日本マイクロサージャリー学会会誌
Online ISSN : 2185-9949
Print ISSN : 0916-4936
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27 巻 , 4 号
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特集1 移植皮弁の選択 私のファーストチョイス―頭頸部に用いる皮弁―
  • 中山 敏, 福岡 晃平, 陶山 淑子, 長谷川 泰久, 兵藤 伊久夫, 亀井 譲
    27 巻 (2014) 4 号 p. 110-116
    公開日: 2014/12/25
    ジャーナル 認証あり
    Maxillary reconstruction by fibular flap was reported in 1994. Now, it is known as one common method for skeletal reconstruction in the maxilla. Maxillary reconstruction by fibular flap contributes to improvement of facial contour, closing the palate, and stabilizing the denture. Many patients are satisfied with this operation. Procedures of maxillary reconstruction by fibular flap are similar to mandibular reconstruction, but differ in some points. We introduce some tips and pitfalls of maxillary reconstruction using a fibular flap.
    1. Preoperative planning is crucial.
    2. 3D Models are useful for preoperative planning.
    3. Fixing the bone pieces should be completed before setting the bone graft to the defect.
    4. To prevent unfavorable strain and pressure to the anastomosed vessels, the positioning of the flap and the vessels must be considered carefully.
    21 years ago, we performed the first ever case of maxillary reconstruction by fibular flap with implant denture and the patient is still alive and healthy.
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特集2 血管吻合術後の管理と移植組織サルベージ法の実際
原著
  • 山中 清孝, 須賀 久司
    27 巻 (2014) 4 号 p. 126-131
    公開日: 2014/12/25
    ジャーナル 認証あり
    This paper reports on extensor tenolysis with transfer of an adipofascial flap including the perforator of the dorsal metacarpal artery.
    This technique was performed on 5 fingers in 5 cases. Extensor adhesion was caused by proximal phalanx fracture in 3 cases, extensor laceration in 1 case, and dorsal dislocation of PIP joint with central slip laceration in 1 case. The average age of the patients was 43 years, ranging from 20 to 56 years. Injured digits included 4 little fingers and 1 index finger.
    The results revealed that the active ROM of PIP and DIP joints improved postoperatively in all cases, but the extension lag of PIP joints deteriorated in 4 cases ( P < 0.05 ).
    The pedicled adipofascial flap using the perforator of the dorsal metacarpal artery is effective for preventing extensor adhesion. This technique is quite simple for flap elevation and acceptable for donor site morbidity.
    Furthermore, this flap does not include the muscle belly, so the operation can be performed under local anesthesia.
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  • 鈴木 歩実, 川端 秀彦
    27 巻 (2014) 4 号 p. 132-138
    公開日: 2014/12/25
    ジャーナル 認証あり
    We have performed toe-to-hand transfer on nine pediatric patients with congenital ectrodactyly ( oligodactyly 1 ; monodactyly, 5 ; adactyly, 3 ) since 1994. Mean age at the time of transfer was 4.7 years and the mean follow-up period was 12 years. Seven patients received transfer of the second toe from a normal foot, and the remaining two patients underwent simultaneous amputation of anomalous lower extremities and transfer of the toes from the amputated foot. The toe-to-hand transfers were all successful ; however, all patients required secondary operations. Five patients required surgery for opposing digits. For a patient with a severely ectrodactylous hand, toe-to-hand transfer is an essential procedure, but secondary surgery is required to achieve pinching and grasping function. Additionally, when planning treatment for patients presenting with combined upper and lower extremity abnormalities, reconstruction using “spare parts” should be considered in order to minimize the loss of normal tissue.
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