Biomedical subjects

I Koshima

Publications and source records attributed to I Koshima.

At least 55 records · Page 3Linked to original sources

PubMed1995

Connected deep femoral and gluteal perforator-based flap for repair of an extensive defect on the posterior thigh.

An island connected "Siamese" deep femoral and gluteal perforator-based flap with double vascular pedicles, the perforators from the deep femoral and superior gluteal arteries, was transferred successfully to repair an extensively large posterior thigh defect in an 84-year-old man. For reconstruction of large, massive defects of the posterior thigh region, this connected "Siamese" flap has the following advantages: (1) the flap and the pedicles are nearest to the defect, (2) the skin territory of the flap is extremely long, (3) the flap elevation is easy, because there are several perforators that can be considered as pedicle candidates in both the deep femoral and the gluteal perforator-based flaps, (4) there is no necessity for positional change to elevate the flap, and (5) no sacrifice of muscles implies little postoperative functional limitation of the donor leg.

Aged↗

PubMed1995

Free combined thin wrap-around flap with a second toe proximal interphalangeal joint transfer for reconstruction of the thumb.

The combined thin wrap-around flap from the big toe and the proximal interphalangeal joint of the second toe is characterized by (1) a single vascularized joint, which is used to preserve the second toe with a free iliac bone graft, (2) a thin wrap-around flap, which allows the pulpal fatty tissue on the remaining bone of the big toe to be retained and accept a skin graft, (3) a wrap-around flap with a partial distal phalangeal bone, and (4) a microplate for firm fixation at the proximal bone union and early joint motion. The advantages of this method are (1) the cosmetic appearance is excellent with use of the thin wrap-around flap; (2) there is joint motion in the reconstructed thumb with strong pinch and vice pinch; (3) the vascularized joint with a microplate allows for early postoperative motion; (4) bone grafting from another donor site is unnecessary; (5) bone growth is possible in children with open epiphyses; and (6) the big and second toes are preserved with minimal donor-site morbidity. This method is indicated for thumb losses at a level distal to the metacarpophalangeal joint or at the level of the proximal phalanx.

Adult↗

PubMed1995

[Free rectus abdominis muscle perforating artery flaps for reconstruction of the head and neck defects].

During the past eight years, tissue defects of the head and neck region in a total of 45 patients were repaired with free rectus abdominis muscle perforating artery flaps. These flaps are subclassified into (1) reduced musculocutaneous flaps, (2) thin reduced musculocutaneous flaps, (3) paraumbilical perforator-based flaps, and (4) thin paraumbilical perforator-based flaps. The advantages of these flaps are as follows. Since the flaps involve no or only a small portion of the rectus abdominis muscle, (1) the muscle can be left intact on the abdominal wall, and (2) a thin flap can be easily created by simple defatting of the flap. These flaps overcome the major disadvantages of the conventional rectus abdominis musculocutaneous flap, i.e., bulkiness of the flap and frequent postoperative abdominal herniation. The territory of the thin flaps is within 10 cm around the perforator. These flaps are suitable for defects in the head and neck region, because simultaneous flap elevation is possible at the time of tumor resection. Paraumbilical perforator-based flaps are suitable for young females and elderly patients.

Aged↗

PubMed1994

Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the "mosaic" flap principle.

"Mosaic" flaps, i.e., connected anteromedial thigh-groin flaps, and connected anterolateral thigh-medial thigh flaps, the pedicles of which are the perforators of the lateral circumflex femoral system, the superficial circumflex iliac vessels, and the perforators from the femoral vessels are used to repair cervical skin defects involving the pharyngoesophagus. Although they appear to be similar to "siamese" flaps, these mosaic flaps are a new concept because they consist of two adjacent flaps that are simultaneously elevated with double pedicles including the lateral circumflex femoral system. The pedicles of the groin or the medial thigh flaps are anastomosed to the muscle branch or the descending branch of the lateral circumflex femoral system, which is the pedicle of the anterior thigh flaps, and the system is joined to a single recipient vessel as a "bridge" flap. The main advantages of these mosaic flaps are (1) they offer single recipient vessels, (2) they offer a larger extension of the vascular territory of a skin flap, and (3) they offer the possibility of creating custom-made composite flaps such as musculocutaneous and osteocutaneous flaps, and (4) the elevation of the flaps simultaneous with head and neck tumor resection is possible. Based on cited cases, it is suggested that mosaic flaps are suitable to use for reconstruction of massive cervical defects involving the cervical skin and the pharyngoesophagus due to recurrent laryngeal carcinomas.

