論文 - 貴志　和生

Veno-accompanying artery fasciocutaneous flap

Aramaki-Hattori Noriko, Kishi Kazuo

Japanese Journal of Plastic Surgery 59 （ 7 ） 704 - 710 2016年07月

ISSN  0021-5228

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<p>Our group developed the veno-accompanying artery fasciocutaneous (VAF) flap, which was a new concept of flap developed in the 1990s that depended on unnoticed blood supply. The VAF flap is a high versatility pedicle flap which can be created almost anywhere with cutaneous veins. However, distally based VAF flaps are prone to congestion in the peripheral part of the flap compared to proximally based flaps, and thus are unsuitable for large defects. The VAF flap cannot be used in infected sites or compression sites, because the blood supply of VAF flaps comes from arterioles accompanying the cutaneous veins. Therefore, we created a new concept of flap-the VAF-myocutaneous (mc) combined flap- to compensate for this drawback. The VAF-mc flap includes a portion of muscle to increase the blood supply to the flap. In this article, we describe the history of the discovery of the VAF flap and its recent modifications.</p>

Picosecond pulse duration laser treatment for dermal melanocytosis in Asians

Ohshiro Takafumi, Ohshiro Toshio, Sasaki Katsumi, Kishi Kazuo

Laser Therapy 25 （ 2 ） 99 - 104 2016年06月

ISSN  0898-5901

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<p>Background and aims: Recently novel picosecond duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that the ps-laser could be an alternative treatment for dermal pigmented lesions and performed a retrospective review to evaluate the efficacy and safety of the ps-laser. Subjects and methods: A retrospective photographic review of 10 patients with dermal pigmented lesions was performed (ages from 4 months to 52 yr), 6 nevus of Ota, 3 ectopic Mongolian spots and 1 Mongolian spots. The patients were treated in the Ohshiro Clinic with picosecond 755 nm alexandrite laser (ps-Alex laser) and picosecond 1064 nm Nd:YAG laser (ps-Nd:YAG laser) from April 2014 to December 2015 (ps-Alex laser, 7 patients; ps-Nd:YAG laser, 3 patients, 1 to 3 treatment sessions). Improvement was evaluated as percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a five category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; Excellent, 75-94%; and Complete, 95-100% improvement. Adverse events were also assessed. Results: All ten patients obtained clinical improvement ranging from fair to excellent. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months follow-up. The ps-Nd:YAG laser caused severe transient erythema and swelling but no post-inflammatory hyperpigmentation. Conclusions: Our results suggest that the 755 nm and 1064 nm ps-lasers are efficacious for the treatment of dermal pigment lesions, with minimum adverse events.</p>

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

貴志 和生

SPRINGERPLUS 5   1565 - 1567 2016年06月

研究論文（学術雑誌）,  ISSN  2193-1801

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A New Technique for Posterior Distraction in Craniosynostosis

Sakamoto Yoshiaki, Miwa Tomoru, Nakajima Hideo, Yoshida Kazunari, Kishi Kazuo

Journal of Craniofacial Surgery 2016年05月

ISSN  1049-2275

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<p>BACKGROUND:: Posterior cranial vault distraction osteogenesis is a common treatment for syndromal patients of brachycephaly and oxycephaly. Although posterior distraction can increase intracranial volume, the flattened head phenotype is difficult to correct. The authors examined a new posterior distraction technique termed double-door distraction for improvement of the flattened head phenotype. METHODS:: From 2010 to 2013, 6 patients with flattened posterior craniums were operated on using the double-door distraction technique. The calvarial segment was cut at the midline and divided into 2 pieces. Distractors were then fixed in parallel to join the calvarial pieces. The distraction was initiated at a rate of 1.0?mm/day and continued until proper cranial form was confirmed by radiography and appearance. RESULTS:: The average surgery time was 2?hours 47?minutes and the amount of distraction ranged from 15 to 22?mm. An improved head shape and expanded cranial vault was achieved in all patients without any complications. CONCLUSIONS:: The double-door distraction technique is a useful technique not only for calvarial expansion, but also for correction of the flattened posterior cranium phenotype.</p>

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Assessment of bioabsorbable hydroxyapatite for secondary bone grafting in unilateral alveolar cleft

Takemaru Masashi, Sakamoto Yoshiaki, Sakamoto Teruo, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 69 （ 4 ） 493 - 496 2016年04月

