Spatiotemporal alterations of autophagy marker LC3 in rat skin fibroblasts during wound healing process

To investigate the possible implications of autophagy, one of the degradation pathways induced by metabolic stress, in the dynamic reconstructive process of wound healing, the appearance and changes of punctate structures for microtubule-associated protein 1 light chain 3 (LC3), an autophagosome marker, were examined in a rat skin wound healing model. Although the ratio of LC3-II/LC3-I in Western blotting was not evidently changed during the wound healing process, LC3-positive dots were clearly observed in fibroblasts and myofibroblasts, and occasionally in macrophages, by immunohistofluorescence microscopy. Some of the LC3-positive dots were colocalized with Atg16L signal, an isolation membrane marker, and electron microscopy revealed the presence of typical autophagosomes in fibroblasts near the margin of the wound. The number of LC3-positive dots per fibroblast increased during the later period of the proliferation phase, and interestingly, it was higher in the margin than the center of the wound. It was also high in the periwound skin area. These results suggest that drastic functional changes in fibroblasts during wound healing process are accompanied by the alteration of the autophagy-lysosomal degradation system.

Eyelid reanimation using crossface nerve graft: Relationship between surgical outcome and preoperative paralysis duration

BACKGROUND

To reanimate the mimetic muscles, crossface nerve graft (CFNG) is an effective surgical option. However, muscle atrophy after facial paralysis may influence the surgical result. We analyzed the relationship between surgical result and preoperative paralysis duration.

METHODS

We performed CFNG on 15 patients. The sural nerve was transferred between the affected and nonaffected sides of the zygomatic branch. Eyelid function and eyelid lid were evaluated using the modified House-Brackmann scale. The effects of age, sex, cause of facial paralysis, graft nerve length, and preoperative paralysis duration were evaluated.

RESULTS

The mean follow up period was 9.3 ± 3.3 (range 4-14) years. Eyelid closure was excellent in four patients, good in six, fair in one, and poor in four. Statistically, no significant difference was observed between those patients with excellent or good outcomes and fair or poor outcomes regarding age (40.9 ± 11.0 years vs. 22.6 ± 20.8; P = .067), sex (male/female = 2/8 vs. 3/2; P = .250), cause (tumor/trauma = 10/0 vs. 3/2; P = .095), and length of nerve graft (14.4 ± 0.8 cm vs. 13.8 ± 1.6 cm; P = .375). The average preoperative paralysis duration in the excellent/good patients was significantly shorter than that in the fair/poor patients (P = .005). All eight cases with preoperative paralysis of less than 6 months showed a marked excellent/good result. Two of the seven patients with preoperative paralysis was 6 months or longer marked fair/poor result. (P = .007).

CONCLUSIONS

To achieve successful results with CFNG, surgery should be performed within 6 months of the onset of paralysis.

Two-step hepatic artery reconstruction for a hepatic artery lacking in length for the use of a microclamp in living donor liver transplantation

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A graft hepatic artery we experienced too short to rotate a microclamp in living donor liver transplantation.

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We performed two-step hepatic artery reconstruction.

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In the first step, we cut the recipient right hepatic artery and used it as an arterial graft.

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The graft hepatic artery was coapted to the distal stump of the arterial graft without a microclamp.

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In the second step, the proximal stump of the arterial graft was coapted to the recipient right hepatic artery.

Introduction

We describe successful two-step hepatic artery reconstruction in a patient whose graft site hepatic artery was too short for the use of a microclamp in living donor liver transplantation.

Presentation of case

A 57-year-old woman was diagnosed as having hepatitis C and liver cirrhosis. Her 26-year-old son was the living liver donor. The living donor underwent right lobectomy. The dissected graft hepatic artery was too short for the use of a microclamp. The recipient right hepatic artery was cut and used as an arterial graft. The graft right hepatic artery was sutured to the right hepatic artery of the arterial graft and the graft posterior branch of the right hepatic artery was sutured to the middle hepatic artery of the arterial graft. After reconstruction of the portal vein and hepatic vein was completed, anastomosis was performed between the graft right hepatic artery and right hepatic artery. The patency of the vessels was checked using color Doppler ultrasonography for 1 week postoperatively. No postoperative complications involving blood flow of the hepatic artery were observed.

Discussion

In our case, the recipient hepatic artery was cut and used as an arterial graft. Although the number of anastomotic sites of the hepatic artery increased, we could perform hepatic artery reconstruction safely and easily.

Conclusion

Two-step hepatic artery reconstruction is a useful method in cases where the recipient hepatic artery does not have enough length.

