Abstract
Surgery involving the use of a tubed pedicle flap has become a fairly common practice in the field of otorhinolaryngology of late. The most important thing to be considered in the transplantation of such a tube is blood circulation.
In order to enhance fast, accurate and safe transplantation, a number of experiments and clinical studies have been carried out and reports on them made available.
The author selected from among these reports a technique of measuring skin temperature as one means of deciding when transplantation should take place, and has utilized it as much as possible regarding patients in his department for whom plastic surgery has been indicated.
In addition, specimens are prepared from circular sections of the graft obtained at the time of transplantation and subjected to staining and microscopic examination in order to ascertain whether there is any correlation between the histopathologic findings and the results of skin temperature measurements.
kin temperature measurements carried out in the case of patients who underwent tube transplantations in this department indicated that the central area of the tube had the lowest temperature immediately after preparation, revealing a considerable difference from that of the peripheral nerves and the ends of the central nerves.
Generally, however, a rise in temperature was noted within a week after preparation, followed by a gradual decline in turn leading to the maintaining of a constant temperature after about three weeks.
In the transplanted flap, the lowest temperature was detected slightly toward the transplanted end rather than at the center, while the temperature at the transplanted end was rather high. This was presumed to be due to circulatory reaction occurring immediately after transplantation at the end of the transplanted tube the recipient area and the carrier, as well as to the high temperature reaction similar to that often observed in a fresh wound. However, the temperature at the transplanted end was never the same as those of the recipient area and the carrier.
Even when the second end was transplanted a certain time after the first, a temperature change similar to that occurring when the first end was transplanted was noted. Again, a constant temperature was maintained after about three weeks.
Judging from the results of the present experiments, the appropriate time for amputation and transplantation is around three weeks after preparation of the tube. The skin temperature of an infected tube was higher than that at any other area of the skin surface.
In the case of a tube in which necrosis was observed, the temperature at the necrotic lesion was considerably low despite a high temperature in the surrouding region. This was probably due to the mechanism acting to relieve the lesion of necrosis.
Histopathologically, such marked changes in the epidermis cuticle as shortening and spongiosis of the needle legs were clearly observed in specimens obtained 1-3 months after preparation, but these changes became slight after a period of 4 months or more.
In the case of the corium, marked fibrosis, proliferation of capillaries and inflltration of round cells were noted in specimens obtained from the tube 1-3 months after preparation. Although slight changes were observed in specimens obtained 4-6 months after preparation, the changes first began to become minimized 7 months after preparation.
Findings concerning the panniculus adipasus were similar to those of the corium, while the disappearance of changes in the adnexa was observed within a period of 6 months.
Although a slight increase in pigmentation was observed in the whole specimens of the tube thus prepared, this would not present any problem where the Japanese are concerned.
