A Comparative Assessment of Scars Resulting From Skin Grafts in Facial Defects.

PURPOSE: The authors compared facial scars after split-thickness skin grafts (STSGs) performed with a dermal substitute or after full-thickness skin grafts (FTSGs) in facial defect. MATERIALS AND METHODS: The medical records of patients who had undergone FTSG or STSG with dermal substitute after skin cancer surgery between March 2016 and December 2018 were retrospectively reviewed. The scars resulting from skin grafts were assessed using the patient and observer scar assessment scales (PSAS and OSAS) in our clinic after a minimum of 6 months postoperatively. RESULTS: Of the 50 study subjects, 35 patients (FTSG group) received FTSG only and 15 patients (STSG group) received STSG with the dermal substitute. The total scores of PSAS and OSAS were significantly lower in the FTSG group and it is suggested that both patients and observers thought that better scar outcomes were achieved when FTSGs were used. However, for defects smaller than 1.8 cm2 and defects located in the periorbital area, there was no statistically significant difference in the scores of PSAS and OSAS in the 2 groups. Interestingly, for defects located in the periorbital area, although there was no significant difference, PSAS and OSAS scores were lower in the STSG group than in the FTSG group. In other word, scar outcomes in the STSG group were better. CONCLUSIONS: Although there was no significant difference, unlike what we usually know, our result shows that STSG with dermal substitute tended to produce comparable or rather better results than FTSG under some conditions.

Prognosis of Patient With Resorbable Plates and Screws Under the Incision Site.

Various resorbable plates and screws were used for facial bone fractures because of several strengths. However, there are few studies on their clinical course and long-term follow-up concerning their degradation and resorption time. The authors present rare case of long term follow-up of resorbable plates and screws under the incision site.

Protruding Meningioma of the Forehead With Extensive Hyperostosis Mimicking Skull Osteoma.

Meningioma is the most common intracranial benign tumor in adults. Hyperostosis accompanies about 4.5% of meningiomas. The authors report a rare case of hyperostotic meningioma that may have been misdiagnosed as giant osteoma.A 42-year male visited our clinic due to an egg-sized, hard mass on his left forehead. The mass suspected to be giant osteoma was about 4.2 × 4.0 cm sized, hard, non-movable, and non-tender. But based on radiologic findings, the mass was diagnosed as meningioma with extensive hyperostosis.Without neurologic symptoms, the diagnosis of meningioma associated with hyperostosis can be challenging and be misdiagnosed as fibrous dysplasia and osteoma by simple examination without enhanced CT and MRI.Therefore, although osseous lesions are strongly suspected to be osteomas, surgeons should consider other diagnoses, and if necessary, use contrast enhanced CT or MRI to differentiate these bony lesions.

Reconstruction of Congenital Cranial Defect Using Autologous Bone Graft in Aplasia Cutis Congenita.

Many methods have been devised to repair cranial defects. Here, we report the use of a simple technique for the repair of a congenital cranial defect associated with aplasia cutis congenita (ACC).A newborn baby at 39 weeks of gestation was consulted with a scalp and cranial defect at the vertex measuring 3 × 1.5 cm. A 3-D CT scan of the skull confirmed the presence of a cranial defect at the sagittal suture and a normal brain structure. On the 13 day of life, the newborn was taken to an operating room. An autologous bone graft was harvested from adjacent normal parietal bone and grafted into the debrided congenital cranial defect. The soft tissue defect was then covered by rotation flaps.The postoperative 3-D CT scan presented a well-positioned autologous bone graft. At 1 month postoperatively, the skull contour was normal and there was no palpable defect.We report a successful surgical outcome for a congenital cranial and soft tissue defect in ACC treated using an autologous bone graft and rotation flaps. Although conservative therapy may be an alternative option, we recommend appropriate surgical reconstruction in patients at risk of potentially fatal complications.

Usefulness of Ramified Cephalic Vein Graft in the Wrist for Connection With Concomitant Vein in Head and Neck Reconstruction.

A vein graft in head and neck reconstruction is essential in some circumstances. The cephalic vein in the wrist has a suitable caliber for both a concomitant vein and the internal jugular vein (IJV). A vein graft involving the cephalic vein and its branches was used in 2 cases of head and neck reconstruction. The ramified distal vein was anatomized with a concomitant vein, and the proximal larger vein was anastomosed with the IJV using an end-to-side technique. After placement of vein grafts using the cephalic vein, the flaps were stable with no venous complications. To overcome the size difference between concomitant veins and the IJV, the authors recommend the cephalic vein including its distal branches in the wrist area.

