研究者詳細 - 貴志　和生

論文 - 貴志　和生

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Effective scoring of scapha prevents helix irregularity in prominent ear correction - A biomechanical study

Nagasao Tomohisa, Miyamoto Junpei, Shimizu Yusuke, Kasai Shogo, Kishi Kazuo, Kaneko Tsuyoshi

Journal of Cranio-Maxillofacial Surgery 42 （ 6 ） 711 - 717 2014年

ISSN 1010-5182

Background: As the antihelix is created in the operation for prominent ear, the helix often presents irregularities. This biomechanical study aims to elucidate effective techniques to prevent these irregularities. Methods: Finite element models were produced simulating 10 prominent ears. The scaphas of the 10 models were thinned to simulate scoring or abrasion of the cartilage. The thinning was conducted in four fashions. In the first group, no thinning was conducted (Non-Scoring Models); in the second group, the upper half of the scapha was thinned (Upper-Scoring Models); in the third group, the lower half of the scapha was thinned (Lower-Scoring Models); in the fourth group, the whole scapha was thinned (Whole-Scoring Models). Mattress sutures were applied to create the antihelix to simulate Mustarde's in-suture technique. Thereafter, transformation of the helix's contour was evaluated. Results: Irregularity developed on the upper region of the helix with Non-Scoring and Lower-Scoring Models; the degree of the upper-region's irregularity was reduced with Upper-Scoring Models and Whole-Scoring Models. Although the edge of the helix moved in the posterior-medial direction with other type models, it moved in the anterior direction with Whole-Scoring Models. Conclusion: Irregularity of the upper region of the helix can be prevented by performing scoring or abrasion of the upper part of the scapha. The prominence of the helix and width of the auricle are adjustable by varying the areas of the scapha receiving scoring or abrasion. These findings are useful in improving operative outcomes in the treatment of prominent ears.

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Evaluation of antibiotic-loaded calcium phosphate bone cement in a cranium-infected experimental model

Sakamoto Yoshiaki, Ochiai Hiroko, Ohsugi Ikuko, Inoue Yoshikazu, Yoshimura Yoko, Kishi Kazuo

Neurologia Medico-Chirurgica 54 （ 8 ） 647 - 653 2014年

ISSN 0470-8105

Treatment of calvarial defects has remained a challenge in reconstruction surgery, especially because of infection at these sites. We produced a bactericidal biomaterial for treating infected bone defects by using calcium phosphate bone cement mixed with antibiotics. We evaluated the usefulness of this material mixed with the antibiotic vancomycin in a cranium-infected rat model. The concentration of vancomycin used was 5.0 wt%, as reported in our previous study. In order to establish the rat model, a cranium defect (diameter, 5 mm) was made that was infected with methicillin-resistant Staphylococcus aureus (MRSA). Thirty-six rats were divided into 6 groups depending on whether an autologous graft or bone cement with or without antibiotic was used for the defect. After 1 and 4 weeks, abscess formation was checked, tissue bacterial counts were determined, and pathological examination was performed. At both 1 and 4 weeks, no MRSA was detected on tissue bacterial culture or pathological examination in groups that received bone cement with antibiotics. In groups that received bone cement without antibiotic, MRSA was detected, and the bone cement had compromised and disintegrated into several slices. In conclusion, bone cement that contains antibiotics appears to be effective not only for reconstruction in cases of cranial defect, but also in terms of preventing infection.

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Irregular location of major pectoral muscle can be a causative factor of pectus excavatum

Nagasao Tomohisa, Shimizu Yusuke, Morotomi Tadaaki, Takano Naoki, Jiang Hua, Kishi Kazuo

Medical Hypotheses 82 （ 5 ） 512 - 517 2014年

ISSN 0306-9877

Pectus excavatum-commonly known as funnel chest-is one of the most frequently observed congenital deformities, in which the patients' thoraces present concavity. This paper presents our original hypothesis that the abnormal positioning of the major pectoral muscle can be a potential factor in the occurrence of pectus excavatum, and evaluates the validity of the hypothesis by performing an anatomical and a biomechanical study. An anatomical study on clinical cases revealed that the major pectoral muscle tends to be positioned more superiorly in pectus excavatum patients than in normal persons. The biomechanical study, using three-dimensional finite element dynamic simulation, revealed that the major pectoral muscle functions to elevate the sternum and that the elevating effect is reduced when the muscle is located at superior regions on the thoracic wall. These findings support our hypothesis that the abnormal position of the major pectoral muscle is a potential causative factor for pectus excavatum. This hypothesis suggests that, during surgical correction of pectus excavatum with an open approach, surgeons should reposition the major pectoral muscle to its correct anatomical position to avoid recurrence.

