記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌外科学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pyogenic spondylodiscitis is an extremely rare complication of esophagectomy for esophageal cancer. CASE PRESENTATION: A 70-year-old Japanese man, with a previous medical history of type 2 diabetes mellitus, coronary artery disease, and laryngeal cancer, received neoadjuvant chemotherapy and underwent thoracoscopic esophagectomy with gastric tube reconstruction for advanced esophageal cancer. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. However, partial necrosis in the gastric tube developed to form refractory anastomotic fistula. Two months after the initial surgery, debridement and free jejunal transfer reconstruction with the pectoralis major muscle flap were performed. Although the postoperative course of the second surgery was uneventful, the patient complained of severe lower back pain and fever. The patient was diagnosed with pyogenic spondylodiscitis according to the results of the magnetic resonance imaging. Enterobacter cloacae were isolated from the arterial blood culture. Sensitive antibiotics were administered continuously, and the patient required to use a lumbar corset for 2 months. Subsequently, his physiological signs and symptoms had completely disappeared. CONCLUSION: To the best of our knowledge, this case study is the first study that reported pyogenic spondylodiscitis of the lumbar spine, a complication of cervical anastomotic fistula after surgery for advanced esophageal cancer.

DOI： 10.1186/s40792-020-00922-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語  

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

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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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

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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 Tokyo  

Phlegmonous gastritis is a rapidly progressive bacterial infection of the stomach wall. It has a high mortality rate and aggressive treatment, either with antibiotics or surgical resection, is required. Here, we report an extremely rare case of phlegmonous gastritis associated with advanced esophageal cancer. A 65-year-old Japanese man was urgently admitted to the hospital due to pyrexia and gastrointestinal symptoms. Abdominal computed tomography revealed widespread diffuse thickening of the gastric wall. On endoscopic examination, an ulcerative mass was detected at the lower thoracic esophagus, and a markedly elevated submucosal lesion was present in the middle of the stomach body. Biopsy specimens taken endoscopically from the esophageal tumor confirmed a diagnosis of squamous cell carcinoma. Gastric biopsy cultures were positive for Streptococcus viridans, leading to a diagnosis of phlegmonous gastritis associated with esophageal cancer. After the patient's condition improved with preoperative antibiotic administration, we performed a thoracoscopic esophagectomy, a total gastrectomy and a reconstruction of the gastrointestinal tract using a pedicled right colon. Histological examination of the resected specimen confirmed that the gastric mass was compatible with a phlegmon.

DOI： 10.1007/s12328-018-0867-z

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The 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. METHODS: Twenty-four patients with an average age of 27.0 years (range, 9-52 years) 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). RESULTS: The mean follow up time was 10.1 months (range, 4-22 months). The flaps ranged in size from 3 × 5 cm to 16 × 6 cm. 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. CONCLUSIONS: With 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

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記述言語：英語   出版者・発行元：Lippincott Williams and 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

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Postoperative bronchopleural fistula (BPF) and empyema are not uncommon after lung cancer surgery. Some patients require reconstructive surgery to achieve wound healing. In this report, we describe a novel method of reconstructive surgery for BPF and empyema. METHODS: From 1996 through 2014, we performed reconstructive surgery for the treatment of BPF and empyema in 13 cases. BPF or a pulmonary fistula was present in 11 patients at the time of reconstruction. Of these, a free fascial patch graft combined with a free soft tissue flap was used to close the fistula in 6 cases. In the other 5 cases, primary fistula closure or direct coverage of the fistula with a transferred flap was performed. Medical records were retrospectively reviewed, and postoperative results were compared for these methods. RESULTS: All the flaps were transferred successfully except in 1 case. Although postoperative air leakage was observed in 5 cases, most of these healed with conservative management. Of 11 fistulas, 8 were successfully controlled. Although differences were not statistically significant, a higher success rate of fistula closure was obtained in patients with a fascial patch graft (100% vs 40%). As a result, 9 patients could be discharged from the hospital, but 4 died during their hospital stay. CONCLUSION: Although the incidence of in-hospital mortality was high, fistula closure with a fascial patch graft combined with free flap transfer was effective for the treatment of BPF and empyema, compared with other procedures.

