Mechanical Dilation of the Recipient Vessel with the DeBakey Vascular Dilator in Lower Extremity Reconstruction: A Report of Two Cases.

In lower extremity reconstruction, the recipient vessel often requires long-range mechanical dilation because of extensive vasospasm or plaque formation induced by concomitant atherosclerosis. While a forceps dilator can be used to manipulate and dilate vessels approximately 1 cm from their end, a DeBakey vascular dilator can dilate long-range vessels. The authors successfully performed free flap reconstruction of the lower extremity using the DeBakey vascular dilator. Of the two patients who underwent lower extremity reconstruction, one had extensive vasospasm, and the other had plaques in the recipient arteries. Irrigation with 4% lidocaine and dilation of the lumen with a forceps dilator were insufficient to restore the normal arterial blood flow. Instead, a DeBakey vascular dilator with a 1-mm diameter tip was gently inserted into the lumen. Then, to overcome vessel resistance, the dilator gently advanced approximately 10 cm to dilate the recipient artery. Normal arterial blood flow was gushed out after dilating the vessel lumen using a DeBakey vascular dilator. The vascular anastomosis was performed, and intravenous heparin 5000 IU was administered immediately after anastomosis. Prophylactic low-molecular-weight-heparin (Clexane, 1 mg/kg) was administered subcutaneously to both patients for 14 days. The reconstructed flap survived without necrosis in either patient.

Breast Reconstruction after Breast Implant-Associated Anaplastic Large Cell Lymphoma Treatment: A Case Report and Literature Review.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell non-Hodgkin's lymphoma that occurs in patients with at least one prior textured breast implant. BIA-ALCL has a relatively good prognosis when treated promptly. However, data on the methods and timing of the reconstruction process are lacking. Herein, we report the first case of BIA-ALCL in Republic of Korea in a patient who underwent breast reconstruction using implants and an acellular dermal matrix (ADM). A 47-year-old female patient was diagnosed with BIA-ALCL stage IIA (T4N0M0) and underwent bilateral breast augmentation using textured breast implants. She then underwent removal of both breast implants, total bilateral capsulectomy, adjuvant chemotherapy, and radiotherapy. There was no evidence of recurrence at 28 months postoperatively; therefore, the patient wished to undergo breast reconstruction surgery. A smooth surface implant was used to consider the patient's desired breast volume and body mass index. The right breast was reconstructed with a smooth surface implant and an ADM in the prepectoral plane. Breast augmentation was performed on the left breast using a smooth surface implant. The patient was satisfied with the results and recovered fully with no complications.

Implantation and tracing of green fluorescent protein-expressing adipose-derived stem cells in peri-implant capsular fibrosis.

BACKGROUND: Adipose-derived stem cells (ASCs) have been reported to reduce fibrosis in various tissues. In this study, we investigated the inhibitory role of ASCs on capsule formation by analyzing the histologic, cellular, and molecular changes in a mouse model of peri-implant fibrosis. We also investigated the fate and distribution of ASCs in the peri-implant capsule. METHODS: To establish a peri-implant fibrosis model, customized silicone implants were inserted into the dorsal site of C57BL/6 wild-type mice. ASCs were harvested from the fat tissues of transgenic mice that express a green fluorescent protein (GFP-ASCs) and then injected into the peri-implant space of recipient mice. The peri-implant tissues were harvested from postoperative week 2 to 8. We measured the capsule thickness, distribution, and differentiation of GFP-ASCs, as well as the cellular and molecular changes in capsular tissue following ASC treatment. RESULTS: Injected GFP-ASCs were distributed within the peri-implant capsule and proliferated. Administration of ASCs reduced the capsule thickness, decreased the number of myofibroblasts and macrophages in the capsule, and decreased the mRNA level of fibrogenic genes within the peri-implant tissue. Angiogenesis was enhanced due to trans-differentiation of ASCs into vascular endothelial cells, and tissue hypoxia was relieved upon ASC treatment. CONCLUSIONS: We uncovered that implanted ASCs inhibit capsule formation around the implant by characterizing a series of biological alterations upon ASC treatment and the fate of injected ASCs. These findings highlight the value of ASCs for future clinical applications in the prevention of capsular contracture after implant-based reconstruction surgery.

