研究者詳細 - 貴志　和生

論文 - 貴志　和生

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Influence of Flap Thickness on Nipple Projection After Nipple Reconstruction Using a Modified Star Flap

貴志和生

AESTHETIC PLASTIC SURGERY 42 （ 4 ） 964 - 970 2018年08月

研究論文（学術雑誌）, ISSN 0364-216X

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Surgical Simulation and Custom-Made Implant for Cranial Fibrous Dysplasia

Sakamoto Yoshiaki, Miwa Tomoru, Yoshida Kazunari, Kishi Kazuo

Journal of Craniofacial Surgery 29 （ 5 ） 1352 - 1353 2018年07月

ISSN 1049-2275

Background: The management of fronto-orbital fibrous dysplasia involves total excision of the dysplastic bone and bone reconstruction using implants. Custom-made implants are used to achieve good contouring. However, the remnant defect after excising the lesion often does not match the implant. Methods: To design the craniotomy line, a template was prepared by preoperative computed surgical simulation. The template was overlaid on the preoperative cranium, such that its inner surface fits exactly with the cranial surface. After excising the lesion by performing osteotomy, the implant was placed in the defect and fixed. Both template and implant were made of hydroxyapatite. Results: The authors treated 4 patients, with fibrous dysplasia involving the fronto-facial region by using the template. Intraoperative trimming of the implant or bone defect was not required in 2 patients, while the third patient required mild trimming. They did not have any complications and obtained good contouring. Conclusion: The hydroxyapatite templates reduced the surgical time by determining the precise craniotomy line preoperatively, thus avoiding needless trimming of the implant and bone defect. Therefore, they can enhance the efficacy of treatment for fronto-orbital fibrous dysplasia lesion.

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A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander

Kono Hikaru, Ishii Naohiro, Takayama Masayoshi, Takemaru Masashi, Kishi Kazuo

Archives of Plastic Surgery 45 （ 4 ） 333 - 339 2018年07月

ISSN 2234-6163

Background Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume. Methods We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05× the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II. Results X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases. Conclusions The volume of a free TRAM flap can be straightforwardly estimated preopera-tively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

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Influence of backscatter radiation on cranial bone fixation devices

Sakamoto Yoshiaki, Koike Naoyoshi, Takei Hideyuki, Ohno Mari, Shigematsu Naoyuki, Kishi Kazuo

Journal of Craniofacial Surgery 29 （ 4 ） 1094 - 1096 2018年06月

ISSN 1049-2275

Postoperative radiation can cause ulcer formation, leading to the denudation of skin over alloplastic materials. The influence of backscatter radiation from fixation devices has not been investigated. The aim of this study is to evaluate backscatter dose variations for different cranial bone fixation devices in an experimental model designed to simulate postoperative radiotherapy. The authors assessed the radiation backscatter doses associated with resorbable (PLLA-PGA) and titanium plates. The samples were irradiated with 6 and 10 MV photon beams from a linear accelerator. Measurements were obtained using an ionization chamber and radiochromic films cut from the same batch. As a result, the backscatter radiation of water and PLLA-PGA proportionally decreased as the depth increased. However, the backscatter radiation of the titanium plate increased just above the plate. This depth lies in the region of the scalp. Each material showed a dose of radioactivity that was higher at 10 MV than that at 6 MV. These devices showed a significant difference, which suggested that these materials amplified the dose compared with water at 6 MV. In conclusion, it is supposed that PLLA-PGA should be used to fix the cranium to decrease the potential for radiation ulcers.

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Influence of Flap Thickness on Nipple Projection After Nipple Reconstruction Using a Modified Star Flap

Ishii Naohiro, Ando Jiro, Harao Michiko, Takemae Masaru, Kishi Kazuo

Aesthetic Plastic Surgery 1 - 7 2018年05月

ISSN 0364-216X

Background: In nipple reconstruction, the width, length, and thickness of modified star flaps are concerns for long-term reconstructed nipple projection. However, the flap’s projection has not been analyzed, based on its thickness. The aim of the present study was to investigate how flap thickness in a modified star flap influences the resulting reconstructed nipple and achieves an appropriate flap width in design. Methods: Sixty-three patients who underwent nipple reconstruction using a modified star flap following implant-based breast reconstruction between August 2014 and July 2016 were included in this case-controlled study. The length of laterally diverging flaps was 1.5 times their width. The thickness of each flap was measured using ultrasonography, and the average thickness was defined as the flap thickness. We investigated the correlation between the resulting reconstructed nipple and flap thickness, and the difference of the change in the reconstructed nipple projection after using a thin or thick flap. Results: The average flap thickness was 3.8 ± 1.7 (range 2.5–6.0) mm. There was a significant, linear correlation between the flap thickness and resulting reconstructed nipple projection (β = 0.853, p < 0.01). Furthermore, the difference between the thin and thick flaps in the resulting reconstructed nipple projection was significant (p < 0.01). Conclusion: Measuring the flap thickness preoperatively may allow surgeons to achieve an appropriate flap width; otherwise, alternative methods for higher projection might be used. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Utility of topical epinephrine for determining the resection range of eyelid sebaceous carcinoma with dermatitis

