Noriyoshi Sumiya

Clinical application and refinement of the microdissected thin groin flap transfer operation

A microdissected thin groin flap is a uniform thin flap with a long vascular pedicle prepared by microdissection of the deep branch of the superficial circumflex femoral system (SCIS). However, the safe dimensions of the flap are not known, and anatomical variations of the SCIS sometimes impede elevation of the flap based on the deep branch. Therefore, modifications of the operation and accumulation of empirical knowledge are required for safe preparation of the flap. Thirty cases of various types of tissue defects were reconstructed using microdissected thin groin flaps. Among these, large flaps exceeding 20 cm on the long axis were investigated to estimate the maximum dimensions of the flap. Additionally, new operative procedures were developed to overcome anatomical variations of the SCIS and to assist preparation of a thin flap. One flap was lost due to a venous thrombosis. A small distal area of three large flaps became necrotic. The perforators from the deep branches were absent in five cases, and three of these flaps were successfully elevated based on the superficial branch using the new method. The clinically deduced safe dimensions of the flap ranged from 5 x 2 cm to 25 x 12 cm. The microdissected thin groin flap was found to be useful for coverage of various types and sizes of skin defects. Through improved operative procedures, a large and extremely thin flap can be prepared safely even if the perforator from the SCIS is absent.

Seven years' survey of our new cleft foot repair.

The reconstruction of lobster-cleft foot is no longer considered from a functional point of view only. The aesthetic appearance of the repaired foot is now considered to be equally important. Since we reported the reconstruction of five toes in 1976, we have operated on 8 patients, totaling 16 cleft foot anomalies. We have followed-up these patients from 3 years to 7 years. As a result, we emphasize that this operative method is excellent in terms of both the function and the aesthetics, and the newly formed toes help to prevent pincer-like deformities. Since those deformities become more serious as a result of weight-bearing, we are convinced that this operation should be done before the patient is 1 year of age, preferably at about 8 months, before walking.

Application of low-pressure negative pressure wound therapy to ischaemic wounds

Negative pressure wound therapy (NPWT) is a useful wound dressing that can be applied to a wide variety of wounds. Patients with ischaemic wounds, however, may experience further necrosis with NPWT at the commonly recommended pressure of -125 mm Hg. We hypothesized that with a suction pressure of -125 mm Hg, tissue pressure will likely occlude most of the capillaries adjacent to the wound edge. Therefore, we treated three patients with ischaemic wounds using low-pressure NPWT at -50 mm Hg. All wounds healed successfully without further necrosis at the wound edge.

Concept and anatomical basis of microdissected tailoring method for free flap transfer.

Background: For a refined microsurgical reconstruction, it is desirable to adjust the flap to fit the three-dimensional details of the defect. Essentially, each vessel arborized in the subcutaneous adipose tissue supplies axial blood flow to an individual small area surrounding the vessel. Therefore, free alteration of the flap would be possible if the anatomy of these branches could be identified during surgery. Methods: The microdissected tailoring method is a new procedure for alteration of the flap, observing the branches of the perforator directly after microdissection. By means of this procedure, three flaps were transferred to complex tissue defects. In addition, among intraadipose branches of 59 perforators, 90 cases of three types of microdissected thin perforator flap transfer were measured to classify the anatomical variations relating to microdissected tailoring of the flap. Results: All flap transfers were uneventful and no circulatory failure of the flaps was observed. Statistical analyses reveal that the intermuscular septum perforator branches at the deeper layer of the adipose tissue and then spreads more widely in the adipose layer than that of muscle perforator, regardless of the type of flap and the length of the intraadipose vessel. Conclusions: Microdissected tailoring of the flap provides the best solution for flap alteration in the reconstruction of a complex-shaped tissue defect. It represents a change in the concept of free flap transfer, because the flap is prepared according to the individual anatomy of the intraadipose vessel.

A technique using a rectus abdominis muscle flap in the treatment of adult congenital tracheoesophageal fistulas

The authors successfully treated an adult with congenital tracheoesophageal fistula (TEF) Gross-C type by the addition of an effective pedicled muscle flap. This patient had undergone 2 thoracotomies when he was an infant at another hospital; however, the fistula recurred. After transection and closure of the fistula, a right rectus abdominis muscle flap between the 2 stumps was interposed. The current case followed a favorable postoperative course; neither fistula nor abdominal hernia occurred.

Long-term survival of a patient with Marshall-Smith syndrome

Abstract. A 7-year-old girl presented with classic signs of typical Marshall-Smith syndrome, a rare early overgrowth syndrome. Her long-term survival, which is extremely uncommon in such patients, can be attributed to the successful securing and maintenance of an airway. Continued follow-up is extremely important in finding out how to ensure long-term survival of such patients.

Treatment of Bowen disease using the ultrasonic surgical aspirator

In most cases, patients with Bowen disease lesions can be easily treated by surgical excision and direct closure; however, the ultrasonic surgical aspirator, an instrument in common use in many fields, offers a good treatment alternative with few drawbacks for patients with lesions that are large and/or located in joint areas, areas that are hard to heal, or areas that are surgically problematic such as the ears, nose, eyelids, and mucous membranes. The clinical application of the ultrasonic surgical aspirator in the treatment of Bowen disease promises considerable benefit in terms of patient comfort because removal of the lesion is easy, is noninvasive, and does not require hospitalization or result in restricted mobility. All of these factors, although benefiting patients, particularly the elderly, can also substantially lower the cost of treatment. (Plast. Reconstr. Surg. 108: 68, 2001.)

Correction of the bilateral complete cleft lip: transformation to a unilateral incomplete cleft lip closure.

The complete lip alveolus and cleft palate is the most difficult of all bilateral clefts to treat because of the deformity of and tissue insufficiency in the prolabium. A bilateral concomitant procedure is impractical for treatment of this condition because of the problems that have to be resolved postoperatively, including a short columella, a lack of philtrum, labial horizontal and vertical insufficiency, and vermilion and alveolar vestibulum insufficiency. A two-stage procedure called the transformation method has been developed to circumvent these problems, and the authors present it here. With this method one side is closed completely using the maximum amount of tissue available. Concomitantly, incomplete closure is performed on the other side. The result at the end of the first stage of the procedure is a condition approximating unilateral incomplete closure. The results were obtained from 6 patients who underwent complete bilateral closure and were followed for at least 2 years with satisfactory results.

Cleft lip-nose repair technique: Sequential repair

The results of repairing cleft lip by aesthetic plastic surgery are now excellent. However, the cleft lipnose deformity is still very difficult to repair with the present techniques. A technique that can repair the cleft lip-nose deformity with good results is presented. The technique is divided into three parts: Part I consists of nasal repair of the primary cleft lip. Part II is nasal reconstruction as a secondary operation with or without lip repair. For example, nasal reconstruction may be secondary to repair of deformities of the sill, rim, limen nasi, septum, or nasal bones. Part III is an aesthetic nasal operation such as rhinoplasty, mentoplasty, or zygomaplasty.

Dermabrasion using an ultrasonic surgical aspirator.

We used an ultrasonic surgical aspirator on the epidermal surface to perform dermabrasion instead of the conventional motor-driven grinder. It was determined on histologic examination that it is possible to fragment the epidermis with greater selectively using the ultrasonic surgical aspirator. Abrasion also can be performed safely on spotty lesions and intricate, problematic regions with the ultrasonic surgical aspirator. We feel that the ultrasonic surgical aspirator is a promising device for use in dermabrasion.