cervico-thoracic oesophagus in 10. In four cases of cervical oesophagus and six of cervico-thoracic oesophagus we performed free jejunal transfer including two long segment transfers with double vascular pedicle. The cervico-thoracic oesophagus was also reconstructed with pedicled alimentary tract transfer (colon interposition or jejunal pull-up) with vascular supercharge in four cases. In one case, cervical oesophageal defect was reconstructed with a latissimus dorsi musculocutaneous flap. We also used a deltopectoral flap to cover the skin defect in three cases. In three cases, a second salvage operation was necessary because of flap necrosis that was caused by unreliable recipient vessels resulting from scar formation and persistent inflammation. Successful restoration of the oesophagus and oral alimentation was achieved in 11 cases. From this study, we concluded that free jejunal transfer is a useful procedure for salvage reconstruction of the oesophagus, particularly for cervical oesophagus or short oesophageal defects. Nonetheless, surgeons should know the indications and limitations of this procedure thoroughly and always be ready to choose other reconstructive options if necessary.
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Affiliation(s)
- Masanao Oki
- Department of plastic and reconstructive surgery, Dokkyo Medical University, 880 Kitakobayashi Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan.
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Kawahara N, Sasaki T, Asakage T, Nakao K, Sugasawa M, Asato H, Koshima I, Saito N. Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective. J Neurosurg 2008; 108:501-10. [PMID: 18312097 DOI: 10.3171/jns/2008/108/3/0501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations. METHODS Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan-Meier method. RESULTS All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3-11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively. CONCLUSIONS The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.
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Affiliation(s)
- Nobutaka Kawahara
- Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Watanabe K, Asakage T, Nakao K, Ebihara Y, Fujishiro Y, Okazaki M, Asato H, Sugasawa M. Planned Simultaneous Cervical Skin Reconstruction for Salvage Total Pharyngolaryngectomy. Jpn J Clin Oncol 2008; 38:167-71. [DOI: 10.1093/jjco/hym177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Miyamoto S, Takushima A, Asato H, Yamada A, Harii K. Secondary reconstruction of the eye socket in a free flap transferred after complete excision of the orbit. ACTA ACUST UNITED AC 2007; 41:59-64. [PMID: 17605437 DOI: 10.1080/02844310601104077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reconstruction of the eye socket in a free flap transferred after complete excision for malignancy is difficult. Between 1980 and 2005 we secondarily reconstructed five eye sockets in free flaps after resection of cancer, cirsoid haemangioma, and the consequences of irradiation for retinoblastoma. Free flaps were used during the primary operations to cover the defects. The eye socket was then reconstructed during the secondary operations with a conventional skin graft in two cases, and with a skin graft using the modified Antia's method in three cases. All free flaps survived and all eye sockets accepted ocular prostheses. Three patients in particular, whose eye sockets were reconstructed using the modified Antia's method, had excellent results. Here we describe operations and problems related to secondary reconstruction of eye sockets in previously transferred free flaps after complete excision, and describe some typical cases.
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Affiliation(s)
- Shimpei Miyamoto
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, Tokyo, Japan.
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Okazaki M, Asato H, Takushima A, Sarukawa S, Nakatsuka T, Yamada A, Harii K. Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer. Plast Reconstr Surg 2007; 119:1223-1232. [PMID: 17496594 DOI: 10.1097/01.prs.0000254400.29522.1c] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few authors have reported the subsequent treatment for patients in whom free tissue transfers in the head and neck have failed as a result of vascular thrombosis. METHODS Between 1993 and May of 2005, 502 free flaps were transferred after head and neck cancer ablation in the authors' hospital, 19 of which resulted in total necrosis caused by vascular thrombosis. The authors categorized these 19 cases into four groups and analyzed the salvage treatment. RESULTS For failed free jejunal transfer, early initiation of oral intake was obtained when another free jejunum was transferred. For failed free soft-tissue transfer for intraoral defects, reconstruction with common free (first choice) or pedicled flaps was used: a voluminous musculocutaneous flap for extensive defects, forearm flap or pedicled pectoralis major flap for intermediate defects, and direct closure for small defects of the oral floor. For failed secondary soft-tissue transfer to improve a certain function, salvage flap transfer was not chosen in the acute setting. For failed secondary maxillary reconstruction, simple reconstruction using the rectus abdominis musculocutaneous flap combined with costal cartilage achieved stable results. The overall success rate of the repeated free flap was 89 percent (eight of nine patients). CONCLUSIONS When a free flap is judged unsalvageable, surgeons should determine subsequent treatments, considering the success rate as one of the most important factors. The authors believe that simple reconstruction using a common free flap is the first choice in most cases. When regional or general conditions do not permit further free flap transfer or when defects are comparatively small, reconstruction with a pedicled flap or direct closure of the defect may be considered.
