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Papers - Kishi, Kazuo

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Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent

Saegusa, Noriko, Sarukawa, Shunji, Ohta, Kunihiro, Takamatsu, Kensuke, Watanabe, Mitsuhiro, Sugino, Takashi, Nakagawa, Masahiro, Akiyama, Yasuto, Kusuhara, Masatoshi, Kishi, Kazuo, Inoue, Keita

PLOS ONE 12 ( 7 ) 869 - 877 2017.07

Research paper (scientific journal), ISSN 1932-6203

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Relationship between Keloid Formation and YAP/TAZ Signaling

Aramaki-Hattori Noriko, Okabe Keisuke, Hamada Mariko, Takato Tamae, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 ( 6 ) 2017.06

Summary: YAP (yes-Associated protein) and TAZ (transcriptional coactivator with PDZ-binding motif) are part of a classical pathway that controls contact inhibition in the Hippo pathway. YAP and TAZ were recently reported to act as nuclear relays of mechanical signals that communicate extracellular matrix rigidity and cell shape. However, the role of YAP/TAZ signaling in keloid formation is unclear. Here, we used immunohistochemistry to investigate YAP/TAZ expression in keloid and nonaffected lesions. YAP/TAZ expression in keloid fibroblasts had a greater tendency to localize to the nucleus relative to that seen in fibroblasts from unaffected tissues. Meanwhile, keratinocytes or endothelial cells from either keloid or unaffected tissues showed no significant differences in YAP/TAZ expression patterns. These results suggest that YAP/TAZ nuclear localization in keloid fibroblasts might activate Hippo signaling and may play an important role in gene expression that affects keloid formation and stiffness.

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

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

Breast Cancer 1 - 6 2017.05

ISSN 1340-6868

Background: In breast reconstruction using a tissue expander (TE), sufficient coverage of the TE with the pectoralis major (PM) muscle, particularly with a musculofascial flap, is highly important for avoiding postoperative complications. In patients in whom the PM is thin, intraoperative trauma often occurs, leading to troublesome repair. The present study aimed to investigate the usefulness of preoperative measurement of PM thickness in planning of breast reconstruction using a TE. Methods: In this case–control study, we identified 68 patients (70 breasts) with mammary carcinoma treated with simple mastectomy and TE insertion from April 2014 to December 2016. We measured average PM thickness at two specific points, sternocostal PM distance on the long axis and sternocostal PM area preoperatively using magnetic resonance imaging. Then, we analyzed the difference in PM thickness among individuals and its relationship to intraoperative trauma to the PM or surgical difficulty creating a muscular pocket (delicate PM). Results: Average PM thickness was significantly larger in younger patients (p = 0.046) and those with larger breasts (p < 0.01). In addition, average PM thickness on the affected side was significantly smaller in patients with delicate PM (12 breasts) (p < 0.01). PM thickness had a significant influence on delicate or firm PM (odds ratio 27.40; 95% confidence interval 2.01–372.00; p = 0.013). Conclusion: These findings demonstrate the usefulness of preoperative measurement of PM thickness in planning of breast reconstruction using a TE. Dissection should be performed more carefully in patients with average PM thickness less than 2.9 mm.

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Modified Dufourmentel flap with superior pedicle

Ishii Naohiro, Shimizu Yusuke, Oji Tomito, Kishi Kazuo

Journal of Plastic Surgery and Hand Surgery 1 - 5 2017.04

ISSN 2000-656X

Purpose: In order to prevent postoperative infection and recurrence of sacrococcygeal pilonidal sinus, the authors developed a modified Dufourmentel flap, involving the superior pedicles, and designed a descriptive prospective study to evaluate its efficiency. Methods: Between July 2007 and March 2014, 16 patients with sacrococcygeal pilonidal sinus were treated with an irregular quadrilateral excision and reconstruction by a modified Dufourmentel flap with superior pedicle. The duration of wound healing, presence of wound complications and permanent hypoesthesia, and recurrence rates were recorded and assessed. Results: None of the patients developed flap necrosis or wound infection postoperatively. The duration of wound healing was 7.2 ± 2.9 (range = 6–15) days. Wound dehiscence was demonstrated in only one patient (6.3%). The mean follow-up period was 4 years and 2 months (range = 4 months–8 years and 8 months), whereby no permanent hypoesthesia or recurrence was detected. Conclusion: The modified Dufourmentel flap with superior pedicle can be safely used as a treatment of sacrococcygeal pilonidal sinus, with excellent results.

