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Papers - Kishi, Kazuo

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Influence of Flap Thickness on Nipple Projection After Nipple Reconstruction Using a Modified Star Flap

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

AESTHETIC PLASTIC SURGERY 42 ( 4 ) 964 - 970 2018.08

Research paper (scientific journal), ISSN 0364-216X

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Surgical Simulation and Custom-Made Implant for Cranial Fibrous Dysplasia

Sakamoto Yoshiaki, Miwa Tomoru, Yoshida Kazunari, Kishi Kazuo

Journal of Craniofacial Surgery 29 ( 5 ) 1352 - 1353 2018.07

ISSN 1049-2275

Background: The management of fronto-orbital fibrous dysplasia involves total excision of the dysplastic bone and bone reconstruction using implants. Custom-made implants are used to achieve good contouring. However, the remnant defect after excising the lesion often does not match the implant. Methods: To design the craniotomy line, a template was prepared by preoperative computed surgical simulation. The template was overlaid on the preoperative cranium, such that its inner surface fits exactly with the cranial surface. After excising the lesion by performing osteotomy, the implant was placed in the defect and fixed. Both template and implant were made of hydroxyapatite. Results: The authors treated 4 patients, with fibrous dysplasia involving the fronto-facial region by using the template. Intraoperative trimming of the implant or bone defect was not required in 2 patients, while the third patient required mild trimming. They did not have any complications and obtained good contouring. Conclusion: The hydroxyapatite templates reduced the surgical time by determining the precise craniotomy line preoperatively, thus avoiding needless trimming of the implant and bone defect. Therefore, they can enhance the efficacy of treatment for fronto-orbital fibrous dysplasia lesion.

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A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander

Kono Hikaru, Ishii Naohiro, Takayama Masayoshi, Takemaru Masashi, Kishi Kazuo

Archives of Plastic Surgery 45 ( 4 ) 333 - 339 2018.07

ISSN 2234-6163

Background Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume. Methods We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05× the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II. Results X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases. Conclusions The volume of a free TRAM flap can be straightforwardly estimated preopera-tively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

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Influence of backscatter radiation on cranial bone fixation devices

Sakamoto Yoshiaki, Koike Naoyoshi, Takei Hideyuki, Ohno Mari, Shigematsu Naoyuki, Kishi Kazuo

Journal of Craniofacial Surgery 29 ( 4 ) 1094 - 1096 2018.06

ISSN 1049-2275

Postoperative radiation can cause ulcer formation, leading to the denudation of skin over alloplastic materials. The influence of backscatter radiation from fixation devices has not been investigated. The aim of this study is to evaluate backscatter dose variations for different cranial bone fixation devices in an experimental model designed to simulate postoperative radiotherapy. The authors assessed the radiation backscatter doses associated with resorbable (PLLA-PGA) and titanium plates. The samples were irradiated with 6 and 10 MV photon beams from a linear accelerator. Measurements were obtained using an ionization chamber and radiochromic films cut from the same batch. As a result, the backscatter radiation of water and PLLA-PGA proportionally decreased as the depth increased. However, the backscatter radiation of the titanium plate increased just above the plate. This depth lies in the region of the scalp. Each material showed a dose of radioactivity that was higher at 10 MV than that at 6 MV. These devices showed a significant difference, which suggested that these materials amplified the dose compared with water at 6 MV. In conclusion, it is supposed that PLLA-PGA should be used to fix the cranium to decrease the potential for radiation ulcers.

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Influence of Flap Thickness on Nipple Projection After Nipple Reconstruction Using a Modified Star Flap

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

Aesthetic Plastic Surgery 1 - 7 2018.05

ISSN 0364-216X

Background: In nipple reconstruction, the width, length, and thickness of modified star flaps are concerns for long-term reconstructed nipple projection. However, the flap’s projection has not been analyzed, based on its thickness. The aim of the present study was to investigate how flap thickness in a modified star flap influences the resulting reconstructed nipple and achieves an appropriate flap width in design. Methods: Sixty-three patients who underwent nipple reconstruction using a modified star flap following implant-based breast reconstruction between August 2014 and July 2016 were included in this case-controlled study. The length of laterally diverging flaps was 1.5 times their width. The thickness of each flap was measured using ultrasonography, and the average thickness was defined as the flap thickness. We investigated the correlation between the resulting reconstructed nipple and flap thickness, and the difference of the change in the reconstructed nipple projection after using a thin or thick flap. Results: The average flap thickness was 3.8 ± 1.7 (range 2.5–6.0) mm. There was a significant, linear correlation between the flap thickness and resulting reconstructed nipple projection (β = 0.853, p < 0.01). Furthermore, the difference between the thin and thick flaps in the resulting reconstructed nipple projection was significant (p < 0.01). Conclusion: Measuring the flap thickness preoperatively may allow surgeons to achieve an appropriate flap width; otherwise, alternative methods for higher projection might be used. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Utility of topical epinephrine for determining the resection range of eyelid sebaceous carcinoma with dermatitis

Kiuchi Tomoki, Shimizu Yusuke, Yamazaki Shun, Awazawa Tsuyoshi, Kishi Kazuo

Archives of Plastic Surgery 45 ( 3 ) 289 - 290 2018.05

ISSN 2234-6163

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A Giant Osteoma of the Ethmoid Sinus

Ishii, Tatsuyuki, Sakamoto, Yoshiaki, Miwa, Tomoru, Yoshida, Kazunari, Kishi, Kazuo

JOURNAL OF CRANIOFACIAL SURGERY 29 ( 3 ) 661 - 662 2018.05

Research paper (scientific journal), ISSN 1049-2275

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Tranilast inhibits the expression of genes related to epithelial-mesenchymal transition and angiogenesis in neurofibromin-deficient cells

Harigai, Ritsuko, Sakai, Shigeki, Nobusue, Hiroyuki, Hirose, Chikako, Sampetrean, Oltea, Minami, Noriaki, Hata, Yukie, Kasama, Takashi, Hirose, Takanori, Takenouchi, Toshiki, Kosaki, Kenjiro, Kishi, Kazuo, Saya, Hideyuki, Arima, Yoshimi

SCIENTIFIC REPORTS 8 E325 - E327 2018.04

Research paper (scientific journal), ISSN 2045-2322

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Wound Bed Preparation for Capsulectomy Using a Hydrosurgery System

Suzuki, Yushi, Yazawa, Masaki, Kishi, Kazuo

WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE 30 ( 4 ) E49 - E51 2018.04

Research paper (scientific journal), ISSN 1044-7946

Inside PRS department;No 39

Kishi Kazuo

Japanese Journal of Plastic Surgery 61 ( 3 ) 318 - 321 2018.03

ISSN 0021-5228

Optimal Conditions for Absorbable Fixation of Hydroxyapatite Ceramic Implants

Sakamoto Yoshiaki, Kishi Kazuo

Journal of Craniofacial Surgery 29 ( 1 ) 248 - 250 2018.01

ISSN 1049-2275

Synthetic hydroxyapatite (HAP) implants are common in craniofacial surgery; the major problem with HAP implants is fixation instability. An ultrasound-assisted pinned resorbable fixation system has recently been introduced. The authors hypothesized that this resorbable system could be used to fix HAP implants. The authors evaluated the optimal HAP porosity and resorbable pin using the pull-out test and microscopic analysis. Hydroxyapatite blocks were synthesized with 0% (dense type), 35% (fine pore type), and 50% (large pore type) porosity. Bioabsorbable pins of 4 sizes were tested: diameters of 1.6 or 2.1mm and lengths of 4 or 7mm. Among the 1.6mm diameter pins, the 7-mm length pins showed higher pull-out strength (large pore, 6.5±1.2 kgf; fine pore, 4.1±0.7 kgf; dense, 2.4±0.4 kgf) than the 4-mm length pins (large pore, 2.1±1.0 kgf; fine pore, 1.3±0.4 kgf; dense, 1.5±0.9 kgf) with all 3 HAP types (P<0.01). Among 2.1-mm diameter pins, all were removed from the large and fine pore HAP types without any resistance. Only three of seven 2.1×7mm pins inserted into the dense type HAP showed pull-out strength (3.9±2.1 kgf). Among all conditions, the 7-mm length, 1.6-mm diameter pin in large pore type HAP showed the highest pull-out strength. Microscopically, the large pore type HAP showed the liquefying pin flowing into the large pore adjacent to the pilot hole. By contrast, the fine pore and dense pore types of HAP did not allow flow, and the pins did not change in structure 3-dimensionally. The authors found that pull-out strength depends on HAP porosity, and pin length and diameter.

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Complete coverage of a tissue expander by a musculofascial pocket including the sternalis muscle during breast reconstruction

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

Archives of Plastic Surgery 45 ( 1 ) 89 - 90 2018.01

ISSN 2234-6163

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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 25 ( 1 ) 68 - 73 2018.01

Research paper (scientific journal), ISSN 1340-6868

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A retrospective analysis of zygomatic fracture etiologies

Sakamoto Yoshiaki, Ogata Hisao, Shido Hirokazu, Kishi Kazuo

JPRAS Open 14 23 - 26 2017.12

Background Zygomatic fractures are some of the most frequently encountered facial fractures. However, the relationships between the trauma etiology, the zygomatic fracture patterns, and patient ages have not been described. Methods Patients treated for isolated malar fractures, between 2004 and 2011, at Keio University Hospital were reviewed in this study. Comparative statistical analyses were conducted, based on the classification of the zygomatic fractures, their causes, and patient ages; p < 0.05 was considered significant. Results In total, 113 patients, aged 16–82-years-old (mean age (SD), 39.8 (17.0)-years-old), including 74 men were analyzed. Patients in their teens and 20s had injuries that were predominantly sports-related (48.8%). With increasing age, the ratio of sports injuries decreased and the number of falls causing injury increased. The frequency of injuries caused by motor vehicle collisions remained reasonably constant across the age groups. Comparing the ratio of shear type fractures with patient ages revealed that 4/13 injuries among patients in their 20s and 30s were of this type, whereas the proportion of shear fractures increased in patients over 40 (17/28, p < 0.05). Conclusion The severities of the zygomatic fractures, their causes, and the associated patient ages were closely related. Based on this study, possible prevention strategies for zygomatic fractures need to be considered.

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Transplanted mesenchymal stem cells are effective for skin regeneration in acute cutaneous wounds of pigs

Ochiai, Hiroko, Kishi, Kazuo, Kubota, Yoshiaki, Oka, Aiko, Hirata, Eri, Yabuki, Hanayo, Iso, Yoshitaka, Suzuki, Hiroshi, Umezawa, Akihiro

REGENERATIVE THERAPY 7 8 - 16 2017.12

Research paper (scientific journal), ISSN 2352-3204

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Anatomical Study of Perfusion of a Periosteal Flap with a Lateral Pedicle

Kim Boktae, Inoue Yoshikazu, Imanishi Nobuaki, Chang Hak, Shimizu Yusuke, Okumoto Takayuki, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 ( 9 ) 2017.09

Background: Pedicled periosteal flaps are commonly used for tissue defects between the base of the skull and the midfacial area. This study aimed to clarify the 3-dimensional vascular distribution of temporal region flaps. Methods: Ten fresh cadavers were used. Full-thickness cranial flaps were elevated from the cranial bone and each layer was detached separately. Contrast enhancement of the full thickness of the scalp, macroscopic evaluation, and histologic analyses were performed. Radiographs were obtained and image analysis was performed using a 3-dimensional monitor. Results: The mean number of deep vessels extending from the parietal branch of the superficial temporal artery was 68.7, including 14.2 and 54.5 vessels on the proximal and distal sides, respectively. The mean number of deep vessels extending from the frontal branch of the superficial temporal artery was 71.6, including 17.6 and 54.0 vessels on the proximal and distal sides, respectively. There were significantly more perforating branches in the distal area than in the proximal area of both the frontal and parietal branches (P = 0.005). There was no significant difference in the number of perforating branches between the frontal and parietal branches. Conclusions: Contrast-enhanced images of the loose areolar tissue and periosteal layers revealed vessels that extended radially. We successfully identified the 3-dimensional structure of the perforating vessels peripheral to the temporal fossa. Our findings provide a theoretical foundation for the feasibility of elevating a periosteal/loose areolar tissue flap with a reliable blood supply without sacrificing the temporal muscle.

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Lymphedema of the Lower Extremities due to Refractory Malignant Lymphoma Treated by Lymphaticovenous Anastomosis

Ishii Naohiro, Aoki Marie, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 ( 8 ) 2017.08

Summary: Lymphaticovenous anastomosis (LVA) is primarily performed for lymphedema of the lower extremities after surgical treatment of gynecologic cancer and lymphedema of the upper extremities after surgical resection of breast cancer; however, LVA for lymphedema due to malignant lymphoma has not been reported to date. We herein present a patient with severe lymphedema of the lower extremities due to refractory malignant lymphoma, which markedly improved with LVA. LVA could contribute to improve quality of life in patients with end-stage disease with lymphedema of the lower extremities due to refractory malignant lymphoma.

