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Kusumoto J, Akashi M, Terashi H, Sakakibara S. Differential Photosensitivity of Fibroblasts Obtained from Normal Skin and Hypertrophic Scar Tissues. Int J Mol Sci 2024; 25:2126. [PMID: 38396801 PMCID: PMC10889571 DOI: 10.3390/ijms25042126] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
It is unclear whether normal human skin tissue or abnormal scarring are photoreceptive. Therefore, this study investigated photosensitivity in normal skin tissue and hypertrophic scars. The expression of opsins, which are photoreceptor proteins, in normal dermal fibroblasts (NDFs) and hypertrophic scar fibroblasts (HSFs) was examined. After exposure to blue light (BL), changes in the expression levels of αSMA and clock-related genes, specifically PER2 and BMAL1, were examined in both fibroblast types. Opsins were expressed in both fibroblast types, with OPN3 exhibiting the highest expression levels. After peripheral circadian rhythm disruption, BL induced rhythm formation in NDFs. In contrast, although HSFs showed changes in clock-related gene expression levels, no distinct rhythm formation was observed. The expression level of αSMA was significantly higher in HSFs and decreased to the same level as that in NDFs upon BL exposure. When OPN3 knocked-down HSFs were exposed to BL, the reduction in αSMA expression was inhibited. This study showed that BL exposure directly triggers peripheral circadian synchronization in NDFs but not in HSFs. OPN3-mediated BL exposure inhibited HSFs. Although the current results did not elucidate the relationship between peripheral circadian rhythms and hypertrophic scars, they show that BL can be applied for the prevention and treatment of hypertrophic scars and keloids.
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Affiliation(s)
- Junya Kusumoto
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (H.T.); (S.S.)
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (H.T.); (S.S.)
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (H.T.); (S.S.)
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2
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Kitano D, Hashikawa K, Furukawa T, Nomura T, Tamagawa K, Sakakibara S, Nibu KI, Terashi H. Salvage surgery for mesenteric lymph node metastasis by resection of the first jejunal flap and reconstruction with the second jejunal flap. J Surg Case Rep 2023; 2023:rjad686. [PMID: 38163056 PMCID: PMC10755089 DOI: 10.1093/jscr/rjad686] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
We report a case of a second free jejunal transfer to treat metastasis in the mesenteric lymph node of the first jejunal flap. A 73-year-old man underwent total pharyngolaryngectomy, bilateral neck dissection, and free jejunal transfer for recurrent hypopharyngeal cancer [left pyriform sinus, pT2N0, moderately differentiated squamous cell carcinoma (SCC)] after radiotherapy. Seven years post-surgery, he underwent transoral videolaryngoscopic surgery for oropharyngeal cancer (soft palate, pT1N0, well-differentiated SCC). Ten years after the first jejunal transfer, metastasis was found in the mesenteric lymph node surrounding the jejunal flap's vascular pedicle. Under general anesthesia, resection of the first jejunum including the affected lymph node, and second jejunal transfer were performed. Lymph node pathological examination revealed poorly differentiated SCC, compatible with pharyngeal cancer metastasis. After neck dissection and jejunal flap transfer, lymphatic collateral pathways toward the flap's mesenteric lymph node might form. Possibly, hypopharyngeal or oropharyngeal cancer metastasized via this pathway.
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Affiliation(s)
- Daiki Kitano
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadashi Nomura
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kotaro Tamagawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Fujii M, Yamada A, Yamawaki K, Tsuda S, Miyamoto N, Gan K, Terashi H. Predictive Factors for Limb Salvage and Foot Ulcer Recurrence in Patients with Chronic Limb-Threatening Ischemia After Multidisciplinary Team Treatment: A 6-Year Japanese Single-Center Study. INT J LOW EXTR WOUND 2023; 22:722-732. [PMID: 34498990 DOI: 10.1177/15347346211041429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/22/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, P = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, P = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, P = .0411) were significantly associated with wound recurrence (P < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.
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Affiliation(s)
- Miki Fujii
- Juntendo University, Graduate school of Medicine, Division of Regenerative medicine, School of Medicine, Department of Plastic and Reconstructive Surgery
| | | | | | | | | | - Kunio Gan
- Kitaharima Medical Center, Ono, Japan
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Maruguchi H, Nomura T, Takeda R, Sakakibara S, Terashi H. A Clinical Study of Histopathological and Clinical Image Changes After Sclerotherapy of Lip Venous Malformations. J Craniofac Surg 2023; 34:2410-2412. [PMID: 37534675 DOI: 10.1097/scs.0000000000009563] [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: 10/05/2022] [Accepted: 05/24/2023] [Indexed: 08/04/2023] Open
Abstract
Venous malformations (VMs) are histopathologically benign but can greatly impair patients' quality of life. Screlothprapy is known to be effective in improving symptoms without a scar, but surgical resection of residual lesions is sometimes necessary due to inadequate reduction. However, there is no consensus on what criteria should be used to consider switching to surgical treatment, and individualized decisions must be made for each case. To investigate the factors that contribute to the lack of efficacy of sclerotherapy in reducing lesions and how to predict this, the authors performed a retrospective clinical imaging and histopathological study of 6 cases of labial vein malformations treated with sclerotherapy and 3 cases without sclerotherapy. Clinical image investigations are based on magnetic resonance imaging before and after sclerotherapy. The authors found a significant decrease in the percentage of cystic components in the total lesion of VMs after sclerotherapy. Histopathological investigations are based on resected VMs with or without sclerotherapy. Elastica van Gieson stains suggested a significant increase in fibrotic tissue inside VMs treated with sclerotherapy compared with those without. In conclusion, magnetic resonance imaging signal changes inside the VMs after sclerotherapy was observed, and it may reflect fibrosis of the tissue. These changes in the VMs after sclerotherapy may reduce the effect of sclerotherapy on tissue reduction should be considered.
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Affiliation(s)
- Hayato Maruguchi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Maeshige N, Uemura M, Hirasawa Y, Yoshikawa Y, Moriguchi M, Kawabe N, Fujii M, Terashi H, Fujino H. Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus. INT J LOW EXTR WOUND 2023; 22:548-554. [PMID: 34255569 DOI: 10.1177/15347346211031318] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching (P < .05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot (P < .01), and these also decreased significantly in the total plantar surface (P < .05). The duration of foot-flat decreased after stretching (P < .05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.
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Affiliation(s)
- Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- Faculty of Health Science, Department of Rehabilitation, Kansai University of Welfare Sciences, Osaka, Japan
| | - Yoshikazu Hirasawa
- Department of Rehabilitation, Kansai Electric Power Hospital, Osaka, Japan
| | - Yoshiyuki Yoshikawa
- Faculty of Health Sciences, Department of Rehabilitation, Naragakuen University, Nara, Japan
| | - Maiki Moriguchi
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Nobuhide Kawabe
- Faculty of Makuhari Human Care, Tohto University, Chiba, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
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Yoshikawa Y, Maeshige N, Yamaguchi A, Uemura M, Hiramatsu T, Tsuji Y, Terashi H. Association between Patients' Body Mass Index and the Effect of Monophasic Pulsed Microcurrent Stimulation on Pressure Injury Healing. Biomedicines 2023; 11:2379. [PMID: 37760820 PMCID: PMC10526075 DOI: 10.3390/biomedicines11092379] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
This secondary analysis study aimed to detect individual variables that influence the efficacy of monophasic pulsed microcurrent on pressure injury healing. Eleven patients with pressure injuries showing delayed healing underwent a microcurrent stimulation period and a placebo period. We analyzed the correlation between the individual variables and the following three outcomes using monophasic pulsed microcurrent: the wound reduction rate in the electrical stimulation period, the reduction rate in the placebo period, and the difference between these two reduction rates. Furthermore, the patients were divided into two groups, one with a wound reduction rate of more than 10% and the other with less than 10%, and the relationship between each variable was compared. As a result, the wound reduction rate in the electrical stimulation period and the difference in the reduction rate between the two periods showed significant positive correlations with patients' body mass index. In addition, a significant difference was observed in the body mass index between subjects with a reduction rate of 10% or higher and those with a reduction rate of less than 10%. This study found a correlation between the effect of monophasic pulsed microcurrent for pressure injury healing and the level of patients' body mass index.
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Affiliation(s)
- Yoshiyuki Yoshikawa
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara 631-0003, Japan
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Kobe 654-0142, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Kobe 654-0142, Japan
| | - Atomu Yamaguchi
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Kobe 654-0142, Japan
| | - Mikiko Uemura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Kobe 654-0142, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Kansai University of Welfare Sciences, Kashiwara 582-0026, Japan
| | | | - Yoriko Tsuji
- Unit of Podiatric Medicine, Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Maeshige N, Hayashi H, Kawabe N, Imaoka S, Sakaki S, Matsumoto J, Kondo E, Ishii T, Kiyota N, Furukawa M, Terashi H, Sonoda Y. Effect of Early Rehabilitation on Walking Independence and Health-Related Quality of Life in Patients With Chronic Foot Wounds: A Multicenter Randomized Clinical Trial. INT J LOW EXTR WOUND 2023:15347346231187178. [PMID: 37448201 DOI: 10.1177/15347346231187178] [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: 07/15/2023]
Abstract
Rehabilitation is usually provided to patients with chronic foot wounds (CFWs) after surgery. This study aimed to assess whether early postoperative rehabilitation could maintain walking independence in hospitalized patients with CFWs. This single-blind, randomized clinical trial was performed between September 10, 2018 and March 2019, involving 60 patients who underwent both surgical procedures and rehabilitation. Participants were randomly allocated into the early rehabilitation (EG, n = 30) or the control (CG, n = 30) groups. EG received early rehabilitation immediately after surgery, while CG received late rehabilitation after wound closure. Both groups received rehabilitation sessions 5 times per week until discharge. The primary outcome was walking independence, measured via Functional Independence Measure (FIM)-gait scores. Secondary outcomes included health-related quality of life (HRQoL) using EuroQol 5 dimensions 5-level (EQ-5D-5L) and the presence of rehabilitation-related adverse events, including dehiscence of wounds and falls. Differences in intervention timing effects were analyzed using nonparametric split-plot factorial design analysis, including Fisher's exact test, Mann-Whitney U test, and Wilcoxon signed-rank test (P < .05). Out of the 60 participants, 53 patients completed the discharge follow up. Three participants (10.0%) from the EG and 4 (13.3%) from the CG dropped out due to postoperative complications unrelated to rehabilitation intervention. No rehabilitation-related adverse events were found. Participants in the EG maintained greater FIM-gait scores during hospitalization than the CG (difference, -1; P = .0001), with a difference of 0 (P = .109) at discharge. EQ-5D-5L significantly improved in both groups (EG: difference, 0.13 [P = .014], CG: difference, 0.17 [P = .0074]). The EG intervention was associated more with maintaining walking independence at discharge than CG intervention. Postoperative rehabilitation improved HRQoL without adverse events, indicating that clinicians should recommend early rehabilitation for patients with CFW to enhance walking independence.
