150 results on '"Minoru Sakuraba"'
Search Results
2. Modified trilobed transposition flap for a distal nasal defect
- Author
-
Akinori Asaka, Shigeo Kyutoku, Takashi Nuri, Minoru Sakuraba, and Koichi Ueda
- Subjects
Dermatology ,General Medicine - Published
- 2023
3. Comparison of salvage surgery for recurrent or residual head and neck squamous cell carcinoma
- Author
-
Minoru Sakuraba, Takeshi Shinozaki, Ryuichi Hayashi, Toshifumi Tomioka, Makoto Tahara, Sadamoto Zenda, Wataru Okano, and Takashi Maruo
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Surgical margin ,Neoplasm, Residual ,Oropharynx ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030223 otorhinolaryngology ,Aged ,Salvage Therapy ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,Standard treatment ,Head and neck cancer ,Cancer ,Hypopharyngeal cancer ,Chemoradiotherapy ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Head and neck squamous-cell carcinoma ,Surgery ,Hypopharynx ,Oncology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Concomitant ,Female ,Larynx ,Neoplasm Recurrence, Local ,business - Abstract
Objective Concomitant chemoradiation therapy is a standard treatment for head and neck cancer. Thus, salvage surgery has become a necessary treatment. The aim of the study was to evaluate the results of salvage surgery by each site of the head and neck, especially the oropharynx, hypopharynx and larynx. Methods This was a retrospective, single-institute study. The primary endpoint was overall survival. Secondary endpoints were disease-free survival, the locoregional control rate after salvage surgery, the indication rate for salvage surgery, the reasons for contraindications to salvage surgery, the post-operative complication rate and the predictors of survival. Results Three-year overall survival after salvage surgery was 58.8% in the salvage surgery group and 8.59% in the other treatment group (P Conclusions Salvage surgery is effective for recurrent or residual cases after concomitant chemoradiation therapy. For oropharyngeal cancer, local control is important, and for oropharyngeal cancer and hypopharyngeal cancer, distant metastasis is important.
- Published
- 2019
4. Goltz Syndrome Combined with Triple X Syndrome, a Case Report
- Author
-
Itaru Sone, Takayuki Honda, Minoru Sakuraba, Kazuro Satoh, Yukinori Kuwajima, Shunsuke Baba, and Yasunori Wada
- Subjects
Otorhinolaryngology ,Oral Surgery - Abstract
Goltz syndrome is a rare X-linked dominant multisystem disorder that presents with ectoderm and mesoderm-derived symptoms. Skin manifestations including congenital patchy skin aplasia, congenital nodular fat herniation, congenital hypo- or hyperpigmentation along Blaschko's lines, telangiectasia, and congenital ridged dysplastic nails are typical in this disorder. Almost all cases of Goltz syndrome correspond to female newborns and that hemizygosis makes the syndrome fetal in males. Triple X syndrome is a relatively common congenital disorder that presents with mild to no symptoms in the developmental and psychiatric realm. The patient reported here was born with multisystem anomaly affecting the eyes, craniofacial region, cardiovascular system, skin, and limbs. A G-banding chromosomal study revealed 47, XXX. She was diagnosed with Goltz syndrome owing to her distinctive skin manifestations. The congenital cervical skin defect healed with conservative treatment. The facial cleft, cleft lip-palate, and syndactyly were successfully treated with multiple surgical treatments. The combination of triple X syndrome and Goltz syndrome is very rare. We describe the expression of presenting with both syndromes simultaneously.
- Published
- 2022
5. Free flap reconstruction of Achilles tendon and overlying skin defect using ALT and TFL fabricated chimeric flap
- Author
-
Shuchi Azuma, Aya Goto, Minoru Sakuraba, Itaru Sone, Nobuyuki Mitsuhashi, Kousuke Sasaki, Atsushi Sugawara, and Junji Ando
- Subjects
musculoskeletal diseases ,Achilles tendon ,reconstruction ,anterolateral thigh flap ,business.industry ,Muscle flap ,Case Report ,Anatomy ,Anterolateral thigh ,musculoskeletal system ,Chimeric free flap ,eye diseases ,Tensor Fasciae Lata ,body regions ,medicine.anatomical_structure ,Automotive Engineering ,tensor fascia latae flap ,Medicine ,Free flap reconstruction ,Achilles tendon rupture ,medicine.symptom ,business - Abstract
A 33-year-old man developed a left Achilles tendon rupture and skin necrosis. We reconstructed the defect using an anterolateral thigh flap and a tensor fasciae lata muscle flap in a chimeric fashion. he was able to stand on a toe of the operated foot without help 6 months postoperatively.
- Published
- 2019
6. Growth Factors & Stem Cells Entrapment in Bio Compatible & Biodegradable Nano Particles to Prevent Early Degradation & Facilitate Gradual Release
- Author
-
C. A. N. Fernando, A H M P Anuruddha, Minoru Sakuraba, and Yoshihisa Saida
- Subjects
Entrapment ,Materials science ,Nanoparticle ,Degradation (geology) ,Nanotechnology ,Stem cell - Abstract
The use of growth factors and stem cells as the core treating agents is one step into creating a biocompatible Solid Lipid Nano Particles (SLNP) for treatments. Apart from obtaining these growth factors and stem cells from the patients, using the bi-product of the extraction process which is the lipid of the patient for the production of the SLNP assures the final product to be biocompatible and of a unique structure. The use of autologous cells and proteins from the patients makes the entire process medically ethical and more viable for treatment procedures. This article, thus discusses on the experimental process of developing such SLNP and the introduction of the relevant medical contraption designed uniquely for the procedure inclusive of a specified membrane.
- Published
- 2021
7. Surgical outcome for colorectal or urinary tract-related fistula: Usefulness of vascularized tissue transfer-a retrospective study
- Author
-
Minoru Sakuraba, Yutaka Fukunaga, Hitoshi Masuda, Masaaki Ito, Azusa Oshima, and Takuya Higashino
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urinary Fistula ,Urinary system ,Fistula ,030232 urology & nephrology ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Rectal Fistula ,Aged ,Retrospective Studies ,Surgical repair ,Transperineal approach ,business.industry ,Retrospective cohort study ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Tissue transfer ,Surgery ,Gracilis muscle flap ,Rectovaginal fistula ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Summary Background It is challenging to manage colorectal or urinary tract-related fistula. We typically treat colorectal or urinary tract-related fistula with a vascularized tissue transfer. This study aimed to analyze the outcomes of our surgical treatments for colorectal or urinary tract-related fistula. Methods This retrospective review included all patients who underwent surgical repair of a colorectal or urinary tract-related fistula at our institution from October 2004 to September 2019. Patients whose surgical outcomes could not be evaluated were excluded. The primary outcome was the overall cure rate. We also evaluated the complication rate and compared the outcomes for rectovaginal fistula with those for urorectal fistula. Results The final analysis included 38 cases, of which 17 were rectovaginal fistula and 16 were urorectal fistula. The transperineal approach was used in 28 cases and transperineal and transabdominal combined in nine cases. A gracilis muscle flap was used in 19 cases and a gluteal fold flap in 13 cases. Although a major leak occurred in nine cases, the fistula was finally cured successfully in 31 cases. A comparison of the outcomes for rectovaginal fistula and urorectal fistula showed that complications occurred in 5/17 cases of rectovaginal fistula and 10/16 cases of urorectal fistula (p = 0.056). Fistulae were cured successfully in 13/17 cases of rectovaginal fistula and 14/16 cases of urorectal fistula (p = 0.656). Conclusion Our surgical treatment for colorectal or urinary tract-related fistula succeeded in 31 of 38 cases. Thus, vascularized tissue transfer is useful for refractory colorectal or urinary tract-related fistula.
- Published
- 2020
8. Analysis of cancer-associated fibroblasts and the epithelial-mesenchymal transition in cutaneous basal cell carcinoma, squamous cell carcinoma, and malignant melanoma
- Author
-
Kousuke Sasaki, Kazuyuki Ishida, Seiichiro Kobayashi, Tamotsu Sugai, Hiroo Amano, Mitsumasa Osakabe, Hiroaki Kimura, Minoru Sakuraba, and Katsuhiko Kashiwa
- Subjects
Adult ,Male ,0301 basic medicine ,Epithelial-Mesenchymal Transition ,Skin Neoplasms ,Biology ,Pathology and Forensic Medicine ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Cancer-Associated Fibroblasts ,Growth factor receptor ,Biomarkers, Tumor ,medicine ,Humans ,Basal cell carcinoma ,Epithelial–mesenchymal transition ,Melanoma ,Aged ,Aged, 80 and over ,Middle Aged ,medicine.disease ,Immunohistochemistry ,Phenotype ,030104 developmental biology ,Podoplanin ,Carcinoma, Basal Cell ,Tissue Array Analysis ,Tumor progression ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Cancer research ,Female - Abstract
Activated cancer-associated fibroblasts (CAFs) and fibroblasts that have undergone the epithelial-mesenchymal transition (EMT) in cancer stroma contribute to tumor progression and metastasis. However, no reports have investigated the CAF phenotype and its clinicopathological relevance in cutaneous malignant tumors, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Here, we investigated the CAF phenotype in cutaneous malignant tumors based on their histology and immunohistochemical expression of CAF-related markers, including adipocyte enhancer-binding protein 1 (AEBP1), podoplanin, platelet-derived growth factor receptor α (PDGFRα), PDGFRβ, fibroblast activating protein (FAP), CD10, S100A4, α-smooth muscle actin (α-SMA), and EMT-related markers (Zeb1, Slug, and Twist). In addition, we assessed the role of the CAF phenotype in cutaneous malignant cancers using hierarchical cluster analysis. Consequently, 3 subgroups were stratified based on the expression pattern of CAF- and EMT-related markers. Subgroup 1 was characterized by low expression of AEBP1, PDGFRα, PDGFRβ, FAP and Slug, whereas subgroup 2 was closely associated with high expression of PDGFRβ, S100A4 and Twist. In addition, high expression levels of podoplanin, PDGFRβ, CD10, S100A4, α-SMA, Zeb1, Slug and Twist were observed in subgroup 3. High expression of CD10 was commonly found in all 3 subgroups. These subgroups were correlated with histologic subtypes, that is, subgroup 1, MM; subgroup 2, BCC; and subgroup 3, SCC. We suggest that the expression pattern of CAF- and EMT-related proteins plays crucial roles in the progression of BCC, SCC, and MM.
