A Rare Case of Metal Exposure After Internal Fixation of Facial Bone Fracture With Autogenous Bone Graft.

Few studies have reported complications in metal fixation systems, such as infection or device exposure. Here, we report our experience with exposed metal screws after the reduction of facial bone fracture. This will be a useful guide to using a metal fixation system in situations in which metal fixation systems should not be used.

A Comparative Assessment of Scars Resulting From Skin Grafts in Facial Defects.

PURPOSE: The authors compared facial scars after split-thickness skin grafts (STSGs) performed with a dermal substitute or after full-thickness skin grafts (FTSGs) in facial defect. MATERIALS AND METHODS: The medical records of patients who had undergone FTSG or STSG with dermal substitute after skin cancer surgery between March 2016 and December 2018 were retrospectively reviewed. The scars resulting from skin grafts were assessed using the patient and observer scar assessment scales (PSAS and OSAS) in our clinic after a minimum of 6 months postoperatively. RESULTS: Of the 50 study subjects, 35 patients (FTSG group) received FTSG only and 15 patients (STSG group) received STSG with the dermal substitute. The total scores of PSAS and OSAS were significantly lower in the FTSG group and it is suggested that both patients and observers thought that better scar outcomes were achieved when FTSGs were used. However, for defects smaller than 1.8 cm2 and defects located in the periorbital area, there was no statistically significant difference in the scores of PSAS and OSAS in the 2 groups. Interestingly, for defects located in the periorbital area, although there was no significant difference, PSAS and OSAS scores were lower in the STSG group than in the FTSG group. In other word, scar outcomes in the STSG group were better. CONCLUSIONS: Although there was no significant difference, unlike what we usually know, our result shows that STSG with dermal substitute tended to produce comparable or rather better results than FTSG under some conditions.

Neutral-layer-free directed self-assembly of block copolymer in trench using capillary force-induced meniscus.

We propose trench-directed self-assembly (TDSA) of a block copolymer (BCP) driven by a capillary force-induced meniscus as a facile scalable nanolithography method. Unlike conventional directed self-assembly methods, TDSA enables the achievement of neutral surface-free vertical orientations of the BCP nanopatterns irrespective of the polarizability of the substrate, which may be, for example, a ceramic (SiO2) on Semiconductor (Si). In our demonstration of the proposed method, we generated various morphologies of the BCP nanopatterns by varying the trench width, and molecular weight of the BCP. The proposed TDSA method is potentially advantageous for the design of a process/device layout required for the development of an effective manufacturing process.

Prognosis of Patient With Resorbable Plates and Screws Under the Incision Site.

Various resorbable plates and screws were used for facial bone fractures because of several strengths. However, there are few studies on their clinical course and long-term follow-up concerning their degradation and resorption time. The authors present rare case of long term follow-up of resorbable plates and screws under the incision site.

Usefulness of Ramified Cephalic Vein Graft in the Wrist for Connection With Concomitant Vein in Head and Neck Reconstruction.

A vein graft in head and neck reconstruction is essential in some circumstances. The cephalic vein in the wrist has a suitable caliber for both a concomitant vein and the internal jugular vein (IJV). A vein graft involving the cephalic vein and its branches was used in 2 cases of head and neck reconstruction. The ramified distal vein was anatomized with a concomitant vein, and the proximal larger vein was anastomosed with the IJV using an end-to-side technique. After placement of vein grafts using the cephalic vein, the flaps were stable with no venous complications. To overcome the size difference between concomitant veins and the IJV, the authors recommend the cephalic vein including its distal branches in the wrist area.

Protruding Meningioma of the Forehead With Extensive Hyperostosis Mimicking Skull Osteoma.

Meningioma is the most common intracranial benign tumor in adults. Hyperostosis accompanies about 4.5% of meningiomas. The authors report a rare case of hyperostotic meningioma that may have been misdiagnosed as giant osteoma.A 42-year male visited our clinic due to an egg-sized, hard mass on his left forehead. The mass suspected to be giant osteoma was about 4.2 × 4.0 cm sized, hard, non-movable, and non-tender. But based on radiologic findings, the mass was diagnosed as meningioma with extensive hyperostosis.Without neurologic symptoms, the diagnosis of meningioma associated with hyperostosis can be challenging and be misdiagnosed as fibrous dysplasia and osteoma by simple examination without enhanced CT and MRI.Therefore, although osseous lesions are strongly suspected to be osteomas, surgeons should consider other diagnoses, and if necessary, use contrast enhanced CT or MRI to differentiate these bony lesions.

