掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Society for Surgical Wound Care  

DOI： 10.36748/ijswc.4.4_150

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：英語  

Abdominal surgery can cause notable scars that adhere to the abdominal tissues below. Full scar removal is generally not recommended due to the risk of intestinal damage and delayed wound healing. Here, we describe a surgical scar-revision procedure for adherent abdominal scars that does not involve either opening the abdominal cavity or total scar removal. A 58-year-old woman exhibited an aesthetically displeasing hypertrophic adherent abdominal scar that extended from the umbilical fold to the pubic area and distorted the umbilicus. It arose from multiple laparotomies for hernia repair and subsequent complications. Pain/discomfort and functional impairment were absent. Scar-revision surgery was conducted under general anesthesia. The skin around the adherent scar was excised down to the subcutaneous layer with a minimal margin. However, only the epidermis and superficial dermal layer of the adherent scar were removed; the deep scar dermis remained. The skin flaps on either side of the midline were then advanced and sutured over the remnant dermis. One year after surgery, the aesthetic and functional outcomes were excellent. Furthermore, no hypertrophic scars or epidermal cysts were found. This technique is effective, efficient, does not involve intraabdominal procedures, provides a vascularized tissue layer, and results in an aesthetically pleasing scar.

DOI： 10.1097/GOX.0000000000005357

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Impaired microcirculation can cause lymphatic leakage which leads to a chronic swelling in the tissues of the body. However, no successful treatment gives any protection against lymphedema due to the lack of well-revealed pathophysiology of secondary lymphedema. Binary image of laminin immunohistochemical expression revealed that distribution of laminin expression localized during surgically induced lymphedema. 67 kDa laminin receptor (67LR) mRNA expression showed a peak at during lymphedema exacerbation. Since the response of 67LR molecules may affect the prevention of inflammation and edema, here we have hypothesized that 67LR ligand of YIGSR peptide could permit reconstructive environment for amelioration of lymphedema and evaluated the effect of YIGSR in a mouse tail model of lymphedema. Indeed, intra-abdominal injections of YIGSR for the first 3 days after inducing lymphedema in the mouse tail model reduced the tail lymphedema on day 14 by 27% (P = 0.035). Histology showed that YIGSR treatment protected lymphedema impairment in epidermis and dermis, and it also inhibited the expansion of intercellular spaces and enhanced especially cell adhesion in the basement membrane as revealed by transmission electron microscopy. Interestingly, the treatment also reduced the local expression of transforming growth factor (TGF)β. Further elucidation of the mechanisms of 67LR-facilitated lymphangiogenesis contributes to find potential targets for the treatment of lymphedema.

DOI： 10.1016/j.bbrep.2023.101514

PubMed

researchmap

記述言語：英語  

Postoperative fixation is required for skin grafts on mobile sites. External wire-frame fixation technique has demonstrated a beneficial role for grafts in specific areas such as lips, eyelids, and fingers. Although this technique is sufficient in most cases, patients with psychosis fail to maintain the lip in resting position, which led us to consider using a more rigid fixation method, known as "Geometric wire-frame fixation." Surgical technique included fixing a perimeter frame around skin graft similar to the conventional external wire-frame fixation. In addition, a geometric frame was prepared to divide the area of the graft geometrically. Then, it was placed on gauze to compress the grafted skin, and connected to the perimeter frame. In case 1, a 33-year-old man with a history of schizophrenia and presenting with flame burn injury sustained while attempting suicide was admitted. The scar on the lips was excised, and an external wire-frame fixation was performed. However, postoperative vigorous mouth movements caused incomplete survival of the skin graft. Geometric wire-frame fixation was performed in the next operation, and the graft fully survived. The patient in case 2 was a 62-year-old man who developed a facial scar contracture after chemical injury by sulfuric acid. We performed geometric wire-frame fixation with contracture release of the upper lip, and the skin graft was fully taken. The geometric wire-frame fixation method allows for rigid fixation of the skin graft and can be considered as a valuable option, especially for lip reconstruction in poorly compliant patients who are unable to maintain proper resting lips.

DOI： 10.1097/GOX.0000000000005248

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本皮膚悪性腫瘍学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本皮膚悪性腫瘍学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本皮膚悪性腫瘍学会  

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/gox.0000000000005010

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pathological scars (including keloids, hypertrophic scars, and scar contractures) are present with high severity among certain populations, particularly in Asians and Africans who are highly prone to develop scars. Understanding the patho-mechanism that underlies scarring, such as mechanosignaling, systemic, and genetic factors, as well as optimal surgical techniques and integrated noninvasive therapeutic methods can guide clinicians to develop treatment protocols that can overcome these issues. This report summarizes a congress at Pacifico Yokohama (Conference Center) on December 19, 2021 involving researchers and clinicians from diverse disciplines who convened to discuss current clinical, preclinical, and most recent research advances in understanding pathological scarring, keloid and hypertrophic scar management, and research progress in wound healing. Presenters described the advances in scar therapies, understanding scarring mechanisms, and scar prevention and assessments tools. Moreover, presenters addressed the challenges during the COVID-19 pandemic and using telemedicine in management of scar patients.

DOI： 10.1097/GOX.0000000000004921

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

UNLABELLED: Keloids are fibroproliferative lesions caused by abnormal dermal wound healing. Keloidal collagen (KC) is a pathognomic feature of keloids, but the mechanism by which it forms is unknown. This study aimed to evaluate the histopathology of KC and thereby gain clues into how it forms. METHODS: The cross-sectional study cohort consisted of a convenience series of patients with keloids who underwent surgical excision. Skin pieces (3 mm2) were collected from the keloid center and nearby control skin. Histopathology was conducted with light and electron microscopy and immunohistochemistry. KC composition was analyzed with protein shotgun analysis. RESULTS: Microscopic analyses revealed the ubiquitous close association between KC and αSMA-positive spindle-shaped cells that closely resembled myofibroblasts. Neither KC nor the spindle-shaped cells were observed in the control tissues. Compared with control skin, the collagen fibers in the KC were overall thinner, their diameter varied more, and their spacing was irregular. These features were particularly pronounced in the collagens in the vicinity of the spindle-shaped cells. Protein shotgun analysis did not reveal a specific collagen in KC but showed abnormally high abundance of collagens I, III, VI, XII, and XIV. CONCLUSIONS: These findings suggest that KC may be produced directly by myofibroblasts rather than simply being denatured collagen fibers. Because collagens VI and XII associate with myofibroblast differentiation, and collagen XIV associates with local mechanical stress, these collagens may reflect, and perhaps contribute to, the keloid-specific local conditions that lead to the formation of KC.

DOI： 10.1097/GOX.0000000000004897

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Keloids are a fibroproliferative, multifactorial, cutaneous disorder whose pathophysiology is not completely understood. Various factors such as high blood pressure, pregnancy, female gender, mechanical tension of local sites, and prolonged wound healing are known to worsen keloids. Childhood-onset keloids are keloids that form before 10 years of age, before various factors in adulthood come into play, and thus studying childhood-onset keloids may provide additional insight into the underlying mechanisms that lead to keloid formation. METHODS: Retrospective chart review was performed on all patients with childhood-onset keloids who were evaluated at our plastic surgery clinic (one of the largest keloid referral centers in Japan) over a 1-year period. RESULTS: Of the 1443 patients with diagnosis of keloids, 131 patients had childhood-onset keloids. Of these, 106 patients (80.9%) were female, 38.9% of patients had family history of keloids, and 48.9% of patients had allergies or allergy-related conditions (asthma, atopic dermatitis, or allergic rhinitis). Vaccination (47.5%) and chickenpox (19.9%) were the most common triggers. Of vaccinations, BCG was the most common trigger. The majority of keloids from BCG were in female patients (92.9%). The most common location was the chest in male patients (30.0%) and the arm in female patients (41.1%). CONCLUSION: To our knowledge, this is the largest report in the literature on childhood-onset keloids. There was overall female predominance in childhood-onset keloids, and even more significant female predominance in BCG-induced keloids.

DOI： 10.1007/s13555-023-00916-0

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

症例は53歳男性で、40歳ごろから歩行時や起床時、脱水時に両下腿の痛みを自覚することがあったが、休息等により自然軽快していた。その後、転職したことにより片道1時間、徒歩と電車での通勤となり、転職3日目に痛みが生じ始め、4日目には間欠性の跛行となった。5日目には痛みは強く持続性となり、その翌日、欠勤のうえ当院受診となった。造影CT所見より下腿前区画コンパートメント症候群を疑い治療を開始した。入院6日目にデブリードマンを施行し、左側は前脛骨筋、長趾伸筋が完全壊死し、右側は前脛骨筋、長趾伸筋、長母趾伸筋が完全壊死していた。入院10日目に左側は一部縫縮、右側は完全縫縮を行い、左側は死腔と潰瘍を認めたため局所陰圧閉鎖療法を併用し、入院18日目に同側大腿部より分層植皮術を施行し治癒した。リハビリテーションの施行と装具の装着により、入院25日で退院となった。発症前と同様の通勤を再開したが、退院後6ヵ月の時点で症状の再燃はない。

researchmap

記述言語：英語  

Fibroma of tendon sheath (FTS) is a rare soft tissue tumor that usually occurs in the upper extremity. Moreover, of the few cases reported in the feet, nearly all occur in the plantar region. We report the case of a large FTS in the dorsum of the left foot that grew quickly into a 4 cm-diameter lesion. The 44-year-old Japanese man noticed the tumor incidentally one year before presentation and could not recall any possible cause. Physical examination showed an elastic hard mass that spread over the third to fifth metatarsal bones. MRI showed iso-intense signals with central hypo-intensity on T1-weighted images and hypo-intense signals on T2-weighted images. Since a biopsy did not reveal any malignant findings, the lesion was excised surgically. The tumor was found to be multilocular, encapsulated, and to arise from the extensor digitorum brevis tendon. Histopathology showed scattered spindle fibroblasts and slit-like vascular structures within the dense collagenous matrix. The tumor was diagnosed on the basis of the clinical, demographic, surgical, and histopathological findings as an FTS arising from the extensor digitorum brevis tendon. A review of the literature revealed seven cases of FTS of the dorsum of the foot, which indicates its rarity. More than one-half of these cases were from Japan. While the cause of FTS remains unclear, trauma has been implicated. We suggest that the cultural background of the patient, which could promote kneeling-induced dorsal foot trauma, may have contributed to the onset/progression of our case. Level of Clinical Evidence: 4.

DOI： 10.1016/j.jpra.2022.11.005

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Keloids are laterally growing fibroproliferative skin disorders. Severe keloids spread widely, sometimes over joints, thus significantly limiting motor function. They are associated with recurrent, very painful draining infections. Here, we report a case of a giant keloid that was successfully treated by combination therapy comprising surgery (partial resection followed by local flap transposition) and subsequent radiotherapy and steroid-plaster therapy. The keloid was first noticed when the patient was 7 years old at the site of a Bacille Calmette-Guérin vaccination she had received on her left shoulder in infancy. The keloid grew rapidly and widely after adulthood. A malignant tumor was suspected at another hospital, but a biopsy at age 45 years indicated the lesion was a keloid. Later, the keloid grew from the shoulder onto the chest and back and over the anterior axilla. At age 62 years, the patient was referred to our hospital. Under general anesthesia, the keloid was partially resected and the wound was covered with a local flap. Postoperative radiotherapy was performed 1 week later. The residual keloid was treated for 18 months with steroid tape. At 18 months after surgery, no recurrence of the keloid was observed. The patient had no pain or movement restriction. She was extremely satisfied with the results and considered the treatment to have improved her quality of life. While a standard strategy for severe keloid remains to be established, combination therapy comprising surgery, postoperative radiotherapy, and steroid-plaster therapy that aims to reduce inflammation and skin tension may be an option.

DOI： 10.1272/jnms.JNMS.2022_89-610

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/GOX.0000000000004847

PubMed

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本創傷外科学会  

DOI： 10.11310/jsswc.14.67

CiNii Research

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Dermatofibroma is a common benign skin lesion with a contested etiology: some believe it is a neoplasm while others propose minor injuries initiate it. Many dermatofibroma variants have been described, including keloidal dermatofibroma, which is unusual by bearing keloidal collagen. Keloidal dermatofibroma was first described in 1998 and only 15 cases have been reported. Since keloids are driven by skin injuries, the existence of keloidal dermatofibroma has been suggested to support the injury hypothesis of dermatofibroma etiology. To better understand keloidal dermatofibroma characteristics and gain clues regarding dermatofibroma etiology, consecutive keloidal dermatofibroma cases (n = 52) and dermatofibroma without keloidal collagen (n = 2077) that were histopathologically diagnosed in 2016-2019 were identified from the records of a Japanese dermatopathology laboratory and compared in terms of demographic, clinical, and histopathological characteristics by univariate analyses. Compared to other dermatofibromas, keloidal dermatofibromas occurred more frequently on the forearm and hand (P < 0.0001 and 0.0019), especially the wrist dorsum, and in the superficial skin layer (P < 0.0001). Keloidal dermatofibromas also demonstrated more cellularity and hemorrhage (both P < 0.0001). Correlation analyses between keloidal collagen amount and keloidal dermatofibroma size (a proxy of time-since-onset) did not support the notion that keloidal collagen deposition and keloidal dermatofibroma formation are triggered simultaneously. Recent injury, as indicated by fresh hemorrhage, was equally common in putatively older and younger keloidal dermatofibromas. Thus, keloidal collagen in keloidal dermatofibromas could be due to injury to preexisting dermatofibromas, which suggests that the keloidal dermatofibroma entity does not prove the injury hypothesis. Commonalities between keloids and keloidal dermatofibromas suggest a link between genetics, provocative events that induce myofibroblast differentiation, and keloidal collagen production.

DOI： 10.1111/1346-8138.16638

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Key risk factors for hypertrophic scarring and surgical-site infections are high-tension wounds, fat necrosis, and dead space. All could be prevented by appropriate superficial fascia suturing. However, the as-yet poorly researched anatomy of the superficial fascia should be delineated. This study is the first to quantify the superficial fascia throughout the human body in vivo. METHODS: Ultrasound was used to analyze the superficial and deep fascia of 10 volunteers at 73 points on 11 body regions, including the upper and lower trunk and limbs. Number, thickness and percentage of superficial fascia layers, and deep fascia and dermis thickness, were measured at each point. RESULTS: Seven hundred thirty ultrasound images were analyzed. Body regions varied markedly in terms of subcutaneous variables. Posterior chest had the thickest deep fascia and dermis and the highest average superficial fascia layer thickness [0.6 mm (95 percent CI, 0.6 to 0.7 mm)]. Anterior chest had the most superficial fascia layers [3.7 (95 percent CI, 3.5 to 3.8)]. Posterior and anterior chest had among the highest percentage of superficial fascia. Abdomen and especially gluteus had a low percentage of superficial fascia. Covariate analyses confirmed that posterior and anterior chest generally had higher superficial fascia content than gluteus and abdomen (both p < 0.001). They also showed that the dermis in the posterior and anterior chest increased proportionally to total fascia thickness. CONCLUSIONS: The superficial fascia, deep fascia, and dermis tend to be thick in high-tension areas such as the upper trunk. A site-specific surgical approach is recommended for subcutaneous sutures. CLINICAL RELEVANCE STATEMENT: Understanding the anatomical distribution of the superficial fascia and deep fascia will help surgeons optimize subcutaneous fasciae suturing, thereby potentially reducing the incidence of surgical-site infections and hypertrophic scars.

DOI： 10.1097/PRS.0000000000009631

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Most lipomas are readily dissected and removed. However, some cases can pose surgical difficulties. This retrospective study sought to identify clinical and radiological risk factors that predict difficult lipoma resection and can be used in a clinically useful scoring system that predicts difficulty preoperatively. METHODS: The study cohort consisted of all consecutive patients who underwent resection of pathology-confirmed lipoma during 2016-2018 at a tertiary care referral center in Tokyo, Japan. Surgical difficulty was defined as difficulty separating some/all of the tumor from the surrounding tissue by hand and inability to extract the tumor in one piece. Descriptive, univariate, and multivariate logistic regression analyses were conducted to identify predictive factors. The predictive accuracy of the scoring system that included these factors was assessed by tenfold cross-validation analysis. Receiver-operating curve (ROC) analysis was conducted to identify the optimal cutoff score for predicting surgical difficulty. RESULTS: Of the 86 cases, 36% involved surgical difficulty. Multivariate analysis showed that subfascial intramuscular location (odds ratio 42.7, 95% confidence interval 3.0-608.0), broad touching of underlying structures (46.5, 3.7-586.0), in-flowing blood vessels (9.3, 1.1-78.5), and unclear boundaries (109.0, 1.1-1110.0) significantly predicted surgical difficulty. These factors were used to construct a 0-4 point scoring system (with one point per variable). On cross-validation, the accuracy of the scoring system was 82.4% (Cohen's kappa of 0.57). ROC analysis showed that scores ≥ 2 predicted surgical difficulty with sensitivity and specificity of 55% and 98%, respectively. CONCLUSIONS: Our scoring system accurately predicted lipoma resection difficulty and may help operators prepare, thereby facilitating surgery.

DOI： 10.1007/s13555-022-00820-z

PubMed

researchmap

記述言語：英語  

DOI： 10.1016/j.jdermsci.2022.10.004

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

UNLABELLED: No standards for the assessment of axillary odor intensity and the effects of therapy for osmidrosis have been established. This study presents an objective method for assessing odor severity in patients with osmidrosis and investigates the volatile odorants and skin flora. METHODS: The odor intensity was measured pre- and postoperatively using an industrial odor sensor in 79 patients with osmidrosis. Cultures of the axillary skin were obtained during skin flap surgery. Volatile odorants of the patients were assessed using an odor-sensor gas chromatograph mass spectrometer, and samples collected from clothing worn by the patients before and after surgery. The skin pH of the axilla was measured before and after surgery. The locations of odorants and bacteria in the skin were observed using electron microscopy. RESULTS: The mean patient age was 28.8 years, and the male-to-female ratio was 4:3. The odor significantly decreased from 52.6 preoperatively to 20.5 postoperatively (P < 0.001). The bacterial flora on the skin included mostly Staphylococcus. Multiple causative substances (volatile proteins) were identified on gas chromatography. The mean preoperative axillary skin pH was 6.21, which was significantly different than that of patients without osmidrosis (5.92; P < 0.01). CONCLUSIONS: An odor sensor accurately assesses odor intensity in patients with osmidrosis. The neutralization of axillary pH may promote the production of odorants by creating the optimal pH for bacterial growth. Odor sensor and pH values can be used pre- and postoperatively as objective assessment measurements for patients with osmidrosis.

DOI： 10.1097/GOX.0000000000004622

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

糖尿病を有する患者の足部低温熱傷潰瘍に対し腰部交感神経節ブロック(lumbar sympathetic nerve block:以下LSNB)を行うことで上皮化が得られた症例を経験した.LSNBは下肢の血流改善効果・交感神経求心路に関与する痛みの緩和効果などがあり,本症例においても糖尿病性神経障害の緩和目的に施行したが,施行後より難治性であった創部の良好な収縮を得た.直接的には下肢の血流改善効果が影響し,間接的には糖尿病性神経障害が緩和したことで十分な創処置が可能になったことが潰瘍の改善に寄与したと考えられた.LSNBは難治性となりやすい糖尿病性足部熱傷潰瘍において,新しい治療の選択肢となりえる.(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

There are two types of pressure injuries: self-load-related pressure injuries (PIs) and medical device-related pressure injuries (MDRPIs), but the differences in risk factors between PIs and MDRPIs have not yet been clarified. If risk factors for PIs and MDRPIs differ, preventive interventions should take this into account. This is a prospective cohort study aimed to determine the cumulative incidence of PIs and MDRPIs in critically ill patients and to identify corresponding risk factors. The study included 1418 patients who were admitted to the critical care medical center of a single university hospital in Tokyo, Japan, between 1 December 2019 and 31 August 2020. The Kaplan-Meier method was used to calculate the cumulative incidence of PIs and MDRPIs. Furthermore, the Cox proportional hazards model was used to analyse the predictors in both the PI and MDRPI incidence and non-incidence groups. Predictors were based on data from the 0th disease day. The cumulative incidence of PIs and MDRPIs was 4.6/1000 person-days and 3.6/1000 person-days, respectively. Multivariate analysis using the Cox proportional hazards model showed that common risk factors for the occurrence of PIs and MDRPIs were possession of PI on admission, higher blood lactate, blood purification therapy, and positional restriction. The risk factors for PIs only were diabetes mellitus, septic shock, and a lower serum albumin level, while the risk factors for MDRPIs only were the D-dimer level and extracorporeal membranous oxygenation treatment. Therefore, prophylactic interventions need to consider these different risk factors.

DOI： 10.1111/wrr.13022

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

UNLABELLED: Keloids are red' invasive scars that are driven by chronic inflammation in the reticular dermis. The role of blood vessels in keloid behavior remains poorly understood. In the present study with 32 keloid patients, we examined the hemodynamics of keloid tissue, the anatomy of the blood vessels feeding and draining the keloids, and the vascular histology of keloids. METHODS: Ten patients with large anterior chest keloids underwent near-infrared spectroscopy, which measured regional saturation of oxygen and total hemoglobin index in the keloid and surrounding skin. Another 10 patients with large chest keloids and three healthy volunteers underwent multidetector-low computed tomography. The extirpated chest keloids of 12 patients were subjected to histology with optical, CD31 immunohistochemical, and electron microscopy. RESULTS: All keloids had a low regional saturation of oxygen and a high total hemoglobin index, which is indicative of blood congestion. Multidetector-low computed tomography revealed dilation of the arteries and veins that were respectively feeding and draining the keloid leading edge. Hematoxylin-eosin staining and CD31 immunohistochemisty revealed considerable neovascularization in the keloid leading edge but not in the center. Electron microscopy showed that the lumens of many vessels in the keloid center appeared to be occluded or narrowed. CONCLUSIONS: Keloids seem to be congested because of increased neovascularization and arterial inflow at the leading edge and blocked outflow due to vascular destruction in the center. The surrounding veins seem to expand in response to this congested state. Methods that improve the blood circulation in keloids may be effective therapies.

