Biomedical subjects

I Koshima

Publications and source records attributed to I Koshima.

At least 37 records · Page 2Linked to original sources

PubMed1999

[Usefulness of percutaneous sclerosing treatment for low-flow vascular lesions].

Peripheral vascular lesions may occur as a result of various clinical problems, cosmetic or dysfunctional causes, or bleeding. In severe cases, coagulopathy and congestive heart failure may occur. Although the efficacy of transarterial embolization (TAE) for arterial vascular lesions is well known, TAE has no effect on low-flow vascular lesions (venous malformations, venous angiomas, and venous components of arteriovenous malformation). Therefore, in such cases, a percutaneous approach is the best method, and we consider sclerotherapy to be the most useful conservative treatment. The primary objective of this study was to confirm the efficacy of percutaneous sclerosing treatment for peripheral low-flow vascular lesions. Lesions were classified on the basis of state of blood flow and morphologic features, and infiltration was classified on the basis of angiographic features and magnetic resonance imaging (MRI) findings. In sclerosing treatment, we used 5% solutions of polidocanol, absolute ethanol, and N-butyl-2-cyanoacrylate (NBCA) as sclerosing agents. Each type of lesion, static or slow-flow, cystic, or localized, showed remarkable improvement after sclerosing treatment with only polidocanol. However, for moderate-to-fast-flow lesions, another sclerosing agent (absolute ethanol/NBCA) was needed. With diffuse infiltrative lesions, surgical repair might be needed, but we recognize the usefulness of sclerosing treatment for functional or cosmetic improvement in these cases.

Adolescent↗

PubMed1999

Dynamic reconstruction of the abdominal wall using a reinnervated free rectus femoris muscle transfer.

Dynamic reconstruction of the abdominal wall using a free reinnervated rectus femoris muscle and an island tensor fascia lata transfer was performed for a large herniation with loss of the bilateral rectus abdominis muscles of the abdominal wall. The tensor fascia lata transfer was used to close an inner side of the abdominal defect, and the rectus femoris muscle replaced the rectus abdominis muscle deficit. The motor nerve of the rectus femoris muscle was sutured to the motor branch of the intercostal nerve. Postoperatively, the transferred rectus femoris muscle was reinnervated via electromyography, and there was no abdominal protrusion and no hernia recurrence.

Abdominal Muscles↗

PubMed1999

[Supramicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the extremities].

During the past eight years, we treated obstructive lymphedema of a unilateral upper extremity in 27 females and of a unilateral or bilateral lower extremity in 35 males and females with supramicrosurgical lymphaticovenular anastomoses and/or conservative treatment. The most common cause of upper limb edema was mastectomy with or without subsequent radiation therapy for breast cancer, and that of lower limb edema was hysterectomy with radiation. As an objective assessment of edema, the circumferences of the affected and opposite normal forearms or lower legs were measured 10 cm below the olecranon of the arm or the lower border of the patella. In patients who received conservative treatment (12 arms and 12 legs), the average excess circumferential length of the affected arm and leg was 6.4 and 7.1 cm over that of normal extremities, average duration of edema before treatment was 3.5 and 5.2 years, average period for conservative treatment was 10.6 months and 1.5 years, and average decreased circumferential length was 0.8 and 0.6 cm, respectively. The rate of circumferential decrease over 4 cm was none in arm and 16.7% in leg edema. In patients who underwent surgery (12 arms and 16 legs), the average excess circumferencial length was 8.9 and 9.8 cm, average duration of edema before surgery was 8.2 and 8.9 years, average follow-up after surgery was 2.2 and 3.3 years, and average decrease in excess circumference was 4.1 and 2.7 cm, respectively. The rate of circumferential decrease over 4 cm was 58.3% in arms and 50% in legs. These results indicate that supramicrolymphaticovenular anastomoses have a valuable place in the treatment of obstructive lymphedema.

