Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

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 1.0 mm 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

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

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 90 degrees 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

PubMed

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

60歳女。右小指の皮下腫瘤感と右小指尺側知覚低下を主訴とした。右小指尺側にTinel徴候陽性の25mm大の弾性硬の腫瘤を認めた。単純MRIでは小指MP関節の掌側、A1靱帯性腱鞘もしくは近傍からの腫瘤が虫様筋や小指球筋を圧排し、T1強調像で低信号、T2強調像で高信号を認め、正常組織への浸潤像が一部疑われた。部分生検で腱鞘線維腫(FTS)の診断であったため、全身麻酔下に腫瘍摘出術を施行した。腫瘍は神経血管束を巻き込むように挟んでいたが分離は可能であり、屈筋腱とは完全に癒着していたため一塊に切除した。病理組織学的診断はFTSであり、裂隙様の血管も存在する線維芽細胞の増加と膠原線維を確認した。術直後から症状は改善傾向にあり、術後3ヵ月現在、合併症を生じず経過良好である。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

・橈骨動脈穿通枝皮弁(Radial artery perforator(RAP)flap)は、橈骨動脈から分岐する皮膚穿通枝を茎にした穿通枝皮弁である。橈骨動脈穿通枝の血管径は極めて細いため、通常は遊離皮弁ではなく有茎皮弁として用いられる。橈骨茎状突起から1〜4cm近位に位置する皮膚穿通枝群(cluster)を皮弁茎とし、皮島を180°回転することで手背橈側や母指基部背側の中程度の大きさの欠損を被覆可能である。皮弁の大きさは、短軸は4〜6cm程度、長軸の皮弁近位端は前腕中間部付近とする。・皮島の回転の妨げとなる穿通枝周囲の線維状索状物は切離し、脂肪組織は温存することで皮弁の静脈還流が安定する。脂肪組織を温存することで皮弁茎にねじれが生じた際に、栄養血管(特に穿通枝の伴走静脈)の虚脱を予防することができる。・皮弁採取部は、植皮を要さず一次縫合できる皮弁デザインが望ましい。それ以上に大きな皮弁が必要となる大欠損に対しては無理をせずに遊離皮弁や遠隔皮弁を選択した方がよい。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

・DMAP flapは第2〜4指間の中手骨頸部(腱間結合のすぐ遠位)から起ち上がる皮膚穿通枝を茎にした皮弁であり、皮島を180°回転することでDIP関節とPIP関節の中間点まで安全に被覆できる。・穿通枝周囲の線維状索状物以外の軟部組織を極力温存することで静脈還流が安定する。・手背の皮弁採取部瘢痕が目立つことがあるため、術前に患者説明が必要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：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)

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Language：Japanese   Publisher：(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。

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

The literature on surgical techniques and recent evidence in microsurgical digital and hand replantation is reviewed. Replantation should not be done routinely without considering postoperative functional outcomes. Achieving best outcomes is related to the success of microvascular anastomosis and to adequacy of bone fixation, tendon and nerve repair, and soft-tissue coverage. Replantation surgery has become a routine procedure. However, little is known about the decision-making process for digital and hand amputation. A study comparing the outcomes of digital and hand amputations treated with replantation or revision amputation is needed. Outcome assessment includes not only function but also patient-reported outcomes.

DOI： 10.1016/j.cps.2019.03.002

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本マイクロサージャリー学会  

DOI： 10.11270/jjsrm.31.185

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Language：Japanese   Publisher：(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。

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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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)

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(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)

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Language：Japanese   Publisher：全日本病院出版会  

手・手指の皮膚軟部組織再建において、最適な皮弁を選択するための意思決定プロセスは依然不明な点が多い。本稿では手のファンクショナル・エステティックユニットの概念を紹介し、皮弁選択のプロセスを解説する。皮弁選択のための第一歩は、欠損がどのユニットに位置するかを確認することである。ユニットは皮線や側正中線などにより輪郭形成され、皮弁辺縁やドナー縫合線をこの輪郭にあわせて再建することで良好な手指機能と外観を獲得できるとする概念である。次にユニット内での欠損サイズ(小中大)を判定し、隣接した皮膚の移動で閉創可能かを判断する。小〜中欠損で閉創可能と判断すれば、皮弁に求められる条件(掌背側どちらの皮膚が適しているか、皮弁サイズ、知覚再建の必要性など)を確認する。これらの条件を満たす皮弁を列挙したら、最後に患者因子、術者因子、ドナーの犠牲などを総合的に判断して最適な皮弁1つに絞り込む。(著者抄録)

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本医科大学医学会  

著者は米国留学時に患者立脚型アウトカムに基づいて治療法を評価する学問があることを知った。従来の医療者目線の客観だけでなく、患者目線の主観を含めて評価するのがその本質である。医療の本来の目的は患者満足度やQOLを向上することであるが、合併症が多い治療法が必ずしも悪い治療法ではないという正反対の結論に至るケースもある。患者立脚型アウトカム研究の一例を紹介し、その応用、課題と展望について述べた。

DOI： 10.1272/manms.14.8

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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手は関節、腱鞘、筋膜腔といった多くの閉鎖空間を有し、その内部で病原体が増殖するタイプの感染症が多い。解剖学的に抗生剤が届きづらいため保存的治療の適応は限られ、閉鎖空間を開放する外科的治療が求められることが多い。外科的治療において、術者は神経血管束、腱、関節などの重要構造物の位置を理解し、それらを極力温存しながら皮膚切開やデブリードマンをすることが求められる。一方で手の感染症患者の多くは、救急外来を受診することが多い。手の感染症は、早期診断・治療が良好な治療成績に直結する分野であり、逆にそれらが遅れると重篤な後遺症を残しかねない。そのため、救急外来医は手外科医による外科的治療が求められる感染症とコンサルテーションの時期に精通する必要がある。本稿では、遭遇する機会の多い手の感染症に焦点を絞り、救急外来における初期診断のポイントと対応、さらに治療法を解説した。(著者抄録)

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

The authors' strategy for soft-tissue coverage of the hand is presented. The concept of replacing like with like and reconstruction with similar adjacent tissue enhances functional and aesthetic outcomes. In this viewpoint, the pedicle perforator flap is an ideal flap. A decision-making algorithm to select an ideal flap for a particular hand defect is challenging, requiring experiential consideration of functional outcome, appearance, donor-site morbidity, and patient satisfaction. To assist surgeons in determining the most appropriate flap with more evidence, studies are necessary to compare the outcomes of each flap by evaluating hand function, aesthetics, donor site morbidity, and patient satisfaction.

DOI： 10.1016/j.hcl.2017.04.001

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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© 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

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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)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Because the course and territory of perforators are different in each region, careful preoperative planning to identify the proper perforators can be critical to ensure a successful dissection of a freestyle pedicled perforator flap. In this study, our first experience for preoperative perforator mapping of a freestyle pedicled perforator flap using multidetector row computed tomography (MD-CT) angiography is presented.Methods: Twelve patients were planned to undergo various soft-tissue reconstructions with freestyle pedicled perforator flaps. They were evaluated with preoperative MD-CT angiography. The OsiriX for mac software was used to process the data obtained from MD-CT angiography. The available images from MD-CT angiography were analyzed to determine where the proper perforators were located for preoperative planning of a freestyle pedicled perforator flap. Through the MD-CT angiography, the optimal perforators were mapped and a reliable flap design could be made so that the flap was elevated more safely and perfectly to cover an adjacent soft-tissue defect.Results: In all 12 patients, each flap was elevated successfully based on the perforators mapped preoperatively with MD-CT angiography. A total of 27 perforators (1-3 perforators per flap) were identified by MD-CT angiography in 12 patients and later confirmed during the flap dissection (sensitivity, 100%).Conclusions: The MD-CT angiography can be a new but very effective imaging modality for preoperative planning of a freestyle pedicled perforator flap surgery. It allows surgeons to accurately select the most appropriate perforators with the shortest intramuscular or suprafascial course preoperatively leading to safer and easier flap dissection.