DOI： 10.1097/GOX.0000000000004374

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本皮膚悪性腫瘍学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: High-resolution manometry, which measures esophageal luminal pressure changes after swallowing, could shed more light on food-transport dynamics after pharyngeal/esophageal reconstruction. This prospective cohort study assessed the influence of two head-and-neck and esophageal tumor-resection and reconstruction approaches on esophageal pressure. METHODS: The cohort consisted of 17 patients who underwent esophageal/pharyngeal resection/reconstruction for cancer and then participated in postoperative high-resolution manometry. Five healthy controls also underwent manometry for comparison. RESULTS: Partial pharyngectomy with patch grafts associated with smooth and continuous esophageal/pharyngeal movement. By contrast, surgery that removed the thoracic esophagus led to complete loss of peristalsis and poor food transport. CONCLUSIONS: High-resolution manometry effectively characterized the changes in food-transport dynamics caused by pharyngeal/esophageal resection/reconstruction. These findings suggest that continuous and smooth movement of the pharynx and esophagus is important for swallowing and high resolution manometry could be useful in patients after pharyngeal/esophageal resection/reconstruction.

DOI： 10.1002/cnr2.1619

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

69歳男性。右上口唇部の腫瘤を主訴とした。初診時、上口唇に32mmの淡紅色で辺縁やや不整な隆起性病変が認められた。また、MRIでは上口唇部皮膚から口輪筋に浸潤する35mm大のT1T2ともに低信号を呈する腫瘤が認められた。治療にあたって、腫瘍の拡大切除は患者QOLを著しく低下させると考え、辺縁切除と皮弁再建を行い、術後は放射線治療を併用することになった。その結果、最終病理診断は原発性皮膚未分化びまん性大細胞型リンパ腫であった。術後3年経過現在、腫瘍の再発はなく、整容的・機能的にも満足のいく結果が得られている。

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20220307420017&doc_link_id=%2Fcw1nimed%2F2022%2F001801%2F019%2F0109-0113%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2022%2F001801%2F019%2F0109-0113%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Microsurgical vascular anastomosis plays an important role in successful free-tissue transfer. The Microvascular Anastomotic Coupler Device (MACD) aims to simplify anastomosis and decrease the time spent on this step, thereby reducing surgeon stress and improving the overall quality of the surgery, especially when venous end-to-side anastomosis is required. Our comparative retrospective cohort study aimed to determine the effect of this widely used device on anastomosis times and complications in head and neck/esophageal reconstruction cases involving venous end-to-side anastomosis using the internal jugular vein as the recipient vessel. Methods: All consecutive patients who underwent head and neck/esophageal reconstruction with hand-sewn or MACD-mediated venous end-to-side anastomosis using the internal jugular vein by three experienced microsurgeons in our tertiary-care hospital in 2012-2020 were identified. Venous anastomosis times and venous trouble cases were recorded. Results: Of the 191 cases, 44 and 147 underwent hand-sewn and MACD-mediated anastomosis respectively. The average venous anastomosis times of these groups were 31 and 11 minutes, respectively. Venous trouble was observed in two hand-sewn (4.5%) and four MACD (2.7%) cases, respectively. Vein twisting and improper coupler placement were the causes in the latter four cases. Conclusions: This study confirmed that MACD simplifies end-to-side venous anastomosis and reduces the time spent on this procedure. Also, for safer anastomosis, it is necessary to pay attention to preventing twisting and improper coupler placement when using MACD. We believe the MACD can improve the quality of reconstructive surgery.

DOI： 10.1097/GOX.0000000000004018

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00398&link_issn=&doc_id=20211202070010&doc_link_id=%2Fad3ksgke%2F2021%2F006412%2F012%2F1453b1459%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2021%2F006412%2F012%2F1453b1459%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   出版者・発行元：(一社)日本創傷治癒学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

症例は4歳女児で、禿髪を主訴とした。頭頂部脂腺母斑の疑いで紹介受診し、頭頂部に1cm大の禿髪と隆起性皮膚局面を認め、頭部単純X線で頭頂骨の骨欠損が疑われたため、腫瘍の切除を計画した。禿髪部周囲の毛根がやや密であり、術中頭蓋骨方向に連続する瘢痕様の索状組織を認めたため、脳神経外科医に確認後、索状物を頭蓋側で結紮して腫瘤を一塊に摘出した。また、頭部単純CTでは頭頂骨矢状縫合付近に小孔を認め、頭蓋骨欠損に連続する脳瘤を考えたが、病理組織学的所見は高分化なアストロサイトと膠原線維のみで構成された組織で脈絡叢は確認されず、免疫組織学的所見でglial fibrillary acidic protein、S-100蛋白が陽性、髄膜のマーカー(EMA)が陰性より、異所性脳組織と診断した。小児の頭部正中に生じた皮膚腫瘤は脳瘤や異所性脳組織を鑑別に挙げる必要がある。

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Oral propranolol is the first-line therapy for infantile hemangioma. Combining it with pulse dye laser (PDL) (595nm-long PDL) could reduce treatment duration and sequelae incidence and severity. OBJECTIVE: To determine the effect of PDL-propranolol treatment on duration to cure and sequelae. METHODS: All consecutive patients with infantile hemangioma who were cured by PDL-propranolol treatment were identified. RESULTS: In the 27 cases, average age at treatment start was 4.3 ± 3.8 months, mean tumor diameter was 11.1 ± 14.0 cm2, and tumor-type was most common (72.4% of lesions). The patients received 9.8 ± 10.5 PDL sessions. After ensuring patients had no physical contraindications, including heart disease, oral propranolol was started at 1 mg/kg/d, increased up to 3 mg/kg/d as a maintenance dose. Mean propranolol treatment duration was 11.1 ± 4.9 months. Total treatment duration was 15.3 ± 10.8 months. CONCLUSION: Our data in the context of recent literature suggest combining propranolol with PDL may reduce propranolol duration without increasing harms.

DOI： 10.1097/DSS.0000000000003018

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Previous approaches to acne management have focused on the four main factors implicated in acne, namely, androgen-mediated sebogenesis (considered integral to acne), hyperkeratinization, colonization with Cutibacterium acnes, and inflammation related to both innate and adaptive mechanisms. Recent advances have facilitated potential novel approaches to acne management, as the pathophysiology and the immunological aspects related to acne and wound healing have evolved. Particular targets that have been shown to be closely involved in acne pathophysiology and wound healing include interleukin (IL)-1β, IL-17, IL-23, and tumor necrosis factor alpha (TNFα). Biological antibodies targeting IL-1β, IL-17, IL-23, and TNFα could provide novel approaches for treating severe acne and related disorders. Acne is primarily a disease associated with sebogenesis. Monosaturated free acids are important components. Insulin growth factor 1 (IGF-1) promotes the proliferation and differentiation of sebocytes and IL-1β. Research into the microbiome may also provide insights into potential future therapeutic options for acne. Scars, both atrophic and hypertrophic, are common sequelae to acne. Risk factors associated with the development of acne scars include genetic, systemic, local, and lifestyle factors. Pro-inflammatory cytokines have been shown to play a crucial role in the development of acne-induced hypertrophic scars. Treatment for extensive inflammatory keloid scarring is limited. Surgery and postoperative radiotherapy are two possible options. Transforming growth factor-β (TGFβ), IL-6, matrix metalloproteinase (MMP), IGF-1, and B cells are found in keloid or hypertrophic scar tissues. Biological antibodies targeting these cytokines may be a potential strategy for the prevention and treatment of this type of scar in the future. Future treatment for acne should embrace approaches that target the main etiological factors of acne. In particular, specific emphasis on aggressive treatment in the acute inflammatory phase to reduce the likelihood of scarring and other clinical sequelae, such as pigmentary changes would be highly desirable. Treatment for established acne-induced sequelae should also be considered.

DOI： 10.1007/s13555-021-00552-6

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Neovascularization plays a critical role in skin graft survival. Up to date, the lack of specificity to solely track the newly sprouting blood vessels has remained a limiting factor in skin graft transplantation models. Therefore, the authors developed a new model by using Flt1-tdsRed BAC transgenic mice. Flt1 is a vascular endothelial growth factor receptor expressed by sprouting endothelial cells mediating neoangiogenesis. The authors determined whether this model reliably visualizes neovascularization by quantifying tdsRed fluorescence in the graft over 14 days. METHODS: Cross-transplantation of two full-thickness 1 × 1-cm dorsal skin grafts was performed between 6- to 8-week-old male Flt1 mice and KSN/Slc nude mice (n = 5). The percentage of graft area occupied by tdsRed fluorescence in the central and lateral areas of the graft on days 3, 5, 9, and 14 was determined using confocal-laser scanning microscopy. RESULTS: Flt1+ endothelial cells migrating from the transgenic wound bed into the nude graft were first visible in the reticular dermis of the graft center on day 3 (0.5 ± 0.1; p < 0.05). Peak neovascularization was observed on day 9 in the lateral and central parts, increasing by 2- to 4-fold (4.6 ± 0.8 and 4.2 ± 0.9; p < 0.001). Notably, some limited neoangiogenesis was displayed within the Flt grafts on nude mice, particularly in the center. No neovascularization was observed from the wound margins. CONCLUSION: The ability of the Flt1-tdsRed transgenic mouse model to efficiently identify the origin of the skin-graft vasculature and visualize graft neovascularization over time suggests its potential utility for developing techniques that promote graft neovascularization.

DOI： 10.1097/PRS.0000000000008039

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Keloids are fibrotic lesions that grow unceasingly and invasively and are driven by local mechanical stimuli. Unlike other fibrotic diseases and normal wound healing, keloids exhibit little transformation of dermal fibroblasts into α-SMA+ myofibroblasts. This study showed that asporin is the most strongly expressed gene in keloids and its gene-ontology terms relate strongly to ECM metabolism/organization. Experiments with human dermal cells (HDFs) showed that asporin overexpression/treatment abrogated the HDF ability to adopt a perpendicular orientation when subjected to stretching tension. It also induced calcification of the surrounding 3D collagen matrix. Asporin overexpression/treatment also prevented the HDFs from remodeling the surrounding 3D collagen matrix, leading to a disorganized network of thick, wavy collagen fibers that resembled keloid collagen architecture. This in turn impaired the ability of the HDFs to contract the collagen matrix. Asporin treatment also made the fibroblasts impervious to the fibrous collagen contraction of α-SMA+ myofibroblasts, which normally activates fibroblasts. Thus, by calcifying collagen, asporin prevents fibroblasts from linearly rearranging the surrounding collagen; this reduces both their mechanosensitivity and mechanosignaling to each other through the collagen network. This blocks fibroblast activation and differentiation into the mature myofibroblasts that efficiently remodel the extracellular matrix. Consequently, the fibroblasts remain immature, highly proliferative, and continue laying down abundant extracellular matrix, causing keloid growth and invasion. Notably, dermal injection of asporin-overexpressing HDFs into murine wounds recapitulated keloid collagen histopathological characteristics. Thus, disrupted interfibroblast mechanocommunication may promote keloid progression. Asporin may be a new diagnostic biomarker and therapeutic target for keloids.

DOI： 10.1096/fj.202100111R

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

71歳女性。3年前に左上眼瞼、左右頬部に軽度硬結を伴う隆起性小病変が出現し、同部が急激に増大したため当科へ受診となった。初診時、左頬部に16mm、左上眼瞼に6mm、右頬部に3mm大の結節性病変が認められ、左頬部・上眼瞼部腫瘤の組織生検で皮膚粘液癌とされた。以後、治療として左頬部と左上眼瞼部の腫瘍切除術を行い、初回手術14日後に左頬部の皮膚欠損部をcheek rotation flapで、また左上眼瞼部皮膚欠損部をhatchet flapで創閉鎖し、右頬部の皮膚腫瘍を切除・単純縫縮した。目下、術後9ヵ月経過で転移・再発所見なく、良好に経過している。

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

ケロイド・肥厚性瘢痕と子宮筋腫の関連を明らかにすることを目的に、子宮筋腫の既往のある患者へアンケート調査を行い、121名より有効回答を得た。その結果、子宮筋腫摘出を目的とした開腹手術後の異常瘢痕発生率は62.0%で、先行研究による産婦人科での下腹部開腹手術後の異常瘢痕発生率(27%)より著明に高いことが分かった。

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

ケロイドは、病理組織学的にはKeloidal collagen(KC)といわれる特徴的なコラーゲン線維が出現することが知られており、今回、KCがどこから産生されるかに焦点をあて、臨床診断でケロイドと診断された患者より採取した検体を対象に、電子顕微鏡による組織学的評価を行った。その結果、ケロイド組織内の細胞はαーSMA陽性を示し、筋線維芽細胞の組織学的特徴を有していた。さらに、組織学的に線維芽細胞様と血管内皮細胞様の2種類の筋線維芽細胞が認められ、筋線維芽細胞がこれらの細胞から分化した可能性が示唆された。従来、KC細胞は線維芽細胞が産生したコラーゲン線維が硝子変性(ヒアリン化)したものと考えられてきたが、上記の結果から、KCは筋線維芽細胞により産生され、発生時点ですでにKCとしての特徴を有している可能性が示唆された。

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

婦人科手術後に発生する肥厚性瘢痕およびケロイドの予防と早期治療を目的に当科(大学附属病院形成外科)では、2006年に産婦人科手術後患者を対象としたScar Control外来を立ち上げ、これまで1万人を超える症例の術後瘢痕経過を診察し、下腹部術後肥厚性瘢痕およびケロイドの発生について検討してきた。今回、2006〜2016年までに当院産婦人科にて手術治療を受けた症例1000例(縦瘢痕500例、横瘢痕500例)を対象に、術後下腹部瘢痕の1ヵ月後タイプ分類、下腹部術後肥厚性瘢痕およびケロイドの発生率(術後1年)、早期治療(ステロイド含有テープ治療)介入による下腹部術後肥厚性瘢痕およびケロイド抑制効果などについて検討した。その結果、下腹部術後肥厚性瘢痕およびケロイドの術後1年目の発生率は、縦瘢痕(500例)で27%、横瘢痕(500例)で24%であった。また、縦瘢痕については、術後1ヵ月時に6タイプの瘢痕に分類が可能で、それぞれのタイプにより術後1年目の瘢痕結果が異なっていたが、瘢痕タイプがA(評価項目である「赤み」「硬さ」「盛り上がり」のいずれも「なし」)以外の患者に術後1ヵ月目から保存的治療による早期治療介入を行うと、術後1年目の肥厚性瘢痕およびケロイドの発生率は低下した。

researchmap

記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00266-021-02379-0

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Facial injections with cosmetic fillers can lead to local artery occlusion. The bilateral nasolabial folds of a 39-year-old woman were injected with hyaluronic acid at another hospital. After the righthand injection, the patient immediately felt pain that ran from the right nasolabial fold to the nasal alar. The injecting doctor suspected embolism due to intravascular misinjection and immediately injected hyaluronidase and vasodilator subcutaneously and intravenously, respectively. Five days later, the patient presented at our hospital with extensive endovascular embolization-related signs: along with some oral mucosa, the skin of the right nasolabial fold, right nasal alar, and right mouth corner exhibited necrosis. We diagnosed secondary peripheral embolus, and we used the treatment, namely, subcutaneously flooding/immersing the embolization site in the peripheral blood vessels with 2000 units of hyaluronidase.

DOI： 10.1016/j.jpra.2021.01.009

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The term carcinoma of unknown primary (CUP) refers to a malignant tumor whose histology suggests strongly that it is a metastasis, yet the primary lesion is unknown despite sufficient whole body evaluation at the time of examination. CUP has similar incidences in men and women and the average age at diagnosis is 60 years. While its overall incidence varies depending on the report, it generally accounts for 1-5% of all cancers. Thus, it is rare. We encountered a case of squamous cell carcinoma of the inguinal region that seemed to be a metastasis and for which we could not find the primary lesion. This case is reported here along with a literature review on CUP to increase awareness of this rare lesion.

DOI： 10.1272/jnms.JNMS.2022_89-206

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

GENERAL PURPOSE: To review the various mechanical forces that affect fibroblasts, keratinocytes, endothelial cells, and adipocytes at the cellular and molecular level as well as scar-reducing mechanical devices currently in clinical use. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Compare and contrast the responses of various types of cells to mechanical forces.2. Identify the mechanical devices and techniques that can help restore skin integrity.

DOI： 10.1097/01.ASW.0000725220.92976.a7

PubMed

researchmap

記述言語：英語  

We previously reported cases of anterior-neck reconstruction using super-thin and perforator-supercharged skin-pedicled flaps harvested from the pectoral area and back. Here, we reconstructed a neck-scar contracture with a long skin-pedicled flap from the pectoral area that survived without congestion despite not being supercharged with a perforator, as planned. The patient, a 67-year-old man, was admitted to our hospital due to neck-scar contracture after a chemical burn 3 years previously. During surgery, the scar was resected above the platysma. A large, 19 × 6-cm skin-pedicled flap was elevated from the left pectoral area. We planned to supercharge the flap by anastomosing the second intercostal perforator to the flap periphery but could not confirm the perforator intraoperatively. To promote flap survival, we did not elevate the flap pedicle more than absolutely necessary and then manipulated the flap very carefully. The flap survived fully and the contracture was effectively released. Thin flaps are useful for reconstructing exposed areas such as the face, neck, and dorsum of the hands that require good outcomes in terms of both function and aesthetics. However, if the flap is too large, ischemia/congestion could arise in the periphery unless the blood flow is stabilized by attaching a perforator. In our case, supercharging was not possible and we had to resort to careful intraoperative maneuvers to ensure flap survival. This approach was successful and suggests that although supercharging of thin and large flaps is preferred, unexpectedly unsuperchargeable flaps can be rescued by careful and finely tuned surgical judgment and techniques.

DOI： 10.1097/GOX.0000000000003404

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

In 2006, we established a scar/keloid-specialized unit in the Department of Plastic, Reconstructive, and Aesthetic Surgery at Nippon Medical School (NMS) in Tokyo, Japan. In the ensuing 15 years, we treated approximately 2,000 new scar/keloid patients annually. This extensive experience has greatly improved the efficacy of the treatments we offer. Therefore, we discuss here the latest NMS protocol for preventing and treating keloids and hypertrophic scars. While this protocol was optimized for Japanese patients, our experience with a growing body of non-Japanese patients suggests that it is also effective in other ethnicities. The extensive evidence-based experience underlying the NMS protocol suggests that it may be suitable as the foundation of a standard international prevention/treatment algorithm for pathological scars.

DOI： 10.1272/jnms.JNMS.2021_88-106

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: Although injections with copolyamide fillers (Aquafilling/Los Deline and Aqualift/Activegel) are currently used widely for breast augmentation, many complications have been reported. A recent position statement by a Korean aesthetic/reconstructive breast surgery society indicated these fillers are the same as polyacrylamide gel (PAAG), which is widely prohibited due to complications. To test this statement, this retrospective cohort study examined the clinical complications after breast augmentation with copolyamide fillers. Nuclear magnetic resonance (NMR) analysis of copolymer and PAAG fillers was also conducted.Methods: All consecutive patients with concerns about or sequelae from copolyamide fillers who visited our hospital in 2018-2020 were identified. The injected formulation, complications, and intraoperative findings were recorded. Copolyamide fillers were compared with PAAG and 2 PAAG fillers (Amazingel and Aquamid) by NMR.Results: Of the 29 patients (all women; average age, 42 years), 17 complained of breast deformity. Eight had puncture site infections and mammary gland inflammation. Five exhibited induration (single large/small lumps). In 4 cases, the filler had migrated outside of the breast, including to the back and vulva; these cases had severe symptoms. NMR showed that the copolyamide and PAAG fillers bore all of the characteristic peaks of PAAG.Conclusions: Our clinical/intraoperative and NMR findings showed, respectively, that copolyamide fillers cause the same complications as PAAG fillers and have the same composition. Thus, the risks of copolyamide fillers for breast augmentation are equivalent to those for PAAG fillers. It is strongly recommended not to use copolyamide fillers until their long-term safety is established.

DOI： 10.1097/GOX.0000000000003296

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Cryptotia is a congenital auricular deformity. Common methods of surgical reconstruction involve creating an auricular temporal groove using local flaps and/or a skin graft. However, it can be difficult to determine which method is most suited to the unique 3-dimensional (3D) structure of each cryptotic ear. Here, we showed that creating 3D ear models of a cryptotic ear with a 3D camera and printer and using these models to simulate surgery with two different flap methods (cat's-ear and square) allowed selection of a reconstruction method that led to good outcomes after the actual surgery. The patient was a 7-year-old girl with left cryptotia. A 3D camera was used to acquire 3D data for the ear. After structural analysis, a home 3D printer was used to print the data into 3D ear models using an elastic material. These models exhibited good plasticity. After subjecting the models to simulated cat's-ear and square flap surgeries, the cat's-ear flap method was considered to better reproduce the healthy side of the ear compared with the square flap method for this particular case. Ear morphology during and after the actual surgery closely resembled the model-ear morphology during and after the simulated cat's-ear flap surgery. We successfully created a full-scale 3D model with good plasticity using a 3D camera and 3D printer. This allowed easy, noninvasive preoperative evaluation and identification of the most suitable operation for the specific case, facilitating easier, more successful surgery.