Can we predict vascular status and culture result based through wound status in diabetic foot infection?

Diabetic foot infection (DFI) should be treated by a multidisciplinary team to prevent amputation and morbid status. As physicians encountering DFI in outpatient clinic, a proper selection of antibiotic treatment and diagnostic approach for a vascular status is essential. We retrospectively investigated the patients with DFI from 2016 to 2017. All patients were examined for vascular status, wound status, and pathologic culture preceding the treatment. No statistical significance was observed between PEDIS grade 1 and 2 and 3 and 4 in culture status and culture results. Association analysis between vascular status and other variables, such as wound score and culture results, has no significant difference. Through these results, the helpful epidemiologic result of microbiology and necessity of examination for peripheral arterial disease were verified.

3-Dimensional Volumetric Analysis of Relationship Between the Orbital Volume Ratio and Enophthalmos in Unoperated Blowout Fractures.

PURPOSE: Blowout fractures are common in midfacial trauma and often involve other parts of facial bones. Sometimes, patients have complications caused by inadequate management. Surgical indications, such as clinical symptoms, can be inaccurate owing to post-traumatic swelling or hematoma formation. Previous studies on the prediction of enophthalmos used the orbital volume ratio (OVR) or only the volume of herniated tissue. This study examined which of these values is more predictive of the degree of enophthalmos. In addition, the predictive values for a 2-mm enophthalmos in unoperated blowout fractures were assessed. PATIENTS AND METHODS: A total of 191 patients underwent nonoperative treatment for blowout fractures at our institution; they were divided into 2 groups according to the degree of enophthalmos (>2 mm vs 0 to 2 mm) and were further divided into 3 subgroups according to the location of the fracture (inferior, medial, or inferomedial). Multifactor logistic regression analysis was performed to determine the relationship between the degree of enophthalmos and these values. RESULTS: We observed a correlation between the OVR and the degree of enophthalmos, as well as a correlation between the volume of herniated tissue and the degree of enophthalmos. Regarding the anatomic location of herniation, the orbital floor was found to be more correlated with the amount of enophthalmos. CONCLUSIONS: The OVR is a more reliable predictor than measurement of the volume of herniated tissue. The relationship found between radiologic examination findings and the degree of enophthalmos can be used as a surgical indication in addition to consideration of the anatomic location.

Use of resorbable mesh and fibrin glue for restoration in comminuted fracture of anterior maxillary wall.

BACKGROUND: The facial bone has a complex structure compared to other bones, and various types of fractures can occur due to its characteristics. Among them, in comminuted fractures of anterior maxillary wall, multiple depressed and impacted bony segments cannot be reduced easily when performing internal fixation using plates and screws or wires, and inadequate restoration leads to a range of complications. This paper introduces an alternative technique using a resorbable mesh with fibrin glue to restore comminuted fractures of anterior maxillary wall. METHODS: Thirteen patients were diagnosed with comminuted fractures of anterior maxillary wall between March 2017 and February 2018 in the authors' hospital. All patients with comminuted fractures of anterior maxillary wall underwent restoration using resorbable mesh with fibrin glue. The patients' demographics, causes of facial trauma, mean operation time, length of hospital stay, follow-up period, and complications were recorded. RESULTS: No major complications and only one hypoesthesia of the skin area was noted. Three months after surgery, the hypoesthesia recovered completely. After surgery (mean, 3.9 months; range, 2-12 months), computed tomography showed that the bone fragments in all patients were fixed successfully in their anatomical places. CONCLUSION: In comminuted fractures of anterior maxillary wall, the use of a resorbable mesh with fibrin glue can be an advantageous and effective method for a successful restoration without complications.

Buried umbilicus with inflammation due to retained rubber foreign body after liposuction: A case report.

INTRODUCTION: Liposuction is one of the most widely performed aesthetic surgeries. It is mainly used for the correction of deep and superficial fat accumulations and remodeling of the body contour. CASE PRESENTATION: We present a rare case of unusual rubber foreign body found within the periumbilical area during the reconstruction of buried umbilicus after liposuction.A 61-year-old female had undergone a liposuction surgery 10 years ago. Last year, she experienced signs of inflammation around the periumbilical area. The patient was treated with antibiotics and daily dressing at a local clinic. However, her symptoms did not improve with treatment.After admission, we decided to reconstruct the umbilicus and explore the previous operative site. During reconstruction of umbilicus, we finally discovered a rubber foreign body in the periumbilical area and buried umbilicus. CONCLUSION: Retained surgical foreign body can clinically manifest as acute reaction, such as an inflammatory response, infection, or abscess within days or weeks after the operation. Patients may complain of pain and discomfort, even months or years after the procedure.Our patient had suffered from delayed inflammation due to retained surgical foreign body after liposuction surgery. We emphasize the need for excellent communication within the surgical team to prevent the incidence of retained surgical bodies.

