Kiyoshi Onishi

A new lunch box-type method in umbilical reconstruction

A simple and easy technique for reconstruction of the umbilicus was devised, with emphasis on forming walls of the umbilicus and a depression in a caudal direction. A quite satisfactory result was obtained. A permanent and sufficient depression for the umbilicus can be expected as a result of three-dimensional formation of walls.

The Ulnar Recurrent Fasciocutaneous Island Flap: Reverse Medial Arm Flap

A new island fasciocutaneous flap raised on the inner medial surface of the upper arm has been used for reconstruction of soft-tissue defects of the elbow. The blood supply to this flap comes from the fasciocutaneous perforators of the ulnar recurrent vessels. This unique vascular arrangement allows for safe transference of the upper medial skin to the elbow region. This flap has been used to cover nine defects in eight patients, and results have been good. Except for one case of sensory disturbance, there were no complications or loss of overlying skin. It is a relatively quick and simple procedure involving only one stage that adequately corrects the skin defect around the elbow region and does not require prolonged splinting.

Endoscopic excision of forehead osteoma.

The endoscopic excision of a forehead osteoma is reported. This method leaves no scars in the forehead, results in positive excision of the tumor, and involves no complications such as nerve damage or vascular injury with direct endoscopic vision. It is considered to be an excellent procedure with respect to cosmetic results.

Medial canthal reconstruction with glabellar combined Rintala flaps.

Background: In medial canthal reconstruction, the continuity of color and texture and the reproduction of natural external appearance are required, and reconstruction with a flap adjacent to the defect is frequently performed as the first choice. The authors have performed reconstruction with a glabellar flap combined with a Rintala flap in five patients. Methods: A glabellar flap, which is rectangular according to the unit principle, was elevated, and after thinning and trimming to the defect shape, was transferred to the medial canthal defect. The donor site of the glabellar flap was closed with a Rintala flap. Results: Reconstruction by means of this procedure was performed in five patients with defects after resection of medial canthal basal cell carcinoma. In one patient with extension of the defect to the upper and lower eyelids, the tip of the glabellar flap was divided into two portions and transferred to the defective site. No recurrence was observed in any patient, and satisfactory results including aesthetic results were obtained in all patients. Conclusions: This technique can be performed readily and is applicable to the reconstruction of relatively large defects and is also aesthetically excellent because of a postoperative suture line that is consistent with the topographic curve. This technique may be useful for medial canthal reconstruction.

Sacral adipofascial turn-over flap for the excisional defect of pilonidal sinus.

&NA; The aim of pilonidal sinus surgery includes complete resection of the lesion and filling of the resultant softtissue defect by some means; this has a major influence on whether a lesion will occur after surgical treatment. The creation of a sacral adipofascial turn‐over flap for the excisional defect has been performed in seven cases of pilonidal sinus since November of 1992. During the postoperative follow‐up period, which ranged from 10 months to 7 years 11 months (mean duration, 5 years 2 months), partial dehiscence of the wound as a result of fatlysis was observed and treated conservatively in one case; however, primary healing was obtained in the other cases. No recurrence was seen in any of the seven cases. This procedure is not indicated in patients in whom wide skin resection is required because of the excessive tension associated with skin closure in such cases. However, the method is convenient, less invasive, and reliable, and therefore considered to be useful in the treatment of pilonidal sinus. (Plast. Reconstr. Surg. 108: 2006, 2001.)

Endoscope-assisted rectus abdominis muscle flap harvest for chest wall reconstruction : Early experience

We performed endoscope-assisted rectus abdominis muscle flap harvests on 2 patients with anterior chest wall defects. For the procedure, a spindle-shaped anterior fascia and the upper two-thirds of the rectus abdominis muscle were elevated endoscopically from an incision at the umblicus and transferred to the chest wall defect through a subcutaneous tunnel. Endoscopic harvest of the rectus abdominis muscle flap minimizes postoperative scarring caused by cutting off the flap, affording expectations of good cosmetic results. Furthermore, this surgical procedure is less invasive, relieves postoperative pain, and enables reduction of donor site morbidity.

Endoscopic harvest of the tensor fasciae latae muscle flap

Endoscopic harvest of the tensor fasciae latae muscle flap is presented. Two cases of abdominal wall hernia were treated with reinforcement of the abdominal wall using endoscopically harvested, pedicled tensor fasciae latae muscle flaps. The scars of the thigh after flap harvest were much shorter than the scar of the conventional open technique and the results were satisfactory. As the tensor fasciae latae muscle is easily undermined, we think it is appropriate to harvest the flap using an endoscope. Fascial grafts can also be harvested in the same manner as the pedicled flap.

Treatment and therapeutic devices in the management of frontal sinus fractures: Our experience with 42 cases*

Summary Forty-two cases with frontal sinus fractures were treated at the Department of Plastic and Reconstructive Surgery of Fujita-Gakuen Health University Hospital between December, 1978 and December, 1987; this experience and a discussion of our management of these cases are presented herein. Our concept of fundamental treatment is based on not obliterating the sinus, but rather removing the devitalized mucosa and establishing permanent drainage to the nose. During the operation, we use a cold light source, which provides a fine operative field, and a special cutting saw which allows us safely to perform bone grafts. Up to now we have experienced no significant complications and have achieved uniformly good results, both functionally and aesthetically.

The dorsal metatarsal V-Y advancement flap for dorsal foot reconstruction

Two cases of dorsal foot reconstruction using dorsal metatarsal V-Y advancement flaps based on dorsal metatarsal vessels are presented. The flap is useful for the repair of small to moderate sized dorsal foot defects.

One-stage repair of blepharophimosis

Congenital blepharophimosis is a congenital anomaly characterized by abnormalities in the area of the eyes, including bilateral ptosis, shortening of the horizontal fissure of the lid, expansion of the intercanthal distance, and epicanthus inversus. The condition is subject to autosomal-dominant heredity and is said to occur more frequently in Orientals than in Occidentals. Over the past 9 years, we have surgically treated 11 cases of congenital blepharophimosis using a procedure in which levator resection and medial canthoplasty are performed in one stage. It has been commonly believed that when levator resection and medial canthoplasty are performed at the same time, tension in the eyelid becomes too strong to achieve favorable results; therefore, the standard procedure has been to divide the operation into two stages. In all 11 cases we experienced, however, it was possible to obtain good results with a single-stage operation.