Rei Ogawa

Nippon Medical School · Department of Plastic and Reconstructive Surgery

Congenital antithrombin III deficiency is an inherited disorder associated with a tendency toward thrombosis. As laboratory findings are not always correlated with the clinical severity, there is no standardized approach for the treatment of leg ulcers, which are often associated with disease or perioperative anticoagulation management. We herein r...

We present a technique for treating orbital floor fractures using three-dimensional (3D) printing technology and a preoperative template based on the mirror image of the unaffected orbit. Our patient, a 56-year-old man, experienced persistent diplopia in the upward direction and left enophthalmos after previous open reduction internal fixation surg...

Axillary accessory breast (AAB) occurs in 2%–6% of women. Like normal breast tissue, ABB can undergo changes, including periodic enlargement that can result in a palpable axillary mass. Fibroadenoma is the most common benign subcutaneous tumor of the breast: it occurs in approximately 25% of women and accounts for 50% of all breast biopsies. Howeve...

Objectives Aneurysmal dermatofibroma (ADF) and hemosiderotic dermatofibroma (HDF) are rare variants of dermatofibroma (DF) characterized by distinct histologic features. While HDF is traditionally considered a precursor to ADF, supporting evidence is limited, and the etiology remains unclear. A retrospective analysis of 2128 DF cases (2016-2019) wa...

Abdominal surgery can cause notable scars that adhere to the abdominal tissues below. Full scar removal is generally not recommended due to the risk of intestinal damage and delayed wound healing. Here, we describe a surgical scar-revision procedure for adherent abdominal scars that does not involve either opening the abdominal cavity or total scar...

Impaired microcirculation can cause lymphatic leakage which leads to a chronic swelling in the tissues of the body. However, no successful treatment gives any protection against lymphedema due to the lack of well-revealed pathophysiology of secondary lymphedema. Binary image of laminin immunohistochemical expression revealed that distribution of la...

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken heart syndrome, generally has a good prognosis but occasionally causes serious complications. It is often triggered by physical and emotional stressors. Burns have been associated with takotsubo cardiomyopathy in six cases in the literature. We report here the seventh c...

Sternal osteomyelitis is a rare but devastating complication of median sternotomy. To achieve good outcomes, it should be diagnosed early and treated appropriately. Standard treatment involves antibiotics, debridement, and reconstruction with flaps. To prevent flap complications and recurrence, the wound bed must be prepared carefully. One approach...

To computationally investigate the recent experimental finding such that extracellular ATP release caused by exogeneous mechanical forces promote wound closure, we introduce a mathematical model, the Cellular Potts Model (CPM), which is a popular discretized model on a lattice, where the movement of a “cell” is determined by a Monte Carlo procedure...

Unlabelled: Lumbar sympathetic nerve block (LSNB) improves blood flow in the lower limbs and relieves pain involving the sympathetic afferents. This study examines the use of LSNB, but there are no reports of its use for the purpose of wound healing. Therefore, the authors planned the following study. Methods: An ischemic limb ulcer was created...

Pathological scars (including keloids, hypertrophic scars, and scar contractures) are present with high severity among certain populations, particularly in Asians and Africans who are highly prone to develop scars. Understanding the patho-mechanism that underlies scarring, such as mechanosignaling, systemic, and genetic factors, as well as optimal...

Unlabelled: Keloids are fibroproliferative lesions caused by abnormal dermal wound healing. Keloidal collagen (KC) is a pathognomic feature of keloids, but the mechanism by which it forms is unknown. This study aimed to evaluate the histopathology of KC and thereby gain clues into how it forms. Methods: The cross-sectional study cohort consisted...

Keloids are benign fibroproliferative skin tumors caused by aberrant wound healing that can negatively impact patient quality of life. The lack of animal models has limited research on pathogenesis or developing effective treatments, and the etiology of keloids remains unknown. Here, we found that the characteristics of stem cells from keloid lesio...

