A microangiographic technique using synchrotron radiation to visualize dermal circulation in vivo.

Conventional angiography cannot resolve dermal small vessels with a diameter of 200 microm or less. In vitro microangiography is currently characterized by better spatial resolution than conventional angiography but does not allow visualization of the blood stream in dermal vessels in vivo. In this study, we introduce a novel synchrotron radiation microangiographic system for visualizing the structure of and blood flow in dermal microvessels in vivo repeatedly. We used monochromatic synchrotron radiation with an energy just above the k-edge of iodine (33.3 keV) as an x-ray and a high-definition television camera system with a high-sensitivity image pick-up tube for detection. The 33.3-keV monochromatic synchrotron radiation allows detection of a small amount of iodine, and the high-definition television camera system can resolve small vessels with high-spatial resolution and no loss of sensitivity. We performed synchrotron radiation angiography of superficial inferior epigastric arteries and their branches in nine rats, and of the caudal artery in 14 rats, and compared angiographic images taken by the current system with those taken by a conventional angiographic system in seven rats. With this new microangiographic technique, we could visualize small dermal vessels with a diameter as low as 50 microm. In addition, repeated angiograms at baseline and under increasing body temperature could be obtained. This new microangiographic approach is expected to be very useful for the assessment of dermal circulation in patients.

The influence of different types of hard-palate closure in two-stage palatoplasty on maxillary growth: cephalometric analyses and long-term follow-up.

Using cephalometric analysis we investigated the influence on maxillary growth of two different types of hard-palate closure in two-stage palatoplasty. In 12 patients with complete unilateral cleft lip, alveolus, and palate, the lip and soft-palate were closed between 3 and 7 months of age. These 12 patients were then assigned to two groups of 6. In one group the hard palate was closed at 1 year 5 to 11 months of age by a vomer flap with a skin graft (VF group, Osada's two-stage palatoplasty) and in the other group it was closed by the mucoperiosteal pushback procedure (PB group). Sella-nasion-point A (SNA) in the VF group at 3 to 4 and after 10 years of age were within normal range and significantly larger than in the PB group. Two patients in the PB group required orthognatic surgery to obtain normal occlusion and a well-balanced profile. We concluded that in two-stage palatoplasty better maxillary growth can be obtained using the vomer flap method than using the pushback procedure.

The influence of different types of hard palate closure in two-stage palatoplasty upon palatal growth: dental cast analysis.

We investigated the influence of different types of hard palate closure in two-stage palatoplasty. In 12 cases the lip and soft palate were closed at the age of 3 to 7 months; these 12 were then divided into two groups. The hard palate was closed at the age of 1 year 5-11 months by the vomer flap with skin graft in the vomer flap (VF) Group (Osada's two-stage palatoplasty), and by push-back procedure of the mucoperiosteal flap in the push-back (PB) Group. Dental casts of the two groups were measured and compared at the ages of 0, 1, 3-4, and after 10 years. 1) In spite of apparent differences in palatal configurations at the age of 3-4 years, no significant differences in palatal size and area were noted between the groups. The cross-sectional areas in the VF Group were significantly larger than those in the PB Group in all the sections. 2) When the two groups were compared for rates of growth from 1 to 3-4 years, no significant differences in palatal size were noted, except in palatal width 1, although palatal growth from 1 to 3-4 years was more consistent and favorable in the VF Group. The rates of growth or change in palatal area and cross sectional-area 2 were significantly larger in the VF Group. 3) In spite of the apparent difference in palatal configuration, after age 10, no significant differences in palatal size, area, and depth were noted except in cross-sectional area 2.

Introducing a solid model for reconstructing the severely deformed hand.

We report a case of a 39-year-old man with a severely deformed hand resulting from an injury sustained in a traffic accident at 2 years of age. A Marjolin ulcer appeared on the cicatricial area 3 years ago. After radical surgery for squamous cell carcinoma, we planned to realign the axis of the ulnarly flexed hand. Prior to surgery, we produced a solid model of the bony framework using laser lithography based on 3-D CT digital image data. The solid model furnished us and the patient with precise information on the deformity and allowed us to perform preoperative simulation surgery. By a two-stage wedge-shaped ostectomy at the end of the radius, the ulnarly deviated axis of the hand was realigned from 100 to 30 degrees (approximate) in clinical measurement and the patient was quite satisfied with the resulting function and appearance. However, there are some disadvantages of the laser lithography solid model: the cost is high, the resin material is very hard and difficult to operate on, and the model does not include soft-tissue structures. The development of a model in the future that includes vessels, nerves, and tendons will enable surgeons to transfer more precisely the results of the simulation surgery to the patient in the operating room.

Augmentation rhinoplasty by subcutaneous midline forehead flap simultaneous with implant removal.

Implant exposure after augmentation rhinoplasty with alloplastic materials is usually associated with some degree of infection, and it is commonplace to remove the implant and wait for several months before re-augmentation. However, some patients cannot accept the resultant deformity after implant removal. We introduced the midline forehead flap for augmentation simultaneous to the removal and obtained favorable results, even when considering the donor site scar on the forehead. We report the surgical technique and two patients treated with this procedure. The advantages and disadvantages of this procedure are also discussed.

