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Department of Plastic and Reconstructive Surgery

Minoru Sakuraba, Takuya Higashino, Azusa Oshima, Yaso Saito, Shuchi Azuma, Satsuki Tachibana

Introduction

The Department of Plastic and Reconstructive Surgery has mainly focused on surgical reconstruction following cancer ablation. In our institution, reconstructive procedures using free flap transfer with microvascular anastomosis are the most important operations (Figure 1). In addition, several methods such as tissue transfer with pedicled flaps, local flaps and skin grafts are used for reconstructive surgery. The objectives of reconstructive surgery are not only morphological reconstruct ion, but also the restorat ion of postoperative functions after ablative surgery. The quality of life (QOL) of the patients can be improved with functional and morphological reconstruction.

Routine activities

Five plastic surgeons cover reconstructive operations both in the National Cancer Center Hospital (NCCH) East in Kashiwa and the NCCH in Tokyo, and train the residents in the two hospitals. These reconstructive surgeries are performed in cooperation with the surgeons of other departments of the hospital, such as the Department of Head and Neck Surgery, Breast Surgery, Orthopedic Surgery, Esophageal Surgery, and Colorectal Surgery and Urology (Table 1). In the NCCH East, Head and Neck reconstruction is the most frequently performed operation accounting for about 60% of reconstructive surgery. In the Head and Neck region, a free jejunal transfer and anterolateral thigh flap transfer are the most frequently used procedures (Table 2). A weekly conference is held with doctors of the Department of Head and Neck surgery, Radiation Oncology and Head and Neck Oncology. Breast reconstruction using autologous tissue transfer was employed in 2005, since then, patients' needs for breast reconstruction is increasing. Also, lymphatico-venular anastomosis as a surgical treatment for lymphedema of the extremities was introduced in 2013.

Research activities

Plastic and reconstructive surgery has focused on the following four aspects in the surgical treatment of cancer for the purpose of contributing to the improvement of the QOL of patients.

  1. Obtaining good functional recovery
  2. Reduction of postoperative complications
  3. Achieving less donor site morbidity
  4. Treatment of postoperative complications after cancer ablation.

With the objective of addressing these four aspects,establishing a standard for reconstructive surgery and developing new techniques of reconstructive surgery are the most important aims of our studies. Multi-institutional analysis of postoperative complication and swallowing function after total pharyngo-laryngo-esophagectomy and reconstruction with a free jejenal graft was performed continuously. This study was supported by a Grant-in-Aid for Cancer Research. The aim of the study is to clarify the relationship between surgical procedures and postoperative complication and function.

Another multi-institutional analysis of postoperative complication after microsurgical head and neck reconstruction was carried out to clarify the risk factor of postoperative vascular thrombosis. Data registration was closed and the data is now under evaluation.

In 2015, we also started to take an active part in a new multi-institutional analysis of risk factors for functional outcome after tongue reconstruction.

Figure 1. Number of Microsurgeries
Figure 1. Number of Microsurgeries

Table 1. Number of patients Table 2. Type of procedures