Aged↗

PubMed1994

Combined anteroposterior tibial perforator-based flap with a vascularized deep peroneal nerve for repair of facial defect.

To reconstruct deep facial defects involving the facial nerves after resection of a malignant parotid tumor, a flap with a vascularized nerve graft is often required because the lesion is often accompanied by poor vascularization as a result of preoperative or postoperative radiotherapy. These defects can be repaired in one stage with a combined anteroposterior tibial perforator-based flap including a vascularized deep peroneal nerve graft. This combined flap can include the long vascularized deep peroneal nerve, and augumentation of the lower leg flaps is possible by additional vascular anastomosis of branches of the source vessel of the neighboring flap, the "mosaic" principle.

Aged↗

PubMed1994

Free vascularized iliac osteomusculocutaneous flaps based on the lateral circumflex femoral system for repair of large mandibular defects.

A free vascularized iliac osteocutaneous flap based on the ascending and transverse branches of the lateral circumflex femoral system was studied by cadaveric investigation. These composite flaps were successfully used in 2 patients with both large mandibular and soft-tissue defects. The advantages of this flap are that (1) the distal portion of the flap is relatively thin, (2) the pedicle vessels are long and large, (3) the skin territory is extremely wide, (4) repositioning of the patient during the operation is unnecessary, (5) the flap can be elevated while the recipient mandibular region is resected by two teams because the donor site is far from the head and neck regions, (6) the donor scar is in an unexposed area and its location permits easy concealment, and (7) subtotal loss of the mandible can be reconstructed with the use of split crests from either side of the ilium because the external and the internal cortices are fed independently by the lateral circumflex femoral and the deep circumflex iliac systems. This appears to be a new concept for reconstruction of total mandibular loss.

Aged↗

PubMed1994

Free rectus femoris muscle transfer for one-stage reconstruction of established facial paralysis.

The free vascularized rectus femoris muscle graft with a long motor nerve was used for reconstruction of unilateral established facial paralysis in one stage. The pedicle vessels were anastomosed to the recipient vessels in the ipsilateral face, and the motor nerve of the muscle, which was led through the upper lip, was sutured to the contralateral facial nerve. The advantages of this one-stage reconstruction as compared with surgery involving second-stage reconstruction are that the reconstruction can be completed in one stage and that the period required for muscle refunctioning after surgery is short. The vascular supply of the rectus femoris muscle can emanate mainly from the lateral circumflex femoral artery. In our cadaveric study, five types of variation were found for origination of a nutrient artery of the muscle. The most common type was one in which the artery derived from the descending branch of the lateral circumflex femoral artery (39 percent). The motor nerve of the rectus femoris muscle is derived from the femoral nerve under the inguinal ligament and runs downward through the intermuscular space between the sartorius muscle and the iliopsoas muscle before entering the posteromedial part of the upper third of the rectus muscle. The advantages of using the rectus muscle are as follows: (1) safety and simplicity exist with one main large arterial supply for arterial anastomosis; (2) the length of the femoral nerve (more than 20 cm) is adequate for reaching the contralateral facial nerve for suturing; (3) a simultaneous operation by two teams is possible with the patient in the supine position; (4) the force and distance of contraction are appropriate to reanimate the face; (5) the rectus muscle can be separated as a segment with appropriate lengths, size, and power for replacing lost muscles in the face; (6) the tendinous fascia in both ends provides a reliable point for anchoring sutures, which provides firmer attachment; and (7) no loss of donor leg function occurs.

Adolescent↗

PubMed1993

A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full-thickness defect of the mental region.

A triple combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft was used for reconstruction of a full-thickness defect of the mental region after wide resection of advanced tongue cancer. The distal end of the pedicle vessels of these double skin flaps, i.e., the lateral circumflex femoral system, was directly anastomosed in tandem to the pedicle of the iliac bone graft, which was enveloped by these flaps. The advantages of this iliac osteocutaneous flap are as follows: It can be transferred within a shorter surgical time because the flaps can be obtained in the supine position simultaneously with tumor resectioning; and its skin components can be separated from the bone because each component has its own pedicle vessels, has a longer vascular pedicle (> 10 cm), and has a thicker crest of the bone graft. This flap is believed to be suitable for reconstruction of large full-thickness defects in various sizes of the mandibular and maxillary regions of the face.

Aged↗

PubMed1993

The gluteal perforator-based flap for repair of sacral pressure sores.

