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Papers - Kishi, Kazuo

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A pitfall of reconstruction for severe enophthalmos

Sakamoto Yoshiaki, Nakajima Hideo, Tamada Ikkei, Kasai Shogo, Kishi Kazuo

Journal of Craniofacial Surgery 22 ( 4 ) 1351 - 1353 2011.07

ISSN 1049-2275

This report describes a pitfall of reconstruction for severe enophthalmos after time has passed following traumatic injury. In severe cases, hypoglobus may be refractory to reconstructive surgery. The posterior wall of the maxillary sinus is sometimes implicated in severe enophthalmos. Thus, we considered that reconstruction of this posterior wall is critical for improvement in hypoglobus. In addition, a satisfactory contour and improvement in hypoglobus were maintained postoperatively.

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Dynamic total skull remodeling by a combination of morcellation craniotomy with distraction osteogenesis

Nakajima Hideo, Sakamoto Yoshiaki, Tamada Ikkei, Ohara Hirotoshi, Kishi Kazuo

Journal of Craniofacial Surgery 22 ( 4 ) 1240 - 1246 2011.07

ISSN 1049-2275

There are no procedures available to reconstruct the normal cranial shape irrespective of the type of cranial deformity with minimal patient stress and morbidity. To achieve dynamic total skull remodeling, we considered a new remodeling concept and developed a new procedure by combining morcellation craniotomy and distraction osteogenesis, termed the MoD procedure, and designed a distraction device, namely the angle variable distraction (AVD) system. Between 2000 and 2009, we treated 41 patients with craniosynostosis (28 and 13 cases of isolated and syndromic craniosynostosis, respectively) by using the MoD procedure with the AVD system. Compared with the conventional methods, the mean operative time was significantly shorter, and the mean transfusion volume was significantly less for the MoD procedure. In all the patients, good cranial shape and adequate cranial volume were achieved without serious complications. In conclusion, the MoD procedure with the AVD system is safe, effective, and reliable for dynamic total skull remodeling with minimal morbidity. It could be used to improve the previous surgical concepts for treating craniosynostosis.

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Preoperative assessment of soft tissue deficiency in the temporal region with reverse engineering

Miyamoto Junpei, Nagasao Tomohisa, Miyamoto Shimpei, Kasai Shogo, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 64 ( 5 ) 695 - 697 2011.05

ISSN 1748-6815

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Bone marrow-derived cells serve as proangiogenic macrophages but not endothelial cells in wound healing

Okuno, Yuji, Nakamura-Ishizu, Ayako, Kishi, Kazuo, Suda, Toshio, Kubota, Yoshiaki

BLOOD 117 ( 19 ) 5264 - 5272 2011.05

Research paper (scientific journal), ISSN 0006-4971

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Isolation and function of mouse tissue resident vascular precursors marked by myelin protein zero

Kubota Yoshiaki, Takubo Keiyo, Hirashima Masanori, Nagoshi Narihito, Kishi Kazuo, Okuno Yuji, Nakamura-Ishizu Ayako, Sano Keigo, Murakami Masato, Ema Masatsugu, Omatsu Yoshiki, Takahashi Satoru, Nagasawa Takashi, Shibuya Masabumi, Okano Hideyuki, Suda Toshio

Journal of Experimental Medicine 208 ( 5 ) 949 - 960 2011.05

ISSN 0022-1007

Vasculogenesis describes the process of de novo vessel formation from vascular precursor cells. Although formation of the first major vessels, such as the dorsal aorta and cardinal veins, occurs during embryonic vasculogenesis, the contribution of precursor cell populations to postnatal vessel development is not well understood. Here, we identified a novel population of postnatal vascular precursor cells in mice. These cells express the Schwann cell protein myelin protein zero (Po) and exhibit a CD45-CD31-VEcad-c-kit⁺CXCR4⁺ surface phenotype. Po⁺ vascular precursors (PVPs) are recruited into the growing vasculature, and comprise a minor population of arterial endothelial cells in adult mice. Recruitment of PVPs into growing vessels is mediated by CXCL12-CXCR4 signaling, and is enhanced during vascular expansion induced by Notch inhibition. Po-specific ablation of Flk1, a receptor for VEGF, results in branching defects and insufficient arterial patterning in the retina, as well as reduced neovascularization of tumors and ischemic tissues. Thus, in postnatal mice, although growing vessels are formed primarily by angiogenesis from preexisting vessels, a minor population of arterial endothelia may be derived from tissue-resident vascular precursor cells.