Fibroma of tendon sheath (FTS) is a rare soft tissue tumor that usually occurs in the upper extremity. Moreover, of the few cases reported in the feet, nearly all occur in the plantar region. We report the case of a large FTS in the dorsum of the left foot that grew quickly into a 4 cm-diameter lesion. The 44-year-old Japanese man noticed the tumor...

Dermatofibroma is a common benign skin lesion with a contested etiology: some believe it is a neoplasm while others propose minor injuries initiate it. Many dermatofibroma variants have been described, including keloidal dermatofibroma, which is unusual by bearing keloidal collagen. Keloidal dermatofibroma was first described in 1998 and only 15 ca...

No standards for the assessment of axillary odor intensity and the effects of therapy for osmidrosis have been established. This study presents an objective method for assessing odor severity in patients with osmidrosis and investigates the volatile odorants and skin flora. Methods: The odor intensity was measured pre- and postoperatively using a...

IntroductionMost lipomas are readily dissected and removed. However, some cases can pose surgical difficulties. This retrospective study sought to identify clinical and radiological risk factors that predict difficult lipoma resection and can be used in a clinically useful scoring system that predicts difficulty preoperatively.Methods The study coh...

To computationally investigate the recent experimental finding such that extracellular ATP release caused by exogeneous mechanical forces promote wound closure, we introduce a mathematical model, the Cellular Pots Model (CPM), which is a popular discretized model on a lattice, where the movement of a "cell" is determined by a Monte Carlo procedure....

Background: Soft-tissue defects in the hand and digits can be effectively covered by using the free superficial palmar branch of radial artery (SPBRA) flap, which is harvested from the radial volar wrist. Since previous anatomical studies on this flap are limited, multidetector-row computed tomography (MDCT) angiography of the upper limbs was cond...

Background: Key risk factors for hypertrophic scarring and surgical site infections are high tension on the wound, fat necrosis, and dead space. All could be prevented by appropriate superficial fascia (SF) suturing. To improve SF suturing, the as-yet poorly researched anatomy of the SF should be delineated. This study is the first to quantify SF...

Background: Surgery is a well-known trigger of keloid and hypertrophic scarring. Sternotomy scars are subject to high skin tension, which is also known to promote pathological scarring. This suggests that sternotomies in adults associate with high pathological-scarring rates, which is also our anecdotal experience. However, this notion has never b...

Keloids and hypertrophic scars are pathological cutaneous scars. They arise from excessive wound healing, which induces chronic dermal inflammation and results in overwhelming fibroblast production of extracellular matrix. Their etiology is unclear. Inflammasomes are multiprotein complexes that are important in proinflammatory innate-immune system...

Keloids are red' invasive scars that are driven by chronic inflammation in the reticular dermis. The role of blood vessels in keloid behavior remains poorly understood. In the present study with 32 keloid patients, we examined the hemodynamics of keloid tissue, the anatomy of the blood vessels feeding and draining the keloids, and the vascular hist...

Cutaneous ossification is a rare, benign dermatological condition where bone forms in the dermis or subcutaneous tissue. It is classified as primary when it emerges without a pre-existing condition and secondary when it associates with an underlying condition such as trauma, scars, inflammation, and neoplastic disease. The secondary form accounts f...

Background High‐resolution manometry, which measures esophageal luminal pressure changes after swallowing, could shed more light on food‐transport dynamics after pharyngeal/esophageal reconstruction. This prospective cohort study assessed the influence of two head‐and‐neck and esophageal tumor‐resection and reconstruction approaches on esophageal p...

Excessive mechanical forces, particularly skin stretch, have been implicated in pathological cutaneous scarring. We hypothesize that this reflects, in part, stretch-induced vessel leakage that provokes prolonged wound/scar inflammation. However, this has never been observed directly. Here, a mouse model was used to examine the effect of skin flap s...

Keloids are laterally growing fibroproliferative skin disorders. In severe cases, keloids spread widely, sometimes over joints, thus significantly limiting motor function. Severe keloids also associate with repeated and very painful draining infections. Here, we report the case of a giant keloid that was successfully treated by combination therapy...

