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Background In this report, we described the use of hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and the hypoglossal nerve for facial reanimation and analyzed the relationship between the outcome of surgery and duration of preoperative paralysis. Methods We performed hypoglossal-facial neurorrhaphy with the jump interpositional nerve graft on nine men and 10 women with unilateral complete facial paralysis. The patients, with a mean age of 39.7 ± 18.1 years (range, 8–65 years) at the time of surgery, experienced preoperative paralysis ranging from 1 to 150 months (mean, 16.9 ± 34.9 months). The movement of the corners of the mouth was evaluated 12 months after surgery using a unique method based on the House–Brackmann grading scale. Results The mean follow-up was 5.6 ± 1.6 years (range, 3–9 years). The movement of the corners of mouth was classified as excellent in two cases, good in seven cases, fair in two cases, and poor in eight cases. Nine of the 11 cases with preoperative paralysis of 6 months or less had excellent or good results, whereas none of the eight cases with preoperative paralysis of 7 months or longer yielded excellent or good results, showing a significant difference (P = 0.01). Conclusions To achieve successful reanimation of the corners of the mouth, hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and the hypoglossal nerve should be performed within 6 months after the onset of facial nerve paralysis. © 2015 Wiley Periodicals, Inc. Microsurgery 36:460–466, 2016.

Background To reanimate the mimetic muscles, crossface nerve graft (CFNG) is an effective surgical option. However, muscle atrophy after facial paralysis may influence the surgical result. We analyzed the relationship between surgical result and preoperative paralysis duration. Methods We performed CFNG on 15 patients. The sural nerve was transferred between the affected and nonaffected sides of the zygomatic branch. Eyelid function and eyelid lid were evaluated using the modified House–Brackmann scale. The effects of age, sex, cause of facial paralysis, graft nerve length, and preoperative paralysis duration were evaluated. Results The mean follow up period was 9.3 ± 3.3 (range 4–14) years. Eyelid closure was excellent in four patients, good in six, fair in one, and poor in four. Statistically, no significant difference was observed between those patients with excellent or good outcomes and fair or poor outcomes regarding age (40.9 ± 11.0 years vs. 22.6 ± 20.8; P = .067), sex (male/female = 2/8 vs. 3/2; P = .250), cause (tumor/trauma = 10/0 vs. 3/2; P = .095), and length of nerve graft (14.4 ± 0.8 cm vs. 13.8 ± 1.6 cm; P = .375). The average preoperative paralysis duration in the excellent/good patients was significantly shorter than that in the fair/poor patients (P = .005). All eight cases with preoperative paralysis of less than 6 months showed a marked excellent/good result. Two of the seven patients with preoperative paralysis was 6 months or longer marked fair/poor result. (P = .007). Conclusions To achieve successful results with CFNG, surgery should be performed within 6 months of the onset of paralysis.

Lipoprostaglandin E1 (lipo-PGE1) has been found accumulating in injured vascular regions. This study examined the localization of lipo-PGE1 in the anastomotic region. The study was divided into three parts. First, we performed anastomosis of the rat femoral artery and vein (n = 17). Lipo-PGE1 labeled with 1,1'-dioctadecyl-1,3,3',3'-tetramethyl-indocarbocyanine was infused intravenously. Hematoxylin-Eosin staining and fluorescence microscopic findings showed that lipo-PGE1 markedly accumulated at the anastomotic site when compared to the contralateral non anastomotic region. Then, we measured laser Doppler flow (LDF) of a lower leg before and after infusion of lipo-PGE1 (n = 7) and saline (n = 7). Increase of blood flow was maintained 1 hour after the infusion of lipo-PGE1 (144% ± 25.0%) when compared to saline infusion. Finally, we performed immunohistochemical and electron microscopic examinations and found that Lipo-PGE1 was incorporated in vascular smooth muscle cells of the anastomotic region. These findings suggest selective accumulation of the lipo-PGE1 in the vascular anastomosis site and affect on the blood flow of repaired vessels. © 2011 Wiley-Liss, Inc. Microsurgery, 2011.

We present herein a case of massive arterial thrombosis of a free rectus abdominal musculocutaneous flap used for reconstructive surgery of gingival carcinoma that could not be rescued. A 54-year-old woman underwent the operation. She had experienced two miscarriages in her 20s, but medical history was otherwise uneventful. Intraoperatively, the anastomosed artery often showed massive arterial thrombosis, and the flaps had become necrotic after bilateral flaps were used. Laboratory findings, 7 days postoperatively, showed high levels of immunoglobulin G anticardiolipin antibody. This value normalized by 2 months postoperatively after using chemotherapy. This case does not match the criteria for antiphospholipid syndrome, but some English-language reports have shown rising antiphospholipid antibody levels, particularly anticardiolipin antibodies, in patients with neoplasm. In those cases, levels have normalized after successful therapy. Antiphospholipid antibody levels should be examined before surgery to identify risks of hypercoagulability.