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Is surgical intervention safe and effective in the treatment of myasthenic blepharoptosis? A multicenter survey in Japan

Shimizu Yusuke, Suzuki Shigeaki, Utsugisawa Kimiaki, Imai Tomihiro, Murai Hiroyuki, Nagane Yuriko, Tsuda Emiko, Nagasao Tomohisa, Ogata Hisao, Yazawa Masaki, Suzuki Norihiro, Kishi Kazuo

European Neurology 71 （ 5-6 ） 259 - 261 2014年

ISSN 0014-3022

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Nasal tip surgery for cleft nose in Asians

Sakamoto Yoshiaki, Miyamoto Junpei, Tamada Ikkei, Kishi Kazuo

Journal of Craniofacial Surgery 25 （ 5 ） 1671 - 1673 2014年

ISSN 1049-2275

"Collapsed nasal tip," one of the most characteristic features of cleft lip nose, resembles the effect of pushing the nose tip with a finger and is especially noticeable among Asians. The authors examined a rhinoplasty technique for improving collapsed nasal tip. Using an intercartilaginous incision, the distal nasal framework, including the alar cartilages, and the caudal septum were widely exposed. A septal extension graft was fixed to the caudal septum, and the alar cartilages were precisely sutured to the extension graft using markings transferred to the extension graft. This procedure was applied to 15 Asian rhinoplasties, with all patients having substantial improvement in the shape of their nasal tip. Comparing those with and without a history of rhinoplasty, effecting a projection of the nasal tip was more difficult in patients with a history of previous rhinoplasties. The advantages of this technique include inconspicuous scarring and versatility in the modification of the nasal tip. Rhinoplasty during the growth period should be planned with consideration of future augmentation rhinoplasties.

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Phlebectasia of the external jugular vein with thrombosis

Matsunaga Keiko, Kishi Kazuo

Surgery Today 44 （ 6 ） 1180 - 1183 2014年

ISSN 0941-1291

An 81-year-old male presented with a soft mass on his neck noted in the supine position. After undergoing an operation for an inguinal hernia, the mass was noted to persist regardless of the patient's position. Computed tomography and magnetic resonance imaging revealed phlebectasia of the external jugular vein with an associated thrombosis. Under general anesthesia, the external jugular vein was ligated and removed, along with the thrombus. A histological section revealed that the tunica media of the external jugular vein was absent, and the smooth muscle layer and elastic fibers were attenuated in the fusiform area of the vein. Due to the risk of propagation of the clot and pulmonary embolism, resection of the external jugular vein is advised in cases of phlebectasia of the external jugular vein.

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Relationship between locations of rib defects and loss of respiratory function-A biomechanical study

Hatano Asako, Nagasao Tomohisa, Cho Yasunori, Shimizu Yusuke, Takano Naoki, Kaneko Tsuyoshi, Kishi Kazuo

Thoracic and Cardiovascular Surgeon 62 （ 4 ） 357 - 362 2014年

ISSN 0171-6425

Objective The present study elucidates the relationship between the locations of rib defects and loss of respiratory function. Methods Ten sets of three-dimensional finite element models were produced from computed tomography data of 10 persons and categorized as normal type models. These models were modified by removing part of the ribs, and the resultant models were categorized as defect type models. Varying the location of the defects, six types of defect model were produced from each of the 10 normal models; the defects were made on the anterior-superior, anterior-inferior, lateral-superior, lateral-inferior, posterior-superior, and posterior-inferior regions of the thorax. To simulate respiration, contracture forces were applied to nonlinear springs modeling respiratory muscles for each of the normal and defect models. Difference in volume of the thoracic cavity between inspiration and expiration phases was viewed as the indicator of respiratory function and was defined as ΔV. The values of ΔV were compared between normal type models and their corresponding defect type models. Results Among the six types of defect, the degree of functional loss was greatest with those defects on the lateral-inferior part of the thorax, where ΔV of the affected side hemithorax drops to 38 to 45% of normal values, whereas ΔV was 62 to 88% with other defect models. Conclusion Thoraces that have defects on their lateral-inferior regions present lower respiratory functioning than thoraces with other defect locations. Hence, in treating clinical cases where defects are expected to occur in this region, effort should be made to minimize the area of the defect.