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The optimal color of background sheets for microsurgery

Kiuchi Tomoki, Ishii Naohiro, Tani Yumiko, Masaoka Kousuke, Suzuki Ayaka, Kishi Kazuo

Archives of Plastic Surgery 44 ( 2 ) 175 - 176 2017.03

ISSN 2234-6163

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Laser treatment for facial scars

Ohshiro Takafumi, Ohshim Toshio, Sasaki Katsutmi, Toriumi Masahiro, Kishi Kazuo

Japanese Journal of Plastic Surgery 60 ( 3 ) 313 - 322 2017.03

ISSN 0021-5228

Facial scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to improve their appearance. Scar management with laser devices is optimized when individual patient and scar characteristics are thoroughly evaluated to determine the best course of treatment. Because scars have a variety of potential etiologies and take a number of forms, no single approach can consistently provide good scar revision. The combined use of various laser devices is essential, and the choice of wavelength and approach are individualized for each patient. In this manuscript, we introduce the concept of scar management with laser devices and the use of various laser systems such as low reactive-level laser therapy (LLLT) for symptomatic scars with inflammation, pulsed-dye laser irradiation for scars with inflammation and telangiectasia, and fractional laser resurfacing, with presentation of representative cases.

An anatomical study on the availability of contralateral recipient vessels in hemi-mandibular reconstruction with vascularised free fibula transfer

Kasai Shogo, Nagasao Tomohisa, Sakamoto Yoshiaki, Shimizu Yusuke, Imanishi Nobuaki, Kishi Kazuo

Journal of Plastic Surgery and Hand Surgery 1 - 4 2017.02

ISSN 2000-656X

Background: In mandibular reconstruction with vascularised free fibula transfer, there are situations where the neck on the operated site lacks recipient vessels for vascular anastomosis due to previous radiological/surgical interventions. Methods: The present study aims to clarify the availability of neck vessels on the contralateral side in such situations. Experimental surgery was conducted on 20 fresh cadavers (six males and 14 females). After the left half of the mandible was removed, free vascularised fibula of equivalent length was transferred to fill the defect. The possibility of connecting the peroneal artery and vein to the superior thyroid artery (STA), transverse coli artery (TCA), internal jugular vein (IJV), and external jugular vein (EJV) of the contralateral side was evaluated. Results: In all samples, the peroneal vessels could reach the STA and EJV. However, the peroneal vessels could reach the TCA and IJV of the contralateral side in only 45% and 64.2% of cases, respectively. The average and standard deviation of the lengths by which vessels were insufficient were 1.1 ± 13.9 mm for IJV and 8.8 ± 24.7 mm for TCA. Conclusions: In reference to these findings, it is concluded that, in situations where neck vessels of the defect side are unavailable, availability of the superior thyroid artery and external jugular vein should be examined first. When these vessels are available as recipient vessels, direct vascular anastomosis is highly likely to be successful. In cases where these vessels are unavailable and the transverse coli artery or internal jugular vein is used as the recipient, vascular interposition might be necessary.

