Security Comparison of Various Surgical Knots Using Nylon Suture.

OBJECTIVE: To evaluate the strengths of various surgical knot techniques, including square knot, surgeon's knot, granny knot, and random knot with the same three throws. METHODS: The authors tested each of the four knot techniques using four different gauges of nylon (polyamide [Ethicon]): 4-0, 5-0, 6-0, and 7-0. Each knot type was tested 20 times per nylon gauge, for a total of 320 knots tested. The authors used a static pull machine to measure elongation at yield and maximal force to break. RESULTS: A comparison of elongation at yield revealed that the surgeon's knot was superior to the square knot, granny knot, and random knots across all gauges of nylons. Further, a comparison of maximal force to break revealed that the surgeon's knot was superior to the square knot, granny knot, and random knots when using 4-0, 5-0, and 6-0 nylon but not when using 7-0 nylon. CONCLUSIONS: The surgeon's knot was the strongest, and random knot was the weakest when the authors used nylon 4-0, 5-0, and 6-0. While handling fine suture materials such as 7-0 nylon, knot failure appears to be unrelated to the knot technique used. This study provides not only fundamental guidance for tying surgical knots using nylon, but also a rational basis for an adequately strong knot choice in various fields of surgery.

Endoscopic Forehead Lift Using Pretrichial Vertical Incisions and Solid Suture Technique: Effective Fixation and Lesser Scar Formation.

ABSTRACT: Endoscopic forehead lift with frontal incisions behind anterior hairline has been used conventionally not to exposure scar on the forehead. Accordingly, patients with convex forehead, high hairline, and redundant forehead skin are regarded as not good candidates for endoscopic forehead lift. However, we introduce the advantages of pretrichial vertical incision on the forehead using techniques that minimize the risk of scar formation. Between December 2019 and April 2021, 73 patients who underwent endoscopic forehead lift using pretrichial vertical incision and cortical bone tunnel fixation method were enrolled in this study. One plastic surgeon independently assessed postoperative 6 months scar using Scar Cosmesis Assessment and Rating scale, which include clinician questions and patient questions. Seventy-three patients (67 women and 6 men) with a mean age of 54.5 years (range, 19- 76 years) were included in this study. Skin sutures were stitched out 7.15 days after surgery (range, 7-8 days). All patients were followed up over 6 months. ''Overall impression" and ''patient question'' scored zero in all patients. In 14 patients, pencil-thin line was shown, and the other 1 patient showed a little hyperpigmentation in 1 scar out of 3 frontal scars. Erythema, track marks or suture marks, and hypertrophy/atrophy were scored zero in all patients. The worst total score was 1 in 15 patients. Pretrichial vertical incision with cortical bone tunnel fixation using nonabsorbable suture provides several advantages comparing to conventional incision behind anterior hairline. Scar, which is the only potential concern, was not substantive problem and can be overcome with our techniques.

Treatment of multiple craniofacial osteomas by endoscopic approach.

Osteomas are benign osteogenic neoplasms that usually occur as solitary craniofacial lesions. Multiple osteomas are rare, particularly those that do not occur as part of an associated syndrome. We report a case of a 72-year-old woman who presented with multiple bony protrusions over the forehead and scalp. She denied any diagnosis of syndromes that are known to be associated with osteomas. Surgical excision was performed by endoscopically resecting more than 30 osteomas of the frontal and bilateral parietal bones. Compared with conventional surgical excision through a direct incision, endoscopic-assisted surgery is a simple and effective method for the treatment of multiple craniofacial osteomas and is associated with excellent cosmetic outcomes and no neurovascular complications.

Temporal Hollowing Augmentation With Polyetheretherketone Patient-Specific Implant.

Temporal hollowing is a common complication of surgical dissection in the temporal region. As it is a serious cosmetic problem, the need for reconstruction is increasing. Advances in medical imaging, computer software, 3-dimensional printing technology, and biochemistry have enabled surgeons to use patient-specific implants for correction of craniofacial deformities. Titanium, polymethylmethacrylate, and polyetheretherketone are representative materials of the alloplastic implant. In this article, the authors report the first case of temporal hollowing augmentation using a polyetheretherketone patient-specific implant.

Analysis of the risk factors that determine composite graft survival for fingertip amputation.

