Nagahiro Takahashi

New continuous negative-pressure and irrigation treatment for infected wounds and intractable ulcers.

Background: Continuous irrigation and the vacuum-assisted closure system are effective methods for the treatment of infected wounds and intractable ulcers. The objective of this study was to simultaneously use both of the above methods as a new approach for obtaining more satisfactory, accelerated wound healing. Methods: After debridement of the wound, indwelling irrigation and aspiration tubes are placed in the wounds that have been sutured closed. With open wounds, a sponge with the same shape as the wound is placed directly onto the wound surface, and after the two tubes are inserted in the sponge, the wound is covered with film dressing to make the wound completely airtight. A bottle of physiologic saline solution is then attached to the irrigation tube, and a continuous aspirator (Mera Sacume) is attached to the aspiration tube. The bottle of physiologic saline solution is placed at the same height as the wound, and with a pressure gradient between the two of 0, continuous aspiration is applied. Results: All nine cases treated as closed air cavity wounds with this method healed after 2 to 3 weeks. In eight cases of open wound, recurrence of infection was observed in only one case. Conclusions: The two treatments of continuous irrigation and negative pressure were observed to have an additive and synergistic effect for earlier wound healing. Furthermore, the present method can dramatically reduce the number of dressing changes required, patient pain, psychological stress, and treatment cost.

A new modified forked flap with subcutaneous pedicles for adult cases of bilateral cleft lip nasal deformity: from normalization to aesthetic improvement.

In adult cases of bilateral cleft lip nasal deformity, an esthetically satisfying result can not be obtained only by manipulation inside the nose with the nasal tip pointing upward. The nasal tip should be made in a more anterior direction for nasal esthetic improvement. Additional tissue beyond the nose is needed, and the forked flap is a useful method in such cases. However, the blood circulation of long and narrow flaps containing the scar, especially after open rhinoplasty, is unstable. We have developed a new long and narrow forked flap that has a more stable blood circulation. The forked flap was made using two subcutaneous pedicles attached to the periphery of the each flap. We applied this flap to five adult cases of bilateral cleft lip nasal deformity. Four of the cases had the scar associated with the flying bird incision, and one case required no treatment after the primary repair. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the profile was esthetically improved. In the final stage of correction for adult cases of bilateral cleft lip nasal deformity, this method, making maximum use of the tissue containing the scar in not only the white lip but also the vermilion, is very effective. It is very important to obtain nasal esthetic improvement for the adult patient with bilateral cleft lip nasal deformity.

Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects

The fabella is a sesamoid bone located in the proximal tendon of the gastrocnemius muscle. In rare cases, its presence may lead to a variety of clinical problems, including fabella syndrome and common fibular (CF) nerve palsy. The purpose of this study was to analyze the morphology of the fabella and CF nerve and discuss the influence of any existing fabellae on the size of the CF nerve. The morphology of the fabella and CF nerve in the popliteal region of the lateral head of the gastrocnemius muscle was investigated in 102 knees of 51 Japanese cadavers. The maximum circumference of the thigh, knee, and calf and the frequency, position, and size of the fabella were measured. In addition, the CF nerve width and thickness were measured proximal to the fabellar region and again as the CF nerve passed posterior, lateral, or medial to the region. A fabella was observed in 70 knees (68.6%). The CF nerve adjacent to the fabella was significantly wider and thinner than in the region proximal to the fabella (P < 0.001). In cases in which a bony fabella was present, there was a significant relationship between the thickness of the CF nerve and the circumference of the thigh and knee. The following factors were observed to contribute to the presence of a fabella causing alterations in the size of the CF nerve: a bony fabella, a CF nerve path posterior or lateral to the fabella, and subjects with a thin physique and bony fabella. Clin. Anat. 26:893–902, 2013.

Anatomical Research of the Three-dimensional Route of the Thoracodorsal Nerve, Artery, and Veins in Latissimus Dorsi Muscle.

Background: The latissimus dorsi (LD) muscle flap has been widely used in facial reanimation surgery. However, there are no standards to what degree the muscle flap may be safely thinned because the three-dimensional positional relationship of thoracodorsal artery, vein, and nerve inside the LD muscle is poorly understood. Methods: From 18 formalin-fixed cadavers, we made 36 transparent specimens of LD muscles using a newly developed decoloration technique. In 26 specimens, nerve staining (Sihler’s staining method) and silicone rubber (Microfil) injection to the thoracodorsal artery were performed, and the relationship of the artery and the vein was examined in 10 specimens. Results: The thoracodorsal artery and vein always ran parallel in a deeper layer compared to the nerve. The thoracodorsal nerve constantly existed in a deeper layer than half (50%) of the muscle in the range of use of the muscle flap in facial reanimation surgery. Conclusions: The thoracodorsal nerves ran in a shallower layer, and the depth to the nerve in the muscle flap in actual facial reanimation surgery is safe enough to avoid damage to the nerves. The LD muscle may be thinned to half its original thickness safely.

Maxillary reconstruction using chimeric flaps of the subscapular artery system without vein grafts and the novel usage of chimeric flaps.

The purpose of this study was to overcome the disadvantages associated with the shortness of the vascular pedicle of subscapular system combined flaps when performing the maxillary reconstruction procedure. Combined flaps of the subscapular artery system were used for maxillary reconstruction. A latissimus dorsi myocutaneous flap, a scapular fasciocutaneous flap, and two kinds of scapular bone flaps were elevated as combined flaps. Next, the circumflex scapular artery (CS) and vein were cut off from the combined flaps and anastomosed to the serratus anterior branch, thereby establishing chimeric flaps. Then, maxillary reconstruction was performed using these flaps. We encountered two patients who underwent maxillectomy for maxillary cancer. Satisfactory improvements in facial shape were obtained in both cases. In cases in which combined flaps of the subscapular artery system are used for maxillary reconstruction, the biggest problem is that the vascular pedicle does not reach the recipient vessel in the neck due to the shortness of the CS. Therefore, vein grafts are generally performed to extend the flaps to the maxilla. Our novel procedure has the great advantages of long vascular pedicles and high flexibility in setting the flaps without the use of vein grafts.

Surgical treatment of pharyngeal atresia.

Congenital pharyngeal atresia is a very rare gastrointestinal anomaly, with only seven cases of complete pharyngeal atresia having been reported. Five of these cases were autopsy reports and success in surgery to enable oral ingestion was not reported even for the two surviving cases. This is a report of a 1.5-year-old boy with complete congenital pharyngeal atresia who was saved by an emergency tracheostomy directly after birth, and on whom we performed surgery to reconstruct the pharyngeal cavity and prevent re-occlusion and restonosis. Approximately four years after the surgery, no restenosis of the pharyngeal cavity has been observed, and the patient is capable of orally ingesting ordinary meals and breathing and vocalizing by closing the tracheal lumen for nearly satisfactory results.

A method for accurately designing flaps for use in reconstructive surgery of the oral and oropharyngeal region using surgical wire

Figure 1 The method used to copy the shape of the tissue defec With the tongue protruding in the anterior direction, the shape of wire to match the margin of the defect. 1. The shape from the lowe and the apex of the tongue to the posterior end of the inferior sur oral floor through the inside of the alveolus to the posterior end of t through buccal mucosa and soft palate and the lateral wall of th oropharynx. 4. The straight line segments from the lower end of the straight line segment from the lower end of the base of the tongu tissue defect was recreated by connecting these wires and the ski