Kazuteru Doi
Ogori Daiichi General Hospital



  • Hand Surgery 10/2015; 20(03):482-483. DOI:10.1142/S0218810415720260
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    ABSTRACT: We report on an 82-year-old man with an infected non-union of the right tibia in which the peroneal artery was the sole artery supplying the lower leg, owing to peripheral arterial disease. He underwent tibial reconstruction using the pedicled vascularised fibular graft in a flow-through manner (without ligation of either the proximal or distal ends of the peroneal artery) and achieved successful bony union.
    Journal of orthopaedic surgery (Hong Kong) 04/2015; 23(1):111-5. · 0.70 Impact Factor
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    ABSTRACT: The use of skin flap as a monitoring tool cannot sensitively reflect the vascularity of a functioning free muscle transfer (FFMT), and it may result in delayed detection of vascular compromise. We report the use of compound muscle action potentials (CMAPs) as a supplemental method in the monitoring of free gracilis transfers. In 46 successful free gracilis transfers in 23 patients following total brachial plexus injury (BPI), CMAPs were measured every hour for 75 h postoperatively. We analyzed the amplitude, latency, and duration to understand the Wallerian degeneration effect and thresholds to warn vascular compromise clinically. After the primary study, we applied CMAP monitoring for 23 clinical cases. Three basic wave patterns of the CMAPs with or without dispersion were recognized. Forty-two CMAPs were successfully traced and 27 CMAPs with one constant wave pattern showed two types of amplitude and latency changes; positive and negative Wallerian degeneration. The mean 1-h maximal decreases of amplitudes and elongation of latency were 36% and 77%, respectively; however, they returned to the original pattern within 1 h. There were no significant differences of reinnervation time and final strength of elbow flexion between these 46 muscle transfers. In the clinical series, we experienced two cases of vascular compromise that showed CMAP critical alterations without skin flap changes. Our preliminary results show that the measurement of CMAPs has great potential for the sensitive and reliable monitoring of muscle circulation after FFMT. The clinical critical values of CMAP amplitude changes for vascular compromise are >40% sudden decrease, and they continued to decrease further. This technique is most useful for postoperative vascular monitoring of a buried muscle flap, and it is proven to be of clinical significance in current vascular compromised cases. Level Ⅳ, Case Series. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
    Journal of Plastic Reconstructive & Aesthetic Surgery 02/2015; 68(7). DOI:10.1016/j.bjps.2015.02.006 · 1.42 Impact Factor
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    ABSTRACT: To investigate the clinical outcomes of endoscopic carpal tunnel release for severe carpal tunnel syndrome in octogenarians compared with a younger cohort. Fifty-five hands in 48 patients were enrolled in this study. There were 27 hands in 24 octogenarians and 28 hands in 24 patients in a younger group with average ages of 83 and 60 years, respectively. Postoperative follow-ups were 8.5 and 7.2 months, respectively. Clinical evaluation included documentation of subjective symptoms and Semmes-Weinstein testing before surgery, 3 months after surgery, and at final follow-up. Symptom severity and function outcomes scores and compound muscle action potential of abductor pollicis brevis as an electrophysiological assessment were evaluated before surgery and at the final follow-up. Nocturnal pain and paresthesias were improved in all patients. The octogenarians had poorer recovery of Semmes-Weinstein testing score and better improvement of outcomes scores than the younger group. There was no difference of the results in postoperative electrophysiological improvement between the groups. Endoscopic release for severe carpal tunnel syndrome relieved symptoms and improved activities of daily living in octogenarians. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
    The Journal Of Hand Surgery 12/2014; 39(12):2448-53. DOI:10.1016/j.jhsa.2014.09.018 · 1.67 Impact Factor
  • Narihito Kodama · Kazuteru Doi · Yasunori Hattori ·
