Makoto Hikosaka

Advantages of open treatment for syndactyly of the foot: Defining its indications

For the repair of syndactyly of the foot, skin grafting is often used to close the skin defect, but open treatment is not common. However, with grafting, an additional scar at the donor site and patchwork-like scar at the recipient site are inevitable. Our aim was to describe the process of epithelialisation and define the indications for open treatment of syndactyly of the foot. The open treatment was used on 16 webs. The texture of epithelialised surface resembled volar skin; the visible scar was mainly at the dorsal edge; and web creep occurred predominantly on the volar side and resembled the natural slope of the commissure. Open treatment is better than skin grafting because of better match of texture without a patchwork-like scar, and it is indicated in cases of simple incomplete syndactyly of the foot that extends proximal to the distal interphalangeal joint.

A new method to quantify subtle morphological deformities in nasal profile curvatures and its application for analysis of unilateral cleft lip noses

OBJECTIVE The authors conducted the present study to elucidate what elements characterize the nasal profiles of patients with unilateral cleft lips (CLs). MATERIALS AND METHODS A total of 40 Japanese unilateral CL patients were studied. For each patient, the nasal profile curve was traced on three-dimensional computer tomography image. Then four points were marked on the contour. The points were NAS (Nasion), MAP (the Most Anterior Point on the nasal profile curve), GPRN (the Genuine Pronasale: the point on the nasal curve at which the curve protrudes most), and SBN (Subnasale: the point at the columellar base). Using specially designed software, the distances between these marking points were measured along the nasal profile curve. RESULTS In CL patients, the distance between the MAP and GPRN is longer, and the GPRN is located more inferiorly than in non-cleft persons. CONCLUSION The nasal tip tends to become round and to droop in unilateral CL patients. In order to avoid this deformity pattern, the nasal tip should be reshaped to present a sharper curvature and corrected superiorly.

Cleft palate repair using a marginal musculo-mucosal flap.

Objective: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. Methods: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. Results: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. Conclusions: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non–push-back method of hard palate repair.

Evaluation of maxillary sinus volume in cleft alveolus patients using 3-dimensional computed tomography

Objective The aim of the study was to evaluate the volume of the maxillary sinus in patients with cleft alveolus. Study Design This is a retrospective, descriptive study. Patients and Methods The 3-dimensional computed tomographic data of 218 maxillary sinuses of 109 patients with cleft alveolus were compared with those of 100 sinuses of 50 healthy individuals. Results No significant difference in the maxillary sinus volume was found between the patients with cleft alveolus and the noncleft individuals. In the patients with cleft palate and alveolus, the maxillary sinus volume was significantly larger on the right side, but no significant difference was found between the cleft and noncleft sides. Conclusions The volume of the maxillary sinus in the patients with cleft alveolus is not different from that of the noncleft individuals. The information about the maxillary sinus is clinically important in executing such operations as endoscopic sinus surgery.

Refined simple line closure for macrostomia repair: Designing a mucosal triangular flap on the commissure region

Congenital macrostomia is a relatively rare deformity. A number of different methods for its correction have been reported in the past. Here, we report our refined method of correcting macrostomia. Our method is characterized by creation of a small triangular mucosal flap on the cleft region of the lower red lip where the tissue appears identical to the normal commissure. Adequate advancement of this flap into the mouth along with proper reconstruction of muscle continuity and simple line closure of the skin enable correction of macrostomia with a natural-looking commissure in a symmetric position with an acceptable scar.

QOL after head and neck reconstruction: Evaluation of Japanese patients using SF-36 and GOHAI

OBJECTIVE To evaluate the health-related quality of life (HRQOL) of Japanese patients with head and neck cancer after treatment. STUDY DESIGN Cross-sectional, descriptive study. PATIENTS AND METHODS Twenty-nine patients who underwent resection and reconstruction of the head and neck cancer between September 2001 and January 2008 at the National Hospital Organization Tokyo Medical Center completed the Short Form 36 (generic QOL measure) and the General Oral Health Assessment Index (oral-specific QOL measure). RESULTS The generic QOL of the patients was relatively maintained while oral-specific QOL was impaired compared to the Japanese norms. The patients with musculo-cutaneous flaps and 1y or longer after operation reported significantly lower QOL. CONCLUSION This is a unique study on Japanese patients with relatively longer time after operation. Further evaluation with increased number of cases and disease-specific QOL scale is required to better understand the QOL of the patients.

Extended latissimus dorsi rotational V-Y advancement flap for the reconstruction of axillary defects after excision of hidradenitis suppurativa

procedure. Ninety female patients had free flap breast reconstruction at the University of California, Irvine from January of 2004 to December of 2008. The average reimbursement was 38.3 percent of billed charges. The mean and median reimbursement was

Reconstruction of the Urethral Sphincter with Dynamic Graciloplasty in a Male Rabbit Model

6597 and

QOL of the Patients with Lymph Edema: Evaluation of Japanese Patients using SF-36

4962, respectively. Of these 90 patients, seven returned to the group for a cosmetic procedure, for a total of nine procedures. One of these patients had multiple cosmetic procedures. The overall return rate of subjects for cosmetic procedures after microvascular free flap breast reconstruction is 7.7 percent. In addition, the incidence of cosmetic surgery after microvascular free flap breast reconstruction was one cosmetic surgical procedure for every 10 microvascular free flap breast reconstructions performed, or close to two procedures per year. Although there is an 8 percent self-referral rate for cosmetic procedures, the total number of cosmetic referrals is expected to be larger because these data are inclusive of only the subject specifically and do not account for patient referrals, family members, fillers, or neuromodulators. If each free flap breast reconstruction performed can yield an additional cosmetic procedure rate of 10 percent, with an assumption that a cosmetic procedure costs on average

Anatomic basis of anorectal reconstruction by dynamic graciloplasty with pudendal nerve anastomosis.

3992.36 (based on the American Society for Aesthetic Plastic Surgery list of cost per surgical procedure),2 each free flap procedure will earn an additional