DOI： 10.1097/SAP.0000000000000728

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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

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Language：Japanese   Publisher：(一社)日本作業療法士協会  

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Publishing type：Research paper (scientific journal)  

In this paper, microvascular augmentations (i. e., perforator supercharging) to narrow-pedicled super-thin flaps, the long wing of propeller flaps, and free super-thin flaps are described. By identifying perforators, we can make a super-thin flap using perforator supercharging. We confirm that these developments in flap surgery have produced a new concept for making flaps. We can now make a flap anywhere on the body with the required size and thickness (even super-thin flaps). In this paper, we show some cases that prove our new theory. Moreover, our new devices in making flaps will be able to develop new supercharged super-thin flaps that will be good reconstructive materials to use for many patient with severe burns around the world.

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(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)

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

手指皮膚軟部組織欠損の治療法は多岐に渡るが,1指節を越えた手指皮膚軟部組織欠損で腱や骨が露出する場合には遊離皮弁も選択肢となる.今回我々は橈骨動脈浅掌枝superficial palmar branch of the radial arteryをドナーとした遊離皮弁による手指皮膚軟部組織欠損の3例を経験した.1例はring injuryの血行再建術後の手指掌側皮膚欠損に,2例はDIP関節を含んだ手指背側皮膚軟部組織欠損に用いた.本皮弁の利点は,患指の手関節掌側部から採取でき,一期的に縫縮可能で,薄さ・色調・質感が手指に類似し,比較的大きな手指皮膚軟部組織欠損の再建に利用でき,主要血管を犠牲にしないこと等が挙げられる.(著者抄録)

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Language：Japanese   Publisher：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)

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形成外科領域において、multi detector-row computed tomography(以下、MDCT)による穿通枝造影CT検査(perforator computed tomographic angiography;以下、P-CTA)や顔面骨形態の解析の有用性はこれまでに多く報告されている。MDCTは大学病院だけでなく多くの市中病院に導入され、画像データ解析ソフトであるdigital imaging and communication in medicine(以下、DICOM)viewerは手軽に入手することができるようになり、今やほとんどの施設で画像解析が可能である。本稿では、MDCTの撮影方法の実際と無償でダウンロード可能なDICOM viewerであるOsiriXを用いた解析方法について紹介する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：全日本病院出版会  

今でこそ薄い皮弁の作成は一般的になったと思われるが、20世紀末まではまだ皮弁は厚い(bulky)ものという一般的概念が世界的に浸透していた。しかるに、先立って1980年代に中国で超薄皮弁が開発され皮弁の菲薄化は躊躇されなくなっていた。しかしその理論と成果は未熟であって、なぜ皮弁を薄くしても安全に生着するのか、血管系との関連は何かという疑問に答える明確な理論はなかった。そこで、筆者らは中国人医師らと様々な動物実験を行い、結論としてある程度の太さの穿通枝があれば、人体のいかなる部位にも真皮下血管網で栄養される超薄皮弁が作成でき、その遠位部に穿通枝などの微小血管付加を加えれば、いかなる大きさでも完全生着が可能であるという結論を得た。それは血管系から「探す皮弁」という従来の発想を脱却し、作成したい部位の皮弁にいかなる血管を付ければ生着するかといういわば「創る皮弁」への変換であった。本稿ではその概略について述べるものである。(著者抄録)

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Language：Japanese   Publisher：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)

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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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)

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Language：Japanese   Publisher：全日本病院出版会  

顔面の母斑で再建を要する大きさあるいは部位のものについて、摘除後に如何なる再建術が必要か記述した。特に、眼瞼、外鼻、耳介にかかるものでは、周到な手術計画に基づいた再建術式が必要であり、単純な植皮のみでは対応できないことがある。したがって各種の局所皮弁、遊離皮弁、エキスパンダーの利用などすべての形成外科的手技に精通していなければならない。また、多くは小児期に施行されるので成長してから追加すべき手術を常に考えていかねばならない。本稿で供覧する症例が顔面に生じた再建を要するような母斑症例の手術に少しでもヒントになれば幸いである。(著者抄録)

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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)

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Informa Healthcare  

We report the case of a 43-year-old man who had a degloving injury of the left hand from a printer machine. There was no response to a pin prick test over the peripheral portion of the degloved skin, so a branch of a digital artery was selected for anastomosis to a subcutaneous vein, which resulted in survival of the degloved tissue with no signs of congestion. Postoperative care and rehabilitation were straightforward, and functional results.were satisfactory.

DOI： 10.3109/2000656X.2013.806389

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We developed a transplantable tissue-engineered skin equivalent composed of autologous cultured keratinocytes, fibroblasts, and a decellularized allogeneic dermis (acellular allogeneic dermal matrix; ADM) obtained from cadavers. In a process taking 3 weeks, cultured autologous keratinocytes from burn patients were expanded and then grown on ADMs. The tissue-engineered autologous skin equivalents (TESEs) were then transplanted in a one-stage procedure to the debrided third-degree burn wounds of 4 patients. The mean graft survival rate was 96%. Delayed graft loss and graft fragility were not observed. Histological and immunohistological findings indicated that the transplanted TESE had similar characteristics to normal human split-thickness skin grafts. These results suggest that the TESE using ADM can be used for permanent repair of full-thickness skin defects.

DOI： 10.1272/jnms.81.356

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肘窩や腋窩の瘢痕拘縮で健常皮膚が中央部に遺っている場合は、皮下組織茎プロペラ皮弁の90°回転の適応である。四肢の潰瘍や組織欠損で、皮弁による修復が望まれる場合は、近位に穿通枝があればそれを茎とした、遠位短翼近位長翼のプロペラ皮弁の180°回転が適用される。注意点は穿通枝伴走静脈の捻れである。これを防ぐためには、穿通枝の茎を出来る限り長くとり、穿通枝周囲の索状物を十分に除去せねばならない。また、長翼の血流に不安がある場合は、superchargingや皮静脈付加が有用である。(著者抄録)

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Publishing type：Research paper (scientific journal)  

Electrical injury is the complex damage caused by the damage of the Joules of heat that are created when an electric current flows. The damage is done by the electric current itself, an arc electric discharge, and a spark (flash) electric discharge. The damage to organs such as blood vessels, nerves, and muscles, through which electric current passes easily, is particularly intense. If cardiopulmonary arrest is avoided at the time of injury, reconstructing the injury site is as important as treating crash syndrome to prevent renal insufficiency to enable convalescence. The severity of the electric injury depends on the measurement of the Joules of heat. Additionally, unlike in a regular burn, the organ damage often far exceeds the apparent surface damage. Necrosis of the deeper tissues occurs and necessitates regular debridement. In many cases, amputation of the limbs becomes necessary. However, in electrical injuries to the arms or hands part, an early relaxing incision and debridement are necessary if the hand is to have some function. Amputation can be avoided by using skin flaps for reconstruction. In the present case, two abdominal distant flaps had to be used for necrosis of the thumb and the little finger due to electrical injury. Although the skin graft did not engraft, we obtained a good final result this time. We are therefore reporting this case.

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：静岡県整形外科医会  

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Language：Japanese   Publisher：静岡県整形外科医会  

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Language：Japanese   Publisher：静岡県整形外科医会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

67歳男。右手掌小指にMeyerding分類におけるグレード1のデュプイトラン拘縮を呈し、拘縮感を訴えた。手術では手関節ブロック下に、皺に沿った皮膚のZ形成術と、cordを含めた腱膜切除術を施行した。創部にはペンローズドレーンを留置し、4-0ポリジオキサノン糸にて最小限の真皮縫合後、5-0ナイロン糸にて表面縫合し、手術終了とした。術後翌日から15Gyを3分割で3日間照射し、術後10日で全抜糸した。術後2年が経過する現在、再発傾向はない。

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

症例は62歳男性で、脱法ドラッグである亜硝酸アミル(RUSH)を飲用し、意識消失および循環不全をきたした。チアノーゼが著明に認められ、動脈血液ガス検査にてメトヘモグロビン(MetHb)60.4%であったことから、メトヘモグロビン血症と診断された。メチレンブルーの点滴静脈注射を開始し、MetHbは1時間後には37.5%、3時間後は1.9%に減少した。また問診にてRUSH以外にシルデナフィルも同時服用していたことが判明した。RUSH内服から720分および730分後に洞調律欠落の後の心停止を2回来し、いずれもCardio-Pulmonary Resuscitation(CPR)にて心拍再開した。経静脈ヘーシングが開始されるも、脈拍不整や上室性および心室性期外収縮、心室領拍などが間欠的に認められた。第9病日に臨床心臓電気生理学的検査を施行したところ、心房からHis束にかけてブロックが出現した。心房からHis束にもともと器質的異常があると考えられた。以降も上室性期外収縮の散発および脈拍不整が認められたが、意識レベルや全身状態に変化なく、外来通院フォローとして第15病日に独歩で自宅退院した。

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：静岡県整形外科医会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

In the clinical decision-making process, prognostic information gives physicians guidance regarding disease and treatment that can be passed along to patients. Using the clinical scenario of a type IIIB open tibial fracture as an example, this article focuses on how to search prognostic literature effectively and how to critically appraise prognostic studies. A well-built clinical question using the Patients, Intervention, Comparison, and Outcomes methodology helps plastic surgeons derive information from the vast resources in an effective and time-efficient manner. Subsequent critical appraisal of the collected studies is the essential step for identifying the most relevant high-quality evidence to provide the best prognostic information to guide patient decision-making. (Plast. Reconstr. Surg. 131: 655, 2013.)

