切断組織再接着・欠損組織再建

切断損傷

スーパーマイクロサージャリーによる外径 0.3mm の血管吻合*
* 山本匠、ほか．To Be a Supermicrosurgeon- Supermicrosurgeryの練習法と実際．脳神経外科速報．2011;21(10):1114-20

切断組織の再接着術

比較的よくみられる手指切断損傷のほか、陰茎・耳介・鼻・口唇・足趾切断など稀な切断損傷に対しても、切断組織に血管が確認される場合は積極的に再接着を行っております＊。

（＊Yamamoto T, et al. Lymph flow restoration after tissue replantation and transfer: importance of lymph axiality and possibility of lymph flow reconstruction using free flap transfer without lymph node or supermicrosurgical lymphatic anastomosis. Plast Reconstr Surg 2018 Sep;142(3):796-804）

切断指の再接着術（骨接合・腱縫合ののち、静脈移植を併用し動脈2本・神経2本・静脈3本を顕微鏡下に吻合した）*

* Yamamoto T, et al. Lymph flow restoration after tissue replantation and transfer: importance of lymph axiality and possibility of lymph flow reconstruction using free flap transfer without lymph node or supermicrosurgical lymphatic anastomosis. Plast Reconstr Surg 2018 Sep;142(3):796-804

組織切断後の再建術

　切断損傷において切断組織が再接着不可能な場合（切断組織がみつからないなど）、再接着術後に再接着組織が壊死した場合（損傷が強い場合は再接着数日後から血流が途絶えることがあります）、または断端形成後に神経痛（有痛性断端神経種）や機能障害のため再建術を希望される場合は、別の部位から欠損部に移植することで各種組織を再建することができます。

　指切断後の指欠損では足趾移植（当科では採取した足趾の機能面・整容面も考慮して、採取部の犠牲が少ないような採取法や採取部へのドミノ再建術を行っています）、陰茎欠損には各種知覚皮弁・筋弁・骨弁をもちいた機能的尿道・陰茎再建、耳介欠損では肋軟骨移植・皮弁移植併用による耳介再建、鼻欠損ではさまざまな組織をもちいたキメラ型組織移植による鼻腔・外鼻再建、口唇欠損では粘膜弁・皮弁・筋肉弁・筋膜などをもちいた機能的口唇再建など、スーパーマイクロサージャリーの技術を応用して機能的かつ可能な限り低侵襲に（犠牲が少なく）再建手術を行っています。

I趾爪とII趾関節を組み合わせたTwisted-Toe移植による機能的・整容的母指、およびキメラ型腸骨鼠経穿通枝弁移植による採取部のドミノ再建

Yamamoto T. Harvard University Visiting Professor Inaugural Joseph Utpon Lectureship “To Be a SUPER-microsurgeon”. Harvard University, Boston, USA, Aug 2023.

採取部位(第II趾)の趾・爪を温存する足趾移植（toetip移植）

Yamamoto T, et al. Use of non-enhanced angiography to assist the second toetip flap transfer for reconstruction of the fingertip defect. Microsurgery 2014;34(6):481-3.

採取部位の犠牲が少ない足趾移植（hemipulp移植）

Yamamoto T, et al. Transversely-inset great toe hemi-pulp flap transfer for the reconstruction of a thumb-tip defect. Microsurgery 2014 Oct 31 [Epub ahead of print]

