Radiographic and clinical outcomes of muenster and sugar tong splints for distal radius fractures: a comparative study.

BACKGROUND: Non-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs. METHODS: In this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients' satisfaction after treatments. RESULTS: There were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images. CONCLUSIONS: The study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures. LEVEL OF EVIDENCE: Level IV; Retrospective Comparison; Treatment Study.

Factors affecting satisfaction in patients with a rotator cuff retear: CT arthrography-based study.

PURPOSE: The relationship between retear that may occur after rotator cuff repair and patient satisfaction is not well established. This study aimed to determine whether the types and size of the retear evaluated by computed tomography arthrography (CTA) influenced patient satisfaction. We also analyzed the patient factors that could affect patient satisfaction. PATIENTS AND METHODS: A total of 50 patients who were diagnosed with rotator cuff retear after undergoing arthroscopic rotator cuff repair were included in this study. All the patients were dichotomously classified into the satisfactory or dissatisfactory groups according to the patients' self-classifications. CTA was used to assess the attachment status of the footprint, detect retear on the medial side of the footprint of the repaired cuff, and determine the retear size. Demographic factors, including sex, age, occupation, dominant upper extremity, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation status, and functional shoulder score, were investigated. RESULTS: Thirty-nine patients were classified into the satisfactory group and 11 patients were classified into the dissatisfactory group. There were no differences in age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation, and duration of follow-up between the two groups. However, the postoperative American Shoulder and Elbow Surgeon (ASES) score (P < 0.01), visual analog scale (VAS) pain level (P < 0.01), anteroposterior (AP) length (P < 0.01), and area of the retear site (P < 0.01) were significantly different. CONCLUSION: The AP length and area of the retear site estimated using CTA were confirmed as the significant risk factors for dissatisfaction. However, the type of repaired rotator cuff judged by the attachment status of the footprint did not correlate with patient satisfaction. In addition, the postoperative VAS pain scale and ASES score was correlated with patient satisfaction.

Aesthetic Removal of Foreign Body Granulomas of Forehead Via Pretrichial Approach.

ABSTRACT: In the field of plastic surgery, various filler types have been developed, which are widely used for cosmetic or reconstruction purposes. However, unregulated substances often injected by unlicensed practitioners may cause difficult-to-treat side effects, such as foreign body granulomas. Since the forehead is an exposed area and the lesions are likely extensive, complete surgical removal with inconspicuous scar can be difficult. In addition, pharmacological treatments, such as steroids, have only a temporary effect. The authors report successful cases of foreign body removal combined with subcutaneous forehead lift via a pretrichial approach for cosmetic satisfaction.Ten patients who had received illegal filler injections that resulted in chronic granulomas on the forehead were studied. The granulomas were confirmed using sonography, and simultaneous foreign body removal and subcutaneous forehead lifts using pretrichial incisions were planned. For the surgical method, the forehead flap was carefully elevated to a uniform thickness in the subcutaneous plane via a pretrichial incision, and the foreign body was removed, paying attention to the forehead contour and nerve damage; excess skin was excised from the top of the flap to tighten the remaining skin on the forehead.None of the patients developed complications, such as skin necrosis, infection, hematoma, or wound dehiscence, during the follow-up period. The functional and aesthetic outcomes were satisfactory in all the patients.The subcutaneous forehead lift via a pretrichial incision seems to facilitate foreign body removal and improve the forehead deformity by tightening the remaining skin.

Assessment of Hindfoot Alignment: Intraoperative Fluoroscopy Versus Standing Radiograph.

Few intraoperative assessments are available for hindfoot alignment. In the current study, we demonstrated the feasibility of hindfoot alignment via intraoperative fluoroscopy. We retrospectively compared measurements of heel alignment obtained via intraoperative fluoroscopy with those acquired using standard radiographs. Two observers compared the heel alignment ratios and angles derived from 100 pairs of images. The effects of age, sex, laterality, and body mass index on the discrepancy between fluoroscopic images and radiographs were analyzed. The heel alignment ratio revealed a strong correlation between standing radiograph and intraoperative fluoroscopy, based on a correlation coefficient of 0.844 (p < .001). The heel alignment angle also showed significant correlation based on a correlation coefficient value of 0.667 (p < .001). None of the demographic factors showed any significant effect on the discrepancy between the 2 sets of images. Our study showed that the heel alignment determined via intraoperative fluoroscopy was comparable to that of a standard standing radiograph without any significant association with demographic factors.

Is subtle cavus foot a risk factor for chronic ankle instability? Comparison of prevalence of subtle cavus foot between chronic ankle instability and control group on the standing lateral radiograph.

BACKGROUND: Subtle cavus foot (SCF) is an entity characterized by mild cavus. However, few studies have examined whether a SCF may be a risk factor for chronic ankle instability (CAI). METHODS: This study included 116 patients who underwent lateral ankle ligament repair (modified Broström operation) for CAI and 105 controls. We used the standing lateral radiograph, so compared calcaneal pitch angle, Meary's angle, heights of the first and fifth metatarsal bases, and fibular positions between groups. Additionally, two observers subjectively rated the standing lateral radiographs for the presence of SCF. RESULTS: There were no significant intergroup differences in any of the radiographic angles. The prevalence of SCF was 20.7% in the CAI group and 18.1% in the control group according to observer 1 versus 21.6% and 28.6% (CAI group and control group, respectively) according to observer 2. There were no significant intergroup differences in the proportion of SCF between the two observers (p=0.105 and 0.211, respectively). CONCLUSION: SCF was not a significant risk factor for CAI when judging by standing lateral radiograph, and the detection of SCF seems to require considerable experience. Thus, care should be taken when determining whether to perform corrective osteotomies when treating CAI patients with SCF. LEVEL OF EVIDENCE: III, case control.

The Efficacy of Hyaluronidase in Early Surgery of Nasal Bone Fracture.

A nasal bone fracture is one of the most common facial injuries and is often treated by closed reduction. Typically, 2 to 3 weeks are needed for patients to return to daily life because the operation is performed after swelling around the fracture site is reduced. This study aimed to investigate that hyaluronidase injection could reduce swelling, perform early operation and return to daily life accelerated.From January 2017 to December 2017, 181 patients with nasal bone fracture were analyzed. 60 patients underwent hyaluronidase injection and massage to reduce edema, then performed surgery within 2 to 4 days. The remaining patients were treated conservatively (massage alone); they then underwent surgery. Ultrasonography was used to measure changes in skin thickness, and the treatment duration, outcome, and patient satisfaction were compared.The duration from injury to surgery was short in the early operation group, and the period of recovery and return to ordinary life was significantly shorter than in the conventional group. The difference in skin thickness after hyaluronidase injection and massage was 0.8 mm in the early operation group; there was no significant difference in the conventional group. There was no statistically significant difference in satisfaction between the 2 groups, but the mean satisfaction was higher in the early operation group.In patients with nasal bone fracture after facial trauma, hyaluronidase injection, and massage led to reduced edema. This might improve patient satisfaction by allowing earlier operation and earlier return to daily life.

The Epidemiology of Dupuytren's Disease in Korea: a Nationwide Population-based Study.

BACKGROUND: To date, there have been few reports on the nationwide population-based epidemiology of Dupuytren's disease (DD). We investigated the prevalence and incidence of DD in Korea using the large dataset provided by the Korean Health Insurance Review and Assessment Service. This study is the second nationwide epidemiological study of DD after the study in Taiwan. METHODS: Records of patients diagnosed with DD between 2007 and 2014 were extracted from the large dataset by diagnostic code searching (International Classification of Disease 10th revision code M72.0) and were included in the study. We calculated the prevalence and incidence of DD based on the total population of Korea provided by the Korean Statistical Information Service. Diseases associated with DD and the trends in surgery for DD were also analyzed. RESULTS: A total 16,630 patients were diagnosed with DD during the study period. The mean annual prevalence was 32.2 per 100,000 population (41.8 per 100,000 for men; 22.5 per 100,000 for women). The mean annual incidence was 1.09 per 100,000 population (1.80 per 100,000 for men; 0.38 per 100,000 for women). The common diseases associated with DD were hypertension (30.5%), diabetes mellitus (26.7%), hyperlipidemia (20.4%), ischemic heart disease (7.9%), and cerebrovascular disease (4.6%). The mean annual proportion of the patients who had surgery for DD was 5.24% of all DD patients. CONCLUSION: The prevalence and incidence of DD in Korea were 100-1,000 times lower than those in western countries; however, it was slightly larger than that in Taiwan.

Incidence and Seasonal Variation of Distal Radius Fractures in Korea: a Population-based Study.

BACKGROUND: The present study aimed to investigate the incidence and seasonal variation of distal radius fractures (DRFs) in Korea. METHODS: We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service from 2011 to 2015. We used International Classification of Diseases, 10th revision codes and procedure codes to identify patients of all ages with newly diagnosed DRFs. RESULTS: An average of about 130,000 DRFs occurred annually in Korea. The incidence of DRF, by age group, was highest in the 10 to 14-year-old age group for males and the highest in the 70s age group for females, with a rapid increase of incidence after 50 years. The peak incidence of DRF occurred during winter; however, the incidence greatly varied annually when compared with that of other seasons. The incidence of DRFs during the winter season was correlated with the average temperature. CONCLUSION: The annual incidence of DRF was 130,000 in Korea. The incidence increased under an intense cold surge during winter. Active preventive measures are recommended especially in women exceeding 50 years considering the higher incidence in this age group.

Clinical Results of Autogenous Palmaris Longus Tendon Graft for Ruptures of Multiple Extensors in Rheumatoid Hands.

PURPOSE: The purpose of this study was to evaluate the clinical outcome of autogenous palmaris longus grafting for extensor tendon ruptures of 2 or more fingers in rheumatoid hands and to identify the factors related to the clinical outcome. METHODS: Between 2000 and 2013, a total 41 patients with advanced rheumatoid arthritis and multiple extensor tendon ruptures reconstructed with autogenous palmaris longus tendon grafts were reviewed. Extension lag at the metacarpophalangeal (MCP) joint, total active motion (TAM), and fingertip-to-palm (TTP) distance were evaluated at final follow-up. Simple regression analysis was done to determine the factors predictive of clinical outcome. RESULTS: The mean extension lag at the MCP joint of the reconstructed finger was 9° (range, 0°-90°; median, 0°). The mean TAM was 239° (range, 85°-280°; median, 260°), and the mean TTP distance was 5 mm (range, 0-50 mm; median, 0 mm). Simple regression analysis showed that only age was related to extension lag at the MCP joint and only arthritis of the MCP joint was related to TAM. CONCLUSIONS: In rheumatoid arthritis, extensor tendon reconstruction of multiple extensor tendon ruptures using autogenous palmaris longus tendon graft is a viable option to achieve a favorable clinical result. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Imaging sonographic findings of in a case of proliferating trichilemmal tumor of a finger: A case report.

Proliferating trichilemmal tumor (PTT) is a rare tumor that originates from the outer root sheath of a hair follicle. About 90% of PTTs occur on the scalp. The sonographic findings of PTT in the subungual region have not been reported previously. In our case, sonography showed a heterogeneous mass containing echogenic foci with no detectable intratumoral vascularity. These echogenic foci probably represent keratin and cholesterol. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:215-217, 2018.

National Surgical Trends for Distal Radius Fractures in Korea.

The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ≥ 20 years with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30-100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.

Nonincisional Conjoint Fascial Sheath Suspension: A Novel Technique for Minimally Invasive Blepharoptosis Correction.

BACKGROUND: Mild to moderate blepharoptosis, or ptosis, is relatively common among Asians, and it is not uncommon to offer ptosis correction at the time of double-eyelid surgery in this patient population. The traditional open approaches to ptosis correction are subject to scarring and prolonged recovery time, whereas the newer nonincisional approaches are marred by issues of incomplete correction or recurrence. This study describes a new nonincisional technique that overcomes the limitations of current methods by using conjoint fascial sheath (CFS) for suspension. METHODS: From January 2014 to April 2015, a retrospective review was conducted on 21 patients (41 eyelids) who underwent simultaneous nonincisional ptosis correction and double-eyelid surgery. All patients had either mild or moderate ptosis without excess skin hooding and excellent or good levator palpebrae function. RESULTS: Mild ptosis correction (1-loop CFS suspension) was performed in 25 eyelids, and moderate ptosis correction (2-loop CFS suspension) was performed in 16 eyelids. At 6 months of follow-up, 23 eyelids (56.1 %) improved to "normal" with overall improvement seen in 33 eyelids (80.0%). The mean marginal reflex distance 1 increased from 3.16 ± 0.61 mm preoperatively to 4.11 ± 0.61 mm postoperatively, which was statistically significant (P < 0.001). CONCLUSIONS: Mild to moderate ptosis correction with nonincisional CFS suspension technique is a safe and effective method that combines the benefits of nonincisional procedure with longevity and precision seen in the traditional open approaches. The procedure is easy to perform with minimal recovery time and high patient satisfaction and can be combined with nonincisional double-eyelid surgery.

Biomechanical Properties of 3-Dimensional Printed Volar Locking Distal Radius Plate: Comparison With Conventional Volar Locking Plate.

PURPOSE: This study evaluated the biomechanical properties of a new volar locking plate made by 3-dimensional printing using titanium alloy powder and 2 conventional volar locking plates under static and dynamic loading conditions that were designed to replicate those seen during fracture healing and early postoperative rehabilitation. METHODS: For all plate designs, 12 fourth-generation synthetic composite radii were fitted with volar locking plates according to the manufacturers' technique after segmental osteotomy. Each specimen was first preloaded 10 N and then was loaded to 100 N, 200 N, and 300 N in phases at a rate of 2 N/s. Each construct was then dynamically loaded for 2,000 cycles of fatigue loading in each phase for a total 10,000 cycles. Finally, the constructs were loaded to a failure at a rate of 5 mm/min. RESULTS: All 3 plates showed increasing stiffness at higher loads. The 3-dimensional printed volar locking plate showed significantly higher stiffness at all dynamic loading tests compared with the 2 conventional volar locking plates. The 3-dimensional printed volar locking plate had the highest yield strength, which was significantly higher than those of 2 conventional volar locking plates. CONCLUSIONS: A 3-dimensional printed volar locking plate has similar stiffness to conventional plates in an experimental model of a severely comminuted distal radius fracture in which the anterior and posterior metaphyseal cortex are involved. CLINICAL RELEVANCE: These results support the potential clinical utility of 3-dimensional printed volar locking plates in which design can be modified according the fracture configuration and the anatomy of the radius.

A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis.

BACKGROUND: Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment. QUESTIONS/PURPOSES: (1) Which treatment (compression bandaging with nonsteroidal antiinflammatory drugs [NSAIDs], aspiration, or aspiration with steroid injections) is associated with the highest likelihood of resolution of nonseptic olecranon bursitis? (2) Which treatment is associated with earliest resolution of symptoms? (3) What factors are associated with treatment failure by 4 weeks? METHODS: We enrolled 133 patients from two centers; after applying prespecified exclusions (septic bursitis or concomitant inflammatory arthritis, intraarticular elbow pathology, recent aspiration or steroid injection done elsewhere, and refusal to participate), 90 patients were randomly allocated to receive compression bandaging with NSAIDs (C), aspiration (A), or aspiration with steroid injection (AS) groups (30 patients in each). The groups were similar at baseline in terms of age and gender. Seven patients (four from Group A and three from Group AS) were lost to followup. All patients were followed up weekly for 4 weeks, and the same treatment procedure was repeated if the bursitis recurred with any substantial fluid collection. At 4 weeks, the state of resolution and pain visual analog scale (VAS) were evaluated. Failed resolution was defined as presence of persistent olecranon bursal fluid collection at Week 4 after the initiation of the treatment; on the contrary, if bursal fluid collection was clinically reduced or completely disappeared by the end of Week 4, the treatment was considered successful. We compared the proportion of resolution by Week 4 and the median times to resolution among the treatment groups. In addition, we evaluated whether the resolution affected pain VAS and what factors were associated with the resolution. RESULTS: There were no differences in the proportion of patients whose bursitis resolved by Week 4 among the three treatment groups (Group C: 25 of 30 [83%], relative risk of resolution failure: 0.68 [95% confidence interval {CI}, 0.27-1.72], p = 0.580; Group A: 17 of 26 [65%], relative risk of resolution failure: 2.19 [95% CI, 0.98-4.87], p = 0.083; Group AS: 23 of 27 [85%], relative risk of resolution failure: 0.59 [95% CI, 0.22-1.63], p = 0.398) (p = 0.073). Steroid injection after aspiration (Group AS) was associated with the earliest resolution (2.3 weeks [range, 1-4 weeks]) when compared with aspiration alone (Group A; 3.1 weeks [range, 2-4 weeks]) and compression bandaging with NSAIDs (Group C; 3.2 weeks [range, 2-4 weeks]), p = 0.015). Longer duration of symptoms before treatment was the only factor associated with treatment failure by 4 weeks (failed resolution: 6 weeks [range, 2-9 weeks]; successful resolution: 4 weeks [range, 0.4-6 weeks]; p = 0.008). CONCLUSIONS: With the numbers available, there were no differences in efficacy when compression bandaging with NSAIDs, aspiration, and aspiration with steroid injection were compared. However, we were powered only to detect a 30% difference, meaning that if there were a smaller difference in efficacy among the groups, we might not have detected it in a study of this size. Our data can be used as pilot data to power future prospective (and likely multicenter) trials. Because olecranon bursitis can recur, and because treatments like aspiration and aspiration with steroid injection can cause complications, unless future trials demonstrate clear efficacy advantages of aspiration and/or injection both at short and longer terms, we suggest that compression bandaging and a short course of NSAIDs may offer the most appropriate balance of safety and efficacy. LEVEL OF EVIDENCE: Level II, therapeutic study.