A gluteal perforator-based flap employing the gluteus maximus muscle perforators located around the sacrum is described. A cadaveric study disclosed the existence of several significant perforators all around the gluteal region. Among these, the parasacral perforators originating from the internal pudendal artery and lateral sacral artery have proven useful for the repair of sacral pressure sores. A total of eight decubitus in seven patients were treated with gluteal perforator-based flaps. There were no postoperative complications, such as flap necrosis and wound infection, with the exception of fistula formation in one case. This flap requires no transection or sacrifice of the gluteus maximus muscle, and elevation time for the flap is short. However, the perforators are located at various sites and thus require some careful dissection.

Adult↗

PubMed1993

Extended wrap-around flap for reconstruction of the finger with recurrent arteriovenous malformation.

Treatment of arteriovenous malformations of the finger is difficult because complete resection of malformations by ligation or en bloc resecting methods is impossible. We used an extended wrap-around flap consisting of a combined wrap-around flap and a dorsalis pedis flap to reconstruct the soft-tissue defects following complete resection of a recurrent malformation in the index finger. This method has two advantages: no postoperative recurrence of the malformation is expected, and the affected finger can be preserved. However, it is indicated only for malformations with no invasion to the bone and localized in one finger.

Adult↗

PubMed1993

Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle.

Chimeric composite flaps combined using microanastomoses consist of two or more flaps or tissues, each with an isolated pedicle and a single vascular source. Free combined chimeric flaps using the lateral circumflex femoral system were used to treat massive composite defects of the head and neck in 10 cases. A combined anterolateral thigh flap and vascularized iliac bone graft based on the lateral circumflex femoral system and the deep circumflex iliac system was the most commonly used combination. An anteromedial thigh flap and a paraumbilical perforator-based flap were also combined with this principal combination. The advantages of this chimeric flap over other osteocutaneous flaps are: (1) The flap is relatively thin and the pedicle vessels are up to 10 cm longer and are wider than those of other flaps for easier harvesting of the flap. (2) It is unnecessary to reposition the patient. (3) The vascular pedicle to the skin can be separated from that of the bone. (4) The donor site is not close to the recipient site. (5) The donor scar is in an unexposed area. (6) The skin territory of this flap is extremely wide. (7) A combined anterolateral and anteromedial thigh flap and vascularized iliac bone graft can be easily obtained as an extended combined osteocutaneous flap. (8) Other neighboring skin flaps, such as a groin flap, a paraumbilical perforator-based flap, or a medial thigh flap, can be combined with this chimeric flap because several major muscle branches to be anastomosed derive from the lateral circumflex femoral system. Chimeric composite flaps using the lateral circumflex femoral system are considered suitable for the repair of massive composite defects of the head and neck.

Adult↗

PubMed1993

Sixty cases of partial or total toe transfer for repair of finger losses.

Our experience with partial or total toe transfers for the reconstruction of finger deficits is presented. Sixty-one toes were transferred to reconstruct finger deficits in 60 patients. The transfers from the big toe consisted of 3 vascularized whole-nail grafts, 4 onychocutaneous flaps which included the nail and a skin flap from the toetip, 16 thin osteo-onychocutaneous flaps, 4 wrap-around flaps, and 3 combined wrap-around and dorsalis pedis flaps. The transfers from the second toe consisted of 6 trimmed toetips including the nail, 16 second toes, 1 combined second toe and a dorsalis pedis flap, and 1 second toe and third toe. The other transfers mainly consisted of other flaps, including a hemipulp flap and a first web space flap. Regarding the transfers from the big toe, vascularized nail grafts and onychocutaneous flaps were found to be most suitable for the treatment of total nail loss, thin osteo-onychocutaneous flaps for distal phalangeal loss of the thumb, wrap-around flaps with a vascularized iliac bone graft for thumb loss above the metacarpal joint, and the combined wrap-around and dorsalis pedis flaps for a total thumb deficit. Regarding the transfers from the second toe, the trimmed toetips including the nail were most suitable for claw nail deformities, the second toe was most suitable for finger loss except for the thumb with the proximal interphalangeal joint, and the combined second toe and dorsalis pedis flap was most applicable for a total thumb deficit including thenar skin loss.

Adult↗

PubMed1993

Free anterolateral thigh flaps for reconstruction of head and neck defects.

