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Where we are

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Plastic surgery department; in-line No.30495

About super-microsurgery

Concept
From about 1990, the anastomosis of a minute blood vessel, lymphatic vessel of a diameter of 0.3-0.8mm, or nerve fascicles has become enabled by the supermicrosurgery technique. The operative duration of the conventional reconstructive surgery became short, and the new, less invasive free tissue transplantation procedure has been developed. The reason behind this would be the progress of the anastomosis technique under the microscope and the anatomy of the microvascular system, and the development of the various kinds of vasodilatation agent for the background.

Perforator-to-perforator flap
We have developed new perforator flaps whose vessels are anastomosed to the perforators in the recipient region. This technique is less invasive for the donor site, and reduces the operative duration. The success rate is as good as the conventional procedure. For a bad point, a slightly advanced technique is necessary for harvesting the flap and the vascular anastomoses.

We show below several examples.
・radial artery perforator flap for hand or nose reconstruction
・thoracodorsal artery perforator flap for eye socket reconstruction
・rectus abdominis muscle perforator flap for face or breast reconstruction, or augmentation
・deep inferior epigastric artery perforator flap for face or breast reconstruction
・superficial circumflex iliac artery perforator flap for upper or lower limb reconstruction
・medial plantar artery perforator flap for finger reconstruction
・free toetip transfer for fingertip reconstruction
・vascularized nerve flap for facial palsy

The supermicrosurgery enabled the less invasive procedure by these perforator flaps in the category of upper or lower limb reconstruction, head and neck, face reconstruction, breast reconstruction, and penile reconstruction. Furthermore, for the past 20 years, the effect of the lymphatic venular anastomosis under the local anesthesia has been confirmed.

Forsight
As for the reconstructive surgery by the supermicrosurgical technique, Japan continues to lead the world. Especially, the reconstructive surgery by perforator flaps is sent by Japan and settles in European countries including Belgium, Italy and also U.S.A., and now classes are held all over the world and grows more and more popular in each countries. The topic of the reconstructive surgery of the new age would be the development of new procedure by the anastomosis technique of a minute blood vessel, lymphatic vessel of a diameter of 0.3-0.8mm, or nerve fascicles, and the expansion of the object disease.

About LVA

Lymphedema and Lymphatico-venular anastomosis (LVA)

Lymphedema
Lymphedema is a disease with swelling in extremities or face due to congested lymph. It occurs primary or secondary after pelvic lymphadenectomy or radiotherapy. Without treatment, lymphedema progression not only makes extremities swollen, but also disabled patients functionally and put patients in high risk of infection or malignancy

Treatments for lymphedema
Prophylaxis of lymphedema progression by elastic stocking and skin care is the most important. Prophylaxis and early treatment of infection (cellulitis) is also very important because cellulitis worsens lymphedema rapidly. Though complex decongestive physiotherapy, one of conservative treatments, is considered effective, it has a major fault to require a life-long daily treatment. Surgical treatments, including resection of edematous tissue, subcutaneous drainage by insertion of nylon threads or dermis etc., are problematic due to invasiveness. We perform less-invasive surgery, lymphatico-venular anastomosis (LVA) in which lymphatic channels are bypassed into small venules via a small skin incision, and patients after LVA showed good results.

Lymphatico-venular anastomosis (LVA)
Using supermicrosurgery (anastomosis technique less than 0.5mm), it became possible to anastomose very small vessels and to perform less-invasive and effective lymphedema surgery, lymphatico-venular anastomosis (LVA). Based on findings of preoperative lymphography, 2cm-wide skin incision is made after local anesthesia. Lymph flow is bypassed into venous circulation by anastomosing lymphatic channels to venules. We perform LVAs with 2-4 operators using 2-4 operating microscopes simultaneously to make LVAs as much as possible within 4 hour operation time, because the number of LVAs correlates with treatment efficacy. Patients are usually alert under local anesthesia and watch the operation monitor with operation explanation by operators. Admission duration is about 1-2 weeks.

ICG lymphography
Lymph flow can be assessed by specialized camera after injection of indocyanine green (ICG). Injection of ICG is usually done the day before surgery for preoperative examination, sometimes it is done in outpatients clinic for evaluation of the lypmhedema state. ICG is injected bilaterally even in patients with one-side lymphedema to compare with findings on normal side.