Kensuke Nose

Surgical treatment of laryngeal web with mucosa graft

Surgical treatment of laryngeal webbing varies with the extent and site of the web. An extensive one seems to be best treated by laryngofissure and skin or mucosa transplantation. Recent experiences with four cases of thick glottal webbing indicated that a mucosa graft was better for the voice result than a skin graft. For success in the airway and voice results, the salient points in surgery include 1) precise midline thyrotomy, 2) shaping of the vocal cord under fiberoptic control, and 3) mucosa grafting with the combined use of a pliable stent or fibrin glue for fixation.

Reconstruction of both eyelids following electrical burn.

A case of severe electrical burn of the unilateral upper and lower eyelids is reported, together with the surgical technique of reconstruction. A 25-year-old man suffered an electrical burn on his left eyelids. On admission, his left upper and lower eyelids were subtotally necrotic. Total eyelid reconstruction was performed 2 1/2 months later. A chondromucosal graft taken from the nasal septum was utilized as the deep layer of the upper eyelid, which was covered by sliding down the remaining levator muscle and connective tissues to maintain the blood supply to the composite graft. The outer layer of the upper lid was reconstructed with a free split-thickness skin graft. The lower lid was reconstructed with a local flap lined with a free mucosal graft. This sandwich method using the levator muscle as a core was found useful for reconstructing both the upper and lower eyelids.

Increase in length of experimental skin flaps that survive with dibutyryl cyclic AMP.

One of the most important research topics in plastic surgery is the extension of the length of skin flaps that survive. We have investigated the increase in the length of skin flaps that can be achieved by giving dibutyryl cyclic AMP (DB-cAMP) to rabbits with experimental skin flaps and compared the results with those in animals not given DB-cAMP. Three variables, the arrival of DB-cAMP in the critical area of circulation of the flap (n = 6), changes in the blood flow in the flap (n = 10), and increase in the length of skin flap that survived (n = 30) were investigated by high performance liquid chromatography and laser Doppler flowmetry. DB-cAMP reached the critical area of circulation in the skin flap (dye distance), increased the blood flow within this area (mean (SEM) peak value 30 minutes after operation 1.24 (0.06) ml/min/kg compared with 1.06 (0.02) in control flaps), and extended the length of the flap that survived (mean (SEM) length seven days after operation 66.1 (3.0) mm compared with 60.8 (1.8) mm in the control group). We conclude that DB-cAMP improved the blood flow in skin flaps in rabbits with a consequent increase in the length of skin flap that survived.

Use of a microcrystalline collagen hemostatic agent in palatoplasty for cleft palate.

The push back operation was performed as the first palatoplasty in 51 patients with cleft palate. During surgery a microcrystalline collagen hemostatic agent (MCH) was used in 23 (MCH group). The other 28 served as controls.Good hemostasis was obtained with MCH. It was very useful in 4 patients, useful in 15, and indefinite in 4. There were no differences in the duration of infusion or fever between the MCH group and the control group.In the MCH group there was no postoperative fever and no side effects.In some cases MCH was applied to the open wound, and wound healing was accelerated.

Pharyngeal flap operation and nasal breathing.

The clinical effectiveness of the pharyngeal flap operation for cleft palate has been widely documented. For the success of this operation, the lateral velopharyngeal apertures must be closed by mesial movement of the lateral pharyngeal wall during phonation, but they must be large enough for normal nasal breathing.To determine the minimum size of the lateral velopharyngeal apertures needed for normal nasal breathing, we measured their size with small balls. Nasal airway resistance was determined by both active-anterior and active-posterior methods. It was assumed that the pharyngeal flap had raised the resistance and disturbed nasal breathing when the difference in resistance between the two measurements was large.The minimum size of the two lateral velopharyngeal apertures needed for normal nasal breathing was found to be 6-7mm.