Hisashi Aoyama

Composite Gastric Seromuscular and Omental Pedicle Flap for Urethral and Scrotal Reconstruction after Fournier's Gangrene

A new composite gastric seromuscular and omental pedicle flap is described that can provide immediate airtight or watertight closure in the repair of complex defects involving the urethra. This flap was used to repair defects of the urethra, scrotum, and abdominal wall in a patient with Fourniers gangrene. The seromuscular patch was sutured to the urethral defect, and the omentum was applied over the defects of the scrotum and abdominal wall. This new procedure made it possible to close the skin primarily without leakage or infection. The patient had an uncomplicated recovery. Postoperative urethrography demonstrated no leakage or stenosis.

The Effect of Skin Grafts on the Ratio of Collagen Types in Human Post-Burn Wound Tissues

Pepsin digests of human post-burn wound tissues grafted with autologous fresh skin showed a significantly lower ratio, 0.37 +/- 0.04 (mean +/- S.D.), of type III to type I collagen determined by interrupted gel electrophoresis than the ratio, 0.55 +/- 0.13, measured in ungrafted wound tissues (p less than 0.001). In wounds grafted with frozen skin there was no significant difference from ungrafted wounds, but a significantly higher ratio, 0.46 +/- 0.08, than that in wounds grafted with fresh skin (p less than 0.001). These results were consistent with the histological features of the wound tissues.

Isolation of a substance toxic to mitochondrial function from the burned skin of rats

Abstract Extract from burned skins of rats contained an activity impairing the respiratory control index (RCI) of liver mitochondria in vitro . This mitochondria-toxic activity was significantly enhanced 1–2 weeks after the thermal injury. When analysed 2 weeks post burn, most of the toxic activity appeared to be associated with the eschar. The activity was heat stable and was easily extracted with ether from the acidified aqueous extract. When tested with this ether extracted preparation, not only RCI but ADP/O and the rate of ATP-formation were also impaired in a dose-dependent manner. At higher concentrations of the ether extract, electron transport itself was inhibited. Thin layer chromatography of the above preparation revealed 5 iodine-positive bands; the toxic activity was associated with only one of them (Band 3). This substance could be purified by high-performance liquid chromatography essentially to a single band on thin layer chromatography. The extract from sham-operated normal skins also contained this substance but much less in amount—2–20 per cent of that in burned skins when estimated by absorbance at 215 nm. Current analyses indicate that the mitochondria-toxic substance in burned skins may be a lipid, probably a derivative of fatty acids, which is a normal component of the skin, and may be produced in excess after thermal injury.

Possibility of venous return through bone marrow in the free fibular osteocutaneous flap

The authors report a case of a free fibular graft that was successful as a result of venous return delivered through the bone marrow. A 26-year-old man underwent reconstruction of the left tibia and a soft-tissue defect of the lower leg. A free vascularized fibular bone and skin flap was elevated. The fibular vessels were anastomosed to the dorsalis pedis vessels. The elevated fibular bone was fixed to the tibia. The next day, reanastomosis was necessary because of venous thrombosis. However, the fibular vein rethrombosed, but blood flow was ascertained by Doppler flowmetry, with darker blood flow being recognized from the edge of the flap. Four days after surgery, the skin color gradually improved, and the flap had almost completely taken. On retrospective evaluation, the authors concluded that this flap succeeded because venous return was routed through the bone marrow in the free fibular graft.

Systemic absorption of sulphadiazine, silver sulphadiazine and sodium sulphadiazine through human burn wounds

Systemic absorption of water-soluble and water-insoluble drugs through human burn wounds was compared. Serum levels of sulphadiazine were estimated after application of silver sulphadiazine (water-insoluble) cream, sulphadiazine (water-insoluble) cream and sodium sulphadiazine (water-soluble) cream. It was found that the absorption of sodium sulphadiazine was greater than that of sulphadiazine or silver sulphadiazine.

