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Yasunori Hattori

Publications and source records attributed to Yasunori Hattori.

At least 19 recordsLinked to original sources
PubMed2007

The use of free vascularized corticoperiosteal grafts from the femur in the treatment of scaphoid non-union.

Most scaphoid non-unions can be treated successfully with conventional bone graft and screw fixation. Only a few cases with established avascular necrosis of the proximal fragment and previous failed conventional bone grafting should undergo vascularized bone graft. Cases in which the fragments are too small to accommodate a vascularized bone graft are better treated by alternative procedures. This article describes the role of vascularized bone grafting for scaphoid non-union, indications, donor bone selection, the authors' operative technique for vascularized bone graft from the supracondylar region of the femur, outcomes, and complications.

Bone Transplantation↗
PubMed2006

Ultrasonographic evaluation of functioning free muscle transfer: comparison between spinal accessory and intercostal nerve reinnervation.

This study focuses on the application of ultrasonography as a means of measuring the cross-sectional area (CSA) of the transferred muscle and evaluating its force recovery following functioning free muscle transfer. The objective of the study was to compare the CSA of a transferred muscle that is either reinnervated by the spinal accessory nerve (SAN) or the intercostal nerve (ICN), and to evaluate the difference in their force recovery. Ten patients with complete avulsion of the brachial plexus who underwent a double free muscle technique for restoring prehensile function were evaluated. All patients were followed up for at least 1.5 years after the operation. The CSAs of 20 transferred gracilis muscles in 10 patients, reinnervated either by SAN or ICN, were measured by ultrasonography. The CSA was measured at relaxation and at maximal isometric contraction. The force recovery of each muscle was expressed as the contraction rate (CR), calculated by dividing the CSA of the muscle in maximum isometric contraction by the CSA of the muscle in relaxation. The mean CSA of the transferred muscles reinnervated by the SAN was 2.98 +/- 0.723 cm (2) in relaxation and 3.95 +/- 1.296 cm (2) in maximum isometric contraction; thereby a CR of 1.32 +/- 0.174 was obtained. The mean CSA of the transferred muscles reinnervated by the ICN was 2.32 +/- 0.520 cm (2) and 2.69 +/- 0.566 cm (2) in relaxation and maximal isometric contraction, respectively; thus a CR of 1.16 +/- 0.068 was obtained. Results showed that the CR was significantly higher among the transferred muscles reinnervated by the SAN than those by the ICN. This study demonstrated that muscles that are reinnervated by the SAN resulted in stronger recovery than those reinnervated by the ICN, and that ultrasonography has the capacity to evaluate force recovery of each muscle by measuring the CSA during the two phases of muscle activity.

Accessory Nerve↗
PubMed2006

Vascularized ulnar nerve graft.

The purpose of this article is to describe the indications, anatomy, and harvesting technique of vascularized ulnar nerve graft based on the superior ulnar collateral artery (SUCA) for reconstruction of upper extremity function. The ulnar nerve has an extrinsic blood supply consisting of multiple dominant systems: the SUCA, the inferior ulnar collateral artery, the posterior ulnar recurrent artery, and the ulnar artery. The entire length of the ulnar nerve can survive based on the SUCA and its venae comitantes. The vascularized ulnar nerve graft is used when there is a hopeless prognosis for ulnar nerve repair. This technique may be selected if there is a definite evidence of preganglionic injuries of the C8 and T1 roots in brachial plexus injuries. This technique can be recommended for reconstruction of a large defect of the median or radial nerves in selected cases, such as upper arm replantation.

Accidents, Traffic↗
PubMed2006

Technique of harvesting the gracilis for free functioning muscle transplantation.

In this article, we describe our technique and experience in harvesting the gracilis muscle for free functioning muscle transplantation (FFMT). The gracilis is the most commonly used muscle for FFMT. The main indication for gracilis FFMT is traumatic brachial plexus injury. Gracilis muscle has a class 2 vascular pedicle, with a dominant vascular pedicle originating from the profunda femoris vessels and a single motor nerve originating from the obturator nerve. During gracilis harvest, it is important to include the entire fascia around the muscle to ensure vascularity of the skin paddle and enhance muscle gliding in its new bed. Mobilization of the adductor longus allows tracing of the pedicle to its origin from the profunda femoris vessels, hence, achieving the maximum available length of the pedicle. Lengthening of gracilis tendon with a periosteal strip provides a free gracilis long enough to span the distance from the clavicle to the distal forearm. The main complications are related to the wound, and these include delayed healing, infection, and scar-related problems. The functional deficit after gracilis harvest is negligible.

