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Biomedical subjects

S Kyutoku

Publications and source records attributed to S Kyutoku.

12 recordsLinked to original sources
PubMed2000

[The latest innovations in the operation of en-bloc resection on the frontal skull base].

We have organized skull base surgery teams with otolaryngologists, neurosurgeons and plastic surgeons since 1993 and managed frontal skull base malignancies by a combined transbasal and transfacial approach. However, in the maneuvers, several problems are yet to be solved in minimizing tumor recurrence and postoperative complications. We have recently developed a microscopic en-bloc resection method assisted by an endoscope, and VFOT flap (vascularized frontal outer table flap) for the reconstruction on the frontal skull base. The VFOT flap can be elevated simultaneously with bifrontal craniotomy. The pedicled calvarian bone is split, and the frontal outer table with the pericranium is placed on the frontal base defect caused by the tumor resections. Those procedures seem to be useful for skull base surgery, and easy to perform for neurosurgeons.

Adult↗
PubMed1999

Experience with the rectus abdominis myocutaneous flap with vascularized hard tissue for immediate orbitofacial reconstruction.

For a considerable tissue defect of the orbitofacial region after skull base or head and neck tumor en bloc extirpation, we have developed the "flying buttress" technique using the vascularized hard tissue rather than the multi-stage operative method using bone graft or alloplastic materials. The procedure reconstructs the inferior orbital rim and the zygomatic prominence--flying buttresses bridging transversely in a missing face--with free flap coverage, simultaneously in the primary surgery so that the bony structure is maintained for years and ptosis of a large flap is minimized. We prefer to use the rectus abdominis myocutaneous flap for tissue restoration and two types of vascularized hard tissue: the costal cartilages combined with the flap and the temporalis muscle-pedicled calvarial bone. Representative cases are illustrated and the technique is detailed.

Adolescent↗
PubMed1998

[Orbito-facial reconstruction after extensive anterior skull base, head and neck resection using a rectus abdominis musculocutaneous flap].

In response to the recent advances in aggressive excision of skull base and head and neck malignancies, a more sophisticated method primary reconstruction has been developed using a craniofacial techniques for preservation of postoperative quality of life. We have developed an inferior pedicled rectus abdominis musculocutaneous flap with rib cartilages for reconstruction of the orbito-facial region. The advantages of this flap are as follows; 1) Simultaneous flap elevation in a supine position is possible, 2) Easy, versatile and reliable flap adjustment can be made for complicated space defect, 3) Curvature of the ipsilateral rib cartilages is suitable for inferior orbital rim, 4) Lower risk of pleura laceration as compared with a superior pedicled flap. In the past 5 years, the composite free flaps have been applied for 3 cases of hemi orbito-facial defect, with better results than in previous cases. Our technique for the flap application in a representative case is illustrated.

Head and Neck Neoplasms↗
PubMed1996

Hemifacial dismasking flap for anterior skull base tumor--technical note.

A new approach to malignant tumor in the anterior skull base using a hemifacial dismasking flap is described. A bicoronal incision is extended unilaterally down to the neck, degloving the craniofacial tissue to widely expose the skeleton underneath, allowing easy resection of an extensive tumor without postoperative scarring of the face. This method has been used successfully on five patients.

Adenocarcinoma↗
PubMed1996

[The operation for malignant tumors in the frontal skull base: combined transbasal & transfacial approach].

The authors have previously reported on an extensive transbasal approach, through which a supraorbital bar is osteotomized. This operative technique has been applied by the authors not merely to benign but also to malignant tumors in the frontal skull base. However, in the operation for malignant tumors of the frontal base, it is important to resect en-bloc the tumors and surrounding tissues, such as dura of the skull base and the orbital contents. The authors describe the operative mode of the combined transbasal & transfacial approach and its good results in 19 cases with malignant tumors in the frontal skull base, and 3 types of en-bloc resection in this operative approach (from type A to C) are introduced. Type A of en-bloc resection in the combined transbasal & transfacial approach was performed in 11 cases with the tumors invading the ethmoid sinuses. Type B was performed in 4 cases with tumors extending to the orbit. Type C was performed in 4 cases with tumors extending to the orbit and the maxillary sinuses on the affected side. These operative modes are useful in skull base surgery.

