Shigeru Ichioka

Saitama Medical University · plastic surgery

Penile prosthesis implantation can be considered in patients with unsuccessful treatment with phosphodiesterase type 5 inhibitors for erectile dysfunction. Its associated postoperative complications include infection and urethral injury. Nevertheless, only a few studies have reported the successful management of severe cases. Herein, we report a ca...

Ultrasonic debridement devices are minimally invasive and effective for biofilm removal, allowing for debridement of necrotic tissue while minimizing damage to normal tissues, such as the blood vessels and nerves. The use of ultrasonic debridement has been reported for foot ulcers and pressure ulcers but not Fournier gangrene. The perineal area, wh...

A 43-year-old female patient had a necrotizing soft tissue infection in the temporal region. Because of the necrotic temporoparietal fascia, auricular reconstruction was attempted using the temporalis muscle flap; the flap was successfully placed. The use of the temporalis muscle flap was considered a treatment option for salvaging the auricle.

Although revascularization has evolved, treating foot gangrene with chronic limb-threatening ischemia remains challenging. There have been many reports on bypass surgery and free flap transfer. Meanwhile, few studies have reported on endovascular therapy and free flap transfer, with high flap survival rates and high wound complication rates. Wound...

Introduction: Low-density lipoprotein (LDL) apheresis is a treatment option for patients with unhealed chronic limb-threatening ischemia (CLTI) after revascularization. The newly developed AS-25 is a direct hemoperfusion-type apheresis device that differs from conventional LDL apheresis therapy and is designed to specifically adsorb both LDL-C and...

We present a case of symmetrical peripheral gangrene of the extremities due to acute infectious purpura fulminans that was reconstructed with four free flaps harvested from the bilateral backs. We reconstructed the right and left, upper and lower limbs using the parascapular flap and latissimus dorsi muscle flap from one side and the scapular flap...

We experienced a case of a sacral pressure ulcer complicated with Leriche syndrome, an aortoiliac artery occlusion that has not been previously reported. In this case, the abdominal aorta below the bifurcation of the renal arteries into the bilateral common iliac arteries was occluded, and wound healing was delayed. Therefore, endovascular treatmen...

In consultation with academia and the Pharmaceuticals and Medical Devices Agency (PMDA), we have developed guidance for drafting protocols for clinical trials concerning medical devices for the healing of hard-to-heal wounds without ischaemia. The guidance summarises the validity of single-arm trials for hard-to-heal wounds, the definition of hard-...

Objective This study investigates the advantages of hydrosurgical debridement compared with surgical debridement. Method Thermal skin burns were created on the backs of male Wistar rats. Surgical debridement was used to treat one wound and hydrosurgical debridement (Versajet Hydrosurgery System, Smith&Nephew, UK) used to treat the second wound. De...

We report the case of an 86-year-old postmenopausal woman with severe labial adhesion. The adhesion overlying the vestibule was manually separated and the skin defect was covered with bilateral vulvoperineal flaps. Reconstruction using the vulvoperineal flap enabled to prevent recurrence by covering with normal skin tissue.

We present a case of Raynaud’s disease with digital ulcers that was successfully treated with hyperbaric oxygen therapy. Hyperbaric oxygen therapy can be considered as a safe and useful adjunct treatment for intractable digital ulcers in patients with Raynaud’s disease.

Background The rectus abdominis myocutaneous flap has been used as the first choice for pelvic and perineal reconstruction. However, due to previous abdominal surgery and multiple stoma placements in our patients, the rectus abdominis myocutaneous flap could not be used for such reconstruction. Here, we describe the use of bilateral gluteal fold fl...

Total contact casting（TCC）is an offloading modality used in the treatment of foot ulcers to reduce plantar pressure and the shear forces generated during walking. It can be performed in the outpatient setting. We conducted a multicenter prospective registry study to examine the effects, complications, and costs of using TCC as a treatment for refra...

Introduction: Functional salvage is the most important aspect of limb salvage. Deformities caused by forefoot amputations can result in foot inversion for several years and promote wound formation. Therefore, they are usually treated with surgical off-loading. Here, we report the use of triple arthrodesis to correct an inverted foot deformity after...