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    ABSTRACT: Purpose To evaluate the usefulness of ultrasonography for measurement of functioning free muscle transfer strength and estimate the capacity and potential of ultrasonography measurement. Methods Twenty-five patients underwent functioning free muscle transfer for brachial plexus injury. The cross-sectional areas (CSAs) of the transferred muscle and the contralateral gracilis (control) were measured using ultrasonography. First, the reliability and reproducibility of the ultrasonography measurements of the muscle CSA was investigated. Next, force recovery was evaluated by calculating the contraction ratio (CR), which was defined as the value equal to the CSA of the transferred muscle under maximum isometric contraction divided by the CSA value in a complete rest position. The CR of the contralateral gracilis was calculated in the same manner. The CR of the transferred muscle and the control were compared statistically. We also analyzed the correlation between the CR of the transferred muscle and other measurements of muscle strength. The follow-up duration was 24 to 87 months after surgery. Results The reliability and reproducibility of the ultrasonography measurements was determined statistically. The CR of the transferred muscle (1.30 ± 0.12) was significantly greater than that of the contralateral gracilis (1.22 ± 0.13). Furthermore, the CR of the transferred muscle showed significant correlations with both manual muscle testing and elbow arc of motion. Conclusions Ultrasonography measurement of transferred muscle can easily indicate the recovery process of rehabilitation in a quantitative and dynamic manner. This study demonstrated that ultrasonography has the capacity to evaluate force recovery objectively. Type of study/level of evidence Therapeutic IV.
    The Journal Of Hand Surgery 11/2014; 39(11). DOI:10.1016/j.jhsa.2014.06.120 · 1.67 Impact Factor
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    ABSTRACT: Purpose To report the outcomes of modified Camitz abductor plasty using the released flexor retinaculum as a pulley in patients with advanced carpal tunnel syndrome. Methods A retrospective review of 46 hands in 43 patients who underwent modified Camitz abductor plasty was performed. Active palmar abduction of thumb and pulp pinch strength were assessed. Patient-reported outcome measures were assessed using the Disabilities of the Arm, Shoulder, and Hand and Carpal Tunnel Syndrome instrument. As an electrophysiological assessment, compound muscle action potential (CMAP) from abductor pollicis brevis (APB) was investigated. Results At 3 months, active palmar abduction of thumb and pulp pinch strength significantly improved. Although pulp pinch strength further improved, active abduction of thumb did not improve at the final follow-up. Both the patient-reported outcome measures improved at 3 months and further improved at final follow-up. Approximately 75% of improved scores were obtained at the first 3 months after surgery and the balance of improved scores (25%) was obtained by the time of final follow-up. Useful recovery of postoperative APB-CMAP (amplitude > 1.8 mV) was obtained in 3 hands (7%) at 3 months after surgery and in 23 hands (50%) at final follow-up. There was no statistical significance of the postoperative results including active palmar abduction of thumb and improvement of patient-reported outcome measures at final follow-up between the hands with useful recovery of postoperative APB-CMAP and the hands without it. Conclusions Modified Camitz abductor plasty benefitted the early improvement of activity of daily living in patients with advanced carpal tunnel syndrome. It acted not only as an internal splint in patients who eventually recovered thenar muscle function but also as the sole palmar abductor of the thumb in patients who failed to recover useful thenar muscle function. Type of study/level of evidence Therapeutic IV.
    The Journal Of Hand Surgery 10/2014; 39(12). DOI:10.1016/j.jhsa.2014.09.008 · 1.67 Impact Factor
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    ABSTRACT: Radiation-induced brachial plexopathy is a delayed complication of radiation treatment for tumors involving the neck and chest area and is progressive. A 56-year-old woman presented to us with loss of elbow flexion and weak wrist and finger extension 15 years after she received external beam radiation to the left chest, axilla, and supraclavicular region for treatment of breast cancer. She was managed with a gracilis free muscle transfer for elbow flexion and hand prehension. By 2 years after surgery she regained elbow range of motion of 40° to 110° and improved in hand function. She was able to perform activities of daily living. Disabilities of the Arm, Shoulder, and Hand score improved from 56 to 20.