- Published
- 2018
9. Mandibular reconstruction in elderly patients
- Author
-
Minoru Sakuraba, Shimpei Miyamoto, and Takuya Higashino
- Subjects
Male ,medicine.medical_specialty ,Surgical Flaps ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,stomatognathic system ,Scapula ,Patient age ,Humans ,Medicine ,In patient ,Fibula ,Mandibular reconstruction ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bone Transplantation ,business.industry ,Soft tissue ,030206 dentistry ,General Medicine ,Perioperative ,Surgery ,stomatognathic diseases ,Oncology ,Vascularized bone ,030220 oncology & carcinogenesis ,Female ,Mouth Neoplasms ,Mandibular Reconstruction ,business ,Bone Plates ,Algorithms - Abstract
Background and objectives The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients. Methods We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft (n = 49), mandibular reconstruction plate and soft tissue flap (n = 22), and soft-tissue flap (n = 50). We compared perioperative outcomes among groups and investigated factors affecting the choice of reconstructive technique. Results Rates of postoperative complications did not differ significantly among groups. Mandibular reconstruction plate was indicated only for anterior mandibular defects. Soft-tissue flap was indicated for posterior mandibular defects in patients aged ≥75 years or with a poor postoperative Eichner index. Conclusions Mandibular reconstruction plate and soft-tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.
- Published
- 2018
10. Analysis of a Surgical Treatment for Persistent Urorectal Fistulas after Radical Cancer Surgery: A Comparison of Prostate Cancer and Rectal Cancer
- Author
-
Yoshinobu Komai, Norio Saito, Minoru Sakuraba, Yasuyuki Sakai, and Masaaki Ito
- Subjects
Male ,medicine.medical_specialty ,Urinary Fistula ,Colorectal cancer ,Urology ,Rectus Abdominis ,030232 urology & nephrology ,Surgical Flaps ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,medicine ,Humans ,Rectal Fistula ,Surgical treatment ,Aged ,Retrospective Studies ,Prostatectomy ,Rectal Neoplasms ,business.industry ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Gracilis Muscle ,030220 oncology & carcinogenesis ,business ,Cancer surgery - Abstract
Introduction: The study aimed to present our experience of surgical treatment for urorectal fistulas (URF) that develop after cancer surgery. Materials and Methods: Fourteen patients with URF who were treated at our institution from 2005 through 2015 were retrospectively analyzed. Among these, 7 patients had previous surgical treatment of prostate cancer (PC) and the other 7 had been treated for rectal cancer (RC). The fistula was resected through a perineal incision, and the urinary and fecal defects were separately closed with the hinge flap method followed by interposition of a muscle flap transfer. Results: The overall fistula closure rate was 79%. Although the closure rate of the URF was lower in patients with previous RC surgery compared to the PC patients (57 vs. 100%), it did not reach statistical significance. Conclusions: URF treatment using an interposition muscle flap offers a high success rate of fistula closure. However, complicated fistulas occurring after RC surgery involving the prostate or the seminal vesicle might be difficult to repair by this surgery alone.
- Published
- 2017
11. Protocol for a multicentre, prospective, cohort study to investigate patient satisfaction and quality of life after immediate breast reconstruction in Japan: the SAQLA study
- Author
-
Makoto Hikosaka, Taro Kusano, Koichi Tomita, Tomoyuki Yano, Yoshihiro Kimata, Mitsuru Sekido, Toshihiko Satake, Kenta Miyabe, Mayu Muto, Tomoaki Kuroki, Yui Tsunoda, Satoko Watanabe, Yukiko Aihara, Yukiko Kuramoto, Takuhiro Yamaguchi, Minoru Sakuraba, Tempei Miyaji, Aya Goto, Takashi Kawaguchi, Hiroyoshi Doihara, Sadamoto Zenda, Yuko Hosoya, Mifue Taminato, Miho Saiga, and Hiroki Utsunomiya
- Subjects
medicine.medical_specialty ,Mammaplasty ,Breast surgery ,medicine.medical_treatment ,Breast Neoplasms ,breast tumours ,030230 surgery ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Patient satisfaction ,Japan ,Quality of life ,Humans ,Multicenter Studies as Topic ,Medicine ,Prospective Studies ,Prospective cohort study ,Mastectomy ,business.industry ,General Medicine ,breast surgery ,medicine.disease ,plastic & reconstructive surgery ,Observational Studies as Topic ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Family medicine ,Quality of Life ,Surgery ,Observational study ,business ,Breast reconstruction ,Declaration of Helsinki - Abstract
IntroductionThe aim of breast reconstruction (BR) is to improve patients’ health-related quality of life (HRQOL). Therefore, measuring patient-reported outcomes (PROs) would clarify the value and impact of BR on a patient’s life and thus would provide evidence-based information to help decision-making. The Satisfaction and Quality of Life After Immediate Breast Reconstruction study aimed to investigate satisfaction and HRQOL in Japanese patients with breast cancer who undergo immediate breast reconstruction (IBR).Methods and analysisThis ongoing prospective, observational multicentre study will assess 406 patients who had unilateral breast cancer and underwent mastectomy and IBR, and were recruited from April 2018 to July 2019. All participants were recruited from seven hospitals: Okayama University Hospital, Iwate Medical University Hospital, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Showa University Hospital, University of Tsukuba Hospital, Osaka University Hospital and Yokohama City University Medical Center. The patients will be followed up for 36 months postoperatively. The primary endpoint of this study will be the time-dependent changes in BREAST-Q satisfaction with breast subscale scores for 12 months after reconstructive surgery, which will be collected via an electronic PRO system.Ethics and disseminationThis study will be performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects published by Japan’s Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare, the modified Act on the Protection of Personal Information and the Declaration of Helsinki. This study protocol was approved by the institutional ethics committee at the Okayama University Graduate School of Medicine, Dentistry, on 2 February 2018 (1801-039) and all other participating sites. The findings of this trial will be submitted to an international peer-reviewed journal.Trial registration numberUMIN000032177.
- Published
- 2021
12. Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer
- Author
-
Makoto Tahara, Minoru Sakuraba, Naoki Nakamura, Takaki Ariji, Atsushi Motegi, Sunao Tokumaru, Mitsuhiko Kawashima, Tetsuo Akimoto, Mitsutoshi Ooishi, Sadamoto Zenda, Satoko Arahira, and Ryuichi Hayashi
- Subjects
Adult ,Male ,Mucositis ,Oncology ,Larynx ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Dermatitis ,Kaplan-Meier Estimate ,Xerostomia ,Disease-Free Survival ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Positron Emission Tomography Computed Tomography ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,Adverse effect ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Head and neck cancer ,Cancer ,Radiotherapy Dosage ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Head and neck squamous-cell carcinoma ,Primary tumor ,Surgery ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Female ,Radiotherapy, Intensity-Modulated ,Neoplasm Recurrence, Local ,business - Abstract
OBJECTIVE To evaluate the feasibility of postoperative intensity-modulated radiotherapy for head and neck cancer by investigating the patterns of failure after this therapy. METHODS A retrospective chart review was performed. RESULTS Between March 2006 and December 2013, 122 consecutive patients with head and neck squamous cell carcinoma were treated by surgery followed by postoperative intensity-modulated radiotherapy. In regard to the site of the primary tumor, 59 (48%) patients had cancer of the oral cavity, 31 (26%) patients had cancer of the hypopharynx, 14 (11%) patients had cancer of the oropharynx, 10 (8%) patients had cancer of the larynx and 8 (7%) patients had cancer of unknown primary. The median follow-up period of the surviving patients was 54 months (range, 25-115). Concurrent chemotherapy was administered in 76 patients (62%). The median prescribed radiation dose was 66 Gy. The 3-year overall survival, progression-free survival, distant metastasis free survival and loco-regional control rates were 59%, 48%, 52.4% and 71%, respectively. Of the 122 patients, 32 developed loco-regional recurrence as the initial recurrence, including in-field recurrence in 26 patients, marginal recurrence in five patients and out-field recurrence in seven patients. Of the five patients with marginal recurrence, four have had two or more surgeries before the intensity-modulated radiotherapy and three had oral cavity cancer. Severe adverse events were not frequent, occurring at a frequency of
- Published
- 2016
13. Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction
- Author
-
Yoshihiro Kimata, Satoshi Onoda, Narusi Sugiyama, Minoru Sakuraba, and Hiroshi Matsumoto
- Subjects
medicine.medical_specialty ,Reconstructive surgery ,business.industry ,Cancer ,medicine.disease ,University hospital ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,In patient ,Preoperative irradiation ,Major complication ,030223 otorhinolaryngology ,Head and neck ,business ,Surgical site infection - Abstract
The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods.