Dissection↗
PubMed2005

Restoration of prehension using double free muscle technique after complete avulsion of brachial plexus in children: a report of three cases.

PURPOSE: Brachial plexus injury in children, excluding birth palsy, is relatively rare and seldom reported. We report our technique, the results of this procedure, and problems we encountered in treating children with brachial plexus injury. METHODS: From 1999 through 2002, we treated 3 children with complete avulsion of the brachial plexus due to trauma by using double free muscle technique (DFMT) with a nerve transfer procedure using the contralateral seventh cervical nerve root transfer to reconstruct prehensile function. There were 2 boys aged 5 and 11 years and a girl aged 4 years. All patients were followed up for at least 3 years after the surgery. RESULTS: All the transferred muscles survived without any vascular complications and were reinnervated successfully. The average active range of elbow flexion was 125 degrees (range, 90 degrees - 145 degrees ). The average total active range of motion of the fingers was 69 degrees (range, 40 degrees -102 degrees ). All patients obtained voluntary prehensile function and could use the reconstructed hand for activities of daily living. They were able to lift and carry light objects with the reconstructed hand and heavy objects with both hands. CONCLUSIONS: The results of DFMT for reconstruction of BPI in children were encouraging. Appropriate postoperative rehabilitation under close supervision is important to obtain useful prehensile function.

Accessory Nerve↗
PubMed2005

Arthroscopically assisted reduction and immobilization of intraarticular fracture of the distal end of the radius: several options of reduction and immobilization.

On the basis of preoperative computerized tomography scanning and newly developed 3-dimensional reconstruction technique, Doi classified intraarticular distal radial fracture to 2-, 3-, and 4-part type, according to the number of main fracture fragments in distal radial aspect. This classification system simply, as well as perspicuously, describes the status of joint surface, thereby providing an intuitionist and practical guideline for arthroscopy procedure. Between 1992 and 2003, 91 patients ranged from 21 to 79 years of age with intraarticular distal radius fracture were treated with an arthroscopically assisted operation at our department. Among these patients, 42, 34, and 15 cases were 2-, 3-, and 4-part type, accounting for 46%, 37%, and 17% respectively. Wrist arthroscopy was applied individually according to the different type, with the purpose of achieving <1mm reduction. Role of arthroscopy was postreduction examination for 14 cases, as K-wire guider in 13 cases, assisting reduction, and immobilization in 61 cases. Four of the 61 cases changed to ORIF. Immobilization methods include external fixator combined with K-wire or plate combined with pullout wire or screw. K-wire without other implant was applied to 6 cases. In 1 case, a screw was the only implant.

Arthroscopy↗
PubMed2005

Proposal of new category for congenital unilateral upper limb muscular hypertrophy.

According to congenital anomalies of the hand and forearm classifications, the common characteristic of overgrowth problems is the skeletal overgrowth of part or all of the hand. Congenital unilateral muscular hypertrophy of the upper extremity has been classified under the overgrowth (gigantism) problems as whole-limb hemihypertrophy. The common characteristic of overgrowth problems is the skeletal overgrowth of part or all of the hand, which is not prominent in these patients. Only 15 cases with this anomaly have been reported since 1962. These patients have abnormal muscles with hypertrophic appearance and changed tendon to muscle length ratio. This type of muscular hypertrophy shows an increase in the number of fibers in transverse section, as also seen in multiply innervated muscles like the sartorius and gracilis in humans. Although this phenomenon has a mosaic type distribution, there is no progression of the muscular hypertrophy during growth period. Hand deformities are not due to a part of progression of the disease but result of imbalance of the extrinsic and intrinsic muscles. The evolutionary changes of skeletal muscles should be investigated to explain this congenital phenomenon and might be classified in a different entity from the present categories.