DOI： 10.1097/GOX.0000000000003194

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Plastic surgery requires extensive wide-ranging surgical knowledge, special technical dexterity, and personal skills in order to achieve improved quality of life and satisfying outcomes for patients. For decades, international plastic surgery fellowship programs have offered opportunities to enhance the subspecialty training of young plastic surgeons abroad and promote international exchange of information in the field of plastic surgery. However, concerns around enrolling in a nontraditional educational strategy at the postgraduate level have restricted young plastic surgery residents from pursuing comprehensive training opportunities overseas. Therefore, we present a personal experience of a distinct established international fellowship program in plastic, reconstructive, and aesthetic surgery at Nippon Medical School Hospital, Japan, as an example. This institution has adopted the use of highly skilled surgical techniques, providing basic research education along with the teaching of essential personal skills needed in modern plastic surgery. As a mean to promote international educational collaboration in plastic surgery, we discussed the modern plastic surgery educational strategies worldwide that participate in developing a successful plastic surgeon's career.

DOI： 10.1097/GOX.0000000000003367

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Objective: Various skin incision methods have been reported for reduction mammoplasty and mastopexy. This report describes a new incision method that may improve on conventional methods, particularly with respect to prevention of hypertrophic scars. Methods: We developed a comma-shaped incision method that results in fewer scars and less strain on the suture line. We then applied this new method to two cases, namely, one case of breast reduction and one case of breast fixation. Results: In both cases, we achieved good results. There was no scar at the inframammary fold, and no hypertrophic scar formation. All scars were within the breast area and were not in contact with the brassiere wire; hence, there was less pain after the operation. Conclusions: We developed a new incision method for reduction mammoplasty and mastopexy.

DOI： 10.1272/jnms.JNMS.2021_88-313

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Summary: In general, facial nerve palsy is treated by reconstructive surgeons, and the role of cosmetic surgeons is largely seen as secondary. The present report describes a case of refractory facial nerve palsy that arose after malignant parotid-tumor resection and high-dose radiotherapy, and that we reconstructed with a combination of cosmetic and reconstructive procedures. The procedures consisted of facelift techniques (lateral SMASectomy, creation of a nasolabial fold with three suture loops anchored at the temporal fascia, and frontal lift), a new wrinkle-removing technique wherein the frontal-muscle function was disrupted, and excision of surplus skin to rejuvenate the face. The outcomes were good, including at 1 year after surgery, and the 71-year-old patient expressed considerable satisfaction. The frontalis muscle resection effectively removed the wrinkles, helped balance the left and right sides, and permitted anti-aging surgery. This procedure has permanent effects, unlike other methods (eg, botulinum-toxin injections) that serve to weaken facial muscle function. It is notable that despite the high-dose radiotherapy the patient had received and the resulting extensive subcutaneous-tissue adhesion, our surgical protocol was relatively easy to perform as well as highly effective. Thus, even static reconstruction can give great hope and satisfaction to patients with facial nerve palsy.

DOI： 10.1097/GOX.0000000000003452

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Keloid disease is hard to fully eradicate. Recurrence and other unsatisfactory results were found in many patients. No current therapeutic modality has been determined to be most effective for treating keloid scars. Intralesional corticosteroid injections is most commonly recommended for primary management of small and young keloids as well as hypertrophic scars. However, it's difficult for patients to adhere to long-term triamcinolone acetonide injection therapy because of the pain, inconvenience or complications including hormonal imbalance or irregular menstruation. OBJECTIVE: We aimed to determine whether and how Strontium-90 brachytherapy as an adjuvant radiation could affect keloid recurrence after intralesional triamcinolone and 5-fluorouracil injections. METHODS: We included keloid patients from March 2019 to September 2019 and randomly allocated them to two groups after 3 intralesional triamcinolone and 5-fluorouracil injections at 3 weeks interval. The experimental group received Strontium-90 brachytherapy at a total dose of 15-20Gy, while the control group didn't receive any adjuvant treatment. We performed both Vancouver Scar Scale scoring and Color Doppler ultrasound examination to monitor and evaluate lesions regularly. A one-year follow-up was completed for each patient. RESULTS: 31 patients who had 42 keloids in total were recruited. We found intralesional triamcinolone and 5-fluorouracil injections could effectively reduce the thickness and modify the hardness of small and young keloids. Strontium-90 brachytherapy reduced the one-year recurrence rate from 85.7 percent to 44.4 percent after 3 intralesional triamcinolone and 5-fluorouracil injections. The lesions' thickness or elasticity was not affected by Strontium-90 brachytherapy. CONCLUSION: Strontium-90 brachytherapy as an adjuvant radiation could effectively reduce small sized keloids recurrence after intralesional triamcinolone and 5-fluorouracil injections. It worked by enhancing the lesions' stability post-injection. TRIAL REGISTRATION: The clinical trial registration number: ChiCTR2000030141. Name of trial registry: Chinese Clinical Trial Registry (http://www.chictr.org.cn/).

DOI： 10.1371/journal.pone.0248799

PubMed

researchmap

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/GOX.0000000000003451

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report the case of an elderly male patient with ductal carcinoma in situ(DCIS) of the nipple. A 93-year-old man visited the hospital because of pain and bleeding in and swelling of the right nipple. A benign tumor was suspected, but a definite diagnosis could not be made before surgery based on echo and cytology findings; thus, a malignant tumor could not be ruled out. He underwent partial mastectomy combined with the areola and nipple for diagnosis and treatment. Histologic examination confirmed the diagnosis of DCIS of the nipple. The surgical margin was negative. At 6 months after the surgery, he was doing well with no evidence of disease in the absence of postoperative adjuvant therapy. Thus, clinicians should consider breast carcinoma of the nipple as a differential diagnosis when an elderly man presents with swelling of the nipple.

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: A universally accepted therapeutic strategy for umbilical keloids has not been determined. Our team has had considerable success with combination therapy composed of surgical excision followed by postoperative radiotherapy and steroid plaster/injection. Methods: All consecutive patients with umbilical keloids that developed from endoscopic surgical scars and underwent minimal-margin keloid excision followed by umbilicoplasty with a flap if needed, tension-reduction suturing, and postoperative radiotherapy in 2013-2017 in the keloid/scar-specialized clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School. The postsurgical radiotherapy regimen was 15 Gy administered in 2 fractions over 2 consecutive days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape or, if needed, steroid plaster. The primary study focus was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the growth of stiff red lesions in even small areas of the scar that was refractory to 2-6 months of steroid-plaster therapy. Results: The case series consisted of 34 patients with 34 lesions. Three lesions (8.8%) recurred. One recurrence was successfully treated by concomitant steroid plaster/injection. The other 2 cases were resistant to steroid injection and underwent reoperation without radiotherapy followed by 6 months of steroid-plaster therapy. None of the 3 cases recurred within 2 years of steroid plaster/injection completion or reoperation. Conclusion: Umbilical keloids can be successfully treated by customized treatment plans that involve appropriate surgical modalities (including umbilicoplasty, if required), postoperative radiotherapy (15 Gy/2 fractions/2 days), and wound/scar self-management with silicone tape and steroid plaster.

DOI： 10.1097/GOX.0000000000003181

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cutaneous pathological scars are fibrotic lesions that grow continuously, invade the adjacent skin, and are erythematous, itchy, and painful. Their etiology remains unclear but may involve genetic, local mechanical, and systemic factors. Here, we will summarize the main systemic factors that shape cutaneous pathological scarring, especially keloid formation and aggravation. They include circulating cytokines, chemokines, growth factors, particular cell types, sex hormones, the systemic renin-angiotensin system, and vitamin D, all of which directly shape the angiogenesis, inflammation, fibrosis, and remodeling in pathological scars. There are also several environmental factors that more indirectly influence pathological scar formation or progression, namely diet, smoking, psychological stress, and exercise. Notably, much of the evidence on these systemic factors focus on their effects on one pathological scar characteristic, namely their fibrosis. However, systemic factors probably also shape other pathological scar characteristics. We describe two new avenues of keloid research that may greatly improve our understanding of pathological scarring and the systemic factors that affect it. One is the multiple similarities between keloids and tumors; the other is the different stem-cell populations in keloids. We expect this research will greatly aid the development of diagnostic biomarkers for cutaneous pathological scars and drugs/techniques/regimens that prevent, improve, or cure these scars.

DOI： 10.1096/fj.202001157R

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

researchmap

記述言語：英語  

Although keloids are common on the joints, precordial areas, and abdomen, toe keloids are rare. The limited literature to date also suggests that they can be difficult to treat. We experienced the case of a 21-year-old woman with toe keloids on the first, second, and third toes that arose after ingrown-nail operations at another hospital. The second toe keloid was resected but recurred. Since subsequent conservative treatments were ineffective, the patient was referred to our hospital. The first visit revealed three large keloids: in particular, the keloid on the second toe had engulfed the entire circumference of the toe. Surgery with the core-excision method and postoperative radiotherapy were performed. After the sutures were removed, the scars were treated for 24 hours/day with steroid plaster until the induration disappeared. One and a half years after the operation, recurrence was not observed and the appearance of the toes had improved greatly. Thus, combination therapy composed of core excision, radiotherapy, and steroid plaster therapy is highly effective for toe keloids.

DOI： 10.1097/GOX.0000000000003085

PubMed

researchmap

記述言語：英語   出版者・発行元：CENTER ACADEMIC PUBL JAPAN  

Summary The purpose of this study was to determine the effect of beta-carotene supple-mentation to Japanese Black calves on the peripheral blood leukocyte population. Twenty-two Japanese Black calves were alternately assigned to two groups. Eleven calves received 20 mg/d of beta-carotene orally from 2 to 8 wk of age (BC group), and the other 11 calves did not receive (control group). The serum beta-carotene concentration in the BC group at 4, 8 and 12 wk of age were significantly higher than those in the control group (p<0.05). The numbers of CD4+ cells in the BC group were significantly higher than those in the control group at 4 wk of age (p<0.05). These results confirmed that beta-carotene supplemen-tation to Japanese Black calves affected the peripheral blood leukocyte population.

DOI： 10.3177/jnsv.66.381

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hypertrophic scars (HSs) and keloids are histologically characterized by excessive extracellular matrix (ECM) deposition. ECM deposition depends on the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteases (TIMPs). TIMP-1 has been linked to ECM degradation and is therefore a promising therapeutic strategy. In this study, we generated super carbonate apatite (sCA) nanoparticle-encapsulated TIMP-1 small interfering RNA (siRNA) (siTIMP1) preparations and examined the effect of local injections on mouse HSs and on ex vivo-cultured keloids. The sCA-siTIMP1 injections significantly reduced scar formation, scar cross-sectional areas, collagen densities, and collagen types I and III levels in the lesions. None of the mice died or exhibited abnormal endpoints. Apatite accumulation was not detected in the other organs. In an ex vivo keloid tissue culture system, sCA-siTIMP1 injections reduced the thickness and complexity of collagen bundles. Our results showed that topical sCA-siTIMP1 injections during mechanical stress-induced HS development reduced scar size. When keloids were injected three times with sCA-siTIMP1 during 6 days, keloidal collagen levels decreased substantially. Accordingly, sCA-siRNA delivery may be an effective approach for keloid treatment, and further investigations are needed to enable its practical use.

DOI： 10.1016/j.omtn.2020.08.005

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：THIEME MEDICAL PUBL INC  

Various types of propeller flaps from multiple donor sites can be used to reconstruct anterior trunk skin defects. The actual selection depends on the condition and location of the recipient site, especially if it is to be the chest or abdomen that requires attention. Before surgery commences, it is always important to use an imaging analyses such as computed tomography angiography to examine and identify perforators that could perfuse a perforator-pedicled propeller flap (PPPF), as it is the most multifaceted imaging technique. Clusters of perforators that can be commonly used for the "workhorse" PPPFs for the thoracic and abdominal regions are the internal mammary artery perforator, the musculophrenic artery perforator, and the deep inferior epigastric perforator. These perforators are reliable and large enough to support long and large propeller flaps that will cover most defects in this region, while still allowing primary donor-site closure.

DOI： 10.1055/s-0040-1714270

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：THIEME MEDICAL PUBL INC  

The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the "Tokyo consensus," we proposed a definition and a classification schema for propeller flaps. A propeller flap was defined as an "island flap that reaches the recipient site through an axial rotation." The classification included the SPP (SPP) flap, the perforator pedicled propeller (PPP) flap, and the supercharged PPP (SCP) flap. A recent update added a new category, the axial pedicled propeller (APP) flap. Here we propose our updated and comprehensive classification of propeller flaps, taking into account the previous classification and subsequent publications. Based on their vascular pedicle, we consider the following five types of propellers: (1) SPP flap, 2.PPP flap, its subtype (2a) SCP flap, (3) APP flap, (4) muscle propeller flap, and (5) chimeric propeller flap. The variables that can be taken into account in the classification are as follows: type of nourishing pedicle, degrees of skin island rotation, position of the nourishing pedicle, artery of origin of the pedicle, and flap shape.

DOI： 10.1055/s-0040-1715158

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Treatment of cranial deformity is often performed during infancy in cases such as craniosynostosis and deformational plagiocephaly. To acquire morphologic standards for the treatment goals of these conditions, we created cranial average models and elucidated the growth patterns of the cranium of healthy infants in 3-dimension (3D) using homologous modeling. Methods: Homologous modeling is a technique that enables mathematical analysis of different 3D objects by converting the objects into homologous models that share the same number of vertices with the same spatial relationships. Craniofacial computed tomographic data of 120 healthy infants ranging in age from 1 to 17 months were collected. Based on the computed tomographic data, we created 120 homologous models. Six average 3D models (20 individuals each for 6 different age groups) were created by averaging the vertices of the models. Three-dimensional growth patterns of the cranium were clarified by comparing the 6 average models. Results: We successfully created 6 average models and visualized the growth patterns of the cranium. From 1-month-old to 5-month-old infants, the entire cranium except for the occipital region grows, and the cranium tended to be brachycephalic (cephalic index at 4-5 months: 87.1-97.3), but the growth was thereafter localized to specific areas. Conclusions: Three-dimensional growth patterns of the cranium of healthy infants were clarified. These findings will support the understanding and treatment of the conditions that cause cranial deformity. To our knowledge, this is the first report to visualize the growth patterns of the entire cranium of healthy infants in 3D.

DOI： 10.1097/GOX.0000000000003032

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：THIEME MEDICAL PUBL INC  

Since propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

DOI： 10.1055/s-0040-1715159

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Basic fibroblast growth factor (bFGF) plays several key roles in wound healing. Over the last 2 decades, clinical and basic research on bFGF has been actively conducted in Japan with reports on its potent efficacy in accelerating the healing of chronic ulcers and burn wounds by stimulating key cellular players in the skin. However, its efficacy remains unrecognized internationally. Thus, this study reviews current knowledge about the therapeutic value of bFGF in wound management and scar prevention accumulated in Japan over the last 2 decades. METHODS: We review the Japanese literature that demonstrates the anti-scarring effects of bFGF and exhaustively assess how these effects are exerted. Using the search terms "bFGF OR growth factors AND wound healing in Japan" and "bFGF AND scar prevention in Japan," we conducted a search of the PubMed database for publications on the role of bFGF in wound and scar management in Japan. All eligible papers published between 1988 and December 2019 were retrieved and reviewed. RESULTS: Our search yielded 208 articles; 82 were related to the application of bFGF for dermal wound healing in Japan. Of these, 27 fulfilled all inclusion criteria; 11 were laboratory studies, 7 were case reports, 4 were clinical studies, and 5 were randomized controlled trials. CONCLUSION: Further research, with recognition of the therapeutic value of bFGF in wound and scar management and its clinical applications, is needed to provide additional clinical advantages while improving wound healing and reducing the risk of post-surgical scar formation.

DOI： 10.1007/s13555-020-00407-6

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND The 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Cutera, Inc., Brisbane, CA) and steroid tape (fludroxycortide tape) have been used to treat keloids and hypertrophic scars. OBJECTIVE To evaluate the efficacy of contact-mode 1,064-nm Nd:YAG laser therapy and steroid tape for hypertrophic cesarean-section scars versus conservative therapy (steroid tape only). MATERIALS AND METHODS A medical record review identified 40 consecutive Japanese patients who had hypertrophic scars (total Japan Scar Workshop Scar Scale [JSS] 2015 evaluation scores of 9 to 12) for more than 1 year after a vertical cesarean section and who were treated at our scar-specialist clinic from July 2015 to December 2017. All 40 patients continued treatment until the total JSS score dropped below 3. Recurrence was defined as a >= 1-point increase in the total JSW score 6 months after achieving a total JSS score RESULTS The patients had a mean age of 34.2 years. The test (n= 25) and control (n= 15) groups took on average 16.9 and 24.3 months to achieve a total JSS score <3, respectively (p< .01). In the following 6 months, none of the scars recurred. CONCLUSION Nd:YAG laser treatment effectively decreased the total treatment time of hypertrophic cesarean-section scars. An algorithm for treating mild and severe hypertrophic cesarean-section scars is proposed.

DOI： 10.1097/DSS.0000000000002235

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Cutaneous wound healing is a complex, dynamic physiological process. Traditional methods of promoting wound healing are not always effective. Consequently, alternative modalities, such as photodynamic therapy (PDT), are needed. We examined the effectiveness and underlying mechanisms of PDT in a murine model of acute wound healing.Methods: Two excisional wounds were produced, one on each side of the midline, in C57bL/6J mice. Methyl 5-aminolevulinate hydrochloride (MAL) was applied to the right-side wound. After 1 to 3 hours of incubation, the wound was irradiated with red light. The left-side wound was not treated with MAL or red light. On Day 14, the wounds were excised and subjected to histological and immunohistochemical analysis.Results: During the first week, no difference was seen between the two sides. However, at week 2, PDT-treated wounds exhibited delayed re-epithelialization. On Day 14, hematoxylin and eosin (HE) staining showed a continuous epithelial lining in untreated wounds. In contrast, PDT-treated wounds partially lacked epithelium in the wound bed. Masson's Trichrome (MTC) staining showed a thicker dermis and more collagen fibers and inflammatory cells in PDT-treated wounds than in untreated wounds. Immunohistochemical analyses showed significantly fewer CD31(+) blood vessels and greater collagen III density in PDT-treated wounds than in untreated wounds. However, treated and untreated wounds did not differ in collagen I density.Conclusions: PDT delayed acute wound healing in a murine model of secondary intention wound healing.

DOI： 10.1272/jnms.JNMS.2020_87-301

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

当院では耳ケロイドに対し基本的に外科的切除+術後放射線治療の組み合わせを第一選択としており、外来受診、手術、放射線治療(1〜2日)、抜糸の最低4〜5日間の通院で治療が可能である。外科的切除では耳垂には楔状切除、耳介にはくり抜き法を基本とし、症例に応じてZ形成術や皮弁作成術を追加しており、術後はケロイドの再発予防を目的として十分な圧迫固定を行い、基本的には術後3日以内に放射線治療を開始している。また、術後は1〜1ヵ月半毎に6ヵ月〜数年間の経過観察を行い、術後創部の硬さを認める症例には早期よりステロイド治療を開始している。現時点で再発率の上昇はなく、放射線治療に伴う有害事象も認めていない。

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Soft tissue fibrosis in important organs such as the heart, liver, lung, and kidney is a serious pathological process that is characterized by excessive connective tissue deposition. It is the result of chronic but progressive accumulation of fibroblasts and their production of extracellular matrix components such as collagens. Research on pathological scars, namely, hypertrophic scars and keloids, may provide important clues about the mechanisms that drive soft tissue fibrosis, in particular the vascular involvement. This is because these dermal fibrotic lesions bear all of the fibrotic characteristics seen in soft tissue fibrosis. Moreover, their location on the skin surface means they are readily observable and directly treatable and therefore more accessible to research. We will focus here on the roles that blood vessel-associated cells play in cutaneous scar pathology and assess from the literature whether these cells also contribute to other soft tissue fibroses. These cells include endothelial cells, which not only exhibit aberrant functions but also differentiate into mesenchymal cells in pathological scars. They also include pericytes, hepatic stellate cells, fibrocytes, and myofibroblasts. This article will review with broad strokes the roles that these cells play in the pathophysiology of different soft tissue fibroses. We hope that this brief but wide-ranging overview of the vascular involvement in fibrosis pathophysiology will aid research into the mechanisms underlying fibrosis and that this will eventually lead to the development of interventions that can prevent, reduce, or even reverse fibrosis formation and/or progression.

DOI： 10.3390/ijms21072542

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Bacterial infection is a common wound complication that can significantly delay healing. Classical local therapies for infected wounds are expensive and are frequently ineffective. One alternative therapy is photodynamic therapy (PDT). We conducted a systematic review to clarify whether PDT is useful for bacteria-infected wounds in animal models. PubMed and Medline were searched for articles on PDT in infected skin wounds in animals. The language was limited to English. Nineteen articles met the inclusion criteria. The overall study methodological quality was moderate, with a low-moderate risk of bias. The animal models were mice and rats. The wounds were excisional, burn, and abrasion wounds. Wound size ranged from 6 mm in diameter to 1.5 x 1.5 cm(2). Most studies inoculated the wounds with Pseudomonas aeruginosa or methicillin-resistant Staphylococcus aureus. Eleven and 17 studies showed that the PDT of infected wounds significantly decreased wound size and bacterial counts, respectively. Six, four, and two studies examined the effect of PDT on infected wound-cytokine levels, wound-healing time, and body weight, respectively. Most indicated that PDT had beneficial effects on these variables. PDT accelerated bacteria-infected wound healing in animals by promoting wound closure and killing bacteria.