ISSN  1748-6815

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<p>Aim The aim of this study was to evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex for secondary bone graft in unilateral alveolar cleft. Patients and methods From August 2013 to January 2014, 15 patients with unilateral cleft lip and alveolar cleft were enrolled and randomly assigned to two blinded groups. In group I, a cancellous iliac bone graft was placed at the alveolar cleft. In group II, 0.5 ml of HA/Col was placed at the alveolar cleft, and the cancellous iliac bone was positioned in the remaining space. All patients underwent bone grafting with particulate cancellous bone and marrow taken from the anterior iliac crest. Results No complications were observed in any patient. The groups did not differ in age, cleft volume, or surgical duration. Intraoperative blood loss and patient-controlled intravenous analgesia (PCA) use were significantly lower in group II (p &lt;0.05) in comparison to group I. The 1-month volume was 0.895 ml in group I and 0.482 ml in group II (p &lt;0.05). When the 1-month volume in group II was adjusted for 0.5-ml volume of HA/Col, there was no significant difference in the 1-month volumes (p = 0.32). The 6- and 12-month volumes did not differ significantly between the groups (p = 0.768 and p = 0.165, respectively). Conclusion The autogenous bone was gradually absorbed, while the HA/Col was absorbed and replaced by the autogenous bone. Thus, HA/Col can be used as an iliac graft in alveolar bone graft procedures to reduce the amount of autogenous bone required from the crest, patient stress, and morbidity.</p>

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Negative-pressure wound therapy for diabetic ischemic foot wounds in hemodialysis patients

Matsuzaki Kyoichi, Kishi Kazuo

European Journal of Plastic Surgery    1 - 6 2016年02月

ISSN  0930-343X

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<p>Background: The evidence-based recommendations in 2011 state that a negative-pressure wound therapy (NPWT) may be considered as an advanced wound care therapy for lower limb ulceration after successful revascularization. Since the grade of recommendation was determined by six articles which did not study patients with similar wound severity to critical limb ischemia (CLI), we investigated the patients with similar one. Methods: Of the 169 cases who were surgically treated for lower extremity wounds due to CLI between January 1, 2007, and December 31, 2013, nine cases satisfied the following criteria in our institute. There were patients on hemodialysis due to diabetic nephropathy among patients with CLI, and percutaneous transluminal angioplasty (PTA) was performed. These patients had foot gangrene, underwent debridement, and then underwent second-stage midfoot wound closure. Their wounds were completely healed. After performing debridement until the second-stage wound closure surgery, the localized wound therapy without NPWT in three patients (group 1) before health insurance covered NPWT in 2010 and using NPWT in six patients (group 2) thereafter. Results: The mean period until wound closure surgery after debridement was 55.7 ± 11.2 days in group 1 and 31.3 ± 6.6 in group 2. Significant difference in the number of days was observed between the two groups (p = 0.002). Conclusions: Period of time from debridement to the time of wound closure surgery was significantly shortened with NPWT after revascularization by means of PTA in CLI patients. Level of Evidence: Level IV, therapeutic study.</p>

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A rare case of a broken dental bur perforating the medial orbital wall without damaging the eye

貴志 和生

QUINTESSENCE INTERNATIONAL 47 （ 1 ） 75 - 79 2016年01月

研究論文（学術雑誌）,  ISSN  0033-6572

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Dermoscopic findings in pigmented Bowen's disease of the lip

貴志 和生

EUROPEAN JOURNAL OF DERMATOLOGY 26 （ 6 ） 613 - 614 2016年01月

研究論文（学術雑誌）,  ISSN  1167-1122

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Hair induction by cultured mesenchymal cells using sphere formation

Kishi Kazuo, Hayashi Ruka

1453   85 - 92 2016年

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<p>Isolated dermal cells possess the capacity to induce hair growth. The cells cannot be expanded while they retain the capacity for hair induction, and lose their potential immediately after cultivation. Sphere-forming multipotent cells derived from the dermis (skin-derived precursors [SKPs]) possess hair-inducing activity. These observations provide two possibilities for the determination of the capacity for hair induction: capacity is dependent on either identity as a dermal cell or on the process of sphere formation. We developed a method that demonstrates cultivated mesenchymal cells derived from dermis and lung tissue possess in vivo hair-inducing capacity via sphere formation.</p>

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A biomechanical study of relationship between sternum defect patterns and thoracic respiration

貴志 和生

COMPUTER ASSISTED SURGERY 21 （ 1 ） 1 - 8 2016年

研究論文（学術雑誌）,  ISSN  2469-9322

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Reconstruction of the Urethral Sphincter with Dynamic Graciloplasty in a Male Rabbit Model

貴志 和生

UROLOGIA INTERNATIONALIS 96 （ 2 ） 217 - 222 2016年

研究論文（学術雑誌）,  ISSN  0042-1138

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Biomechanical study of relationship between sternum defect patterns and thoracic respiration

Nagasao Tomohisa, Kasai Shogo, Shimizu Yusuke, Sakamoto Yoshiaki, Hatano Asako, Morotomi Tadaaki, Ogata Hisao, Kishi Kazuo

