Naohiro Ishii

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.

A tie-over with “untied” parallel stitches: A useful technique for fixation of a bolster after treatment of cryptotia

We describe a new technique for the treatment of cryptotia by which stitches for bolster fixation are inserted parallel to the auriculartemporal sulcus and temporarily left untied. After the bolster has been inserted into the temporal sulcus, the corresponding ends of the threads are tied to each other. Our technique is easy to use and secures a firm bolster fixation, and we recommend it for the treatment of cryptotia.

Alar groove plasty using a subcutaneous flap technique in bulbous nose repair after cleft lip plasty.

BACKGROUND Bulbous nose is a ball-like nasal deformity, frequently seen in postoperative cleft lip patients, that is hard to prevent despite numerous techniques available for nasal tip plasty. Here we describe a new method for correcting bulbous nose in cleft lip patients by creating an ideal alar groove. METHODS A subcutaneous flap with the pedicle of the overlying skin connected circumferentially is made just beneath the position for the ideal alar groove. The subcutaneous flap is fixed to the septum cartilage to create the alar groove depression on the nasal tip. This method is generally performed in conjunction with other rhinoplasty using the open nasal approach. RESULTS Three postoperative cleft lip and nose patients underwent alar groove plasty combined with rhinoplasty. All retained good contour after the operation. CONCLUSION Alar groove plasty using the subcutaneous flap technique improves bulbous nose deformities of cleft lip patients and can retain good postoperative contour.

A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander

Background Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume. Methods We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05×the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II. Results X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases. Conclusions The volume of a free TRAM flap can be straightforwardly estimated preoperatively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

Lymphedema of the Lower Extremities due to Refractory Malignant Lymphoma Treated by Lymphaticovenous Anastomosis

Summary: Lymphaticovenous anastomosis (LVA) is primarily performed for lymphedema of the lower extremities after surgical treatment of gynecologic cancer and lymphedema of the upper extremities after surgical resection of breast cancer; however, LVA for lymphedema due to malignant lymphoma has not been reported to date. We herein present a patient with severe lymphedema of the lower extremities due to refractory malignant lymphoma, which markedly improved with LVA. LVA could contribute to improve quality of life in patients with end-stage disease with lymphedema of the lower extremities due to refractory malignant lymphoma.

Modified Dufourmentel flap with superior pedicle: a useful technique for sacrococcygeal pilonidal sinus

Abstract Purpose: In order to prevent postoperative infection and recurrence of sacrococcygeal pilonidal sinus, the authors developed a modified Dufourmentel flap, involving the superior pedicles, and designed a descriptive prospective study to evaluate its efficiency. Methods: Between July 2007 and March 2014, 16 patients with sacrococcygeal pilonidal sinus were treated with an irregular quadrilateral excision and reconstruction by a modified Dufourmentel flap with superior pedicle. The duration of wound healing, presence of wound complications and permanent hypoesthesia, and recurrence rates were recorded and assessed. Results: None of the patients developed flap necrosis or wound infection postoperatively. The duration of wound healing was 7.2 ± 2.9 (range = 6–15) days. Wound dehiscence was demonstrated in only one patient (6.3%). The mean follow-up period was 4 years and 2 months (range = 4 months–8 years and 8 months), whereby no permanent hypoesthesia or recurrence was detected. Conclusion: The modified Dufourmentel flap with superior pedicle can be safely used as a treatment of sacrococcygeal pilonidal sinus, with excellent results.

Firmly fixed dressing with tie‐over: a useful technique to reduce postoperative hematoma formation for surgical wound of the scalp

Firmly fixed dressing with tie-over: a useful technique to reduce postoperative hematoma formation for surgical wound of the scalp Editor, Dressing the scalp is difficult because there is no skin for adherence. Moreover, compression of the surgical wound is difficult, which can lead to postoperative hematoma. Several reports on dressing of the scalp exist; however, reports on good compression and less gap between the gauze and scalp are lacking. We developed a new method for firmly fixing the dressing, using the tie-over technique for surgical wounds of the scalp, compared it with the conventional dressing method (gauze and elastic net), and investigated its efficacy. Between April 2011 and March 2016, we performed tumorectomy for skin tumors and subcutaneous tumors on the scalp in 138 cases (80 male, 58 female; mean age 44.5 years, range 2–88 years). After tumor resection and closure, we made symmetric fixed sutures approximately every 2 cm, using 3-0 or 4-0 nylon, approximately 2 cm from the surgical wound in cases of skin tumors or near the dead-space edge in cases of subcutaneous tumors (Fig. 1a,b). A gauze pad was piled over the sutures (Fig. 1c). Then, the fixed sutures were tied over the gauze pad with moderate pressure (Fig. 1d). Postoperative images for dressing with the conventional and tie-over methods are shown in Figure 1e,f. We inserted a drain for patients who had received stronger anticoagulant medication (e.g., clopidogrel) or had uncontrolled hypertension or dead space >10 cm. On postoperative days 1 or 2, the tied-over knots were cut and gauze pad was removed; the drain, if placed, was also removed. The surgical wound could thereafter be washed without a gauze, and sutures were removed based on adaptation of the wound and patients’ choice. The average diameter of the wounds was 3.3 cm (range 1.7– 7.5 cm). We compared the dressing with the tie-over method [tie(+) group] and conventional method [(tie( ) group)] for incidence of postoperative hematoma and wound dehiscence in all cases, including short wounds (<3.5 cm), long wounds (≥3.5 cm), and skin tumor and subcutaneous tumor cases (Table 1). Data were analyzed using the Statistical Package for

Breast reconstruction of an unusual configuration using two paranemic implants

Implant-based breast reconstruction can be performed using a choice of various types of breast implants. However, cases where the breast shapes are unsuitable for implant-based reconstruction method are occasionally encountered. We present two patients with wide trunks who underwent breast reconstruction using an unusual configuration that involved a latissimus dorsi myocutaneous flap combined with two paranemic implants.

Surgery Requiring Detailed Preoperative Simulation and Scar De-epithelialization to Repair Severe Postoperative Scarring from Gastroschisis

We present the case of a patient with severe postoperative scarring from surgical treatment for gastroschisis, with the intestine located immediately under the dermal scar. Although many patients are unsatisfied with the results of scar repair treatment, few reports exist regarding severe or difficult cases involving the surgical repair of postoperative scar contracture. We achieved an excellent result via simulation involving graph paper drawings that were generated using computed tomography images as a reference, followed by dermal scar deepithelialization. The strategy described here may be useful for other cases of severe postoperative scar contracture after primary surgery for gastroschisis.

Complete Coverage of a Tissue Expander by a Musculofascial Pocket Including the Sternalis Muscle during Breast Reconstruction

Naohiro Ishii, Yusuke Shimizu, Jiro Ando, Michiko Harao, Masaru Takemae, Kazuo Kishi Department of Plastic and Reconstructive Surgery, Tochigi Cancer Center, Tochigi; Department of Plastic and Reconstructive Surgery, University of the Ryukyus Hospital, Okinawa; Department of Breast Surgery, Tochigi Cancer Center, Tochigi; Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan