Biomedical subjects

K Nohira

Publications and source records attributed to K Nohira.

32 records · Page 2Linked to original sources

PubMed1994

Experience with arteriovenous malformations treated with flap coverage.

Fourteen patients with arteriovenous malformations were treated with surgical resection followed by well-vascularized tissue transfer. Free-tissue transfers were used in 12 of the patients and axial local flaps in 2 patients to reconstruct the region with arteriovenous malformations. The feeding arteries of the arteriovenous malformations were used as recipient vessels in all cases of free-tissue transfers without any trouble in microvascular anastomosis. With an average follow-up of 3 years and 2 months, 12 patients showed no clinical recurrence (86 percent). Follow-up angiography in seven patients showed complete disappearance of malformations in two patients and residual malformations not enlarged in three patients. Two patients had residual malformations that were noted to be increasing in follow-up angiograms, and they also had clinical evidence of recurrence. In these patients an intramaxillary recurrence in one and intraorbital in the other appeared at about 1 and 3 years, respectively, after surgery. This therapeutic concept can be expected to provide great remission in the treatment of arteriovenous malformations.

Adult↗

PubMed1994

Facial reconstruction with free-tissue transfer.

The article provides a retrospective review of 25 free-tissue transfers for facial reconstruction on 24 recipient sites in 21 patients. The recipient sites of the face were classified into frontal (4 patients), orbital (2 patients), nasal (2 patients), buccal (11 patients), and oral region (5 patients). The transferred flaps included 16 fasciocutaneous flaps (6 forearm flaps, 5 scapular flaps, 2 anteromedial thigh flaps, 1 lateral arm flap, 1 dorsalis pedis flap, and 1 deltopectoral flap) and 8 myocutaneous flaps (6 latissimus dorsi myocutaneous flaps, 1 serratus anterior myocutaneous flap, 1 rectus abdominis myocutaneous flap, and 1 prefabricated flap). Thinning modifications such as the expansion, reduction, or extension techniques were performed in the myocutaneous flap to avoid having a bulky flap. In our view, the flap from the trunk matches the facial skin color better than that from the extremity. Satisfactory results were attained in all cases in which a complete replacement of the facial aesthetic unit was performed.

Adolescent↗

PubMed1993

Abdominoplasty in paraplegic patients.

Obese paraplegics can suffer discomfort when they lie in a prone position and site in wheelchairs. Two paraplegic cases who underwent abdominoplasty to eliminate such complaints are presented, with satisfactory results.

Abdominal Muscles↗

PubMed1993

Role of bone graft in reconstruction of skull base defect: is a bone graft necessary.

Ten patients underwent reconstruction of skull base defects between 1989 and 1992. In this series, the maximum size of the skull base defect was 6 x 5 cm. Three patients underwent bone grafts to reinforce the skull base. The postoperative course of seven patients without bone grafts was uneventful. There was no cerebrospinal fluid leakage, meningitis, extradural abscess, on brain herniation. On the other hand, two of the three patients with bone grafts developed extradural abseesses requiring the bone grafts to be removed. Although the number of patients in this series is not large, this study demonstrates that the use of bone grafts in reconstruction of skull base detects could be one of the factors in increasing the chances of infectious complications. We think that a bone graft is not necessary to reconstruct moderate-sized skull base defects.

Journal Article↗

PubMed1993

Superiority of the fasciocutaneous flap in reconstruction of sacral pressure sores.

The gluteal maximus muscle has been used in the treatment of sacral pressure sores since the 1970s. However, it is noted that the muscle portion of the transferred flap shows highly atrophic degeneration and the muscle itself is not suitable tissue for covering the pressure-bearing area. We have managed various fasciocutaneous flaps as the first choice for reconstruction of sacral pressure sores and obtained good results. The fasciocutaneous flap has an anatomical structure that resists physical stimulation or external pressure and an abundant blood supply via its fascial plexus. In addition, if we use a gluteal maximus myocutaneous flap at first, some fasciocutaneous flaps are compromised because of the design and blood supply. We suggest that the fasciocutaneous flap has the first priority and is superior to the gluteal maximus myocutaneous and muscle flaps in reconstruction of sacral pressure sores.