Effect of acellular dermal matrix thickness and surface area on direct-to-implant breast reconstruction.

Background: The use of an acellular dermal matrix is advantageous for direct-to-implant breast reconstruction after skin-preserving mastectomy, but is associated with postoperative complications, especially increased seroma. Therefore, this study aimed to determine whether acellular dermal matrix surface area and thickness are associated with an increased risk of seroma. Methods: This retrospective chart review was based on the medical records of patients who underwent submuscular direct-to-implant breast reconstruction from January 2011 to June 2018 by a single surgeon. The acellular dermal matrices were divided into groups according to surface area and thickness (group I, thin and small; group II, thin and large; group III, thick and small; and group IV, thick and large). The drainage volume and period were analyzed between the groups using an analysis of variance. The factors influencing drainage were analyzed using Pearson correlation coefficients. Results: Of the 219 cases of direct-to-implant breast reconstruction (217 patients), 77, 63, 42, and 37 were in groups I, II, III, and IV, respectively. A large acellular dermal matrix resulted in a larger drainage volume, longer drainage period, and more complications. The drainage volume increased as the body mass index (r=0.217; P<0.01), mastectomy volume (r=0.358; P<0.01), and implant volume (r=0.385; P<0.01) increased. There was no difference in drainage volume, drainage period, and complications depending on the thickness and manufacturer of the acellular dermal matrix. Conclusions: In direct-to-implant breast reconstruction, the use of a larger acellular dermal matrix, not a thicker acellular dermal matrix, increases the drainage volume and period, thereby resulting in a greater risk of seroma or infection.

The Fate of Antibiotic Impregnated Cement Space in Treatment for Forefoot Osteomyelitis.

Forefoot osteomyelitis can be an extremely challenging problem in orthopedic surgery. Unlike conventional methods, such as amputations, antibiotic impregnated cement space (ACS) was recently introduced and perceived as a substitute for amputation. The purpose of this study was to compare clinical features between diabetic and non-diabetic groups and to evaluate the efficacy of ACS in the treatment of forefoot osteomyelitis, by identifying the clinical characteristics of ACS. We inserted ACS into the forefoot osteomyelitis patients and regularly checked up on them, then analyzed the clinical features of the patients and failure reasons, if ACS had to be removed. Average survival rate of ACS was 60% (21 out of 35 cases) and main failure reason was recurrence of infection. There was no significant clinical difference between diabetic and non-diabetic groups. We concluded that ACS could be a possible way of avoiding amputation if infection is under control. ACS seems to be an innovative method with promising results for foot osteomyelitis, but widely accepted indications need to be agreed upon.

High-Resolution Environmentally Extended Input-Output Model to Assess the Greenhouse Gas Impact of Electronics in South Korea.

South Korea is a global leader in electronics, but little is known about their climate change impact. Here, we estimate the direct and indirect greenhouse gas (GHG) emissions of Korean electronics by developing a new and high-resolution (∼380 sectors) environmentally extended input-output model, named KREEIO. We find that final demand for Korean electronics led to nearly 8% of national GHG emissions in 2017, mostly because of indirect emissions embodied in the electronics supply chain. Notably, the semiconductor and display sectors contributed 3.2% and 2.4% to national emissions, with capital investment accounting for 17% of the two sectors' total emissions or nearly 1% of national emissions. For other electronic products, scope 1, scope 2, and upstream scope 3 emissions on average accounted for 3%, 10%, and 87% of a sector's GHG intensity, respectively. Detailed contribution analysis suggests that reducing Korean electronics GHG emissions would benefit most from the transition to a low-carbon electricity grid, but mitigation efforts in many other sectors such as metals and chemicals are also important. Overall, our study underscores the significance of electronics GHG emissions in South Korea, especially those from semiconductors and displays, and the mitigation challenges these sectors face as demand continues to grow globally.

Chemically controlled megasonic cleaning of patterned structures using solutions with dissolved gas and surfactant.

