Takashi Hirai

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.

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.

Histological hair removal study by ruby or alexandrite laser with comparative study on the effects of wavelength and fluence

BACKGROUND: Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences. METHODS: Unwanted hairs were treated with a ruby laser (Chromos 694, ICN PhotonIcs, UK) at 10, 14 or 18 J/cm2 or with an alexandrite laser (LPIR, Cynosure, USA) at 11, 14 or 17 J/cm2. A 3 mm skin punch biopsy was taken immediately after each laser exposure and also 1 month later. Specimens were stained for histological observation. They were observed using immunohistochemistry with antibodies recognizing factor VIII related antigen or PCNA, and also by the TUNEL method. Similarly, electron microscopic observation was examined. RESULTS: Immediately after the laser exposure, moderate follicular damage was observed following treatment with either type of laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either type of laser. A similar fluence with either laser treatment resulted in similar histological changes. CONCLUSION: In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence are similar.

Unusual masses found within ruptured silicone gel breast prostheses.

Imaging of breast implants has assumed more importance in medicine than ever before. Radiologists and surgeons alike have struggled to accurately identify folds in prostheses, rupture of prostheses, and migration of gel. Here we present two patients with an unusual presentation of masses within the gel of ruptured silicone gel-containing prostheses. In one instance, the mass was an organized hematoma. In the other, two round, calcified masses were found that we presume are hematomas that have become calcified over time. Radiologists and surgeons identifying spherical or ovoid masses seemingly within gel breast prostheses should entertain the possibility that the mass represents an organized hematoma and that the implant is ruptured.

Potential use of beards for single-follicle micrografts: convenient follicle-harvesting technique using an injection needle.

The authors developed a convenient hair-harvesting procedure using a disposable 18-gauge injection needle, which is common in every clinical scene. The needle was used as a skin puncher to harvest single follicles. The harvested micrografts were transplanted without trimming any of the adjacent tissue around the follicle. Clinical applications for the reconstruction of eyebrows in cases of anhydrotic ectodermal dysplasia and facial scars are demonstrated. Each patient showed a favorable result, and there was no scar formation at the donor site. This procedure makes hair harvesting smooth, speedy, and less traumatic. Beards as well as occipital hairs can be used as donors for single-follicle micrografts with this method in male patients.