Background: Many surgical techniques for the treatment of pincer nails have been reported. However, there are two mainly unsolved problems: the formation of dead space on each side of the distal phalanx, and the unnatural form of the nail bed after surgery. We easily solved these problems by inventing a skin incision design, and subcutaneous suturing. Methods: We performed a new surgical method on 30 pincer nails in 25 patients. Incision lines were drawn 3 mm from the paronychium and the distal nail fold to preserve the natural form of the paronychium. To close the dead space made by disconnecting the connective tissue around the distal phalanx, the proximal dermis and periosteum of the distal phalanx were sutured together twice on each side. Results: The subjects were evaluated using the curvature index. The mean curvature index was 2.20 (2SD, 0.95, SE, 0.10) before surgery, and 1.19 (2SD, 0.21, SE, 0.02) one year after surgery, which was significantly lower (p < 0.01, Wilcoxon signed rank test). The appearance of the postoperative nail was good in all cases, and there was no recurrence reported. Conclusions: Our new method is simple and effective and can preserve favorable nail appearance postoperatively.
Since the umbilicus is located on the surface of the body, many patients visit plastic surgeons for concerns regarding umbilical disorders. We performed a retrospective review of our clinical cases to characterize the types of umbilical lesions treated by plastic surgeons. The majority of lesions that we treated were common in the field of plastic surgery, such as umbilical hernia, skin tumors, and omphalitis with urachal remnants. However, there was a peculiar case of a patient who presented with rectal cancer with umbilical metastases. Metastasis of a visceral malignancy to the umbilicus is known as Sister Mary Joseph's nodule, and it is associated with a poor prognosis. The patient presented with gastrointestinal perforation at the time of initial examination, indicating that some patients who visit plastic surgeons for umbilical lesions may require immediate medical treatment. While urachal remnants are common cystic lesions of the umbilicus, there are some rare cases of patients who present with remnants of the umbilical artery. We also examined the incidence of umbilical artery remnants. Here, we report cases of patients with umbilical lesions in order to identify rare lesions that may otherwise be missed during regular clinical examinations.
Introduction: The tie-over method is generally used for fixation after suturing of skin grafts. However, suturing and fixation of skin grafts for extensive burns and ulcers are time-consuming, and tissue damage may occur when there is scarring of the surrounding tissue. In addition, the removal of sutures takes time and is painful. Therefore, we developed a modified skin graft fixation method. Here, we present the application of this modified skin graft fixation method in nine patients. Material and methods: The study included nine patients (six males, three females) with age ranging from 34 to 70 years and mean age of 55 years. The cause of injury was burn in five cases, with heat press, necrosis due to infection, skin necrosis owing to hematoma, and electrical injury in one case each. This study included mesh skin grafting in three cases, sheet skin grafting in four, and both in two cases. The size of the skin grafts ranged from 30 cm²–400 cm² with a mean of 203 cm². The skin graft was not sutured; instead, it was fixed with a silicon contact layer and negative pressure wound therapy (NPWT). Results: This method was successful in all cases. Conclusions: This simple and rapid method allows successful skin graft fixation without graft suturing.
When performing a scar revision surgery for conspicuous scars with wide suture marks, all scars, including the suture marks, need to be excised. However, when the distance between the suture marks is wide, a high tension is needed to close the wound, which leads to complications such as wound dehiscence or hypertrophic scarring. We performed multiple Z-plasty for the treatment of such scars, utilizing the suture marks as the end of the lateral limbs of the Z-plasties. This technique allows more normal skin to be preserved between the suture marks; moreover, tensile force needed to close the wound becomes less. We report good outcomes in the two cases treated using our original technique.
A 51-year-old woman visited the hospital because of pain and swelling in the left anterior chest region. Computed tomography revealed a large abscess with bone destruction in the left sternoclavicular joint and gas patterns from the subcutaneous tissue to the anterior mediastinum. There was no history of bone destruction of the sternoclavicular joint. Pathological examination revealed inflammatory cell infiltration in the bone and granulation tissue but no other lesions. Hence, a combined diagnosis of pyogenic arthritis of the left sternoclavicular joint, clavicular pyogenic osteomyelitis, and mediastinal abscess was made. The patient was treated three times with surgical debridement and antibiotics for 63 days. No recurrence was observed after discharge, and the patient is currently receiving regular outpatient care.
Calciphylaxis is a rare and life-threatening disorder characterized by painful skin ulceration. Treatment is not yet standardized; however, a case of calciphylaxis successfully treated by intravenous sodium thiosulfate was reported in 20041). Since then, several reports have supported the use of sodium thiosulfate in the treatment of calciphylaxis. However, intravenous administration of sodium thiosulfate may be limited owing to its systemic side effects. We report the successful treatment of a female patient with intractable right-leg calciphylaxis who was administered both intravenous and intralesional sodium thiosulfate combination therapy without side effects.
A perforator-pedicled propeller (PPP) flap is often employed for reconstruction of the distal lower extremity. However, flap congestion that often causes flap necrosis occurs in the propeller flap. Although several procedures have been reported previously, a preferable method for preventing congestion and rescuing massive flap necrosis in PPP flap cases is undetermined. A healthy 41-year-old man who sustained a pilon fracture in his right leg required soft tissue reconstruction because of strong edema that did resolve even after a staged protocol. A PPP flap pedicled with a perforator from the posterior tibial artery was harvested and rotated 180° to cover the defect. After reconstructive surgery, the flap developed severe congestion indicating the possibility of near-total flap loss. The flap was rescued by rotating it back to where its perfusion was stable. It was then rotated again in stages into the targeted position every 2 to 3 days over a period of 7 days. The flap was rescued and the wound was healed. Delayed in-stage rotation of the flap was one of the options for salvaging a PPP flap from congestion especially in cases with severe soft tissue edema such as pilon fracture.
Although abdominal flaps are commonly used in breast reconstruction surgery, donor site infections are often difficult to treat because of the large area of the affected region. In our practice, we begin continuous irrigation at an early stage for treatment-resistant cases. Between July 2013 and December 2019, four out of 180 patients (2.2%), who underwent breast reconstruction with free deep inferior epigastric perforator flaps at our institution, experienced antibiotic-resistant infections in the donor site. The wounds were scraped and cleaned, and a continuous irrigation system was placed under general anesthesia. For the washing protocol, continuous irrigation was performed with 1,000 ml/day physiological saline, which included one dose of the antibiotic per day, for 5 days postoperatively. Once white blood cell counts returned to preoperative levels, continuous irrigation was stopped. The irrigation system and drain were removed once drain volume reached <30 mL/day; antibiotics were also stopped. Infections subsided in all four patients, and they were discharged at a mean of 8.8 days (range, 7-12 days) after reoperation. While our continuous irrigation method requires general anesthesia, it does not require postoperative wound treatment, resulting in less pain, a shorter wound healing period, and better cosmetic results.