Role of plastic surgeons in the trauma center: national level I trauma center startup experience in South Korea.

ABSTRACT: Although it is well recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I trauma center.This study included patients who presented to a single, regional, level I trauma center between March 1, 2016 and February 28, 2018. Patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Cases requiring consultation for the correction of posttraumatic deformity or secondary deformity and trauma sequelae, such as scars, were excluded. Data on patients' demographics and detailed surgical procedures were acquired from electronic medical records. The reviewed cases were categorized by the primary anatomical region requiring surgery and the primary procedure performed.A total of 1544 patients underwent surgery, and 2217 procedures were recorded during the 2-year study period. In 2016, 1062 procedures on 690 patients, and, in 2017, 1155 procedures on 787 patients were registered. The average age of the patients who underwent plastic surgical procedure due to a trauma-related cause was 38.4 years (range, 2 days to 91 years), and 1148 patients (77.7%) were male. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. The most commonly elevated free flap was the ALT flap (n = 69).Plastic surgeons play various roles in level I trauma centers, such as in the management of facial injury, performing limb-saving free tissue transfers, and complex wound reconstruction with flaps or skin grafts. Thus, plastic surgeons are an essential part of trauma centers.

Characteristics of Panfacial Fractures in the Elderly: Etiology, Fracture Patterns, Concomitant Injuries, and Postoperative Complication Risk.

BACKGROUND: Facial trauma, including panfacial fractures caused by high-impact trauma, is increasingly frequent in elderly patients. The purpose of this study was to investigate the effects of the particularly serious and challenging panfacial fractures on elderly adults. METHODS: The authors retrospectively reviewed the files of all patients who were operated for panfacial fractures at our institution from December 2006 to December 2018. The definition of a panfacial fracture was a concurrent fracture in 2 or more locations, including nasoethmoid, frontozygomaticomaxillary, Le Fort I and II, and mandibular fractures. The authors reviewed in-hospital medical records to collect data on the medical history, cause of injury, fracture location, accompanying surgery, postoperative complications, duration of hospital stay, laboratory results, radiographic studies, and computed tomography scans. RESULTS: A total of 454 patients were enrolled. Among them, 57 (13%) were <19 years old, 304 (72%) were 19 to 60 years old, and 62 (15%) were >60 years old. Compared with younger patients, those aged older than 60 years were more likely to have underlying diseases including diabetes, hypertension, and antiplatelet, and showed a significantly higher proportion of brain hemorrhage, internal organ contusion, surgical site infection, and hematoma after surgery. CONCLUSION: The authors have analyzed the largest number of panfacial fractures in an elderly population so far. The pattern of injury and sequelae of severe facial trauma in elderly patients may be more serious, and the postoperative course more prone to complications than in younger patients. Therefore, more delicate treatment and a high degree of suspicion are needed.

Clinical factors in patients with congenital muscular torticollis treated with surgical resection.

BACKGROUND: Congenital muscular torticollis (CMT) is characterized by persistent head tilt toward the affected side. No consensus exists regarding the cause of this disorder. In this study, we analyzed various clinical factors in patients with CMT who were treated with surgical release. This analysis enabled us to identify potential causative factors of CMT and to establish a basis for surgical interventions. METHODS: In total, 584 patients who underwent surgical intervention for CMT from October 2007 to December 2016 were included in this study. Their demographic characteristics, birthrelated factors, and clinical features were analyzed. RESULTS: Data from 525 patients were analyzed in this study after exclusion of those with insufficient information. Before birth, 31 patients (5.9%) were diagnosed with oligohydramnios, and 87 (16.6%) had a breech presentation. Seven (1.3%) cases of clavicle fracture and two (0.4%) cases of cephalohematoma were noted at birth. Before surgery, 397 patients (75.6%) underwent physiotherapy and 128 patients (24.4%) did not. The duration of physiotherapy ranged from 1 to 50 months (average, 6 months). CONCLUSIONS: Our study shows that 16.6% of the CMT patients presented in the breech position, which is a much higher rate than that observed in the general population (3%-4%). We hypothesize that being in the breech position as a fetus appears to exert a significant influence on shortening and fibrosis of the sternocleidomastoid muscle.