Ultrasonic observation of the nail matrix

BACKGROUND

The authors made use of echograms for the observation of the nail matrix.

OBJECTIVE

To inspect the nail matrix and identify what causes nail plate deformities.

METHODS

A 30-MHz frequency high-resolution B-mode was applied to normal and damaged nails.

RESULTS

Clear shadows of underlying nail plates were observed beneath the proximal nail fold. Some cases with nail plate deformities showed damaged sub-proximal fold nail plates, which would indicate nail matrix deformities.

CONCLUSION

The echograms had diagnostic value to nail plate deformities. If a normal echogram is obtained at the proximal nail fold, the nail bed will be the place at which the nail deformities occur. If the echogram indicates any sub-proximal fold nail plate changes, the damaged nail matrix may be attributable to the nail deformities. Echograms also gave clear echoic shadows of subungual tumors. That contributed to identifying the infiltrating border of subungual malignant melanomas around the nail matrix noninvasively.

Heel coverage with a T-shaped distally based sural island fasciocutaneous flap

Two cases of heel damage that were reconstructed with a T-shaped distally based island fasciocutaneous flap in the sural area are presented. This flap is vascularized by the distal sural arterial network. The advantages of this flap are: (1) It does not sacrifice any major arteries of the leg. (2) It covers the whole calcaneal area with a one-stage operation. (3) It can be elevated without losing any nerve sensitization in the leg. (4) The donor site can be closed with primary sutures when the flap is small enough. We conclude that our procedure is suitable for reconstructing soft tissue defects of the calcaneal area.

Versatility of the free or pedicled superficial cervical artery skin flaps in head and neck burns

The usefulness of the free or pedicled superficial cervical artery skin flap in reconstructive surgery of head and neck burns is reported. This flap can be made with the pivot point near the cervical region. Moreover, it can be elevated as a free or long vascular pedicled flap. Therefore, it is widely applicable in reconstructing the scar contractures of the head and neck, particularly in extensively and deeply burned patients.

Three-dimensional CT system using a personal computer

A three-dimensional CT display system using a personal computer was developed and used for diagnosis of craniofacial abnormalities. The advantages of this system are that it is inexpensive and easy to operate.

The use of a wire frame to fix grafts externally

We have shown the effectiveness of using externally attached frames made of Kirschner wires in fixing grafts. The technique has proved to be useful for securing grafts to graft beds and it has prevented the edges of the grafts from lifting. With simple materials and a simple technique, the tie-over method combined with external wire frames has brought about better results in sheet skin grafting.

The propeller flap method

We report a method of elevating and rotating a flap, like a propeller, for the release of scar contractures. We have obtained satisfactory results in the repair of scar contractures in the cubital and axillary regions. This flap may be applied to the flexor side in other regions, for example the groin, popliteal fossa and fingers where burn contractures are common.

A case of so-called Mikoshi-Kobu

The case of a 35-year-old Japanese male patient with so-called Mikoshi-Kobu is presented. Because articles about this type of tumor are rare, we report this case with its surgical and histopathological findings.

Combination of the square flap method and the dermal sling to correct flat or inverted nipples

A technique for the correction of flat or inverted nipples is presented. The procedure is a combination of the square flap method, which better shapes the corrected nipple, and the dermal sling, which provides good support for the repaired nipple.

A prefabricated hair-bearing island flap for lip reconstruction

We report a case of reconstruction of the upper lip in the male using a prefabricated hair-bearing island flap. The flap was made by implantation of a superficial temporal vascular bundle with microvascular anastomoses to the facial vessels. We conclude that the technique is a useful alternative to other methods of reconstruction because of its reliable blood supply.

The square flap method

We report a method for increasing the distance between two points on the skin surface by using two triangular flaps and a square flap. The theoretical lengthening is excellent when one of the triangular flaps is right-angled. The method has been used successfully in 40 cases of scar contracture, various clefts and cryptotia.

Use of scarred flaps and secondary flaps for reconstructive surgery of extensive burns

We report the usefulness of scar flaps and secondary flaps in the surgical repair of extensively burned patients. Burn scar contractures repaired with scarred axial pattern flaps, scarred musculocutaneous flaps and scarred fasciocutaneous flaps are described. However, it is our contention that their application should be strictly limited. An example of the use of scarred secondary axial pattern and musculocutaneous flaps for reconstruction of a burned ear is shown.

Congenital auricular cleft

We have reported on a patient with a congenital auricular deformity in whom the cleft was between the helix and the earlobe. This is an extremely rare situation. We have named it congenital auricular cleft, because the case we described is different from congenital cleft earlobe in terms of position of the cleft.