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Affiliation(s)
- Mutsumi Okazaki
- Tokyo, Mitaka, Moroyama, and Sendai, Japan From the Departments of Plastic and Reconstructive Surgery of Graduate School of Medicine, University of Tokyo; Kyorin University; Saitama Medical School; and Tohoku University
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Liu G, Kawaguchi H, Ogasawara T, Asawa Y, Kishimoto J, Takahashi T, Chung UI, Yamaoka H, Asato H, Nakamura K, Takato T, Hoshi K. Optimal Combination of Soluble Factors for Tissue Engineering of Permanent Cartilage from Cultured Human Chondrocytes. J Biol Chem 2007; 282:20407-15. [PMID: 17493933 DOI: 10.1074/jbc.m608383200] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Since permanent cartilage has poor self-regenerative capacity, its regeneration from autologous human chondrocytes using a tissue engineering technique may greatly benefit the treatment of various skeletal disorders. However, the conventional autologous chondrocyte implantation is insufficient both in quantity and in quality due to two major limitations: dedifferentiation during a long term culture for multiplication and hypertrophic differentiation by stimulation for the redifferentiation. To overcome the limitations, this study attempted to determine the optimal combination in primary human chondrocyte cultures under a serum-free condition, from among 12 putative chondrocyte regulators. From the exhaustive 2(12) = 4,096 combinations, 256 were selected by fractional factorial design, and bone morphogenetic protein-2 and insulin (BI) were statistically determined to be the most effective combination causing redifferentiation of the dedifferentiated cells after repeated passaging. We further found that the addition of triiodothyronine (T3) prevented the BI-induced hypertrophic differentiation of redifferentiated chondrocytes via the suppression of Akt signaling. The implant formed by the human chondrocytes cultured in atelocollagen and poly(l-latic acid) scaffold under the BI + T3 stimulation consisted of sufficient hyaline cartilage with mechanical properties comparable with native cartilage after transplantation in nude mice, indicating that BI + T3 is the optimal combination to regenerate a clinically practical permanent cartilage from autologous chondrocytes.
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Affiliation(s)
- Guangyao Liu
- Departments of Cartilage and Bone Regeneration (Fujisoft), and Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-8655, Japan
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Okazaki M, Asato H, Takushima A, Sarukawa S, Okochi M, Suga H, Harii K. Reconstruction with Rectus Abdominis Myocutaneous Flap for Total Glossectomy with Laryngectomy. J Reconstr Microsurg 2007; 23:243-9. [PMID: 17876726 DOI: 10.1055/s-2007-981502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
From October 1999 to July 2005, defects after total glossectomy with laryngectomy (TGL) for cancer of the tongue or middle pharynx were reconstructed with rectus abdominis myocutaneous (RAMC) flaps in nine patients. The skin flaps were designed larger in width than the original defect to create a funnel-shaped oropharynx and prevent stricture. Six patients had uneventful postoperative courses and began to eat perorally 8 to 15 days postoperatively. One patient suffered flap necrosis due to arterial thrombosis and two patients had leakage. Eventually, eight patients could eat soft foods or gruel, except one patient who had ingested food through a gastrostomy preoperatively. When TGL was performed without mandibulectomy, the blood supply for the remnant mucosa of the backside of the mandible is generally not good, for which the reconstruction with the overlapping deepithelialized flap and muscle is useful for prevention of the fistula formation. We considered that the RAMC flap is a good option for reconstruction after TGL.
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Affiliation(s)
- Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Kyorin University, School of Medicine, Tokyo, Japan
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Abstract
In secondary reconstruction of the maxilla, skeletal reconstruction as well as soft tissue augmentation is required to obtain a good contour. We present a new strategy for combining a costal cartilage graft with a rib-latissimus dorsi flap. We used this method to treat a 39-year-old man who had previously undergone total maxillectomy. First, a vascularized rib, elevated together with a latissimus dorsi flap, was fixed between the middle of the maxilla and the edge of the zygomatic arch. The small defects that could not be reconstructed with the rib only were reconstructed with a costal cartilage graft. The patient did not develop any postoperative infection or flap necrosis. Thirteen months after the secondary reconstruction, he presented with a good contour of the cheek. Our method was effective for the reconstruction of a complex skeletal defect of the maxilla.
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Affiliation(s)
- Hirotaka Suga
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Okazaki M, Asato H, Okochi M, Suga H. One-Segment Double Vascular Pedicled Free Jejunum Transfer for the Reconstruction of Pharyngoesophageal Defects. J Reconstr Microsurg 2007; 23:213-8. [PMID: 17530613 DOI: 10.1055/s-2007-981503] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The reported success rates of free jejunal transfer are over 95%, but in cases of postoperative vascular thrombosis, the salvage of jejunal flap is often difficult because of poor ischemic tolerance of the jejunum. To reduce the incidence of jejunal necrosis due to vascular thrombosis to nearly zero, we employed one-segment double vascular pedicled free jejunal transfer. Different from conventional double pedicled free jejunal transfer (transfer of the two jejunal segments by anastomosing two pairs of jejunal root vessels), the arcade vessels are used as an additional feeder after the routine anastomosis of jejunal root vessels in our method. Between December 2004 and January 2006, 20 patients with laryngeal, pharyngeal, or cervical esophageal cancer underwent free jejunal transfer using this method. In all patients, the jejunal flap survived completely without any complication associated with vascular anastomosis or blood circulation of the flap. The disadvantage of this procedure is the approximately 1-hour prolonged operative time. Although we have experienced only 20 cases and not obtained statistically significant validity of this method compared with conventional one, we believe that the concept of our method is one of the help for safer pharyngoesophageal reconstruction, especially in patients with higher risk of vascular thrombosis.
