素輪 善弘

Recent studies have shown that adipose-derived stromal/stem cells (ASCs) contain phenotypically and functionally heterogeneous subpopulations of cells, but their developmental origin and their relative differentiation potential remain elusive. In the present study, we aimed at investigating how and to what extent the neural crest contributes to ASCs using Cre-loxP-mediated fate mapping. ASCs harvested from subcutaneous fat depots of either adult P0-Cre/or Wnt1-Cre/Floxed-reporter mice contained a few neural crest-derived ASCs (NCDASCs). This subpopulation of cells was successfully expanded in vitro under standard culture conditions and their growth rate was comparable to non-neural crest derivatives. Although NCDASCs were positive for several mesenchymal stem cell markers as non-neural crest derivatives, they exhibited a unique bipolar or multipolar morphology with higher expression of markers for both neural crest progenitors (p75NTR, Nestin, and Sox2) and preadipocytes (CD24, CD34, S100, Pref-1, GATA2, and C/EBP-delta). NCDASCs were able to differentiate into adipocytes with high efficiency but their osteogenic and chondrogenic potential was markedly attenuated, indicating their commitment to adipogenesis. In vivo, a very small proportion of adipocytes were originated from the neural crest. In addition, p75NTR-positive neural crest-derived cells were identified along the vessels within the subcutaneous adipose tissue, but they were negative for mural and endothelial markers. These results demonstrate that ASCs contain neural crest-derived adipocyte-restricted progenitors whose phenotype is distinct from that of non-neural crest derivatives.

Normal abdominal expansion that occurs as a result of hormonal actions during pregnancy may be prevented by the presence of excessive scar tissue in individuals who have received severe burns. In these instances, the lack of abdominal expansion may cause maternal pain and put the infant at risk. A 23-year-old pregnant woman presented with severe abdominal wall contracture due to a major burn sustained during childhood. At 20 weeks of pregnancy, expansion abdominoplasty, consisting of zigzag incisions in the fascia to release the contracture and a split-thickness skin graft, was performed. The patient gave birth, via a planned cesarean operation at 36 weeks of pregnancy, to a baby girl in good condition; the postpartum course was uneventful.

To clarify whether a supercharged free jejunal transfer would have a different clinical outcome from the usual transfer method, we examined clinical data from cases of esophago-pharyngeal reconstruction. Fifty-three patients in whom the hypopharynx and cervical esophagus was reconstructed with a free jejunal transfer were divided into two groups: 19 normal procedures and 34 supercharged. Clinical outcomes including intraoperative and postoperative events, complications and deglutition were compared statistically. There were no significant differences between the groups in terms of the rates of free flap failure, leakage, stenosis, drinking status, dysphagia, or operating time. There were no significant advantages in clinical outcomes when using a supercharge. However, supercharged flaps with an intraoperative arterial thrombosis were all rescued and survived. Thus, a supercharge in free flap is not necessary for all cases. Its indication should be limited to cases when free flaps are not reliable because of intraoperative thrombosis and arterial insufficiency. (c) 2012 Wiley Periodicals, Inc. Microsurgery, 2013.

A 16-year-old male patient presented with a 3-year history of an enlarging right upper eyelid mass. His condition did not improve, and he complained of double vision on leftward gaze. A fixed, nontender, firm subcutaneous mass was clinically noted, and magnetic resonance imaging confirmed a partially cystic tumor in the right intratemporal and pterygopalatine fossae, which extended into the orbit through the inferior orbital fissure. Mass effects of the tumor and statistical analysis allowed for easy preoperative diagnosis. The tumor was easily removed without any complications by the combined use of coronal incision and lateral orbitotomy. This approach is useful for resection of lateral orbital tumors, including dumbbell-shaped tumors extending intraorbitally.

Adipose-derived stem cells (ADSCs) are attracting increased attention as a novel source in regenerative medicine. Transplantation of ADSCs promotes functional recovery in animal models of peripheral nerve injury, but the mechanism of enhanced nerve regeneration remains to be elucidated. In addition, it is important to examine whether the supportive functions of ADSCs are dependent on donor age or anatomic site of origin. In this study, we examined the effects of factors produced by mouse ADSCs on Schwann cells (SCs) and dorsal root ganglion (DRG) neurons in vitro and compared these effects among ADSCs from donors of different age and from different anatomic regions. ADSC-derived soluble factors supported survival and proliferation of SCs and promoted neurite outgrowth in DRG neurons. These beneficial effects were far superior to that of factors from 3T3-L1 cells and comparable to those of SC- and astrocyte (AC)-derived factors. ADSCs from different sources similarly retained their neurotrophic activity. Real-time reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay analyses demonstrated that ADSCs produced various growth factors, some of which were more abundant than in SCs and ACs. These results suggest that ADSCs promote peripheral nerve regeneration partly through paracrine secretion of trophic factors and regardless of donor age or anatomic site of origin.