Adult↗

PubMed1998

Flow-through vascularized toe-joint transfer for reconstruction of segmental loss of an amputated finger.

A segmental finger defect was reconstructed in a 46-year-old woman with a free flow-through vascularized toe-joint, including the proximal interphalangeal joint, the plantar digital nerve, and tendons of the second toe. The advantages of this composite flap are: (1) The segmental loss of the finger can be easily reconstructed to achieve a normal anatomic structure. (2) Excellent cosmesis is achieved, compared with conventional flaps such as the groin flap. (3) The distal segment of the donor toe can be preserved. (4) The transected digital arteries of the amputated finger can be simultaneously reconstructed with a flow-through arterial interposition. (5) The digital nerve can be repaired with a vascularized plantar digital nerve graft.

Female↗

PubMed1998

Free combined anterolateral thigh flap and vascularized fibula for wide, through-and-through oromandibular defects.

Through-and-through oromandibular defects require the greatest amount of soft-tissue volume among the transfers for head and neck defects. A new method, a large anterolateral thigh flap combined with a vascularized fibula graft in a chimera fashion, has been used for two patients with wide through-and-through oromandibular defects. Among the candidates for such a large skin flap, the anterolateral thigh flap seems to be the best, for the following reasons. (1) Its pedicle, the lateral circumflex femoral system, has several major branches of equal size of anastomosis of the peroneal vessels. (2) As the majority of such patients with multiple previous surgery have lost recipient vessels near the mandible, the longest vascular pedicle is required. (3) There is no need for positional changes, and simultaneous flap elevation with the tumor resectioning is possible. (4) Use of the fibula allows for reconstruction of the entire mandible, if necessary. (5) Some of the shortcomings of individual donor sites for massive composite osteocutaneous flaps are minimized, because each component consists of two donor sites. (6) Operating time for this flap elevation is minimized, compared to that for massive composite osteocutaneous flaps, because the individual components can be obtained simultaneously by two teams.

Aged↗

PubMed1998

Paraumbilical perforator flap without deep inferior epigastric vessels.

With the introduction of supramicrosurgery, a new paraumbilical perforator flap without a deep inferior epigastric vessel and with very small perforator anastomoses was used for nine patients. The abdominal defects of two patients, the lower leg or foot defects of five patients, and the scalp defects of two patients were repaired with an island perforator flap. The advantages of the paraumbilical perforator flap are as follows: (1) there is a very short operating time for flap elevation; (2) there is no invasion or sacrifice of any rectus abdominis muscle; (3) for middle-aged, obese patients, the donor site may be the best from the cosmetic point of view; (4) many small recipient vessels to anastomose the perforator exist throughout the body; (5) a thin skin flap with adequate thickness can be created easily with simultaneous removal of fatty tissue; (6) secondary defatting around the perforator can be done by minor surgery under local anesthesia; and (7) a vascularized adiposal flap with adequate thickness can be created easily. This flap seems to be indicated for female patients with defects in the abdominal wall and the lower leg. The island flap can easily resurface abdominal skin defects, such as intestinal fistula or radiation ulcers. The free flap is suitable for covering defects in the lower leg, foot, and scalp temporarily before administration of a tissue expander.

Adolescent↗

PubMed1998

Muscle stapling technique for free muscle transfer to the face.

Free muscle transfer for facial reanimation can be facilitated by the use of a linear gastrointestinal stapler. This technique not only offers reliable muscle insertion at the recipient site but also helps to provide an adequate motor unit by facilitating safe muscle debulking, splitting, and tailoring.

Adult↗

PubMed1997

Three-dimensional combined flaps for reconstruction of complex facial defects following cancer ablation.