    The Journal Of Hand Surgery 10/2014; 39(10). DOI:10.1016/j.jhsa.2014.06.128 · 1.67 Impact Factor
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    ABSTRACT: Study design. This was a retrospective study of eight patients with Cervical Spondylotic Amyotrophy who underwent multiple muscle transfers.Objective. The purpose of this study was to evaluate results of multiple muscle transfers about the shoulder and elbow in patients with cervical spondylotic amyotrophy.Summary of Background Data. Cervical spondylotic amyotrophy is characterized by severe muscle atrophy of the shoulder girdle and elbow. Even after cervical spine surgery many patients have poor shoulder and elbow function.Methods. Multiple muscle transfer procedures including the transfer of trapezius, pectoralis major, latissimus dorsi muscles and Steindler's procedure for reconstruction of shoulder and elbow function were performed in eight patients with cervical spondylotic amyotrophy. Patients were evaluated at a mean of 18.2 months (range of 5-75 months).Results. All eight patients obtained satisfactory functional recovery with improvement of active range of motion without any systemic and local complications within three to six months postoperatively. Patients at last follow up had obtained a mean of 91 degrees of shoulder abduction, 111 degrees of shoulder flexion, 23 degrees of external rotation and 110 degrees of elbow flexion. Disabilities of the arm, shoulder and hand (Japanese version) disability score improved by a mean of 28 points.Conclusion. Multiple muscle transfers can improve shoulder and elbow function in cervical spondylotic amyotrophy, in cases of not only poor outcome following cervical surgery, but also in advanced paralysis. It is a useful set of procedures even in old patients, and provides definitive functional improvement of shoulder and elbow function from three to six months.
    Spine 07/2014; 39(21). DOI:10.1097/BRS.0000000000000523 · 2.30 Impact Factor
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    ABSTRACT: Hopkins syndrome is a rare cause of poliomyelitis-like paralysis affecting 1 or more extremities after an acute attack of asthma. The exact etiology of Hopkins syndrome is not known. A 4-year-old girl developed acute asthma followed by complete flaccid paralysis of the left upper extremity. She underwent staged reconstruction using the double free muscle transfer technique. Rigorous postoperative physiotherapy was carried out to achieve a good functional outcome. At recent follow-up, 27 months after the first procedure, the patient was able to effectively use the reconstructed hand for most daily activities. She had good control and could perform 2-handed activities. The selection of a suitable operative treatment and suitable donor nerves is critical, and there are no clear guidelines in the literature. The double free muscle transfer can be effectively employed in similar cases to restore grasping function.
    The Journal of hand surgery 02/2014; 39(2):312-316. DOI:10.1016/j.jhsa.2013.11.012 · 1.67 Impact Factor
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    ABSTRACT: Vascular trauma associated with brachial plexus injury affects the selection of reconstructive procedures. Often, there is a paucity of appropriate recipient vessels with adequate blood flow for functioning free muscle transfer. The presence of associated vascular injuries of the subclavian or axillary artery is considered a contraindication to the double free muscle technique. The authors hypothesized that vascular repair of subclavian or axillary artery trauma might not be necessary for successful reconstruction using the double free muscle technique, provided that the recipient arteries for functioning free muscle transfer (e.g., thoracoacromial and thoracodorsal arteries) are found to be patent on preoperative angiography. The authors investigated the pathway of collateral circulation and potential recipient vessels for functioning free muscle transfer reconstruction in 20 brachial plexus injury patients associated with subclavian or axillary artery trauma using multidetector-row computed tomographic angiography. Based on these findings, the authors restored upper extremity function using the double free muscle technique without surgical repair of the injury to the major vessel in three patients. The suprascapular artery was the major stem artery for collateral circulation, and the circumflex scapular and subscapular arteries were major reentry arteries. The authors successfully used the thoracoacromial and thoracodorsal arteries as the recipient vessels for functioning free muscle transfers in the double free muscle technique. The preliminary functional outcomes of all three cases were satisfactory. This study demonstrates the feasibility of double free muscle technique reconstruction in brachial plexus injury patients, without actual vascular repair for the associated subclavian or axillary artery trauma. Therapeutic, IV.
