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Biomedical subjects

M Kakibuchi

Publications and source records attributed to M Kakibuchi.

At least 19 recordsLinked to original sources
PubMed2004

Combination of transconjunctival and endonasal-transantral approach in the repair of blowout fractures involving the orbital floor.

In the repair of orbital blowout fractures through eyelid or conjunctival incision, it is difficult to see the posterior edge of the fracture and the condition of the herniated tissue before reduction of the orbital contents. Prolapsed orbital tissue or infraorbital nerve and vessels may therefore be damaged in the reduction. The recently advocated combination of traditional transconjunctival approach and endoscopic transantral approach allows reduction and reconstruction under clear endoscopic vision without a facial skin incision. We modified this technique to make it less invasive and applied it to the repair of orbital blowout fractures involving the orbital floor. The use of a 70-degree straight endoscope through an enlarged ostium as for functional sinus surgery allowed clear sight of the roof of the antrum. During the repair of the orbital floor through a transconjunctival approach, reduction and reconstruction was assisted from the antrum. Twelve cases of fresh blowout fractures were treated with this approach. There were seven male and five female patients. Mean age was 23.5 years. Causes of injuries were fights, motor vehicle or bicycle accidents, and sports. Patients with concomitant fractures involving the orbital rim were excluded. Persistent diplopia was present in eight cases and enophthalmos of more than 2 mm was detected in five cases preoperatively. The average intervals from injury to surgery was 22.8 days.Exploration, reduction and reconstruction of the orbital floor fractures were precisely performed with this procedure. Large orbital floor defects were reconstructed with silicone sheets, thin iliac bone grafts or nasal septal cartilage. In all eight cases that showed diplopia, ocular movement recovered and symptomatic diplopia disappeared after surgery. Enophthalmos of more than 2 mm was also improved in all five cases. One early case showed temporary entropion. Transient numbness of the cheek appeared in five cases and temporary maxillary sinusitis recovered in one case. Postoperative infection was not observed.This method provides visualisation of posterior edge of the fracture and the condition of herniated orbital contents before initiation of reduction. Dual manipulation by two surgeons is also possible in reduction and reconstruction of the orbital floor.

Adolescent↗
PubMed2001

Supercharged gastric tube pull-up procedure for total esophageal reconstruction.

Total esophageal reconstruction using a gastric tube is complicated because it sometimes causes postoperative complications such as anastomotic leakage, stenosis, or fistula formation resulting from insufficient blood flow at the distal end. To overcome this problem, during the past 5 years the authors performed seven additional microvascular anastomoses using the short gastric vessels of the gastric tube. No postoperative complications occurred except partial tracheal necrosis in 1 patient. Postoperative radiographic examination showed no reflux or stasis in all patients, and no evidence of necrosis at the anastomotic site of the pulled-up gastric tube was observed by postoperative endoscopy. This technique reduces risk and may contribute to the successful reconstruction of the digestive tract after total esophagectomy.

Aged↗
PubMed2001

Epithelial-mesenchymal interactions in wounds: treatment of palmoplantar wounds by nonpalmoplantar pure epidermal sheet grafts.

BACKGROUND: Palms and soles differ from other body sites in terms of clinical and histologic appearance and response to mechanical stress. We previously reported that palmoplantar fibroblasts regulate keratin 9, which is a marker of palms and soles. OBJECTIVE: To treat palmoplantar wounds by using nonpalmoplantar pure epidermal sheets as a graft. DESIGN: Nonrandomized controlled trials. SETTING: University dermatology and plastic surgery services. PATIENTS: Forty-eight patients with palmoplantar wounds caused by burns, trauma, chronic ulcers, and the resection of malignant tumors, such as squamous cell carcinoma and acral lentiginous melanoma. INTERVENTIONS: The patients received nonpalmoplantar pure epidermal sheet grafts (n = 14), nonpalmoplantar donor site skin grafts (n = 17), or palmoplantar donor site skin grafts (n = 17). MAIN OUTCOME MEASURES: Clinical and histologic findings. RESULTS: The pure epidermal sheets were successfully grafted and gradually demonstrated the adoption of a palmoplantar phenotype when reticular dermis of the recipient site remained. The epidermis showed hyperkeratosis and acanthosis by histologic studies and stained positively for keratin 9 in all of the suprabasal keratinocyte layers like palmoplantar-type skin. Pure epidermal sheets were placed on deeper wounds after the wounds had an artificial dermis applied and adopted the palmoplantar phenotype without erosions and ulcerations. Neither nonpalmoplantar split-thickness nor full-thickness skin grafts resulted in a palmoplantar phenotype. CONCLUSIONS: Pure epidermal sheet grafting would be useful for the treatment of palmoplantar wounds as nonpalmoplantar epidermis is much easier to obtain clinically. In addition, secondary procedures are not required to repair the donor site, since this wound is superficial.

Adolescent↗
PubMed1999

[Esophageal reconstruction for esophageal stricture after corrosive injury].