Adult↗

PubMed1993

Laserflowgraphy: a new visual blood flow meter utilizing a dynamic laser speckle effect.

We developed a visual laser blood flow meter that is capable of providing two-dimensional color graphic representations of blood flow distribution for a given area by utilizing a dynamic laser speckle effect. The device is called the laserflowgraph. The principle and configuration of this flowmeter, comparison with the 133Xe clearance method, difference from thermography, and clinical uses of this flowmeter in flap monitoring are presented. Flow level of the laserflowgraph was significantly correlated with blood flow rate determined by 133Xe clearance in observations on the forearms of normal volunteers. The laserflowgraph reflected blood flow through the region between the skin surface and the deeper region of the papillary layer of the dermis. The laserflowgraph is a highly useful, practical, and reliable tool for assessing cutaneous blood flow and is expected to be applicable to various clinical fields.

Adult↗

PubMed1992

Comparison of Indium-111-labeled leukocyte scintigraphy and Technetium-99m joint scintigraphy in rheumatoid arthritis and osteoarthritis.

This study was undertaken to evaluate the use of Indium-111-labeled leukocyte (111In-WBC) imaging compared with Technetium-99m pertechnetate (99mTcO4-) imaging in 19 patients with rheumatoid arthritis (RA) and 8 with osteoarthritis. Knee and wrist joints were evaluated for both radionuclides. The results indicated a good correlation of the clinical assessment of pain and swelling with joint uptake ratio (JUR) between 111In-WBC and 99mTcO4- in RA and osteoarthritis patients. We observed a discrepancy in both imagings in "burned out" cases. It was concluded that a JUR of 111In-WBC could distinguish active RA from inactive RA or osteoarthritis at a value of 1.15 and that the use of 111In-WBC was a more reliable procedure than 99mTcO4-.

Adult↗

PubMed1992

Reconstruction of recurrent pressure sores using free flaps.

The authors describe two successful reconstructions of recurrent pressure sores with free fasciocutaneous flaps. In Case 1, a free lateral thigh flap pedicled on the first and third direct cutaneous branches of the deep femoral vessels was used to cover a large recurrent sacral pressure sore. The vascular pedicle was dissected to the deep femoral trunk proximally and anastomosed to the inferior gluteal vessels. In Case 2, a free medial plantar flap was transferred to a recurrent ischial pressure sore. The vascular pedicle was dissected to the posterior tibial vessels proximally. The long vascular pedicle of the flap was passed through the femoral subcutaneous tunnel, and end-to-side microvascular anastomoses were performed to the superficial femoral trunk without any vein grafts. The authors advocate the use of free tissue transfer for recurrent pressure sore reconstruction.

Humans↗

PubMed1992

[Ulnar nerve palsy in a RA patient after total knee replacement: a case report].

A 49-year-old housewife had suffered from classical seropositive rheumatoid arthritis for 24 years. The shoulders and hands were involved but the most severs pain and deformity were in both elbows and knees. Consequently, she was unable to sit on wheel chair and was confined to a bed. And then, she was admitted to the Chiba Rehabilitation Center in September, 1986 for bilateral total knee replacement. In April 1987, she had an operation upon the right knee and in June, she had an operation upon the left knee. About 6 weeks after surgery, she felt numbness in bilateral hands. The diagnosis was cubital tunnel syndrome. This was confirmed by electromyographic studies. Surgical release was undertaken without delay. The day following operation the patient remarked on the absence of numbness in bilateral hands.

Arthritis, Rheumatoid↗

PubMed1989

Replacing losses in kind: improved sensation following heel reconstruction using the free instep flap.

Two similar patients, with extensive defects of the heel treated by free tissue transfer of the contralateral instep, are discussed. Durable coverage and near normal static two-point discrimination were obtained in both. Improved results are attributed to the proximal interfascicular dissection of the medial plantar nerve and implantation into the posterior tibial nerve as the recipient. This flap may be transferred with only relatively minor donor-site complications. The contralateral instep free flap provides an ideal, durable, and sensate heel replacement, particularly when local tissues are unavailable.