Acoustic cavitation is used for megasonic cleaning in the semiconductor industry, especially of wafers with fragile pattern structures. Control of transient cavitation is necessary to achieve high particle removal efficiency (PRE) and low pattern damage (PD). In this study, the cleaning performance of solutions with different concentrations of dissolved gas (H2) and anionic surfactant (sodium dodecyl sulfate, SDS) in DIW (DI water) on silicon (Si) wafers was evaluated in terms of PRE and PD. When only DIW was used, PRE was low and PD was high. An increase in dissolved H2 gas concentration in DIW increased PRE; however, PD also increased accordingly. Thus, we investigated the megasonic cleaning performance of DIW and H2-DIW solutions with various concentrations of the anionic surfactant, SDS. At 20 ppm SDS in DIW, PRE reached a maximum value and then decreased with increasing concentration of SDS. PRE decreased slightly with increasing concentrations of SDS surfactant when dissolved in H2-DIW. Furthermore, PD decreased significantly with increasing concentrations of SDS surfactant in both DIW and H2-DIW cases. A high-speed camera setup was introduced to analyze bubble dynamics under a 0.96 MHz ultrasonic field. Coalescence, agglomeration, and the population of multi-bubbles affected the PRE and PD of silicon wafers differently in the presence of SDS surfactant. We developed a hypothesis to explain the change in bubble characteristics under different chemical environmental conditions.

Raphani Semen (Raphanus sativus L.) Ameliorates Alcoholic Fatty Liver Disease by Regulating De Novo Lipogenesis.

In this study, we investigated the pharmacological effect of a water extract of Raphani Semen (RSWE) on alcoholic fatty liver disease (AFLD) using ethanol-induced AFLD mice (the NIAAA model) and palmitic acid (PA)-induced steatosis HepG2 cells. An RSWE supplement improved serum and hepatic triglyceride (TG) levels of AFLD mice, as well as their liver histological structure. To explore the molecular action of RSWE in the improvement of AFLD, we investigated the effect of RSWE on four major pathways for lipid homeostasis in the liver: free fatty acid transport, lipogenesis, lipolysis, and ß-oxidation. Importantly, RSWE decreased the mRNA expression of de novo lipogenesis-related genes, such as Srebf1, Cebpa, Pparg, and Lpin1, as well as the protein levels of these factors, in the liver of AFLD mice. That these actions of RSWE affect lipogenesis was confirmed using PA-induced steatosis HepG2 cells. Overall, our findings suggest that RSWE has the potential for improvement of AFLD by inhibiting de novo lipogenesis.

Projection-dependent heterogeneity of cerebellar granule cell calcium responses.

Cerebellar granule cells (GCs) relay mossy fiber (MF) inputs to Purkinje cell dendrites via their axons, the parallel fibers (PFs), which are individually located at a given sublayer of the molecular layer (ML). Although a certain degree of heterogeneity among GCs has been recently reported, variability of GC responses to MF inputs has never been associated with their most notable structural variability, location of their projecting PFs in the ML. Here, we utilize an adeno-associated virus (AAV)-mediated labeling technique that enables us to categorize GCs according to the location of their PFs, and compare the Ca2+ responses to MF stimulations between three groups of GCs, consisting of either GCs having PFs at the deep (D-GCs), middle (M-GCs), or superficial (S-GCs) sublayer. Our structural analysis revealed that there was no correlation between position of GC soma in the GC layer and location of its PF in the ML, confirming that our AAV-mediated labeling was important to test the projection-dependent variability of the Ca2+ responses in GCs. We then found that the Ca2+ responses of D-GCs differed from those of M-GCs. Pharmacological experiments implied that the different Ca2+ responses were mainly attributable to varied distributions of GABAA receptors (GABAARs) at the synaptic and extrasynaptic regions of GC dendrites. In addition to GABAAR distributions, amounts of extrasynaptic NMDA receptors appear to be also varied, because Ca2+ responses were different between D-GCs and M-GCs when glutamate spillover was enhanced. Whereas the Ca2+ responses of S-GCs were mostly equivalent to those of D-GCs and M-GCs, the blockade of GABA uptake resulted in larger Ca2+ responses in S-GCs compared with D-GCs and M-GCs, implying existence of mechanisms leading to more excitability in S-GCs with increased GABA release. Thus, this study reveals MF stimulation-mediated non-uniform Ca2+ responses in the cerebellar GCs associated with the location of their PFs in the ML, and raises a possibility that combination of inherent functional variability of GCs and their specific axonal projection contributes to the information processing through the GCs.