- Published
- 2016
14. Combined salivary duct carcinoma and squamous cell carcinoma suspected of carcinoma ex pleomorphic adenoma
- Author
-
Hirofumi Kuno, Takashi Mukaigawa, Minoru Sakuraba, Satoshi Fujii, Ryuichi Hayashi, Makoto Tahara, and Tomohiro Enokida
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,Hyalinized fibrosis ,business.industry ,General Medicine ,medicine.disease ,Asymptomatic ,Pathology and Forensic Medicine ,Salivary duct carcinoma ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Carcinoma ex pleomorphic adenoma ,030220 oncology & carcinogenesis ,medicine ,Immunohistochemistry ,Basal cell ,Salivary gland neoplasm ,Palpable mass ,medicine.symptom ,business - Abstract
A 76-year-old Japanese woman had noticed an asymptomatic and palpable mass in her left parotid gland region for 20 years. The tumor had showed rapid growth during the last two months. Therefore, the tumor was clinically suspected of being a malignant tumor and was surgically resected. A histopathological examination revealed that the tumor consisted of two different histopathological neoplastic components accompanied by hyalinized fibrosis at the center of the tumor. The two-neoplastic components were squamous cell carcinoma and salivary duct carcinoma. The tumor was suspected to be a carcinoma ex pleomorphic adenoma after considering the clinical course and the histopathological findings, such as hyalinized fibrosis at the center of the tumor. There was no evidence of recurrence at 30 months after the surgical resection.
- Published
- 2016
15. A Case of Bleeding Pulmonary Artery Pseudoaneurysm Successfully Treated with Emergency Microsurgery
- Author
-
Yaso Saito, Tomoyuki Hishida, Koreyuki Kurosawa, and Minoru Sakuraba
- Subjects
medicine.medical_specialty ,bronchopleural fistula ,business.industry ,medicine.medical_treatment ,lcsh:Surgery ,Bronchopleural fistula ,Lung abscess ,lcsh:RD1-811 ,Microsurgery ,medicine.disease ,pulmonary artery pseudoaneurysm ,emergent microsurgery ,Surgery ,Dissection ,Catheter ,Pseudoaneurysm ,medicine.artery ,Pulmonary artery ,Medicine ,Radiology ,Embolization ,business - Abstract
Pulmonary artery pseudoaneurysm (PAP) is rare. Reported causes of PAP include chest trauma, catheterization, and inflammatory diseases, such as pneumonia and lung abscess. We report a case of bleeding PAP successfully treated with emergency microsurgical reconstruction. A 50-year-old man with T3N1M0 lung cancer of the right upper lobe underwent right upper and middle lobectomy, inferior lobe S6 segmentectomy, and lymph node dissection. An infection of the right residual S6 developed. The inflammation then resulted in PAP. The infected S6 lesion was removed 6 weeks after the first surgery. However, 11 weeks after the first surgery the PAP bled. Although hemostasis was achieved through manual pressure, rebleeding was suspected, and surgery was emergently performed. Firm hemostasis was obtained after debridement and suturing of the lacerated pulmonary artery. A free rectus abdominis musculocutaneous (RAMC) flap with a 22 × 10-cm skin island was then raised and used to cover the pulmonary artery. The flap was used to fill the space that had been occupied by pyothorax. The patient was discharged from the hospital 19 days after the emergent microsurgery. The main treatment approaches for PAPs are catheter embolization and open surgery, but which approach is better is controversial. Surgical treatment was appropriate for our patient because the bleeding vessel was exposed after fenestration. An advantage of reconstruction with a free RAMC flap is the reduced risks of worsening infection and rebleeding, because the space of the defect is filled with tissue having an abundant blood supply and coverage is provided to the area of bleeding.
- Published
- 2016
16. Early detection of local recurrence after soft tissue sarcoma resection and flap reconstruction
- Author
-
Eisuke Kobayashi, Masahide Fujiki, Hirokazu Chuman, Minoru Sakuraba, and Shimpei Miyamoto
- Subjects
medicine.medical_specialty ,Soft Tissue Neoplasm ,Soft Tissue Neoplasms ,Physical examination ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Soft tissue sarcoma ,Sarcoma ,Plastic Surgery Procedures ,medicine.disease ,Occult ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Radiological weapon ,Orthopedic surgery ,Neoplasm Recurrence, Local ,business ,Magnetic Resonance Angiography - Abstract
Flap reconstruction has become an essential component in soft tissue sarcoma treatment. However, the clinical features of local recurrence after soft tissue sarcoma resection and flap reconstruction remain unclear. The present study aimed to establish effective follow-up strategies after soft tissue sarcoma resection and flap reconstruction. Data from patients who underwent soft tissue sarcoma resection and immediate flap reconstruction were retrospectively reviewed. Follow-up after surgery included history taking and physical examination during every visit to the hospital. Magnetic resonance imaging to evaluate the primary site was performed six months after the end of treatment then annually for ten years. The methods of detection of local recurrence were assessed. A total of 229 consecutive patients were included in the present study. During a median follow-up period of 40 months, 33 patients (14.4%) developed local recurrence. Twenty-three recurrences that occurred on the margin of the transferred flap were detected as palpable mass prior to radiological assessment; among the remaining ten recurrences that occurred in the deep layer of the transferred flap, six were detected by abnormal clinical findings and four were clinically occult and detected by surveillance radiological assessment. Surveillance radiological assessment has an important role in early detection of local recurrence that develops in the deep layer of the transferred flap. Therefore, meticulous clinical assessment combined with routine radiological study should be performed during follow-up evaluation for local recurrence after soft tissue sarcoma resection and flap reconstruction.
- Published
- 2016
17. Predictive factors of dysphagia after lateral and superior oropharyngeal reconstruction with free flap transfer
- Author
-
Ryuichi Hayashi, Masahide Fujiki, Minoru Sakuraba, and Shimpei Miyamoto
- Subjects
medicine.medical_specialty ,Univariate analysis ,business.industry ,Medical record ,medicine.medical_treatment ,Retrospective cohort study ,General Medicine ,Free flap ,Logistic regression ,Dysphagia ,Surgery ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Oropharyngeal Neoplasm ,Oncology ,030220 oncology & carcinogenesis ,otorhinolaryngologic diseases ,Medicine ,medicine.symptom ,030223 otorhinolaryngology ,business - Abstract
Background and Objectives Lateral and superior oropharyngeal reconstruction is technically challenging and can be complicated by postoperative dysphagia. The aim of this retrospective study was to identify the predictive factors of dysphagia after lateral and superior oropharyngeal reconstruction with free flap transfer and to establish better management for cases with these predictive factors. Methods We performed a retrospective chart review of 109 patients who had undergone lateral and superior oropharyngeal reconstruction with free flap transfer for oropharyngeal cancer. Preoperative, operative, and postoperative variables were examined, and possible predicative factors for dysphagia were subjected to univariate analysis and multivariate logistic regression analysis. Results Dysphagia occurred in 16 patients (14.7%). Multivariate logistic regression analysis identified extensive tongue base resection, postoperative radiotherapy, and history of radiotherapy to the head and neck region as independent factors contributing to dysphagia after lateral and superior oropharyngeal reconstruction. Of these factors, extensive tongue base resection was the most important. Conclusions Early intervention to minimize the risk of dysphagia should be performed for patients identified with these predictive factors. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
18. Anterolateral thigh flap for axillary reconstruction after sarcoma resection
- Author
-
Akira Kawai, Shimpei Miyamoto, Hirokazu Chuman, Masahide Fujiki, and Minoru Sakuraba
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030230 surgery ,Microsurgery ,Anterolateral thigh ,Neurovascular bundle ,medicine.disease ,Iliotibial tract ,Surgery ,Resection ,Chest wall reconstruction ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Reconstructive microsurgery ,medicine ,Sarcoma ,business - Abstract
Background Reconstruction of extensive axillary defects after sarcoma resection presents a challenging problem in reconstructive microsurgery. The purpose of this report was to investigate the feasibility of the free anterolateral thigh (ALT) flap for oncologic axillary reconstruction. Methods The extensive axillary defects in six patients with sarcoma was reconstructed using a free ALT flap. The defect size ranged from 15 × 11 to 28 × 25 cm2. Five patients had recurrent cases and the ipsilateral latissimus dorsi flap had been already used in three patients. Two patients with a full-thickness defect underwent chest wall reconstruction with the iliotibial tract. Results All flaps survived completely and the wounds healed without complications in all patients. Conclusions The free ALT flap is an ideal flap for axillary reconstruction after extensive sarcoma resection. It can be tailored to the requirements of the individual's defect and provides durable coverage for the axillary neurovascular bundle and intrathoracic structures. Flap harvesting in the lateral decubitus position enables a two-team approach. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.