DOI： 10.1097/PRS.0b013e31827c6f90

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：全日本病院出版会  

Multi-detector-row CT(以下、MDCT)は新しい方式のCT画像診断装置であり、近年では多くの病院で導入されている。従来のCTはX線検出器が1列に並んでいるだけであったが、MDCTはこの検出器が複数列並んでいるため多検出器型CTと呼ばれる。MDCTの開発・進歩に伴い、体軸方向の解像度が向上したことで従来の画像検査では描出できなかった細い血管や薄い骨が3次元画像として鮮明に描出可能になった。MDCTによる穿通枝造影検査は現時点での最も精度の高い検査法であり、術者のストレス減少、手術時間短縮に寄与する。また、MDCTを用いた穿通枝血管解剖研究、顔面骨骨折(特に骨の薄い鼻篩骨・眼窩骨)の診断精度の向上、顔面移植の術前検査としての有用性、血管腫の診断など今後の更なる広がりが期待される分野である。(著者抄録)

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INTRODUCTION: Many cases of severe keloid are associated with high blood pressure (hypertension). An analysis of 100 consecutive patients with keloid in our department in 2011 revealed that patients with multiple (>3) or large keloids (>10 cm(2)) were significantly more likely to have hypertension than patients with mild keloids (<2 or <10 cm(2)). In the present paper, a case of severe keloids associated with hypertension is described. How such patients should be treated is discussed. METHODS: This 63-year-old woman had hypertension together with severe keloids that covered her right elbow, wrist joints, and thumb and made it difficult for her to use her right hand. The contractures were released by using surgery and postoperative radiation therapy. The internal medicine clinic started her on a Ca-channel blocker (amlodipine besilate) and an angiotensin II blocker (candesartan cilexetil). RESULTS: The contractures were completely released by a distally based radial artery flap and postoperative 4 MeV electron beam irradiation (15 Gy/3 fractions for 3 days). The angiotensin-converting enzyme inhibitor and the Ca-channel blocker improved the objective symptoms of the remaining keloids. CONCLUSIONS: If patients with severe keloids present, the possibility of hypertension should be considered: the patient may have hypertension already or may be affected in the future. Hypertension may be a risk factor of keloid deterioration. Antihypertensive treatment may reduce symptoms of patients with severe keloids. At present, surgery and postoperative radiotherapy appear to be the only solution to the functional problems experienced by patients with severe keloids.

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Purpose Few guidelines exist regarding the most effective approach to scientific oral presentations. Our purpose is to (1) develop a standardized instrument to evaluate scientific presentations based on a comprehensive review of the available literature regarding the components and organization of scientific presentations and (2) describe the optimal characteristics of scientific presentations.Methods At the Sixty-sixth (2011) Annual Meeting of the American Society for Surgery of the Hand, 69 presentations were evaluated by at least 2 independent observers. A rating instrument was developed a priori to examine presentation content (background, methods, results, and conclusions), presentation style (speech, structure, delivery, slide aesthetics), and overall quality. We examined correlations between reviewers' ratings of each component as well as overall perceived quality of the presentation using regression analysis. Intraclass correlation coefficients were calculated to measure the degree of variation because of reviewer disagreement and identify the aspects of presentations that contribute to overall quality.Results Reviewer agreement was high for presentation content, and less than 1% of variation was caused by reviewer disagreement for background, methods, and conclusions. With respect to presentation style, reviewers agreed most frequently regarding speech and slide appearance, and only 9% and 13%, respectively, of the variation was caused by reviewer disagreement. Disagreement was higher for delivery and presentation structure, and 21% of the variation was attributable to reviewer disagreement. Speaker delivery and slide appearance were the most important predictors of presentation quality, followed by the quality of the presentation of conclusions and background information. Presentation of methods and results were not associated with overall presentation quality.Conclusions Distinct aspects of presentation content and style correlate with quality, which can be reliably and objectively measured. By focusing on selected concepts with visually simple slides, speakers can enhance their delivery and may potentially improve the audience's comprehension of the study findings. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.

DOI： 10.1016/j.jhsa.2012.09.018

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Perforator-based propeller flaps permit flap rotation up to 180 degrees. This ability to transfer skin from one longitudinal axis to another has led to the increasing use of perforator-based propeller flaps in extremity reconstruction, especially lower-extremity reconstruction. However, the application of perforator-based propeller flaps to upper-extremity reconstruction is still limited. This article reports two cases of successful reconstruction of elbow region defects with radial collateral artery perforator (RCAP)-based propeller flaps.The elbow region has a variety of perforators available for perforator-based propeller flap reconstruction. Among them, the RCAP seems to be one of the most reliable options. This is because there are less anatomical variations of perforators' location on the lateral upper arm than on the medial upper arm. By using an RCAP perforator as a flap pedicle, the small-to-medium sized defects (<6 cm in diameter) around elbow regions can be closed primarily without skin grafts. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2012.03.013

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Schwannomas (neurilemmomas) are the most common benign tumors of peripheral nerves and originate from the myelinating cells of the nerve sheath. We present a case of congenital schwannoma of the hand. (J Hand Surg 2012;37A:2007-2011. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.)

DOI： 10.1016/j.jhsa.2012.07.011

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0b013e318254fc0e

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Language：Japanese   Publisher：(株)全日本病院出版会  

前胸部の巨大なケロイドに対し皮弁手術目的でMDCTによる皮膚穿通枝造影検査を施行した9例の画像をもとに、ケロイドと周囲皮膚における「動静脈分布」「内胸動静脈穿通枝分布」「血管構造」の解析を行った。その結果、ケロイド中心部は血行不良であるのに対し、ケロイド表面から周囲にかけては著明な血管新生と血流量増加が認められ、これはケロイド本体の虚血に伴う代償性変化、またはケロイド自体の炎症に伴う炎症性変化ではないかと推測された。内胸動静脈穿通枝の分布については、ケロイド周囲に位置する穿通枝が他部位の穿通枝に比べて有意に拡張していた。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publisher：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2011.11.040

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Reconstruction of a distally ruptured extensor pollicis longus tendon in the rheumatoid patient generally involves a tendon transfer or intercalary graft. We present an alternative technique using the radial half of the extensor carpi radialis longus as a turn-over graft. Using the turn-over technique with a half-slip of the extensor carpi radialis longus avoids the traditional limitations of the extensor carpi radialis longus tendon in distal extensor pollicis longus tendon repairs and precludes the need for a free tendon graft. (J Hand Surg 2012;37A:1217-1220. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.)