Publication rate of presentations at Korean plastic surgery meetings: The R&R Forum, KSAPS, and KSPRS (2011-2015).

BACKGROUND: Since the initial Research and Reconstruction Forum (R&R Forum) in 2011, the R&R Forum, Korean Society for Aesthetic Plastic Surgery (KSAPS), and Korean Society of Plastic and Reconstructive Surgeons (KSPRS) have held annual meetings. This study was conducted to provide updated information on the publication rate of presentations at those meetings. METHODS: Plastic surgery-related abstracts presented at the R&R Forum, KSAPS, and KSPRS between 2011 and 2015 were collected. The sessions were divided into free papers, posters, and e-presentations (or e-posters) for each annual meeting. Abstract publication status was confirmed through PubMed, Google Scholar, the KCI-Korean Journal Database, and the KMbase database. RESULTS: In total, 2,335 abstracts were presented in the free paper, poster, and e-presentation sessions. Of these, 622 (26.6%) were published. The overall publication rates were 240 of 684 abstracts (35.1%) presented at the R&R Forum, 56 of 216 abstracts (25.9%) presented at the KSAPS meetings, and 326 of 1,435 abstracts (22.7%) presented at the KSPRS meetings. In terms of specific annual meetings, the 2014 R&R Forum had the highest publication rate (39.9%), followed by the 2015 KSAPS (31.0%) and the 2015 KSPRS (28.8%). CONCLUSIONS: Scientific researchers present diverse results at these professional meetings, with a focus on innovative surgical techniques and improved surgical outcomes. This is our second study on this topic. Despite its limitations, this study indirectly shows that the recognition of Korean plastic surgeons and the quality of the annual meetings of Korean societies of plastic surgery have risen to the global level.

Ischemic Time in Free-Flap Surgery With Arteriovenous Bundle Interposition Graft: Comparison of Two Anastomosis Sequences.

BACKGROUND: During free-tissue transfer for scalp reconstruction, pedicle lengthening may be required when finding a recipient vessel is difficult because of defects from previous surgery. Arteriovenous (AV) bundle interposition grafting is a good option. This study compared 2 sequences of AV bundle interposition grafting when flap pedicle lengthening is needed. METHODS: Two anastomosis methods were used. In the recipient lengthening type (R type), the flap was harvested and the AV bundle was harvested from a donor vessel for lengthening. In the flap lengthening type (F type), the flap was harvested first. Next, in contrast to that in the R type method, the authors performed anastomosis with a flap pedicle and bundle before the AV bundle was harvested. RESULTS: The mean flap pedicle length was 8.75 cm (range, 5-11 cm). The AV bundle had a mean length of 9.25 cm (range, 6-13 cm), meaning that 13 cm of additional pedicle length can be added. The mean length of the extended vascular pedicle was 18 cm (range, 14-23 cm). CONCLUSION: This study compared the results of F type and R type AV bundle interposition grafting. The F type allowed easy monitoring of the anastomosis of the flap pedicle and ensured flap stability by reducing continuous ischemic time. Finally, this study confirmed the efficacy and safety of the AV bundle interposition graft in scalp reconstruction.

Distally-based free anterolateral thigh flap with a modified vena comitans.

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.

Breast reconstruction statistics in Korea from the Big Data Hub of the Health Insurance Review and Assessment Service.

