Toshihiko Hayashi

Hokkaido University | Hokudai · Department of Plastic and Reconstructive Surgery

Background Reconstruction of the oral modiolus should be considered for facial defects involving the lip and cheek. We have performed free flap reconstruction using a novel technique that includes a vertical and a horizontal sling for full-thickness defects involving the oral commissure. Patients and Methods We used a free radial forearm flap and...

Background Pseudo-Kaposi sarcoma (PKS) is a rare vascular proliferative disease, caused by arteriovenous malformation (AVM) and chronic venous insufficiency. The lesions are characterized by purple or reddish-brownish papules, plaques, and nodules. Although benign, it is clinically similar to Kaposi's sarcoma (KS), a malignant disease, and must be...

This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic drainage pat...

Background This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic d...

The recommended treatment strategy for stage 3 bisphosphonate-related osteonecrosis of the jaw (BRONJ) is currently rigid plate fixation without bone reconstruction. However, a recent systematic review indicated the utility of microsurgical reconstruction after resection of BRONJ. Several types of flaps have been described but their applications ar...

Purpose: Severe lymphedema is difficult to treat because of the associated extensive scar formation. Therefore, preventing scar formation might alleviate the severity of lymphedema following lymphadenectomy. In this study, we evaluated the usefulness of flap transfer, performed immediately after lymphadenectomy, for preventing scar formation. Met...

We report a clinical technical note of a patient for whom open surgery of temporomandibular joint (TMJ) mobilization was performed for treating bilateral TMJ ankylosis where the temporoparietal fascia flap (TPFF) was found to be useful. We infer that using such biological tissues prevents postoperative readhesion of the TMJ. The TPFF is often used...

This study aimed to determine the appropriate treatment methods and evaluate associated factors by comparing nonoperative treatment alone with a combination of both nonoperative and surgical treatment in 34 patients with mandibular osteoradionecrosis (mORN). The associated cure factors were analyzed by Cox regression. Propensity scores were calcula...

Background: Mesenchymal stem cells or their conditioned medium improve chronic wound healing, and their effect is enhanced by hypoxia. Diabetic foot ulcers are chronic wounds characterized by abnormal and delayed healing, which frequently require amputation. The authors evaluated the effect of topical application of conditioned medium from hypoxic...

PurposeLymphocutaneous fistula after lymph node dissection is intractable, yet there is no established treatment strategy. This study demonstrates the wound closure time achieved by a new method of combined internal and external negative pressure wound therapy (CIEN) in patients with lymphocutaneous fistula.Methods The subjects of this study were s...

We report a case of third-degree burn involving 5% of the total body surface area caused by off-label use of Hanautherm®, an infrared radiant heat lamp for bed-warming, in a patient with severe accidental hypothermia. This iatrogenic burn required repeated surgical interventions and long-term hospitalization and caused subsequent cosmetic disfigure...

Objective In critical limb ischaemia (CLI), first-line therapy is revascularisation, but alternative treatment options are needed in certain cases. Maggot debridement therapy (MDT) is historically considered to be contraindicated in ischaemic ulcers. Wound care in patients with CLI is becoming increasingly diverse with the development of novel reva...

Background Recurrence rates of keloids have generally been reported at one time point. However, the longer the duration after treatment, the greater the likelihood that such lesions will recur. In this study, we analysed the time to recurrence during long-term follow-up. Material and methods We retrospectively reviewed recurrence-free interval in...

The purpose of this retrospective study was to compare outcomes of cleft palate repair in patients with non-syndromic Pierre Robin sequence (NS-PRS) versus those with non-syndromic isolated cleft palate (NS-ICP). Pierre Robin sequence (PRS) was defined as a diagnosis of the triad of microretrognathia, glossoptosis, and cleft palate, and the severit...

Hidradenitis suppurativa is a chronic recurrent folliculitis that results in the development of abscesses and the formation of sinus tracts and scarring. Studies identifying the optimal surgical technique in patients with hidradenitis suppurativa are lacking, but the reused skin-graft technique is a reliable approach for the resection of chronic hi...

Background: The applications of negative-pressure wound therapy (NPWT) have been well documented. Nowadays, NPWT can be used to treat extensive tissue loss after complete resection of soft tissue malignancy, such as invasive skin cancer or sarcoma. Materials and methods: Information on demographics, total days of therapy, complications, recurrence...