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Affiliation(s)
- Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Hisae Hayashi
- Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Aichi, Japan
| | - Nobuhide Kawabe
- Faculty of Makuhari Human Care, Tohto University, Makuhari, Chiba, Japan
| | - Shinsuke Imaoka
- Department of Rehabilitation, Oita Oka Hospital, Oita, Oita, Japan
| | - Satoko Sakaki
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Saitama, Japan
| | - Junichi Matsumoto
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Saitama, Japan
| | - Eriko Kondo
- Department of Rehabilitation Medicine, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tatsuya Ishii
- Department of Rehabilitation Medicine, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Naruaki Kiyota
- Department of Rehabilitation Medicine, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | | | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuma Sonoda
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
- Advanced Research Center for Well-being, Kobe University, Kobe, Hyogo, Japan
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Kitagawa H, Sugimoto I, Bito T, Yamanaka K, Terashi H. Partial Excision and Ablative Carbon Dioxide Fractional Laser Therapy for Multiple Apocrine Hidrocystomas on the Periorbital Regions and Cheeks. Case Rep Dermatol Med 2023; 2023:6318220. [PMID: 37470046 PMCID: PMC10353895 DOI: 10.1155/2023/6318220] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
A 51-year-old Japanese woman presented with translucent papules on the periorbital area and cheeks that had progressively enlarged over five years. She underwent a skin biopsy and was diagnosed with multiple apocrine hidrocystomas. Her lesions became more pronounced and obscured her vision when her body warmed up, such as during bathing. To alleviate her symptoms, we began treatment by partially resecting the tumors on the lower eyelids. After surgery, her vision was no longer obscured. Approximately 1.5 years later, she underwent ablative 10,600 nm carbon dioxide fractional laser therapy for the mildly enlarged apocrine hidrocystomas on her lower eyelids and cheeks. At roughly six months of follow-up, the symptoms had improved, and the cosmetic results were satisfactory, although minor scarring and hypopigmentation were still evident. These case findings underscore the effectiveness of ablative carbon dioxide fractional lasers in treating apocrine hidrocystomas.
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Affiliation(s)
- Hiroshi Kitagawa
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie 514-8507, Japan
- Department of Plastic and Aesthetic Surgery, Kobe University, Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Isao Sugimoto
- Department of Aesthetic and Plastic Surgery, Sugimoto Aesthetic and Plastic Surgery Clinic, 5-4-10 Kotonocho, Chuo-ku, Kobe, Hyogo 651-0094, Japan
| | - Toshinori Bito
- Department of Dermatology, Bito Dermatology Clinic, City-Plaza F3, 4-1-4 Asahi-Dori, Chuo-ku, Kobe, Hyogo 651-0095, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Hiroto Terashi
- Department of Plastic and Aesthetic Surgery, Kobe University, Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
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Ueda M, Hirayama Y, Ogawa H, Nomura T, Terashi H, Sakakibara S. Vasodilating Effects of Antispasmodic Agents and Their Cytotoxicity in Vascular Smooth Muscle Cells and Endothelial Cells-Potential Application in Microsurgery. Int J Mol Sci 2023; 24:10850. [PMID: 37446027 DOI: 10.3390/ijms241310850] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to elucidate the vasodilatory effects and cytotoxicity of various vasodilators used as antispasmodic agents during microsurgical anastomosis. Rat smooth muscle cells (RSMCs) and human coronary artery endothelial cells (HCAECs) were used to investigate the physiological concentrations and cytotoxicity of various vasodilators (lidocaine, papaverine, nitroglycerin, phentolamine, and orciprenaline). Using a wire myograph system, we determined the vasodilatory effects of each drug in rat abdominal aortic sections at the concentration resulting in maximal vasodilation as well as at the surrounding concentrations 10 min after administration. Maximal vasodilation effect 10 min after administration was achieved at the following concentrations: lidocaine, 35 mM; papaverine, 0.18 mM; nitroglycerin, 0.022 mM; phentolamine, 0.11 mM; olprinone, 0.004 mM. The IC50 for lidocaine, papaverine, and nitroglycerin was measured in rat abdominal aortic sections, as well as in RSMCs after 30 min and in HCAECs after 10 min. Phentolamine and olprinone showed no cytotoxicity towards RSMCs or HCAECs. The concentrations of the various drugs required to achieve vasodilation were lower than the reported clinical concentrations. Lidocaine, papaverine, and nitroglycerin showed cytotoxicity, even at lower concentrations than those reported clinically. Phentolamine and olprinone show antispasmodic effects without cytotoxicity, making them useful candidates for local administration as antispasmodics.
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Affiliation(s)
- Misato Ueda
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yasuki Hirayama
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Haruo Ogawa
- Hyogo Prefectural Harima-Himeji General Medical Centre, Himeji 670-8560, Japan
| | - Tadashi Nomura
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroto Terashi
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Shunsuke Sakakibara
- Department of Plastic and Aesthetic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Murai N, Koyanagi-Aoi M, Terashi H, Aoi T. Re-generation of cytotoxic γδT cells with distinctive signatures from human γδT-derived iPSCs. Stem Cell Reports 2023; 18:853-868. [PMID: 36963392 PMCID: PMC10147660 DOI: 10.1016/j.stemcr.2023.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/26/2023] Open
Abstract
For a long time, ex vivo-expanded peripheral-blood-derived γδT cell (PBγδT)-based immunotherapy has been attractive, and clinical trials have been undertaken. However, the difficulty in expanding cytotoxic γδT cells to an adequate number has been a major limitation to the efficacy of treatment in most cases. We successfully re-generated γδT cells from γδT cell-derived human induced pluripotent stem cells (iPSCs). The iPSC-derived γδT cells (iγδTs) killed several cancer types in a major histocompatibility complex (MHC)-unrestricted manner. Single-cell RNA sequencing (scRNA-seq) revealed that the iγδTs were identical to a minor subset of PBγδTs. Compared with a major subset of PBγδTs, the iγδTs showed a distinctive gene expression pattern: lower CD2, CD5, and antigen-presenting genes; higher CD7, KIT, and natural killer (NK) cell markers. The iγδTs expressed granzyme B and perforin but not interferon gamma (IFNγ). Our data provide a new source for γδT cell-based immunotherapy without quantitative limitation.
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Affiliation(s)
- Nobuyuki Murai
- Division of Stem Cell Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan; Division of Advanced Medical Science, Graduate School of Science, Technology and Innovation, Kobe University, Kobe, Hyogo, Japan; Division of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Michiyo Koyanagi-Aoi
- Division of Stem Cell Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan; Division of Advanced Medical Science, Graduate School of Science, Technology and Innovation, Kobe University, Kobe, Hyogo, Japan; Center for Human Resource Development for Regenerative Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Division of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Takashi Aoi
- Division of Stem Cell Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan; Division of Advanced Medical Science, Graduate School of Science, Technology and Innovation, Kobe University, Kobe, Hyogo, Japan; Center for Human Resource Development for Regenerative Medicine, Kobe University Hospital, Kobe, Hyogo, Japan.
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11
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Sonoda Y, Maeshige N, Uemura M, Imaoka S, Kawabe N, Hayashi H, Fujii M, Tsuji Y, Furukawa M, Kohzuki M, Terashi H. Effect of Partial Foot Amputation Level on Gait Independence in Patients With Chronic Lower Extremity Wounds: A Retrospective Analysis of a Japanese Multicenter Database. INT J LOW EXTR WOUND 2023:15347346231158864. [PMID: 36814399 DOI: 10.1177/15347346231158864] [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: 02/24/2023]
Abstract
Partial foot amputation (PFA) is generally planned to minimize the amputation level; nonetheless, the effect of PFA levels on gait independence in amputees remains unclear. This study aimed to investigate the impact of PFA levels of the forefoot on gait independence in patients with chronic lower extremity (LE) wounds. This multicenter retrospective cohort study included 232 hospitalized Japanese patients treated and rehabilitated for chronic LE wounds. A multivariate analysis based on PFA levels was conducted for gait independence at discharge, with age and comorbidities as independent variables. Patients with Lisfranc amputation had significantly less independent gait than patients with more distal amputation and those without amputation (<22% vs >40%; P = .027; Fisher's exact test). Logistic regression analysis revealed that Lisfranc amputation (odds ratio [OR]: 0.257, P = .047), age (OR: 0.559, P = .043), and chronic limb-threatening ischemia (OR: 0.450, P = .010) were independent factors associated with gait independence. Additionally, the regression model confirmed discrimination performance using the C index (0.691, P < .001) with receiver operating characteristic analysis. In patients with chronic LE wounds undergoing PFA, Lisfranc amputation was negatively associated with gait independence.
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Affiliation(s)
- Yuma Sonoda
- Advanced Research Center for Well-being, 12885Kobe University, Kobe, Hyogo, Japan
| | - Noriaki Maeshige
- 91723Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Mikiko Uemura
- 91723Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
- 38082Faculty of Health Science, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Shinsuke Imaoka
- 38411Department of Rehabilitation, Oita Oka Hospital, Oita, Oita, Japan
| | - Nobuhide Kawabe
- 13101Faculty of Makuhari Human Care, Tohto University, Makuhari, Chiba, Japan
| | - Hisae Hayashi
- 38291Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Aichi, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoriko Tsuji
- Unit of Podiatric Medicine, 38303Kobe University Graduate School of Medicine, Department of Plastic Surgery, Kobe, Hyogo, Japan
| | | | - Masahiro Kohzuki
- 13302Department of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Yamagata, Japan
| | - Hiroto Terashi
- 38303Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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12
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Maeshige N, Moriguchi M, Fujii M, Kanazawa H, Yoshikawa Y, Kitamura K, Okuno F, Yamaguchi A, Uemura M, Hosomi M, Hara K, Terashi H, Fujino H. Acute Effects of Combination Therapy by Triceps Surae Stretching and Electrical Stimulation to the Tibialis Anterior on Medial Forefoot Plantar Pressure During Gait in Patients With Diabetes Mellitus. INT J LOW EXTR WOUND 2023:15347346221148456. [PMID: 36594523 DOI: 10.1177/15347346221148456] [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: 01/04/2023]
Abstract
High plantar flexor moment and limited ankle mobility are known to cause high plantar pressure under the forefoot. Stretching is an effective physical therapy for the limited ankle range of motion (ROM), and electrical stimulation is used to regulate the activity of antagonistic muscle via the action of reciprocal inhibition. Additionally, stretching paired with electrical stimulation has been reported to improve the limited ROM significantly. This study aims to investigate the influences of stretching on triceps surae (STR), electrical stimulation to tibialis anterior (ES), and the combination (ES+STR) on the ROM, kinematic parameters, and plantar pressure distribution during gait in patients with diabetes mellitus. Planter pressure and other parameters were measured before and after the intervention of ES, STR, ES+STR, or the rest sitting on the bed (CON) for 10 min. Pressure time integral under the medial forefoot decreased in the ES+STR compared to CON (P< .05). Interestingly, ES+STR increased passive and dynamic ROM on ankle dorsiflexion during gait and increased the lateral center of pressure excursion (P < .05). Furthermore, these changes were followed by decreased contact duration under the medial forefoot (P < .05). The combined therapy improves ankle mobility during gait and reduces the contact duration and the plantar pressure under the medial forefoot in patients with diabetes mellitus.