Reconstruction of Congenital Cranial Defect Using Autologous Bone Graft in Aplasia Cutis Congenita.

Many methods have been devised to repair cranial defects. Here, we report the use of a simple technique for the repair of a congenital cranial defect associated with aplasia cutis congenita (ACC).A newborn baby at 39 weeks of gestation was consulted with a scalp and cranial defect at the vertex measuring 3 × 1.5 cm. A 3-D CT scan of the skull confirmed the presence of a cranial defect at the sagittal suture and a normal brain structure. On the 13 day of life, the newborn was taken to an operating room. An autologous bone graft was harvested from adjacent normal parietal bone and grafted into the debrided congenital cranial defect. The soft tissue defect was then covered by rotation flaps.The postoperative 3-D CT scan presented a well-positioned autologous bone graft. At 1 month postoperatively, the skull contour was normal and there was no palpable defect.We report a successful surgical outcome for a congenital cranial and soft tissue defect in ACC treated using an autologous bone graft and rotation flaps. Although conservative therapy may be an alternative option, we recommend appropriate surgical reconstruction in patients at risk of potentially fatal complications.

Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis.

BACKGROUND: Stress signals during sucking activity such as nasal flaring, head turning, and extraneous movements of the body have been attributed to incoordination of sucking, swallowing, and respiration (SSR) in premature infants. However, the association of uncoordinated sucking pattern with developmental outcomes has not yet been investigated. The aim of this study was to investigate whether uncoordinated sucking pattern during bottle-feeding in premature infants is associated with the developmental outcomes at 8-12 and 18-24 months of age (corrected for prematurity). METHODS: We retrospectively reviewed the medical records and video recordings for the Neonatal Oral-Motor Assessment Scale (NOMAS) of premature infants and divided them into two groups based on the presence or absence of incoordination. The Bayley-III cognition composite scores of the incoordination-positive and incoordination-negative group were compared at 8-12 and 18-24 months of age. RESULTS: Seventy premature infants exhibited a disorganized sucking pattern according to the NOMAS. The average Bayley-III cognition composite scores at 8-12 months of age were 92.5 ± 15.6 and 103.0 ± 11.3 for the incoordination-positive (n = 22) and incoordination-negative groups (n = 48), respectively (p = 0.002). The average Bayley-III cognition composite scores at 18-24 months were 90.0 ± 17.9 and 100.7 ± 11.5 for the incoordination-positive (n = 21) and incoordination-negative groups (n = 46), respectively (p = 0.005). A multiple linear regression analysis indicated that the presence of uncoordinated sucking pattern, grade 3 or 4 germinal matrix hemorrhage-intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were independently associated with cognitive development at 18-24 months of age. CONCLUSIONS: Uncoordinated sucking pattern in premature infants was independently associated with a higher risk of abnormal developmental outcome in the cognitive domain of the Bayley-III at both 8-12 and 18-24 months. There may be a need for periodic follow-up and early intervention for developmental delay when incoordination of SSR that results in stress signals on the NOMAS is observed before 40 weeks postmenstrual age.

3-Dimensional Volumetric Analysis of Relationship Between the Orbital Volume Ratio and Enophthalmos in Unoperated Blowout Fractures.

PURPOSE: Blowout fractures are common in midfacial trauma and often involve other parts of facial bones. Sometimes, patients have complications caused by inadequate management. Surgical indications, such as clinical symptoms, can be inaccurate owing to post-traumatic swelling or hematoma formation. Previous studies on the prediction of enophthalmos used the orbital volume ratio (OVR) or only the volume of herniated tissue. This study examined which of these values is more predictive of the degree of enophthalmos. In addition, the predictive values for a 2-mm enophthalmos in unoperated blowout fractures were assessed. PATIENTS AND METHODS: A total of 191 patients underwent nonoperative treatment for blowout fractures at our institution; they were divided into 2 groups according to the degree of enophthalmos (>2 mm vs 0 to 2 mm) and were further divided into 3 subgroups according to the location of the fracture (inferior, medial, or inferomedial). Multifactor logistic regression analysis was performed to determine the relationship between the degree of enophthalmos and these values. RESULTS: We observed a correlation between the OVR and the degree of enophthalmos, as well as a correlation between the volume of herniated tissue and the degree of enophthalmos. Regarding the anatomic location of herniation, the orbital floor was found to be more correlated with the amount of enophthalmos. CONCLUSIONS: The OVR is a more reliable predictor than measurement of the volume of herniated tissue. The relationship found between radiologic examination findings and the degree of enophthalmos can be used as a surgical indication in addition to consideration of the anatomic location.