We report a case of successful microsurgical reattachment of an amputated ear. Microsurgical reattachment should be considered whenever possible.

Background: Although free flap is gaining popularity for the reconstruction of diabetic foot ulcers, it is unclear whether free flap reconstruction increases the chances of postoperative independent ambulation. The aim of this study is to evaluate the relationship between free flap success and postoperative ambulation. Methods: This study reviewed...

In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces a...

Individual patient-level data underlying results presented in the tables of this study. (PDF)

Although remarkable progress has recently been made in the field of limb salvage, recurrent cases are becoming a problem. In such cases, blood circulation and the function of the limb worsen. We treat such cases using a combination of rehabilitation, specialized equipment, and artificial limbs. In some cases, we are unable to prevent recurrence. Th...

Acute limb ischemia results from sudden deterioration in the arterial supply to the limb, occasionally leading to limb loss or fatality. Antiphospholipid syndrome (APS) is known to induce acute limb ischemia among the various etiologies responsible for arterial obstruction. APS is a systemic autoimmune disorder characterized by a combination of art...

Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostect...

Lipo-prostaglandin E1 (lipo-PGE1) is a well-known potent vasodilator that increases peripheral blood flow. However, the effects of this agent on wound bed microcirculation still remain unclear. The present study aims to improve the experimental model which our group developed to visualise wound bed microcirculation and to evaluate acute stimulation...

We encountered a rare case of refractory ulcer due to occlusion of the popliteal artery. This occlusion occurred without any trauma, approximately two years after the patient underwent total knee arthroplasty (TKA). We achieved a good result with ulcer treatment using the negative pressure wound therapy (NPWT) system and new devices including an ul...

Cutaneous sinus tracts in the cheek region are caused by infection in the periapical area of the tooth. The diagnosis is challenging unless we consider a dental origin because such tracts occur uncommonly and mimic other common disorders. Additionally, affected patients often have no symptoms and they are usually unaware of the underlying dental co...

Foot infection is a leading cause of amputations in diabetic patients. An infected foot would precede about 60% of lower extremity amputations. With an increasing infection severity, there is a significant trend toward an increased risk for amputation. Identification of critical colonization is essential in order to prevent infection. However, its...

Abstract A previous experiment using an in vivo mouse model has proved that hypoxia increased angiogenesis during wound healing. It was hypothesised that one of the mechanisms for wound healing impairment in diabetes includes insufficient angiogenic ability in response to hypoxia. The current study aims to investigate the influence of hypoxia on wo...

The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according to whether the initial necrosis was in the great toe or in o...

Chronic wounds due to diabetes mellitus (DM) and/or peripheral arterial disease (PAD) often occur in the pedal region peripheral to the ankle. To predict wound healing potential of limb ulcers, skin perfusion pressure (SPP) and transcutaneous oxygen tension (TcPO2) have recently become popular as the parameters that reflect skin microcirculation. O...

Capillaries were believed to be the sole source of O2 supply to tissue. However, the recent studies have demonstrated a longitudinal PO2 drop in arterioles, suggesting the possibility of O2 supply from arterioles. Furthermore, analysis of the diffusion process based on the PO2 drop has shown that the O2 diffusivity in the arteriolar wall was dramat...

Foot baths and showering are two widely used methods to cleanse limb ulcers. However, some clinicians warn that foot baths may contribute to the spread of infection at the ulcer site. This study aimed to retrospectively investigate the relationship between cleansing methods and the limb prognoses of 236 patients with chronic limb ulcers. These pati...

Microcirculation plays a direct role in the accomplishment of the principal purpose of the circulation system. The functions of microcirculation incorporate oxygen supply, transport, diffusion, and exchange of nutrients and metabolites between blood and tissue, maintenance of body temperature, regulation of blood pressure, tissue defense and repair...

Abstract Experimental results have previously been reported for a new biological dressing consisting of concentrated plasma proteins and platelet-rich plasma (PRP), which is named Platelet-Protein film (PPF). Based on the results of this experimental study, a clinical trial was begun to examine the usefulness of PPF. Although fresh autologous PPF i...