Swallowing a corrosive agent (alkali or acid) often causes severe pharyngeal, laryngeal or esophageal stricture (caustic stenosis), which is usually very difficult to treat. This paper reports two cases of esophageal stricture treated by esophagoplasty. Both cases had attempted suicide by swallowing a sodium hydroxide solution or acid. Case 1 was a 66-year-old man found to have severe hypopharynx and thoracic esophagus stenosis with supraglottic stricture. The supraglottic stricture was reconstructed with an ileocolon graft and laryngectomy. The intestinal anastomosis was patent, but the peristaltic motion in the ileocolon was not good. The patient continues to have difficulty achieving sufficient oral feeding and to receive supplemental feeding via a jejunostomy. Case 2 was a 81-year-old woman with severe thoracic esophagus stenosis after gastrectomy. The lesion was reconstructed with a jejenum graft. The intestinal anastomosis was patent. She achieved oral alimentation of both liquids and solids without aspiration after surgery. Esophagectomy in these cases can be difficult and hazardous due to extensive fibrosis and many adhesions to adjacent structures. In both cases, the reconstructed intestine passed through the ante-sternal route, so there was severe scar formation in the mediastinum, and an esophago-skin fistula formed in the cervical skin. Cervical vessels and intestinal vessels were anastomosed for blood supply to the reconstructed intestinal tract. This method is useful because it is safe and results in good deglution.

Aged↗
PubMed1997

Prevalence of human herpesvirus-8 in skin lesions.

A putative new herpesvirus, designated Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus-8 (HHV-8) was recently identified in AIDS-related Kaposi's sarcoma. The DNA sequence of the virus is homologous to the gamma-herpesviruses such as herpesvirus Saimiri or Epstein-Barr virus, both of which are tumorigenic, suggesting that this new virus may also be oncogenic. Thus, we determined whether the virus is present in other skin lesions. DNA samples from 118 skin specimens were tested for the HHV-8 sequence by polymerase chain reaction (PCR) and Southern hybridization. The sequences were detected in 13 of 21 samples from Bowen's disease, three of 11 squamous cell carcinomas, three of 11 actinic keratoses, three of seven leucoplakia, one of six from Paget's disease, one of 12 malignant melanoma, one of seven neurofibromas, two of seven chronic dermatites and one of 14 normal skin samples. On sequencing the PCR products, new mutation points were detected. These results suggest that the virus is associated with lesions other than Kaposi's sarcoma and may be more widespread than expected (with a latent level too low to be detected), like the other herpesviruses. Some lesions. e.g. in Bowen's disease or squamous cell carcinoma, may be locally immunosuppressed, allowing the virus to replicate until the copy number is sufficient for detection.

Adolescent↗
PubMed1997

Free rectus abdominis musculocutaneous flap for head and neck reconstruction.

Surgery in the head and neck often results in large and complex tissue defects. The free rectus abdominis musculocutaneous flap has many advantages for reconstruction of these defects. A good volume of tissue can be harvested with a long and large-diameter vascular pedicle. A reliable blood supply enables thinning, shaping and molding of the flap, and it can be elevated with the patient in the supine position. The harvesting technique is easy with good visualization. The authors prefer this free flap for reconstructing relatively large defects in the head and neck, and have had experience with 55 cases, which were analyzed for results and complications.

Abdominal Muscles↗
PubMed1996

Expanded free scalp flap.

Expansion of a large free scalp flap before transfer can allow direct closure of the flap donor site, thereby avoiding the need for a skin graft or local flap to close the donor site. A case is presented of anterior scalp reconstruction with an expanded posterior scalp free flap.

Accidents, Traffic↗
PubMed1995

Effects of washing acid injuries to the skin with water: an experimental study using rats.

A skin acid injury model has been constructed using SD rats and 1N HCl. The changes over time, with particular attention to subcutaneous tissue pH, were recorded and included a comparative study of the effect of washing with water at 1, 3 and 10 min after injury, on subcutaneous tissue pH. After inflicting an acid injury, the subcutaneous tissue pH of control animals reached its minimum value at the seventh minute, and had not recovered to the pre-experimental level by the 60th minute. In the group of rats which was washed at 1 min, the pH did not drop below 7.5, it remained virtually unchanged. In the group washed at 3 min, the pH declined slightly, but subsequent to washing, the pH increased gradually. In the group washed at 10 min, the changes in pH were almost the same as those in the untreated group. These results indicated that if washing was carried out before the subcutaneous tissue pH level reached a minimum value, any remaining acid on the skin surface could be washed away, effectively suppressing the subsequent fall in pH.

Animals↗
PubMed1995

Retroauricular hairline flap transfer to the face.

For facial skin defects including the hair-bearing area of preauricle-sideburn, lateral forehead-temporal hairline, and upper eyelid-eyebrow region, the transfer of a hairline flap that incorporates a skin flap is one option available for creating a natural hairline. An island or free retroauricular hairline flap (retroauricular skin flap including retroauricular hairline) based on the superficial temporal vessels or posterior auricular vessels was used to reconstruct facial skin defects including hair-bearing areas in seven patients. All flaps "took" perfectly, and aesthetically satisfactory results were achieved with minimal donor-site morbidity. However, flap vessels must be selected with great care during the surgical procedure because of the anatomic variation found among patients in the positions of the superficial temporal and posterior auricular vessels.

Adult↗