DOI： 10.1111/iwj.13269

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

・植皮術では植皮片の二次拘縮を予防するために全層植皮術を行う。・小児手指への植皮の場合、採皮部の第1選択は足の内顆とする。・指間にかかる瘢痕拘縮では、指間は局所皮弁で再建する。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background:The authors developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array technology. It may aid wound healing because it is likely to be associated with lower risks of infection and heat-induced pain compared with conventional ultrasound methods. The authors hypothesized that the microdeformation it induces accelerates wound epithelialization. Its effects on key wound-healing processes (angiogenesis, collagen accumulation, and angiogenesis-related gene transcription) were also examined.Methods:Immediately after wounding, bilateral acute wounds in C57BL/6J mice were noncontact low-frequency ultrasound- and sham-stimulated for 1 hour/day for 3 consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as the percentage change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (five to six per time point) and subjected to histopathology with hematoxylin and eosin and Masson trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis.Results:Compared to sham-treated wounds, ultrasound/phased-array-treated wounds exhibited significantly accelerated epithelialization (65 +/- 27 percent versus 30 +/- 33 percent closure), angiogenesis (4.6 +/- 1.7 percent versus 2.2 +/- 1.0 percent CD31(+) area), and collagen deposition (44 +/- 14 percent versus 28 +/- 13 percent collagen density) on days 5, 2, and 5, respectively (all p < 0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively.Conclusions:The authors' noncontact low-frequency ultrasound phased-array device improved the wound-healing rate. It was associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. The device may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.

DOI： 10.1097/PRS.0000000000006481

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The authors developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array technology. It may aid wound healing because it is likely to be associated with lower risks of infection and heat-induced pain compared with conventional ultrasound methods. The authors hypothesized that the microdeformation it induces accelerates wound epithelialization. Its effects on key wound-healing processes (angiogenesis, collagen accumulation, and angiogenesis-related gene transcription) were also examined. METHODS: Immediately after wounding, bilateral acute wounds in C57BL/6J mice were noncontact low-frequency ultrasound- and sham-stimulated for 1 hour/day for 3 consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as the percentage change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (five to six per time point) and subjected to histopathology with hematoxylin and eosin and Masson trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis. RESULTS: Compared to sham-treated wounds, ultrasound/phased-array-treated wounds exhibited significantly accelerated epithelialization (65 ± 27 percent versus 30 ± 33 percent closure), angiogenesis (4.6 ± 1.7 percent versus 2.2 ± 1.0 percent CD31 area), and collagen deposition (44 ± 14 percent versus 28 ± 13 percent collagen density) on days 5, 2, and 5, respectively (all p < 0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively. CONCLUSIONS: The authors' noncontact low-frequency ultrasound phased-array device improved the wound-healing rate. It was associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. The device may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.

DOI： 10.1097/PRS.0000000000006481

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background and Objectives There is currently intense multidisciplinary interest and a maturing body of literature regarding laser treatments for traumatic scars, but international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the tremendous potential of laser techniques, offer recommendations for safe and efficacious treatment, and promote wider patient access guided by future high-quality research. Study Design/Materials and Methods An international panel of 26 dermatologists and plastic and reconstructive surgeons from 13 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the laser treatment of traumatic scars. A three-step modified Delphi method took place between March 2018 and March 2019 consisting of two rounds of emailed questionnaires and supplementary face-to-face meetings. The panel members approved the final manuscript via email correspondence, and the threshold for consensus was at least 80% concurrence among the panel members. Results The manuscript includes extensive detailed discussion regarding a variety of laser platforms commonly used for traumatic scar management such as vascular lasers and ablative and non-ablative fractional lasers, special considerations such as coding and laser treatments in skin of color, and 25 summary consensus recommendations. Conclusions Lasers are a first-line therapy in the management of traumatic scars and contractures, and patients without access to these treatments may not be receiving the best available care after injury. Updated international treatment guidelines and reimbursement schemes, additional high-quality research, and patient access should reflect this status. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc.

DOI： 10.1002/lsm.23201

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background: Severe keloids are currently treated with surgical resection followed by radiation. Radiotherapy is essential for preventing recurrences. Fascia tensile reduction suturing may also prevent recurrence. We asked whether superficial fascia tensile reduction with or without deep fascia tensile reduction reduced skin mechanical tension and yielded good outcomes.Methods: Geometric modeling on 3-dimensional anatomic shapes assessed the effect of superficial fascia tensile reduction with or without deep fascia tensile reduction on skin tension. A retrospective cohort study was performed on patients with severe anterior-chest keloids with Japan Scar Workshop-scar scale classification score >= 16 who underwent resection plus fascia tensile reduction plus radiotherapy between 2011 and 2016 and were followed for >18 months. Patient characteristics and 18-month postoperative outcomes were examined. Postoperative outcome was defined as rates of keloid disappearance, improvement, and obvious recurrence.Results: Maximal mechanical forces placed on the dermis by dermal sutures, dermal sutures plus superficial fascia tensile reduction, and dermal sutures plus superficial fascia tensile reduction plus deep fascia tensile reduction were 4,700, 573, and 697 Pa, respectively. Adding deep fascia tensile reduction to superficial fascia tensile reduction decreased the force on the superficial fascia. Of 77 cohort patients, 27 and 50 underwent superficial fascia tensile reduction and superficial fascia tensile reduction plus deep fascia tensile reduction, respectively. Superficial fascia tensile reduction plus deep fascia tensile reduction patients underwent complete excision more often (60.0% vs 37.0%, P = .046). The groups did not differ in 18-month surgical outcome, including recurrence rate (P = .670).Conclusion: Our 2003 study showed that in anterior-chest keloids, resection plus non-fascial suturing plus radiotherapy led to a 43.1% recurrence. Thus, fascia tensile reduction suturing helps reduce anteriorchest keloid recurrence to similar to 5.2%. Superficial fascia tensile reduction plus deep fascia tensile reduction is suitable for relatively large keloids that require total resection. Deep fascia tensile reduction may facilitate superficial fascia tensile reduction but may only be useful when it is technically difficult to achieve reduction with superficial fascia tensile reduction alone. (C) 2019 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.surg.2019.07.028

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Wound healing is a complex biological process, and imbalances of various substances in the wound environment may prolong healing and lead to excessive scarring. Keloid is abnormal proliferation of scar tissue beyond the original wound margins with excessive deposition of extracellular matrix (ECM) and chronic inflammation. Despite numerous previous research efforts, the pathogenesis of keloid remains unknown. Vascular endothelial cells (VECs) are a major type of inductive cell in inflammation and fibrosis. Despite several studies on vascular morphology in keloid formation, there has been no functional analysis of the role of VECs. In the present study, we isolated living VECs from keloid tissues and investigated gene expression patterns using microarray analysis. We obtained 5 keloid tissue samples and 6 normal skin samples from patients without keloid. Immediately after excision, tissue samples were gently minced and living cells were isolated. Magnetic-activated cell sorting of VECs was performed by negative selection of fibroblasts and CD45+ cells and by positive selection of CD31+cells. After RNA extraction, gene expression analysis was performed to compare VECs isolated from keloid tissue (KVECs) with VECs from normal skin (NVECs). After cell isolation, the percentage of CD31+ cells as measured by flow cytometry ranged from 81.8%-98.6%. Principal component analysis was used to identify distinct molecular phenotypes in KVECs versus NVECs and these were divided into two subgroups. In total, 15 genes were upregulated, and 3 genes were downregulated in KVECs compared with NVECs using the t-test (< 0.05). Quantitative RT-PCR and immunohistochemistry showed 16-fold and 11-fold overexpression of SERPINA3 and LAMC2, respectively. SERPINA3 encodes the serine protease inhibitor, α1-antichymotripsin. Laminin γ2-Chain (LAMC2) is a subunit of laminin-5 that induces retraction of vascular endothelial cells and enhances vascular permeability. This is the first report of VEC isolation and gene expression analysis in keloid tissue. Our data suggest that SERPINA3 and LAMC2 upregulation in KVECs may contribute to the development of fibrosis and prolonged inflammation in keloid. Further functional investigation of these genes will help clarify the mechanisms of abnormal scar tissue proliferation.

DOI： 10.3389/fcell.2020.00658

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aim: Abnormal scars such as hypertrophic scars (HSs) and keloids are excessively growing scars that exhibit chronic inflammation and capillary vasculogenesis. The lipid mediator sphingosine-1-phosphate (S1P) is important in inflammatory cell recruitment and angiogenesis. Fingolimod (FTY720) is an analog of S1P and thus functionally antagonizes S1P receptors and inhibits the enzyme that produces S1P. We examined the effects of topical FTY720 injections on mechanical force-induced HS progression. Methods: Mechanical force-induced HSs were generated in C57BL6/J mice by suturing a dorsal incision and applying a stretching device on Days 6, 8, 10, and 12. On Days 8, 10, and 12, intracutaneous FTY720 (10 μM) or control vehicle injections were performed. On Day 14, scar tissues and blood were procured and subjected to histology and flow cytometry. Results: Flow cytometry showed that FTY720 decreased the frequencies of macrophages with M2 predominance in the scars but had no effect on total, CD4+, or CD8a+ T cell frequencies. FTY720 also decreased the vascular endothelial cell frequencies in the scar along with the microvessels, as determined by immunohistochemistry. Compared to the vehicles, FTY720 treatment significantly reduced the gross scar area and the cross-sectional scar area on histology. On the other hand, FTY720 tended to reduce white blood cells and significantly reduced the lymphocyte frequencies in the blood. Conclusion: Topical FTY720 induces M2 predominance and impairs angiogenesis. Therefore, its local immunosuppressive mechanisms differ from those of conventional immunosuppressive agents. Topical FTY720 can be a novel therapeutic option for abnormal scars that are difficult to control with corticosteroids. Its lymphocytopenic effects may be limited by careful optimization of the treatment regimen.

DOI： 10.1155/2020/7057195

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Primary cilia (PC) are solitary, post-mitotic, microtubule-based, and membrane-covered protrusions that are found on almost every mammalian cell. PC are specialized cellular sensory organelles that transmit environmental information to the cell. Signaling through PC is involved in the regulation of a variety of cellular processes, including proliferation, differentiation, and migration. Conversely, defective, or abnormal PC signaling can contribute to the development of various pathological conditions. Our knowledge of the role of PC in organ development and function is largely based on ciliopathies, a family of genetic disorders with mutations affecting the structure and function of PC. In this review, we focus on the role of PC in their major signaling pathways active in skin cells, and their contribution to wound healing and scarring. To provide comprehensive insights into the current understanding of PC functions, we have collected data available in the literature, including evidence across cell types, tissues, and animal species. We conclude that PC are underappreciated subcellular organelles that significantly contribute to both physiological and pathological processes of the skin development and wound healing. Thus, PC assembly and disassembly and PC signaling may serve as attractive targets for antifibrotic and antiscarring therapies.

DOI： 10.3389/fcell.2020.578384

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.

DOI： 10.1186/s41038-019-0175-y

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ADIS INT LTD  

Introduction: Keloids are a cutaneous fibroproliferative disorder. Despite the fact that keloids are relatively common lesions, the statistics of patient with keloids especially sex difference remain unknown. To better understand it, we conducted an extensive cross-sectional analysis of a large cohort of patients with keloids (n=1659). The study showed for the first time that female sex may be an inherent keloid risk factor.Methods: This cross-sectional study of 1659 consecutive patients with keloids who attended a plastic surgery outpatient clinic in Japan in 2014 analyzed age at keloid onset, age at the first medical examination for keloid, and the influence of sex on these variables.Results: In both male and female patients, the keloids were most likely to start in puberty and there was no significant difference in the mode value for age of onset (16 vs. 20 years). Though female patients were twice as prevalent as male patients at nearly all onset ages, female patients predominated over male patients with a gender ratio of 2.7:1 in cases of onset before the age of 15 years. Moreover male and female patients did not differ in terms of the meanSD duration between keloid onset and the first medical examination. This finding shows that female patients do not get their keloids examined earlier than male patients. These observations together suggest that female sex may promote early keloid development due to physiological, not social, reasons.Conclusion: This is the first report to suggest that female sex may drive keloidogenesis because of physiological reasons. Individuals were most likely to seek a medical examination almost 10 years after onset, regardless of sex. These findings provide new insight into the importance of sex in the development and progression of keloids. Future studies should address the influence of sex hormones on the keloid.

DOI： 10.1007/s13555-019-00327-0

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

先天性耳介変形の正確な形態把握と矯正器具作製を目的として、3Dカメラ・プリンタを用いて耳介3Dモデルを作製した。今回、この耳介3Dモデルの有用性について代表症例を供覧するとともに、文献的考察を含めて報告した。当院で治療を行った先天性耳介変形13名のうち7名11耳に対し3Dモデルを用いた矯正療法を行い、6例で手術療法を選択した。3Dカメラ撮影により非侵襲的に耳介の3Dモデルを構築することが可能であった。一般的に用いられることが多い硬性プラスチック素材ではなく弾性フィラメントで出力を行うことで3Dモデルは用手的に変形可能であり、実際の耳介に近い矯正が可能であった。モデルを理想的な形態に変形させ、熱可塑性樹脂や鋼線とカテーテルなどにより矯正器具を作製した。折れ耳の3Dモデルで舟状窩の再現が困難な症例があるが(耳輪と対耳輪上脚が接着し窪みの再現が困難である場合)おおよその矯正後耳介を再現してから矯正器具を作製することで器具を修正する必要はなかった。

researchmap

記述言語：英語   出版者・発行元：WILEY  

Web of Science

researchmap

記述言語：英語   出版者・発行元：WILEY  

Web of Science

researchmap

記述言語：英語   出版者・発行元：WILEY  

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background One suggested reason for aberrant wound healing in keloid scars is chronic inflammation of the dermis. We hypothesized that excessive blood vessel formation and high capillary density in keloid tissue is caused by dysfunction of endothelial progenitor cells. Methods We compared the number of circulating endothelial progenitor cells and vasculogenic and angiogenic capacity, as well as secretory function, of circulating CD34(+) cells in keloid patients and healthy individuals. Results Compared to mononuclear cell cultures from healthy donors, cultures of peripheral blood mononuclear cells obtained from keloid patients showed a more than twofold increase in the number of peripheral blood EPCs (fibronectin-adhering cells that phagocytized acetylated low-density lipoprotein and bound Ulex europaeus agglutinin-I lectin). However, there was no difference in colony-forming ability and participation in in vitro angiogenesis between circulating CD34(+) cells isolated from keloid patients and healthy individuals. This means that circulating CD34(+)/endothelial progenitor cells in keloid patients have normal vasculogenic and angiogenic function. However, CD34(+) cells derived from keloid patients demonstrated a more than sevenfold expression of the interleukin-8 gene and a more than fivefold expression of the vascular endothelial growth factor gene than CD34(+) cells derived from healthy individuals. Conclusions These results support the role of vascular endothelial growth factor and interleukin-8 in increased recruitment of endothelial progenitor cells in keloid patients.

DOI： 10.1111/ijd.14575

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Therapies for upper arm keloids include surgical excision followed by postoperative radiotherapy, silicone tape stabilization, and steroid plaster. However, a universally accepted therapeutic strategy for upper-arm keloids is lacking. Methods: All consecutive patients with single upper-arm keloids who underwent keloid excision followed by tension-reducing suturing, multiple z-plasties, and postoperative radiotherapy in 2013-2016 in the keloid/scar specialist clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School, were included in this case series study. Only keloids that arose from the small injury produced during Bacillus Calmette-Guérin vaccination were selected. The postsurgical radiotherapy regimen was 18 Gy administered in 3 fractions over 3 days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape and, if needed, steroid plaster. The primary study objective was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the growth of stiff red lesions in even small areas of the scar that was refractory to at least 2 months of steroid plaster therapy. Results: In total, 38 patients with 38 lesions were enrolled. Two lesions (5.3%) recurred. Both recurrences were successfully treated by concomitant steroid plaster and steroid injection. The recurrence patients were significantly more likely than the nonrecurrence patients to have multiple keloids. The 2 groups did not differ in terms of original keloid size. Conclusions: Upper-arm keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including multiple z-plasties), postoperative radiotherapy (18 Gy/3 fractions/3 d), and postoperative wound/scar self-management with silicone tape and steroid plaster.

DOI： 10.1097/GOX.0000000000002496

PubMed

researchmap

記述言語：英語  

Optic canal fracture (OCF) is a traumatic injury that requires urgent intervention because it can induce optic nerve damage and visual impairment. Despite the severity of OCF, a standard treatment method has not been established. In this article, we report a case of OCF and traumatic optic nerve injury in which visual acuity was recovered by releasing the optic canal using an unconventional lateral approach. A 43-year-old man presented with right lateral ethmoid fracture, right orbit blowout fracture, and OCF. The visual acuity was "hand motion" before surgery. Decompression was performed 10 hours after injury by approaching the right optic canal laterally from a coronal incision in front of the right ear, cutting along the border of the sphenoid bone, and scraping away some of the sphenoid wing and zygomatic bone. Steroid pulse therapy was added. Eventually, the visual acuity improved to 0.2 and the intraocular pressure decreased to 16.0 mm Hg. Compared with conventional methods, this method associates with better safety because (1) it causes relatively little bleeding and cerebrospinal fluid leak; (2) once the sphenozygomatic suture is identified, the distance to the optic canal is relatively short; and (3) if the fracture point is on the outer optic canal, the fracture line can be observed directly. Steroid pulse therapy may also have contributed to the good visual outcome. This is the first report of a novel lateral approach to OCF that is safe, effective, and only requires plastic surgery skills.

DOI： 10.1097/GOX.0000000000002489

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Cranioplasty is complicated in children with severe, extensive head trauma because allografting is not advisable in pediatric patients and the amount of available autologous materials is limited. To overcome these problems, Takumi reported a novel procedure called catcher's mask cranioplasty in 2008, in which split-rib grafts are placed perpendicularly over each other while calvarial grafts are placed in the hairless forehead region. Despite the small amount of grafts used, this method can yield esthetically satisfactory results and provides excellent structural integrity. Here, we report 2 cases of catcher's mask cranioplasty and their long-term outcomes. After more than 10 years, the transplanted bone grafts have not resorbed and have maintained their esthetically pleasing contours. In conclusion, catcher's mask cranioplasty is an effective option for traumatic cranial defects in children.

DOI： 10.1097/GOX.0000000000002395

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Wound healing starts with the recruitment of inflammatory cells that secrete wound-related factors. This step is followed by fibroblast activation and tissue construction. Sphingosine-1-phosphate (S1P) is a lipid mediator that promotes angiogenesis, cell proliferation, and attracts immune cells. We investigated the roles of S1P in skin wound healing by altering the expression of its biogenic enzyme, sphingosine kinase-1 (SphK1). The murine excisional wound splinting model was used. Sphingosine kinase-1 (SphK1) was highly expressed in murine wounds and that SphK1-/- mice exhibit delayed wound closure along with less angiogenesis and inflammatory cell recruitment. Nanoparticle-mediated topical SphK1 overexpression accelerated wound closure, which associated with increased angiogenesis, inflammatory cell recruitment, and various wound-related factors. The SphK1 overexpression also led to less scarring, and the interaction between transforming growth factor (TGF)-β1 and S1P receptor-2 (S1PR2) signaling is likely to play a key role. In summary, SphK1 play important roles to strengthen immunity, and contributes early wound healing with suppressed scarring. S1P can be a novel therapeutic molecule with anti-scarring effect in surgical, trauma, and chronic wound management.

DOI： 10.3390/ijms20143381

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cryptotia is an auricular muscle abnormality that causes the superior and posterior auricular area to be buried under the temporal skin. Surgical treatment approaches can be divided into skin grafts and local flaps. Complex cases also require cartilage/muscle modification. In this study, we treated one case each with the Square flap method and the Cat's Ear flap method. The aim was to help surgeons select the most appropriate surgical procedure on a case-by-case basis. Methods: Two typical cryptotia cases were treated with the Square or Cat's Ear flap method. Finite element analysis was performed with ADINA v8.9 software, a PC (Windows 7, CPU: Core i7, Memory: 8 GB), and a hyperelastic skin model (skin diameter 20 cm; thickness 2 mm). The model scales were about 500 nodes and 500 elements (tetrahedron). Results: The Square flap method involved advancing the square flap between the two triangular flaps. Switching then generated dog-ears that created a big valley. In the Cat's Ear flap method, the two triangular flaps were rotated in the same direction, whereas a square flap was advanced slightly on the opposite side. This created a large dog-ear. Conclusions: This study suggested that the Cat's Ear flap method may be particularly useful for cryptotia patients whose posterior auricular groove is shallow when the buried helix is pulled out. The Square flap method may be suitable for other cases because it effectively extrudes the buried helix with comparatively small excision.

DOI： 10.1097/GOX.0000000000002315

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

This case report describes a recent case where a patient with hypopharyngeal cancer underwent resection and reconstruction with a free jejunum flap and the surgeons found a rare variation in the branching pattern of the common carotid artery. Specifically, the left facial artery arose directly from the common carotid artery, whereas the left superior thyroid artery arose from the facial artery. This branching pattern has not been reported previously. Although this is a hitherto unique case, head and neck and reconstructive surgeons should be aware of the possibility that this branching pattern may be present because it could complicate the outcomes of both neck dissection and reconstruction by free tissue transfer.

DOI： 10.1097/GOX.0000000000002305

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Fibroproliferative disorders result in excessive scar formation, are associated with high morbidity, and cost billions of dollars every year. Of these, keloid disease presents a particularly challenging clinical problem because the cutaneous scars progress beyond the original site of injury. Altered mechanotransduction has been implicated in keloid development, but the mechanisms governing scar progression into the surrounding tissue remain unknown. The role of mechanotransduction in keloids is further complicated by the differential mechanical properties of keloids and the surrounding skin. METHODS: The authors used human mechanical testing, finite element modeling, and immunohistologic analyses of human specimens to clarify the complex interplay of mechanical stress, strain, and stiffness in keloid scar progression. RESULTS: Changes in human position (i.e., standing, sitting, and supine) are correlated to dynamic changes in local stress/strain distribution, particularly in regions with a predilection for keloids. Keloids are composed of stiff tissue, which displays a fibrotic phenotype with relatively low proliferation. In contrast, the soft skin surrounding keloids is exposed to high mechanical strain that correlates with increased expression of the caveolin-1/rho signaling via rho kinase mechanotransduction pathway and elevated inflammation and proliferation, which may lead to keloid progression. CONCLUSIONS: The authors conclude that changes in human position are strongly correlated with mechanical loading of the predilection sites, which leads to increased mechanical strain in the peripheral tissue surrounding keloids. Furthermore, increased mechanical strain in the peripheral tissue, which is the site of keloid progression, was correlated with aberrant expression of caveolin-1/ROCK signaling pathway. These findings suggest a novel mechanism for keloid progression.

