著者

小山田 基子 大安 剛裕 伊藤 綾美

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.31, no.1, pp.25-28, 2018 (Released:2018-03-23)

参考文献数

14

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In cases of multiple finger amputation, replantation of all amputated fingers may not be possible depending on the condition of the amputated fingers. Therefore, other reconstructive procedures should be considered, such as ectopic replantation, which is an important treatment option, especially when the thumb is one of the amputated fingers. We report the case of a 22-year-old man with complete amputation of his left thumb and index finger. The thumb amputation level was distal of the carpometacarpal joint and the amputated thumb was crushed too severely to perform replantation. We ectopically replanted the amputated index finger to the thumb stump at the anatomical position because the amputated index finger was less damaged. Good results were obtained in terms of both function and appearance.

著者

三宅 志歩 佐々木 薫 明星 里沙 佐々木 正浩 大島 純弥 渋谷 陽一郎 相原 有希子 関堂 充

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.35, no.1, pp.1-8, 2022 (Released:2022-03-25)

参考文献数

10

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Free fibula flap transfer, which consists of a vascularized segment of the long fibula, is the gold standard for mandibular reconstruction; however, this flap lacks sufficient soft tissue. In this report, we present a case of mandibular reconstruction in which the free fibula flap included two skin paddles vascularized by the proximal perforator(PP)and distal perforator(DP). The two skin paddles provided sufficient soft tissue and improved the outcome in terms of reconstructing the facial contours with a single flap. The PP has anatomical variations in terms of(a)location, running through both musculo- and septo-cutaneous regions, and(b)bifurcation, originating from the peroneal artery or more proximal positions. As skin paddles involving the PP have slightly thicker fat tissue and larger soleus muscle tissue than those involving DP, they may be useful for supplying soft tissue in mandibular reconstruction.

著者

大中 敬子 普天間 朝上 米田 晋 西田 康太郎

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.34, no.3, pp.167-171, 2021

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<p> The graft on flap method is useful for fresh fingertip amputation. We report a case in which the composite graft method was used after injury and the graft on flap method was used for cutaneous graft necrosis on day 12. A 48-year-old woman sustained complete amputation of her little finger after getting her hand caught in a machine at work. The injury was crush type and the amputation level was subzone II (Ishikawa's classification) . The osteo-cutaneous composite graft method was applied 2 and a half hours after injury. As cutaneous graft necrosis observed on day 12, the graft on flap method was performed on the same day. The defect lesion was covered with a volar V-Y advanced flap after the distal phalanx fragment was fixed. The flap survived and union of the distal phalanx fracture was achieved 2 months after surgery. The nail grew 3 months after surgery. Seven months after surgery, she had neither numbness nor pain, and had no difficulties. The graft on flap method may be effective in cases where bone and nail bed grafts survive even if the operation is delayed.</p>

著者

石井 直弘 清水 雄介 青木 麻利江 鈴木 彩馨 貴志 和生

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.33, no.3, pp.178-181, 2020

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<p>Various techniques for nail reconstruction have been reported until now; however, a simple one providing good esthetic results was difficult to find. Arterialized venous toenail flap is a free flap that includes the nail bed and matrix with a pedicle formed solely by the subcutaneous vein of the toe. The use of this flap is minimally invasive, easy, and the flap has a high survival rate. The mechanism of graft survival remains unknown given the non-physiological circulation. To the best of our knowledge, no studies have explained this mechanism with reference to detailed postoperative course. We herein present two cases of nail reconstruction performed using arterialized venous toenail flap. We analyzed the postoperative course in detail, which enabled us to postulate on the mechanism of graft survival.</p>

著者

大中 敬子 普天間 朝上 金城 政樹 大久保 宏貴 仲宗根 素子 金谷 文則

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.33, no.1, pp.19-23, 2020

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<p>Traumatic toe amputation has been rarely reported because of the limited number of cases, difficulty of the operative procedure and fewer problems with the absence of toes than fingers. We report toe amputation in 2 children. Case 1: A 15-year-old girl with crush type, Ishikawa classification subzoneⅡ, incomplete amputation of the first toe underwent revascularization with a vein graft. Skin necrosis was observed at the crush zone, and skin grafting was required after debridement and artificial dermis transplant. Case 2: A 7-year-old girl with crush type, Ishikawa classification subzoneⅡ, incomplete amputation of the fifth toe underwent revascularization. Skin necrosis was observed at the tip of the toe and the distal phalanx was resorbed partially, but the toe survived.</p>

