Analysis of cancer-associated fibroblasts and the epithelial-mesenchymal transition in cutaneous basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Activated cancer-associated fibroblasts (CAFs) and fibroblasts that have undergone the epithelial-mesenchymal transition (EMT) in cancer stroma contribute to tumor progression and metastasis. However, no reports have investigated the CAF phenotype and its clinicopathological relevance in cutaneous malignant tumors, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Here, we investigated the CAF phenotype in cutaneous malignant tumors based on their histology and immunohistochemical expression of CAF-related markers, including adipocyte enhancer-binding protein 1 (AEBP1), podoplanin, platelet-derived growth factor receptor α (PDGFRα), PDGFRβ, fibroblast activating protein (FAP), CD10, S100A4, α-smooth muscle actin (α-SMA), and EMT-related markers (Zeb1, Slug, and Twist).

The Classification of Swanson for Congenital Anomalies of Upper Limb Modified by the Japanese Society for Surgery of the Hand (JSSH).

The aim of this study is to introduce the classification of Swanson for congenital anomalies of upper limb modified by the Japanese Society for Surgery of the Hand (the JSSH modification) in English. The Swanson classification has been widely accepted by most hand surgeons. However, several authors have suggested that complex cases, particularly those involving the complex spectrum of cleft hand and symbrachydactyly, are difficult to classify into the classification schemes.

Reconstruction of the sacral region using the lumbo-gluteal sensory flap.

Purpose: Local skin flaps are used for reconstruction of sacral decubitus ulcers because of their structural endurance against the patient's weight. However, a major concern is associated with decubitus recurrence after repair. Sensory flaps are one choice to prevent recurrence.

Alveolar reconstruction by distraction osteogenesis under unfavorable conditions.

We present a patient who underwent alveolar reconstruction using vertical mandibular lengthening by distraction osteogenesis under unfavorable conditions. Part of the alveolar bone in the center of the mandible was resected, together with a squamous cell carcinoma located on the oral floor. We used vertical mandibular lengthening from the region of the remaining mandible inferior to the bony defect to reconstruct the alveolus, combined with a free musculocutaneous flap as a cover.

Facial nerve reconstruction using a vascularized lateral femoral cutaneous nerve graft based on the superficial circumflex iliac artery system: an application of the inferolateral extension of the groin flap.

The use of an inferolateral extension technique of a groin flap has previously been reported. This technique involves harvesting an extended portion from the anterolateral thigh, including the lateral femoral cutaneous nerve (LFCN) and its accompanying vessels, attached to a groin flap via communications between the LFCN-accompanying vessels and the superficial circumflex iliac artery (SCIA) system. In this study, we used this technique involving a vascularized LFCN combined with a groin flap to reconstruct a facial nerve defect.

Reconstruction of the cervical trachea using a prefabricated corticoperiosteal flap from the femur.

We treated a severe cervical fistula with a defect of tracheal cartilage using prefabrication of a corticoperiosteal flap combined with a cutaneous flap.The patient was a 16-year-old male with a cervical tracheal fistula that developed after a tracheostomy. Almost all the circumference of the trachea just below the cricoid cartilage up to the 4th tracheal cartilage had been lost.

Efficacy of distraction osteogenesis for mandibular reconstruction in previously irradiated areas: clinical experiences.

The efficacy of distraction osteogenesis in an irradiated area is controversial, although this procedure is now widely used in the field of craniomaxillofacial surgery. We report the clinical results from 4 patients with mandibular defects treated by lengthening of the irradiated mandibles. All patients had a mandibular defect caused by ablation of a malignant tumor.

Inferolateral extension of the groin flap based on the artery accompanying the lateral femoral cutaneous nerve.

The authors reconstructed hand defects using a new type of the extended groin flap in two patients. The extended portion includes the lateral femoral cutaneous nerve (LFCN) and the artery accompanying the LFCN (LFCA). Circulation to the extended portion was maintained by the communicating branches between the LFCA and the superficial circumflex iliac artery (SCIA).

Operative technique to harvest an arterial flap from the posterolateral calf region: how can we elevate a lateral gastrocnemius perforating artery flap safely?

The posterior calf region is a useful donor site for skin or composite flaps including muscle and/or nerves. We reported the first clinical use of the lateral gastrocnemius perforating artery flap including a vascularized sural nerve in 2003. This flap was elevated based on a perforator arising from the lateral head of the gastrocnemius muscle.

Orbicularis oris myomucosal island flap transfer to the nose.

We developed the orbicularis oris myomucosal island flap (OOMMIF) to reconstruct the nasal lining in one stage. The OOMMIF blood supply derives from the intramuscular vascular network which communicates with the submucosal vascular plexus via the vascular network formed by the deep ascending branches of the superior labial artery. An oral mucosal flap of approximately 2 x 3cm can be harvested from the upper lip pedicled solely on the orbicularis oris muscle.

Secondary craniofacial reconstruction of huge frontoethmoidal encephalomeningocele after primary neurosurgical repair.

Frontoethmoidal encephalomeningocele is a congenital herniation of intracranial contents, including meninges, brain and part of the ventricle, through a bony defect in the skull at the junction of the frontal and ethmoid bones. Management involves meticulous preoperative assessment using computed tomography scans and magnetic resonance imaging, and surgical repair of the central nervous system, skeletal deformities of the orbit, downward displacement of the medial canthi, upward displacement of the eyebrows, and nasal deformities. Frontoethmoidal encephaloceles are best operated on via a craniofacial approach which enables repair of the central nervous system and skeletal deformities in one stage.

Reconstruction of a severe maxillofacial deformity after tumorectomy and irradiation using distraction osteogenesis and LeFort I osteotomy before vascularized bone graft.

We present the successful reconstruction of a large mandibular defect with a severe maxillofacial deformity after malignant tumor resection and irradiation. The patient was a 16-year-old boy with a defect in the left mandible, which extended from the mandibular body to the condylar process and hypoplasia of the maxillozygomatic complex on the left side as a result of ablation and radiotherapy of a grown rhabdomyosarcoma in the left infratemporal fossa at the age of 10. We planned a two-stage reconstruction because of his wide mandibular defect and hypoplasia.

Gastrocnemius perforating artery flap including vascularized sural nerve.

A degree of communication was found between the superficial sural artery (the concomitant vessel of the sural nerve) and the muscle perforators from the gastrocnemius muscle, together with the cutaneous branches of the peroneal artery. A fasciocutaneous flap designed in the posterior calf region, including the vascularized sural nerve, was elevated based on the perforating artery of the gastrocnemius. This compound flap was used to reconstruct facial nerves and soft-tissue defects created by resection of malignant tumors in three patients.

Inferior extension of the groin flap based on the descending branch of the superficial circumflex iliac artery.

The authors present a groin flap which was extended inferiorly and included the descending branch of the superficial circumflex iliac artery (SCIA) as a new alternative technique. Little research has been previously done on the descending branch of the SCIA, but the authors found clinically that this small branch was consistently present, and decided to make use of it to extend the groin flap inferiorly. The procedure extending the groin flap was successfully applied in three patients, one with a degloving injury of the leg, and two with progressive hemifacial atrophy.