Computer Assisted Surgery 21 （ 1 ） 1 - 8 2016年

ISSN  1092-9088

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<p>Background: Various types of sternum defects are produced after the removal of thoracic tumors involving the sternum. The present study aims to elucidate the relationship between the defect patterns and their effects on thoracic respiration. Methods: Ten sets of finite element models were produced simulating thoraces of 10 persons and termed normal models. With each of the 10 normal models, the sternum was removed in six different ways to produce new models termed defect models. Defect models were categorized into hemi-superior (H-S), hemi-inferior (H-I), hemi-whole length (H-W), bilateral-superior (B-S), bilateralinferior (B-I), and bilateral-whole length (B-W) defect types, depending on the locations of the defects. Respiratory movement was dynamically simulated with these models. The volume change the thoraces present during respiration was measured to evaluate the effectiveness of thoracic respiration. This value - defined as ΔV - was calculated and was compared between normal and defect models. Results: With H-W and B-W type models, ΔV dropped to around 20% of normal values. With H-S and B-S type models, ΔV dropped to around 50% of normal values. With H-I and B-I type models, ΔV presented values almost equivalent to those of normal models. Conclusion: Effectiveness of thoracic respiration is seriously impaired when the whole length of the sternum is absent. Reconstruction of the defect is essential for these cases. However, since the upper part of the sternum is most important for effective thoracic respiration, priority should be placed on the upper part in performing reconstruction.</p>

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Investigating the pressure-reducing effect of wound dressings

Matsuzaki K., Kishi K.

Journal of wound care 24 （ 11 ） 512 - 517 2015年11月

ISSN  0969-0700

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<p>Objective: Currently, polyurethane foam dressings are commercially available from many manufacturers. However, the pressure-reducing effect is expected to differ by the formulation and combination of the main and secondary ingredients and by manufacturing method. In this study, we investigated the effects of pressure reduction using dressing materials with various structural characteristics, including polyurethane foam dressings based on the engineering point of view, focusing on the dry state. Method: Pressure was measured in a model that simulated compression on the sacral region in a decubitus position. Pressure was measured for different dressings: ten products, consisting of five types of material (polyurethane foam, hydropolymeric, Hydrofiber, hydrocolloid, and low-adherent absorbent). Results: All dressings used in this study showed significantly reduced pressure. ALLEVYN Non-Adhesive had the lowest pressure at 35.833 ± 1.155 mmHg, and DuoDERM Extra Thin CGF had the highest pressure at 66.867 ± 1.060 mmHg. The pressure of the control was 74.667 ± 1.405 mmHg. The other dressings were: ALLEVYN Adhesive: 44.233 ± 0.777 mmHg; ALLEVYN Gentle Border: 46.967 ± 1.537mmHg; Mepilex Border: 53.867 ± 0.231 mmHg; Biatain Silicone: 56.000 ± 0.520 mmHg; TIELLE: 57.267 ± 3.403 mmHg;Versiva XC: 65.900 ± 0.800 mmHg; DuoDERM CGF: 57.267 ± 1.007 mmHg; and Melolin: 53.433 ± 1.973 mmHg. Conclusion: The pressure-reducing effect of dressing differs not only by material type but also by product. That is, the pressure-reducing effect can differ even if the dressings are of the same material type, such as polyurethane foam. Our study investigated only the effect of materials and structural characteristics on the cushion of dressings in the dry state. Therefore, further investigation is needed to confirm the effect of pressure reduction by dressing to meet the conditions in the clinic. Declaration of interest: Authors have no conflict of interest to declare.</p>

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Mesh-like incisions are a simple and effective modification of the traditional components separation technique

Uchikawa-Tani Yumiko, Yazawa Masaki, Kishi Kazuo

JPRAS Open 5   41 - 45 2015年09月

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<p>The components separation technique (CST) was first described in 1990 and involves elevating the external oblique muscle and medially advancing the muscle complex to close abdominal wall defects. Because this procedure is straightforward and does not require prosthetic materials to repair the defect, many surgeons have adopted it. However, some patients who undergo this technique develop Spigelian herniation or "lateral bulging", which is a projection deformity of the lateral abdominal wall. These patients may require prosthetic reinforcement to strengthen the abdominal wall due to the relaxing incision that is made during the CST. In this report, we describe a simple modification to improve the relaxing incision by substituting several short incisions for the traditional single, long incision in the external oblique fascia. These short incisions create a mesh-like pattern in the fascia, which preserves the strength of the lateral abdominal wall and may help prevent Spigelian herniation or lateral bulging. Although the separation of the external oblique muscle from the internal oblique muscle is slightly cumbersome compared to the traditional CST, the plane is avascular and sparsely connected, which allows separation using a finger or tools in our modified technique. Further studies are needed to confirm whether this technique is effective for large defects, although this simple modification may preserve the strength of the lateral abdominal wall without the need for prosthetic materials.</p>