Treatment of rectovaginal fistula with gracilis muscle flap transposition: long-term follow-up.

PURPOSE: Rectovaginal fistulas are difficult to treat completely, especially when patients present with a history of multiple surgeries and radiation therapy. We aimed to evaluate the efficacy of gracilis muscle flap transposition to treat rectovaginal fistula. METHODS: We performed a retrospective chart review of all gracilis muscle transposition cases and other procedures between January 2009 and July 2016. RESULTS: Total 53 cases were reviewed. A total of 11 patients underwent gracilis muscle flap transposition for rectovaginal fistula repair, with 8 patients showing good results without recurrence (total success rate, 72.7%). Comparison of this patient group with patients who had undergone other surgical procedures for rectovaginal fistula repair showed that those who received a gracilis transposition flap had significantly higher average number of previous surgeries (2.18 ± 1.17 vs. 1.1 ± 1.25) and had previously undergone radiotherapy at a significantly higher rate (63.6 vs. 26.2%). Furthermore, none of our patients complained of donor site discomfort. CONCLUSIONS: Based on these results, we recommend using the gracilis muscle flap for rectovaginal fistula repair in cases where there is a history of radiotherapy and had surgical failure more than twice.

Efficacy of 2 Representative Topical Agents to Prevent Keloid Recurrence After Surgical Excision.

PURPOSE: Keloids are difficult to remove successfully and there is no universally accepted treatment. After surgical excision of the keloid, there are various management methods for prevention of keloid recurrence, such as intralesional injection, radiation, and topical agents. A few studies have compared topical agents with other treatments. The aim of this study was to investigate effective topical agents for the prevention of recurrent keloid after surgical excision. MATERIALS AND METHODS: Eligible articles were sought using core databases, including Medline, Embase, and Cochrane databases, up to April 2016. The predictor variables were mitomycin C (MC) and imiquimod cream treatment after keloid excision. The outcome variable was keloid recurrence rate. RESULTS: The search strategy identified 120 publications. After screening, 9 articles were selected for review. Articles were divided into 2 groups: MC and imiquimod cream. The recurrence rate after surgical excision in the MC group was estimated to be 16.5%, and that in the imiquimod cream group was estimated to be 24.7%. CONCLUSION: If intralesional injection or radiation is not available, then MC or imiquimod 5% cream could be an effective alternative in preventing keloid recurrence.

Osmidrosis Treatment Approaches: A Systematic Review and Meta-Analysis.

BACKGROUND: There are many treatment modalities associated with osmidrosis. The purpose of this study was to identify and compare effective osmidrosis treatments. METHODS: A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. The osmidrosis treatment modalities were extracted as predictor variables, and recurrence and complications were extracted as outcome variables. Subgroup analysis was performed with regard to combined curettage, and fixed and random effect models were applied. RESULTS: Forty studies published prior to February 2016 were identified. The group that received surgery had the lowest incidence of recurrence as 3.0%, followed by the liposuction and laser groups (5.5%, 8.2%, respectively). The liposuction group had the lowest incidence of complications (hematoma, 1.6%; necrosis, 1.5%), followed by the surgery (hematoma, 1.9%; necrosis, 2.1%) and laser groups (hematoma, 3.1%; necrosis, 4.5%). When combining curettage, the recurrence rate was lower in the surgery (P = 0.06) and liposuction groups (P < 0.01). CONCLUSIONS: Surgery treatment has been demonstrated as the most effective result for treating osmidrosis. Liposuction has been identified as the most effective treatment, with the lowest number of associated complications. Combining the curettage method was an effective option for lowering recurrence rate in surgery and liposuction treatments. Finally, laser treatment was not significantly associated with benefits.

