Approaching patients with panfacial fractures by using an anatomical reference: A novel concept and preliminary study.

Panfacial fractures are challenging for craniofacial surgeons. Aside from involving multiple subunits, they also lack the reliability of a useful landmark of the facial skeleton. Properly, reducing and fixing palatal fracture to re-establish the premorbid maxillary dental arch is important. This was a retrospective study conducted from 2015 to 2020. All patients underwent computed tomography (CT) scan for surgical planning of orthognathic surgery due to either esthetic or occlusion concerns. The classification of occlusion was recorded as class I, II, and III. The parameters measured on CT were the distance between the midpoint of the supra-orbital foramen/notch (IS), mesio-buccal cusp tips (IB), central fossa (IC), palatal cusp tips (IP), and the midpoint of the palatal marginal gingiva (IM) of the bilateral maxillary first molars. The IS was compared with the IB, IC, IP, and IM. The results were analyzed by using one-way repeated measurement analysis of variance. Eighty-seven patients (36 men and 51 women) were included in the study. There were 13 patients of class I malocclusion, 8 of class II malocclusion, and 66 of class III malocclusion. The IS was comparable to the IC in all three groups. The IS can predict the IC, regardless of the patient's occlusion, and can be subsequently used to decide the width of maxillary dental arch in panfacial fracture management. Further studies are necessary to obtain more definite results.

Reconstruction of Tibia Fracture With Soft Tissue Defect.

BACKGROUND: We aimed to compare different methods to treat lower leg soft tissue defects with tibia fracture using free flaps and pedicled flaps. We also highlighted the aesthetic outcome after using 1-stage secondary debulking procedure for tibia area. PATIENTS AND METHODS: From December 2000 to March 2017, 83 patients with lower leg defects and tibia fractures were reconstructed using 71 free flaps and 12 pedicled flaps. One-stage secondary debulking procedures were performed for 39 patients after flap reconstruction. Infection control and aesthetic outcomes using 5-point Likert scale were reviewed after a 16-month follow-up. RESULTS: Twenty-five myocutaneous free flaps, 45 fasciocutaneous free flaps, 1 fibula free flap, 12 pedicled flaps of which 8 were distally based sural artery flaps, and 4 medial gastrocnemius flaps were used. The flap survival rate was 100%. There was no recurrence of osteomyelitis in any patient after reconstruction with any of these flaps. Using a 5-point Likert scale, performance of a 1-stage secondary debulking procedure showed statistically significant difference in terms of contour, color, and texture compared with the group without debulking procedure. CONCLUSIONS: The use of free flaps and pedicled flaps in the reconstruction of lower leg defects with tibia fracture is reliable and results in good infection control. A 1-stage secondary debulking procedure delivers excellent long-term aesthetic outcome after reconstruction of the tibia area.

Determining factors in relation to lymphovascular characteristics and anastomotic configuration in supermicrosurgical lymphaticovenous anastomosis - A retrospective cohort study.

INTRODUCTION: Supermicrosurgical lymphaticovenous anastomosis (LVA) can be performed in different configuration such as end-to-end (LVEEA), end-to-side (LVESA), and side-to-end (LVSEA). Each configuration has its own advantages and disadvantages. However, it has remained ambiguous as to which anastomotic o configuration to choose. The aim of this study is to analyze and compare the relative sizes of lymphatic vessel (LV) and recipient vein (RV), in attempts to provide the basis for proper selections of the anastomotic configuration. METHODS: From March 2016 to October 2018, 100 lymphedema patients with 103 lymphedematous lower limbs (stage I-III) were included. All patients underwent supermicrosurgical LVA. Demographic data and intraoperative findings, including the number and size of the LV/RV, the size discrepancies, and the numbers of LVA performed were recorded. The severity of LVs were classified based on the lymphosclerosis classification (s0, s1, s2, and s3). One-way ANOVA test and post hoc analysis with Bonferroni's correction were performed for size discrepancy analysis. RESULTS: A total 730 LVA were performed with 621 LVs and 468 RVs, averaging 7.1 LVA per limb. Of these, 367 (50.3%) were LVEEA, 333 (45.6%) were LVESA, and 30 (4.1%) were LVSEA. The average LV and RV size was 0.61 ± 0.35 mm and 0.87 ± 0.43 mm, respectively (p < 0.001). The average LV size in different configuration: LVEEA = LVESA < LVSEA (p < 0.001); The average RV size: LVEEA = LVSEA < LVESA (p < 0.001); The size discrepancy: LVESA > LVSEA > LVEEA (p < 0.001).The LVSEA group has more s1 lymphatic vessels as opposed to LVEEA and LVESA (p = 0.004). CONCLUSION: The size and the comparative discrepancy between the LVs and RVs are the determining factors for proper anastomotic configuration selection during LVA. LVESA was more frequently performed when vessel size discrepancy was larger. The efficacy of each anastomotic configuration has yet to be determined.

Combined Subdermal Pocket Procedure and Abdominal Flap for Distal Finger Amputations in a Toddler.

A girl (aged 1 year and 9 months) sustained traumatic amputation to her middle and ring fingers (zone 1C) by a cup-sealing machine. Full-thickness dorsal skin burn over amputated fingertips was also noted. Emergent finger replantation was performed. Following bone fixation, bilateral digital arteries and nerves were repaired. After complete debridement of the necrotic dorsal skin, the extensor tendon and joint were exposed. Moreover, all dorsal veins were destroyed. The pulps (middle and ring fingers) were de-epithelialized and inserted into the subdermal pocket over her left abdomen. The 2 raised skin flaps were transferred to reconstruct the dorsal skin defects. Division of the replanted finger from abdomen was performed at the 14th postoperative day. The fingers survived completely. Good functional and aesthetic outcomes were achieved.