論文

Hair follicles have their own anagen, catagen and telogen cycle. Many molecules involved in hair follicle development are also involved in the hair cycle. In the present review, we summarize the molecules that control the every stage of the hair cycle.

Based on our concept of PAFS and LAPS concerning the subcutaneous adipofascial structure over the entire body, macroscopic and histological investigations of fat lobules, fat cells, fascial tissue and vessels in each system were performed with fresh and embalmed cadavers. Mutual relations between macroscopic and histological images were then defined.

In lower eyelid reconstruction, we use a V-Y advancement flap from the lower lateral cheek. The technique is simple and the scar after surgery is fine. On the other hand, we recommend supporting the reconstructed flap firmly to prevent ectropion due to either scar contraction or gravity. We use fascia lata fixed to a newly developed screw system that is directly inserted into the lateral orbital rim. By using these techniques, lower eyelids were successfully reconstructed.

Until a certain developmental stage, cutaneous wounds in mammalian fetuses heal rapidly without scars with complete regeneration of the skin. In the process of fetal wound healing, infammatory responses, granulation proliferation, and scar formation that are observed in adults are not seen. Numerous studies have reported the causes of fetal scarless cutaneous regeneration, including reduced expression of TGF-β1 and higher levels of hyaluronan in the extracellular matrix, from the viewpoints of molecular biology and cellular biology, but the mechanisms are not completely understood. Although a variety of substances that inhibit scar formation have been investigated, currently it is almost impossible for adult cutaneous wounds to heal completely without scars. Except for a few animal species, perfect regeneration after wounding can occur only during the gestation period. By strictly comparing the stages before and after the transition from the regeneration of skin to scarring, it will be possible to investigate the mechanisms of cutaneous regeneration.

Exposing the alloplastic materials after skull reconstruction is very difficult because of the risk of infection and the choice of reconstruction procedures. Conventional procedures were divided into two-step or multi-step surgery. To perform one-stage surgery, a transverse rectus abdominis myocutaneous flap combined with vascularized costal cartilages has been used for head reconstruction after exposing the alloplastic materials in two patients. This is the first report using the flap for skull reconstruction. In this article, we describe the usefulness and the disadvantages of the transverse rectus abdominis myocutaneous flap combined with vascularized costal cartilages.

We developed an easy way to release tension from an abdominal cutaneous suture by plicating the anterior rectus sheath for several centimetres. We used this in two patients and the scars were satisfactory. Plication of the fascia is an easy and effective way of releasing the tension of a cutaneous sutured line.

Regenerative medicine has been progressing based on stem cell, scaffold, and developmental researches. Among them, stem cells or progenitor cells play key roles in regenerative medicine. In plastic surgery, many types of stem or progenitor cells are in clinical use. Keratinocyte progenitor cells have been clinically used as cultured epidermal cells. Bone marrow mesenchymal stem cells and adipose derived stem cells are beginning to be applied in various lesions. Although they have the potential to give benefits to the applied lesion, their effects may come not from the regenerative ability of stem cells but from cytokine effects. In order to progress regenerative medicine in plastic surgery, we have to investigate the mechanism of the benefits of the stem cells after application to the lesion.

Currently, simultaneous maxillomandibular distraction osteogenesis is a standard procedure for the correction of hemifacial microsomia. Many variations of the procedure have been reported. However, a common problem has been the extended duration of the procedure. In particular, the lengthy intermaxillary fixation period includes a prolonged distraction series that requires the restriction of oral food intake and creates significant stress for the patient, which has a profound effect on patient satisfaction. To avoid this stress, we have developed tandem osteotomy with distraction osteogenesis, termed the TODO procedure. The TODO procedure not only shortens the intermaxillary fixation period and the duration of therapy but also creates the ideal skeletal proportions, with horizontalization of the occlusal plane. The TODO procedure has the added benefit of producing a marked aesthetic improvement. The patient was extremely satisfied by the result and endured minimal stress.

The etiology of the clinical entity commonly known as unilateral coronal synostosis is often described as the unilateral fusion of the coronal ring. However, recent theories have poorly explained the basis of the deformities associated with unilateral coronal synostosis. We retrospectively analyzed computed tomographic data sets from 18 patients who presented with unilateral coronal synostosis and arrived at our hospital between 1985 and 2010. Using three-dimensional reconstructions of the computed tomographic images, analyses of the cranial base and measurements of each cranial bone were performed. As a result, the ipsilateral and contralateral basion-clinoid-pterion angles did not differ significantly (P = 0.49) and were almost identical in each case. However, the ipsilateral basion-partis-petrosae anglewas wider than the corresponding contralateral angle (P < 0.001). In addition, the ipsilateral nasion-clinoid-pterion angle and the sphenoid, zygomatic, and temporal bones on the ipsilateral side were significantly shorter than those on the contralateral side (P < 0.001). Based on a shortening ratio, the sphenoid bone was smaller (42.0% T 10.9%) than the temporal (68.9% ± 7.58%) and zygomatic bones (71.1% ± 8.38%). This difference was significant (P < 0.001). In conclusion, restricted growth potential of the central portion of the ipsilateral sphenoid bone was identified. We propose that the coronal ring, which includes the frontoparietal and frontosphenoidal sutures, and the sphenosquamosal suture are involved in unilateral coronal synostosis. Using our findings and the theory of Delashaw et al, the deformity observed in unilateral coronal synostosis can be explained more adequately and/or completely.

