The characteristics of the patients who visited the emergency department with fever, after the chronification of COVID-19 pandemic

Objective@#This study examined the characteristics of patients visiting the emergency department (ED) with fever after the chronification of the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#This retrospective observational study analyzed the medical records of patients who visited the ED with fever from May 1 to October 31, 2021, and the corresponding period in 2019. This study was conducted at a single center in Seoul, Korea. @*Results@#There was no statistical difference in the comorbidities of the patients of the two groups: the AC (after the COVID-19 pandemic) group and the BC (before the COVID-19 pandemic) group. As for the level of consciousness at the time of ED arrival, there was a significantly larger decrease in consciousness (verbal response or less) in the AC group than in the BC group (P=0.002). In the case of the National Early Warning Score (NEWS), the proportion was higher in the AC group in the moderate-risk and high-risk groups (P=0.003). The median time from symptom onset to ED arrival was 15.7 hours in the BC group and 13.8 hours in the AC group, and there was no significant difference (P=0.137). When leaving the ED, the AC group had a higher admission rate to the ward and intensive care unit than the BC group. There was no statistical difference in the in-hospital mortality between the two groups (2.9% and 2.4%, respectively; P=0.62). @*Conclusion@#Patients who visited the emergency room with fever after one year of the COVID-19 pandemic showed a similar time from symptom onset to ED arrival compared to patients who visited before the COVID-19 pandemic. In addition, there was no difference in in-hospital mortality among these patients compared to those with fever before the COVID-19 pandemic.

Is the retroauricular region a suitable donor site for full-thickness skin grafting in the era of mask wearing?

Background@#During the coronavirus disease 2019 (COVID-19) pandemic, the everyday use of face masks massively increased to prevent the spread of infection. Many people complain of ear pain and erosion when wearing a mask for extended periods of time. If prolonged mask usage is uncomfortable for ordinary people, a question arises—how much more inconvenient must mask wearing be for patients with a full-thickness skin graft (FTSG) donor site in the retroauricular region? Herein, we evaluated complications related to face mask use in 27 patients with a retroauricular FTSG donor site, with the goal of clarifying whether the retroauricular region is still an appropriate FTSG donor site in the context of the COVID-19 pandemic. @*Methods@#Complications in 27 patients treated by FTSGs harvested from the retroauricular region from 2019 to 2021 were investigated. A questionnaire comparing the normal and the operated sides was administered. Pain, itching, soreness, deformity, and symmetry were further investigated. @*Results@#Pain and itching were the only observed complications. The operated side was slightly more painful than the normal side in four patients (14.8%), and four patients (14.8%) reported itching on the operated side. However, all patients who experienced complications stated that the pain or itching did not interfere with mask wearing. Most symptomatic patients were older than 60 years of age (23.8%, p=0.185) and wore masks for longer periods of time (28.5%, p=0.326). @*Conclusion@#Few retroauricular donor site-related complications occurred, and none of these complications caused inconvenience in daily life. Therefore, in the COVID-19 pandemic, the use of the retroauricular region as an FTSG donor site remains appropriate.

Usefulness of Early Warning Scores, ROX index, and CURB-65 in the prognostic evaluation of patients with COVID-19

Objective@#Early identification of COVID-19 in patients is important to prevent significant worsening of the disease. This study was undertaken to verify whether MEWS (Modified Early Warning Score), NEWS(National Early Warning Score), ROX index, and CURB-65, which are early diagnostic tools for severe respiratory diseases, could be applied to patients visiting the emergency room for COVID-19. @*Methods@#This retrospective observational study included patients who visited an emergency medical center from September 1 to October 31, 2020, and from January 1 to February 28, 2021. Based on the vital signs and blood tests during the emergency room visit, severity evaluation tools and early diagnostic tools for severe cases were used and compared according to their area under the curve (AUC) values. The primary outcome was in-hospital mortality, while the secondary outcomes were intensive care unit admission rate and the need for mechanical ventilation based on these four tools (MEWS, NEWS, ROX index, and CURB-65). @*Results@#A total of 667 patients were analyzed. No significant difference was determined between the non-survivor group and survivor group in the MEWS values (P=0.13), but statistically significant differences were observed for NEWS (5 vs. 1, P<0.05), CURB-65 (2 vs. 1, P<0.05), and ROX index (16.61 vs. 23.1, P<0.01). The AUC value of NEWS for death prediction indicated a good predictive power at 0.80, while that of MEWS showed a low predictive power at 0.57, which was statistically significant. Moreover, the AUC values of CURB-65 and ROX index did not differ significantly from values obtained for NEWS. @*Conclusion@#As early diagnostic tools for predicting death in COVID-19 patients, NEWS, ROX index, and CURB-65 showed excellent discrimination ability, whereas MEWS showed statistically and significantly lower discrimination ability.

