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Biomedical subjects

K Harii

Publications and source records attributed to K Harii.

At least 109 records · Page 6Linked to original sources
PubMed1994

Treatment of brachymetatarsia by callus distraction (callotasis).

Callus distraction (callotasis) has already become a popular procedure in the lengthening of limbs. With the development of a small device, it can also be applied to the hand or foot, thus providing benefits in the treatment of brachymetatarsia. Four toes of 3 patients with brachymetatarsia of the fourth toe were treated by this method, and excellent elongation of from 17.50 to 32.55 mm (average, 23.71 mm) was acquired. The treatment period ranged from 78 to 141 days (average, 112.5 days). More time was required in the earlier cases, but the most recent took only 11 weeks. The optimal distraction rate is considered to be 0.35 mm per half-day. Reshortening after treatment ranged from 3.6 to 5.5 mm (average, 4.7 mm), or from 15% to 26% (average, 20.5%) of the distracted length. About 90% of the resorption was observed within 1 month, except in a case that involved a postoperative fracture, and no resorption was seen after 2 surgical months. Regarding complications, subluxation of joints was seen in 2 patients and a postoperative fracture in 1 patient. Subluxation was caused by tendons resisting elongation. The procedure is described, representative cases are illustrated, and problems encountered are discussed.

Adolescent↗
PubMed1994

Correction of the cleft nasal deformity with an L-shaped iliac bone graft.

We describe our technique for correcting a cleft lip nasal deformity using L-shaped iliac bone grafts to achieve additional structural support and the desired nasal projection and profile. Augmenting the nasal bridge creates the illusion of a narrower nose. Further, the columellar portion of the L-shaped graft provides stabilization, eliminating the "see-saw" effect of the bridge graft on the fulcrum of the bony bridge, which can lead to a depressed tip and loss of the root indentation. Clinical and radiographic observation has revealed that this method of correction has consistently produced satisfactory results.

Adolescent↗
PubMed1994

Tendinocutaneous free flap transfer to cover an extensive skin-tendon defect of the dorsum of the hand: case report.

The combined loss of skin and tendons after avulsion or degloving injuries continues to be a challenging problem. A 51-year-old man sustained an extensive avulsion injury of the dorsal hand. He underwent reconstruction with a vascularized tendinocutaneous free flap transfer from the dorsum of the foot and was followed for over a year. The functional and aesthetic results were satisfactory.

Foot↗
PubMed1994

Versatility of a free inferior rectus abdominis flap for head and neck reconstruction: analysis of 200 cases.

Between 1984 and 1991, 200 inferior rectus abdominis muscle and musculocutaneous free flap transfers were performed for reconstruction of defects or deformities resulting from removal of cancer in the head and neck region. Primary reconstruction was performed in 190 of 200 cases (95 percent), and secondary reconstruction in 10 cases (5 percent). The most common indication was tongue cancer in 78 patients, followed by cancer of the oropharynx. Total flap necrosis occurred in 10 cases (5 percent) and partial necrosis in two cases (1 percent). Donor-site morbidity was minimal. One of the distinct advantages of this flap is that the volume of the muscle and/or the fatty tissue attached to a given skin paddle can be readily adjusted to suit individual requirements. This flap has proven particularly useful for complex or large tissue defects in the head and neck region.

Adolescent↗
PubMed1994

Long-term follow-up of nerve conduction velocity in cross-face nerve grafting for the treatment of facial paralysis.

Motor nerve conduction velocity in a sural nerve graft crossing the face for the treatment of facial paralysis was measured postoperatively for more than 3 years. Forty-three cases of free gracilis muscle transplantation combined with a cross-face nerve graft were evaluated. The cross-face nerve graft was stimulated at two sites more than 5 cm apart by bipolar stimulating electrodes, and conduction velocity was calculated by dividing the length of this segment by the difference between the latencies of the evoked action potentials recorded from the grafted muscle. A tendency toward increase in motor nerve conduction velocity was noticed even 3 years after the sural nerve graft. This suggests that the grafted nerve has the potential to recover over a long period of time. The average velocity in measurements after the third postoperative year was 40.5 +/- 6.2 m/s (mean +/- SD), which corresponds to the lower limit of the normal value for the sural or facial nerve.