This study investigated the role of nitric oxide (NO) in the mechanism of blood flow increase in the wound bed during negative pressure wound therapy (NPWT). We developed an improved experimental model that allowed visualisation of the wound bed microcirculation under NPWT. Wounds were created on the mouse ear, taking care to preserve the subdermal...

Abstract We present our experience with a 22-year-old man who had Crohn's disease with rhinophyma-like hypertrophy of the nose arising from pyogenic skin disease of the face. The clinical appearance did not precisely match any previously reported skin diseases.

Objective: Lower levels of ceramides in the stratum corneum are considered to be an etiologic factor in the dry and barrier-disrupted skin of patients with atopic dermatitis, psoriasis vulgaris, and xeroderma pigmentosum. Topical ceramides therapy has currently been used to improve skin barrier function. However, little is known about the effect o...

Abstract This study has reported the efficacy of an autologous bone marrow-impregnated collagen matrix experimentally and clinically. Then, it reflected that platelet rich plasma (PRP) was as good a source of growth factors as bone marrow and available in a less invasive procedure. This study aimed to compare the efficacy of a PRP-impregnated colla...

Abstract Application of tissue engineering currently provides promising therapeutic options in the fields of plastic surgery and wound management. The ability of scaffold material for cell proliferation and differentiation is the key for tissue engineering. This study has developed a novel nanofibre composed of poly glycolic acid (PGA) and collagen...

Abstract Experimental results have previously been reported for a new biological dressing consisting of concentrated plasma proteins and platelet-rich plasma (PRP), which is named Platelet-Protein film (PPF). This study reports clinical experience using PPF produced from the patients' own blood by the original technique. Ten patients with chronic w...

Although oxygen is essential for the wound healing process, tissue hypoxia is known to stimulate angiogenesis. To explore these inconsistent findings, we estimated the influence of the oxygen environment on wound healing with our original model. Experiment 1 (Establishment of the model): To modify the topical oxygen tension, oxygen impermeable (pol...

Background: Clinicians encounter pincer nails at a high incidence among bedridden cases who are free from weight bearing. The mechanical force transmitted by walking and loading may affect the nail configuration. This study was aimed at evaluating the influence of mechanical forces on the nail configuration. Methods: Study 1 was conducted on a s...

The preservation of healthy tissue during surgical debridement is desirable as this may improve clinical outcomes. This study has estimated for the first time the amount of tissue lost during debridement using the VERSAJET system of tangential hydrosurgery. A multicenter, prospective case series was carried out on 47 patients with mixed wound types...

The advances in regenerative medicine currently provide attractive options for strong enhancement of wound healing. Tissue engineered products are composed of three prime constituents: biomaterials, growth factors and cells. Among them employment of cells in wound management has been motivated by the discovery of endothelial progenitor cells (EPCs)...

Pressure ulcers (PrUs) are a challenging health concern for both the clinician and the patient. The exact incidence and prevalence of PrUs varies widely among specific clinical populations, from 0.4% to 38% in acute care, from 2.2% to 24% in long-term care and from 0% to 17% in home care. The economic impact of these wounds is impressive with an es...

 Persons with limited mobility are at risk for pressure ulcers. The development of pressure ulcers following earthquakes has been reported secondary to disaster-related spinal cord injury. In the aftermath of the Great East Japan Earthquake, members of a disaster medical assistance team (DMAT), which included plastic surgeons and wo...

Bone marrow attracted our attention as a potentially beneficial material for the treatment of wounds, because it contains multipotential progenitor cells and produces growth factors. We impregnated autologous bone marrow cells on to a collagen matrix that had been used for the treatment of chronic wounds. The bone marrow-impregnated collagen matrix...

Negative Pressure Wound Therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer-reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations de...

Studies in healthy volunteers and patients with renal failure have shown that vibration, applied with a frequency of 47 Hz and a vibrational intensity of 600 mVpp, increases microcirculation of blood in the skin. This controlled, in vivo, experimental study was conducted to further evaluate the effect of vibration on skin microcirculation and to as...

