Extracellular Vesicles from Adipose-Derived Stem Cells Relieve Extremity Lymphedema in Mouse Models.

Background: Transplantation of adipose-derived mesenchymal stem cells (ADSCs) has been reported to improve the severity of chronic lymphedema. Extracellular vesicles (EVs) derived from mesenchymal stem cells have been reported to exert effects such as the promotion of angiogenesis, suppression of inflammation, and regeneration of damaged organs. In this study, the authors show that lymphangiogenesis was induced by EVs derived from ADSCs and reveal the therapeutic potential of these EVs for the treatment of lymphedema.

Jumping Extracorporeal Free Latissimus Dorsi Myocutaneous Flap for Aesthetic Reconstruction After Anterior Skull Base and Orbital Cancer Resection.

The authors introduce successful free latissimus dorsi myocutaneous flap transfer, which was temporarily placed onto the face extracorporeally because the position of orbital defect is far from the submandibular microvascular anastomosis region. The authors then secondarily resected the excess part of the flap after 3 weeks of neovascularization period. Although multistage surgery is needed, jumping extracorporeal flap is a useful option to achieve aesthetic outcomes especially in a challenging situation.

Aesthetic Reconstruction of a Facial Defect After Subtotal Resection of the Parotid Gland Using a Superficial Circumflex Iliac Artery Pure Skin Perforator Flap.

In the reconstruction of facial defects, thin and flexible coverage of the defect is desirable for cosmetic reasons. A free flap is 1 possible surgical option; however, a flap containing a fatty layer is bulky. in this study, the authors describe the reconstruction of a facial defect after subtotal parotidectomy for right parotid carcinoma using a superficial circumflex iliac artery pure skin perforator flap, with consideration given to facial contour.

The Relationship between Dental Findings and Tongue Pressure: A Survey of 745 Community-Dwelling Adults and Elderly Persons in Japan.

Introduction: Reduced tongue pressure is one of the causes of dysphagia. The purpose of this study was to investigate the relationship between dental findings and tongue pressure, and whether prosthetic treatment prevents reduced tongue pressure.

Methods: This was a cross-sectional study.

Anorectal Transplantation: The First Long-term Success in a Canine Model.

Objective: Anorectal transplantation is a challenging procedure but a promising option for patients with weakened or completely absent anorectal function.

Summary Background Data: We constructed a canine model of anorectal transplantation, evaluated the long-term outcomes, and controlled rejection and infection in allotransplantation.

Methods: In the pudendal nerve function study, 6 dogs were randomly divided into 2 groups, transection and anastomosis, and were compared with a control using anorectal manometry, electromyography, and histological examination.

Resection and Reconstruction of Giant Abdominoscrotal Arteriovenous Malformation.

Genital arteriovenous malformations are rare and present unique surgical challenges in preserving urogenital function, abdominal wall integrity, and lower limb perfusion. A 32-year-old man with a giant abdominoscrotal arteriovenous malformation presented with recurrent heavy bleeding. Due to the high risk of rebleeding and fatal hemorrhage, surgery with curative intent was proposed and the patient was counseled on the risks of ischemia to the lower limb, testes, and penis.

Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study.

Background: Patients with head and neck cancer who are receiving radiotherapy can develop aspiration pneumonia. Determination of the incidence of aspiration pneumonia and the associated risk factors could facilitate the identification of high-risk patients.

Methods: In this retrospective study, we determined the incidence of aspiration pneumonia in 357 patients receiving radiotherapy along with oral care for head and neck cancer.

Hair Regeneration Potential of Human Dermal Sheath Cells Cultured Under Physiological Oxygen.

We investigated the effect of oxygen tension on the proliferation and hair-inductive capacity of human dermal papilla cells (DPCs) and dermal sheath cells (DSCs). DPCs and DSCs were separately obtained from human hair follicles and each cultured under atmospheric/hyperoxic (20% O), physiological/normoxic (6% O), or hypoxic (1% O) conditions. Proliferation of DPCs and DSCs was highest under normoxia.

