Long-term results of nail correction with double wires for pincer nail deformity: A retrospective cohort study.

There is no consensus on the best treatment for pincer nail deformity. We developed a novel procedure that uses double wires to treat pincer nail deformity on the great toe. This study aimed to describe this technique for pincer nail deformity treatment and present the long-term findings/observations. After injecting a local anesthetic, a mini router was used to make holes on both sides of the nail plate edge, and the wire was inserted in two places, one proximal and the other distal to the great toenail. The wire was removed when it moved to the tip of the great toe as the nail grew. Patients who underwent this method were evaluated retrospectively from 2014 to 2020. Patients with less than 24 months of follow-up were excluded. If pain occurred again, it was deemed as a recurrence. A total of 27 patients (36 toes, mean age: 69.5 years) were evaluated. In all cases, the pain disappeared 1 week after the procedure. In the correction period (mean 2.7 months), six toes had complications (nail break, four toes and nail hold pain, two toes), while recurrence occurred in four toes within 2 years. Curvature (nail tip height/width of nail tip × 100%) improved significantly up to 1-year post-procedure (37.7 ± 14.4%, p < 0.05) as compared to pre-correction (53.8 ± 24.7%). The procedure time was short (approximately 10 minutes), and the treatment was completed with a single procedure. In addition, the recurrence rate was low.

Treatment of Ecchymosis with a Pulsed Dye Laser.

Ecchymosis is a common side effect after injury and surgery. A pulsed dye laser (PDL) is the gold standard for vascular lesions and can minimize ecchymosis. Heating induces hemoglobin modification due to oxidative and heat reactions with the formation of bilirubin and methemoglobin, resulting in color changes to brown-yellow. Therefore, downtime following cosmetic procedures can be shortened.

Prospective comparison study of a 550 picosecond 755 nm laser vs a 50 ns 755 nm laser in the treatment of nevus of Ota.

Since the introduction of selective photothermolysis, Q-switched nanosecond lasers have been used for the treatment of dermal pigmented lesions. Over the past several years, picosecond lasers have been introduced to the cosmetic community. We recently performed a study comparing a 550 picosecond 755 nm laser versus a 50 ns 755 nm laser, with the purpose of evaluating the clinical efficacy and complications of each laser when treating nevus of Ota. Ten Asian patients with nevus of Ota were enrolled in the study. Each lesion was split into 2 parts, and patients were treated with a 755 nm picosecond laser (PSL) and a 755 nm nanosecond laser (NSL). The clinical endpoint for fluence choice was immediate whitening (PSL: 2.33 ~ 3.36 J/cm2, NSL: 5.5 ~ 7 J/cm2) of the treated area. The pulse duration was fixed at 550 picoseconds (PSL) and 50 ns (NSL). The spot size of each laser was 2.5-3 mm. Laser treatments were performed until excellent clinical improvement was observed. Patients were examined 1 week after the first treatment, at each follow-up visit, and 6 months after the last laser treatment. The average number of treatment sessions to achieve excellent clinical improvement was 4.2 treatments using PSL and 5.4 treatments using NSL. One case of hyperpigmentation and one case of hypopigmentation were observed in the NSL treatment group. There were no complications in the PSL treatment group. The 755 nm 550 picosecond laser is significantly more effective than the 755 nm 50 ns laser in the treatment of nevus of Ota. The PSL treatment group also had minimum side effects.

Mechanism of crescent-shaped and ring-shaped epidermal damage from laser hair removal with cryogen spray cooling.

The safety and efficacy of laser hair removal have been well established through many clinical studies and through clinical use over the past 25 years. A laser hair removal device that protects the epidermis by utilizing cryogen spray cooling (CSC) is widely used internationally. In darker skin types, post-inflammatory hyperpigmentation (PIH) can occur after laser hair removal. In particular, laser hair removal with CSC is known to cause crescent-shaped or ring-shaped PIH. In this experiment, we report a visualization of this PIH mechanism. The laser used in this experiment is a 755-nm-long-pulsed alexandrite laser. Graph paper was treated with this laser to assess for thermal damage. We investigated changes in thermal damage due to differences in laser spot size, fluence output, and laser beam angle in relation to the graph paper. When using a spot size of 18 mm, we observed that higher fluences caused crescent-shaped thermal damage on the margins of the treated graph paper. It was also confirmed that when the hand piece is not held perpendicular to the skin, the laser-treated area is expanded and the CSC range is narrowed. These factors caused the area of thermal damage to widen. This widening causes ring-shaped thermal injury, leading to PIH. We treated graph paper using a hair removal laser with CSC to investigate the mechanism of crescent or ring-shaped thermal damage. Laser treatment on graph paper is effective as a test for defects in the CSC device. Factors that cause inadequate cooling, which leads to PIH, are large spot size, high fluence, not holding the laser hand piece perpendicular to the skin, and malfunctioning of CSC device.