DOI： 10.1097/GOX.0000000000001199

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

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記述言語：英語  

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 × 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

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2014.10.027

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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.

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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  

Closing large skin defects of the upper back is a challenging problem. We have developed an efficient design for a latissimus dorsi musculocutaneous flap for reconstruction in this region. The longitudinal axis of the skin island was designed to be perpendicular to the line of least skin tension at the recipient site so that primary closure of the flap donor site changed the shape of the recipient site to one that was easier to close. We used this method for four patients with skin cancers or soft-tissue sarcomas of the upper back in 2011 and 2012. The size of skin defects after wide excision ranged from 11 x 10 to 25 x 20 cm(2), and all skin defects could be covered by the flaps and all wounds of donor site could be closed without skin grafts. No wound complications occurred in any patient. Functional and aesthetic outcomes were satisfactory in all patients. This flap design is effective for reconstructing large skin defects of the upper back. (c) 2013 Wiley Periodicals, Inc.

DOI： 10.1002/micr.22108

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DOI： 10.3109/23320885.2014.974607

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DOI： 10.1155/2014/327549

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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  

Postoperative monitoring of buried anterolateral thigh flaps is difficult with standard methods. Although a monitoring skin flap based on a second cutaneous perforator is often used, it requires tedious dissection of 2 sets of perforators and cannot be used when a second perforator is absent. We present 2 patients who underwent head and neck reconstruction with buried anterolateral thigh flaps, which were monitored with a small, externalized segment of the vastus lateralis muscle accompanying the main skin island. Both flaps survived, and the monitoring muscle flaps remained pink throughout the postoperative period until removal. For monitoring, a vastus lateralis muscle flap has several advantages over a skin flap. This method obviates the need for dissecting a second cutaneous perforator and allows reliable monitoring regardless of the number of available cutaneous perforators. We believe this method is a versatile option for monitoring buried anterolateral thigh flaps.

DOI： 10.1097/SCS.0b013e31829a8621

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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: Limb amputation has historically been the first choice of treatment for patients with bone or soft-tissue sarcomas involving major blood vessels. However, recent advances in surgical technique have allowed limb-salvage surgery. We reviewed our experiences with limb-salvage surgery and immediate vascular reconstruction following en bloc resection of bone or soft-tissue sarcomas of the lower extremity.
Materials and method: We reviewed 23 patients (15 male and eight female; mean age, 43.6 years) who underwent limb-salvage surgery and immediate vascular reconstruction. Details of surgical factors and postoperative complications were evaluated.
Results: Reconstructed vessels remained patent in 21 cases. The rate of limb oedema was higher in patients who underwent only arterial reconstruction after arteriovenous resection. Twenty patients could walk well without crutches a few months after reconstructive surgery. All patients avoided amputation. Two patients died of disseminated disease within 3 years after surgery.
Conclusion: The high rate of limb oedema suggests that venous reconstruction is necessary after arteriovenous resection. Vascular reconstruction and musculocutaneous flap techniques are useful in limb-salvage surgery and are indicated for patients who have achieved good disease control.
Evidence Rating Scale for Therapeutic Studies: Level III. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2013.01.001

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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  

The flow-through fibula flap utilizing the soleus branch as a distal runoff has not yet been reported. We herein present a patient with left tibial adamantimoma in whom wide resection of the tumor resulted in a segmental tibial defect 22 cm in length. The defect was successfully reconstructed with a flow-through free fibula osteocutaneous flap using the soleus branch of the peroneal artery as a distal runoff. The short T-segment of the peroneal artery was interposed to the transected posterior tibial artery. The soleus branch has a constant anatomy and a larger diameter than the distal stump of the peroneal artery. Short interposed flow-through anastomosis to the major vessels is much easier and more reliable than the conventional methods. We believe that our method represents a versatile option for vascularized fibula bone grafting for extremity reconstruction. (C) 2012 Wiley Periodicals, Inc. Microsurgery, 33: 60-62,2013