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Affiliation(s)
- Noriaki Maeshige
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Maiki Moriguchi
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hoshinori Kanazawa
- Graduate School of Information Science and Technology, 13143The University of Tokyo, Tokyo, Japan
| | - Yoshiyuki Yoshikawa
- Department of Rehabilitation, Faculty of Health Sciences, 12968Naragakuen University, Nara, Japan
| | | | - Fumiya Okuno
- Department of Rehabilitation, Eikokai Ono Hospital, Ono, Japan
| | - Atomu Yamaguchi
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
| | | | - Kenta Hara
- 36719Kita-Harima Medical Center, Ono, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, 12885Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, 12885Kobe University Graduate School of Health Sciences, Kobe, Japan
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13
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Masaoka K, Tokuhara S, Tsuchiya K, Komatsu Y, Sakakibara S, Nomura T, Terashi H. Palliative Free Flap Surgery for Plantar Sarcoma: A Case Report and Literature Review. Cureus 2022; 14:e30488. [PMID: 36415386 PMCID: PMC9674429 DOI: 10.7759/cureus.30488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
We report a case of palliative surgery in a 73-year-old patient with metastatic plantar sarcoma. The patient underwent resection and irradiation of an undifferentiated spindle cell sarcoma in the right plantar region. The wound was not closed and systemic metastases were observed. The chief complaint of the patient on his first visit to our department was difficulty walking due to pain in the right plantar region. Since we were unsuccessful in relieving the pain with conservative treatment, we decided to perform a palliative free tissue transfer to the right plantar. The surgery was successful, the skin ulcer healed, and the pain was relieved after the surgery. When performing palliative surgery, more detailed preoperative management and planning are necessary to achieve a successful outcome. The selection of the flaps according to the local lesion and metastatic lesions and changes in the local hemodynamics should be considered when planning.
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14
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Osaki T, Hasegawa Y, Tamura R, Fukui T, Oe K, Niikura T, Nomura T, Hashikawa K, Terashi H. Combined treatment using cross-leg free flap and the Masquelet technique: a report of two cases. Case Reports Plast Surg Hand Surg 2022; 9:99-104. [PMID: 35402656 PMCID: PMC8986292 DOI: 10.1080/23320885.2022.2039667] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We introduce a treatment that combines the cross-leg free flap with the Masquelet technique and describe two cases using this method for bone and soft tissue reconstruction. Both patients were successfully treated and ambulatory. This novel method can be safely performed using the delay technique, indocyanine-green angiography and near-infrared spectroscopy.
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Affiliation(s)
- Takeo Osaki
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuko Hasegawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Tamura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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15
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Yoshikawa Y, Maeshige N, Uemura M, Tanaka M, Kawabe N, Yamaguchi A, Fujino H, Terashi H. Prediction of callus and ulcer development in patients with diabetic peripheral neuropathy by isosceles triangle-forming tuning fork. SAGE Open Med 2022; 10:20503121221085097. [PMID: 35310932 PMCID: PMC8928360 DOI: 10.1177/20503121221085097] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/15/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Tuning fork vibration sensation testing is widely used as a diagnostic test to detect diabetic neuropathy. However, evidence-based literature indicates that reliability between examiners is low. Attaching isosceles triangle diagrams on tuning forks lowers the discrepancy between examiners. This study aimed to analyze the relationship between vibration sensation measurement using an improved tuning fork and the presence of callus and wound development in patients with diabetic peripheral neuropathy. Methods: Participants included 56 general older adults and 52 patients with diabetic peripheral neuropathy. The methods included confirmation of the presence or absence of callus, range of motion of the ankle and the first metatarsophalangeal joint, vibratory sensitivity of the medial malleolus and the dorsal aspect of the first distal phalanx using an improved tuning fork, and touch-pressure sensitivity of the plantar aspect of the hallux. Patients with diabetic peripheral neuropathy were followed up for 3 years to check for the presence or absence of wounds. Results: When compared with the general older adults, the patients with diabetic peripheral neuropathy had significantly lower touch-pressure sensitivity (p < 0.01), vibratory sensitivity at the distal phalanx (p < 0.01) and medial malleolus (p < 0.01), ankle dorsiflexion range of motion (p < 0.01), and metatarsophalangeal joint extension range of motion (p < 0.01). The area under the receiver operating characteristic curve with callus formation was 0.93 for the medial malleolus and 0.96 for the distal phalanx, indicating that the accuracy of the distal phalanx was higher (p < 0.01) than the medial malleolus. According to the Cox proportional hazard analysis, the vibratory sensitivity of the distal phalanx was a significant risk factor for ulcer development (p < 0.05). Conclusion: These findings suggest that the vibration sensation test, which we improved via the technique described in this study, is useful for predicting the occurrence of callus and ulcer.
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Affiliation(s)
- Yoshiyuki Yoshikawa
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- Department of Rehabilitation, Faculty of Health Science, Kansai University of Welfare Sciences, Osaka, Japan
| | - Masayuki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences, Okayama Healthcare Professional University, Okayama, Japan
| | - Nobuhide Kawabe
- Faculty of Makuhari Human Care, Tohto University, Chiba, Japan
| | - Atomu Yamaguchi
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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16
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Sakai A, Hashikawa K, Sakakibara A, Murai N, Nomura T, Akashi M, Terashi H. A Case of a Rare Branching Pattern in the Carotid Artery. Eplasty 2022; 22:ic1. [PMID: 35602519 PMCID: PMC9097898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ayumi Sakai
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine
| | - Kazunobu Hashikawa
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine
| | - Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine
| | - Nobuyuki Murai
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine
| | - Tadashi Nomura
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine
| | - Hiroto Terashi
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine
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17
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Kitano D, Matsuo J, Sakakibara S, Oomura A, Osaki T, Okada K, Terashi H. Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection. Cureus 2021; 13:e18086. [PMID: 34692301 PMCID: PMC8523244 DOI: 10.7759/cureus.18086] [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] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Extra-anatomical bypass grafting is a surgical method used to remove an infected aortic graft and promote revascularization with a new graft in the non-infected area. Here, we report a case of intractable post-sternotomy mediastinitis (PSM) with aortic graft infection which was treated with extra-anatomical bypass grafting. A 56-year-old woman with a history of multiple aortic dissection and prosthetic graft replacement in the thoracoabdominal area developed PSM with aortic arch graft infection. Bacterial culture of the exposed prosthetic graft tissue yielded multidrug-resistant Pseudomonas aeruginosa. Meticulous debridement of the wound and management by negative pressure wound therapy with continuous irrigation was performed. However, the infection of the prosthetic graft could not be controlled. Extra-anatomical bypass was performed between the left common carotid artery and right subclavian artery via the right common carotid artery. Then, the infected graft was removed. After the resolution of infection, the mediastinal wound was reconstructed with a pedicled latissimus dorsi myocutaneous flap, which was harvested from the right dorsum. No recurrence of infection occurred in the nine-month follow-up period. Debridement and removal of exposed artificial graft are considered the gold standard for treating wound infection. In situ replacement of infected aortic grafts carries a risk of re-infection due to residual bacterial contamination of the periprosthetic tissue. Extra-anatomical bypass would be a useful option for reducing the risk of re-infection in patients with intractable PSM and prosthetic aortic graft infection. Further studies are warranted to evaluate the risks and benefits of this operative method.
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Affiliation(s)
| | - Jiro Matsuo
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Atsushi Oomura
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Takeo Osaki
- Plastic Surgery, Hyogo Cancer Center, Akashi, JPN
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
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18
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Matsuda T, Ohura N, Mineta K, Ho M, Kaku I, Ishii K, Inoue M, Ichioka S, Tanaka R, Kawamoto A, Terashi H, Kishi K, Kobayashi Y. Hard-to-heal wound treatment medical devices: clinical trial protocol in Japan. J Wound Care 2021; 30:666-676. [PMID: 34382845 DOI: 10.12968/jowc.2021.30.8.666] [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: 11/11/2022]
Abstract
In consultation with academia and the Pharmaceuticals and Medical Devices Agency (PMDA), we have developed guidance for drafting protocols for clinical trials concerning medical devices for the healing of hard-to-heal wounds without ischaemia. The guidance summarises the validity of single-arm trials for hard-to-heal wounds, the definition of hard-to-heal wounds without ischaemia, methods of patient enrolment and clinical endpoints. This review focuses on the logical thinking process that was used when establishing the guidance for improving the efficiency of clinical trials concerning medical devices for hard-to-heal wounds. We particularly focused on the feasibility of conducting single-arm trials and also tried to clarify the definition of hard-to-heal wounds. If the feasibility of randomised control trials is low, conducting single-arm trials should be considered for the benefit of patients. In addition, hard-to-heal wounds were defined as meeting the following two conditions: wounds with a wound area reduction <50% at four weeks despite appropriate standards of care; and wounds which cannot be closed by a relatively simple procedure (for example, suture, skin graft and small flaps). Medical devices for hard-to-heal wound healing are classified into two types: (1) devices for promoting re-epithelialisation; and (2) devices for improving the wound bed. For medical devices for promoting re-epithelialisation, we suggest setting complete wound closure, percent wound area reduction or distance moved by the wound edge as the primary endpoint in single-arm trials for hard-to-heal wounds. For medical devices for improving the wound bed, we suggest setting the period in which wounds can be closed by secondary intention or a simple procedure, such as the primary endpoint.
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Affiliation(s)
| | - Norihiko Ohura
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Koji Mineta
- Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Mami Ho
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - I Kaku
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Kensuke Ishii
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Madoka Inoue
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Shigeru Ichioka
- Department of Plastic Surgery, Saitama Medical University, Saitama, Japan
| | - Rica Tanaka
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoko Kobayashi
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
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19
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Tamura R, Hashikawa K, Sakakibara S, Osaki T, Kitano D, Maruguchi H, Nomura T, Sugiyama D, Terashi H. Experimental study on the efficacy of a hybrid artificial nerve: The hot dog method. Int J Artif Organs 2021; 44:711-717. [PMID: 34144663 DOI: 10.1177/03913988211026000] [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: 11/15/2022]
Abstract
INTRODUCTION We hypothesized that hybrid artificial nerves might overcome the limitations of a nerve conduit by isolating nerve fascicles from autologous nerves. Nerve sacrifice during harvest, a drawback of conventional autologous nerve transplantation, may be reduced by the hot dog method. The hot dog method (based on the morphology of hybrid artificial nerves) adds nerve conduits to autologous nerve fascicles. METHODS Forty-eight rats with a 10-mm sciatic nerve defect were divided into six groups (n = 8 per group) according to the neural reconstruction method: autologous nerve transplantation, the hot dog method, nerve conduit, nerve fascicle transplantation, sham control, and nerve fascicle isolation were classified as Groups I, II, III, IV, V, and VI, respectively. The sciatic nerve function was assessed in these groups, a histological evaluation was performed, and statistical analyses were conducted based on these data. RESULTS Group III (nerve conduit) and Group IV (nerve fascicle transplantation) showed the lowest functional and axonal regenerative effects, followed by Group II (hot dog method) and Group I (autologous nerve transplantation). Group VI (nerve fascicle isolation) tended to achieve better recovery in motor function and axonal regeneration than Group I (autologous nerve transplantation). CONCLUSIONS The hot dog method is simple, safe, and easy to execute. This method can serve as a new neural reconstruction method that uses artificial nerves.