We describe a newly designed technique for the quick, easy, and cost-effective fixation of mesh skin grafts in a range of skin conditions and patients. We fixed the skin graft using octyl-2-cyanoacrylate (Dermabond; Ethicon), which was termed «Dendritic bonding». This technique exhibits several advantages over surgical stapling and suturing with absorbable sutures.

Background: The resection of neurofibromas in Von Recklinghausen's disease (NF-1) is frequently complicated by potentially life-threatening intraoperative and postoperative hemorrhage, due to the high tumor vascularity and tissue friability. Methods: This report describes a novel technique for the resection of neurofibromas using the LigaSure™ (Valleylab, Tyco International Healthcare, Boulder, CO) vessel sealing system. We compared five cases of NF-1 tumor removal which used this vessel sealing system, with six cases that did not, and recorded the intraoperative and postoperative blood loss, length of hospitalization, and postoperative complications. Results: In all cases employing the LigaSure™, the perioperative blood loss was less than 600 ml (30 ∼ 570 ml), and no patient developed a postoperative hematoma or other bleeding complications. In contrast, the cases not using the LigaSure™ had greater blood loss as well as a higher rate of postoperative hematomas. Conclusions: The LigaSure™ provides excellent hemostasis with few complications when used for neurofibroma removal.

Background: To achieve optimal outcomes in reduction malarplasty, it is important to preserve the natural curvature of the cheek while reducing the zygoma prominence and the width of the midface. The present article introduces an effective technique that aims to achieve these purposes. Methods: Through an intraoral approach, boomerang-shaped bone incision lines are marked on the anterior aspect of the zygomatico-maxillary junction. The lines are placed medial to the most prominent part of the zygoma. The zygomatic arch is divided at its posterior part through a small incision made in the pre-auricular region. By performing these manoeuvres, a unit of bone-composed of a part of the zygoma body and zygomatic arch - is mobilised. The mobilised bone is shifted medially, reducing the width of the midface and making the zygoma region less prominent. After performing reduction malarplasty for 89 patients (10 males and 79 females) using this technique, clinical outcomes were evaluated. Results: Outcomes of the treatment was optimal, with over 80% of the patients evaluating the results as excellent in terms of effectiveness in malar prominence, facial width and symmetry. Conclusion: Because the continuity of the main part of the zygoma body and zygomatic arch is preserved in our technique, medial transfer of the zygoma is enabled while preserving the natural curvature of the malar region and the superior-inferior position of the zygomatic arch. Because of these advantages, we recommend our technique as an effective technique of reduction malarplasty.

Numerous reports have been published regarding the reconstruction of the breast, but the majority of these reports focus on breast reconstruction for defects caused by the removal of breast cancers. The authors treated a rare case of unilateral amastia where a 54-year-old female had a complete absence of the breast on one side, though the breast on the other side was intact. The defect was reconstructed successfully with a transverse rectus abdominis myocutaneous flap (TRAM) flap. The present study introduces this rare case with reference to past reports of amastia.

OBJECTIVE: To improve skin appearance at the donor site of a split-thickness skin graft, part of the harvested skin was minced and grafted back onto the site in a process we named "recruited minced skin grafting." MATERIALS AND METHODS: Thirteen Japanese patients who needed split-thickness skin grafts were treated with recruited minced skin grafting. Five patients were used as controls, in whom donor sites were treated with the traditional method. Part of the split-thickness skin was minced using two surgical blades (number 24) to an approximate particle size of less than 0.5 mm. Minced skin was spread and transplanted onto the donor site and covered with polyurethane foam. Twelve months after the operation, donor sites were scored for hypopigmentation, hyperpigmentation, redness, and disruption of skin texture. Gross appearance was evaluated according to total score. RESULTS: Donor sites treated with recruited minced skin grafts had significantly better appearance than those of controls. Donor sites that had more than 5% of the total area treated tended to have better results. CONCLUSION: Recruited minced skin grafting is a good method of improving the appearance of the donor site.

Background: Among congenital nasal deformities, proboscis lateralis is one of the rarest. Boo-Chai classified proboscis lateralis into four groups. Recently, we encountered a new case of proboscis lateralis with median cleft lip. We noticed that this classification had not been considered according to convalescence and embryologics, and further refinement seemed to be needed. Methods: We reviewed all cases of proboscis lateralis reported in English through 2009 and classified them by intercanthal distance. Results: A total of 34 studies involving 50 cases were reviewed. Six cases were identified as having normal intercanthal distance. Three of them presented nose abnormalities and fit Boo-Chai group II category. The other three were consistent with group I. Hypertelorism was observed in 27 cases and was further divided into two groups based on the occurrence of a frontal encephalocele. Seventeen cases without a frontal encephalocele were compatible with Boo-Chai groups III and IV. The other 10 cases associated with a visible encephalocele had encephalopathy; most died at an early age, and long-term survival cases suffered developmental delay and mental retardation. Seventeen cases were defined as hypotelorism, and all cases also presented as holoprosencephaly. Conclusions: The redefined classification contains two new groups: group V as hypertelorism with encephalocele and group VI as hypotelorism. A new classification scheme is proposed as not only convenient for clinical application but also embryologically accurate.