Ritsu Aoki

Pacman flap method.

Background: The V-Y flap is a well-known method for closure of round skin defects. However, with conventional V-Y flaps, it is sometimes difficult to advance the flap sufficiently, especially where there is a lack of subcutaneous tissue. Thus, the authors have devised a new technique named after a famous Japanese video game. Method: The flap design is almost the same as a conventional V-Y flap. Instead of cutting off the two triangular parts of the V flap, those two parts are rotated and advanced to meet at the center of the defect. Results: The authors have operated on 18 patients with this method, and in all the cases, the flap survived completely. No secondary surgery was required to correct dog-ear deformity. Conclusions: This method is easy and can be applied in many situations. The authors conclude that this can be the first choice for closing circular skin defects.

Simultaneous bilateral breast reconstruction with autologous tissue transfer after the removal of injectable artificial materials: a 12-year experience.

Background: Over the years, breast augmentation with injectable artificial materials has presented significant clinical and social problems, particularly in Japan, because of later complications. The authors have used autologous tissue to treat patients who want not only to have these materials removed but also to maintain breast contour. The purpose of this study was to review the clinical outcome of the authors’ reconstruction procedures retrospectively. Methods: A total of 38 breasts in 19 consecutive cases treated between 1991 and 2002 were reviewed. The patients were all women, ranging in age from 41 to 70 years old (mean age, 53.4 years). The average period from injection to reconstruction was 26.5 years. After removal of the injected materials, both breasts were simultaneously reaugmented with deepithelialized rectus abdominis flaps. The incidence of associated complications was investigated. Results: The 38 flaps consisted of 31 free transverse rectus abdominis musculocutaneous flaps, five pedicled transverse rectus abdominis musculocutaneous flaps, and two pedicled vertical rectus abdominis musculocutaneous flaps. Three flaps with totalnecrosis (7.9 percent) because of venous thrombosis were found in two cases. Partial flap necrosis was observed in six flaps (15.8 percent). Hematoma requiring a surgical procedure occurred in one case (5.3 percent). Negligible abdominal bulging requiring no additional procedure was found in seven cases (36.8 percent). Conclusions: The complication rate seemed to be relatively high compared with that for breast reconstruction after mastectomy. Nevertheless, autologous tissue transfer may be one of the ideal procedures for breast reaugmentation after the removal of injectable materials, because affected patients prefer not to undergo reaugmentation with other artificial materials.

Fixation of intracapsular fractures of the condylar head with bioabsorbable screws

A newly-developed fixation technique using bioabsorbable screws gave satisfactory results in fractures of the condylar head. The fracture lines ran obliquely (craniolateral to mediocaudal) on three-dimensional computed tomography. Two bioabsorbable screws were positioned vertically to the fracture lines. This technique is useful despite limited access to the condyle.

A False-Positive Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) Imaging Result for a Patient After Augmentation Mammaplasty

BackgroundVarious materials and methods have been used for augmentation mammaplasty since it was first performed in Japan in the late 1940s. Although augmentation mammaplasty is not associated with an increased risk of breast cancer, a number of studies have reported that breast implants, or subsequent changes around these foreign substances, can affect images made by mammography, CT, or MRI during breast cancer screening. A method that is increasingly being used to detect cancer is positron emission tomography (PET).MethodsTo determine the effect of augmentation mammaplasty on PET imaging, we subjected ten women who had previously undergone augmentation mammaplasty to PET imaging as well as other imaging methods. We also measured tumor markers and performed pathologic studies.ResultsThe histologic analyses failed to detect any cases of malignancy. We assess the efficacy of PET for detecting breast cancer in women who had undergone augmentation mammaplasty and describe the features of the PET images of these women. Finally, we discuss future research objectives in relation to PET-based screening for breast cancer.ConclusionIt is important to identify an imaging methodology that improves the detection of breast cancer in patients with a previous mammaplasty. We show here that FDG-PET may improve breast cancer detection after mammaplasty.

Make-Up Therapy for Burn Scar Patients

The advances in the burn medicine have brought an increase in the survival rate of extensive burn patients. However, unfortunately, the increase in survival from severe burn is not directly connected with the happiness of the patients. According to our data, only 25% of the patients whose BSA was more than 30% could recover their original position after the discharge from plastic surgical ward [1]. Most of them had to live on social welfare because they could not obtain jobs due to their appearance. Plastic and reconstructive surgery could help mainly functionally. For those who had injured extensively, as the donor site for skin grafting or flaps were very limited, the aesthetic results were not satisfactory. So we introduced the make-up therapy combined with plastic and reconstructive surgical treatments.

Aesthetic microsurgical reconstruction of the female lower leg

In the true sense of the term, “aesthetic reconstruction of lower leg” means that patients accept the appearance of their reconstructed lower leg(s) and are willing to go outside in short trousers or a knee-length skirt without feeling embarrassed. Because of this, soft tissue reconstruction of large areas of the female lower leg is especially challenging. In this paper, we focus on the “aesthetic reconstruction of the female lower leg” and discuss this problem and its solutions. Case 1 was a 25-year-old patient with an avulsion injury. A 13 × 25-cm muscle-sparing transverse rectus abdominis (TRAM) flap was used for the reconstruction. However, in addition, a free groin flap and parascapular flap were added to reconstruct the whole lower leg over a 2.5-year period. Case 2 was a 25-year-old patient with a soft tissue defect. A 15 × 30-cm muscle-sparing TRAM flap was used for the reconstruction. In retrospect, it was clear that the texture and color of the TRAM flap resembled those of the lower leg reasonably well. We suggest that the muscle-sparing TRAM flap or the deep inferior epigastric perforator flap should be a first choice of tissue for the reconstruction of the female lower leg, especially when aesthetics and donor-site morbidity are taken into consideration.

Sentinel node biopsy in a patient with malignant melanoma of the under back.

In patients with malignant melanoma, the site for lymph node dessection is now determined by the primary site of the tumor according to the standard of UICC. However, sometimes it is difficult to predict accurate lymph node drainage because the tumor occupies two or three lymph node areas, which Sappey called “Watershed” areas, such as the midline of the trunk. We applied the technique of sentinel node biopsy (SNB) using patent blue dye for the patient with malignant melanoma of the under back. It was possible to detect the lymph node drainage flowing not only to the groin area but also to the axillar area. We consider that SNB is one of the effective methods to determine the lymph node drainage of the tumor in so-called “Watershed” areas. [Skin Cancer (Japan) 2002; 17: 31-37]