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Development of One-Step Drill-Tap for a Resorbable Screw

Sakamoto Yoshiaki, Kishi Kazuo

Journal of Craniofacial Surgery 2017.01

ISSN 1049-2275

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Venous anastomosis for prevention of venous congestion in distally based flaps

Ihara Jun, Imanishi Nobuaki, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 ( 12 ) 2017.01

Background: Distally based flaps are useful for the treatment of skin defects of the extremities. However, congestion in the peripheral part of the flap due to reverse flow can cause partial flap necrosis. Previously, we reported on the effectiveness of venous anastomoses to rescue peripheral congestion of distally based flaps and applied this idea in a clinical setting. In this report, we present clinical cases of distally based flaps with venous supercharge anastomoses for changing the reverse venous flow into physiological flow, thereby reducing venous congestion. Methods: Four patients with skin defects of the extremities (2 cases with defects of the knee and the upper third of the lower leg, 1 case of the lower third of the lower leg, and 1 case of the distal third of the forearm) were treated with local flaps (2 cases with distally based greater saphenous venoadipofascial sartorius muscle combined flaps, 1 case with a distally based lesser saphenous venoadipofascial flap, and 1 case with a distally based ulnar artery perforator flap). In each reconstruction, 1 or 2 veins in the flaps were anastomosed with superficial veins in the recipient area to change the reverse venous flow into a normal, physiologic flow. Result: All flaps healed completely without any obvious venous congestion or flap necrosis. The coverage quality provided by these defects was satisfactory. Conclusions: Adding venous anastomoses may reduce the risk of venous congestion and improve the outcomes of the distally based flaps.

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Cleft palate repair without lateral relaxing incision

Ogata Hisao, Sakamoto Yoshiaki, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 ( 3 ) 2017.01

Background: The goals of successful palate repair include optimization of speech and feeding, avoidance of fistula formation, and mitigation of adverse maxillary growth. However, the effects of scar formation on maxillary growth have not been discussed in detail. Methods: Between November 2010 and December 2011, the palateplasty was performed for 24 patients with cleft palate (median age, 12 months; range, 11-18 months). In the velum, a symmetrical intravelar veloplasty with mucosal Z-plasty was performed on both the nasal and oral sides. In the hard palate, instead of lateral relaxing incisions, a 1-line mucoperiosteal incision along the cleft margins was designed with subperiosteal undermining in the entire palatine bone. The palatal mucoperiosteum was sutured together in the middle of the cleft, and the cleft was directly closed without lateral relaxing incisions. The patients were monitored for 6 months to 1.6 years. Results: None of the cases had issues concerning flap viability, and all palate repairs healed well. Postoperative results were satisfactory, without any complications such as dehiscence, perforation, or palatal fistula. Conclusions: The method presented in this article was effective, with successful palatal closure and without scar formation or mucosal defects along the alveolus. We conclude that minimum contracture of the hard palate was useful for not only mitigating adverse maxillary growth but also for orthodontics.

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Surgery requiring detailed preoperative simulation and scar de-epithelialization to repair severe postoperative scarring from gastroschisis

Ishii Naohiro, Oji Tomito, Kishi Kazuo

Archives of Plastic Surgery 44 ( 4 ) 337 - 339 2017

ISSN 2234-6163

We present the case of a patient with severe postoperative scarring from surgical treatment for gastroschisis, with the intestine located immediately under the dermal scar. Although many patients are unsatisfied with the results of scar repair treatment, few reports exist regarding severe or difficult cases involving the surgical repair of postoperative scar contracture. We achieved an excellent result via simulation involving graph paper drawings that were generated using computed tomography images as a reference, followed by dermal scar de-epithelialization. The strategy described here may be useful for other cases of severe postoperative scar contracture after primary surgery for gastroschisis.