Accelerated human epidermal turnover driven by increased hyaluronan production.

BACKGROUND: Hyaluronan (HA) is an essential component of extracellular matrix in the skin, but its functions in the epidermis remain elusive. OBJECTIVE: We examined the interaction of increased HA production mediated by 1-ethyl-ß-N-acetylglucosaminide (ß-NAG2), a newly developed highly selective inducer of HA production which is intracellularly converted to UDP-N-acetylglucosamine, a substrate of HA, with epidermal proliferation and differentiation. METHODS: The amount, molecular size and epidermal tissue distribution of HA and expression of CD44, a cell surface receptor for HA, were analyzed in ß-NAG2-treated organ cultured human skin, reconstructed human skin equivalents or cultured human skin keratinocytes. The relationship between HA and epidermal proliferation or differentiation was examined. RESULTS: ß-NAG2 significantly increased HA production in the epidermis of skin explants or skin equivalents without affecting molecular size of HA (>2000 kDa) or CD44 mRNA expression. Histochemical experiments revealed that ß-NAG2 enhances HA signals in the basal to granular layers of the epidermis of skin equivalents, accompanying increased epidermal stratification. Immunohistochemical experiments demonstrated that signals of Ki67, transglutaminase 1 and filaggrin are increased in ß-NAG2-treated skin equivalents, and these observations were confirmed by the data showing that mRNA expression of PCNA, transglutaminase 1 (TGM1) and filaggrin (FLG) is significantly up-regulated by ß-NAG2 in skin equivalents. Importantly, blockade of HA production by inhibiting conversion of ß-NAG2 to UDP-NAG abolished ß-NAG2-mediated up-regulation of PCNA, TGM1 and FLG mRNA expression in cultured keratinocytes. CONCLUSION: These results suggest that increased epidermal HA production plays a key role in epidermal morphogenesis and homeostasis by accelerating keratinocyte proliferation and differentiation.

Prospective Comparison Study of 532/1064 nm Picosecond Laser vs 532/1064 nm Nanosecond Laser in the Treatment of Professional Tattoos in Asians.

BACKGROUND AND AIMS: Although, the pulse width should be shorter than the thermal relaxation time of the target, nanosecond laser pulses are not short enough for tattoo removal. Complications are common, such as hyper or hypopigmentation, textural changes, and scarring. Moreover, patients with darker skin types are at a higher risk of complications from tattoo removal using these lasers. Picosecond lasers were developed to overcome the limitation of nanosecond lasers. We did a comparison study of a 532/1064 nm picosecond laser vs a 532/1064 nm nanosecond laser to evaluate the clinical efficacy and complications of multi-color tattoos in Asians. MATERIALS AND METHODS: Eleven Asian patients with 37 professional tattoos were enrolled in the study. Each patient was treated with a 532/1064 nm nanosecond laser and a 532/1064 nm picosecond laser. The spot size that was used with each laser was 3 mm. Four treatments were performed, with four week intervals between each treatment. Patients were examined a week after the first treatment and 3 months after the last treatment. RESULTS AND CONCLUSIONS: All patients tolerated the treatments well. The efficacy of the 1064 nm picosecond laser for black tattoos is significantly better than the other studied lasers. The efficacy of the 532 nm picosecond laser is significantly better than the other studied lasers for red tattoos. The efficacy of the 532 nm picosecond laser is significantly better than the 532 nm nanosecond laser and better than the 1064 nm picosecond laser for green tattoos. Mild to moderate post-inflammatory hyperpigmentation was observed in 35.1%, 24.3% 27.0%, and 21.6% of the tattoos treated with the 532 nm nanosecond laser, the 532 nm picosecond laser, the 1064 nm nanosecond laser, and the 1064 nm pico-second laser, respectively. Paradoxical darkening (5.4%) was observed equally with each type of laser. There was no scar formation in any of the tattoos treated. The 532/1064 nm picosecond laser is more effective than the 532/1064 nm nanosecond laser in the treatment of multi-color tattoos in Asians. The 532 nm picosecond laser is more effective than 1064 nm picosecond laser in every tattoo color, with the exception of black. Paradoxical darkening was observed, even the use of picosecond lasers.

A New Technique Using Modified Dehaan's Method for Median Cleft Lip Closure: A Case Report.

