Radical resection of tongue and oropharyngeal carcinomas often results in complex defects that are challenging to reconstruct. Furthermore, remaining function should not be disturbed by the ...reconstruction. We introduce a new flap design and monitored swallowing and speech following reconstruction of complex oral defects. The new design consists of four lobes on a single pedicle. The first reconstructs the tongue, the second the tongue base, the third the oral floor, and the fourth the lateral wall. The records of cases performed between July 2002 and December 2006 were reviewed. Twenty-three patients (17 men and 6 women) with an average age of 60 years underwent immediate reconstruction using a free flap after radical resection of a malignant carcinoma of tongue or oropharynx using a free flap. Postoperative swallowing and speech were rated using a self-report questionnaire. Moreover, the functional outcome in patients with and without a tongue base defect was compared. All free flaps took entirely, and postoperative function was largely satisfactory. Swallowing in patients with and without a tongue base defect was similar, but speech was more impaired in patients who had a tongue base defect. Our new design is effective for reconstructing intraoral defects three-dimensionally. However, further refinement is required to preserve speech.
Background: Midkine is a heparin-binding growth factor preferentially expressed in tumor cells. The present study was performed to utilize anti-midkine antibody for tumor therapy. Methods: A ...monoclonal antibody to midkine was raised by immunizing mice deficient in the midkine gene. The binding site of the antibody was studied by using N-terminal half and C-terminal half of midkine, both of which were chemically synthesized. Doxorubicin (DOX)-conjugate of the antibody was produced by chemical conjugation. The effects of the antibody and the conjugate on cell growth were examined using a midkine-secreting tumor cell, i.e. human hepatocellular carcinoma cell (HepG2). Results: The monoclonal antibody bound to the N-terminal half of midkine. The antibody did not inhibit the growth of HepG2 cells probably because the active domain of midkine is in the C-terminal half. We produced the antibody conjugated with DOX with the hope that the conjugate would be internalized accompanied with midkine. Indeed, the antibody-DOX conjugate significantly inhibited the growth of HepG2 cells compared with DOX-conjugated control IgG. Conclusion: The result raises the possibility of using anti-midkine antibody conjugated with DOX for cancer therapy.
Omental flaps, with their associated rich and pliable vascular arcades, are frequently used in clinical practice for the reconstruction of complex and irregular defects. There is little experimental ...evidence, however, to prove that omental flaps can be a useful tool for the defects. Using a gastric-wall defect model, we performed histological and immunocytochemical examinations. We created an omental flap lining a 2.0-mm defect perforating the center of the anterior wall of a rat stomach. We examined the tissue response during gastric wall regeneration by H&E and Masson trichrome stains. We also performed immunocytochemical studies for the detection of proliferating cell nuclear antigen (PCNA), factor VIII-related antigen, fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF). One day after the operation, the omental flap was found to firmly adhere to the gastric serosa surrounding the defect. An extensive inflammatory response occurred from Day 1 to 3 with dilated vessels in the omentum. From Days 3 to 7, a significant number of PCNA-positive cells, FGF-2-positive cells and VEGF-positive cells were observed at the edge of the mucosa and within the granulation tissue. On Day 4, in place of extensive inflammation, an exuberant granulation tissue response was observed from the omentum. The defect had been covered by stratified villi by Day 7. This study demonstrated that an omental flap came to rapidly adhere to the defect serving as a source of extensive inflammation and granulation for the rich and pliable vascular arcades.
Cranial osteomyelitis is a common complication of brain surgery. A one-stage reconstructive repair of the cranial bone is desirable, but risks active infection. The authors have developed a ...reconstructive technique for osteomyelitis-related cranial defects that fills the dead space with an omental flap and uses a titanium mesh plate for the structural element. This report describes the successful treatment of 8 patients using this approach.
The authors found that a previously transferred free flap vascular pedicle, distal to the first microvascular anastomosis, can be used as a recipient vessel for an additional free flap transfer. Free ...flap transfers were performed by using the standard procedure in patients with head and neck cancer. The mean age of the patients was 62 years. Five patients were men and three were women. A second free flap was transferred for secondary primary head and neck cancer in two cases, facial deformity in two cases, osteomyelitis of the skull in two cases, recurrent cancer in one case, and exposure of a mandibular reconstruction plate in one case. The interval between the two operations was from 4 months to 12 years (median, 21 months). All secondary free flaps were performed successfully. In two cases, the external jugular vein proximal to the previously anastomosed site was used for venous drainage. In another case, additional venous anastomosis was performed for flap congestion. It became clear that a previously transferred free flap vascular pedicle could be used as a recipient vessel for microvascular anastomosis. This is an excellent procedure for additional free flap transfers. (Plast. Reconstr. Surg. 1091246, 2002.)