DOI： 10.1097/PRS.0000000000005717

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aetiology of keloids is becoming clearer, but many questions remain, including about the most optimal treatment. Current therapies include surgical excision, radiotherapy, and various pharmaceutical drugs. However, none of these drugs are keloid-specific. Moreover, all current interventions are associated with high recurrence rates. Here, we review the pharmaceutical interventions that are currently available. All are based on the fact that keloids are an expanding solid mass with intense chronic inflammation at its advancing edges. Consequently, current pharmaceuticals aim to reduce the mass and/or symptoms of keloids, similar to surgery and radiotherapy. They include chemotherapies, immunotherapies, volume-reducing therapies, and anti-inflammatory therapies. We also describe new advances in keloid pharmaceuticals. They include drugs that were designed to treat systemic diseases such as hypertension or breast cancer but were found to also treat keloids. Furthermore, recent progress in genetic, epigenetic, and stem cell therapies suggests that they could become useful in the keloid field. This review of pharmaceutical advances will hopefully promote additional research and the development of effective and specific pharmaceuticals for keloids.

DOI： 10.1111/iwj.13104

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Angiogenesis, the growth of new blood vessels from pre-existing vessels, is critical for cutaneous wound healing. However, it remains elusive how endothelial cells (ECs) and pericytes (PCs) establish new blood vessels during cutaneous angiogenesis. We set up a live-imaging system to analyze cutaneous angiogenesis in adult zebrafish. First, we characterized basic structures of cutaneous vasculature. In normal skin tissues, ECs and PCs remained dormant to maintain quiescent blood vessels, whereas cutaneous injury immediately induced angiogenesis through the vascular endothelial growth factor signaling pathway. Tortuous and disorganized vessel networks formed within a few weeks after the injury and subsequently normalized through vessel regression in a few months. Analyses of the repair process of injured single blood vessels revealed that severed vessels elongated upon injury and anastomosed with each other. Thereafter, repaired vessels and adjacent uninjured vessels became tortuous by increasing the number of ECs. In parallel, PCs divided and migrated to cover the tortuous blood vessels. ECs sprouted from the PC-covered tortuous vessels, suggesting that EC sprouting does not require PC detachment from the vessel wall. Thus, live imaging of cutaneous angiogenesis in adult zebrafish enables us to clarify how ECs and PCs develop new blood vessels during cutaneous angiogenesis.

DOI： 10.1007/s10456-018-09660-y

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: A large proportion of scars in clinical practice represent good candidates for surgical revision by virtue of their unfavorable characteristics and relative orientation with respect to skin relaxed tension lines. W-plasty is a very popular excisional revision technique, which involves breaking up the scar margins into small triangular components, which are advanced and interdigitated without any rotation or transposition. Methods: We performed an extensive literature search using Pubmed MEDLINE, Web of Science, and Embase using the following keywords [W-plasty] AND [scar] AND [revision]. We retrieved 13 articles pertinent to the indications, geometrical design, and technical evolution of the W-plasty scar revision variants. We formulate indications for the use of isosceles/equilateral as opposed to scalene triangle W-plasty and integrate our experience with regards to the choice of geometrical design for different bodily regions. Conclusions: W-plasty represents a popular technique in reconstructive plastic surgery practice. We believe that the exact W-plasty design should be guided by the relaxed skin tension line definition and to this effect propose 2 main variants of geometrical design pertinent to the index anatomical site.

DOI： 10.1097/GOX.0000000000002179

PubMed

researchmap

記述言語：英語  

The endogenous electric field (EF) of skin wounds plays an important role in the biological processes that underlie wound healing. Treatments that modulate wound-EFs promote healing. However, the mechanism(s) that underlie this effect remain unclear. Agilent-based microarrays were used to determine the transcriptomes of the keratinocyte line HaCaT, normal human dermal fibroblasts, and the human dermal endothelial cell line HMEC-1 before and after high-voltage alternating current (AC)-EF (14,000 V, 90 Hz) treatment. The keratinocytes had the most genes whose transcription was altered by EF. They included the cytochrome P450 (CYP) genes CYP1A1 and CYP1B1, HMOX1, EREG, DUSP5, and SLC7A11 (all upregulated), and DOCK8, ABCC6, and CYP26A1 (all downregulated). As shown by transcriptional-network analysis, all three CYP genes played central roles in the EF-induced changes in keratinocyte transcriptome. To the best of our knowledge, this is the first study that demonstrates that CYP genes play a key role in the transcriptional responses of human keratinocytes to EF treatment. Further investigations into the effects of EF on wound healing, aging, and regenerative medicine are likely to y

DOI： 10.1016/j.bioelechem.2018.11.014

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids. Methods: All consecutive patients with single or multiple anterior chest wall keloids who underwent keloid excision, tension-reducing suturing, z-plasty, and postoperative radiotherapy in 2013-2016 in Nippon Medical School were included in this case series study. Only keloids that arose from small injuries such as folliculitis or acne were selected. The surgery was followed by tension-reducing self-management of the wounds with silicone tape and steroid plaster. The postsurgical radiotherapy modality was 18 Gy administered in 3 fractions over 3 days. The primary study outcome was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the development of stiff and red lesions in even a small part of the scar that did not respond to 6 months of steroid plaster therapy. Results: In total, 141 patients with 141 lesions were enrolled. Of the 141 lesions, 15 (10.6%) recurred. All recurrences were successfully treated by steroid plaster and steroid injection. The recurrence patients did not differ from the nonrecurrence patients in terms of the size of the original keloid or gender distribution. Conclusions: Anterior chest wall keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including z-plasty) followed by postoperative radiotherapy (18 Gy in 3 fractions over 3 days) and scar self-management with silicone tape and steroid plaster.

DOI： 10.1097/GOX.0000000000002177

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

Scars are the final result of the four processes that constitute cutaneous wound healing, namely, coagulation, inflammation, proliferation, and remodeling. Permanent scars are produced if the wounds reach the reticular dermis. The nature of these scars depends on the four wound healing processes. If the remodeling process is excessive, collagen degradation exceeds collagen synthesis and atrophic scars are produced. If the inflammation phase is prolonged and/or more potent for some reason, inflammatory/pathological scars such as keloids or hypertrophic scars can arise. If these pathological scars are located on joints or mobile regions, scar contractures can develop. When used with the appropriate timing and when selected on the basis of individual factors, surgical techniques can improve mature scars. This review paper focuses on the surgical techniques that are used to improve mature scars, burn scars, and scar contractures. Those methods include z-plasties, w-plasties, split-thickness skin grafting, full-thickness skin grafting, local flaps (including the square flap method and the propeller flap), and expanded flaps, distant flaps, regional flaps, and free flaps.

DOI： 10.1186/s41038-019-0144-5

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0000000000005324

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Background: Measurement of heart weight is important when investigating cause of death, but there is presently no satisfactory method of heart weight estimation by postmortem computed tomography (PMCT).Method: We investigated 33 consecutive cases that underwent both PMCT and autopsy between February 2008 and June 2014. Heart and left ventricular (LV) weights were calculated by PMCT morphometry. We used a simple method to estimate LV weight: We assumed that LV was an ellipsoid and multiplied its volume on PMCT with myocardial specific gravity. We then compared the various heart and LV weights using linear regression. The calculated and estimated LV weights on PMCT were also compared.Results: It was not possible to predict heart weight at autopsy from PMCT (R-2 =0.53). However, heart weight at autopsy could be accurately predicted from LV weight calculated by PMCT (R-2 = 0.77). In addition, there was a strong correlation between the estimated and calculated LV weights by PMCT (R-2 =0.92). Heart weight at autopsy could also be accurately predicted using the PMCT-estimated LV weight (R-2 =0.72).Conclusion: Heart weight at autopsy could be accurately predicted using a simple method in which LV volume was assumed to be an ellipsoid on PMCT. (C) 2019 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.forsciint.2018.12.019

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Objective: Autism spectrum disorder (ASD) is a developmental disorder characterized by communication deficits and social difficulties, and individuals with ASD frequently exhibit varied levels of language abilities. However, the neurophysiological mechanisms underlying their language deficits remain unclear. To gain insight into the neurophysiological mechanisms of receptive language deficits, we assessed cortical activation patterns in adolescents with ASD during silent word-reading. Methods: We used magnetoencephalography to measure cortical activation during a silent word-reading task in 14 adolescent boys with high-functioning ASD and 17 adolescent boys with typical development (TD). Results: Compared with participants with TD, those with ASD exhibited significantly decreased cortical activation in the left middle temporal gyrus, left temporoparietal junction, bilateral superior temporal gyrus, left posterior insula, and right occipitotemporal gyrus, and increased activation in the right anterior insula. Participants with ASD also exhibited a lack of left-lateralization in the central sulcus and abnormal right-lateralization in the anterior insula area. Furthermore, in participants with ASD, we found that abnormal activation of the right central sulcus correlated significantly with lower visual word comprehension scores, and that decreased activation of the right anterior insula correlated significantly with the severity of social interaction difficulties. Conclusion: Our findings suggest that atypical cortical activation and lateralization in the temporal-frontal area, which is associated with higher-order language processing functions, such as semantic analysis, may play a crucial role in visual word comprehension and social interaction difficulties in adolescents with ASD.

DOI： 10.1016/j.braindev.2018.10.013

Web of Science

Scopus

PubMed

researchmap

記述言語：英語  

OBJECTIVE: Data on cranial morphology of healthy individuals can be used as the guide in the treatment of cranial deformity. There are many reports analyzing the cranial morphology of healthy children in the past. But most of them focus on 2-dimensional values, and there are only a few reports, which analyzed the cranial morphology of Japanese healthy infants. We report a novel method that enables the comprehensive analysis of cranial morphology of Japanese healthy infants in 3D. METHODS: Craniofacial CT data of 20 healthy infants (9 males, 11 females) ranging in age from 1 to 11 months were collected. Based on the CT data, we created 20 homologous models of cranium using software specifically designed to support homologous modeling. We averaged vertex coordinates of the homologous models to create average model. We further performed principal component analysis, and created virtual models based on each principal component. The contribution rate was calculated, and the features described by each principal component were interpreted. RESULTS: We created the average cranial model of Japanese healthy infants. Seven principal components (cumulative contribution rate: 89.218%) were interpreted as to which part of the cranial shape each component was related to. The elements were extracted that may characterize the cranial morphology of some of the clinical conditions such as dolico/brachycephaly and deformational plagiocephaly. Some of these elements have not been mentioned in the past literature. CONCLUSION: Homologous modeling was considered to be valid and strong tool for comprehensive analysis of cranial morphology.

DOI： 10.1097/SCS.0000000000004893

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.

DOI： 10.1272/jnms.JNMS.2019_86-406

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：英語   出版者・発行元：JAPAN SOC VET SCI  

To evaluate the preventive effects of combined vaccination for Pasteurella multocida, Mannheimia haemolytica and Histophilus somni on respiratory diseases in Japanese Black calves, 295 calves at one farm were alternately assigned to two groups; 147 calves received the vaccine at 4 and 8 weeks of age (vaccination group), and the other 148 calves did not receive vaccine (control group). The incidences of respiratory diseases were 25.9 and 70.9% in the vaccination and control groups, respectively, and the odds ratio for comparison between the two groups was 0.143 (95% confidence interval: 0.086–0.238). Administration of the multiple vaccine to Japanese black calves might be one of effective factor for prevention of respiratory diseases.

DOI： 10.1292/jvms.19-0256

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Keloids can be treated in a number of ways, including by surgery. Multiple studies now show that while surgical monotherapy associates with extremely high rates of recurrence (50%-80%), postoperative radiotherapy can significantly reduce these recurrence rates. Ongoing improvements in radiation technology have further increased the safety and efficacy of this combination protocol. Of the various radiotherapies that have been used in this setting, electron beam (β-ray) irradiation is currently the best due to its excellent dose distribution and safety. The maximal biologically effective dose (BED) for keloids is 30 Gy (using an estimated α / β ratio of 10); increasing the dose has no further benefits and elevates side effects. Over the last two decades, we have modified and then fine-tuned our radiotherapy protocol for keloid excision wounds. Thus, our early protocol was used for all body sites and consisted of 15 Gy/3 fr/3 days. We then customised the radiotherapy protocol so that body sites that are highly prone to recurrence (e.g. the anterior chest) receive higher doses while low recurrence sites like the earlobe receive a much smaller dose. More recently, we tweaked this body site-customised protocol so that fewer fractions are employed. Therefore, we currently apply 18 Gy/3 fr/3 days to high-recurrence sites, 8 Gy/1 fr/1 day to earlobes and 15 Gy/2 fr/2 days to other body sites. These radiotherapy protocol changes were accompanied by the evolution of body site-customised surgical approaches. As a result of these developments, our overall keloid recurrence rate is now below 10%.

DOI： 10.1177/2059513119891113

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI  

The purpose of this study was to determine the effect of vaccination and beta-carotene supplementation on blood oxidative stress and antibody response in calves. Thirty Japanese Black calves were randomly assigned to two groups. Fifteen calves received 20 mg of beta-carotene supplemented into their daily provided rations from 2 to 8 weeks of age (BC group), and the other 15 calves did not receive the daily beta-carotene supplement (control group). All calves received a commercially available modified live bovine respiratory syncytial (RS) virus vaccine at 4 and 8 weeks of age. Blood samples were taken at 2, 4, 8, and 12 weeks of age. At 4 weeks of age, the concentration of reactive oxygen metabolites within serum were significantly lower in the BC group than the concentrations measured in the control group. Also at 4 weeks of age, the concentration of biological antioxidant capacity within serum was significantly higher in the BC group than the concentrations measured in the control group. Both groups showed a gradual decrease of antibody titers to live bovine RS virus in the samples taken from 2 to 12 weeks of age. These results confirmed that beta-carotene supplementation decreased oxidative stress. However, beta-carotene supplementation did not affect the antibody response to live bovine RS virus vaccination, perhaps due to the presence of the maternal antibody.

DOI： 10.3390/vetsci5040102

Web of Science

Scopus

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

症例は54歳女性で、約27年前に、歩行中に車と接触し右肩甲部を強打し救急搬送された。約2ヵ月前、着替え中に右肩甲部の腫瘤を自覚した。右肩甲部に7×7cm大の、弾性やや硬の皮下腫瘤を触知した。腫瘤とその上の皮膚の可動性は良好であったが、腫瘤とその深部は一部不良であった。炎症所見は認めず、圧痛もなかった。超音波検査では60×64×24mm大の境界明瞭で平滑な多房性の皮下腫瘤を認め、低エコーの嚢胞内には液体成分の流動性変化を認めた。造影MRIでは、T1低信号、T2 STIR高信号の、造影効果のない多房性嚢胞状の腫瘤を認め、内部に鏡面像を認めた。境界は明瞭で周囲への波及は認めず、悪性疾患を疑う所見はなかった。画像所見からはリンパ管奇形を疑い、全身麻酔下、腹臥位にて腫瘍摘出術を行った。病理組織検査でリンパ管奇形と診断した。種々のサイズの嚢胞状病変が混在し、混合型とした。創部の陥凹変形、瘢痕の肥厚を認めるが、術後の経過は良好で、合併症や再発は認めていない。

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Sclerotic fibromas of the skin (SFSs) have a very characteristic histology but the clinical signs are nonspecific. Consequently, it is extremely difficult to make a diagnosis of SFS on the basis of the clinical findings only. We report here two cases of SFS arising on the right scapular region and the right lower leg, respectively. Both cases were clinically similar to keloids. Skin surgeons should remember that SFSs are an important differential diagnosis from keloids.

DOI： 10.1272/jnms.JNMS.2018_85-45

Web of Science

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report two cases of granular cell tumors (GCTs) arising on rare sites, namely, the nape and umbilicus. While GCTs have a very characteristic histology, their clinical signs and symptoms are non-specific. Therefore, it is extremely difficult to make a diagnosis of GCT on the basis of clinical findings only. The two cases reported here were clinically similar to hypertrophic scars and keloids, respectively. Skin surgeons should remember that GCTs are an important differential diagnosis from hypertrophic scars and keloids.

DOI： 10.1272/jnms.JNMS.2018_85-44

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Objective: Individuals with autism spectrum disorder (ASD) often show characteristic differences in auditory processing. To clarify the mechanisms underlying communication impairment in ASD, we examined auditory language processing with both anatomical and functional methods. Methods: We assessed the language abilities of adolescents with ASD and typically developing (TD) adolescents, and analyzed the surface-based morphometric structure between the groups using magnetic resonance imaging. Furthermore, we measured cortical responses to an auditory word comprehension task with magnetoencephalography and performed network-based statistics using the phase locking values. Results: We observed no structural differences between the groups. However, the volume of the left ventral central sulcus (vCS) showed a significant correlation with linguistic scores in ASD. Moreover, adolescents with ASD showed weaker cortical activation in the left vCS and superior temporal sulcus. Furthermore, these regions showed differential correlations with linguistic scores between the groups. Moreover, the ASD group had an atypical gamma band (25–40 Hz) network centered on the left vCS. Conclusions: Adolescents with ASD showed atypical responses on the auditory word comprehension task and functional brain differences. Significance: Our results suggest that phonological processing and gamma band cortical activity play a critical role in auditory language processing-related pathophysiology in adolescents with ASD.

DOI： 10.1016/j.clinph.2018.05.014

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

近年、日本在住の外国人が増加している。それに伴い、外国籍の親をもつ小児が熱傷を受傷し、日本の医療機関を受診する例が増えている。今回われわれは、外国籍の親が熱傷に対する十分な初期対応を行わなかったために重症化し、虐待が疑われた小児熱傷の2例を経験した。言語、教育、文化など社会背景が日本と異なる点で虐待の有無の判断がむずかしく対応に苦慮した。今後、他施設においても同様の症例が増加することが予想されたため、文献的考察を加えて報告する。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: Patients with head and neck or esophageal cancer who undergo resection and reconstructive surgery sometimes develop fistulae that exhibit delayed wound healing. We developed a novel negative pressure wound therapy (NPWT) that employs a Penrose drain. This case series report describes its effect on the wound healing and treatment duration of cancer patients with postoperative fistulae.Methods: This consecutive case series consisted of all patients from February 2014 to February 2017 who underwent resection and reconstruction for head and neck or esophageal cancer and who then developed a fistula that was treated with either NPWT or a second flap that did not resolve the fistula or led to fistula recurrence and was then treated with NPWT. A Penrose drainage tube was inserted into the fistula, and a NPWT device was applied.Results: Eleven patients (10 males, 1 female; mean age, 67.4 years) underwent NPWT for fistulae that arose after tumor resection and reconstruction (n = 6) or after fistula reconstruction (n = 5). The resection was for esophageal (n = 4), laryngeal (n = 3), oral (n = 2), and hypopharyngeal (n = 2) cancer. In 9 cases, 1 week of NPWT led to rapid and complete wound healing. In 2 cases, complete healing occurred after 3-4 weeks of NPWT.Conclusions: Our NPWT applies continuous negative pressure inside the fistula only and dramatically promoted fistula healing. This approach may work by cleaning the fistula and promoting mucosal surface adhesion. It is particularly effective when the tissue surrounding the fistula is soft due to fresh tissue transfer.

DOI： 10.1097/GOX.0000000000001885

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

BackgroundThe elbow is a challenging region to reconstruct functionally. Several closure methods for elbow wounds have been reported, including flap surgery. Here, we present the results obtained using a propeller flap pedicled by a posterior ulnar recurrence artery perforator (PURAP) or a radial collateral artery perforator (RCAP) for functional reconstruction of soft tissue defects in elbows.MethodsTwenty-four patients with an average age of 27.0years (range, 9-52years) underwent elbow soft tissue reconstructions between 2005 and 2015. Twenty-one patients were male and three were female. Among them, 18 patients received a PURAP flap transfer and six received a RCAP flap transfer. The frequent soft tissue defects were due to release of a postburn scar contracture in 12 patients, trauma in ten patients. Functional results were obtained by measuring range of motion (ROM).ResultsThe mean follow up time was 10.1months (range, 4-22months). The flaps ranged in size from 3x5cm to 16x6cm. Nearly all flaps survived with only one showing partial necrosis. 16 and 8 patients achieved ranges of motions of 0-5 and 6-15 degree extension and 130-145 degree flexion.ConclusionsWith the aims of easy flap harvest, primary donor site closure, skin texture match, and avoiding vascular anastomosis, both PURAP and RCAP were employed. Both flap transfer techniques were safe and effective for elbow soft tissue reconstruction. It is important to ensure that the skin defect and flap design are closely matched.

DOI： 10.1002/micr.30270

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI  

DOI： 10.3390/ijms19061749

Web of Science

Scopus

PubMed

researchmap

DOI： 10.1097/GOX.0000000000001801

PubMed

researchmap

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Objective: The choice between local flap designs for burn reconstruction is largely shaped by aesthetic, vascularity, procedural complexity, and wound-closure considerations. However, another key consideration is how well specific local flap designs release post-burn scar contractures. This is because constant tension on wound edges can generate pathological scarring. However, the ability of specific local flap to release post-burn scar contractures is poorly understood. This question was addressed by this study of patients who underwent local flap surgery to release post-burn scar contractures.Methods: The flap type, its original size, and the degree to which the flap extended 6 months after surgery were recorded.Results: Of the 40 patients enrolled, 20 received an island flap and 20 received a skin-pedicled flap. The scars were most commonly located on the anterior chest, axilla, and cubital fossa, followed by the lateral chest, abdomen, thigh, and popliteal fossa. Six months after surgery, the skin-pedicled and island flaps had extended on average by 1.53-and 1.28-fold, respectively.Conclusions: While it was technically easier to transfer island flaps to the recipient site, they released contractures less effectively than skin-pedicled flaps. The postoperative extensibility of flaps should be considered when determining which flap design is optimal for the individual patient. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.