Kiuchi Tomoki, Shimizu Yusuke, Yamazaki Shun, Awazawa Tsuyoshi, Kishi Kazuo

Archives of Plastic Surgery 45 （ 3 ） 289 - 290 2018年05月

ISSN 2234-6163

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A Giant Osteoma of the Ethmoid Sinus

貴志和生

JOURNAL OF CRANIOFACIAL SURGERY 29 （ 3 ） 661 - 662 2018年05月

研究論文（学術雑誌）, ISSN 1049-2275

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Tranilast inhibits the expression of genes related to epithelial-mesenchymal transition and angiogenesis in neurofibromin-deficient cells

貴志和生

SCIENTIFIC REPORTS 8 E325 - E327 2018年04月

研究論文（学術雑誌）, ISSN 2045-2322

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Wound Bed Preparation for Capsulectomy Using a Hydrosurgery System

貴志和生

WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE 30 （ 4 ） E49 - E51 2018年04月

研究論文（学術雑誌）, ISSN 1044-7946

Inside PRS department;No 39

Kishi Kazuo

Japanese Journal of Plastic Surgery 61 （ 3 ） 318 - 321 2018年03月

ISSN 0021-5228

Optimal Conditions for Absorbable Fixation of Hydroxyapatite Ceramic Implants

Sakamoto Yoshiaki, Kishi Kazuo

Journal of Craniofacial Surgery 29 （ 1 ） 248 - 250 2018年01月

ISSN 1049-2275

Synthetic hydroxyapatite (HAP) implants are common in craniofacial surgery; the major problem with HAP implants is fixation instability. An ultrasound-assisted pinned resorbable fixation system has recently been introduced. The authors hypothesized that this resorbable system could be used to fix HAP implants. The authors evaluated the optimal HAP porosity and resorbable pin using the pull-out test and microscopic analysis. Hydroxyapatite blocks were synthesized with 0% (dense type), 35% (fine pore type), and 50% (large pore type) porosity. Bioabsorbable pins of 4 sizes were tested: diameters of 1.6 or 2.1mm and lengths of 4 or 7mm. Among the 1.6mm diameter pins, the 7-mm length pins showed higher pull-out strength (large pore, 6.5±1.2 kgf; fine pore, 4.1±0.7 kgf; dense, 2.4±0.4 kgf) than the 4-mm length pins (large pore, 2.1±1.0 kgf; fine pore, 1.3±0.4 kgf; dense, 1.5±0.9 kgf) with all 3 HAP types (P<0.01). Among 2.1-mm diameter pins, all were removed from the large and fine pore HAP types without any resistance. Only three of seven 2.1×7mm pins inserted into the dense type HAP showed pull-out strength (3.9±2.1 kgf). Among all conditions, the 7-mm length, 1.6-mm diameter pin in large pore type HAP showed the highest pull-out strength. Microscopically, the large pore type HAP showed the liquefying pin flowing into the large pore adjacent to the pilot hole. By contrast, the fine pore and dense pore types of HAP did not allow flow, and the pins did not change in structure 3-dimensionally. The authors found that pull-out strength depends on HAP porosity, and pin length and diameter.

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Complete coverage of a tissue expander by a musculofascial pocket including the sternalis muscle during breast reconstruction

Ishii Naohiro, Shimizu Yusuke, Ando Jiro, Harao Michiko, Takemae Masaru, Kishi Kazuo

Archives of Plastic Surgery 45 （ 1 ） 89 - 90 2018年01月

ISSN 2234-6163

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Individual difference in pectoralis major muscle thickness and its effect on single-stage breast reconstruction using a tissue expander

貴志和生

BREAST CANCER 25 （ 1 ） 68 - 73 2018年01月

研究論文（学術雑誌）, ISSN 1340-6868

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A retrospective analysis of zygomatic fracture etiologies

Sakamoto Yoshiaki, Ogata Hisao, Shido Hirokazu, Kishi Kazuo

JPRAS Open 14 23 - 26 2017年12月

Background Zygomatic fractures are some of the most frequently encountered facial fractures. However, the relationships between the trauma etiology, the zygomatic fracture patterns, and patient ages have not been described. Methods Patients treated for isolated malar fractures, between 2004 and 2011, at Keio University Hospital were reviewed in this study. Comparative statistical analyses were conducted, based on the classification of the zygomatic fractures, their causes, and patient ages; p < 0.05 was considered significant. Results In total, 113 patients, aged 16–82-years-old (mean age (SD), 39.8 (17.0)-years-old), including 74 men were analyzed. Patients in their teens and 20s had injuries that were predominantly sports-related (48.8%). With increasing age, the ratio of sports injuries decreased and the number of falls causing injury increased. The frequency of injuries caused by motor vehicle collisions remained reasonably constant across the age groups. Comparing the ratio of shear type fractures with patient ages revealed that 4/13 injuries among patients in their 20s and 30s were of this type, whereas the proportion of shear fractures increased in patients over 40 (17/28, p < 0.05). Conclusion The severities of the zygomatic fractures, their causes, and the associated patient ages were closely related. Based on this study, possible prevention strategies for zygomatic fractures need to be considered.