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Efficacy and safety of oral propranolol for infantile hemangioma in Japan

Kaneko, Tsuyoshi, Sasaki, Satoru, Baba, Naoko, Koh, Katsuyoshi, Matsui, Kiyoshi, Ohjimi, Hiroyuki, Hayashi, Nobukazu, Nakano, Atsuko, Ohki, Kentaro, Kuwano, Yoshihiro, Morimoto, Akira, Tamaki, Zenshiro, Kakazu, Mariko, Kishi, Kazuo, Oyama, Tomoki, Sato, Atsushi, Kato, Rumiko, Higuchi, Takeshi

PEDIATRICS INTERNATIONAL 59 ( 8 ) 869 - 877 2017.08

Research paper (scientific journal), ISSN 1328-8067

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Distraction Osteogenesis for Brachymetatarsia by Using Internal Device

Kitabata Reina, Sakamoto Yoshiaki, Nagasao Tomohisa, Kishi Kazuo

Plastic and Reconstructive Surgery - Global Open 5 ( 7 ) 2017.07

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Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with Contracture

Kuriyama Erika, Ochiai Hiroko, Inoue Yoshikazu, Sakamoto Yoshiaki, Yamamoto Naoki, Utsumi Toshiaki, Kishi Kazuo, Okumoto Takayuki, Matsuura Akihiro

Plastic and Reconstructive Surgery - Global Open 5 ( 7 ) 2017.07

Background: Capsular contracture is a common complication after breast augmentation surgery. This study pathologically evaluated the soft-tissue response to surface modifications in both smooth and textured tissue expander prostheses. Methods: Smooth tissue expanders and textured tissue expanders in 5 cases each were used for breast reconstruction after mastectomy. Histological samples were harvested from the capsules when the tissue expanders were replaced by silicone implants. Collagen orientation and cellular responses were assessed histologically. Capsular contracture was evaluated using the Baker classification 6 months and 2 years after the removal of the tissue expander. Results: The capsules surrounding the smooth tissue expanders tended to produce more contracture than those surrounding the textured tissue expanders. The collagen architecture of the capsules of the smooth tissue expanders showed random orientation with fragmentation. Conversely, the capsules of the textured tissue expanders showed parallel orientation with collagen bundles of almost normal structure. Significantly more fibrils of elastin and myofibroblasts were found in the capsules surrounding the smooth tissue than in those surrounding the textured ones. Conclusions: The collagen fibers surrounding the smooth tissue expanders could be cracked during expansion, which may lead to scarring and contracture. Conversely, the collagen orientation surrounding the textured tissue expanders was excellent. Moreover, the increase in elastic fibers and myofibroblasts in the capsules surrounding the smooth tissue expanders may be associated with in vivo contraction patterns. Therefore, the surface type of tissue expanders affects capsular contraction after replacement with definitive implants.

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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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Veno-accompanying artery fasciocutaneous flap

Aramaki-Hattori Noriko, Kishi Kazuo

Japanese Journal of Plastic Surgery 59 ( 7 ) 704 - 710 2016.07

ISSN 0021-5228

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.

Picosecond pulse duration laser treatment for dermal melanocytosis in Asians

Ohshiro Takafumi, Ohshiro Toshio, Sasaki Katsumi, Kishi Kazuo

Laser Therapy 25 ( 2 ) 99 - 104 2016.06

ISSN 0898-5901

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.

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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 1565 - 1567 2016.06

Research paper (scientific journal), 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 2016.05

ISSN 1049-2275

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.

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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 2016.04

ISSN 1748-6815

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 <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 <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.

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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 2016.02

ISSN 0930-343X

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.

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

Matsuzaki, Kyoichi, Aoki, Tomoko, Oji, Tomito, Nagashima, Hayato, Tsue, Chisato, Maki, Risa, Kishi, Kazuo

QUINTESSENCE INTERNATIONAL 47 ( 1 ) 75 - 79 2016.01

Research paper (scientific journal), ISSN 0033-6572

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Dermoscopic findings in pigmented 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 2016.01

Research paper (scientific journal), ISSN 1167-1122

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Hair induction by cultured mesenchymal cells using sphere formation

Kishi Kazuo, Hayashi Ruka

1453 85 - 92 2016

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.

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A 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

Research paper (scientific journal), ISSN 2469-9322

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

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

UROLOGIA INTERNATIONALIS 96 ( 2 ) 217 - 222 2016

Research paper (scientific journal), 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

ISSN 1092-9088

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.

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Investigating the pressure-reducing effect of wound dressings

Matsuzaki K., Kishi K.

Journal of wound care 24 ( 11 ) 512 - 517 2015.11

ISSN 0969-0700

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.

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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 2015.09

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.

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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 2015.09

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.

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

Kiuchi, Tomoki, Shimizu, Yusuke, Nagasao, Tomohisa, Ohnishi, Fumio, Minabe, Toshiharu, Kishi, Kazuo

JOURNAL OF PLASTIC SURGERY AND HAND SURGERY 49 ( 4 ) 224 - 228 2015.08

Research paper (scientific journal), 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 2015.07

ISSN 1049-2275

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<0.05). In contrast, the mean lateral wall thickness of the idiopathic exophthalmos group was significantly thicker than that of the control group (P>0.01). The lateral wall length was shorter with significant difference (P>0.05). The perpendicular distance and the width of the nasal cavity in the idiopathic exophthalmos group were longer with significant difference (P>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.

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Deltopectoral flap

Yazawa Masaki, Kishi Kazuo

Otolaryngology - Head and Neck Surgery (Japan) 87 ( 7 ) 463 - 467 2015.06

ISSN 0914-3491

The GETA technique

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

Child's Nervous System 31 ( 5 ) 773 - 776 2015.05

ISSN 0256-7040

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.

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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 2015.05

ISSN 1748-6815

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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 2015.05

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

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

CHILDS NERVOUS SYSTEM 31 ( 5 ) 773 - 776 2015.05

Research paper (scientific journal), ISSN 0256-7040

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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

JOURNAL OF CRANIOFACIAL SURGERY 26 ( 3 ) 680 - 681 2015.05

Research paper (scientific journal), 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 2015.04

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 2015.04

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 2015.03

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 2015.03

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 2015.01

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 2015.01

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 ) 2015.01

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

Yazawa, Masaki, Mori, Taisuke, Nakayama, Yasuhide, Kishi, Kazuo

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART B-APPLIED BIOMATERIALS 103 ( 1 ) 92 - 96 2015.01

Research paper (scientific journal), 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

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 ( 3-4 ) 312 - 315 2015.01

Research paper (scientific journal), ISSN 1341-321X

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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 & RECTUM 58 ( 1 ) 104 - 108 2015.01

Research paper (scientific journal), 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

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

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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

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

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

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

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 2014.11

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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Evaluation of bone volume after secondary bone grafting in unilateral alveolar cleft using computer-aided engineering

Nagashima Hayato, Sakamoto Yoshiaki, Ogata Hisao, Miyamoto Junpei, Yazawa Masaki, Kishi Kazuo

Cleft Palate-Craniofacial Journal 51 ( 6 ) 665 - 668 2014.11

ISSN 1055-6656

The purpose of this study was to evaluate the initial defect and the outcome of bone grafts for unilateral alveolar cleft. To determine the absorption of the bone graft in patients with unilateral cleft, computer-aided engineering (CAE) with multi-detector row computed tomography (MDCT) was used. MDCT scans of 29 patients were taken immediately preoperatively and at 1 month and 6 months postoperatively. The patients underwent bone grafting between 8 and 14 years of age using iliac crest bone grafts. Three-dimensional models were created in each period, and the defect at the alveolar cleft and volume of the bone graft were determined in each patient using CAE. Cleft volume and success of alveolar bone grafting were significantly correlated (P < .01). Alveolar clefts with cleft palate required more bone volume than those without cleft palate (P < .01), but the resorption rate did not significantly differ between alveolar clefts with and without cleft palate (0.48 ± 0.14 and 0.49 ± 0.18, respectively; P = .93). In conclusion, three-dimensional reconstruction of bone grafts using CAE based on MDCT provides a valuable objective assessment of graft volume.

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A titanium screw-retaining temporary denture on the raw surface muscular flap for the immediate maxillary reconstruction

Miyashita Hidetaka, Asoda Seiji, Horie Nobuyuki, Usuda Shin, Kato Shin, Muraoka Wataru, Yamada Yuka, Yoshikawa Momoko, Hasegawa Toshihiro, Onizawa Katsuhiro, Tanaka Ichiro, Yazawa Masaki, Ogata Hisao, Kishi Kazuo, Tomita Toshiki, Nakagawa Taneaki, Kawana Hiromasa

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 2014.10

ISSN 2212-5558

Objective: In any immediate reconstruction of the maxillofacial defect after total maxillectomy, the defect is often covered with a flap, however, dentures cannot be maintained stably by the flap, because of the high mobility and large amount of displacement of the flap under pressure. Therefore, we developed a method in which a muscle flap is transplanted without creating a skin island in the oral cavity and a denture is immediately fixed with titanium screws, and obtained favorable results. Patients and methods: The subjects were 9 patients who underwent resection for maxillary sinus cancer. In all patients, a free rectus abdominis muscle flap was used for the reconstruction and the raw surface of the muscle tissue was left in the oral cavity without creating a skin island. Dentures that had been made preoperatively were fixed on the remaining palate and alveolus with titanium screws for one month, so that they covered the muscle tissue. Results: Good palatal morphology was formed without hanging down after epithelialization of the surface of the muscle tissue. In comparison with the preoperative levels, the masticatory and conversational functions recovered to 77% and 90%, on average. Conclusions: Our method is considered to be one of the useful reconstruction methods for maxillofacial defects.

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Inferolateral marginal orbitectomy

Shimizu Y., Nagasao T., Sakamoto Y., Kishi K.

International Journal of Oral and Maxillofacial Surgery 43 ( 10 ) 1211 - 1215 2014.10

ISSN 0901-5027

The number of patients with mild exophthalmos, without severe eye symptoms, who wish to undergo aesthetic orbital decompression, is increasing. Removal of the lateral and inferior orbital walls is a common procedure for mild to moderate exophthalmos. However, the limited space between the globe and the orbital wall is often troublesome for surgeons introducing surgical devices. As a result, the decompression tends to be insufficient in the posterior region of the orbit. We describe a simple adjuvant surgical technique to address this limitation. Through a laterally extended, transconjunctival approach, the inferior and lateral margins of the orbit are removed in a crescent shape before the actual decompression. This manoeuvre widens the working space and offers better visibility, enabling sufficient removal of the orbital walls. The technique presented facilitates the approach to the posterior regions of the orbit, enabling surgeons to more easily perform orbital decompression.

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Surgical treatment for medically refractory myasthenic blepharoptosis

Shimizu Yusuke, Suzuki Shigeaki, Nagasao Tomohisa, Ogata Hisao, Yazawa Masaki, Suzuki Norihiro, Kishi Kazuo

Clinical Ophthalmology 8 1859 - 1867 2014.09

ISSN 1177-5467

Patients and methods: Eight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients.Purpose: Currently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis.Results: Seven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period.Conclusion: Our results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and discuss comprehensive treatment plans to increase the quality of life for patients with myasthenia gravis.

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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 2014.08

Research paper (scientific journal), ISSN 0470-8105

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Concentration of rat bone marrow nucleated cells using hypo-osmotic hemolysis in distilled water

Ohnishi Fumio, Ochiai Hiroko, Kishi Kazuo

Plastic and Reconstructive Surgery 2014.07

ISSN 0032-1052

BACKGROUND: Bone marrow aspirates contain primarily red blood cells. To achieve efficient cell transplantation for regeneration, the red blood cells need to be removed from the aspirates. Cell isolation is typically performed using density gradient centrifugation. However, this method entails issues of clinical safety and convenience. This study describes an efficient method to concentrate bone marrow nucleated cells by hypo-osmotic hemolysis. METHODS: The optimal hemolysis conditions were determined by diluting the bone marrow suspensions with distilled water in various dilution ratios. Then, the resulting cell fractions were transplanted in a rat cranial defect model to evaluate their effects on bone formation and their angiogenic effects. RESULTS: The optimal hemolysis conditions were a 3.3-fold dilution in distilled water and a hypo-osmotic exposure time of 45 seconds. Nucleated cells obtained using this method included granulocytes and mononuclear cells. These cells contain cytoplasmic angiogenic factors, including vascular endothelial growth factor, basic fibroblast growth factor, and hepatocyte growth factor. In a rat cranial defect model, callus formation and angiogenesis were significantly increased following transplantation of concentrated marrow nucleated cells in this manner. CONCLUSIONS: These results suggest angiogenic and osteogenetic effects of transplanting marrow nucleated cells using this hypo-osmotic method.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. American Society of Plastic Surgeons.

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3-D analysis of dislocation in zygoma fractures

Toriumi, Masahiro, Nagasao, Tomohisa, Itamiya, Tomoki, Shimizu, Yusuke, Yasudo, Hiroki, Sakamoto, Yoshiaki, Ogata, Hisao, Kishi, Kazuo

JOURNAL OF CRANIO-MAXILLOFACIAL SURGERY 42 ( 5 ) 397 - 402 2014.07

Research paper (scientific journal), ISSN 1010-5182

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Phlebectasia of the external jugular vein with thrombosis: report of a case

Matsunaga, Keiko, Kishi, Kazuo

SURGERY TODAY 44 ( 6 ) 1180 - 1183 2014.06

Research paper (scientific journal), ISSN 0941-1291

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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 2014.06

Research paper (scientific journal), ISSN 0171-6425

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Original article classification of congenital midline upper lip sinuses

Aoki Marie, Sakamoto Yoshiaki, Nagasao Tomohisa, Miyamoto Junpei, Kishi Kazuo

Cleft Palate-Craniofacial Journal 51 ( 2 ) 154 - 157 2014.03

ISSN 1055-6656

Background: We recently encountered a case of a midline upper lip sinus, one of the rarest congenital lip sinuses. Several embryological hypotheses have been proposed regarding the etiology of this rare disease, but it remains obscure. Methods: We reviewed all cases of upper lip sinus reported in the English language through 2011, and classified them into three types according to accompanying anomalies and the site of the fistula. Results: Twenty-eight studies involving 31 cases were reviewed and classified. A type I sinus was a midline sinus without accompanying anomalies. There were 13 such cases, with a female predilection. Type II sinuses were midline sinuses with accompanying anomalies, and there were nine such cases. Type III sinuses were lateral sinuses with or without accompanying anomalies; there were nine cases. Conclusions: Our classification scheme is not only convenient for clinical application, but also reflects the embryological process responsible for congenital lip sinuses.