DOI： 10.1016/j.burns.2017.09.016

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

We encountered a case of a man who was diagnosed with severe congenital neutropenia as a child and presented at the age of 45 years with pyoderma gangrenosum (PG) of the lower leg. PG associates with an underlying systemic disease, most commonly inflammatory bowel, rheumatic, or hematological disease or malignancy. However, in many cases, the underlying disease was not known. Surgery can trigger PG. The histopathological features of PG were nonspecific, and diagnosis requires excluding other conditions that have a similar appearance. Our analyses showed that the PG in our case was secondary to severe congenital neutropenia, which had promoted an infection of keratinous cysts. The patient bore a mutation in the ELANE gene encoding neutrophil elastase. Only 1 other case of neutropenia-associated PG has been reported previously: the association was only suspected. The present complex case was effectively treated by systemic treatment of the neutropenia with granulocyte colony-stimulating factor and regional surgical treatment. Histology of the excised tissue revealed keratinous cysts that were diffusely distributed with inflammatory granulation tissue. We believe that the rupture of the walls of the keratinous cysts may have caused the PG. At the time of writing (3 years since the initial presentation), the PG has not recurred. This case shows the importance of performing detailed examinations, including blood tests, to determine the disease underlying PG. This was because if the underlying disease was identified, its treatment was likely to promote healing of the wound after local surgery and prevent recurrence.

DOI： 10.1097/GOX.0000000000001676

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Background: The concept of the "super-thin flap" (also known as the subdermal vascular network flap) was introduced in Japan in 1994. Its distinctive characteristic is its extreme thinness: it is thinned to the point that the subdermal vascular network (subdermal plexus) can be seen through the minimal fat layer. Since 2006 in Vietnam, we have used circumflex scapular artery-supercharged occipito-cervico-dorsal (OCD) super-thin flaps to reconstruct cases of neck and face scar contracture.Materials and methods: This case series comprised all 82 patients with neck and face scar contracture who underwent reconstruction with an OCD supercharged super-thin flap from 2006-2015 at the Vietnam National Institute of Burns. The flap was thinned and anastomosed at the distal area after elevation. All patients received one flap.Results: Of the 82 flaps, 77 survived completely. The remaining five developed distal superficial necrosis (n=3) and interruption of the sutures due to infection; these required resuturing (n=2). In two of the three necrosis cases, the necrotic area affected 50% of the flap. Eighty of the eighty-two patients were satisfied with both the functional and aesthetic results.Conclusions: The OCD super-thin flap has clear benefits, and although it is thin, its vasculature is reliable. Thus, it may be one of the best choices for reconstruction of neck and face scar contractures. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.

DOI： 10.1016/j.burns.2017.07.020

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

全国42施設の79名の熱傷治療に携わる医師に対して、新鮮熱傷創に対する銀含有創傷被覆材の使用の現状についてのアンケート調査を行った。回答者の所属科は、形成外科55名、救急診療科20名、皮膚科4名であった。銀含有創傷被覆材のうち、アクアセルAg、アクアセルAg BURNを対象とし、質問項目は、使用頻度や使用方法、熱傷深度や部位による使い分け、他の局所療法とくらべた利点や欠点などについて調査を行った。結果として、最近の本邦で銀含有創傷被覆材は、III度が混在する熱傷創や、顔面や陰部などの特殊な部位への使用は限られるもののII度熱傷創の局所療法として普及してきていること、また明らかに熱傷局所処置回数を減らせるなど、患者と医療者双方の負担を軽減できるということが分かり、局所療法における標準治療の一つとして定着していくであろうと予想された。今後の課題としては、新鮮熱傷だけでなく熱傷治療全般への応用や有効性を検討していく必要があると思われた。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Purpose To distinguish between adenocarcinoma in situ (AIS)-minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) showing pure or part-solid ground-glass nodules (GGNs) by high-resolution computed tomography (HRCT) texture analysis.Materials and methods This retrospective study included 101 consecutive patients with 115 pure or part-solid GGNs <= 3 cm diameter, which were surgically resected and pathologically diagnosed with AIS, MIA, or IAC (48 AIS-MIA and 67 IAC) between April 2011 and March 2015. Each tumor was manually segmented on axial CT images, and the following texture features were calculated: volume, mass, mean CT value, variance, skewness, kurtosis, entropy, uniformity, and percentile CT numbers (10th, 25th, 50th, 75th, 90th, 95th percentiles). The differences between AIS-MIA and IAC were statistically evaluated using univariate, multivariate, and receiver operating characteristic analysis.Results Compared with IAC, AIS-MIA had significantly greater skewness, kurtosis, and uniformity, whereas in the other parameters, AIS-MIA demonstrated significantly lower values than those of IAC. Multivariate analysis revealed that independent differentiators were the 90th percentile CT numbers (P < 0.001) and entropy (P = 0.005) with an excellent accuracy (area under the curve, 0.90).Conclusions The 90th percentile CT numbers and entropy can accurately distinguish AIS-MIA from IAC.

DOI： 10.1007/s11604-017-0711-2

Web of Science

Scopus

researchmap

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0000000000004058

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Reconstruction of the anterior neck requires attention to both aesthetic and functional outcomes. In general, skin grafts are not suitable for anterior neck reconstruction in Asian patients, even when artificial dermis is used before skin grafting. Therefore, we have employed various types of thin flaps for anterior neck reconstruction, including the cervico-pectoral flap. However, we have realized that, to fully release neck contractures and therefore achieve the full range of neck extension, the skin pedicle must be sufficiently wide. Therefore, we have started reconstructing anterior neck scar contractures using wide, thin, and long flaps that are harvested from the anterior chest wall. In this article, we describe the case of a 71-year-old man who presented with a neck contracture and tracheal fistula after receiving extensive burns. A transposition flap bearing the internal mammary artery perforator was harvested from the anterior chest wall to repair the neck wounds that were left after removing the scar. At the same time, the tracheal fistula was covered by the flap. The aesthetic and functional results were acceptable. The effectiveness of supercharged transposition flaps from the anterior chest wall for reconstructing anterior neck scar contraction is discussed.

DOI： 10.1097/GOX.0000000000001485

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jid.2017.05.041

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

The skin graft is a prevalent reconstructive method for burn injuries. We have been applying external wire frame fixation methods in combination with skin grafts since 1986 and have experienced better outcomes in percentage of successful graft take. The overall purpose of this method was to further secure skin graft adherence to wound beds in hard to stabilize areas. There are also location-specific benefits to this technique such as eliminating the need of tarsorrhaphy in periorbital area, 1 allowing immediate food intake after surgery in perioral area, 2 and performing less invasive fixing methods in digits, 3 and so on. The purpose of this study was to clarify its benefits and applicable locations. We reviewed 22 postburn patients with skin graft reconstructions using the external wire frame method at our institution from December 2012 through September 2016. Details of the surgical technique and individual reports are also discussed. Of the 22 cases, 15 (68%) were split-thickness skin grafts and 7 (32%) were full-thickness skin grafts. Five cases (23%) involved periorbital reconstruction, 5 (23%) involved perioral reconstruction, 2 (9%) involved lower limb reconstruction, and 10 (45%) involved digital reconstruction. Complete (100%) survival of the skin graft was attained in all cases. No signs of complication were observed. With 30 years of experiences all combined, we have summarized fail-proof recommendations to a successful graft survival with an emphasis on the locations of its application.

DOI： 10.1097/BCR.0000000000000614

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: Ischemia-reperfusion injury is one of the leading causes of tissue damage and dysfunction, in particular, free tissue transfer, traumatically amputated extremity, and prolonged tourniquet application during extremity surgery. In this study, the authors investigated the therapeutic effects of hydrogen gas on skeletal muscle ischemia-reperfusion injury.Methods: The authors compared the concentration of hydrogen in a muscle on intraperitoneal administration of hydrogen-rich saline and on inhalation of hydrogen gas. Animals were subjected to ischemia-reperfusion. Mice were treated with inhalation of hydrogen gas, and the hind gastrocnemius muscle was collected. Muscle morphology and inflammatory change were evaluated after ischemia-reperfusion. Moreover, a footprint test was performed to assess the functional effect of hydrogen.Results: Hydrogen concentration of tissue was significantly higher, and the elevated level was maintained longer by hydrogen gas inhalation than by intraperitoneal administration of hydrogen-rich saline. Infarct zone and area with loss of tissue structure and marked cellular infiltration were significantly decreased in groups treated by hydrogen gas inhalation during ischemia-reperfusion; however, these effects were not observed by posttreatment of hydrogen. One week after ischemia-reperfusion, mice that had been pretreated with hydrogen gas recovered faster and achieved smoother walking in appearance compared with mice in the other groups as assessed by the footprint test.Conclusions: Inhalation of hydrogen gas attenuates muscle damage, inhibits inflammatory response, and enhances functional recovery. These findings suggest that the optimal route for hydrogen delivery is continuous inhalation of hydrogen gas, which could be a novel clinical mode of treatment in ischemia-reperfusion injury.

DOI： 10.1097/PRS.0000000000003878

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Keloids grow and do not regress. They are characterised histologically by hyalinised keloidal collagen (HKC). HKC amounts vary, and the mechanism by which they form is unclear. To clarify how HKCs form and whether their formation associates with specific clinical features, we studied the histological findings of earlobe keloids and compared them with respective clinical features. A total of 50 earlobe keloids from 43 patients were used for histological analysis of keloid size (mm2 ), HKC area (mm2 ) and HKC area ratio (%). As a result, keloid durations ranged from 3 months to >13 years. Early-stage keloids exhibited little HKC and a tendency for the HKCs to locate in perivascular regions. In later-stage keloids, the HKCs were extremely interconnected and formed a thick bitten donut-shaped region. HKC area ratios correlated positively with keloid duration (r2 = 0·58, P<0·05). HKC area ratios and keloid durations did not correlate with keloid sizes. These patterns of HKC formation and growth may explain why local therapies, which effectively remove fibroblasts and accumulated collagen but not HKCs, are ineffective in older keloids. Keloids should be promptly treated after diagnosis, and older keloids with extensive HKCs may require surgical excision followed by radiotherapy.

DOI： 10.1111/iwj.12763

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Blackwell Publishing Inc.  

Keloid is a cutaneous fibroproliferative disorder. It results from impaired wound healing that generates persistent inflammation and extensive deposition of collagen fibers in the wound/scar. Keloids tend to be worse in hypertensive patients. The present prospective cross-sectional study assessed whether endothelial dysfunction, which occurs in hypertension, associates with keloid formation and progression. This study included randomly selected patients with keloids who were assessed for surgical keloid treatment in 2013–2014. A series of nonkeloid patients admitted to the hospital was also recruited during this period. To measure endothelial function, all patients underwent digital reactive hyperemia peripheral arterial tonometry. Test results were expressed as reactive hyperemia index (RHI) and augmentation index (AI). In total, 57 patients with keloids and 19 nonkeloid controls were recruited. Keloid patients did not differ from the controls in terms of demographic or clinical variables, but had significantly worse RHI and AI values. Moreover, poor RHI and AI values associated with keloid development on binomial logistic regression. The keloid patients were then divided into four groups depending on whether their keloids started at age 0–12, 13–18, 19–29, or ≥30 years. Patients whose keloids arose before and well after puberty tended to have lower RHI than the controls, but these differences did not achieve statistical significance. However, these two groups did have significantly poorer AI values than the controls. Thus, endothelial dysfunction could cause keloid formation and/or aggravation. This indicates that vascular endothelial cells are important for wound healing.

DOI： 10.1111/wrr.12601

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Keloid is a cutaneous fibroproliferative disorder. It results from impaired wound healing that generates persistent inflammation and extensive deposition of collagen fibers in the wound/scar. Keloids tend to be worse in hypertensive patients. The present prospective cross-sectional study assessed whether endothelial dysfunction, which occurs in hypertension, associates with keloid formation and progression. This study included randomly selected patients with keloids who were assessed for surgical keloid treatment in 2013-2014. A series of nonkeloid patients admitted to the hospital was also recruited during this period. To measure endothelial function, all patients underwent digital reactive hyperemia peripheral arterial tonometry. Test results were expressed as reactive hyperemia index (RHI) and augmentation index (AI). In total, 57 patients with keloids and 19 nonkeloid controls were recruited. Keloid patients did not differ from the controls in terms of demographic or clinical variables, but had significantly worse RHI and AI values. Moreover, poor RHI and AI values associated with keloid development on binomial logistic regression. The keloid patients were then divided into four groups depending on whether their keloids started at age 0-12, 13-18, 19-29, or 30 years. Patients whose keloids arose before and well after puberty tended to have lower RHI than the controls, but these differences did not achieve statistical significance. However, these two groups did have significantly poorer AI values than the controls. Thus, endothelial dysfunction could cause keloid formation and/or aggravation. This indicates that vascular endothelial cells are important for wound healing.

DOI： 10.1111/wrr.12601

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00398&link_issn=&doc_id=20171109030002&doc_link_id=%2Fad3ksgke%2F2017%2F006011%2F005%2F1240-1245%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2017%2F006011%2F005%2F1240-1245%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

43人(男性11人、女性32人、16〜59歳)から切除した耳垂ケロイド50例を解析した。皮膚腫瘍切除後に生じた1例を除く全てのケロイドは、ピアス後に生じた。42例は初発、8例は再発したケロイドであった。罹患期間、病理組織学的に太く硝子化した好酸性の膠原線維(HKC)占有面積、大きさ、HKC占有面積率の中央値は、それぞれ24ヵ月、94.5mm2、344mm2、33.7%であった。HKCは真皮浅層から深層にかけて存在し、点在もしくは互いに集簇していた。1束の点在するHKCは主に血管周囲に発生し、数束からなる癒合したHKCは、最終的にbitten donut-shaped様の組織像を呈した。HKC外周占有率はケロイドの罹患期間とともに増加した。罹患期間とケロイドの大きさに有意な関係は認めなかった。罹患期間とHKC占有面積率は有意な正の相関を示したが、罹患期間と大きさ、HKC占有面積率と大きさには有意な相関は認めなかった。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00398&link_issn=&doc_id=20171109030004&doc_link_id=%2Fad3ksgke%2F2017%2F006011%2F007%2F1256-1263%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2017%2F006011%2F007%2F1256-1263%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

DOI： 10.1111/exd.13460

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Keloids are fibroproliferative skin disorders characterised clinically by continuous horizontal progression and post-surgical recurrence and histologically by the accumulation of collagen and fibroblast ingredients. Till now, their aetiology remains clear, which may cover genetic, environmental and metabolic factors. Evidence in the involvement of local mechanics (e.g. predilection site and typical shape) and the progress in mechanobiology have incubated our stiffness gap hypotheses in illustrating the chronic but constant development in keloid. We put forward that the enlarged gap between extracellular matrix (ECM) stiffness and cellular stiffness potentiates keloid progression. Matrix stiffness itself provides organisational guidance cues to regulate the mechanosensitive resident cells (e.g. proliferation, migration and apoptosis). During this dynamic process, the ECM stiffness and cell stiffness are not well balanced, and the continuously enlarged stiffness gap between them potentiates keloid progression. The cushion factors, such as prestress for cell stiffness and topology for ECM stiffness, serve as compensations, the decompensation of which aggravates keloid development. It can well explain the typical shape of keloids, their progression in a horizontal but not vertical direction and the post-surgical recurrence, which were evidenced by our clinical cases. Such a stiffness gap hypothesis might be bridged to mechanotherapeutic approaches for keloid progression.

DOI： 10.1111/iwj.12693

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語  

Keloids are caused by excessive scar formation that leads to scar growth beyond the initial scar boundaries. Keloid formation and progression is promoted by mechanical stress such as skin stretch force. Consequently, keloids rarely occur in paralyzed areas and areas with little skin tension, such as the periauricular region. Therefore, periauricular incision is commonly performed for face lifts. We report a rare case of keloids that arose from face-lift scars in a patient with bilateral facial nerve paralysis. A 51-year-old Japanese man presented with abnormal proliferative skin masses in bilateral periauricular scars. Seventeen years before, he had a cerebral infarction that resulted in permanent bilateral facial nerve paralysis. Three years before presentation, the patient underwent face-lift surgery with periauricular incisions. We diagnosed multiple keloids. We removed the masses surgically, closed the wounds with sutures in the superficial musculoaponeurotic system layer to reduce tension on the wound edges, reconstructed the earlobes with local skin flaps, and provided 2 consecutive days of radiotherapy. The wounds/scars were managed with steroid plasters and injections. Histology confirmed that the lesions were keloids. Ten months after surgery, the lesions did not exhibit marked regrowth. The keloids appeared to be caused by the patient's helmet, worn during his 3-hour daily motorcycle rides, which placed repeated tension on the periauricular area. This rare case illustrates how physical force contributes to auricular and periauricular keloid development and progression. It also shows that when performing surgery with periauricular incisions, care should be taken to eliminate wound/scar stretching.

DOI： 10.1097/GOX.0000000000001417

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

掲載種別：論文集(書籍)内論文  

© 2017 Elsevier Inc. All rights reserved. Stem cell-based therapies for the repair and regeneration of various tissues and organs offer a paradigm shift that may provide alternative therapeutic solutions for a number of diseases. The use of embryonic stem cells or induced pluripotent stem cells in clinical situations is still limited due to cell regulation, genetic manipulation, and ethical considerations, even though these cells are theoretically highly beneficial. Adipose-derived stem cells (ASCs) seem to be an ideal population of stem cells for practical regenerative medicine because they are not subject to the same restrictions. Additionally, because of their autologous tissue origin, they are nonimmunogenic, and are plentiful and easy to harvest. Although ASCs originate from mesodermal lineages, recent preclinical studies have shown that the use of ASCs in regenerative medicine is not limited to mesodermal tissue, but also extends to both exodermal and endodermal tissues and organs. In summary, ASCs are a promising source of stem cells for future cell-based therapies in the fields of regenerative medicine and tissue engineering.

DOI： 10.1016/B978-0-12-803506-1.00050-4

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Keloids are a manifestation of a fibroproliferative scarring disorder of the skin and develop in response to dermal injury in patients with a susceptible background. Local, systemic, and genetic factors contribute to keloid susceptibility. These factors include tension on the edges of the wound, hormonal influences, and ethnicity, respectively. Castleman's disease is a rare lymphoproliferative disorder that is characterized by the unregulated overproduction of interleukin-6, which leads to systemic lymphadenopathy and constitutional inflammatory symptoms. This case report shows that the bilateral auricular keloids of an adult woman were greatly exacerbated by the onset of Castleman's disease. We present our multimodal management algorithm for auricular keloids, which involves core excision and radiation therapy and achieves excellent aesthetic outcomes. The current treatment pathway for auricular keloids and the possible relationship between interleukin-6 and keloid progression will be discussed.

DOI： 10.1097/GOX.0000000000001336

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本手外科学会  

researchmap

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Low-grade cribriform cystadenocarcinoma (LGCCC) is a rare tumor of the salivary gland that most often arises from the parotid gland. A 51-year-old man developed a small mass on the right parotid gland 5 years ago. A preoperative magnetic resonance image showed abnormal intensity, an atypical characteristic for such a tumor; therefore, the diagnosis was difficult. Thus, a superficial parotidectomy was performed as a total excisional biopsy to remove the tumor. Histopathological analyses revealed that the tumor was composed of a single cyst comprising cells containing mucosal fluid, with proliferation of large cells. Also, proliferation of the tumor epithelium showed a papillary cribriform pattern of proliferation with a partial ring form, and the tissue inside the tumor was replaced by a hematoma. Mild cellular atypia was observed. Immunostaining for S-100 was positive, and the Ki-67 ratio was < 5%. These histopathological findings led to a diagnosis of LGCCC of the parotid gland. At 54 months after surgery, the patient has had no recurrence or facial palsy. LGCCC is a rare neoplasm of the salivary gland and is listed in the current World Health Organization classification (2005) as a variant of cystadenocarcinoma. This case suggests that a thorough preoperative examination can lead to better diagnosis of rare tumors, including LGCCC. Thus, if a plastic surgeon is to correctly diagnose and treat parotid grand tumors, including LGCCC, then a detailed preoperative examination, including imaging, a disease course review, a physical examination, and differential diagnosis, should be considered carefully.

DOI： 10.1097/GOX.0000000000001306

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：MDPI  

Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1 alpha, IL-1 beta, IL-6, and tumor necrosis factor-alpha are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.

