In Plastic Surgery, we aim to morphologically and functionally repair and reconstruct abnormalities and deformities on the surface of the body and nearby areas such as trauma, congenital anomalies, and post-surgical operations. Deformation and dysfunction of the body surface, especially the face, is a problem that greatly affects the quality of life of patients. We provide treatment by making full use of experience, medical knowledge, surgical techniques, and cooperation with other departments.
Trauma
Appropriate initial treatment is provided for injuries in cooperation with the emergency department. If surgical treatment is required, appropriate surgery is performed at the appropriate time. In particular, facial trauma and facial bone fractures are treated with an emphasis on how to make the scratches less noticeable and how to repair the deformation and damage. Burns are treated in cooperation with the emergency department and regional medical institutions, ranging from life-saving treatment to deformity, deformity, and functional reconstruction. We actively repair not only fresh wounds but also old ones.
congenital anomaly
We treat congenital anomalies of the face such as cleft lip and cleft palate, fingers and toes, and other congenital anomalies of the body surface. Especially for cleft lip and palate, we promote team medical care with Pediatrics, Otorhinolaryngology, orthodontics, oral surgery, audiologic and speech therapists, and nurses. We strive to start treatment at birth and provide appropriate treatment at the appropriate time of development. Although it is often a long-term treatment, we provide treatment while maintaining a relationship of trust while fully explaining and consulting with the patient and family. Nurturing medical care can also be adapted.
Tumor resection, reconstructive surgery
In cooperation with other clinical departments, we perform reconstruction after resection of malignant tumors from excision and reconstruction of skin and subcutaneous tumors. We have a cooperative relationship with various clinical departments, including head and neck surgery, Breast Surgery, and Dermatology. In reconstruction after malignant tumor resection, we use various skin flaps and microscopic free skin flaps to improve the quality of life of patients. In addition, for reconstruction after breast cancer surgery, breast reconstruction using silicone gel implants is also covered by health insurance.
others
We also actively provide laser treatment (insurance treatment) for nevi and bruises, ptosis, intractable ulcers, and keloid treatments. In addition, we treat diseases that are generally covered by insurance in Plastic Surgery.
We provide appropriate treatment according to each patient's symptoms, progress, and wishes.
The Plastic Surgery outpatient clinic is open three times a week on Mondays, Wednesdays, and Fridays. First visits and follow-up visits are available on any day of the week. Also, on Thursday mornings, we have an outpatient clinic specializing in keloids and hypertrophic scars. Clinical keloid. The staff involved in the study practiced multidisciplinary therapy.
Surgery is inpatient on Tuesdays and Thursdays (general anesthesia). On Mondays, Wednesdays, and Fridays, outpatient (one-day) surgery (local anesthesia) is performed. Surgery is performed by multiple people, including the operator and caregivers, in a perfect system. If you live nearby and the surgery is relatively less invasive, day surgery with general anesthesia is possible.
Medical record
Main diseases/treatments
Facial soft tissue injuries are treated not only for cosmetic purposes but also for functional improvements. In addition, facial bone fractures are operated on as early as possible and fixed with a bioabsorbable plate (osteosynthesis material). We also perform surgery for old facial trauma.
facial bone fracture
At our hospital, we perform about 100 surgeries a year for facial bone fractures caused by traffic accidents, falls, sports, etc. Surgery is recommended within a few weeks to a month after injury. If it takes a long time before the surgery, the bone may harden while deformed and various symptoms may remain, so we recommend that you see a doctor as soon as possible. Treatment may also be possible for deformities that remain after healing, regardless of whether surgery was performed.
<cheekbone fracture>
Symptoms include difficulty opening the mouth, pain when opening the mouth, pain when chewing, numbness in the cheeks, upper lip, and gums, and flattening of the cheeks.
Four incisions are made in the lower eyelid, outer eyebrows, temporal region, and oral cavity to reduce the fracture, followed by plate and screw fixation (Fig. 1). The plates and screws used at our hospital are mainly biodegradable and absorbable osteosynthetic materials, which decompose in about 3 to 5 years and basically do not need to be removed. Normally, you will need to stay in the hospital for 1-2 nights, but you will be able to carry out daily activities from the day after the surgery.