Adult↗
PubMed1994

The gonial angle stripper: an instrument for the treatment of prominent gonial angle.

In the Orient, a prominent gonial angle, so-called benign masseteric hypertrophy, is rather common and considered unattractive. Therefore, its surgical correction is one of the most popular forms of facial skeletal contouring. For accurate and safe osteotomy of the mandibular angle region, a gonial angle stripper was specially invented. It has a small projection that will ease identification of the osteotomy line in a narrow operative field. The tool has been clinically used in eight patients to prove its usefulness, especially for a posteriorly developed mandibular angle.

Adolescent↗
PubMed1993

Free lateral calcaneal flap.

Our cadaver dissection demonstrated that the lateral calcaneal artery is large enough for microsurgical anastomosis. Based on the finding, the lateral calcaneal flap was first successfully applied as a free flap that included the lesser saphenous vein and the sural nerve in the pedicle. This thin sensory flap, dispensing with main arterial damage, is indicated for the lesion of the posterior heel, plantar, and hand.

Adult↗
PubMed1992

Facial midline and symmetry: modified face bow.

A facial "cone" can be drawn inside the head. The apex of the cone is the midpoint of the line that connects both ear canals, point C, and the face is the base. A modified face bow is designed with holes through which a Steinmann pin is passed, meeting at the apex of the facial cone. After the ear bolts are symmetrically fixed, the Steinmann pin through the central hole follows the midline of the face as the bow rotates from the forehead to the chin. The right and left facial bony protrusions can be evaluated by two Steinmann pins projecting through the corresponding holes on the face bow. This device is utilized to determine the facial midline and facial symmetry during surgery. It also can be used as a tool for anthropologic studies.

Equipment Design↗
PubMed1992

Free forearm flap for closure of difficult oronasal fistulas in cleft palate patients.

There were four patients with palatal clefts who had been operated on many times previously but who still had large oronasal defects due to wound disruption. Moreover, there was considerable scar in the residual palatal tissue, which was contracted in the anteroposterior dimension. These patients were treated with a radial forearm flap transfer. The technical aspects of this reconstruction are emphasized, especially methods to enhance primary healing and to facilitate in setting the flap. Three of the patients were successfully reconstructed with one operation. The fourth had a small area of dehiscence anteriorly that was later closed with advancement of the flap tissue. There were no other complications. With the replacement of healthy tissue, the palate could be pushed further back to achieve better repair of the muscle. This would contribute to better speech function. In every patient, nasal regurgitation was eliminated, and speech quality improved significantly. The radial forearm flap is ideal for intraoral use, providing thin, hairless skin with a long, large-caliber vascular pedicle. It can reconstruct defects in one stage with well-vascularized tissue and minimal dissection of the palate. In a select group of cleft palate patients, this free-tissue transfer should be considered to achieve closure of large oronasal fistulas in patients with dense scar.

Adult↗
PubMed1990

Split lamellae switch flap for upper eyelid reconstruction.

A new concept for elevating a switch flap from the lower eyelid and then closing the defect is advocated. This flap is composed of two different-sized lamellae, the horizontally extended anterior lamella and the conventional wedge-shaped posterior lamella and lid margin. The donor's defect is to be closed with each lamella; the posterior lamella is horizontally advanced and directly closed with the aid of lateral canthotomy and cantholysis, and the anterior lamella is closed directly by extending the incision laterally to the temporal region and advancing the skin superolaterally. The switch flap can be applied to previously unindicated, nontypical upper eyelid defects by means of the split lamella concept and procedure. An illustrative case is presented.

Adolescent↗