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Papers - Kishi, Kazuo

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Anal and perianal reconstruction after extramammary Paget's disease using a posterior thigh flap with a thin square wing

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 8 ) 1353 - 1356 2010.08

ISSN 1748-6815

Extramammary Paget's disease regularly requires a wide resection of skin, often including the anal tract. When reconstructing the anal tract, simulating natural anatomy by creating the thinnest possible flap is essential to prevent incontinence. We reconstructed the anal and perianal area using a posterior thigh trilobed flap. The lobe to be transposed to the anal duct had a square design and was thinned. The other lobes were used to cover perianal defects and the flap donor site. Using this method, we reconstructed three patients who required large perianal area and anal tract resections. All flaps took well, and after the initial healing process, the patients did not develop lasting incontinence. We conclude that the posterior thigh flap with a thin square wing is useful for reconstruction of the anal tract and perianal area.

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A novel approach to thoracic wall reconstruction based on a muscle perforator

Kishi Kazuo, Imanishi Nobuaki, Ninomiya Ruka, Okabe Keisuke, Ohara Hirotoshi, Hattori Noriko, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 8 ) 1289 - 1293 2010.08

ISSN 1748-6815

When reconstructing the thoracic wall, non-adaptation of the suture line is a critical concern, especially when artificial implants are used. Therefore, a reliable and safe flap is required. Based on an anatomical study of cadavers, we decided to dissect the pectoralis major musculo-cutaneous flap into two parts, on the surface and beneath the muscle fascia, while preserving the muscle perforators. We designated the skin portion as the V-Y advancement flap or rotation V-Y advancement flap and the muscle flap as the transposition flap. Both flaps had different suture lines. We applied this method to two patients requiring reconstruction of anterior thoracic defects with artificial implants. One patient did not have adverse effects, and the flaps took well. The shape of the breast did not change significantly. However, the other patient was a heavy smoker. Although the V-Y advancement flap took well, the cutaneous triangular tip made at the time of tumour resection became necrotic. However, the underlying pectoralis major muscles successfully covered the implants and did not show any signs of infection. In conclusion, reconstruction of the anterior thoracic wall to change the suture line with a V-Y advancement flap, based on the muscle perforator and pectoralis major muscle flap, is a useful and reliable method, especially when an artificial implant is used.

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Treatment of giant congenital melanocytic nevi with enzymatically separated epidermal sheet grafting

Kishi Kazuo, Ninomiya Ruka, Okabe Keisuke, Konno Eri, Katsube Ken ichi, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 6 ) 914 - 920 2010.06

ISSN 1748-6815

Treatment of giant congenital melanocytic nevi (GCMNs) must be considered from both a cosmetic and a medical aspect of reducing the risk of a growing malignancy. We treated five patients who had a GCMN on the trunk with an enzymatically separated epidermal sheet taken from their excised GCMN skin. All patients underwent enzymatically separated epidermal sheet grafting at the age of 2 months. With the patient under general anaesthesia, we removed the affected area with an electric dermatome until the brown colour had almost completely disappeared. The removed skin was immersed in dispase I solution (1000 U ml^-1) dissolved in Ringer's solution at 37 °C for 75-105 min until the epidermal sheet separated from the dermis without tension. Three back lesions and two abdominal lesions were treated. In all cases, the enzymatically separated epidermis grafted well, without infection. The amount of discharge that accumulated from immediately after the operation until the first dressing change (performed at 3 days after the operation) was reduced compared with that from curettage. The skin colour was light brown at first and gradually became lighter within a few months. The grafted areas were soft and did not show significant re-pigmentation. In most cases, hard hair did not grow on the treated area. Histological samples taken 1 year after the operation showed that the dermal layer was reconstituted without pigmented nevus cells. Enzymatically separated epidermal grafting is a useful method for the treatment of GCMN, is easy to perform and leaves cosmetically satisfactory results.

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Complicated Surgical Resection of Malignant Tumors in the Upper Cervical Spine After Failed Ion-Beam Radiation Therapy

Matsumoto, Morio, Watanabe, Kota, Ishii, Ken, Tsuji, Takashi, Takaishi, Hironari, Nakamura, Masaya, Toyama, Yoshiaki, Chiba, Kazuhiro, Imanishi, Yorihisa, Kishi, Kazuo, Kawana, Hiromasa

SPINE 35 ( 11 ) E505 - E509 2010.05

Research paper (scientific journal), ISSN 0362-2436

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The unilocular fat-cell graft

Ohara H., Kishi K., Nakajima T.

