Kotaro Yoshimura

• M.D.
• Chair at Jichi Medical University

Orchestrated hormonal interactions in response to feeding and fasting play a pivotal role in regulating glucose homeostasis. Here, we show that in obesity, the production of follistatin-like 3 (FSTL3), an endogenous inhibitor of Activin B, in adipose tissue is increased in both mice and humans. The knockdown of FSTL3 improves insulin sensitivity an...

Background The pathogenesis of deterministic radiation damage is not clearly understood, but it has been reported that fibroinflammatory pathways are up-regulated. We hypothesized that the number of adipose-derived stem/stromal cells (ASCs) decline after radiotherapies, preventing normalization of fibrosis and angiogenesis, resulting in chronic rad...

Run-over injuries, particularly those involving burns from vehicle exhaust systems, present significant challenges due to the complexity of associated trauma. This report details two cases where enzymatic debridement using anacaulase was employed for burns sustained during run-over incidents. Both cases involved extensive injuries, including fractu...

Background Breast cancer survival rates have increased significantly, underscoring the importance of enhancing long-term health-related quality of life. Breast reconstruction following mastectomy has emerged as a common approach that contributes to improved health-related quality of life. Nonetheless, chronic pain following breast reconstruction is...

Background Chronic pain is relatively common after breast cancer surgery, including breast reconstruction. Autologous fat grafting (AFG) has gained attention as a novel method for breast reconstruction, and recent clinical studies have also shown effects of AFG on alleviation of chronic pain after breast cancer surgery. Our objective was to conduct...

Lymphaticovenous anastomosis (LVA), which involves connecting lymphatic vessels to veins under a microscope, is widely performed around the world as a surgical treatment for lymphedema due to its relatively low patient burden and consistent efficacy. One of the crucial points of LVA is identifying suitable lymphatic vessels from among many lymphati...

Background Radiation therapies are often associated with permanent devitalization in the surrounding tissue. We hypothesized that stem cells are damaged depending on each irradiation dose and frequency of fractionated radiotherapies, which results in impaired tissue function including wound healing capacity. Methods To test the hypothesis, suscept...

Background: Co-transplantation of adipose-derived stem cells (ASCs) and endothelial progenitor cells (EPCs) has shown superior angiogenic effects than ASCs alone in recent animal studies. However, EPCs could only be collected from blood vessels or bone marrow. Thus, we have established a method for purifying adipose-derived endothelial progenitor...

Unlabelled: Fat grafting has established its niche in a wide spectrum of aesthetic and reconstructive procedures. A consensus-based method of harvest, processing, enrichment, injection, and assessment is lacking, despite the rising trends in its application. We conducted a survey among plastic surgeons to evaluate and identify trends of fat grafti...

INTRODUCTION: Fat grafting has revolutionized plastic surgery practices since Coleman brought it to the frontline in 1995, and it is now used in a variety of areas ranging from breast reconstruction to regenerative medicine. However, due to a lack of evidence-based studies, multicenter, prospective, and/or randomized trials, we still don’t recogniz...

Wearable sensors have seen remarkable recent technological developments, and their role in healthcare is expected to expand. Specifically, monitoring tissue circulation in patients who have undergone reconstructive surgery is critical because blood flow deficiencies must be rescued within hours or the transplant will fail due to thrombosis/haematom...

Bradycardia and asystole due to oculocardiac reflex (OCR) are potential intraoperative complications of periocular surgery. We report a case of asystole due to OCR that occurred during surgical repair performed 40 hours after an orbital blowout fracture. The patient had vomiting, bradycardia, and ocular motility disorder before the operation. Durin...

The sagittal split ramus osteotomy (SSRO) has been performed mainly on an inpatient basis because of the duration of anaesthesia and the potential risk of postoperative complications, such as bleeding, pain, nausea, and vomiting. However, advances in both surgical and anaesthetic management have enabled the reduction of these risks and shortened th...

Background The authors recently performed plastic surgeries for a small number of patients with hemophilia, HIV infection, and morphologic evidence of lipodystrophy. Because the pathophysiological mechanism of HIV-associated lipodystrophy remains to be elucidated, we analyzed subcutaneous adipose tissues from the patients. Methods All six patients...

Human adipose tissue is a rich source of adipose-derived stem cells (ASCs) and vascular endothelial progenitor cells (EPCs). However, no standardized method has been established for the isolation and purification of adipose-derived EPCs (AEPCs). The aim of this study was to establish a method for the isolation and purification of AEPCs. The stromal...