DOI： 10.1002/micr.22043

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

Background: The reconstruction of large, complex defects of the abdominal wall after the ablation of malignant tumours can be challenging. The transfer of an anterolateral thigh (ALT) flap is an attractive option. This study compared free ALT flaps and pedicled ALT flaps for abdominal wall reconstruction.
Methods: From 1996 through 2011, 20 patients underwent abdominal wall reconstruction with ALT flaps. The flaps were pedicled in 12 patients and free in eight patients. Medical records were reviewed for complications and clinical and demographic data. Abdominal wall defects were classified into the following four groups: upper midline, lower midline, upper quadrants and lower quadrants.
Results: Pedicled flaps were transferred to the upper midline region in one patient, the lower midline region in six patients and lower quadrants in five patients. Free flaps were transferred to the lower midline region in two patients, upper quadrants in four patients and lower quadrants in two patients. Mean reconstructive time was significantly longer with free flaps (6 h 32 min) than with pedicled flaps (4 h 55 min, p = 0.035). Although free flaps (mean size, 360 cm(2)) were larger than pedicled flaps (mean size, 289 cm(2)), the difference was not significant (p = 0.218). The rates of complications did not differ between free flaps and pedicled flaps. No total flap loss occurred, and there was partial loss of only a single pedicled flap, which was the flap furthest from the pivot point. Infections developed of two pedicled flaps and three free flaps.
Conclusion: This study suggests that complication rates do not differ between free and pedicled ALT flaps. The choice of flap depends on the size and location of the defect and the length of the vascular pedicle. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2012.05.003

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

熱傷潰瘍に対する植皮術では、術前の移植床形成と周術期の感染対策が重要である。今回われわれは、汚染の強いIII度熱傷創に対する分層植皮術の際のタイオーバーに銀含有ハイドロファイバー創傷被覆材を併用したところ、緑膿菌感染を制御し、植皮の良好な生着を得た。銀含有ハイドロファイバー創傷被覆材は滲出液と細菌の制御に優れており、創傷治療に対する有効性が示された報告が数多くある。創傷治癒促進と感染制御の双方に効果があるため、熱傷潰瘍治療においても有効であることが報告されている。今回の症例で、汚染の強い熱傷潰瘍に対する植皮術の周術期管理においても有用な医療材料であることが示唆された。(著者抄録)

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記述言語：英語   出版者・発行元：OXFORD UNIV PRESS  

DOI： 10.1093/jjco/hyr024

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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  

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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  

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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  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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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  

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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  

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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  

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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  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

下咽頭癌と食道癌に関わる再建術について概説した。下咽頭癌切除に伴う再建術は、咽喉食摘後の遊離あるいは有茎組織移植や下咽頭部分切除後のパッチ状組織移植が挙げられる。有茎組織としては大胸筋皮弁が、遊離組織としては遊離空腸あるいは前外側大腿皮弁や前腕皮弁が用いられることが多い。食道再建術に用いる材料は遊離空腸、前外側大腿皮弁、大胸筋皮弁などが挙げられ、食塊を通る経路を作成することが目的である。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04260&link_issn=&doc_id=20181129410002&doc_link_id=130007530252&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007530252&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：克誠堂出版  

© 2018 Medical Information Center. All rights reserved. Background: Reconstruction with sternoclavicular resection is occasionally needed in extensive head and neck surgery. However, this technique is invasive and requires high-level surgical skill. The complications and prognosis of this technique have not been adequately investigated. This study aimed to clarify the risks and benefits of sternoclavicular resection. Methods : Between 2012 and 2015, 7 patients underwent reconstruction with sternoclavicular resection for extensive head and neck cancer. The prognosis and complications after surgery were analyzed in all patients. Results: Sternoclavicular resection was performed in 3 cases of extensive invasive cancer and in 3 salvage surgery cases. Resection was used to stop bleeding in 1 case. 6 patients were able to start oral feeding, and none had occurrence of fistula after the last surgery. 2 patients died because of cancer recurrence. Conclusions : Sternoclavicular resection enables resumption of oral feeding and improves the quality of life. Our analysis suggested that sternoclavicular resection is a key technique in head and neck cancer surgery.