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 3 ) 488 - 492 2010.03

ISSN 1748-6815

Autologous fat grafting has become a common procedure for augmenting soft tissue. However, there are still some problems with resorption and cyst formation after injection, which mainly arise from insufficient nourishment of the transplanted fat tissues. In this study, using a mouse model, we enzymatically digested fat tissues into unilocular fat cells, and then transplanted the unilocular fat cells by sub-dermal injection to allow the transplanted cells to easily spread within the injected area. Fat tissue was harvested from a green fluorescent protein transgenic mouse (C57BL/6), and the optimal digestion time was determined to be 30 min. The fat cells were then injected into the sub-dermal layer of the head skin of a C57BL/6 mouse. As a control, minced fat without digestion was also injected. The animals were sacrificed immediately after injection and on days 1, 2 and 3, as well as at weeks 1, 2 and 4 after injection, and the recipient skins were collected for microscopic observation. The unilocular fat cells were observed to spread in a solitary manner among the recipient tissues, and no necrotic areas or cysts were observed. The minced-fat-graft control showed central necrosis in the transplanted region. In addition, the minced fat tissue needed to be injected with an 18-gauge syringe, but the unilocular fat cells could be injected with a 26-gauge syringe. Thus, the unilocular fat-cell graft was determined to be a superior alternative to conventional fat grafts.

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Management of craniofacial hyperostosis in proteus syndrome

Sakamoto Yoshiaki, Nakajima Hideo, Kishi Kazuo, Shimizu Ruka, Nakajima Tatsuo

Journal of Craniofacial Surgery 21 ( 2 ) 414 - 418 2010.03

ISSN 1049-2275

Proteus syndrome is a rare congenital hamartomatous condition that is characterized by a wide range of malformations, occasionally involving the head and the face. Skin and skeletal developmental malformations are common and may be manifested in significant physical anomalies. In this report, we describe the cases of 2 patients affected by this condition. For one patient, a recurrence occurred 4 years after the elimination of cranial hyperostosis. In the second patient, although we observed macrosomia and peculiar countenance in the context of craniofacial hyperostosis, the patient did not visit a clinic for approximately 50 years before seeking treatment. The management of the craniofacial involvement is described, and a literature overview is presented.

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Reconstruction of vulva using pudendal thigh gluteal fold bilobed flap

Ninomiya Ruka, Kishi Kazuo, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 2 ) 2010.02

ISSN 1748-6815

In reconstructing a large defect of the vulva, we combined the gluteal fold and the pudendal thigh flaps and made a bilobed flap. Using this gluteal fold pudendal thigh bilobed flap, we reconstructed a vagina with sufficient depth and width. The surrounding skin defect was simultaneously reconstructed. Sensation was intact in all areas of the reconstruction. In addition, the sutured lines of both donor sites are hidden in the gluteal and inguinal folds. Thus, the gluteal fold pudendal thigh bilobed flap seems to be ideal for reconstructing large vulvar defects.

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Simple two-stage reconstructive technique for the treatment of infected dura mater

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Plastic and Reconstructive Surgery 125 ( 1 ) 2010.01

ISSN 0032-1052

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Immunolocalization of Epstein-Barr virus-related antigens in a case of sweat gland adenocarcinoma

Tanese K., Ishiko A., Hayase K., Yoshida T., Kishi K., Yamada T.

British Journal of Dermatology 161 ( 3 ) 694 - 697 2009.09

ISSN 0007-0963

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Histological responses of cutaneous vascular lesions following photodynamic therapy with Talaporfin sodium

