研究者詳細 - 貴志　和生

論文 - 貴志　和生

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Salt as a new colored solid model for simulation surgery

Okumoto Takayuki, Sakamoto Yoshiaki, Kondo Suguru, Ogata Hisao, Kishi Kazuo, Yoshimura Yohko

The Journal of craniofacial surgery 26 （ 3 ） 680 - 681 2015年05月

ISSN 1049-2275

BACKGROUND: Simulated craniomaxillofacial surgery is critical for planning the procedure, shortening operative time, and practicing the procedure. However, typical models are expensive, given their solid materials, and the surgical sensations do not accurately reflect the procedure performed using human bone. To solve these problems, a new solid salt model has been developed.METHOD: Stereolithography data was generated using computed tomography data, and a salt model was created using a 3D inkjet printer. By extracting specific data for elements such as the teeth and mandibular canal, these elements were highlighted in the solid model using different colored material. Also, we compared the maximum load and plastic deformation of the salt model, a stereolithographic resin model, and a pig limb.RESULT: The salt model had similar tenacity to bone, and the risk of damage to the teeth and inferior alveolar nerve was easily confirmed.CONCLUSION: The material cost of the salt model is extremely low, and the salt model may provide a more accurate sensation of cutting human bone. Thus, this model is useful for both simulated operation and practice for inexperienced surgeons.

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The GETA technique: a novel technique protecting the dura against the distractors for early cranial expansion

貴志和生

CHILDS NERVOUS SYSTEM 31 （ 5 ） 773 - 776 2015年05月

研究論文（学術雑誌）, ISSN 0256-7040

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Salt as a New Colored Solid Model for Simulation Surgery

貴志和生

JOURNAL OF CRANIOFACIAL SURGERY 26 （ 3 ） 680 - 681 2015年05月

研究論文（学術雑誌）, ISSN 1049-2275

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Evaluation of velopharyngeal closure by 4D imaging using 320-detector-row computed tomography

Sakamoto Yoshiaki, Soga Shigeyoshi, Jinzaki Masahiro, Yamada Yoshitake, Ogata Hisao, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 68 （ 4 ） 479 - 484 2015年04月

ISSN 1748-6815

Objective Current imaging techniques for velopharyngeal closure (VPC) evaluation are two-dimensional, static, or distressing, thus necessitating multiple procedures to understand this three-dimensional and dynamic area. We validated the use of a novel four-dimensional (4D) computed tomography (CT) technique for the morphological and kinematic evaluation of VPC in cleft palate patients based on dynamic volume scanning with 320-detector-row CT. Methods Five patients aged 4-10 years (40% males) with persistent velopharyngeal insufficiency post palatoplasty underwent conventional tests (cephalometry and video-nasal endoscopy) and 4D-CT. For each patient, complete multiplanar reconstruction, 4D airway CT, and 4D-CT endoscopy data for all scanning phases were compared with cephalometric and video-nasal endoscopy data. The movements of the velum and posterior pharyngeal walls were graded by each modality. Results 4D airway CT revealed higher anatomical detail than cephalometry, additionally providing dynamic images. 4D-CT endoscopy and video-nasal endoscopy were in agreement for all patients regarding the patterns of VPC, with complete visualization of VPC in five versus one patient, respectively. 4D airway CT and cephalometry showed a discrepancy in one case, wherein grading by cephalometry was overestimated. 4D-CT was also useful in determining the width and length of a proposed pharyngeal flap. The examination time (mean ± standard deviation (SD), seconds), including patient preparation time, was 224 ± 73, 492 ± 145, and 718 ± 123 for cephalometric radiographs, CT, and video-nasal endoscopy, respectively. The mean estimated radiation dose during 4D-CT was 4.44 ± 1.64 mSv. Conclusions 4D-CT provides detailed morphological and kinematic analysis of VPC and may offer advantages over conventional procedures.

