Tomoaki Kuroki

Establishment of gene-vaccinated skin grafting against Toxoplasma gondii infection in mice.

Vaccine effects of in vivo gene-vaccinated skin graft were evaluated against Toxoplasma gondii (T. gondii) infection. By using a gene gun, cDNA coding T. gondii SAG1 molecule was intracutaneously vaccinated into C57BL/6 (B6; a susceptible strain), BALB/c (a resistant strain) and (C57BL/6 x BALB/c) F1 (CBF1) mice, and the gene-vaccinated skin of these strains was transplanted to CBF1 mice. Regarding the antibody production against SAG1, CBF1-recipient mice transplanted with the SAG1 gene-vaccinated B6 skin were high responders, whereas CBF1 mice skin grafted with vaccinated skin of both BALB/c and CBF1 mice were low responders. The donor-derived LC/DC migrated to the draining lymph nodes of the recipients from the skin graft within 3 days. The vaccine effect against T. gondii challenge infection was obtained in CBF1 mice which received the skin graft of the SAG1 gene-vaccinated BALB/c mice.

Association between plate location and plate removal following facial fracture repair.

BACKGROUND Titanium-based plates used to repair facial fractures are sometimes removed despite their high biocompatibility. Local discomfort can lead to plate removal surgery. Local discomfort may differ according to patient characteristics, tissue properties and plate thickness; however, little is known about the relationship between these conditions and plate removal. METHODS We performed a hospital-based, retrospective cohort study of patients who underwent internal fixation for facial or frontal bone fracture. To identify factors associated with plate removal, we used multivariate logistic regression models. RESULTS Data from 138 patients were analysed. All plates were made of commercially pure titanium, and all screws were made of titanium, 6% aluminium and 4% vanadium alloy. Plate thickness was 1.2 mm or 0.6 mm. Among plate locations, the frontozygomatic suture showed the highest percentage of complications (84%, 86 of 102 patients). The majority consisted of palpability and visibility. In patients who underwent plate removal (n = 96), all plates and screws were removed successfully. All plate-related complications were resolved after plate removal. No complications were introduced by plate removal. Plates 1.2 mm in thickness on the frontozygomatic suture had a relative risk of complications 2.48 times (95% confidence interval, 1.13-5.43) that of plates 0.6 mm in thickness. By multivariate analysis, the presence of plates on the frontozygomatic suture was a significant and independent risk factor for removal. Patients with plates on the frontozygomatic suture had a risk of plate removal 3.95 times (95% confidence interval, 1.55-10.07; P < 0.01) that of patients without plates on the frontozygomatic suture. CONCLUSION Plates on the frontozygomatic suture have a high rate of complications. Thick plates increase these risks. Patients with plates on the frontozygomatic suture are more likely to undergo plate removal surgery than patients without plates on the frontozygomatic suture.

Reconstruction of a fingertip with a thenar perforator island flap

Abstract We raised thenar island flaps that were supplied by perforators that originated in the superficial palmar arch or the superficial palmar branch of the radial artery for the reconstruction of fingertip defects in eight patients. The flap was so well-vascularised that a large flap with increased mobility could be raised. The donor site was covered with well-vascularised thick tissue, and skin grafting of the donor site was avoided in all cases. No patient developed a complication, and all flaps survived. Functional and cosmetic results of both fingertips and donor sites were excellent. A perforator island flap from the thenar eminence can be raised easily without injuring any digital and palmar arteries. They have a good colour and texture that matches the fingertips and donor site defects on the palm.

External-internal oblique reverse blood supply musculocutaneous flap for chest wall reconstruction

A defect resulting from resection of advanced breast tumor can be quite large, posing a difficult reconstructive challenge. A significant number of such patients are found to have local recurrences after receiving beam radiation therapy and chemotherapy. The external oblique musculocutaneous flap is now considered a reliable option, with segmental blood supply from the posterior intercostal arteries. We report a 57-year-old man with local recurrence of breast tumor after external beam therapy. We faced a difficult challenge in performing reconstruction because of (1) several previous operations that used most of the usual options and (2) the absence of recipient vessels for microsurgery. We performed an external-internal oblique musculocutaneous flap with a reverse blood supply from the lateral branches of the inferior epigastric artery. Our use of a reverse-flow externalinternal oblique flap supports the concept of rotating the muscles as a unit to encourage viability of the denervated and relatively devascularized component.

A New Surgical Approach for Tessier No. 4 Facial Cleft Reconstruction: Lip-Rescue Flap

AbstractCraniofacial clefts are rare, severe challenges for surgeons about which there is limited literature. Tessier Number 4 (No. 4) clefts are one of the most complex craniofacial anomalies and present difficulties in surgical treatment. The most-common deformities associated with Tessier No. 4 clefts are displacements of the lower eyelids, medial canthus, and ala and decreased distance between the lower eyelids and lips. In surgery to correct these deformities, the greatest challenges are the design and the placement of the landmarks and incisions. Because of its relative rarity and wide range of severity, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. The present study presents a new lip-rescue flap technique as an alternative approach for reconstructing Tessier No. 4 facial clefts.

Bidirectional fascia graft for congenital unilateral lower lip palsy in an adult

Congenital unilateral lower lip palsy, caused by palsy or hypoplasia of the depressor anguli oris muscle, shows inverting and insufficient depression of the affected side of the lower lip while opening the mouth and is usually noticed when the infant cries. There are very few reports on the treatment of the congenital unilateral lower lip palsy. Passive treatments, such as the resection of the marginal mandibular branch of the unaffected side, prevent emotive movement of the face, whereas dynamic reconstructions, such as neurovascular muscle transfer, are too invasive. For congenital lower lip palsy, a simple reconstruction using bidirectional fascia grafts was reported by Udagawa et al. Briefly, a horizontal fascia graft placed anterior to the orbicularis oris muscle is pulled downwards by a vertical fascia graft, the inferior end of which is fixed to the