Effectiveness of aspiration or deroofing for blister management in patients with burns: A prospective randomized controlled trial.

BACKGROUND: Health care providers commonly encounter blisters when treating burn patients. The question as to whether burn blisters should be drained or deroofed has long been debated. To our knowledge, there has been no controlled, randomized clinical trial to determine which treatment is the best management option. METHODS: Between March 2016, and September 2016; 40 patients with burn blisters greater than 6-mm were enrolled in our study. Patients were randomized into 2 groups: aspiration group and deroofing group. The number of days to complete re-epithelialization was noted. Patient and Observer Scar Assessment Scale data were recorded from subjects and investigators at 4 time points. Pain during dressing changes was evaluated using a visual pain scale. Bacterial cultures were also obtained. RESULTS: Average number of days to complete wound healing was 12 days in the aspiration group and 12.55 days in deroofing group. On the Patient and Observer Scar Assessment Scale, investigators found that the aspiration group scars demonstrated improvements in relief and thickness while subjects rated aspiration scars better in terms of pain. Patients with palm/sole blister in the deroofing group scored higher than aspiration group on the visual analogue pain score but it was also not statistically significant (2.66 vs 3.25). The overall incidence of colonization with microorganisms in each group was not significant (15% vs 40%). CONCLUSION: Neither aspiration nor deroofing is a superior treatment of burn blister. However, some objective indicators suggest that aspiration treatment might be more effective than deroofing treatment.

Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula: A case report.

RATIONALE: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula. PATIENT CONCERNS: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. DIAGNOSES: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula. INTERVENTIONS: The patient underwent a right nephrectomy at the department of urology. OUTCOMES: Two months after surgery, the patient was clinically well with no discharging fistula. LESSONS: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP.

Predictive Laboratory Findings of Lower Extremity Amputation in Diabetic Patients: Meta-analysis.

Lower extremity amputation is a source of morbidity and mortality among diabetic patients. This meta-analysis aimed to identify significant laboratory data in patients with diabetic foot ulcer with high rates of lower extremity amputation. We performed a systematic literature review and meta-analysis using MEDLINE, EMBASE, and Cochrane databases. We extracted and evaluated 11 variables from the included studies based on amputation rates. This study used the Newcastle-Ottawa Scale to assess the quality of the studies. The search strategy identified 101 publications from which we selected 16 articles for review. We identified HbA1c, fasting blood glucose, white blood cells, C-reactive protein, and erythrocyte sedimentation rate as predictive variables of higher major amputation rate. Although further investigation of long-term and prospective studies is needed, we identified 5 variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.

Unusual Aspergillus Infection After Dermal Filler Injection.

According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection.

The Lymphocyte-Monocyte Ratio Predicts Patient Survival and Aggressiveness of Ovarian Cancer.

OBJECTIVE: To measure the prognostic value of the lymphocyte-monocyte ratio (LMR) in patients with epithelial ovarian cancer (EOC). METHODS: We retrospectively examined the LMR as a prognosticator in a cohort of 234 patients with EOC who underwent surgical resection. Patients were categorized into two different groups based on the LMR (LMR-low and LMR-high) using cut-off values determined by receiver operating characteristic (ROC) curve analysis. The objective of the study was to assess the effect of the LMR on progression-free survival (PFS) and overall survival (OS), and to validate the LMR as an independent predictor of survival. RESULTS: Using the data collected from the whole cohort, the optimized LMR cut-off value selected on the ROC curve was 2.07 for both PFS and OS. The LMR-low and LMR-high groups included 48 (20.5%) and 186 patients (79.5%), respectively. The 5-year PFS rates in the LMR-low and LMR-high groups were 40.0 and 62.5% (P < 0.0001), respectively, and the 5-year OS rates in these two groups were 42.2 and 67.2% (P < 0.0001), respectively. On multivariate analysis, we identified age, International Federation of Gynecology and Obstetrics (FIGO) stage, and cancer antigen 125 levels to be the strongest valuable prognostic factors affecting PFS (P = 0.0421, P = 0.0012, and P = 0.0313, respectively) and age, FIGO stage, and the LMR as the most valuable prognostic factors predicting OS (P = 0.0064, P = 0.0029, and P = 0.0293, respectively). Conclusion : The LMR is an independent prognostic factor affecting the survival of patients with EOC.