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Influence of backscatter radiation on cranial reconstruction implants

Sakamoto, Yoshiaki, Koike, Naoyoshi, Takei, Hideyuki, Ohno, Mari, Miwa, Tomoru, Yoshida, Kazunari, Shigematsu, Naoyuki, Kishi, Kazuo

BRITISH JOURNAL OF RADIOLOGY 90 ( 1070 ) 486 - 488 2017

Research paper (scientific journal), ISSN 0007-1285

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Co-occurrence of Sturge-Weber syndrome and Klippel-Trenaunay-Weber syndrome phenotype

Sakaguchi Yuri, Takenouchi Toshiki, Uehara Tomoko, Kishi Kazuo, Takahashi Takao, Kosaki Kenjiro

American Journal of Medical Genetics, Part A 2017

ISSN 1552-4825

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Effect of Platelet-Rich Plasma on Bone Grafting of Alveolar Clefts

Sakio Reiko, Sakamoto Yoshiaki, Ogata Hisao, Sakamoto Teruo, Ishii Takenobu, Kishi Kazuo

Journal of Craniofacial Surgery 28 ( 2 ) 486 - 488 2017

ISSN 1049-2275

The purpose of this study was to evaluate the effectiveness of platelet-rich plasma (PRP) on the absorption of the bone graft in the alveolar cleft. Twenty-nine patients with alveolar clefts in unilateral cleft lip were examined; 6 were the control group and received iliac cancellous bone and marrow grafts without PRP, while the remaining 23 comprised the PRP group and received grafts with PRP. Quantitative evaluation of remaining bone was made by the computer-aided engineering with multidetector row computed tomography at 1 month and 1 year after surgery. Satisfactory bone bridging formation was observed in all patients. Two patients in control group and 1 patient in PRP group developed wound dehiscence with minor bone exposure. One year postoperatively, the canine was exposed and orthodontically guided into an ideal arch relation in all patients. The mean resorption ratio was 49.9 ± 17.2% and 44.9 ± 14.4% with no significant difference (P = 0.60). In conclusion, there is currently no evidence to suggest that autologous PRP is of value for effect on the bone resorption for alveolar bone graft.

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Firmly fixed dressing with tie-over

Ishii Naohiro, Takemaru Masashi, Kishi Kazuo

International Journal of Dermatology 2017

ISSN 0011-9059

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Simultaneous decompression of the orbital lateral wall and optic canal for fibrous dysplasia in early adolescence

Tamura Ryota, Miwa Tomoru, Sakamoto Yoshiaki, Kohno Maya, Kishi Kazuo, Yoshida Kazunari

SpringerPlus 5 ( 1 ) 2016.12

ISSN 2193-1801

Introduction: Patients with fronto-orbital fibrous dysplasia (FD) occasionally present fronto-orbital protrusion, exophthalmos, and visual acuity disturbance. Simultaneous management of these conditions has not been previously described. Case description: A-10-year-old female with fronto-orbital FD complained of left visual acuity disturbance. Head computed tomography showed compressed optic canal secondary to thickened bone. Decompression of the optic canal via the left frontotemporal extradural approach, opening of the lateral orbital wall, and dissection of the prominent zygoma were done simultaneously. The patient’s visual acuity disturbance and exophthalmos subsequently improved postoperatively. Discussion and evaluation: When optic canal decompression is performed by the fronto-temporal approach, opening of the lateral orbital wall can be done simultaneously to decrease the intraorbital pressure and to prevent exophthalmos. In addition, although aesthetic plastic surgery is not generally recommended during the growing phase (due to the possibility of recurrence), this approach can prevent skin loosening and adverse cosmetic outcomes. Conclusions: Aesthetic plastic surgery for fronto-orbital FD is recommended to prevent skin loosening. Opening of the lateral orbital wall should be performed when optic canal decompression is planned.

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Microsurgical training using reusable human vessels from discarded tissues in lymph node dissection

Ishii Naohiro, Kiuchi Tomoki, Oji Tomito, Kishi Kazuo

Archives of Plastic Surgery 43 ( 6 ) 595 - 598 2016.11

ISSN 2234-6163

The use of human vessels at the beginning of microsurgery training is highly recommended. But vessels with the appropriate length for training are not often obtained. Whether these vessels may be reused for training has not been reported. Accordingly, we harvested vessels from discarded tissues in lymph node dissection and demonstrated that vascular anastomosis training using the same human vessels several times is possible by placing the vessels in a freezer and defrosting them with hot water. Vascular walls can be stored for microsurgical training until about 4 years after harvest, as shown in the gross appearance and histologic findings of our preserved vessels. We recommend the technique presented here for the longterm reuse of human vessels for microsurgery training that closely resembles real procedures.

