An Anatomical Dissection Method for Observation of Fibrous Facial Structures.

BACKGROUND: In recent years, structures including the superficial musculoaponeurotic system and retaining ligaments that support the facial soft tissue have been clarified. However, these structures are very difficult to observe in their entirety by the standard gross anatomical procedure (ie, dissection from superficial to deep layers). Furthermore, accurate descriptions of these structures are rare in both anatomical and plastic surgery textbooks. The aim of this study was to clarify the facial fibrous structures in a gross anatomical view. METHODS: The authors' novel method used soft facial tissue and bone. The tissue was fixed in gelatin and sectioned at a thickness of 5 to 10 mm. Each section was placed on a wooden board; the bone was then pinned, and the skin was pulled outward with sutures to hyperextend the soft tissue. Subsequently, the loose connective tissue was torn and fat tissue was removed under a surgical microscope. After the removal of fat tissue, the fibrous facial structures (eg, the superficial musculoaponeurotic system and retaining ligaments) could be observed clearly. RESULTS: The thickness of the sections allowed three-dimensional observation, such that a structure located deep within a section could be clearly observed. The expansion of soft tissue facilitated observation of the facial layer and fibrous structures, and the locations of nerves and vessels. Therefore, the facial layer structure was readily discerned. CONCLUSION: This method is likely to be very useful in the field of plastic surgery because it enabled intuitive identification of facial layers and their characteristics. CLINICAL RELEVANCE STATEMENT: The dissection method developed by the authors reveals the connected morphology of each tissue of the face, thus providing basic data for analyzing soft tissue changes due to aging and gravity. This will be useful for the development of anti-aging medicine.

Successful Treatment of Full Thickness Frontal Skull Bone Defect With Dermal Fat Grafting and Artificial Bone Grafts.

Rigid reconstruction for frontal bone defects not only improves function, but also approximates more normal appearance. However, in cases involving dural scar contractures, a concave deformation remains when rigid reconstruction is performed without compensating for dead space created by swelling of the brain. This study involved 4 cases in which a 2-stage reconstruction procedure was used to first eliminate dead space by grafting dermal fat, and subsequently carry out rigid reconstruction to achieve a natural forehead configuration. This method is advantageous and considered to be effective in allowing dead space to be easily filled with minimal invasiveness for concave deformations of the dura mater with bone defects. Furthermore, the risk of artificial bone exposure is reduced by adding the dermal component of dermal fat, which is grafted to thinned frontal skin.

Closure of Intractable Enterocutaneous Fistula with a Rectus Abdominis Musculocutaneous Flap.

Large enterocutaneous fistulas of the small intestine are rare and difficult to close, particularly if the fistula is associated with massive leakage of digestive juice and the residual intestinal tract is too short for anastomosis. We present a patient who underwent small bowel resection and secondary anastomosis following massive necrosis of the small intestine due to superior mesenteric artery thrombosis. After resection of an enterocutaneous fistula and reanastomosis, the residual small bowel was only 70 cm long with a persistent fistula. We successfully closed the fistula by employing a hinged rectus abdominis musculocutaneous flap. Here, we report our procedure for treating a large enterocutaneous fistula without performing laparotomy and bowel resection.

Experimental study on maintaining the curvature of transplanted cartilage: Influence of the number of cartilage struts.

BACKGROUND: When auriculoplasty is performed for microtia, wire often becomes exposed during the long postoperative period. We have investigated other materials for fixing cartilage. We previously reported that absorbable sutures are more appropriate than wire. The present animal experiments investigated the reasons why fixation of transplanted cartilage is maintained when using absorbable sutures. METHODS: The costal cartilages of Sprague-Dawley rats were harvested, and three cartilage transplant models were prepared. After bending a costal cartilage into a U-shape, it was fixed by using only absorbable sutures as the control or was fixed by suturing one or two cross struts of cartilage to the U-shaped graft. Then the cartilages were subcutaneously transplanted into the backs of the rats. They were removed 8 weeks later, and the return rate of the bent cartilages was assessed. RESULTS: The return rate was 74.0%, in the suture-only group (control), 27.9% in the one-strut group, and 8.3% in the two-strut group. When the sites of contact between the U-shaped graft and the cartilage struts were observed by light microscopy, adhesion of the two cartilages by fibrous connective tissue was observed. CONCLUSION: U-shaped cartilage grafts demonstrated a smaller return rate when there was a larger contact area with the cartilage struts. Each strut was fixed by fibrous connective tissue at the contact site, thereby maintaining the shape of the graft. Thus, when creating a cartilage framework, it is important to fix the bent cartilage to the cartilage struts with a sufficiently large contact area.

Histological study of costal cartilage after transplantation and reasons for avoidance of postoperative resorption and retention of cartilage structure in rats.

BACKGROUND: Limited information is available on the biological status of transplanted cartilage from which the perichondrium has been removed. This article describes the histological and three-dimensional structural picture of cartilage, using green fluorescent protein (GFP) transgenic rats and normal wild rats. METHODS: Three sections of costal cartilage were harvested from 10-week-old wild rats. One section was used as a specimen while two were subcutaneously collected from the dorsal region of 10-week-old GFP rats at 4 and 8 weeks post-transplant. The experiment was performed in two randomized groups. The perichondrium was removed from transplanted cartilage in the first group and perichondrium of transplanted cartilage remained intact in the second group. Histology and focused ion beam/scanning electron microscope (FIB/SEM) tomography were used to evaluate the transplanted cartilage. RESULTS: All 40 transplanted sections were harvested and no infections, exposure or qualitative change of cartilage matrix were seen following transplant. Histological analyses showed that the surface layer of the GFP-negative transplanted cartilage was replaced with GFP-positive chondrocytes 8 weeks post-transplant in the first group. A three-dimensional layer of perichondrium-like tissue reconstructed around the cartilage at 8 weeks was confirmed, resembling normal perichondrium. However, the GFP-positive chondrocytes were not replaced in the second group. CONCLUSIONS: The cell renewal of chondrocytes is necessary for subcutaneously transplanted cartilage to maintain its tissue composition over a long period of time. The histological and ultrastructural analyses revealed that cells from recipient tissue generated new chondrocytes even when cartilage was implanted after removing the perichondrium.

A new modified Pudendal Thigh Flap of vaginoplasty including reconstruction of vaginal vestibule.

We modified the conventional Pudendal Thigh Flap (PTF) on the vaginoplasty including reconstruction of vaginal vestibule. After the operation, no stenosis of the vaginal vestibule and opening of the vagina was observed. It is believed that our technique is cosmetically and functionally possible and a useful method.