- Published
- 2015
19. Clinical analysis of 33 flow-through latissimus dorsi flaps
- Author
-
Shimpei Miyamoto, Minoru Sakuraba, and Masahide Fujiki
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Anastomosis ,Surgical Flaps ,Recipient artery ,Young Adult ,Thoracic Arteries ,medicine.artery ,medicine ,Humans ,Child ,Pelvis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Circumflex scapular artery ,Clinical pathology ,business.industry ,Anastomosis, Surgical ,Retrospective cohort study ,Middle Aged ,Plastic Surgery Procedures ,Surgery ,medicine.anatomical_structure ,Regional Blood Flow ,Child, Preschool ,Scalp ,Superficial Back Muscles ,Feasibility Studies ,Female ,business - Abstract
Summary Introduction Indications for flow-through latissimus dorsi (LD) flaps have been limited for reconstructing distal extremities. In addition, there has been little discussion in regard to the question of which branch is most suitable as a distal runoff of the flow-through anastomosis. The aims of this study were to investigate the feasibility of flow-through LD flaps in various areas in the body and the rationale for branch selection for the distal runoff vessel. Methods This retrospective study included 33 patients who underwent reconstruction of an oncology-related defect with a free flow-through LD flap. Defect locations, branches used for the distal runoff, and postoperative complications were investigated. Results The defect location was in the lower extremity in 13 patients, the scalp in seven, the upper extremity in six, the pelvis in six, and the chest in one. In 19 of the 33 patients, the defects were located in areas other than the distal extremities. The circumflex scapular artery (CSA) was most frequently used as the distal runoff vessel (24 patients) followed by the serratus anterior branch (SAB) (five patients). All flaps were transferred successfully without anastomotic failure. Conclusions The flow-through LD flap is a reliable option for reconstruction in many areas of the body. It can provide high success rates not only for extremity reconstruction but also for scalp and pelvic reconstruction. The CSA matches well with the workhorse recipient vessels. The SAB is suitable when there is a vascular defect of the recipient artery.
- Published
- 2015
20. Combined use of anterolateral thigh flap and pharyngeal flap for reconstruction of extensive soft-palate defects
- Author
-
Yutaka Fukunaga, Minoru Sakuraba, Shimpei Miyamoto, Masahide Fujiki, Shogo Nagamatsu, and Ryuichi Hayashi
- Subjects
medicine.medical_specialty ,Soft palate ,business.industry ,medicine.medical_treatment ,Pharynx ,Palatal Neoplasms ,Thigh ,Microsurgery ,Prosthesis ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Medicine ,Surgical Flaps ,030223 otorhinolaryngology ,business ,Pharyngeal flap - Abstract
Background Functional reconstruction of extensive soft-palate defects is challenging for microsurgeons. The versatility of the combination of a free anterolateral thigh flap and a superiorly based pharyngeal flap for oncologic soft-palate reconstruction was investigated. Methods The combination of flaps was used for immediate reconstruction after total or subtotal resection of the soft palate in five consecutive patients from 2006 to 2011. Results All flaps survived completely. Palatal fistula and miniplate infection each developed in one patient but healed conservatively. Follow-up period ranged from 21 to 66 months. All patients tolerated a regular diet without significant aspiration or nasal regurgitation. Speech intelligibility was excellent in all patients, and none required a palatal prosthesis. Conclusions The combination of an anterolateral thigh flap and a superiorly based pharyngeal flap is a versatile option for reconstructing extensive soft-plate defects. This method is simple and achieves reproducible results with limited donor-site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.
- Published
- 2015
21. Flow-through anastomosis for both the artery and vein in leg free flap transfer
- Author
-
Shimpei Miyamoto, Minoru Sakuraba, and Masahide Fujiki
- Subjects
Oncologic resection ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Free flap ,Anastomosis ,Microsurgery ,medicine.disease ,Thrombosis ,Surgery ,Venous thrombosis ,medicine.anatomical_structure ,Medicine ,business ,Vein ,Artery - Abstract
Objective Free flap transfer is an essential part of limb-sparing surgery for leg sarcoma; however, this procedure is associated with a high failure rate. The aim of this study was to identify factors that contribute to microvascular compromise and flap failure for leg free flap transfer, while focusing on anastomotic techniques (end-to-end, end-to-side, and flow-through anastomoses). Patients and methods Data from 56 consecutive patients who underwent leg free flap transfer after oncologic resection were retrospectively reviewed. Of these patients, flow-through anastomosis was performed with the artery in 29 and the vein in 24, whereas conventional techniques were performed in others. The variables contributing to microvascular compromise and flap failure were statistically analyzed. Results Venous thrombosis (four patients, 7.1%) was more frequent than arterial thrombosis (one patient, 1.8%) and (4 patients, 7.1%) resulted in flap loss. All anastomotic failures occurred in end-to-end anastomoses. All flow-through anastomoses achieved patency both for the artery and vein. No anastomotic failure or flap loss occurred in 22 flaps which were transferred with flow-through anastomosis for both the artery and vein. Flow-through venous anastomosis tended to have a lower rate of microvascular compromise and flap loss than conventional techniques (P = 0.13 and 0.25, respectively). Conclusion The key to successful leg free flap transfer is to prevent venous failure; thus, flow-through venous anastomosis may be a breakthrough solution. Preferential use of flow-through anastomosis for both the artery and vein can provide predictable results in leg free flap transfer. © 2015 Wiley Periodicals, Inc. Microsurgery 35:536–540, 2015.
- Published
- 2015
22. Analysis of functional outcomes in patients with mandible reconstruction using vascularized fibular grafts
- Author
-
Minoru Sakuraba, Azusa Oshima, Ryuichi Hayashi, Masahide Fujiki, Shimpei Miyamoto, and Takuya Higashino
- Subjects
Normal diet ,business.industry ,medicine.medical_treatment ,Soft diet ,Mandible ,Dentistry ,030230 surgery ,Microsurgery ,Segmental Mandibulectomy ,Masticatory force ,Bite force quotient ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,Surgery ,In patient ,business - Abstract
Backgrounds Although a vascularized fibular graft (VFG) is the favored method for mandible reconstruction, only few functional reports have been published. In this study, surgical outcomes and functional results after mandible reconstruction were analyzed. Patients and methods From 1999 through 2010, oromandibular defects after segmental mandibulectomy were reconstructed with VFG in 101 patients. Operative outcomes and subjective functional evaluation was performed. Of these, 44 patients could be evaluated for functional outcomes, and bite force was measured with an occlusal force meter in 24 patients. Results Major surgical complications required secondary revisional surgery developed in four patients. A normal diet was possible in 37 patients (84.1%), and a soft diet was possible in 7 patients (15.9%). Conversational ability was rated as excellent in 42 patients (95.5%). The mean bite force on the nonaffected side of the mandible was 187.7 N, and bite force decreased as the number of osteotomies in the VFG increased. Furthermore, bite force was significantly lower (P = 0.001) on the affected side (58.2 N), compared to nonaffected side (191.9 N). Conclusions Although masticatory force decreases as the number of osteotomies increases, oral function after mandible reconstruction is satisfactory in most cases. Transfer of a VFG is a safe and reliable method for functional mandible reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.
- Published
- 2015
23. Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery
- Author
-
Fumihiko Nakatani, Shimpei Miyamoto, Minoru Sakuraba, Masahide Fujiki, and Masanobu Sakisaka
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Femoral artery ,Free flap ,Thigh ,Revascularization ,Popliteal artery ,Surgery ,medicine.anatomical_structure ,medicine.artery ,medicine ,Radiology ,Circumflex ,Surgical Flaps ,Fibula ,business - Abstract
Reconstruction of complex knee defects including the popliteal artery presents a challenging problem in reconstructive microsurgery. Reconstruction of the popliteal artery and soft-tissue coverage should be performed simultaneously for limb salvage. We present the one-stage reconstruction of a complex knee defect including the popliteal artery using a free flow-through anterolateral thigh (ALT) flap as a bypass flap in two patients with sarcomas. In both patients, the popliteal artery and vein were reconstructed using branches of the lateral circumflex femoral arterial system. The flaps survived without vascular compromise and the limbs were preserved successfully. Free flow-through ALT flap enables simultaneous leg revascularization and soft-tissue coverage with a single free flap. The lateral circumflex femoral arterial system has many branches with large diameters, making it suitable for reconstruction of multiple infrapopliteal arteries.
- Published
- 2015
24. A 'no-touch-technique' in mandibular reconstruction with reconstruction plate and free flap transfer
- Author
-
Ryuichi Hayashi, Minoru Sakuraba, Shogo Nagamatsu, Shimpei Miyamoto, and Masahide Fujiki
- Subjects
medicine.medical_specialty ,business.industry ,Wound dehiscence ,Fistula ,medicine.medical_treatment ,Perioperative ,Free flap ,030230 surgery ,Microsurgery ,medicine.disease ,Segmental Mandibulectomy ,Surgery ,03 medical and health sciences ,Venous thrombosis ,0302 clinical medicine ,stomatognathic system ,030220 oncology & carcinogenesis ,Bone plate ,Medicine ,business - Abstract
Objective Mandibular reconstruction with a mandibular reconstruction plate (MRP) and free flap transfer can involve serious plate-related complications. The aim of our study is to present our new “no-touch-technique” which keeps an MRP not contaminated to saliva during the entire operation for the reduction of plate-related complications. Patients and Methods Data were retrospectively collected on 29 patients who had undergone segmental mandibulectomy for head and neck tumor and mandibular reconstruction with an MRP and free flap transfer from 2004 to 2013; 12 patients were reconstructed with our no-touch-technique from 2010 to 2013 (no-touch-technique group), and 17 patients with the conventional technique from 2004 to 2009 (conventional group). A rectus abdominis musculocutaneous flap or anterolateral thigh flap was transferred in all patients. The rates of perioperative recipient site complications including total flap necrosis, partial flap necrosis, wound infection, fistula formation and wound dehiscence, and reoperation for complications were compared between the groups. Results All flaps were successfully transferred although one venous thrombosis formation occurred in the conventional group. The rate of wound infection in the no-touch-technique group (8.3%) was significantly lower than that in the conventional group (47.1%) (P = 0.04). Additionally, the rate of fistula formation in the no-touch-technique group (8.3%) tended to be lower than that in the conventional group (29.4%) (P = 0.35). Conclusion The results of our study showed that our no-touch-technique may be a safe and effective procedure for the prevention of perioperative plate-related complications for mandibular reconstruction with an MRP and free flap transfer. © 2015 Wiley Periodicals, Inc. Microsurgery 36:115–120, 2016.