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Affiliation(s)
- Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Kyorin University, Tokyo
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Abstract
Some patients who undergo pharyngolaryngoesophagectomy with free jejunal transfer reconstruction have a history of esophagectomy and gastric pull-up. We retrospectively reviewed a series of 12 patients to examine the characteristic problems in free jejunal transfer for patients with a history of esophagectomy and gastric pull-up. There was no postoperative thrombosis. No anastomotic leakage or fistula was found. Five of 12 patients presented postoperatively with dysphagia. Two of the 5 patients showed stricture at the distal anastomosis. Three of the 5 patients showed no stricture. However, their reconstructed tracts were tortuous around the distal anastomosis, which could be a cause of dysphagia. Even in patients with a history of esophagectomy and gastric pull-up, free jejunal transfer can be performed safely, although the functional outcome of swallowing is not always satisfactory.
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Affiliation(s)
- Hirotaka Suga
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Iida T, Takushima A, Asato H, Harii K. Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction. J Plast Reconstr Aesthet Surg 2006; 59:1372-6. [PMID: 17113522 DOI: 10.1016/j.bjps.2006.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2005] [Accepted: 01/18/2006] [Indexed: 11/29/2022]
Abstract
We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.
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Affiliation(s)
- Takuya Iida
- Department of Plastic and Reconstructive Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 182-8611 Japan.
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Koshima I, Urushibara K, Fukuda N, Ohkochi M, Nagase T, Gonda K, Asato H, Yoshimura K. Digital artery perforator flaps for fingertip reconstructions. Plast Reconstr Surg 2006; 118:1579-1584. [PMID: 17102731 DOI: 10.1097/01.prs.0000232987.54881.a7] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Isao Koshima
- Tokyo and Okayama, Japan From the Departments of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, and Kawasaki Medical School
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Sarukawa S, Okazaki M, Asato H, Koshima I. Volumetric Changes in the Transferred Flap after Anterior Craniofacial Reconstruction. J Reconstr Microsurg 2006; 22:499-505; discussion 506-7. [PMID: 17048130 DOI: 10.1055/s-2006-951313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The goal of craniofacial reconstruction is not only life-saving but also facial aesthetics. From this viewpoint the authors evaluated the facial symmetry of patients after craniofacial reconstruction. The subjects were seven patients reconstructed after craniofacial resections. Their CT or MR images were evaluated just after surgery, 1 month after surgery, and 6 months after surgery. Based on these images, the proportion of simple area (PSA) and the proportion of overlapped area (POA) were calculated. The PSA is the proportion of the reconstructed quarter to the contralateral one, and the POA is the proportion of the overlapped area in the reconstructed quarter to the normal one. These values were assessed in two groups: five patients without and two with split calvarial bone grafts. Results demonstrated that the volumetric change of the reconstructed face with the bone graft was relatively stable.
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Affiliation(s)
- Shunji Sarukawa
- Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan
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Ogata F, Fukuda N, Ohkochi M, Nagase T, Gonda K, Asato H, Yoshimura K, Koshima I. Digital Artery Perforator (DAP) Flaps for Fingertip Reconstructions. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-949066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yamaoka H, Asato H, Ogasawara T, Nishizawa S, Takahashi T, Nakatsuka T, Koshima I, Nakamura K, Kawaguchi H, Chung UI, Takato T, Hoshi K. Cartilage tissue engineering using human auricular chondrocytes embedded in different hydrogel materials. J Biomed Mater Res A 2006; 78:1-11. [PMID: 16596585 DOI: 10.1002/jbm.a.30655] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To seek a suitable scaffold for cartilage tissue engineering, we compared various hydrogel materials originating from animals, plants, or synthetic peptides. Human auricular chondrocytes were embedded in atelopeptide collagen, alginate, or PuraMatrix, all of which are or will soon be clinically available. The chondrocytes in the atelopeptide collagen proliferated well, while the others showed no proliferation. A high-cell density culture within each hydrogel enhanced the expression of collagen type II mRNA, when compared with that without hydrogel. By stimulation with insulin and BMP-2, collagen type II and glycosaminoglycan were significantly accumulated within all hydrogels. Chondrocytes in the atelopeptide collagen showed high expression of beta1 integrin, seemingly promoting cell-matrix signaling. The N-cadherin expression was inhibited in the alginate, implying that decrease in cell-to-cell contacts may maintain chondrocyte activity. The matrix synthesis in PuraMatrix was less than that in others, while its Young's modulus was the lowest, suggesting a weakness in gelling ability and storage of cells and matrices. Considering biological effects and clinical availability, atelopeptide collagen may be accessible for clinical use. However, because synthetic peptides can control the risk of disease transmission and immunoreactivities, some improvement in gelling ability would provide a more useful hydrogel for ideal cartilage regeneration.
