How did rehabilitation professionals act when faced with the Great East Japan earthquake and disaster? Descriptive epidemiology of disability and an interim report of the relief activities of the ten Rehabilitation-Related Organizations.

OBJECTIVE: Inter-organizational coordination is important for rehabilitation disaster relief. The 2011 Great East Japan Earthquake and Disaster was unprecedented, being geographically widespread and multifaceted. Faced with the crisis, rehabilitation professionals established the 10 Rehabilitation-Related Organizations of Rehabilitation Support Service (10-RRO). The objectives of this paper are to provide descriptive epidemiology and assess the activities of 10-RRO. DESIGN: Descriptive. METHODS: Epidemiological data on disability were collected, mainly from official sources. Relief activities were reviewed from daily reports, and the preparedness, initial response and functioning of 10-RRO were assessed with a questionnaire directed at 36 executives of individual organizations. RESULTS: The disaster was characterized by a very low ratio of injuries to death of 0.372, and an odds ratio of deaths among disabled persons of 2.32. 10-RRO provided relief activities at 3 shelters. The total number of dispatch days ranged from 107 to 146, and the cumulative number of professionals and evacuees served was 1,202 and 7,300, respectively. Support activities included prevention of immobilization, daily life support, environmental improvement and transition to temporary housing. The questionnaire survey revealed poor preparedness, satisfactory initial response and support activities, and problems of data collection and advocacy. CONCLUSION: The disaster was characterized by minimal trauma and a great need for preventing immobilization. This first collaborative endeavour was successful.

Concept and anatomical basis of microdissected tailoring method for free flap transfer.

BACKGROUND: For a refined microsurgical reconstruction, it is desirable to adjust the flap to fit the three-dimensional details of the defect. Essentially, each vessel arborized in the subcutaneous adipose tissue supplies axial blood flow to an individual small area surrounding the vessel. Therefore, free alteration of the flap would be possible if the anatomy of these branches could be identified during surgery. METHODS: The microdissected tailoring method is a new procedure for alteration of the flap, observing the branches of the perforator directly after microdissection. By means of this procedure, three flaps were transferred to complex tissue defects. In addition, among intraadipose branches of 59 perforators, 90 cases of three types of microdissected thin perforator flap transfer were measured to classify the anatomical variations relating to microdissected tailoring of the flap. RESULTS: All flap transfers were uneventful and no circulatory failure of the flaps was observed. Statistical analyses reveal that the intermuscular septum perforator branches at the deeper layer of the adipose tissue and then spreads more widely in the adipose layer than that of muscle perforator, regardless of the type of flap and the length of the intraadipose vessel. CONCLUSIONS: Microdissected tailoring of the flap provides the best solution for flap alteration in the reconstruction of a complex-shaped tissue defect. It represents a change in the concept of free flap transfer, because the flap is prepared according to the individual anatomy of the intraadipose vessel.

Clinical application and refinement of the microdissected thin groin flap transfer operation.

A microdissected thin groin flap is a uniform thin flap with a long vascular pedicle prepared by microdissection of the deep branch of the superficial circumflex femoral system (SCIS). However, the safe dimensions of the flap are not known, and anatomical variations of the SCIS sometimes impede elevation of the flap based on the deep branch. Therefore, modifications of the operation and accumulation of empirical knowledge are required for safe preparation of the flap. Thirty cases of various types of tissue defects were reconstructed using microdissected thin groin flaps. Among these, large flaps exceeding 20 cm on the long axis were investigated to estimate the maximum dimensions of the flap. Additionally, new operative procedures were developed to overcome anatomical variations of the SCIS and to assist preparation of a thin flap. One flap was lost due to a venous thrombosis. A small distal area of three large flaps became necrotic. The perforators from the deep branches were absent in five cases, and three of these flaps were successfully elevated based on the superficial branch using the new method. The clinically deduced safe dimensions of the flap ranged from 5 x 2 cm to 25 x 12 cm. The microdissected thin groin flap was found to be useful for coverage of various types and sizes of skin defects. Through improved operative procedures, a large and extremely thin flap can be prepared safely even if the perforator from the SCIS is absent.

Free microdissected thin groin flap design with an extended vascular pedicle.

BACKGROUND: The senior author has developed a method of microdissection whereby a thin perforator flap can be elevated accurately in a single-stage procedure. Recently, the authors also applied the microdissection technique to the inguinal area and elevated microdissected thin groin flap. METHODS: In preparation of the flap, the perforator penetrating the fascia of the sartorius muscle is initially detected suprafascially, and then the deep adipose and subfascial layer of the inguinal area is dissected using an operating microscope. After confirming the distribution of the blood vessels in this area, the flap is elevated while dissection is performed between the deep and superficial adipose layers. RESULTS: Six cases of scar contracture or skin defect by general burn, three cases of other types of traumatic tissue defects, and one case of skin loss at the donor site of an extended wraparound flap were successfully reconstructed with these new flaps. CONCLUSIONS: The uniform thinness and long vascular pedicle are distinctive characteristics of this flap compared with the traditional groin flap. Moreover, the buried vessels in the deep adipose layer and fascia can be confirmed by microdissection; this enables prediction of the safe area of the flap.

Recovery of disused replanted digits by second toe hemipulp flap transfer.

BACKGROUND: Amputation of the distal phalanx is the most common among all mutilation injuries. Generally, it has been believed that the prognosis of this type of amputation is satisfactory; however, disuse of digits because of severe atrophy and sensory disturbances is frequently observed in the follow-up period. METHODS: The authors intended to use the second toe hemipulp flap for recovery of these disused digits and transferred the flaps to eight severely atrophic postreplanted digits. Objective sensory recovery was assessed along with estimation of the "usefulness" of the reconstructed fingers. RESULTS: No complications were observed postoperatively, and estimations of the functional results were almost satisfactory. CONCLUSION: This procedure significantly improved the prognosis of the replantation of severely crushed digits.