We have used free forearm flaps for closure of various intraoral and oropharyngeal defects after radical ablation of tumors. A problem remained, however, in that split-thickness skin grafts required to close the forearm defect had to be obtained from other areas. To avoid this disadvantage, we de-epithelialized forearm flaps and the donor defects were closed with the split-thickness skin obtained from flap de-epithelialization. As a result of this procedure, unnecessary scarring has been avoided and postoperative management has been simplified. Such complications as flap loss, fistulae, or scar contracture have not occurred with greater frequency than is seen in normal circumstances. The de-epithelialized forearm flap procedure is explained. Histological findings concerning the de-epithelialized forearm flap are described, and the advantages of this method stated.

Adult↗

PubMedDate not supplied

Correction of microtia with construction of the tragus using a chondrocutaneous flap.

For microtia correction we have been inserting a cartilage framework and reconstructing the tragus at the first operation in one stage, using part of the microtic ear. This procedure is started with transposition of the lower two-thirds of the microtic ear to make a lobule. The upper third of the microtic ear is elevated as a chondrocutaneous flap which is then transposed downwards to the conchal cavity to make a tragus. The cartilage of the chondrocutaneous flap is anchored, using a bolster to pull it back and outwards. Using this technique, we have reconstructed 34 microtic ears. Adequate positioning of the auricle and tragus has been achieved and a natural auricle obtained even when observed from a frontal oblique direction.

Child↗

PubMedDate not supplied

Magnetic resonance imaging for diagnosing skin tumors.

The depth and three-dimensional morphology of skin tumors were studied with MR imaging. This technology was found to be an effective tool not only for evaluating depth but also for determining the degree of invasion of malignant tumors in the skin and soft tissue. Of the various tumors examined, this method was particularly useful for visualizing malignant melanoma and malignant fibrous histiocytoma. Thus, it is likely that MR imaging has great potential as an auxiliary tool for the diagnosis of other types of malignant skin tumors. By means of three-dimensional displays, tumors were more clearly visualized with respect to their relationship to the surrounding tissue and the three-dimensional state of infiltration, which was particularly useful in deciding on an appropriate resection area prior to surgery. The authors expect further technologic improvements in MR imaging in the future which will serve to increase the benefits obtained in its clinical applications.

Abdominal Neoplasms↗

PubMedDate not supplied

Three-dimensional analysis of craniofacial bones using three-dimensional computer tomography.

We studied the three-dimensional (3D) deformities in patients with congenital facial anomalies, such as cleft lip and palate or hemifacial microsomia using three-dimensional CT (3DCT) images. At the same time, the data from the 3DCT was processed and analyzed using a 3DCT measurement system which we have recently developed. The coordinates of the 67 test points on the craniofacial bones were determined on a 3D image prepared by the 3DCT measurement system. Using this system, we prepared the 'skeletograms', which present deformities of craniofacial bones in detail as a 3D wire frame model, for detailed analysis of the craniofacial bones' deformities.

Adolescent↗

PubMedDate not supplied

Effect of a collagen matrix containing epidermal growth factor on wound contraction.

Excessive wound contraction is known to lead to pathological wound contracture. Using a rabbit model, we applied a bovine type I collagen matrix sponge as a dermal substitute and human epidermal growth factor to full-thickness excisional wounds. Wound contraction was assessed 14 and 28 days after wounding. It was found that both collagen matrix and epidermal growth factor significantly inhibited wound contraction (p < 0.001) in all wounds treated with collagen matrix alone or treated with 0.1 and 1 microg of epidermal growth factor 28 days after wounding. Interestingly, the combination of collagen matrix with epidermal growth factor strongly inhibited wound contraction over matrix alone (p < 0.01 on day 28). Histological analyses showed a regular horizontal arrangement of collagen fibers in the dermis under wounds treated with these substances but not under untreated wounds. Furthermore, using a fibroblast-populated collagen gel, the direct inhibitory effect of epidermal growth factor on gel contraction by fibroblasts was also observed. Collagen gels without stimulation contracted to 29.5 +/- 0. 6% of their original size, as determined 6 days after culturing. At 3 days or more, epidermal growth factor inhibited collagen gel contraction by fibroblasts (after 6 days: 34.2 +/- 1.8%, p > 0.05; 36.5 +/- 2.8%, p < 0.05; and 39.8 +/- 2.1%, p < 0.001 at 1, 10, and 100 ng/ml of epidermal growth factor, respectively). In conclusion, collagen matrix and epidermal growth factor, particularly in combination, may be useful in the prevention of wound contracture.

Animals↗

PubMedDate not supplied

Development of a chronic skin defect model and a study of cytokine secretion using the model.