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Spatial and temporal control of laminin-332 and-511 expressions during hair morphogenesis

Imanishi, Hisayoshi, Tsuruta, Daisuke, Tateishi, Chiharu, Sugawara, Koji, Kobayashi, Hiromi, Ishii, Masamitsu, Kishi, Kazuo

MEDICAL MOLECULAR MORPHOLOGY 47 ( 1 ) 38 - 42 2014.03

Research paper (scientific journal), ISSN 1860-1480

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Combined use of resorbable poly-l-lactic acid-polyglycolic acid implant and bone cement for treating large orbital floor fractures

Sakamoto Yoshiaki, Shimizu Yusuke, Nagasao Tomohisa, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 67 ( 3 ) 2014.03

ISSN 1748-6815

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The "halo technique"

Sakamoto Yoshiaki, Nakajima Hideo, Kishi Kazuo

International Journal of Dermatology 53 ( 2 ) 2014.02

ISSN 0011-9059

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Combined usage of intercostal nerve block and tumescent anaesthesia

Shimizu Yusuke, Nagasao Tomohisa, Taneda Hiroko, Sakamoto Yoshiaki, Asou Toru, Imanishi Nobuyuki, Kishi Kazuo

Journal of Plastic Surgery and Hand Surgery 48 ( 1 ) 51 - 55 2014.02

ISSN 2000-656X

Patients are occasionally unhappy with the size, shape, and positioning of breast implants. An option to improve their satisfaction with breast augmentation includes directly involving them in the process with awake surgery done under nerve block and tumescence. This study describes the resultsof using such an awake anaesthesia technique in 35 patients. After the intercostal nerves dominating the Th3 to Th6 regions were anaesthetized using 0.5% bupivacaine, a tumescent solution consisting of lidocaine, epinephrine, and saline was injected around the mammary gland, and breast augmentation was conducted using silicon implants. The majority of patients (31/35) reported no pain during the procedure and all patients were able to choose and confirm their final implant size and positioning. In all cases, blood loss was less than 10 ml. No patient experienced pneumothorax or toxicity of local anaesthetics. Combined usage of the intercostal nerve block and tumescent anaesthesia effectively reduces pain during breast augmentation. Keeping patient conscious enables meeting their requests during operation, contributing to increased satisfaction. For these advantages, combined usage of the intercostal nerve block and tumescent anaesthesia is recommended as a useful anaesthetic technique for breast augmentation.

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New pathogenesis and the classification in scaphocephaly

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

Journal of Plastic Surgery and Hand Surgery 48 ( 1 ) 24 - 27 2014.02

ISSN 2000-656X

The aetiology of scaphocephaly is often described as premature fusion of the sagittal suture. This study observed wave-like deformations in abnormally long and narrow skulls typical of scaphocephaly, and these deformations were divided into two types: type I deformations (one wave) and type II deformations (two waves). However, the pathogeneses of these deformations are unknown. Computed tomographic data sets were retrospectively analyzed from 18 patients with scaphocephaly who were admitted to the hospital between 2000-2010. Using three-dimensional reconstructions of the computed tomographic images, the relationship was analysed between the wave deformation types and the state of the sutures and fontanelles. The results demonstrate that the type of wave deformation was dependent on the location of the sagittal suture closure. Specifically, the premature closure of the posterior half of the sagittal suture caused a type I deformation, while total closure resulted in a type II deformation (p < 0.001). It is hypothesized that restricted growth of the fused suture causes billowing, which results in a waving deformation. The deformities that are often observed in sagittal synostosis can be explained more accurately.

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Spatial and temporal control of laminin-332 and -511 expressions during hair morphogenesis

Imanishi Hisayoshi, Tsuruta Daisuke, Tateishi Chiharu, Sugawara Koji, Kobayashi Hiromi, Ishii Masamitsu, Kishi Kazuo

Medical Molecular Morphology 47 ( 1 ) 38 - 42 2014

ISSN 1860-1480

Hair is one of the smallest organs, but has many important functions to mammals. Hair morphogenesis occurs through the reciprocal exchange of epithelial and mesenchymal signals. There are some reports about the expression of laminin-511 and -332 during hair morphogenesis, but are no reports of the chronological expression and function of laminin-511 and its counter regulator laminin-332 during hair morphogenesis. Our results of immunoblotting revealed that laminin-332 proteins were detected at stage 0 and downregulated during stage 1 to stage 2, and then recovered at stage 3. However, laminin α5 expression was constant throughout stages 0-3. According to the results of semi-quantitative RT-PCR, the mRNA expression of all laminin-332 subunits increased gradually from stage 0 to stage 2, while the mRNA expression of all laminin-511 subunits remained constant from stage 0 to stage 3. Our results suggest that the proper expression of laminin-332 and laminin-511 may regulate appropriate hair morphogenesis.

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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

Research paper (scientific journal), ISSN 0014-3022

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Alternative continuous quilting suture technique for preventing hematoma in axillary osmidrosis

Shimizu Yusuke, Nagasao Tomohisa, Kishi Kazuo, Asou Toru

Dermatologic Surgery 40 ( 9 ) 1058 - 1060 2014

ISSN 1076-0512

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Combined usage of hydroxyapatite and cross-finger flap for fingertip reconstruction

Nagasao Tomohisa, Kurihara Kunihiro, Shimizu Yusuke, Toriumi Masahiro, Sakamoto Yoshiaki, Jiang Hua, Yu Dazhi, Kishi Kazuo

Journal of Plastic Surgery and Hand Surgery 48 ( 3 ) 205 - 208 2014

ISSN 2000-656X

Reconstruction for fingertip defects categorized as Type 3 and Type 4 in Allen's classification is challenging, because surgeons need to reconstruct not only the pulp but also great parts of the distal phalangeal bone. This paper introduces an original technique for the reconstruction of defects of these types. The defects of seven fingers (two small fingers and five index fingers) of seven patients (three males and four females; aged 14-44 years) were repaired. After the fingertip is divided in a fish-mouth fashion to expose the stump of the distal phalangeal bone, a curved block of hydroxyapatite is grafted to fill the phalangeal defect and straighten the nail bed. A rectangular flap is raised from the dorsal side of the neighbouring finger in the region between the PIP and DIP joints. Then the fish-mouth region carrying the grafted hydroxyapatite is covered with the rectangular flap to reconstruct the pulp. The rectangular cross-finger flap is separated 3-4 weeks postoperatively. In all seven cases, the flap survived completely. Infection developed in no case. In all cases, aesthetic appearance of the pulp and nail presented improvement, satisfying the patients. Combined usage of hydroxyapatite and a cross-finger flap from the neighbouring finger is an effective method for the reconstruction of type 3 and type 4 defects in Allen's classification.

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Cutaneous carcinosarcoma arising from a burn scar

Fujii Takako, Fukuzumi Satoshi, Hayakawa Kazuhito, Ishida Yasuo, Sakamoto Yoshiaki, Kishi Kazuo

Dermatologic Surgery 40 ( 8 ) 916 - 918 2014

ISSN 1076-0512

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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

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

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

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

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

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

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

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 2013.12

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

Nakanishi, Yuji, Nagasao, Tomohisa, Shimizu, Yusuke, Miyamoto, Junpei, Fukuta, Keizo, Kishi, Kazuo

JOURNAL OF PLASTIC SURGERY AND HAND SURGERY 47 ( 6 ) 472 - 475 2013.12

Research paper (scientific journal), 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 ) 2013.10

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 ) 2013.10

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 2013.09

ISSN 1055-6656

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

Sakamoto, Yoshiaki, Nakajima, Hideo, Imanishi, Nobuaki, Kishi, Kazuo

INTERNATIONAL JOURNAL OF DERMATOLOGY 52 ( 9 ) 1125 - 1128 2013.09

Research paper (scientific journal), 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 2013.07

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

Oji, Tomito, Sakamoto, Yoshiaki, Ogata, Hisao, Tamada, Ikkei, Kishi, Kazuo

INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 77 ( 7 ) 1183 - 1185 2013.07

Research paper (scientific journal), 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

Nagasao, Tomohisa, Aramaki-Hattori, Noriko, Shimizu, Yusuke, Yoshitatsu, Sumiko, Takano, Naoki, Kishi, Kazuo

MEDICAL HYPOTHESES 81 ( 1 ) 136 - 141 2013.07

Research paper (scientific journal), 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 2013.05

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

Yamazaki, Shun, Suami, Hiroo, Imanishi, Nobuaki, Aiso, Sadakazu, Yamada, Minoru, Jinzaki, Masahiro, Kuribayashi, Sachio, Chang, David W., Kishi, Kazuo

CLINICAL ANATOMY 26 ( 2 ) 258 - 266 2013.03

Research paper (scientific journal), 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 ) 2013.01

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

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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Three-dimensional demonstration of the lymphatic system in the lower extremities with multi-detector-row computed tomography

Yamazaki Shun, Suami Hiroo, Imanishi Nobuaki, Aiso Sadakazu, Yamada Minoru, Jinzaki Masahiro, Kuribayashi Sachio, Chang David W., Kishi Kazuo

Clinical Anatomy 26 ( 2 ) 258 - 266 2013

ISSN 0897-3806

Sentinel lymph node biopsy (SLNB) has had a great impact on the staging and treatment of cancer. The purpose of this study was to study the lymphatic anatomy of the lower extremities by constructing three-dimensional images using multi-detector-row computed tomography (MDCT). To select appropriate contrast media for MDCT lymphatic imaging in a cadaver, we tested four kinds of contrast media by injecting them into fresh swine kidneys. After the suitable contrast medium was selected, 10 lower extremities from 5 fresh cadavers were studied. After injection of the contrast medium, each lower extremity was scanned with high-spatial-resolution MDCT. The zinc oxide mixture was found to be the most appropriate contrast formula for MDCT imaging of cadaver lymphatics in terms of CT value and no extravasation. The high-resolution MDCT imaging revealed two different superficial lymphatic pathways in the legs. One lymphatic pathway accompanying the great saphenous vein had a constant course and was connected to the superficial inguinal lymph nodes. However, another pathway, along the small saphenous vein, was variable. Some of the deep lymphatic vessels bypassed the inguinal lymph nodes. Using a new protocol, we were able to construct three-dimensional images of the lower extremity lymphatics in a cadaver model. MDCT imaging provided novel information about two different superficial lymphatic pathways in the lower extremities. Clin. Anat., 2013.

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A biomechanical study regarding the effect of tissue harvesting from the thorax on its movement during inspiration

Hatano, Asako, Nagasao, Tomohisa, Shimizu, Yusuke, Jin, Hongmei, Kaneko, Tsuyoshi, Cho, Yasunori, Jiang, Hua, Kishi, Kazuo

COMPUTER AIDED SURGERY 18 ( 5-6 ) 118 - 128 2013

Research paper (scientific journal), ISSN 1092-9088

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Fetal skin possesses the ability to regenerate completely

Kishi Kazuo, Okabe Keisuke, Shimizu Ruka, Kubota Yoshiaki

Keio Journal of Medicine 61 ( 4 ) 101 - 108 2012.12

ISSN 0022-9717

Until a certain developmental stage, cutaneous wounds in mammalian fetuses heal rapidly without scars with complete regeneration of the skin. In the process of fetal wound healing, infammatory responses, granulation proliferation, and scar formation that are observed in adults are not seen. Numerous studies have reported the causes of fetal scarless cutaneous regeneration, including reduced expression of TGF-β1 and higher levels of hyaluronan in the extracellular matrix, from the viewpoints of molecular biology and cellular biology, but the mechanisms are not completely understood. Although a variety of substances that inhibit scar formation have been investigated, currently it is almost impossible for adult cutaneous wounds to heal completely without scars. Except for a few animal species, perfect regeneration after wounding can occur only during the gestation period. By strictly comparing the stages before and after the transition from the regeneration of skin to scarring, it will be possible to investigate the mechanisms of cutaneous regeneration.

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Wing flap reconstruction for large defects of the lower lip

Uchikawa, Yumiko, Yazawa, Masaki, Takayama, Masayoshi, Kishi, Kazuo

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY 65 ( 12 ) 1725 - 1728 2012.12

Research paper (scientific journal), ISSN 1748-6815

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Transverse rectus abdominis myocutaneous flap combined with vascularized costal cartilages in cranial reconstruction

Sakamoto Yoshiaki, Kishi Kazuo, Ogata Hisao, Nakajima Hideo

Journal of Craniofacial Surgery 23 ( 6 ) 1687 - 1689 2012.11

ISSN 1049-2275

Exposing the alloplastic materials after skull reconstruction is very difficult because of the risk of infection and the choice of reconstruction procedures. Conventional procedures were divided into two-step or multi-step surgery. To perform one-stage surgery, a transverse rectus abdominis myocutaneous flap combined with vascularized costal cartilages has been used for head reconstruction after exposing the alloplastic materials in two patients. This is the first report using the flap for skull reconstruction. In this article, we describe the usefulness and the disadvantages of the transverse rectus abdominis myocutaneous flap combined with vascularized costal cartilages.

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A convenient retainer for artificial eye sockets

Shimizu Yusuke, Nagasao Tomohisa, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 11 ) 1598 - 1599 2012.11

ISSN 1748-6815

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New technique for releasing tension to prevent widening of an abdominal scar

Kishi Kazuo, Imanishi Nobuaki, Kobayashi Naoshi, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic Surgery and Hand Surgery 46 ( 5 ) 364 - 366 2012.10

ISSN 2000-656X

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Clinical application of stem cells/progenitor cells in plastic surgery

Kishi Kazuo

Japanese Journal of Plastic Surgery 55 ( 10 ) 1055 - 1059 2012.10

ISSN 0021-5228

Regenerative medicine has been progressing based on stem cell, scaffold, and developmental researches. Among them, stem cells or progenitor cells play key roles in regenerative medicine. In plastic surgery, many types of stem or progenitor cells are in clinical use. Keratinocyte progenitor cells have been clinically used as cultured epidermal cells. Bone marrow mesenchymal stem cells and adipose derived stem cells are beginning to be applied in various lesions. Although they have the potential to give benefits to the applied lesion, their effects may come not from the regenerative ability of stem cells but from cytokine effects. In order to progress regenerative medicine in plastic surgery, we have to investigate the mechanism of the benefits of the stem cells after application to the lesion.

Maxillomandibular tandem osteotomy with distraction osteogenesis for hemifacial microsomia

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

Journal of Craniofacial Surgery 23 ( 5 ) 1362 - 1363 2012.09

ISSN 1049-2275

Currently, simultaneous maxillomandibular distraction osteogenesis is a standard procedure for the correction of hemifacial microsomia. Many variations of the procedure have been reported. However, a common problem has been the extended duration of the procedure. In particular, the lengthy intermaxillary fixation period includes a prolonged distraction series that requires the restriction of oral food intake and creates significant stress for the patient, which has a profound effect on patient satisfaction. To avoid this stress, we have developed tandem osteotomy with distraction osteogenesis, termed the TODO procedure. The TODO procedure not only shortens the intermaxillary fixation period and the duration of therapy but also creates the ideal skeletal proportions, with horizontalization of the occlusal plane. The TODO procedure has the added benefit of producing a marked aesthetic improvement. The patient was extremely satisfied by the result and endured minimal stress.