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Not only "nurture", but also "nature", influence the outcome of zygoma repair

Nagasao Tomohisa, Itamiya Tomoki, Sakamoto Yoshiaki, Shimizu Yusuke, Ogata Hisao, Jiang Hua, Kishi Kazuo, Kaneko Tsuyoshi

Journal of Plastic Surgery and Hand Surgery 47 （ 6 ） 484 - 488 2013年12月

ISSN 2000-656X

The present study aims to elucidate the relationship between preoperative deviation patterns of fractured zygomas and treatment outcomes. Forty-five randomly selected patients with tri-pod type zygoma fractures were classified into a medial rotation group and a lateral rotation group, depending on preoperative deviation patterns. A minimum of 6 months after the operation, symmetry of the cheek was evaluated by three plastic surgeons using a VAS system. The evaluated scores were compared between the two groups. Furthermore, simulation of postoperative secondary deformity was performed by applying hypothetically defined relapse forces on CAD models produced by referring to the CT data of 20 patients. The deviation values obtained by the simulation were compared between the two groups. The results demonstrate that VAS scores were higher for the lateral rotation group than for the medial rotation group and that the deviation values were higher for the medial rotation group than for the lateral rotation group. It is concluded that treatment outcomes of zygoma fractures are affected by preoperative deviation patterns. Cases with medial rotation are likely to present poorer outcomes than those with lateral rotation.

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The inverted Batman incision: A new incision in transcolumellar incision for open rhinoplasty

貴志和生

JOURNAL OF PLASTIC SURGERY AND HAND SURGERY 47 （ 6 ） 472 - 475 2013年12月

研究論文（学術雑誌）, ISSN 2000-656X

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Surgical treatment of severe blepharoptosis and facial palsy caused by oculopharyngodistal myopathy

Shimizu Yusuke, Suzuki Shigeaki, Mori-Yoshimura Madoka, Nagasao Tomohisa, Toriumi Masahiro, Oji Tomito, Murata Miho, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 66 （ 10 ） 2013年10月

ISSN 1748-6815

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A vascularised gracilis flap with tibial bone for the reconstruction of the Achilles tendon

Uchikawa Yumiko, Yazawa Masaki, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 66 （ 10 ） 2013年10月

ISSN 1748-6815

Rupture of the Achilles tendon is a very common trauma. Reconstruction of a chronic Achilles tendon defect is challenging for reconstructive surgeons, and several methods have been described. The ideal reconstruction would result in the patients resuming the activity level they were accustomed to before the injury. In our patient, the Achilles tendon was reconstructed using the gracilis muscle flap, and the flap was fixed using a fragment of the tibial bone, yielding satisfactory results. In this report, we describe this procedure employed and provide a description of the case.

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Role of solid model simulation surgery for hemifacial microsomia

Sakamoto Yoshiaki, Ogata Hisao, Nakajima Hideo, Kishi Kazuo, Sakamoto Teruo, Ishii Takenobu

Cleft Palate-Craniofacial Journal 50 （ 5 ） 623 - 626 2013年09月

ISSN 1055-6656

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The interrupted V-Y advancement flap for the reconstruction of the vulvovaginal defect

貴志和生

INTERNATIONAL JOURNAL OF DERMATOLOGY 52 （ 9 ） 1125 - 1128 2013年09月

研究論文（学術雑誌）, ISSN 0011-9059

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Mechanical strength and in vitro antibiotic release profile of antibiotic-loaded calcium phosphate bone cement

Sakamoto Yoshiaki, Ochiai Hiroko, Ohsugi Ikuko, Inoue Yoshikazu, Yoshimura Yohko, Kishi Kazuo

Journal of Craniofacial Surgery 24 （ 4 ） 1447 - 1450 2013年07月

ISSN 1049-2275

Some case reports described the usage of bone cement mixed with antibiotics. However, there are few studies that referred to experimental research of calcium phosphate cement with antibiotics. Thus, we mixed vancomycin and amikacin with bone cement in various concentrations and examined its characterization and antibacterial activity. As a result, 6.25 wt% over the concentration could not mix with cement. With an increase in the antibiotic content, the hardening time was prolonged and the compressive strength tended to decrease. In consistency, vancomycin mixed cement increased, whereas amikacin mixed cement decreased. The elution of antibiotics showed sustained release. In conclusion, the characteristics of the bone cement changed based on the amount of antibiotics added, and calcium phosphate cement is useful as a drug carrier.

