Yamaguchi-shi, Japan
Yamaguchi-shi, Japan

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Tan S.-H.,Yamaguchi University | Shigetomi M.,Yamaguchi University | Doi K.,Ogori Daiichi General Hospital
Journal of Reconstructive Microsurgery | Year: 2012

This experiment establishes the principles of using the compound muscle action potential (CMAP) as a possible postoperative monitor for free muscle grafts. Twenty rabbits were divided into two groups of ten each to investigate the effects of ischemia on CMAP of the muscles. Rectus femoris model was used and contralateral muscle was used as control. In all muscles total normothermic ischemia of 1.5 hours to mimic the time needed for transfer and inset of the flap was followed by occlusion of the artery in one group and vein in another group after 3 hours. During this ischemia of 1 hour, the CMAP amplitudes decreased and the latencies were prolonged. Latency prolongation was detected within 10 minutes of total, arterial, or venous ischemia. During the revascularization, both amplitude and latency improved, but not to the original values at the start. The results show that CMAP monitoring can provide easily detectable, objective indication of vascular compromise to a muscle graft within as early as 10 minutes of total, arterial, and venous ischemia. Changes in latency are more constant and predictable compared with amplitude changes. This method can provide continuous monitoring and can be used in buried muscle grafts. Copyright © 2012 by Thieme Medical.


Satbhai N.G.,Ogori Daiichi General Hospital | Doi K.,Ogori Daiichi General Hospital | Hattori Y.,Ogori Daiichi General Hospital | Sakamoto S.,Ogori Daiichi General Hospital
Bone and Joint Journal | Year: 2016

Aims Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve transfers (NT, 18 cases). Methods They were evaluated for functional outcome and quality of life (QoL) using the Disability of Arm, Shoulder and Hand questionnaire, both pre-and post-operatively. The three groups were compared and followed-up for at least 24 months. Results The mean shoulder abduction and flexion were comparable in all groups, but external rotation was significantly better in the DFMT group as were range and quantitative power of elbow flexion. Patients who had undergone DFMT had reasonable total active finger movement and hook grip strength. All groups showed improvement in function at a level greater than a minimum clinically important difference. The DFMT group showed the greatest improvement. Discussion Patients in the DFMT group had a better functional outcome and QoL recovery than those in the NT and SMT groups. © 2016 The British Editorial Society of Bone & Joint Surgery.


Addosooki A.,Sohag University | Doi K.,Ogori Daiichi General Hospital | Hattori Y.,Ogori Daiichi General Hospital | Wahegaonkar A.,Ogori Daiichi General Hospital
Journal of Hand Surgery | Year: 2012

Purpose: We reviewed 18 patients who had received double free muscle transfers and wrist arthrodesis to determine the effect of the stiff wrist on digital motion and function. Methods: The patients were 15 men and 3 women with a mean age of 24 years. We determined the total active motion of the metacarpophalangeal and interphalangeal joints just before performing the arthrodesis and at final follow-up. We recorded the Disabilities of the Arm, Shoulder, and Hand functional score at the same times. Results: All of our patients showed evidence of fusion at a mean of 12 ± 2 weeks (range, 1015 wk). The digital mean total active motion was 39° ± 21°before arthrodesis and 49°± 25°after arthrodesis. Preoperative Disabilities of the Arm, Shoulder, and Hand scores significantly decreased after fusion. Three cases were complicated postoperatively by wound hematoma. Five patients required wrist arthrodesis hardware removal because of skin irritation. Conclusions: Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function. Type of study/level of evidence: Therapeutic IV. © 2012 American Society for Surgery of the Hand.


Satbhai N.G.,Ogori Daiichi General Hospital | Doi K.,Ogori Daiichi General Hospital | Hattori Y.,Ogori Daiichi General Hospital | Sakamoto S.,Ogori Daiichi General Hospital
Journal of Hand Surgery: European Volume | Year: 2014

The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°-110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12-86). No donor site deficit was seen in any patient. © 2013 The Author(s).


Hattori Y.,Ogori Daiichi General Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2012

We report an unusual case of proximal interphalangeal joint locking of the ring finger due to the neglected flexor digitorum profundus avulsion. Although rare, it should be noted that locking is a potential complication after this injury.


Dodakundi C.,Ogori Daiichi General Hospital | Doi K.,Ogori Daiichi General Hospital | Hattori Y.,Ogori Daiichi General Hospital | Sakamoto S.,Ogori Daiichi General Hospital | And 3 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores. Methods: Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure. Results: The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of followup was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23° (range, 0° to 80°) for shoulder flexion, 31° (range, 0° to 90°) for shoulder abduction,218° (range,280° to 40°) for shoulder external rotation, 62° (range, 0° to 130°) for the shoulder rotation arc, 119° (range, 90° to 150°) for elbow flexion, and 233° (range, 260° to 220°) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was M0 in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46° (range, 0° to 98°), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure. Conclusions: Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2013 by the journal of bone and joint surgery, incorporated.


