Nature Portfolio Acta Medica Okayama 2045-2322 15 1 2025 Lymphatic flow dynamics under exercise load assessed with thoracic duct ultrasonography 14323 EN Akira Shinaoka Department of Lymphatics and Edematology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine Yoshihiro Kimata Department of Plastic and Reconstructive surgery, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine The thoracic duct (TD) is the largest lymphatic vessel proximal to the venous system. It undergoes morphological changes in response to lymph flow from the periphery, with automatic contraction controlling the dynamics to propel lymph toward the venous system. Recent advancements in ultrasonography have facilitated non-invasive observations of the TD’s terminal, including its valve and wall motions. Observations of TD movements allow predictions of lymphatic flow dynamics. However, no studies have yet documented the changes in the TD under exercise-induced lymph flow enhancement in humans. Here, using 18-MHz high-frequency ultrasonography, we demonstrate for the first time that the TD diameter significantly expands under exercise load. This study analyzed 20 participants; the maximum TD diameters at rest and post-exercise were 2.69 ± 1.06 mm and 3.41 ± 1.32 mm, respectively (p = 0.00000056). While various methods exist for observing the TD, our approach―dynamically monitoring the TD diameter using sonography in real time and correlating it with lymphatic flow dynamics―offers a novel contribution. No potential conflict of interest relevant to this article was reported.

Japan Society of Plastic and Reconstructive Surgery Acta Medica Okayama 2436-259X 2 3 2023 A Case of a Transwoman with Colorectal Cancer after Flap Vaginoplasty 98 101 EN Shiho Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Fuminori Teraishi Department of Minimally Invasive Therapy Center, Okayama University Hospital Sari Fujimoto Department of Plastic and Reconstructive Surgery, Okayama University Hospital Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Sho Takeda Department of Gastroenterological Surgery, Okayama University Hospital Shuhei Narita Department of Gastroenterological Surgery, Okayama University Hospital Koya Yamashita Department of Gastroenterological Surgery, Okayama University Hospital Kunitoshi Shigeyasu Department of Gastroenterological Surgery, Okayama University Hospital Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Hospital Yuzaburo Namba Department of Gender Center, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Vaginoplasty is a gender-affirming surgery (GAS) for transwomen that laid its foundation in the 1950s and continues to be widely practiced worldwide. We present here a case of a 70-year-old transwoman who underwent lower anterior resection for rectal cancer 12 years after vaginoplasty. The preoperative diagnosis was rectal cancer (Rb-Ra, type 2, cT2N0M0, stage 1). All imaging studies showed a cord-like structure between the prostate and the anterior wall of the rectum, which was thought to be the neovagina. Careful dissection of the anterior rectal wall was required because the distance between the neovagina and the rectum was only 1.5 mm. The role of hormonal therapy and GAS in cancer development in transwomen is unclear. It is important to have regular check-ups for malignancies in patients who have undergone GAS, and if surgical procedures are needed, they should be treated by physicians who are familiar with the procedure. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 2050-0904 12 5 2024 Decades of stability of conjunctival vascular malformations in two patients e8933 EN Toshihiko Matsuo Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Takehiro Tanaka Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University A 65-year-old woman with diabetic retinopathy underwent glaucoma surgery to construct a filtering bleb adjacent to conjunctival hemangioma, and showed bleb function and stable hemangioma for a decade. A 1.5-year-old girl with right eye lid and cheek swelling by orbital to facial lymphangioma was followed for visual acuity development. Conjunctival lymphangioma was stable in 20 years. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 135 3 2023 医学における「ビジュアルアート教育」の展開：第４ステップ― 医学教育に必要な“気づき”を与える授業― 152 157 EN Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Mikako Obika Department of General Medicine, Okayama University Hospital Takuya Kubo Department of Emergency and Critical Care Medicine, Okayama University Hospital Masumi Otsuka OTSUKA DESIGN Co., Ltd. Yuko Okamoto Okayama Prefectural Museum of Art Koh Fukutomi Okayama Prefectural Museum of Art Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Hospital No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 135 3 2023 患者が教えてくれた頭頸部再建と手技の開発 129 135 EN Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 135 2 2023 医学における「ビジュアルアート教育」の展開：第３ステップ― 岡山県立美術館の協力による対話型鑑賞の導入― 85 88 EN Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Mikako Obika Department of General Medicine, Okayama University Hospital Takuya Kubo Department of Emergency and Critical Care Medicine, Okayama University Hospital Masumi Otsuka OTSUKA DESIGN Co., Ltd. Yuko Okamoto Okayama Prefectural Museum of Art Koh Fukutomi Okayama Prefectural Museum of Art Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Hospital No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Safety and Efficacy of a Well-Fitting Brassiere after Breast Reconstruction: A Qualitative Study 11 19 EN Satoko Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Miho Saiga Department of Plastic and Reconstructive Surgery, Okayama University Hospital Takayuki Motoki Department of General Surgery, Okayama Saiseikai General Hospital Tadahiko Shien Department of Breast and Endocrine Surgery, Okayama University Hospital Naruto Taira Department of Breast and Endocrine Surgery, Okayama University Hospital Hiroyoshi Doihara Department of Breast and Endocrine Surgery, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Original Article 10.18926/AMO/64356 The importance of a well-fitted, comfortable brassiere to overall quality of life after breast reconstruction has not been evaluated. Our aim was to determine the impact of a semi-customized brassiere on patients’ health-related quality of life after breast reconstruction. The subjects were prospective patients with mastectomy who were to undergo immediate or delayed breast reconstruction at our hospital. After surgery, a professional bra fitter sized each patient for a semi-customized brassiere and provided follow-up consultations. A self-reported questionnaire on breast aesthetics, postoperative pain, and satisfaction was used to assess the primary outcomes. Data were prospectively collected at baseline (before surgery) and at 1, 3, 6, and 12 months after surgery and analyzed. Forty-six patients (50 breasts) were included in the analysis. Consistent wearing of the brassiere reduced pain (p<0.05), with good overall satisfaction (p<0.001). Aesthetic scores on breast shape and size were higher with than without the custom brassiere at 3 months (p=0.02) and 6 months (p=0.03) after surgery. Wearing the brassiere reduced anxiety at all time points of measurement. A well-fitting brassiere ensured safety and provided a high degree of satisfaction without anxiety for patients after breast reconstruction. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 133 3 2021 第45回日本リンパ学会総会 198 199 EN Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences No potential conflict of interest relevant to this article was reported.