著者

松末 武雄

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.32, no.4, pp.157-162, 2019-12-25 (Released:2019-12-25)

参考文献数

9

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This single-center retrospective study included patients who underwent free-flap transfer performed by the same surgeon; antithrombotic therapy was the only variable. The sample included 11 patients (group A) who received heparin and prostaglandin E1 (PGE1) postoperatively, 23 patients (group B) who did not receive heparin but received PGE1 postoperatively, and 24 patients (group C) who did not receive either heparin or PGE1 postoperatively. Patient background characteristics were not significantly different among the groups. The incidences of arterial occlusion, venous occlusion, postoperative bleeding, and partial necrosis were not significantly different among the groups (arterial occlusion: one patient in group A, none in group B, and one patient in group C, p = 0.5; venous occlusion: none in group A, two patients in group B, and one patient in group C, p = 0.79; postoperative bleeding: three patients in group A, two patients in group B, and two patients in group C, p = 0.29; partial necrosis: none in group A, three patients in group B, and three patients in group C, p = 0.63) . These results suggest that heparin and PGE1 administration do not improve impaired blood flow following free-flap transfer. Considering the potential complications, these drugs may be unnecessary.

著者

比嘉 円 太田 英之 佐々木 宏 佐々木 梨恵 村山 敦彦

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.31, no.2, pp.57-61, 2018 (Released:2018-06-25)

参考文献数

10

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Objective: To examine the predictors influencing the graft survival rate after replantation in patients with digital amputations. Methods: We investigated the factors affecting the graft survival rate in 111 patients (131 digits) who underwent replantation after digital amputation between April 2010 and March 2016. Age, hypertension, diabetic status, smoking history, partial continuity status of the skin and hypodermal tissue of the amputated digit, level of amputation, and shape of amputation for engrafted and necrotized groups were compared. Results: Overall, 95 digits grafted successfully and 36 necrotized. The mean age in the necrotized group (46.1±16.3) was significantly older than in the engrafted group (39.7±14.6). The graft survival rate was 72.5%, and this was significantly higher in patients with clean-cut and blunt amputations than in those with crushing and avulsion amputations (86.3% vs 63.8%). It was also significantly higher when continuity of the soft-tissue was partially retained, compared with the absence of continuity (84.8% vs 65.9%). The lowest graft survival rate was for distal joint amputation (66.0%). Patients with hypertension, diabetes, and smoking history showed low graft survival rates. Conclusion: Age, soft-tissue non-continuity, crushing amputation, and avulsion amputation are predictors of poor outcome for graft survival.

著者

林 洸太 服部 泰典 土井 一輝 坂本 相哲

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.31, no.2, pp.62-67, 2018 (Released:2018-06-25)

参考文献数

9

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In fingertip amputations, surgeons may encounter technical difficulties in vein grafting for anastomosis of small and fragile vessels.In this retrospective study, we evaluated the survival rate, complications, and surgical techniques for fingertip replantation with vein grafting.One hundred and twenty-five fingertip replantation procedures were performed in 116 patients between 1996 and 2017 at our hospital. There were 74 amputations in zone I and 51 in zone II. Twenty-five amputated fingertips in zone I were replanted with vein grafting for arterial or venous repairs. Among the 25 procedures with vein grafts, there were 11 with arterial repairs, 6 with venous repairs, and 8 with both arterial and venous repairs.In the procedures with vein grafting, vascular thrombosis was found in 6, of which there were 4 arterial and 2 venous thromboses. In 4 cases of arterial thrombosis, the circulation gradually deteriorated within 2 or 3 days and subsequent necrosis of the replanted fingertip occurred, presumably because of severe damage to the soft tissue.The overall survival rate of replantation with vein grafting was 84%.Although skillful microsurgical techniques and longer operation times are in high demand, our results using vein grafts for successful fingertip replantation are encouraging.

著者

山内 大輔

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.31, no.4, pp.217-225, 2018 (Released:2018-12-25)

参考文献数

11

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The reverse digital artery flap (RDAF) is useful for skin coverage of the finger, but postoperative flap congestion is a serious problem. The degree of flap congestion varies with the type of injury and may affect the treatment for congestion. We examined the treatment outcomes of 24 fingertips by separating them by the type of injury based on the presence of a narrow skin bridge. There were 13 cases in the crush group and 11 cases in the avulsion group. Congestion was confirmed in half of the crushed skin bridge ( - ) group. In the crushed skin bridge ( + ) group, congestion was not observed. In the avulsion skin bridge ( - ) group, congestion was observed in all cases. In the avulsion skin bridge ( + ) group, low grade congestion was observed. A RDAF will adequately survive without the skin bridge in crush injuries, but congestion can be avoided by attaching the skin bridge. In the case of avulsion injury, the flap can survive, but congestion cannot be avoided only with a skin bridge, and it is likely that a wider skin bridge or subcutaneous venous network will be needed.