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Involvement of the sphenosquamosal suture for unilateral coronal synostosis

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

Journal of Craniofacial Surgery 23 ( 5 ) 1267 - 1269 2012.09

ISSN 1049-2275

The etiology of the clinical entity commonly known as unilateral coronal synostosis is often described as the unilateral fusion of the coronal ring. However, recent theories have poorly explained the basis of the deformities associated with unilateral coronal synostosis. We retrospectively analyzed computed tomographic data sets from 18 patients who presented with unilateral coronal synostosis and arrived at our hospital between 1985 and 2010. Using three-dimensional reconstructions of the computed tomographic images, analyses of the cranial base and measurements of each cranial bone were performed. As a result, the ipsilateral and contralateral basion-clinoid-pterion angles did not differ significantly (P = 0.49) and were almost identical in each case. However, the ipsilateral basion-partis-petrosae anglewas wider than the corresponding contralateral angle (P < 0.001). In addition, the ipsilateral nasion-clinoid-pterion angle and the sphenoid, zygomatic, and temporal bones on the ipsilateral side were significantly shorter than those on the contralateral side (P < 0.001). Based on a shortening ratio, the sphenoid bone was smaller (42.0% T 10.9%) than the temporal (68.9% ± 7.58%) and zygomatic bones (71.1% ± 8.38%). This difference was significant (P < 0.001). In conclusion, restricted growth potential of the central portion of the ipsilateral sphenoid bone was identified. We propose that the coronal ring, which includes the frontoparietal and frontosphenoidal sutures, and the sphenosquamosal suture are involved in unilateral coronal synostosis. Using our findings and the theory of Delashaw et al, the deformity observed in unilateral coronal synostosis can be explained more adequately and/or completely.

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The dendritic bonding technique

Sakamoto Yoshiaki, Kishi Kazuo

Journal of Surgical Technique and Case Report 4 ( 2 ) 92 - 93 2012.07

ISSN 2006-8808

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Use of the LigaSure™ vessel sealing system in neurofibroma excision to control postoperative bleeding

Konno Eri, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 6 ) 814 - 817 2012.06

ISSN 1748-6815

Background: The resection of neurofibromas in Von Recklinghausen's disease (NF-1) is frequently complicated by potentially life-threatening intraoperative and postoperative hemorrhage, due to the high tumor vascularity and tissue friability. Methods: This report describes a novel technique for the resection of neurofibromas using the LigaSure™ (Valleylab, Tyco International Healthcare, Boulder, CO) vessel sealing system. We compared five cases of NF-1 tumor removal which used this vessel sealing system, with six cases that did not, and recorded the intraoperative and postoperative blood loss, length of hospitalization, and postoperative complications. Results: In all cases employing the LigaSure™, the perioperative blood loss was less than 600 ml (30 ∼ 570 ml), and no patient developed a postoperative hematoma or other bleeding complications. In contrast, the cases not using the LigaSure™ had greater blood loss as well as a higher rate of postoperative hematomas. Conclusions: The LigaSure™ provides excellent hemostasis with few complications when used for neurofibroma removal.

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Pivoting distraction osteogenesis in hemifacial microsomia

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

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 6 ) 2012.06

ISSN 1748-6815

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The boomerang osteotomy - A new method of reduction malarplasty

Nakanishi Yuji, Nagasao Tomohisa, Shimizu Yusuke, Miyamoto Junpei, Kishi Kazuo, Fukuta Keizo

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 5 ) 2012.05

ISSN 1748-6815

Background: To achieve optimal outcomes in reduction malarplasty, it is important to preserve the natural curvature of the cheek while reducing the zygoma prominence and the width of the midface. The present article introduces an effective technique that aims to achieve these purposes. Methods: Through an intraoral approach, boomerang-shaped bone incision lines are marked on the anterior aspect of the zygomatico-maxillary junction. The lines are placed medial to the most prominent part of the zygoma. The zygomatic arch is divided at its posterior part through a small incision made in the pre-auricular region. By performing these manoeuvres, a unit of bone-composed of a part of the zygoma body and zygomatic arch - is mobilised. The mobilised bone is shifted medially, reducing the width of the midface and making the zygoma region less prominent. After performing reduction malarplasty for 89 patients (10 males and 79 females) using this technique, clinical outcomes were evaluated. Results: Outcomes of the treatment was optimal, with over 80% of the patients evaluating the results as excellent in terms of effectiveness in malar prominence, facial width and symmetry. Conclusion: Because the continuity of the main part of the zygoma body and zygomatic arch is preserved in our technique, medial transfer of the zygoma is enabled while preserving the natural curvature of the malar region and the superior-inferior position of the zygomatic arch. Because of these advantages, we recommend our technique as an effective technique of reduction malarplasty.

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A case of congenital unilateral amastia

Hatano Asako, Nagasao Tomohisa, Sotome Keiichi, Shimizu Yusuke, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 5 ) 671 - 675 2012.05

ISSN 1748-6815

Numerous reports have been published regarding the reconstruction of the breast, but the majority of these reports focus on breast reconstruction for defects caused by the removal of breast cancers. The authors treated a rare case of unilateral amastia where a 54-year-old female had a complete absence of the breast on one side, though the breast on the other side was intact. The defect was reconstructed successfully with a transverse rectus abdominis myocutaneous flap (TRAM) flap. The present study introduces this rare case with reference to past reports of amastia.

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Recruited minced skin grafting for improving the skin appearance of the donor site of a split-thickness skin graft

Simizu Ruka, Kishi Kazuo, Okabe Keisuke, Uchikawa Yumiko, Sakamoto Yoshiaki, Hattori Noriko, Imanishi Nobuaki

Dermatologic Surgery 38 ( 4 ) 654 - 660 2012.04

ISSN 1076-0512

OBJECTIVE: To improve skin appearance at the donor site of a split-thickness skin graft, part of the harvested skin was minced and grafted back onto the site in a process we named "recruited minced skin grafting." MATERIALS AND METHODS: Thirteen Japanese patients who needed split-thickness skin grafts were treated with recruited minced skin grafting. Five patients were used as controls, in whom donor sites were treated with the traditional method. Part of the split-thickness skin was minced using two surgical blades (number 24) to an approximate particle size of less than 0.5 mm. Minced skin was spread and transplanted onto the donor site and covered with polyurethane foam. Twelve months after the operation, donor sites were scored for hypopigmentation, hyperpigmentation, redness, and disruption of skin texture. Gross appearance was evaluated according to total score. RESULTS: Donor sites treated with recruited minced skin grafts had significantly better appearance than those of controls. Donor sites that had more than 5% of the total area treated tended to have better results. CONCLUSION: Recruited minced skin grafting is a good method of improving the appearance of the donor site.

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Recruited Minced Skin Grafting for Improving the Skin Appearance of the Donor Site of a Split-Thickness Skin Graft

Simizu, Ruka, Kishi, Kazuo, Okabe, Keisuke, Uchikawa, Yumiko, Sakamoto, Yoshiaki, Hattori, Noriko, Imanishi, Nobuaki

DERMATOLOGIC SURGERY 38 ( 4 ) 654 - 660 2012.04

Research paper (scientific journal), ISSN 1076-0512

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New classification scheme of proboscis lateralis based on a review of 50 cases

Sakamoto Yoshiaki, Miyamoto Junpei, Nakajima Hideo, Kishi Kazuo

Cleft Palate-Craniofacial Journal 49 ( 2 ) 201 - 207 2012.03

ISSN 1055-6656

Background: Among congenital nasal deformities, proboscis lateralis is one of the rarest. Boo-Chai classified proboscis lateralis into four groups. Recently, we encountered a new case of proboscis lateralis with median cleft lip. We noticed that this classification had not been considered according to convalescence and embryologics, and further refinement seemed to be needed. Methods: We reviewed all cases of proboscis lateralis reported in English through 2009 and classified them by intercanthal distance. Results: A total of 34 studies involving 50 cases were reviewed. Six cases were identified as having normal intercanthal distance. Three of them presented nose abnormalities and fit Boo-Chai group II category. The other three were consistent with group I. Hypertelorism was observed in 27 cases and was further divided into two groups based on the occurrence of a frontal encephalocele. Seventeen cases without a frontal encephalocele were compatible with Boo-Chai groups III and IV. The other 10 cases associated with a visible encephalocele had encephalopathy; most died at an early age, and long-term survival cases suffered developmental delay and mental retardation. Seventeen cases were defined as hypotelorism, and all cases also presented as holoprosencephaly. Conclusions: The redefined classification contains two new groups: group V as hypertelorism with encephalocele and group VI as hypotelorism. A new classification scheme is proposed as not only convenient for clinical application but also embryologically accurate.

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New Classification Scheme of Proboscis Lateralis Based on a Review of 50 Cases

Sakamoto, Yoshiaki, Miyamoto, Junpei, Nakajima, Hideo, Kishi, Kazuo

CLEFT PALATE-CRANIOFACIAL JOURNAL 49 ( 2 ) 201 - 207 2012.03

Research paper (scientific journal), ISSN 1545-1569

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The formation of an angiogenic astrocyte template is regulated by the neuroretina in a HIF-1-dependent manner

Nakamura-Ishizu, Ayako, Kurihara, Toshihide, Okuno, Yuji, Ozawa, Yoko, Kishi, Kazuo, Goda, Nobuhito, Tsubota, Kazuo, Okano, Hideyuki, Suda, Toshio, Kubota, Yoshiaki

DEVELOPMENTAL BIOLOGY 363 ( 1 ) 106 - 114 2012.03

Research paper (scientific journal), ISSN 0012-1606

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Alternative 1-step nasal reconstruction technique

Kishi Kazuo, Imanishi Nobuaki, Shimizu Yusuke, Shimizu Ruka, Okabe Keisuke, Nakajima Hideo

Archives of Facial Plastic Surgery 14 ( 2 ) 116 - 121 2012.03

ISSN 1521-2491

Objective: To describe a 1-step nasal reconstruction technique for use in lieu of a paramedian forehead flap that is usually raised at the location of the supratrochlear artery. Methods: Using angiography in 10 fresh cadavers, we confirmed the arterial anatomy of the nasal and forehead regions to refine the paramedian forehead flap. Based on the anatomical data, we performed nasal reconstruction in 6 patients who had a full-thickness defect of the nasal ala or who needed alar base reconstruction with an island paramedian forehead flap based on the angular artery. Results: From the anatomical study, we confirmed a rich network among the supratrochlear, dorsonasal, and angular arteries around the medial canthus. In the clinical cases, the subcutaneous pedicle was tunneled beneath the skin, without conspicuous bulkiness. For all patients, the operation was completed in 1 stage, and the flaps healed without evidence of necrosis. Conclusions: By moving the pedicle downward, a fullthickness nasal defect can be reconstructed in 1 stage that includes the alar lining or alar base with the paramedian forehead flap. This avoids restriction of the rotation arc, particularly when the alar lining or alar base is also needed for reconstruction.

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Extended latissimus dorsi rotational V-Y advancement flap for the reconstruction of axillary defects after excision of hidradenitis suppurativa

Uchikawa Yumiko, Nakajima Hideo, Suda Shunichi, Hikosaka Makoto, Ochiai Hiroko, Kishi Kazuo

Plastic and Reconstructive Surgery 129 ( 3 ) 2012.03

ISSN 0032-1052

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Extension of the jejunum in the reconstruction of cervical oesophagus with free jejunum transfer using the thoracoacrominal vessels as recipients

Nagasao Tomohisa, Shimizu Yusuke, Kasai Shogo, Hatano Asako, Ding Weijin, Jiang Hua, Kishi Kazuo, Imanishi Nobuaki

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 2 ) 156 - 162 2012.02

ISSN 1748-6815

Backgrounds: The degree to which the jejunum can reach upward is a significant consideration in cervical oesophagus reconstruction with vascularised free jejunum transfer using the thoracoacrominal vessels as recipient vessels. The present study aims to elucidate this issue. Materials and methods: In 30 fresh cadavers, the thoracoacrominal vessels were dissected, and the jejunums were harvested, carrying the second branches of the superior mesenteric arteries and veins as their pedicles. After the mesenteric vessels were anastomosed to the thoracoacrominal vessels, the jejunums were advanced to their maximum upward degree, and the positions of the oral ends were evaluated referring to the hyoid bone. The evaluation was performed under three conditions. In the first condition, the jejunums were simply advanced. In the second condition, tension of the mesenteriums was reduced by incising their serosa. In the third condition, mesenterial incision was also performed, and the anastomosed pedicles were placed under the clavicles. Results: The jejunums can reach superior to the hyoid bone by 2.1 ± 1.5 SD cm for males and by 1.9 ± 1.5 SD for females. By incising the mesenteric serosa, these distances can be extended by about 2 cm for males and 1 cm for females. Further extension of 2 cm can be obtained for both sexes by placing the pedicle under the clavicle. Conclusion: With patients whose neck regions lack vessels available for vascular anastomosis, the thoracoacrominal vessels are used in free jejunum transfer for cervical oesophagus reconstruction. The findings of the present study are useful in planning this type of reconstruction.

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Anthropometric evaluation of bilateral cleft lip nose with cone beam computed tomography in early childhood

Miyamoto Junpei, Miyamoto Shimpei, Nagasao Tomohisa, Nakajima Tatsuo, Kishi Kazuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 2 ) 169 - 174 2012.02

ISSN 1748-6815

Background: Nasal tip features of cleft lip nose cannot be defined well using conventional measurement methods. Therefore, we developed a new method in which vertical nasal tip (the pronasale) position is evaluated based on the Frankfurt-Horizontal plane. This measurement was applied to bilateral cleft lip patients in early childhood. Methods: Cone beam computed tomography (CT) records of bilateral cleft lip patients after primary rhinoplasty aged from 5 to 8 years (n = 13) were investigated retrospectively. As age-matched controls, data from a normal group (n = 17) and complete unilateral cleft lip group after primary rhinoplasty (n = 19) were included. In each group, nasolabial angle (β), nasal tip angle (α), nasal width (al-al), columellar length (sn-c′), nasal tip protrusion (sn-prn), and vertical nasal tip position (sn′-prn′/sn′-n′) were investigated. Results: With the exception of vertical nasal tip position and nasal width, the measurement data of the bilateral cleft lip patients were acceptable. In the bilateral cleft lip group, however, vertical nasal tip position was significantly higher and nasal width was significantly larger than those in the normal and unilateral groups (P < 0.0001 and P = 0.0298; P = 0.0001 and P = 0.0002, respectively). Conclusions: In cleft lip nose, the lower lateral cartilage that normally composes the nasal tip domes is splayed out, causing cephalic positioning of the pronasale. Nasal tip collapse was more severe in bilateral cleft lip than in the unilateral group. These results were compatible with the fact that many bilateral cleft lip patients require augmentation rhinoplasty after adolescence even after primary rhinoplasty.