<Maxillary Fracture>
In particular, a fracture called Le Fort type I fracture (Fig. 2) has symptoms such as pain when biting and misalignment of the bite. Basically, an incision is made in the oral cavity to reduce the fracture. At this time, the upper and lower teeth are fixed in a state of occlusion. This fixation may be done only during surgery or may continue after surgery.
<orbital fracture>
Fractures are often caused by situations such as being hit by a baseball in the eye or being punched in the eye during a boxing match. Impaired eye movement (dysmotility, Figure 3) or drooping of the eyeballs (pitting eyes) can lead to double vision (diplopia). Especially in young people, the muscle that moves the eyeball may get caught in the fracture site, and in that case, emergency surgery may be required. If you have symptoms such as nausea/vomiting, severe pain when you move your eyes, or a slowed heart rate (bradycardia), it is highly likely that your muscles are pinched, so you need to see a doctor urgently.
An incision is made in the lower eyelid to reduce the fracture, and an absorbable sheet made of the same material as the plate described above is placed (Fig. 4). This also usually requires hospitalization for about 1-2 nights, but daily life is possible from the day after surgery, except for strenuous exercise.
<nasal bone fracture>
Symptoms include nasal deformation, nosebleeds, and nasal congestion. It's basically aimed at improving aesthetics. A special instrument is inserted into the nose for reduction (manual reduction). After reduction, the nose is stuffed with gauze, and the outside (nose back) is fixed by applying a sheet. Normally gauze needs to be worn for about a week, and scine needs to be worn for about two weeks. In our hospital, all cases are reduced under general anesthesia because reduction is accompanied by strong pain and sufficient reduction is performed. A one-night hospital stay is usually required, but it is also possible to perform the surgery on a day-to-day basis.
It should be noted that surgery after the injury has healed while the deformity has been healed requires a different method, and the burden will be greater, so we recommend treatment before the deformity heals (within a few weeks).
If you visit our hospital's emergency outpatient department, you will be asked to visit our department the day after the injury, and the surgery date will be determined. Patients who were diagnosed at other hospitals should also see a doctor as soon as possible, and it is easier to obtain favorable results if surgery is performed early.
<Multiple facial fractures>
There are various conditions. In cases where the deformity remains after surgery, or in cases where the deformity cannot be operated in the first place and has been cured once, treatment will be performed according to the symptoms.
<Other facial soft tissue injuries>
For large facial injuries, Plastic Surgery may perform stitches and other procedures. Our department also treats scars that affect the shape and movement of the face.
We treat wide-range burns that require whole-body management to small-range burns. Extensive burns are treated jointly with the emergency department. We also treat scar contracture and deformity after healing of burns.
For cleft lip and cleft palate treatment, we provide team medical care with various in-hospital and out-of-hospital facilities. From birth to adulthood, we perform several surgeries at appropriate times with the best technology. In addition, speech therapy, orthodontics at affiliated hospitals, and facial bone orthodontics at dental and oral surgery are also available.
lip plastic surgery
About 3 months after birth, weight 5-6 kg.
There are various types of cleft lip, such as unilateral cleft, bilateral cleft, complete cleft, and incomplete cleft, and the morphology also varies depending on the patient. It is important to perform surgery that is finely tuned according to the degree and condition of the patient's cleft lip.
The current situation is that the surgical method differs slightly depending on the facility and the operator. At our clinic, we consider the best method according to the condition of the patient's cleft lip.
We do not perform rhinoplasty in initial cleft lip surgery. This is to avoid the growth disorder of the patient's external nasal cartilage due to the surgical invasion. Rhinoplasty is performed after the patient grows a little more.
palatoplasty surgery
Surgery is performed when the child is one and a half years old and weighs 10 kg. It is important to do this before the patient begins to speak meaningful words from babbling. The cleft palate must be closed to achieve correct articulation.
It's a bit of a painful surgery for the patient, but it's an operation that should be overcome.
speech therapy
Start after cleft palate surgery, depending on your age. Even after cleft palate surgery, some patients cannot speak normally due to the degree of muscle development in the pharynx. In order for such patients to acquire normal articulation, specialized speech pathologists provide language training. Patients who cannot articulate normally despite continued language training may need to consider further treatment (surgery).