Negative pressure wound therapy (NPWT) is becoming a commonplace treatment in many clinical settings. New devices and dressings are being introduced. Despite widespread adoption, there remains uncertainty regarding several aspects of NPWT use. To respond to these gaps, a global expert panel was convened to develop evidence-based recommendations des...

The lymphatic network is capable of reconstruction after the regional lymphadenectomy; however, the biological reconstruction system has not been fully elucidated. Our aim is to evaluate the reconstruction system after bilateral iliac lymphadenectomy using rat models and to establish and characterize rat lymphatic endothelial cells (rLECs) from the...

Recently due to the increase in diabetes and peripheral arterial disease (PAD), the number of chronic foot wounds is increasing. In 2000, the TASC (Trans Atlantic Inter-Society) proposed the "Guidelines on the Treatment of PAD", for evidence-based standardization of PAD treatment ; a revision of the Guidelines was also published in 2007 (TASC II)....

Recent progress in regenerative medicine to treat chronic wounds is tremendous. Novel therapies are yielding substantial benefits for patients with severe ischemic limbs which never responded to conventional therapies. We here introduce a gelatin hydrogel drug-delivery system loaded with bFGF, gene therapies using heptocellular growth factor (HGF),...

To illustrate the association between hydroxyurea and the development of ulcers. A case study is presented, in which histological changes, mean corpuscular volume (MCV) and transcutaneous oxygen tension (TcPO2) were all measured and analysed, both during hydroxyurea treatment and following it's discontinuation. Two months following the cessation of...

Negative pressure wound therapy, NPWT, is a treatment accelerated wound healing process through the delivery of subatmospheric pressure within a closed environment. NPWT has significant beneficial effects on wound healing: The drainage of unbalanced exudate, growth of granulation tissue formation, control of infection, adhesion of underming of the...

Stimulating the repair process after surgical debridement may provide healing of chronic wounds to a level that conventional care measures cannot achieve. For this purpose, platelet-rich plasma (PRP) has attracted attention because it contains and releases various growth factors to promote wound healing. Simple centrifugation procedures supply PRP...

Although previous reports have suggested the efficacy of autologous bone marrow-impregnated collagen matrix experimentally and clinically, we occasionally encounter difficult wounds that fail to respond to the treatment. The current study retrospectively investigated the factors that affect clinical outcomes based on the hypothesis that periwound m...

In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O-POSSUM), w...

To study the role of nitric oxide (NO) in regulating oxygen consumption by vessel walls, the oxygen consumption rate of arteriolar walls in rat cremaster muscle was measured during enhancement and inhibition of NO synthesis. The oxygen consumption rate of arteriolar walls was calculated based on the intraand peri-vascular oxygen tension (PO2) measu...

The reconstruction of pressure ulcers always carries the risk of infection and wound disruption without the technical problems and blood flow deficiency. Thus, it is important to prepare carefully in the preoperative management of pressure ulcer coverage. Cases with infection and necrosis were treated in a 2 stage procedure; first, debridement and...

Duchenne muscular dystrophy (DMD) is a lethal X-linked disorder of striated muscle caused by the absence of dystrophin. Recently, impairment of vascular dilation under shear stress has been found in DMD, but the underlying molecular mechanism is not fully understood. Moreover, dilation of intramuscular arterioles, which may be a key to the molecula...

Although previous studies have proved that subatmospheric pressure in vacuum assisted closure therapy increased blood flow at the wound edge, no reports have presented data on blood flow in the wound bed. This study examined a technique that visualized microcirculation of the wound bed and estimated the acute effect of negative pressure. The superf...

The oxygen consumption of keloids and hypertrophic scars has never been quantitatively presented, although abnormal metabolic conditions must be associated with their pathophysiology. We invented an original measurement system equipped with a Clark oxygen electrode for ex vivo samples. The measurement of a mouse wound-healing model revealed immatur...

The effect of vibration on skin microcirculation was studied to investigate the possibility of clinical use of vibration to prevent and treat pressure ulcers. Vibrations at a vibrational intensity of 600, 800, or 1,000 mVpp with a fixed frequency of 47 Hz were applied horizontally to the ear of male hairless mice (n = 6 for each group) under inhala...