Nature Portfolio Acta Medica Okayama 2045-2322 12 1 2022 A new severity classification of lower limb secondary lymphedema based on lymphatic pathway defects in an indocyanine green fluorescent lymphography study 309 EN Akira Shinaoka Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Kazuyo Kamiyama Department of Nursing, Kagawa Prefectural Central Hospital Kiyoshi Yamada Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Most protocols for lymphatic imaging of the lower limb conventionally inject tracer materials only into the interdigital space; however, recent studies indicate that there are four independent lymphatic vessel groups (anteromedial, anterolateral, posteromedial, and posterolateral) in the lower limb. Thus, three additional injection sites are needed for lymphatic imaging of the entire lower limb. We aimed to validate a multiple injection designed protocol and demonstrate its clinical benefits. Overall, 206 lower limbs undergoing indocyanine green fluorescent lymphography with the new injection protocol were registered retrospectively. To assess the influence of predictor variables on the degree of severity, multivariable logistic regression models were used with individual known risk factors. Using a generalized linear model, the area under the curve (AUC) of the conventional clinical model, comprising known severity risk factors, was compared with that of the modified model that included defects in the posterolateral and posteromedial groups. Multivariable logistic regression models showed a significant difference for the posteromedial and posterolateral groups. The AUC of the modified model was significantly improved compared to that of the conventional clinical model. Finding defects in the posteromedial and posterolateral groups is a significant criterion for judging lymphedema severity and introducing a new lymphedema severity classification. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Pyogenic Ventriculitis After Anterior Skull Base Surgery Treated With Endoscopic Ventricular Irrigation And Reconstruction Using a Vascularized Flap 243 248 EN Yusuke Tomita Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yosuke Shimazu Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masato Kawakami Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroshi Matsumoto Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kentaro Fujii Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masahiro Kameda Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takao Yasuhara Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yasuki Suruga Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomoyuki Ota Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuhiko Kurozumi Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Isao Date Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Case Report 10.18926/AMO/61908 Ventriculitis is a rare, serious complication of neurosurgery. A 59-year-old man who had undergone a craniotomy for a paranasal adenocarcinoma, developed a right frontal cystic lesion. We performed a bifrontal craniotomy to remove the lesion. The dura was repaired with non-vascularized free fascia lata in watertight fashion. Ventriculitis occurred 3 days postoperatively. Ventricular drainage, craniectomy, and endoscopic irrigation were undertaken to remove an abscess. The dura and the resection cavity were reconstructed using a vascularized anterolateral thigh adipofascial flap. His symptoms disappeared, indicating that endoscopic irrigation and reconstruction can effectively address ventriculitis even in patients in critical clinical condition. No potential conflict of interest relevant to this article was reported.

BMJ Publishing Group Acta Medica Okayama 2044-6055 11 2 2021 Protocol for a multicentre, prospective, cohort study to investigate patient satisfaction and quality of life after immediate breast reconstruction in Japan: the SAQLA study e042099 EN Miho Saiga Department of Plastic and Reconstructive Surgery, Okayama University Hospital Yuko Hosoya Department of Plastic and Reconstructive Surgery, Iwate Medical University Hiroki Utsunomiya Department of Surgery and Plastic Surgery, Showa University Koto Toyosu Hospital Yukiko Kuramoto Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research Satoko Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Koichi Tomita Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University Yukiko Aihara Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba Mayu Muto Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center Makoto Hikosaka Department of Plastic and Reconstructive Surgery, National Center for Child Health and Development Takashi Kawaguchi Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences Tempei Miyaji Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo Takuhiro Yamaguchi Division of Biostatistics, Tohoku University Graduate School of Medicine Sadamoto Zenda Division of Radiation Oncology, National Cancer Center Hospital East Aya Goto Department of Plastic and Reconstructive Surgery, Iwate Medical University Minoru Sakuraba Department of Plastic and Reconstructive Surgery, Iwate Medical University Taro Kusano Kusano Taro Clinic Kenta Miyabe Department of Plastic and Reconstructive Surgery, Showa University Hospital Tomoaki Kuroki Department of Plastic and Reconstructive Surgery, Showa University Hospital Tomoyuki Yano Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research Mifue Taminato Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University Mitsuru Sekido Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba Yui Tsunoda Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center Toshihiko Satake Department of Plastic and Reconstructive Surgery, Toyama University Hospital Hiroyoshi Doihara Department of Breast and Endocrine Surgery, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Introduction The aim of breast reconstruction (BR) is to improve patients' health-related quality of life (HRQOL). Therefore, measuring patient-reported outcomes (PROs) would clarify the value and impact of BR on a patient's life and thus would provide evidence-based information to help decision-making. The Satisfaction and Quality of Life After Immediate Breast Reconstruction study aimed to investigate satisfaction and HRQOL in Japanese patients with breast cancer who undergo immediate breast reconstruction (IBR). Methods and analysis This ongoing prospective, observational multicentre study will assess 406 patients who had unilateral breast cancer and underwent mastectomy and IBR, and were recruited from April 2018 to July 2019. All participants were recruited from seven hospitals: Okayama University Hospital, Iwate Medical University Hospital, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Showa University Hospital, University of Tsukuba Hospital, Osaka University Hospital and Yokohama City University Medical Center. The patients will be followed up for 36 months postoperatively. The primary endpoint of this study will be the time-dependent changes in BREAST-Q satisfaction with breast subscale scores for 12 months after reconstructive surgery, which will be collected via an electronic PRO system. Ethics and dissemination This study will be performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects published by Japan's Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare, the modified Act on the Protection of Personal Information and the Declaration of Helsinki. This study protocol was approved by the institutional ethics committee at the Okayama University Graduate School of Medicine, Dentistry, on 2 February 2018 (1801-039) and all other participating sites. The findings of this trial will be submitted to an international peer-reviewed journal. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1996-1944 13 23 2020 Long-Term Effect of Honeycomb beta-Tricalcium Phosphate on Zygomatic Bone Regeneration in Rats 5374 EN Ryoko Nakagiri Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Satoko Watanabe Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kiyofumi Takabatake Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hidetsugu Tsujigiwa Department of Life Science, Faculty of Science, University Science Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University In recent years, artificial bones with high biocompatibility have been developed for hard tissue reconstruction. However, current bone replacement methods are inadequate for large defects, causing infection, exposure, and damage. We have developed a new honeycomb beta-tricalcium phosphate (TCP) material, which achieved good bone regeneration after implantation in a rat complete zygomatic bone defect. In this study, we further investigated the ability of honeycomb beta- TCP for remodeling after bone regeneration as a long-term result. Bone morphogenic protein (BMP)-2-free honeycomb beta-TCP (TCP group) and honeycomb beta-TCP with BMP-2 (BMP group) were implanted in the zygomatic bone of rats. Micro-computed tomography was performed to track the zygomatic bone morphology, and specimens were histologically examined for osteogenesis and remodeling. In the TCP group, no bone formation was observed at 1 month, but it was observed at 6 months. Bone formation was observed in the BMP group at 1 month, and beta-TCP absorption reproducing the zygomatic bone morphology was observed at 6 months. This honeycomb beta-TCP with BMP-2 may provide appropriate remodeling that reproduces good bone formation in the early stage and good morphology in the long term, offering an alternative bone reconstruction material to vascularized bone grafts. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2451-8654 19 2020 HAMAMATSU-ICG study: Protocol for a phase III, multicentre, single-arm study to assess the usefulness of indocyanine green fluorescent lymphography in assessing secondary lymphoedema 100595 EN Shinsuke Akita Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine Naoki Unno Department of Vascular Surgery, Hamamatsu Medical Center Jiro Maegawa Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicin Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Hidekazu Fukamizu Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine Yuichiro Yabuki Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine Akira Shinaoka Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Masaki Sano Second Department of Surgery, Hamamatsu University School of Medicine Yohei Kawasaki Clinical Research Center, Chiba University Hospital Tadami Fujiwara Clinical Research Center, Chiba University Hospital Hideki Hanaoka Clinical Research Center, Chiba University Hospital Nobuyuki Mitsukawa Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine Introduction</br> Secondary lymphoedema of the extremities is an important quality-of-life issue for patients who were treated for their malignancies. Indocyanine green (ICG) fluorescent lymphography may be helpful for assessing lymphoedema and for planning lymphaticovenular anastomosis (LVA). The objective of the present clinical trial is to confirm whether or not ICG fluorescent lymphography using the near-infrared monitoring camera is useful for assessing the indication for LVA, for the identification of the lymphatic vessels before the conduct of LVA, and for the confirmation of the patency of the anastomosis site during surgery.</br> Methods and analysis</br> This trial is a phase III, multicentre, single-arm, open-label clinical trial to assess the efficacy and safety of ICG fluorescent lymphography when assessing and treating lymphoedema of patients with secondary lymphoedema who are under consideration for LVA. The primary endpoint is the identification rate of the lymphatic vessels at the incision site based on ICG fluorescent lymphograms obtained before surgery. The secondary endpoints are 1) the sensitivity and specificity of dermal back flow determined by ICG fluorescent lymphography as compared with 99mTc lymphoscintigraphy―one of the standard diagnostic methods and 2) the usefulness of ICG fluorescent lymphography when confirming the patency of the anastomosis site after LVA.</br> Ethics and dissemination</br> The protocol for the study was approved by the Institutional Review Board of each institution. The trial was filed for and registered at the Pharmaceuticals and Medical Devices Agency in Japan. The trial is currently on-going and is scheduled to end in June 2020. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1996-1944 13 21 2020 Effect of Honeycomb β-TCP Geometrical Structure on Bone Tissue Regeneration in Skull Defect 4761 EN Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kiyofumi Takabatake Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hidetsugu Tsujigiwa Department of Life Science, Faculty of Science, Okayama University Science Satoko Watanabe Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryoko Nakagiri Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Keisuke Nakano Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitoshi Nagatsuka Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University The effect of the geometric structure of artificial biomaterials on skull regeneration remains unclear. In a previous study, we succeeded in developing honeycomb beta-tricalcium phosphate (beta-TCP), which has through-and-through holes and is able to provide the optimum bone microenvironment for bone tissue regeneration. We demonstrated that beta-TCP with 300-mu m hole diameters induced vigorous bone formation. In the present study, we investigated how differences in hole directions of honeycomb beta-TCP (horizontal or vertical holes) influence bone tissue regeneration in skull defects. Honeycomb beta-TCP with vertical and horizontal holes was loaded with BMP-2 using Matrigel and Collagen gel as carriers, and transplanted into skull bone defect model rats. The results showed that in each four groups (Collagen alone group, Matrigel alone group, Collagen + BMP group and Matrigel + BMP-2), vigorous bone formation was observed on the vertical beta-TCP compared with horizontal beta-TCP. The osteogenic area was larger in the Matrigel groups (with and without BMP-2) than in the Collagen group (with and without BMP-2) in both vertical beta-TCP and horizontal beta-TCP. However, when BMP-2 was added, the bone formation area was not significantly different between the Collagen group and the Matrigel group in the vertical beta-TCP. Histological finding showed that, in vertical honeycomb beta-TCP, new bone formation extended to the upper part of the holes and was observed from the dura side to the periosteum side as added to the inner walls of the holes. Therefore, we can control efficient bone formation by creating a bone microenvironment provided by vertical honeycomb beta-TCP. Vertical honeycomb beta-TCP has the potential to be an excellent biomaterial for bone tissue regeneration in skull defects and is expected to have clinical applications. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 132 2 2020 医学における「ビジュアルアート教育」の導入：第2 ステップ― アートから診る力，伝える力を養う― 98 101 EN Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yohei Kitaguchi Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masumi Otsuka OTSUKA DESIGN Co., Ltd. No potential conflict of interest relevant to this article was reported.

Lippincott, Williams & Wilkins Acta Medica Okayama 2169-7574 8 4 2020 Utilization of a Simple Surgical Guide for Multidirectional Cranial Distraction Osteogenesis in Craniosynostosis e2797 EN Chihiro Matsui Department of Plastic and Reconstructive Surgery,Okayama University Hospital Eijiro Tokuyama Department of Plastic and Reconstructive Surgery,Okayama University Hospital Takaya Senoo Department of Plastic and Reconstructive Surgery,Okayama University Hospital Kiyoshi Yamada Department of Plastic and Reconstructive Surgery,Okayama University Hospital Masahiro Kameda Department of Neurological Surgery, Okayama University Hospital Tetsuo Takeuchi Department of Occlusal and Oral Functional Rehabilitation, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery,Okayama University Hospital Background: Multidirectional cranial distraction osteogenesis (MCDO) can achieve a desired shape for deformities of the cranium. In the past, visual estimation was used to reflect on the actual skull, but it was time-consuming and inaccurate. Here we demonstrate an effective osteotomy navigation method using surgical guides made from a dental impression silicone. <br/> Methods: Seven patients who underwent MCDO between August 2013 and September 2016 were included in the study. Five cases involved utilization of the surgical guide for osteotomy. Three-dimensional (3D) printed cranium models were made using 3D computed tomography (3DCT) imaging data and dental impression silicone sheets were molded using the printed cranium models. These surgical guides were sterilized and used for intraoperative osteotomy design. Vertical distance between nasion/porion and osteotomy lines were calculated using 3D printed cranial models and postoperative 3DCT images to assess reproducibility. <br/> Results: The average surgical time/design time was 535/37.0 minutes for the nonsurgical guide group and 486.8/11.8 minutes for the surgical guide group (SG). Treatment using the surgical guide was significantly shorter in terms of operative time and time required for design. For the vertical distance comparison, the average distance was 5.7mm (SD = 0.3) in the non-SG and 2.5mm (SD = 0.44) in the SG, and SG was more accurate. <br/> Conclusions: Shorter operative times and higher reproducibility rates could be achieved by using the proposed surgical guide, which is accurate, low-cost, and easily accessible. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 1 2020 The Novel Eryngii Method of Nipple Reduction for Female-to-Male Transsexuals 83 87 EN Toru Sakurai Department of Plastic and Reconstructive Surgery, Okayama University Hospital Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Kensuke Manako Department of Plastic and Reconstructive Surgery, Okayama University Hospital Syo Komagoe Department of Plastic Surgery, Okayama Saiseikai General Hospital Yuko Mukai Department of Plastic and Reconstructive Surgery, Okayama University Hospital Yoshiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Yuzaburo Namba Department of Gender Center, Okayama University Hospital Case Report 10.18926/AMO/57958 Nosaka, NobuyukiMastectomy is usually the first and most important surgical procedure in female-to-male (FTM) individuals with gender identity disorder. Nipple reduction is also important in the process of reconstructing the chest wall for a more male appearance. If the nipples remain large after a mastectomy, the results may be disappointing to many FTM transsexuals. Nipple reduction enables these individuals to go to the beach or Japanese public baths, where they may go topless in public. We therefore consider that nipple reduction is indicated for all FTM transsexuals who desire it. There are a variety of methods for the reduction of enlarged nipples for women or non-FTM patients, but only a few reports have described the process used to create masculine-appearing nipples for FTM transsexuals. We developed a novel technique called the Eryngii method for creating male-like nipples using a 4-mm diameter dermal punch knife. The name of the method refers to the Eryngii king trumpet mushroom, which the nipple resembles after the surgical process. The main strength of this method is that it permits the creation of ideal nipples without difficulty. Here we introduce the technique and discuss our history of surgical methods for nipple reduction, including improvements and elaborations. No potential conflict of interest relevant to this article was reported.

