Facial contour reconstruction in lipodystrophy using a double paddle dermis-fat radial forearm free flap.

Facial lipodystrophy is a relatively rare disease and very little has been reported concerning the reconstruction of this facial deformity compared with Romberg's disease. In this article we report a new surgical procedure using a double paddle radial forearm dermis--fat free flap. By using this unique flap, we could reconstruct soft tissue defects on both cheeks in a one-stage operation using one flap.

Sixty cases of partial or total toe transfer for repair of finger losses.

Our experience with partial or total toe transfers for the reconstruction of finger deficits is presented. Sixty-one toes were transferred to reconstruct finger deficits in 60 patients. The transfers from the big toe consisted of 3 vascularized whole-nail grafts, 4 onychocutaneous flaps which included the nail and a skin flap from the toetip, 16 thin osteo-onychocutaneous flaps, 4 wrap-around flaps, and 3 combined wrap-around and dorsalis pedis flaps.

Preparation of oversulfated fucoidan fragments and evaluation of their antithrombotic activities.

Oversulfated fucoidan fragments (20-40 and 40-60 kDa) were prepared, and their fibrinolytic and anticoagulant activities were compared with those of oversulfated fucoidan (100-130 kDa) reported previously [Soeda et al., Biochem. Pharmacol.

Binding of cerebrosides and sulfatides to saposins A-D.

Saposins are a family of four small glycoproteins, all of which are derived from prosaposin, and are involved in the lysosomal hydrolysis of various sphingolipids. Results from this investigation demonstrate that saposins A-D bind to galactosyl- and glucosylceramide. The binding was highly dependent on the solution pH; maximum binding of glucosylceramide to all saposins occurred at pH 7.

Reinnervation of denervated Pacinian corpuscles: ultrastructural observations in rats following free nerve grafts.

Nerve transection and immediate free nerve grafts using rat sciatic nerves were employed to observe the morphologic changes in periodical denervation and reinnervation of Pacinian corpuscles located on the interosseous membrane between the fibula and tibia. During periods of from 2 weeks to 20 months after the surgery, a total of 28 corpuscles were obtained under an operating microscope and processed for morphologic analysis using light and electron microscopes. Based on our morphologic findings, normal corpuscles were composed of an axon terminal and inner and outer cores.

Free anterolateral thigh flaps for reconstruction of head and neck defects.

The anterolateral thigh flap is a septocutaneous artery flap based on the septocutaneous or muscle perforators of the lateral circumflex femoral system. Little has been reported about the variations in its vascular anatomy and its application for head and neck reconstruction. We report 22 cases in which this flap was used for the reconstruction of head and neck defects.

The effect of carbohydrate removal on stability and activity of saposin B.

Saposin B is involved in the hydrolysis of sulfatides, GM1 ganglioside, globotriaosylceramide, and several other sphingolipids and glycerolipids by lysosomal hydrolases. Saposin B is one of four small glycoproteins (saposins) derived from prosaposin. The carbohydrate chain of saposin B was removed and deglycosylated saposin B was characterized and compared with native saposin B.

Extended wrap-around flap for reconstruction of the finger with recurrent arteriovenous malformation.

Treatment of arteriovenous malformations of the finger is difficult because complete resection of malformations by ligation or en bloc resecting methods is impossible. We used an extended wrap-around flap consisting of a combined wrap-around flap and a dorsalis pedis flap to reconstruct the soft-tissue defects following complete resection of a recurrent malformation in the index finger. This method has two advantages: no postoperative recurrence of the malformation is expected, and the affected finger can be preserved.

The gluteal perforator-based flap for repair of sacral pressure sores.

A gluteal perforator-based flap employing the gluteus maximus muscle perforators located around the sacrum is described. A cadaveric study disclosed the existence of several significant perforators all around the gluteal region. Among these, the parasacral perforators originating from the internal pudendal artery and lateral sacral artery have proven useful for the repair of sacral pressure sores.

Effect of saposins on acid sphingomyelinase.

The effect of saposins (A, B, C and D) on acid sphingomyelinase activity was determined using a crude human kidney sphingomyelinase preparation and a purified sphingomyelinase preparation from human placenta. Saposin D stimulated the activity of the crude enzyme by increasing its apparent Km and Vmax. values for sphingomyelin hydrolysis.

Binding and transport of gangliosides by prosaposin.

Prosaposin, the precursor of saposins A, B, C, and D, which activate lysosomal hydrolysis of sphingolipids, exists in various tissues and body fluids and is especially abundant in the nervous system. Prosaposin and saposins A,B, C, and D formed stable complexes with 13 different gangliosides as measured by an assay using column chromatography. Gangliosides of the gangliotetraose type (a series) were bound with high affinity, whereas b series gangliosides, O-acetylated gangliosides, and gangliosides with shorter carbohydrate chains, were bound with lower affinity.

Extended latissimus dorsi musculocutaneous flaps for extremely wide cervical skin defects involving the cervical esophagus.

Two cases using island distally and anteriorly extended latissimus dorsi musculocutaneous flaps for one-stage reconstruction of pharyngoesophageal defects of the entire front of the neck are reported. The advantage of this flap is its extremely large skin territory, which provides a reliable vascular supply. This flap is suitable for extremely wide cervical defects where the recipient vessels are damaged after severe infection and irradiation.

Free thin paraumbilical perforator-based flaps.