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Affiliation(s)
- Ryosuke Tamura
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shunsuke Sakakibara
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeo Osaki
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Daiki Kitano
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hayato Maruguchi
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Hiroto Terashi
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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20
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Kitano D, Sakakibara S, Ishida Y, Nomura T, Terashi H. Congenital Cheek Fistula: A Rare Case of Developmental Abnormality in the Buccal Area. Cureus 2021; 13:e15657. [PMID: 34277250 PMCID: PMC8281784 DOI: 10.7759/cureus.15657] [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] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
A congenital cheek fistula is a rare malformation in the buccal area. Here, we report the case of a congenital cheek fistula in a 50-year-old woman who visited our clinic with complaints of swelling and pain in her left cheek. Physical examination revealed a small hole in the left corner of the mouth present since birth. She had no other congenital malformations in the maxillofacial region such as an accessory ear and cleft lip. Manual compression of the cheek mass induced serous discharge from the hole. Magnetic resonance imaging (MRI) showed a cystic lesion in the left cheek and a fistula within the orbicularis oris muscle that opened into the small hole. After immediate incision and drainage of the cyst, both the cyst and fistula were surgically resected. The cystic lesion was completely delineated from the boundary of the parotid gland. The orbicularis oris muscle was partially incised to remove the fistula and the surrounding scar tissue. Histopathological examination of the resected specimen revealed a cavity consisting of epithelium inside the fistula. The postoperative course was insignificant. No recurrence of the cyst was observed six months postoperatively. The operative and pathological findings demonstrated that the ectoderm-derived epithelial tissue was enclosed by the mesoderm-derived muscle tissue. The mixture of different germ layer-derived tissues suggested that the fistula was a type of congenital transverse facial cleft induced by malfusion of the mandibular and maxillary prominences during embryonic development. The differential diagnoses of the congenital cheek fistula included orocutaneous fistulas and salivary fistulas. MRI was useful in delineating the border between the lesion and the surrounding tissue.
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Affiliation(s)
- Daiki Kitano
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Yasuhisa Ishida
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
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21
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Kodama A, Takahara M, Iida O, Soga Y, Terashi H, Kawasaki D, Izumi Y, Mii S, Komori K, Azuma N. Ambulatory Status Over Time after Revascularization in Patients with Chronic Limb-Threatening Ischemia. J Atheroscler Thromb 2021; 29:866-880. [PMID: 34039832 PMCID: PMC9174083 DOI: 10.5551/jat.62892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: Maintaining functional status through revascularization is a major goal in patients with chronic limb-threatening ischemia (CLTI). Nevertheless, there is a lack of clarity on the impact of revascularization on mobility over time. This study examined ambulatory status over time after revascularization and predictors of ambulation loss in CLTI patients.
Methods: We used a clinical database established by the Surgical reconstruction versus Peripheral INtervention in pAtients with critical limb isCHemia study, a prospective, multicentre, observational study including patients with CLTI. The primary endpoint was mobility over time.
Results: Of the 381 patients, the ambulatory proportion at baseline was 71%. The proportion gradually decreased, finally reaching 40% at 36 months. In non-ambulatory patients at revasacularisation, approximately 20-40% of patients achieved ambulation. Multivariate analysis confirmed that age, impaired mobility before CLTI onset and at revascularization, renal failure on dialysis, and WIfI clinical stage 4 were positively associated with ambulation loss at either specific or all time points, whereas male sex and surgical reconstruction were inversely associated with the outcomes at specific time points.
Conclusion: Mobility in the overall population gradually decreased, whereas the number of deceased patients increased. Advanced age, impaired mobility before CLTI onset and at revascularization, renal failure on dialysis, and WIfI stage 4 were associated with ambulation loss at almost all points after revascularization.
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Affiliation(s)
- Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine
| | | | | | - Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
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22
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Ogaki T, Iida O, Hata Y, Yamauchi N, Yokoi C, Takahara M, Terashi H, Mano T, Asada Y. The perioperative and long-term fates of patients with chronic limb-threatening ischaemia who underwent secondary major amputations. Int Wound J 2021; 19:36-43. [PMID: 33998127 PMCID: PMC8684859 DOI: 10.1111/iwj.13594] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
This study investigated the perioperative and long-term fates of patients with chronic limb-threatening ischemia (CLTI) who underwent secondary major amputations. From April 2010 to December 2018, 1653 CLTI patients primarily underwent endovascular therapy (EVT). Of these patients, 138 who underwent secondary major amputations were included in this study. The primary outcome measure was the mortality. Prognostic factors associated with perioperative (30-day) and late mortality (after 30 days) were assessed. The 30-day mortality was 9.6%. Patients who died during the perioperative period had lower ejection fractions on echocardiography than those in the perioperative survivors (49.5 ± 14.9% vs 58.6 ± 12.4%, P = .018). None of the other clinical characteristics were significantly associated with perioperative death. Two-years postoperatively, 49.6%, 12.2%, and 4.3% of the patients had died, had contralateral amputations, and had additional above-knee amputations, respectively. In the alive patients who had not undergone additional amputation at 2 years, only 25.9% were ambulatory, whereas 51.7% and 22.4% were in wheelchairs and bedridden, respectively. An age ≥80 years and serum albumin <3.0 g/dL were significantly associated with late mortality (P = .032 and P = .042, respectively). In conclusion, the perioperative and long-term fates after secondary major amputation in CLTI patients who underwent EVT were considerably poor.
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Affiliation(s)
- Tomoe Ogaki
- Department of Plastic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yosuke Hata
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Natsumi Yamauchi
- Department of Plastic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Chika Yokoi
- Department of Plastic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yuji Asada
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
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Fujii M, Terashi H, Yokono K, Armstrong DG. The Degree of Blood Supply and Infection Control Needed to Treat Diabetic Chronic Limb-Threatening Ischemia with Forefoot Osteomyelitis. J Am Podiatr Med Assoc 2021; 111:464165. [PMID: 33872358 DOI: 10.7547/18-185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetic foot ulcers combined with ischemia and infection can be difficult to treat. Few studies have quantified the level of blood supply and infection control required to treat such complex diabetic foot ulcers. We aimed to propose an index for ischemia and infection control in diabetic chronic limb-threatening ischemia (CLTI) with forefoot osteomyelitis. METHODS We retrospectively evaluated 30 patients with diabetic CLTI combined with forefoot osteomyelitis who were treated surgically from January 2009 to December 2016. After 44 surgeries, we compared patient background (age, sex, hemodialysis), infection status (preoperative and 1- and 2-week postoperative C-reactive protein [CRP] levels), surgical bone margin (with or without osteomyelitis), vascular supply (skin perfusion pressure), ulcer size (wound grade 0-3 using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification), and time to wound healing between patients with healing ulcers and those with nonhealing ulcers. RESULTS Preoperative CRP levels and the ratio of ulcers classified as wound grade 3 were significantly lower and skin perfusion pressure was significantly higher in the healing group than in the nonhealing group (P < .05). No other significant differences were found between groups. CONCLUSIONS This study demonstrates that debridement should be performed first to control infection if the preoperative CRP level is greater than 40 mg/L. Skin perfusion pressure of 55 mm Hg is strongly associated with successful treatment. We believe that this research could improve the likelihood of salvaging limbs in patients with diabetes with CLTI.
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Kitano D, Osaki T, Sakakibara S, Nomura T, Hashikawa K, Terashi H. Perineal reconstruction with pedicled rectus abdominis myocutaneous flap after posterior pelvic exenteration -A 3D model study. Int J Surg Case Rep 2021; 80:105629. [PMID: 33609946 PMCID: PMC7903330 DOI: 10.1016/j.ijscr.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/25/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/20/2022] Open
Abstract
Pedicled rectus abdominis myocutaneous flap was used for pelvic reconstruction. The flap and vascular pedicle were passed through the shortest intra-pelvic path. The shortest path passed between the bladder and pelvic wall. Flap’s cranial side was assigned to the perineum and caudal side to pelvic floor. Resected area dead space was filled with subcutaneous tissues of the flap.
Introduction Limited literature exists regarding the positional relationship between the pedicled-rectus abdominis myocutaneous (p-RAMC) flap and residual pelvic organs post posterior pelvic exenteration (PPE). Presentation of case Four patients underwent PPE and reconstruction with a p-RAMC flap. After harvesting the p-RAMC flap with the deep inferior epigastric artery and veins as the vascular pedicle, the intra-pelvic shortest pathway of the flap was created. We dissected the subcutaneous tissues of the flap donor site toward the perineal defect along the inner wall of the pelvis. The pubic origin of the rectus abdominis muscle was preserved. A three-dimensional model was constructed using an image processing software. The vascular pedicle ran almost linearly along the inner wall of the pelvis. The muscle belly was placed on the pelvic floor through the posterior wall of the urinary bladder which filled the dead space of the resected area. All flaps survived without significant complications. Discussion Assigning the cranial side of the flap to the perineum and caudal side to the pelvic floor could reduce postoperative intrapelvic complications. By preserving the pubic origin of the rectus abdominis muscle, a shock absorber of the pedicle of the flap was created, preventing over-traction of the flap while passing through the intrapelvic pathway. Conclusion A p-RAMC flap via intra-pelvic shortest pathway is an ideal reconstructive method for large skin defect in perineal area after PPE.
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Affiliation(s)
- Daiki Kitano
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Takeo Osaki
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-0021, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-0021, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Ogawa H, Kusumoto J, Nomura T, Hashikawa K, Terashi H, Sakakibara S. Wire Myography for Continuous Estimation of the Optimal Concentration of Topical Lidocaine as a Vasodilator in Microsurgery. J Reconstr Microsurg 2021; 37:541-550. [PMID: 33517569 DOI: 10.1055/s-0040-1722759] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intraoperative vasospasm during reconstructive microvascular surgery is often unpredictable and may lead to devastating flap loss. Therefore, various vasodilators are used in reconstructive microsurgery to prevent and relieve vasospasm. Lidocaine is a vasodilator commonly used in microvascular surgery. Although many reports have described its in vitro and in vivo concentration-dependent vasodilatory effects, limited studies have examined the pharmacological effects of lidocaine on blood vessels in terms of persistence and titer. METHODS In this study, the vasodilatory effect of lidocaine was examined by using the wire myograph system. Abdominal aortas were harvested from female rats, sliced into rings of 1-mm thickness, and mounted in the wire myograph system. Next, 10, 5, 2, and 1% lidocaine solutions were applied to the artery, and the change in vasodilation force, persistence of the force, and time required to reach equilibrium were measured. RESULTS The vasodilatory effect was confirmed in all groups following lidocaine treatment. Although strong vasodilation was observed in the 10% lidocaine group, it was accompanied by irreversible degeneration of the artery. Vasodilation in the 1% lidocaine group was weaker than that in the other groups 500 seconds after lidocaine addition (p < 0.05). Between the 5 and 2% lidocaine groups, 5% lidocaine showed a stronger vasodilatory effect 400 to 600 seconds after lidocaine addition (p < 0.01); however, there was no significant difference in these groups after 700 seconds. Additionally, there was no difference in the time required for the relaxation force to reach equilibrium among the 5, 2, and 1% lidocaine groups. CONCLUSION Although our study confirmed the dose-dependent vasodilatory effect of lidocaine, 5% lidocaine showed the best vasodilatory effect and continuity with minimal irreversible changes in the arterial tissue.
