Katsutoshi Motegi

Consideration of the formation and biological significance of hypertrophic scar

An incision placed at right angles to the direction of skin cleavage lines is susceptible to the development of a haematoma within the sutured wound. Moreover, the edges of the sutured incision are not firmly fixed together by the material and the sutured incision is subjected to direct tension. For these 3 reasons an incision not conforming with the direction of skin cleavage lines may frequently allow stretching and postoperative hypertrophy of a scar. The biological function of a young hypertrophic scar may be an expansion-relaxation movement of the capsule of scar tissue like a bellows, at right angles to the direction of skin cleavage lines in near, though not quite, synchronism with the surrounding dermis. The biological function of a mature scar may be a movement of the scar tissue in exact synchronism with the dermis as activated by the combination of a bellows-like movement of the capsule of scar tissue in the direction at right angles to the skin cleavage lines and an expansion-relaxation movement of the main structure of the scar tissue in the direction parallel with the skin cleavage lines.

Orientation of cleavage lines, fibrous connective tissues and blood vessels in the facial skin

The cleavage lines experimentally produced on the facial region in 30 Japanese cadavers were investigated macroscopically and histologically. The results obtained showed the same directional arrangement of the cleavage lines, fibrous connective tissues (especially the collagen fibres) and blood vessels.

Relation between cleavage lines and scar tissues.

As viewed in relation to cleavage lines, the histological structure of scar tissues, whether old or new, closely simulates the structure of a cable. Bundles of collagen fibres, the main component of scar tissue, that run at right angles to the direction of the cleavage lines, may be likened to a cable core while fibres that surround the main structure of the scar tissue, parallel with the direction of the cleavage lines, may be likened to the coating material of a cable.

Skin incision parallel with skin cleavage lines for access to the fractured zygomatic arch

In surgery of the fractured zygomatic arch the skin incision was placed parallel with the skin cleavage lines, directly over the zygomatic arch. The fracture site was exposed by blunt dissection of the subcutaneous tissue. Facial palsy may be predicted as a possible sequel to this incision. In fact, facial paresis occurred in 1/3 of the patients but it disappeared within 6 months. It appeared that the facial nerve was only damaged by stretching during the surgical procedure but was not severed by the incision. The postoperative scars presented no unsightly appearance, if the incision was placed completely parallel with the cleavage lines.

Cleavage lines of the oral mucosa in Japanese cadavers.

Cleavage lines were experimentally reproduced in the oral mucosa of Japanese cadavers. They were investigated macroscopically and histologically. The reproduced cleavage lines showed little directional variation by sex or age. From the histological findings, the mucosal cleavage lines were interpreted to represent cleavage split along the direction of connective tissue fibres in the lamina propria.

The use of thin split-skin grafting after diagnostic — therapeutic tumour removal

Summary In cases of superficial tumours of suspected malignancy, a biopsy was not performed, but the tumour was excised completely, together with the surrounding healthy tissue. The tissue removed was used for histological diagnosis, and the wound was closed with a thin split-skin graft, which has the advantage of permitting early detection of any recurrent malignancy.

Clinical Studies on Diabetes Mellitus and Diseases of Oral Region

Of the 25,672 patients who visited this clinic between January 1964 and March 1973, 126 were diabetic. These were examined statistically and the following results were obtained. 1. Together with diabetes the following disorders pertaining to the realm of oral surgery were observed: Alveolar pyorrhea (49 cases), infection of oral tissues other than periodontal tissues (24 cases), simple periodontitis (15 cases), tumors (13 cases), dental caries (9 cases), neuralgia (6 cases) and several disorders. 2. Of these 126 cases, 85 needed tooth extraction, which was actually performed in 67 cases with the following results: (a) Of the 67 cases, 13 developed complications such as dry socket, postoperative infection, sequestrum around the extraction socket, etc. This was a significantly higher incidence than in an equal number of controls. (b) In the cases with complications convalescence was prolonged to an average of 54.2 days. (c) In the cases with complications, the preoperative fasting blood sugar level averaged 194.5 mg/dl, which was much higher than in the cases which did not develop complications (average 142.4 mg/dl).

A case of topical application of Rifampicin with blocks of the infra-orbital nerve and the stellate ganglion in the treatment of herpes zoster

Katsutoshi Motegi, Shoichi Banba, Masatsugu Shimizu, Tadashi Ueno The first Department of Oral Surgery, School of Dentistry, Tokyo Medical and Dental University (Director : Prof. Tadashi Ueno) Nagaaki Suzuki, Yasuya Kubota Department of Anaesthesiology, School of Dentistry, Tokyo Medical and Dental University (Director : Prof. Yasuya Kubota) Eitaro Takatsuka Department of Anaesthesiology, School of Medicine, Tokyo Medical and Dental University (Director : Prof. Etsutaro Ikezono)