Microcirculation plays a direct role in the accomplishment of the principal purpose of the circulation system. The functions of the microcirculation incorporates oxygen supply, transport, diffusion, and exchange of nutrients and metabolites between blood and tissue, maintenance of body temperature, regulation of blood pressure, tissue defense and r...

The growth factors derived from platelets and plasma proteins mediate the wound-healing process that is characterized by the sequential migration and differentiation of several cell populations that give rise to angiogenesis, collagen synthesis, wound contraction, and re-epithelialization. To evaluate the efficacy of the blood-derived factors in wo...

Recent technological advances of the CCD (Charge-Coupled Device) video-probe have made microscopes more compact and greatly improved their sensitivity. Additionally, this progress has enabled researchers to utilize such devices for clinical application. We newly designed a compact capillaroscopy which was composed with a CCD video-probe equipped a...

The leukocyte-endothelium interaction is known to contribute to reperfusion injury, which is considered to participate in the pathophysiology of pressure ulcers, and integrin alphaV beta3 (alphavbeta3) has been shown to mediate the processes of cellular adhesion in various types of cells. This study aims to clarify leukocyte behavior in our origina...

Our simple criteria for selection of two efficient flaps achieves consistently good results for most sacral ulcers. One hundred and ten patients had their sacral ulcers reconstructed with the Limberg flap (n = 48) or the distal-perforator-based V-Y (DPVY) flap (n = 62). The criteria for selection were based on pinching of the donor skin to estimate...

To clarify the oxygen transport across the microvessels and oxygen distribution in the skeletal muscle, we have newly designed an intravital laser microscopy with oxygen-dependent quenching of phosphorescence technique to determine both the microvascular and the tissue pO2. After injecting the phosphorescent probe into systemic blood, phosphorescen...

Background: Sentinel lymph node (SLN) biopsy has already been established as a common procedure with malignant lymphoma and breast cancer. In colorectal cancer, however, the application of the SLN theory remains uncommon and its clinical significance is also unclear. In addition, the characteristics of the lymphatic vessels that connect SLNs or the...

We tested the hypothesis that oxygen is supplied to the resting skeletal muscle by arterioles rather than by capillaries. This hypothesis was evaluated in rats and rabbits by combining different approaches (1) determination of the intravascular oxygen tension (PO2) in arterioles of different diameters, (2) measurement of the perfused capillary numb...

The objective of this study was to evaluate whether the nitric oxide (NO) released from vascular endothelial cells would decrease vessel wall oxygen consumption by decreasing the energy expenditure of mechanical work by vascular smooth muscle. The oxygen consumption rate of arteriolar walls in rat cremaster muscle was determined in vivo during NO-d...

We hypothesised that the implementation of a validated method of audit, the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM), would be useful in the evaluation of the risks of debridement in bedridden patients with pressure ulcers. With the orthopaedic version of POSSUM (O-POSSUM), physiological data an...

This study aims to investigate the effect of collagen matrix impregnated with bone marrow on wound healing angiogenesis in an effective microcirculatory model and to describe our clinical experience. We used a skinfold chamber of original design which visualises microcirculation following wound creation on the dorsal skin of the mouse to establish...

To study the role of nitric oxide (NO) in regulating oxygen consumption by vessel walls, the oxygen consumption rate of arteriolar walls in rat cremaster muscle was measured in vivo during flow-induced vasodilation and after inhibiting NO synthesis. The oxygen consumption rate of arteriolar walls was calculated based on the intra- and perivascular...

Numerous plasma proteins and cytokines derived from platelets mediate wound healing process that is characterized by the migration and differentiation of several cell populations that give rise to angiogenesis, collagen synthesis, wound contraction and re-epithelialization. To evaluate the efficacy of the blood derived factors in wound healing, we...

Shear force is believed to affect pressure ulceration. Therefore, dressing materials that reduce shear force may prevent ulceration and facilitate healing. We measured the following three properties: the coefficient of friction between the outer layer of the dressings and the patient's clothes; the degree of adhesiveness between the inner layer of...