End-to-side anastomosis requires highly specialized techniques. An easy end-to-side anastomosis technique enables anastomosis of vessels with different diameters and under various situations. We invented T-shaped metal stents and evaluated novel methods of end-to-side sutureless anastomosis, confirming their safety, effectiveness, and operability....

Adipose-derived stem cells (ASCs) have been growing in popularity for their potential in wound healing and tissue engineering. Stem cell therapies are limited in application, with the need to maintain cell viability and function as well as safety concerns. It has been increasingly reported that the effects of ASCs are predominantly attributable to...

Frontometaphyseal dysplasia (FMD), also known as Gorlin-Cohen syndrome, is a rare genetic syndrome. This syndrome affects the skeletal system and connective tissue, and causes a wide spectrum of manifestations of the skull, tubular bones, cardiovascular system, urinary system, and/or gastrointestinal system. Craniofacial findings of FMD are charact...

Therapeutic effects of adult stem-cell transplantations are limited by poor cell-retention in target organs, and a reduced potential for optimal cell differentiation compared to embryonic stem cells. However, contemporary studies have indicated heterogeneity within adult stem-cell pools, and a novel culturing technique may address these limitations...

Aim: We aimed to describe the clinical presentation, operative or medical management, and postoperative recurrence of bladder endometriosis (BE). Methods: We conducted a national survey to investigate BE cases from 2006 to 2016 in Japan. Histologically diagnosed cases were extracted and then investigated for the following factors: age at diagnos...

The aim of this publication is to disseminate the clinical practice guidelines for the treatment of intestinal, bladder/ureteral, thoracic and umbilical endometriosis, already published in Japanese, to non-Japanese speakers. For developing the original Japanese guidelines, the clinical practice guideline committee was formed by the research team fo...

Filler injection demand is increasing worldwide, but no ideal filler with safety and longevity currently exists. Sodium alginate (SA) is the sodium salt of alginic acid, which is a polymeric polysaccharide obtained by linear polymerization of two types of uronic acid, d-mannuronic acid (M) and l-guluronic acid (G). This study aimed to evaluate the...

Background Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis.Methods To overcome the problems with lipoinjection, the authors developed a novel strategy known as cellassisted lipotransfer (CAL). In CAL, autologous adiposederived stem (stromal) cells (ASCs)...

Alopecia has several causes, but its relationship with ischemia/hypoxia has not yet been investigated in detail. In this study, we studied the changes of hair follicles induced by ischemia and potential effects of normobaric hyperoxygenation (NBO) on the hair cycle and growth. We found that skin ischemia reduced hair growth rate, hair shaft size, a...

We investigated the effect of oxygen tension on the proliferation and hair-inductive capacity of human dermal papilla cells (DPCs) and dermal sheath cells (DSCs). DPCs and DSCs were separately obtained from human hair follicles and each cultured under atmospheric/hyperoxic (20% O2), physiological/normoxic (6% O2), or hypoxic (1% O2) conditions. Pro...

Study objective: To identify the clinical presentation, diagnostic evaluation, operative or medical management, and postoperative recurrence of umbilical endometriosis. Design: A retrospective national survey. Setting: Obstetrics and Gynecology and Plastic Surgery Departments at a teaching hospital in Japan. Patients: Patients with umbilical...

Fronto-orbital advancement by distraction osteogenesis is a useful means of surgically correcting bicoronal synostosis. However, the scope for morphological revision is limited. To address this issue, we developed a multidirectional cranial distraction osteogenesis (MCDO) technique that we quantitatively assessed in patients with bicoronal synostos...

Signs of aging in facial skin correlate with lifespan and chronic disease; however, the health of aging skin has not been extensively studied. In healthy young skin, the dermis forms a type III collagen-rich dermal papilla, where capillary vessels supply oxygen and nutrients to basal epidermal cells. Chicken eggshell membranes (ESMs) have been used...

Background Salvia miltiorrhiza (SM) is a herb used in Chinese medicine formulations for promoting blood circulation and minimizing vascular stasis. It has been successfully utilized in treating cardiovascular diseases, such as atherosclerosis, thromboembolism, and angina. Objective To study the effect of SM injections in autologous fat grafting to...

Background: Insufficient narrowing of alar width, alar distortion, and noticeable scarring are commonly encountered after alar base reduction. The authors aimed to demonstrate an alar cinching with subcutaneous flaps procedure to reduce the alar width while controlling the alar axis and sidewall curvature. Methods: A retrospective chart review o...

Background: Previously, the authors developed a new method of distraction osteogenesis for the treatment of craniosynostosis, multidirectional cranial distraction osteogenesis (MCDO). The purpose of this study is to review the authors' experience of MCDO for remodeling of the anterior cranium in the patients of craniosynostosis. Methods: Forty-f...