Scopus

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

再建を伴う食道切除術において胸鎖骨切除を要した頭頸部悪性腫瘍7例(男性5例、女性2例、平均年齢65.6歳)の治療成績について検討した。胸鎖骨切除の理由は腫瘍切除と縦隔気管孔造設に伴う計画的胸鎖骨切除が3例、術後合併症に対する救済手術が3例、術中合併症の止血目的が1例であり、胸鎖骨切除に起因する合併症は認めなかった。術後経口摂取が可能となった症例は6例で、食事再開は術後10日から22日であり、手術によって食事摂取を含むQOLは著明に改善した。予後は計画的胸鎖骨切除3例中2例が担癌生存、1例が無病生存で、救済手術3例中2例が担癌生存であり、死亡は2例であった。本術式は難易度が高いが、広範囲切除完遂の一助となり、生命予後と術後QOLが良好な症例も認められた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00398&link_issn=&doc_id=20180727150007&doc_link_id=%2Fad3ksgke%2F2018%2F006108%2F013%2F1008-1014%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2018%2F006108%2F013%2F1008-1014%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：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本美容外科学会  

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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  

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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  

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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  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

頭頸部顔面領域、特に顔面領域は血流が豊富な組織であり皮弁手術の際にも皮弁血流に関しては他部位よりも有利であるという認識が一般的である。しかしながら唾液や鼻汁などが存在し感染の危険は一定の確率であること、耳介や鼻部、頸部などは感染を契機としてさらなる問題を引き起こすことから早期の対処が求められる。今回は自験例および文献報告を踏まえて顔面頸部の感染についての対策を報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

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記述言語：日本語   出版者・発行元：日本組織移植学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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J-GLOBAL

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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  

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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  

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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  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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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。

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

15歳女。5年前に鼻前底部の横紋筋肉腫を発症し、3回の手術に加え、化学療法、放射線療法を施行されたが再発を繰り返した。腫瘍は硬口蓋から中咽頭にかけて進展・増大し、気道狭窄をきたしたが、気管切開による延命は本人・家族とも望まず、腫瘍の縮小を目的に当科受診した。初診時、出血を伴う弾性硬の腫瘍が鼻腔から前方に突出しており、体表外の腫瘍は7×8×6cm大であった。手術による腫瘍縮小は多量の出血が予想され、また本人・家族とも全身麻酔下の手術は望んでいなかったため、Mohsペーストによる腫瘍の減量を行った。結果、1ヵ月で腫瘍の高さが半分になり、2ヵ月後には更に減量されて気道狭窄が改善し、経口摂取が可能となった。

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本創傷外科学会  

欠損が比較的軽度な気管皮膚瘻3例(全例男性、年齢54〜70歳)に対して反転皮弁と大腿筋膜移植、局所皮弁を利用して瘻孔閉鎖を行った。その結果、全例で皮弁は生着し、術後合併症もみられず、術後3ヵ月〜1年の時点で再発や呼吸苦などの有害事象もみられず、良好な経過が得られた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05739&link_issn=&doc_id=20160509310003&doc_link_id=10.11310%2Fjsswc.7.15&url=https%3A%2F%2Fdoi.org%2F10.11310%2Fjsswc.7.15&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

手術記録など、臨床に即した描写を効率よくしていくための解説を実際の画像から構築する方法、解剖学的視点から構築する方法、記憶を頼りに構築する方法に分け、さらにPowerPoint、Keynote、手描きスキャンなどの特徴とともに例示した。(著者抄録)

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04260&link_issn=&doc_id=20141024470001&doc_link_id=%2Fcw1nimed%2F2014%2F001004%2F002%2F0162-0163%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2014%2F001004%2F002%2F0162-0163%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：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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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  

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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  

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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  

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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  

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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  

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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  