Free flaps are becoming the preferred method of choice for head and neck reconstruction. However, many patients who have undergone radiotherapy and radical neck dissection or who require treatment ...for recurrent tumor, often present difficulty in choosing recipient vessels. The authors have noted a potential recipient vein coursing vertically along the anterior ridge of the trapezius muscle. They used this vein as the recipient vein in two patients; the two free flaps were transferred successfully without complications. This vein, which they provisionally named the posterolateral cervical vein (PLCV), is considered an important option as a recipient vein in head and neck reconstruction when more commonly used recipient cervical veins are unavailable.
Accumulating evidence suggests that the delivery of human adipose tissue-derived stromal cells (hASCs) has great potential as regenerative therapy. This was performed to develop a method for ...expanding hASCs by reducing the amount of serum required. We demonstrate that hASCs were able to expand efficiently in media containing 2% serum and fibroblast growth factor-2. These cells, or low serum cultured hASCs (hLASCs), expressed cell surface markers similar to those on bone marrow-derived mesenchymal stem cells, and could be differentiated into cells of mesenchymal lineage. Of interest, hLASCs secreted higher levels of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) than hASCs cultured in 20% serum (hHASCs). Moreover, hLASC-conditioned media significantly increased endothelial cell (EC) proliferation and decreased EC apoptosis compared to that obtained from hHASCs or control media only. Antibodies against VEGF and HGF virtually negated these effects. When hASCs were administered into the ischemic hindlimbs of nude rats, hLASCs improved blood flow, increased capillary density, and raised the levels of VEGF and HGF in the muscles as compared with hHASCs. In conclusion, we demonstrate a novel low serum culture system for hASCs, which may have great potential in regenerative cell therapy for damaged organs in the clinical setting.
Enamel prisms in mammalian enamel structure including human are considered to have originated in the reptilian enamel. The author has reported the original pattern of enamel prisms and of ...Hunter-Schreger bands in fossil reptiles of Mosasaurus sp. and Phytosaurus sp. The origin of the patterns of crystallite groups appear to arise in the fossil reptiles. Mosasaurus sp. had an island pattern and Phytosaurus sp. had a slender pattern. These two types are of various sizes, and are formed by variable numbers of ameloblasts. The number of ameloblasts involved in the formation of the crystallite group may change during amelogenesis. The present study observed the initial crystallite groups as enamel islands, in the surface of the early secretory stage of amelogenesis of living Alligator mississippiensis. These crystallite groups become bigger and more uniform in size during amelogenesis, being formed by several ameloblasts in the maturation stage. The border of crystallite groups observed appear as the lamella in human enamel. These crystallite groups may develop into the enamel prisms and Hunter-Schreger bands.
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Several reports describe methods of treatment for avascular necrosis of the femoral head (ANFH) involving 0 to 2 mm of collapse. Some cases of ANFH have good prognoses, requiring only ...non-weight-bearing treatment. Other cases rapidly progress to collapse and complete destruction with enlargement of the necrotic area. The progression of the necrotic area is related to the activity of the original disease, steroid treatment, and the size and location of the necrotic area in the early stages of the disorder. In this report, a vascularized pedicle bone graft was used to treat ANFH, particularly those cases identified as Stage II on the system established by the Japanese Investigation Committee. Surgery involved curettage of necrotic bone, implantation of spongy bone, and application of a vascularized pedicle bone graft. Grafts were taken from the ilium and included the superficial circumflex iliac artery (SCIA). A bony canal was made in the anterior femoral neck, from which the necrotic bone was curetted and to which the bone graft was applied. The deep circumflex iliac artery (DCIA) was also used in combination with the SCIA. The postoperative weight-bearing period was six months. Follow-up periods lasted one to six years. Seventeen of 23 Stage II joints (19 cases) achieved satisfactory results at a mean of three years after surgery. Three Stage II joints and three Stage III joints continue to have significant problems. One of these six has been converted to a dual-bearing type endoprosthesis. The unsuccessful results generally occurred in patients who were treated with steroids.
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