Hidradenomas are relatively rare benign tumors in the dermis that differentiate into eccrine or apocrine sweat glands. They often present as round or oval nodules and vary in color. Generally, they occur in the head and neck region. Keloid scars are often red, elevated lesions that are caused by chronic inflammation in the reticular dermis. These s...

Purpose: Surgical Site Infections (SSIs) and Hypertrophic scars (HSs) are the most common complications of wound healing. Most SSIs are superficial infections involving the skin and subcutaneous tissue (SQ) only. Abnormal scaring is driven by ongoing dermal inflammation in high skin tension areas (e.g. anterior and posterior chest). For prevention,...

Keloids are fibrotic lesions that grow unceasingly and invasively and are driven by local mechanical stimuli. Unlike other fibrotic diseases and normal wound healing, keloids exhibit little transformation of dermal fibroblasts into α‐SMA+ myofibroblasts. This study showed that asporin is the most strongly expressed gene in keloids and its gene‐onto...

In general, facial nerve palsy is treated by reconstructive surgeons, and the role of cosmetic surgeons is largely seen as secondary. The present report describes a case of refractory facial nerve palsy that arose after malignant parotid-tumor resection and high-dose radiotherapy, and that we reconstructed with a combination of cosmetic and reconst...

Introduction Keloids are pathological scars that are notorious for their chronic and relentless invasion into adjacent healthy skin, with commonly seen post-therapeutic recurrence after monotherapies. Methods An English literature review on keloid pathophysiology was performed by searching the PubMed, Embase and Web of Science databases, to find o...

Background: Neovascularization plays a critical role in skin graft survival. Up to date, the lack of specificity to solely track the newly sprouting blood vessels has remained a limiting factor in skin graft transplantation models. Therefore, the authors developed a new model by using Flt1-tdsRed BAC transgenic mice. Flt1 is a vascular endothelial...

The term carcinoma of unknown primary (CUP) refers to a malignant tumor whose histology suggests strongly that it is a metastasis, yet the primary lesion is unknown despite sufficient whole body evaluation at the time of examination. CUP has similar incidences in men and women and the average age at diagnosis is 60 years. While its overall incidenc...

We previously reported cases of anterior-neck reconstruction using super-thin and perforator-supercharged skin-pedicled flaps harvested from the pectoral area and back. Here, we reconstructed a neck-scar contracture with a long skin-pedicled flap from the pectoral area that survived without congestion despite not being supercharged with a perforato...

Although injections with copolyamide fillers (Aquafilling/Los Deline and Aqualift/Activegel) are currently used widely for breast augmentation, many complications have been reported. A recent position statement by a Korean aesthetic/reconstructive breast surgery society indicated these fillers are the same as polyacrylamide gel (PAAG), which is wid...

Facial injections with cosmetic fillers can lead to local artery occlusion. The bilateral nasolabial folds of a 39-year-old woman were injected with hyaluronic acid at another hospital. After the righthand injection, the patient immediately felt pain that ran from the right nasolabial fold to the nasal alar. The injecting doctor suspected embolism...

Cryptotia is a congenital auricular deformity. Common methods of surgical reconstruction involve creating an auricular temporal groove using local flaps and/or a skin graft. However, it can be difficult to determine which method is most suited to the unique 3-dimensional (3D) structure of each cryptotic ear. Here, we showed that creating 3D ear mod...

Keloids are pathological scars that are characterized histologically by an overwhelming aggregation of fibroblasts and collagen type I within the inflammatory reticular dermis. Their clinical characteristics include continuous growth and invasion into the neighboring healthy skin beyond the original wound boundary via an erythematous and pruritic l...

A 51-year-old woman visited the hospital because of pain and swelling in the left anterior chest region. Computed tomography revealed a large abscess with bone destruction in the left sternoclavicular joint and gas patterns from the subcutaneous tissue to the anterior mediastinum. There was no history of bone destruction of the sternoclavicular joi...