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Affiliation(s)
- Haruo Ogawa
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Iida O, Takahara M, Soga Y, Kodama A, Terashi H, Azuma N. The Association of Preoperative Characteristics with Reintervention Risk in Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia. J Atheroscler Thromb 2021. [PMID: 32224557 DOI: 10.5551/jat.54866.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM To investigate the associations between preoperative characteristics and the risk of reintervention in patients undergoing revascularization for chronic limb-threatening ischemia (CLTI) in a contemporary real-world setting. METHODS We retrospectively analyzed data from a clinical database formed by the Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) study, which was a multicenter, prospective, observational study. The study population was composed of 520 CLTI patients with the wound, ischemia, and foot infection (WIfI) classes I-3 with resting pain or classes I-2/3 with ulcers/gangrene. Of the 520 patients, 192 had surgical reconstruction planned, whereas 328 had endovascular therapy (EVT) alone planned at the time of registration. The current analysis was conducted to explore the associations between preoperative characteristics and the risk of reintervention. RESULTS A total of 452 participants (87%) completed the 3-year follow-up regarding reintervention. The competing risk analysis estimated that the three-year cumulative incidence rates for reintervention and reintervention-free deaths were 44.0% and 28.7%, respectively. No preoperative characteristics had a significant interaction effect with EVT versus surgical reconstruction. The risk analysis identified the following independent risk factors for reintervention: 1) EVT instead of bypass reconstruction, 2) renal dysfunction, 3) history of revascularization after CLTI onset (i.e., requirement of redo revascularization for CLTI), and 4) bilateral CLTI. Patients with more than one of these risk factors had an increased risk of reintervention. CONCLUSIONS The current study identified preoperative characteristics associated with an increased risk of reintervention. No preoperative characteristics had any significant interactions with EVT or surgical reconstruction.
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Affiliation(s)
- Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | | | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Hiroto Terashi
- Kobe University Graduate School of Medicine, Department of Plastic Surgery
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
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Iijima M, Orimo S, Terashi H, Suzuki M, Hayashi A, Shimura H, Kitagawa K, Okuma Y. Effects of istradefylline for quality of life in Parkinson's disease with freezing of gait: A singlearm, open-label, prospective, multicenter study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.264] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Osaki T, Tamura R, Nomura T, Hashikawa K, Terashi H. Treatment of orbital blowout fracture using a customized rigid carrier. J Craniomaxillofac Surg 2020; 48:1052-1056. [PMID: 32988713 DOI: 10.1016/j.jcms.2020.09.002] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/15/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE This study aimed to examine the usefulness of treating orbital blowout fracture using a customized rigid carrier. MATERIAL AND METHODS Patients who underwent surgery for orbital blowout fractures in our department from April 2016 to March 2019 were recruited in the study. We molded a rigid thermoplastic material into the same shape as the reconstruction material according to the 3D model and transplanted it into the orbital space along with the reconstruction material. We assessed Hertel exophthalmometry, awareness of diplopia, and the Hess area ratio (HAR%). RESULTS We performed this procedure in 15 patients with blowout fractures. Reconstruction materials used were iliac bone, absorbable plates, and titanium mesh in 12, 2, and 1 patient, respectively. None of the patients showed a difference of more than 2 mm on Hertel exophthalmometry. Only one patient had diplopia after surgery. The average preoperative and postoperative HAR% were 83.1 and 90.6, respectively. HAR% was more than 85% in 6 of 7 postoperative cases. CONCLUSIONS This method can be applied for surgery using various reconstructive materials and can be a useful method, especially in patients with a wide range of orbital bone defects.
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Affiliation(s)
- Takeo Osaki
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Ryosuke Tamura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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29
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Takahara M, Iida O, Soga Y, Kodama A, Terashi H, Suzuki K, Sugimoto I, Azuma N. Heterogeneity of Age and Its Associated Features in Patients with Critical Limb Ischemia. Ann Vasc Dis 2020; 13:300-307. [PMID: 33384734 PMCID: PMC7751078 DOI: 10.3400/avd.oa.20-00067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 01/26/2023] Open
Abstract
Aim: Critical limb ischemia (CLI) has a wide age distribution. We aimed here to reveal age-associated clinical features in CLI patients. Materials and Methods: We analyzed 531 Japanese CLI patients referred to vascular centers. The three-year mortality risk by age was compared to that for the Japanese nationals, derived from Japan’s national life table data. Clinical characteristics associated with age in CLI patients were also explored. Results: Mean age was 73±10 years. Whereas 27.9% were aged ≥80 years, 19.2% were aged <65 years. Mortality risk was increased with age, but its risk ratio relative to the same-aged nationals was higher in younger patients. Incidence of major amputation was higher in a younger population. Receiving welfare, smoking, increased body mass index, diabetes with hemoglobin A1c ≥7.0%, non-high density lipoprotein cholesterol ≥190 mg/dL, renal failure, and the Wound, Ischemia, and foot Infection classification stage 4 were associated with younger age, whereas non-ambulation and institutionalization were associated with older age. Conclusion: Patients aged <65 years, belonging to the working-age population, reached almost one fifth of the CLI population. Younger patients had a lower mortality risk in the population, but had a higher risk ratio relative to the same-aged nationals. Socioeconomic disadvantage, poor cardiovascular risk control, and wound severity were associated with younger age.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine
| | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital
| | - Ikuo Sugimoto
- Department of Vascular Surgery, Aichi Medical University
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
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30
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Yanagi H, Terashi H, Takahashi Y, Okabe K, Tanaka K, Kimura C, Ohura N, Goto T, Hashimoto I, Noguchi M, Sasayama J, Shimada K, Sugai A, Tanba M, Nakayama T, Tsuboi R, Sugama J, Sanada H. The Japanese registry for surgery of ischial pressure ulcers: STANDARDS-I. J Wound Care 2020. [DOI: 10.12968/jowc.2020.29.sup9a.s39] [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] [Indexed: 11/11/2022]
Abstract
Objective: To clarify the surgical indications and the appropriate perioperative management of ischial pressure ulcers (PUs). Method: A two-year prospective, nationwide registry study was carried out across 26 medical institutions in Japan. All participating institutions managed ischial PUs according to the standardisation of total management and surgical application for the refractory decubitus (STANDARDS-I) perioperative protocol. Analysis was conducted on a range of clinically or statistically important variables for the achievement of primary or secondary endpoints: complete wound healing and hospital discharge at three months, and complete wound healing at one month after surgery, respectively. Results: A total of 59 patients took part in the study. All patients underwent surgery for ischial PUs during the study period. Patients who had achieved the primary endpoint had a higer preoperative functional independence measurement (FIM score), a higher ‘G’ score in the DESIGN-R scale and were more likely to have healed by primary intention. Patients who had achieved the secondary endpoint were more likely to have spastic paralysis, preoperative physiotherapy and localised infection of the wound, among other variables. Conclusion: This survey suggests that preoperative physiotherapy increases the speed of wound healing, and good granulation of the wound bed preoperatively increases the likelihood of woundless discharge from hospital, whereas the existence of comorbidities negatively influences the likelihood of woundless discharge from hospital. The study also suggests that the existence of spastic paralysis, preoperative infection of the wound, or surgical reduction of the ischial tubercle speeds up the healing of the wound. However, the wound failed to heal significantly more often in patients with increasing white blood cell count after surgery.
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Affiliation(s)
- Hideyuki Yanagi
- Kobe Academia Clinic, Hyogo, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University, Hyogo, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Katsuyuki Okabe
- Okabe Plastic Surgery and Orthopedics Clinic, Kanagawa, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Chu Kimura
- Department of Plastic Surgery, Hakodate General Central Hospital, Hokkaido, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Norihiko Ohura
- Department of Plastic Surgery, Kyorin University, Tokyo, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, Tohoku University, Miyagi, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Ichiro Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokushima University, Tokushima, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Madoka Noguchi
- Department of Nursing, Kobe University Hospital, Hyogo, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Junichi Sasayama
- Hyogo Prefectural Rehabilitation Center, Hyogo, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Kenichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University, Ishikawa, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Ayumi Sugai
- Department of Nursing, Hoshigaoka Medical Center, Osaka, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Mitsuko Tanba
- Department of Nursing, Kyorin University Hospital, Tokyo, Japan
- The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Scientific Education Committee, Japanese Society of Pressure Ulcers
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
- Scientific Education Committee, Japanese Society of Pressure Ulcers
| | - Junko Sugama
- Wellness Promotion Science Center, Kanazawa University, Ishikawa, Japan
- Scientific Committee, Japanese Society of Pressure Ulcers
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- President, Japanese Society of Pressure Ulcers
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Nomura T, Nakasone M, Okamoto T, Ejiri H, Osawa S, Hashikawa K, Terashi H. Use of dermal fat grafts for treating anetoderma with lipoatrophy following involution of hemangiomas. Pediatr Dermatol 2020; 37:776-779. [PMID: 32445219 DOI: 10.1111/pde.14207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 11/28/2022]
Abstract
Infantile hemangioma (IH) is a benign vascular tumor that gradually involutes over several years. Rapidly involuting congenital hemangioma (RICH) is the relatively rare congenital vascular tumor that is fully grown at birth and does not undergo postnatal growth and involutes during the first year. However, after involution of both IH and RICH, some have severe sequelae, such as redundant skin or conspicuous scarring, requiring additional treatment. We present the case of a 6-year-old girl with a concave deformity due to subcutaneous atrophy, skin darkening, and altered skin texture of her left zygomatic region following involution of a hemangioma. We successfully treated this patient by transferring a dermal fat graft. This technique can be beneficial for atrophic sequelae after regression of a hemangioma and is easy to perform and cosmetically effective.