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Affiliation(s)
- Hisayo Yamaoka
- Department of Fujisoft ABC Cartilage and Bone Regeneration, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo 113-0033, Japan
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Takushima A, Harii K, Asato H, Momosawa A, Okazaki M. One-stage reconstruction of facial paralysis associated with skin/soft tissue defects using latissimus dorsi compound flap. J Plast Reconstr Aesthet Surg 2006; 59:465-73. [PMID: 16749192 DOI: 10.1016/j.bjps.2005.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neurovascular free muscle transfer is now the mainstay for smile reconstruction in the treatment of established facial paralysis. Since facial paralysis due to ablative surgery or some specific disease sometimes accompanies defects of the facial skin and soft tissue, simultaneous reconstruction of defective tissues with facial reanimation is required. The present paper reports results for 16 patients who underwent reconstruction by simultaneous soft tissue flap transfer with latissimus dorsi muscle for smile reconstruction of the paralysed face. Soft tissue flaps comprised skin paddle overlying the latissimus dorsi muscle (n=6), serratus anterior musculocutaneous flap (n=5), serratus anterior muscle flap (n=2), and latissimus dorsi perforator-based flap with a small muscle cuff (n=3). The latissimus dorsi muscle can be elevated as a compound flap of various types, and thus offers the best option as a donor muscle for facial reanimation when soft tissue defects require simultaneous reconstruction.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, 181-8611, Japan.
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Okazaki M, Asato H, Sarukawa S, Takushima A, Nakatsuka T, Harii K. Availability of End-to-Side Arterial Anastomosis to the External Carotid Artery Using Short-Thread Double-Needle Microsuture in Free-Flap Transfer for Head and Neck Reconstruction. Ann Plast Surg 2006; 56:171-5. [PMID: 16432326 DOI: 10.1097/01.sap.0000197620.03306.2f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We seldom have difficulties in the selection of appropriate recipient arteries for microvascular free flap transfer in the head and neck region because many sizable branches (branch artery) of the external carotid artery (ECA) or subclavian artery are available. However, we occasionally encountered the lack of an appropriate recipient artery, especially in secondary reconstruction or reconstruction following the extensive ablation of recurrent cancer. For these challenging cases, we have used end-to-side arterial anastomosis directly to the ECA. Between July 1997 and December 2004, end-to-side anastomosis of the flap artery to the ECA was employed in 16 cases. The reason for its use included the marked size discrepancy between the jejunal artery and branch artery in 4 jejunal transfer cases, the lack of 2 appropriate recipient arteries for double free flap transfers in 1 case, and the lack of an available branch artery as a recipient due to poor regional conditions in 11 cases. Fifteen of 16 flaps underwent an uneventful postoperative course, except 1 whose flap artery was pressed by the submandibular gland and sustained thrombosis 3 days postoperatively. In this case, however, the flap survived perfectly after prompt thrombectomy and reanastomosis. Eventually, all 16 flaps survived completely. We reconfirmed the availability of end-to-side anastomosis to the ECA when a suitable branch artery is not available. Although end-to-side anastomosis to the ECA is laborious compared with end-to-end anastomosis, our newly developed short-thread double-needle microsuture combined with the back-wall-first technique helps to ensure easier anastomosis. Using this device, because all stitches are carried from inside the vessel to outside, the surgeon can place the first stitch at any point on the posterior wall and advance the next suture to the preferred site of the previous suture, and suturing can be performed more safely even in cases where the tunica intima is separated from the tunica media due to arteriosclerosis, previous irradiation, or surgery.
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Affiliation(s)
- Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Okazaki M, Asato H, Takushima A, Nakatsuka T, Sarukawa S, Inoue K, Harii K, Sugawara Y, Makuuchi M. Hepatic artery reconstruction with double-needle microsuture in living-donor liver transplantation. Liver Transpl 2006; 12:46-50. [PMID: 16382462 DOI: 10.1002/lt.20550] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In living-donor liver transplantation (LDLT), reconstruction of the hepatic artery is challenging because the recipient artery is located deep in the abdominal cavity and the operating field is limited. Also, the hepatic artery of the graft is short and the recipient artery is occasionally damaged. To overcome these difficulties, we developed a double-needle microsuture technique for artery reconstruction. A total of 161 adult patients received 163 LDLTs using this new technique. The first suture was placed at the most difficult point in the artery to be visualized through the microscope. Each stitch was placed from the inner side of the arterial wall to the outer side. The posterior stitch was tied pulling toward the back. The subsequent sutures were advanced anteriorly on either side adjacent to the previous suture. Hepatic artery thrombosis occurred in 4 patients (2.5%), only 2 (1.2%) of which were associated with arterial reconstruction. Intimal dissection developed in the recipient artery in 2 patients (1.2%). Three (50%) of these 6 complications occurred more than 10 days after LDLT. In conclusion, this suturing technique allows for safe intimal adaptation even when the arterial tunica intima is separated from the tunica media, because all stitches are carried from inside of the vessel to the outside, contributing to more satisfactory results.