The Effect of Botulinum Toxin A on the NADPH Oxidase System and Ischemia-Reperfusion Injury.

BACKGROUND: Despite the increasing popularity of various materials for ischemia-reperfusion (I/R) injury mitigation, research on botulinum toxin type A (BoNTA) remains limited. This study assesses BoNTA's efficacy in protecting flaps from I/R injury by inhibiting the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system and reducing reactive oxygen species (ROS) production. METHODS: Seventy-six Sprague-Dawley rats were studied. We examined the effects of BoNTA on superoxide production in four rats using a lucigenin-enhanced chemiluminescence assay (LECL). Another group of 60 rats had their superficial inferior epigastric artery (SIEA) flaps treated with either BoNTA or saline and clamped for 0, 1, and 4 hours before reperfusion. Flap survival and histological outcomes were assessed five days post-operation. ROS production in SIEA flaps and femoral vessels was analyzed in 12 additional rats, post-I/R injury. RESULTS: The LECL results showed that the BoNTA group had significantly lower superoxide production compared to controls, with notable reductions at 4 hours. While no significant differences were noted at the 0 and 1-hour marks, the 4-hour mark showed significant protective effects in BoNTA-treated groups. The survival rate was 90% for BoNTA-treated rats versus 60% for controls ( P = 0.028). Significant reductions in ROS were also observed in the 4-hour I/R group. CONCLUSIONS: BoNTA effectively protects against I/R injury by inhibiting the NADPH oxidase system and reducing ROS levels. These results support further investigation into the specific mechanisms of NADPH oxidase inhibition by BoNTA and its potential clinical applications, given its safety profile. CLINICAL RELEVANCE STATEMENT: The findings from the present study are expected to provide a basis for clinical studies regarding this use of BoNTA.

Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review.

We systematically reviewed the incidence of complications and outcomes of different surgical methods for acute perilunate injury in the MEDLINE, Scopus, Embase and Cochrane Library databases. Forty-three articles with 880 patients were included. The most common complications were arthritis (30%), carpal instability (15%), avascular necrosis of the lunate (12%), complex regional pain syndrome (11%), and nonunion or avascular necrosis of the scaphoid (9%). In the meta-analysis, the mean scapholunate gap was 1.7 mm in the closed surgery group and 2.3 mm in the open surgery group, which was a statistically significant difference. The mean flexion-extension arc of the wrist and modified Mayo wrist score were better in the closed surgery group than in the open surgery group. However, these findings may relate to different cohorts in terms of injury severity. Therefore, the causal relationship between closed surgery and better outcomes may be uncertain as less severe subluxations are more likely to be treated closed.

Reconstruction of complex knee wounds with a distally based gracilis flap and gastrocnemius myocutaneous flap: A case report.

A gastrocnemius muscle flap is a versatile option for covering the proximal one-third of the lower leg and around the knee. On the other hand, it is of limited use in patients with short gastrocnemius muscle or insufficient volume. The authors present a case in which a knee soft tissue defect occurred in a very thin patient and was reconstructed using a gastrocnemius myocutaneous flap and a distally based gracilis flap as a supplementary flap.

The Effect of Botulinum Toxin A on NADPH oxidase system and Ischemia Reperfusion Injury.