Adolescent↗
PubMed1994

The histologic analysis of distraction osteogenesis of the mandible in rabbits.

The process of bone formation in mandibular lengthening by distraction was studied in 30 rabbits. The mandible was subjected to a corticotomy, held in a neutral position for 2 weeks, and then lengthened at 0.18 mm per 12 hours for 24 days using a unilateral external fixation device (Orthofix M-100). On completion of the distraction, x-ray analysis showed that the distracted gap was filled with callus organized into three zones, namely, two sclerotic zones with a central radiolucent zone. These zones became indistinguishable from the adjacent preexisting mandible at 10 weeks after distraction. Histologically, new bone, which was formed by both intramembranous and endochondral ossification, underwent remodeling and resulted in cortical bone by 8 to 10 weeks after completion of distraction.

Animals↗
PubMed1994

Free neurovascular muscle transplantation for the treatment of facial paralysis using the hypoglossal nerve as a recipient motor source.

Seventeen cases of free-muscle transplantation using the hypoglossal nerve as a recipient motor nerve for the treatment of long-standing or irreversible facial paralysis are reported with details of a follow-up study. The muscle, usually the latissimus dorsi muscle, is transferred to the cheek with microvascular anastomoses. The muscle's motor nerve is sutured to the hypoglossal nerve. There are three classifications of hypoglossal nerve sectioning: total section, central section, and lower section. The results were compared on the basis of these three methods, leading to the recommendation that branches of the hypoglossal nerve diverging inferiorly to innervate the suprahyoid muscles be utilized as a recipient motor source. This method permits acceptably natural movement of the grafted muscle without functional disability of the tongue. Good candidates for this procedure are considered to be those patients for whom muscle transplantation combined with a cross-face nerve graft cannot be adopted because of bilateral paralysis or surgical intervention on the healthy side of the face or who are so old that the long two-stage operation holds no hope for them.

Adult↗
PubMed1994

Tissue expansion in facial reconstruction.

The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin similar in color and texture and superior to skin obtained elsewhere, thereby surpassing conventional methods. However, there still remain some problems relating to procedural details, such as the selection of tissue expanders and sites of their insertion; the design, elevation, suturing, and fixation of the expanded flap; and the management of free margins such as the lower lip and lower eyelid. In each case, some modification is required with respect to the status of the defect. The experiences encountered in a series of 23 patients are described, with illustration of several representative cases, and advantages and problems are discussed.

Adolescent↗
PubMed1993

Experimental study on growth of epiphysial plate: free graft in rabbits.

The growth potential of a free graft of an epiphysial plate was investigated in rabbits. Two epiphysial plate grafts were harvested from each iliac crest. One was grafted to the head (onto bone) and the other to the ear (onto cartilage). Both of the epiphysial plates enlarged to a maximum height of 1.4 cm and became similar to iliac crests. Enchondral ossification was observed up till approximately 28 weeks of age. We conclude that an epiphysial plate has growth potential after free heterotopic transplantation.

Animals↗
PubMed1993

Reconstruction of the cervical trachea with a free forearm flap.

With the aim of voice restoration after repair of a total defect or obstruction of the cervical trachea, we developed a new method of total cervical tracheal reconstruction with a free forearm flap. The forearm flap is inverted to form a tube and then interposed between the subglottic trachea and an adjacent cutaneous fistula created at the upper portion of the tracheostoma. A permanent tracheostoma is preserved, and an L-shaped silicone tube is inserted in the reconstructed cervical trachea and the tracheostoma as a stent. In two patients, both became able to speak.

Adolescent↗
PubMed1993

Mandibular lengthening by gradual distraction: analysis using accurate skull replicas.

Bone lengthening in the upper and lower extremities by gradual distraction has become an accepted procedure. We have used an extraoral device to lengthen the mandible in four patients with unilateral mandibular hypoplasia. Using an accurate skull replica, the proposed corticotomy line, intended direction of lengthening, and appropriate position for the screws were determined. Following distraction, a significant increase in the dimensions of the affected mandible was obtained in each case. In this series, accurate skull replicas proved very useful for defining the anatomy, for surgical simulation and for pre- and postoperative evaluation.

Adolescent↗
PubMed1993

Comprehensive planning of operative strategy for separation of ischiopagus tripus twins with particular reference to quality of life.

