Kenjiro Hasegawa

Preoperative identification of perforator vessels by combining MDCT, doppler flowmetry, and ICG fluorescent angiography.

The position of perforator vessels varies between individuals. In this report, we present our experience on the use of combining multidetector‐row computed tomography (MDCT), Doppler flowmetry, and indocyanine green (ICG) fluorescent angiography to identify perforator vessels of flaps for reconstruction. We evaluated the advantages, disadvantages, and chose the necessary examination, depending on characteristics of the flap.

A Novel Model for Supermicrosurgery Training : The Superficial Inferior Epigastric Artery Flap in Rats

The purpose of this study was to determine the usefulness of a new flap model, the superficial inferior epigastric artery (SIEA) flap for supermicrosurgical training. Experimental groups were randomly divided into three groups of 10 rats each. In each group SIEA flaps were elevated and then returned to their original locations with or without vascular anastomosis of the superficial inferior epigastric vessels. Group 1: free SIEA flap, group 2: free SIEA flap with 1 hour ischemia time, group 3: free SIEA flap with 4 hours ischemia time, group 4: SIEA flap without vascular anastomosis. The viability rate was 80% with group 1, 50% with group 2, and 40% with group 3. All nonvascularized flaps (group 4) underwent complete necrosis. These findings suggest that preservation of blood flow in a flap has a beneficial effect on the prevention of microthrombosis in the subcutaneous capillary network of the skin and increases the flap survival rate. The SIEA flap with preserved circulation is an ideal model for developing supermicrosurgical skills.

Overview of treatments for male genital lymphedema : critical literature review and anatomical considerations

thrombolysis varied from “established extensive clot in either the arterial or the venous system,”2 to “no sufficient restoration of blood flow after blood clot evacuation,”1 to “failure to reestablish venous outflow after establishing good arterial inflow.”3 The salvage rate of the treatment groups ranged from 30 to 75 percent, and that of the control groups ranged from 29 to 67 percent. The literature on the clinical efficacy of thrombolytic agents in free-flap salvage has not been well documented; thus, this is a level II evidence-based systematic analysis. All of the findings come from the four retrospective comparative studies, and the equivocal results suggest that it is not possible to draw clear conclusions about the role of thrombolytic agents in free-flap salvage. Further studies are needed regarding their indications, dosages, routes of administration, efficacy, safety, and patient randomization. Intensive flap monitoring at a specialized microsurgical intensive care unit by well-trained staff and urgent reexploration remain critical for free-flap salvage. DOI: 10.1097/PRS.0b013e318245eab1

Repositioning of the malpositioned ear with a new technique of fascia lata suspension

Facial deformities are often observed in von Recklinghausen disease’s patients because of the development of pachydermia or neurofibromas. If a neurofibroma develops in the temporal or occipital area, the ear will be pushed downward. To correct this ‘low-set’ ear, excision of the tumour and redundant skin and closure of the skin are often performed. However, the ear deformity often recurs soon after surgery because the skin extends around the ear. We describe a new technique for fixing the malpositioned ear to the normal position using strips of fascia lata. The use of fascia lata strips allows rigid fixation of the ear in almost all directions without total fixation of the ear. Case 1 was a 39-year-old woman with neurofibromatosis type I and a low-set right ear (Figure 1B). After the tumour was excised, a subcutaneous tunnel was created around the ear. Two 7-mm-wide, 150-mm-length strips of fascia lata were linked end to end to make a single longer strip. This was passed through the subcutaneous tunnel, and both ends were pulled as does a hammock (Figure 1C, D). One end was fixed to the temporal bone, and the other end was fixed to the zygomatic bone. The fixation was performed with the Mitek Micro Quick Anchor System (DePuy Mitek, Inc., Rayham, MA). The ear was thus repositioned anteriorsuperiorly. The posterior inclination of the ear was corrected by pulling the upper fascial strip more strongly. An excellent permanent result was evident 8 months after surgery (Figure 1G). Case 2 was a 38-year-old man with a low-positioned left ear, caused by an extremely large tumour in the temporooccipital area (Figure 2B). We could not create a subcutaneous tunnel around the ear because of bleeding. Therefore, three subcutaneous tunnels were created behind the ear and one end of each strip was fixed to the posterior auricular cartilage. The other end was fixed to the temporal bone. The incision was closed directly. An excellent permanent result had been obtained 6 months after surgery (Figure 2G). To reposition a malpositioned auricle, rigid fixation is needed to counteract gravitational forces. However, direct fixation to the temporal region with a suture often will not prevent the auricle from returning to its original position.