Sadao Tsukada

The use of a free medialis pedis flap for resurfacing skin defects of the hand and digits: results in five cases.

A free medialis pedis flap was used to repair skin defects of the fingers and hand in five patients, the flap sizes ranging from 2 x 3 cm to 5 x 10 cm. Four flaps survived completely, but the largest flap turned necrotic along the dorsal margin, which is thought to have resulted from an incorrect flap alignment. A free medialis pedis flap possesses several advantages: (1) It is very thin in comparison with other standard free flaps; (2) it can be used for small repairs, unlike many conventional free flaps; (3) it possesses two draining venous pathways, the vena comitans and the subcutaneous veins; (4) the diameters of its vessels are similar to those of the fingers; (5) it provides a good color and texture match for finger repairs; and (6) a good recovery of protective sensation is achievable, probably due to its thinness. However, this flap also has some disadvantages: A skin graft is usually required for donor-site closure, and it cannot be used as a sensory flap.

Articulation at age 4 in children with early repair of cleft palate.

We report the articulation results in 87 4-year-old children with overt cleft palates who had been repaired at age 1 by the same surgeon and were found to have no factors obstructing their speech-language development. We further present data on developmental courses before age 4 in 81 subjects and after age 4 in 64 subjects. Forty-five of the 87 subjects showed normal articulation: 24 had already acquired normal speech sounds and 21 were still in the course of normal development. In this group only 1 patient showed incompetent velopharyngeal closure. Abnormal articulation was found in 42, among whom only 4 showed incompetent velopharyngeal closure. The most common abnormal articulatory type was palatalized articulation (70%), which had been seldom found in earlier studies. Palatalized articulation showed less of a tendency to correct itself spontaneously than did glottal stops. Abnormal articulation improved spontaneously after 4 years of age in some subjects. The significance of detailed postsurgical follow-up and the necessity of accumulation of more data are emphasized.

Transfer of free skin grafts with a preserved subcutaneous vascular network.

We present our new approach for preserved subcutaneous vascular network (PSVN) skin transplantation. To confirm the revascularization of the grafts, we undertook a microscopic study and found that, because of the rich anastomotic communication between the recipient vessels and the PSVN on the undersurface of the skin graft, successful adaptation to the recipient bed is achieved—enhancing the transplantability of the skin graft. We also noted that the absence of injury to the dermis of the graft permits the undersurface of the graft to be in contact with the raw surface with a minimum of scar formation. Finally, neither contracture nor wrinkling of the skin grafts was observed during the six-year follow-up study.

Golden Proportion for Maxillofacial Surgery in Orientals

The facial position and balance of eyes, nose, and mouth in typical Japanese individuals were investigated, based on the golden proportion for each of these relationships. We found that Japanese tend to have a longer upper lip and shorter chin length compared with Caucasians. We believe that this tendency represents a general facial characteristic of the Oriental population. Each ratio obtained from determinations by our method was used for preoperative and postoperative aesthetic analysis in maxillofacial surgery. This method is considered useful because it permitted us to understand quantitatively the positional relationship and the balance of eyes, nose, and mouth in the face and to make comparisons with typical subjects.

The superficial temporal and retromandibular veins as guides to expose the facial nerve branches

The superficial temporal vein and retromandibular vein were used as a guide to expose facial nerve branches in the parotid gland, and this procedure was applied to open reduction of mandibular condyle fractures (14 patients) and to superficial parotidectomy (6 patients). The advantages of this method are as follows: It is very easy to identify the superficial temporal vein as a guide, and it produces very little surgical stress because the procedure for exposing the facial nerve branches through the course of the vein is the same as the procedure for exposing the condyle and elevating the superficial lobe of the parotid gland.

Patterns of arterial distribution in the duplicated thumb.

The arterial blood supply of the duplicated thumb was studied in 42 hands using the angiography technique. The developing factor of the duplicated thumb also may hinder the developing process of the limb artery, especially in the early stage when the median artery develops. In 73.8 percent of duplicated thumbs, two digital arteries were present, and 96.8 percent of them had one digital artery in each member. Simple ablation of the supernumerary digit leaves the thumb with a single end-arterial blood supply. The developmental mechanism of the duplicated thumb may depend not on duplication of the limb bud, but on splitting of the limb mesenchyme. The group of type VII of Wassels classification was different from the other types in terms of origin of the digital artery distributing blood to the duplicated thumb.

Repair of complete syndactyly by tissue expansion and composite grafts

Repair of complete syndactyly by a combination of tissue expansion and composite grafts from the glabrous non-weight bearing areas of the foot has been performed on three syndactylies in two patients. The commissure and the lateral areas of the proximal and middle phalanges were covered with expanded skin and the separated fingertips were covered with composite grafts. Without using an ordinary skin graft, this method can provide aesthetically excellent results with good skin colour and texture.

Intraosseous lipoma of the skull: a report of two cases

Case histories of a 12-year-old boy and a 20-year-old woman with hyperostosis of the frontoparietal bones are presented. Microscopical examination of the lesions showed intraosseous lipoma with hyperostosis of diploë. In both cases, only the prominent part of the tumor was removed for cosmetic reasons. The results were satisfactory, and there was no evidence of recurrence over a period of six years.

Electron microscopic study on black pig skin irradiated with pulsed dye laser (504 nm)

Selective damage of epidermal pigment cells induced by 504 nm pulsed dye laser at different pulse durations and fluence on black pig skin was examined electron microscopically. Epidermal melanosomes were satisfactorily disrupted at shorter pulse duration (100 ns). Epidermal blister formation and necrosis were seen at 2 days postirradiation, and reepithelization was evident at 7 days postirradiation in all specimens. Repigmentation was evident 21 to 56 days after irradiation. Histological pigmentary incontinence was evident at 2 days and persisted until 56 days postirradiation. This phenomenon was observed more frequently in skin exposed to longer pulse duration and at low fluences. Optimal parameters required to induce epidermal melanosome disruption using the 504 nm pulsed dye laser will be discussed.

Past and present treatment of complete scalp avulsion

SummaryTwo cases which illustrate past and present treatments of complete scalp avulsion are presented. One of these cases was treated by conventional dermatome graft ten years ago. Another was a recent case in which an attempt to revascularize a complete avulsed scalp was made using microsurgical techniques. In the latter case a successful replantation was obtained.