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 microsurgical free tissue transfers, pedicled flaps, local flaps, skin
grafts, and the like. Among these procedures, we frequently use microsurgical
transfer techniques, which have the advantages of reliable vascularity, less
infection, better postoperative function, and wider resection of advanced
lesions. Applications of these techniques are increasing in various areas
of tissue defects, and now more than a hundred microsurgical operations, including
cases treated at the National Cancer Center Hospital (NCCH) in Tsukiji, are
performed per year.
Routine Activities
Three plastic surgeons cover reconstructive operations at both NCCHE
in Kashiwa and NCCH in Tsukiji, and these surgeons train the residents in
the two hospitals. Every week three to four re-constructive operations are
performed. We opened a microsurgical laboratory for research and training
programs in 1996.
Types of tissue defects are
shown below in relation to several regions.
1) Head and neck regions: Tissue defects of the
tongue, oral cavity, meso-pharynx, hypopharynx and cervical esophagus, mandibular
bone, facial skin and facial nerve, etc.
2) Orthopedic regions: Tissue defects of the extremities,
including bone, muscle, nerve, skin, vessels, etc. and large tissue defects
of the body.
3) Breast region: 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 for skin cancer.
6) Neurosurgical regions: Tissue defects of the
scalp, skull, and skull base region.
7) Gynecological region: Reconstruction of the perineal
region.
New Developments
1.Prospective studies of functional analysis after
the reconstruction of head and neck defects were continued.
2.A monitoring system of the transferred flap was
introduced.
3.A procedure for simple reconstruction of pharyngeal
defects with a free jejunal graft was established.
|
Site-Distribution
of Primary Lesion |
|
|
Primary
Sites |
No.
of cases both in NCCHE and NCCH |
|
Head
and neck regions |
|
|
Tongue |
20 |
|
Hypopharynx |
31 |
|
Cervical esophagus |
6 |
|
Methopharynx |
13 |
|
Oral floor |
5 |
|
Gingival |
8 |
|
Buccal mucosa |
5 |
|
Salivary glands |
2 |
|
Maxillary sinu |
2 |
|
Retromolar |
3 |
|
Skull base |
2 |
|
Others |
20 |
|
Orthopedic
regions |
13 |
|
Breast
regions |
1 |
|
General
surgical regions |
7 |
|
Dermatologic
regions |
10 |
|
Neurosurgical
regions |
2 |
|
Gynecological
regions |
1 |
|
Total |
151 |
|
NCCH:
National Cancer Center Hospital, NCCHE: National Cancer Center Hospital
East. |
|
|
Reconstructive
Techniques Employed |
||
|
Methods |
No.
of cases both in NCCHE and NCCH |
|
|
Free
flap |
||
|
Rectus abdominis M.C. |
34 |
|
|
Jejunal graft |
39 |
|
|
Anterolateral thigh |
17 |
|
|
Scapular flap |
1 |
|
|
Groin |
3 |
|
|
Iliac bone |
5 |
|
|
Fibula bone |
5 |
|
|
Scapular bone |
1 |
|
|
Radial forearm |
1 |
|
|
Latissimus dorsi M.C. |
3 |
|
|
Vascuralized nerve graft |
1 |
|
|
Other
microsurgical procedures |
9 |
|
|
Pedicled
flap |
||
|
Pectoralis major M.C. |
12 |
|
|
Rectus abdominis M.C. |
2 |
|
|
Pericranial flap |
2 |
|
|
Dertopectroal flap |
6 |
|
|
Local
flap |
10 |
|
|
Others
procedures |
6 |
|
|
Total |
157 |
|
|
M.C.,
musculocutaneous. |
||
(Y. KIMATA)