Ohshiro Takafumi, Nakajima Tatsuo, Ogata Hisao, Kishi Kazuo

Keio Journal of Medicine 58 ( 3 ) 176 - 184 2009.09

ISSN 0022-9717

Background: Mono-L-aspartyl chlorin e6 (Talaporfin sodium) is a novel photosensitizer, and is currently being used in photodynamic therapy for various malignant tumors in combination with irradiation with a 664 nm laser. An interesting characteristic of Talaporfin sodium is that the skin photosensitivity after injection of this agent disappears faster than any other existing photosensitizers. This study examined the vascular events that occurred postirradiation in the chicken comb as a capillary malformation model after photosensitization with Talaporfin sodium. Materials and Methods: A single intravenous bolus injections of Talaporfin sodium was administered to the chickens, and a 1 cm diameter area of the comb of each animal was irradiated with a 664 nm visible red laser. The gross changes in the chicken combs were recorded for 7-14 days after photodynamic therapy. For the histological examination, HE, PTAH and Azan stained sections were analyzed. Results: All treated chicken combs had blanched after photodynamic therapy. Microscopy demonstrated an absence of erythrocytes and the vessel lumina were obliterated, leaving the normal overlying epidermis completely intact. Concomitantly with selective destruction of the capillaries in the target area, moderate invasion of inflammatory cells and a slight increase in the stroma were observed. Conclusions: In the chicken comb model, photodynamic therapy with Talaporfin sodium effectively achieved selective destruction of the microvasculature while leaving the epidermis intact. Our results strongly suggest that photodynamic therapy with Talaporfin sodium could be a feasible method to treat dermal hypervascular lesions.

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MMP-13 plays a role in keratinocyte migration, angiogenesis, and contraction in mouse skin wound healing

Hattori Noriko, Mochizuki Satsuki, Kishi Kazuo, Nakajima Tatsuo, Takaishi Hironari, D'Armiento Jeanine, Okada Yasunori

American Journal of Pathology 175 ( 2 ) 533 - 546 2009.08

ISSN 0002-9440

Matrix metalloproteinases (MMPs) have been implicated in wound healing. To analyze the roles of MMP-9 and MMP-13 in wound healing, we generated full-thickness cutaneous wounds in MMP-9 knockout (KO), MMP-13 KO, MMP-9/13 double KO, and wildtype mice. Macroscopic wound closure was delayed in all of the KO mice, as compared with wild-type mice. The rate of re-epithelialization was significantly delayed in MMP-9 KO and MMP-13 KO mice and remarkably delayed in MMP-9/13 double KO mice, as compared with wild-type mice. Both MMP-9 and MMP-13 were expressed by the leading edges of epidermal cells in wild-type mice, and the migration of keratinocytes was suppressed by treatment with an MMP inhibitor or transfection of small interfering RNAs for MMP-9 or MMP-13, as compared with controls. The vascular density in wound granulation was significantly lower in both MMP-13 KO and MMP-9/13 double KO mice than in wild-type mice. Degradation of connective tissue growth factor in wound tissue was transiently prevented in MMP-13 KO mice. Morphometric analyses demonstrated a reduction in both wound contraction and myofibroblast formation in both MMP-13 KO and MMP-9/13 double KO mice. Proliferation and transforming growth factor-β1-induced myofibroblast differentiation of dermal fibroblasts from MMP-13 KO mice were decreased, as compared with wild-type dermal fibroblasts. These data suggest that MMP-13 plays a role in keratinocyte migration, angiogenesis, and contraction in wound healing, while MMP-9 functions in keratinocyte migration.

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Angiographic study of the superior laryngeal artery

Imanishi Nobuaki, Kondoh Tetsuo, Kishi Kazuo, Aiso Sadakazu

Okajimas Folia Anatomica Japonica 86 ( 2 ) 61 - 65 2009.08

ISSN 0030-154X

The study goals were to demonstrate the superior laryngeal artery in detail with angiograms and to understand its vasculature three-dimensionally. Three fresh cadavers were totally injected with lead oxide-gelatin mixture. The larynx with the surrounding tissue was resected and radiographed stereoscopically with soft X ray system. We get informed consent from a person in question and the bereaved family. The superior laryngeal artery was divided into the ascending and descending branches. The ascending branch supplied the epiglottis chiefly from the ventral surface, and anastomosed with branches of the lingual artery. The descending branch supplied the vestibular and vocal folds, muscles of the larynx and mucosa over the muscles, and anastomosed with distal branches of the superior thyroid artery. Stereographic angiograms and macroscopic observation enabled us to understand vasculature of the superior laryngeal artery.

