Olfactory Dysfunction in Nasal Bone Fracture

BACKGROUND: All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. METHODS: A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I–IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. RESULTS: Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. CONCLUSION: Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.

Acellular Dermal Matrix to Treat Full Thickness Skin Defects: Follow-Up Subjective and Objective Skin Quality Assessments

BACKGROUND: There are several options for replacement of the dermal layer in full-thickness skin defects. In this study, we present the surgical outcomes of reconstruction using acellular dermal substitutes by means of objective and subjective scar assessment tools. METHODS: We retrospectively reviewed the medical records of 78 patients who had undergone autologous split-thickness skin graft with or without concomitant acellular dermal matrix (CGDerm or AlloDerm) graft. We examined graft survival rate and evaluated postoperative functional skin values. Individual comparisons were performed between the area of skin graft and the surrounding normal skin. Nine months after surgery, we compared the skin qualities of CGDerm graft group (n=25), AlloDerm graft group (n=8) with skin graft only group (n=23) each other using the objective and subjective measurements. RESULTS: The average of graft survival rate was 93% for CGDerm group, 92% for AlloDerm group and 86% for skin graft only group. Comparing CGDerm grafted skin to the surrounding normal skin, mean elasticity, hydration, and skin barrier values were 87%, 86%, and 82%, respectively. AlloDerm grafted skin values were 84%, 85%, and 84%, respectively. There were no statistical differences between the CGDerm and AlloDerm groups with regard to graft survival rate and skin functional analysis values. However, both groups showed more improvement of skin quality than skin graft only group. CONCLUSION: The new dermal substitute (CGDerm) demonstrated comparable results with regard to elasticity, humidification, and skin barrier effect when compared with conventional dermal substitute (AlloDerm).

A Retrospective Review of Iatrogenic Skin and Soft Tissue Injuries

BACKGROUND: Even though the quality of medical and surgical care has improved remarkably over time, iatrogenic injuries that require surgical treatment including injuries caused by cast and elastic bandage pressure, extravasation, and dopamine-induced ischemia still frequently occur. The goal of this study was to estimate the incidence and analyze the distribution of iatrogenic injuries referred to our department. METHODS: A retrospective clinical review was performed from April 2006 to November 2010. In total, 196 patients (116 females and 80 males) were referred to the plastic surgery department for the treatment of iatrogenic injuries. We analyzed the types and anatomic locations of iatrogenic complications, along with therapeutic results. RESULTS: An extravasation injury (65 cases, 37.4%) was the most common iatrogenic complication in our study sample, followed by splint-induced skin ulceration, dopamine-induced necrosis, prefabricated pneumatic walking brace-related wounds and elastic bandage-induced wounds. Among these, prefabricated pneumatic walking brace-related complication incidence increased the most during the 5-year study period. CONCLUSIONS: The awareness of the very common iatrogenic complications and its causes may allow physicians to reduce their occurrence and allow for earlier detection and referral to a plastic surgeon. We believe this is the first study to analyze iatrogenic complications referred to a plastic surgery department in a hospital unit.