Clinical characteristics and risk factors for mortality of patients hospitalized with COVID-19 in Korea

Objective@#The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. @*Methods@#This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. @*Results@#The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.

Usefulness of the Glasgow Blatchford Score and Pre-Rockall Score as a tool for predicting the need for endoscopic treatment in vulnerable patients with upper gastrointestinal bleeding

Objective@#Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population. @*Methods@#Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve. @*Results@#A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant. @*Conclusion@#Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.

Effects on workers in hospital dedicated to infectious diseases from coronavirus disease 2019 outbreak: emotional change and stress comparison between occupations

Objective@#The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. @*Methods@#An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. @*Results@#The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. @*Conclusion@#Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Reconstruction of a small defect of the lower vermilion adjacent to white roll using a modified O-Z flap

Reconstruction of lip defects is important because the lips play an important role in maintaining aesthetic facial balance, facial expressions, and speech. There are various methods of lip reconstruction such as primary repair, skin grafting, and utilization of local and free flaps. It is important to select a proper reconstruction method according to the size and location of lip defect. Failure to select an appropriate method may result in distortion, color mismatch, sensory loss, and aesthetic imbalance. Herein we present a case of successful aesthetic reconstruction of the lower vermilion. We removed a venous malformation, which was limited to the lower vermilion and adjacent to the white roll, and repaired the defect using the modified O-Z flap.

Usefulness of the Glasgow Blatchford Score and Pre-Rockall Score as a tool for predicting the need for endoscopic treatment in vulnerable patients with upper gastrointestinal bleeding

Objective@#Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population. @*Methods@#Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve. @*Results@#A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant. @*Conclusion@#Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.

Effects on workers in hospital dedicated to infectious diseases from coronavirus disease 2019 outbreak: emotional change and stress comparison between occupations

Objective@#The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. @*Methods@#An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. @*Results@#The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. @*Conclusion@#Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Predictive factors of drainage volume and drain duration after the inframammary approach to nipple-areolar-complex sparing mastectomy and implant-based breast reconstruction

Background@#The placement of a closed suction drain is indispensable for preventing serious infections; however, closed suction drains are inevitably accompanied by increases in local infections, pain, and length of hospital stay, and delays in breast cancer treatment including postoperative chemotherapy and radiotherapy. We analyzed predictive factors of total drainage volume and duration. @*Methods@#Among patients who were diagnosed with primary breast cancer between January 2016 and December 2017, we retrospectively analyzed those who underwent immediate implant-based breast reconstruction. Factors that could affect the total volume and duration of drainage, including lipo-prostaglandin E1 use, preoperative chemotherapy, resected breast issue weight, age, body mass index (BMI), serum white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) level, were analyzed. @*Results@#The mean volume and duration of drainage were 1,213.6 mL and 14.8 days respectively. BMI and CRP on postoperative day (POD) 1 were correlated with the total drainage volume. Age, BMI, and resected breast tissue weight were correlated with the drainage duration. Multiple regression analysis showed that CRP level on POD 1, age, and resected breast tissue weight significantly affected the drainage duration. Multiple regression analysis also showed that the total drainage volume was significantly affected by BMI and CRP level on POD 1. @*Conclusions@#The factors found to affect the duration of drainage in patients undergoing implant-based breast reconstruction were CRP on POD 1, age, resected breast tissue weight, and BMI. The CRP level on POD 1 and BMI influenced the total volume of drainage.