The International Institute of Anticancer Research Acta Medica Okayama 0258-851X 33 1 2019 Relationship Between Renal Dysfunction and Oral Mucositis in Patients Undergoing Concurrent Chemoradiotherapy for Pharyngeal Cancer: A Retrospective Cohort Study. 183 189 EN HIROFUMI MIZUNO Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences HISATAKA MIYAI Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences AYA YOKOI Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences TERUMASA KOBAYASHI Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences CHIAKI INABU Junpukai Daiku Dental Clinic TAKAYUKI MARUYAMA Center for Innovative Clinical Medicine, Okayama University Hospital DAISUKE EKUNI Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences NOBUYOSHI MIZUKAWA Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital SHIN KARIYA Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences KAZUNORI NISHIZAKI Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences YOSHIHIRO KIMATA Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences MANABU MORITA Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences BACKGROUND/AIM:<br/> The aim of this retrospective cohort study was to investigate the association between renal dysfunction (RD) and the development of oral mucositis (OM) in patients undergoing concurrent chemoradiotherapy (CCRT) for pharyngeal cancer including radiation to the oral cavity.<br/> PATIENTS AND METHODS:<br/> Of 130 patients diagnosed as having pharyngeal cancer who received CCRT at the Okayama University Hospital Head and Neck Cancer Center, 44 were finally selected.<br/> RESULTS:<br/> During the observation period, 24 (54.5%) patients experienced severe OM (grade 3). The Cox proportional hazards regression model demonstrated that RD (hazard ratio(HR)=2.45, 95% confidence interval(CI)=1.067-6.116, p=0.035) and nasopharynx/oropharynx as center of the irradiated area (HR=2.56, 95% CI=1.072-5.604, p=0.034) were significantly associated with the incidence of severe OM (grade 3).<br/> CONCLUSION:<br/> In patients with pharyngeal cancer treated with CCRT including radiation to the oral cavity, RD at baseline can be a risk factor for developing severe OM. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Risk Factors for Postoperative Hematoma after Chest Wall Contouring for Female-to-Male Transsexuals: A Clinical Study 441 447 EN Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery,Okayama University Hospital Toru Sakurai Department of Plastic and Reconstructive Surgery,Okayama University Hospital Yuko Mukai Department of Plastic and Reconstructive Surgery,Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery,Okayama University Hospital Yuzaburo Namba Department of Gender Center, Okayama University Hospital Original Article 10.18926/AMO/57375 Gender dysphoria is a condition in which a discrepancy between biological sex and gender identity causes distress. Many female-to-male transsexuals (FTMTS) are uncomfortable with female breasts. Chest wall contouring surgery is effective for obtaining a male-type chest, reducing mental stress, and increasing sexual satisfaction in such cases. At the Okayama University Hospital Gender Center, we have obtained positive results using an algorithm to determine the most appropriate surgical method for chest wall contouring in FTMTS patients. However, serious complications requiring reoperation, such as hematoma, may still occur. Postoperative hematomas were found in 15 (4.18%) of 358 FTMTS patients who underwent chest contouring surgery at our hospital between 2006 and 2018. Postoperative hematoma was examined retrospectively. The median time to the onset of hematoma was 7 (6-12) h after the initial surgery. The main blood vessels causing bleeding were those in the head-side skin flap region where visual confirmation was difficult and the perforator vessels from the pectoralis major muscle. Intraoperative bleeding and the operation time had a significant impact on the onset of postoperative hematoma. This is the first retrospective study that investigated the blood vessels and other factors contributing to postoperative hematoma development after chest wall contouring. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Developing Microsurgery through Experience in Yangon General Hospital, Myanmar 393 401 EN Department of Plastic, Maxillofacial and Oral Surgery, Yangon General Hospital, University of Medicine (1) Myitzu Win Department of Plastic, Maxillofacial and Oral Surgery, Yangon General Hospital, University of Medicine (1) Moe Thuzara Department of Plastic, Maxillofacial and Oral Surgery, Yangon General Hospital, University of Medicine (1) Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kiyoshi Yamada Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Michael Leung Department of Plastic and Reconstructive Surgery, Monash Health Original Article 10.18926/AMO/57369 Although many surgical centers perform microsurgery routinely in developed countries, performing microsurgery is challenging in resource-poor developing countries, such as Myanmar. With the establishment of educational training programs and the assistance of volunteer plastic surgical teams, local plastic surgeons can learn the techniques of microsurgery and apply them clinically. The purpose of this study was to establish baseline data and define the challenges of performing microsurgery in Yangon General Hospital, Myanmar. Sixty-four patients underwent reconstruction with free flaps from January 2015 to January 2018. All clinical records of these cases were assessed. The number of free flap reconstructions performed increased from 11 in the first year to 24 in the third year. The anterolateral thigh flap was the most commonly used (42%). The most common sites of reconstruction were mandible and intraoral defects. Total flap survival occurred in 58 of 64 patients (89%). The total salvageable flap rate for revision surgery was 66.6%; the successful revision rate was highest in 2017, with fewer complications. The flap salvage rates increased and the operative duration decreased as clinical experience improved. Establishing a microsurgical center requires a strong multidisciplinary team, clinical experience, continuous learning, sensible clinical application, and effective interdepartmental and intradepartmental cooperation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 5 2017 Vaginoplasty with a Pudendal-groin Flap in Male-to-female Transsexuals 399 405 EN Yuko Mukai Department of Plastic and Reconstructive Surgery, Okayama University Hospital Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Morito Sugimoto Department of Urology, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Yuzaburo Namba Department of Gender Center, Okayama University Hospital Original Article 10.18926/AMO/55437 Many vaginoplasty techniques have been introduced to improve the outcomes of sex reassignment surgery for male-to-female transsexuals. Some vaginoplasty patients still require additional skin grafts, making dilation mandatory to overcome shrinkage. We developed a new vaginoplasty method (called the “pudendal-groin flap”) that uses pudendal-groin flaps. One of this procedure’s advantages is that skin grafts are unnecessary, even for patients with small penises and scrotums. We introduce the procedure here and describe our evaluation of its utility. We retrospectively analyzed the cases of the 15 patients who underwent vaginoplasty using pudendal-groin flaps from May 2010 to January 2016 at our institution. We compared the complications as well as the functional and aesthetic outcomes with those of previous studies. The most common complication was bleeding, which occurred at the corpus spongiosum or while creating a new vaginal cavity. Bleeding can be reduced with more careful hemostasis and dissection. Aside from inadequate vaginal depth in one patient, the incidence of other complications, sexual intercourse, and aesthetic outcomes were acceptable. The pudendal- groin flap is thin and pliable and can create sufficient vaginal depth without skin grafts. The resulting scar is inconspicuous. Our findings suggest that vaginoplasty using the pudendal-groin flap method is feasible. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 4 2017 Cervical Spine Osteoradionecrosis 345 349 EN Masato Tanaka Department of Orthopaedic Surgery, Okayama University Hospital Yoshihisa Sugimoto Department of Orthopaedic Surgery, Okayama University Hospital Tomoyuki Takigawa Department of Orthopaedic Surgery, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Hospital Case Report 10.18926/AMO/55312 Osteoradionecrosis (ORN), a well-known complication of radiotherapy in the mandibular bone, is very rare in the cervical spine. The authors report the result of a 3-year follow-up of a 63-year-old female patient with ORN of the cervical spine. The patient had a history of laryngeal carcinoma and was treated with chemotherapy and radiation therapy with a total of 120 Gy. Eight years later, she developed acute, severe neck pain due to cervical spine necrosis. The authors performed vascularized fibular bone graft and posterior pedicle screw fixation to reconstruct her cervical spine. The patient was successfully treated with surgery, and cervical alignment was preserved. She had neither neurological deficits nor severe neck pain at her final follow-up 3 years later. Delaying treatment of ORN may be life threatening, so the early diagnosis of this condition is important for patients who receive radiotherapy. Otolaryngologists and spine surgeons should understand this potential complication to speed diagnosis and treatment as early as possible. No potential conflict of interest relevant to this article was reported.