Orthodontics
If you have a cleft jaw or cleft palate, your teeth will inevitably become misaligned. We ask a specialist orthodontist (other hospital) to perform orthodontic treatment. It is an indication for independence support medical care (nurturing medical care).
Orthodontics is also necessary in preparation for bone grafting into the jaw cleft. In addition, orthodontic treatment will continue to be performed after the jaw cleft bone graft surgery.
顎裂骨移植手術
Some patients have a cleft in the alveolar ridge (gums) as an extension of the cleft palate. Clefts in the alveolar ridge can cause missing or straitened teeth. Around the age of 7-8 when the permanent teeth erupt, bone is grafted into the jaw cleft to close it. Bone marrow is harvested and transplanted mainly from the ilium.
Lip Revision / Labioplasty
This is the final surgery for the cleft lip. After the age of 14-16, it is performed after the cartilage of the face has matured. It covers a wide range of procedures, including correction of external nose deformities and correction of scars on the lips. Surgery is performed after thorough consultation according to the patient's condition. Currently, you can use medical care for independence support up to the age of 18, so we will consider it so that you can finish it by then. Of course, adult cases are also covered by health insurance. In addition, we ask dental and oral surgery departments for treatment (such as osteotomy) for bone deformation of the maxilla and mandible.
Polydactyly and syndactyly (hands and feet) are also relatively common congenital anomalies. Appropriate treatment (surgery) is performed on appropriate Nanshiki. For polysyndactyly (dactyly), surgery is usually performed after the age of one.
Auricular deformation such as microtia and accessory ear. Eyelid abnormalities such as congenital ptosis. Trunk abnormalities such as umbilical hernias and inverted nipples. We deal with various body surface abnormalities.
In cooperation with Head and Neck Surgery, we perform reconstructive surgery after head and neck tumor resection. We perform one-stage reconstruction as much as possible by making full use of various skin flaps. We are working towards morphological and functional reconstruction.
Resection of various head and neck malignant tumors (tongue cancer, oropharyngeal cancer, buccal mucosa cancer, maxillary cancer, etc.) and benign tumors, and large tissue defects due Otorhinolaryngology trauma, etc. In contrast, it is an operation in which a large amount of tissue is harvested from another part of the body and transplanted. The tissue is collected with blood vessels attached, reconnected to the blood vessels in the head and neck (vascular anastomosis), and engrafted at the transplant site. This is called “free tissue transplantation”. In addition, the tissue may be moved from the chest, which is close to the head and neck, without being cut off, and this is called "pedicle flap surgery."
Head and neck reconstruction is also aimed at minimizing functional disorders such as impaired swallowing (dysphagia) and impaired speech intelligibility (dysarthria, nasopharyngeal atresia). For this purpose, it is necessary to choose an appropriate reconstruction method for the defect site. Here we present a representative skin flap.
In addition, reconstruction of the facial nerve damaged by surgery may be performed at the same time, or may be reconstructed after a while.
- Rectus abdominis myocutaneous flap
Features: Collect skin and fat on the rectus abdominis muscle. Because it has thick muscle, volume can be secured, and it is used for the base of the tongue (tongue root) and large and deep facial defects due to excision of maxillary cancer.
Closure: The harvested part can be sewn closed. Post-surgery complications: Muscle strength is reduced by harvesting the rectus abdominis muscle, but this has little effect on daily life. The stitched closure can become fragile and result in an "abdominal incisional hernia." For prevention, you may also wear a belly band
・Lateral forearm flap
Features: Usually, blood vessels are attached to the skin near the wrist of the non-dominant arm and collected. Since it is a thin and flexible skin flap, it is used for reconstruction of the tongue, palate, inner cheeks, etc. Blood flow in the hand is mainly maintained by two arteries, the radial artery and the ulnar artery, of which the radial artery is used.
Closing the wound: Skin grafting is performed by sewing the skin collected from the abdomen, etc., to the collected part.
Postoperative complications: Pigmentation occurs in the skin-grafted area and becomes conspicuous as a patchwork. Part of the thumb may also become numb, as a branch of the radial nerve is sacrificed.
・Anterolateral thigh flap (ALT flap)
Features: Collect by attaching a blood vessel to the skin, subcutaneous fat, and fascia of the anterolateral thigh. It is collected with a blood vessel, the descending branch of the lateral femoral circumflex artery (and its accompanying vein). It is characterized by the fact that relatively large skin flaps can be harvested.