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New technique for medial canthoplasty that incorporates modified V-W epicanthoplasty

Sakamoto Yoshiaki, Nakajima Hideo, Tamada Ikkei, Kishi Kazuo

Archives of Facial Plastic Surgery 14 ( 1 ) 59 - 61 2012.01

ISSN 1521-2491

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EFFECTIVENESS OF SUBCUTANEOUS TISSUE INJECTION OF LIDOCAINE BEFORE INTRALESIONAL INJECTION OF TRIAMCINOLONE ACETONIDE FOR KELOID TREATMENT

Sakai, Shigeki, Hattori, Noriko, Kishi, Kazuo

WOUND REPAIR AND REGENERATION 20 ( 1 ) A11 - A11 2012.01

Research paper (scientific journal), ISSN 1067-1927

New Technique for Medial Canthoplasty That Incorporates Modified V-W Epicanthoplasty

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

ARCHIVES OF FACIAL PLASTIC SURGERY 14 ( 1 ) 59 - 61 2012.01

Research paper (scientific journal), ISSN 1521-2491

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An internal distraction device for le Fort distraction osteogenesis

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

Journal of Plastic, Reconstructive and Aesthetic Surgery 65 ( 1 ) 61 - 67 2012.01

ISSN 1748-6815

Le Fort distraction osteogenesis is sometimes applied to improve the facial appearance in craniofacial dysostosis or cleft lip and palate. Distraction devices are generally classified into external and internal types. The movement of external distractors can be controlled easily but their large size and the need for a facial mask cause much psychological stress to the patient. Internal distractors are smaller and better tolerated, but they are not easily controllable and removal is difficult. We designed an internal distraction device to eliminate the problems of the currently available distractors -Nakajima's angle-variable internal distraction (NAVID) system - and aimed to assess its clinical applicability. Between 2000 and 2010, we treated 16 patients with the NAVID system: Le Fort I, III, III + I and IV distractions were performed in three, five, four and four patients, respectively. Distraction was started after a 1-week latency period. Then, the exposed rod was cut, and the distractors were left in place for 3 months or more as retention devices, and thereafter removed. All patients showed satisfactory occlusion and facial aesthetics. Open bite during the consolidation period was the main complication. In conclusion, the NAVID system is safe, effective and reliable for all types of Le Fort distraction osteogenesis.

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Catheter displacement into inferior epigastric vein causing local phlebitis and cellulitis

Hattori Noriko, Hattori Hidenori, Takahashi Kazushi, Suzuki Norihiro, Kishi Kazuo

Case Reports in Medicine 2012 2012

ISSN 1687-9627

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Long-term outcome of fibrous dysplasia

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

Neurologia Medico-Chirurgica 51 ( 12 ) 857 - 860 2011.12

ISSN 0470-8105

A 10-year-old girl presented with facial asymmetry associated with bulging of the right fronto-orbital region with no symptoms. Computed tomography demonstrated enlargement of the right zygomatic, frontal, ethmoid, and sphenoid bones. Abnormal proliferation of the bone had obliterated the sphenoid, right frontal sinus, and right ethmoid sinuses. These radiological findings suggested right optic nerve compression due to fibrous dysplasia. Right optic canal decompression was performed. In preparation for recurrence, the resulting bone defect in the right orbital roof was reconstructed using the outer table of the split lesion bone. The removed frontal bone was divided into intact and lesioned parts, and the intact part was returned. The lesioned part was split and the outer table graft used to reconstruct the frontal region. A temporal musculopericranial flap was used to form a barrier between the opened ethmoid sinus and cranial cavity. A protrusion appeared on the left forehead 10 years later, and was shaved to improve the aesthetic appearance. The patient was followed up for a total of 23 years. The use of dysplastic bone involves the risk of recurrence, but the period of recurrence is delayed and the progression stops after adolescence, so the second operation involved only shaving for aesthetic appearance. This procedure is one of the treatments of choice because of easy reconstruction, easy revision, and good results.

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My technique and prevention of surgical complications; veno-accompanying- artery adipofascial (VAF) flap; it's application and avoidance of complication

Kishi Kazuo

Japanese Journal of Plastic Surgery 54 ( 12 ) 1381 - 1387 2011.12

ISSN 0021-5228

Maxillary-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia

Nakajima Hideo, Sakamoto Yoshiaki, Tamada Ikkei, Ogata Hisao, Kishi Kazuo, Sakamoto Teruo

Journal of Cranio-Maxillofacial Surgery 39 ( 8 ) 549 - 553 2011.12

ISSN 1010-5182

We treat hemifacial microsomia with a combination of surgery and orthodontic treatment during the growth period, resulting in early improvement in facial asymmetry and the induction of normal growth. We previously used gradual distraction of the mandibular ramus for Pruzansky's type II classification (Pruzansky, 1969). In type II cases, the maxilla should also be treated actively as, using this technique, improvement of the occlusal plane is difficult to achieve, resulting in a cross bite and difficulties in post-operative orthodontic treatment - especially in older patients. Morphologically, the mandibular angle region of the operative side is flat, and the angle of the mouth remains elevated. We performed mandibular-driven simultaneous maxillo-mandibular distraction while the occlusion was maintained using intermaxillary anchorage. However, mandibular-driven distraction tended to elongate the face because the mandible only elongated downwards and the mandibular ramus did not reach the glenoid. Furthermore, external distraction devices produce significant distress for patients until removal of the device and cause scars on the face. We developed a new internal distraction device with a variable angle and performed maxillary-driven simultaneous maxillo-mandibular distraction using this device. The result was morphologically satisfactory and solved the above problems. Because the patient was in the growth period, careful follow-up and induction to normal growth were important while the inferior growth of the affected side was monitored.

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An anatomical study on the position of the summit of the zygoma

Nagasao Tomohisa, Nakanishi Yuji, Shimizu Yusuke, Hatano Asako, Miyamoto Junpei, Fukuta Keizo, Kishi Kazuo

Plastic and Reconstructive Surgery 128 ( 5 ) 1127 - 1138 2011.11

ISSN 0032-1052

Background: To achieve optimal outcomes in reduction malarplasty, the area of zygoma from which volume should be reduced must be accurately identified. This anatomical study aims to evaluate the location of the zygoma region that contributes most to the protrusion of the cheek. MethodS: The morphology of the zygoma was studied on 121 Japanese adults (73 men and 48 women). The midpoint of the inferior orbital rim, zygomaticomaxillary junction, the junction between the frontal process and the zygomatic arch, and the lateral orbital rim were marked to be used as anatomical reference points. Then, a vertical plane intersecting the anterior and posterior edges of the zygoma was marked. The point of the zygoma most distant from the plane was defined as the summit of the zygoma. Three-dimensional measurement using graphic software was performed, and the positional relationships between the summit and the four reference points were evaluated. Results: In terms of horizontal position, the summit is located lateral to the lateral orbital rim and medial to the junction between the frontal process and the zygomatic arch. Regarding vertical position, the summit exists at higher positions in men than in women. Conclusions: The summit of the zygoma is located medial to the junction of the frontal process and zygomatic arch. Therefore, bone incision lines should be placed medial to the posterior edge of the frontal process in reduction malarplasty; effective correction of the protrusion cannot be achieved solely by detachment of the zygomatic arch. The summit is located higher for men than for women. Therefore, bone incision lines should be placed higher for men than for women.

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An Anatomical Study on the Position of the Summit of the Zygoma: Theoretical Bases for Reduction Malarplasty

Nagasao, Tomohisa, Nakanishi, Yuji, Shimizu, Yusuke, Hatano, Asako, Miyamoto, Junpei, Fukuta, Keizo, Kishi, Kazuo

PLASTIC AND RECONSTRUCTIVE SURGERY 128 ( 5 ) 1127 - 1138 2011.11

Research paper (scientific journal), ISSN 0032-1052

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Branchial arch defects and 19p13.12 microdeletion

Kosaki Kenjiro, Saito Hideyuki, Kosaki Rika, Torii Chiharu, Kishi Kazuo, Takahashi Takao

American Journal of Medical Genetics, Part A 155 ( 9 ) 2212 - 2214 2011.09

ISSN 1552-4825

We present a patient with preauricular tags, preauricular and branchial pits, stenosis of the external auditory canals, mild hearing loss, and mild developmental delay who had a de novo 19p13.12 submicroscopic deletion. The size of the deletion was 760-kb, extending from 15,300,338 to 16,064,271 (hg18; NCBI Build 36.1). Our finding supports the notion that 19p13.12 represents a unique microdeletion syndrome characterized by branchial arch defects and the concept of exclusion mapping indicates that the putative locus for the branchial arch development is included in the 0.8-Mb interval defined by the deletion in the presently reported patient.

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Evaluation of Three Cases Using a Novel Titanium Mesh System-Skull-Fit (R) with Orbital Wall (Skull-Fit WOW (R))-For Cranial Base Reconstructions

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

SKULL BASE-AN INTERDISCIPLINARY APPROACH 21 ( 5 ) 279 - 286 2011.09

Research paper (scientific journal), ISSN 1531-5010

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Branchial Arch Defects and 19p13.12 Microdeletion: Defining the Critical Region Into a 0.8 M Base Interval

Kosaki, Kenjiro, Saito, Hideyuki, Kosaki, Rika, Torii, Chiharu, Kishi, Kazuo, Takahashi, Takao

AMERICAN JOURNAL OF MEDICAL GENETICS PART A 155A ( 9 ) 2212 - 2214 2011.09

Research paper (scientific journal), ISSN 1552-4825

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Sphere formation restores and confers hair-inducing capacity in cultured mesenchymal cells

Shimizu, Ruka, Okabe, Keisuke, Kubota, Yoshiaki, Nakamura-Ishizu, Ayako, Nakajima, Hideo, Kishi, Kazuo

EXPERIMENTAL DERMATOLOGY 20 ( 8 ) 679 - 681 2011.08

Research paper (scientific journal), ISSN 0906-6705

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Preoperative modeling of costal cartilage for the auricular reconstruction of microtia

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

Plastic and Reconstructive Surgery 128 ( 1 ) 2011.07

ISSN 0032-1052

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A pitfall of decompression for severe exophthalmos

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

Journal of Craniofacial Surgery 22 ( 4 ) 1348 - 1350 2011.07

ISSN 1049-2275

This report addresses a pitfall of decompression for severe exophthalmos. In mild cases, removal of the orbital floor is an effective treatment, but in severe cases, the results of this approach are sometimes unsatisfactory, and only decompression is necessary. In these cases, orbital decompression in 3 areas including the medial wall, the lateral wall, and the orbital floor is usually performed. A 5.0-mm mean reduction in exophthalmos is observed, but more reduction is difficult to achieve.We considered the possibility that removal of the posterior wall of the maxillary sinus is critically important to achieving greater recovery. It is proposed that this technique is effective in creating about 10 mm of improvement for severe exophthalmos.

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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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Anal and perianal reconstruction after extramammary Paget's disease using a posterior thigh flap with a thin square wing

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 8 ) 1353 - 1356 2010.08

ISSN 1748-6815

Extramammary Paget's disease regularly requires a wide resection of skin, often including the anal tract. When reconstructing the anal tract, simulating natural anatomy by creating the thinnest possible flap is essential to prevent incontinence. We reconstructed the anal and perianal area using a posterior thigh trilobed flap. The lobe to be transposed to the anal duct had a square design and was thinned. The other lobes were used to cover perianal defects and the flap donor site. Using this method, we reconstructed three patients who required large perianal area and anal tract resections. All flaps took well, and after the initial healing process, the patients did not develop lasting incontinence. We conclude that the posterior thigh flap with a thin square wing is useful for reconstruction of the anal tract and perianal area.

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A novel approach to thoracic wall reconstruction based on a muscle perforator

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

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 8 ) 1289 - 1293 2010.08

ISSN 1748-6815

When reconstructing the thoracic wall, non-adaptation of the suture line is a critical concern, especially when artificial implants are used. Therefore, a reliable and safe flap is required. Based on an anatomical study of cadavers, we decided to dissect the pectoralis major musculo-cutaneous flap into two parts, on the surface and beneath the muscle fascia, while preserving the muscle perforators. We designated the skin portion as the V-Y advancement flap or rotation V-Y advancement flap and the muscle flap as the transposition flap. Both flaps had different suture lines. We applied this method to two patients requiring reconstruction of anterior thoracic defects with artificial implants. One patient did not have adverse effects, and the flaps took well. The shape of the breast did not change significantly. However, the other patient was a heavy smoker. Although the V-Y advancement flap took well, the cutaneous triangular tip made at the time of tumour resection became necrotic. However, the underlying pectoralis major muscles successfully covered the implants and did not show any signs of infection. In conclusion, reconstruction of the anterior thoracic wall to change the suture line with a V-Y advancement flap, based on the muscle perforator and pectoralis major muscle flap, is a useful and reliable method, especially when an artificial implant is used.

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Treatment of giant congenital melanocytic nevi with enzymatically separated epidermal sheet grafting

Kishi Kazuo, Ninomiya Ruka, Okabe Keisuke, Konno Eri, Katsube Ken ichi, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 6 ) 914 - 920 2010.06

ISSN 1748-6815

Treatment of giant congenital melanocytic nevi (GCMNs) must be considered from both a cosmetic and a medical aspect of reducing the risk of a growing malignancy. We treated five patients who had a GCMN on the trunk with an enzymatically separated epidermal sheet taken from their excised GCMN skin. All patients underwent enzymatically separated epidermal sheet grafting at the age of 2 months. With the patient under general anaesthesia, we removed the affected area with an electric dermatome until the brown colour had almost completely disappeared. The removed skin was immersed in dispase I solution (1000 U ml^-1) dissolved in Ringer's solution at 37 °C for 75-105 min until the epidermal sheet separated from the dermis without tension. Three back lesions and two abdominal lesions were treated. In all cases, the enzymatically separated epidermis grafted well, without infection. The amount of discharge that accumulated from immediately after the operation until the first dressing change (performed at 3 days after the operation) was reduced compared with that from curettage. The skin colour was light brown at first and gradually became lighter within a few months. The grafted areas were soft and did not show significant re-pigmentation. In most cases, hard hair did not grow on the treated area. Histological samples taken 1 year after the operation showed that the dermal layer was reconstituted without pigmented nevus cells. Enzymatically separated epidermal grafting is a useful method for the treatment of GCMN, is easy to perform and leaves cosmetically satisfactory results.

