Kozo Ishikawa

Distally based dorsalis pedis island flap for coverage of the distal portion of the foot

A distally based dorsalis pedis island flap is described which has been successfully used for reconstructing the distal portion of the foot in two patients with amputation of all 5 toes. The indication for this flap is a wide skin defect of the distal half of the dorsal foot without history of local vascular disorder. The arterial inflow of the flap comes from the posterior tibial artery via the deep plantar branch of the dorsalis pedis artery, while the venous drainage is most likely to be through the venae comitantes of the dorsalis pedis artery to those of the deep branch.

The use of subcutaneous pedicle flaps in the treatment of postburn scar contractures.

Subcutaneous pedicle flaps, which were usually applied to repair small skin defects in the face or the fingertip, have been used with success in the treatment of 17 postburn scar contractures, with the exception of one partial flap necrosis. The results indicate the reliability and usefulness of this technique in the treatment of scar contractures, even in the extremities or the trunk. Subcutaneous pedicle flaps are effective for relatively wide contractures or quadratic contractures. When the skin tension across the contracture line is too great to use any local flap, such as a Z-plasty or V-Y plasty, the subcutaneous pedicle flap is particularly useful, because it can be freely designed in an area where the tension is small. When the flap contains some superficial scarring, the subcutaneous pedicle flap is preferred over other local flaps because of the superior vascularity and mobility.

Arthrodesis of the distal interphalangeal joint using a bioabsorbable rod as an intramedullary nail

There are several fixation techniques for arthrodesis of the distal interphalangeal joint. Since February 1999 we have used a bioabsorbable (poly-L-lactide, PLLA) rod as an intramedullary nail for arthrodesis of 15 distal interphalangeal joints and one interphalangeal joint of the thumb. The advantages include the absence of protruding hardware that would require removal, and technical simplicity. Preoperative diagnoses included degenerative arthritis in five patients, post-traumatic arthritis in 10 patients, and non-union after arthrodesis with crossed Kirschner wires in one patient. All patients were observed until there was clinical and radiographic evidence of fusion with the mean interval to fusion of 8 weeks (range 6-12). There were two cases of minor intermittent local swelling, which resolved. Fixation with a PLLA rod for arthrodesis of the distal interphalangeal joint is a simple and effective technique.

Viability and quantitative dermofluorometry of experimental arterialised and non-arterialised venous flaps

In an attempt to predict venous flap viability, uptake and excretion of fluorescein dye injected intravenously was followed quantitatively at 10 min intervals on flaps on the surface of rabbit ears, with the use of a fiberoptic dermofluorometer. This instrument is a reliable indicator of circulation in non-arterialised or arterialised venous flaps, as it is in conventional flaps. This work shows that arterialised venous flaps are more reliable and have a larger skin territory than non-arterialised ones. Survival of the arterialised venous flap can be attributed primarily to the blood circulation, while the non-arterialised venous flap relies for its survival on both blood circulation and plasmatic inhibition from the bed as well.

Fingertip replantation with an efferent A-V anastomosis for venous drainage: clinical reports

Abstract In five cases of fingertip replantation where conventional venous anastomosis was found to be impossible, an efferent arteriovenous anastomosis was successfully used instead for drainage.

Free lateral calcaneal flap

Our cadaver dissection demonstrated that the lateral calcaneal artery is large enough for microsurgical anastomosis. Based on the finding, the lateral calcaneal flap was first successfully applied as a free flap that included the lesser saphenous vein and the sural nerve in the pedicle. This thin sensory flap, dispensing with main arterial damage, is indicated for the lesion of the posterior heel, plantar, and hand.

Distally based lateral calcaneal flap.

In our cadaver dissection, the connection between the lateral calcaneal artery, the lateral tarsal artery, and the branch of the lateral plantar artery was corroborated, indicating possible reverse blood flow in the lateral calcaneal artery. The distally based lateral calcaneal flap has been successfully used in 2 patients. Vascular anatomy, indication, and technical points of the surgery as well as advantages and disadvantages of the flap are discussed.

Direct monitoring of the microcirculation in experimental venous flaps with afferent arteriovenous fistulas

This study was conducted to determine the survival mechanism of tissue transfers which make use of an afferent arteriovenous fistula. The study was carried out using a rabbit ear chamber method. In the first experiment (n = 34), the rabbit ear was used to create a flap with a central afferent arteriovenous fistula with either dual (n = 28) or single (n = 6) drainage. In the second experiment (n = 6), a flap with a central arteriovenous fistula with single drainage was created as above. The central vein was then ligated in the flap to investigate the influence of the competent venous valve in the central vein. In both the first and second experiments, blood flow was noted in the capillaries and arterioles. This finding was interpreted as meaning that a flap with an afferent arteriovenous fistula is nourished through capillary circulation. It appears that the blood flow can circumvent the competent venous valve to perfuse the distal part of the ear.

Dorsal digital perforator flap for reconstruction of distal dorsal finger defects

Three patients are presented in whom defects of the distal part of the dorsum of the finger were covered with a rotation flap or V-Y advancement flap based on a single perforating branch of the digital artery running from the volar to the dorsal side. This method is useful for the reconstruction of the distal dorsal region of the fingers, because the flap is more mobile, has a smaller skin island and is less invasive compared to the previous flaps. This type of flap conforms to the concept of a perforator flap arising from the main artery.

Osteosynthesis in digital replantation using bioabsorbable rods

There are several fixation techniques for osteosynthesis in digital replantation. Kirschner wire fixation is used commonly but the wires protrude and disturb mobilization. Moreover, it requires removal. Since February 1995, the authors have been using a bioabsorbable rod made of poly-L-lactide as an intramedullary nail for osteosynthesis in digital replantation. The advantages of this technique include the absence of protruding hardware that would require removal and technical simplicity. This method has been applied for 15 arthrodeses (12 distal interphalangeal joints, 1 proximal interphalangeal joint, and 2 interphalangeal joints of the thumb) and for 11 diaphysis fractures (5 proximal, 5 middle, and 1 distal phalanx). All patients were observed until there was clinical and radiographic evidence of fusion (average interval to fusion, 8.4 wk). Bone resorption occurred in one patient. There were no cases of nonunion or infection. Poly-L-lactide rod fixation is a simple and effective technique.