BACKGROUND: While studies aimed at overcoming ischemia-reperfusion (IR) injury using various materials are becoming popular, studies using botulinum toxin type A (BoNTA) are still limited. This study tested the hypotheses that BoNTA can protect flaps from IR injury by inhibiting the NADPH oxidase system and suppressing ROS (reactive oxygen species) production. MATERIAL AND METHODS: The subjects were Sprague-Dawley rats (n = 76). In 4 rats, the effects of different dose of BoNTA on superoxide production was evaluated through lucigenin enhanced chemiluminescence assay (LECL) using SD rats' thoracic aorta ring. In 60 SD rats, The BoNTA and normal saline-pretreated superficial inferior epigastric artery (SIEA) flaps were clamped for 0, 1, and 4 hours, and reperfused. On the 5th day after the opeartion, well-maintained flaps were grossly inspected, survival rates were analyzed, and histological analysis was also performed. In 12 rats, after making IR injury through the same model, SIEA flap segments and femoral vessels were obtained, and ROS production was evaluated through LECL and dihydroethidium (DHE) staining. RESULTS: In LECL, the experimental group produced a smaller amount of superoxide than the control group through NADPH oxidase inhibition (p < .05). There was no significant difference between the experimental and control group in the 0, and 1 hour IR groups, but the experimental group (90%) showed a higher survival rate than the control group (60%) in the 4 hours IR group (p = .028). In the measurement of ROS production through LECL and DHE staining, there was no significant difference in the 0, and 1 hour IR groups, but a significant difference was shown in the 4 hours IR group in both the SIEA flaps and femoral vessels (p < .05). SUMMARY: This study verified hypothesis that BoNTA can protect flaps from IR injury by inhibiting the NADPH oxidase system and suppressing ROS production. Based on this research model, future research should be expanded into studies on subtypes or subunits of NADPH oxidase, and the findings from the present study are expected to contribute and lead to clinical studies on BoNTA, which has already been proven to be clinically safe.

Tailored versus conventional surgical debridement in complex facial lacerations in emergency department: A retrospective study.

Surgical debridement is an essential step in treating complex facial lacerations (CFL). As the CFL severity increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient. Because the severity and shape of each CFL vary, it is necessary to tailor the customized pre-excisional design, that is, tailored surgical debridement (TSD), for each case before performing surgical debridement. The use of TSD can enable effective debridement of CFL with higher severity. This study aimed to compare the cosmetic outcomes and complication incidence of CSD versus TSD according to CFL severity. In this retrospective observational study, eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded as Grades I and II. The outcomes of CSD and TSD were compared using the scar cosmesis assessment and rating (SCAR) scale, wherein a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcomes between the 2 groups was compared. The SCAR score and percentage of good cosmetic outcomes between the 2 groups were compared overall and by severity. For analyzing complication incidence, asymmetry, infection, and dehiscence incidence were compared. In total, 252 patients were enrolled [121 (48.0%) CSD and 131 (52.0%) TSD]. The median SCAR scores were 3 (1-5) and 1 (0-2) in all enrolled patients (P < .001), 2 (0-4), and 1 (0-1) in Grade I patients (P < .01), and 5 (4-6) and 1 (1-2) in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The percentage of good cosmetic outcomes was 46.3% and 84.0% overall (P < .001), 59.6% and 85.0% in Grade I patients (P < .01), and 9.4% and 83.5% in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The incidence of complications was significantly higher in the CSD group than in the TSD group, but this was limited to asymmetry. No significant difference was noted in infection or dehiscence. Compared with CSD, TSD can lead to an objectively good cosmetic prognosis at higher CFL severity and can reduce facial asymmetry occurrence.

Designing with relaxed skin tension line in perforator-based island flap for sacral sore reconstruction: A STROBE-compliant observational study.

Many various types of operative techniques have been performed used to treat make-up for sacral defects. Perforator-based flaps with flap transposition, but achieving an optimal flap design and tension-free flap closure without skeletonizing the perforator requires a great deal of clinical experience. In this study, we demonstrate perforator selection based on considerations of the relaxed skin tension line (RSTL), which has proven to be a suitable method of achieving an efficient flap design that enables primary closure. Twenty-five perforator-based flap procedures were performed on 25 patients at a single institution from February 2018 to January 2021. The medical records of patients were retrospectively reviewed. Twenty-three flaps survived completely. Two flaps developed partial tip necrosis but recovered after secondary healing, and 1 patient developed temporary congestion, which resolved spontaneously. No recipient or donor site recurrence or dehiscence was identified during follow-up. We report our clinical experiences of perforator-based flap use in the sacral region. When selecting an appropriate perforating vessel, 2 important points should be considered, that is, a flap long axis parallel to RSTLs and defect shape. According to the method presented in this paper, perforator-based flaps can be transposed safely and easily with few complications and serve as useful practice models to cover sacral defects.