In this report, we described the use of hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and the hypoglossal nerve for facial reanimation and analyzed the relationship between the outcome of surgery and duration of preoperative paralysis.We performed hypoglossal-facial neurorrhaphy with the jump interpositional nerve graft on nine men and 10 women with unilateral complete facial paralysis. The patients, with a mean age of 39.7 ± 18.1 years (range, 8-65 years) at the time of surgery, experienced preoperative paralysis ranging from 1 to 150 months (mean, 16.9 ± 34.9 months). The movement of the corners of the mouth was evaluated 12 months after surgery using a unique method based on the House-Brackmann grading scale.The mean follow-up was 5.6 ± 1.6 years (range, 3-9 years). The movement of the corners of mouth was classified as excellent in two cases, good in seven cases, fair in two cases, and poor in eight cases. Nine of the 11 cases with preoperative paralysis of 6 months or less had excellent or good results, whereas none of the eight cases with preoperative paralysis of 7 months or longer yielded excellent or good results, showing a significant difference (P = 0.01).To achieve successful reanimation of the corners of the mouth, hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and the hypoglossal nerve should be performed within 6 months after the onset of facial nerve paralysis. © 2015 Wiley Periodicals, Inc. Microsurgery 36:460-466, 2016.

Reconstruction of the hepatic artery (HA) is challenging, because there are technical difficulties. Especially, it is difficult to repair the posterior wall. In 2006, we reported an experimental study of the posterior wall first continuous suturing combined with the interrupted suturing and we also confirmed the safety of this procedure. In this article, we report our clinical experiences using this procedure for the HA reconstruction in living-donor liver transplantation. First, we repaired the posterior wall of the HA with continuous suturing. Then, the anterior wall is repaired with the interrupted suturing using a nylon suture with double needle. Between 2006 and 2009, we performed 13 HA reconstructions using our procedure. In all patients, the HA reconstruction was completed easily and uneventfully without oozing from the posterior wall or postoperative HA thrombosis. Our procedure has the benefits of both continuous and interrupted suturing. We believe that it is useful for reconstruction of the HA in living-donor liver transplantation.

Lipoprostaglandin E1 (lipo-PGE1) has been found accumulating in injured vascular regions. This study examined the localization of lipo-PGE1 in the anastomotic region. The study was divided into three parts. First, we performed anastomosis of the rat femoral artery and vein (n = 17). Lipo-PGE1 labeled with 1,1'-dioctadecyl-1,3,3',3'-tetramethyl-indocarbocyanine was infused intravenously. Hematoxylin-Eosin staining and fluorescence microscopic findings showed that lipo-PGE1 markedly accumulated at the anastomotic site when compared to the contralateral non anastomotic region. Then, we measured laser Doppler flow (LDF) of a lower leg before and after infusion of lipo-PGE1 (n = 7) and saline (n = 7). Increase of blood flow was maintained 1 hour after the infusion of lipo-PGE1 (144% ± 25.0%) when compared to saline infusion. Finally, we performed immunohistochemical and electron microscopic examinations and found that Lipo-PGE1 was incorporated in vascular smooth muscle cells of the anastomotic region. These findings suggest selective accumulation of the lipo-PGE1 in the vascular anastomosis site and affect on the blood flow of repaired vessels.

We present herein a case of massive arterial thrombosis of a free rectus abdominal musculocutaneous flap used for reconstructive surgery of gingival carcinoma that could not be rescued. A 54-year-old woman underwent the operation. She had experienced two miscarriages in her 20s, but medical history was otherwise uneventful. Intraoperatively, the anastomosed artery often showed massive arterial thrombosis, and the flaps had become necrotic after bilateral flaps were used. Laboratory findings, 7 days postoperatively, showed high levels of immunoglobulin G anticardiolipin antibody. This value normalized by 2 months postoperatively after using chemotherapy. This case does not match the criteria for antiphospholipid syndrome, but some English-language reports have shown rising antiphospholipid antibody levels, particularly anticardiolipin antibodies, in patients with neoplasm. In those cases, levels have normalized after successful therapy. Antiphospholipid antibody levels should be examined before surgery to identify risks of hypercoagulability.

We describe post-total maxillectomy secondary facial contour reconstruction using an osteocutaneous scapular flap nourished by flow-through vascularization from the radial vascular system. Scar contracture caused by either total or partial maxillectomy for maxillary cancer was completely released with exposure of the edge of the zygomatic arch, orbital floor, and nasal bone. The scapular skin flap was placed into the mucosal defect, and the orbital floor and zygomatic prominence were reconstructed with the scapular bone. The flap nutrient vessels were anastomosed to radial vessels and cephalic vein grafts. Two representative cases are illustrated to demonstrate the application and advantage of this operative method.

A comparative study was conducted of the results of venous end-to-end and end-to-side anastomosis in 948 clinical cases of microvascular free-tissue transfers for head and neck reconstruction following tumor resection. End-to-side anastomosis to the internal jugular vein was achieved uneventfully in the present series, while a variety of recipient veins was used for end-to-end anastomosis. The incidence of thrombosis was 1.8% (15/835) in the end-to-end anastomosis group and 2.7% (3/113) in end-to-side venous anastomosis. No statistical difference was observed between the two groups. One may hesitate to perform end-to-side anastomosis because of unfamiliarity, concern over technical difficulty, and unreliability. As a result of our statistical analysis, we are convinced that end-to-side anastomosis directly to the internal jugular vein, whenever available, is the preferred procedure in microvascular free-tissue transfers for reconstruction of the head and neck following tumor resection.