Child, Preschool↗
PubMed2005

Selection of grip function in double free gracilis transfer procedures after complete paralysis of the brachial plexus.

Double free gracilis transfer (DFGT) procedures introduced by Doi et al have resulted in significant improvement in maintaining functional prehensile hand after total brachial plexus injury (TBPI). However, not all patients with satisfactory recovery of finger motion could improve their prehensile function. The use of reconstructed hand in daily activities was examined retrospectively to plan individual grip function, depending on the patient's own demand. Thirty patients who had had reconstruction with DFGT procedures were evaluated retrospectively according to total active motion (TAM), power grip, hook grip, and pinch function. Power grip was evaluated by holding a bottle and hook grip by lifting a weight. Only 11 patients (36%) had very light pulp-to-pulp pinch, 11 (36%) had power grip, and 25 (83%) had hook grip. The mean weight that could be carried by hook grip was 1.3 kg. The mean TAM was 43 degrees. Pain sensation was the only encouraging sensation recovery, radiating to the chest. Fine movements of the hand like pinching require well-developed exquisite control of movements. TBPI patients have the contralateral normal limb, which they always prefer, only using their reconstructed hand when the activity requires both hands, such as when holding a bottle to open its cap or lifting bags when the contralateral normal hand is already engaged. For performance of these actions, hook grip and power grip are the useful prehensile hand functions that can be obtained after DFGT. Selection of grip functions should be done according to patient needs, and the late-stage reconstructive hand operations should be decided according to preferred grip function.

Adolescent↗
PubMed2005

Double-strand suturing fixation technique for treatment of acute volar plate avulsion fracture of the base of the middle phalanx.

A new suturing technique for treatment of acute volar plate avulsion fracture of the proximal interphalangeal joint is reported. Because this technique that consists of double-strand suture is rigid enough and never obstructs joint motion, early motion exercise can be allowed. This technique only demands simple skill like conventional K-wire fixation. Furthermore, removal of fixation material is not necessary.

Acute Disease↗
PubMed2004

Free vascularized joint transfer from the nonreplantable digit as a free flap for primary reconstruction of complex hand injury.

We report our experience in treating a a patient with an electrical saw injury to the right hand that resulted in incomplete amputation of the ring and small fingers at the metacarpophalangeal (MCP) joint with segmental tissue loss. Ray amputation of the small finger was performed because of extensive tissue loss. The proximal interphalangeal joint of the nonreplantable small finger was transferred as a fillet flap for primary reconstruction of the severely damaged MCP joint of the ring finger after revascularization. Two years after surgery active range of motion of the reconstructed MCP joint was 35 degrees extension to 85 degrees flexion with no instability or pain.

Accidents, Occupational↗
PubMed2004

Obturator nerve injury associated with femur fracture fixation detected during gracilis muscle harvesting for functioning free muscle transfer.

A rare case is reported in which injury of the motor nerve of the gracilis (obturator nerve) was detected during its harvesting for functioning free muscle transfer. The probable cause of this rare injury was considered to be accidental penetration while drilling for a proximal locking screw in intramedullary nailing during previous femur fracture surgery.

Adult↗
PubMed2004

Traumatic major muscle loss in the upper extremity: reconstruction using functioning free muscle transplantation.

Traumatic crushing injuries of the muscle compartments will occasionally cause major muscle or muscle-group loss with concomitant irreparable nerve injuries. Those cases with or without the availability of local muscle transfers form another indication for functioning free muscle transplantation (FFMT). The authors report their experience with 20 FFMTs in 14 patients with severe muscle loss from 1986 to 1996. They were selected because all their major muscle loss was primarily due to muscle avulsion, avascularity, and necrosis, but not secondarily due to nerve injury or ischemic injury. The motor nerves innervating these muscles were either disrupted after muscle debridement or avulsed from the neuromuscular junction concomitantly. The initial injury in this series was so severe that in many cases amputation was advised. Fractures were present in almost half the cases (6/14). Half the cases required revascularization due to rupture of major vessels (7/14), and the need for free-tissue transfer for soft-tissue coverage was demonstrated in over two-thirds (8/14). All FFMTs were innervated by the motor nerve which originally innervated the lost major muscle(s), and to replace palmar arm compartment (elbow flexors, 6 cases), palmar forearm compartment (finger flexors, 6 cases), and dorsal forearm compartment (finger extensors, 8 cases). Postoperative follow-up ranged from 3 to 12.5 years (average: 8.3 years). The success rate, i.e., achieving M4 muscle strength, was nearly 90 percent (18 of 20 FFMTs). Two cases with sub-optimal results were performed in the acute stage for the purpose of soft-tissue coverage and functional results. These reconstructions make the originally compromised limb useful for most activities of daily living. This type of injury should be recognized as providing a good prognosis after application of the FFMT, and arbitrary amputation should be avoided.