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A novel rat model of incisional surgical site infection model developed using absorbable multifilament thread inoculated with Escherichia coli

Fujimura Naoki, Obara Hideaki, Suda Koichi, Takeuchi Hiroya, Matsuda Sachiko, Kurosawa Tomoko, Katono Yasuhiro, Murata Mitsuru, Kishi Kazuo, Kitagawa Yuko

Journal of Infection and Chemotherapy 21 （ 4 ） 312 - 315 2015年04月

ISSN 1341-321X

The development of an effective rat model of incisional surgical site infection (SSI) has so far proven difficult. In this study, we created a novel incisional SSI model and validated it in terms of both macroscopic and microscopic aspects including its response to treatment using antimicrobial wound-dressing, Aquacel Ag®. Wounds were created on the dorsum of rats. 3-0 Vicryl®threads inoculated with Escherichia coli were inserted in the wound beds in the infection group (n=6). The wounds were closed for two days to induce infection and then opened and covered with polypropylene sheets during the study. Aquacel Ag was placed under the polypropylene sheet in the infected wounds of the Aquacel Ag group rats (n=6). The wounds in the control group (n=6) contained sterile Vicryl thread that had not been inoculated with E. coli. The macroscopic appearance, wound area, bacterial counts, and histology of each group were evaluated. The infection group demonstrated significantly lower wound healing (p<0.001), greater bacterial counts (median [interquartile range] ratings, 2.15×107 [0.51×107-53.40×107] vs 2.07×104 [0.60×104-4.45×104]CFU/g, respectively; p<0.01), and severer histological inflammation (p<0.001) than the control group. The Aquacel Ag group was only able to show significantly better wound healing than the infection group (p<0.001). The new incisional SSI model exhibited all clinical manifestations of incisional SSI. It could be utilized to assess the effectiveness of newly developed treatments for incisional SSI.

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Assessment of the RIVET fixation system for cranioplasty using the pull-out technique

Sakamoto Yoshiaki, Minabe Toshiharu, Kato Tatsuya, Kishi Kazuo

Journal of Cranio-Maxillofacial Surgery 43 （ 2 ） 281 - 284 2015年03月

ISSN 1010-5182

Cranioplasty using custom-made hydroxyapatite (HAP) ceramic implants is a common procedure to repair skull defects. However, commercially available titanium screws are only minimally stabilized due to characteristic brittleness. We developed the RIVET technique which involves fixing a bioabsorbable plate atop a HAP block using bioabsorbable screws extending beyond both layers, and evaluated fixation strength using the pull-out test and microtomography. Three experimental conditions were compared: a non-RIVET group, RIVET group, and dry skull control group. Pull-out strength significantly differed across groups (non-RIVET group, 1.33 ± 1.21 kgf; RIVET group, 4.46 ± 0.84 kgf; and control group, 6.99 ± 1.14 kgf, P < 0.01). Microtomography of the dry skull control group revealed thread grooves fitted to the screws. The non-RIVET and RIVET groups presented fewer thread grooves than the control group, and the screws did not fit perfectly to the HAP block. However, fixation in the RIVET group was more stable, as the rivet was firmly lodged into the implant. In conclusion, by melting and creating the rivet, pull-out strength can be increased and rigid stabilization of HAP can be obtained. This technique uses commercially available absorbable plate and screws, and thus can be used widely in clinical applications involving HAP blocks with different porosities and thicknesses.

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Management of chronic expanding haematoma using triamcinolone after latissimus dorsi flap harvesting

Hamada Mariko, Shimizu Yusuke, Aramaki-Hattori Noriko, Kato Tatsuya, Takada Keiko, Aoki Marie, Kishi Kazuo, Nagasao Tomohisa

Archives of Plastic Surgery 42 （ 2 ） 218 - 222 2015年03月

ISSN 2234-6163

Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH.

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Intra-eyebrow frontalis suspension using inverted Y-shaped short autogenous fascia lata for blepharoptosis with poor levator function

Shimizu Yusuke, Nagasao Tomohisa, Shido Hirokazu, Fujii Takako, Kato Tatsuya, Aoki Marie, Takada Keiko, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 68 （ 1 ） 49 - 55 2015年01月

ISSN 1748-6815

Frontalis suspension using autogenous fascia lata is a common procedure for blepharoptosis with poor levator function. However, donor-site morbidity associated with fascia lata harvest cannot be ignored. In conventional procedures, the required length of the fascia lata is usually >5-12 cm with a lateral thigh skin incision of approximately 5 cm or more. The present study introduces a new frontalis suspension procedure in which the required size (length and width) of the fascia lata and length of lateral thigh incision is much smaller. The harvested fascia lata is tailored to an inverted Y shape and the separated caudal legs are fixed to the tarsus while the cephalic end is grafted inside the eyebrow through a suborbital septum tunnel. In the present study, 11 patients who underwent the new procedure with a minimum of 6 months of follow-up were evaluated. The average length and width of the harvested fascia lata in unilateral ptosis cases were 2.85 and 0.89 cm, respectively. The average length of the lateral thigh incision was 1.25 cm. The margin reflex distance improved in all cases at 6 months postoperatively. The cosmetic result was graded as good to excellent in most of the patients. Trichiasis, widened donor scar, and eyebrow notch were noted as complications. The present method is a good alternative for the treatment of blepharoptosis with poor levator function. It potentially reduces donor-site morbidity as compared with conventional frontalis muscle suspension procedures using autogenous fascia lata.

