Biomedical subjects
Publications and source records attributed to S Soeda.
In three cases a nasalis musculocutaneous flap, using the dog-ear, has been used to help close the secondary defect after transfer of a superiorly based nasolabial flap to the nose. In one case part of the nasalis flap was used to close a defect in the nasal lining.
The anterolateral thigh flap is based on the septocutaneous perforators of the lateral circumflex femoral artery. Little has been written about anomalies of its vascular pedicle. We report two variants of the pedicle vessel in eight patients in whom this flap was used, and absence of the perforators in five other cases in whom it was attempted. The anterolateral thigh flap has the advantages of thin and pliable skin, long and large pedicle, inconspicuous donor scar and the technical possibility of combination with fascia, sensory nerve and iliac bone. If the perforators are absent, a tensor fasciae latae musculocutaneous flap or anteromedial thigh flap is available with only minor changes of the flap outline.
This report presents a successful case of lip and chin reconstruction by a compound radial artery forearm free flap. This was a versatile source of tissue in the absence of local tissue for reconstruction.
Although free vascularized iliac bone graft has been successfully used for the reconstruction of large bone defect with microvascular surgery, there is a serious problem of how to repair in one-stage, those cases having a large bone defect with a very wide skin defect. A free combined anterolateral flap and vascularized iliac bone graft with double vascular pedicles seems to be a most suitable method for cases having both large bone and skin defects. Two case reports are presented in which this flap was used. Based on the authors' cases, the advantages of this flap are its thinness and the extreme wideness of the skin territory. The anatomy of the pedicle vessels is large and long, and the donor scar can be made in an unexposed area. This flap can be considered for use in one-stage reconstructions of both large bone and skin defects in the oral and leg regions.
The application of the subcutaneous pedicle flap for perineal defects is presented. We recognize from clinical experience that the perineal area has a sufficient subcutaneous vascular network from internal and external pudendar arteries. We found that the subcutaneous pedicle flaps can be used safely in the perineal area the same as the facial area. The perineal defect that reaches to the vaginal orifice or anus needs to be reconstructed three dimensionally, not flat. The subcutaneous pedicle flap with vertical pedicle can produce natural shape and depth of the perineum.
Subcutaneous free or moving bodies are rare. We report two cases of subcutaneous movable bodies. These two bodies were treated by surgical excision. Histopathological findings were free fatty tissues and calcifying epithelioma. The cause of free fatty bodies and the mechanism by which they turn into a widely moving calcifying epithelioma are now obscure; however, trauma may be a possible cause of these lesions.
After wide excision of the squamous cell carcinoma, the large defect of the ulnar side of the left hand was treated successfully by a distally based ulnar artery island forearm flap. The flap has excellent circulation and can cover the wide defect of the hand.
Werner's syndrome is a rare condition of autosomal recessive inheritance associated with features of accelerated aging. We describe 2 patients whose elbow defects were repaired with muscle flap or distally based ulnar recurrent artery flap. Protein analysis for the biopsied skin showed a remarkable increase of abnormal proteins in the range from 40,000 to 60,000 molecular weight. An abnormally low-molecular-weight protein in serum was also detected in the patient, but no abnormal proteins were seen in the urine. It is suggested that Werner's trophic ulcer can be repaired by ordinary skin flap, and we conclude that some abnormal proteins are produced in the Werner's skin and serum.
Extensive excision of malignant tumors in the medial portion of the eyelids involving the medial canthal tendon and orbicularis oculi muscle results in the lateral displacement of the eyelids and forward drift of the medial canthal region during the healing process if they are not repaired. We present three successful cases of reconstruction of an extensive defect in the medial portion of the eyelids by the island median forehead flap with frontal muscle and frontal galea aponeurotica to repair the medial canthal tendon and orbicularis oculi muscle. This improved technique successfully avoids lateral displacement of the eyelids and forward drift of the medial canthal region, and is a treatment choice for the extensive medial canthal defect.
