Motoi Kato

Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection.

AbstractIndocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases. As a result, dermal back flow appeared in 95 cases, with 38 in the lower abdominal area and 31 in the genital area. We confirmed 3 cases of superficial lymphatic collateral ways extending above the umbilical level to the axillary lymph nodes. All 3 cases had similarity in lower abdominal edema, so excessive lymphatic fluid in the lower abdomen was assumed to be the cause. Lymphatic collateral ways from abdomen to axillary lymph nodes in this study was likely to be designed to prevent the progress of lymphedema.

Hands-free vein visualizer for selection of recipient vein with an intact valve in lymphatic supermicrosurgery

clear how an insidious infection of a multifilament silk mesh as Seri , which slowly interpenetrate the original tissue, being completely replaced by it, leads to devastating consequences. Literature doesn’t report any previous SeriScaffold infection, even though the U.S. Food and Drug Administration has announced a voluntary recall because of a mesh, used for laparoscopic surgery may have been packaged in improperly sealed pouches with resultant contamination and patient’s infection. Late infections can occur with all foreign materials, and we can’t prove that the multifilament silk mesh was the raison of the infection. A lack of mesh integration in the infected breast, let us suspect a bacterial growth on the silk-derived scaffold, that prevented its interpenetration with the human body. Thus, further studies on this material and on different ADM and non ADM-materials may shed light on the real ability of bacteria to adhere to the multifilament silk mesh, leading to late infections.

Reconstruction of the ankle complex wound with a fabricated superficial circumflex iliac artery chimeric flap including the sartorius muscle: A case report

Free flap reconstruction of the foot and ankle can be challenging in that it must fulfill functional and esthetic demands. Injury of this region is often associated with fractures, and muscle flaps are sometimes preferred. Here we present a case of the use of superficial circumflex iliac artery (SCIA) chimeric flap for reconstruction of ankle complex wound. A 78‐year‐old lady sustained open fractures of the left distal tibia, fibula, and talus, with a 10 × 6 cm2 soft‐tissue defect over the lateral aspect of her left ankle due to an automobile accident. A 7 × 3 cm2 sartorius muscle component was inset to cover the exposed left ankle joint capsule, and a 5 × 10 cm2 SCIP skin paddle was used for coverage of the defect. The postoperative course was uneventful, and the sartorius muscle component and the SCIP skin paddle survived completely. Six months after the reconstruction, the flap and the donor site showed pleasing cosmesis, and the patient could ambulate with a supple ankle without crutches. The sartorius muscle component was elevated based on the deep branch of the SCIA, and was chimerically combined with a SCIP skin paddle for reconstruction of a complex ankle injury.

Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern

The anatomy of the lateral thoracic artery perforator flap remains controversial, but this region is extremely useful as a reconstructive donor site. In this report, we describe the usefulness of the preoperative color Doppler ultrasound evaluation for the harvesting of the lateral thoracic artery perforator flap, and we clarify its branching pattern. Twenty-seven patients underwent the preoperative color Doppler ultrasound assessment before perforator flaps were harvested. We evaluated the branching pattern and the diameter of the flaps by direct observation. All flaps were successfully transferred, and it was found that the branching pattern of the lateral thoracic perforator is divided into three groups: the superficial branch, the medial branch, and the deep branch. Their appearance ratios were 48.1% (13/27), 14.8% (4/27), and 81.5% (22/27), respectively. The lateral thoracic artery perforator flap has a great deal of anatomical variation, and vessels with relatively small diameters compared to those of other flaps. This is why flaps from this region are not currently popular. This study revealed the superiority of the color Doppler ultrasound for preoperative planning of the lateral thoracic artery perforator flap elevation. Furthermore, the branching pattern and the diameters of the different branches were specified.

Simple wire retractor for supermicrosurgical lymphaticovenular anastomosis

Supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for lymphedema with its less invasiveness and effectiveness. Although preoperative imaging methods such as indocyanine green lymphography facilitates successful LVA, it is not easy to manipulate lymphatic vessels in the deep fat layer. We often need a retractor to gain enough space. A conventional surgical retractor is useful for better visibility of a surgical field, but would disturb a surgeon’s supermicrosurgical procedures with its long handle. To resolve the drawback, we developed an original retractor made from a conventional K-wire. A 0.8 mm K-wire is bent with a pair of pliers to fit the width and the depth of the surgical site of LVA; usually, 3 3 3 3 3 cm is useful for LVA (Fig. 1A). Our retractor has several advantages; 1) easy to create; 2) low cost with reusability; and 3) no long handle that may disturb a surgeon’s procedures (Fig. 1B).

Nipple adenoma in a 2-year-old boy

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40‐50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy.

Vein wrapping technique for side-to-end anastomosis in lymphatic venous anastomosis

Dear Editor, Lymphatic venous anastomosis (LVA) using a microsurgical approach has become increasingly popular for patients needing lymphatic surgery. Although most advanced staged patients often have highly stenotic and fibrotic lymphatic vessels (Yamamoto, Yamamoto, Hayashi, & Koshima, 2017), some retain strong flow and can still achieve effective LVA. Small-caliber veins are usually dissected to minimize any size discrepancy. However, the corresponding small-caliber lymph vessels can be difficult to handle, making it time consuming to achieve good patency, particularly if there is tension. When performing multiple LVAs, the use of suture techniques that can ensure good anastomoses is important (Kato, Watanabe, & Iida, 2016). Herein we used a simple suture technique to avoid the difficulties of LVA and ensure complete anastomosis within minutes. First, the side wall of the lymph vessel is cut to make a large hole on its side using fine scissors or a scalpel. At this point, it is important to ensure that the posterior wall of the lymph vessel is preserved. Next, an oblique cut is made to the vein to cover the hole in the side wall of the lymph vessel, and 12-0 nylon stay sutures are applied at the proximal and distal sides. Finally, the posterior vein tongue is wrapped around to close the anterior side of the vein and to completely cover the hole in the lymph vessel (Figure 1). This wrapping technique is a modification of side-to-end anastomosis. In clinical situations requiring LVA, size discrepancy and lymphatic vessel tension frequently disturb surgeons (de la PenaSalcedo, Cuesy, & Lopez-Monjardin, 2000), and the need for complicated suture methods can cause errors (eg, stitching the back wall) that result in lymphatic obstruction (Kato, Watanabe, Iida, Watanabe, & Megumi, 2017; Kato & Yamamoto, 2015). Therefore, needle from inside to outside is preferable than outside to inside, especially on small caliber vessels (Hasegawa, Sugiyama, Namba et al., 2008). With our method, only the first two sutures at the proximal and distal end of the side wall pass through smaller caliber vessels. Furthermore, both sutures can be performed from inside to outside.

Cleft Lip and Palate Repair Using a Surgical Microscope

Background Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. Methods We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. Results The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. Conclusions Surgical microscopy was demonstrated to be useful during cleft operations.