Plastic and Reconstructive Surgery
Overview of the departmentKunihiro Nakai. The Department of Plastic and Reconstructive Surgery was newly established in July 2013. We target “functional” and “cosmetic” repair of disease/trauma-related tissue defects/deformities. We are responsible for the treatment of small penetrating wounds/skin tumors, reconstruction of large tissue defects/deformity related to trauma/the resection of malignant tumors, and management of aging-related changes, such as blepharoptosis.
Consultation system/therapeutic strategies
As patients with body surface diseases are treated, it is important to improve not only functional but also cosmetic aspects. In particular, the face is seen by others, and a beautiful appearance (“natural beauty”) is considered more important. Our goal is to provide advanced medical services.
Two specialists in plastic surgery are responsible for medical care. We hope that many patients will become familiar with the Department of Plastic and Reconstructive Surgery, which has not yet been commonly recognized, and that we will effectively meet the needs of residents in this area.
Fields of expertise
Breast reconstruction after surgery for breast cancer
Based on the timing of surgery, this procedure is classified into 2 types: primary surgery during which reconstruction is simultaneously performed with extirpation of breast cancer; and secondary surgery consisting of extirpation of breast cancer, followed by reconstruction after the condition becomes stable. There are two reconstruction methods: one using self-tissues, such as the muscle of the abdomen and latissimus dorsi muscle of the back, and the other using a prosthetic silicone implant. Both of these methods have advantages/limitations; therefore, the most appropriate surgical method is determined based on patients’ wishes. In 2014, reconstruction with a drop-shaped silicone implant, as a natural breast shape, became covered by health insurance. This procedure can be performed only in hospitals authorized by the Japan Society of Oncoplastic Surgery. Our hospital is designated as an authorized hospital.
The Department of Plastic and Reconstructive Surgery specializes in techniques to treat the skin, considering the importance of appearance. Skin incision and suture methods are selected based on the suture site, wrinkle direction, hair growth, and tension. Precise dermal operations and appropriate wound treatment make trauma/burns and surgical scars less conspicuous.
In patients with blepharoptosis related to aging or the use of contact lenses, surgery is performed to improve the eyelid skin and eyelid-lifting function. The visual field is extended, reducing the consciousness to lift the eyebrows. Deep wrinkles on the forehead may disappear, exhibiting secondary effects, that is, the relief of headache and stiff shoulders.
Advanced medical practice
Microscopic microvascular anastomosis
To facilitate skin/tissue transplantation in a state in which blood flow is maintained, we specialize in the anastomosis of microvessels measuring approximately 1 mm in diameter under a microscope. Recently, advances in techniques and surgical instruments/microscopes have facilitated supermicrosurgery to suture tubular structures measuring 1 mm or smaller. Using this procedure, the replantation of amputated fingers and reconstruction of tissue defects after extended tumorectomy are performed. This procedure is also used to anastomose lymphatic vessels with veins in patients with lymphedema of the upper and lower limbs.
Symptoms/diseases treated in our department
1) Trauma: Facial bone fracture, penetrating wounds, abrasion, burns, skin defects, refractory skin ulcers, pressure ulcers, amputated fingers, cicatricial contracture, and hypertrophic scar/keloid
2) Skin tumors: Nevus, angioma, benign tumors of the skin, skin cancer, and soft tissue tumors
3) Reconstructive surgery: Tissue transplantation for tissue defects after head and neck tumorectomy, breast reconstruction for breast defects after the resection of breast cancer
4) Congenital abnormalities: Polydactyly, symphalangy, dysplasia of the ear auricle, navel protrusion, and cleft lip/palate
5) Others: Blepharoptosis, entropium ciliarum/ectropium palpebrae, facial paralysis, armpit odor, lymphedema, varices of the lower limbs, and ingrown nails
Diseases treated in our department vary: those of systemic organs. Patients are not familiar with the Department of Plastic and Reconstructive Surgery, and the contents of treatment are not recognized. Please see the homepage of the Japan Society of Plastic and Reconstructive Surgery (http://www.jsprs.or.jp/general/).
○ Although the field of plastic and reconstructive surgery involves that of cosmetic surgery, only patients with diseases covered by health insurance are treated in our department. Please consult us to confirm whether or not health insurance-based treatment is possible.
Primary examinations and explanations
Infrared-ray monitoring camera
The injection of indocyanine green facilitates the visualization of subcutaneous blood/lymphatic vessels’ courses through an infrared-ray camera. In the Department of Plastic and Reconstructive Surgery, this procedure is used to identify lymph nodes during the resection of malignant tumors, evaluate free tissue blood flow during microscopic vascular anastomosis, and identify the courses of lymphatic vessels during lymphaticovenular anastomosis for lymphedema, as a surgery-supporting system.