Bovine serum albumins (BSA), modified with a variety of carboxyl group agents, stimulated the tissue-type plasminogen activator (t-PA)-catalyzed activation of human plasminogen. Modification with taurine (tau) and putrescine (put) provided the best stimulants. The tauBSA and putBSA were effective at a concentration of 5 micrograms/ml and enhanced the Lys-plasminogen activation by two-chain t-PA in a dose-dependent manner to a maximum of 44- to 46-fold at 200 micrograms/ml. The Km values for the activation of Glu-plasminogen by t-PA in the presence of tauBSA and putBSA (100 micrograms/ml) were 1.7 and 1.8 microM, while the kcat values were 0.059 and 0.062 s-1, respectively. T-PA was bound to both tauBSA and putBSA, which were immobilized on agarose beads, with KD values of 163 and 138 nM, respectively. The two modified BSAs were good substrates for plasmin and were hydrolyzed by the enzyme to small peptides. All of these modified BSA-related actions were inhibited by lysine analogs (e.g. tranexamic acid) which were adjusted to the concentrations required for the inhibition of the plasminogen (Kringle 1 domain) binding to fibrin. On the other hand, acetylation or succinylation of the amino groups of BSA was not effective, while alkylation of the thiol groups of this protein resulted in a moderate stimulation of the plasmin generation. The present results show that t-PA and plasminogen form complexes with certain charge-modified BSAs via their lysine-binding sites. The different stimulation potency of modified BSAs may provide a model for in vivo counterparts of fibrin.
A series of C-sulfoethylated and/or N-acetylated poly(D-Glu, D-Lys) (polyGL) derivatives was synthesized and their effects on tissue-type plasminogen activator (t-PA)-induced fibrinolysis were investigated. These derivatives accelerated t-PA-induced plasma (fibrin) clot lysis and t-PA-catalyzed plasminogen activation with the following order of potency: C-sulfoethylated and N-acetylated polyGL greater than N-acetylated polyGL greater than C-sulfoethylated polyGL greater than polyGL. The most potent stimulator C-sulfoethylated and N-acetylated polyGL associated with both t-PA and plasminogen under low ionic conditions, whereas it did not prevent the bindings of t-PA and plasminogen to fibrin. These results suggest that t-PA and plasminogen preferentially bind to sulfated or carboxylated polyanions, which may be required to possess certain neutral groups, and such complex formation may improve the plasminogen activation kinetics in a different manner from that of fibrin.
This report describes a case of lumbo-sacral radiation ulcer which was treated successfully by an external oblique musculocutaneous flap supplied mainly by the subcostal artery.
We report the reconstruction of scalp defects by subcutaneous pedicle flaps with transverse pedicles. These flaps are supplied by vascular networks in the upper and lower parts of the epicranial aponeurosis. We have used this technique in 12 cases and have found it to be a useful alternative to other methods of scalp reconstruction.
A modified transposition flap is described which is useful in closing triangular defects with sides of unequal length and avoids the unnecessary sacrifice of skin to tailor the defect to the flap. The technique is illustrated with four cases.
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A considerable amount of literature has been written on microneurovascular surgery for the reconstruction of partial defects in fingers, but little has been published on reconstruction to replace lost fingernails. We report on two clinical cases in which a free vascularized nail graft and a "double onychocutaneous flap" were used successfully. We suggest that the free vascularized nail graft is a superior method in reconstruction to treat fingernail loss or deformity.
Using rat femoral and epigastric vessels, the efficacy of an autogenous venous cuff and reduction in the number of required sutures were examined. Cut vessels were anastomosed with two sutures using 11-0 nylon, and the anastomotic site was covered with a venous cuff. After two weeks, the patency of the anastomosed vessels was evaluated. Although results in large-caliber femoral veins were poor, the femoral arteries and epigastric vessels demonstrated high patency rates. In microscopic and scanning electron microscopic evaluations, gaps and depressions between sutures were observed, but they were smoothly covered by endothelium. These results suggest the usefulness of the venous cuff in microvascular surgery, especially in anastomosing fine-caliber vessels.
Reconstruction of a large defect of the vermilion border of the lip poses difficult problems. It may result in a vermilion border deformity or reduce the buccal cavity. In this article we describe reconstruction of the vermilion border of the lower lip using bilateral island vermilion flaps pedicled by labial arteries, a modification of Kapetansky's double-pendulum flaps. We found that our technique was a very reliable and versatile alternative to other local flaps.