Infantile hemangiomas arising in the palate are rare. The authors describe a case of ulcerated infantile hemangioma of the hard palate with feeding difficulty. To our knowledge, this is the first reported case of immunohistochemically diagnosed palatal infantile hemangioma successfully treated using oral propranolol.

Introduction: Calciphylaxis is a serious life-threatening skin condition, which mainly affects dialysis patients. The mortality rate is reported to be as high as 50–80%, mainly due to severe wound infection. Thus, appropriate wound care is critical for its management, but still there is no consensus on the optimal method for this purpose. Materials...

Background Acral melanoma (AM) is an epidemiologically and molecularly distinct entity that is underrepresented in clinical trials on immunotherapy in melanoma. We aimed to analyze the real-world efficacy of anti-PD-1 antibodies in advanced AM. Patients and methods We retrospectively evaluated unresectable stage III or stage IV AM patients treated...

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...

Reconstruction of upper eyelid defects should aim for a moveable lid with perfect corneal protection and good aesthetic quality. Numerous procedures to reconstruct large upper eyelid defects have been reported, but these methods require 2-stage procedures. A new method for reconstructing full-thickness upper eyelid defects after tumor excision in a...

Oculo-auriculo-fronto-nasal syndrome (OAFNS) is a rare anomaly characterized by features overlapping those of frontonasal dysplasia (FND) and the oculo-auriculo-vertebral spectrum (OAVS). ¹ The FND features malformation of frontonasal process-derived structures, characterized by anomalies in the central portion of the face. The OAVS is characterize...

Keloids can be recalcitrant, and a well-planned treatment strategy is essential. Multiple ear piercings have recently become popular, particularly among younger age groups. Management of keloids that develop after piercing of the ear cartilage may be particularly problematic. Helical rim keloids are difficult to excise because of the complex, three...

Background and objectives Vascularized lymph node transfer (LNT) is gaining popularity in the treatment of lymphedema. However, it is unclear whether the vascularization of transferred lymph nodes (LNs) contributes to functional improvement. High endothelial venules (HEVs) are specialized vessels that allow lymphocytes to enter LNs. In this study,...

Purpose Vascularized lymph node transfer is becoming more common in the treatment of lymphedema, but suitable small animal models for research are lacking. Here, we evaluated the feasibility of pedicled vascularized inguinal lymph node transfer in mice. Methods Twenty‐five mice were used in the study. An inguinal lymph node‐bearing flap with a vas...

The timing of cleft lip nose surgery remains controversial. The less invasive the procedure at the time of primary cleft lip repair, the less the growth and development of the nose is affected. Therefore, the nasal-stenting component of presurgical nasoalveolar molding has increasingly been used. However, not all cleft centers use such treatment. C...

Keloids mark a chronic inflammatory disease characterized by a fibroproliferative disorder of the skin. A genome-wide association study (GWAS) has revealed that single nucleotide polymorphism (SNP) rs8032158 in the neural precursor cell expressed, developmentally down-regulated 4 (NEDD4) gene, which has six protein-coding transcript variants (TV),...

Lymph node (LN) transplantation is a recognized method for reconstruction of the lymphatic system and is used in the clinical setting to treat lymphedema. However, it is unclear whether transplanted LNs contribute to immune surveillance. In this study, we investigated whether a single transplanted non‐vascularized LN, defined as a tumor‐draining tr...

Background: Lymph node transplantation is being increasingly recognized as a method of reconstruction of the lymphatic system for the treatment of lymphedema. However, the mechanisms regulating the connections between the lymphatic vessels and the lymph nodes remain poorly understood. The objective of this study was to examine whether removal of a...

Purpose This study evaluated short-term and long-term changes in bone height after mandibular reconstruction using an osteotomized fibula graft, with the aim of identifying factors associated with atrophy of the graft in an elderly population. Methods This retrospective study involved patients who underwent mandibular reconstruction using a free v...

Background: The purpose of this study was to evaluate the superficial lymph drainage patterns of primary skin cancers of the head arising from the occipital or parietal region. Methods: The dominant patterns of lymph drainage were retrospectively reviewed in eight patients aged 36-85?years with skin cancers in the occipital or parietal region in...