OBJECTIVE: Median cleft lip is an extremely rare congenital abnormality that can be classified into "true" (characterized by true tissue separation) and "false" (caused by holoprosencephaly). We report a patient with true median cleft lip who underwent cheiloplasty using the surgical procedure for bilateral cleft lip. METHODS: The subject was a girl, who presented with mild orbital hypertelorism. Alveolar cleft with midline cleft lip extending slightly to the white lip, and anterior basal meningocele was observed. The patient was in good general condition and had undergone cheiloplasty using modified DeHaan's method at 5 months of age. RESULTS: In many reports to date, surgical procedures for median cleft lip could not avoid leaving a scar on the midline; however, in the present case, we were able to achieve a clear Cupid's bow with an unremarkable scar consistent with the philtral columns. Furthermore, a nostril sill had formed in the flat base of the nasal cavity. The morphology of the opened nostril base also improved. CONCLUSION: This procedure is only indicated for patients with mild cleft. However, better esthetic surgical outcomes are generally requested for milder original deformations. This surgical procedure was effective in esthetically improving the median cleft lip.

Speech Outcomes of 10-year-old Children after Early Palatoplasty Using Presurgical Orthodontics at 6 Months of Age.

OBJECTIVE: We aimed to assess whether patients who underwent early palatoplasty have normal speech. METHODS: 19 patients with unilateral cleft lip and palate were enrolled in this study. At 6 months of age, we performed simultaneous lip, maxilla, and palate repair using presurgical orthodontics. Speech development was assessed by evaluating velopharyngeal function (VPF) and development of articulation for 10 years. RESULTS: No articulation disorders were observed after 4 years of age. Although palatalized articulation was evidently temporary in 3 cases before 4 years of age, all patients recovered without any speech training. Normal VPF rates were as follows: at 4 and 7 years of age 78.9% (n = 15), 10 years of age 73.7% (n = 4). 10 patients temporarily presented with mild VPI after 5 years of age although they had a normal VPF until 4 years of age. CONCLUSION: Early palatoplasty after narrowing the cleft palate using presurgical orthodontics is beneficial for development of articulation. The rate of normal VPF did not decrease over the years.

A Case of Occipital Malignant Peripheral Nerve Sheath Tumor with Neurofibromatosis Type 1.

INTRODUCTION: The prognosis of malignant peripheral nerve sheath tumor (MPNST) with neurofibromatosis type 1 (NF-1) is worse than that of a solitary MPNST, because of the tumor size and location difficult to resect completely. We experienced a case of MPNST in the occipital region with NF-1. CASE REPORT: A 59-year-old woman presented with NF-1 and an MPNST of the occipital region. We performed wide excision involving the occipital bone, and reconstructed with a titanium plate and a free latissimus dorsi muscle flap. Despite three operations and postoperative radiotherapy, the tumor locally recurred after each surgery; further complicated by lung and mediastinal metastasis. Adjuvant therapy was insufficient to control local recurrence, which was observed intracranially, resulting in sagittal sinus invasion. Thirty months after the initial surgery, the patient died of respiratory failure due to lung metastasis. CONCLUSION: MPNST with NF-1 has poorer prognosis than that of a solitary lesion. Recently, it is reported in several literature that combination therapy with surgery and radiotherapy improve survival rates. But as we presented, when the complete local resection with free margin could not achieved due to the size and anatomical location of the tumor, the effectiveness of radiotherapy is not sufficient to control local recurrence.

Comparison of mandibular stability after SSRO with surgery-first approach versus conventional ortho-first approach.

METHODS: Postoperative mandibular stability in the surgery-first (SF) approach and ortho-first (OF) approach in orthognathic surgery was retrospectively assessed using the lateral cephalo X-P in 38 patients with skeletal Angle Class III malocclusion who underwent sagittal split ramus osteotomy (SSRO). RESULTS: The postoperative mandibular relapse of the two groups observed from T1 (2 weeks after the surgery) to T2 (for the OF group, a year after surgery; for the SF group, the day orthodontic treatment was completed) was compared. The mean (SD) horizontal relapse at pogonion was 0.86 (0.92) mm in the forward direction in the SF group and 0.90 (1.09) mm in the forward direction in the OF group. No significant difference was found in the amount of horizontal movement between the two groups. On the other hand, the mean (SD) vertical relapse at pogonion was 1.59 (2.91) mm in the downward direction in the SF group and 0.14 (1.30) mm in the upward direction in the OF group, showing a significant difference in the amount of movement between the two groups. The degree of completion of the occlusion at T2 in the SF group was compared with that in the OF group by measuring OB, OJ, L1-occlusal plane angle, and interincisal angle. No significant difference was found between the two groups and the post-treatment occlusion was clinically favourable. CONCLUSION: Although the SF approach has several advantages for patients, the method of operation and fixation should be selected carefully to maintain postoperative mandibular stability.