Adolescent↗
PubMed2004

Radioisotope technique to evaluate the motor functional status of donor nerve for upper extremity reconstruction.

A rapid and precise method of nerve fascicle identification based on measurement of choline acetyltransferase activity using radioisotope technique was used intraoperatively during upper extremity reconstruction. This technique can be used to evaluate the motor function of donor fascicles directly and quantitatively. This technique is useful to evaluate the motor functional status of donor fascicles during functioning free muscle transfer, to distinguish between preganglionic and postganglionic injuries in brachial plexus injury, and to differentiate between motor and sensory fascicles during nerve grafting procedures.

Journal Article↗
PubMed2004

Vascular malformation of hand: cavernous lymphangioma.

A case of congenital cavernous lymphangioma of the hand presenting in a newborn is presented. The mass on the dorsum of the hand was removed with the overlying skin and underlying paratenon at three years of age. Re-surfacing was performed with a free flap transfer. There were no post-operative complications during one year of follow-up.

Hand↗
PubMed2003

Kienböck's disease with congenital capitohamate coalition in an ulnar ray defect: a case report.

We report a patient who developed Kienböck's disease with congenital capitohamate coalition and absence of the little finger: an ulnar ray abnormality of the hand without hypoplasty or defect of the ulna at the forearm. Kienböck's disease combined with an ulnar ray abnormality is a rare situation and the force distribution is unclear. The etiology of the Kienböck's disease is still obscure, so numerous surgical procedures have developed. Capitohamate fusion is one of them, but the case reported here highlights the fact that capitohamate fusion may be a questionable treatment for Kienböck's disease.

Carpal Bones↗
PubMed2003

A benefit of the volar approach for wrist arthroscopy.

We reviewed 230 cases of wrist arthroscopy using a volar approach and evaluated its advantage in various wrist disorders. In general, a dorsal approach has been preferred in wrist arthroscopy. The volar approach has been avoided because of the presence of significant structures, such as radial and ulnar arteries, their venae comitantes, median and ulnar nerves, and flexor tendons. However, we can access the wrist joint securely using the volar approach through the tendon sheath of the flexor carpi radialis. Through this approach, we can adequately visualize the dorsal rim fragment of the intra-articular fracture of the distal radius, dorsal synovial proliferation of the rheumatoid wrist, and volar segment tear of the scapholunate and lunotriquetral interosseous ligaments. We had no complications with wrist arthroscopy using the volar approach in 230 patients. The volar approach for wrist arthroscopy is a valuable procedure to evaluate and treat various wrist disorders.

Adult↗
PubMed2003

Arthroscopic assessment of the volar region of the scapholunate interosseous ligament through a volar portal.

PURPOSE: The volar region of the scapholunate interosseous ligament is one of the key structures that maintains scapholunate alignment. It is, however, difficult to evaluate this ligament using standard diagnostic procedures, including the arthroscopy through a dorsal portal. We have performed arthroscopic evaluation of this ligament through a volar portal. METHODS: Skin incision was made at just radial of the flexor carpi radialis tendon and the portal was opened through the tendon sheath. RESULTS: The volar approach enabled us to directly observe the extent of the tear of the volar region of scapholunate interosseous ligament. A shaver is inserted through the dorsal portal, and debridement can be performed by using the volar portal vein. We have not had any complications using volar portal. CONCLUSION: Volar approach is a feasible and safe procedure to evaluate and treat the volar region of the scapholunate interosseous ligament.

Arthroscopy↗