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 consisted 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 of in the National Cancer Center Hospital (NCCH) in Tsukiji, are performed per year.
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
shown below in relation to several regions.
1) Head and Neck Regions: Tissue defects of tongue,
oral cavity, mesopharynx, hypopharynx and cervical esophagus, mandibular bone,
facial skin and facial nerve etc.
2) Orthopedic Regions: Tissue defects of extremities
including bone, muscle, nerve, skin, vessels etc. and large tissue defects
of the body.
3) Breast Regions: Deformity of breast tissue.
4) Hepatobiliary and Pancreatic Surgical Regions:
Microvascular Reconstruction of the arterial system of the intra-abdominal
organs.
5) Esophageal and Thoracic Surgical Regions: Tissue
defects of esophagus and chest wall.
6) Colorectal Surgical Regions: Tissue defects of
abdominal wall.
7) Dermatological Regions: Tissue defects after
ablative surgery of skin cancer.
8) Neurosurgical Regions: Tissue defects of scalp,
skull and skull base region.
9) Gynecological Regions: Reconstruction of perineal
region.
10) Ophthalmological Region: Eye-socket reconstruction.
New Developments
1. Prospective studies about the functional analysis
after reconstruction of total or subtotal glossectomy were continued.
2. Classification of the oropharyngeal wall defects
and their postoperative functional analysis were performed.
|
Site-Distribution
of Primary Lesion |
|
|
Primary Sites |
No.
of cases both in NCCHE and NCCH |
|
Head and Neck regions |
|
|
Tongue |
27 |
|
Hypopharynx |
35 |
|
Cervical esophagus |
6 |
|
Methopharynx |
24 |
|
Oral floor |
6 |
|
Gingival |
9 |
|
Buccal mucosa |
7 |
|
Salivary glands |
1 |
|
Maxillary sinu |
8 |
|
Retromolar |
4 |
|
Skull base |
1 |
|
Others |
26 |
|
Orthopedic regions |
18 |
|
Breast regions |
1 |
|
Hepatobiliary and pancreatic regions |
6 |
|
Esophageal and thoracic regions |
5 |
|
Colorectal regions |
2 |
|
Dermatologic regions |
8 |
|
Neurosurgical regions |
0 |
|
Gynecological regions |
2 |
|
Ophthalmological regions |
1 |
|
Total |
197 |
|
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. |
47 |
|
Jejunal graft |
43 |
|
Anterolateral thigh |
24 |
|
Fibula bone |
10 |
|
Scapular bone |
1 |
|
Radial forearm |
1 |
|
Latissimus dorsi M.C. |
5 |
|
Vascuralized nerve graft |
1 |
|
Other microsurgical procedures |
14 |
|
Pedicled flap |
|
|
Pectoralis major M.C. |
1 |
|
Rectus abdominis M.C. |
2 |
|
Dertopectroal flap |
6 |
|
Perforating flap |
3 |
|
Others |
9 |
|
Local flap |
19 |
|
Others procedures |
12 |
|
Total |
198 |
|
M.C.,
musculocutaneous |
|
(Y. KIMATA)
