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Hair transplant surgery is a useful treatment modality for patients with male-pattern hair loss and recent studies have shown its utility in scarring hair loss. In this case, a 60-year-old man underwent hair transplant surgery for restoration of a bald area from resection of a malignant tumor of the scalp followed by split-thickness skin grafting. Here, we report a favorable outcome of hair transplant surgery using the follicular unit extraction (FUE) method. Because of uncertain hemodynamics in the graft bed, a preliminary surgery with 100 grafts was performed to verify the engraftment of all 100 grafts. Then, 1330 grafts were transplanted in the remaining bald region, producing satisfactory results. As demonstrated in this case, successful hair transplant can be achieved in split-thickness skin grafting sites by paying careful attention to hemodynamics in the recipient site. FUE is minimally invasive with the formation of a small scar in the donor site, and thus is a useful treatment modality for various types of hair loss.

The purpose of this study was to evaluate our experience of microvascular anastomosis of intraperitoneal vessels. Between 1985 and 1994, 117 microsurgical reconstructions were done using intraperitoneal vessels. These included oesophageal reconstruction (n = 106), reconstruction of the hepatic arterial, superior mesenteric arterial, or portal venous system (n = 8), and reconstruction of the chest or abdominal wall (n = 3). We used 129 intraperitoneal arteries and 117 intraperitoneal veins. Of a total of 246 intraperitoneal vessels, five hepatic arteries, seven splenic, 14 gastroepiploic, six superior mesenteric, 178 jejunal, 30 ileocolic, four middle colic arteries or veins, and two portal veins were used for microvascular anastomosis. The overall successful rate for these reconstructive cases was 97% (114/117). Microsurgical use of intraperitoneal vessels is a safe and developing procedure in plastic and reconstructive surgery.

Treacher Collins syndrome (TCS) is caused by mutations in TCOF1 of the nonsense, small deletion, and small insertion types, which most likely result in haploinsufficiency. We report a novel de novo nonsense mutation 2731C → T, resulting in Arg911Stop, which truncates the protein. Our patient had the classic findings of TCS, but with documented craniosynostosis, choanal atresia, and esophageal regurgitation. © 2004 Wiley-Liss, Inc.

食道胃静脈瘤に対し, 内視鏡的硬化療法 (endoscopic injection sclerotherapy) を施行し, 経過観察中に食道癌を認めた症例につき術式上の工夫を加えたので報告する。症例は54歳の男性。1988年8月, 食道静脈嬉破裂に対しEISにて止血した後, 5か月にわたり頻回の追加治療を受けた。その後, 経過観察していたが, 1991年5月, 食道内祝鏡検査で下部食道 (Ei) に発赤を認め, 生検を行った結果, 扁平上皮癌 (深達度ep) の診断でレーザー治療を受けた。1992年1月, Elに再び癌を認めたため, 手術目的で入院となった。術前内視鏡では, 食道静脈嬉は改善されていたが, 胃静脈瘤を認めた。非開胸食道抜去, 胸壁前胃管再建に短胃静脈-外頭静脈吻合を加えた結果, 胃管鬱血, 静脈瘤の増悪に対処しえて良好な予後が得られた。

Squamous cell carcinoma of the lower lip is a common tumor. Of the many methods available for reconstructing lower lip defects after radical excision, we found double cross lip flaps from each lateral side of the upper lip philtrum rotated into the defect of the lower lip to be an effective method, not only functionally but also cosmetically. The main reason why satisfactory results were obtained by this procedure is that the anatomical structure (skin-orbicularis oris muscle-mucosa, vermilion) of the upper lip is very similar to that of the lower lip. Our experience is with double cross lip operations in the management of lower lip cancers are described.

The details of surgical techniques for primary correction of the unilateral cleft lip nose and their results for 45 cases are reported. The technique employed an infracartilaginous incision on the affected side, thus allowing direct suturing of the alar cartilage onto the lateral cartilage. For the postoperative evaluation, the nasal form in both frontal and bottom views was scored for five items. In overall evaluation, the grades of “Good,” “Fair,” and “Poor” were derived from the total scores of five items. In the postoperative results (range of follow-up: 24 months to 84 months), 24 cases were rated “Good” (53.3%), 13 cases “Fair” (28.9%), and 8 cases “Poor” (17.8%). Thirty cases appear not to need secondary correction (66.6%). The technique is useful because the alar cartilages and lateral cartilages can be accurately sutured, and relatively stable results can be obtained.