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Complicated Surgical Resection of Malignant Tumors in the Upper Cervical Spine After Failed Ion-Beam Radiation Therapy

Matsumoto, Morio, Watanabe, Kota, Ishii, Ken, Tsuji, Takashi, Takaishi, Hironari, Nakamura, Masaya, Toyama, Yoshiaki, Chiba, Kazuhiro, Imanishi, Yorihisa, Kishi, Kazuo, Kawana, Hiromasa

SPINE 35 ( 11 ) E505 - E509 2010.05

Research paper (scientific journal), ISSN 0362-2436

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The unilocular fat-cell graft

Ohara H., Kishi K., Nakajima T.

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 3 ) 488 - 492 2010.03

ISSN 1748-6815

Autologous fat grafting has become a common procedure for augmenting soft tissue. However, there are still some problems with resorption and cyst formation after injection, which mainly arise from insufficient nourishment of the transplanted fat tissues. In this study, using a mouse model, we enzymatically digested fat tissues into unilocular fat cells, and then transplanted the unilocular fat cells by sub-dermal injection to allow the transplanted cells to easily spread within the injected area. Fat tissue was harvested from a green fluorescent protein transgenic mouse (C57BL/6), and the optimal digestion time was determined to be 30 min. The fat cells were then injected into the sub-dermal layer of the head skin of a C57BL/6 mouse. As a control, minced fat without digestion was also injected. The animals were sacrificed immediately after injection and on days 1, 2 and 3, as well as at weeks 1, 2 and 4 after injection, and the recipient skins were collected for microscopic observation. The unilocular fat cells were observed to spread in a solitary manner among the recipient tissues, and no necrotic areas or cysts were observed. The minced-fat-graft control showed central necrosis in the transplanted region. In addition, the minced fat tissue needed to be injected with an 18-gauge syringe, but the unilocular fat cells could be injected with a 26-gauge syringe. Thus, the unilocular fat-cell graft was determined to be a superior alternative to conventional fat grafts.

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Management of craniofacial hyperostosis in proteus syndrome

Sakamoto Yoshiaki, Nakajima Hideo, Kishi Kazuo, Shimizu Ruka, Nakajima Tatsuo

Journal of Craniofacial Surgery 21 ( 2 ) 414 - 418 2010.03

ISSN 1049-2275

Proteus syndrome is a rare congenital hamartomatous condition that is characterized by a wide range of malformations, occasionally involving the head and the face. Skin and skeletal developmental malformations are common and may be manifested in significant physical anomalies. In this report, we describe the cases of 2 patients affected by this condition. For one patient, a recurrence occurred 4 years after the elimination of cranial hyperostosis. In the second patient, although we observed macrosomia and peculiar countenance in the context of craniofacial hyperostosis, the patient did not visit a clinic for approximately 50 years before seeking treatment. The management of the craniofacial involvement is described, and a literature overview is presented.

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Reconstruction of vulva using pudendal thigh gluteal fold bilobed flap

Ninomiya Ruka, Kishi Kazuo, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 63 ( 2 ) 2010.02

ISSN 1748-6815

In reconstructing a large defect of the vulva, we combined the gluteal fold and the pudendal thigh flaps and made a bilobed flap. Using this gluteal fold pudendal thigh bilobed flap, we reconstructed a vagina with sufficient depth and width. The surrounding skin defect was simultaneously reconstructed. Sensation was intact in all areas of the reconstruction. In addition, the sutured lines of both donor sites are hidden in the gluteal and inguinal folds. Thus, the gluteal fold pudendal thigh bilobed flap seems to be ideal for reconstructing large vulvar defects.

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Simple two-stage reconstructive technique for the treatment of infected dura mater

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Plastic and Reconstructive Surgery 125 ( 1 ) 2010.01

ISSN 0032-1052

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Immunolocalization of Epstein-Barr virus-related antigens in a case of sweat gland adenocarcinoma

Tanese K., Ishiko A., Hayase K., Yoshida T., Kishi K., Yamada T.

British Journal of Dermatology 161 ( 3 ) 694 - 697 2009.09

ISSN 0007-0963

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Histological responses of cutaneous vascular lesions following photodynamic therapy with Talaporfin sodium

Ohshiro Takafumi, Nakajima Tatsuo, Ogata Hisao, Kishi Kazuo

Keio Journal of Medicine 58 ( 3 ) 176 - 184 2009.09

ISSN 0022-9717

Background: Mono-L-aspartyl chlorin e6 (Talaporfin sodium) is a novel photosensitizer, and is currently being used in photodynamic therapy for various malignant tumors in combination with irradiation with a 664 nm laser. An interesting characteristic of Talaporfin sodium is that the skin photosensitivity after injection of this agent disappears faster than any other existing photosensitizers. This study examined the vascular events that occurred postirradiation in the chicken comb as a capillary malformation model after photosensitization with Talaporfin sodium. Materials and Methods: A single intravenous bolus injections of Talaporfin sodium was administered to the chickens, and a 1 cm diameter area of the comb of each animal was irradiated with a 664 nm visible red laser. The gross changes in the chicken combs were recorded for 7-14 days after photodynamic therapy. For the histological examination, HE, PTAH and Azan stained sections were analyzed. Results: All treated chicken combs had blanched after photodynamic therapy. Microscopy demonstrated an absence of erythrocytes and the vessel lumina were obliterated, leaving the normal overlying epidermis completely intact. Concomitantly with selective destruction of the capillaries in the target area, moderate invasion of inflammatory cells and a slight increase in the stroma were observed. Conclusions: In the chicken comb model, photodynamic therapy with Talaporfin sodium effectively achieved selective destruction of the microvasculature while leaving the epidermis intact. Our results strongly suggest that photodynamic therapy with Talaporfin sodium could be a feasible method to treat dermal hypervascular lesions.

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MMP-13 plays a role in keratinocyte migration, angiogenesis, and contraction in mouse skin wound healing

Hattori Noriko, Mochizuki Satsuki, Kishi Kazuo, Nakajima Tatsuo, Takaishi Hironari, D'Armiento Jeanine, Okada Yasunori

American Journal of Pathology 175 ( 2 ) 533 - 546 2009.08

ISSN 0002-9440

Matrix metalloproteinases (MMPs) have been implicated in wound healing. To analyze the roles of MMP-9 and MMP-13 in wound healing, we generated full-thickness cutaneous wounds in MMP-9 knockout (KO), MMP-13 KO, MMP-9/13 double KO, and wildtype mice. Macroscopic wound closure was delayed in all of the KO mice, as compared with wild-type mice. The rate of re-epithelialization was significantly delayed in MMP-9 KO and MMP-13 KO mice and remarkably delayed in MMP-9/13 double KO mice, as compared with wild-type mice. Both MMP-9 and MMP-13 were expressed by the leading edges of epidermal cells in wild-type mice, and the migration of keratinocytes was suppressed by treatment with an MMP inhibitor or transfection of small interfering RNAs for MMP-9 or MMP-13, as compared with controls. The vascular density in wound granulation was significantly lower in both MMP-13 KO and MMP-9/13 double KO mice than in wild-type mice. Degradation of connective tissue growth factor in wound tissue was transiently prevented in MMP-13 KO mice. Morphometric analyses demonstrated a reduction in both wound contraction and myofibroblast formation in both MMP-13 KO and MMP-9/13 double KO mice. Proliferation and transforming growth factor-β1-induced myofibroblast differentiation of dermal fibroblasts from MMP-13 KO mice were decreased, as compared with wild-type dermal fibroblasts. These data suggest that MMP-13 plays a role in keratinocyte migration, angiogenesis, and contraction in wound healing, while MMP-9 functions in keratinocyte migration.

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Angiographic study of the superior laryngeal artery

Imanishi Nobuaki, Kondoh Tetsuo, Kishi Kazuo, Aiso Sadakazu

Okajimas Folia Anatomica Japonica 86 ( 2 ) 61 - 65 2009.08

ISSN 0030-154X

The study goals were to demonstrate the superior laryngeal artery in detail with angiograms and to understand its vasculature three-dimensionally. Three fresh cadavers were totally injected with lead oxide-gelatin mixture. The larynx with the surrounding tissue was resected and radiographed stereoscopically with soft X ray system. We get informed consent from a person in question and the bereaved family. The superior laryngeal artery was divided into the ascending and descending branches. The ascending branch supplied the epiglottis chiefly from the ventral surface, and anastomosed with branches of the lingual artery. The descending branch supplied the vestibular and vocal folds, muscles of the larynx and mucosa over the muscles, and anastomosed with distal branches of the superior thyroid artery. Stereographic angiograms and macroscopic observation enabled us to understand vasculature of the superior laryngeal artery.

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Extended split superior gluteus maximus musclocutaneous flap and reconstruction after resection of perianal and lower gluteal hidradenitis suppurativa

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 62 ( 8 ) 1081 - 1086 2009.08

ISSN 1748-6815

Various modifications of the gluteus maximus musculocutaneous flap have been reported. Among them, the split gluteus maximus musculocutaneous flap is easy to prepare and does not leave ambulatory insuffiency. However, the safety of extending the skin portion beyond the margin of the muscle has not yet been clarified. Angiography was performed systemically on 11 fresh cadavers, and the distance the margin of the gluteus maximus muscle could be extended was observed. Based on these anatomical data, reconstruction after total skin resection of perianal and lower gluteal hidradenitis suppurativa was performed with an extended split superior gluteal maximus musclocutaneous flap. Surgery was performed on three sides of two patients. From the anatomical results, we found that it is possible to extend the flap beyond the iliac crest several centimetres superiorly, and to the gluteal fold inferiorly, and several centimetres laterally. We designed the flap such that the extended area is situated in these areas. All flaps took well and did not show any congestion or necrosis. There were no recurrences at least 1 year after surgery. When reconstructing the lower part of the buttock, an extended split superior gluteus maximus musclocutaneous flap is easy to raise and leaves aesthetically satisfactory results. Thus it may be the first choice for reconstruction of the lower buttock.

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Reconstruction of skin defects after resection of severe gluteal hidradenitis suppurativa with fasciocutaneous flaps

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki

Journal of Plastic, Reconstructive and Aesthetic Surgery 62 ( 6 ) 800 - 805 2009.06

ISSN 1748-6815

Background: Although skin grafting after resection of the hidradenitis suppurativa is frequently used, the contour after skin grafting is unsatisfactory. We studied four patients who suffered from severe gluteal hidradenitis suppurativa and needed total skin resection of the affected lesion. Methods: Reconstruction after total skin resection was performed with fasciocutaneous (FC) flaps of three different designs based on an arterial anatomical study: an island V-Y advancement flap based on the descending branch of the inferior gluteal artery; a rotation V-Y advancement flap based on the first perforator of the deep femoral artery and the descending branch of the inferior gluteal artery; and, a bilobed flap at each lobe containing either the descending branch or medial branch of the inferior gluteal artery. The flap designs were decided from the size and the location of the skin defect. Results: The contours after reconstruction were satisfactory and did not experience any recurrence of hidradenitis suppurativa for at least 1 year after operation. Conclusion: We showed three different designs of FC flaps to cover the gluteal skin defects based on the anatomical study. FC flaps may be chosen for reconstruction after resection of perianal hidradenitis suppurativa.

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M-CSF inhibition selectively targets pathological angiogenesis and lymphangiogenesis

Kubota, Yoshiaki, Takubo, Keiyo, Shimizu, Takatsune, Ohno, Hiroaki, Kishi, Kazuo, Shibuya, Masabumi, Saya, Hideyuki, Suda, Toshio

JOURNAL OF EXPERIMENTAL MEDICINE 206 ( 5 ) 1089 - 1102 2009.05

Research paper (scientific journal), ISSN 0022-1007

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Head and neck reconstruction using a combined sternomastoid musculocutaneous external jugular veno-accompanying-artery adipofascial flap

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Journal of Plastic, Reconstructive and Aesthetic Surgery 62 ( 4 ) 510 - 513 2009.04

ISSN 1748-6815

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Reconstruction modality based on the spare part concept for massive soft tissue defects following oncological hemipelvectomy

Morii, Takeshi, Susa, Michiro, Nakayama, Robert, Kishi, Kazuo, Morioka, Hideo, Yabe, Hiroo

JOURNAL OF ORTHOPAEDIC SCIENCE 14 ( 2 ) 192 - 197 2009.03

Research paper (scientific journal), ISSN 0949-2658

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Early serial Q-switched ruby laser therapy for medium-sized to giant congenital melanocytic naevi

Kishi K., Okabe K., Ninomiya R., Konno E., Hattori N., Katsube K., Imanish N., Nakajima H., Nakajima T.

British Journal of Dermatology 161 ( 2 ) 345 - 352 2009

ISSN 0007-0963

Background Medium-sized to giant congenital melanocytic naevi (CMN) are difficult to treat, especially if the lesions appear on the face or extremities where treated areas are visible and cosmesis is important. Objectives In infants, nests of pigmented naevus reside more superficially and the skin is more transparent than in adults, so we treated medium-sized to giant CMN with early serial Q-switched ruby laser therapy from infancy. Patients and methods We treated nine patients with medium-sized to giant CMN on the face or upper limbs from 1 month of age with early serial Q-switched ruby laser therapy. The laser power was initially 5 J cm) ² and increased in 0 5 J cm) ² steps to a maximum of 10 J cm) ². There were three treatment sites on the forehead, one on the temple, one on the cheek and four on the upper arm. Results It took 8-15 treatments for the CMN to become a colour similar to the surrounding skin. The mean number of treatments was 9 6. The colour was reduced to 0-20% of the colour of the baseline lesion in all nine patients. Partial slight repigmentation occurred in eight of these patients. These naevi were treated with an additional one or two Q-switched ruby laser irradiations and successfully lightened for at least 1 year. In the remaining patient, pigmentation returned to a level similar to the original lesion within 1 month of the last treatment. Therefore, the lesion was excised for cosmetic reasons. After the treatment series, the skin texture was fine and no patients had hypertrophic scarring. Conclusions Although treatment of one patient with the Q-switched ruby laser therapy failed, the remaining patients responded well and had good to excellent skin texture without hypertrophic scarring. Early serial Q-switched ruby laser treatment, starting from infancy, is a promising treatment method for this condition.