Little Brown Acta Medica Okayama 0148-7043 76 3 2016 A Novel Lymphaticovenular Anastomosis Rat Model 332 335 EN Satoshi Onoda Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama Kumiko Matsumoto Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama INTRODUCTION:　 Lymphaticovenular anastomosis (LVA) has become an important procedure for the surgical treatment of lymphedema. In the past, the anatomy of the lymphatic system of animal models has been reported. However, to our knowledge, there have been few reports of animal models of LVA including training model. In this study, we report on a relatively simple and ideal animal LVA model based on peritoneal lymph ducts and veins.　 PATIENTS AND METHODS:　 For 10 rats, diameters of lumbar lymphatic ducts and iliolumbar veins in the peritoneal cavity on both sides were measured, and LVA was performed. In addition, we measured the diameters of 28 lymphatic ducts and veins in 8 patients who had previously undergone LVA and compared the results with those obtained in this rat model.　 RESULTS:　 The mean diameter of the lymphatic ducts was 0.61 mm, and the iliolumbar veins were 0.81 mm. On the other hand, the mean diameters of the 28 lymphatic ducts and veins of the 8 patients in whom we performed LVA were 0.58 and 0.76 mm, respectively. The differences in the diameters of the lymph vessels and veins between the rats and patients were not statistically significant.　 CONCLUSIONS:　 We report on an LVA model involving the use of the lumbar lymphatic duct and iliolumbar veins of rats. The diameter, nature, and placement of the anastomosis using this model are very similar to that noted during real human surgery. We believe that our rat model will be useful as a practical training model for LVA and in studies on postoperative changes in LVA. No potential conflict of interest relevant to this article was reported.

Japanese Breast Cancer Society Acta Medica Okayama 1340-6868 24 2 2017 Development of a Japanese version of the BREAST-Q and the traditional psychometric test of the mastectomy module for the assessment of HRQOL and patient satisfaction following breast surgery 288 298 EN Miho Saiga Department of Plastic and Reconstructive Surgery, Okayama University Hospital Naruto Taira Department of Breast and Endocrine Surgery, Okayama University Hospital Yoshihiro Kimata Satoko Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Yuko Mukai Department of Plastic and Reconstructive Surgery, Okayama University Hospital Kojiro Shimozuma Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University Taeko Mizoo Department of Breast and Endocrine Surgery, Okayama University Hospital Tomohiro Nogami Department of Breast and Endocrine Surgery, Okayama University Hospital Takayuki Iwamoto Department of Breast and Endocrine Surgery, Okayama University Hospital Takayuki Motoki Department of Breast and Endocrine Surgery, Okayama University Hospital Tadahiko Shien Department of Breast and Endocrine Surgery, Okayama University Hospital Junji Matsuoka Department of Breast and Endocrine Surgery, Okayama University Hospital Hiroyoshi Doihara Department of Breast and Endocrine Surgery, Okayama University Hospital BACKGROUND:　 An understanding of health-related quality of life (HRQOL) is of utmost importance in both oncological and esthetic breast surgery. The BREAST-Q is a patient-reported outcome (PRO) measure that investigates HRQOL and patient satisfaction before and after breast surgery. The aim of this study was to develop a Japanese version of the BREAST-Q including the mastectomy module, the reconstruction module, the augmentation module and the reduction/mastopexy module, and to assess the psychometric properties of the mastectomy module among Japanese women.　 METHODS:　 The Japanese version of the BREAST-Q was developed through forward translation, backward translation and patient testing. Traditional psychometric testing of the mastectomy module was administered to 45 post-mastectomy patients.　 RESULTS:　 The mastectomy, reconstruction, augmentation and reduction/mastopexy modules were formally developed into Japanese. Despite cultural difference between Japanese women and original target population, the contents were considered to be valid among Japanese woman. With the exception of the sexual well-being subscale, good reliability and validity were evident for the mastectomy module (Test-retest reliability 0.76-0.95, Chronbach's alpha coefficient 0.77-0.98).　 CONCLUSIONS:　 The BREAST-Q Japanese version is a useful PRO measure for investigating the impact of breast surgery on HRQOL and patient satisfaction. Further validation in younger Japanese women is needed to determine the usefulness of the sexual well-being subscale. No potential conflict of interest relevant to this article was reported.

Lippincott Williams & Wilkins Acta Medica Okayama 00321052 137 1 2016 Histologic Evaluation of Lymphaticovenular Anastomosis Outcomes in the Rat Experimental Model: Comparison of Cases with Patency and Obstruction 83e 91e EN Satoshi Onoda Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, University of Okayama Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, University of Okayama Kumiko Matsumoto Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, University of Okayama Kiyoshi Yamada Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, University of Okayama BACKGROUND: Lymphaticovenular anastomosis plays an important role in the surgical treatment of lymphedema. The outcomes of lymphaticovenular anastomosis are evaluated based on changes in edema; however, isolated assessment of the anastomosis itself is difficult. The authors used an animal experimental model to conduct a detailed examination of histologic changes associated with lymphaticovenular anastomosis and determined the factors important for success. METHODS: The experimental lymphaticovenular anastomosis model was created using lumbar lymph ducts and iliolumbar veins of Wistar rats. The authors performed anastomosis under a microscope and reviewed postoperative histologic changes using optical and electron microscopy. In addition, electron microscopy and histology were used for detailed examination of the area in the vicinity of the anastomotic region in cases with patency and obstruction. RESULTS: The patency rates immediately after, 1 week after, and 1 month after lymphaticovenular anastomosis were 100 percent (20 of 20), 70 percent (14 of 20), and 65 percent, respectively. A detailed examination of the anastomotic region with electron microscopy revealed that, in cases with patency, there was no notable transformation of the endothelial cells, which formed a smooth layer. In contrast, in obstruction cases, the corresponding region of the endothelium was irregular in structure. CONCLUSIONS: Vessel obstruction after lymphaticovenular anastomosis may be associated with irregular arrangement of the endothelial layer, leading to exposure of subendothelial tissues and platelet formation. One part of the postoperative changes after anastomosis and a cause of obstruction were elucidated in this study. The authors' results may enable improvements in lymphaticovenular anastomosis by translating back to real clinical operations. No potential conflict of interest relevant to this article was reported.

