Plastic and Reconstructive Surgery
Introduction
Plastic surgical procedures fall into two major subdivisions: reconstructive and cosmetic. In our institution, reconstructive procedures are the main operations. In order to restore a natural appearance and to maintain postoperative function after ablative surgery, we use several methods consisting of microsurgical free tissue transfer, pedicled flap, local flap, skin graft, etc. Among these procedures, microsurgical transfer techniques are frequently used because of 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 a hundred microsurgical operations, including cases in the National Cancer Center Hospital (NCCH), Tokyo, are performed each year by our clinical staff.
Routine Activities
Three plastic surgeons cover reconstructive operations both in the NCCH East in Kashiwa and the NCCH in Tsukiji, and train the residents in the two hospitals. Every week three to four reconstructive operations are performed.
We opened a microsurgical laboratory for research and training programs in 1996.
Types of tissue defects are as follows in relation to several regions.
1) Head and Neck Regions: Tissue defects of the tongue, oral cavity, mesopharynx, hypopharynx and cervical esophagus, madibular bone, facial skin and facial nerve, etc.
2) Orthopedic Regions: Tissue defects of extremities including the bone, muscle, nerve, skin, vessels etc. and large tissue defects of the body.
3) Breast Regions: Deformity of breast tissue.
4) General Surgical Regions: Tissue defects of the esophagus, abdominal and chest wall, etc.
5) Dermatological Regions: Tissue defects after ablative surgery of skin cancer.
6) Neurosurgical Regions: Tissue defects of the scalp, skull and skull base region.
7) Gynecological Regions: Reconstruction of the perineal region.
New Developments
1. Prospective studies about the functional analysis after the reconstruction of head and neck defects were started.
2. New method for reconstruction of facial palsy after ablative surgery of the parotid gland utilizing vascularized nerve graft was performed.
Statistics
| Primary sites | No. of cases in NCCHE (NCCH) |
|
| Head and neck regions | ||
| Tongue | 16 | (0) |
| Hypopharynx | 29 | (2) |
| Cervical esophagus | 6 | (2) |
| Mesopharynx | 21 | (1) |
| Oral floor | 7 | (0) |
| Gingiva | 18 | (0) |
| Buccal mucosa | 4 | (0) |
| Maxillary sinus | 5 | (0) |
| Retromolar | 5 | (0) |
| Skull base | 1 | (4) |
| Others | 16 | (3) |
| Orthopedic regions | 4 | (15) |
| Gastrointestinal regions | 8 | (1) |
| Chest wall reconstruction | 1 | (2) |
| Dermatologic regions | 0 | (2) |
| Total | 141 | (32) |
Cancer Center Hospital East.
| Total microsurgical operations | 141 |
| Reoperation | 5 (3.5%) |
| Total necrosis | 4 (2.8%) |
| Reconstructive methods | No. of cases in NCCHE (NCCH) |
|
| Free flap | ||
| Rectus abdominis m.c. | 44 | (7) |
| Jejunal graft | 37 | (4) |
| Iliac bone | 5 | (0) |
| Groin | 5 | (2) |
| Fibula bone | 1 | (4) |
| Latissimus dorsi m. | 0 | (1) |
| Vastus muscle | 0 | (1) |
| Vascularized nerve graft | 2 | (0) |
| Radial forearm | 2 | (0) |
| Pectoralis major m.c. | 1 | (0) |
| Pedicled flap | ||
| Pectoralis major m.c. | 9 | (2) |
| Latissimus dorsi m.c. | 0 | (6) |
| Rectus abdominis m.c. | 1 | (0) |
| Trapezius m.c. | 1 | (0) |
| Pericranial flap | 1 | (3) |
| Deltopectoralis | 9 | (1) |
| Local flap | 8 | (1) |
| Externa oblique muscle | 1 | (0) |
| Others | ||
| Free nerve graft | 1 | (0) |
| Super charge | 1 | (0) |
| Skin graft | 15 | (8) |
| Total | 144 | (40) |
(Y. Kimata)