The composite graft is the only surgical method that is able to maintain digital length and provide soft tissue coverage without donor site morbidities in microsurgically non-replantable fingertip amputations. This study aimed to explore the risk factors that determine the survival of composite grafts. Clinical characteristics associated with graft survival were retrospectively analysed by a comparison between the graft survival and failure groups. Of 94 patients who underwent a composite graft for fingertip amputation, the graft survived in 84 (89%). Surviving grafts showed reperfusion within 1 week. Multivariate analysis revealed that graft failure was independently associated with a crushing injury. Based on the risk factors from the comparison analyses and a review of previously published studies, a cutting injury, grafting the injured finger within 5 hours of injury, and being a non-smoker are associated with good results. In these circumstances, excellent outcomes with a high success rate can be achieved by composite graft in most adult patients as an alternative treatment to microsurgical replantation. Level of evidence: IV.

Delayed formation of sterile abscess after zygomaticomaxillary complex fracture treatment with bioabsorbable plates.

We present a patient who showed a sterile abscess after facial bone fixation with bioabsorbable plates and screws. He had zygomaticomaxillary complex and periorbital fracture due to falling down. The displaced bones were treated by open reduction and internal fixation successfully using bioabsorbable plate system. However, at postoperative 11 months, abrupt painless swelling was noted on the previous operation sites, left lateral eyebrow and lower eyelid. By surgical exploration, pus-like discharge and degraded materials were observed and debrided. The pathologic analysis revealed foreign body reaction with sterile abscess. This complication followed by bioabsorbable device implantation on maxillofacial bone surgery has been rarely reported in which we call attention to the maxillofacial plastic surgeons.

Anatomical study of the first dorsal extensor compartment for the treatment of de Quervain's disease.

INTRODUCTION: Anatomical variations of the first dorsal extensor compartment (1st EC) are commonly noted. MATERIALS AND METHODS: Forty cadaver hands were dissected to define the 1st EC. Through the gross findings, we classified the contents according to the presence of septation, subcompartment, and variation of tendons. Bony cross-section of the wrist was performed to reveal any bony pattern within the 1st EC. We also measured the anatomical structures of the 1st EC. RESULTS: A septum that results in subcompartments was present in 24, complete in 2 and incomplete in 22 hands distally. The mean size of the 1st EC was 20.69±12mm in length, and 8.65±0.67mm in width. The mean length of the septum was 11.18±5.18mm, while the mean width of the subcompartment was 3.18±0.40mm. All the subcompartments enclosed only extensor pollicis brevis (EPB) tendons. The mean number of abductor pollicis longus and EPB tendon slips was 2.6±0.5 and 1.1±0.2, respectively. The bony floor of the 1st EC was classified into five types. Two distinctive grooves separating two tendons with protruding osseous ridge (type I, n=9), two distinctive grooves separating two tendons without protruding osseous ridge (type II, n=10), a single distinct groove with osteophytes (type III, n=16), indistinct groove with fibrous septum separating two tendons (type IV, n=4), and indistinct groove without fibrous septum (type V, n=1). CONCLUSION: Knowledge about the 1st EC abnormality is mandatory for the successful treatment of de Quervain's disease.

Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction.

Reconstruction of soft tissue defects in the foot remains a challenge due to its specialized tissue for weightbearing and ambulation. Considering the principle of replacing "like with like," adjacent soft tissues would be a best option for a donor site. Although several kinds of reverse-flow island flaps for the lower leg have been well described, intrinsic foot reverse flow flaps have been rarely reported. We describe 3 kinds of reverse-flow intrinsic fasciocutaneous flaps (RIFFs) for foot reconstruction. From September 2012 to August 2015, a retrospective study was done on case notes of all patients who had a RIFF for coverage of soft tissue defects within the foot following trauma or tumor ablation. A total of 7 patients were included in this study, with an average of 5 × 3.5 cm sized defects in the forefoot, second and third web space, and sole, which were reconstructed with RIFF. All flaps were well perfused and recovered excellent function of the foot with satisfactory aesthetics and minimal limitations in range of motion. However, one case showed a complication of venous congestion, due to remnant scar tissues, which resolved after medical leech application. Donor defects healed completely with split thickness skin grafting in all cases. Soft tissue defects within the foot were repaired successfully by RIFF. In spite of its technical challenges, it is a reliable one-stage procedure requiring no microsurgical anastomosis. Precise vascular evaluation of the reverse inflow has to be preceded for satisfactory outcome of RIFF.