Motonao Iwasawa

Nonsurgical Correction of Congenital Auricular Deformities in the Early Neonate: A Preliminary Report

We conclude that auricular deformities of the early neonate are corrigible by nonsurgical correction. Ideally, the correction should be started immediately after birth (realistically, at latest by the third day after birth) in order to obtain satisfactory and irreversible results.

Lower eyelid reconstruction with a conchal cartilage graft.

A conchal cartilage graft without skin or mucosa was used as a posterior lining for lower eyelid reconstruction in seven patients. The raw surface of the graft was smooth enough to cause no corneal irritation and was epithelialized from the surrounding mucosa about 3 to 4 weeks after the operation. The lower eyelid reconstructed in this method produced a stable lid margin.

Arterialized venous flaps from the thenar and hypothenar regions for repairing finger pulp tissue losses.

Pulp tissue loss of the fingers was repaired with arterialized venous flaps from the thenar or hypothenar regions in 13 patients. Thirteen of the 15 flaps transferred survived completely. The thenar and hypothenar skin is durable and of appropriate texture for replacement of finger pulp defects. An average flap size of 2 x 3 cm was adequate for repairing the tissue loss of the fingers. These are not sensory flaps. However, they exhibited useful sensory recovery within 6 months of the operation. This method is simple and results in minimal donor-site morbidity. The arterialized venous flap is thus a useful alternative for the repair of finger pulp tissue losses.

Reconstruction of the lips, oral commissure, and full-thickness cheek with a composite radial forearm palmaris longus free flap

Reconstruction of the lower and upper lips, commissure, and full-thickness cheek defects using a composite radial forearm palmaris longus free flap with secondary commissuroplasty is described. This flap is useful for reconstruction of the total lower lip as well as larger defects that include full-thickness cheek and the commissure.

Functional lip reconstruction with a radial forearm free flap combined with a masseter muscle transfer after wide total excision of the chin.

Total lower lip reconstruction was accomplished by combining a radial forearm free flap with a masseter muscle transfer. The patient, who had T4 carcinoma, had the entire lower lip resected including the depressor anguli oris muscle. A radial forearm flap was used to reconstruct the lower lip lining and the floor of the oral cavity. The right and left masseter musculofascial flaps were elevated and transferred in the medial-superior direction, and the peripheral margins of the flaps were sutured together. The lateral margins of the flaps were then sutured to the orbicularis oris muscle of the upper lip. Good sphincter function was obtained more than 1 year after the operation, electromyography revealed almost normal mobility of the transferred masseter muscles, and no sagging of the masseter muscle sling was observed. This procedure appears to be effective for the reconstruction of sphincter function of the lower lip after wide excision of the entire chin.

Functional reconstruction of total lower lip defects with a radial forearm free flap combined with a depressor anguli oris muscle transfer.

Two total lower lip reconstructions were accomplished by combining a radial forearm free flap and a depressor anguli oris muscle transfer. The radial forearm flap was used to reconstruct the inner surface of the lower lip. The bipedicled musculofascial flap, which includes both depressor anguli oris muscles, the depressor labii inferioris muscles, and the mentalis muscles, was elevated onto the chin and sutured superiorly to the modioli to obtain innervated sphincter function. Good results were obtained both aesthetically and functionally. Electromyography revealed almost normal mobility of the depressor anguli oris muscles 6 months after the operation. No drooling was seen during mastication, and no air leakage was observed during puffing of the cheeks. This is an effective procedure for the reconstruction of the sphincter function of the lower lip.

RECOVERY OF SENSITIVITY IN THE HAND AFTER RECONSTRUCTION WITH ARTERIALISED VENOUS FLAPS

Loss of soft tissues of the fingers were repaired in 22 patients using 25 arterialised venous flaps harvested from the thenar, hypothenar, or forearm regions. Twenty-one of the flaps survived completely, 16 of which were raised from the thenar or hypothenar region, and the other five from the forearm region. We studied the sensory recovery and skin characteristics of the flaps harvested from the three regions. Good sensory recovery was obtained for the thenar or hypothenar venous flaps, which were characterised by durable skin and suitable texture for replacement of defects in the finger pulp. On the other hand, no moving two-point discrimination was recorded during the follow-up period in the group given forearm venous flaps. These flaps showed instability during pinching and grasping. However, larger flaps and longer veins can be harvested from the forearm region. This type of flap is therefore considered useful for covering dorsal defects of the finger or large and multiple skin defects.

Use of a monitor muscle flap in buried free forearm flap transfer.

The free forearm flap is a reliable and versatile tool in head and neck reconstruction. However, the patency of the mlcrovascular anastomosis is difficult to monitor when the flap is buried in the reconstruction of the esophagus or orbital floor. We used a portion of forearm muscle on a branch of the radial artery and wein as a monitor flap. After the free forearm flap transfer, the monitor muscle flap was placed extemally through a small skin incision. Flap viability was assessed by observing the color of the bleeding elicited from the muscle flap. Monitor muscle flaps are raised easily during elevation of the forearm flap. This technique was used successfully in 5 patients. This monitoring method provides a simple and rellable assessment of viability when direct monitoring of the forearm flap is not possible.

Free temporal fascial flap for coverage and extensor tendon reconstruction

An improved method for reconstructing injured tendons of the dorsum of the hand is presented. We transferred a two-layered temporal fascial flap to the hand and inserted the rolled, deep temporal fascia between the stump of the extensor tendons. This procedure can improve extensor tendon function with minimal scarring in spite of the limitation of available tissue.

CONGENITAL CURVED NAIL OF THE FOURTH TOE

Five cases of congenital curved nail of the fourth toe are reported. Patients included four males and one female; four cases were bilateral, and one was unilateral. There were no other significant associated anomalies of the extremities, and only the fourth toes were affected. The features of the deformity are a curved nail and hypoplasia of the soft tissue and bone of the distal phalanx of the fourth toe. This anomaly may be transmitted autosomally and is unique in that it may be of mesodermic origin.