In this report, we present a case in which a free anterolateral thigh (ALT) flap was transferred for head and neck reconstruction after oropharyngeal cancer ablation, and a retrograde arterial inflow was used to salvage the flap when the main arterial pedicle showed usual repeated spasms. The flap was raised as a chimera flap comprising a fasciocutaneous flap and a vastus lateralis muscle flap. After reperfusion, the pedicle artery exhibited spasms repeatedly and vascular flow was unstable. Therefore, we performed arterial supercharge. In the distal portion of the muscle flap, a small arterial branch was dissected as a reverse-flow arterial pedicle. The recipient artery was also a retrograde limb of the superior thyroid artery. The flap survived; however, postoperative ultrasonographic echo evaluation revealed that the spastic descending branch of the lateral circumflex femoral artery was obstructed and that the reverse-flow muscular perforator alone nourished the whole flap. In free ALT flap transfer, a small perforator level artery was able to nourish a flap, even in a retrograde manner. Moreover, when the vasculature of the free flap is unstable, retrograde arterial supply to a small perforator can be an option to save the flap transfer. (C) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

Perineal lipomas are uncommon congenital anomalies. They mainly develop in male patients with an accessory scrotum, posterior to the original scrotum. However, on rare occasions, these lipomas can occur in female patients with an accessory labioscrotal fold. We report on three such cases, where the lipomas were found in the anterior part of the right side of the labia majora. None had other anomalies, with the exception of one who had premature growth of pubic hair on the accessory labioscrotal fold. Skin with a rugated scrotal appearance was present in all cases.

The vascular supercharge (additional microvascular anastomosis) has rarely been used for free flaps, and the blood circulation in the transferred tissue has not been recorded. We have made double vascular anastomoses during free jejunal transfer to reduce the possibility of loss of the flap from vascular occlusion. To evaluate the efficacy of additional arterial and venous anastomoses to improve the circulation in the transferred tissue, we analysed the results of blood gas measurements including venous partial pressure of oxygen (pO(2)) and carbon dioxide (pCO(2)) from the distal arcade vein. The free jejunal transfer was made using two pairs of arterial and venous anastomoses. Blood gas concentrations were analysed in samples drawn from the vein in the jejunal arcade before harvest, after the anastomosis of one paired artery and vein, after an additional arterial anastomosis, and after anastomoses of two pairs of artery/vein. The results showed that the venous pCO(2) was not changed by increasing the number of anastomosed vessels. The venous pO(2) was raised both by an additional arterial anastomosis and by two pairs of anastomoses, compared with that at the other two time points measured (p=0.04, p=0.02, respectively). An additional arterial anastomosis seemed to have more effect on the pO(2) than an additional artery/vein pair. Additional arterial and venous supercharging therefore has a similar effect on hyperbaric oxygenation. This effect is mainly caused by arterial supercharging. (C) 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

To reduce the possibility of necrosis in free jejunal transfer after total pharyngolaryngo-oesophagectomy, we made a second set of arterial and venous anastomoses in addition to the usual cervical arterial and venous anastomoses. To obtain two different arterial flows (carotid and subclavian systems), the recipient arteries were the superior thyroid and the transverse cervical. For venous flow, the internal and external jugular veins were used. All flaps survived. This procedure, which is limited to the already dissected neck with no procedures in other areas, is less invasive than others. Its advantages are that when one vessel has thrombosed the other vessel functions as a safety valve, and the greater pliability of the vascular pedicles makes it easier to reach the recipient vessels. Because this method is theoretically safe and results in less possibility of losing a flap when the anastomosis is unreliable, the double-pedicled transfer can be an option for safer free jejuna] transfer. (C) 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

In a standard free jejunal transfer, one artery and one vein are anastomosed. However, when raising the jejunal flap, a one-segment jejunum sometimes has two arteries and one accompanying vein as a vascular pedicle. Free jejunal transfer in which two arteries and one vein are anastomosed was designed. We report on the safety and advantages of using this artery-dominant transfer when performing microvascular anastomosis. This technique was used when a one-segment jejunum had two arteries and an accompanying vein. Eight patients underwent this arterial-supercharged free jejunal transfer. All flaps survived, and no complications developed except for two cases of intraoperative thrombosis before the procedure. It is important to transfer the artery-rich graft into the same physiological environment by reconstructing the similar hemodynamics. The grafts can be transferred without harm. This artery-dominant method can be an option when conditions are unfavorable for safer jejunal transfer.

