Kaneshige Satoh

Lower leg reconstruction using a sural fasciocutaneous flap.

The fasciocutaneous flap in the lower leg has been widely used since Ponténs 1981 report. The cutaneous artery running along the sural nerve—known as the superficial sural artery—has an important role in the blood supply of the fasciocutaneous flap in the lower leg as stated by Haertsch. The superficial sural artery has great variation with regard to its location and the origin of the vessel. The cutaneous artery is intimately connected to the sural nerve or the lateral sural nerve. It may run along the sural nerve or along the lateral sural nerve. We examined this vessel in 10 cadaver dissections and applied it in 17 clinical cases of pedicled, island, and free flaps. The island sural fasciocutaneous flap is particularly versatile for the reconstruction of the soft tissue defect around the knee joint. The operative procedure involving the island fasciocutaneous flap and the characteristics of this sural fasciocutaneous flap are described.

Speech and velopharyngeal function following maxillary advancement in patients with cleft lip and palate

The influence of maxillary advancement by osteotomy on speech was examined in 10 patients with cleft palates (6 males, 4 females). Ages at the time of surgery ranged from 16 to 26 years (mean, 19.5 yr). LeFort I and II osteotomies were performed in 9 patients and 1 patient, respectively. Preoperatively and postoperatively, hypernasality, nasal emission on pressure consonants, and articulation disturbances were evaluated perceptually, and velopharyngeal function was evaluated by lateral cephalographic and nasopharyngoscopic studies. Hypernasality, which had been judged preoperatively to be absent or slight in 1 patient each, remained unchanged after surgery, whereas the remaining 8 patients showed increased hypernasality after surgery. Nasal emission showed a similar tendency. Articulation errors were not improved postoperatively. Lateral cephalograms recorded from the patients with increased hypernasality showed increases in the shortest palatopharyngeal length and in the soft-palate-length–to–pharyngeal-depth ratio. Also, deterioration in velopharyngeal closure was noted postoperatively compared with preoperatively by nasopharyngoscopy in the majority of patients with increased hypernasality.

Reverse-flow anterior tibial flap type III

A new anterior tibial flap has been designed. It is nourished by a single septocutaneous branch of the anterior tibial artery and its veins, running vertically through the anterior crural septum and appearing in the deep fascia of the lower half of the lower leg. This differs from the two other types of anterior tibial flap which have been reported and are nourished by different septocutaneous branches. We call our flap the anterior tibial flap type III in order to avoid confusion. We have applied it clinically in two cases as a reverse-flow island flap, anastomosing one vena comitans to a superficial vein at the edge of the wound in order to avoid venous congestion. Both flaps survived well with no problems.

Congenital bilateral zygomatico-mandibular fusion with mandibular hypoplasia

We report a very rare case of congenital bilateral zygomatico-mandibular fusion with mandibular hypoplasia. Soon after birth, the patient underwent tracheotomy because of upper airway obstruction. At the age of one and a half years, reconstruction of the temporomandibular joint and lengthening of the ramus with a costochondral graft were performed. Only a few cases of congenital bony syngnathia revealed in this case have been described in the literature.

Heel and foot reconstruction using reverse-flow posterior tibial flap

Island flaps supplied by the intermuscular cutaneous perforator (IMCP) from a deep vessel, such as the peroneal flap pedicled by IMCP from the peroneal vessel or the anterior tibial flap supplied by IMCP from the anterior tibial vessel, are reported to be useful in reconstructive procedures for soft-tissue defects of the lower leg. However, the posterior tibial flap, pedicled by IMCP from the posterior tibial vessel, has not yet been fully described. The posterior tibial flap can be used either as a normal-flow or as a reverse-flow flap. It is particularly versatile as a reverse-flow flap for reconstruction of soft-tissue defects of the heel and foot. Three reverse-flow posterior tibial flaps were clinically applied, without venous anastomosis, to reconstruct heel and foot defects, and all three survived completely. The operative procedure and its characteristics are described.