DOI： 10.1016/j.jhsa.2012.02.042

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We present a case of breast reconstruction using bilaterally divided transverse rectus abdominis musculocutaneous flaps after the removal of severe siliconoma. In Japan, we have examined many patients who have had foreign substance injected into the breasts for augmentation. Most of these patients have had delayed complications. We believe that autologous tissue transfer is an ideal procedure for breast reaugmentation in patients who want to have artificial materials removed from the breasts but to maintain breast contour. (J Nippon Med Sch 2012; 79: 223-227)

DOI： 10.1272/jnms.79.223

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0b013e31824a9f76

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Short-term results after proximal interphalangeal joint arthroplasty with pyrolytic carbon (pyrocarbon) implant have shown that this implant has high complication rates, but patient satisfaction is high. The authors evaluated the effectiveness of the implant for use in proximal interphalangeal joint at a minimum of 2 years of follow-up.Methods: Thirteen consecutive candidates who underwent 21 proximal interphalangeal joint arthroplasty procedures with pyrocarbon implant were evaluated prospectively. Functional measurements and the Michigan Hand Outcomes Questionnaire were administered preoperatively and at 12 months and intermediate term (>2 years) postoperatively. Preoperative and intermediate-term mean data for all functional measures and questionnaire scores were compared.Results: Thirteen patients were treated, with a mean follow-up of 44 months. Grip strength, key pinch strength, and active arc of motion demonstrated no statistical difference between preoperative and intermediate-term assessment. All domains of the Michigan Hand Outcomes Questionnaire showed improved large effect size at intermediate-term follow-up, especially pain and satisfaction. There were 10 complications in nine joints complication rate, 42.9 percent). Patients without complications had better functional outcomes; however, there were no statistical differences in questionnaire scores between patients with and without complications, except for pain (p = 0.04).Conclusions: Proximal interphalangeal joint arthroplasty with pyrocarbon implant seems to be an effective way of reducing pain without sacrificing active arc of motion. Despite a high complication rate, patients were generally satisfied, especially with pain relief, and complications did not affect patients' satisfaction even when hand function was affected. Further decision-making analysis to compare arthroplasty and fusion for each finger may help surgeons to select the appropriate operative procedures. (Plast. Reconstr. Surg. 129: 1139, 2012.)

DOI： 10.1097/PRS.0b013e31824a2e38

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Background: The usual hypertrophic scar reconstruction methods such as Z- and W-plasties can leave noticeable scars and involve excessive normal skin excision, particularly in long linear hypertrophic scars longer than 10 cm. Thus, we invented and applied the small-wave incision method for patients with linear hypertrophic scars. Methods: A total of 40 patients with linear hypertrophic scars were included in this study. The patients were randomly assigned to the linear incision group (n = 20) or the small-wave incision group (n = 20). All scars were mildly hypertrophic, longer than 10 cm, and located in the lower abdominal/suprapubic region. They occurred after Cesarean section or gynecological or abdominal surgery. Patient age and sex, the cause of the scar, and the preoperative and postoperative sizes of the scar were recorded. Postoperative scar size and recurrence were evaluated for 18 months. Mathematical comparisons were also madetomultiple linear incision, Z-plasty, planimetric Z-plasty, and W-plasty. Results: Postoperative recurrence was 40 and 15% in linear and small-wave groups, respectively (P = 0.77). The main risk factor for recurrence was postoperative size (P = 0.043). Mathematical comparisons revealed that the small-wave method can achieve the same release of tension with the least normal skin excision while making the scar irregular via an accordion effect. Conclusion: The small-wave method can meet both the functional and the cosmetic requirements of long linear hypertrophic scar reconstruction while reducing complication risks. © Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011.

DOI： 10.1007/s00266-011-9821-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: The occipitocervicopectoral flap has a local skin pedicle in the occipital region, with the distal portion of the flap in the pectoral region. One disadvantage of the occipitocervicopectoral flap is its limited flap length. To overcome this disadvantage, a perforator supercharging technique was applied to enlarge the original flap length. The aims of this study are to present a clinical application of the perforator-supercharged occipitocervicopectoral flap for face and neck reconstruction and to discuss a perforator supercharging technique and perforator anatomy.Methods: All perforator-supercharged occipitocervicopectoral flaps that were used for face and neck reconstructions were analyzed retrospectively.Results: In all nine cases, the second internal mammary artery perforator was attached at the end of the occipitocervicopectoral flap and supercharged with the contralateral recipient facial artery vessels. The average flap size was 22.6 x 6.2 cm, without any flap loss. It was possible to cover a large defect extending to bilateral sides with thin and pliable local skin tissue. All patients were satisfied with functional and aesthetic results achieved postoperatively after 6 months.Conclusions: The internal mammary artery perforator-supercharged occipitocervicopectoral flap can be considered a type of bipedicle perforator flap and can provide reliable flap vascularity. By using a perforator supercharging technique, we can adjust and enlarge the flap length tailored to the defect. (Plast. Reconstr. Surg. 129: 879, 2012.)CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

DOI： 10.1097/PRS.0b013e318244230b

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

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Language：English   Publisher：WILEY-BLACKWELL  

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BACKGROUND: The correction of large area limb defects that are the result of congenital abnormalities, traumatic injury, inflammation, or tumors is a challenging task for clinicians. The need to restore the physical, mechanical, and cosmetic aspects of the limb results in a difficult balancing act between deformity repair and tissue reconstruction, between the soft tissue and bone reconstructions, and between the physical, mechanical, and esthetic restorations. METHODS: Between 2003 and 2011, 59 patients with large area limb defects underwent 1- or 2-stage reconstructions that combined external fixation with microsurgical osteocutaneous flap transfer. In 1-stage reconstruction, the Ilizarov device was applied as a dynamic fixator before pathological bone resection. Free osteoseptocutaneous flap transplantation was then performed. This is suitable for simple bone defects with temporary continuity such as osteomyelitis. In 2-stage reconstruction, the Ilizarov device served as both an external fixator and tractor before debridement. This was followed by secondary free osteoseptocutaneous flap transplantation. This is suitable for complex bone defects like those seen in pseudarthrosis, fractures, and tumors. In all cases, the Ilizarov device was kept in position until bone union was confirmed by both surgeons and the radiologist. RESULTS: All patients survived the procedure. Using Paley's classification system, there were 3 (5.1%) true complications, 2 (3.4%) obstacles, and 5 (8.5%) problems. CONCLUSIONS: The staged methods allowed the seamless repair and reconstruction of bone and combined it with soft tissue reconstruction. This simultaneously restored the limb function and esthetics with minimal costs in terms of time, money, and patient pain.

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：バイエル薬品(株)  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Previous studies have shown large variation in the rate of common surgical procedures performed for the rheumatoid hand. This article provides a comprehensive overview of each surgical treatment option for rheumatoid hand reconstruction.

DOI： 10.1016/j.cps.2011.07.004

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Background Toe-to-thumb transfer is an established procedure for reconstruction of traumatic thumb amputations. The four types of toe-to-thumb transfers are the second toe, the great toe, the wrap-around great toe and the trimmed great toe transfers. The purpose of this study is to conduct a systematic review of the literature to compare outcomes amongst different methods of toe-to-thumb transfers. Methods A literature search using 'toe-to-thumb transfer' combined with 'thumb injury' and 'thumb reconstruction' as keywords and limited to humans and the English language identified 633 studies. Studies were included in the review if they (1) present primary data, (2) report three or more toe-to-thumb transfers for isolated complete traumatic thumb amputation between the metacarpophalangeal joint and the interphalangeal joint (both excluded) and (3) present functional outcome data. Results Twenty-five studies representing 450 toe-to-thumb transfers met the inclusion criteria. They included 101 second toe transfers, 196 great toe transfers, 122 wrap-around transfers and 31 trimmed toe transfers. The mean survival rate was 96.4%. No statistically significant differences could be detected between the four transfers with regards to survival, arc of motion, total active motion, grip and pinch strength and static two-point discrimination. Conclusions All four types of toe transfer procedures have predictably high survival rates and good patient satisfaction scores. The current data are inadequate to make any comments with regards to donor site morbidity. Till such data are available, an evidence-based recommendation for the superiority of a specific type of toe-to-thumb transfer cannot be made. © 2011 American Association for Hand Surgery.