Although the supercharge (additional microvascular anastomosis) technique is often used in pedicled transfer of parts of the gastrointestinal tract, this is rarely performed during free jejunal transfer (FJT). The differences in blood circulation and outcomes between the usual single pedicle flap and a double pedicle flap are not well known. Therefore, we evaluated the effect of an additional arterial anastomosis in FJT. The FJT was performed using one venous and two arterial anastomoses after hypopharyngeal cancer ablation. To assess the effects of an arterial supercharge, bloodegas analysis, including the venous partial pressure of oxygen (pO(2)) and partial pressure of carbon dioxide (pCO(2)), was performed on samples drawn thrice from the jejunal vein: before harvest, after the anastomosis of a paired artery and vein and after an additional arterial anastomosis. The result revealed that the venous pO(2) was elevated by the additional arterial anastomosis, compared with the two other measuring times (P=0.04). The venous pCO(2) did not show significant changes. By being given a dominant artery, a jejunal flap can develop a physiological circulatory environment and can establish nutritional pathways without adverse effects. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

皮様嚢腫は胎生期の外胚葉組織の迷入により発生する先天性疾患である。頭頸部での発生はその殆どが眉毛周囲と口腔底においてであり，耳介周囲に生ずることは少ない。耳後部に認められた皮様嚢腫を2例経験したので，文献的考察を交えて報告する。耳後部の皮様嚢腫はまれではあるが，小児期だけでなく思春期や青年期に受診することもあり，画像所見で軟部腫瘤を認めた場合，鑑別として考慮すべき疾患の一つと考えた。

症例は62歳，男性。アルコール多飲歴とアルコール性肝障害の既往がある。身体所見や画像所見上，項部や両肩甲部，腰部に両側対称性びまん性に広がる脂肪塊を認めた。臨床像より多発性対称性脂肪腫症と診断した。項部と腰部について全身麻酔下に摘出術を行った。項部は脂肪吸引を用いたが，脂肪塊は線維質と血流に富んで破砕しがたく，吸引は困難であった。腰部では内視鏡補助下に行い，術野をモニターで確認することができ安全であった。また切開を最小限とすることができ有用であった。

We present the case of a 51-year-old man with recurrent MFH of his right upper arm. Magnetic resonance imaging showed that it was located near neurovascular structures. However, generally preoperative images cannot always reveal an accurate relationship between the tumor and these structures. Therefore, in some patients, neurovascular structures are sacrificed unnecessarily. In other patients, neurovascular structures are preserved with an inappropriate margin, followed by local recurrence. For these reasons, surgical removal of the tumor was performed using "in situ preparation" (ISP), which was reported by Matsumoto et al in 2002, and skin defect after tumor excision was covered by the ipsilateral pedicled radial forearm flap. The new method (ISP) enables the preparation of neurovascular bundles and intraoperative evaluation of the surgical margin without contamination by tumor cells. With this method, additional procedures, including alcohol soaking of the preserved neurovascular bundle can also be performed to preserve the continuity of vessels. One year postoperatively, there was no recurrence or neurological, functional disturbance. We suggest that ISP is a useful method for maintaining excellent limb function after tumor resection.

Free jejunum was transferred to a patient with recurrent hypopharyngeal carcinoma under unfavorable cervical conditions, caused by prior therapeutic chemoradiotherapy for hypopharyngeal carcinoma and gastric pull-up with cervical leak, resulting from treatment for thoracic esophageal cancer. The cervical recipient vessels were buried in extensively scarred fibrous tissues, so they were thought to be less reliable. Because postoperative vascular occlusion was anticipated, in addition to the ordinary single vascular anastomosis to the damaged cervical vessels, secondary vascular anastomosis to the healthy chest vessels was performed. We designed the graft to have double vascular pedicles that communicated with each other through arcade vessels. This made it possible to anastomose doubly to an intact thoracoacromial artery in the chest by elongating the vascular pedicles of the mesentery without the need for an interpositional vein graft, in addition to ordinary anastomosis in the damaged neck. The flap is nourished by the vessels from two different origins (carotid and axillary arteries, internal jugular and axillary veins) at two different places (damaged and healthy areas). This method increases the quantity of feeding vessels while improving the quality of the recipient vessels within the local area and flow sources. It is one treatment option when conditions are unfavorable for safer jejunal transfer. Copyright © 2008 by Thieme Medical Publishers, Inc.

Juvenile xanthogranuloma is a relatively uncommon benign cutaneous fibrohistiocytic lesion that shows spontaneous regression. We report a case of juvenile xanthogranuloma, which formed a relatively large nodule and rapidly progressed after curettage. A 9-month-old girt had a mass in the skin over the lumbar region of her back that extended to the fascia. The lesion was histologically diagnosed as juvenile xanthogranuloma after total resection of the mass. Although preoperative diagnosis is quite difficult, plastic surgeons should be familiar with this entity. Juvenile xanthogranuloma should be considered in the differential diagnosis of benign tumours and tumour-like lesions in infants. The clinical presentation and histological findings are discussed. (C) 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.