The anterolateral thigh flap is a septocutaneous artery flap based on the septocutaneous or muscle perforators of the lateral circumflex femoral system. Little has been reported about the variations in its vascular anatomy and its application for head and neck reconstruction. We report 22 cases in which this flap was used for the reconstruction of head and neck defects. Based on our clinical and cadevaric experiences, the derivation of the vascular pedicle of this flap has four variations by which the septocutaneous perforators are derived from the descending branch of the lateral circumflex femoral system and/or from the transverse branch of that system, or for which there are no septocutaneous perforators but there are muscle perforators originating from the lateral circumflex femoral system. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with stereoangiograms or simple angiograms and Doppler audiometry. The anterolateral thigh fasciocutaneous flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and for large full thickness defects of the lip. The advantages of this flap are safe elevation, a long and wide vascular pedicle, skin that is generally thin, and good pliability. Even if the skin is thick, a thinner flap can be created by sacrificing a large amount of fatty tissue. Furthermore, the skin territory is very wide and long. The donor defect can often be closed directly with its scar being less noticeable. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessels. This can be overcome, however, by employing preoperative stereoangiograms.

Adult↗

PubMed1993

Reinnervation of denervated Pacinian corpuscles: ultrastructural observations in rats following free nerve grafts.

Nerve transection and immediate free nerve grafts using rat sciatic nerves were employed to observe the morphologic changes in periodical denervation and reinnervation of Pacinian corpuscles located on the interosseous membrane between the fibula and tibia. During periods of from 2 weeks to 20 months after the surgery, a total of 28 corpuscles were obtained under an operating microscope and processed for morphologic analysis using light and electron microscopes. Based on our morphologic findings, normal corpuscles were composed of an axon terminal and inner and outer cores. The axon terminal disappeared within 2 weeks after the nerve grafts, but the original inner and outer core cells remained for up to 20 months. In addition, a small number of collagen fibrils was observed between the inner and outer core cells. After 4 months, multiple axon terminals began to regenerate in the inner core. From 7 to 20 months, these axon terminals in some corpuscles developed a structure resembling that of normal terminals. Some of these terminals were located in the center of the inner core, but a few were in contact with the outside of the inner core. The production of collagen fibrils in denervated corpuscles was periodically activated in the intercellular spaces. These findings suggest that the morphologic changes in denervated corpuscles correspond to those in denervated nerves. Inner core cells, which are continuous with Schwann cells, remain in their original condition in denervated corpuscles until regenerating nerves enter the inner core and are essential for corpuscle regeneration, because they may produce some trophic substances that induce the regeneration of multiple axon terminals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

Free thin osteo-onychocutaneous flaps from the big toe for reconstruction of the distal phalanx of the fingers.

Free osteo-onychocutaneous flaps from the big toe have frequently been used for the reconstruction of distal phalangeal loss of the fingers. The thickness of the fatty tissue, however, makes these flaps bulky. We believe this disadvantage can be overcome with a free thin osteo-onychocutaneous flap from the big toe and consider this thin composite flap to be a superior method of reconstruction for the treatment of distal phalangeal loss.

Adolescent↗

PubMed1992

Free thin paraumbilical perforator-based flaps.

A free paraumbilical perforator-based flap fed by a muscle perforator from the inferior deep epigastric artery and with no muscle was used in 13 patients. Among them, a free thin paraumbilical perforator-based flap with a thin layer of fat, to protect the subdermal plexus of the vessels, was used in seven patients. The dominant pedicle perforator of this thin flap is usually located around the umbilicus and a large flap can be obtained. Its critical length-to-breath ratio is considered to be 4:3. The advantages of this flap are a long and large vascular pedicle, rare postoperative abdominal herniation, little bulkiness of the flap, and a relatively large skin territory. The disadvantages are technical difficulties in dissection of the perforator and anatomical variation in the location of the perforator. We believe this flap largely overcomes the problems of the conventional rectus abdominis musculocutaneous flap.

Abdominal Muscles↗

PubMed1992

Extended latissimus dorsi musculocutaneous flaps for extremely wide cervical skin defects involving the cervical esophagus.

Two cases using island distally and anteriorly extended latissimus dorsi musculocutaneous flaps for one-stage reconstruction of pharyngoesophageal defects of the entire front of the neck are reported. The advantage of this flap is its extremely large skin territory, which provides a reliable vascular supply. This flap is suitable for extremely wide cervical defects where the recipient vessels are damaged after severe infection and irradiation.

Aged↗

PubMed1992

The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers.

Microvascular replantation at the distal phalangeal level has recently been reported by several authors, but as yet the rate of success has not been constant owing to the technical difficulties associated with small vessels. To solve this problem, over the last 4 years we have used arteriovenous anastomosis to reestablish either the arterial system or the venous drainage system in the 33 digits of our 23 patients. The results have been excellent, with a 91 percent success rate. Such results for replantation of the distal phalanx may be maintained and improved if a small venous graft with several branches is also utilized.

Adolescent↗