Delayed Reduction of Nasal Bone Fractures

BACKGROUND: Nasal bone fractures are managed by closed reduction within the 2-week period, and are managed by secondary correction after this time. There is little literature on the delayed reduction for nasal bone fractures beyond the 2-week duration. We report our experience with nasal fractures, which were reduced beyond this period. METHODS: A retrospective review was performed for all patients who had undergone closed reduction of isolated nasal bone fracture. Patients were included for having undergone reduction of nasal bone fractures at or more than 2 weeks after the injury. Medical records were reviewed for demographic information, injury mechanism, fracture type, delay in treatment, and cause for delay. Postoperative outcomes were evaluated using computed tomography images. RESULTS: The review identified 10 patients. The average reduction time was 22.1 days. Five of patients underwent reduction between days 15 and 20, and the remaining five patients underwent reduction between days 21 and 41. The postoperative outcomes were excellent in 8 patients and good in 2 patients. CONCLUSION: Outcomes were superior for nasal fractures with displaced end plates and multiple fracture segments. Our study results appears to support delayed reduction of isolated nasal fractures in the presence of factors that delay bony reunion.

Perceptions of Prophylactic Mastectomy in Korea

BACKGROUND: Increasingly, prophylactic mastectomy has been evaluated as a treatment of breast cancer. Hereditary breast cancer now accounts for approximately 5%-10% of all cases of breast cancer, meaning that the widespread implementation of prophylactic mastectomy may significantly reduce the occurrence of breast cancer. However, prophylactic mastectomy is rarely performed in Korea. Therefore, in this study, we assessed Koreans' attitudes toward and awareness of preventive mastectomy. METHODS: This was a prospective study of a cohort of patients attending outpatient clinics and their relatives. Data were collected using self-administered questionnaires assessing sex, age, educational level, knowledge of breast cancer, understanding of prophylactic mastectomy, attitudes toward prophylactic mastectomy, and reasons for choosing prophylactic mastectomy. RESULTS: Sixty-five patients were included. Most patients (36.9%) were between 40 and 49 years of age and 58.4% were college graduates. Only six respondents (9%) understood prophylactic mastectomy, and 17 respondents (27%) stated that they would agree to undergo prophylactic mastectomy if necessary. Reasons given for refusing prophylactic mastectomy included aesthetic concerns (38%), the perception that it would not cure the disease (26%), possible surgical complications (24%), and financial cost (6%). CONCLUSIONS: In this study, most of the respondents showed a poor knowledge of prophylactic mastectomy. Ultimately, it will be necessary to establish medical guidelines for patients with a high risk of breast cancer, with the objective of providing accurate information and proper treatment at hospitals.

Breast Reconstruction Using Implant: Long Term Follow-up Complications & Patient's Satisfaction

BACKGROUND: The breast reconstruction using implant has been conducted widely. Many studies were presented to analyze the complications, but most of these studies were conducted with patients relatively short term period follow up. The authors studied with patients who were followed up at least five years. METHODS: Among the patients who were underwent breast reconstruction with implant from 1998 to 2007, 37 patients who met were followed up more than 5 years were selected in the study. Relationships between factors such as the operation methods, volume, type of surfaces of the implants, etc. and the complication rate or reoperation rate were analyzed. The level of satisfactory scoring was measured by patients' and 5 plastic surgeons. RESULTS: Complications were developed in 21 patients (65.6%) and 9 of them underwent reoperations. Infection was most common cause of complication. Implant removal was conducted to 7 patients, and 5 of them due to infection. The percentages of patients who received postoperative chemotherapy or radiotherapy in complication group and implant removal group were higher than the whole group whereas such correlation was not statistically significant. Direct Implant insertion has 50% of complication and 80% in permanent expander insertion and 73.7% of expanderimplant exchange. The average value of subjective score at last follow up was 4.2 points and the average value of objective score was 5.74. CONCLUSIONS: The incidence rate of complications was relatively high, and the final followup satisfaction score was low. This study should be helpful not only to select reconstruction methods, but also further studies to compare with other reconstruction methods.