英文論文

1. Yamamoto T. Onco-Reconstructive Supermicrosurgery. Eur J Surg Oncol. 2019 Jul;45(7):1146-1151.
2. Yamamoto T, et al. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: a chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg. 2016 Jun 23 [epub ahead of print]
3. Fuse Y, Yoshimatsu H, Yamamoto T. Lateral approach to the deep branch o the superficial circumflex iliac artery for harvesting a SCIP flap. Microsurgery Feb 23 [epub ahead of print]
4. Yamamoto T, Iida T, Yoshimatsu H, Fuse Y, Hayashi A, Yamamoto N. Lymph flow rrestoration after tissue replantation and transfer: importance of lymph axiality and possibility of Yamamoto T reconstruction using free flap transfer without lymph node or supermicrosurgical lymphatic anastomosis. Plast Reconstr Surg 2018 Sep;142(3):796-804
5. Pafitanis G, Narushima M, Yamamoto T, Miller R, Koshima I. Insights to establish early learning curve in clinical supermicrosurgery. Microsurgery. 2018 Dec 17 [epub ahead of print]
6. Brahma B, Yamamoto T. Breast cancer treatment-related lymphedema (BCRL): an overview of the literature and updates in microsurgery reconstruction. Eur J Surg Oncol. 2019 Jan 4 [epub ahead of print]
7. Ganry L, Fuse Y, Sakai H, Reiko T, Yamamoto T. Refinement of the chicken wing supermicrosurgical training model: pre-operative indocyanine  green injection highlighting vessels' visualization under 0.4mm of diameter. Microsurgery Jan 21 [epub ahead of print]
8. Yamamoto T, Yamamoto N, Kageyama T, Sakai H, Fuse Y, Tsuihiji K, Tsukuura R. Definition of perforator flap: what does a "perforator" perforate? Global Health & Medicine. 2019; 1(2):114-116. DOI: 10.35772/ghm.2019.01009
9. Yamamoto T, Yamamoto N, Kageyama T, Sakai H, Fuse Y, Tsuihiji K, Tsukuura R. Supermicrosurgery for oncologic reconstructions. Global Health & Medicine. 2020; 2(1):18-23. DOI: 10.35772/ghm.2019.01019
10. Rodriguez JR, Fuse Y, Sakai H, Tsukuura R, Yamamoto T. Ulnar artery concomitant veins of the chicken wing for advanced supermicrosurgery training. Microsurgery. 2021 Jan;41(1):102-103.
11. Miyazaki T, Tsukuura R, Yamamoto T, Daniel BW. Nerve vascularity in free vascularized nerve flaps. Glob Health Med. 2020 Aug 31;2(4):263-264.
12. Sumiya R, Tsukuura R, Mihara F, Yamamoto T. Free superficial circumflex iliac artery perforator fascial flap for reconstruction of upper abdominal wall with extensive infected herniation: A case report. Microsurgery. 2021 Mar;41(3):270-275.
13. Mukarramah DA, Tsukuura R, Kageyama T, Sakai H, Fuse Y, Tsuihiji K, Yamamoto T. Side-to-side supermicrosurgical anastomosis training using chicken wing model with V-shaped traction method. Microsurgery. 2021 Mar;41(3):300-301
14. Yamamoto T, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto N. Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction. J Surg Oncol. 2021 Apr;123(5):1232-1237.
15. Tsuihiji K, Daniel BW, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto T. Free tensor fascia lata true-perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol-induced Charcot foot: A case report and literature review. Microsurgery. 2021 Jul;41(5):473-479.
16. Yamamoto T, Yamamoto N, Fuse Y, Kageyama T, Sakai H, Tsukuura R. Subdermal dissection for elevation of pure skin perforator flaps and super-thin flaps: the dermis as a landmark for the most superficial dissection plane. Plast Reconstr Surg. 2021 Mar 1;147(3):470-478.
17. Yamamoto T, Yamamoto N, Kageyama T, Sakai H, Fuse Y, Tsukuura R. Lymph-interpositional-flap transfer (LIFT) based on lymph-axiality concept: simultaneous soft tissue and lymphatic reconstruction without lymph node transfer or lymphatic anastomosis. J Plast Reconstr Aesthet Surg.  2021 Oct;74(10):2604-2612.
18. Yamamoto T, Yamamoto N. An extended superficial circumflex iliac artery perforator flap transfer for a relatively-small breast reconstruction after total mastectomy. Microsurgery. 2021 Jun 2. [epub ahead of print]
19. Tsukuura R, Yamamoto T. Free medialis tarsus flap transfer for reconstruction of toe necrosis: A case report. Microsurgery. 2021 Jun 22. Epub ahead of print.
20. Fuse Y, Yamamoto T, Kageyama T, Sakai H, Tsukuura R, Yoshimatsu H, Yamamoto N. Domino Free Flap Transfer Using a Superficial Circumflex Iliac Artery Perforator Flap for the Toe Flap Donor Site. Ann Plast Surg. 2022 Mar 1;88(3):293-297.
21. Yamamoto T, Yamamoto N. Five Essential Principles for First Web Space Reconstruction in the Burned Hand. Plast Reconstr Surg. 2021 Aug 30 [epub ahead of print]
22. Yamamoto T, Daniel BW, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto N. Expanding indication of free hypothenar flap transfer: sequential pedicled ulnar palm flap transfer to a relatively-large hypothenar flap donor site. J Plast Reconstr Aesthet Surg. 2022 Jan;75(1):332-339.
23. Yamamoto T, Yamamoto N, Ishiura R. Free double-paddle SCIP flap transfer for partial maxillectomy reconstruction: a case report. Microsurgery. 2021 Oct 7 [Epub ahead of print]
24. Yamamoto T, Daniel BW, Jose RR, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto N. Radical reduction and reconstruction for male genital elephantiasis: Superficial circumflex iliac artery perforator (SCIP) lymphatic flap transfer after elephantiasis tissue resection. J Plast Reconstr Aesthet Surg. 2021 Sep 5 [Online ahead of print] 2022 Feb;75(2):870-880.
25. Tsukuura R, Yamamoto T. Sensate superior gluteal artery perforator flap for a patient with deep sacral ulcer: a case report and literature review. Microsurgery 2021 Nov 9 [epub ahead of print] 2022 Mar;42(3):271-276.