A mirror image of the first and second branchial arch syndrome associated with cleft lip and palate in monozygotic twins.

A rare case of monozygotic twins revealing a mirror image of the first and second branchial arch syndrome with accessory ear and hemifacial microsomia, associated with unilateral cleft lip and palate, is presented. Although the concordance and/or discordance rate of monozygotic or dizygotic twins with cleft lip and palate is well reported, that of twinning of the first and second branchial arch syndrome has been very rarely described. First and second branchial arch syndrome occurs sporadically but cleft lip and palate are strongly related to the influence of environmental factors with a considerable hereditary tendency. The study of twinning of congenital anomalies is important in the investigation of the pathogenesis of genetic and environmental effects. The twins were diagnosed as monozygotic with almost complete certainty by ABO blood typing, HLA typing, finger prints, and DNA typing. Concordance was noticed, which suggests a hereditary tendency. Since concordance in these monozygotic twins was exhibited by a precise mirror image of first and second branchial arch syndrome, spinal scoliosis and cleft lip and palate, it is possible that an environmental factor induced these complex anomalies.

Comparative study of reverse flow island flaps in the lower extremities--peroneal, anterior tibial, and posterior tibial island flaps in 25 patients.

The reverse flow island flap is one of the most versatile reconstructive procedures in the lower extremity. There are three major arteries, the peroneal, the anterior tibial, and the posterior tibial artery, and a reverse flow island flap pedicled by each vessel and its intermuscular cutaneous perforators is available. Twenty-five reverse flow island flaps were clinically applied for soft tissue defects in the lower leg (10 peroneal, 8 anterior tibial, and 7 posterior tibial flaps). We report a comparative study of the characteristics and indications of the peroneal, anterior tibial, and posterior tibial reverse flow flaps. We conclude that the anterior tibial reverse flow flaps are more likely, without venous anastomosis, to become congested and necrose than the peroneal and posterior tibial flaps.

A new osteotomy for genioplasty : stepped osteotomy : preliminary report

A new osteotomy for genioplasty, stepped osteotomy, is described. This osteotomy is a combination of horizontal and sagittal osteotomy of the mandibular symphysis. It consists of horizontal osteotomy at a distance of 3 to 4 mm below the apexes of the anterior teeth, connecting at right angles with the conventional horizontal osteotomy below the mental foramen, making a step-fashioned osteotomy of the chin. This procedure is particularly advantageous in simultaneous elongation and advancement genioplasty because the central portion between the apexes of the anterior teeth and the conventional horizontal osteotomy line is available as augmentation and the bony contact of the osteotomized mandible can be retained in elongating the chin. The characteristics of this procedure are described and typical patients are shown.

Correction of prominent zygomata by tripod osteotomy of the malar bone

Reduction of the prominent zygomata is occasionally required in aesthetic surgery in Oriental patients. Two approaches to surgical exposure are commonly used; one is oral and the other is coronal. In addition, there are two basic surgical concepts of reduction malar-bone plasty; one is thinning and chiseling the prominent area, and the other is mobilizing the prominent zygoma by osteotomy of the zygomata. We devised a new tripod osteotomy of the zygomata by the coronal exposure approach and applied it to correct prominent zygomata in association with frontoperiorbital lifting in Oriental patients. Satisfactory results were obtained and we concluded that this was an effective procedure to correct prominent zygomata for elderly Oriental patients.

Tensor fasciae latae perforator flap

The tensor fasciae latae perforator flap and a new technique, named microdissection, for one-stage accurate formation of a thin flap were presented. Microdissection enables the perforator in the adipose tissue to be used as a lengthened pedicle, and the flap can be transferred without adding and reducing excess fat tissue to the recipient and donor sites. This microdissected thin tensor fasciae latae perforator flap can be used conveniently in many aspects of reconstructive surgery, especially in cases of severe bum scar contracture of the extremities.