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New V-Y advancement method "Clione Method" for reconstructive surgery

Shimizu Ruka, Kishi Kazuo, Nakajima Hideo

Japanese Journal of Plastic Surgery 54 ( 4 ) 415 - 422 2011.04

ISSN 0021-5228

The V-Y advancement flap is one of the most frequently used methods in plastic surgery. But the movement of the flap is sometimes disrupted by tension, and there are various practical methods to release the tension of the flaps. We investigated a new method modifying V-Y advancement, in which we add a slit-cut in the middle of the flap, and insert a triangle shaped skin surplus into the space which is usually trimmed. We named this method the "Clione Method", because it resembles a clione, a cold-ocean dwelling creature. We used this method in 7 cases (2 cases are presented in this article), which required large tissue reconstruction after radical resection of tumors or scars. In all cases, the "Clione Method" was useful for covering the defects with less tension at the tip of the flaps, and all the flaps successfully survived. The "Clione Method" has the following advantages: 1) It does not leave complicated scarring on the flap which directly covers the defect, 2) The skin surplus which is trimmed and discarded is reused naturally, 3) The sutured line does not become straight eventually, which can prevent scar contracture, and 4) The technique is simple. On the other hand, an additional cut must be made on the flap, and thus the method should be used only when the flap is not undermined beneath the flap, or when there is sufficient blood supply under the flap.

The "crossbeam technique"

Sakamoto Yoshiaki, Nakajima Hideo, Tamada Ikkei, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 64 ( 3 ) 2011.03

ISSN 1748-6815

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The "crossbeam technique": A technique for taking bone grafts from the ilium

Sakamoto, Yoshiaki, Nakajima, Hideo, Tamada, Ikkei, Kishi, Kazuo

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY 64 ( 3 ) E82 - E83 2011.03

Research paper (scientific journal), ISSN 1748-6815

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Reconstruction of the scalp with a calvarial defect

Nagasao Tomohisa, Horiguchi Takashi, Miyamoto Junpei, Kishi Kazuo

Surgery Today 41 ( 2 ) 189 - 196 2011.02

ISSN 0941-1291

Purpose: To review our clinical cases and devise a protocol for selecting the best operative methods to reconstruct the scalp with a calvarial defect. Methods: We reviewed the original disease, the areas and depths of the scalp and calvarial defects, the methods of reconstruction, and complications in 20 patients. Results: The defect was caused by secondary cranial infection following decompressive craniectomy for intracranial hemorrhage (ICH) in 11 patients; extensive removal of the scalp and calvaria for resection of a malignant tumor in 6 patients; and by secondary cranial infection following removal of a malignant tumor in 3 patients. Cranial infection was frequently associated with abscess formation around the fixation screws and plates, suggesting that artificial materials induced the infection. We reconstructed the defect using free flaps in 15 patients and using local flaps in 5 patients. Conclusions: When restoring the calvaria in the primary operation, the use of metal screws and plates should be minimized to prevent cranial infection and subsequent scalp and calvaria defects. Local flaps are appropriate for reconstructing relatively small defects (<20 cm ²), whereas free flaps are better for reconstructing relatively large defects (>25 cm ²).