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Affiliation(s)
- Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mika Nakasone
- Department of Plastic Surgery, Shinko Hospital, Kobe, Japan
| | - Takako Okamoto
- Department of Plastic Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Hirotaka Ejiri
- Department of Plastic Surgery, Joyo Ejiri Hospital, Himeji, Japan
| | - Sayuri Osawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Iida O, Takahara M, Soga Y, Kodama A, Terashi H, Azuma N. The Association of Preoperative Characteristics with Reintervention Risk in Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia. J Atheroscler Thromb 2020; 28:52-65. [PMID: 32224557 PMCID: PMC7875141 DOI: 10.5551/jat.54866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/24/2022] Open
Abstract
AIM To investigate the associations between preoperative characteristics and the risk of reintervention in patients undergoing revascularization for chronic limb-threatening ischemia (CLTI) in a contemporary real-world setting. METHODS We retrospectively analyzed data from a clinical database formed by the Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) study, which was a multicenter, prospective, observational study. The study population was composed of 520 CLTI patients with the wound, ischemia, and foot infection (WIfI) classes I-3 with resting pain or classes I-2/3 with ulcers/gangrene. Of the 520 patients, 192 had surgical reconstruction planned, whereas 328 had endovascular therapy (EVT) alone planned at the time of registration. The current analysis was conducted to explore the associations between preoperative characteristics and the risk of reintervention. RESULTS A total of 452 participants (87%) completed the 3-year follow-up regarding reintervention. The competing risk analysis estimated that the three-year cumulative incidence rates for reintervention and reintervention-free deaths were 44.0% and 28.7%, respectively. No preoperative characteristics had a significant interaction effect with EVT versus surgical reconstruction. The risk analysis identified the following independent risk factors for reintervention: 1) EVT instead of bypass reconstruction, 2) renal dysfunction, 3) history of revascularization after CLTI onset (i.e., requirement of redo revascularization for CLTI), and 4) bilateral CLTI. Patients with more than one of these risk factors had an increased risk of reintervention. CONCLUSIONS The current study identified preoperative characteristics associated with an increased risk of reintervention. No preoperative characteristics had any significant interactions with EVT or surgical reconstruction.
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Affiliation(s)
- Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | | | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Hiroto Terashi
- Kobe University Graduate School of Medicine, Department of Plastic Surgery
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
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Takahara M, Iida O, Soga Y, Kodama A, Terashi H, Utsunomiya M, Okazaki J, Azuma N, The Spinach Study Investigators. Duration from Wound Occurrence to Referral to a Vascular Center in Japanese Patients with Critical Limb Ischemia. Ann Vasc Dis 2020; 13:56-62. [PMID: 32273923 PMCID: PMC7140155 DOI: 10.3400/avd.oa.19-00102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: Clinical guidelines have long recommended referring patients with clerical limb ischemia (CLI) to a vascular specialist early in the course of their disease to plan for revascularization options. However, no data were so far available on how promptly CLI patients were referred to a vascular center in the real-world settings in Japan. This study aimed to survey the duration from wound occurrence to referral to a vascular center in CLI patients in Japan. Materials and Methods: We analyzed a database of a prospective, multicenter registry in Japan, including 428 CLI patients presenting ischemic wounds and referred to vascular centers. The duration of the wound occurrence was surveyed at registration. Results: The wound duration exceeded 1 month in 58.2% [95% confidence interval: 53.2% to 63.1%] of the patients, and 3 months (i.e., one season) in 15.9% [12.4% to 19.4%]. No clinical features were significantly associated with the wound duration. The wound duration was independently associated with the wound severity evaluated using the Wound, Ischemia, and foot Infection classification system (P=0.030). Conclusion: A substantial number of CLI patients referred to vascular centers had a long duration of wounds, i.e., time from wound occurrence to the referral.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Makoto Utsunomiya
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - Jin Okazaki
- Department of Vascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - The Spinach Study Investigators
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.,Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.,Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan.,Department of Vascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.,Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Takahara M, Iida O, Soga Y, Kodama A, Terashi H, Azuma N. Current and Past Obesity in Japanese Patients with Critical Limb Ischemia Undergoing Revascularization. J Atheroscler Thromb 2020; 28:44-51. [PMID: 32188794 PMCID: PMC7875150 DOI: 10.5551/jat.55145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/16/2022] Open
Abstract
Aim: Recent studies suggested that past history of obesity or maximum body mass index (BMI) in the past was a strong prognostic predictor in a general population. The current study aimed to survey the distribution of current and maximum BMIs and to investigate their prognostic impact in patients with critical limb ischemia (CLI), whose prognosis was poor even after revascularization. Methods: We analyzed a database of a prospective, multicenter registry in Japan, including 499 CLI patients undergoing revascularization. Their current and maximum BMIs were surveyed at registration. The distribution and the impact on the prognosis were explored. Results: The estimated means (95% confidence intervals) of current and maximum BMIs were respectively 22.0 (21.7 to 22.3) and 25.3 (24.8 to 25.8) kg/m2; the difference was 3.3 (2.9 to 3.7) kg/m2. The prevalence of current obesity (BMI ≥ 25 kg/m2) was 18% (15% to 22%), whereas 48% (43% to 53%) had ever been obese (maximum BMI ≥ 25 kg/m2). Past obesity was not rare even in currently lean subjects (BMI < 18.5 kg/m2), with the prevalence of 18% (7% to 29%). Current BMI, but not maximum BMI, was associated with the mortality risk; the adjusted hazard ratios per 5 kg/m2 increase were 0.61 [0.46, 0.81] (P = 0.001) and 1.07 [0.87, 1.31] (P = 0.55), respectively. Conclusion: The prevalence of current obesity was as low as 18% (15% to 22%) in Japanese CLI patients undergoing revascularization, whereas about a half were formerly obese. Maximum BMI was not independently associated with the mortality risk in the population.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
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Kusumoto J, Takeo M, Hashikawa K, Komori T, Tsuji T, Terashi H, Sakakibara S. OPN4 belongs to the photosensitive system of the human skin. Genes Cells 2020; 25:215-225. [DOI: 10.1111/gtc.12751] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Junya Kusumoto
- Department of Plastic Surgery Kobe University Graduate School of Medicine Kobe Japan
- Department of Oral and Maxillofacial Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Makoto Takeo
- Laboratory for Organ Regeneration RIKEN Center for Biosystems Dynamics Research Kobe Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Takashi Tsuji
- Laboratory for Organ Regeneration RIKEN Center for Biosystems Dynamics Research Kobe Japan
| | - Hiroto Terashi
- Department of Plastic Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery Kobe University Graduate School of Medicine Kobe Japan
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Azuma N, Takahara M, Kodama A, Soga Y, Terashi H, Tazaki J, Yamaoka T, Koya A, Iida O. Predictive Model for Mortality Risk Including the Wound, Ischemia, Foot Infection Classification in Patients Undergoing Revascularization for Critical Limb Ischemia. Circ Cardiovasc Interv 2019; 12:e008015. [DOI: 10.1161/circinterventions.119.008015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background:
The aim of this study was to develop a predictive model for mortality risk based on preoperative risk factors, including the Wound, Ischemia, Foot Infection (WIfI) classification, in patients undergoing revascularization for critical limb ischemia.
Methods:
We analyzed a database of the Surgical reconstruction versus Peripheral Intervention in Patients With Critical Limb Ischemia registry, a multicenter, prospective, observational study that included 520 critical limb ischemia patients (192 surgical and 328 endovascular patients).
Results:
Multivariate Cox regression analysis identified old age, impaired mobility, low body mass index, renal failure, heart failure, and high WIfI grade as independent risk factors for all-cause mortality (all
P
<0.05). The risk score comprising these risk factors discriminated the mortality risk well; the 2-year survival rate was >90% in the first quantile of the risk score and ≈20% in the fifth quantile. The area under the time-dependent receiver operating characteristics curve was 0.829 for thirty-day mortality and 0.811 for 2-year mortality. Adding more detailed preoperative information to the predictive model revealed that cystatin C-based estimated glomerular filtration rate, left ventricular ejection fraction, and cholinesterase levels were additional independent risk factors, but the predictive accuracy of the model was not significantly improved, according to the time-dependent receiver operating characteristics curve and net reclassification improvement.
Conclusions:
The current study developed a risk score for mortality using preoperative risk factors, including the WIfI classification, in critical limb ischemia patients undergoing revascularization.
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Affiliation(s)
- Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A., A.K.)
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan (M.T.)
| | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.)
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.)
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.)
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (J.T.)
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Japan (T.Y)
| | - Atsuhiro Koya
- Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A., A.K.)
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.)
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Osaki T, Nomura T, Hashikawa K, Terashi H. Reverse vascular pedicle digital island flap with preservation of the dorsal branch of the digital nerve. Case Reports Plast Surg Hand Surg 2019; 6:74-78. [PMID: 31276012 PMCID: PMC6598538 DOI: 10.1080/23320885.2019.1632202] [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] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/12/2019] [Indexed: 10/28/2022]
Abstract
A reverse vascular pedicle digital island flap is a useful treatment option for reconstruction in fingertip amputation. We describe a surgical procedure to preserve the dorsal branch of the digital nerve in the middle phalanx during elevation of this flap with favourable outcomes.
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Affiliation(s)
- Takeo Osaki
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Abstract
For the treatment of patients with critical limb ischemia (CLI), the angiosome concept is essential in revascularization and wound treatment. In this article, we describe how we use the angiosome concept for surgically treating CLI wounds and review some essential reports. For wounds in patients with CLI to heal, both successful revascularization and wound management are crucial. In order to preserve the blood supply as much as possible intraoperatively, surgeons should always consider the angiosome concept.
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Affiliation(s)
- Miki Fujii
- Department of Plastic and Reconstructive Surgery, Critical Limb Ischemia Center, Kitaharima Medical Center, Ono, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic and Reconstructive Surgery, Kobe University Hospital, Kobe, Hyogo, Japan
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39
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Maruguchi H, Nomura T, Sasaki S, Hashikawa K, Terashi H. Mature teratoma treated as lymphatic malformation for 5 years: a case report and literature review. Case Reports Plast Surg Hand Surg 2019; 6:63-68. [PMID: 31231672 PMCID: PMC6566496 DOI: 10.1080/23320885.2019.1619458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
Teratomas and lymphatic malformations are included in the differential diagnosis of congenital neck masses. They can exhibit similar clinical findings. The authors present a case of mature teratoma that had been managed as a lymphatic malformation for years. Clinicians should be careful not to dismiss clues for the correct diagnosis.