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Affiliation(s)
- Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Abstract
Pharyngoesophageal reconstruction using free jejunal transfer is a reliable procedure, but the achievement of perfect functional results is still challenging. We present a devised method. Jejunoesophageal anastomosis is performed after 2 longitudinal incisions are made at the side corners of the esophageal stump. This maneuver not only enlarges the size of the esophageal stump but also provides a "Z-plasty-like" effect, which reduces the risk of delayed stricture formation. The pharyngojejunal anastomosis is performed in an end-to-end manner. Irrespective of the highest point of the pharyngeal defect, a longitudinal incision is made at the edge of the jejunal graft corresponding to the midpoint of the back wall of the pharyngeal stump. With this concept, considerable longitudinal tension is placed on the posterior side of the jejunal graft, whereas moderate tension is placed on the anterior side of the graft, which prevents the fistula formation that tends to occur in the anterior suture line. Twenty patients underwent the reconstruction using this operative procedure. In all cases, postoperative deglutition was satisfactory without jejunal redundancy or constriction. We believe that our method can be applied in most cases of pharyngoesophageal defects, providing simple and reasonable reconstruction using free jejunal transfer with stable results.
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Affiliation(s)
- Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Takushima A, Harii K, Asato H, Momosawa A, Okazaki M, Nakatsuka T. Choice of osseous and osteocutaneous flaps for mandibular reconstruction. Int J Clin Oncol 2005; 10:234-42. [PMID: 16136367 DOI: 10.1007/s10147-005-0504-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Indexed: 10/25/2022]
Abstract
Microvascular free flap transfer currently represents one of the most popular methods for mandibular reconstruction. With the various free flap options now available, there is a general consensus that no single kind of osseous or osteocutaneous flap can resolve the entire spectrum of mandibular defects. A suitable flap, therefore, should be selected according to the specific type of bone and soft tissue defect. We have developed an algorithm for mandibular reconstruction, in which the bony defect is termed as either "lateral" or "anterior" and the soft-tissue defect is classified as "none," "skin or mucosal," or "through-and-through." For proper flap selection, the bony defect condition should be considered first, followed by the soft-tissue defect condition. When the bony defect is "lateral" and the soft tissue is not defective, the ilium is the best choice. When the bony defect is "lateral" and a small "skin or mucosal" soft-tissue defect is present, the fibula represents the optimal choice. When the bony defect is "lateral" and an extensive "skin or mucosal" or "through-and-through" soft-tissue defect exists, the scapula should be selected. When the bony defect is "anterior," the fibula should always be selected. However, when an "anterior" bone defect also displays an "extensive" or "through-and-through" soft-tissue defect, the fibula should be used with other soft-tissue flaps. Flaps such as a forearm flap, anterior thigh flap, or rectus abdominis musculocutaneous flap are suitable, depending on the size of the soft-tissue defect.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
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Koshima I, Ozaki T, Gonda K, Okazaki M, Asato H. Posterior Tibial Adiposal Flap for Repair of Wide, Full-Thickness Defect of the Achilles Tendon. J Reconstr Microsurg 2005; 21:551-4. [PMID: 16292732 DOI: 10.1055/s-2005-922435] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Wide, full-thickness defects on the posterior aspect of the distal lower leg involving the Achilles tendon are usually repaired with free fasciocutaneous flaps or local skin flaps. The former require microvascular techniques; there is a donor-site scar due to skin grafting; and a longer operating time. The latter results in a wide scar near the donor defect. The authors developed a new reconstructive procedure using local fascia turned over to create a new Achilles tendon, and wrapping it with a posterior tibial adiposal island flap based on the dominant perforator of the posterior tibial artery, which was elevated from the medial aspect of the lower leg. The advantages of this method are that no donor scar appeared on the posterior aspect of the lower leg, and there was no need for microvascular techniques. This method is especially suitable for young women.