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Dermoscopic findings in pigmente Bowen’s disease of the lip

Nomura Hisashi, Funakoshi Takeru, Yokoyama Tomoaki, Amagai Masayuki, Okabe Keisuke, Kishi Kazuo, Tanikawa Akiko

European Journal of Dermatology 26 ( 6 ) 613 - 614 2016.11

ISSN 1167-1122

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Decreased contralateral breast volume after mastectomy, adjuvant chemotherapy, and anti-estrogen therapy, in particular in breasts with high density

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

Journal of Plastic, Reconstructive and Aesthetic Surgery 2016.08

ISSN 1748-6815

Adjuvant chemotherapy and anti-estrogenic therapy can result in decreased volume of the contralateral breast, following mastectomy for the treatment of breast cancer. However, no data on the effect of adjuvant therapy on contralateral breast volume have previously been reported. We aimed to evaluate the extent to which adjuvant therapy and differences in breast density contribute to decreased breast volume.We conducted a prospective cohort study, selecting 40 nonconsecutive patients who underwent immediate breast reconstruction with mastectomy and expander insertion followed by expander replacement. We measured the contralateral breast volume before each procedure. The extent of the change was analyzed with respect to adjuvant therapy and breast density measured by preoperative mammography.The greatest decrease in breast volume was 135.1 cm³. The decrease in breast volume was significantly larger in the adjuvant therapy (+) group, particularly in patients with high breast density, than in the adjuvant therapy (-) group. Significant differences between the chemotherapy (+), tamoxifen (+) group and the chemotherapy (-), tamoxifen (+) group were not found. Breast density scores had a range of 2.0-3.3 (mean: 2.8).In breast reconstruction, particularly when performed in one stage, preoperative mammography findings are valuable to plastic surgeons, and possible decreases in the contralateral breast volume due to adjuvant therapy, particularly in patients with high breast density, should be considered carefully.

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Usefulness of an Osteotomy Template for Skull Tumorectomy and Simultaneous Skull Reconstruction

Oji Tomito, Sakamoto Yoshiaki, Miwa Tomoru, Nakagawa Yu, Yoshida Kazunari, Kishi Kazuo

Journal of Craniofacial Surgery 2016.07

ISSN 1049-2275

BACKGROUND:: Simultaneous tumor resection and cranioplasty with hydroxyapatite osteosynthesis are sometimes necessary in patients of skull neoplasms or skull-invasive tumors. However, the disadvantage of simultaneous surgery is that mismatches often occur between the skull defect and the hydroxyapatite implant. To solve this problem, the authors developed a customized template for designing the craniotomy line. METHODS:: Before each operation, the craniotomy design was discussed with a neurosurgeon. Based on the discussion, 2 hydroxyapatite implants were customized for each patient on the basis of models prepared using computed tomography data. The first implant was an onlay template for the preoperative cranium, which was customized for designing the osteotomy line. The other implant was used for the skull defect. Using the template, the osteotomy line was drawn along the template edge, osteotomy was performed along this line, and the implant was placed in the skull defect. RESULTS:: This technique was performed in 3 patients. No implant or defect trimming was required in any patient, good cosmetic outcomes were noted in all patients, and no complications occurred. CONCLUSION:: Use of predesigned hydroxyapatite templates for craniotomy during simultaneous skull tumor resection and cranioplasty has some clinical advantages: the precise craniotomy line can be designed, the implant and skull defect fit better and show effective osteoconduction, trimming of the implant or defect is minimized, and the operation time is shortened.

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