In this study, we established a delayed healing chronic type wound model in order to investigate the etiology of chronic wound healing, including wound contraction. Establishment of the model was important for clarification of the mechanism(s) of chronic wound healing and wound contraction and for use in evaluating therapeutic efficacy. A pedicled skin flap was raised beneath the panniculus carnosus membrane on the backs of mice, and after the loose connective tissue at the base of the flap was completely removed surgically, the flap was replaced and sutured. Seven days after surgery, a full-thickness defect measuring 1.5 x 1.5 cm was made in the center of the skin flap. At that time, a defect of the same size, including the panniculus carnosus membrane, was made in another group of mice as controls, and changes with time in wound area were compared between the two groups. The exudate retained on the wound surface was collected, and various cytokines contained in the exudate were measured. In the control group, the wound rapidly contracted and almost completely epithelialized and closed 21 days after surgery. On the other hand, the wound area was significantly larger in the delayed model than in the control animals during the observation period, revealing a delay in wound contraction. Transforming growth factor-beta, interleukin-1beta, and tumor necrosis factor-alpha in the exudates from the wound of the model were significantly higher than in those of the control group, whereas interleukin-6 was low in the model. From these results, it was concluded that this model could be a useful experimental system for studies on wound contraction as well as clarifying the mechanism of so called chronic type wounds.

Animals↗

PubMedDate not supplied

Pulmonary metastasis from endometrial carcinoma.

The objective of this article is to investigate the clinical features of pulmonary metastasis (PM) from endometrial adenocarcinoma, in particular, the predictors of prolonged survival after PM detection. Fifteen patients who developed PM and underwent chest computed tomography (CT) scans for evaluation of PM were studied: 12 patients with pulmonary recurrence and 3 patients with PM on presentation. All patients with bilateral nodules or lymphangitic spread had metastases in other sites prior to or concomitant with PM, most of which were detected in para-aortic lymph nodes and/or the vaginal wall, while only one of five patients with a limited number (n < or = 5) of unilateral nodules had these metastases. The median survival time for the 10 patients with bilateral PMs was significantly shorter than that of the 5 patients with a limited number of unilateral nodules who were treated with surgery (7 versus 50 months, P = 0.005). Patients who developed pulmonary recurrence 2 years after the initial therapy had a significantly longer survival than those who developed it within 2 years (31 versus 10 months, P = 0.01). In conclusion, the distribution of PM determined by CT scans and the time interval between the initial therapy and the detection of pulmonary recurrence are the predictors of survival after PM detection.

Adenocarcinoma↗

PubMedDate not supplied

The effects of drugs on the arachidonate cascade in experimentally burned rabbits.

Platelet reduction and renal dysfunction may occur after major thermal injury and be causally related to changes in the arachidonate cascade. In this article two new drugs, prostaglandin I2 analog OP-41483 (Venopirin) and thromboxane synthetase inhibitor OKY-046 (Cataclot), were tested in addition to aspirin in animal experiments with rabbits. The rabbits were divided into five groups and measurements made before and 8 and 24 hours after burn injury. The results indicate that platelet reduction and renal dysfunction occur within 8 hours after thermal injury in the no-therapy group and renal dysfunction could not be prevented completely even by adequate infusion therapy, but treatment with OP-41483 proved to suppress platelet reduction and improve renal function. Improvement in renal function was also noted in animals treated with aspirin or OKY-046, but platelet reduction could not be prevented by these drugs. Analysis of the time course of changes in thromboxane B2 level and 6-keto prostaglandin F1 alpha level disclosed that animals treated by infusion showed an elevation in thromboxane B2 and a significant elevation in the thromboxane B2/6-keto prostaglandin F1 alpha ratio, whereas animals treated with these three drugs showed a reduction in the thromboxane B2/6-keto prostglandin F1 alpha ratio. These results indicate that an effective measure for prevention of dysfunction of the organs after thermal injury is treatment with drugs that can modify the arachidonate cascade and cause an absolute or relative reduction in TXA2.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

Histopathological changes in the hair follicle after irradiation of long-pulse alexandrite laser equipped with a cooling device.

Several laser systems are currently used for epilation. However, the optimal parameters and treatment protocols remain largely unknown. In this study, the histopathological changes in the hair follicles after long pulsed alexandrite laser irradiation are discussed and the clinical application of irradiation energy at the time of treatment is described. The laser used in this study is equipped with a computer controlled cooling device. A histopathological study was performed to compare the differences in the degree of degeneration in the epidermis and follicles treated with and without the cooling device. In comparison with normal hair papilla, in the laser irradiated skin, injury of melanin containing cells and hair shafts and external root-sheaths in the periphery were observed, while the epidermis was completely protected by the cooling device. The condition of the hair papilla of the tissue irradiated at a fluence of 25 J/cm2 with a spot diameter of 15 mm and 20 J/cm2, with a spot diameter of 18 mm were investigated thoroughly. Swollen papilla and selective destruction of the site where melanocytes were present were observed. The results of this study strongly indicate the efficacy of a long-pulsed alexandrite laser equipped with a computer controlled cooling device for clinical depilation.

Beryllium↗