Hattori Y.,Yamaguchi University | Hattori Y.,Ogori Daiichi General Hospital | Doi K.,Yamaguchi University | Sakamoto S.,Ogori Daiichi General Hospital | Satbhai N.,Ogori Daiichi General Hospital
Journal of Reconstructive Microsurgery | Year: 2013

Anatomic variations in branching pattern of axillary artery (AxA) are common and typically involve subscapular artery (SsA) and posterior circumflex humeral artery (PCHA). Several skin and muscle flaps are based on the branches of AxA. Furthermore, these branches are frequently used as recipient vessels in functioning free muscle transfers for upper extremity reconstruction and in breast reconstruction. Accurate knowledge of the normal anatomy and variations in branching pattern of AxA is of significant clinical importance for the reconstructive microsurgeon. The purpose of this article is to report the variable branching pattern of AxA based on multidetector-row computed tomography angiography study of 62 upper extremities. The thoracoacromial artery consistently originated from the first or second part of AxA. The classic origin and branching patterns of SsA and PCHA were observed in 21 cases (33.9%). Anatomic variations of SsA and PCHA were observed in 41 upper extremities (66.1%). In addition to the classic pattern, five distinct variations were noted. © 2013 by Thieme Medical Publishers, Inc.


Hattori Y.,Ogori Daiichi General Hospital | Doi K.,Ogori Daiichi General Hospital | Koide S.,Ogori Daiichi General Hospital | Sakamoto S.,Ogori Daiichi General Hospital
Journal of Hand Surgery | Year: 2014

Purpose: To investigate the clinical outcomes of endoscopic carpal tunnel release for severe carpal tunnel syndrome in octogenarians compared with a younger cohort. Methods: Fifty-five hands in 48 patients were enrolled in this study. There were 27 hands in 24 octogenarians and 28 hands in 24 patients in a younger group with average ages of 83 and 60 years, respectively. Postoperative follow-ups were 8.5 and 7.2 months, respectively. Clinical evaluation included documentation of subjective symptoms and Semmes-Weinstein testing before surgery, 3 months after surgery, and at final follow-up. Symptom severity and function outcomes scores and compound muscle action potential of abductor pollicis brevis as an electrophysiological assessment were evaluated before surgery and at the final follow-up. Results: Nocturnal pain and paresthesias were improved in all patients. The octogenarians had poorer recovery of Semmes-Weinstein testing score and better improvement of outcomes scores than the younger group. There was no difference of the results in postoperative electrophysiological improvement between the groups. Conclusions: Endoscopic release for severe carpal tunnel syndrome relieved symptoms and improved activities of daily living in octogenarians. Copyright © 2014 by the American Society for Surgery of the Hand. All rights reserved.).


Dodakundi C.,Ogori Daiichi General Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2012

Calcium pyrophosphate dihydrate deposition disease typically involves the wrist joint in the form of calcifications of the triangular fibrocartilage and the distal radioulnar joint. We describe an 87-year-old male who presented to us with asymptomatic form of deposition with multiple flexor tendon calcifications causing chronic median nerve compression. Simple carpal tunnel decompression relieved his median nerve symptoms.


Hattori Y.,Ogori Daiichi General Hospital | Doi K.,Ogori Daiichi General Hospital | Sakamoto S.,Ogori Daiichi General Hospital | Satbhai N.G.,Ogori Daiichi General Hospital
Plastic and Reconstructive Surgery | Year: 2013

BACKGROUND: Vascular trauma associated with brachial plexus injury affects the selection of reconstructive procedures. Often, there is a paucity of appropriate recipient vessels with adequate blood flow for functioning free muscle transfer. The presence of associated vascular injuries of the subclavian or axillary artery is considered a contraindication to the double free muscle technique. The authors hypothesized that vascular repair of subclavian or axillary artery trauma might not be necessary for successful reconstruction using the double free muscle technique, provided that the recipient arteries for functioning free muscle transfer (e.g., thoracoacromial and thoracodorsal arteries) are found to be patent on preoperative angiography. METHODS: The authors investigated the pathway of collateral circulation and potential recipient vessels for functioning free muscle transfer reconstruction in 20 brachial plexus injury patients associated with subclavian or axillary artery trauma using multidetector-row computed tomographic angiography. Based on these findings, the authors restored upper extremity function using the double free muscle technique without surgical repair of the injury to the major vessel in three patients. RESULTS: The suprascapular artery was the major stem artery for collateral circulation, and the circumflex scapular and subscapular arteries were major reentry arteries. The authors successfully used the thoracoacromial and thoracodorsal arteries as the recipient vessels for functioning free muscle transfers in the double free muscle technique. The preliminary functional outcomes of all three cases were satisfactory. CONCLUSION: This study demonstrates the feasibility of double free muscle technique reconstruction in brachial plexus injury patients, without actual vascular repair for the associated subclavian or axillary artery trauma. Copyright © 2013 by the American Society of Plastic Surgeons.

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