DOI： 10.3390/ijms18030606

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

目的:2012年に日本医科大学付属病院で多剤耐性アシネトバクター(以下MDRA)の院内伝播があり、MDRA陽性患者には当科で局所陰圧閉鎖療法を行った症例も含まれていた。局所陰圧閉鎖療法と汚染・感染との関連性と感染対策について考察した。対象と方法:MDRA陽性となった患者のなかで、当科がV.A.C.ATS治療システム(以下V.A.C.)を用いた局所陰圧閉鎖療法を行った患者を調査した。結果:当院のMDRA陽性患者25名のうち5名が当科で局所陰圧閉鎖療法を行っていた。その5名はすべて同一病棟の入院患者であった。当院のMDRA陽性患者はすべて保菌のみで、感染症で難渋した症例はなかった。環境培養検査でV.A.C.の内部フィルター部からはMDRAが検出されず、V.A.C.そのものがMDRAを媒介したことは否定的であった。考察:患者が移動する際に外すチューブのコネクターやチューブ表面からMDRAが伝播する可能性も考えられた。MDRAは接触感染により伝播しやすく、注意が必要である。(著者抄録)

researchmap

PubMed

researchmap

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0000000000003015

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The commonly used flap models have drawbacks that limit their usefulness. In the random skin flap model, flap necrosis is caused by both arterial and venous insufficiency. In the axial skin flap model, flap viability is easily affected by the pedicle blood flow and can result in complete necrosis. This study aimed to establish a new rat skin flap model that has a consistent flap survival rate and in which venous congestion and arterial ischemia can be readily distinguished macroscopically. METHODS: Rats underwent reverse U-shaped bipedicled superficial epigastric artery flap elevation. The right superficial epigastric vessels formed the pedicle. In the control rats (n = 3), the left superficial epigastric vessels were left intact. In the ischemia group (n = 10), the left superficial epigastric artery was ligated. In the congestion group (n = 10), the left superficial epigastric vein was ligated. The flap was returned to the original site and sutured. The surrounding neovascularization was blocked by polyurethane film. Flap survival rates were evaluated on postoperative day 3. RESULTS: The flaps in the ischemia and congestion groups were noticeably pale and violet, respectively. Flap necrosis was noted in the contralateral distal zone only. It started on postoperative day 2 in the ischemia and congestion groups. The mean flap survival rates of the control, ischemia, and congestion groups were 100 percent, 61.8 percent (range, 56.9 to 67.1 percent), and 42.3 percent (35.7 to 48.7 percent), respectively (all p < 0.001). CONCLUSIONS: The flap facilitated discrimination of the effects of ischemia and congestion. This new rat skin flap model is simple and easy to construct, and has a consistent flap survival rate.

DOI： 10.1097/PRS.0000000000002900

PubMed

researchmap

DOI： 10.1177/2059513117735483

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

The vascular anatomy of perforators varies between individuals; thus, accurate preoperative assessment of perforators is essential for safely planning perforator flaps. Perforator computed tomographic angiography (P-CTA) with multidetector-row computed tomography (MDCT) is one of the best available methods to precisely reveal the 3-dimensional anatomic details of perforators. The aim of this article is to describe the authors' experience using P-CTA with MDCT for detecting the perforating vessel preoperatively and a step-by-step approach to harvest perforator flaps based on this technique. This article also provides a comprehensive review of literature on other preoperative assessment tools of perforators.

DOI： 10.1016/j.cps.2016.09.004

Web of Science

PubMed

researchmap

DOI： 10.1177/2059513117690937

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE  

Excessive dermal scarring (EDS) is a wound healing complication, characterized by protruded erythematous and inelastic 'proliferative scar tissue' which is associated with increased and prolonged inflammation process within the wound microenvironment. As inflammation plays a key role in this process, methods to contain or attenuate excessive inflammation hold promise in treatment and prophylaxis of EDS conditions.While cold exposure is notorious as the causative agent a wide array of morbidities and fatalities, its tempered use is exploited in medicine for ablative and therapeutic applications. "Subphysiological cold" has been administered for its antiinflammatory effects which act via decreasing vascular permeability and downregulating proliferation of cells in the wound environment; this knowledge supports our hypothesis that "subphysiological cold application" can also be utilized in human EDS prophylaxis and treatment. In this study, we are reviewing the mechanisms of its both deleterious and therapeutic actions and suggesting another possible application for prevention and/or treatment of human EDS conditions. (C) 2016 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.mehy.2016.10.009

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：wiley  

Mechanobiology is an emerging field of study that looks at the biological responses of tissues to mechanical forces. Mechanotherapy is defined as a therapy that utilizes mechanical force to impose desired tissue changes. Recent studies have shown that mechanical forces have a particularly pronounced effect on nail configuration, and thus may be involved in the development of nail deformities such as koilonychia and pincer nail. Based on our experiments, nails may have an automatic curvature function that adapts to the daily upward mechanical forces, and an imbalance between these two forces may cause nail deformation. This chapter introduces the effect of mechanical force on nail configuration from a mechanobiological point of view and presents future perspectives on mechanotherapy for nail deformities.

DOI： 10.1002/9781118966174.ch17

Scopus

researchmap

記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：wiley  

The last phase of wound-healing generates the scar. While wound closure requires appropriate amounts of intrinsic tension, extrinsic mechanical forces on the wound can promote the development and progression of heavy scars, such as keloids and hypertrophic scars. The TGFβ/Smad, integrin, MAPK/G protein, TNF-α/NF-κB, Wnt/β-catenin, interleukin, and calcium ion pathways appear to play key roles in cutaneous scarring. Further elucidation of these and other scar mechanosignaling pathways will help us better understand scar development. This, in turn, will facilitate research into this promising field, and may promote the development of pharmacological interventions that can ultimately prevent, reduce, or even reverse scar formation or progression.

DOI： 10.1002/9781118966174.ch16

Scopus

researchmap

記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：wiley  

Human skin is the largest organ of the body. During growth and development, the skin expands to cover the growing skeleton and soft tissues by constantly responding to the intrinsic forces of underlying skeletal growth. In addition, it responds to the extrinsic forces generated by body movements and external mechanical stimuli. Therefore, mechanobiology plays an important role in skin biology and disease pathogenesis. In this chapter, we will review the skin structure, the skin receptors for mechanical forces, and the skin disorders associated with mechanobiological dysfunction, such as keloid, scleroderma, pincer nails, bullous pemphigoid, Ehlers-Danlos syndrome (EDS), cutis laxa, skin aging, diabetic skin ulcers, leprosy, and lymphedema. Lastly, we will present a short review of mechanotherapy and its future development.

DOI： 10.1002/9781118966174.ch14

Scopus

researchmap

記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：wiley  

Acute and chronic wounds are common and are a major burden on health care systems. Chronic wounds with clinical chronicity, high risk of relapse, and complications are attracting increasing interest. Proper cutaneous wound-healing acting to restore anatomical continuity and physiological functions is a major focus for clinicians and researchers. As the largest organ in the human body, the skin faces a constant tide of mechanical stimuli that can shape the healing process. Current research highlights the mechanotransduction mechanisms and potential mechanotherapies that can apply or alter mechanical forces to the skin in order to improve wound-healing. This chapter summarizes the current state of mechanobiology in cutaneous wound-healing, as well as detailing mechanotherapies such as negative-pressure wound therapy, shockwave therapy, ultrasound therapy, and potential electrotherapy. A better understanding of basic mechanotransduction and clinical mechanotherapy will facilitate research into this promising field, leading to the development of strategies that can restore the mechanical equilibrium of skin and improve wound-healing.

DOI： 10.1002/9781118966174.ch15

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE  

Keloids and hypertrophic scars are fibroproliferative disorders (FPDs) of the skin that result from abnormal healing of injured or irritated skin. They can be called pathological or inflammatory scars. Common causes are trauma, burn, surgery, vaccination, skin piercing, folliculitis, acne, and herpes zoster infection. The pathogenesis of these scars clearly involves local conditions such as delayed wound healing, wound depth, and the tension of the skin around the scars. Scar severity is also shaped by interactions between these local factors and genetic and systemic factors such as hypertension and sex hormones. Notably, to evaluate scar severity, the Japan Scar Workshop (JSW) has established the JSW Scar Scale. Our studies show that tension on the skin around the wound results in prolonged and/or repeated bouts of inflammation in the reticular layer of the dermis and that this inflammation generates abnormal numbers of blood vessels (as well as collagen and nerve fibers) in the dermal reticular layer. We hypothesize that local factors, such as the mechanobiology of the dermis and blood vessels, along with genetic and systemic factors promote pathological scar development by inducing endothelial dysfunction (i.e., vascular hyperpermeability) during the inflammatory stage of wound healing. The continued presence of these factors prolongs the influx of inflammatory cells and factors, thereby leading to fibroblast dysfunction.Evidence for this hypothesis includes the fact that all effective treatments of keloids, namely, radiotherapy, compression therapy, steroid administration, and long-pulsed Nd:YAG laser therapy, act, at least partly, by suppressing blood vessels.At present, keloids are classified as strongly inflammatory scars, while hypertrophic scars are considered to be mildly inflammatory scars. However, we propose that keloids and hypertrophic scars are simply manifestations of the same skin FPD and differ only in the degree of endothelial dysfunction and therefore inflammation. We therefore suggest that these pathological scars should be classified on the basis of the factor that causes the endothelial dysfunction. Thus, primary scars are caused by congenital endothelial dysfunction (e.g., a mutation prevents endothelial gaps from closing smoothly) while secondary scars are caused by endothelial dysfunction that results from aging, arterial sclerosis, and/or repeated/very strong local mechanical forces. We expect that primary keloids develop at younger ages and tend to become severe, while secondary keloids are seen in all ages and can vary in clinical severity.Thus, abnormal blood vessel regulation may underlie keloid and hypertrophic scar pathogenesis, which suggests that inhibiting abnormal angiogenesis and vascular hyperpermeability may be an important therapeutic approach. (C) 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

DOI： 10.1016/j.mehy.2016.09.024

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/GOX.0000000000001138

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: The Clavien-Dindo (CD) classification is used to evaluate the severity of surgical complications. However, its usefulness in esophageal reconstruction has not been reported. To address this, this case series study used the CD classification to evaluate the complications after cervical esophageal reconstruction with free jejunum transfer or supercharged pedicled intestinal transfer.Methods: All consecutive patients who underwent esophageal cancer surgery with larynx-preserving free jejunum or pedicled ileocolic transfer in June 2012-December 2015 were identified. The postoperative complications were classified using the CD classification.Results: In total, 22 patients (20 men and 2 women; mean age, 63.3 years) underwent esophageal cancer reconstruction with larynx-preserving free jejunum transfer (n = 9) and supercharged pedicled intestinal transfer (n = 13). Seven patients underwent prophylactic tracheotomy. Four patients underwent emergent tracheotomy 1 or 5 days after surgery. The most frequent complication was recurrent nerve paralysis (RNP) (n = 8). Of these 8 RNP cases, 6 and 2 were classified as CD I and III complications, respectively. Pneumonia was the next most common complication (n = 7). Of these 7 pneumonia cases, 5 and 2 were classified as CD II and III, respectively. There were 2 cases of intestinal anastomosis leakage (CD II and III). On average, patients were able to start oral alimentation 15.1 (9-35) days after surgery.Conclusions: Our analysis with the CD classification suggested that vascularized free jejunum transfer or supercharge-drainage pedicled ileocolic transfer prevents postoperative intestinal anastomosis leakage and that prophylactic tracheotomy is especially indicated in cases with significant surgical damage in the cervical region.

DOI： 10.1097/GOX.0000000000001113

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: It is difficult to completely resect huge anterior chest wall keloids and then close the wound directly. We report here our retrospective analysis of our case series of patients with such keloids who underwent reconstruction with internal mammary artery perforator (IMAP) pedicled propeller flaps and then received postoperative high-dose-rate superficial brachytherapy.Methods: All consecutive patients with large/severe keloids on the anterior chest wall who underwent keloid resection followed by reconstruction with IMAP-pedicled propeller flaps and then high-dose-rate superficial brachytherapy in our academic hospital were identified. All cases were followed for >18 months. Donor site position, perforator pedicle, flap size, angle of flap rotation, complications, and recurrence were documented.Results: There were nine men and one woman. The average age was 37.9 years. The average follow-up duration was 28.7 months. The largest flap was 16 x 4 cm. The dominant perforators of the internal mammary artery were located in the sixth (n = 2), seventh (n = 5), eighth (n = 1), and ninth (n = 2) intercostal spaces. Twelve months after surgery, patients reported marked relief from keloid-associated pain and itching, except in two patients who underwent partial keloid resection; their remaining keloids were still troublesome but after conservative therapies, including steroid ointments/plasters, the keloids gradually ameliorated. Eighteen months after surgery, there was no keloid recurrence or new development of keloids on the donor site.Conclusions: IMAP-pedicled propeller flaps transfer skin tension from the anterior chest wall to the abdomen. Our series suggests that this approach combined with radiation therapy can control keloid recurrence.

DOI： 10.1097/GOX.0000000000001049

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Advances in skin regeneration have resulted in techniques and products that have allowed regeneration of both the dermis and epidermis. Yet complete skin regeneration requires the adnexal skin structures. Thus it is crucial to understand the regenerative potential of hair follicles where genetic, nutritional, and hormonal influences have important effects and are critical for skin regeneration. The follicular stem cell niche serves as an anatomical compartment, a structural unit, a functional integrator, and a dynamic regulator necessary to sustain internal homeostasis and respond to outside stimuli. In particular, mechanics such as pressure, compression, friction, traction, stretch, shear, and mechanical wounding can influence hair loss or growth. Relevant niche signaling pathways such as Wnt, bone morphogenetic protein, fibroblast growth factor, Shh, and Notch may yield potential targets for therapeutic interventions.

DOI： 10.1111/wrr.12451

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：Elsevier Inc.  

The 3-D structure of living organisms is influenced by various physical factors, including gravity, atmospheric pressure, and water pressure. These constant, seemingly unremarkable mechanical forces are in fact essential for forming, maintaining, and changing the dynamic structures and functions of our cells, tissues, and organs. "Mechanobiology" is the study of the molecular cascades and cellular responses that are triggered by mechanical forces. A more comprehensive and improved understanding of mechanobiology may greatly facilitate the development of new therapies that act by controlling mechanical forces and thereby specifically induce desired molecular, cellular, tissue, and/or organ formation, changes, or repair. We have denoted these therapies as "mechanotherapies.".

DOI： 10.1016/B978-0-12-802225-2.00009-X

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Ingrown nails are defined as inflammation of the lateral nail fold that is caused by penetration by the nail plate and associates with pain and/or infection. The pain associated with ingrown nail hampers walking, raises the risk of falls, and decreases the quality of life. The Sogawa method is a novel conservative medical treatment for ingrown nails that is based on stainless steel wire. It was first reported in 2012 by Sogawa, and we have found that it is very effective for ingrown nails, especially in difficult cases. Here, we show the beneficial effects of the Sogawa method in 2 extremely difficult cases where ingrown nails had recurred after partial nail ablation. We found the Sogawa method to be a quick and easy technique that rapidly improves the pain associated with ingrown nails and later produces properly configured nails. Our experience suggests that it is suitable for severe ingrown nails, such as too short ingrown nails and ingrown nails that have strong inflammation and granulation tissue formation. This is significant because it is difficult to treat such cases with conventional conservative methods, which means that the only remaining therapeutic option is surgery. Thus, the Sogawa method is a novel and highly effective ingrown nail treatment that obviates the need for invasive surgical treatment.

DOI： 10.1097/GOX.0000000000000719

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00398&link_issn=&doc_id=20160714240006&doc_link_id=%2Fad3ksgke%2F2016%2F005907%2F008%2F0738-0748%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2016%2F005907%2F008%2F0738-0748%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本頭蓋顎顔面外科学会  

複数回の開頭腫瘍摘出後再建手術後に腫瘍が再発し広範な切除が行われた2症例(症例1:40歳男、症例2:52歳男)に対し、筋体付き前外側大腿皮弁を用いて頭皮・頭蓋底の再建を行った。特に症例1では、この再建手術後にも再発したため再度再建を行い、そのさい前外側大腿皮弁の血管茎をレシピエント血管として用いた。前外側大腿皮弁は血管茎が長く、移植床のレシピエント血管として再利用できることから頭蓋底再建に有用と考えられたので報告した。

researchmap

記述言語：日本語   出版者・発行元：(一社)日本手外科学会  

researchmap

記述言語：英語   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Keloids and hypertrophic scars are fibroproliferative disorders of the skin that are caused by abnormal healing of injured or irritated skin. It is possible that they are both manifestations of the same fibroproliferative skin disorder and just differ in terms of the intensity and duration of inflammation. These features may in turn be influenced by genetic, systemic, and local risk factors. Genetic factors may include single nucleotide polymorphisms, while systemic factors may include hypertension, pregnancy, hormones, and cytokines. The most important local factor is tension on the scar. Over the past 10 years, our understanding of the pathogenesis of keloids and hypertrophic scars has improved markedly. As a result, these previously intractable scars are now regarded as being treatable. There are many therapeutic options, including surgery, radiation, corticosteroids, 5-fluorouracil, cryotherapy, laser therapy, anti allergy agents, anti-inflammatory agents, bleaching creams and make-up therapies. However, at present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery, followed by radiation and the use of steroid tape/plaster.

DOI： 10.1272/jnms.83.46

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

We experienced a rare case of sclerosing polycystic adenosis ( SPA) arising in a parotid gland. A 33-year-old man who underwent unspecified surgery for a lesion in the left parotid gland 23 years ago presented with a lesion on the same site. Computed tomography scan revealed an encapsulated 3 x 2 cm lesion. Intraoperative findings showed that the tumor was embedded deep in the parotid gland. Marginal tumor excision was performed to preserve the facial nerve. Histopathological and immunohistochemical findings led to the final diagnosis of SPA. The surgery was not associated with any other complications. To date, 28 months after surgery, recurrence has not been observed. The treatment protocol of SPA has not yet been established. To make plastic surgeons familiar with this disease, we describe this case, which was successfully treated without any complications.

DOI： 10.1097/GOX.0000000000000614

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

下肢の皮膚軟部組織欠損の治療において、従来の厚い皮弁による再建では、(1)整容面での患者満足度が低い、(2)関節をまたぐ部分では厚い皮弁が原因で関節可動域制限をきたすことがある、(3)厚い皮弁のdebulkingに複数回の手術を要し、それに伴い時間・労力・費用がかかる、などの問題点が挙げられる。穿通枝皮弁の開発・発展の歴史は皮弁再建におけるthin flapの適応を拡大し、下肢の皮膚軟部組織欠損再建においても上記の問題点を解決する方法として注目されている。本稿では、下肢の皮膚軟部組織欠損に対する穿通枝皮弁を用いた治療戦略を解説する。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Keloids are characterized by the formation of excessive scar tissue that extends beyond the area of the initial wound. Keloid redness is due to angiogenesis and chronic inflammation and is an important indicator of the severity of the lesion and the effectiveness of treatment. METHODS: The color of 33 untreated keloids from 30 patients was measured with a narrow-band reflectance colorimeter. The erythema and melanin levels in the keloids (Ek and Mk, respectively) were recorded with control data obtained from the flexor aspect of the forearm (Ec and Mc, respectively). The keloid color was also evaluated subjectively. RESULTS: The Ek or Mk values did not vary significantly according to symptom intensity, scar region, patient age, and patient sex. Younger patients (<40 years) and female patients had significantly higher Ek/Ec ratios than did older patients and male patients, respectively. Subjective keloid redness evaluations distinguished keloids with high Ek/Ec ratios from keloids with low Ek/Ec ratios (P<0.0001) but could not distinguish keloids with high Ek from keloids with low Ek. CONCLUSIONS: Subjective evaluations of keloids in Japanese subjects reflected Ek/Ec ratios, which were strongly affected by variation in background skin color. The subjective assessment of the color of keloids or other skin disorders should be performed with caution in Asian populations.

DOI： 10.1272/jnms.83.142

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本頭蓋顎顔面外科学会  

症例は4歳男児で、左眉毛外側より排膿を認め、炎症反応を伴う耳前瘻孔と診断された。その後、排膿を繰り返すため紹介受診した。瘻孔は耳前部と言うより左眉毛外側にあり、左上眼瞼に軽度の腫脹があった。造影MRIで左眉毛外側の皮膚から索状構造を認め、類皮嚢腫を疑い手術のため入院した。全身麻酔下に手術を施行した。摘出標本の大きさは約10×25mmであった。骨は吸収性のプレートで固定した。病理組織像は重層扁平上皮からなる瘻管壁があり、毛嚢が認められた。術後6ヵ月後のMRIでは腫瘍の再発などは認めていない。術後顔面神経側頭枝に障害が生じたが、6ヵ月後には改善傾向であった。術後2年半が経過しており、眉毛の位置に左右差を認めない。

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Our bodies are subjected to various mechanical forces, which in turn affect both the structure and function of our bodies. In particular, these mechanical forces play an important role in tissue growth and regeneration. Adipocytes and adipose-derived stem cells are both mechano-sensitive and mechanoresponsive. The aim of this review is to summarize the relationship between mechanobiology and adipogenesis. PubMed was used to search for articles using the following keywords: mechanobiology, adipogenesis, adipose-derived stem cells, and cytoskeleton. In vitro and in vivo experiments have shown that adipogenesis is strongly promoted/inhibited by various internal and external mechanical forces, and that these effects are mediated by changes in the cytoskeleton of adipose-derived stem cells and/or various signaling pathways. Thus, adipose tissue engineering could be enhanced by the careful application of mechanical forces. It was shown recently that mature adipose tissue regenerates in an adipose tissue-engineering chamber. This observation has great potential for the reconstruction of soft tissue deficiencies, but the mechanisms behind it remain to be elucidated. On the basis of our understanding of mechanobiology, we hypothesize that the chamber removes mechanical force on the fat that normally impose high cytoskeletal tension. The reduction in tension in adipose stem cells triggers their differentiation into adipocytes. The improvement in our understanding of the relationship between mechanobiology and adipogenesis means that in the near future, we may be able to increase or decrease body fat, as needed in the clinic, by controlling the tension that is loaded onto fat.