We report two cases of central venous catheter-related deep venous thrombosis (DVT) that occurred after oral cancer resection and reconstruction with vascularized free flap. In addition, we present a manual on coping with DVT which has been used by dentists in the Hokkaido University Hospital since July 2014. First case: A 60-year-old man with oral...

Full-thickness defects of the entire nasal ala, including the rim, can be challenging to reconstruct. A forehead flap may provide a more imperceptible and natural-appearing reconstructed nasal ala. Previously, many authors have insisted adding cartilaginous infrastructural support for an entire, full-thickness defect to keep the postoperative alar...

Early excision and skin grafting is the principle treatment for a burned hand although there are occasions when it cannot be done such as severe general condition, delayed consultation, and the lack of a definitive assessment of burn depth. This study analyzes the factors that affected function after a delayed excision and skin graft for hands with...

Background: Past studies showed that integumentectomy and incontinuity could be effective procedures in the surgical management of melanoma patients. The present study reports on the historical background of these procedures. In addition, we analyze the ICG assisted integumentectomy and incontinuity techniques and algorithms that we had created wh...

The authors report a case of an 84-year-old woman with an exposed mandibular plate after reconstruction, which finally healed with combination therapy using vacuum-assisted closure therapy and hyperbaric oxygen therapy. The woman was diagnosed with mucosal carcinoma of the right oral cavity. During reconstruction after segmental excision of the man...

Background: Although extramammary Paget disease (EMPD) usually appears as carcinoma in situ, it sometimes becomes invasive (iEMPD) and fatal. However, a TNM staging system for iEMPD has yet to be established. Objective: The aim of this study was to establish a TNM staging system for iEMPD. Methods: We retrospectively collected iEMPD patients t...

In invasive extramammary Paget's disease (EMPD), distant metastases may develop and the condition may become fatal; however, no standardized treatment has been established. Although based on only a few cases, several chemotherapy regimens were reported to be promising. We conducted a multicenter, retrospective study to evaluate the efficacy of doce...

The cheek region is the most common site for malignant tumor occurrence and the treatment of malignant skin tumor requires extensive local excision. Many previous reports have covered methods of reconstruction using local flaps for skin defects in the cheek region.In this article, we describe our experience with a surgical reconstruction using a ne...

Various techniques have been described for unilateral cleft lip repair. These may be broadly classified into three types of procedure/concept: the straight-line method (SL; Rose-Thompson effect); rotation–advancement (RA; upper-lip Z-plasty); and the triangular flap method (TA; lower-lip Z-plasty). Based on these procedures, cleft lip repair has ev...

Background and aim: Neuregulin-1 is an essential axoglial signal required for peripheral nerve development, and evidence that neuregulin-1 is also required for effective nerve repair is growing. In this study, the effects of neuregulin-1-impregnated gelatin hydrogels on nerve regeneration and functional recovery after anastomosis of the facial ner...

Although extramammary Paget's disease (EMPD) mostly presents as intraepithelial carcinoma, we sometimes encounter patients with invasive EMPD (iEMPD) who have lymph node metastasis and may develop distant metastasis. Although sentinel lymph node biopsy (SLNB) is widely accepted for various cancers, there is no large study that has assessed its role...

We previously reported double innervation of rat mimetic muscles with labeling of facial nuclei. However, whether denervated mimetic muscles are affected after such nerve repair is not known. Rats were divided into five groups: Group A, controls; Group B, complete facial palsy; Group C, complete facial palsy with repair using end-to-end neurorrhaph...

Lymphedema is a condition characterized by progressive swelling and adipose deposition that occurs commonly after lymphadenectomy. Recent clinical studies have suggested that the transfer of lymph nodes to the lymphedematous limb can improve lymphatic function. In this report, we investigate dynamic modulation of lymphatic flow and the microscopic...

Open abdomen management is commonly used for the critically injured patients to avoid abdominal compartment syndrome. But it usually continues for days to weeks and finally results in abdominal wall defect that is too wide to close at once. This article presents an alternative approach to close the giant abdominal wall defect by using the combinati...

We report a case of multiple primary melanomas detected after long-term follow-up for the first primary melanoma. A patient with cutaneous melanoma in the left breast region received treatment at 42 years of age. After the initial treatment, we followed the patient on a yearly basis. A new primary cutaneous melanoma was observed in the right femora...