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Affiliation(s)
- Hayato Maruguchi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Sasaki
- Center for Vascular Anomalies, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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40
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Ikeno Y, Sakakibara S, Yokawa K, Kitani K, Nakai H, Yamanaka K, Inoue T, Tanaka H, Terashi H, Okita Y. Post-sternotomy deep wound infection following aortic surgery: wound care strategies to prevent prosthetic graft replacement†. Eur J Cardiothorac Surg 2019; 55:975-983. [PMID: 30544183 DOI: 10.1093/ejcts/ezy389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/11/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the early and long-term outcomes of our multidisciplinary strategy for treating deep sternal wound infection after aortic grafting, which consisted of debridement by a plastic surgeon, negative pressure wound therapy with continuous irrigation and chest wall reconstruction. METHODS We performed a retrospective analysis of 18 patients who had a deep sternal wound infection following aortic grafting through a median sternotomy between January 2009 and December 2017. All patients had organisms cultured from mediastinal tissue within 2 months from the initial aortic surgery. The prosthetic grafts were exposed in 15 patients during resternotomy. Our protocol involved repeat debridement and negative pressure wound therapy with continuous irrigation twice a week until the results of the culture were negative and chest wall reconstruction was complete. RESULTS The mean duration from primary aortic surgery to resternotomy was 23.7 ± 15.9 days. Except for 1 patient, 17 patients underwent chest wall reconstruction. The mean duration from resternotomy to chest wall reconstruction was 31.1 ± 28.0 days. The hospital mortality rate was 16.7% (3 patients), although no patients died of wound-related causes. The mean follow-up period was 2.9 ± 2.5 years. Overall survival was 69.6 ± 11.4% at 1 year and 54.2 ± 13.3% at 5 years. Freedom from reoperation for reinfection was 94.4 ± 5.4% at 5 years. CONCLUSIONS Our wound care strategy achieved acceptable early and late survival in patients who had deep sternal wound infection following aortic grafting. This strategy may benefit those who experience this devastating complication.
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Affiliation(s)
- Yuki Ikeno
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keitaro Kitani
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Nakai
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Maeshige N, Torii K, Tabuchi H, Imai M, Koga Y, Uemura M, Aoyama-Ishikawa M, Miyoshi M, Fujino H, Terashi H, Usami M. Inhibitory Effects of Short-Chain Fatty Acids and ω-3 Polyunsaturated Fatty Acids on Profibrotic Factors in Dermal Fibroblasts. Eplasty 2019; 19:e4. [PMID: 30858902 PMCID: PMC6404726] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Dermal fibroproliferative disorders impair patients' quality of life. Although several therapeutic approaches exist for treatment of dermal scars, the development of effective ointments with few adverse effects could improve these therapeutic methods. Short-chain and ω-3 polyunsaturated fatty acids are reported to be immunomodulators with anti-inflammatory properties. Our aim was to evaluate anti-inflammatory and antifibrogenic effects of these fatty acids in human dermal fibroblasts. Methods: Cells were incubated with short-chain fatty acids (butyrate or propionate; 0-16 mM) and/or ω-3 polyunsaturated fatty acids (docosahexaenoic acid or eicosapentaenoic acid; 0-100 μM) for 24 hours to evaluate antifibrogenic effects and for 3 or 48 hours to evaluate anti-inflammatory effects after stimulation with lipopolysaccharide or without stimulation. Expression levels of α-smooth muscle actin, collagen I, collagen III, and IL-6 were evaluated, as were cell proliferation, stress fiber formation, and histone acetylation. Results: In the lipopolysaccharide-unstimulated group, butyrate inhibited mRNA expression of α-smooth muscle actin and collagen III more effectively than propionate and increased histone acetylation. Docosahexaenoic acid inhibited mRNA expression of α-smooth muscle actin and collagen III, whereas eicosapentaenoic acid did not. Combining butyrate with docosahexaenoic acid had stronger effects, downregulating α-smooth muscle actin, collagen I, and collagen III mRNA. As for cell proliferation and stress fiber formation, butyrate acted as a stronger inhibitor than docosahexaenoic acid and the combined administration had stronger effects. In the lipopolysaccharide-stimulated group, butyrate and docosahexaenoic acid attenuated IL-6 mRNA upregulation by lipopolysaccharide. Conclusion: Butyrate and docosahexaenoic acid may be a novel therapeutic approach to treatment of dermal fibroproliferative disorders.
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Affiliation(s)
- Noriaki Maeshige
- aDepartment of Rehabilitation Science,bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan,Correspondence:
| | - Kazuhiro Torii
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroto Tabuchi
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Midori Imai
- cDepartment of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuka Koga
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Michiko Aoyama-Ishikawa
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Makoto Miyoshi
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | | | - Hiroto Terashi
- cDepartment of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Usami
- bDivision of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan,dFaculty of Clinical Nutrition and Dietetics, Konan Women’s University, Kobe, Japan
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Iida O, Takahara M, Soga Y, Kodama A, Terashi H, Mano T, Azuma N. THE ASSOCIATION OF PREOPERATIVE CHARACTERISTICS WITH THE REINTERVENTION RISK IN PATIENTS UNDERGOING REVASCULARIZATION FOR CRITICAL LIMB ISCHEMIA. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31745-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kitano D, Osaki T, Nakasone M, Nomura T, Hashikawa K, Terashi H. Two cases of debulking surgery for lower limb diffuse plexiform neurofibroma with transcatheter arterial embolisation. Int J Surg Case Rep 2019; 55:132-135. [PMID: 30738368 PMCID: PMC6370563 DOI: 10.1016/j.ijscr.2019.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Diffuse plexiform neurofibroma (DPN) in patients with neurofibromatosis type 1 (NF1) causes motility dysfunction in severe cases. Transcatheter arterial embolisation (TAE) is an effective haemorrhage control method in vascular tumour surgery. PRESENTATION OF CASE We performed debulking surgery for DPN in the buttock and posterior thigh of two NF1 patients. Preoperative TAE with gelatine particles to tumour feeder vessels was conducted in both cases. Operative bleeding volumes were 500 and 4970 mL, respectively. In the latter case, the resection area extended to the upper poles of the buttocks, and the tumour invaded deeply into the surrounding tissues. Massive haemorrhage occurred, and internal iliac arterial balloon was inflated temporarily to further suppress the bleeding. Delayed wound healing due to TAE occurred; debridement and wound closure were required. Motor function improvement was confirmed in both patients. DISCUSSION Bleeding volumes varied because of highly developed collateral pathways and tumour invasiveness. As the upper pole of the buttock was perfused by the superior gluteal artery and its numerous collateral vessels, complete haemostasis was difficult despite adequate TAE. Because delineating the tumour border from the normal tissue was impossible due to the high tumour invasiveness, cutting into the hypervascular tumour was inevitable. As gelatine particles were absorbed but remained within the vessels, prolonged wound ischaemia and delayed healing occurred. CONCLUSION Although TAE with gelatine particles and balloon occlusion were reliable haemorrhage control methods in debulking surgery for lower limb DPN, optimal haemorrhage control technique, compatible with haemostasis and wound healing, was desired.
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Affiliation(s)
- Daiki Kitano
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeo Osaki
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Mika Nakasone
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Iida O, Takahara M, Soga Y, Kodama A, Terashi H, Azuma N. Three-Year Outcomes of Surgical Versus Endovascular Revascularization for Critical Limb Ischemia: The SPINACH Study (Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia). Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005531. [PMID: 29246911 PMCID: PMC5753823 DOI: 10.1161/circinterventions.117.005531] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/03/2017] [Indexed: 01/09/2023]
Abstract
Supplemental Digital Content is available in the text. Background— The aim of this study was to compare clinical outcomes between surgical reconstruction and endovascular therapy (EVT) for critical limb ischemia (CLI) in today’s real-world settings. Methods and Results— This multicenter, prospective, observational study registered and followed 548 Japanese CLI patients. The registration was in advance of revascularization; 197 patients were scheduled to receive surgical reconstruction, and the remaining 351 were scheduled to receive EVT. The primary end point was 3-year amputation-free survival, compared between the 2 treatments in an intention-to-treat manner, using propensity score matching. Interaction analysis was additionally performed to explore which subgroups had better outcomes with surgical reconstruction or EVT. After propensity score matching, the 3-year amputation-free survival was not significantly different between the 2 groups (52% [95% confidence interval, 43%–60%] and 52% [95% confidence interval, 44–60%]; P=0.26). Subsequent interaction analysis identified (1) Wound, Ischemia, and foot Infection (WIfI) classification W-3, (2) fI-2/3, (3) history of ipsilateral minor amputation, (4) history of revascularization after CLI onset, and (5) bilateral CLI as the factors more favorable for surgical reconstruction, whereas (1) diabetes mellitus, (2) renal failure, (3) anemia, (4) history of nonadherence to cardiovascular risk management, and (5) contralateral major amputation were as those less favorable for surgical reconstruction. Conclusions— The 3-year amputation-free survival was not different between surgical reconstruction and EVT in the overall CLI population. The subsequent interaction analysis suggested that there would be a subgroup more suited for surgical reconstruction and another benefiting more from EVT. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/. Unique identifier: UMIN000007050.
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Affiliation(s)
- Osamu Iida
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.).
| | - Mitsuyoshi Takahara
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Yoshimitsu Soga
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Akio Kodama
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Hiroto Terashi
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
| | - Nobuyoshi Azuma
- From the Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.); Department of Diabetes Care Medicine (M.T.) and Department of Metabolic Medicine (M.T.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.); Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.); Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.); and Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A.)
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Yokoi H, Ho M, Iwamoto S, Suzuki Y, Ansel GM, Azuma N, Handa N, Iida O, Ikeda K, Ikeno F, Ohura N, Rosenfield K, Rundback J, Terashi H, Uchida T, Yokoi Y, Nakamura M, Jaff MR. Design Strategies for Global Clinical Trials of Endovascular Devices for Critical Limb Ischemia (CLI) - A Joint USA-Japanese Perspective. Circ J 2018; 82:2233-2239. [PMID: 29962385 DOI: 10.1253/circj.cj-18-0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/09/2022]
Abstract
For more than 10 years, the Harmonization by Doing (HBD) program, a joint effort by members from academia, industry and regulators from the United States of America (USA) and Japan, has been working to increase timely regulatory approval for cardiovascular devices through the development of practical global clinical trial paradigms. Consistent with this mission and in recognition of the increasing global public health effects of critical limb ischemia (CLI), academic and government experts from the USA and Japan have developed a basic framework of global clinical trials for endovascular devices for CLI. Despite differences in medical and regulatory environments and complex patient populations in both countries, we developed a pathway for the effective design and conduct of global CLI device studies by utilizing common study design elements such as patients' characteristics and study endpoints, and minimizing the effect of important clinical differences. Some of the key recommendations for conducting global CLI device studies are: including patients on dialysis; using a composite primary endpoint for effectiveness that includes 6-month post-procedure therapeutic success and target vessel patency; and using a 30-day primary safety endpoint of perioperative death and major adverse limb events. The proposed approach will be uniquely beneficial in facilitating both the initiation and interpretation of CLI studies and accelerating worldwide CLI device development and innovation.