Background:. Dermabond Advanced (DBA) has been widely used globally; however, severe contact dermatitis (CD) can be a serious adverse effect of DBA use. In this study, we investigated the characterization and incidence rate of CD after using DBA and the safe use of DBA. Methods:. One hundred consecutive patients who underwent skin closure with DBA...

Two medications for androgenetic alopecia, finasteride and minoxidil, have evidence to support their use but with only moderate success. Hair transplantation, a surgical technique for various types of hair loss, is limited by the number of har-vestable grafts. Stem and dermal papilla cells have been discovered in hair follicles. Research on these f...

Background: Clinical sequelae of irradiation (ischemia, fibrosis, and atrophy) result in tissue devitalization, where wound healing capacity is impaired. Fat or fat-derived products may work to treat such pathology. Methods: Non-lethal irradiation at various doses (5 Gy, 10 Gy, 15 Gy) and frequencies (1-3 times on sequential days) was delivered...

Tumoral calcinosis is a rare condition in which a calcified mass grows around a large joint, and can occur in patients undergoing renal dialysis. Here, we report the case of a 64-year-old man with a long history of dialysis who presented with a giant, painless mass in his right shoulder joint. A near-complete surgical resection is performed without...

Chronic changes following radiotherapy include alterations in tissue-resident stem cells and vasculatures, which can lead to impaired wound healing. In this study, novel recombinant human collagen peptide (rhCP) scaffolds were evaluated as a biomaterial carrier for cellular regenerative therapy. Human adipose-derived stem cells (hASCs) were success...

For chronic wounds, the delivery of stem cells in spheroidal structures can enhance graft survival and stem cell potency. We describe an easy method for the 3D culture of adipose-derived stem/stromal cells (ASCs) to prepare a ready-to-use injectable. We transferred suspensions of monolayer-cultured ASCs to a syringe containing hyaluronic acid (HA)...

Compromised circulation is a potential complication during the postoperative period following tissue transplantation. The use of a monitoring device allows physicians to detect compromised circulation immediately. Such monitoring devices need to be continuously usable, wearable, and area-detectable. However, existing devices fail to satisfy all of...

Patients with syndromic craniosynostosis often require a large amount of cranial expansion to avoid intracranial hypertension, but the surgical procedure remains controversial. A patient of severe syndromic craniosynostosis with multiple bony defects and anomalous venous drainage at the occipital region was treated by multidirectional cranial distr...

Background:. Multidirectional cranial distraction osteogenesis (MCDO) is a procedure of ours developed earlier for treating craniosynostosis. However, the numerous bone flaps led to prolonged operative time and occasional bone detachment from dura. We have since simplified the osteotomy design. In treating sagittal synostosis, required bone flaps h...

Background: Fat grafting frequently requires multiple treatments and thus repeated liposuction to achieve treatment goals. The purpose of this study is to evaluate whether cryopreservation of adipose tissue may facilitate future fat grafting. Methods: Lipoaspirates were harvested from six adult females and preserved using two cryopreservation me...

Background: Although the charting of normal intracranial volume (ICV) is fundamental for managing craniosynostosis, Asian norms in this regard are unknown. The purpose of this study was to establish a growth curve for ICVs in a large series of normal Asian children, providing reference values to guide corrective surgery. Methods: A total of 124...

Background: The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (msTRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps is superior. We aimed to co...

Anteromedial maxillectomy is typically performed in conjunction with low-dose radiotherapy and intraarterial chemotherapy. In doing so, the extent of surgical defects is reduced. However, nasal deviation and oral incompetence may ensue, due to cicatricial contracture of wounds, and may be distressing to these patients. Herein, we report a series of...

Takotsubo cardiomyopathy (TCM) is a form of transient heart failure that clinically mimics acute coronary syndrome and is characterized by left ventricular wall motion abnormalities. The pathophysiology of TCM is not well established. TCM is often preceded by emotional or physical stress and may occur after surgery. We present 3 cases of TCM occurr...

Background: The proximal ends of internal mammary (IM) vessels are now the most common recipient vessels for breast reconstruction. On the other hand, bilateral deep inferior epigastric artery perforator (DIEP) flaps are often needed according to the territory and the volume required for reconstruction. The usefulness of retrograde IM vessels as s...

Background Keloids are a dermal fibroproliferative scar of unknown etiology. There is no good animal model for the study of keloids, which hinders the development and assessment of treatments for keloids. Methods Human keratinocytes and dermal fibroblasts were isolated from 3 human skin tissues: normal skin, white scars, and keloids. A mixed-cell...