Since most fetuses with drug-induced cleft lip have concurrent cleft palate, they die shortly after birth as a result of difficulty in suckling. We devised an experimental model, in which cleft lip unaccompanied by cleft palate was produced artificially, in order to permit long-term follow-up of intrauterine cleft lip repair surgery. Fifteen Jcl:ICR mice each on days 15, 16, 17 and 18 of gestation (the day when a vaginal plug was found = day 0 of gestation) were used. Each mouse was laparotomized by midline incision of the lower abdomen, and the fetus at the distal end or the fetus adjacent to the fetus at the distal end of the uterine horn was subjected to surgery. Using a surgical microscope, the uterine wall was incised, and the amnion and chorion were pierced to expose the snout of the fetus. After unilateral complete cleft lip was created, the wound was repaired with 10–0 nylon sutures. The snout was then replaced within the uterus, and the surgical wound in the uterine wall was closed. The uterine horn was then placed back into the peritoneal cavity, and the abdominal wound was closed. The dams were then returned to their individual cages, and the fetuses were delivered spontaneously. The live birth rate for surgically treated fetuses was 60% in animals treated on day 15 of gestation, 73% among those treated on day 16, 80% among those treated on day 17, and 60% among those treated on day 18. The offspring underwent the normal course of postnatal growth, with good jaw development and no cicatrization at the site of upper lip surgery either grossly or histologically.

Normal skin extensibility in the living body of 94 healthy male subjects ranging in age from 3 months to 73 years was determined quantitatively with the Bio-Skin Tension Meter at 12 sites. In comparison with the age of 20-29 years, the skin extensibility, particularly in the age group of less than 2 years, was significantly high. However, no significant difference from the age groups of 12-14, 15-19, 30-49 and over 50 years was found at any site. Correlation by age was noted at the extremities, excluding the posterior upper arm and at the lower abdomen, with the extensibility of the group less than 1 year as the maximum value, decreasing gradually down to 3-5 or 6-8 years. At the cheek, shoulder, anterior chest, and posterior upper arm, however, no correlation with age was noted.

Treacher Collins Syndrome (TCS) (OMIM 154500) is a congenital, craniofacial disorder inherited as an autosomal dominant trait. The responsible gene for TCS, TCOF1, was mapped to 5q32-33.1 and identified in 1996. Since then, TCOF1 mutations in patients with TCS have been reported from Europe, North and South America, however, no TCS cases from an Asian country have been molecularly characterized. Here we report mutational analysis for 11 Japanese patients with TCS for the first time, and have identified TCOF1 mutations in 9 of them. The mutations detected were various, but most likely all the mutations are predicted to result in a truncated gene product, known as treacle. One mutation frequently reported was included in our cases, but no missense mutations were detected. These findings are similar to those for the previous studies for TCS in other races. We have speculated about the molecular mechanisms of the mutations in most cases. Collectively, we have defined some of the characteristic molecular features commonly observed in TCS patients, irrespective of racial difference.

We present a case of reconstruction of the left cheek with a prefabricated musculocutaneous flap. A pedicled serratus anterior muscle flap was transferred to the left chest, deep to skin. The muscle flap and overlying skin were expanded. The expanded, prefabricated musculocutaneous flap was then transferred as a free flap to the left cheek defect.

Regarding radial ray deficiency, several reports suggest that preaxial limb anomalies occur frequently, while postaxial limb anomalies and cleft hand (split-hands) are rarely associated with VACTERL. We describe a rare clinical case of VACTERL with cleft hand and a number of visceral anomalies.

Radical distal pancreatectomy with en-bloc resection of the common hepatic, celiac, and left gastric arteries for pancreatic body cancer that involves these arteries does not routinely require arterial reconstruction because the collateral pathways via the pancreatoduodenal arcades from the superior mesenteric artery are recruited immediately. However, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and may lead to fatal complications. This article describes the middle colic artery-gastroepiploic artery bypass as an emergent salvage procedure for restoring collateral flow.The inferior pancreatoduodenal artery was accidentally injured in 2 of 9 patients who underwent the radical procedure between 1997 and 2001. Microvascular anastomosis between the left branch of the middle colic artery and the gastroepiploic artery in an end-to-side fashion was employed.The pulsation of the gastroepiploic artery and the color of the stomach recovered immediately after completion of the middle colic artery-gastroepiploic artery bypass. No ischemia-related complication developed postoperatively. Postoperative angiography showed the middle colic artery-gastroepiploic artery bypass supplying arterial flow to the liver, stomach, duodenum, and pancreas.The middle colic artery-gastroepiploic artery bypass is an excellent alternative restoring compromised collateral flow via the pancreatoduodenal arcades when microsurgical technique is available.