Wiley-Liss Acta Medica Okayama 00224790 114 8 2016 Relationship of the number and size of superficial groin lymph nodes with the stage of secondary lymphatic edema 940 946 EN Satoshi Onoda Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama Kiyoshi Yamada Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama Noriko Seki Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama Yuji Hiramatsu Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama PURPOSE: This study evaluated the relationships of the size and number of superficial groin lymph nodes with the lower limb lymphedema stage and thus examined the role of superficial lymphatic lymph nodes in secondary lymphedema development. METHODS: We determined the number and size of superficial groin lymph nodes using horizontal plane computed tomography (CT) and the lymphedema stage in the lower limbs of 25 patients with gynecologic cancer. RESULTS: The patients had an average of 2.92 (range, 1-7) superficial groin lymph nodes; the mean size of the 146 evaluated lymph nodes was 7.55 mm (range, 5-15 mm). In 19 of 25 patients (76%), the side with major edema contained fewer superficial groin lymph nodes. In total, 22 patients (88%) had fewer superficial groin lymph nodes or a smaller total lymph node size on the edematous dominant side. CONCLUSIONS: In this evaluation of the link between superficial groin lymph node laterality and secondary lymphedema staging, we found that patients with large lymph node numbers and sizes tended to present with a relatively earlier stage of lymphedema. Our results therefore suggest that the size and number of superficial groin lymph nodes affect the lymphedema stage. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 2 2017 Three-Dimensional Imaging of Lymphatic System in Lymphedema Legs Using Interstitial Computed Tomography-lymphography 171 177 EN Kiyoshi Yamada Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Akira Shinaoka Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Original Article 10.18926/AMO/54986 As a new trial, we used interstitial computed tomography-lymphography (CT-LG) in 10 patients with lower extremity lymphedema (n=20 limbs) at stage 0, 1, 2, or 3 under the International Society of Lymphology (ISL) classification. In all cases, CT-LG, lymphoscintigraphy, and indocyanine green fluorescence-lymphography (ICG-LG) were performed. In the examination of the ascending level of depicted lymphatic vessels, we measured the diameters of lymphatic vessels detected with CT-LG and conducted an image analysis of dermal backflow of lymph (DB). CT-LG had better resolution than lymphoscintigraphy and enabled the clear visualization of lymphatic vessels with a minimum lumen size of 0.7 mm. CT-LG also showed the three-dimensional architecture of the DB, which originated from deep lymphatic collectors via branched small lymphatic vessels. Our findings are quite valuable not only for detailed examinations of lymphedematous sites and for the lymphedema surgery, but also for investigations of the pathogenesis of lymphedema which has not yet been established. We observed that lymphoscintigraphy could show the lymphatic vessels up to the thigh level in all cases, whereas CT-LG enabled the vessels’ visualization up to the leg level at maximum. In conclusion, CT-LG provided adequate and detailed three-dimensional imaging of the lymphatic system in lymphedema patients. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 128 3 2016 岡山大学病院頭頸部がんセンターにおける医科歯科合同手術の現状解析とその意義 191 196 EN Nobuyoshi Mizukawa Departments of Oral and Maxillofacial Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital Tomoo Onoda Departments of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Cancer Center, Okayama University Hospital Hiroshi Matsumoto Departments of Plastic and Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital Seiko Takeda Departments of Oral and Maxillofacial Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital Youhei Noda Departments of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Cancer Center, Okayama University Hospital Satoshi Onoda Departments of Plastic and Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital Mai Fukushima Departments of Oral and Maxillofacial Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital Munechika Tsumura Departments of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Cancer Center, Okayama University Hospital Tetsuo Takeuchi Departments of Dental Laboratory, Head and Neck Cancer Center, Okayama University Hospital Narushi Sugiyama Departments of Plastic and Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital Yoshihiro Kimata Departments of Plastic and Reconstructive Surgery, Head and Neck Cancer Center, Okayama University Hospital 　　We have been collaborating with head and neck surgeons, plastic surgeons and oral surgeons in surgeries for many patients with head and neck carcinomas（ especially oral carcinomas） since 2006（ fiscal year 2005）. The Head and Neck Cancer Center was established at Okayama University Hospital in 2012. 　This Center was the first of its kind at a national university hospital in Japan. 　At the Center, 174 operations on head and neck carcinomas and 96 reconstructive operations were performed in 2014（ fiscal year）. 　Medical and dental collaborative operations have been increasing almost every year since the 2005 fiscal year. There were 45 collaborative operations in the 2014 fiscal year, which included 30 cases of bone or metal plate reconstruction or plate reinforcement of the jaws. 　There were 76 medical and dental collaborative operations in the 7 years before the establishment of the Center, with a mean of 10.9 operations per year. Since the establishment of the Center, there have been 112 cases over 3 years with a mean of 37.3 operations per year. The number of surgeries has been markedly increased by the establishment of the Head and Neck Cancer Center. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 3 2016 Structure of a New Palatal Plate and the Artificial Tongue for Articulation Disorder in a Patient with Subtotal Glossectomy 205 211 EN Ken-ichi Kozaki Department of Dental Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shigehisa Kawakami Department of Occlusal and Oral Functional Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Konishi Division of Physical Medicine and Rehabilitation, Okayama University Hospital Keiji Ohta Dental Laboratory Division, Okayama University Hospital Jitsuro Yano Department of Occlusal and Oral Functional Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoo Onoda Department of Otolaryngology-Head and Neck Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuyoshi Mizukawa Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazunori Nishizaki Department of Otolaryngology-Head and Neck Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Iida Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akio Gofuku Graduate School of Natural Science and Technology, Okayama University Masanobu Abe Department of Computer Science, Okayama University Shogo Minagi Department of Occlusal and Oral Functional Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Dream Speech Project Case Report 10.18926/AMO/54420 A palatal augmentation prosthesis (PAP) is used to facilitate improvement in the speech and swallowing functions of patients with tongue resection or tongue movement disorders. However, a PAPʼs effect is limited in cases where articulation disorder is severe due to wide glossectomy and/or segmental mandibulectomy. In this paper, we describe speech outcomes of a patient with an articulation disorder following glossectomy and segmental mandibulectomy. We used a palatal plate (PP) based on a PAP, along with an artificial tongue (KAT). Speech improvement was evaluated by a standardized speech intelligibility test consisting of 100 syllables. The speech intelligibility score was significantly higher when the patient wore both the PP and KAT than when he wore neither (p＝0.013). The conversational intelligibility score was significantly improved with the PP and KAT than without PP and KAT (p＝0.024). These results suggest that speech function can be improved in patients with hard tissue defects with segmental mandibulectomy using both a PP and a KAT. The nature of the design of the PP and that of the KAT will allow these prostheses to address a wide range of tissue defects. No potential conflict of interest relevant to this article was reported.