Background: There is no standard method to ensure survival of random-pattern skin flaps. The authors developed a rat anemia model to observe survival of random-pattern skin flaps after blood transfusion and hemodilution. Methods: Anemia was induced by withdrawal of 35 percent blood volume followed by compensation with the same amount of blood (b...

Background: The pathophysiology of lymphedema is poorly understood. Current treatment options include compression therapy, resection, liposuction, and lymphatic microsurgery, but determining the optimal treatment approach for each patient remains challenging. Objectives: We characterized skin and adipose tissue alterations in the setting of seco...

Background Immediate autologous breast reconstruction after skin-sparing mastectomy is an esthetically superior method, and a free abdominal flap is often used. However, in Asian patients, little redundant abdominal skin and thin subcutaneous tissue are common, necessitating the development of a more suitable flap design and setting. We devised a n...

Fat grafts are valuable for soft-tissue regeneration and augmentation. However, fat graft systems require further improvement for the prediction of graft retention. The concentration of adipose-derived stromal/stem cells (ASCs) is one of the most important factors that affect graft retention; however, current cell quantification techniques have not...

Serious lip injuries can occur during orthognathic surgery. Although an Angle Wider device, which is commonly used during orthognathic surgery, provides some lip protection, it leaves more than half of the lip exposed to surgical instruments. Here, we describe a novel technique to protect the entire upper and lower lips during orthognathic surgery...

Immediate reconstruction of orbitomaxillary defects is challenging for head and neck reconstructive surgeons. The primary goals of orbitomaxillary reconstruction are to cover the skin and mucosal defects, fill the defect space, and reconstruct the natural facial contour. In this report, two patients who underwent extended orbitomaxillectomy and imm...

A deep burn wound is a critical condition that generally necessitates vascularized tissue coverage. We performed the injection of platelet-derived factor concentrates combined with non–cross-linked hyaluronic acid scaffolds for 2 patients with critical burn wounds with bone and tendon exposure and achieved successful healing. Hyaluronic acid was co...

Introduction: Condensation of grafted fat has been considered a key for achieving better outcomes after fat grafting. The purpose of this study was to investigate the therapeutic potentials of two mechanical tissue micronizing procedures: squeeze and emulsification. Materials and methods: Human aspirated fat was centrifuged (centrifuged fat: CF)...

Background and aim: The reduced incidence of donor site morbidity after deep inferior epigastric perforator (DIEP) flap is because the rectus muscle and its fascia are preserved. However, no study has proved that trunk flexion recovers not by the compensatory effect of the contralateral rectus muscle but by reinnervation of the ipsilateral rectus...

Autologous fat graft is now established as a useful method for breast reconstruction, but the unpredictable rate of graft survival has proven problematic. We have previously introduced our method of Cell Assisted Lipotransfer (CAL) to improve graft survival rate. In this report, we describe a novel method using multiple CAL sessions to completely r...

Autologous free fat grafting and lipoinjection have a history of 120 years for the treatment of deformity. The change of transplantation techniques from excised adipose tissue grafting to lipoinjection, development of techniques of liposuction and lipoinjection, and discovery of adipose-derived stem and stromal cells have provided major advancement...

Although various injection techniques of hyaluronic acid (HA) filler for facial rejuvenation have been developed, correction of deep wrinkles/grooves, such as the nasolabial fold (NLF), with intradermal or subdermal injections remains difficult. We tested the intradermal HA injection method to place multiple HA struts by (1) inserting a small needl...

Unlabelled: Three-dimensional culture of mesenchymal stem/stromal cells for spheroid formation is known to enhance their therapeutic potential for regenerative medicine. Spheroids were prepared by culturing human adipose-derived stem/stromal cells (hASCs) in a non-cross-linked hyaluronic acid (HA) gel and compared with dissociated hASCs and hASC s...

Background: Despite the clinical potential of adipose-derived stem/stromal cells (ASCs), there are some clinical difficulties due to the regulation of cell therapies. Materials & methods: Micronized cellular adipose matrix (MCAM) injectable was prepared through selective extraction of connective tissue fractions in fat tissue only through mechan...

Ionizing radiation is often used to treat progressive neoplasms. However, the consequences of long-term radiation exposure to healthy skin tissue are poorly understood. We aimed to evaluate the short- and long-term radiation damage to healthy skin of the same irradiation given either as single or fractional doses. C57BL/J6 mice were randomly assign...

Recent technical and scientific advances in fat grafting procedures and concepts have improved predictability of fat grafting. Large-volume fat injection is gaining much attention as an attracting procedure for body contouring and reconstruction, but an increasing number of complications also has been recognized over the world. In this article, typ...