DOI： 10.1007/s11552-011-9340-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: The dorsal metacarpal artery perforator flap is a versatile solution for resurfacing soft-tissue defects of fingers. The authors present their experience in applying this flap for a variety of finger wounds for which conventional means may not be amenable.Methods: Fifty-eight dorsal metacarpal artery perforator flaps were used to resurface 60 finger soft-tissue defects in 56 patients over a 5-year period. Fifty-two patients were men and their average age was 37 years. This flap was used to reconstruct soft-tissue defects after debridement of infected wounds in 28 patients, traumatic wounds in 26 patients, and electrical burns in two patients.Results: The average flap size was 4.6 x 2.3 cm; 34 flaps were based on the second dorsal metacarpal artery perforator, 14 were based on the third dorsal metacarpal artery perforator, and 10 were based on the fourth dorsal metacarpal artery perforator. Twenty-one flaps were used to resurface defects distal to the proximal interphalangeal joint, and 37 flaps were used to resurface defects over the proximal interphalangeal joint and proximal to it. Skin grafting was needed to close the donor defect in seven patients. Complications included venous congestion in six flaps and arterial insufficiency in three flaps, with total loss of two flaps and infection in one case.Conclusion: The dorsal metacarpal artery perforator flap is a thin, pliable flap that is simple to raise, has minimal donor-site morbidity, and can reliably cover soft-tissue defects up to the proximal half of the middle phalanx. (Plast. Reconstr. Surg. 128: 166e, 2011.)

DOI： 10.1097/PRS.0b013e318221ddfa

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Language：Japanese   Publisher：(株)全日本病院出版会  

著者等は巨大なケロイドに対して皮弁を用いた再建術を行っており、特に、血管茎を軸に回転させて移動するプロペラ皮弁を好んで用いてきた。今回、切除後一期的縫縮が不可能なケロイドに対してプロペラ皮弁を使用し術後1年以上経過観察しえた13例の成績を報告した。手術部位は胸部が10例、肩が1例、恥骨上部が2例で、皮弁は部位別にそれぞれ内胸動脈穿通枝茎プロペラ皮弁、胸背動静脈茎プロペラ皮弁、浅腸骨回旋動静脈プロペラ皮弁を使用した。皮弁の挙上方法は、血管茎を同定した後、少なくとも浅筋膜を含むように挙上し、皮弁内の浅筋膜や深筋膜を移植床の筋膜と縫合することで皮弁の皮膚にかかる張力を軽減させる工夫を行った。皮弁採取部位に対しては、筋膜レベルで確実に減張縫合を行い、真皮縫合は最小限とした。術後は20Gy/4分割/4日間の密封小線源による高線量率表在照射を皮弁採取部と移植床縫合部双方に行い、抜糸後はサージカルテープによるテーピング固定を行った。手術成績は全例で皮弁の完全生着が得られ、ケロイドの再発は1例も認めていない。

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0b013e3182173e3e

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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DOI： 10.1097/PRS.0b013e3182131b54

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Purpose A propeller flap is an island flap that moves from one orientation to another by rotating around its vascular axis. The vascular axis is stationary, and flap movement is achieved by revolving on this axis. Early propeller flaps relied on a thick, subcutaneous pedicle to maintain vascularity, and this limited the flap rotation to 90 degrees. With increasing awareness of the location and the vascular territory perfused by cutaneous perforators, it is now possible to design propeller flaps based on a single perforator, so-called "perforator-based propeller flaps." These flaps permit flap rotation up to 180 degrees. We present the results of upper limb soft tissue reconstruction using perforator-based propeller flaps. We constructed a treatment strategy based on the location of the soft tissue defect and the perforator anatomy for expedient wound coverage in 1 stage.Methods All perforator-based propeller flaps derived from 3 institutions that were used for upper limb soft tissue reconstruction were retrospectively analyzed. The parameters studied included the size and location of the defect, the perforator that was used, the size and shape of the flap, the direction (ie, clockwise or counter-clockwise) of flap rotation, the degree of twisting of the perforator, the management of the donor site (ie, linear closure or skin grafting), and flap survival (recorded as the percentage of the flap area that survived).Results Twelve perforator-based propeller flaps were used to reconstruct upper limb soft tissue defects in 12 patients. Six different perforators were used as vascular pedicles. The donor defects of 11 flaps could be closed primarily. One flap was partially lost in a patient with electrical burns.Conclusions Perforator-based propeller flaps provide a reliable option for covering small- to medium-size upper limb soft tissue defects. (J Hand Surg 2011;36A:853-863. Copyright (C) 2011 by the American Society for Surgery of the Hand. All rights reserved.)

DOI： 10.1016/j.jhsa.2010.12.021

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Propeller flaps feature a highly reliable reconstructive method, based on a perforator vessel. Since their introduction in 1991, a great variety of propeller flaps have been described, according to their shape and their potential of coverage. Indeed, these flaps have progressively been refined and modified, concerning their vascularity and space design. The authors present a classification of propeller flaps. This anatomical classification is necessary to understand the dissection procedure and the differences between the numerous types of propeller flaps nowadays described. It is the international classification, which should be used for the description and conception of these flaps. © 2010 Elsevier Masson SAS.

DOI： 10.1016/j.anplas.2010.11.004

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本創傷外科学会  

34歳男。電気ノコギリに左手を巻き込まれ、左示指指尖部を完全切断した。切断指の挫滅の程度が軽度であったため、全身麻酔下にて再接着術を施行した。術前の単純X線写真で末節骨骨幹部に横骨折を認め、0.8mmのキルシュナー鋼線2本で末節骨を固定した。指動脈は動脈弓レベルで切断され、動脈弓血管の一部が電気ノコギリの回転により引き抜き損傷をきたしていた。遠位切断指に吻合可能な動脈を認めず、末節骨指腹部側に静脈を1本認めるのみであった。そのため、中枢側の指動脈と切断指側の静脈を1組吻合した。AV吻合直後より指尖部の色調は良好となった。術後、創縁から持続的に出血を認めたが、術後48時間で完全に止血し、切断端の鬱血は認めなかった。順調に経過し、整容的・機能的に満足のいく結果を得た。

DOI： 10.11310/jsswc.2.78

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0b013e31820a6551

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: The propeller flap is defined as (1) being island-shaped, (2) having an axis that includes the perforators, and (3) having the ability to be rotated around an axis. The advantage of the propeller flap is that it is a pedicle flap that can be applied to cover defects located at the distal ends of the extremities. The specific aims of the authors' study were (1) to evaluate the usefulness of multidetector-row computed tomography in the planning of propeller flaps and (2) to present a clinical case series of propeller flap reconstructions that were planned preoperatively using multidetector-row computed tomography.Methods: The authors retrospectively analyzed all cases between April of 2007 and April of 2010 at Nippon Medical School Hospital in Tokyo, where multidetector-row computed tomography was used preoperatively to plan surgical reconstructions using propeller flaps.Results: Thirteen patients underwent 16 flaps using the propeller flap technique. The perforators were identified accurately by multidetector-row computed tomography preoperatively in all cases.Conclusions: This is the first report describing the application of multidetector-row computed tomography in the planning of propeller flaps. Multidetector-row computed tomography is superior to other imaging methods because it demonstrates more precisely the perforator's position and subcutaneous course using high-resolution three-dimensional images. By using multidetector-row computed tomography to preoperatively identify a flap's perforators, the surgeon can better plan the flap design to efficiently conduct the flap surgery. (Plast. Reconstr. Surg. 127: 703, 2011.)

DOI： 10.1097/PRS.0b013e318200a99e

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Over the past few years, the use of propeller flaps, which base their blood supply on subcutaneous tissue or isolated perforators, has become increasingly popular. Because no consensus has yet been reached on terminology and nomenclature of the propeller flap, different and confusing uses of the term can be found in the literature.Methods: In this article, the authors report the consensus on the definition and classification of propeller flaps reached by the authors that gathered at the First Tokyo Meeting on Perforator and Propeller Flaps in June of 2009. Some peculiar aspects of the surgical technique are discussed.Results: A propeller flap can be defined as an "island flap that reaches the recipient site through an axial rotation." The classification is based on the nourishing pedicle (subcutaneous pedicled propeller flap, perforator pedicled propeller flap, supercharged propeller flap), the degrees of skin island rotation (90 to 180 degrees) and, when possible, the artery of origin of the perforator.Conclusions: The propeller flap is a useful reconstructive tool that can achieve good cosmetic and functional results. A flap should be called a propeller flap only if it fulfils the definition above. The type of nourishing pedicle, the source vessel (when known), and the degree of skin island rotation should be specified for each flap. (Plast. Reconstr. Surg. 127: 716, 2011.)