    Plastic and Reconstructive Surgery 12/2013; 132(6):1504-12. DOI:10.1097/PRS.0b013e3182a80616 · 2.99 Impact Factor
  • N G Satbhai · K Doi · Y Hattori · S Sakamoto ·
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    ABSTRACT: The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°-110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12-86). No donor site deficit was seen in any patient.
    11/2013; 39(8). DOI:10.1177/1753193413512245
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    ABSTRACT: Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores. Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure. The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of follow-up was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23° (range, 0° to 80°) for shoulder flexion, 31° (range, 0° to 90°) for shoulder abduction, -18° (range, -80° to 40°) for shoulder external rotation, 62° (range, 0° to 130°) for the shoulder rotation arc, 119° (range, 90° to 150°) for elbow flexion, and -33° (range, -60° to -20°) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was M0 in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46° (range, 0° to 98°), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure. Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 08/2013; 95(16):1505-12. DOI:10.2106/JBJS.K.01279 · 5.28 Impact Factor
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    ABSTRACT: Anatomic variations in branching pattern of axillary artery (AxA) are common and typically involve subscapular artery (SsA) and posterior circumflex humeral artery (PCHA). Several skin and muscle flaps are based on the branches of AxA. Furthermore, these branches are frequently used as recipient vessels in functioning free muscle transfers for upper extremity reconstruction and in breast reconstruction. Accurate knowledge of the normal anatomy and variations in branching pattern of AxA is of significant clinical importance for the reconstructive microsurgeon. The purpose of this article is to report the variable branching pattern of AxA based on multidetector-row computed tomography angiography study of 62 upper extremities. The thoracoacromial artery consistently originated from the first or second part of AxA. The classic origin and branching patterns of SsA and PCHA were observed in 21 cases (33.9%). Anatomic variations of SsA and PCHA were observed in 41 upper extremities (66.1%). In addition to the classic pattern, five distinct variations were noted.
    Journal of Reconstructive Microsurgery 07/2013; 29(8). DOI:10.1055/s-0033-1351354 · 1.31 Impact Factor
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    ABSTRACT: Outcomes of Kanaya's procedure for congenital proximal radioulnar synostosis varied depending on the type of radial head dislocation. In our series of 14 patients with 17 forearms who underwent Kanaya's original procedure, the postoperative total rotation arc of the forearm was unsatisfactory in cases with posterior radial head dislocation. We examined the outcomes with respect to the type of radial head dislocation and radial shaft curvature. Radial shafts with a posterior radial head dislocation had only one curve and the radii of the curve were statistically smaller than those in anterior dislocated or enlocated heads, which had two curves. As a result, we modified the osteotomy site for proximal radioulnar synostosis with posterior radial head dislocation and achieved improved forearm rotation and physiological rotation of the radial head in our latest two cases.
    07/2013; 39(5). DOI:10.1177/1753193413493386
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    ABSTRACT: The strategy of limb salvage following surgical resection of skeletal tumor has led to an increased demand for more complex reconstructive options in order to achieve better functional outcomes. Functional neuro-vascularized muscle transfer (FMT) is a beneficial tool for restoring joint movement involving the reconstruction of "movement" in the affected extremity. Until now, however, the clinical application of FMT was mainly limited to trauma cases and to date, very few studies have focused on musculoskeletal oncology. In this study, we reviewed patients who underwent wide resection for extremity sarcoma and functional reconstruction using FMT and discussed the advantages, indications and complications of the procedure.
