Yukihide Tsuchida

The effect of aging and arteriosclerosis on human skin blood flow

Skin blood flow in the deltoid region of 65 men was measured by the xenon 133 clearance method and in studying the correlation of age, total cholesterol and systolic blood pressure to skin blood flow, the following results were obtained. (1) Skin blood flow significantly decreased with increase in age. In calculating skin blood flow at 20 and 70 years of age from the regression line between skin blood flow and age, it was estimated that skin blood flow at 70 years of age decreased to 40% of that at 20 years of age. (2) Skin blood flow significantly decreased with increase in total cholesterol and systolic blood pressure. (3) Skin blood flow showed the closest correlation with age, followed by total cholesterol and systolic blood pressure which showed a weak correlation. It is estimated from the foregoing results that as skin blood flow in patients with arteriosclerosis decreases more in elderly individuals than in young persons, their wound healing is delayed.

Age-related changes in skin blood flow at four anatomic sites of the body in males studied by xenon-133

The normal skin blood flow in healthy subjects consisting of 28 males whose ages ranged from 20 to 72 years was measured by the xenon-133 clearance method at four different sites of the body to determine the presence of any age-related changes. The following results were obtained: Significant age-related changes were observed in the skin blood flow of the deltoid region, anterior chest, dorsum of the hand, and dorsum of the foot. Normal skin blood flow was demonstrated to be highly dependent on age and to significantly decrease with age. Average skin blood flow at these four regions of those 70 years of age decreased by 30 to 40 percent when compared to that of those 20 years of age. The skin blood flow at the deltoid region of healthy subjects was higher by 6.3 ml/100 gm per minute than that of patients in poor condition with cancer of the head and neck.

Changes in hemodynamics in jejunal flaps of rabbits due to ischemia, venous congestion, and reperfusion as measured by means of colored microspheres.

&NA; The effect on the jejunal hemodynamics of restoration of blood flow of the jejunal artery or vein in the free jejunal flap has not yet been elucidated. In the present study, a model of ischemia and reperfusion in the jejunal flap of rabbits, and that of venous congestion and reperfusion, were prepared. Jejunal blood flow was measured by means of colored microspheres, and changes in jejunal blood flow were analyzed. Three segmental jejunal flaps were designed on each rabbit (n = 16), with one artery and one vein kept intact. Arterial clamp and venous clamp groups were prepared with a control group in which there was no clamping. After clamping for 5 minutes (n = 7), the jejunal blood flow of the arterial clamp group decreased to 1.6 percent of that of the control group (p= 0.0002), and that of the venous clamp group decreased to 31.2 percent of that of the control group (p = 0.0041). At 5 minutes after release of clamping, the jejunal blood flow of the arterial clamp group recovered to only 74.1 percent of that of the control group, with no consistent tendency; that of the venous clamp group recovered to 45.9 percent of that of the control group (p = 0.0194), with an increase of only 14.7 percent over that of the clamped jejunal blood flow group. Thus, injury of the jejunal hemodynamics in the venous clamp group had already begun in response to clamping for 5 minutes. After clamping for 30 minutes (n = 9), the jejunal blood flow of the arterial clamp group decreased to 4.3 percent of that of the control group (p = 0.0060), and that of venous clamp group decreased to 12.5 percent of that of the control group (p = 0.0106). At 5 minutes after release of clamping, jejunal blood flow of the arterial clamp group recovered to 171.0 percent of that of the control group (p = 0.0295), and that of venous clamp group recovered to 41.7 percent of that of the control group (p = 0.0276). Jejunal blood flow of the arterial clamp group recovered to 409.7 percent of that of the venous clamp group (p < 0.0001). When measurement of jejunal blood flow was repeated twice after changing the color of microspheres, jejunal blood flow of the second measurement was approximately 24 percent greater in mean value than that of the first measurement. The histologic results of the jejunum of the arterial clamp group clamped for 30 minutes showed no injury, which was similar to the results of the control group. The jejunum of the venous clamp group clamped for 5 minutes showed injury with severe hemorrhage in the lamina propria, and irreversible injury 30 minutes thereafter, with massive hemorrhage in all layers of the jejunal wall. In conclusion, as microcirculatory hemodynamics and histologic results of the jejunum demonstrated evidence of injury even by venous congestion for 5 minutes, restoration of blood flow of the free jejunal flap must be started from the jejunal vein. (Plast. Reconstr. Surg. 101: 147, 1998.)

Regional differences in the skin blood flow at various sites of the body studied by xenon 133

Normal skin blood flow was measured by the xenon 133 clearance method at different anatomic sites of the body and the following results were obtained. First, the skin blood flow of the face and anterior chest was significantly greater than that of the deltoid region (P < 0.01). The skin blood flow of the dorsal side of the hand and foot was significantly lower than that of the deltoid region (P < 0.01). A tendency was observed for the skin blood flow to decrease gradually from the upper part of the body to the lower part of the body. For example, the ratio of the highest value at the face to the lowest value at the dorsal side of the foot was about 2.5:1, indicating a remarkable difference among the various sites of the body. The skin blood flow at the dorsum of the hand was significantly higher by about 25.4 percent than that of the fool (P < 0.01). Second, the skin blood flow at the left side of the dehoid region was higher by about 5 percent than that of the right side (P < 0.01). Bilateral comparison of the skin blood flow at the dorsal side of the hand and foot showed that the values were almost the same on the left and right.