BACKGROUND: Previously, surveys have been used to investigate breast reconstruction statistics. Since 2015, breast reconstruction surgery after mastectomy has been covered by the National Health Insurance Service in Korea, and data from breast reconstruction patients are now available from the Health Insurance Review and Assessment Service (HIRA). We investigated statistics in breast reconstruction in Korea through statistics provided by the HIRA Big Data Hub. METHODS: We investigated the number of cases in mastectomy and breast reconstruction methods from April 1, 2015 to December 31, 2016. Data were furnished by the HIRA Big Data Hub and accessed remotely online. Results were tabulated using SAS Enterprise version 6.1. RESULTS: The 31,155 mastectomy cases included 7,088 breast reconstruction cases. Implantbased methods were used in 4,702 cases, and autologous methods in 2,386. The implantbased reconstructions included 1,896 direct-to-implant and 2,806 tissue-expander (2-stage) breast reconstructions. The 2-stage tissue-expander reconstructions included 1,624 expander insertions (first stage) and 1,182 expander-to-permanent-implant exchanges (second stage). Of the autologous breast reconstructions, 705 involved latissimus dorsi muscle flaps, 498 involved pedicled transverse rectus abdominis myocutaneous (TRAM) flaps, and 1,183 involved free-tissue transfer TRAM flaps, including deep inferior epigastric perforator free-tissue transfer flaps. There were 1,707 nipple-areolar complex reconstructions, including 1,565 nipple reconstructions and 142 areola reconstructions. The 1-year mean number of breast reconstructions was 4,050. CONCLUSIONS: This was the first attempt to evaluate the total number of breast reconstruction procedures using accurate, comprehensive data, and our findings may prove valuable as a foundation for future statistical studies of breast reconstruction procedures in Korea.

Repair of Lower Canalicular Laceration Using the Mini-Monoka Stent: Primary and Revisional Repairs.

BACKGROUND: We present our results of primary repair of lower canalicular injury using the Mini-Monoka stent and report our experience with revisional repair of canalicular blocks to treat epiphora following primary repair METHODS:: We performed primary repair in 169 canalicular laceration patients using Mini-Monoka. The primary repair was defined as the first operation proceeded within 48 hours after injury. Revisional repairs were performed in patients who underwent primary repair of canalicular laceration and subsequently complained of epiphora with canalicular block owing to peripheral scarring. In revisional repair, a Mini-Monoka stent was reinserted to maintain the realigned lacrimal pathway. RESULTS: The primary repair achieved functional success in 94.7% of patients. After primary repair, nine patients complained of epiphora. Two of 9 patients underwent CDCR and 5 underwent revisional repair of canalicular blockage. The revisional repair achieved functional success in 4 of 5 patients. After revisional repair, scar contracture and asymmetry of the medial canthus or malposition of the lower lacrimal punctum were corrected. Cosmetically, all 5 patients were satisfied with the results. Functionally, one patient complained persistent epiphora and was treated with CDCR. CONCLUSIONS: We were able to experience simple, safe, and successful primary repair of lower canalicular injuries using the Mini-Monoka stent. If epiphora owing to canalicular block after primary repair and asymmetry of the medial canthus owing to scar contracture or malposition of lacrimal punctum are present, scar release and realignment of the canaliculus with Mini-Monoka insertion at the time of revisional repair are recommended.

Axillary Advancement Suture to Minimize Post-Implantation Deformity in Implant-Based Breast Reconstruction.

Patients who have undergone implant-based breast reconstruction after skin-sparing mastectomy often complain about bulging on the upper flank or inferior axillary area. This is most likely because the subcutaneous tissue layer of the upper flank, which is continuous with the breast tissue, tends to show inferolateral drooping once the subcutaneous tissue becomes loose after eliminating the breast parenchyma. In addition, one of the weaknesses of implant surgery is that implants cannot completely replace the tissue removed during skin-sparing mastectomy (SSM). This leads to the formation of a depression and a stepping effect superior and lateral to the implant on both sides. Notably, because the pectoralis major muscle is quite thin, when there is a depression around the superolateral area of the implant, it acts as a band, which then leads to tissue bulging and serious aesthetic problems. Here, we describe a simple advancement suture technique that can be used to resolve these two aesthetic problems in direct-to-implant breast reconstruction. The advancement sutures are performed after the implant and drains are inserted following SSM and before closing the incision. First, the surgeon confirms the depression in the superolateral area of the implant insertion site by redraping a skin flap lateral to the margin. If a depression is suspected, the surgeon uses forceps to pull the subcutaneous tissue in the lateral flank pocket over to the lateral border of the pectoralis major muscle, superolateral to the implant. At this point, correction of the lateral flank bulging and depression on the superolateral border is verified. If the result is not satisfactory, the surgeon may attempt advancing the subcutaneous fat from different areas; the more posterior the tissue is advanced, the better it eliminates the lateral bulging and superolateral depression. However, too much advancement may cause extra tension, potentially resulting in tearing of the tissue. A round needle is used to suture two to three stitches, before completing wound closure. By performing this simple advancement suture, we were able to successfully minimize post-implantation deformity-bulging on the lateral flank and depression at the superolateral implant margin. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Conversion from weight to volume of mastectomy specimen: Convenient equations.