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Morphological Analysis of the Upper Eyelid Tarsus in Asians

Nagasao, Tomohisa, Shimizu, Yusuke, Ding, Weijin, Jiang, Hua, Kishi, Kazuo, Imanishi, Nobuyuki

ANNALS OF PLASTIC SURGERY 66 ( 2 ) 196 - 201 2011.02

Research paper (scientific journal), ISSN 0148-7043

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Morphological analysis of the upper eyelid tarsus in asians

Nagasao Tomohisa, Shimizu Yusuke, Ding Weijin, Jiang Hua, Kishi Kazuo, Imanishi Nobuyuki

Annals of Plastic Surgery 66 ( 2 ) 196 - 201 2011.02

ISSN 0148-7043

Purpose: The present study aims to evaluate morphologic variations of the upper tarsus in Asians. Methods: Measurements of superior-inferior and medial-lateral lengths were performed on 54 embalmed cadavers. The superior-inferior length of the tarsus was measured at the central and lateral parts. On the basis of the measured values, shapes of the tarsi were evaluated and categorized. Results: The tarsi were classified into 3 morphologic categories-the sickle, triangular, and trapezoid types. The upper margins of the sickle, triangular, and trapezoid type tarsi present round, triangular, and flat lines, respectively. Among the 54 examined specimens, 29 (55.6%), 16 (29.6%), and 9 (16.7%) belonged to the sickle, triangular, and trapezoid groups, respectively. Conclusions: The upper eyelid tarsi present morphologic variations with the Asian population. In performing surgical correction of blepharoptosis or surgical production of double-folds, this individual variation should be taken into consideration.

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Japanese Journal of Plastic Surgery

Kishi Kazuo

Japanese Journal of Plastic Surgery 54 ( 1 ) 1 2011.01

ISSN 0021-5228

Capsule formation can make secondary reconstruction of the dura mater unnecessary after cranial infection

Nagasao Tomohisa, Shinoda Jun, Horiguchi Takashi, Kishi Kazuo

Journal of Craniofacial Surgery 22 ( 1 ) 84 - 88 2011.01

ISSN 1049-2275

Purpose: Defects of the dura mater caused by surgical intervention are often reconstructed using artificial substitutes such as polytetrafluoroethylene membrane (Gore-Tex in commercial name). In cases where secondary infection develops after the initial operation, the artificial substitute used in the primary surgery needs to be removed, and the cranial defect should be covered with tissues abundant in blood supply. The present study discusses the necessity of secondary reconstruction of the dural defect in the recovery operation. Methods: A retrospective study was conducted on 12 patients in whom artificial substitute was exposed because of necrosis of the overlying tissues due to infection or radiation. In recovery operations, the artificial substitute was removed, and the conditions of the underlying defects were evaluated. Results: In all cases, capsule formation had developed to cover dural defects underneath the infected artificial substitutes. The capsules were transparent and watertight, presenting no leakage of cerebrospinal fluid. After coverage of the defect regions using free-flap transfer, no patient developed postoperative complications in follow-up periods of at least 6 months. Conclusions: Capsule formation occurs under artificial substitutes after replacement of the dura mater. Because the capsules retain the cerebrospinal fluid, replacement of the artificial materials is unnecessary in the secondary operation.

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Evaluation of three cases using a novel titanium mesh system-Skull-Fit® with orbital wall (Skull-Fit WOW®)-for cranial base reconstructions

Hattori Noriko, Nakajima Hideo, Tamada Ikkei, Sakamoto Yoshiaki, Ohira Takayuki, Yoshida Kazunari, Kawase Takeshi, Kishi Kazuo

Skull Base 21 ( 5 ) 279 - 286 2011

ISSN 1531-5010

Cranial base reconstructions associated with tumor resections around the orbital wall often require that both the upper and lateral orbital walls be reconstructed during a single procedure. Previously, we used titanium mesh plates that were preoperatively fabricated based on three-dimensional models. Although these plates are precise and do not increase the probability of infection, we still had to use autologous bones to reconstruct the orbital walls. Recently, we developed a new titanium mesh platecalled Skull-Fit®with orbital wall (Skull-Fit WOW®), enabling us to reconstruct the cranial base and orbital walls without bone grafts. Here, we report on three reconstruction cases in which the novel titanium mesh-orbital wall system was used. In all three cases, the customized titanium mesh system performed satisfactorily with little, if any, complications.