Reconstruction of a small defect of the lower vermilion adjacent to white roll using a modified O-Z flap

Reconstruction of lip defects is important because the lips play an important role in maintaining aesthetic facial balance, facial expressions, and speech. There are various methods of lip reconstruction such as primary repair, skin grafting, and utilization of local and free flaps. It is important to select a proper reconstruction method according to the size and location of lip defect. Failure to select an appropriate method may result in distortion, color mismatch, sensory loss, and aesthetic imbalance. Herein we present a case of successful aesthetic reconstruction of the lower vermilion. We removed a venous malformation, which was limited to the lower vermilion and adjacent to the white roll, and repaired the defect using the modified O-Z flap.

Does Laparoscopic Adhesiolysis Reduce the Risk of Small Bowel Obstruction Related Readmissions and Reoperations Compared to Open Adhesiolysis?

Purpose@#The present study aimed to assess the safety and efficacy of laparoscopic adhesiolysis in decreasing recurrent episodes of small bowel obstruction (SBO) compared to that of the conventional open procedure. @*Methods@#Among 373 patients who visited our emergency department from January 2000 to July 2018 due to small bowel obstruction, 67 patients who underwent adhesiolysis were included in this study. Eighteen and 49 patients comprised the open adhesiolysis (OA) and laparoscopic adhesiolysis (LA) groups, respectively. Clinical demographics, computed tomography (CT) findings, laboratory results, and perioperative outcomes were compared. Further, the long-term follow-ups of SBO related re-admissions and re-operations were also compared. @*Results@#Preoperative baseline data, pain characteristics, laboratory findings, and ileus-related CT findings showed no significant difference between the two groups. LA was related to less blood loss and complications, along with early bowel movement recovery. Similarly, fewer SBO-related re-admissions [OA vs. LA=8 (44.4%) vs. 3 (6.1%), p=0.001] and re-operations [OA vs. LA=3 (16.7%) vs. 1 (2.0%), p=0.025] were observed in LA compared to OA. @*Conclusion@#LA is a safer and more feasible procedure for SBO treatment compared to OA. This procedure showed a reduction in SBO-related re-admission and re-operation rates.

Analysis of characteristics of patients who come to ‘emergency medical center via one-stop treat system for heavily drunken people’

Objective@#This study described the effectiveness of the one-stop treat system (OTS) and the improvements characterizing the patients who come to an emergency medical center via the one-stop treat system for heavily drunken people @*Methods@#An observational retrospective study was conducted on patients, aged 19 years or older, who visited the emergency department (ED) from January 2014 to December 2017 with alcohol intoxication (AI). The subjects were divided into two groups, that is, AI patients who come to ED directly or those who came via OTS. We compared and analyzed the characteristics of two groups including gender, age, date, mode of the ED visit, level of consciousness, diagnosis, ED length of stay (LOS), hospital LOS, and final outcomes. @*Results@#A total of 8,144 patients were enrolled in the study. There were 2,221 AI patients who visited ED directly and 5,923 AI patients who visited ED via OTS. Patients arriving via OTS had more medical or surgical problems than the patients who came directly from the ED. Discharged patients via OTS showed a longer ED LOS (312 minutes [range, 169-520 minutes], P<0.001). Compared with patients who came directly from ED, the patients via OTS showed a higher admission rate (10.7% vs. 3.4%, respectively; P<0.001), and a higher death rate in ED (0.6% vs. 0%, respectively; P<0.001). @*Conclusion@#Compared the characteristics of the patients from ED directly in 2014-2017, the patients via OTS had higher severity and admission rate, and a longer ED LOS. Our findings suggest that we should pay attention to patients via OTS because the patients have high severity of illness.

Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes

Background@#Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. @*Methods@#All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. @*Results@#In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. @*Conclusions@#Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Oncoplastic breast reduction using the short scar periareolar inferior pedicle reduction technique

After a partial mastectomy, large or ptotic breasts can be reconstructed using breast reduction techniques. Wise-pattern reduction is typically used to remove masses in any quadrant of the breast, but this technique leaves a large inverted T-shaped scar. Instead, the short scar periareolar inferior pedicle reduction (SPAIR) technique involves a periareolar line and does not result in a scar along the inframammary fold (IMF). A 49-year-old patient with macromastia and severely ptotic breasts was diagnosed with invasive cancer of the left breast. Her large breasts caused pain in her back, shoulders, and neck. She also expressed concern about postsurgical scarring along the IMF. In light of this concern, we chose the SPAIR technique, and we designed and performed the procedure as described by Hammond. During surgery, we removed 36 g of breast tumor and 380 g of breast parenchyma from the left breast. To establish symmetry, we also removed 410 g of tissue from the right breast. Postoperatively, the patient reported satisfaction regarding the reduction mammaplasty and, in particular, noted decreased back, shoulder, and neck pain. In summary, we used the SPAIR technique to achieve oncologic and aesthetic success in a patient with macromastia and a tumor located lateral to the nipple-areolar complex.