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Post-traumatic hyperpigmentation

Ohshiro Takafumi, Ohshiro Toshio, Sasaki Katsumi, Kishi Kazuo, Shimizu Yusuke

Japanese Journal of Plastic Surgery 58 （ 1 ） 71 - 80 2015年01月

ISSN 0021-5228

Post-traumatic hyperpigmentation (PTH) is a common symptom after skin injuries in Asians. PTH occurs on scars or skin following acute inflammation. PTH is classified into the following three conditions based on the pigmented lesions : an increase of epidermal melanin due to the activation of epidermal melanocytes after inflammation, incontinentia pigmenti histological, and dermal implantation of foreign substances known as a "traumatic tattoo". LLLT and LED irradiation are effective methods for controlling skin inflammation. The increase in epidermal melanins. known as basal hyperpigmentation. gradually disappears within 6-12 months. To shorten the treatment period, topical bleaching ointments such as hydroquinone. tretinoin, and vitamin C as well as IPL/long-pulsed alexandrite laser treatments are available. In the case of incontinentia pigmenti histological, which involves chronic inflammation in the skin, the basement membrane is partially destroyed and epidermal melanins are "dropped" into dermal lesions. These dropped melanins are digested by macrophages, which remain as melanophages in the dermal lesions for several years, and so this type of dermal pigmentation does not disappear spontaneously. Therefore, Q-switched lasers are used for the selective treatment of dermal hyperpigmentation. For the treatment of PTH, personalized, appropriate therapeutic planning based on a precise diagnosis is important.

Recurrent myoepithelioma treated by palatal and piriform apertural approaches

Okumoto Takayuki, Nagashima Hayato, Inoue Yoshikazu, Yamauchi Makiko, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 3 （ 9 ） 2015年01月

Myoepithelioma is a rare, benign salivary neoplasm, most frequently located in the salivary gland; extrasalivary cases most commonly occur in the palate. This tumor is prone to recurrence. We present a case of recurrent myoepithelioma in the nasal cavity with a palatal fistula treated both by a palatal approach and a piriform apertural approach. The combination of these approaches widens the surgical space, allowing removal of the mass. It is important not only to excise the mass but also to allow for reconstruction.

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Basic study of soft tissue augmentation by adipose-inductive biomaterial

貴志和生

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART B-APPLIED BIOMATERIALS 103 （ 1 ） 92 - 96 2015年01月

研究論文（学術雑誌）, ISSN 1552-4973

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A novel rat model of incisional surgical site infection model developed using absorbable multifilament thread inoculated with Escherichia coli

貴志和生

JOURNAL OF INFECTION AND CHEMOTHERAPY 21 （ 3-4 ） 312 - 315 2015年01月

研究論文（学術雑誌）, ISSN 1341-321X

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Anatomic Basis of Anorectal Reconstruction by Dynamic Graciloplasty With Pudendal Nerve Anastomosis

貴志和生

DISEASES OF THE COLON & RECTUM 58 （ 1 ） 104 - 108 2015年01月

研究論文（学術雑誌）, ISSN 0012-3706

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Reconstruction of partial helical defects

Shimizu Yusuke, Nagasao Tomohisa, Okabe Keisuke, Kishi Kazuo

Dermatologic Surgery 41 （ 12 ） 1419 - 1423 2015年

ISSN 1076-0512

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A case report of true prehallux

Okumoto Takayuki, Aramaki-Hattori Noriko, Taguchi Yoshihiro, Inoue Yoshikazu, Matsuzaki Kyoichi, Kishi Kazuo

JPRAS Open 4 （ 1 ） 26 - 29 2015年

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An anatomic study of nipple position and areola size in asian men

Kasai Shogo, Shimizu Yusuke, Nagasao Tomohisa, Ohnishi Fumio, Minabe Toshiharu, Momosawa Akira, Kishi Kazuo