The technical factors of microangiography were studied, and the authors found that the main limiting factors in resolution were the injection pressure of the contrast medium and the thickness of the materials. A gentle manual hand pressure injection, with the aid of visual monitoring under the operating microscope, were keys to obtaining beautiful microangiograms.

Three patients, a female and two males, 28, 15, and 14 years of age, with Kabuki make-up syndrome (KMS) were studied for middle and inner ear abnormalities by using CT scanning of the petrous bones. All three patients had bilateral dysplasia of the inner ear, i.e., hypodysplasia of the cochlea, vestibule, and semicircular canals (so-called Mondini dysplasia), whereas their middle ears had no abnormalities. Audiometry demonstrated a sharp decrease in hearing of the high tone range, bilateral in one and unilateral in another, while the third patient was noncooperative. In view of these findings, it would be advisable to study each individual with KMS and hearing impairment for possible inner ear abnormalities.

The effects of lipo-prostaglandin (PG) E1, which are lipid microspheres containing PGE1, were examined using 2 x 12 cm random pattern skin flaps on the backs of five rabbits. Five rabbits acted as controls. Both surviving length (8.5 (3.1) compared with 4.9 (1.8) cm) and surviving area (22.1 (9.3) compared with 11.5 (6.1) cm2) of the skin flap were significantly increased (p < 0.03 in each case). In three additional rabbits the blood flow on the distal side of the skin flap, where it was poor, was measured using a laser image blood flowmeter. Blood flow was improved five to 15 minutes after injection of lipo-PGE1 and was maintained for at least 60 minutes. In conclusion, lipo-PGE1 increased the blood flow of the random skin flaps, resulting in significant enlargement of the surviving area of skin flaps.

Penetration of flomoxef into the maxillary and mandibular bones was assayed clinically to provide data about its usefulness for the prevention of postoperative infection after maxillofacial surgery. Twenty-one patients undergoing maxillofacial surgery at our department were given flomoxef 2 g dissolved in 20 ml of physiological saline intravenously over 3 minutes during operation, and the serum, maxillary and mandibular concentrations were measured 1, 3, and 6 hours after injection by the band culture method using Escherichia coli 7437 as the indicator strain. The mean concentrations were 53.4, 16.1, and 2.6 micrograms/ml, respectively, in the serum, 17.6, 7.8, and 1.0 micrograms/g in maxillary bone, and 16.4, 4.2, and 0.9 micrograms/g in mandibular bone. The mean bone:serum ratios at 1, 3, and 6 hours were 33.0%, 48.2%, and 36.8%, respectively, for maxillary bone, and 30.7%, 26.2%, and 35.7% for mandibular bone. When compared with previously reported data on the bone:serum ratios in jaw of various other intravenous antibiotics, our results show that penetration of flomoxef into maxillary and mandibular bone is extremely high. As all the intramaxillary and intramandibular concentrations exceed its MIC80 values against clinical isolates of bacteria frequently isolated in cases of infection in the oral and maxillofacial region, it is apparent that one intravenous shot of flomoxef 2 g allows penetration of the drug into the maxillary and mandibular bones at effective concentrations. Flomoxef is therefore potentially useful for the prevention and treatment of infections in the oral and maxillofacial region, as it has excellent penetration into the maxillary and mandibular bones.

The purpose of this study was to evaluate human mandibular lengthening by gradual distraction. The operation was performed under nasoendotracheal anesthesia. After exposing the angle of the mandible through an intraoral incision, two half-pins were inserted on each side of the corticotomy line. Following this, a corticotomy was performed using a sagittal saw, and the mandible was gently fractured. The external bone lengthening device was applied leaving a bone gap of 3 mm. Serial distraction of 1 mm per day was started on the 10th postoperative day. The device was left in place for retention purposes for 9–11 weeks. Three patients (average age 10 years and 3 months) underwent this procedure. The distraction achieved was 19 mm. Postoperatively, improvement of facial asymmetry and increased volume and length of the mandible were noted without any perioperative complications. The follow-up period averaged 13 months. These results suggested that this procedure is beneficial for the treatment of craniofacial microsomia.

Distally based radial and ulnar forearm flaps were employed to reconstruct iatrogenic dorsal skin defects of hands in young children. The defects resulted from the extravasation of intravenous medication; flaps were required for reconstruction because the extensor tendons were exposed in the base of the ulcer in Case 1 and were involved in dense scar tissue in Case 2. The reverse forearm flap is an easy and reliable technique requiring short operating time, and it allows initiation of early physiotherapy compared with the other techniques, such as free flap or an abdominal flap.

Obese paraplegics can suffer discomfort when they lie in a prone position and sit in wheelchairs. Two paraplegic cases who underwent abdominoplasty to eliminate such complaints are presented, with satisfactory results.