Two different hard palate closure techniques in two-stage palatoplasty: effects on velopharyngeal closure and articulation.

Two different hard palate closure techniques, in two-stage palatoplasty, was evaluated in 12 patients. The lip and soft palate were closed at 3 to 7 months of age. The patients were then divided into two groups of six and the hard palate closed at 17 to 23 months of age, either by a vomer flap (VF) with a skin graft (Osada's two-stage palatoplasty) in the VF group, or by the push-back (PB) procedure of the mucoperiosteal flap in the PB group. Velopharyngeal closure (VPC) during a gag reflex before and after hard palate closure, and the articulation of these patients after closure, were evaluated and compared between the two groups. Regarding VPC before hard palate closure, three "Poor" and three "Borderline" outcomes were noted in each group. We conclude that, by introducing the pharyngeal flap, the patients in the VF group obtained good articulation, actually comparable to that in the PB group.

Attempt to obtain greater dermal depth of vascular injury using dye-enhanced laser technique: a new approach.

BACKGROUND AND OBJECTIVE: Although pulsed dye laser has been successfully used in the treatment of portwine stains, a number of patients had incomplete clearance because the depth of penetration by the pulsed dye laser was inadequate. This study was performed to establish the greater penetration depth of vascular injury using a dye-enhanced laser technique. STUDY DESIGN/MATERIALS AND METHODS: The ruby laser at 694.3 nm was used, and the corresponding specific dye was Prussian blue solution (maximum absorbance 694 nm). We compared the penetration depth of vascular injury by the ruby laser irradiation after the Prussian blue injection with that by the dye laser irradiation. A flashlamp dye laser with a pulse duration of 300 microseconds and a 5 mm diameter spot size was used to 6.2 J/cm2 at 590 nm. The Prussian blue solution was injected into the superficial epigastric artery of white male Japanese rabbits, immediately followed by the ruby laser exposure to 6.2 J/cm2 at a pulse duration of 283 microseconds in a 15 x 15 mm spotsize. Depth of penetration was measured from the dermoepidermal junction to the deepest site of vascular injury at 24 hours after laser exposure. RESULTS: Mean penetration of 590 nm of the dye laser light was 1.45 mm; mean penetration of the 694.3 nm ruby laser irradiation after the Prussian blue injection was 2.33 mm. Ruby laser penetration was greater than that of the dye laser. CONCLUSION: This study emphasizes that the ruby laser irradiation after the Prussian blue injection can induce deeper vascular injury than the dye laser inducing similar pathological changes.

Reconstruction of microtia using tissue expander.

In this article, microtia was reconstructed by the use of a tissue expander to obtain a sufficient temporal skin flap that ensures an acceptable contour of the auricle. This article introduces the operative procedure and the authors' experience.

[Development of laser systems in the treatment of hyperpigmented skin lesions].

Laser beams have been in common use for the treatment of hyperpigmented skin lesions. However, therapeutic efficacy has been limited mainly because the output is circular with a Gaussian distribution of intensity, which makes it difficult to apply a uniformly distributed dose to the lesions. We have developed a technique whereby a laser beam is converted to have a square and uniform output intensity distribution. The principle of this technique is that the divergent laser beam enters a glass square pillar, propagates through the pillar repeating the total reflection and emerges with a uniform intensity distribution over the cross-section at the end of the pillar. The device applied this technique is incorporated in a hand-piece and both ruby and argon laser systems have been developed. The ruby laser has been used for the treatment of the melanistic skin lesions such as nevus cell nevus and nevus spilus. In clinical application, 36 of 67 cases have shown remarkably effective results with an improvement rate of 53.7%. The argon laser has been used for the treatment of vasogenic skin lesions such as portwine stain. In clinical application, 44 of 66 cases have shown effective results and the improvement rate is 66.7%. These results are excellent when compared with the other methods of treatment and with laser therapy previously used.

[Reconstruction of oral defects using free revascularized jejunum transfer].

Reconstruction of the oral cavity after extended surgery poses many difficult problems. The vital functions of the oral cavity, especially swallowing, mastication and breathing, are seriously impaired by resection of the tongue, floor of the mouth, gingiva or jaw bone. We have used the free revascularized jejunal transfer for reconstruction of the oral cavity in 10 patients and have had good functional and cosmetic results. The advantages of this method are as follows: 1) it is a one-stage operation; 2) the flexibility of the graft preserves maximal tongue function; 3) the graft can be applied to difficult anatomic sites, and 4) the mucosal defect is covered with jejunal mucosa and induration is minimum. Our success rate with this procedure has been 90%. In our experience, this transfer is useful for reconstruction of a massive defect in the oral cavity.

Reconstruction of sternal defects with autologous bone grafts and myocutaneous flap of the latissimus dorsi muscle.

In one case of sternal metastasis associated with necrotic osteomyelitis from breast carcinoma we performed subtotal sternotomy including adjacent structures. The resulting defect over the pericardium was reconstructed by the fibula, ribs and a myocutaneous flap of the latissimus dorsi muscle for protection and stability of the anterior chest wall after the operation. The usefulness of the myocutaneous flap of latissimus dorsi muscle for skin coverage over a wide defect in the anterior chest wall is discussed.