Instead of conventional multiple-paddle or folded free flaps, the authors introduce three types of free combined tissue transfers for cosmetic and functional restoration of massively large facial defects. Three cases reported here were repaired with combined flaps consisting of two or more tissues, such as combined free anterolateral thigh flaps and vascularized muscle or bone grafts. In cases with complex defects in the upper lateral face, facial dynamics were also reconstructed with a free vascularized innervated muscle graft. A complex hemifacial defect involving the orbita and nose can be easily reconstructed with free osteocutaneous flaps in two stages. For complex craniofacial defects, the concept of combined chimeric tissue transfers is most suitable. The ideal pedicle vessels for the combined flaps are considered to be those in the lateral circumflex femoral system, which is far from the head and neck regions, because flap elevation can proceed simultaneously with tumor resection.

Aged↗

PubMed1997

A double-muscle transfer using a divided rectus femoris muscle for facial-paralysis reconstruction.

There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.

Adult↗

PubMed1997

One-stage reconstruction of established facial paralysis using a rectus abdominis muscle transfer.

A free vascularized rectus abdominis muscle graft with a long motor nerve was used for reconstruction of unilateral established facial paralysis in one stage. Regarding the procedure, the pedicle vessels were anastomosed to the recipient vessels in the ipsilateral face, and the motor nerve of the muscle was sutured to the contralateral facial nerve. The advantages of using the rectus abdominis muscle are as follows: (1) the muscle is very thin, not bulky, (2) the muscle can be split easily to reduce the volume, (3) the intercostal nerve is long enough (more than 20 cm) to reach the contralateral facial nerve for suturing, (4) the pedicle vessels are large and long, (5) it is possible to carry out simultaneous operations with two teams, and (6) the donor-site morbidity is minimal. The disadvantages of this method are that complicated surgical dissection is required to obtain a motor nerve and that a postoperative abdominal hernia may occur.

Adolescent↗

PubMed1997

A full-thickness chondrocutaneous flap from the auricular concha for repair of tracheal defects.

A free full-thickness chondrocutaneous flap from the auricular concha for the repair of large tracheal defects was transferred successfully. The flap is based on the superficial temporal vessels (reversed flow) and the posterior auricular vessels. The advantages of this flap for the repair of tracheal defects are (1) its dissection is easy, (2) thin components of the flap provide a wide postoperative airway, (3) the structure of the reconstructed trachea is made firm by the conchal cartilage with vascularization, (4) the highly vascularized cartilage results in less resorption than a free cartilage graft, (5) the donor site can be repaired easily and is concealed by the remnant auricle, and (6) a long arterial pedicle (reversed flow) can be obtained. The disadvantages are (1) there may be temporary postoperative congestion of the flap, (2) postoperative narrowing of the auriculocephalic sulcus may occur, and (3) a short venous pedicle often requires a vein graft.

Adult↗

PubMed1996

Free vascularized deep peroneal nerve grafts.

An ideal donor site for vascularized nerve grafts should have a constant anatomy, minimal functional loss after the nerve has been sacrificed, and a dependable blood supply parallel to the nerve over a relatively long distance. Creating a pedicle for a free vascularized deep peroneal nerve graft with the anterior tibial vessels seems to be a most suitable method for repairing long nerve gaps of over 20 cm and digital nerve defects with severe finger damage. Applications of this nerve graft to digital nerve losses with severely scarred beds created by avulsion injury, and two-stage reconstruction in some partial brachial plexus palsies (free vascularized nerve graft in the first stage and free vascularized muscle graft in the second stage) are well indicated. Advantages of this technique are: (1) A long nerve graft (up to 25 cm) can be obtained, and anomalies are rare (the nerve is absent in only 4 percent of cases). (2) The caliber of the vascular pedicle is large (approximately equal to 3 mm). (3) The nerve has a sufficient blood supply from the collateral blood vessels. (4) The graft can be easily obtained in the supine position. (5) A monitoring skin flap, based on the inferior lateral peroneal artery, can be attached to the nerve graft. (6) Sensory loss resulting from the sacrifice of the nerve covers a minimal area. (7) A donor scar on the anterior aspect of the lower leg is more acceptable than one on the posterior aspect because of less movement in walking. Disadvantages of this technique are: (1) Sacrifice of the large vessels in the lower leg may result in circulatory complications in the donor foot; to avoid this problem, preoperative angiography is recommended. (2) The donor scar is in an exposed area in female patients. (3) There may be temporary postoperative edema and disability in the donor leg.