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Wound-associated skin fibrosis

Shaw Tanya J., Kishi Kazuo, Mori Ryoichi

Endocrine, metabolic & immune disorders drug targets 10 ( 4 ) 320 - 330 2010.12

ISSN 1871-5303

Skin fibrosis, in its mildest form, may present only a minor aesthetic problem, but in the most severe cases it can lead to debilitating pathologies of the skin, for example keloid and hypertrophic scars, and systemic sclerosis. In recent years, extensive basic research aimed at understanding the molecular mechanisms underlying fibrosis has revealed an impressive but baffling number of genes, molecules, and cell types that may contribute to this problem. However, one recurring and consistent theme in these studies is that inflammatory cells and their secreted mediators appear to be leading culprits in activating dermal fibroblasts to become fibrotic. This review will first describe the histology of normal versus fibrotic skin, and will also describe the process of wound repair, a primary cause of skin fibrosis. We will then focus on what is currently known about the molecular mechanisms underlying skin fibrosis, with particular attention paid to how inflammation contributes. Finally, current treatment strategies and emerging therapeutic targets will be discussed.

A new surgical correction of cryptotia with superior auricular myocutaneous flap

Sakamoto Yoshiaki, Nakajima Hideo, Kishi Kazuo, Imanishi Nobuaki

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 12 ) 1995 - 2000 2010.12

ISSN 1748-6815

This report introduces a new method for the correction of cryptotia using an advancement flap supplied by both superior auricular muscle and skin pedicle. This procedure has many advantages: the design is simple, the procedure is easy, the hairline is not disturbed by the operation, the maintenance of a deep auricular sulcus allows the patient to wear glasses, the scar behind the auricle is not visible, recurrence of the cryptotia is prevented and there is no need for additional skin grafting. Satisfactory contour and protrusion of the upper part of the auricle were maintained postoperatively.

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Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum

Nagasao, Tomohisa, Noguchi, Masahiko, Miyamoto, Junpei, Jiang, Hua, Ding, Weijin, Shimizu, Yusuke, Kishi, Kazuo

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 140 ( 6 ) 1294 - U117 2010.12

Research paper (scientific journal), ISSN 0022-5223

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Distribution of adipose-derived stem cells in adipose tissues from human cadavers

Kishi Kazuo, Imanishi Nobuaki, Ohara Hirotoshi, Ninomiya Ruka, Okabe Keisuke, Hattori Noriko, Kubota Yoshiaki, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 10 ) 1717 - 1722 2010.10

ISSN 1748-6815

Background: Adipose-derived stem cells (ASCs) possess multipotency in vivo and in vitro, and thus are thought to be very promising precursors for use in regenerative medicine. ASCs can be concentrated from adipose tissue by enzymatic digestion and transplanted to increase angiogenesis or for cosmesis. ASC transplants are now being performed in a clinical setting. Although data on ASCs are extensive, the distribution of ASCs in human fat tissue has not been fully clarified. Thus, it is important to identify the distribution of ASCs to obtain cell populations rich in ASCs for clinical use. Methods: ASCs express CD34, a cell surface marker. As CD34 is also expressed by endothelial cells, we immunohistochemically stained 2-μm-thick serial paraffin sections of fat tissue obtained from various parts of formalin-fixed cadavers with anti-CD31 and anti-CD34 antibodies to distinguish ASCs from endothelial cells. Results: CD34(+)/CD31(-) cells were mainly found in connective tissue tracts and perivascularly. Among fat tissues obtained from various sites, fat tissues in the thoracic back and lower abdomen were richest in CD34(+)/CD31(-) cells. Conclusion: The concentrations of CD34(+)/CD31(-) cells in adipose tissues differ between sites. The sites most highly enriched for ASCs were identified, and it is now possible to select the best sites for collection of ASCs for transplantation.

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A backflip flap

Sakamoto Yoshiaki, Nakajima Hideo, Tamada Ikkei, Uchikawa Yumiko, Kishi Kazuo

Plastic and Reconstructive Surgery 126 ( 4 ) 2010.10

ISSN 0032-1052

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Three-dimensional arterial anatomy of the gluteus maximus and the proper method of muscle splitting

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Plastic and Reconstructive Surgery 126 ( 2 ) 2010.08

ISSN 0032-1052

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