The demand for minimally invasive procedures has increased over the years in the field of cosmetic surgery, and we here introduce a novel facial rejuvenation procedure which uses pneumatic injection of hyaluronic acid and hypertonic glucose solution. We mixed 1 mL non-crosslinked hyaluronic acid (HA) and 9 mL 20% glucose solution, and injected the...

Autologous fat grafting is an exciting part of plastic and reconstructive surgery. Fat serves as a filler and its role in tissue regeneration will likely play a more important role in our specialty. As we learn more about the basic science of fat grafting and the standardized techniques and instruments used for fat grafting, this procedure alone or...

Deep-tissue injury (DTI) is a unique type of pressure ulcer (PU) in which deep-tissue damage expands outwards to the superficial skin. DTI progresses rapidly into a severe PU, despite initially appearing as only a bruise or darkened tissue in the superficial skin. Although some DTI detection methods are available, there is currently no strategy for...

Recent research indicates that the adipose tissue of non-vascularized grafts is completely remodeled within 3 months, although origins of next-generation cells are unclear. Inguinal fat pads of GFP mice and wild-type mice were cross-transplanted beneath the scalp. At 1, 2, 4, and 12 weeks post-transplantation, grafted fat was harvested, weighed and...

Aspirated fat contains unnecessary components such as water, oil, and blood cells. For better outcomes, tissue purification and condensation are useful, especially when injection volume to the recipient site is limited. Because aspirated fat is relatively poor in adipose-derived stem/stromal cells (ASCs), ASC condensation seems important for obtain...

Autologous fat grafting has become an important procedure for volumization and revitalization, although clinical outcomes depend greatly on technique. It was revealed recently how grafted fat tissue survives, regenerates, or dies. Experimental results provided the underlying mechanism and clinical implications for therapeutic strategies to maximize...

Stage-specific embryonic antigen-3 (SSEA-3)-positive multipotent mesenchymal cells (multilineage differentiating stress-enduring [Muse] cells) were isolated from cultured human adipose tissue-derived stem/stromal cells (hASCs) and characterized, and their therapeutic potential for treating diabetic skin ulcers was evaluated. Cultured hASCs were sep...

Various types of hyperpigmented skin lesions exist. Asians frequently experience postinflammatory hyperpigmentation in association with aggressive treatments, and accurate clinical diagnosis is crucial for their appropriate management. In this article, we classified hyperpigmented lesions according to pigment localization : epidermal, dermal melano...

Autologous fat grafting is a common and safe method of treatment for volume and contour defects in plastic surgery. In this study, cell-assisted lipotransfer (CAL) was used to treat 18 patients (age range, 16 to 60 years) with chest wall deformity or mammary hypoplasia from 2006 to 2012. Included in this series were 3 Poland's syndrome, 2 unilatera...

Background: Fat grafting is a promising modality for soft-tissue augmentation/reconstruction. However, grafted fat tissue is not initially perfused and relies on plasmatic diffusion from the recipient bed until revascularization occurs. The authors evaluated the therapeutic effects of normobaric hyperoxygenation for enhancing fat graft retention....

Autologous fat injection into the breast has been performed widely for breast augmentation and reconstruction because of recent technical and scientific advancements. However, it is important to learn what occurs and how problematic it can be if fat grafting is not conducted appropriately. Oil cysts were explanted from three subjects who underwent...

Background: Hyperbaric oxygenation has been used for various purposes, but its clinical application is limited due to its pulmonary toxicity. We evaluated the therapeutic value of normobaric hyperoxygenation (NBO) for vascularized and nonvascularized tissue transplantation. Methods: Tissue oxygen partial pressure (PtO2) was measured for various or...

Adipose tissue contains multipotent stem/progenitor cells, which are present perivascularly between adipocytes. Adipose stem cells (ASCs) play crucial roles not only in the physiological turnover of adipocytes and capillaries but also in post-injury tissue repair. ASCs have been utilized in cell-assisted lipotransfer for the treatment of facial lip...

Fat grafting is promising, but clinical outcomes are not always predictable. The mechanisms of tissue revascularization/regeneration, and tissue necrosis and subsequent absorption/fibrosis of the graft, are poorly understood. An autologous inguinal fat pad was transplanted under the scalp of mice, and detailed cellular events during the first 3 mon...

Adipose-derived stem/progenitor cells (ASCs) are typically obtained from the lipoaspirates; however, a smaller number of ASCs can be isolated without enzymatic digestion from the infranatant liposuction aspirate fluid (LAF). We evaluated the effectiveness of an adherent column, currently used to isolate mesenchymal stromal cells from bone marrow, t...