Biomechanical demands comparison in 119 emergency medical services activities when using manual and powered stretcher carts: a scenario-based randomized cross-over simulation study

OBJECTIVE@#The purpose of this study was to compare the biomedical demands between a manual stretcher cart (Manual Cot) and a novel powered stretcher cart (Power Cot) during simulated routine stretcher handling activities.@*METHODS@#A randomized cross-over design mannequin simulation study was planned. Fourteen participants sequentially performed routine stretcher handling tasks, including unloading, lowering, raising, and loading tasks with the Manual Cot and Power Cot. The biomechanical workload of each participant was assessed by measuring the muscle activity of four muscles (bilateral L4/5 erector spinae and rectus femoris) through an 8-channel electromyogram (EMG) measurement system by attaching the surface EMG. The time required to perform each task was measured, and after the end of the simulation, the participants were given a subjective questionnaire consisting of seven items (five-point Likert scale) on the usefulness and usability of the two stretcher carts.@*RESULTS@#Fourteen participants, six males and eight females, performed four routine stretcher handling scenarios. The median total task times for the Manual Cot and Power Cot were similar (95 seconds; range, 49-105 vs. 94 seconds; range, 84–140; P=0.063). For the lowering, raising, and loading tasks, the effects of Power Cot were significantly lower than the normalized muscle voluntary contraction (%) cumulative sum of the back or thigh (P<0.05). Compared to Manual Cot, the use of Power Cot resulted in a decrease in total muscle activity of 18.0–63.5% in the back muscles and 6.7-83.9% in the thigh muscles during the task simulation. The participants preferred the Power Cot in terms of usefulness in subjective perceptions.@*CONCLUSION@#This simulation study identified that the Power Cot reduced the physical stress of emergency medical services workers without any significant performance time delay when performing stretcher-handling activities.

Factors affecting mastectomy specimen density in direct-to-implant breast reconstruction

BACKGROUND: Direct-to-implant breast reconstruction following nipple-sparing mastectomy is becoming increasingly common. The weight of the breast specimen informs implant selection. However, specimens of the same weight may have different volume. Therefore, identifying the factors affecting the density of breast specimens may facilitate the selection of implants with an appropriate volume. METHODS: From December 2015 to May 2018, 108 patients underwent direct-to-implant reconstruction following nipple-sparing mastectomy. The weight of the breast specimens was measured using an electronic scale in the operating room. Furthermore, the volume of specimens was measured using the water displacement technique. Multiple regression analysis was performed on factors that can affect breast density, such as menopause, neoadjuvant chemotherapy (CTx), age, body mass index, and diabetes mellitus. RESULTS: The average density of breast specimens in patients older than 50 years (n=36) was 0.96±0.04 g/mL, which was significantly lower than the 1.01±0.08 g/mL observed in patients younger than 50 years (n=72) (P=0.007). The mean density of breast specimens in patients who underwent neoadjuvant CTx (n=25) was 0.96±0.06 g/mL, which was significantly lower than the value of 1.00±0.08 g/mL in those who did not (n=83). CONCLUSIONS: It is advisable to select an implant slightly larger than the mastectomy specimen weight in patients older than 50 years or in those who have undergone neoadjuvant CTx.

Correlation between dermal thickness and scar formation in female patients after thyroidectomy

BACKGROUND: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. METHODS: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. RESULTS: There was a positive correlation between dermal thickness and scar score (p < 0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p < 0.05). CONCLUSION: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

Modified Anterior Craniofacial Osteotomy Using Partial Nasal Bone Division and Reconstruction in Frontoethmoidal Sinus Meningioma

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.

Modified Anterior Craniofacial Osteotomy Using Partial Nasal Bone Division and Reconstruction in Frontoethmoidal Sinus Meningioma

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.