Takao Harashina

Augmentation of circulation of pedicled transverse rectus abdominis musculocutaneous flaps by microvascular surgery

The biggest problem of the TRAM flap for breast reconstruction is distal necrosis or fat lysis due to poor circulation. In order to utilise the entire TRAM flap tissue in extensive tissue defects, the contralateral rectus muscle is used as a pedicled carrier and the ipsilateral superficial or inferior epigastric vessels are anastomosed with appropriate recipient vessels in the axilla. This procedure has been performed in three cases with no necrosis, fat lysis or hardening of the flap tissue, proving adequate circulation in the flap.

Dermis-fat graft after parotidectomy to prevent Frey's syndrome and the concave deformity

Dermis-fat grafts were performed on 7 patients at the time of parotidectomy to prevent Freys syndrome and the characteristic concave deformity. Only 1 patient demonstrated postoperative Freys syndrome, and 1 demonstrated a slightly concave deformity due to fat absorption. Although other barrier materials have been reported to achieve success in preventing gustatory sweating, our method simultaneously corrects the associated deformity of facial contour as well.

The Relntionship Between Venous Occlusion Time In Island Flaps And Flap Survivals

Island flaps were raised from the lower abdomen in rats, pedicled on the superficial epigastric vessels. The venous return was blocked by ligating the single draining vein. After various periods of occlusion, the venous continuity was restored by resecting the thrombosed portion of the vein and performing an end-to-end anastomosis. The results showed that if the venous occlusion time was 6 hours or less, the flaps survived. If the occlusion time exceeded 8 hours, all the flaps failed.

The intimal healing of microvascular anastomoses.

Examination with the S.E.M. shows that 5 days after surgery the microanastomoses area is covered with pseudointima, and the regeneration of the intima is completed within two weeks. Comparing the two different suture techniques (large bites and small bites), there are no differences between them in the resultant patency rates. The large bites produce less immediate leakages. There were no significant differences in the process of intimal healing.

Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Case report.

We present a successful clinical case (perhaps the first) of primary reconstruction of the breast after radical mastectomy by use of a free skin-fat-muscle flap.

Expansion of smaller vessel diameter by fish-mouth incision in microvascular anastomosis with marked size discrepancy.

We have found that to expand the diameter of the smaller vessel by a fish-mouth incision is useful in performing microvascular end-to-end and end-to-side anastomosis, with marked discrepancy in size.

Free skin flap from the retroauricular region to the nose.

We present two new, one-stage methods for resurfacing a part of the face-- (1) the microvascular transfer of a free retroauricular flap, and (2) an island flap from the galea covered by a full-thickness skin graft from the retroauricular region. Both procedures provided the same good color match, without leaving a readily visible donor scar.

Breast reconstruction with microsurgical free composite tissue transplantation

Abstract In the reconstruction of breast and adjacent soft tissue defects, whether congenital or acquired, three components must be considered: the quality and quantity of the overlying skin, the volume of the breast itself and the pectoral muscles, and lastly the nipple-areola complex. Microvascular surgical techniques permit the transfer of large composite flaps in one stage. In this paper we describe our experience inapplying this composite flap technique to the problem of breast reconstruction.

Reconstruction of the hard palate using free iliac bone convered with a jejunal flap

In this paper we report the reconstruction of a large defect of the hard palate by covering free iliac bone with a jejunal flap. The new palate is moist and tough but not bulky. This new method brings with it the useful concept that the jejunum might nourish the free bone through its serosa.

Finger pulp reconstruction with a free sensory medial plantar flap

This report describes the successful use of a free sensory medial plantar flap for the reconstruction of the volar skin of the index finger. Six months after the operation a corrective procedure was performed because the flap was bulky. A favourable result was obtained both functionally and aesthetically, with two-point discrimination of 4 mm, one year after reconstruction.