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Extended split superior gluteus maximus musclocutaneous flap and reconstruction after resection of perianal and lower gluteal hidradenitis suppurativa

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 62 ( 8 ) 1081 - 1086 2009.08

ISSN 1748-6815

Various modifications of the gluteus maximus musculocutaneous flap have been reported. Among them, the split gluteus maximus musculocutaneous flap is easy to prepare and does not leave ambulatory insuffiency. However, the safety of extending the skin portion beyond the margin of the muscle has not yet been clarified. Angiography was performed systemically on 11 fresh cadavers, and the distance the margin of the gluteus maximus muscle could be extended was observed. Based on these anatomical data, reconstruction after total skin resection of perianal and lower gluteal hidradenitis suppurativa was performed with an extended split superior gluteal maximus musclocutaneous flap. Surgery was performed on three sides of two patients. From the anatomical results, we found that it is possible to extend the flap beyond the iliac crest several centimetres superiorly, and to the gluteal fold inferiorly, and several centimetres laterally. We designed the flap such that the extended area is situated in these areas. All flaps took well and did not show any congestion or necrosis. There were no recurrences at least 1 year after surgery. When reconstructing the lower part of the buttock, an extended split superior gluteus maximus musclocutaneous flap is easy to raise and leaves aesthetically satisfactory results. Thus it may be the first choice for reconstruction of the lower buttock.

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Reconstruction of skin defects after resection of severe gluteal hidradenitis suppurativa with fasciocutaneous flaps

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki

Journal of Plastic, Reconstructive and Aesthetic Surgery 62 ( 6 ) 800 - 805 2009.06

ISSN 1748-6815

Background: Although skin grafting after resection of the hidradenitis suppurativa is frequently used, the contour after skin grafting is unsatisfactory. We studied four patients who suffered from severe gluteal hidradenitis suppurativa and needed total skin resection of the affected lesion. Methods: Reconstruction after total skin resection was performed with fasciocutaneous (FC) flaps of three different designs based on an arterial anatomical study: an island V-Y advancement flap based on the descending branch of the inferior gluteal artery; a rotation V-Y advancement flap based on the first perforator of the deep femoral artery and the descending branch of the inferior gluteal artery; and, a bilobed flap at each lobe containing either the descending branch or medial branch of the inferior gluteal artery. The flap designs were decided from the size and the location of the skin defect. Results: The contours after reconstruction were satisfactory and did not experience any recurrence of hidradenitis suppurativa for at least 1 year after operation. Conclusion: We showed three different designs of FC flaps to cover the gluteal skin defects based on the anatomical study. FC flaps may be chosen for reconstruction after resection of perianal hidradenitis suppurativa.

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M-CSF inhibition selectively targets pathological angiogenesis and lymphangiogenesis

Kubota, Yoshiaki, Takubo, Keiyo, Shimizu, Takatsune, Ohno, Hiroaki, Kishi, Kazuo, Shibuya, Masabumi, Saya, Hideyuki, Suda, Toshio

JOURNAL OF EXPERIMENTAL MEDICINE 206 ( 5 ) 1089 - 1102 2009.05

Research paper (scientific journal), ISSN 0022-1007

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Head and neck reconstruction using a combined sternomastoid musculocutaneous external jugular veno-accompanying-artery adipofascial flap

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 62 ( 4 ) 510 - 513 2009.04

ISSN 1748-6815

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Reconstruction modality based on the spare part concept for massive soft tissue defects following oncological hemipelvectomy

Morii, Takeshi, Susa, Michiro, Nakayama, Robert, Kishi, Kazuo, Morioka, Hideo, Yabe, Hiroo

JOURNAL OF ORTHOPAEDIC SCIENCE 14 ( 2 ) 192 - 197 2009.03

Research paper (scientific journal), ISSN 0949-2658

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Early serial Q-switched ruby laser therapy for medium-sized to giant congenital melanocytic naevi

Kishi K., Okabe K., Ninomiya R., Konno E., Hattori N., Katsube K., Imanish N., Nakajima H., Nakajima T.

