Taro Kusano

Posttraumatic ectopic nail of the toe

Ectopic nail is a rare disorder, and the majority of the reported cases are congenital. We report a case of posttraumatic ectopic nail of the right IV toe, with a review of the literature.

Antitragicus muscle resection: A key to correction of prominent lobules

The antitragicus muscle arises from the outer part of the antitragicus cartilage, and inserts into the helical tail and antihelix. Overdevelopment or malpositioning of the antitragicus muscle exerts an anterior pull on the helical tail, and it can cause prominent lobules. We attempted prominent lobule correction using antitragicus muscle resection and helical tail setback in combination with a Mustarde or Furnas suture technique. Seventeen children with prominent lobules underwent this technique, and all had satisfactory outcomes. Resection of the antitragicus muscle is minimally invasive and easy to perform. This procedure is a key to successful lobular setback.

Classification of recipient veins in microsurgical flap reconstructions of the lower extremities.

Abstract It is difficult to cure severe open fractures of the lower extremities due to the frequent occurrence of severe damage to soft tissues or blood vessels, as well as bone defects, and concomitant infection, such as osteomyelitis. If appropriate treatment is not performed, long-term complications, such as nonunion of the bone, intractable ulcers, or other disorders, may arise. Between 1993 and 2010, we reviewed the records of 27 patients, and 28 limbs were treated. A total of 31 free-tissue transfers were performed on these 28 limbs. In this study, we classified the degree of damage based on the operative appearance of the condition of the recipient vein. A state that was normal or near-normal was described as type I—normal. A vein that was buried under a scar, but was comparatively easy to detach and retained a moderate adventitia was classified as type II—moderate. A vein with close adhesion between the wall and the scar that was not easy to detach was described as type III—severe. We also examined the relationships between recipient vein type and each of the following: (1) concomitant injury, (2) bone reconstruction, (3) preoperative infection, (4) length of time from injury to reconstruction, (5) eventual reoperation, and (6) flap necrosis. The results showed that there was a statistically significant relationship between recipient vein type and each of the following: bone reconstruction, preoperative infection, eventual reoperation, and flap necrosis. The selection of recipient vein is a factor that greatly affects the outcome of reconstruction of open fractures of the lower extremities. It is important to preoperatively estimate the condition of recipient vein even though it is difficult to preoperatively assess the condition. In some cases, only recipient veins in poor condition can be found intraoperatively on the affected leg. Under such circumstances, a cross-leg flap or a vein graft should be performed without hesitation to use recipient veins in a better condition.

Natural mastopexy repositioning based on age-related mean breast shape

BACKGROUND The most important element during breast reconstruction preoperative planning is determining the new position and shape of the breast. A youthful breast with no signs of ptosis may not necessarily be the ideal breast for women of all ages. However, indicators have not been established on how breasts should be positioned depending on age. We investigated and reported on the proper positioning of the breasts based on age during breast reconstruction using mean age-based data from three-dimensional (3D) modeling. METHODS We photographed 110 breast cancer patients using a compact 3D scanner and calculated the measured means. Data were grouped according to age group. Three-dimensional simulation images from all patients were reconstructed from the data. Breasts from all age groups were divided into healthy and affected breasts. For each measured value, the means of the two groups were compared. RESULTS There were no major differences in the mean values in the 30s, 40s, and 50s age groups. Major changes were noted in the 60s age group compared with the 30s, 40s, and 50s age groups. There were no statistically significant differences between healthy and affected breasts. CONCLUSIONS This is the first study to use a 3D method to calculate the means based on age group. This study showed that particular attention should be paid to age-related changes during breast reconstruction surgeries for women aged ≥60 years. We believe that the method used in our study on mean breast shape based on age group can be used as a reference or indicator to ensure that the reconstruction of natural breasts befits the age of the patient.

Solitary fibrous tumor of the inguinal region

Solitary fibrous tumors (SFT) have recently been established to be of mesenchymal origin. Although there are numerous reports of SFTs arising from the pleura, reports of the tumor arising from extrapleural sites are comparatively rare [Fletcher CDM, Unni K, Mertens F (eds) World Health Organization classification of tumors, pathology & genetics, tumors of soft tissue and bone. IARC Press, Lyon, pp 86–901, 2002]. We report a case of SFT arising in the inguinal region.