DOI： 10.1097/PRS.0b013e3181fed6b2

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本創傷外科学会  

53歳男。右環指PIP関節掌側面に皮膚剥脱創を受傷し縫合処置を受けたが、局所感染徴候を認め受傷1週間後にデブリードマンを施行して開放創とし、受傷24日後に三次元ワイヤーフレーム外固定法を用いて植皮術を施行することとした。潰瘍面は右環指掌側面にPIP関節をまたぐように存在し、創周囲には上皮化傾向を認めた。まず、潰瘍の創縁を新鮮化してデブリードマンを施行し、術後のPIP関節伸展固定目的でワイヤーフレームを創縁に合わせて立体的に作製し、植皮片の固定と関節の固定を同時に行った。術後1年時点で移植皮膚は軽度の拘縮を認めるが、PIP関節に認めた屈曲拘縮は改善して可動域はほぼ正常となった。

DOI： 10.11310/jsswc.2.43

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本創傷外科学会  

"プロペラ皮弁法"の術前評価法としてのMDCTによる穿通枝造影検査(perforator CT angiography;以下P-CTA)の有用性を報告する。術前にMDCTによるP-CTAを施行し,かつプロペラ皮弁で再建を行った症例を対象に後ろ向き調査を行った。対象は11例,13皮弁で,皮弁茎は5皮弁が皮下茎,8皮弁が穿通枝茎であり,皮島の形状は通常の楕円形が9皮弁,2葉が3皮弁,4葉が1皮弁であった。皮弁の大きさは最小が6.5×2cm,最大が27×8cmであり,ドナーは植皮をした2例を除いて単純縫縮が可能であった。生着率は1例に部分壊死を認めたが,残り10例は100%生着した。MDCTで同定した穿通枝は,疑陽性,偽陰性は認めなかった。さらにMDCTによるP-CTAを導入することで,平均約21%の時間短縮となった。MDCTによるP-CTAは"プロペラ皮弁法"の安全性を高め,手術時間を短縮することが示唆された。(著者抄録)

DOI： 10.11310/jsswc.1.125

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Polyacrylamide hydrogel has gained international attention as a new injectable permanent filler that appears to be ideal for soft-tissue augmentation. However, studies on the safety of polyacrylamide hydrogel injection are limited and inconsistent. In the authors' experience, polyacrylamide hydrogel injections can induce complications.Methods: The authors retrospectively reviewed all cases where patients injected with polyacrylamide hydrogel for cosmetic purposes between 2004 and 2007 at other clinics suffered complications that led them to come to the authors' facility. The authors retrieved the patient histories, the duration between injection and presentation in their clinic, the materials and sites that were injected, whether injection was combined with other procedures, the clinical findings of the complications, the preoperative imaging analysis results, the operative methods used to correct the problem, and the chemical analysis of the extirpated injected material.Results: Of the 15 cases, all were women, except for one man, who was injected in his penis. Four, two, four, and four of the women were injected in their cheeks, nose, eyelids, and breasts, respectively. The product names of the injected materials were Aquamid and Amazingel. Five patients underwent surgery to remove the injected material or a foreign body granuloma.Conclusions: There has recently been a steady increase in the number of cases in Asian countries where polyacrylamide hydrogel injection has led to complications necessitating treatment. This is the First report of this phenomenon in Japan. The authors found that once these complications occur, they are difficult to treat. Further studies are needed to elucidate the risks involved in this procedure. (Plast. Reconstr. Surg 126: 1349, 2010.)

DOI： 10.1097/PRS.0b013e3181ead122

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Background: The occipital artery (OA) has three major cutaneous branches, all of which can be used to make occipital artery perforator (OAP) flaps on the posterior scalp and nape. To optimise OAP flap design, it is important to determine the supra-fascial perforator directionality (SPD) of the three branches.Materials and methods: We analysed the anatomical characteristics of the OAP by using the stored Digital Imaging and Communications (DICOM) multidetector-row CT (MDCT) data of 10 cases. For all cases, the branches arising from the OAP were counted and their origins and courses were traced on the computer. Branch diameters and lengths, and the distance between branch origin and the occipital protuberance or mastoid process, were measured. Averages were calculated.Results: All cases had three OAP branches, namely an ascending, a transverse and a descending branch (the average branch number was 3.2 +/- 0.4). Their average vessel diameters were 16.8, 10.8 and 10.0 mm, respectively. Their average SPD lengths were 71.1, 20.8 and 21.6 mm, respectively. After the OA penetrated the fascia (thus becoming the OAP), the descending branch arose from the OAP within 10 mm of the piercing point and travelled downwards and inwards. Above the descending branch bifurcation point, the OAP divided into the transverse branch, which travelled upwards and inwards, and the ascending branch, which travelled upwards.Conclusions: The OAP has three branches, all of which can be reliable vascular pedicles for scalp and nape skin flaps. Knowing the SPD of each branch is important for designing flap shape. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2009.09.021

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Language：English   Publisher：ELSEVIER SCI LTD  

DOI： 10.1016/j.bjps.2009.12.008

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイドに対する外科的治療としては切除縫縮後に放射線照射を行うのが有効とされているが、感染や排膿を繰り返し縫縮困難な症例では皮弁術や植皮術を選択せざるを得ない場合がある。今回、当科で2001〜2008年に皮弁術+術後放射線照射を行ったケロイド4例の治療成績について検討した。男性2例、女性2例、年齢27〜62歳、フォローアップ期間は14〜54ヵ月で、治療成績はexcellent 2例、good 1例、poor 1例であった。ケロイドに対する皮弁術の利点として、ケロイドにかかる緊張を十分に解除できることや、縫縮術よりも小さい張力で再建可能なこと、症状の急速な抑制が期待できることなどがある。一方、次のような問題点も存在する。1)皮弁採取部にケロイドが発生するリスクがある。2)採取部を含めた広範囲な放射線照射が必要である。3)再発を予防するためには、緊張を生じない十分な大きさの皮弁が必要となる。4)採取部の縫縮時に張力をかけず、ケロイド好発部位は避けるなどの注意が必要となる。

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鼻翼部の瘢痕拘縮や変形に対する治療として、局所皮弁術や有茎皮弁移植術が広く行われているが、鼻翼の変形が顔面の広範囲熱傷に伴うケースでは、鼻部の近傍や顔面の中に適切な皮弁を作製し得ない場合がある。そのような症例では、鼻翼部の瘢痕拘縮を解除した後に全層植皮での再建を余儀なくされるが、術後しばしば植皮部の再拘縮に悩まされる。再拘縮を軽減するためには、移植される真皮部分をより厚くし、皮弁の厚さに近づけることが必要と考えられる。この目的のために著者等は、当該患者3例に対し、全層植皮に先立って皮膚欠損部に自家真皮移植を行い、その後(2〜3週後)二期的に全層植皮(overlay)を行うことを試み、植皮部の再拘縮を軽減することができたので報告した。

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

Various types of dermal fillers have been developed for soft tissue augmentation, including hyaluronic acid products, which have been approved by regulatory agencies in Europe, the United States, and elsewhere. Phosphatidylcholine (PPC) injection has attracted attention for its application in the treatment of cellulite, weight loss, and skin rejuvenation. Because the public can now buy PPC and similar products from various online pharmacy websites without the involvement of a clinician, there is potential for misuse. The authors discuss two cases of complications experienced by patients after self-injection of hyaluronic acid and PPC for aesthetic purposes.