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A 25-year review of cases with submucous cleft palate

貴志和生

INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 77 （ 7 ） 1183 - 1185 2013年07月

研究論文（学術雑誌）, ISSN 0165-5876

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Transformation of keloids is determined by stress occurrence patterns on peri-keloid regions in response to body movement

貴志和生

MEDICAL HYPOTHESES 81 （ 1 ） 136 - 141 2013年07月

研究論文（学術雑誌）, ISSN 0306-9877

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The RIVET

Shido Hirokazu, Sakamoto Yoshiaki, Miwa Tomoru, Ohira Takayuki, Yoshida Kazunari, Kishi Kazuo

Journal of Craniofacial Surgery 24 （ 3 ） 946 - 948 2013年05月

ISSN 1049-2275

Cranioplasty using custom-made hydroxyapatite (HAP) ceramic implants is a common procedure for the repair of skull defects. The advantages of using HAP are that it is nonmetallic, unlike titanium; biocompatible; and osteoconductive. Furthermore, it can be molded to any complex shape that may be needed. A disadvantage is that titanium screws and plates are in development for its fixation. We developed a technique for implant fixation using bioabsorbable screws and plates, and named this technique RIVET: resorbable immobilization for vacuolar en bloc technique.Before each operation, the implant was customized for the patient in question on the basis of models prepared using computed tomography data. The bioabsorbable plates were attached to the implant by drilling, tapping, and screwing, as shown in the video (http://links.lww.com/ SCS/A43). The interior portion of the screw was then melted to flatten it against the internal surface of the implant, forming a rivet to join the plate and HAP implant.We used this technique for cranial reconstruction in 2 patients, with satisfying and functional results. We did not encounter any complications.In conclusion, the technique described here allows surgeons to fix implants and plates together more rigidly, giving a better result than possible with previous methods.

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Three-dimensional demonstration of the lymphatic system in the lower extremities with multi-detector-row computed tomography: A study in a cadaver model

貴志和生

CLINICAL ANATOMY 26 （ 2 ） 258 - 266 2013年03月

研究論文（学術雑誌）, ISSN 0897-3806

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Evaluation of maxillary sinus volume in cleft alveolus patients using 3-dimensional computed tomography

Hikosaka Makoto, Nagasao Tomohisa, Ogata Hisao, Kaneko Tsuyoshi, Kishi Kazuo

Journal of Craniofacial Surgery 24 （ 1 ） 2013年01月

ISSN 1049-2275

OBJECTIVE: The aim of the study was to evaluate the volume of the maxillary sinus in patients with cleft alveolus. STUDY DESIGN: This is a retrospective, descriptive study. PATIENTS AND METHODS: The 3-dimensional computed tomographic data of 218 maxillary sinuses of 109 patients with cleft alveolus were compared with those of 100 sinuses of 50 healthy individuals. RESULTS: No significant difference in the maxillary sinus volume was found between the patients with cleft alveolus and the noncleft individuals. In the patients with cleft palate and alveolus, the maxillary sinus volume was significantly larger on the right side, but no significant difference was found between the cleft and noncleft sides. CONCLUSIONS: The volume of the maxillary sinus in the patients with cleft alveolus is not different from that of the noncleft individuals. The information about the maxillary sinus is clinically important in executing such operations as endoscopic sinus surgery.

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Venous architecture of the glabellar to the forehead region

Shimizu Yusuke, Imanishi Nobuaki, Nakajima Tatsuo, Nakajima Hideo, Aiso Sadakazu, Kishi Kazuo

Clinical Anatomy 26 （ 2 ） 183 - 195 2013年

ISSN 0897-3806

The precise venous anatomy of the glabellar to the forehead region remains unknown. This study aimed to detail the venous architecture of the glabellar region to the forehead in conjunction with that of the supratrochlear artery to reduce the risk of venous congestion of flaps in this area. Fifteen fresh human cadavers were examined here. In five specimens, contrast medium was injected only into the venous system; in 10 specimens, two different types of contrast media were injected into the arterial and venous systems, respectively. A total of 30 hemifacial specimens were radiographed stereoscopically and observed microscopically. In all the cadavers, a distinct vein (termed as the "transverse nasal root vein") connected the bilateral angular veins. One or two large ascending veins branched from the transverse nasal root or angular vein, coursing toward the forehead skin. Numerous small veins branched out from the large ascending vein(s), forming a subdermal polygonal venous network. Small ascending veins arose from this network and coursed toward the dermis, draining venous flow from the dermis. Three different-sized valves prevented the reflux of blood in the venous pathway. The large ascending vein(s) and supratrochlear artery ran parallel only in the medial canthal area. Tiny venous vasa vasorum surrounded the adventitia of the supratrochlear artery and anastomosed with the polygonal venous network, while a few small veins from the vasa vasorum ascended toward the dermis. Understanding the venous architecture of this region is expected to facilitate the safe elevation of various flaps in the area. Clin. Anat. 2013.

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