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Affiliation(s)
- Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital
| | - Mami Ho
- Office of Medical Devices III, Pharmaceuticals and Medical Devices Agency
| | - Shin Iwamoto
- Office of Medical Devices II, Pharmaceuticals and Medical Devices Agency
| | | | - Gary M Ansel
- Center for Critical Limb Care, OhioHealth/Riverside Methodist Hospital
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Nobuhiro Handa
- Office of Medical Devices III, Pharmaceuticals and Medical Devices Agency
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | | | - Norihiko Ohura
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine
| | | | | | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center
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Saito I, Hasegawa T, Ueha T, Takeda D, Iwata E, Arimoto S, Sakakibara A, Akashi M, Sakakibara S, Sakai Y, Terashi H, Komori T. Effect of local application of transcutaneous carbon dioxide on survival of random-pattern skin flaps. J Plast Reconstr Aesthet Surg 2018; 71:1644-1651. [PMID: 30031765 DOI: 10.1016/j.bjps.2018.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/11/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Skin flap procedures are widely used to reconstruct skin and soft tissue defects. Skin flap necrosis is a serious postoperative complication. Many researchers have introduced pharmacological agents to improve flap ischemia in experimental studies. However, outcomes of these studies remain controversial. We previously demonstrated that transcutaneous CO2 application improves hypoxia in fracture repair. In this study, we hypothesized that improving hypoxia by transcutaneous CO2 application can improve the blood flow in skin flaps and increase angiogenesis. We investigated whether transcutaneous CO2 application can increase the survival of random-pattern skin flaps. MATERIALS AND METHODS Six-week-old male Sprague-Dawley rats were divided into two equal groups: the control group (n = 6) and CO2 group (n = 6). A random-pattern skin flap was constructed in these rats. Topical CO2 was applied using a hydrogel every day for 5 days in the CO2 group. The flap survival area was measured on postoperative days 1, 3, and 5. The vessel density and expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and hypoxia-inducible factor-1α (HIF-1α) were evaluated on postoperative day 5. RESULTS A statistically significant difference was found in the percentage of the flap survival area between the two groups on postoperative days 3 and 5 (p < 0.05). Furthermore, the expression of VEGF and bFGF was significantly higher and that of HIF-1α was significantly lower in the CO2 than in the control group (p < 0.05). CONCLUSIONS Transcutaneous CO2 application can improve the blood flow in skin flaps and increase angiogenesis, thus increasing the survival of random-pattern skin flaps.
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Affiliation(s)
- Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Takeshi Ueha
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; NeoChemir Inc., Kobe, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Satomi Arimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Moriguchi M, Maeshige N, Ueno M, Yoshikawa Y, Terashi H, Fujino H. Modulation of plantar pressure and gastrocnemius activity during gait using electrical stimulation of the tibialis anterior in healthy adults. PLoS One 2018; 13:e0195309. [PMID: 29746498 PMCID: PMC5944963 DOI: 10.1371/journal.pone.0195309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 03/20/2018] [Indexed: 01/29/2023] Open
Abstract
High plantar flexor moment during the stance phase is known to cause high plantar pressure under the forefoot; however, the effects on plantar pressure due to a change of gastrocnemius medialis (GM) activity during gait, have not been investigated to date. Reciprocal inhibition is one of the effects of electrical stimulation (ES), and is the automatic antagonist alpha motor neuron inhibition which is evoked by excitation of the agonist muscle. The aim of this study was to investigate the influences of ES of the tibialis anterior (TA) on plantar pressure and the GM activity during gait in healthy adults. ES was applied to the TAs of twenty healthy male adults for 30 minutes at the level of intensity that causes a full range of dorsiflexion in the ankle (frequency; 50 Hz, on-time; 10 sec, off-time; 10 sec). Subjects walked 10 meters before and after ES, and we measured the peak plantar pressure (PP), pressure time integral (PTI), and gait parameters by using an F-scan system. The percentage of integrated electromyogram (%IEMG), active time, onset time, peak time, and cessation time of TA and GM were calculated. PP and PTI under the forefoot, rear foot, and total plantar surface significantly decreased after the application of ES. Meanwhile, changes of gait parameters were not observed. %IEMG and the active time of both muscles did not change; however, onset time and peak time of GM became significantly delayed. ES application to the TA delayed the timing of onset and peak in the GM, and caused the decrease of plantar pressure during gait. The present results suggest that ES to the TA could become a new method for the control of plantar pressure via modulation of GM activity during gait.
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Affiliation(s)
- Maiki Moriguchi
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Suma-Ku, Kobe, Hyogo, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Suma-Ku, Kobe, Hyogo, Japan
- * E-mail:
| | - Mizuki Ueno
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Suma-Ku, Kobe, Hyogo, Japan
| | - Yoshiyuki Yoshikawa
- Miyabinosato Home-visit nursing care station, Patio Akashi 1F, Uozumicho, Nakao, Akashi, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kusunokicho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Suma-Ku, Kobe, Hyogo, Japan
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Hiraoka Y, Akashi M, Wanifuchi S, Kusumoto J, Shigeoka M, Hasegawa T, Hashikawa K, Terashi H, Komori T. Association between pain severity and clinicohistopathologic findings in the mandibular canal and inferior alveolar nerve of patients with advanced mandibular osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:264-271. [PMID: 29776771 DOI: 10.1016/j.oooo.2018.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/31/2017] [Revised: 03/06/2018] [Accepted: 03/16/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pain is one of the most problematic symptoms in patients with osteoradionecrosis of the jaws. This study investigated the associations between pain severity and morphologic alterations of the mandibular canal and inferior alveolar nerve, in respective computerized tomography images and resected specimens of mandibular osteoradionecrosis. STUDY DESIGN We assessed 14 lesions in 13 patients who underwent segmental mandibulectomy for surgical debridement and simultaneous reconstruction with free fibula flap (1 patient exhibited bilateral lesions). The extent of the mandibular canal bone defect on preoperative coronal computerized tomography images and the number of inferior alveolar nerve fascicles in resected specimens were evaluated. Comparisons were made between the slight pain and extreme pain groups. In most of the patients in the extreme pain group, either mandibular canal bone defects were absent or entire circumferential defects were present; inferior alveolar nerve fascicles were either distinguishable or completely absent in the resected specimens. RESULTS Although there was no statistically significant association between extreme pain and computerized tomography or histopathologic findings, the histopathologically indistinguishable inferior alveolar nerve fascicles was significantly associated with slight pain. CONCLUSIONS The degree of degeneration of mandibular canal and inferior alveolar nerve may be associated with pain severity in patients with mandibular osteoradionecrosis.
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Affiliation(s)
- Yujiro Hiraoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Manabu Shigeoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Yanagi H, Terashi H, Takahashi Y, Okabe K, Tanaka K, Kimura C, Ohura N, Goto T, Hashimoto I, Noguchi M, Sasayama J, Shimada K, Sugai A, Tanba M, Nakayama T, Tsuboi R, Sugama J, Sanada H. The Japanese registry for surgery of ischial pressure ulcers: STANDARDS-I. J Wound Care 2018; 27:174-183. [PMID: 29509114 DOI: 10.12968/jowc.2018.27.3.174] [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: 11/11/2022]
Abstract
OBJECTIVE To clarify the surgical indications and the appropriate perioperative management of ischial pressure ulcers (PUs). METHOD A two-year prospective, nationwide registry study was carried out across 26 medical institutions in Japan. All participating institutions managed ischial PUs according to the standardisation of total management and surgical application for the refractory decubitus (STANDARDS-I) perioperative protocol. Analysis was conducted on a range of clinically or statistically important variables for the achievement of primary or secondary endpoints: complete wound healing and hospital discharge at three months, and complete wound healing at one month after surgery, respectively. RESULTS A total of 59 patients took part in the study. All patients underwent surgery for ischial PUs during the study period. Patients who had achieved the primary endpoint had a higer preoperative functional independence measurement (FIM score), a higher 'G' score in the DESIGN-R scale and were more likely to have healed by primary intention. Patients who had achieved the secondary endpoint were more likely to have spastic paralysis, preoperative physiotherapy and localised infection of the wound, among other variables. CONCLUSION This survey suggests that preoperative physiotherapy increases the speed of wound healing, and good granulation of the wound bed preoperatively increases the likelihood of woundless discharge from hospital, whereas the existence of comorbidities negatively influences the likelihood of woundless discharge from hospital. The study also suggests that the existence of spastic paralysis, preoperative infection of the wound, or surgical reduction of the ischial tubercle speeds up the healing of the wound. However, the wound failed to heal significantly more often in patients with increasing white blood cell count after surgery.
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Affiliation(s)
- Hideyuki Yanagi
- Kobe Academia Clinic, Hyogo, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University, Hyogo, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Katsuyuki Okabe
- Okabe Plastic Surgery and Orthopedics Clinic, Kanagawa, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Chu Kimura
- Department of Plastic Surgery, Hakodate General Central Hospital, Hokkaido, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Norihiko Ohura
- Department of Plastic Surgery, Kyorin University, Tokyo, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Takahiro Goto
- Department of Plastic and Reconstructive Surgery, Tohoku University, Miyagi, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Ichiro Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokushima University, Tokushima, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Madoka Noguchi
- Department of Nursing, Kobe University Hospital, Hyogo, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Junichi Sasayama
- Hyogo Prefectural Rehabilitation Center, Hyogo, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Kenichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University, Ishikawa, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Ayumi Sugai
- Department of Nursing, Hoshigaoka Medical Center, Osaka, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Mitsuko Tanba
- Department of Nursing, Kyorin University Hospital, Tokyo, Japan; and The Working Group for the Surgical Indication, Japanese Society of Pressure Ulcers
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan; and Scientific Education Committee, Japanese Society of Pressure Ulcers
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan; and Scientific Education Committee, Japanese Society of Pressure Ulcers
| | - Junko Sugama
- Wellness Promotion Science Center, Kanazawa University, Ishikawa, Japan; and Scientific Committee, Japanese Society of Pressure Ulcers
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; and President, Japanese Society of Pressure Ulcers
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50
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Atomura D, Aihara J, Omori M, Terashi H. Utility of perioperative skin perfusion pressure measurement for treatment of ulcers caused by arteriovenous access ischaemic steal. Int Wound J 2018; 15:454-459. [PMID: 29356404 DOI: 10.1111/iwj.12886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022] Open
Abstract
Arteriovenous access ischaemic steal is a serious complication following arteriovenous fistula (AVF) construction. The aim of treatment is to improve distal circulation without impairing the function of the fistula. Therefore, any repair should be performed with intraoperative monitoring. We report 2 cases of this disorder treated using perioperative measurement of skin perfusion pressure (SPP) for preoperative surgical planning and intraoperative guidance. A 73-year-old woman with a left cubital AVF developed gangrene of the tip of the left little finger. Arteriovenous access ischaemic steal was suspected. The SPP of the little finger was 18 mm Hg, which increased to 65 mm Hg after manual occlusion of the fistula. A 58-year-old woman with a left antebrachial AVF had gangrene of the tip of the left middle finger. The SPP was 19 mm Hg, and steal syndrome was suspected based on angiography and the SPP with manual occlusion of the fistula. In both cases, serial plication of the fistula was performed based on intraoperative perfusion pressure monitoring, leading to the successful resolution of the ischaemic steal syndrome. In both cases, haemodialysis could be continued through the repaired fistula.
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Affiliation(s)
- Daisuke Atomura
- Department of Plastic Surgery, Kawasaki Hospital, Kobe, Japan
| | - Junko Aihara
- Department of Plastic Surgery, Kawasaki Hospital, Kobe, Japan
| | - Makoto Omori
- Department of Plastic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroto Terashi
- Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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