Masayuki Sawaizumi

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.

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.

Free vascularised epiphyseal transfer designed on the reverse anterior tibial artery

This report describes a case of radial club hand which was reconstructed by a proximal growth plate of the fibula supplied by the reverse anterior tibial artery. A brief discussion on epiphyseal transfer of the fibula is included.

Sliding shape-designed latissimus dorsi flap.

The latissimus dorsi musculocutaneous flap can provide a large, reliable flap for reconstruction of various areas of the body. This flap can also be extended quite some way over the anterior and upper border of the muscle, although its width is limited to between 10 cm and 12 cm if direct closure of the donor site defect is required. This paper presents a sliding-shaped modification of the latissimus dorsi flap that enables the flap to be used efficiently in covering a wide defect as well as in correcting the donor site defect. Sawaizumi M, Maruyama Y. Sliding shape-designed latissimus dorsi flap. Ann Plast Surg 1997;38:41-45

Endoscopic Extraction of Lipomas Using an Ultrasonic Suction Scalpel

Lipomas were extracted with an ultrasonic suction scalpel, assisted by an endoscope, with good results. The combined surgical technique is described in this paper. Preoperative clinical findings and diagnostic imaging of the patients provided a preoperative diagnosis of lipomas. For the procedure, the endoscope was inserted through a small incision immediately above the tumor. The tumor was endoscopically confirmed and then extracted with an ultrasonic scalpel. Complete lipoma extraction was achieved in all patients without recurrence. The patients had good cosmetic results with only minimal postoperative scarring. The endoscopic extraction of lipomas with an ultrasonic scalpel is proven to be highly useful, especially for large tumors, and permits a less invasive and more reliable surgical operation.

Use of endoscopic surgery for forehead recontouring.

Forehead recontouring in endoscopic surgery is presented. Eleven cases of protruded forehead deformity caused by benign tumor and one case of concave deformity caused by depressed frontal bone fracture were treated. All lesions were approached through incisions made in the hair-bearing area and operated on endoscopically. This method left no scars on the forehead, and the results were satisfactory. It is considered to be an excellent procedure with regard to cosmetic results.

Percutaneous endoscopic sinus surgery for frontal sinusitis or a cyst.

Using percutaneous endoscopic surgery, we achieved good results in patients with frontal sinus cyst. The surgical procedure is described and discussed. The endoscopic system consisted of a needle-shaped rigid fiberscope (direct-vision and angle-vision types [30 degrees, 90 degrees]) 1.7 mm in diameter with a light source. A small incision was made at the eyebrow, the sinus was cleaned, and an opposite hole was made through the existing wound. This procedure permitted less invasive surgery under direct view of the surgical field compared with conventional percutaneous transnasal frontal sinus procedures. Postoperative patency of the sinus was also satisfactory. This percutaneous endoscopic procedure was designed for surgical maneuvers in the frontal sinus through a small, 3- to 5-mm incision. This technique is considered effective for the treatment of inflammatory disorders of the frontal sinus caused by positional abnormalities after trauma or recurrence after conservative transnasal surgery.

Resection and reconstruction of sternnum

In case of sternal resection, it is necessary to preserve bone material indispensable for the stability of the anterior chest wall and air tightness of the thoracic cavity, and the support of the chest wall integrity must be restored by some means. Various techniques have been applied to the reconstruction of the chest wall following resection. During the last 10 years, we have performed reconstructive operation for 6 cases of the chest wall following resection of the sternum in recurrent cases of breast cancer or invaded case of primary breast cancer. In these patients, the chest wall was reconstructed using a rib-latissimus dorsi osteomyocutaneolus flap or a latissimus dorsi myocutaneous flap. The sternum was totally resected in 3 cases, and in all 3 cases, reconstructed using a rib-latissimus dorsi osteomyocutaneous flap. Although postoperative pulmonary function decreased, all cases could be relieved from endotracheal intubation within 17 hours after operation, and had no problems in activities of daily living or occurrence of chest flailing or paradoxical movement of the chest. An artificial material (expanded polytetrafluoroethlene patch) was used in only one patient for the reconstruction of the osseous thorax, but this case developed infection during postoperative chemotherapy. After this experience, we used only biological materials for the reconstruction of the chest wall and postoperatively performed radiotherapy and/or chemotherapy on all cases. We have observed no flap infection or detachment since then. One characteristic of using the latissimus dorsi myocutaneous flap is that it is easily elevated and rarely causes serious postoperative esthetic or functional problems. The flap is also easily utilized to reinforce the osseous thorax because ribs immediately below the latissimus dorsi muscle are readily mobilized as a pedicle graft. Reconstruction of the chest wall following resection of the sternum, described in this report, allowed us to perform radiotherapy and/or chemotherapy without serious postoperative complications on the cases relapsing after treatment of breast cancer. The 2-year survival rate is 50% and one of these cases survived up to 10 years after resection of the sternum. Thus we prefer to perform resection of the sternum for sternal recurrence of breast cancer if there are no metastatic lesions in other organs.

Endoscopic osteosynthesis of zygomatic fractures using minimal-access incisions*

SummaryEndoscopically assisted osteosynthesis of zygomatic fractures was performed on 28 patients. The procedure involved miniplate fixation of the frontozygomatic fracture through two small temporal incisions in the hair-bearing area, with an additional incision 5 mm in length at the lateral brow for percutaneous drilling and screwing. Reduction of the displaced zygomatic body was carried out using an elevator through a small upper buccal sulcus incision. Fixation of the zygomaticomaxillary fracture was also performed directly through the buccal incision. The favourable results demonstrated that these minimal-access procedures allow endoscopic minimally invasive plate fixation of zygomatic fractures and reduce facial scarring.

Use of temporary miniplate for fixation in cases of mandibular fracture.

Luhr miniplate is used for temporary fixation and adjustment so that ideal occlusion and fracture alignment can be achieved. In this procedure, the lower edge of the mandible is first temporarily fixed, and precise bone alignment is achieved through dynamic compression using the temporary miniplate. Afterward, one or more miniplates are attached on the ideal line to maintain structural integrity during bone restoration. This method is a simple restoration technique that allows temporary auxiliary fixation to assist precise attachment of the manipulative miniplate. No special instrument or devices are required. It is, therefore, quite beneficial as an auxiliary technique for reconstructive surgery of this type.