Characteristics and outcomes of lymphaticovenular anastomosis in older patients with bilateral involvement versus younger patients with unilateral involvement in lower extremity lymphedema.

Objective: We have previously reported that patients with idiopathic primary lymphedema of adult onset can be classified into an older group with bilateral involvement and a younger group with unilateral involvement and that there are significant differences in the characteristics of these groups. The aims of this study were to investigate the features of these two groups further by evaluating the lymphatics while performing lymphaticovenular anastomosis (LVA) and to compare the effectiveness of LVA between the two groups.

Methods: This study enrolled 74 patients (136 edematous legs) in whom indocyanine green (ICG) lymphography and LVA were performed.

Indocyanine green lymphography findings in older patients with lower limb lymphedema.

Objective: Lymphedema is classified as primary or secondary according to the underlying cause. Primary lymphedema is hereditary and is considered a consequence of an inherited abnormality of the lymphatic system. Secondary lymphedema, however, is a consequence of lymphatic failure resulting from trauma, parasitic infection, or iatrogenic obstruction.

Free latissimus dorsi musculocutaneous flap for external hemipelvectomy reconstruction.

Introduction: External hemipelvectomy is one of the most extensive surgical procedures for locally advanced pelvic tumors. Stump coverage with the local tissues can be difficult in recurrent cases. Herein, we report our experience with immediate stump coverage using a free latissimus dorsi musculocutaneous (LDMC) flap after external hemipelvectomy for recurrent pelvic malignancies.

Therapeutic effects of a recombinant human collagen peptide bioscaffold with human adipose-derived stem cells on impaired wound healing after radiotherapy.

Chronic changes following radiotherapy include alterations in tissue-resident stem cells and vasculatures, which can lead to impaired wound healing. In this study, novel recombinant human collagen peptide (rhCP) scaffolds were evaluated as a biomaterial carrier for cellular regenerative therapy. Human adipose-derived stem cells (hASCs) were successfully cultured on rhCP scaffolds.

Hemi-Intravascular Stenting for Supermicrosurgical Anastomosis.

Background: Although supermicrosurgical anastomosis is a widely known reconstructive microsurgical technique, it is difficult to perform. To expand the clinical use of supermicrosurgery, we used hemi-intravascular stenting (hemi-IVaS), which is performed by inserting an intravascular stent into one side of the vessel. We conducted lymphaticovenular anastomosis, free perforator flap transfer, and fingertip replantation with supermicrosurgical anastomosis using hemi-IVaS technique and examined its usefulness.

Visualization of Accessory Lymphatic Pathways in Secondary Upper Extremity Lymphedema Using Indocyanine Green Lymphography.

Introduction: The anatomical variations in accessory lymphatic pathways around the axillary region may work as a drainage route for excess lymphatic fluid accumulation in secondary upper extremity lymphedema. In this report, accessory lymphatic pathways extending to the shoulder, neck, and breast regions in secondary upper extremity lymphedema patients are shown using indocyanine green (ICG) lymphography.

Patients And Methods: Between January 2012 and May 2015, 30 limbs of 29 patients with upper extremity lymphedema after malignant tumor resection were evaluated.

Superficial Circumflex Iliac Artery Perforator Flap for Dorsalis Pedis Reconstruction.

Reconstruction of dorsalis pedis with soft tissue is challenging because it needs to preserve thin structure to ensure that the patient will be able to wear shoes. Here, we report the use of a thin superficial circumflex iliac artery perforator (SCIP) flap in dorsalis pedis reconstruction. A 67-year-old man presented with a third-degree burn, which exposed his extensor tendons.

Free Flap Salvage after Recurrent Venous Thrombosis by Means of Large-Scale Treatment with Medical Leeches.

