The Kojima I and II labiomatricectomy procedures are long-established methods for surgical treatment of ingrown toenails. Since 1980, we have employed the Kojima procedures as our standard treatment for ingrown toenails.
In this paper, we describe the Kojima procedures in detail.
We emphasize the importance of preserving the lateral interosseous ligament to prevent postoperative nail deformities.
We believe that surgical treatment of ingrown toenails using the Kojima procedures has advantages over conservative treatment in terms of the treatment period and recurrence.

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This retrospective report describes the treatment outcomes of patients who underwent operation by the author for pincer nails using the Kosaka method (1999, J.Jpn.P.R.S.).
Only those who could be followed for 6 or more months postoperatively were included. There were 60 patients (111 toenails) who met the inclusion criteria over 12 years from 2000 to 2011.
Postoperatively, 79 toenails (71%) showed no nail deformity and the patient did not have pain, slight nail deformity remained postoperatively in 16 toenails (14%). Thus 85% of nails showed improvement, and only 16 nails had poor outcomes. Ingrown nail deformity developed in 12 toenails (11%), and recurrence was seen in 5 toenails of 3 patients (4%).
The Kosaka operation method showed 85% improvement in patients in this study, suggesting that this method is an effective treatment for pincer nails. Although the recovery time is long, the curative effect is good. If surgical candidates are appropriately selected, the Kosaka method offers a favorable probability of successful outcome for patients with pincer nails.

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Many treatment methods for incurvated nails have been reported. In this paper, we describe a novel procedure for incurvated nail deformity. Before surgery, we do not remove the full nail plate, but rather only remove the exposed portion of the nail. The nailbed-periosteal flap is elevated as a bipedicle flap, and the bilateral nail matrix is removed. The dorsal portion of the distal end of the distal phalanx is removed and made smooth with a bone rasp. The lateral nail fold is deepithelized and the nailbed-periosteal flap is then sutured back onto it.
Total removal of the nail plate makes a new deformation of the nail plate. In this method, the deformation is considered to be minimal. In addition, a bipedicle flap has good blood flow, and wound healing is also advantageous. Suturing the tip of the nail bed can sometimes be difficult, but in this method there is no need to suture.

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There have been many reports on both operative and conservative treatments for ingrown nails. However, relatively little has been reported on treatment selection for incurvated nails. This is despite the great number of patients who suffer from incurvated nails, which are frequently seen in the elderly. Furthermore, an ingrown nail can become incurvated following surgical treatment. Therefore, it seems that a considerable number of potential patients exist. In this report, I show that corrective treatment using a super elastic wire, which has become common in recent years, is effective not only for incurvated nail, but can also be applied for ingrown nails of various pathological conditions by adding adjunctive treatment. I also discuss in this report the appropriate caregiver attitude for treatment of nails. My experience in correction of incurvated and ingrown nails has demonstrated that conservative treatment is appropriate for both pathological conditions, especially treatment with a super elastic wire.

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A previous study introduced the application of an "unfolded cube advancement flap" for wide skin defects and wide scars on the face and extremities. This method uses tissue expanders to expand the skin into a cube-like shape, which is then advanced over the area of loss.
In this study we report the application of this method in 7 cases of head and face reconstruction, and 4 cases of reconstruction of the extremities. This method was successful in all of the patients who underwent head and face reconstruction, with a satisfactory esthetic outcome that achieved coincidence of the suture marks, wrinkle lines and regular multiple scar contour lines. Slight circulatory problem were encountered, however, in the most displaced areas of the flaps, and contour line irregularities were seen in all 4 of the extremity repairs. However this technique was markedly effective for esthetic improvement of extensive scarring.

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In this study we report a consecutive series of thirty cases in which intraoperative scalp expansion by Foley catheter was applied. A 30 ml balloon was used as the standard expander and was expanded by several sessions of injecting saline for 5 minutes and deflating for 3 minutes in a cyclic loading manner. All of the scalp wounds were primarily closed with no skin flap necrosis. The most common reason for the procedure was excision of sebaceous nevi in 12 cases. This method was also effective for repair of auricular deformities, as in a partial defect of the helix, which could be successfully restored by 2ml- balloon expansion of both surfaces of the auricular skin without bony support underneath. Because changes in the expanded skin such as blanching might lead to epidermal necrosis, expansion should be discontinued when sweat-like excretion is seen. Extrusion of the expanded balloon was another problem encountered, and this could be prevented by expanding adjacent skin through an intralesional or marginal skin incision before the lesions were completely excised. Transient alopecia occurred in several cases around the hair whorl, but conservative treatment ensured that hair was restored within 6 months. Our results suggested that this method is safe and markedly effective for scalp or auricular restoration.

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Diabetic neuropathy and vascular insufficiency can cause gangrene and skin ulcers of the foot, and concomitant infectious disorders often necessitate lower extremity amputation. While progress in the medical treatment of diabetes has improved the prognosis of diabetic patients, the problems associated with diabetic foot require highlighting.
In Japan, with lifestyle-associated diseases on the rise, diabetic gangrene of the foot will likely be encountered with increasing frequency. We will also likely see increased incidence of related diseases such as ischemic heart disease and brain infarction. In patients with vascular insufficiency, these diseases have poor prognosis.
We, as plastic surgeons, describe in this report the problem of diabetic foot disease and lower extremity amputation, as well as the decision making process in lower extremity amputation.

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