Demarcative Necrosis Along Previous Laceration Line After Filler Injection.

In recent years, fillers have been widely used for soft tissue augmentation. Although they are generally considered to be safe, many complications have been reported to date. Nose and nasolabial fold augmentations with fillers can lead to an implementation of nasal skin necrosis, possibly caused by intravascular embolism and/or extravascular compression. Herein, we present a case of a successfully treated patient who experienced skin necrosis after an injection of dermal fillers into the nasolabial fold. Interestingly, we discovered that the patient had experienced a laceration 8 years ago around the area in which the filler was injected.

Unusual Aspergillus Infection After Dermal Filler Injection.

According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection.

Negative Pressure Wound Therapy as Effective and Comfortable Management After Treatment of Osmidrosis.

Although osmidrosis has been widely discussed in respect to its treatment modalities, there has been no definite consideration of postoperative management after the treatment of osmidrosis. We have tested the 40-125 mmHg range of negative pressure. We present negative pressure wound therapy (NPWT) of 70 mmHg for postoperative management in osmidrosis because NPWT has a role in removing fluid, such as blood or seroma, and diminishing the dead space between the skin and subcutaneous tissue. Patients who receive NPWT have shown successful treatment outcomes and no skin necrosis or hematoma formation. Additionally, NPWT could improve postoperative daily activity compared with conventional compressive dressings. LEVEL OF EVIDENCE V: 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 .

Iatrogenic Through-and-Through Conchal Defect Secondary to Auricular Cartilage Graft.

BACKGROUND: Over the past few years, conchal cartilage has been most often used in rhinoplasty. The donor site complications following conchal cartilage graft harvesting are scar formation, hematoma formation, and delayed wound healing, although hematoma is one of the most important and common complications. A complete conchal defect as a complication of auricular cartilage graft harvesting has not been previously reported in the literature. The authors report an unusual case of an iatrogenic conchal defect resulting from conchal cartilage graft harvesting that was treated using a posterior auricular island flap. METHODS: A 24-year-old male with a left conchal inflammation and perforation visited our plastic surgery department after receiving augmentation rhinoplasty and tip plasty using a conchal cartilage graft. A tight dressing had been applied to the ear, and postoperative infection was uncontrolled, which resulted in iatrogenic conchal perforation. RESULTS: A tie-over bolster dressing has been widely used to prevent hematoma following conchal cartilage graft harvesting with an associated donor site complication. However, a tight tie-over dressing and inappropriate postoperative care can cause complete through-and-through conchal defects. The posterior auricular island flap provides an elegant means of reconstructing conchal defects. CONCLUSIONS: In the described case, aesthetic reconstruction of a conspicuous iatrogenic conchal defect was achieved with minimal scarring using the posterior auricular island flap. To the best of our knowledge, this report is the first to describe reconstruction of an iatrogenic defect in the concha as a complication of auricular cartilage graft harvesting. LEVEL OF EVIDENCE V: 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 .

Short-term outcomes following reduced-port, single-port, and multi-port laparoscopic surgery for colon cancer: tailored laparoscopic approaches based on tumor size and nodal status.

PURPOSE: Surgeons have recently developed more minimally invasive surgical procedures to reduce surgical stress and improve cosmesis. Although single-port laparoscopic colectomy (SPLC) has potential benefits over multi-port laparoscopic colectomy (MPLC), there are concerns about the increased technical difficulties associated with SPLC. Therefore, we attempted reduced-port laparoscopic colectomy (RPLC). The purpose of this study was to evaluate the difference in perioperative outcome following tailored laparoscopic approaches for colon cancer on the basis of tumor characteristics. METHODS: The prospectively collected data of 170 patients who underwent only minimally invasive colectomy for colon cancer from July 2010 to June 2013 were reviewed. The MPLC, SPLC, and RPLC groups comprised 92 (54.1 %), 40 (23.5 %), and 38 (22.4 %) patients, respectively. RESULTS: The number of harvested lymph nodes was significantly higher in the RPLC group than in the MPLC and SPLC groups (29.9 ± 21.5, 21.9 ± 12.1, and 24.2 ± 13.8, respectively; p = 0.027). The mean operating time was significantly different among the MPLC, SPLC, and RPLC groups (243.5 ± 59.0, 207.2 ± 49.6, and 216.2 ± 53.7 min, respectively; p = 0.001). The time to first flatus was also significantly different among the MPLC, SPLC, and RPLC groups (3.1 ± 1.2, 3.6 ± 1.3, and 3.4 ± 1.1 days, respectively; p = 0.039). No significant differences in the other short-term surgical outcomes were observed among the three groups. CONCLUSIONS: SPLC and RPLC according to tailored laparoscopic approaches for colon cancer appear to be beneficial in terms of operative time and lymph node retrieval, and may be considered as surgical options in laparoscopic colectomy for colon cancer patients with favorable tumor characteristics.