The effect of some ointment bases on the systemic absorption of tobramycin from various wound surfaces of burned patients

Three kinds of 0.2 per cent tobramycin ointment were prepared with tobramycin and 3 ointment bases (cream, polyethylene glycol and hydrophilic petrolatum), and applied to the various wound surfaces of 5 burned patients. The systemic absorptions of tobramycin were compared with the values of the tentative AUC (area under the curve of tobramycin blood level, micrograms.h/ml.g) until 12 hours after the applications, by determining tobramycin level in blood. Similar values of AUC from the cream and polyethylene glycol ointments were obtained, while that of hydrophilic petrolatum ointment was very low. The systemic absorption of tobramycin from the polyethylene glycol ointment was studied when the ointment was applied to the wound surfaces of 7 patients with partial-thickness burn, 9 patients with full-thickness burn and 6 patients with burn ulcer. The mean values of the tentative AUC of patients with partial-thickness burn, full-thickness burn and burn ulcer were found to be 0.06, 0.03 and 0.15, respectively. These results showed that cream and polyethylene glycol bases should be used carefully as a vehicle of tobramycin ointments because of the rapid systemic absorption of tobramycin from human burn wounds, especially burn ulcer.

Toxic effects of extracts from burned skin, serum and blister fluid of burn patients on mitochondrial function

Abstract The toxic activities in burned skin, in serum or in blister fluid of burn patients were examined for their impairing activity on rat liver mitochondrial function by incubating mitochondria with saline extracts of these materials. Toxic activities on mitochondrial function such as lowering respiratory control index but not ADP/O ratio were demonstrated in extracts of burned skins and in sera of non-surviving burn patients, but were not present in sera and in blister fluids of surviving burn patients.

Mitochondria-toxic activity in burned human skin: relation to severity of burn and period after burn

Toxic activity in the extracts of burned human skins impairing respiratory control of rat-liver mitochondria was compared in terms of the severity of burn injury and period after burn. The toxic activity was detected in the extracts from skins of third-degree burn, but not in those from skins of deep-dermal burn or of burn ulcers, in the present experimental conditions. In the case of third-degree burn, the toxic activity was not evident during the first few days post burn, but was significantly increased after 10 days. The results of this study suggest the effective period for early therapeutic débridement of the necrotized tissues in the management of severely burned patients.

Endoscopic correction of pectus excavatum.

Endoscopic surgery is minimally invasive and can be used to achieve superior cosmetic results. Conventional correction of pectus excavatum results in a long scar. Correction by use of endoscopic surgery involves a smaller skin incision. In this study, endoscopic correction of pectus excavatum was performed in 20 cases. A small transverse skin incision was made above the xyphoid process. A wide area beneath the pectoralis major muscle was dissected under endoscopic visualization. Subperichondrial resection was performed under direct visualization when possible. Subperichondrial resection of the third or fourth rib was performed under endoscopic visualization. Ravitchs chondrotomy of the second or third rib was performed under endoscopic visualization. Endoscopy was also useful for sternal elevation, with minimal risk of pleural perforation. Kirschner wire was inserted percutaneously under the sternum to prevent postoperative paradoxical respiration. In all cases, the postoperative course was uneventful. The advantages of endoscopic pectus excavatum correction are a short scar, control of bleeding, safe dissection of the pleura from the sternum without the risk of pleural perforation, and ease of sternal elevation without injury to the intramammary vessels. However, the endoscopic operation is long and is not useful in adults because subperichondrial resection in adults is difficult to perform. (Plast. Reconstr. Surg. 107: 333, 2001.)

Effect of autografting on the diameter of collagen fibrils in human postburn wounds

The effect of skin grafts on the size of collagen fibrils in autografted human burn wounds was examined. In autografted burn wounds, the mean (+/- standard deviation) diameter of collagen fibrils was 61.16 +/- 15.18 nm, against 39.77 +/- 6.51 nm in ungrafted burn wounds. This result indicates that autografts (0.1 mm thick) promote the maturation of collagen in burn wounds.