An Adverse Implication of Radiation Therapy for Implant-Retained Maxillofacial Prostheses.

We report the 19-year postoperative course of a patient whose maxillary defect was reconstructed with maxillofacial implant-retained facial prostheses. The patient received 60 Gy of radiation therapy. Adjunctive hyperbaric oxygen therapy was administered and four 4.0-mm long maxillofacial implants were inserted. Four years and 6 months after insertion surgery, two of the four implants were lost and the others showed bone regression in the surrounding bone. All implants were replaced with Epitec System maxillofacial implants placed in non-irradiated bone. Eleven years and 6 months after replacement, the Epitec System has been maintaining good and firm osseointegration. Appropriate selection of implant sites and no history of radiation therapy are keys to successful implant reconstruction. However, adjunctive hyperbaric oxygen therapy is believed to be effective, osseointegrated implant should be inserted at a point appropriately distant from an irradiated lesion.

Pyogenic Granuloma: A Retrospective 10-year Analysis of 82 Cases.

OBJECTIVE: Pyogenic granuloma (PG) is a common acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. Recently, PG was considered a capillary hemangioma and was renamed as lobular capillary hemangioma (LCH). A clinical retrospective analysis of PG cases in our institute over a period of 10 years was performed. METHODS: The study involved 82 cases of pathologically diagnosed PG managed and treated at the Plastic Surgery Department of Tokai University between 1995 and 2004. Individual data from charts were reviewed for age, gender, affected site, size of lesion, predisposing factors, and treatment. All lesions were treated surgically using an excision followed by suture, or shave excision followed by CO2 laser ablation. RESULTS: The overall male to female ratio was 1.5:1. In 28% of the total cases, a preceding lesion was evident prior to the occurrence of PG. The head and neck area were the most commonly affected sites (56%), followed by the upper limb (22%), trunk (16%), and lower limbs (6%). CO2 laser ablation was performed successfully in 24% of patients and resulted in no recurrences. CONCLUSION: Based on our results, we recommend surgical excision followed by CO2 laser ablation as the first-choice treatment for PGs.

Lip Repair Surgery for Bilateral Cleft Lip and Palate in a Patient Diagnosed with Trisomy 13 and Holoprosencephaly.

We report a case of lip repair surgery performed for bilateral cleft lip and palate in a patient diagnosed with trisomy 13 and holoprosencephaly. At the age of 2 years and 7 months, the surgery was performed using a modified De Hann design under general anesthesia. The operation was completed in 1 h and 21 min without large fluctuations in the child's general condition. The precise measurement of the intraoperative design was omitted, and the operation was completed using minimal skin sutures. It is possible to perform less-invasive and short surgical procedures after careful consideration during the preoperative planning. Considering the recent improvements in the life expectancy of patients with trisomy 13, we conclude that surgical treatments for non-life threatening malformations such as cleft lip and palate should be performed for such patients.

Cranial Reconstruction in a Pediatric Patient Using a Tissue Expander and Custom-made Hydroxyapatite Implant.

A tissue expansion technique in conjunction with a custom-made artificial bone implant was effective for a large cranial reconstruction in a pediatric patient. The patient was an eight-year-old boy with cranial bone fracture, acute subdural hematoma in the left lobe, and acute epidural hematoma in the right lobe due to an accident. Wound dehiscence and artificial dura infection were observed as postoperative complications. Because of insufficiency of the skin flap caused by scar contracture, a scalp skin expansion using a tissue expander was necessary before reconstruction with the artificial bone implant. This combined procedure provided safe coverage of the implant and resulted in good wound healing. There are relatively few reports involving the use of tissue expanders for cranioplasty; furthermore, our search of the literature did not reveal any reports involving children. We believe that this procedure is safe and effective for early rehabilitation in pediatric patients.

A case of chronic infection 28 years after silicone orbital implant.

Silicone was one of the most common biocompatible materials used for orbital floor reconstruction about twenty to thirty years ago. Recently, surgeons hardly use silicone due to numerous reports of complications such as infection, extrusion and implant displacement. We present a case of chronic infection seen after 28 years of silicone implant used in orbital floor repair. Although it is reported that infection due to silicone implant may decrease after long years of follow up, our case demonstrated the possible case of unexpected infection after more than twenty years with orbital silicone implant.