Three-step orbitofacial reconstruction after extended total maxillectomy using free RAM flap and expanded cervicofacial flap with cartilage grafts

Facial defect after an extended total maxillectomy is one of the most difficult deformities to reconstruct aesthetically, because the defect is not only large but also three-dimensional. Although free-flap reconstruction is useful, the patchwork-like scar, bad colour match and poor texture match are major problems. The contracture and displacement of the reconstructed eyelids and eye socket are also serious matters. To resolve these problems, we have performed a three-step reconstruction using a free rectus abdominis myocutaneous (RAM) flap and an expanded cervicofacial flap with cartilage grafts. In the first step, a free RAM flap was transplanted to the defect after extended total maxillectomy. In the second step, tissue expanders were placed under the skin of the cheek and neck a year after the RAM flap transplantation. After expansion of the cheek and neck skin, the third step was performed. The inferior part of the external skin island of the RAM flap was raised and sutured to the superior margin of the skin island to create a pouch for the eye socket. Costal cartilage was grafted to reconstruct the orbital floor and malar prominence, and auricular cartilage was grafted to reconstruct the tarsal plates. Finally, the expanded cervicofacial flap was rotated to cover this construct. Two weeks after reconstruction, the neo-eyelids were divided to form the lid fissure. We performed the three-step reconstruction on six cases after extended total maxillectomy. In all cases, a deep and stable eye socket was reconstructed. The reconstructed eyelids and cheek were natural in appearance with good colour and texture match without conspicuous scars. To obtain symmetry and natural appearance in the orbitomaxillary reconstruction, there are five points that should be formed; the eye socket, the groundwork of the eye socket, the orbital floor and malar prominence, the tarsal plates and the surface of the eyelids and cheek. We do not reconstruct the palate to set prosthetic dentures and to clean the surface of the skin island in the nasal cavity. To reconstruct the indispensable five points and achieve satisfying results, we propose this three-step reconstruction.

Surgical repair of transverse facial cleft: oblique vermilion-mucosa incision

Various surgical techniques have been reported for the repair of the transverse facial cleft using a straight-line closure, Z- or W-plasty, local flaps, etc. However, several problems remain such as deviation, distortion and scars in the commissure and cheek. To resolve these problems, we studied the anatomy of the commissure again and devised the most reasonable method for repair of the transverse facial cleft. In our new method, oblique vermilion and mucosa incision lines, 45 degrees to the vermilion-cutaneous junction, were designed. After mucosal closure, the orbicularis muscle was reconstructed by cross-overlap joining the upper muscular bundle over the lower muscular bundle at an angle of 90 degrees. The skin was sutured using horizontal straight-line closure with a small Z-plasty lateral to the nasolabial fold. We performed the new method on seven macrostomias. The patient cohort consisted of four girls and three boys, and their ages ranged from 4 months to 3 years. Symmetrical commissure and natural oral movement was obtained in the past five cases. The scar around the commissure and cheek was inconspicuous in all cases. The new method used the oblique vermilion-mucosa incision and straight-line closure, the cross-overlap joining of the muscular bundles at an angle of 90 degrees , and the horizontal straight-line skin closure with a small Z-plasty lateral to the nasolabial fold. This method, which is anatomically reasonable, can construct a symmetrical and natural commissure without conspicuous scars.

Combination of hypoglossal-facial nerve jump graft by end-to-side neurorrhaphy and cross-face nerve graft for the treatment of facial paralysis

The cross-face nerve graft and the interpositional jump graft were performed simultaneously for 13 patients with facial paralysis. The period between the onset of paralysis and surgery ranged from 3 to 32 weeks. In nine patients, surgery was performed within 3 months of the onset of paralysis. The patients in whom reinnervation by both grafts succeeded could smile without closing their eyes by moving the tongue and could close the eye on the affected side without an accompanying oral movement. The expression was natural and included fine muscle movements. Spontaneous recovery of the facial nerve was observed in three patients. Among patients who showed functional recovery without spontaneous recovery, House-Brackman's palsy grade was II in one patient, III in five patients, and IV in one patient. Functional deficits of the tongue were not observed. We recommend that this surgery be performed within 3 months of onset of paralysis.

FCR system in Hokkaido University Hospital

The complete digital x-ray system using FCR is now being used in daily diagnosis as a part of the picture archiving and communications system (PACS) in Hokkaido University (HU) Hospital. This project is based on a 3-year plan started in 1988. In the first year (1988), six Fuji Computed Radiography (FCR) units (two FCR501, one FCR502, three FCR7000), PACS interfaces, and an optical disk system were installed. In the first year, about 60% of x-ray filming changed from the conventional technique to the FCR, and 60% of FCR images were transferred to PACS. In the second year, we began to use FCR in gastrointestinal (GI) study with two additional FCR7000s and three x-ray TV units. Then the percentage of plain films made by FCR increased to 80%. In the third year, angiographic studies will be converted to FCR. A specially designed built-in type FCR is under development to examine the entire spine. When this project is complete, almost all conventional radiography except chest tomography will be performed by FCR. The tomography x-ray computed radiography (CR) unit with automatic-imaging plate (IP) changer is expected to be developed soon.