Background: A universally accepted therapeutic strategy for umbilical keloids has not been determined. Our team has had considerable success with combination therapy composed of surgical excision followed by postoperative radiotherapy and steroid plaster/injection. Methods: All consecutive patients with umbilical keloids that developed from endo...

Although keloids are common on the joints, precordial areas, and abdomen, toe keloids are rare. The limited literature to date also suggests that they can be difficult to treat. We experienced the case of a 21-year-old woman with toe keloids on the first, second, and third toes that arose after ingrown-nail operations at another hospital. The secon...

Objective: Various skin incision methods have been reported for reduction mammoplasty and mastopexy. The aim of our study was to develop a better method by improving conventional methods, with particular focus on the prevention of hypertrophic scars. Methods: We developed a comma-shaped incision method that would result in fewer scars and less stra...

In 2006, we established a scar/keloid-specialized institution in the Department of Plastic, Reconstructive, and Aesthetic Surgery at Nippon Medical School (NMS) in Tokyo, Japan. In the ensuing 15 years, we treated approximately 2000 new scar/keloid patients annually. This extensive experience has greatly improved the efficacy of the treatments we o...

Hypertrophic scars (HSs) and keloids are histologically characterized by excessive extracellular matrix (ECM) deposition. ECM deposition depends on the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteases (TIMPs). TIMP-1 has been linked to ECM degradation and is therefore a promising therapeutic strategy. In th...

The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90 degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isola...

Purpose Keloid is a poorly understood disease that is unique to humans. Hypertrophic scars are similar to keloids and may transform into keloids over time. The standard treatments for these scars are limited by inconsistent efficacy and long treatment/follow-up times. Therefore, a new treatment that is effective for all abnormal scar cases is neede...

Background: Cutaneous wound healing is a complex, dynamic physiological process. Traditional methods of promoting wound healing are not always effective. Consequently, alternative modalities, such as photodynamic therapy (PDT), are needed. We examined the effectiveness and underlying mechanisms of PDT in a murine model of acute wound healing. Met...

Keloids are chronic inflammatory fibrous tumors that cause excessive production of such extracellular macromolecules as collagen, due to the overexpression of various growth factors and cytokines. The etiology of keloids is unknown. They cause pain and itching, which together with the red mass leads to physical and mental stress in patients. No def...

Aim: Abnormal scars such as hypertrophic scars (HSs) and keloids are excessively growing scars that exhibit chronic inflammation and capillary vasculogenesis. The lipid mediator sphingosine-1-phosphate (S1P) is important in inflammatory cell recruitment and angiogenesis. Fingolimod (FTY720) is an analog of S1P and thus functionally antagonizes S1P...

Cutaneous scars are believed to be due to aberrant wound healing that alters the levels of collagens in the dermis. Definite diagnoses of scar types that clearly distinguish them from other scar types will facilitate the selection of the most appropriate therapies for individual scars and patients. To this end, cutaneous scars are classified as nor...

Keloids can be treated in a number of ways, including by surgery. Multiple studies now show that while surgical monotherapy associates with extremely high rates of recurrence (50%–80%), postoperative radiotherapy can significantly reduce these recurrence rates. Ongoing improvements in radiation technology have further increased the safety and effic...

Abstract There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly pron...

Hypertrophic scars are caused by abnormal healing of injured skin. The scars are red and elevated and have an unappealing appearance. Moreover, they associate with intermittent pain, persistent itching, and a sensation of contraction. The inflammation in the scars is continuous and local, being mainly found in the reticular layer of the dermis of t...

Therapies for upper arm keloids include surgical excision followed by postoperative radiotherapy, silicone tape stabilization, and steroid plaster. However, a universally accepted therapeutic strategy for upper-arm keloids is lacking. Methods: All consecutive patients with single upper-arm keloids who underwent keloid excision followed by tension...

Optic canal fracture (OCF) is a traumatic injury that requires urgent intervention because it can induce optic nerve damage and visual impairment. Despite the severity of OCF, a standard treatment method has not been established. In this article, we report a case of OCF and traumatic optic nerve injury in which visual acuity was recovered by releas...