- Published
- 2015
25. Rotationplasty with Vascular Reconstruction for Prosthetic Knee Joint Infection
- Author
-
Shimpei Miyamoto, Fumihiko Nakatani, Masahide Fujiki, Minoru Sakuraba, and Akira Kawai
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,Prosthetic joint ,medicine.medical_treatment ,Rotationplasty ,Prosthetic limb ,Case Report ,General Medicine ,medicine.disease ,Prosthesis ,Thrombosis ,Surgery ,lcsh:RD701-811 ,lcsh:Orthopedic surgery ,Vascular reconstruction ,Prosthetic knee ,medicine ,Femur ,business - Abstract
Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.
- Published
- 2015
26. Venous-supercharged freestyle posterior thigh flap without a descending branch of the inferior gluteal artery for reconstruction in the infragluteal region
- Author
-
Eisuke Kobayashi, Yutaka Fukunaga, Minoru Sakuraba, and Shimpei Miyamoto
- Subjects
Male ,medicine.medical_specialty ,Fibrosarcoma ,Combined use ,Soft Tissue Neoplasms ,Posterior thigh flap ,Transplant Donor Site ,Biceps ,medicine.artery ,Inferior gluteal artery ,medicine ,Humans ,Vein ,Aged ,Vascular pedicle ,business.industry ,Anatomy ,medicine.disease ,Myocutaneous Flap ,Surgery ,body regions ,medicine.anatomical_structure ,Thigh ,Buttocks ,Sarcoma ,Sciatic nerve ,business - Abstract
The posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer.
- Published
- 2014
27. The Superior Rectal Artery as a Recipient Vessel for Free Flap Transfer After Partial Sacrectomy in Patients With Chordoma
- Author
-
Eisuke Kobayashi, Minoru Sakuraba, Masaki Arikawa, Shimpei Miyamoto, Akira Kawai, and Masahide Fujiki
- Subjects
Male ,0301 basic medicine ,Sacrum ,medicine.medical_specialty ,Rectum ,Free flap ,Anastomosis ,Free Tissue Flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Chordoma ,Humans ,Medicine ,Superior rectal artery ,Spinal Neoplasms ,business.industry ,Arteries ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,body regions ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Superficial Back Muscles ,cardiovascular system ,030101 anatomy & morphology ,business ,Sacral Chordoma ,Lumbosacral joint - Abstract
Free flaps have rarely been used to reconstruct lumbosacral defects, primarily because of the lack of suitable recipient vessels in this region. We propose the novel use of the superior rectal artery as a recipient vessel for free flap transfer after partial or total sacrectomy. We transferred free flow-through latissimus dorsi musculocutaneous flaps, with the superior rectal vessels as recipient vessels, to reconstruct defects after partial sacrectomy in 2 patients with sacral chordoma. The flaps survived completely, and the wounds healed uneventfully in both patients. The superior rectal artery is easier to dissect and anastomose than are gluteal vessels and is less affected by patients' postoperative postural change than are extraperitoneal vessels. We believe that the superior rectal artery is a versatile recipient vessel for free flap transfer to reconstruct sacrectomy defects.
- Published
- 2016
28. Comparison of Donor Site Drainage Duration and Seroma Rate Between Latissimus Dorsi Musculocutaneous Flaps and Thoracodorsal Artery Perforator Flaps
- Author
-
Minoru Sakuraba, Shimpei Miyamoto, Azusa Oshima, Masaki Arikawa, Masahide Fujiki, and Takuya Higashino
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Mammaplasty ,030230 surgery ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,medicine.artery ,medicine ,Humans ,Drainage ,Aged ,Retrospective Studies ,Aged, 80 and over ,Thoracodorsal artery ,Musculocutaneous Flaps ,business.industry ,Retrospective cohort study ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Myocutaneous Flap ,Surgery ,body regions ,Seroma ,Treatment Outcome ,030220 oncology & carcinogenesis ,Superficial Back Muscles ,Female ,Breast reconstruction ,business ,Perforator Flap ,Perforator flaps - Abstract
Introduction Donor site seroma formation and prolonged drainage duration are common complications of using latissimus dorsi musculocutaneous (LDMC) flaps. The present retrospective study aimed to investigate the effect of types of back flap harvest on drainage duration and seroma formation rates. Methods Adult patients (n = 155) who underwent reconstruction with a latissimus dorsi flap from January 2010 to October 2015 were included in the study, of which 54 patients underwent breast reconstruction with a pedicled LDMC flap (LD breast group), 80 patients underwent an LDMC flap transfer for purposes other than breast reconstruction (LD nonbreast group), and 21 patients underwent soft tissue reconstruction with a thoracodorsal artery perforator (TAP) flap (TAP group). Flap size, drainage durations, and seroma formation rates at donor sites were compared among the 3 groups. Results Flap sizes significantly differed between the LD nonbreast group (median value, 185.5 cm) and the other 2 groups (119 cm in the LD breast group. 127.5 cm in the TAP group), with no significant difference observed between the LD breast and TAP groups. The mean drainage duration was 11.6 days for the LD breast group. 9.82 days for the LD nonbreast group, and 4.81 days for the TAP group. Drainage durations significantly differed among the groups. Seroma formation rate of the LD breast group (42.6%) was significantly higher than those of the other groups. Conclusions The type of back flap harvest used significantly affected drainage duration and seroma formation rate in the present study. Lumbar fat extension with the use of a LDMC flap for breast reconstruction may lead to seroma formation. Thoracodorsal artery perforator flaps are associated with minimal risks of seroma formation and significantly shortened drainage duration compared with LDMC flaps.
- Published
- 2017
29. Accompanying artery of sciatic nerve as recipient vessel for free-flap transfer: A computed tomographic angiography study and case reports
- Author
-
Yutaka Fukunaga, Yoshikazu Tanzawa, Shimpei Miyamoto, Fumihiko Nakatni, Minoru Sakuraba, and Masahide Fujiki
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Free flap ,Posterior compartment of thigh ,Microsurgery ,Thigh ,Surgery ,Computed tomographic angiography ,medicine.anatomical_structure ,medicine ,Recipient vessel ,Sciatic nerve ,Radiology ,business ,Artery - Abstract
Suitable recipient vessels for free-flap transfer are hard to find in the posterior thigh. To investigate the versatility of accompanying artery of sciatic nerve as a recipient vessel in this region, we performed computed tomographic angiographic study of 20 consecutive healthy thighs in 10 patients. The presence and internal diameter of the accompanying artery were studied. The accompanying artery of the sciatic nerve was present in 11 thighs (55%) and the internal diameter of the artery at the mid-thigh level ranged from 2.1 to 3.2 mm. We used this artery as a recipient vessel for free flaps transferred to reconstruct extensive thigh defects in three patients with sarcomas. In all patients the flaps survived without vascular compromise. No sensory or motor dysfunction in the sciatic nerve distribution occurred in any patients. We believe that the accompanying artery of the sciatic nerve may be a recipient vessel for free-flap transfer in selected patients. © 2014 Wiley Periodicals, Inc. Microsurgery 35:284–289, 2015.
- Published
- 2014
30. Risk factors for tracheal necrosis after total pharyngolaryngectomy
- Author
-
Minoru Sakuraba, Masahide Fujiki, Shimpei Miyamoto, Shogo Nagamatsu, and Ryuichi Hayashi
- Subjects
Univariate analysis ,medicine.medical_specialty ,Necrosis ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,Tracheoesophageal fistula ,Hypopharyngeal cancer ,respiratory system ,Esophageal cancer ,medicine.disease ,Surgery ,Laryngectomy ,Otorhinolaryngology ,Esophagectomy ,medicine ,medicine.symptom ,business - Abstract
Background Tracheal necrosis is a severe complication of total pharyngolaryngectomy (TPL). The purpose of this retrospective study was to identify risk factors for tracheal necrosis after TPL. Methods We performed a retrospective chart review of 177 patients who had undergone TPL. The preoperative, operative, and postoperative variables were examined, and possible risk factors for tracheal necrosis were subjected to univariate analysis and multivariate logistic regression. Results Tracheal necrosis occurred in 35 patients (19.8%), and tracheoesophageal fistula subsequently developed in 3 of these patients. Multivariate logistic regression analysis identified total esophagectomy and diabetes mellitus as significant risk factors for tracheal necrosis after TPL. Conclusion The findings of this study will be useful for assessing the risk of tracheal necrosis after TPL. In patients at high risk for tracheal necrosis, efforts should be made to preserve the tracheal circulation and to prevent life-threatening sequelae if tracheal necrosis occurs. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1207–1210, 2015
- Published
- 2014
31. Statistical Analysis of Surgical Site Infection After Head and Neck Reconstructive Surgery
- Author
-
Ryuichi Hayashi, Minoru Sakuraba, Shimpei Miyamoto, Shogo Nagamatsu, and Kenichi Kamizono
- Subjects
Adult ,Male ,Reconstructive surgery ,medicine.medical_specialty ,Multivariate analysis ,Adolescent ,Free Tissue Flaps ,Young Adult ,Postoperative Complications ,Risk Factors ,Surgical oncology ,medicine ,Humans ,Surgical Wound Infection ,Prospective Studies ,Hypoalbuminemia ,Young adult ,Prospective cohort study ,Aged ,Neoplasm Staging ,Aged, 80 and over ,business.industry ,Cancer ,Odds ratio ,Middle Aged ,Plastic Surgery Procedures ,Prognosis ,medicine.disease ,Surgery ,Oncology ,Head and Neck Neoplasms ,Female ,business ,Follow-Up Studies - Abstract
Surgical site infections (SSIs) occur at a rate exceeding 40 % after head and neck reconstruction and are due in part to the clean-contaminated surgical field, in which cutaneous fields interact with oral or pharyngeal fields. The aim of this study was to clarify the most important risk factors for SSI and to identify effective strategies for preventing SSI. In 2011 and 2012, 197 patients who underwent head and neck reconstructive surgery were studied at National Cancer Center Hospital East, Japan. The SSI rate, risk factors for SSI, and biological aspects of SSI were evaluated prospectively. A total of 42 patients (21.3 %) had SSIs, and 62 bacterial species were identified at infection sites. Significant risk factors for SSI identified with multivariate analysis were hypoalbuminemia [P = 0.002, odds ratio (OR) = 3.37], reconstruction with vascularized bone transfer (P = 0.006, OR = 3.99), and a poor American Society of Anesthesiologists Physical Status score (P = 0.041, OR = 3.00). Most bacteria identified were species that persist around cutaneous and pharyngeal fields, but multidrug-resistant bacteria were rare. The SSI rate at our hospital is lower than rates in previous studies. To minimize SSI, intervention to improve the patient’s perisurgical nutritional status and a more appropriate mandible reconstructive strategy should be considered.