An anterolateral thigh flap was salvaged using 110 medical leeches in the absence of an available vein for reanastomosis. After surgical construction of the flap for full-thickness thoracic wall reconstruction, the patient developed complete venous occlusion. Specifically, the anastomotic vein developed complete occlusion, and the internal jugular vein had a thrombus.

Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators.

Introduction: The thoracodorsal artery perforator flap with capillary perforators (TAPcp) is based on capillary perforators arising from the descending branch of the thoracodorsal artery and can overcome the drawbacks of the conventional TAP flap, which results in anatomical variations due to the presence of a dominant muscle or septocutaneous perforators. We applied color Doppler ultrasonography (US) to preoperatively visualize capillary perforators of the descending branch of thoracodorsal artery to facilitate successful flap elevation.

Patients And Methods: Using preoperative color Doppler US, we examined seven flaps in seven patients who had undergone reconstruction with TAPcp flaps between January 2014 and April 2015.

Proximal and distal patterns: Different spreading patterns of indocyanine green lymphography in secondary lower extremity lymphedema.

Background: As a clinical evaluation of secondary lymphedema of the leg, indocyanine green (ICG) lymphographic assessment has established its usefulness. In this study, we analyzed the ICG findings of patients with secondary lymphedema of the leg, focusing on the location and spreading pattern of dermal backflow (DBF).

Methods: Between April 2013 and June 2015, we investigated ICG findings performed on 90 patients with secondary lymphedema of the leg following malignant cancer resection.

Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection.

Indocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases.

Preoperative color Doppler ultrasound assessment in planning of SCIP flaps.

Introduction: Superficial circumflex iliac artery perforator (SCIP) flap is based on the perforator of superficial circumflex iliac artery (SCIA) system, and is a highly useful surgical tool with a wide variety of clinical applications. The SCIA system is associated with considerable anatomical variation, however, rendering transfer of a SCIP flap technically difficult.

Patients And Methods: Using preoperative color Doppler ultrasound (US), we examined a total of 11 flaps of 11 patients who had undergone reconstruction with SCIP flap from April to August of 2014.

Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern.

The anatomy of the lateral thoracic artery perforator flap remains controversial, but this region is extremely useful as a reconstructive donor site. In this report, we describe the usefulness of the preoperative color Doppler ultrasound evaluation for the harvesting of the lateral thoracic artery perforator flap, and we clarify its branching pattern. Twenty-seven patients underwent the preoperative color Doppler ultrasound assessment before perforator flaps were harvested.

Normothermic preservation of the rat hind limb with artificial oxygen-carrying hemoglobin vesicles.

Background: For managing major limb amputation, it is important to consider ischemic time and reperfusion injury by free radicals after the blood supply is reestablished. State of preservation during transplant surgery is crucial for the survival and function of the tissue, graft, or organ. In this study, we confirmed the effect of intermittent blood flow in rat ischemic hind limb and developed a new oxygenic preservation method using artificial oxygen carrying hemoglobin vesicles (HbVs).

Reconstruction of a full-thickness, complex nasal defect that includes the nasal septum using a free, thin superficial inferior epigastric artery flap.

Complex nasal defects present a surgical challenge, particularly in cases with a full-thickness defect that extends into the nasal septum. Although the superficial inferior epigastric artery (SIEA) flap has been widely used as a bulky flap for soft tissue augmentation, reports on its use as a thin flap are limited. We present a case of complex nasal defect reconstruction using a free, thin SIEA flap.

Locating recipient perforators for perforator-to-perforator anastomosis using color Doppler ultrasonography.

Background: The authors investigated the efficacy of color Doppler ultrasonography (US) to locate perforators prior to performing perforator-to-perforator anastomosis in free flap reconstruction.

Methods: The authors examined 20 patients who had undergone free flap transfers between April 2013 and July 2014 at the Department of Plastic and Reconstructive Surgery, University of Tokyo Hospital. On the day before surgery, color Doppler US examination was performed to locate lower-extremity perforators.