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Rat dorsal paired island skin flaps

Ohara Hirotoshi, Kishi Kazuo, Nakajima Tatsuo

Keio Journal of Medicine 57 ( 4 ) 211 - 216 2008.12

ISSN 0022-9717

Rectangular flaps on the rat or mouse dorsum are frequently used for flap survival elongation research. However, since rectangular flaps are purely random, the survival rate varies among individuals. A reliable animal flap model with low individual variation is desirable for flap survival research, especially in the angiogenic field. We investigated the survival rate of paired flaps in the rat dorsum containing 3 vascular territories in each flap, and determined their usefulness for flap elongation research. Two symmetrical adjoining rectangular flaps (11×3 cm each) were drawn on the rat dorsum. Two days after material injection, flaps were elevated with only the deep circumflex iliac vessels as the vascular pedicle. Flaps were immediately sutured back and the flap survival area was measured 7 days after the operation. The control group (n = 9) had saline solution injected in both flaps. The bone marrow group (n = 8) had bone marrow injected in the right flap, and saline solution injected in the left flap. In the control group, the survival rate of the paired flaps was not statistically different (right flap, 89.0±5.6%; left flap, 89.3±4.5%). In the bone marrow group, the survival rate between the bone marrow injected flap (89.9±3.7%), and the saline flap (84.8±4.3%) was statistically different. The rat dorsal paired island skin flap model shows low difference in flap survival rate and uses an internal control. This is a suitable model for flap survival elongation research.

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E-cadherin expression in the subepithelial nevus cells of the giant congenital nevocellular nevi (GCNN) correlates with their migration ability in vitro

Matsuda N., Katsube K., Mikami S., Katsuki Y., Iseki H., Mukai M., Yamaguchi A., Takano Y., Nakajima T., Nakajima H., Kishi K.

Journal of Dermatological Science 52 ( 1 ) 21 - 30 2008.10

ISSN 0923-1811

Background: Giant congenital nevocellular nevi (GCNN) are histologically characterized by the broad distribution of nevus cells in the epidermis and dermis. Objective: To characterize E-cadherin in GCNN and define its role in nevic cell migrations. Methods: Twenty-four cases were immunohistochemically examined and in five cases cells were isolated for primary culture for migration assays. Results: The nevus cells in the superficial region showed the immunoreactivity of E-cadherin in a membranous pattern, but those in the deep part of dermis had little immunoreactivity. Ultra-structural analysis of the superficial nevus cells revealed that E-cadherin immunodeposits in the fibrillar processes around the cell body in a spotted pattern. This distribution pattern is quite different from that in the adherens junction of skin squamous epithelial cells. Boyden chamber experiments were performed using primary cultures of intradermal nevus cells. EDTA pretreatment reduced cell migration to the E-cadherin positive side when the E-cadherin positive population was relatively large in the primary cultures. Conclusions: These results indicate that E-cadherin in the nevus cells may affect nevus cell motility rather than intercellular attachment.

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Leukemia inhibitory factor regulates microvessel density by modulating oxygen-3 dependent VEGF expression in mice

Kubota Yoshiaki, Hirashima Masanori, Kishi Kazuo, Stewart Colin L., Suda Toshio

Journal of Clinical Investigation 118 ( 7 ) 2393 - 2403 2008.07

ISSN 0021-9738

To meet tissue requirements for oxygen, capillaries must be properly distributed without excess or shortage. In this process, tissue oxygen concentration is well known to determine capillary density via the hypoxia-induced cascade, in which HIFs and VEGF play key roles. However, some additional mechanisms modulating this cascade are suggested to be involved in precise capillary network formation. Here, we showed that leukemia inhibitory factor (LIF) was predominantly expressed in developing endothelium, while its receptor was expressed in surrounding cells such as retinal astrocytes. The retinas of Lif-/- mice displayed increased microvessel density accompanied by sustained tip cell activity, due to increased VEGF expression by astrocytes in the vascularized area. Lif-/- mice resisted hyperoxygen insult in the oxygen-induced retinopathy model, whereas they paradoxically had increased numbers of neovascular tufts. In an in vitro study, LIF inhibited hypoxia-induced VEGF expression and proliferation in cultured astrocytes. Lif-/- mice also exhibited similarly increased microvessel density and upregulated VEGF in various tissues outside the retina. Together, these findings suggest that tissues and advancing vasculature communicate to ensure adequate vascularization using LIF as well as oxygen, which suggests a new strategy for antiangiogenic therapy in human diseases such as diabetic retinopathy and cancer.

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Leukemia inhibitory factor regulates microvessel density by modulating oxygen-dependent VEGF expression in mice

Kubota, Yoshiaki, Hirashima, Masanori, Kishi, Kazuo, Stewart, Colin L., Suda, Toshio

JOURNAL OF CLINICAL INVESTIGATION 118 ( 7 ) 2393 - 2403 2008.07

Research paper (scientific journal), ISSN 0021-9738

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Quantitative evaluation of elderly skin based on digital image analysis

Tanaka, Hiromasa, Nakagami, Gojiro, Sanada, Hiromi, Sari, Yunita, Kobayashi, Hiroshi, Kishi, Kazuo, Konya, Chizuko, Tadaka, Etsuko

SKIN RESEARCH AND TECHNOLOGY 14 ( 2 ) 192 - 200 2008.05

Research paper (scientific journal), ISSN 0909-752X

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Three-dimensional venous anatomy of the dermis observed using stereography

Imanishi, Nobuaki, Kishi, Kazuo, Chang, Hak, Nakajima, Hideo, Aiso, Sadakazu

JOURNAL OF ANATOMY 212 ( 5 ) 669 - 673 2008.05

Research paper (scientific journal), ISSN 0021-8782

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A new dog ear correction technique

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki

Journal of Plastic, Reconstructive and Aesthetic Surgery 61 ( 4 ) 423 - 424 2008.04

ISSN 1748-6815

When moving a local flap, a dog ear sometimes appears at the base of the flap. If we try to correct the dog ear primarily, the blood supply to the flap may be disturbed. In such a case, the dog ear is prone to be corrected secondarily. In the present report we show a new technique for correcting a dog ear that enables correction to be done primarily and sufficiently. The principle of the technique is to de-epithelialise the dog ear portion and dig it in to the dermis to preserve the subdermal plexus at the base of the flap intact. This method is useful especially at the base of a transposition flap because the pedicle tends to be narrowed by the conventional correction.

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Rapid, severe repigmentation of congenital melanocytic naevi after curettage and dermabrasion

Kishi K., Matsuda N., Kubota Y., Katsube K. I., Imanishi N., Nakajima T.

British Journal of Dermatology 156 ( 6 ) 1251 - 1257 2007.06

ISSN 0007-0963

Background: Curettage and dermabrasion are effective in treating giant congenital melanocytic naevi (GCMN). We report two patients with rapid, severe postoperative repigmentation. To the best of our knowledge this is the first report on the histological features of such patients. Objectives: We wish to call attention to histological features that may cause rapid, severe repigmentation after curettage and dermabrasion of medium to giant CMN. Patients/methods: From 1998 to 2002, we treated 23 patients with medium to giant CMN with curettage and dermabrasion. Patients being treated ranged in age from 1 month to 19 years. Histological samples were taken from the centre of naevi in all patients during surgery. Histological types were 12 intradermal and 11 compound. Follow-up after curettage lasted at least 3 years. Results: Among our 23 patients only two showed repigmentation soon after surgery. Histological sections from these two patients indicated naevoid cells in the deep dermis along hair follicles or sebaceous glands. However, no such pigmented naevoid cells along hair follicles were observed in samples from patients successfully treated with curettage and dermabrasion with less repigmentation. Conclusions: Although we saw only two cases of repigmentation soon after curettage and dermabrasion, we suspect a correlation between pigmented naevoid cells around hair follicles and repigmentation. If histological sections of skin biopsies show pigmented cells along hair follicles in the deep dermis, other treatments such as total skin resection followed by skin grafting or tissue expansion may be better choices than curettage or dermabrasion.

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Distally based greater saphenous venoadipofascial-sartorius muscle combined flap with venous anastomosis

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki

Plastic and Reconstructive Surgery 119 ( 6 ) 1808 - 1812 2007.05

ISSN 0032-1052

In reconstruction of the extremities, a distally based flap is useful for covering the distal parts. Distally based flaps are, however, prone to congestion in the peripheral part of the flap, followed by partial necrosis because of insufficient venous drainage caused by resistance of the venous valves. To rescue peripheral congestion of the distally based flap, venous anastomosis is effective so that the venous blood flows in the direction of the venous valve. We applied this idea to a patient who had skin defects around the knee after a wide resection of the skin tumor, and covered them with a distally based greater saphenous venoadipofascial-sartorius muscle combined flap. The whole area of the flap took well without congestion after anastomosis of the vein.

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Molecules involved in the hair cycle

Kishi Kazuo, Kubota Yoshiaki, Nakajima Hideo, Nakajima Tatsuo

Japanese Journal of Plastic and Reconstructive Surgery 50 ( 2 ) 157 - 161 2007.02

ISSN 0021-5228

Macroscopic and histological studies of the subcutaneous adipofascial tissue

Imanishi Nobuaki, Nakajima Hideo, Kishi Kazuo

Japanese Journal of Plastic and Reconstructive Surgery 49 ( 10 ) 1083 - 1088 2006.10

ISSN 0021-5228

The reconstruction of the lower eyelid with V-Y advancement flap

Kishi Kazuo, Nakajima Hideo, Imanishi Nobuaki, Nakajima Tatsuo

Japanese Journal of Plastic and Reconstructive Surgery 49 ( 7 ) 749 - 754 2006.07

ISSN 0021-5228

In lower eyelid reconstruction, we use a V-Y advancement flap from the lower lateral cheek. The technique is simple and the scar after surgery is fine. On the other hand, we recommend supporting the reconstructed flap firmly to prevent ectropion due to either scar contraction or gravity. We use fascia lata fixed to a newly developed screw system that is directly inserted into the lateral orbital rim. By using these techniques, lower eyelids were successfully reconstructed.

Mutual dependence of murine fetal cutaneous regeneration and peripheral nerve regeneration

Kishi Kazuo, Ohyama Kyoji, Satoh Hiroko, Kubota Yoshiaki, Tanaka Takara, Imanishi Nobuaki, Nakajima Hideo, Kawamura Kohki, Nakajima Tatsuo

Wound Repair and Regeneration 14 ( 1 ) 91 - 99 2006.01

ISSN 1067-1927

Mammalian fetal cutaneous wounds made at certain developmental stages show complete regeneration. It is reported that wound healing in both adult and fetal skin is disrupted by denervation. Furthermore, fetal cutaneous regeneration has unique aspects such as epidermal wrinkle texture regeneration and dermal regeneration that depend on developmental stage. Therefore, we have examined the relationship of fetal cutaneous regeneration with denervation. We made cutaneous wounds on fetal mice at various developmental time points including embryonic days (E)13, E15, and E17, and compared the regenerating patterns of peripheral nerves in the skin. We found that when the fetuses are wounded at an early stage of development, peripheral nerves regenerate quicker than at later stages of development when peripheral nerve regeneration is delayed. Next, we denervated the intercostal nerves and made wounds at the denervated sites on E13 and E15. We found that epidermal wrinkling and dermal regeneration were disrupted by denervation. These findings indicate that components of fetal cutaneous regeneration and peripheral nerve regeneration are mutually dependent.

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Skin reconstitution in SCID mice

Kishi Kazuo, Kubota Yoshiaki, Katsube Kenichi, Satoh Hiroko, Shimizu Yusuke, Imanishi Nobuaki, Nakajima Hideo, Nahajima Tatsuo

Japanese Journal of Plastic and Reconstructive Surgery 48 ( 9 ) 979 - 984 2005.09

ISSN 0021-5228

In fetal regenerative wound healing, dermal mesenchymal cells directly migrate into the wound and regenerate the dermal structure. On the contrary, loose fascial cells beneath the dermis construct scar tissue in the late stage of development. We co-transplanted fetal epidermal cells and dermal or loose fascial mesenchymal cells onto a skin defect in SCID mice to evaluate the regenerative activity of their skin. The cells used for transplantation were obtained from fetal C57b1 mice on embryonic day 17, and suspended enzymatically. Four weeks after the transplantation, almost normal skin was regenerated in the animals that were transplanted with dermal and epidermal cells. Conversely, scar-like tissue was constructed in the animal wounds into which loose fascial and epidermal cells were transplanted. We found it useful to use this model to evaluate the cutaneous regenerative activity of various cells.

Our revised classification of skin flaps and opinion for 2004 classification of skin flaps

Nakajima Hideo, Iwanishi Nobuaki, Kishi Kazuo

Japanese Journal of Plastic and Reconstructive Surgery 48 ( 7 ) 745 - 755 2005.07

ISSN 0021-5228

Vascular systems of the flaps are constructed of following elements; i) types of blood circulation in the flaps, ii) vessel types of vascular pedicles, iii) separation points of vascular pedicles. The blood circulation of flaps is constructed of the dermal vascular system and the subdermal vascular system. Based on the combination of these elements, skin flaps can be categorized into the thin cutaneous flap, the split thickness cutaneous flap, and the full thickness cutaneous flap. The blood circulation in the deep fascia itself is poor, and thus the deep fascia does not contribute to the blood supply of the cutaneous flaps. Accordingly, the cutaneous flaps containing the whole subcutaneous adipose layer without deep fascia is basically similar to the fasciocutaneous flap. However, we categorized the former as full thickness cutaneous flap to prevent the confusion of terminology. From the clinical aspects, perforating vessels that construct the vascular pedicles were categorized into 6 types based on the vascular pattern from the source vessel to the dermal plexus. These six types of perforating vessels can be simplified as follows: 1) direct cutaneous vessels, 2) accompanying vessels, 3) muscular artery perforators, 4) septal perforators.