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Chest wall reconstruction using the pectoralis major flap with dual-partitioned partially cut ribs

Uchikawa-Tani Yumiko, Yazawa Masaki, Konno Eri, Kishi Kazuo

JPRAS Open 5   7 - 12 2015年09月

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<p>In some cases, skeletal and soft issue elements are required for chest wall reconstruction. Although muscle flaps and ribs are commonly used for achieving ideal reconstruction, deformation and loss of bone strength are unavoidable in such cases. In the present report, we describe a technique for chest wall reconstruction that can help avoid such donor site deformity. A 59-year-old woman with metastasis of a malignant mixed tumor in the parotid gland underwent resection from the sternoclavicular joint to the first and second ribs, including the manubrium and part of the sternum body. To achieve chest wall reconstruction, we used a pectoralis major flap along with two dual-partitioned ribs. In this modified procedure, instead of simply using the flaps with the whole ribs (which is common), we only used the anterior cortical portion of the ribs. This helped preserve the chest wall strength and prevented deformity at the donor site. At 7 months after surgery, the cut ribs in the reconstructed area and the original donor site appeared stable, without any complications, on computer tomography. Although the thickness of the bone used was half of that used with the conventional method, the skeletal strength was sufficient for her daily activities. Our modified method requires some additional effort for cutting the ribs, but the rest of the procedure involves the use of a conventional, simple rib-muscle flap. With this method, donor site deformity can be prevented, and the procedure can not only be adapted for chest wall reconstruction but also for other skeletal reconstructions that require the use of ribs.</p>

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Composite grafting for distal digital amputation with respect to injury type and amputation level

貴志 和生

JOURNAL OF PLASTIC SURGERY AND HAND SURGERY 49 （ 4 ） 224 - 228 2015年08月

研究論文（学術雑誌）,  ISSN  2000-656X

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A hypothesis for the pathologic mechanism of idiopathic exophthalmos based on computed tomographic evaluations

Takada Keiko, Sakamoto Yoshiaki, Shimizu Yusuke, Nagasao Tomohisa, Kishi Kazuo

Journal of Craniofacial Surgery 26 （ 5 ） 1639 - 1642 2015年07月

ISSN  1049-2275

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<p>The causes of idiopathic exophthalmos were still unknown. We used computed tomography to compare the orbital structures of patients with idiopathic exophthalmos and those of a healthy Japanese population. A total of 18 orbits (ranged 17-52 years) in idiopathic exophthalmos and 334 normal orbits (ranged 17-59 years) were included. On computed tomography, the eyeball and orbit sizes, lateral wall thickness and length, perpendicular distance from the interzygomatic line to the medial orbital rim, and the nasal cavity width were measured. No significant differences in eyeball or orbit sizes were found between the idiopathic exophthalmos and control groups (P&lt;0.05). In contrast, the mean lateral wall thickness of the idiopathic exophthalmos group was significantly thicker than that of the control group (P&gt;0.01). The lateral wall length was shorter with significant difference (P&gt;0.05). The perpendicular distance and the width of the nasal cavity in the idiopathic exophthalmos group were longer with significant difference (P&gt;0.05). The cause of idiopathic exophthalmos is compression of orbital contents by the medial wall expansion. The force of expansion of medial wall also influences the zygoma according to Wolff law.</p>

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Deltopectoral flap

Yazawa Masaki, Kishi Kazuo

Otolaryngology - Head and Neck Surgery (Japan) 87 （ 7 ） 463 - 467 2015年06月

ISSN  0914-3491

The GETA technique

Aoki Marie, Sakamoto Yoshiaki, Miwa Tomoru, Yoshida Kazunari, Kishi Kazuo

Child's Nervous System 31 （ 5 ） 773 - 776 2015年05月

ISSN  0256-7040

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<p>Purpose: Posterior cranial vault distraction profoundly enlarges intracranial volume. To perform this procedure during the first year of life, the cranium is too thin to fix the distractors. Sometimes, the screws penetrate the bone, which risks scratching the dura during distraction. To solve this problem, we developed an implant fixation technique using bioabsorbable screws and plates, and named it the GETA technique.Methods: In cases in which the bone is thinner than the screws, a resorbable sheet is placed between the bone and the dura to protect the dura from the tips of the screws.Results: We used this technique for cranial distraction in four patients, with satisfactory results and without complications.Conclusions: The technique described here allows craniofacial surgeons to fix the distractors without injuring the dura.</p>

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A hammock flap

Sakamoto Yoshiaki, Nakajima Hideo, Imanishi Nobuaki, Okumoto Takayuki, Kato Tatsuya, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 68 （ 5 ） 738 - 740 2015年05月

ISSN  1748-6815

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