- Published
- 2014
32. Immediate soft-tissue reconstruction using a rectus abdominis myocutaneous flap following wide resection of malignant bone tumours of the pelvis
- Author
-
Minoru Sakuraba, Shimpei Miyamoto, Hirokazu Chuman, Koichi Ogura, Tomohiro Fujiwara, and Akira Kawai
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Rectus Abdominis ,Bone Neoplasms ,Prosthesis ,Surgical Flaps ,Soft tissue reconstruction ,Humans ,Medicine ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Pelvic Bones ,Pelvis ,Retrospective Studies ,business.industry ,Wound dehiscence ,Soft tissue ,Skin Transplantation ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Hemipelvectomy ,Treatment Outcome ,medicine.anatomical_structure ,Rectus abdominis myocutaneous flap ,Female ,Sarcoma ,business ,Follow-Up Studies - Abstract
Resection of malignant bony tumours of the pelvis creates large bone and soft-tissue defects, and is frequently associated with complications such as wound dehiscence and deep infection. We present the results of six patients in whom a rectus abdominis myocutaneous (RAM) flap was used following resection of a malignant tumour of the pelvis. Bony reconstruction was performed using a constrained hip tumour prosthesis in three patients, vascularised fibular graft in two and frozen autograft in one. At a mean follow-up of 63 months (16 to 115), no patients had a problem with the wound. Immediate reconstruction using a RAM flap may be used after resection of a malignant tumour of the pelvis to provide an adequate volume of tissue to eliminate the dead space, cover the exposed bone or implants with well-vascularised soft tissue and to reduce the risk of complications. Cite this article: Bone Joint J 2014;96-B:270–3.
- Published
- 2014
33. Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects
- Author
-
Minoru Sakuraba, Shimpei Miyamoto, Fumihiko Nakatani, Yutaka Fukunaga, Junichi Nakao, Shuji Kayano, Eisuke Kobayashi, and Kenichi Kamizono
- Subjects
Sartorius muscle ,medicine.medical_specialty ,Groin ,business.industry ,Superficial femoral artery ,medicine.medical_treatment ,Microsurgery ,medicine.disease ,eye diseases ,Surgery ,medicine.anatomical_structure ,Femoral triangle ,Medicine ,Radiology ,Sarcoma ,business ,Wide resection ,Perforator flaps - Abstract
Soft-tissue defects after wide resection of groin sarcomas have been reconstructed with well-characterized flaps, such as rectus abdominis, gracilis, and anterolateral thigh flaps. To our knowledge, the use of superficial femoral artery perforator (S-FAP) flaps for this purpose has not been reported. We report on three female patients in whom groin defects after sarcoma resection were reconstructed with pedicled S-FAP flaps. The dimensions of the skin defects ranged from 13.5 × 11 to 16 × 14.5 cm. Sizable perforators from the superficial femoral arteries were identified preoperatively around the apex of the femoral triangle with computed tomographic angiography or color Doppler ultrasonography. The lengths of the flaps ranged from 17 to 19 cm. The main perforator penetrated the sartorius muscle in two patients and emerged between the sartorius and the adductor longus muscles in the other patient. The postoperative course was uneventful, and results were satisfactory in all patients. The main advantages of the S-FAP flap over more commonly used flaps are that it is easier to harvest and is associated with less donor-site morbidity. We believe that the S-FAP flap may be a versatile option for the coverage of groin defects. © 2014 Wiley Periodicals, Inc. Microsurgery 34:470–474, 2014.
- Published
- 2014
34. Mandible reconstruction with a vascularized fibular graft (Review Article)
- Author
-
Minoru Sakuraba
- Subjects
Orthodontics ,business.industry ,Mandible ,Medicine ,business ,Review article - Published
- 2014
35. Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction
- Author
-
Shuji Kayano, Masahide Fujiki, Minoru Sakuraba, and Shimpei Miyamoto
- Subjects
Cephalic vein ,medicine.medical_specialty ,business.industry ,Internal Mammary Vein ,Combined use ,Anastomosis ,Surgery ,Jejunum ,medicine.anatomical_structure ,medicine.vein ,Pectoralis major muscle flap ,cardiovascular system ,medicine ,Surgical Flaps ,business ,Vein - Abstract
Secondary reconstruction of thoracic esophageal defects is a challenging problem for microsurgeons. Because of previous surgeries and coexisting disease, gastric pull-up, and creation of a pedicled colon conduit are often impossible. Transfer of a supercharged pedicled jejunum flap or free jejunal interposition is usually the last resort; however, identifying appropriate recipient vessels and adequately covering the reconstructive conduit are often difficult. We performed secondary thoracic esophageal reconstruction with combined use of the cephalic vein as a recipient vein and the pectoralis major muscle flap for coverage in three patients. Two patients underwent transfer of a supercharged pedicled jejunum flap, and the other patient underwent free jejunal interposition. No wound complications occurred, and all patients could resume oral intake. The cephalic vein is a more reliable recipient vein than is the internal mammary vein. The skin graft-covered pectoralis major muscle flap provides secure external coverage to prevent anastomotic leakage even in complicated cases. Combined use of the cephalic vein and the skin graft-covered pectoralis major muscle flap is a versatile option for secondary thoracic esophageal reconstruction.
- Published
- 2013
36. Clinical factors associated with postoperative complications and the functional outcome in mandibular reconstruction
- Author
-
Hiroyuki Sakurai, Yoshihiro Kimata, Akihiko Takushima, Masahiro Nakagawa, Sunao Tsuchiya, Takashi Nakatsuka, and Minoru Sakuraba
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mandible ,Dentistry ,Retrospective cohort study ,Free flap ,Microsurgery ,Logistic regression ,Surgery ,Statistical significance ,Bone plate ,medicine ,Segmental resection ,business - Abstract
Background Few studies have performed a multiple factor analysis to assess the factors associated with successful mandibular reconstructions in a large number of subjects. The purpose of this study is to evaluate the functional outcome in mandibular reconstruction by means logistic regression analysis. Methods Since April 2005 to September 2009, 126 patients underwent segmental resection of the mandible for cancer ablation and mandibular reconstruction with free flaps at 6 Japanese institutions. The patients' charts were reviewed retrospectively. Twelve patients were excluded for the reconstruction was with double flaps, or they went under secondary reconstruction. With logistic regression analysis in 114 subjects, we assessed multiple factors influencing postoperative speech intelligibility, feeding ability, and postoperative complications of mandibular reconstruction. Results The use of a reconstruction plate with a soft-tissue free flap only was showed to have a deleterious effect on postoperative feeding. The strong association in the level of statistical significance between the use of a reconstruction plate with soft-tissue free flaps only and the occurrences of major complications was indicated. It was also statistically revealed that the postoperative presence of opposing teeth contributed to both speech intelligibility and oral intake. Conclusions In our research, osteocutaneous flaps were superior to reconstruction plates with soft-tissue free flaps regard to the postoperative feeding ability and major complication rate. © 2013 Wiley Periodicals, Inc. Microsurgery 33:337–341, 2013.
- Published
- 2013
37. Closure of difficult pharyngocutaneous fistula following salvage laryngectomy: case report
- Author
-
Takeshi Shinozaki, Simpei Miyamoto, Minoru Sakuraba, Shogo Nagamatsu, Nobuko Suesada, and Ryuichi Hayashi
- Subjects
medicine.medical_specialty ,Oncology ,Otorhinolaryngology ,Salvage laryngectomy ,business.industry ,Closure (topology) ,Medicine ,Pharyngocutaneous Fistula ,business ,Surgery - Published
- 2013
38. Reuse of same recipient vessels for head and neck second free-flap reconstruction
- Author
-
Ryuichi Hayashi, Shuji Kayano, Masao Asai, Shogo Nagamatsu, Shimpei Miyamoto, and Minoru Sakuraba
- Subjects
medicine.medical_specialty ,Oncology ,Otorhinolaryngology ,business.industry ,Medicine ,Free flap reconstruction ,Reuse ,business ,Head and neck ,Surgery - Published
- 2013
39. Recent advances in reconstructive surgery: head and neck reconstruction
- Author
-
Takashi Nakatsuka, Yoshihiro Kimata, Shimpei Miyamoto, Satoshi Ebihara, Ryuichi Hayashi, Minoru Sakuraba, and Kiyonori Harii
- Subjects
medicine.medical_specialty ,Reconstructive surgery ,medicine.medical_treatment ,Free flap ,Free Tissue Flaps ,Surgical Flaps ,Japan ,Surgical oncology ,medicine ,Humans ,Head and neck ,business.industry ,General surgery ,Hematology ,General Medicine ,Plastic Surgery Procedures ,Microsurgery ,Surgery ,Review article ,Radiation therapy ,Oncology ,Head and Neck Neoplasms ,business ,Head ,Neck - Abstract
Although advances in radiotherapy and chemotherapy for cancers of the head and neck have been remarkable, surgical resection followed by reconstructive surgery is still the mainstay of treatment. Of the reconstructive procedures, microsurgical tissue transfer has been considered the standard method for restoring postoperative functions and morphology. In this review article, we discuss the history of reconstructive surgery for treating cancers of the head and neck, current problems, and future challenges.