    Surgical Oncology 07/2012; 21(4):263-8. DOI:10.1016/j.suronc.2012.06.005 · 3.27 Impact Factor
  • Soo-Heong Tan · Mitsunori Shigetomi · Kazuteru Doi ·
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    ABSTRACT: This experiment establishes the principles of using the compound muscle action potential (CMAP) as a possible postoperative monitor for free muscle grafts. Twenty rabbits were divided into two groups of ten each to investigate the effects of ischemia on CMAP of the muscles. Rectus femoris model was used and contralateral muscle was used as control. In all muscles total normothermic ischemia of 1.5 hours to mimic the time needed for transfer and inset of the flap was followed by occlusion of the artery in one group and vein in another group after 3 hours. During this ischemia of 1 hour, the CMAP amplitudes decreased and the latencies were prolonged. Latency prolongation was detected within 10 minutes of total, arterial, or venous ischemia. During the revascularization, both amplitude and latency improved, but not to the original values at the start. The results show that CMAP monitoring can provide easily detectable, objective indication of vascular compromise to a muscle graft within as early as 10 minutes of total, arterial, and venous ischemia. Changes in latency are more constant and predictable compared with amplitude changes. This method can provide continuous monitoring and can be used in buried muscle grafts.
    Journal of Reconstructive Microsurgery 06/2012; 28(6):387-93. DOI:10.1055/s-0032-1315761 · 1.31 Impact Factor
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    ABSTRACT: Full range of motion and powerful shoulder abduction can be performed without any deltoid muscle function by the supplemental action of the supraspinatus and biceps brachii muscles. For evaluation of deltoid muscle function, we need to negate these actions, which can be done with the "akimbo test," in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm. We examined the akimbo test in five patients with incomplete upper-type brachial plexus injury, five patients with suprascapular nerve palsy, and six patients with axillary nerve palsy. Presence of some abduction is a prerequisite to perform this test. No patient with incomplete upper-type brachial plexus injury could demonstrate this sign when the deltoid did not show a certain level of the power to abduct the shoulder joint. All patients with suprascapular nerve could demonstrate this sign as the deltoid was normal. No patient with axillary nerve paralysis could demonstrate this sign. The akimbo test is a simple clinical test to determine deltoid muscle paralysis or dysfunction, especially when patients can demonstrate shoulder abduction due to supplementary action of other muscles.
    Journal of Reconstructive Microsurgery 05/2012; 28(6):375-9. DOI:10.1055/s-0032-1313772 · 1.31 Impact Factor
  • Chaitanya Dodakundi · Yasunori Hattori · Kazuteru Doi ·
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    ABSTRACT: Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit.
    Journal of Reconstructive Microsurgery 04/2012; 28(5):297-300. DOI:10.1055/s-0032-1311684 · 1.31 Impact Factor
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    ABSTRACT: Conventional skin flap monitoring is one of the widely used methods to assess postoperative circulation in innervated free muscle transfer (IFMT). However, following reexploration for vascular compromise and reestablishing circulation, functional recovery of the muscle despite surviving skin flap is not clear. The purpose of this article is to report three such cases and determine the reliability of viable skin flap in an IFMT with a second ischemic event. Long-term functional results were assessed in terms of reinnervation time, elbow range of motion, strength of elbow flexion, finger function in terms of total active motion, and power lifting with hook grip. These IFMTs developed complete or partial necrosis of the muscle and could not obtain satisfactory function. The conventional monitoring of the skin flap did not promptly reflect vascularity of IFMT, and a surviving skin flap after reexploration for compromised vascularity does not guarantee complete survival of the muscle. There is a need for earlier and rapid detection of vascular compromise in IFMTs.
    Journal of Reconstructive Microsurgery 04/2012; 28(4):267-71. DOI:10.1055/s-0032-1311681 · 1.31 Impact Factor
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    ABSTRACT: We report an unusual case of proximal interphalangeal joint locking of the ring finger due to the neglected flexor digitorum profundus avulsion. Although rare, it should be noted that locking is a potential complication after this injury.
    Hand Surgery 04/2012; 17(1):115-6. DOI:10.1142/S0218810412720094

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