A 27-year-old mother was diagnosed by prenatal ultrasonography as having triplets at gestational age 32 weeks. Following cesarean section at 37 weeks, a pair of female babies were noted for the first time to be joined by a common pelvis with three lower limbs. They had separate upper gastrointestinal tracts, which joined in the distal ileum, leading to a common colon, rectum, and a single anus. Each twin had a functioning kidney, with a single ureter leading to a common bladder. A common urethra originating from the bladder neck ran into the urogenital sinus of one baby. Prior to the surgical separation, placement of four tissue expanders and 20 pneumoperitoneums were performed, in order to stretch the parietes for easier approximation of the wound edges. At 13 months of age, separation was performed, requiring 17 hours. The skin and musculature from the conjoined third leg was used as a fillet for abdominal wall closure in each patient. One infant was given the distal half of the colon and an entire anus with a temporary jejunostomy, and the right half of the bladder with the urethra. The other infant was given the proximal half of the colon with a permanent colostomy, and the left half of the bladder with permanent cystostomy using appendiceal pedicle graft (Mitrofanoff's procedure). This is the 10th case of surgical separation in ischiopagus tripus twins reported in the literature, and the seventh successful separation with both patients alive.

Female↗
PubMed1993

Pseudocyst of the auricle: case reports and its biochemical characteristics.

Pseudocyst of the auricle is a rare, asymptomatic cystic swelling of the auricle resulting from accumulation of yellow viscous fluid with unknown cause. We herein report 3 such patients in whom biochemical study of the aspirated fluid revealed markedly elevated activity of lactate dehydrogenase (LDH) and a preponderance of LDH-4 and LDH-5. We postulate that pseudocyst formation is due to the disruption of the auricular cartilage and that LDH in the fluid is released from the auricular cartilage. This observation supports that the lesions represent a pattern of chondromalacia. It is hypothesized that the cause of such pseudocysts is repeated minor trauma.

Adult↗
PubMed1993

Experience with U-shaped gluteal thigh flap for reconstruction of radionecrosis in the sacral region.

The gluteal thigh flap first reported by Hurwitz in 1980 can provide a large reliable flap for coverage of the sacrogluteal and perineal regions. This flap can be extended quite some way along its axial inferior gluteal vessels, but its width is limited to approximately 10 cm if direct approximation of the donor site defect is required. In this article, we report a U-shaped modification of the gluteal thigh flap for efficient use of the flap in covering a large defect in the sacrogluteal region.

Aged↗
PubMed1993

Extremely thinned inferior rectus abdominis free flap.

To overcome a major drawback of the inferior rectus abdominis free flap, unpleasant thickness in a obese patient, a method of extreme thinning of the flap has been introduced. Extreme thinning is achieved by resecting a large volume of subcutaneous fatty tissue of the flap using scissors without damaging the subdermal vascular plexus. According to our clinical experience, it is supposed that the extremely thinned portion can be prepared safely when the width-to-length ratio is within 1:2.

Abdominal Muscles↗
PubMed1993

Eye socket reconstruction with free-flap transfer.

Patients afflicted with retinoblastoma or other malignant orbital tumors often undergo eyeball excision and irradiation in infancy, which results in severe deformities of the orbit. It is very difficult to achieve the reconstruction of such severely depressed and contracted eye sockets because both augmentation and formation of an eye socket are required. We usually perform a free-flap transfer with microvascular anastomoses in such situations and have experienced 25 cases since 1980. Various kinds of flaps, such as the groin flap, dorsalis pedis flap, scapular flap, and others, were utilized. The degree of depression and whether sufficient conjunctiva for lining of the eye socket remains are important in the selection and design of the donor flap. To obtain an orbit with a natural appearance, many of the patients required subsequent minor revision operations such as debulking, dermal fat grafts, canthoplasty, fascia suspension, and so on.

Adolescent↗
PubMed1992

Breast reconstruction with the free TRAM flap after breast cancer surgery.

The authors' experiences with 34 free lower TRAM flap transfers, in which 19 primary reconstructions and 15 secondary reconstructions were successfully achieved, are reviewed. The free TRAM flap yielded better results than the pedicled TRAM flap in cases where reconstruction of the infraclavicular and anterior axillary areas, as well as of the breast mound itself, was required.

Adult↗