British Journal of Dermatology 161 ( 2 ) 345 - 352 2009

ISSN 0007-0963

Background Medium-sized to giant congenital melanocytic naevi (CMN) are difficult to treat, especially if the lesions appear on the face or extremities where treated areas are visible and cosmesis is important. Objectives In infants, nests of pigmented naevus reside more superficially and the skin is more transparent than in adults, so we treated medium-sized to giant CMN with early serial Q-switched ruby laser therapy from infancy. Patients and methods We treated nine patients with medium-sized to giant CMN on the face or upper limbs from 1 month of age with early serial Q-switched ruby laser therapy. The laser power was initially 5 J cm) ² and increased in 0 5 J cm) ² steps to a maximum of 10 J cm) ². There were three treatment sites on the forehead, one on the temple, one on the cheek and four on the upper arm. Results It took 8-15 treatments for the CMN to become a colour similar to the surrounding skin. The mean number of treatments was 9 6. The colour was reduced to 0-20% of the colour of the baseline lesion in all nine patients. Partial slight repigmentation occurred in eight of these patients. These naevi were treated with an additional one or two Q-switched ruby laser irradiations and successfully lightened for at least 1 year. In the remaining patient, pigmentation returned to a level similar to the original lesion within 1 month of the last treatment. Therefore, the lesion was excised for cosmetic reasons. After the treatment series, the skin texture was fine and no patients had hypertrophic scarring. Conclusions Although treatment of one patient with the Q-switched ruby laser therapy failed, the remaining patients responded well and had good to excellent skin texture without hypertrophic scarring. Early serial Q-switched ruby laser treatment, starting from infancy, is a promising treatment method for this condition.

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Rat dorsal paired island skin flaps

Ohara Hirotoshi, Kishi Kazuo, Nakajima Tatsuo

Keio Journal of Medicine 57 ( 4 ) 211 - 216 2008.12

ISSN 0022-9717

Rectangular flaps on the rat or mouse dorsum are frequently used for flap survival elongation research. However, since rectangular flaps are purely random, the survival rate varies among individuals. A reliable animal flap model with low individual variation is desirable for flap survival research, especially in the angiogenic field. We investigated the survival rate of paired flaps in the rat dorsum containing 3 vascular territories in each flap, and determined their usefulness for flap elongation research. Two symmetrical adjoining rectangular flaps (11×3 cm each) were drawn on the rat dorsum. Two days after material injection, flaps were elevated with only the deep circumflex iliac vessels as the vascular pedicle. Flaps were immediately sutured back and the flap survival area was measured 7 days after the operation. The control group (n = 9) had saline solution injected in both flaps. The bone marrow group (n = 8) had bone marrow injected in the right flap, and saline solution injected in the left flap. In the control group, the survival rate of the paired flaps was not statistically different (right flap, 89.0±5.6%; left flap, 89.3±4.5%). In the bone marrow group, the survival rate between the bone marrow injected flap (89.9±3.7%), and the saline flap (84.8±4.3%) was statistically different. The rat dorsal paired island skin flap model shows low difference in flap survival rate and uses an internal control. This is a suitable model for flap survival elongation research.

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E-cadherin expression in the subepithelial nevus cells of the giant congenital nevocellular nevi (GCNN) correlates with their migration ability in vitro

Matsuda N., Katsube K., Mikami S., Katsuki Y., Iseki H., Mukai M., Yamaguchi A., Takano Y., Nakajima T., Nakajima H., Kishi K.

Journal of Dermatological Science 52 ( 1 ) 21 - 30 2008.10

ISSN 0923-1811

Background: Giant congenital nevocellular nevi (GCNN) are histologically characterized by the broad distribution of nevus cells in the epidermis and dermis. Objective: To characterize E-cadherin in GCNN and define its role in nevic cell migrations. Methods: Twenty-four cases were immunohistochemically examined and in five cases cells were isolated for primary culture for migration assays. Results: The nevus cells in the superficial region showed the immunoreactivity of E-cadherin in a membranous pattern, but those in the deep part of dermis had little immunoreactivity. Ultra-structural analysis of the superficial nevus cells revealed that E-cadherin immunodeposits in the fibrillar processes around the cell body in a spotted pattern. This distribution pattern is quite different from that in the adherens junction of skin squamous epithelial cells. Boyden chamber experiments were performed using primary cultures of intradermal nevus cells. EDTA pretreatment reduced cell migration to the E-cadherin positive side when the E-cadherin positive population was relatively large in the primary cultures. Conclusions: These results indicate that E-cadherin in the nevus cells may affect nevus cell motility rather than intercellular attachment.

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