Plastic & Reconstructive Surgery

Introduction
Plastic surgical procedures fall into two major subdivisions: reconstructive and cosmetic. In our institution, mainly reconstructive procedures are carried out. In order to restore a natural appearance and to maintain postoperative function after ablative surgery, we use several methods including microsurgical free tissue transfer, pedicled flaps, local flaps, skin grafting, etc. Among these procedures, microsurgical transfer techniques are frequently used because of their many advantages such as reliable vascularity, less infection, better postoperative function and wider resection of advanced lesions. Therefore, applications are increasing in various areas of tissue defects and now more than 100 microsurgical procedures, including cases in the National Cancer Center Hospital (NCCH), Tokyo, are carried out annually by our clinical staff.

Routine Activities
Two plastic surgeons cover reconstructive operations in both NCCHE and NCCH, and some residents are training in this division. Every week three to four reconstructive operations are performed. For research and training programs, we opened a microsurgical laboratory in NCCHE in 1996. Types of tissue defects are shown below, for several regions.
1. Head and Neck:
Tissue defects of the tongue, oral cavity, mesopharynx, hypopharynx, cervical esophagus, mandibular bone, facial skin, and facial nerve, etc.
2. Orthopedic
Tissue defects of the extremities including bone, muscle, nerve, skin, vessels, etc., and large tissue defects of the body.
3. Breast
Deformity of breast tissue.
4. General Surgical
Tissue defects of the esophagus, abdominal and chest walls, etc.
5. Dermatological
Tissue defects after ablative surgery for skin cancer.
6. Neurosurgical Regions
Tissue defects of the scalp, skull and skull base region.
7. Gynecological
Reconstruction of perineal region.

New Developments
1. Sensory flaps for reconstruction of tongue defects have been used and a functional investigation was performed. Free jejunal grafting was used as a patch graft for repair of intraoral defects.
2. In an attempt to preserve the voice, free flap transfer was carried out for repair of defects after cancer ablation around the larynx.
3. A new method of reconstructing the abdominal wall utilizing a pedicled anterolateral thigh flap was established.

Statistics

Microsurgical Reconstruction for Head and Neck Regions
Primary site No. Reconstructive methods No.

Tongue 32 Rectus abdominis MC* 49

Hypopharynx and 35 Jejunal graft 38

Cervical esophagus
Anterolateral thigh 13

Mesopharynx 14 Latissimus dorsi MC* 0

Oral floor 7 Radial forearm 2

Gingiva 9 Scapular 5

Buccal mucosa 6 Iliac bone 0

Salivary Glands 2 Fibular bone 4

Maxillary sinus 1 Vascularized nerve 2

Others 3

Total 109
113
*Musculocutaneous

Microsurgical Reconstruction for Head and Neck Regions
Primary site	No.	Reconstructive methods	No.
Tongue	32	Rectus abdominis MC*	49
Hypopharynx and	35	Jejunal graft	38
Cervical esophagus		Anterolateral thigh	13
Mesopharynx	14	Latissimus dorsi MC*	0
Oral floor	7	Radial forearm	2
Gingiva	9	Scapular	5
Buccal mucosa	6	Iliac bone	0
Salivary Glands	2	Fibular bone	4
Maxillary sinus	1	Vascularized nerve	2
Others	3
Total	109		113

Reconstruction for Other Regions
Region No.

Orthopedic 11 (7)

Dermatologic 8 (0)

Breast 5 (1)

Gynecologic 2 (0)

Neurosugical 4 (0)

General surgical 7 (3)

Total 37 (11)
The figures in parentheses indicate the number of free flaps. There were no major complications in any of our cases.

Reconstruction for Other Regions
Region	No.
Orthopedic	11 (7)
Dermatologic	8 (0)
Breast	5 (1)
Gynecologic	2 (0)
Neurosugical	4 (0)
General surgical	7 (3)
Total	37 (11)

Incidence of Complications

No.

Re-operation 6 (5.5%)

Total necrosis 6 (5.5%)

Partial necrosis 3 (2.8%)

Major leakage 4 (3.7%)

Minor leakage 12 (11.0%)

Pneumonia 2 (1.8%)

Incidence of Complications
	No.
Re-operation	6 (5.5%)
Total necrosis	6 (5.5%)
Partial necrosis	3 (2.8%)
Major leakage	4 (3.7%)
Minor leakage	12 (11.0%)
Pneumonia	2 (1.8%)

(Y. Kimata)

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