Aesthetic Surgery Journal 35 （ 2 ） NP20 - NP27 2015年

ISSN 1090-820X

Background: In planning gender-reassignment surgery for biological women and treating men with gynecomastia, surgeons must have a thorough understanding of anatomically correct nipple positions and appropriate areola sizes in men. Objectives: The authors sought to determine whether body height or body mass index (BMI) affects nipple position or areola size in men. Methods: Anatomic measurements of the nipples and areolae of 50 Japanese men were obtained. A relative coordinate system was defined, where the medial-lateral and superior-inferior positions of the nipple were quantitatively indicated by distance ratios between anatomic landmarks. Nipple positions were evaluated for each patient by referring to this coordinate system, and the positions were compared between groups categorized by body height or BMI. Results: Nipple position was not significantly affected by body height. However, the nipple tended to be located more laterally in participants with higher BMI. The vertical nipple position differed between standing and supine positions. Tall men had larger areolae than short men; however, areola size did not differ with respect to BMI. Conclusions: Nipple position and areola size vary by body shape. Consideration of the differences is recommended when performing procedures such as female-to-male gender-reassignment surgery or correction of gynecomastia.

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Anatomic basis of anorectal reconstruction by dynamic graciloplasty with pudendal nerve anastomosis

Hikosaka Makoto, Yazawa Masaki, Sakuma Hisashi, Uchikawa Yumiko, Takayama Masayoshi, Kishi Kazuo

Diseases of the Colon and Rectum 58 （ 1 ） 104 - 108 2015年

ISSN 0012-3706

BACKGROUND: Dynamic graciloplasty has been proposed for anal reconstruction, but this method has 2 major drawbacks. First, an electrical device is required for control of the gracilis. The anastomosis with the pudendal nerve will provide more physiological control. Second, the limitation in the mobility of the muscle flap results in wrapping the anal canal with the muscle's distal portion, which is tendonlike and inelastic. Enhancing the mobility of the muscle flap will enable wrapping with the proximal, muscle-like, and extensible portion, possibly providing better sphincteric function. However, the basis for such an operative method is lacking. OBJECTIVE: The aim of this study is to provide the basis for the refined method of anal sphincter reconstruction by dynamic graciloplasty with pudendal nerve anastomosis and to verify the feasibility of lengthening the nerve to the gracilis muscle flap by dissecting into the muscle belly, detaching the gracilis muscle from its origin, and enhancing the mobility of the muscle flap. STUDY DESIGN: This is a retrospective, descriptive study. METHODS: The results from the anatomical study on 9 cadavers are reported. RESULTS: Tension-free anastomosis of the pudendal nerve and nerve to the gracilis was successfully performed in all the 9 cases: in 2 cases, by lengthening the nerve. The detachment of the muscle origin improved the mobility of the muscle flap, and the more proximal portion could be used for wrapping the anal canal, as confirmed in 4 cases. LIMITATIONS: The limited number of cases was a shortcoming of this study. CONCLUSIONS: By lengthening the nerve to the muscle, the gracilis can be used for anal sphincter reconstruction with pudendal nerve anastomosis, negating the need for an electrical device. By detaching the origin of the gracilis muscle, its proximal portion can be used to wrap the anal canal, possibly enabling a longer functional canal with stronger constricting force and better vascularity. These modifications to past methods may improve fecal continence after the operation.

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Local release of pioglitazone (a peroxisome proliferator-activated receptor γ agonist) accelerates proliferation and remodeling phases of wound healing