In this paper, a review of unfavorable head and neck reconstructive cases due to the complication of microvascular anastomosis at our institute is described. Between 2004 and 2014, the total number of head and neck reconstructive cases in which free flaps and microvascular augmentation were performed as team surgery was 239. In this series, 11 case...

Total laryngo-pharyngo-esophagectomy (TLPE) with gastric pull-up reconstruction is still considered to be associated with major complications and a significant risk of in-hospital death. Minimally invasive esophagectomy, avoiding thoracotomy and laparotomy, has been increasingly performed for esophageal malignancies with the hope of reducing mortal...

Langerhans cells sarcoma, a neoplastic proliferation of Langerhans cell with malignant cytologic features, is a very rare disease. To date, only about 40 cases of Langerhans cell sarcoma, including the present case, have been reported. We present a case of Langerhans cell sarcoma in right ear skin occuring in a old-aged male patient. Histologically...

Langerhans cells sarcoma, a neoplastic proliferation of Langerhans cell with malignant cytologic features, is a very rare disease. To date, only about 40 cases of Langerhans cell sarcoma, including the present case, have been reported. We present a case of Langerhans cell sarcoma in right ear skin occuring in a old-aged male patient. Histologically...

We report a case of a gun shot wound treated at our hospital. A 59-year-old man was accidentally injured by a rifle bullet fired by a fellow hunter. The entrance wound was located on the medial side of the left leg, and the bullet exited on the lateral side of the same leg; the wound was approximately 20×15 cm in width. A comminuted left tibial fra...

Objective This study was performed to investigate speech outcomes after three different types of palatoplasty for the same cleft type. The objective of this study was to investigate the surgical techniques that are essential for normal speech on the basis of each surgical characteristic. Methods Thirty-eight consecutive nonsyndromic patients with...

Tessier cleft types 3 and 4 are both rare craniofacial anomalies. Here we present the first case of a girl born with a combined anomaly of Tessier clefts 3 and 4 with severe bilateral cleft lip, a displaced premaxilla, and three-dimensional underdevelopment of the hard and soft tissues of the maxilla and zygoma. This type of rare facial cleft poses...

Aim: Although most of the extramammary Paget's disease (EMPD) presents as carcinoma in situ, we sometimes encounter patients with invasive EMPD (iEMPD) with lymph node metastasis which may develop distant metastasis. Sentinel lymph node biopsy (SLNB) is conducted in various cancers, however, there is no large study that assessed its role in iEMPD.T...

Purpose: The incidence of postoperative wound dehiscence following inguinal lymph node dissection (ILND) is higher than that in other anatomic regions. To prevent wound dehiscence, intraoperative interventions, such as trimming off the ischemic part of the flap before wound closure based on indocyanine-green (ICG) fluorescence angiography, have be...

Coagulation disorders can be classified into two types: excessive bleeding and excessive clotting. Furthermore, the severity of the coagulation disorders can vary significantly among patients. We evaluated two relatively rare cases involving factor XIII subunit deficiency and antiphospholipid syndrome (APS) with concomitant systemic lupus erythemat...

Keloid is an inflammatory and fibrotic disease with an unknown pathogenesis. Regulatory T cells (Tregs) of CD4+ lineage can suppress other effector CD4+ T cells and modulate the immune response. A relative decrease in the number of Tregs may be involved in the pathogenesis of inflammatory and fibrotic diseases. We therefore investigated the number...

The most common site for melanoma occurrence is the cheek region, and the treatment of melanoma requires extensive local excision. This study evaluated factors that influence the selection of reconstructive procedures after excision of a cheek melanoma. A total of 26 cases (12 with skin grafts, 7 with local flaps, and 7 with free flaps) were includ...

Background: Negative pressure wound therapy (NPWT) has been frequently used in the management of various wounds, including diabetic ulcers, pressure ulcers and post operative wounds. Before the introduction of NPWT with a vacuum-assisted closure system (VAC® Therapy; KCI Inc., San Antonio, Texas, U.S.A.) approved by the Japanese health insurance sy...