2004年10月〜2010年5月に遊離組織移植による頭頸部再建手術を行った796例中、皮弁を有しない遊離空腸移植例を除外し、術後移植組織の血流モニターとして皮弁を観察できた520例544皮弁の中から臨床的観察により皮弁の血流障害を疑った12例(男性6例、女性6例、平均62.6歳)を対象に、後方視的に検討した。再建部位の内訳は舌6例、中咽頭5例、頬粘膜1例であった。再建方法は大腿皮弁7例、腹直筋皮弁5例であった。異常所見としては鬱血7例、蒼白5例で、皮弁蒼白であった症例は全てピン刺激痛覚検査陰性であった。全例で、異常発見後、速やかに開創し、吻合血管を直接確認した。開創時に血管吻合部に血栓を認めず、モニタリング用皮弁のみの血流障害による偽陽性と判断されたものを1例認めた。明らかに血管吻合部の血栓が認められたのは8例(動脈4例、静脈4例)であった。そのうち5例(動脈3例、静脈2例)で、吻合部血栓を除去し、血管再吻合を行い、3例では開創時救済不能と判断されたため再吻合を行わなかった。臨床的観察法は皮弁血流の判断に多少の経験を必要とし、皮弁の救済率がやや低いという欠点を有するものの、高感度かつ偽陽性率が低く、低コストで簡便な、有用な方法であると考えられた。

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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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  

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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  

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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  

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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  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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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  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本美容外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

前額部の熱傷瘢痕上に生じた基底細胞癌を経験したので報告する。症例は74歳、女性。3歳時に前額部に熱傷を受傷した。73歳時に同部位にびらんが出現し、軟膏療法などを行ったが治療に反応しなかったため、1年後に摘出したところ、病理所見にて基底細胞癌と診断された。現在術後2年の経過にて再発は認めていない。熱傷瘢痕上に生じた基底細胞癌は過去にも報告があるが、顔面の熱傷瘢痕上に発生した基底細胞癌の報告はわれわれの渉猟し得た範囲では本邦で初めてであったため、文献的考察を加えて報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

近年、創傷管理における最新の知識と技術が急速に普及し、以前では皮弁による手術以外の選択肢が考えられない組織欠損であっても、植皮による再建や保存的に治癒させることも可能となってきた。特に難治性潰瘍と呼ばれる一群においては、この傾向が顕著に現れている。このような状況の中で、本稿では下腿・足における瘢痕拘縮や腫瘍切除後の組織欠損など、血行に問題がない症例に対する再建方法に加え、末梢動脈疾患(peripheral arterial disease;PAD)や慢性静脈不全症(chronic venous insufficiency;CVI)などを基礎疾患として生じる難治性潰瘍症例における外科的治療の考え方を、皮弁手術を中心に紹介する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

初診したケロイド症例のうち、手術単独治療後再発例を対象とし、部位、治療経過および結果などについて検討した。ケロイド症例全体のうち手術単独治療後再発例が占める割合は17%で、ケロイド部位別では、腹部で31%と最も高く、次いで、耳介部が24%、頸部が16%であった。手術単独治療後に再発した症例のうちの、約25%は保存的治療によって治療効果が得られた。手術治療および術後電子線治療を必要とした症例のうち、約85%は再発を認めず治療を終了した。手術および電子線治療を行っても、再度再発を認めた症例は腹部、肩部、胸部に認めていた。再発の結果、恥骨を越えて鼠径部まで拡大していた例は、術後電子線治療を行っても約30%が再発した。耳介ケロイドの手術単独治療後再発例に対しては、全例において再発を防ぐことができた。

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

光線力学療法(PDT)によるケロイド由来線維芽細胞に対する増殖抑制効果やコラーゲン抑制効果を確認し、ケロイドに対する新しい治療への可能性を考え、臨床応用を試みた。にきび後に生じた多発性、難治性ケロイド症10例を対象とした。すべての症例でPDT治療によるケロイド抑制効果を認めた。完全に消失した例から、ケロイドの高さが半分以上減少した例、ケロイド縮小したが、半分以下にはならなかった例まで、抑制効果の程度はばらつきがあった。5-aminolevulinic acidを用いたPDTがケロイドの新しい治療法のひとつになる可能性が示唆された。

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

産婦人科で手術治療を受けた全症例を対象とした特殊外来(Scar Control外来)を立ち上げた。その経過および現在までに得られた成果について報告した。受診者総数は264例で、対象総数の58%であった。切開方向は、縦切開が70%以上で、途中で脱落する率は低かった。術後の瘢痕痕経過のばらつきは、術後1ヵ月頃に明らかになり、術後1ヵ月頃の瘢痕は、成熟瘢痕様、中間群、肥厚性瘢痕の3グループに大きく分類できた。

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本熱傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本褥瘡学会  

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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  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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J-GLOBAL

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