- Published
- 2012
40. Reconstruction of Complex Groin Defects After Sarcoma Resection
- Author
-
Masahide Fujiki, Minoru Sakuraba, Eisuke Kobayashi, Masanobu Sakisaka, Fumihiko Nakatani, and Shimpei Miyamoto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Treatment outcome ,Bone Neoplasms ,030230 surgery ,Groin ,Risk Assessment ,Surgical Flaps ,Resection ,Abdominal wall ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Wound Healing ,business.industry ,Graft Survival ,Follow up studies ,Sarcoma ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Limb Salvage ,Surgery ,body regions ,surgical procedures, operative ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Graft survival ,Female ,business ,Follow-Up Studies - Abstract
Complex groin defects after sarcoma resection require reconstruction of multiple vital structures that can include the major vessels, the overlying skin, the abdominal wall, and the hip joint. We investigated the feasibility of limb preservation after complex groin reconstruction.The subjects were 12 consecutive patients who underwent complex groin reconstruction after sarcoma resection. In all patients, the defect included a major artery (external iliac or femoral) and overlying skin. The defect included the abdominal wall in 5 patients and the hip joint in 2. Arterial reconstruction was performed with an autologous vein graft in 9 patients and with an expanded polytetrafluoroethylene graft in 3. Soft-tissue coverage was performed with a pedicled rectus abdominis musculocutaneous flap in 7 patients, a free latissimus dorsi musculocutaneous flap in three, and a free anterolateral thigh flap in 2.Postoperative complications occurred in 7 patients (58.3%). Limb salvage was possible in 8 patients (66.7%) with 39 months' median follow-up. Two patients required amputation because of wound problems, and 2 required amputation because of local recurrence of the tumor.Limb salvage is possible even after extensive resection of groin sarcoma, although the rate of postoperative wound complications is substantial. Proper selection of the arterial conduit and the soft-tissue flap, depending on the components of the defect, are mandatory for successful reconstruction.
- Published
- 2016
41. Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital
- Author
-
Yoshihiro, Kimata, Hiroshi, Matsumoto, Narusi, Sugiyama, Satoshi, Onoda, and Minoru, Sakuraba
- Subjects
Hospitals, University ,Microsurgery ,Treatment Outcome ,Japan ,Head and Neck Neoplasms ,Humans ,Plastic Surgery Procedures ,Head ,Neck - Abstract
The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods.
- Published
- 2016
42. Longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction
- Author
-
Shimpei Miyamoto, S Zenda, Masahide Fujiki, and Minoru Sakuraba
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Free flap ,Surgical Flaps ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Swallowing ,Tongue ,Percutaneous endoscopic gastrostomy ,medicine ,Humans ,Longitudinal Studies ,030223 otorhinolaryngology ,Aged ,Retrospective Studies ,Adjuvant radiotherapy ,business.industry ,Glossectomy ,General surgery ,Tongue reconstruction ,General Medicine ,Middle Aged ,Plastic Surgery Procedures ,Dysphagia ,Combined Modality Therapy ,Surgery ,Deglutition ,Tongue Neoplasms ,Radiation therapy ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,medicine.symptom ,business ,Deglutition Disorders - Abstract
Objective:This study evaluated the longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction.Methods:The study comprised 16 patients who had: undergone glossectomy and tongue reconstruction with free flap transfer, received adjuvant radiotherapy, and survived without recurrence for at least 1 year. Swallowing function, as indicated by tolerance of oral intake, was evaluated before radiotherapy, at radiotherapy completion, and at 6 and 12 months after radiotherapy completion.Results:Before radiotherapy, all patients could tolerate oral intake. At radiotherapy completion, only three patients could consume all nutrition orally. However, swallowing function improved over time, and by 12 months after radiotherapy completion it had returned nearly to that before radiotherapy.Conclusion:Acute dysphagia due to radiotherapy after tongue reconstruction is severe, but can improve gradually. Multidisciplinary support of patients during percutaneous endoscopic gastrostomy dependence is important to improve long-term functional outcomes.
- Published
- 2016
43. Single venous anastomosis versus dual venous anastomoses in free anterolateral thigh flap transfer: A cohort study
- Author
-
Takuya Higashino, Minoru Sakuraba, Masahide Fujiki, Azusa Oshima, and Shimpei Miyamoto
- Subjects
Adult ,Male ,medicine.medical_specialty ,030230 surgery ,Anastomosis ,Free Tissue Flaps ,Surgical methods ,Veins ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Aged ,Thigh surgery ,Aged, 80 and over ,business.industry ,Anastomosis, Surgical ,Anterolateral thigh ,Middle Aged ,Plastic Surgery Procedures ,Surgery ,Thigh ,030220 oncology & carcinogenesis ,Venous anastomosis ,Female ,business ,Cohort study - Published
- 2016
44. Combined use of free jejunum and pectoralis major muscle flap with skin graft for reconstruction after salvage total pharyngolaryngectomy
- Author
-
Kenichi Kamizono, Shimpei Miyamoto, Minoru Sakuraba, Ryuichi Hayashi, Masahide Fujiki, and Shogo Nagamatsu
- Subjects
medicine.medical_specialty ,integumentary system ,business.industry ,medicine.medical_treatment ,Combined use ,Salvage therapy ,Pharyngocutaneous Fistula ,Total pharyngolaryngectomy ,Surgery ,Laryngectomy ,Jejunum ,medicine.anatomical_structure ,Pectoralis major muscle flap ,medicine ,Pectoralis Muscle ,business - Abstract
Salvage total pharyngolaryngectomy after failed organ-preserving therapy often results in composite defects involving the alimentary tract, trachea, and neck skin. This retrospective study examined combined use of the free jejunum flap and the pectoralis major muscle flap with skin graft for such a complex reconstruction. We reviewed 11 patients who underwent free jejunum transfer for alimentary reconstruction and pedicled pectoralis major muscle flap transfer with a skin graft on the muscle for simultaneous neck skin resurfacing after salvage total pharyngolaryngectomy from 2005 through 2010. The operative morbidity rate was 27.3%. No pharyngocutaneous fistula developed in this series. Oral intake could be resumed within 3 weeks after surgery in all patients. Seven of 11 patients had a functional tracheostoma with adequate stomal patency. Combined use of free jejunum and pectoralis major muscle flap with skin graft provided secure wound closure even for complicated cases.
- Published
- 2012
45. Thoracoacromial vessels as recipients for head and neck reconstruction and cause of vascular complications
- Author
-
Yoshihiro Kimata, Ryuichi Hayashi, Masao Asai, Takayuki Asano, Satoshi Onoda, Shimpei Miyamoto, and Minoru Sakuraba
- Subjects
medicine.medical_specialty ,Reconstructive surgery ,business.industry ,medicine.medical_treatment ,Neck dissection ,Microsurgery ,medicine.disease ,Thrombosis ,Reconstruction method ,Surgery ,Radiation therapy ,Venous thrombosis ,cardiovascular system ,Medicine ,Radiology ,business ,Head and neck - Abstract
Background: The choice of recipient vessels is an important factor for successful head and neck reconstruction. Finding good recipient vessels for neck microsurgery can be difficult after patients have undergone radiation therapy, previous neck dissection or developed neck infections due to pharyngocutaneous fistulae. Thoracoacromial arteries and veins can be good alternatives to common recipient vessels in such patients. We reviewed the complications, advantages and disadvantages associated with using thoracoacromial arteries and veins as recipient vessels. Methods: We reviewed eight patients whose thoracoacromial arteries and veins served as recipient vessels for head and neck reconstruction between 2002 and 2009. Preoperative status, reconstruction method and operative outcomes with complications were evaluated. Results: Postoperative complications related to microsurgical anastomosis developed in two of the eight patients. One arterial and venous thrombosis developed in each patient. We considered that the arterial thrombosis was derived from a technical problem with the operation and the venous thrombosis was derived from postoperative external pressure. Conclusions: Thoracoacromial arteries and veins are good recipient vessels for patients who have undergone ablative or reconstructive surgery, radiation therapy, or have a neck infection due to complications. However, we believe that using these vessels as recipients requires specific precautions that differ from those associated with general head and neck reconstruction. © 2011 Wiley Periodicals, Inc. Microsurgery, 2011
- Published
- 2011
46. Salvage total pharyngolaryngectomy and free jejunum transfer
- Author
-
Minoru Sakuraba, Shogo Nagamatsu, Ryuichi Hayashi, and Shimpei Miyamoto
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Salvage therapy ,Retrospective cohort study ,Hypopharyngeal cancer ,Anastomosis ,medicine.disease ,Thrombosis ,Surgery ,Laryngectomy ,Radiation therapy ,Otorhinolaryngology ,medicine ,business ,Chemoradiotherapy - Abstract
Objectives/Hypothesis: The objective of this retrospective study was to examine the safety and efficacy of free jejunum transfer after total pharyngolaryngectomy after radiotherapy (RT) or chemoradiotherapy (CRT) to the neck for patients with recurrent or second primary disease. Study Design: Retrospective study. Methods: A total of 313 patients were divided into two groups on the basis of a history of RT to the neck: 86 patients had received RT and 227 patients had not. The patients who had received RT were subdivided on the basis of the type of previous treatment: those who had received RT alone (32 patients) and those who had undergone concurrent CRT (54 patients). Postoperative complications were compared between RT and non-RT groups and between the RT-alone and CRT groups. Results: The rates of complications did not differ significantly between the RT and non-RT groups, but the rates of anastomotic thrombosis and carotid rupture were slightly but not significantly higher in the RT group than in the non-RT group. The overall complication rate did not differ between the RT-alone group and the CRT group. Conclusions: Pharyngolaryngectomy and free jejunum transfer can be performed safely, even in patients who have received RT, without significant increases in morbidity or mortality. However, a risk of carotid rupture due to pharyngocutaneous fistula remains in patients who have received RT, and prevention and early detection of fistulas are crucial. The risk of postoperative complications is not higher with CRT than with RT alone.