著者

玉井 進

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.32, no.2, pp.38-40, 2019 (Released:2019-06-25)

参考文献数

6

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Susumu Tamai, M.D. finished his Postgraduate Course in Orthopedic Surgery at Nara Medical University in 1964 and earned a Ph.D. with his thesis on “Experimental Surgery on Replantation of Amputated Limbs in Dogs”. During his 4 year course of study, he also mastered the technique of microvascular surgery for miniature blood vessels, which was initially developed by Jacobson and Suarez in 1960.On July 27th, 1965, a 28-year-old male amputated his left thumb at the MP joint level by a steel cutter. He was transferred to Nara Medical University Hospital 30 minutes after the injury. At the request of patient, the replantation team decided to attempt replantation of the thumb. Under brachial plexus block anesthesia and after applying a tourniquet on the arm, the MP joint was fused by two wires and the extensor tendon was repaired. The flexor tendon was not repaired as it was not routine procedure at that time. Two volar digital arteries were repaired using 8-0 monofilament nylon sutures and two dorsal veins were repaired with 7-0 braided silk under an operating microscope. Following recirculation, the thumb became pink and the skin was closed. The postoperative course was uneventful without complications.

著者

佐藤 陽介 辻 英樹 松井 裕帝 佐藤 和生 小田 和孝 大野 健太郎

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.32, no.2, pp.60-64, 2019 (Released:2019-06-25)

参考文献数

5

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Purpose: This retrospective case series examined wound complications after Tamai zone V replantation, and describes a potential strategy to increase the finger survival rate and improve function.Methods: Nine patients (22 fingers) underwent Tamai zone V replantation at our institution between 2011/9 and 2017/5. We performed a detailed chart review to identify features of their postoperative soft tissue progress, finger loss rate and details of additional surgeries.Results: Four patients (10 fingers) lost all replanted fingers, whereas in five patients (12 fingers) , all fingers survived. In all four failure cases, tissue necrosis developed gradually in the replantation zone covering the vascular anastomoses, and vascular thrombosis and spasm were observed approximately 1 week after the first replantation. In contrast, 3 out of 5 patients did not develop tissue necrosis. The fingers of the remaining 2 patients were salvaged by performing timely flap coverage of the necrotic tissue overlaying the vascular anastomoses.Conclusion: Early flap coverage to the Tamai zone V replantation area may be effective in preventing vascular thrombosis and spasm leading to finger loss, and it made it easier to perform additional reconstructive surgeries.

著者

普天間 朝上 金城 政樹 大久保 宏貴 仲宗根 素子 川越 得弘 金谷 文則

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌

巻号頁・発行日

vol.30, no.4, pp.167-173, 2017

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We reviewed 30 cases of brachial plexus palsy (11 complete palsies, 19 upper palsies), with reconstruction of the shoulder abduction and elbow flexion using nerve transfer and/or graft. Clinical outcomes and surgical effectiveness were evaluated.<BR>The average age at surgery was 25.2 years, the average period from injury to surgery was 3.4 months, and minimum follow-up was 1 year, averaging 3.7 years.<BR>Regarding shoulder reconstruction, accessory nerve transfer to suprascapular nerve was performed in 16 cases (combined with axillary nerve reconstruction in 6 upper palsies). Nerve graft was performed in 6 cases.<BR>For elbow reconstruction, intercostal nerve transfer to the motor branch of the biceps muscle was performed in 17 cases. Oberlin procedure (in 9 cases) and partial median nerve transfer (in 3 cases) were performed for upper palsy.<BR>Nerve graft procedures were not satisfactory in shoulder reconstruction. However, accessory nerve transfer with axillary nerve reconstruction achieved favorable results, with muscle strength recovery to MMT 3 or greater in shoulder abduction.<BR>Intercostal nerve transfer achieved favorable result in younger patients.<BR>The Oberlin procedure achieved better elbow function in the short term. However, in C5 - 7 root injury cases, the Oberlin procedure was less effective. Median/ulnar funiculus transfer should be selected following confirmation by electronic stimulation during operation.