Is the platysma flap musculocutaneous? Angiographic study of the platysma

Imanishi Nobuaki, Nakajima Hideo, Kishi Kazuo, Chang Hak, Aiso Sadakazu

Plastic and Reconstructive Surgery 115 ( 4 ) 1018 - 1024 2005.04

ISSN 0032-1052

Background: The platysma flap has often been used for reconstructions of the head and neck, but the arterial anatomy of the platysma itself has not been clarified. Methods: The anterolateral neck skin in five sides of four fresh cadavers that had been injected systemically with a lead oxide-gelatin mixture was elevated and divided into three layers: the skin with adipofascial tissue over the platysma, the platysma, and the adipofascial tissue under the platysma. Radiographs were taken of each specimen using the soft x-ray system. Results: The anterolateral neck skin was chiefly supplied by branches of the submental, facial, superior thyroid, transverse cervical, and occipital arteries, and it was found that the vasculature of the arterial branches can be classified into three groups. In all of the groups, the arterial branches penetrated the platysma and did not run long in the platysma layer. The platysma was supplied by only small vessels from the arterial branches. Furthermore, there was little connection between the vascular plexus of the platysma and that of the skin layer with adipofascial tissue above the platysma and the platysma located in the subcutaneous tissue. Conclusions: The platysma flap should be considered fasciocutaneous rather than musculocutaneous. Therefore, the platysma flap should usually be elevated with the deep adipofascial tissue under the platysma. Flap survival is threatened if it is elevated without the adipofascial tissue under the muscle as with a usual musculocutaneous flap.

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The fetal dermal but not loose fascial mesenchymal cells possess regenerative activity of dermal structure

Kishi Kazuo, Katsube Kenichi, Satoh Hiroko, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Cell Transplantation 14 ( 9 ) 709 - 714 2005

ISSN 0963-6897

Fetal skin possesses a regenerative activity until certain developmental stages. However, the origin of cells that regenerate dermis after wounding has not been clarified yet. In the present study we located the origin of cells that reconstruct fetal dermal structure by histological examination and by marking cells in the loose fascia. Next we evaluated the regenerative activity of fetal dermal mesenchymal cells by cotransplanting with fetal epidermal cells onto the skin defect of scid mice. We conclude that fetal dermal mesenchymal cells but not loose fascial cells possess regenerative activity even on the environment in scid mice.

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Tissue engineering of skeletal muscle in collagen gel

Kishi Kazuo, Satoh Hiroko, Tanaka Takara, Kubota Yoshiaki, Koyama Taroh, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Japanese Journal of Plastic and Reconstructive Surgery 47 ( 9 ) 1001 - 1005 2004.09

ISSN 0021-5228

In order to construct functional skeletal muscle in vitro for tissue engineering, cell alignment followed by the fusion of skeletal muscle cells, and the construction of basement membrane are needed. Of the various means used to align skeletal muscle cells, the mechanical load method is the most popular. In the present paper, we describe the history of attempts to align skeletal muscle cells in vitro and the construction of basement membrane. We then describe the challenges we faced to achieve skeletal muscle tissue engineering in type I collagen gel by co-culturing various types of cells including skeletal muscle cells, fibroblasts, endothelial cells, and fetal rat anterior horn cells.

Transplanted mesenchymal stem cells are effective for skin regeneration in acute cutaneous wounds

Satoh Hiroko, Kishi Kazuo, Tanaka Takara, Kubota Yoshiaki, Nakajima Tatsuo, Akasaka Yoshikiyo, Ishii Toshiharu

Cell Transplantation 13 ( 4 ) 405 - 412 2004

ISSN 0963-6897

Mesenchymal stem cells (MSCs) possess the capacity for site-specific differentiation of cell types in response to cues provided by different organs. This phenomenon suggests that MSCs participate in cutaneous wound regeneration. However, there are no prior reports on the influence of the local application of MSCs on cutaneous wound regeneration. To examine the effects of MSCs on wound regeneration, we cultured bone marrow cells of the femur of rats and treated the plastic adherent cells with a differentiation medium to induce differentiation. After treatment, we found that the bone marrow-derived plastic adherent cells possessed myogenesis, chondrogenesis, and adipogenesis capabilities, indicating that these cells are MSCs. The bone marrow-derived plastic adherent cells were injected intradermally into the skin of rats, and linear full-thickness incisional wounds were made immediately through the injected area. At 14 days after operation, wounds transplanted with bone marrow-derived plastic adherent cells had healed with very fine scars. Collagen architecture was thick and appeared to be similar to normal dermis. Histomorphologic scale analysis demonstrated significant differences between the control and the wounds transplanted with bone marrow-derived plastic adherent cells. These results indicate that transplanted MSCs can respond quite normally to wound healing and regenerate dermal structure.

Anatomical study of subcutaneous adipofascial tissue

Nakajima Hideo, Imanishi Nobuaki, Minabe Toshiharu, Kishi Kazuo, Aiso Sadakazu

Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 38 ( 5 ) 261 - 266 2004

ISSN 0284-4311

The subcutaneous adipofascial tissue over the entire body was radiographically and macroscopically investigated in 20 fresh and embalmed cadavers. The subcutaneous adipofascial tissue was made up of two adipofascial layers. Because the superficial layer forms a solid structure and is thought to protect against external forces, the adipofascial system formed by the solid structure was named the "protective adipofascial system (PAFS)". Because the deep layer forms a mobile layer and is thought to lubricate musculoskeletal movement, the adipofascial system formed by the mobile structure was named "lubricant adipofascial system (LAFS)". By classifying subcutaneous adipofascial tissue by its functional characteristics, we found we could understand the subcutaneous adipofascial structure over the entire body well.

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Nasal reconstruction by thin forearm flap

Nakajima Hideo, Imanishi Nobuaki, Kishi Kazuo, Sasaki Katsumi

Japanese Journal of Plastic and Reconstructive Surgery 46 ( 9 ) 891 - 900 2003.09

ISSN 0021-5228

It is theoretically possible to thin a forearm flap by clarifying the subcutaneous adipofascial structure and vasculature of the forearm, and a thin forearm flap has been developed accordingly based on the anatomy. In our report, we discussed indications for thin flap usage from a point of view which considers reconstruction of skin, bone and mucosal defects. Our first choice for thin forearm flap usage utilizes the two skin paddles and the radial bone for reconstructing whole defects of the nose. With this method, the donor site, if possible, is covered with the VAF flap using the basilic vein and its accompanying arteries after elevating the flap.

Expression of bone morphogenetic proteins during mandibular distraction osteogenesis in rabbits

Yazawa Masaki, Kishi Kazuo, Nakajima Hideo, Nakajima Tatsuo

Journal of Oral and Maxillofacial Surgery 61 ( 5 ) 587 - 592 2003.05

ISSN 0278-2391

Purpose: We examined the expression pattern of bone morphogenetic proteins (BMPs) during mandibular distraction osteogenesis in rabbits and also investigated the mechanism of membranous bone distraction. Materials and Methods: Twenty-three rabbits underwent mandibular distraction (protocol; no latency period, a 1-week distraction at 0.5 mm/d, and a 2-week consolidation period). Samples were collected at 3, 5, and 7 days of distraction and at 1-week and 2-week consolidation. We prepared undecalcified fresh-frozen sections and immunohistochemically evaluated the expression of BMPs 2 through 8. Results: Both endochondral ossification and intramembranous ossification were observed. The expression of BMPs 2, 4, 5, and 6 was observed continuously from the beginning of distraction. BMP-7 was expressed weakly. The expression of BMP-3 was not observed conspicuously during distraction but was strongly expressed at 1- and 2-week consolidation. Conclusion: The expression pattern of BMPs during membranous bone distraction was similar to that during long bone distraction, but it differed from the expression pattern of long bone distraction in that the expression of BMPs was maintained for 2 weeks after the completion of distraction.

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Transplanted endothelial progenitor cells augment the survival areas of rat dorsal flaps

Kubota Yoshiaki, Kishi Kazuo, Satoh Hiroko, Tanaka Takara, Nakajima Hideo, Nakajima Tatsuo

Cell Transplantation 12 ( 6 ) 647 - 657 2003

ISSN 0963-6897

Endothelial progenitor cells (EPCs) have been identified in peripheral blood, and have been reported to be incorporated into ischemic regions such as the ischemic hindlimb. In this study, we examined whether or not transplantation of EPCs is useful for salvaging surgical flaps in vivo. At the same time, we quantitatively compared the neovascularization ability of transplanted EPCs and that of mature endothelial cells (ECs). ECs obtained from the aorta of rats by explantation and passaged several times were used in the present study. EPCs were obtained from the blood of rat hearts. The blood samples were separated by density gradient centrifugation. Light-density mononuclear cells (MNCs) were collected and cultured on plastic plates coated with rat plasma vitronectin. Cells attached at day 7 of culture were deemed to be EPCs. Then PBS (control), ECs, or EPCs (3.0 × 10⁵ suspended in 1.0 ml PBS) were injected at the middle of a flap. Seven days after surgery, the survival lengths of the flaps were evaluated. EPC-transplanted groups revealed statistically significant augmentation of survival length compared with the other two groups (p < 0.003). EPC-transplanted groups had significantly more angiographically detectable blood vessels (p < 0.003) and significantly higher capillary density (p < 0.03) than the other two groups. Confocal microscopy revealed that EPCs were incorporated into enhanced neovascularization. These results suggest that transplantation of EPCs may be useful for salvaging surgical flaps, and EPCs are superior to ECs in neovascularization ability.

A challenge to construct functional tissue engineered skeletal muscle

Kishi Kazuo, Satoh Hiroko, Tanaka Takara, Kubota Yoshiaki, Imanishi Nobuaki, Nakajima Hideo, Nakajima Tatsuo

Japanese Journal of Plastic and Reconstructive Surgery 45 ( 5 ) 419 - 424 2002

ISSN 0021-5228

In order to construct functional skeletal muscle in vitro for tissue engineering, the micro architecture including microcirculation, neuromuscular junctions, and cell alignment has to be constructed. Thus it has been said that tissue engineered skeletal muscle will not be realized until two or three decades in the future. Skeletal muscle, however, possesses the ability to regenerate partial defects even in adult animals, and this regenerative activity can be a blue print for skeletal muscle tissue engineering. In the present paper, we describe the principle of skeletal muscle regeneration, and then describe the challenges to achieve skeletal muscle tissue engineering.

骨格筋のTissue Engineering のチャレンジと展望

Kishi Kazuo，Satou Hiroko，Kubota Yoshiaki，Nakajima Tatsuo

形成外科 45 ( 5 ) 419-424 2002

Research paper (scientific journal), Joint Work

胎仔の創傷治癒―胎仔型から成獣型創傷治癒への変換点を探る

Kishi Kazuo

医学のあゆみ 198 ( 11 ) 776-777 2001.09

Research paper (scientific journal), Single Work

Fetal scarless wound healing

Kishi K.

Connective Tissue 32 ( 4 ) 361 - 366 2000

ISSN 0916-572X

Differential responses of collagen and glycosaminoglycan syntheses and cell proliferation to exogenous transforming growth factor β1 in the developing mouse skin fibroblasts in culture

Kishi Kazuo, Nakajima Hideo, Tajima Shingo

British Journal of Plastic Surgery 52 ( 7 ) 579 - 582 1999.10

ISSN 0007-1226

Skin fibroblast cultures were established from mouse foetuses at days 14, 15, 16 and 18 of gestation and from newborn mice. Modulations of mitotic and biosynthetic phenotypes of the fibroblasts by transforming growth factor β1 (TGFβ1) were studied. Treatment of the fibroblasts with TGFβ1 at doses of 1 and 10 ng/ml for 48 h resulted in significant stimulation of cell proliferation in the 15-, 16- and 18-day foetal fibroblasts and a slight stimulation in the 14-day foetal fibroblasts. Treatment with TGFβ1 resulted in stimulation of collagen synthesis approximately 2-fold in the 18-day foetal and newborn fibroblasts, but failed to stimulate it in the 14-, 15- and 16-day foetal fibroblasts. TGFβ1 stimulated glycosaminoglycan (GAG) synthesis throughout all developmental stages approximately 1.8-2.6 fold. Histological study demonstrated that skin wounds made at day 16 of gestation were replaced with normal-appearing dermis, but at day 18 the wounds left dermal fibrosis and lack of hair follicles. These results indicate that the modulations of fibroblast phenotypes (proliferation and syntheses of collagen and GAG) in response to TGFβ1 occur at different stages of gestation. Ontogenic transitions of skin wound healing and collagen synthetic phenotype with TGFβ1 treatment in cultured fibroblasts occurred between days 16 and 18 of gestation, suggesting that the unresponsiveness of collagen synthesis to exogenous TGFβ1 in cell culture may be related to the phenomenon of scarless wounds in the foetus.

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骨浸潤，頸部リンパ節転移を認めた後頭部有棘細胞癌の1例

Takahashi Shinichi, Kawahara Junko, Kishi Kazuo, Nakajima Hideo

日本皮膚外科学会誌 1 ( 1 ) 92-92 1998.02

Research paper (scientific journal), Joint Work

磁場が線維芽細胞TGF-β₁ 発現に及ぼす影響

Kishi Kazuo, Tsuchiya Yuichi, Nakajima Hideo, Tajima Shingo

日本生体磁気学会誌特別号 9 ( 1 ) 68-69 1996.05

Research paper (scientific journal), Joint Work

磁場が線維芽細胞コラーゲン合成に及ぼす影響

Kishi Kazuo, Tsuchiya Yuichi, Nakajima Hideo, Tajima Shingo

日本生体磁気学会誌特別号 9 ( 1 ) 66-67 1996.05

Research paper (scientific journal), Joint Work

肋間動脈穿通枝によって栄養される肋骨附き広背筋皮弁による下顎再建の経験

Hirano Sahoko

頭頚部腫瘍 22 ( 1 ) 120-126 1996.03

Research paper (scientific journal), Joint Work

定常磁場曝露による皮弁生着に及ぼす影響

Fukuzumi Satoshi, Nakajima Hideo, Imanishi Nobuaki, Kishi Kazuo, Tsuchiya Yuichi, Ohnishi Yuko

日本生体磁気学会誌 8 ( 1 ) 168-171 1995.05

Research paper (scientific journal), Joint Work

皮弁虚血再灌流による活性酸素産生に対する磁場の影響

Tsuchiya Yuichi, Nakajima Hideo, Fukuzumi Satoshi, Imanishi Nobuaki, Kishi Kazuo, Ohnishi Yuko

日本生体磁気学会誌 8 ( 1 ) 164-167 1995.05

Research paper (scientific journal), Joint Work

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