- Published
- 2011
47. Window resection of the trachea and secondary reconstruction for invasion by differentiated thyroid carcinoma
- Author
-
Shinpei Miyamoto, Hiroyuki Daiko, Minoru Sakuraba, Masakazu Miyazaki, Ryuichi Hayashi, Masahisa Saikawa, Takeshi Shinozaki, Mitsuru Ebihara, and Seiji Kishimoto
- Subjects
Male ,medicine.medical_specialty ,Anastomosis ,Disease-Free Survival ,Thyroid carcinoma ,Cricoid cartilage ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,Thyroid Neoplasms ,Aged ,Retrospective Studies ,Ultrasonography ,business.industry ,Cartilage ,Anastomosis, Surgical ,Cancer ,Retrospective cohort study ,General Medicine ,Middle Aged ,Prognosis ,Costal cartilage ,medicine.disease ,Carcinoma, Papillary ,Surgery ,Trachea ,medicine.anatomical_structure ,Otorhinolaryngology ,Thyroidectomy ,Female ,Tomography, X-Ray Computed ,business ,Follow-Up Studies - Abstract
Objective In cases of differentiated thyroid carcinoma, the presence or absence of invasion into the circumferential organs is an important prognostic factor. Surgical procedures include circular resection of the trachea with end-to-end anastomosis and window resection with secondary closure. We have used window resection with secondary closure since 1993, and herein retrospectively analyze the treatment outcomes for this surgical procedure in order to determine the indications for procedure selection. Methods Subjects comprised 41 cases of invasion by differentiated thyroid carcinoma into the trachea, for which surgery was performed at the Department of Head and Neck Surgery of the National Cancer Center Hospital East from 1993 to 2007. The mean age was 65.7 ± 7.9 years, and the median length of the observation period was 43 months. There were 17 cases (41.4%) cases of secondary relapse. Results The 5-year and 10-year overall survival rates for this surgical procedure were 78.9% and 74.5%, respectively, while the 5-year and 10-year local control rates were 92.4% and 73.4%, respectively. The pathological resection stump was positive in 27 cases (65.8%), but no significant differences in treatment outcome were observed between the stump-positive group and the stump-negative group. There were 26 cases in which closure of the tracheal fistula was performed by the time of observation. When the tracheal defect had a diameter equivalent to 7 rings of the trachea or less and a circumference half that of the tracheal cartilage or smaller, including partial cricoid cartilage, it was possible to perform closure with only a local flap. For larger defects, reconstruction was performed using hard tissues or materials, such as hydroxyapatite, titanium mesh, and costal cartilage. There were 2 cases that required re-window because of dyspnea after closure. Conclusion The treatment outcomes for this surgical procedure for invasive cases of differentiated thyroid carcinoma into the trachea resulted in a low rate of local recurrence and similar survival rates as described in other reports. Even for cases of resection exceeding half the circumference of the trachea, closure of the tracheal fistula can be performed using hard tissues or materials; however, in such cases, we believe that closure should be attempted progressively in a two-stage reconstruction.
- Published
- 2011
48. One-stage reconstruction of a tracheal defect with a free radial forearm flap and free costal cartilage grafts
- Author
-
Yutaka Fukunaga, Seiichi Yoshimoto, Minoru Sakuraba, Koreyuki Kurosawa, Masanobu Sakisaka, Shuji Kayano, Shimpei Miyamoto, and Masahide Fujiki
- Subjects
Adult ,Male ,Microsurgery ,medicine.medical_specialty ,medicine.medical_treatment ,Ribs ,Free Tissue Flaps ,Risk Assessment ,Tracheotomy ,Forearm ,Tracheal Neoplasm ,Humans ,Medicine ,Postoperative Care ,Rib cage ,business.industry ,Cartilage ,Anastomosis, Surgical ,Carcinoma ,Graft Survival ,Anatomy ,Plastic Surgery Procedures ,respiratory system ,Costal cartilage ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Tracheal Neoplasms ,business ,Airway ,Follow-Up Studies - Abstract
Reconstructing the trachea is challenging because of its multilayer structure and airway function; multiple procedures are often required. We report a case of one-stage reconstruction for a tracheal defect. The surgery was performed with a free radial forearm flap and free costal cartilage grafts. Air leakage occurred postoperatively but healed without additional surgery. The reconstructed trachea has retained its shape, diameter and airway function for 14 months despite the patient's history of radiotherapy. This one-stage procedure with well-vascularised tissue was successfully used to reconstruct a stable, well-functioning trachea.
- Published
- 2014
49. Phase I trial of chemoradiotherapy with the combination of S-1 plus cisplatin for patients with unresectable locally advanced squamous cell carcinoma of the head and neck
- Author
-
Makoto Tahara, Ryuichi Hayashi, Kazuto Matsuura, Mitsuhiko Kawashima, Atsushi Ohtsu, Kenji Kawada, Hirofumi Mukai, Minoru Sakuraba, Hironobu Minami, and Takashi Ogino
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Administration, Oral ,Capsules ,Kaplan-Meier Estimate ,Suspensions ,Pharmacokinetics ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Feeding tube ,Aged ,Neoplasm Staging ,Tegafur ,Chemotherapy ,Radiotherapy ,business.industry ,Head and neck cancer ,Area under the curve ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Head and neck squamous-cell carcinoma ,Surgery ,Drug Combinations ,Oxonic Acid ,Oncology ,Head and Neck Neoplasms ,Area Under Curve ,Carcinoma, Squamous Cell ,Female ,Cisplatin ,business ,Febrile neutropenia ,Chemoradiotherapy - Abstract
The aim of the present study was to determine the maximum tolerated dose (MTD) of S-1 in combination with chemoradiotherapy (CRT) in patients with unresectable locally advanced squamous cell carcinoma of the head and neck, and evaluate the difference in pharmacokinetics of S-1 when administered as a suspension via a feeding tube or orally as a capsule. Chemotherapy consisted of administration of S-1 twice daily on days 1–14 at escalating doses of 40, 60 and 80 mg/m2 per day, and cisplatin at 20 mg/m2 per day on days 8–11, repeated twice at a 5-week interval. Single daily radiation of 70 Gy in 35 fractions was given concurrently starting on day 1. Two additional cycles of chemotherapy were planned after the completion of CRT. Before starting CRT, each patient received S-1 via two different administration methods. Twenty-two patients were enrolled. The MTD was reached with S-1 at 80 mg/m2 per day, with two of six patients experiencing febrile neutropenia lasting more than 4 days. All four patients whose creatinine clearance was decreased to
- Published
- 2010
50. One-sided soft palatal reconstruction with an anterolateral thigh fasciocutaneous flap: Report of two cases
- Author
-
Minoru Sakuraba, Sunao Tsuchiya, and Takashi Nakatsuka
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Adenoma, Pleomorphic ,Free Tissue Flaps ,medicine ,Humans ,Fascia ,Aged ,Palatal Neoplasms ,Radial forearm ,Soft palate ,business.industry ,Skin Transplantation ,Middle Aged ,Plastic Surgery Procedures ,Microsurgery ,Anterolateral thigh ,Salivary Gland Neoplasms ,Surgery ,Fasciocutaneous flap ,Treatment Outcome ,medicine.anatomical_structure ,Thigh ,One sided ,Cuff ,Carcinoma, Squamous Cell ,Palate, Soft ,business - Abstract
Soft palate reconstruction is one of the greatest challenges for reconstructive surgeons. In the last 2 decades, anterolateral thigh (ALT) flaps have emerged as a popular reconstructive option because of the low donor morbidity, replacing radial forearm (RF) flaps. For soft palatal reconstructions, however, the RF flap remains the option of first choice, and only a few reports have described soft palatal reconstruction using an ALT flap. At our hospital, ALT flaps were utilized in two cases with soft palatal tumors. During the operation, the nasal side was left unepithelized. To prevent infection of the perforators and pedicles, we dissected a muscle cuff for the perforators and positioned the perforators near the edge of the flap. The postoperative courses were uneventful, and the patients gained almost normal function. ALT fasciocutaneous flaps are a feasible option for soft palatal reconstruction. © 2010 Wiley-Liss, Inc. Microsurgery, 2011.
- Published
- 2010
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.