Closing the wound: Basically, the collected part can be sewn closed.
Postoperative Complications: A streak scar remains on the thigh. Since the muscles are manipulated, muscle weakness and pain may occur at first, but eventually it will have little effect on daily life.
There are reconstructions using silicone expanders (water balloons) and implants, and reconstructions using your own tissues (lattis dorsi or rectus abdominis). There are two methods: simultaneous with breast cancer surgery and after breast cancer surgery.
Treatment varies depending on the type, size, location and age of the tumor. The resected tumor is diagnosed by pathological examination. In addition to general anesthesia, day surgery and laser treatment (pigment laser, Q-switch ruby laser, insurance coverage only) are also available.
Medications include tapes containing steroids and local injections of steroids. In surgical treatment, radiation therapy is used in combination with keloids that may recur. For scar contracture, we perform surgery for scar contracture and hypertrophic scars caused by various causes such as trauma, after surgery, and after burns.
Keloid/hypertrophic scar
Keloids can develop from microscopic wounds such as acne, insect bites, piercings, injection marks, or scars from injuries or surgery.
It is characterized by redness and swelling, which gradually expands and presents with persistent pain and itching. It is a disease that occurs only in humans, and the exact cause is unknown.
At our Plastic Surgery clinic, we have set up an outpatient clinic specializing in keloids, where doctor who have been treating keloids for many years conduct specialized examinations and provide treatment.
In addition to steroid tape patches, internal medicine (tranilast), and steroid injections, there are treatments that combine radiation therapy after surgical excision. It may take several years to completely heal, and some keloids are resistant to treatment, and they may recur, so patient treatment is required. Patients who have given up treatment at other facilities because they are told that they cannot be cured also come to our hospital. Please don't hesitate to seek medical attention.
In our department, we are conducting research on the fundamental pathology of keloids and new treatments in the future in collaboration with RIKEN. (see clinical studies)Hypertrophic scars are red, raised and similar in appearance to keloids, but they do not extend beyond the original scar. It occurs when burns or surgical wounds do not heal properly, and is pathologically different from keloids.
Treatment may be relieved by surgical treatment alone, or conservative treatment including topical agents may be performed. We also do this treatment.
Keloid specialist outpatient clinic
Thursday morning (Monday, Wednesday, and Friday mornings are also available)
Anterior chest keloid
Pimples are small, hard, red bumps that gradually grow, connect to each other, and spread to the left and right (Fig. 1). It often has a dumbbell shape.
In addition, scars from open chest surgery gradually spread left, right, up and down, and wounds in drainage holes for blood removal also become keloids. (Figure 2)
The case in Figure 1 underwent resection and irradiation.
The case in Fig. 2 was relieved only by steroid injection.
umbilical keloid
It often arises from the surgical scar of endoscopic surgery.
Since the skin of the umbilical cord is thin, the epidermis rolls up at the time of suturing, resulting in a tumor called an epidermal cyst (atheroma), which is often repeatedly infected and inflamed and gradually rises.
The lower case was resected and radiation irradiation was performed.
earlobe keloid
It often originates from a piercing hole.
Consistent with the hole, a lump forms and gradually enlarges. Unlike other keloids, it often has less redness.
The lower case was resected and radiation irradiation was performed.
shoulder keloid
It often occurs from acne or insect bites. It can also result from a minor surgery to remove a boil.
In the case below, steroid injections were continued for 4 years, and the redness and itchiness almost disappeared.
lower abdomen keloid
It often occurs from surgical scars after laparotomy in Urology, gynecology, surgery, and caesarean section.
The lower case was resected and radiation irradiation was performed.
In order to improve the condition where the eyelids droop and make it difficult to see, there are various methods depending on the cause, such as excision of the drooping skin, shortening and forward rotation of the muscle that lifts the eyelids (levator blepharo), and lifting the eyelids with the fascia. I am having surgery in
clinical research
Our department conducts clinical research to solve various clinical questions. Observational studies are conducted without direct consent and with this revelation. In addition, intervention studies and observational studies that have been reviewed and approved by the hospital's clinical research ethics committee are conducted after obtaining the individual patient's consent.