Adult↗

PubMed1986

Indium-111 leukocyte imaging in patients with rheumatoid arthritis.

This study evaluates the usefulness of labeled leukocyte imaging in patients with rheumatoid arthritis. In 33 patients, the incidence of pain and swelling in 66 wrist joints and 66 knee joints was compared with the accumulation of [111In]leukocytes. No accumulation of [111In]leukocytes was seen in any of the patients' wrists (0/12) or knee joints (0/14) when both pain and swelling were absent. In contrast, 93% (25/27) of wrist joints and 80% (24/30) of knee joints with both pain and swelling were positive by [111In]leukocyte scintigraphy. There was little correlation between the stage of the disease, as determined by radiography, and [111In]leukocyte accumulation. This study suggests that [111In]leukocyte imaging may be a reliable procedure for monitoring the activity of rheumatoid arthritis, especially for confirming the lack of an ongoing inflammatory response.

Adult↗

PubMedDate not supplied

Mesenteric flap in free jejunal transfers: a versatile technique for head and neck reconstruction.

BACKGROUND: The technique of free jejunal transfers has been widely used for pharyngoesophageal reconstruction. However, secondary infectious and fistulous complications may develop in extensive and preoperatively high-dose irradiated cases. METHODS: A generous jejunomesenteric composite graft was harvested and the mesenterium was effectively applied for head and neck reconstruction. RESULTS: The mesenteric flap connected with the revascularized jejunum was used as means for obliterating dead space in the head and neck region, as a cover for the cover for the cervical vessels, as a vascularized bolstering for the vascular and enteral anastomoses, or as a vascularized bed for skin grafting when the skin flaps are deficient. Only one small fistula occurred in 10 patients who underwent the mesenteric flap. CONCLUSIONS: This versatile technique is expected to reduce the incidence of postoperative complications in pharyngoesophageal reconstruction using free jejunal transfers.

Adult↗

PubMedDate not supplied

Combined V figure-shaped scapular osteocutaneous and latissimus dorsi myocutaneous flap for composite mandibular reconstruction.

BACKGROUND: As early as 1981, the scapular crest was reported as a versatile donor site of vascularized bone flap. In our institute, much attention has been paid to applying a compound flap based on the subscapular vascular system for composite mandibular reconstruction. METHODS: The combined V figure-shaped scapular osteocutaneous and latissimus dorsi myocutaneous flap has been used for primary or secondary reconstruction of the mandible, intraoral mucosa and/or external skin following major ablation of the malignant tumors in seven patients. RESULTS: There was one total flap failure. Satisfactory results were obtained in the remaining patients. CONCLUSIONS: The V figure-shaped scapular bone flap supplied by the angular branch provides a long rotation arc of vascular pedicle, a long bony segment of more than 14 cm, and a good contour of mental protuberance. The combination of the scapular osteocutaneous flap with latissimus dorsi myocutaneous flap allows reliable reconstruction of massive and three-dimensional composite mandibular defects.

Adult↗

PubMedDate not supplied

A new alternative in burn reconstruction: the muscle vascularized pedicle flap.

A technique is presented that revascularizes a portion of skin and subcutaneous tissue by the implantation of a vascular pedicle surrounded by a small amount of muscle. The muscle vascularized pedicle flap technique allows one to select a skin territory and convert it into a free flap donor site as long as it is within the arc of rotation of a major vascular pedicle. The vascular pedicle and small portion of muscle is simply sutured to a sequentially delayed skin flap. After approximately two or three weeks the newly revascularized skin and subcutaneous tissue is transferred as a conventional free flap. The main advantage is that of freeing the reconstructive surgeon from the anatomical landmarks of the conventional free flap areas. In addition, one can fashion a very thin flap to fit the defect exactly. Illustrative cases are presented.

Adolescent↗