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Affiliation(s)
- Isao Koshima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Japan
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Abstract
Between June 1992 and November 2002, 17 patients underwent secondary reconstruction of circumferential esophageal defects due to the failure of immediate reconstruction following ablation of thoracic esophageal cancer. Salvage reconstruction was achieved using free jejunal transfer in 13 patients (including long segment with double vascular pedicle in 2 cases), skin and/or musculocutaneous flap in 2 cases, and jejunal pull-up in 2 cases. In 5 patients, the second salvage surgery was required because of the failed first salvage. However, successful restoration of the esophagus and peroral alimentation was finally achieved in 16 of 17 patients, except 1 patient with several salvage operations using skin and musculocutaneous flap because the gut was unusable. We concluded that the preferred first choice for salvage restoration is free jejunal transfer. If the length of the esophageal defect is extensive, colonic interposition or jejunal pedicle with microvascular anastomosis for supercharging is the next option. If these procedures cannot be used, the transfer of a long jejunal segment with double vascular pedicles is recommended. Reconstruction using skin and/or musculocutaneous flap is the final option. As primary wound closure is often difficult in secondary reconstruction of the esophagus, a pectoralis major musculocutaneous flap is reliable to cover the reconstructed esophagus because skin flaps located in the neck region may be damaged by neck dissection or irradiation, and coverage of the anastomosis with muscle between the digestive tracts is effective to prevent leakage.
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Affiliation(s)
- Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
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42
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Okazaki M, Asato H. [Role of the plastic surgeon in cranial base surgery]. Nihon Rinsho 2005; 63 Suppl 9:401-6. [PMID: 16201554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Mitsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo
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Takushima A, Harii K, Asato H, Momosawa A. Revisional Operations Improve Results of Neurovascular Free Muscle Transfer for Treatment of Facial Paralysis. Plast Reconstr Surg 2005; 116:371-80. [PMID: 16079658 DOI: 10.1097/01.prs.0000169687.94376.78] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neurovascular free muscle transfer is currently the mainstay for smile reconstruction. However, problems such as excessive muscle bulk and dislocation of the transferred muscle attachment have been described. Furthermore, dynamic movements of the transferred muscle are sometimes too strong or too weak, resulting in facial asymmetry. In these cases, secondary revisional operations for the transferred muscle are required after neurovascular free muscle transfer. This report describes revisional operative procedures in detail and examines the extent of improvement of the smile by comparing preoperative and postoperative results. METHODS Of 468 patients in whom neurovascular free muscle transfer was performed between 1977 and 2000, a total of 183 received revisional operations for the transferred muscle. Operations included revision of muscle attachment in 129 patients, debulking of the cheek in 114 patients, and fascia graft in 21 patients. RESULTS Evaluation with the grading scale was performed in 117 of the 183 patients. Grading improved in 59 patients and worsened in seven patients. The remaining 51 patients displayed no change in grading. Differences between preoperative and post-operative grading were compared statistically, and revisional operations improved the grading score. CONCLUSIONS Revisional operations are effective and important as secondary operations after neurovascular free muscle transfer. However, care must be taken not to damage the neurovascular pedicles.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, Tokyo, Japan.
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Nagase T, Nagase M, Osumi N, Fukuda S, Nakamura S, Ohsaki K, Harii K, Asato H, Yoshimura K. Craniofacial anomalies of the cultured mouse embryo induced by inhibition of sonic hedgehog signaling: an animal model of holoprosencephaly. J Craniofac Surg 2005; 16:80-8. [PMID: 15699650 DOI: 10.1097/00001665-200501000-00016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The pathogenesis of holoprosencephaly is multifactorial, and blockage of Sonic hedgehog signaling is one of the most important causative factors in animal models and human cases. In this study, the authors analyzed facial anomalies of mouse embryos, which were cultured in vitro and exposed to cyclopamine, an alkaloid blocker of Sonic hedgehog signaling. When cultured with cyclopamine for embryonic day 8.5 to 10.5, the whole body size was smaller than normal, and the distance and angle between the nasal placodes were remarkably reduced. Extension of the cranial surface vessels also was noted. No cyclopia was observed. Migration of the cranial neural crest cells seemed to be intact. Expressions of Patched-1 and Gli-1, downstream genes of Sonic hedgehog signaling, also were down-regulated in in situ hybridization and real-time reverse transcriptase-polymerase chain reaction analyses. The authors consider that these facial anomalies represent milder phenotypes of holoprosencephaly.