DOI： 10.1097/GOX.0000000000000564

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

メディカルイラストレーション(MI)は相手に情報をわかりやすく的確に伝えるための武器であり、医学・医療の世界における大切なコミュニケーションツールである。MIの描画方法には様々なものがあり、個々が自分にあった方法を選べばよいと思う。本稿ではMacのプレゼンテーションソフトウェアであるKeynoteを使用した描画方法をstep by stepで簡潔に紹介する。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本創傷治癒学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0000000000001608

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

上肢の皮膚軟部組織欠損の治療において、従来の厚い皮弁による再建では、(1)整容面での患者満足度が低い、(2)関節をまたぐ部分では厚い皮弁が原因で関節可動域制限をきたすことがある、(3)厚い皮弁のdebulkingに複数回の手術を要し、それに伴い時間・労力・費用がかかる、などの問題点が挙げられる。光嶋らによる穿通枝皮弁の開発・発展は皮弁再建におけるthin flapの適応を拡大し、上肢の皮膚軟部組織欠損再建においても上記の問題点を解決する方法として注目されている。本稿では、上肢の皮膚軟部組織欠損に対するthin flapを用いた治療戦略を、穿通枝プロペラ皮弁を中心に解説する。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Keloids are defined as a kind of dermal fibroproliferative disorder resulting from the accumulation of collagen. In the remodeling of extracellular matrix, the balance between matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs) is as critical as the proper production of extracellular matrix. We investigate the role of TIMPs and MMPs in the pathogenesis of keloids and examine the therapeutic potential of TIMP-2. METHODS: The expression of TIMPs and MMPs in most inflamed parts of cultured keloid fibroblasts (KFs) and peripheral normal skin fibroblasts (PNFs) in the same individuals and the reactivity of KFs to cyclic mechanical stretch were analyzed by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay (n = 7). To evaluate the effect of treating KFs with TIMP-2, collagen synthesis was investigated by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay, and microscopic analysis was used to examine the treatment effects of TIMP-2 on ex vivo cultures of keloid tissue (n = 6). RESULTS: TIMP-2 was downregulated in cultured KFs compared with PNFs in the same individuals, and the reduction in TIMP-2 was exacerbated by cyclic mechanical stretch. Administration of TIMP-2 (200 or 300 ng/mL) significantly suppressed expression of Col1A2 and Col3A1 mRNA and collagen type I protein in KFs. TIMP-2 also significantly reduced the skin dermal and collagen bundle thickness in ex vivo cultures of keloid tissue. CONCLUSION: These results indicated that downregulation of TIMP-2 in KFs is a crucial event in the pathogenesis of keloids, and the TIMP-2 would be a promising candidate for the treatment of keloids.

DOI： 10.1097/GOX.0000000000000503

PubMed

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

41歳女。主訴は両頬部の硬結・腫脹であった。他院で10年以上前に頬部と両鼻唇溝にハイドロジェルの注入を受けていた。MRIで下顎骨の両外側にT1強調像で骨格筋と等信号、T2強調像・拡散強調像で高信号の腫瘤性病変を認めた。ハイドロジェル注入後の異物肉芽腫の診断で、プレドニン内服を開始し、両頬部の腫脹は2ヵ月で目立たなくなった。その1ヵ月後に全身麻酔下に口腔内アプローチから異物肉芽腫を可及的に摘出した。異物肉芽腫の内部は黄白色泥状の液体を含有し、細菌培養検査は陰性であった。術後6ヵ月経過し、2cm程度のしこりが残存している。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00398&link_issn=&doc_id=20150909080004&doc_link_id=%2Fad3ksgke%2F2015%2F005809%2F006%2F0972-0974%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2015%2F005809%2F006%2F0972-0974%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: Recent studies suggest that pincer nails are caused by lack of upward mechanical forces on the toe pad. However, clinically significant pincer nails are also often observed among healthy walkers. It was hypothesized that in these cases, the affected toes do not receive adequate physical stimulation from walking and loading. To test this, the gait characteristics of pincer nail cases were assessed by measuring plantar pressure during walking.Methods: In total, 12 bilateral pincer nail cases (24 affected feet) and 12 age-and sex-controlled healthy control subjects (24 ft) were enrolled in this prospective case-control study. Plantar pressure during free ambulation in both the barefoot and shod state was assessed using a digital pressure-plate system named S-Plate platform (Medicapteurs Co. France). First toe pressure and the frequencies of peak pressure in the first toe, metatarsal head, or other foot areas were calculated.Results: In both the barefoot and shod state, the pincer nail group had significantly lower pressure on the first toe than the control group. In both the barefoot and shod state, the peak pressure area was mostly the metatarsal head area in the pincer nail group, whereas it was mostly the first toe area in the control group. Binomial logistic regression analysis revealed that peak pressure area was a significant risk factor for pincer nail development.Conclusion: Walking behavior appears to contribute to pincer nail development. Pincer nails of walkers could be treated by correcting the walking behaviour so that more pressure is placed on the toe pad.

DOI： 10.1186/s13047-015-0100-y

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: "Superthin flap" is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients.Methods: This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 x 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively.Results: Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction.Conclusion: Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope of previously used "superthin flaps."

DOI： 10.1097/GOX.0000000000000449

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

手は露出部であり、熱傷の受傷リスクが比較的高い。手掌側は保存的加療で上皮化が得られる場合が多いが、手背側は解剖学的に皮膚が薄いため、熱傷深度が深達化しやすく、治癒後の瘢痕拘縮に伴う機能障害をきたしやすい。このため、深達性II度熱傷(以下DDB)以上の場合、受傷後早期に適切な手術を行うことが重要であるが、広範囲熱傷などに合併した場合では、全身状態や合併疾患により、やむをえず手術が遅れる場合がある。今回われわれは、受傷から1週間以上経過したDDB以上の手部熱傷2例に対して、ハイドロサージェリーシステム(水圧式ナイフ)「バーサジェット(Smith & Nephew社製)」を用いたデブリードマンを施行し、良好な治療結果を得た。腱や骨や内在筋など複雑な構造を有するため、繊細なデブリードマンの技術を要する手背部の深達性熱傷治療において、バーサジェットは有用であると考えられた。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

大腿の皮膚穿通枝により栄養される代表的な皮弁としては、大腿前面からは内側大腿穿通枝皮弁、前外側大腿穿通枝皮弁、大腿筋膜張筋穿通枝皮弁、下行膝動脈穿通枝皮弁、上膝動脈穿通枝皮弁、さらに大腿後面からは下臀動脈穿通枝皮弁、大腿深動脈穿通枝皮弁、膝窩動脈窩通枝皮弁などが挙げられる。本稿では、大腿の皮膚穿通枝により栄養される有茎穿通枝皮弁を理解しやすくするために、血管解剖をもとに下記6系統に分類した:(1)総一浅大腿動脈系(大腿動脈穿通枝皮弁)、(2)大腿深動脈系(内/外側大腿回旋動脈穿通枝皮弁、大腿深動脈穿通枝皮弁)、(3)下行膝動脈系(下行膝動脈穿通枝皮弁)、(4)上膝動脈系(内/外側上膝動脈穿通枝皮弁)、(5)下臀動脈系(下臀動脈穿通枝皮弁)、(6)膝窩動脈系(膝窩動脈穿通枝皮弁)。さらに各皮弁の特徴と穿通枝プロペラ皮弁として挙上した際の被覆可能範囲を中心に解説した。大腿の有茎穿通枝皮弁は、穿通枝の位置・走行の解剖学的バリエーションが多いため、バックアップ皮弁を常に念頭に置き、信頼できる穿通枝を術中に直視下で確認してから皮弁デザインを最終決定する柔軟性と慎重さが求められる。(著者抄録)

researchmap

記述言語：英語   出版者・発行元：OXFORD UNIV PRESS  

Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

DOI： 10.1097/BCR.0000000000000106

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本手外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

Background: Successful vascular anastomosis is essential for the survival of transferred free tissue. Arterial anastomosis is typically uncomplicated because the lumen is easily maintained and the vessel walls have elasticity. Venous anastomosis, however, is more time consuming because the vessel walls are thin and extensible. This article describes, reviews, and compares 3 currently used venous anastomosis techniques. Methods: From April 2012 through January 2014, free tissue transfer and supercharging pedicled tissue transfer were performed in 107 and 10 patients, respectively, at our hospital. According to the anastomotic technique used, patients (83 men and 34 women
mean age, 60.6 years) were divided into interrupted suture, continuous suture, and microvascular anastomotic coupling device (MACD) groups. Medical records were reviewed, and postoperative results were analyzed. Results: The diameter of anastomosed veins did not differ significantly among the groups. However, among the interrupted suture, continuous suture, and MACD groups, there were significant differences in vascular anastomosis time (51, 43.9, and 29.5 minutes, respectively) and transferred tissue ischemic time (151.9, 139.1, and 117.5 minutes, respectively). Surgical site infection occurred in 9 patients, and flap necrosis occurred in 2 patients. However, complication rates did not differ significantly among the 3 groups. Conclusions: The venous anastomosis technique does not affect the complication rate but does affect anastomosis time and flap ischemia time. On the basis of these results, we believe that the continuous suture and MACD techniques are easier and safer for venous anastomosis than is the traditional interrupted suture technique.

DOI： 10.1272/jnms.82.14

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

This study assessed whether hypertension, a circulating factor, influences local keloid severity. This retrospective cross-sectional study involved 304 consecutive patients (13-78 years old) with keloids who were surgically treated in our hospital between January 2011 and August 2013. Their blood pressure (BP), age and gender, and the size and number of their keloids before surgery were recorded. Ordinal logistic regression analyses showed that BP associated significantly with both keloid size and number (all p&lt;0.0001). Age also associated with keloid size (p&lt;0.0001). However, a Goodness-of-fit chi-square test showed that the prevalence of hypertension was not higher among keloid patients than in the general Japanese population. This study provides epidemiological evidence for the possibility that primary hypertension may aggravate keloids. We propose that the skin, along with the heart and liver, is a target organ of hypertension. The observations of this study, which require validation with large-scale prospective interventional trials, suggest that keloid patients should be screened for hypertension and that antihypertensive treatments may be of prophylactic and therapeutic value for skin fibrosis.

DOI： 10.1111/wrr.12277

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background: Treatments for keloids on the cartilaginous part of the auricle (i.e., the upper part of the ear excluding the earlobe) include surgical excision, cryosurgery, postoperative radiation therapy, steroid injection, taping stabilization, and pressure therapy. However, to date, there is no universally accepted treatment strategy for auricle keloids.Methods: In this retrospective cohort study, the 63 primary auricle keloids in all 57 patients who underwent surgery from 2006 to 2012 were included. Mild scars such as hypertrophic scars were excluded. All 63 scars were treated with surgery, namely, total excision or intralesional excision (core excision method), and postoperative adjuvant radiation therapy and self-managed scar stabilization with surgical tape. The postsurgical radiation therapy consisted of 15 Gy administered in three fractions over 3 days. The recurrence rates associated with the two surgical methods over 18 months of follow-up were recorded.Results: Of the 57 patients, 91.2 percent were women. Of the 63 lesions, 95.2 percent and 4.8 percent were caused by piercing and trauma, respectively. All were primary keloids. Before 2009, all lesions (n = 37) were treated by total excision. After 2009, all lesions (n = 26) were treated by core excision. These methods were associated with recurrence rates of 8.1 percent and 0 percent, respectively, although this difference did not achieve statistical significance (p > 0.05). The overall recurrence rate was 4.8 percent. Complications such as wound dehiscence and pigmentation during the 18-month follow-up period were not observed.Conclusion: Auricle keloids can be treated by customized plans consisting of appropriate surgical modalities, postoperative radiotherapy, and self-management.

DOI： 10.1097/PRS.0000000000000962

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2014.10.027

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Successful vascular anastomosis is essential for the survival of transferred free tissue. Arterial anastomosis is typically uncomplicated because the lumen is easily maintained and the vessel walls have elasticity. Venous anastomosis, however, is more time consuming because the vessel walls are thin and extensible. This article describes, reviews, and compares 3 currently used venous anastomosis techniques.Methods: From April 2012 through January 2014, free tissue transfer and supercharging pedicled tissue transfer were performed in 107 and, 10 patients, respectively, at our hospital. According to the anastomotic technique used, patients (83 men and 34 women; mean age, 60.6 years) were divided into interrupted suture, continuous suture, and microvascular anastomotic coupling device (MACD) groups. Medical records were reviewed, and postoperative results were analyzed.Results: The diameter of anastomosed veins did not differ significantly among the groups. However, among the interrupted suture, continuous suture, and MACD groups, there were significant differences in vascular anastomosis time (51, 43.9, and 29.5 minutes, respectively) and transferred tissue ischemic time (151.9, 139.1, and 117.5 minutes, respectively). Surgical site infection occurred in 9 patients, and flap necrosis occurred in 2 patients. However, complication rates did not differ significantly among the 3 groups.Conclusions: The venous anastomosis technique does not affect the complication rate but does affect anastomosis time and flap ischemia time. On the basis of these results, we believe that the continuous suture and MACD techniques are easier and safer for venous anastomosis than is the traditional interrupted suture technique.

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

We hypothesize that nails have an automatic curvature feature and that their flat shape is maintained by the daily upward mechanical forces from the finger/toe pad. Thus, nail deformities, such as pincer nail, spoon nail, and koilonychias, may be caused by an imbalance between these forces and can be treated by controlling these forces. Here, we report the case of a 55-year-old man whose severe pincer nail was effectively treated by thinning the nail, which reduced the automatic curvature force. This is the first report to show that pincer nail can be treated by a nonsurgical method that reduces the automatic curvature force, thus obviating the need for surgery. This supports the notion that mechanical stimulus-based treatments have high therapeutic potential for nail deformities.

DOI： 10.1097/GOX.0000000000000220

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT, INC  

Background: The chondrogenic potential of adipose-derived stem cells (ASCs) has been previously demonstrated, although several reports have indicated that ASCs produce less cartilage-specific matrix than bone marrow-derived mesenchymal stem cells. In this study, we intended to improve chondrogenic phenotypes of ASCs using hydrostatic pressure (HP), without utilizing any growth factors other than the transforming growth factor-beta 1.Methods: Human ASCs (CD13(+), 44(+), 90(+), 14(-), 31(-), 34(-)) were harvested and cultured. After three passages, the cells were suspended in 0.3% neutralized collagen type I solution and injected into semipermeable membrane tubes, from which 66 pouches were constructed. After a day of incubation, the 66 pouches were divided into three groups. Group HP1: Pouches were incubated for 1 week with treatment of cyclic HP at 0-0.5 MPa (4.93 atm), 0.5 Hz, with a medium replenishment rate of 0.1 mL/min at 37 degrees C, 3% O-2, and 5% CO2 in air using a bioprocessor. This was followed by 3 weeks with no HP and without pouches. Group HP2: Pouches were incubated for the first and third week (2 total weeks) with the same condition of Group HP1. No HP was applied in the second and fourth week. Group AP: Pouches with one end opened were incubated without HP. We evaluated the cell constructs histologically and immunohistochemically, as well as for specific gene expression.Results: Accumulation of the matrix in the HP1 and HP2 groups was much denser than AP groups, particularly after 2 weeks. Cell numbers in the HP groups increased gradually in the middle zone and peaked at 1 week after incubation, maintaining their numbers for the entire course on the surface layer of the construct. In the genomic study results, COL 2A1, COL 10A1, ACAN, SOX9, MMP3, and MMP13 were upregulated and COL 1A1, ITGB1, and PCNA were downregulated by HP. There were no significant differences between HP1 and HP2 gene expression.Conclusion: It was suggested that HP is especially beneficial in the early stage of chondrogenesis of ASCs. Moreover, the expression profile of genes related to chondrocyte differentiation/proliferation was significantly enhanced by HP loading compared with the AP control.

DOI： 10.1089/ten.tea.2013.0525

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0000000000000785

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Lippincott Williams and Wilkins  

Background: Diagnostic and therapeutic strategies for lower-limb lymphedema have not yet been established. The purpose of this study was to estimate the lymphodynamic condition and therapeutic efficacy of lymphovenous anastomosis (LVA) in lower-limb lymphedema patients using 2-phase 99mTc-phytate lymphoscintigraphy with single-photon emission computed tomography-computed tomography (SPECT-CT). Methods: In this study, consecutive patients with lower-limb lymphedema who underwent 2-phase lymphoscintigraphy using 99mTc-phytate were enrolled between June 2013 and June 2014. SPECT-CT was also performed to clarify the relationships between functional and morphological information. In both the early and delayed images, inguinal lymph node accumulation, dermal backflow, and their sequential alternations were evaluated, and liver-to-blood ratio and inguinal lymph node-to-blood ratio were calculated. All participants were classified into 6 types of lymphodynamic conditions based on the image findings. Patients with both dermal backflow and associated normal lymphatic vessel accumulation proceeded to LVA and underwent a second lymphoscintigraphy after the operation. Results: Of all 30 participants, the largest population was categorized as type 4, which had consistent inguinal lymph node accumulation defect with dermal backflow. In 12 operated cases, dermal backflow was degraded in 10 cases by LVA. Liver-to-blood ratio in both early and delayed images and inguinal lymph node-to-blood ratio in delayed image significantly increased after LVA. Conclusions: Lymphoscintigraphy with SPECT-CT can provide both functional and morphological information simultaneously in patients with lower-limb lymphedema. Using these procedures, a type categorization for the patients was devised, which reflects their lymphodynamic conditions. The therapeutic efficacy of LVA could also be estimated quantitatively by the derived findings.

DOI： 10.1097/GOX.0000000000000375

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：DOVE MEDICAL PRESS LTD  

Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed "extracellular matrix replacement therapies". The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use invasive surgical tissue transfer strategies.

DOI： 10.2147/CWCMR.S54680

Web of Science

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The present retrospective cohort study was performed to determine the efficacy of contact-mode 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser laser for keloids and hypertrophic scars. The indication and limitations of this modality are discussed. METHODS: The cohort consisted of 102 consecutive Japanese patients (23 males and 79 females) with keloids and hypertrophic scars for more than 1 year. They were treated every 3-4 weeks for 1 year with a long-pulsed 1064 nm Nd:YAG laser (Cutera, Brisbane, Calif.) in contact mode. Thirty-eight patients had hypertrophic scars and 64 had keloids. The scars were evaluated before the treatment commenced and 1 month after the last session by using the Japan Scar Workshop Scar Scale 2011. Recurrence was assessed at 6 months after the termination of treatment. RESULTS: The average total Japan Scar Workshop score of the keloid and hypertrophic scar region groups dropped significantly after 1 year of treatment compared with before treatment (all P < 0.05). None of the hypertrophic scars or keloids deteriorated. However, 3 of the 34 anterior chest keloids (8.8%) did not respond. The following recurrence rates were observed 6 months after stopping laser treatment: 1 of the abdomen hypertrophic scars (4%), 18 of the anterior chest keloids (52.9%), 5 of the upper arm keloids (35.7%), and 4 of the scapula keloids (25%). CONCLUSIONS: Hypertrophic scars responded significantly better to 1064 nm Nd:YAG laser treatment than keloids. However, keloid recurrence occurred when there was remaining redness and induration, even if only a small part of the scar was affected.

DOI： 10.1097/GOX.0000000000000231

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本美容外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

症例は57歳男性で、作業中に6600Vの交流電流に左環指が接触して電撃症を受傷し、救急救命センターに搬送され全身精査後当科に転科した。左小指の完全壊死、左母指基部の軟部組織から骨に至る壊死、右小指の軟部組織に壊死を認め、電流は左環指から左母指と右小指に流れたと考えられた。創部の保存的治療を開始し、壊死組織との境界が明瞭となった受傷後10日目にデブリードマンと人工皮膚移植術を行い、wound bed preparationを行った。移植12日後に移植床の血流を確認し、移植床の色調が赤色となり、右大腿部からの自家分層植皮片で左母指側と左小指側に移植した。移植片は生着せず脱落し、電撃症による血管損傷と考え、腹部の遠隔皮弁を腹直筋前鞘上で挙上して創部に縫合した。2週後に皮弁の切離とドナーの縫縮手術を行い、皮弁は完全生着した。左小指は失ったが、物を掴む機能は温存され、6年間の経過観察を終了した。なお、右小指は軟膏処置にて上皮化した。

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Hypertrophic scars (HSs) and keloids are commonly seen as two different diseases by both clinicians and pathologists. However, as supported by histological evidence showing they share increased numbers of fibroblasts and accumulate collagen products, HS and keloid might be different forms of the same pathological entity, rather than separate conditions. To test this hypothesis, keloids from patients who underwent scar excisions (n = 20) in Nippon Medical School from 2005 to 2010 were examined histologically. The proportion and distribution of cellular and matrix collagen components were evaluated at the centre and periphery of each sample. In keloid samples, coexistence of hyalinised collagen, which is the most important pathognomonic characteristic of a keloid and dermal nodules that are considered to be characteristic of HS, was found. Moreover, hyalinised fibres appeared to initiate from the corner of the dermal nodules. Key features of inflammation such as microvessels, fibroblasts and inflammatory cells all decreased gradually from the periphery to the centre of keloids, indicative of reduced inflammation in the centre. Thus, we hypothesise that HS and keloid can be considered as successive stages of the same fibroproliferative skin disorder, with differing degrees of inflammation that might be affected by genetic predisposition.

DOI： 10.1111/j.1742-481X.2012.01118.x

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：克誠堂出版(株)  

症例は57歳男性で、作業中に6600Vの交流電流に左環指が接触して電撃症を受傷し、救急救命センターに搬送され全身精査後当科に転科した。左小指の完全壊死、左母指基部の軟部組織から骨に至る壊死、右小指の軟部組織に壊死を認め、電流は左環指から左母指と右小指に流れたと考えられた。創部の保存的治療を開始し、壊死組織との境界が明瞭となった受傷後10日目にデブリードマンと人工皮膚移植術を行い、wound bed preparationを行った。移植12日後に移植床の血流を確認し、移植床の色調が赤色となり、右大腿部からの自家分層植皮片で左母指側と左小指側に移植した。移植片は生着せず脱落し、電撃症による血管損傷と考え、腹部の遠隔皮弁を腹直筋前鞘上で挙上して創部に縫合した。2週後に皮弁の切離とドナーの縫縮手術を行い、皮弁は完全生着した。左小指は失ったが、物を掴む機能は温存され、6年間の経過観察を終了した。なお、右小指は軟膏処置にて上皮化した。

Scopus

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00398&link_issn=&doc_id=20141008100012&doc_link_id=%2Fad3ksgke%2F2014%2F005710%2F015%2F1179-1184%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2014%2F005710%2F015%2F1179-1184%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

researchmap