Adolescent↗

PubMed1996

Scarpa's adipofascial flap for repair of wide scalp defects.

Scarpa's fascia is a prominent superficial fascial system of the body. It consists of a single membrane between the superficial fatty layer and deep fatty layer, and lies widely in the lower abdominal wall. We describe a case with a wide scalp defect resulting from a resection of a dermatofibrosarcoma, and reconstruction of the defect with Scarpa's adipofascial flap (i.e., a combined paraumbilical perforator-based adipofascial flap-groin adipofascial flap). The primary advantage of Scarpa's adipofascial flap for scalp defects is that (1) the donor site is most acceptable for a free flap with a minimal donor scar and minimal dysfunction; (2) even in cases in which large flaps are used, donor defects can be closed directly without skin grafting; (3) in the obese patient, this flap is preferable because of cosmetic improvement of the abdominal wall; (4) the donor area has so many perforators that an extended adipofascial flap can be obtained with a combination of these perforators; and (5) the flap may be nourished with one of several arteries, such as the superficial or deep inferior epigastric artery, or the superficial or deep circumflex iliac artery. The disadvantages of this flap are that the territory with a single artery may be smaller than a skin flap with the same artery and oversurfacing of the graft results in a poor cosmetic appearance. Scarpa's adipofascial flap is indicated when the defects are in an exposed area, especially in children, young patients, and females, and when this procedure is combined with a skin-expanding method in the secondary repair.

Adipose Tissue↗

PubMed1996

Free medial thigh perforator-based flaps: new definition of the pedicle vessels and versatile application.

The medial thigh flap is a perforator-based flap nourished with septocutaneous or muscle perforators originating from the femoral vessels. To date, 8 patients have been repaired with this flap and extended or connected flaps including this flap: 4 patients with lower leg defects and 4 patients with intraoral and neck defects. The advantages of this flap are (1) several pedicle perforators exist for this flap, which makes possible duplicated vascular anastomoses to establish reliable circulation of the transferred flap; (2) the flap can be extended or connected to other neighboring flaps in the anterior thigh, so that extensively wide defects can be closed in one stage; (3) the great saphenous vein can be simultaneously used as a vein graft or for venous drainage for the flap; (4) the anterior branch of the femoral nerve can be used for sensory potential; and (5) there is minimum morbidity of the donor defect and a large dominant vessel for the leg can be preserved. The suitable indications for this flap are defects after removal of skin cancer in the foot or lower leg and wide defects after resection of head and neck cancer, which can be reconstructed with the flap connected to neighboring skin flaps. The disadvantages of this flap are that it has a small, short vascular pedicle and the bulkiness of the flap's fatty tissue often requires thinning.

Aged↗

PubMed1996

Ultrastructural observations of lymphatic vessels in lymphedema in human extremities.

