吉村 浩太郎

Reconstruction of oral scar contracture is often a challenging problem due to the complex structures and functions of the oral cavity. This report describes the treatment of a patient who sustained extensive oral scar contracture following caustic liquid soda ingestion, Surgical release of the scar contracture formed an S-shaped, thin, long defect that was difficult to cover with a conventional flap or skin graft. A jejunal segment was transferred microsurgically as a patch to reconstruct the defect, It sustained a sufficient oral space to provide full opening of the mouth and goad movement of the tongue. A free jejunal flap, used occasionally for reconstruction following oral cancer resection, has significant advantages for restoration of function after release of an oral scar contracture.

Reconstruction of oral scar contracture is often a challenging problem due to the complex structures and functions of the oral cavity. This report describes the treatment of a patient who sustained extensive oral scar contracture following caustic liquid soda ingestion, Surgical release of the scar contracture formed an S-shaped, thin, long defect that was difficult to cover with a conventional flap or skin graft. A jejunal segment was transferred microsurgically as a patch to reconstruct the defect, It sustained a sufficient oral space to provide full opening of the mouth and goad movement of the tongue. A free jejunal flap, used occasionally for reconstruction following oral cancer resection, has significant advantages for restoration of function after release of an oral scar contracture.

A new method that uses a prefabricated free jejunal transfer has been applied to three cancer patients with pharyngoesophageal defects with a high pharyngeal deficit extending up to the nasopharynx. In this method, the jejunum harvested in the usual manner is divided into two segments with a single vascular pedicle. Its distal segment is used to reconstruct the cervical esophagus, and its proximal segment is turned over to create a mucosal patch to cover the high pharyngeal defects. The two segments are then co-apted in a side-by-side anastomosis. The esophagus can be reconstructed in a naturally straight shape without a curved portion or blind loop formation, thus leading to good swallowing function. In our series, all grafts survived well and there was no complication directly related to jejunal transfer. All patients could tolerate a soft diet without difficulty. This method is easy to perform and applicable to any shape or size of very high pharyngeal defects that cannot be reconstructed properly by other methods. Although patients with an advanced hypopharyngeal cancer usually have a poor prognosis, this technique allows a better quality of life for a probable short life span.

Failure to fully restore contractile function after denervation and reinnervation of skeletal muscle engenders significant disability in patients suffering peripheral nerve injuries. This work tested the hypothesis that skeletal muscle denervation and reinnervation result in a deficit in normalized power (W/kg), which exceeds the deficit in specific force (N/cm(2)), and that the mechanisms responsible for these deficits are independent. Adult Lewis rats underwent either transection and epineurial repair of the left peroneal nerve (denervation-reinnervation, n = 13) or SHAM: exposure of the peroneal nerve (SHAM, n = 13). After a 4-month recovery period, isometric force, peak power, and maximum sustained power output were measured in the left extensor digitorum longus (EDL) muscle from each animal. Isometric force measurements revealed a specific force deficit of 14.3% in the reinnervated muscles. Power measurements during isovelocity shortening contractions demonstrated a normalized peak power deficit of 25.8% in the reinnervated muscles, which is accounted for by decreases in both optimal velocity (10.5%) and average force curing shortening (13.7%). Maximum sustained power was similar in both groups. These data support our working hypothesis that both whole muscle force production and power output can be impaired in reinnervated muscle and that the relative deficits in power output exceed the deficits in force production. The mechanisms responsible for the deficits in force production appear to be independent of those that result in changes in peak power output. The measurement of muscle power output may represent a clinically relevant variable for studies of the recovery of mechanical function after motor nerve injury and repair. (C) 1999 Academic Press.

Failure to fully restore contractile function after denervation and reinnervation of skeletal muscle engenders significant disability in patients suffering peripheral nerve injuries. This work tested the hypothesis that skeletal muscle denervation and reinnervation result in a deficit in normalized power (W/kg), which exceeds the deficit in specific force (N/cm(2)), and that the mechanisms responsible for these deficits are independent. Adult Lewis rats underwent either transection and epineurial repair of the left peroneal nerve (denervation-reinnervation, n = 13) or SHAM: exposure of the peroneal nerve (SHAM, n = 13). After a 4-month recovery period, isometric force, peak power, and maximum sustained power output were measured in the left extensor digitorum longus (EDL) muscle from each animal. Isometric force measurements revealed a specific force deficit of 14.3% in the reinnervated muscles. Power measurements during isovelocity shortening contractions demonstrated a normalized peak power deficit of 25.8% in the reinnervated muscles, which is accounted for by decreases in both optimal velocity (10.5%) and average force curing shortening (13.7%). Maximum sustained power was similar in both groups. These data support our working hypothesis that both whole muscle force production and power output can be impaired in reinnervated muscle and that the relative deficits in power output exceed the deficits in force production. The mechanisms responsible for the deficits in force production appear to be independent of those that result in changes in peak power output. The measurement of muscle power output may represent a clinically relevant variable for studies of the recovery of mechanical function after motor nerve injury and repair. (C) 1999 Academic Press.

