Department of Plastic and Reconstructive Surgery
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Department of Plastic and Reconstructive Surgery

01Department Outline

Hisanao Aoki
Hisanao Aoki

The Department of Plastic and Reconstructive Surgery deals with surgery of the physical or facial features and also the reconstruction of damaged tissue as a result of injury or illness. As well as the more obvious goal of functional reconstruction of parts of the body, the utmost care is also taken in surgery to achieve the best results cosmetically.

We deal with a wide-range of conditions including:
- Facial trauma: including facial bone fractures, etc.
- Facial congenital anomalies including: cleft lip, cleft palate, microtia and accessory ear.
- Congenital anomalies of the hands and feet: polydactyly and syndactyly.
- Skin operations: benign and malignant skin tumors, scarring, burns injuries, etc.

We also deal with instances such as jaw deformities, exumbilication, reconstruction of tissue damage resulting from other surgery and laser treatment of birthmarks. Our department also looks after the treatment of varicose veins.

02Conditions and Treatments

1. Burn injuries

For severe burns and burn injuries spread over a large area of the body, we undertake treatment with an emphasis on skin graft procedures, in conjunction with conservative treatment. For burns to the hands, surgery is performed as soon as possible in order to maintain functionality. In conjunction with the Emergency and Critical Care Center and intensive care units, we administer treatment for burns spread over a large area of the body.

2. Facial bone fractures, facial soft tissue damage

From the closing of wounds caused by injury to facial orthopedic reduction for injuries such as nasal, mandibular and zygomatic fracture, we focus on the treatment of across-the-board facial trauma in this department. In instances that affect occlusion of the teeth, such as mandibular and maxillary fracture or multiple fractures, we work in co-operation with the dentistry department. For injuries which affect sight such as orbital fracture, we work with the ophthalmology department. We also work with other departments when multiple fractures necessitate this.

3. Cleft lip, cleft palate

From the initial surgery for cleft lip, to corrective surgery for cleft palate, alveolar cleft involving bone grafting and rhinoplasty for the nose, we offer treatment from the time of birth through to the final stages of treatment in adulthood. For cleft palate, a palatal obturator device is fitted by an orthodontic specialist in our dentistry department and in certain instances of alveolar palate, mandibular and maxillary dentofacial osteotomy is performed. Where speech therapy is needed, we work in collaboration with neighboring specialists in order to facilitate appropriate treatment.

4. Congenital anomalies and trauma to the hands and feet

We specialize in treating polydactyly (superfluous digits) and syndactyly (conjoined digits) of the feet in this department. We also look after surface trauma such as scar contracture and periungual (proximate to the finger/toe nails) problems; however where injuries extend to the tendon and bone, this is taken care of by the orthopedic surgery department.

5. Other congenital anomalies

We treat congenital periauricular anomalies such as accessory ear, microtia and congenital preauricular fistula; facial conditions such as congenital ptosis (drooping eyelids) and conditions affecting the trunk such as inverted nipple and exumbilication.

6. Naevi, hemangioma, benign tumors

For smaller tumors, surgery during an outpatient visit is performed, with the tumor resected and the wound sutured. For instances like lipoma which is located beneath the skin and also for infant patients, the patient is hospitalized for a short period of time and localized or general anesthetic administered depending on the situation. For the treatment of naevi, laser treatment is initially offered for predominately melanocytic naevi (such as moles), and also naevus spilus, naevus of Ota, strawberry hemangioma and Mongolian spot.

7. Malignant tumors, reconstructive surgery

For malignant skin tumors including squamous cell carcinoma, basal cell carcinoma and malignant melanoma, once the affected lesion is resected and all malignant matter confirmed as successfully removed, we restore the damaged region through reconstructive surgery such as skin flap surgery or skin grafting. Under certain circumstances, this is also necessary for patients who undergo procedures like lymph node dissection, radiotherapy and chemotherapy. We also look after patients who require reconstructive surgery as a result of operations relating to head and neck cancer, in which we strive to perform the best outcomes for the patient, both aesthetically and functionally.

8. Scars, scar contracture, keloidal scar

Keloids can be treated with either the topical application of, or localized injections of corticosteroids. Where surgery is required, post-surgical electron-beam irradiation therapy is undertaken in almost all circumstances (in our Radiology Unit.) For hypertrophic scars and scar contracture, successful treatment is possible using pressure therapy; however in some instances surgery is also performed.

9. Bedsores, skin ulcers

In most instances, ointment treatment is initially offered. Through various skin flap and grafting procedures, surgery is also undertaken; however bedsore and ulcer legions are often complex, meaning that a simple removal and closing of the affected area does not solve the problem. For bedsores, changes in lifestyle and equipment including bedding and prostheses are often necessary, with recurrence easily occurring if such measures are not taken; regardless of the fact that a brief period of convalesce was achieved. For ulcers caused by illnesses diagnosed by physicians from internal medicine, we liaise and co-operative with the treatment prescribed. For gangrene of the lower legs and other areas, in situations where circulation problems are the cause, treatment is undertaken with the cardiology and cardiovascular surgery departments. When this isn’t suitable and there are no other available options, amputation is undertaken. This department takes care of amputations up to the knee, all other amputations are looked after by the orthopedic surgery department.

10. Senile ptosis

For this we can perform levator muscle resection surgery, where the excessive skin is resected, elevating the upper eyelid. If surgery is only needed on one side, then hospitalization isn’t necessary, but in instances where both sides require surgery, hospitalization is recommended for around two to three days to monitor swelling of the eyelids. As the Japanese demographic progressively ages, senile ptosis is something that will most likely increase.

11. Other surgery

Surgery for conditions involving excessive body odor (e.g. hyperhidrosis) is covered under national health insurance. For surgery on both sides, hospitalization is generally needed. We also look after surgery for secondary lymphedema and perform lymphoevenous shunt procedures.

12. Laser Treatment

Laser treatment is used for the treatment of strawberry hemangioma, (pulsed dye laser treatment) naevus spilus, naevus of Ota, Mongolian spot and traumatic tattoo (red ruby laser). An improvement is reached in about 90% of hemangioma located on the face and around 60% that are located on the torso or limbs. Naevus of Ota and Mongolian spots achieve an improvement through treatment almost 100% of the time; however naevus spilus is a condition which responds less to treatment, with an improvement in only about 10% of cases.

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