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 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 in 2002
1. The patients who underwent ablative surgery for inferior gingival cancer often lost both the mandibular bone and inferior alveolar nerve. To reconstruct the mandibular bone and restore the sensation of the lower lip, we have developed operative techniques using the vascularized fibula graft and vascularized superficial peroneal nerve.
2. The new concept of palliative reconstruction to increase the quality of remained life was introduced into some patients with unresectable tumor.
3. Prospective studies of functional analysis after reconstruction following total or subtotal glossectomy were continued.
4. Reconstruction after salvage esophagectomy for recurrent tumors following definitive chemotherapy and radiotherapy was continued.

Y. KIMATA

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