Could 5-Fluorouracil or Triamcinolone Be an Effective Treatment Option for Keloid After Surgical Excision? A Meta-Analysis.

PURPOSE: There is no universally accepted treatment regimen to decrease the recurrence rate of keloid formation after its removal, although many treatment options have been suggested. The purpose of this study was to investigate treatment options to prevent keloid recurrence after surgical excision. MATERIALS AND METHODS: A systematic literature review and meta-analysis was performed using the Medline, Embase, and Cochrane databases. Predictor variables were 5-fluorouracil (5-FU) or triamcinolone adjuvant therapy, and the outcome variable was keloid recurrence rate. The Newcastle-Ottawa scale was used to assess the quality of the studies and the Cochrane risk-of-bias tool was used. Publication bias was evaluated using a funnel plot. RESULTS: There were 1,224 publications identified; after screening, 5 were selected for review (1 retrospective cohort, 3 prospective cohorts, and 1 randomized controlled trial). The mean level of keloid recurrence was statistically lower in patients who received 5-FU compared with those who did not (control group; risk ratio, 0.18; 95% confidence interval [CI], 0.04 to 0.75). Triamcinolone was ineffective in lowering the keloid recurrence (risk difference, 0.06; 95% CI, -0.16 to 0.28). CONCLUSION: 5-FU can be considered an effective treatment to decrease keloid recurrence after surgical excision, although further research, including a randomized controlled trial, is required.

Right lower transverse incision versus vertical transumbilical incision for laparoscopic specimen extraction in patients with left-sided colorectal cancer: a comparative study of two mini-laparotomy techniques.

BACKGROUND: The aim of this study was to compare the short-term outcomes of a right lower transverse incision with a vertical transumbilical incision for laparoscopic specimen extraction in patients with left-sided colorectal cancer. METHODS: One hundred eighty-three patients who underwent laparoscopic resection for rectosigmoid colon or upper rectal cancer were included. Propensity score matching was performed to reduce bias caused by differences between the right lower transverse incision (RLT group) and vertical transumbilical incision (VTU group). RESULTS: After matching, 57 patients in the RLT group and 57 patients in the VTU group were found to be equivalent regarding baseline clinicopathological characteristics. Median follow-up time was 31 months. The RLT group showed comparable results to those of the VTU group in terms of perioperative outcomes, postoperative course, and postoperative complications. However, the proportion of patients requiring an additional incision for diverting stoma was significantly lower in the RLT group (p = 0.003). CONCLUSIONS: A right lower transverse incision appears to be as effective as a vertical transumbilical incision regarding short-term outcomes after laparoscopic surgery for left-sided colorectal cancer and may be a preferred extraction site because of its lowered risk of additional mini-laparotomy for diverting stoma.

Ischemic Necrosis of Upper Lip, and All Fingers and Toes After Norepinephrine Use.

A 68-year-old woman with necrosis of total finger, toe, and upper lip was requested by department of internal medicine. She was diagnosed with septic shock and treated with norepinephrine 10 days ago. Norepinephrine is an often-used medicine for normalizing blood pressure in septic shock patients. Norepinephrine stimulates adrenergic receptors, causing vasoconstriction and the rise of blood pressure. These peripheral vasoconstrictions sometimes lead to ischemic changes in end organs. In this case report, the authors describe ischemic necrosis of the upper lip and all fingers and toes after norepinephrine use in a patient in the intensive care unit.