Okayama University Medical SchoolActa Medica Okayama0386-300X8032026A Novel Flap Design to Reduce Urethral Complications in Anterolateral Thigh Phalloplasty: The Pipe Flap Technique213217ENToshiroImaiDepartment of Plastic and Reconstructive Surgery, Tohoku University Graduate School of MedicineToshiyukiWatanabeDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalShihoWatanabeDepartment of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical CenterMasanobuHayashiDepartment of Plastic and Reconstructive Surgery, Tohoku University Graduate School of MedicineYusukeTominagaDepartment of Urology, Okayama University HospitalYuzaburoNambaGender Center, Okayama University HospitalCase Report10.18926/AMO/70857Phalloplasty is one of the most challenging procedures in gender-affirming surgery, and urethral complications remain common despite numerous preventive efforts. No definitive solution has been established, and many patients still require subsequent corrective procedures. We designed a novel anterolateral thigh flap that creates a planned external fistula at the penile base to mitigate urethral complications. The fistula was closed in a second-stage procedure one year later, and the postoperative course was uneventful. We report a case of a transgender man treated with this two-stage gpipe flaph technique, resulting in satisfactory urinary function. This approach may offer a safe and less invasive option for mitigating urethral complications in phalloplasty.No potential conflict of interest relevant to this article was reported.Japan Society of Plastic and Reconstructive SurgeryActa Medica Okayama2436-259X232023A Case of a Transwoman with Colorectal Cancer after Flap Vaginoplasty98101ENShihoWatanabeDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalFuminoriTeraishiDepartment of Minimally Invasive Therapy Center, Okayama University HospitalSariFujimotoDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalToshiyukiWatanabeDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalShoTakedaDepartment of Gastroenterological Surgery, Okayama University HospitalShuheiNaritaDepartment of Gastroenterological Surgery, Okayama University HospitalKoyaYamashitaDepartment of Gastroenterological Surgery, Okayama University HospitalKunitoshiShigeyasuDepartment of Gastroenterological Surgery, Okayama University HospitalShunsukeKagawaDepartment of Gastroenterological Surgery, Okayama University HospitalYuzaburoNambaDepartment of Gender Center, Okayama University HospitalYoshihiroKimataDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalVaginoplasty 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.Okayama University Medical SchoolActa Medica Okayama0386-300X7412020The Novel Eryngii Method of Nipple Reduction for Female-to-Male Transsexuals8387ENToruSakuraiDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalToshiyukiWatanabeDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalKensukeManakoDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalSyoKomagoeDepartment of Plastic Surgery, Okayama Saiseikai General HospitalYukoMukaiDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalYoshiroKimataDepartment of Plastic and Reconstructive Surgery, Okayama University HospitalYuzaburoNambaDepartment of Gender Center, Okayama University HospitalCase Report10.18926/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.ͺRγwοActa Medica Okayama0030-155812622014«―κ«αQΙΞ·ιοI‘Γ109115ENYuzaburoNambaNo potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6832014For Vol.67, No.5 pp325-331 Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual183190ENKenjiroHasegawaYuzaburoNambaYoshihiroKimataCorrected and Republished Article10.18926/AMO/52660Since 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 gtube within a tubeh 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.Okayama University Medical SchoolActa Medica Okayama0386-300X6762013Thumb Polydactyly with a Floating Ulnar Thumb391395ENKenjiroHasegawaYuzaburoNambaYoshihiroKimataCase Report10.18926/AMO/52013Thumb 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 SchoolActa Medica Okayama0386-300X6752013Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual325331ENKenjiroHasegawaYuzaburoNambaYoshihiroKimataCase Report10.18926/AMO/51869Since 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 SchoolActa Medica Okayama0386-300X6742013Negative Pressure Wound Therapy Incorporating Early Exercise Therapy in Hand Surgery:Bag-type Negative Pressure Wound Therapy271276ENKenjiroHasegawaYuzaburoNambaYoshihiroKimataCase Report10.18926/AMO/51073In 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 SchoolActa Medica Okayama0386-300X6162007Vaginoplasty with an M-Shaped Perineo- Scrotal Flap in a Male-to-female Transsexual355360ENYuzaburoNambaNarushiSugiyamaShujiYamashitaKenjiroHasegawaYoshihiroKimataKazushiIshiiYasutomoNasuOriginal Article10.18926/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 SchoolActa Medica Okayama0386-300X6352009Mastectomy in Female-to-male Transsexuals243247ENYuzaburoNambaToshiyukiWatanabeYoshihiroKimataOriginal Article10.18926/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 SchoolActa Medica Okayama0386-300X6232008Phantom erectile penis after sex reassignment surgery213216ENYuzaburoNambaNarushiSugiyamaShujiYamashitaEijiroTokuyamaKenjiroHasegawaYoshihiroKimataCase Report10.18926/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 SchoolActa Medica Okayama0386-300X6262008Vaginoplasty with a Pudendal-Thigh Flap in Intersexuals415419ENYuzaburoNambaNarushiSugiyamaShujiYamashitaKenjiroHasegawaYoshihiroKimataMikiyaNakatsukaCase Report10.18926/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 SchoolActa Medica Okayama0386-300X6042006Fibular osteoadiposal flap for treatment of tibial adamantinoma: a case report.233236ENYuzaburoNambaYoshihiroKimataIsaoKoshimaShinsukeSugiharaTohruSatoArticle10.18926/AMO/30718We 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.ͺRγwοActa Medica Okayama0030-155811332001«―κ«αQΙΞ·ιοIγΓΜΐH279284ENYoshioTakahashiYuuzaburouNambaKoujiKishimotoIsaoKoshimaGENDER IDENTITY DISORDER (GID) is a unique human condition that is classified behaviorally and treated medically with hormones and surgery in the severe form. This condition has been and still somewhat remains controversial by religious belief, social institutions and health care delivery systems. We described the surgical management of transsexuals, so called SEX@REASSGINMENT SURGERY (SRS) and showed the team for gender treatment, GENDER CLINIC. A gender treatment team composing staff members from the Psychiatric, Plastic Surgery, Urology, Obstetric/Gynecological Surgery, and the Social Service, was established at the Hospital of Okayama University Medical schools in 1999. Female-to-Male procedures include mastectomy, phalloplasty, Phalloplasty are completion and an appurtenance, something pleasing to others. Male-to-Female program includes the genital surgery. The genital change surgery consists of the penile inversion, orchiectomy, vaginoplasty. Other prodedures include reduction thyroid chondroplasty, hair transplant, voice change, laryngeal surgery, epilation with the laser. SRS is the only effective treatment available today in the management of GID. The aesthetic and functional results achievable from various procedures are generally satisfactory and are acceptable to the patients. On the other hand, we should remember that the numerous steps of information for SRS will be required.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama2000The treatment of port-wine stains by the dye laser: A study of 644 patientsENNo potential conflict of interest relevant to this article was reported.