DOI： 10.1177/1090820X10374088

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穿通枝皮弁の定義には未だ不明確な部分もあり、特に顔面・頸部の穿通枝は具体的にどのような血管を指すのか定説はない。しかし、大血管から皮膚に派生する小血管を穿通枝と定義するなら、顔面・頸部の超薄皮弁や皮下茎皮弁は穿通枝皮弁ということもできる。そこで本稿では何が穿通枝皮弁かという議論はさておいて、我々が考える顔面・頸部の穿通枝皮弁について症例を提示しつつ供覧する。(著者抄録)

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We present a case of constriction amniotic bands syndrome due to amnion rupture sequence. Amnion rupture sequence is induced by mechanical destruction due to the amniotic band, following early rupture of the amnion. The bands may lead to highly variable and asymmetric clinical manifestations, such as ring constrictions, limb amputations, craniofacial clefts and abdominal wall disruptions. In this case, the constriction band of the forearm was successfully released by a combination therapy of "small-wave incision" and z-plasty. The small-wave incision method involves making a series of small wave-like incisions that are approximately 1 cm in length. This technique is designed to involve minimal normal skin margins. The result of this method is that the accordion effect is maintained but the linear scar is inconspicuous. It is supposed that this method could be used to reconstruct constriction bands in a more aesthetic manner than the past methods that have been used to date. A therapeutic strat gy in the early stage of limb constriction bands and the efficacy of "small-wave incision" for them are discussed in this paper.

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プロペラ皮弁法は(1)島状皮弁で、(2)穿通枝を含んだ茎を軸とし、(3)その軸を中心に回転することで欠損部の被覆、瘢痕拘縮の解除を行う手法である。プロペラ皮弁法の確立は、穿通枝皮弁術の新たな可能性を引き出し、従来遊離皮弁で再建していた症例の多くが本法で再建可能であることがわかってきた。本法は血管吻合を必要としないために手術時間短縮、術者のストレス軽減につながり、結果としてより低侵襲な皮弁再建を可能にする。また、局所皮弁の性質を併せ持つために、整容的観点からも有用であり、今後、四肢に限らず顔面・頸部といった露出部の再建に広く応用されていくと考える。全身に400以上あると言われる穿通枝が存在するところはどこでもプロペラ皮弁はデザインすることが可能であり、今度MDCTなどの画像診断の進歩と共に個々の穿通枝の特徴が解明されていくことでさらに信頼性の高い皮弁再建術が可能になると考える。(著者抄録)

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Language：Japanese   Publishing type：Part of collection (book)  

The superficial cervical artery (SCA) fasciocutaneous flap was first reported by Nakajima et al. in 1984 [1]. Hyakusoku developed it for use as a skin flap in 1990 [2], and in 1993, we succeeded in harvesting it as a free flap [3]. The SCA is now considered to be a transverse cervical perforator or trapezius perforator (Fig. 39.1); thus this flap is widely known as superficial cervical artery perforator (SCAP) flap [4]. The cranial part of the trapezius muscle is thought to contain the SCA (superficial branch of the transverse cervical artery), and the middle part the dorsal scapular artery (DSA; deep branch of the transverse cervical artery) [4]. With its wide arc of rotation, the SCAP flap is large enough to cover large defects after removal of neck scar contractures. © 2010 Springer-Verlag Berlin Heidelberg.

DOI： 10.1007/978-3-642-05070-1_39

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Language：English   Publishing type：Part of collection (book)   Publisher：Springer Berlin Heidelberg  

Available donor skin is so limited in extensive burns that thin meshed split-thickness skin grafts (STSG) or cultured epidermal autografts are commonly used to close the wounds. However, a lack of sufficient dermal beds results in poor cosmetic appearance with thin meshed STSG and poor graft survival with cultured epidermal autografts. © 2010 Springer-Verlag Berlin Heidelberg.

DOI： 10.1007/978-3-642-05070-1_14

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In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS) published a guideline for treatment of carpal tunnel syndrome (CTS) in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen randomized, controlled trials and 12 systematic reviews, including three Cochrane database systematic reviews, were retrieved. Our review revealed that most of the recent studies support the AAOS guideline. However, the recent literature demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation, although the AAOS guideline recommends early surgical treatment only for cases with denervation. The usefulness of splinting and steroids as initial treatments for improving patients' symptoms are also supported by the recent literature, but these effects are temporary. The evidence level for ultrasound treatment is still low, and further studies are needed to determine the effectiveness of this treatment. Finally, our review revealed a paucity of articles comparing the costs of CTS diagnosis and treatment. With the recent focus on health care reform and rising costs, attention to the direct and indirect costs of health care is important for all conditions. Future well designed studies should include cost analyses to help determine the cost burden of CTS. © 2010 Ono et al, publisher and licensee Dove Medical Press Ltd.

DOI： 10.2147/IJGM.S7682

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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We presented the propeller flap method in 1991. In that paper the propeller flap was rotated almost 90 degrees to cover raw surfaces after scar incisions. Recently this method has been developed to recon-struct tissue defects by almost 180 degree rotation. This procedure is now considered to be another use of perforator flaps. However, the definition and classification of this flap are still confusing. Thus, here we present our consideration of this method and our expectations for its further development. 1. Definition of the propeller flap methods Every skin island flap has the possibility of being a propeller flap. However, advancement flaps, transposition flaps and rotation flaps without the need for harvesting as island flaps should be excluded. Consequently, a skin island flap with axial rotation is our definition of the propeller flap method. 2. Classification of the propeller flap methods This classification was organized by pedicle types as follows: 1) Subcutaneous tissue pedicled propeller (SPP) flap 2) Perforator pedicled propeller (PPP) flap 3) Muscle pedicled propeller (MPP) flap 4) Supercharging propeller flap SPP flaps should be used for wound coverage or scar contracture reconstruction with a small rotation. Flaps are vascularized from the subcutaneous pedicle made in the central portion or the acentric portion of flaps, and we generally do not need to identify perforators including those in the subcutaneous tissue pedicles. The degree of rotational freedom of the PPP flap is the largest among the propeller flaps, thus this type can be used for various kinds of reconstructions. MPP flaps are useful for the reconstruction using muscles such as pressure ulcer reconstruction. The supercharging propeller flap will be useful for creating a longer or larger hemi-wing of the flap. 3. Clinical results and discussion Our propeller flap cases with over 90° rotation which was performed between 2006 and 2008 number 10 cases in PPP, 2 cases in MPP and 3 cases in PPP. One flap of SPP showed distal necrosis but the other flaps survived completely. A representative 4 cases were shown. In conclusion, when over 90° rotation is required, care should be exerted with the PPP in preoperative design to avoid distal necrosis.

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本医科大学医学会  

63歳男。既往歴に糖尿病があった。大量飲酒後にサウナに入室し、うつ伏せの状態で意識消失した。1時間後に発見され救急搬送となり、全身硬直、体温39℃、血糖260mg/dl、重度脱水を認めた。搬送直後は顔面に発赤・小水疱を認めるのみであったが、翌日より同部に境界明瞭な紅斑様病変を認め、徐々に赤みが強くなり、熱中症治療後の受傷後18日目に形成外科転科となった。転科時、鼻、上口唇、左頬部、左耳介に境界明瞭な黒色壊死病変を認め、デブリードマンを施行した。黒色壊死部はいずれもIII度熱傷で、特に上口唇は一部口腔内と貫通し、左耳介は軟骨露出を認めた。鼻・上口唇は人工真皮で一時的に創閉鎖を行い、左頬部は局所皮弁で閉創し、左耳介の露出軟骨は後頭部皮弁で皮下に埋め込んだ。更に、受傷後42日目に上口唇の皮膚・軟部組織欠損に対して頤下動脈穿通皮弁による再建を行った。その後、上口唇修正、鼻再建も計画したが、患者の脳血管障害などにより未施行である。

DOI： 10.1272/manms.5.225

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese  

CiNii Books

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(株)全日本病院出版会  

乳房増大(豊胸)術は女性の夢を叶える重要な手術である。それゆえ患者の期待が大きいだけに結果との乖離がトラブルの原因となりやすい。あるいは、患者の劣等感につけ込んだり射幸心を煽ったりして、後遺症を生じる可能性のある方法を不十分なICのもとで行う医師がいることなどもトラブルの原因となる。本稿では現在も我々の施設を訪れる多くの患者から得られる情報から、最近問題となっている事象について詳述する。項目としては、方法別に見たトラブル、アプローチによるトラブル、形状のトラブル、皮膚のトラブル、精神神経的トラブル、今後予想されるトラブル、ヒト・アジュバント病について、乳癌の合併について、妊娠との関係、摘除と再建方法に分けて記述する。(著者抄録)