A free paraumbilical perforator-based flap fed by a muscle perforator from the inferior deep epigastric artery and with no muscle was used in 13 patients. Among them, a free thin paraumbilical perforator-based flap with a thin layer of fat, to protect the subdermal plexus of the vessels, was used in seven patients. The dominant pedicle perforator of this thin flap is usually located around the umbilicus and a large flap can be obtained.

Fibrinolytic and anticoagulant activities of highly sulfated fucoidan.

A series of fucoidan [sulfated poly(L-fucopyranose)] derivatives were prepared by chemical sulfation and desulfation, and they were tested for their abilities to stimulate tissue plasminogen activator (t-PA)-catalyzed plasminogen activation, clot lysis, and the inhibition of fibrin polymer formation. The magnitude of their activities was dependent upon the degree of sulfation. A striking feature of the sulfated fucoidan was that, unlike heparin, it stimulated t-PA-induced plasma clot lysis by protecting plasmin activity from alpha 2-plasmin inhibitor and decreased the rate of fibrin polymer formation.

The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers.

Microvascular replantation at the distal phalangeal level has recently been reported by several authors, but as yet the rate of success has not been constant owing to the technical difficulties associated with small vessels. To solve this problem, over the last 4 years we have used arteriovenous anastomosis to reestablish either the arterial system or the venous drainage system in the 33 digits of our 23 patients. The results have been excellent, with a 91 percent success rate.

Electron microscopic observations of degeneration of human Pacinian corpuscles in amputated fingers.

Amputated human fingers were used to observe the morphologic changes in degeneration of Pacinian corpuscles, and postoperative moving two-point discrimination of the replanted fingers was examined to analyze sensory recovery after replantation. Normal corpuscles are composed of an axon terminal and inner and outer cores, resembling a sliced onion. The inner core is composed of thin, multilayered lamellar cells, and the outer core consists of multiple layers of thin perineurial cells.

An enzyme-linked immunosorbent assay for the detection of plasminogen activator-induced fribrin clot lysis in a circulating plasma system.

A technically easy and sensitive method for the evaluation of the fibrinolytic potency of plasminogen activator in a circulating plasma system was developed. A circulating apparatus was prepared by connecting silicone tubes with two separate chambers. Human plasma and plasminogen activator were allowed to circulate from one chamber through a peristaltic pump into another one which contained biotin-labeled fibrin clot.

Free thin osteo-onychocutaneous flaps from the big toe for reconstruction of the distal phalanx of the fingers.

Free osteo-onychocutaneous flaps from the big toe have frequently been used for the reconstruction of distal phalangeal loss of the fingers. The thickness of the fatty tissue, however, makes these flaps bulky. We believe this disadvantage can be overcome with a free thin osteo-onychocutaneous flap from the big toe and consider this thin composite flap to be a superior method of reconstruction for the treatment of distal phalangeal loss.

Free, thinned, paraumbilical perforator-based flaps.

Free, thinned paraumbilical perforator-based flaps, fed by a muscle perforator from the inferior, deep epigastric artery and having no muscle and little fatty tissue components, were used in two cases. This flap provides great advantages in overcoming some of the problems of the conventional rectus abdominis musculocutaneous flap.

A combined rectus abdominis musculocutaneous flap and vascularized iliac bone graft with double vascular pedicles.

Although a free vascularized iliac bone graft has been successfully used for the reconstruction of large bone defects, there is a serious problem of how to repair in one stage patients having a large bone defect with a very wide skin defect. A free combined rectus abdominis musculocutaneous flap and vascularized iliac bone graft with double vascular pedicles seems to be one of the most suitable methods for patients having large defects of both bone and skin. Based on our patient, the main advantage of this flap is the extreme width of the skin territory.

Free second toe transfer for reconstruction of the distal phalanx of the fingers.

Free transfers of the distal parts of the second toe for reconstruction of distal phalangeal losses of the fingers were successfully carried out. This method is believed to be the best for functional and cosmetic reasons, but major postoperative vascular problems exist. To overcome these problems, multiple vascular anastomoses were employed at operation.

Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm.

A free combined vascularized fibula and peroneal composite flap was transferred to the forearm in a patient with a severely damaged forearm following a heat-press injury. The operative technique, postoperative management, and subsequent clinical course are described, and the advantages of this method are outlined. Not only can the fibula now be used as a free vascularized bone graft in simple bone defects, but further applications, such as a combined fibula and peroneal composite flap, can be employed in the treatment of severely damaged forearms.

High-voltage electrical injury: electron microscopic findings of injured vessel, nerve, and muscle.

Bilateral legs damaged by high-voltage electrical injury were treated by amputation and a free thin rectus abdominis myocutaneous flap with reduced muscle. Damaged arteries at 2 months after injury showed disappearance of endothelium, and a decreased number and morphological changes in smooth-muscle cells. Injured nerves and muscles showed early regenerating processes after total degeneration, and no progressive muscular necrosis.

A new dressing method for free skin grafting in hands.

Using adhesive drapes and a disposable suction drain, the grafted area is compressed by positive pressure that is equivalent to the negative pressure of a suction drain. With this dressing method, the graft can be observed throughout the postoperative course, and can be applied with uniform and constant pressure. Thin drapes accommodate well to various shapes, so this method is uniquely qualified in free skin grafting of hands.

One-stage reconstruction for amputated thumbs with melanoma.

The reconstruction of amputated thumbs is difficult because of a poor prognosis, and the varying length and volume of the lost thumbs. Two patients underwent reconstruction of amputated thumbs in one stage with the use of a modified wrap-around flap procedure. An onychocutaneous flap from the big toe is suitable for partial defects, including the nail of the distal phalanx.