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Affiliation(s)
- Takashi Nagase
- Department of Plastic and Reconstructive Surgery, University Hospital, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Takahashi T, Ogasawara T, Kishimoto J, Liu G, Asato H, Nakatsuka T, Uchinuma E, Nakamura K, Kawaguchi H, Chung UI, Takato T, Hoshi K. Synergistic effects of FGF-2 with insulin or IGF-I on the proliferation of human auricular chondrocytes. Cell Transplant 2005; 14:683-93. [PMID: 16405079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Chondrocyte preparation with the safety and efficiency is the first step in cartilage regenerative medicine. To prepare a chondrocyte proliferation medium that does not contain fetal bovine serum (FBS) and that provides more than a 1000-fold increase in cell numbers within approximately 1 month, we attempted to use the medium containing 5% human serum (HS), but it exerted no more than twofold increase in 2 weeks. To compensate for the limited proliferation ability in HS, we investigated the combinational effects of 12 factors [i.e., fibroblast growth factor (FGF)-2, insulin-like growth factor (IGF)-I, insulin, bone morphogenetic protein-2, parathyroid hormone, growth hormone, dexamethasone, 1alpha25-dihydroxy vitamin D3, L-3,3',5'-triodothyronine, interleukine-1 receptor antagonist, 17beta-estradiol, and testosterone] on the proliferation of human auricular chondrocytes by analysis of variance in fractional factorial design. As a result, FGF-2, dexamethasone, insulin, and IGF-I possessed promotional effects on proliferation, while the combination of FGF-2 with insulin or IGF-I synergistically enhanced the proliferation. Actually, the chondrocytes increased 7.5-fold in number in 2 weeks in a medium containing 5% HS with 10 ng/ml FGF-2, while the cell number synergistically gained a 10-12-fold increase with 5 microg/ml insulin or 100 ng/ml IGF-I in the same period. The proliferation effects were more enhanced at a concentration of 100 ng/ml for FGF-2, and especially for the combination of 100 ng/ml FGF-2 and 5 microg/ml insulin (approximately 16-fold within 2 weeks). In the long-term culture with repeated passaging, this combination provided more than 10,000-fold within 8 weeks (i.e., passage 4). Thus, we concluded that such a combination of FGF-2 with insulin or IGF-I may be useful for promotion of auricular chondrocyte proliferation in a clinical application for cartilage regeneration.
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Affiliation(s)
- Tsuguharu Takahashi
- Department of Fujisoft ABC [corrected] Cartilage & Bone Regeneration, Graduate School of Medicine [corrected] University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo 113-0033 [corrected] Japan
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Abstract
A double vascular pedicled free jejunum was transferred in two patients with complete esophageal defect. When the stomach and colon, which are usually employed for esophageal reconstruction, cannot be used due to previous operations or for other reasons, the jejunum is the next alternative. However, pedicled jejunal transposition is limited in length and may not reach a suitable level over the lower cervical esophagus, even if the distal portion is supercharged. Under such circumstances, a long jejunal segment with two vascular pedicles can be transferred as a free flap and used to reconstruct the whole esophagus in one stage. The paper describes two cases and discusses the advantages of double vascular pedicled free jejunum transfer.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, Tokyo, Japan
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Takushima A, Harii K, Asato H, Ueda K, Yamada A. Neurovascular Free-Muscle Transfer for the Treatment of Established Facial Paralysis following Ablative Surgery in the Parotid Region. Plast Reconstr Surg 2004; 113:1563-72. [PMID: 15114115 DOI: 10.1097/01.prs.0000117186.10112.87] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurovascular free-muscle transfer for facial reanimation was performed as a secondary reconstructive procedure for 45 patients with facial paralysis resulting from ablative surgery in the parotid region. This intervention differs from neurovascular free-muscle transfer for treatment of established facial paralysis resulting from conditions such as congenital dysfunction, unresolved Bell palsy, Hunt syndrome, or intracranial morbidity, with difficulties including selection of recipient vessels and nerves, and requirements for soft-tissue augmentation. This article describes the authors' operative procedure for neurovascular free-muscle transfer after ablative surgery in the parotid region. Gracilis muscle (n = 24) or latissimus dorsi muscle (n = 21) was used for transfer. With gracilis transfer, recipient vessels comprised the superficial temporal vessels in 12 patients and the facial vessels in 12. For latissimus dorsi transfer, recipient vessels comprised the facial vessels in 16 patients and the superior thyroid artery and superior thyroid or internal jugular vein in four. Facial vessels on the contralateral side were used with interpositional graft of radial vessels in the remaining patient with latissimus dorsi transfer. Cross-face nerve grafting was performed before muscle transfer in 22 patients undergoing gracilis transfer. In the remaining two gracilis patients, the ipsilateral facial nerve stump was used as the primary recipient nerve. Dermal fat flap overlying the gracilis muscle was used for cheek augmentation in one patient. In the other 23 patients, only the gracilis muscle was used. With latissimus dorsi transfer, the ipsilateral facial nerve stump was used as the recipient nerve in three patients, and a cross-face nerve graft was selected as the recipient nerve in six. The contralateral facial nerve was selected as the recipient nerve in 12 patients, and a thoracodorsal nerve from the latissimus dorsi muscle segment was crossed through the upper lip to the primary recipient branches. A soft-tissue flap was transferred simultaneously with the latissimus muscle segment in three patients. Contraction of grafted muscle was not observed in two patients with gracilis transfer and in three patients with latissimus dorsi transfer. In one patient with gracilis transfer and one patient with latissimus dorsi transfer, acquired muscle contraction was excessive, resulting in unnatural smile animation. The recipient nerves for both of these patients were the ipsilateral facial nerve stumps, which were dissected by opening the facial nerve canal in the mastoid process. From the standpoint of operative technique, the one-stage transfer for latissimus dorsi muscle appears superior. Namely, a combined soft-tissue flap can provide sufficient augmentation for depression of the parotid region following wide resection. A long vascular stalk of thoracodorsal vessels is also useful for anastomosis, with recipient vessels available after extensive ablation and neck dissection.