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although autologous fat injection (fat grafting) to the breast was performed widely throughout the twentieth century, the authors at their hospital have recently had to repair the damage suffered by a number of patients subjected to this procedure. The authors are concerned that this procedure is being performed incorrectly by untrained and untutored individuals, especially in Japan. The authors report several cases of complications after this procedure. Several related issues are discussed. METHODS: The authors retrospectively reviewed 12 patients who had received autologous fat grafts to the breast and required breast surgery and/or reconstruction to repair the damage presenting between 2001 and 2007. The symptoms are described and the fat grafting procedures that were used are analyzed. RESULTS: All 12 patients (mean age, 39.3 years) had received fat injections to the breast for augmentation mammaplasty for cosmetic purposes. They presented with palpable indurations, three with pain, one with infection, one with abnormal breast discharge, and one with lymphadenopathy. Four cases had abnormalities on breast cancer screening. All patients underwent mammography, computed tomography, and magnetic resonance imaging to evaluate the injected fats. CONCLUSIONS: Autologous fat grafting to the breast is not a simple procedure and should be performed by well-trained and skilled surgeons. Patients should be informed that it is associated with a risk of calcification, multiple cyst formation, and indurations, and that breast cancer screens will always detect abnormalities. Patients should also be followed up over the long-term and imaging analyses (e.g., mammography, echography, computed tomography, and magnetic resonance imaging) should be performed. Copyright © 2008 by the American Society of Plastic Surgeons.

DOI： 10.1097/PRS.0b013e31819347ba

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PubMed

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Publishing type：Research paper (scientific journal)  

Super-thin flaps and its perforator supercharging versions are described according to their kinds and classification. Conventionally, most flaps are designed in an area in which axial vessels exist. On the other hand, a super-thin flap is made with a relatively healthy skin area of extensively burned patients with supercharging avessels or a narrow skin pedicle. That is to say, the super-thin flap is an order-made flap. We have presented several types of super-thin flap that seem to contribute to the functional and cosmetic recovery of a cotour sensitive area such as the face and neck of extensively burned patients.

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：日本皮膚科学会-大阪地方会・京滋地方会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド・肥厚性瘢痕の好発部位での皮膚切開線については、大別して(1)軟部組織にアプローチするための単なる皮膚切開、(2)皮膚腫瘍摘出などで皮膚の一部を切除する皮膚切開、(3)ケロイド・肥厚性瘢痕切除のための切開という3つの場合がある。したがってこれらを一概に語ることは難しいが、切開線の基本と考え方はさほど相違するものではない。いずれにせよ、緊張方向に平行する直線を避け、緊張が分散するようにすることが皮膚切開の基本である。ケロイド・肥厚性瘢痕の好発部位には個人差があり、さらに関節部位や多方向への運動がなされる部位では、切開線の方向によっては肥厚性瘢痕が生じることも多いので、必ずしも好発部位から除外されるものではない。また、本稿では、あわせて不幸にしてケロイド・肥厚性瘢痕が生じた場合の外科的治療についても言及する。(著者抄録)

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

高齢者の難治性皮膚潰瘍の新しい治療法として、培養線維芽細胞を組み込んだ培養真皮が注目されている。高齢者の患者自身の細胞をソースとする培養真皮作成のための基礎的な検討として、培養液と添加血清量の違いによる初代培養への影響を検討した。D-MEMとHFDM-1培地を用いて、高齢者の小皮膚片から線維芽細胞を培養した。その結果、培養効率は、D-MEMよりHFDM-1の方が高いことが示された。またHFDM-1培地を用いる場合、10%血清(FCS)を加えることで、細胞出現率、継代成功率共に向上した。今後さらに高齢者の皮膚線維芽細胞に適した培養方法の改善が必要であると考えられた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese  

We present a case of Chronic Expanding Hematoma (CEH) located in a subscapular lesion caused by frequent motions of wiping. A 67-year-old woman was admitted for evaluation of a mass in her back. She had been suffering from an unpleasant sensation and palpable mass in her subscapular lesion 6 months before admission. A mass greater than 10 cm in a diameter was detected in her right subscapular space on imaging diagnosis and totally excised under general anesthesia. Pathological examination revealed a typical finding of CEH. CEH is a rare condition that gradually increases in size for many years and is difficult to diagnose before operation by imaging diagnosis. In this literature, a differential diagnosis of CEH generated at a major joint was discussed.

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CiNii Books

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Publishing type：Research paper (scientific journal)  

The conventional submental island flap is raised based on the digastric muscle belly. Elevation of the flap using a perforator pedicle without the use of muscle has been reported, and the submental perforator was demonstrated as being reliable. In this paper, simultaneous reconstruction of the upper lip and moustache is described; this illustrates the usefulness of this flap. A 63-year-old male sustained a facial burn in a steam bath. A third degree burn occurred on his upper lip; the central area necrosed completely. Upper lip reconstruction was planned using a submental perforator-based flap. The flap was elevated without using the digastric muscle. The perforator consisted of a large artery and a small vein. After the elevation of the flap, a subcutaneous tunnel was made on the cheek and the flap was passed through the tunnel. The lip defect was reconstructed, and the donor site was closed primarily without tension. The flap survived completely. © 2007 Springer-Verlag.

DOI： 10.1007/s00238-007-0193-z

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

過去4年間にケロイド・肥厚性瘢痕を主訴に受診し、実際にはケロイド・肥厚性瘢痕ではないと考えられた患者、および鑑別診断に苦慮した症例を抽出し、検討した。受診した患者総数は378例中、4例が他の疾患であると考えられた。病理診断によりアポクリン腺腫、混合性腫瘍、成人発症型若年性黄色肉芽腫、慢性毛のう炎であった。また、ケロイドに母斑を合併した症例、病理診断と臨床診断が不一致であった症例もあった。

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Language：Japanese   Publisher：(株)全日本病院出版会  

保存的治療に抵抗した下腹部の細長い線状の肥厚性瘢痕・ケロイドに対し"small wave incision"を用いて治療した。症例1(31歳女)。30歳の時に小腸壊死に対して小腸切除を施行され、術後創部がケロイドとなった。治療抵抗性であったため、外科的治療・術後電子線照射療法を選択した。術後18ヵ月の時点で再発を認めていない。症例2(50歳女)。49歳時にS状結腸癌に対して腫瘍切除を施行され、術後創部が肥厚性瘢痕となった。治療抵抗性であったため外科的治療・術後電子線照射療法を選択した。術後18ヵ月の時点で電子線照射による若干の色素沈着を認めるものの再発を認めていない。

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese  

Due to the uncertainty of survival and absorption of injected fat tissue, this procedure was not generally recognized. However, a small amount of fat injection for facial and body contour repair is considered to be effective and we do not oppose fat injection itself. We confirm that the development of a technique, for example, adipose derived stem cell injection with a small amount of fat tissue to improve fat survival rate has provided us with a safe fat injection treatment. At the same time, there are many victims that have suffered from multiple lumpiness, eruption, and axillary lymph node swelling due to inflammation, pain and deformity following breast augmentation by fat injection. Most of them didn't receive information about complications and the necessity of breast cancel-screening on a regular basis. In this paper, we present the complication cases after fat injection into the breast and validate the evidence scientifically. We anticipate the development and dissemination of correct fat injection in the future.

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：English   Publishing type：Research paper (international conference proceedings)  

DOI： 10.1272/jnms.75.50

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.prs.0000294959.36074.49

Web of Science

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.prs.0000294959.36074.49

Web of Science

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PubMed

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese  

CiNii Books

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Language：Japanese  

CiNii Books

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Language：English  

Skin grafting is a common operative method widely used in the field of plastic, reconstructive, and aesthetic surgery. However, we offer five suggestions to reduce complications and surgical invasiveness. Our tips are as follows. (1) Skin grafts should be harvested on the basis of a swimsuit with high-cut leg openings. (2) A drum dermatome is still useful when a split-thickness skin graft is needed after a full-thickness graft has been harvested. (3) A flower holder is useful for making drainage holes. (4) A tie-over dressing using external wire-frame fixation is recommended. (5) Povidone-iodine gel is recommended with a tie-over dressing. These procedures have been found to be extremely helpful for ensuring the success of skin-grafting procedures.

DOI： 10.1272/jnms.74.386

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PubMed

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/SAP.0b013e3180a032f3

Web of Science

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PubMed

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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