A new method that uses a prefabricated free jejunal transfer has been applied to three cancer patients with pharyngoesophageal defects with a high pharyngeal deficit extending up to the nasopharynx. In this method, the jejunum harvested in the usual manner is divided into two segments with a single vascular pedicle. Its distal segment is used to reconstruct the cervical esophagus, and its proximal segment is turned over to create a mucosal patch to cover the high pharyngeal defects. The two segments are then co-apted in a side-by-side anastomosis. The esophagus can be reconstructed in a naturally straight shape without a curved portion or blind loop formation, thus leading to good swallowing function. In our series, all grafts survived well and there was no complication directly related to jejunal transfer. All patients could tolerate a soft diet without difficulty. This method is easy to perform and applicable to any shape or size of very high pharyngeal defects that cannot be reconstructed properly by other methods. Although patients with an advanced hypopharyngeal cancer usually have a poor prognosis, this technique allows a better quality of life for a probable short life span.

To acquire symmetry of the cheek when smiling, we carried out 39 free vascularised grafts of the muscle, the motor nerve of which was sutured to a stump of the ipsilateral facial nerve, for 39 patients with facial paralysis. We used two methods: an as healthy and fresh as possible facial nerve stump (method 1A, n = 17) or an incompletely affected stump (method 1B, n = 22). The results are classified into grade 1 to 5 indicating increasing efficiency of muscle function. All patients who had method 1A and 14 patients who had method 1B were evaluated grade 4 or better. Both an incompletely affected facial nerve stump and the proximal stump of a facial nerve that had previously been resected have sufficient function to provide contraction in the grafted muscle.

A regenerative change during muscle adaptation to denervation in rats. J Surg Res 81: 139-146, 1999. 10)* Yoshimura K, Harii K, Aoyama T, Shibuya F, Iga T. A new bleaching protocol for hyperpigmented skin lesions with a high concentration of all-trans retinoic acid aqueous gel.

A regenerative change during muscle adaptation to denervation in rats. J Surg Res 81: 139-146, 1999.<br /> 10)* Yoshimura K, Harii K, Aoyama T, Shibuya F, Iga T. A new bleaching protocol for hyperpigmented skin lesions with a high concentration of all-trans retinoic acid aqueous gel.

To acquire symmetry of the cheek when smiling, we carried out 39 free vascularised grafts of the muscle, the motor nerve of which was sutured to a stump of the ipsilateral facial nerve, for 39 patients with facial paralysis. We used two methods: an as healthy and fresh as possible facial nerve stump (method 1A, n = 17) or an incompletely affected stump (method 1B, n = 22). The results are classified into grade 1 to 5 indicating increasing efficiency of muscle function. All patients who had method 1A and 14 patients who had method 1B were evaluated grade 4 or better. Both an incompletely affected facial nerve stump and the proximal stump of a facial nerve that had previously been resected have sufficient function to provide contraction in the grafted muscle.

A one-stage procedure for the reconstruction of a defect of the upper auricle is described. The anterior surface of a carved costal cartilage graft was covered with an anterosuperiorly based skin flap, and the posterior surface was covered by the superficial mastoid fascial flap and a skin graft. This method can be performed easily, without leaving any scar in the hair-bearing area or visible postauricular region, and can be applied to cases in which the condition of the margin scar of an auricular defect is poor.

Many techniques for reconstruction of an absent umbilicus have been described; however, none has achieved a perfect result. We report a new alternative for constructing an umbilicus using a conical flap and present two representative clinical cases. Our technique creates an umbilicus with sufficient depth with good results, including maintenance of depth after more than 1 year.

Many techniques for reconstruction of an absent umbilicus have been described; however, none has achieved a perfect result. We report a new alternative for constructing an umbilicus using a conical flap and present two representative clinical cases. Our technique creates an umbilicus with sufficient depth with good results, including maintenance of depth after more than 1 year.