In addition, in our department, we actively report the knowledge obtained through these activities in domestic and international conference presentations and papers.
Major clinical studies (including observational and intervention studies)
| Research subject name | Person in charge of our hospital | Explanatory text (PDF) |
|---|---|---|
| Function and usefulness of keloid-expressing proteins in diagnosis and treatment of keloids | Mika Ikeda | |
| Research and development of basic technology for practical application of hair follicle regenerative medicine reproducing organ development program | Mika Ikeda |
news
Since we are operating with a small number of people, we currently do not have a special outpatient department, and we are responding to general diseases at the general outpatient department.
To doctors of community medicine
Plastic Surgery outpatient clinic is open on Mondays, Wednesdays, and Fridays. (Tuesday/Thursday outpatient only for emergency cases)
| inpatient surgery | Tuesday Thursday |
|---|---|
| outpatient surgery | Monday, Wednesday, Friday (reservation required) |
| laser therapy | We mainly perform outpatient surgery, but we also perform inpatient surgery when general anesthesia is required, such as for children. |
| Conferences (case review meetings, etc.) | We do it at any time. We also actively participate in joint conferences with other departments such as Head and Neck Surgery. |
| Director rounds | every thursday afternoon |
To doctors of community medicine
Plastic Surgery outpatient clinic is open on Mondays, Wednesdays, and Fridays. (Tuesday/Thursday outpatient only for emergency cases)
| inpatient surgery | Tuesday Thursday |
|---|---|
| outpatient surgery | Monday, Wednesday, Friday (reservation required) |
| laser therapy | We mainly perform outpatient surgery, but we also perform inpatient surgery when general anesthesia is required, such as for children. |
| Conferences (case review meetings, etc.) | We do it at any time. We also actively participate in joint conferences with other departments such as Head and Neck Surgery. |
| Director rounds | every thursday afternoon |
Our hospital participates in the disease registry of the Japan Society of Plastic and Reconstructive Surgery.
For those who are considering reconstructive surgery with an artificial breast
In July 2019, Allergan expanders and textured (rough surface) implants, which were the only insurance approved products in Japan at the time, became a global concern due to an outbreak of BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). It was discontinued and voluntarily recalled. As of 2022, 733 cases of BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) have been reported in breast implant patients undergoing breast augmentation or breast reconstruction, with 36 deaths. The incidence of BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) is reported to be 1 in several thousand to tens of thousands of people. There are 4 cases reported.
Since July 2013, after receiving insurance approval in Japan, we have been performing breast reconstruction surgery using Allergan's Natrel implants at our hospital. Patients who underwent the surgery had a low incidence of BIA-ALCL and slow progression, and it was possible to treat by resecting the implant along with the capsule with early detection. We explained that early detection is possible through physical examination and image diagnosis, and in accordance with the policy recommended by the academic society, we conduct medical examinations every six months and MRI image diagnosis every two years. We do not recommend aggressive removal of implants. If you have undergone breast implant surgery at another hospital and are undergoing follow-up observation at our hospital, we will follow up in the same way.
The expanders that can be used as of June 2022 are Natrell 133S (Allergan), MOTIVA FLORA (Establishment Labs → scheduled to arrive from around July 2022), and Koken (conventional expander). In addition, there are smooth types (bowl-shaped implants with a smooth surface) of inspira (Allergan), Sientra (Sientra), MOTIVA (Establishment Labs → scheduled to arrive in July 2022), and micro-textured types (surface Rough) has Sientra (Sientra).
In our department, after explaining to the patient, we perform breast reconstruction using the expander and implant of your choice.
We also plan to update the information on our website as needed.
June 8, 2022
Kobe City Medical Center General Hospital
Plastic Surgery SurgeryMika Ikeda
Japan Oncoplastic Breast Surgery Society "Information for Patients"
For those who have undergone tissue expander surgery for breast reconstruction and are waiting for breast reconstruction with breast implants (gel-filled artificial breasts).
| Date August 2, 2019 | For those who have undergone tissue expander surgery for breast reconstruction and are waiting for breast reconstruction with breast implants (gel-filled artificial breasts). |
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For those who wish to have breast reconstruction with breast implants (gel-filled artificial breasts)
| As of February 2022 | For those who wish to undergo breast surgery with breast implants (gel-filled artificial breasts) |
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