In minor-form or microform cleft lip, normal anatomical structures with slight displacement remain and should be used effectively to obtain symmetrical results.We treated 7 patients with minor-form or microform cleft lip between 2005 and 2009. In all patients, the peak of Cupid bow with a natural curve of the white roll was recognized on the latera...

Background: The objective of this study is to evaluate the lymph drainage from the primary focus to the regional lymph nodes in patients with melanomas of the upper extremity and upper trunk region. Method: The study is a retrospective study of 20 patients with upper extremity melanomas and 14 patients with upper trunk melanomas treated with axi...

Summary Background There is no consensus on the most appropriate treatment for patients with large to giant congenital melanocytic naevi (CMN) because of the risk of melanoma development. Surgical excision followed by skin grafting or expanded skin coverage may cause unfavourable scarring. There is a balance to be achieved between minimizing the di...

Necrotizing fasciitis (NF) is a rare infection of the deeper layers of skin and subcutaneous tissues, early spreading across the fascia plane within the subcutaneous tissues. We have experienced 29 patients, 20 are males and 9 are females, who have diagnosed as «NF» or «Fournier’s gangrene» which is recognized as groin NF during the period from Jan...

In-transit metastasis (ITM) is a unique manifestation of intralymphatic tumor dissemination, characterized by the presence of melanoma cells between the primary lesion and the draining regional lymph node basin that is clinically associated with poor prognosis. In this study, we aimed to establish an experimental animal model of melanoma ITM, as re...

Microsurgical transfer of the vascularised fat flaps has become a well-established method for soft-tissue augmentation because it has been believed to provide the restoration of symmetry without atrophy. Yet little has been reported on the long-term fate of the vascularised fat flaps. The purpose of this study was to evaluate the postoperative chan...

Hikikomori, or severe social withdrawal, in Japan's young people has been a prominent public mental health concern since around 2000. A case of skin necrosis in a hikikomori teenager is reported in this article. From the patient's history and the shape of the skin ulcer, we diagnosed her necrotic ulcer was pressure sore, caused by sitting on the to...

The triple technique (lymphoscintigraphy, patent-blue staining, and a gamma probe) constitutes a reliable method for the sentinel lymph node (SLN) biopsy. However, in head and neck melanomas, a shine-through phenomenon, which occurs because these SLNs are close to the primary focus, is irreversibly problematic. To get around the shine-through pheno...

In-transit metastases of melanoma almost certainly results from lymphatic dissemination of melanoma cells to tissues between the primary melanoma site and the draining regional lymph nodes. Most in-transit metastases occur after lymphatic obstruction, due either to tumor involvement or to surgical removal. The treatment of in-transit metastatic mel...

The use of an interpositional nerve graft (IPNG) between the facial and hypoglossal nerves for incomplete facial palsy has recently been reported. However, its mechanism has not been elucidated. We established a rat model of IPNG to study incomplete facial palsy and confirmed the direction of innervation through the grafted nerve with or without fa...

Background Venous malformations (VM) of lower extremities have characteristic symptoms, especially swelling, pain at rest or with dependence, or in the morning, or with exertion. Sclerotherapy has been applied and has been showed to alleviate the associated signs and symptoms. The aim of this study is to evaluate the outcomes of ethanol sclerothera...

Published reports indicate that corticosteroid injections can prevent recurrence after keloid excision, but the side effects of repetitive intralesional steroid injections may preclude treatment maintenance. Additionally, few of these studies employed a standardized treatment protocol. To analyze the results of a new uniform treatment protocol comb...

A 50-year-old woman suffering from schizophrenia self-inflicted a laceration on her head and peeled off a wide area of her scalp by inserting her fingers into the wound. The peeled area of her scalp was divided into a large skin flap and a small piece of free skin. Under general anesthesia, we repositioned the two parts. The large flap of skin was...

Radiation therapy for breast cancer has improved survival rates; however, a consequence of this is treatment-induced complications in longer-living patients. Decades after chest wall irradiation, very late onset radiation-induced osteomyelitis can develop, caused by osteoradionecrosis. This may lead to the development of small, but very refractory,...

Treatment in malignant periorbital tumours requires a radical resection of the tumour, and reconstruction of eyelid defects is difficult task because it should aim at gaining functional and aesthetical improvement. We have reviewed 50 cases of malignant periorbital tumour that were treated surgically from 1992 to 2010. We assessed the type of recon...