Sakai Shigeki, Sato Keisuke, Tabata Yasuhiko, Kishi Kazuo

Wound Repair and Regeneration 2015年

ISSN 1067-1927

Peroxisome proliferator-activated receptor γ (PPARγ) is a member of the nuclear receptor superfamily known for its anti-inflammatory and macrophage differentiation effects, as well as its ability to promote fat cell differentiation and reduce insulin resistance. Pioglitazone (Pio) is a PPARγ agonist used clinically as an anti-diabetic agent for improving insulin sensitivity in patients with diabetes. The objective of this study was to develop a drug delivery system (DDS) for the local release of Pio to promote wound healing. Pio of low aqueous solubility was water-solubilized by micelles formed from gelatin grafted with L-lactic acid oligomers, and incorporated into a biodegradable gelatin hydrogel. An 8-mm punch biopsy tool was used to prepare two skin wounds on either side of the midline of 8-week-old mice. Wounds were treated by the hydrogels with (Pio-hydrogel group) or without (control group) Pio, and the wound area were observed 1, 4, 7, and 14 days after treatment. In addition, a protein assay and immunohistological stain were performed to determine the effects of the Pio-hydrogel on inflammation and macrophage differentiation. The Pio-hydrogels promote wound healing. Moreover, Western blotting analysis demonstrated that treatment with Pio-hydrogels resulted in decreased levels of the cytokines MIP-2 and TGF-β, and increased levels of glucose-regulating adiponectin. It is concluded that Pio-incorporated hydrogels promote the proliferation and remodeling phases of wound healing, and may prove to be effective as wound dressings.

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Prognosis of critical limb ischemia

Matsuzaki Kyoichi, Hayashi Ruka, Okabe Keisuke, Aramaki-Hattori Noriko, Kishi Kazuo

Wound Repair and Regeneration 2015年

ISSN 1067-1927

Healthcare providers treating wounds have difficulties assessing the prognosis of patients with critical limb ischemia who had been discharged after complete healing of major amputation wounds. The word "major" in "major amputation" gives the impression of "being more severe" than "minor amputation." Therefore, even if wounds are healed after major amputation, they imagine that prognosis after major amputation would be poorer than that after minor amputation. We investigated the prognosis of diabetic nephropathy patients 2 years after amputations. Those patients underwent dialysis as well as amputation following percutaneous transluminal angioplasty for their foot wounds. They were ambulatory prior to these surgeries. Among 56 cases of minor amputation, 45 were males and 11 were females, and mortality was 41.1%. The mortality of cases with and without a coronary intervention history was 53.1% and 25.0%, respectively (p=0.034). Among 10 cases of major amputation, 9 were males and 1 was female, and mortality was 60%. The mortality of cases with and without a coronary intervention history was 75.0% and 0%, respectively. Although we predicted poor prognosis in cases with major amputation, there was no significant difference in mortality 2 years after amputations (p=0.267). Thus far poor prognosis has been reported for major amputation. It might be due to inclusion of the following patients: patients with wounds proximal to ankle joints, patients with extensive gangrene spreading to the lower legs, patients with septicemia from wound infection and who died around the time of operation, and patients with malnutrition. The results of our present study showed that the outcomes at 2 years postoperatively were similar between patients with major amputations and those with minor amputations, if surgical wounds were able to heal. We should not estimate the prognosis by the level of amputation, rather we should consider the effect of coronary intervention history on prognosis.

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Severe craniosynostosis with Noonan syndrome phenotype associated with SHOC2 mutation

Takenouchi Toshiki, Sakamoto Yoshiaki, Miwa Tomoru, Torii Chiharu, Kosaki Rika, Kishi Kazuo, Takahashi Takao, Kosaki Kenjiro

American Journal of Medical Genetics, Part A 164 （ 11 ） 2869 - 2872 2014年11月

ISSN 1552-4825

Dysregulation in the RAS signaling cascade results in a family of malformation syndromes called RASopathies. Meanwhile, alterations in FGFR signaling cascade are responsible for various syndromic forms of craniosynostosis. In general, the phenotypic spectra of RASopathies and craniosynostosis syndromes do not overlap. Recently, however, mutations in ERF, a downstream molecule of the RAS signaling cascade, have been identified as a cause of complex craniosynostosis, suggesting that the RAS and FGFR signaling pathways can interact in the pathogenesis of malformation syndromes. Here, we document a boy with short stature, developmental delay, and severe craniosynostosis involving right coronal, bilateral lambdoid, and sagittal sutures with a de novo mutation in exon1 of SHOC2 (c.4A>G p.Ser2Gly). This observation further supports the existence of a crosslink between the RAS signaling cascade and craniosynostosis. In retrospect, the propositus had physical features suggestive of a dysregulated RAS signaling cascade, such as fetal pleural effusion, fetal hydrops, and atrial tachycardia. In addition to an abnormal cranial shape, which has been reported for this specific mutation, craniosynostosis might be a novel associated phenotype. In conclusion, the phenotypic combination of severe craniosynostosis and RASopathy features observed in the propositus suggests an interaction between the RAS and FGFR signaling cascades. Patients with craniosynostosis in combination with any RASopathy feature may require mutation screening for molecules in the FGFR-RAS signaling cascade.

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