Microsurgical lymphaticovenous anastomoses were done on a total of 14 patients. Six upper extremities of six female patients (average age 56.5 years) were operated on with lymphaticovenous anastomoses and were followed up for 17 months or more after surgery (average 25.5 months). Twelve legs of eight patients (average age 44.6 years) also were operated on and followed up for 12 months or more after surgery (average 23.4 months). Among these patients, 33 biopsied lymphatic trunks with lymphedema in 16 extremities of 12 patients were evaluated histologically by light and electron microscopy. Regarding the operative effect in the arms, the decreased circumference of the arms ranged from 2 to 9 cm (average 5.3 cm). The rate of preoperative versus postoperative excess circumference decreased in range from 25 to 94.7 percent (average 65.7 percent). As for the surgical effect in the legs, half the legs showed improvement. These postoperative improvements showed no correlation with the preoperative duration of edema and excess circumference in either the upper or lower extremities. Histologically, in the initial stage of lymphedema, there was destruction of both endothelial cells and smooth muscle cells in the proximal level of the lymphatic trunks. The lumen of some proximal trunks was then occluded by organization with a few small recanalizations, but the distal lymphatics remained patent with minimal destruction of both the endothelial cells and the smooth muscle cells even in the later stage of lymphedema. These results suggest that the occlusions of the lymphatic trunks and degeneration of the smooth muscle cells may start from the proximal ends of the extremities and that the timing of the occlusions and the degeneration of smooth muscle cells may not correspond to the duration of edema. It is also considered that because of the smooth muscle degeneration, the lymph-drainage capacity of the lymphatic trunks may be remarkably weakened in the proximal lymphatics of the extremities. Therefore, it is suggested that the remaining lymphatic drainage function with the smooth muscle cells may correlate with the postoperative improvement of edema. It is also suggested that the preoperative ultrastructural examination of the lymph-drainage capacity may be a suitable method for predicting the surgical effect and operative indication for lymphatic edema in the extremities.

Adult↗

PubMed1996

Malignant fibrous histiocytoma of the lateral wall of the orbit.

A 58-year-old male presented with malignant fibrous histiocytoma originating from the lateral wall of the orbit, manifesting as left exophthalmos and diplopia on left lateral gaze. Magnetic resonance (MR) imaging demonstrated the tumor extending into the left orbit and under the temporalis muscle. The tumor was isointense with muscle on T1-weighted MR images and was surrounded by a low-intensity rim, which was proved to be the capsule after histological examination. The tumor was completely removed after detaching the lateral orbital rim and zygomatic arch using the dismasking flap method. He underwent one course of CYVADIC chemotherapy and has demonstrated no recurrence for 1 year and 6 months postoperatively.

Female↗

PubMed1995

The radial artery perforator-based adipofascial flap for dorsal hand coverage.

The radial artery perforator-based adipofascial flap seems to be suitable for resurfacing defects on the dorsal hand. This flap is classified as one of the distally based intertendinous septocutaneous flaps, which are supplied by the dorsal superficial branch of the radial artery. The advantages of this flap are (1) surgery is minimal, of short duration, and associated with minimal donor scarring; (2) the perforator of the flap encompasses a wide and long territory of adipofascial tissue; (3) there is no postoperative functional limitation; (4) freedom of arm movement allows better control of postoperative edema, early physiotherapy, and mobilization; (5) soft-tissue coverage actively contributes to the vascularity of the hand; and (6) the donor forearm cutaneous veins and cutaneous nerves can be preserved.

Adult↗

PubMed1995

Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities.

"Flow-through" anterior thigh flaps are used to reconstruct defects accompanied by major vessel damage in the extremities. These flaps have long flow-through pedicle vessels (which are the descending branch of the lateral circumflex femoral system) that can be interposed into the vascular gaps in the extremities and are composed anatomically of the rectus femoris muscle. The defects of eight patients were repaired successfully with flow-through anterior thigh flaps, which were from 10 to 30 cm in length and 7 to 15 cm in width. The advantages of these flaps are (1) the damaged main vessels (< 20 cm in length) can be reconstructed simultaneously with large skin defects (up to 30 cm in length and 15 cm in width), (2) double arterial inflow by means of both ends of the pedicle artery ensures safe blood circulation of the flap, (3) the lateral circumflex femoral system, the pedicle of the anterior thigh flaps, can be used for chimeric composite flaps for the reconstruction of composite defects with major vessel loss in the extremities, (4) two concomitant veins can be used as a drainage system in extremities with severe edema, and (5) multistage flap transfers are possible to repair recurring defects in the extremities with a single major vessel using additional transection and pedicle interposition.

Adult↗