Accurate restoration of the volume lost during breast removal is the key to achieve beautiful, symmetric breasts. This study aimed to devise a simpler and more accurate method for measuring breast tissue volume by studying the relationship between weight and volume of the excised tissue according to density. Mammograms of 276 women who were advised to undergo breast reconstruction surgery were divided into 4 different groups according to tissue densities. The correlation between weight and volume was studied for each group. The regression equations are as follows: 1st group: V = 1.218 × W+7.45 (V: volume, W: weight). 2nd group: V = 1.036 × W + 10.36. 3rd group: V = 0.969 × W-7.47. 4th group: V = 0.871 × W-14.13. These equations will be useful for reconstruction of natural-appearing and symmetric breasts following mastectomy.

Correction of Lying Ears by Augmentation of the Conchoscaphal Angle.

Lying ears are defined as ears that protrude less from the head, and in frontal view, are characterized by lateral positioning of antihelical contour relative to the helical rim. These aesthetically displeasing ears require correction in accord with the goals of otoplasty stated by McDowell. The authors present a case of lying ears treated by correcting the conchomastoid angle using Z-plasty, resection of posterior auricular muscle, and correction of the conchoscaphal angle by releasing cartilage using 2 full-thickness incisions and grafting of a conchal cartilage spacer. By combining these techniques, the authors efficiently corrected lying ears and produced aesthetically pleasing results.

Selective transgene expression in cerebellar Purkinje cells and granule cells using adeno-associated viruses together with specific promoters.

Adeno-associated virus (AAV) is a powerful tool for gene delivery into the brain and has been used for transgene expression in the cerebellar cortex. Although the efficacies of different AAV serotypes to transduce cerebellar Purkinje cells were examined, it has been difficult to achieve cell-type specific transgene expression. Here we used AAV serotype 1 with two specific promoters, namely, Ca(2+)/calmodulin-dependent protein kinase II α (CaMKIIα) and the minimum region of the GABAA receptor α6 subunit (GABRα6) promoters, and compared their expression patterns in the cerebellar cortex with the expression patterns of ubiquitous promoters that are often used for AAV-mediated expression. Whereas AAV with ubiquitous promoters, the cytomegalovirus early enhancer/chicken ß-actin promoter, and a small fragment of the synapsin-1 gene promoter caused ubiquitous expression in all cerebellar neurons tested, AAV with the CaMKIIα promoter injected into 10-day-old mice enabled selective expression in Purkinje cells. Furthermore, we developed AAV with the GABRα6 promoter, and succeeded for the first time to express the transgene exclusively in granule cells. Fresh cerebellar slices of mice injected with these AAVs were applicable for physiological experiments, such as patch clamp recording, optogenetic imaging, and stimulation. Thus, these AAV vectors are useful tools towards understanding the basic properties of cerebellar neurons or mechanisms of cerebellar functions. Particularly, selective expression in Purkinje or granule cells is useful for analyses using genetically-modified animals, such as knockout mice.

Kirschner Wire Fixation for the Treatment of Comminuted Zygomatic Fractures.

BACKGROUND: The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation. METHODS: A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, Kwire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent'). RESULTS: The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire. CONCLUSION: The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time.