Public Library Science Acta Medica Okayama 1932-6203 9 7 2014 The Neutral Self-Assembling Peptide Hydrogel SPG-178 as a Topical Hemostatic Agent EN Seiji Komatsu Yusuke Nagai Keiji Naruse Yoshihiro Kimata Conventional self-assembling peptide hydrogels are effective as topical hemostatic agents. However, there is a possibility to harm living tissues due to their low pH. The aim of the present study was to demonstrate the efficacy of SPG-178, a neutral self-assembling peptide hydrogel, as a topical hemostatic agent. First, we measured the bleeding duration of incisions made on rat livers after application of SPG-178 (1.0% w/v), SPG-178 (1.5% w/v), RADA16 (1.0% w/v), and saline (n = 12/group). Second, we observed the bleeding surfaces by transmission electron microscopy immediately after hemostasis. Third, we measured the elastic and viscous responses (G′ and G″, respectively) of the hydrogels using a rheometer. Our results showed that bleeding duration was significantly shorter in the SPG-178 group than in the RADA16 group and that there were no significant differences in transmission electron microscopy findings between the groups. The greater the G′ value of a hydrogel, the shorter was the bleeding duration. We concluded that SPG-178 is more effective and has several advantages: it is non-biological, transparent, nonadherent, and neutral and can be sterilized by autoclaving. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 68 3 2014 For Vol.67, No.5 pp325-331 Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual 183 190 EN Kenjiro Hasegawa Yuzaburo Namba Yoshihiro Kimata Corrected and Republished Article 10.18926/AMO/52660 Since 2001, we have been performing phalloplasty with a radial forearm free flap as the flap of first choice in female-to-male transsexuals (FTMTS). In the present case, a 22-year-old FTMTS with a negative Allen test, we achieved good results by performing phalloplasty with an innervated island pedicled anterolateral thigh flap using the “tube within a tube” technique, in which the penis and urethra are constructed with a single flap. As compared to a forearm flap, use of an innervated islandpedicled flap may have the following advantages in phalloplasty: 1) no need for a microsurgical technique; 2) no scars at noticeable sites; 3) small functional loss in the flap donor area; 4) no sacrifice of major blood vessels. Thus, this technique seems to be a useful clinical alternative for phallic reconstruction. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 0959-4965 24 10 2013 Vascularized peripheral nerve grafting promotes myelination of regrowing optic nerve 566 571 EN Seiji Komatsu Taketoshi Wakabayashi Kiyoshi Yamada Kumiko Matsumoto Yoshihiro Kimata Jun Kosaka We investigated whether the use of vascularized peripheral nerve grafts on the optic nerve stump enhances axonal regeneration of retinal ganglion cells compared with isolated nonvascularized grafts. The rat median nerve was microsurgically sutured with its supplying artery and vein to the optic nerve stump. The number of retinal ganglion cells with regenerating axons was evaluated by retrograde labeling into the grafted peripheral nerve, and the myelination of the regenerating axon fibers was examined by electron microscopy. The number of retinal ganglion cells with regenerating axons was significantly higher in the vascularized graft than in the nonvascularized graft. The ratio of myelinated axon fibers was also increased in vascularized grafts. Thus, grafting with their supplying arteries and veins to an injured nerve stump represents a promising strategy to accelerate axonal regeneration from neurons of the central nervous system. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 6 2013 Thumb Polydactyly with a Floating Ulnar Thumb 391 395 EN Kenjiro Hasegawa Yuzaburo Namba Yoshihiro Kimata Case Report 10.18926/AMO/52013 Thumb polydactyly is reported to be the most common congenital anomaly of the hand in Japan. The floating type is not particularly rare, accounting for 0.9 to 15% of all cases of thumb polydactyly. However, to the best of our knowledge, there has been only one case of thumb polydactyly with a floating ulnar thumb, reported by Onizuka. Herein, we report a case very similar to that reported by Onizuka. In our case, the vessels feeding the floating ulnar thumb branched from the superficial palmar arterial arch, and X-rays revealed triphalangism. In surgery, we not only reconstructed the morphology of the thumb, but also tried to preserve the sensation in the reconstructed thumb by transposing the digital nerve of the floating ulnar thumb to the radial thumb. In addition to thumb polydactyly, our case also showed hypoplasia of the thenar muscles. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 5 2013 Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual 325 331 EN Kenjiro Hasegawa Yuzaburo Namba Yoshihiro Kimata Case Report 10.18926/AMO/51869 Since 2001, we have been performing phalloplasty with a radial forearm free flap as the flap of first choice in female-to-male transsexuals (FTMTS). In the present case, a 22-year-old FTMTS with a negative Allen test, we achieved good results by performing phalloplasty with an innervated island pedicled anterolateral thigh flap using the "tube within a tube" technique, in which the penis and urethra are constructed with a single flap. While phalloplasty with an island-pedicled or free anterolateral thigh flap has been reported previously, the present case seems to be the first of phalloplasty with an innervated island-pedicled anterolateral thigh flap using the "tube within a tube" technique. As compared to a forearm flap, use of an innervated island-pedicled flap may have the following advantages in phalloplasty:1) no need for a microsurgical technique;2) no scars at noticeable sites;3) small functional loss in the flap donor area;4) no sacrifice of major blood vessels. Thus, this technique seems to be a useful clinical alternative for phallic reconstruction. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 4 2013 Negative Pressure Wound Therapy Incorporating Early Exercise Therapy in Hand Surgery:Bag-type Negative Pressure Wound Therapy 271 276 EN Kenjiro Hasegawa Yuzaburo Namba Yoshihiro Kimata Case Report 10.18926/AMO/51073 In the postoperative treatment of hand surgery, it is important to start exercise therapy as early as possible. In conventional negative pressure wound therapy, the fingers are immobilized by the film dressing covering the wound and hand, thereby preventing sufficient rehabilitation. Here, we devised a bag-type negative pressure wound therapy that makes it possible to start finger exercises almost immediately, and we applied it to 4 patients:one each with hand burns, symmetrical peripheral gangrene, a crush injury accompanied by extensive skin defects and a fingertip degloving injury. The duration of the bag-type negative pressure wound therapy ranged from three to eight weeks, and good granulation was achieved, so that a skin graft was not required. In addition, particularly in the case of the fingertip degloving injury, good nail regeneration was achieved. Except for the case of symmetrical peripheral gangrene, a good range of joint motion with a percent total active motion (%TAM) of 94.7% or more was achieved. Our therapy was performed by inserting the hand into a sealing bag;sufficient exercise therapy was made possible by expanding the bag during rehabilitation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 3 2011 Churg-Strauss Syndrome with Necrosis of Toe Tips 215 218 EN Koichi Waseda Yasushi Tanimoto Kenjiro Hasegawa Nobuaki Miyahara Daisuke Nojima Genyo Ikeda Arihiko Kanehiro Chiharu Okada Yoshihiro Kimata Mitsune Tanimoto Case Report 10.18926/AMO/46635 Churg-Strauss syndrome (CSS) is a granulomatous necrotizing vasculitis of unknown etiology associated with bronchial asthma. Despite affecting small to medium-sized vessels, necrosis of the digits due to vasculitis is extremely rare. We report a case of CSS with necrosis of the toe tips. A 37-year-old woman with asthma, who had been diagnosed with CSS 2 years ago, was admitted to our hospital with an exacerbation of CSS. The patient had a high grade fever and complained of abdominal pain and numbness of the lower extremities. Blood examination revealed marked eosinophilia. The fever pattern, abdominal pain and blood eosinophilia showed improvement by combination treatment with prednisolone and cyclophosphamide. However, the color of her right toe tips changed, and necrosis finally resulted despite antithrombotic therapy. Arteriography showed narrowing of the dorsalis pedis artery and of the more peripheral arteries of her right leg. Stump plasty with negative pressure dressing therapy for the toe tips, but not amputation, was done to preserve the leg function. While numbness of the extremities remained, no recurrence of necrosis was seen. Clinicians need to be aware that rare complications of CSS, including necrosis of the digits, can occur. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 61 6 2007 Vaginoplasty with an M-Shaped Perineo- Scrotal Flap in a Male-to-female Transsexual 355 360 EN Yuzaburo Namba Narushi Sugiyama Shuji Yamashita Kenjiro Hasegawa Yoshihiro Kimata Kazushi Ishii Yasutomo Nasu Original Article 10.18926/AMO/32875 <p>To date, many techniques have been reported for vaginoplasty in male-to-female trans-sexual (MTFTS) patients, such as the use of a rectum transfer, a penile-scrotal flap and a reversed penile flap. However, none of these procedures is without its disadvantages. We developed a newly kind of flap for vaginoplasty, the M-shaped perineo-scrotal flap (M-shaped flap), using skin from both sides of the scrotum, shorn of hair by preoperative laser treatment. We applied this new type of flap in 7 MTFTS patients between January 2006 and January 2007. None of the flaps developed necrosis, and the patients could engage in sexual activity within 3 months of the operation. The M-shaped flap has numerous advantages: it can be elevated safely while retaining good vascularity, it provides for the construction of a sufficient deep vagina without a skin graft, the size of the flap is not influenced entirely by the length of the penis, and it utilizes skin from both sides of the scrotal area, which is usually excised.