Takashi Kamiji

Microvascular anastomosis using polyethylene glycol 4000 and fibrin glue.

Rat femoral arteries and veins were anastomosed using fibrin glue and a soluble intravascular stent made of polyethylene glycol 4000 (PEG-4000) with a patency rate of 100%. The anastomoses were strong enough to tolerate a pressure of 250 cm H2O. Histological changes at anastomosed sites and toxicity of PEG-4000 were also examined. With this method, an end-to-end anastomosis can be performed easily and quickly.

Fronto-facial monobloc advancement with rigid external distraction (RED-II) system.

Fronto-facial monobloc advancement is one of the most rewarding procedures for upper and mid-face reconstruction in patients with craniosynostosis. However, it has challenging aspects. Epidural abscess and frontal bone necrosis after retrofrontal dead space is one of the major complications and has led many experienced surgeons not to continue with the procedure. Bone distraction can play a great role in preventing these problems. The Rigid External Distraction (RED-II) system is a external distraction device using the cranium as an anchorage point. In two craniosynostosis cases, fronto-facial monobloc advancement with the system was performed. Controllability of the monobloc segment increased significantly. Operative time and blood loss were lessened. No major complications were experienced.

Philtral construction by composite skin-muscle rotation and orbicularis oris muscle advancement in secondary cleft lip deformity.

&NA; The authors describe a method of philtral construction in a secondary cleft lip deformity to achieve better philtral definition and natural lip animation. The operation begins with a skin incision based on the usual design of secondary revision. Subcutaneous undermining is then performed laterally, and medially up to the line of the new philtral ridge, where the lip is divided vertically to the mucosa. A wedge‐shaped flap is developed in the medial lip by dissecting from the posterior mucosal wound edge toward the cutaneous midline up to the dermis. The composite skin‐muscle flap is thus elevated and rotated 90 deg on the axis of the cutaneous midline to form the philtral ridge. The orbicularis oris muscle is reapproximated in the midline by advancing the lateral orbicularis segment. The wedge‐shaped flap is placed over the advanced orbicularis, and the skin is closed. Ten consecutive patients, followed for more than 6 months, were evaluated. In all patients the lip showed a well‐defined philtrum with sufficient thickness and smooth continuity. Natural lip animation was also reproduced. Purportedly, the composite skin‐muscle rotation provides a well‐defined philtrum, and the midline approximation of the orbicularis muscle provides natural lip animation. Haramoto U, Kamiji T, Takagi S, Kubo T, Yoshioka N, Hosokawa K. Philtral construction by composite skin‐muscle rotation and orbicularis oris muscle advancement in secondary cleft lip deformity. Ann Plast Surg 2000;45: 485‐490

Clinical experiences with patients with facial bone deformities associated with hemifacial microsomia.

Eighteen adult patients with hemifacial microsomia were treated with a combination of skeletal and augmentation surgery. Three typical cases are presented. In principle, skeletal and augmentation surgery have recently been performed in combination in a single stage. Groin flaps and scapular or scapular ostocutaneous flaps have mainly been employed for augmentation surgery.

Restoration of the mandible by full-thickness calvarial bone flap.

Two patients with reconstruction of a massive mandibular defect with vascularized full-thickness calvarial bone flaps are reported. In Patient 1, the mandibular body developed osteomyelitis and once was replaced with a metallic prosthesis. The prosthesis later perforated the skin and was removed. Full-thickness calvarial bone flaps were elevated bilaterally to reconstruct the mandibular body. In Patient 2, the mandible was totally destroyed by invasion of squamous cell carcinoma. The lower one-half of the face was resected and replaced with a large island scalp flap with full-thickness calvarial bone.

Reconstruction of microtia with conchal remnant.

In microtia with conchal remnant (type B microtia), there are various degrees of deformity; consequently, different surgical procedures are required for individual cases. To clarify and simplify these complicated surgical techniques, type B microtia is divided into two types, type BI and type BII, from the standpoint of the emphasis on conchal creation. The methods of treatment are discussed.