Background: Severe keloids are currently treated with surgical resection followed by radiation. Radiotherapy is essential for preventing recurrences. Fascia tensile reduction suturing may also prevent recurrence. We asked whether superficial fascia tensile reduction with or without deep fascia tensile reduction reduced skin mechanical tension and...

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively...

Wound healing starts with the recruitment of inflammatory cells that secrete wound-related factors. This step is followed by fibroblast activation and tissue construction. Sphingosine-1-phosphate (S1P) is a lipid mediator that promotes angiogenesis, cell proliferation, and attracts immune cells. We investigated the roles of S1P in skin wound healin...

Background: Fibroproliferative disorders result in excessive scar formation, are associated with high morbidity, and cost billions of dollars every year. Of these, keloid disease presents a particularly challenging clinical problem because the cutaneous scars progress beyond the original site of injury. Altered mechanotransduction has been implica...

Background: One suggested reason for aberrant wound healing in keloid scars is chronic inflammation of the dermis. We hypothesized that excessive blood vessel formation and high capillary density in keloid tissue is caused by dysfunction of endothelial progenitor cells. Methods: We compared the number of circulating endothelial progenitor cells...

This case report describes a recent case where a patient with hypopharyngeal cancer underwent resection and reconstruction with a free jejunum flap and the surgeons found a rare variation in the branching pattern of the common carotid artery. Specifically, the left facial artery arose directly from the common carotid artery, whereas the left superi...

Background: The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids. Methods: All consecutive patients with single or multiple anterior...

The aetiology of keloids is becoming clearer, but many questions remain, including about the most optimal treatment. Current therapies include surgical excision, radiotherapy, and various pharmaceutical drugs. However, none of these drugs are keloid‐specific. Moreover, all current interventions are associated with high recurrence rates. Here, we re...

The endogenous electric field (EF) of skin wounds plays an important role in the biological processes that underlie wound healing. Treatments that modulate wound-EFs promote healing. However, the mechanism(s) that underlie this effect remain unclear. Agilent-based microarrays were used to determine the transcriptomes of the keratinocyte line HaCaT,...

We report two cases of granular cell tumors (GCTs) arising on rare sites, namely, the nape and umbilicus. While GCTs have a very characteristic histology, their clinical signs and symptoms are non-specific. Therefore, it is extremely difficult to make a diagnosis of GCT on the basis of clinical findings only. The two cases reported here were clinic...

Sclerotic fibromas of the skin (SFSs) have a very characteristic histology but the clinical signs are non-specific. Consequently, it is extremely difficult to make a diagnosis of SFS on the basis of the clinical findings only. We report here two cases of SFS arising on the right scapular region and the right lower leg, respectively. Both cases were...

Hypertrophic scars (HSs) and keloids, as the commonly seen pathological scars, are characteristic of rampant proliferation of fibroblasts, accumulation of collagens in the ECM, and altered regulation of growth factors/cytokines. Though their etiology still remains unclear and the postsurgical recurrence keeps a high profile, great efforts have been...

Background:. Patients with head and neck or esophageal cancer who undergo resection and reconstructive surgery sometimes develop fistulae that exhibit delayed wound healing. We developed a novel negative pressure wound therapy (NPWT) that employs a Penrose drain. This case series report describes its effect on the wound healing and treatment durati...

Background: Reconstruction with sternoclavicular resection is occasionally needed in extensive head and neck surgery. However, this technique is invasive and requires high-level surgical skill. The complications and prognosis of this technique have not been adequately investigated. This study aimed to clarify the risks and benefits of sternoclavicu...

We encountered a case of a man who was diagnosed with severe congenital neutropenia as a child and presented at the age of 45 years with pyoderma gangrenosum (PG) of the lower leg. PG associates with an underlying systemic disease, most commonly inflammatory bowel, rheumatic, or hematological disease or malignancy. However, in many cases, the under...