The correlation of skin blood flow with age, total cholesterol, hematocrit, blood pressure, and hemoglobin.

Normal skin blood flow at the deltoid region in 55 men whose ages ranged from 20 to 72 years was measured by the xenon-133 clearance method. In addition, the correlation of skin blood flow with age, systolic blood pressure, total cholesterol, hematocrit, hemoglobin, and total protein was analyzed by multiple regression analysis. The following results were obtained. Normal skin blood flow was found to decrease with increase in age, total cholesterol, and systolic blood pressure and showed a tendency to increase with elevation in hematocrit and hemoglobin values. Of the six parameters examined in the present study, the parameter that showed the strongest correlation with skin blood flow at the deltoid region was age, followed in decreasing order by total cholesterol, hematocrit, systolic blood pressure, and hemoglobin. It could therefore be concluded that age is the most reliable factor in clinically estimating skin blood flow. Furthermore, inasmuch as total cholesterol, hematocrit, systolic blood pressure, and hemoglobin values also were correlated with skin blood flow, these values also should be taken in account in the synthetic evaluation of skin blood flow. It was skin blood flow at the deltoid region that was strongly correlated with age. This was followed by systolic blood pressure, hematocrit, and hemoglobin. Total cholesterol showed a weak correlation with age, but total protein did not demonstrate any correlation with skin blood flow and age. The results of the present study show that skin blood flow would be poor in the elderly and in patients with arteriosclerosis, hypertension, and anemia. Since it is suggested that the wound-healing process is delayed in such patients, utmost care should be exercised in treating their wounds.

The Delay Phenomenon in Types of Deltopectoral Flap Studied by Xenon-133

We have investigated the hemodynamic mechanisms of delay phenomenon of various types of deltopectoral flaps and optimal time for transfer after delay operation using the local clearance method of Xenon-133. Characteristic differences were observed in recovery patterns of the distal blood flow among five types of delay procedure the results obtained are reported. In Group 1 (U-shaped, raised deltopectoral flap), two types of recovery patterns (fast and slow) were obtained. In cases of faster recovery, the optimal transfer time after delay is considered to be almost 10 days. In cases of slow recover in groups I and II (U-shaped, raised deltoid flap), the optimal time for transfer is thought to be 2 to 3 weeks. In group III (deltopectoral flap lined with a split-skin graft) and group IV (tubed, raised deltopectoral flap), a faster recovery pattern was observed than in groups I and II, and the optimum transfer time is considered to be about 7 to 14 days after delay operation. Accordingly, the use of groups III and IV would be highly recommended instead of group I. In group V (bipedicled, raised deltopectoral flap), the time of lateral incision was found to be critical.

Reconstruction of the levator function and conjunctiva using an inferiorly based orbital septal flap for subtotal full-thickness defects of the upper eyelid : Two cases of ocular sebaceous carcinoma

Without using the lower eyelid, functional reconstruction of the tarsoconjunctival layer is challenging for subtotal full-thickness defects of the upper eyelid. In 2 cases of ocular sebaceous carcinoma, the levator function and conjunctiva were reconstructed using the inferiorly based orbital septal flap and conchal cartilage graft. The raw surface of the orbital septal flap was epithelialized within 14 days postoperatively. The new upper eyelid with a stable lid margin could open and close properly. Our surgical procedures may be available in the case that the lower eyelid is not usable.

Minor malformation of skin and soft tissue of the columella and philtrum

We present 3 patients with minor malformation of skin and soft tissue between the unilateral columella and philtrum. The first patient has a number of malformations such as minor cleft nose, notch of the left nostril rim and vermilion, and bifid frenula of the upper lip and right accessory ear, whereas the second patient had a notch of the vermilion and the third patient had minor ocular hypertelorism. The clinical findings observed in these patients suggest that a minor malformation of skin and soft tissue between the unilateral columella and philtrum is a focal fetal dysplasia that developed as a result of embryological failure in the ipsilateral medial nasal process and that these minor malformations are a type of facial cleft.

Lower eyelid reconstruction with cheek flap and conchal cartilage graft

悪性黒色腫切除による下眼瞼全層欠損を耳介軟骨と頬部皮弁により再建した症例を報告した。症例は74歳女性, 下眼瞼LMM, Stage IA (pT1aN0M0) 。切除生検の創縁より10mm離して下眼瞼全層を切除し, 欠損の水平長は15mmとなった。瞼板と眼瞼結膜の欠損は耳介軟骨膜付き耳介軟骨, 皮膚欠損は頬部皮弁にて再建した。耳介軟骨膜面は術後1ヵ月までに周囲からの粘膜再生により上皮化した。術後12ヵ月を経過し, 局所再発はなく整容的と機能的結果は良好である。

A case report of liposarcoma with multiple lipomas.

A 51-year-old male was referred to us with resection of liposarcoma of the upper back region. The patient underwent wide resection of the primary lesion including partially the trapezius muscles, and skin graft. Histological examination revealed no residual lesion of liposarcoma and two lipomas of the lumbar region. The patient is alive without local recurrence and distant metastasis at twenty months postoperatively. [Skin Cancer (Japan) 2001; 16: 332-335]