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Affiliation(s)
- Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Nakatsuka T, Harii K, Asato H, Takushima A, Ebihara S, Kimata Y, Yamada A, Ueda K, Ichioka S. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection. J Reconstr Microsurg 2004; 19:363-8; discussion 369. [PMID: 14515225 DOI: 10.1055/s-2003-42630] [Citation(s) in RCA: 227] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Microvascular free tissue transfer has gained world-wide acceptance as a means of reconstructing post-oncologic surgical defects in the head and neck region. Since 1977, the authors have introduced this reconstructive procedure to head and neck reconstruction after cancer ablation, and a total of 2372 free flaps were transferred in 2301 patients during a period of over 23 years. The most frequently used flap was the rectus abdominis flap (784 flaps: 33.1 percent), followed by the jejunum (644 flaps: 27.2 percent) and the forearm flap (384 flaps: 16.2 percent). In the reported series, total and partial flap necrosis accounted for 4.2 percent and 2.5 percent of cases, respectively. There was a significant statistical difference ( p < 0.05) in complete flap survival rate between immediate and secondary reconstruction cases. The authors believe that the above-mentioned three flaps have been a major part of the armamentarium for head and neck reconstruction because of a lower rate of flap necrosis, compared to other flaps.
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Affiliation(s)
- Takashi Nakatsuka
- Department of Plastic and Reconstructive Surgery, Saitama Medical School, 38 Morohongo, Moroyama, Iruma, Saitama, Japan 350-0495
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Kishi Y, Sugawara Y, Kaneko J, Akamatsu N, Imamura H, Asato H, Kokudo N, Makuuchi M. Hepatic arterial anatomy for right liver procurement from living donors. Liver Transpl 2004; 10:129-33. [PMID: 14755789 DOI: 10.1002/lt.20010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation (LDLT) using right liver grafts is now widely performed. Anatomic classifications of the hepatic artery for right liver procurement, however, are limited. In this study, celiac and mesenteric angiograms of 223 consecutive living donors in a single institution were evaluated. Details of the arterial anastomosis and results were reviewed in 72 patients who underwent primary LDLT using right liver grafts. There was a 6% incidence of hepatic arterial bifurcations that might provide multiple orifices in a right liver graft. Only one right liver graft (1%) had multiple arterial orifices. Single arterial anastomosis without interposition was possible in all patients with right liver grafts and none of them were complicated with hepatic arterial thrombosis. Single arterial anastomosis, therefore, has a high probability of success in right liver graft implantation.
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Affiliation(s)
- Yoji Kishi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Nagase T, Sanai Y, Nakamura S, Asato H, Harii K, Osumi N. Roles of HNK-1 carbohydrate epitope and its synthetic glucuronyltransferase genes on migration of rat neural crest cells. J Anat 2003; 203:77-88. [PMID: 12892407 PMCID: PMC1571138 DOI: 10.1046/j.1469-7580.2003.00205.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
HNK-1 carbohydrate epitope is localized on the surface of avian neural crest cells (NCCs), and is necessary for their migration. However, it is still disputed whether the epitope works in similar ways in mammalian embryos. In this study, we found that HNK-1 carbohydrate epitope was specifically detected in some of the cranial ganglia, migrating trunk NCCs and some non-NCC derivatives in the rat embryo. Two genes encoding glucuronyltransferases that synthesize the HNK-1 epitope in vitro (GlcAT-P and GlcAT-D) were recently identified in the rat. Interestingly, the NCCs in the cranial ganglia expressed the GlcAT-D gene, whereas the migrating trunk NCCs expressed the GlcAT-P gene. To investigate in vivo functions of the GlcATs in the NCC migration further, we overexpressed GlcAT genes by electroporation in the cranial NCCs in cultured rat embryos. Transfection of both GlcAT genes resulted in efficient synthesis of the HNK-1 epitope in the NCCs. GlcAT-P overexpression increased distance of cranial NCC migration, whereas GlcAT-D overexpression did not show this effect. Our data suggest that the HNK-1 epitope synthesized by different GlcATs is involved in migration in the sublineages of the NCCs in the rat embryo, and that GlcAT-P and GlcAT-D mediate different effects on the NCC migration.
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Affiliation(s)
- Takashi Nagase
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of TokyoTokyo, Japan
- Division of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and PsychiatryTokyo, Japan
| | - Yutaka Sanai
- Department of Biochemical Cell Research, Tokyo Metropolitan Institute of Medical Science (RINSHOKEN)Tokyo, Japan
| | - Shun Nakamura
- Division of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and PsychiatryTokyo, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of TokyoTokyo, Japan
| | - Kiyonori Harii
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of TokyoTokyo, Japan
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin UniversityTokyo, Japan
| | - Noriko Osumi
- Division of Developmental Neuroscience, Tohoku University Graduate School of MedicineSendai, Japan
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