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Transplanted mesenchymal stem cells are effective for skin regeneration in acute cutaneous wounds of pigs

貴志和生

REGENERATIVE THERAPY 7 8 - 16 2017年12月

研究論文（学術雑誌）, ISSN 2352-3204

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Anatomical Study of Perfusion of a Periosteal Flap with a Lateral Pedicle

Kim Boktae, Inoue Yoshikazu, Imanishi Nobuaki, Chang Hak, Shimizu Yusuke, Okumoto Takayuki, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 （ 9 ） 2017年09月

Background: Pedicled periosteal flaps are commonly used for tissue defects between the base of the skull and the midfacial area. This study aimed to clarify the 3-dimensional vascular distribution of temporal region flaps. Methods: Ten fresh cadavers were used. Full-thickness cranial flaps were elevated from the cranial bone and each layer was detached separately. Contrast enhancement of the full thickness of the scalp, macroscopic evaluation, and histologic analyses were performed. Radiographs were obtained and image analysis was performed using a 3-dimensional monitor. Results: The mean number of deep vessels extending from the parietal branch of the superficial temporal artery was 68.7, including 14.2 and 54.5 vessels on the proximal and distal sides, respectively. The mean number of deep vessels extending from the frontal branch of the superficial temporal artery was 71.6, including 17.6 and 54.0 vessels on the proximal and distal sides, respectively. There were significantly more perforating branches in the distal area than in the proximal area of both the frontal and parietal branches (P = 0.005). There was no significant difference in the number of perforating branches between the frontal and parietal branches. Conclusions: Contrast-enhanced images of the loose areolar tissue and periosteal layers revealed vessels that extended radially. We successfully identified the 3-dimensional structure of the perforating vessels peripheral to the temporal fossa. Our findings provide a theoretical foundation for the feasibility of elevating a periosteal/loose areolar tissue flap with a reliable blood supply without sacrificing the temporal muscle.

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Lymphedema of the Lower Extremities due to Refractory Malignant Lymphoma Treated by Lymphaticovenous Anastomosis

Ishii Naohiro, Aoki Marie, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 （ 8 ） 2017年08月

Summary: Lymphaticovenous anastomosis (LVA) is primarily performed for lymphedema of the lower extremities after surgical treatment of gynecologic cancer and lymphedema of the upper extremities after surgical resection of breast cancer; however, LVA for lymphedema due to malignant lymphoma has not been reported to date. We herein present a patient with severe lymphedema of the lower extremities due to refractory malignant lymphoma, which markedly improved with LVA. LVA could contribute to improve quality of life in patients with end-stage disease with lymphedema of the lower extremities due to refractory malignant lymphoma.

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Efficacy and safety of oral propranolol for infantile hemangioma in Japan

貴志和生

PEDIATRICS INTERNATIONAL 59 （ 8 ） 869 - 877 2017年08月

研究論文（学術雑誌）, ISSN 1328-8067

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Distraction Osteogenesis for Brachymetatarsia by Using Internal Device

Kitabata Reina, Sakamoto Yoshiaki, Nagasao Tomohisa, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 （ 7 ） 2017年07月

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Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with Contracture

Kuriyama Erika, Ochiai Hiroko, Inoue Yoshikazu, Sakamoto Yoshiaki, Yamamoto Naoki, Utsumi Toshiaki, Kishi Kazuo, Okumoto Takayuki, Matsuura Akihiro

Plastic and Reconstructive Surgery - Global Open 5 （ 7 ） 2017年07月

Background: Capsular contracture is a common complication after breast augmentation surgery. This study pathologically evaluated the soft-tissue response to surface modifications in both smooth and textured tissue expander prostheses. Methods: Smooth tissue expanders and textured tissue expanders in 5 cases each were used for breast reconstruction after mastectomy. Histological samples were harvested from the capsules when the tissue expanders were replaced by silicone implants. Collagen orientation and cellular responses were assessed histologically. Capsular contracture was evaluated using the Baker classification 6 months and 2 years after the removal of the tissue expander. Results: The capsules surrounding the smooth tissue expanders tended to produce more contracture than those surrounding the textured tissue expanders. The collagen architecture of the capsules of the smooth tissue expanders showed random orientation with fragmentation. Conversely, the capsules of the textured tissue expanders showed parallel orientation with collagen bundles of almost normal structure. Significantly more fibrils of elastin and myofibroblasts were found in the capsules surrounding the smooth tissue than in those surrounding the textured ones. Conclusions: The collagen fibers surrounding the smooth tissue expanders could be cracked during expansion, which may lead to scarring and contracture. Conversely, the collagen orientation surrounding the textured tissue expanders was excellent. Moreover, the increase in elastic fibers and myofibroblasts in the capsules surrounding the smooth tissue expanders may be associated with in vivo contraction patterns. Therefore, the surface type of tissue expanders affects capsular contraction after replacement with definitive implants.

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