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 59 5 2005 Sex reassignment surgery for male to female transsexuals: initial experience in Okayama university hospital. 231 233 EN Atsushi Nagai Eijirou Tokuyama Yuzaburo Nanba Tetsuya Tsutsui Yoshihiro Kimata Mikiya Nakatsuka Isao Koshima Takashi Saika Yasutomo Nasu Hiromi Kumon Article 10.18926/AMO/31976 <p>The first case of sex reassignment surgery (SRS) in our hospital was performed in January 2001; as of February, 2005, 4 cases of MTF-SRS had been performed. In the 2 most recent cases, we used penile and scrotal skin flaps to avoid complications. The depth and width of the new vagina was made to be adequate for sexual intercourse. Future attention should be focused on devising a surgical technique that will help prevent the complications of partial necrosis of the epidermal skin and wound dehiscence. Although ours is only an initial experience, we describe our surgical technique herein.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 63 5 2009 Mastectomy in Female-to-male Transsexuals 243 247 EN Yuzaburo Namba Toshiyuki Watanabe Yoshihiro Kimata Original Article 10.18926/AMO/31841 <p>The first operative procedure in sex reassignment surgery (SRS) for female-to-male transsexuals (FTMTS) is mastectomy. This procedure includes the removal of mammary tissue, removal of excess skin, and reduction and proper repositioning of the nipple and areola complex. We have performed mastectomies in over 120 patients since January 2001 and want to describe the operative procedures we have developed. We classified our patients into 3 groups according to the patient's breast volume and the degree of ptosis, and we selected the operative procedure that was suitable for each group. At present all costs for SRS are assumed by the patient in Japan. If the FTMTS patient undergoes the entire series of SRS operations, he has to pay more than 3,000,000 yen. Thus the surgeon should select the proper operative procedure so that the patient can avoid unnecessary additional operations. We describe herein the techniques and the strategy for performing mastectomy in FTMTS.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 62 3 2008 Phantom erectile penis after sex reassignment surgery 213 216 EN Yuzaburo Namba Narushi Sugiyama Shuji Yamashita Eijiro Tokuyama Kenjiro Hasegawa Yoshihiro Kimata Case Report 10.18926/AMO/30981 <p>Between January 2001 and December 2007, we performed vaginoplasty as sex reassignment surgery in a total of 14 male-to-female transsexual (MTFTS) patients [1]. Several complications occurred such as partial flap necrosis, rectovaginal fistula formation and hypersensitivity of the neoclitoris. Just after the operation, some patients feel that their penises still exist, but by several weeks postoperatively, this sensation has disappeared. Herein we report a case of MTFTS in whom the sensation of a phantom erectile penis persisted for much longer.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 62 6 2008 Vaginoplasty with a Pudendal-Thigh Flap in Intersexuals 415 419 EN Yuzaburo Namba Narushi Sugiyama Shuji Yamashita Kenjiro Hasegawa Yoshihiro Kimata Mikiya Nakatsuka Case Report 10.18926/AMO/30948 <p>We treated 2 different types of intersexual patients who underwent a vaginoplasty with the pudendal-thigh flap. One was a female with testicular feminization syndrome for whom we reconstructed the total vagina with a pudendal-thigh flap, and the other was a female with an adrenogenital syndrome for whom we enlarged the introitus of the vagina with the same approach. There were no complications such as a flap necrosis. In addition, there was no stricture of the neo-vagina and no urinary problem.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 60 4 2006 Fibular osteoadiposal flap for treatment of tibial adamantinoma: a case report. 233 236 EN Yuzaburo Namba Yoshihiro Kimata Isao Koshima Shinsuke Sugihara Tohru Sato Article 10.18926/AMO/30718 We treated a case with left tibial adamantinoma by use of a contralateral fibular osteoadiposal flap. The donor site of conventional fibular osteocutaneous flap must be covered with a skin graft because if we close the donor skin defect directly, compartment syndrome might occur. We were able to close the donor skin defect because this combined type flap included only a small monitoring skin paddle. We present herein the utility of the osteoadiposal flap and show the value of a skin-sparing approach with a minimal aesthetic defect. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 122 1 2010 血管腫・血管奇形に対するinterventional radiology 55 59 EN Hidefumi Mimura Hiroyasu Fujiwara Takao Hiraki Hideo Gobara Kentaro Shibamoto Yoshihiro Kimata Toshifumi Ozaki Satoru Sasaki Susumu Kanazawa No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 121 1 2009 血管柄付腓骨皮弁移植とインプラントによる顎骨咬合再建の２例 17 24 EN Shin Takagi Nobuyoshi Mizukawa Joji Fukunaga Nobuhisa Ishida Yukinori Maruo Manabu Kannyama Yoshihiro Kimata Isao Koushima 　Defects of the jawbone have conventionally been repaired using free bone grafts and metallic plates, but patients undergoing reconstruction using these materials experience difficulty using dentures and restoring masticatory function. The use of vascularized bone grafts, which has recently been enabled, has improved bone graft survival rates, and its combination with dental implants has enabled both morphological and functional reconstruction, leading to a higher quality of life. 　We experienced two patients with tumors of the jaw that were treated by resecting and reconstructing it using a vascularized bone graft with the cooperation of the Department of Plastic Surgery in the School of Medicine. We subsequently inserted dental implants, and the superstructure was created by the Department of Prosthetics. We report the course of these patients, who achieved sufficient jaw morphology as well as masticatory function and who are presently satisfied overall three years to three years and nine months postoperatively. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 120 3 2008 頭頸部癌における頭頸部外科，形成外科，口腔外科３科合同手術における口腔外科の役割：下顎再建症例における３Ｄ石膏造形モデルを利用した術前プレート屈曲法 299 305 EN Nobuyoshi Mizukawa Susumu Tominaga Yoshihiro Kimata Tomoo Onoda Narushi Sugiyama Eiki Yamachika Yousuke Yamada Takuji Kimura Tetsuo Takeuchi Takaaki Ueno Shin Takagi The collaboration of various medical teams is crucial for the appropriate treatment of cancer patients. However, in Japan, it is very difficult for oral surgeons to cooperate with head and neck surgeons due to conflicts in the treatment of those patients. There have been few studies on this subject. In the current work, we report on the collaboration of head and neck surgeons, plastic surgeons and oral surgeons in operations on two patients with gingival carcinomas in the mandible. We first prepared plaster 3D models of the patients'mouths by means of ink-jet from CT data. We pre-bent the reconstruction plates using the preoperative 3D models. Therefore, we could save the time required to bend the plate. Plaster models are cheaper than resin models. It is also easy to model the surgery using the plate. During the operation, head and neck surgeons resected the tumors, plastic surgeons performed reconstruction with vascularized bone or skin graft, and oral surgeons (dentists) did plate fixation and took charge of the patients'occlusion. This method resulted in patients having good occlusion after the operation. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 00301558 119 3 2008 頭頸部癌における耳鼻咽喉科, 形成外科, 口腔外科3科合同手術の意義 : 2症例における口腔外科の役割を中心に 267 272 EN Nobuyoshi Mizukawa Susumu Tominaga Yoshihiro Kimata Tomoo Onoda Shigenobu Nomiya Narushi Sugiyama Tomoaki Kawamoto Eiki Yamachika Takaaki Ueno Shin Takagi There is a medical team approach used in many hospitals for oral cancer patients. The members are head & neck surgeons and plastic surgeons, or oral surgeons and plastic surgeons. However, in Japan, it is very difficult for oral surgeons to cooperate with head & neck surgeons, except in the case of extractions and oral health care, because both surgeons treat oral carcinomas and there is therefore a conflict in their scope of practice. We believe it desirable for head & neck surgeons to treat oral cancer patients with tumors extending to other regions, and oral surgeons should be in charge of occlusion in head and neck carcinomas. We treated two patients with oral carcinomas in collaboration with head and neck surgeons and plastic surgeons, with head & neck surgeons resecting the tumors, plastic surgeons reconstructing, and oral surgeons (dentists) taking charge of the occlusion for patients in the operating room. This collaboration resulted in patients having good position of the temporomandibular joint and occlusions after the operation. We therefore conclude that this collaborative team approach may be of benefit to the patients. No potential conflict of interest relevant to this article was reported.