Reconstruction of Orbital Wall Fractures with a Combination of Resorbable Plates and Antibiotic-Impregnated Collagen Sheets.

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

Defect-Oriented Versus Back Scar-Oriented Flap Design in Breast Reconstruction with Latissimus Dorsi Musculocutaneous Flap: A Patient-Reported Satisfaction Outcome Comparison Using BREAST-Q.

BACKGROUND: The design of the latissimus dorsi musculocutaneous flap in breast reconstruction has several options. To date, there have been no reports on the surgical outcomes with flap designed based on the defect shape of the mastectomy site and flap shape of the donor site. To compare patient satisfaction according to the flap design, we designed and conducted independent three sub-studies targeting fifty-three breast reconstruction patients using BREAST-Q© scale. METHODS: In study 1, there was no difference in patient satisfaction between the group with the flap designed according to the shape of mastectomy defect (defect-oriented group) that with the flap designed according to patient's wish regardless of defect shape (back scar-oriented group). In study 2, comparing the results based on the shape of the flap, vertically designed flap showed a statistically significant difference in the psychosocial well-being. In study 3, comparing the results based on the shape of the defect, no significant difference was noted. RESULTS: Even though designing a donor flap based on the shape and orientation of the mastectomy defect has no statistical significance in patient satisfaction or quality of life compared with that based on the patient preference in placement of the donor site scar, the group with the vertical donor design showed better psychosocial well-being than the group with other shapes of the donor flap. By considering the advantages and disadvantages of each flap design, enhanced patient satisfaction and durability and natural aesthetic goal can be achieved. This is the first study to compare the differences in results according to the flap design method during breast reconstruction. Patient satisfaction according to the design of the flap was investigated in the form of a questionnaire survey, and the results were displayed. In addition to breast shape, donor scars and complications were also investigated. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aesthetic Reconstruction of an Old Burr Hole Defect Using a Cancellous Bone Chip and a Porous Polyethylene Implant.

Burr hole trephination is a minimally invasive procedure but can leave a depressed scar at the surgical site. Various materials have been studied to fill such defects; however, to the best of our knowledge, there are no reports of reconstructing old, depressed scars from burr hole surgery. This report presents a patient with depressed scarring near the anterior hairline of the frontal bone on both sides due to burr hole trephination for a subdural hematoma 27 years prior. Computed tomography scans revealed bony defects under the scar. Reconstruction of the bony defect was performed by debriding the bony bed, filling it with hydrated alloplastic cancellous bone, and covering it with a porous SynPOR polyethylene titanium-reinforced implant. During 1 year of follow-up, the reconstruction was maintained without complications. The patient was satisfied with the esthetic outcome. Thus, old bony defects can be repaired using the appropriate materials and techniques.

Orbital Reconstruction Using a Polyetheretherketone Patient-Specific Implant After Removal of a Mucocele Developing After Orbital Fracture Repair.

A few mucoceles developing secondary to facial bone fractures have been reported. Mucocele formation is thought to be attributable to displacement of the respiratory mucosa with obstruction of the sinus opening, especially if untreated. Accurate diagnosis and management are required; a growing mucocele will gradually destroy adjacent bony structures and cause irreversible complications. The authors describe a patient who presented with diplopia and mild discomfort when gazing upward. She had undergone reconstruction of medial and inferior orbital fractures 20 years previously. The patient was diagnosed with a mucocele developing after orbital fracture repair. The patient underwent mucocele removal and orbital reconstruction using a polyetheretherketone patient-specific implant. In a patient with orbital symptoms but without acute trauma, a mucocele should be among the differential diagnoses if history-taking reveals past orbital trauma and surgery. A polyetheretherketone patient-specific implant was effective for orbital reconstruction after mucocele removal.

The changes of distance between nipples following correction of women pectus excavatum.

The breasts in women pectus excavatum patients frequently appear to be slanting medially along the inclination of the distorted ribs. This study aims to evaluate changes in the distance between the nipples and to find out whether medially slanting breasts are corrected in women pectus excavatum patients following modified Nuss procedure. This case series analysis enrolled 22 young women patients with pectus excavatum between October 2011 and September 2020. We measured all the patients' distances from the sternal midline to the right and left nipples, based on chest computerized tomography. We calculated the distances between nipples as being the sum of the right and left distances. The mean age of patients was 16.50 ± 4.73 years, and the follow-up periods were 35.59 ± 20.23 months. The postoperative Haller indices (2.89 ± 0.43) were significantly lower than the preoperative Haller indices (5.14 ± 1.96) (p = 0.000). The distances between the nipples before and after Nuss procedure were 145.17 ± 17.73 mm and 172.29 ± 19.11 mm, which is a significant increase following surgery. (p = 0.000). Our results demonstrated that skeletal correction with modified Nuss procedure in pectus excavatum increased the distance between nipples, indicating that medially slanting breasts had been corrected.

Angioleiomyoma of the Parotid Gland Fed by the Superficial Temporal Artery.

Angioleiomyoma in the head and neck area is rarely observed. This report introduces 2 cases of angioleiomyoma discovered in the parotid gland, particularly with the superficial temporal artery (STA) as the feeding vessel. Each patient was evaluated preoperatively by clinical manifestation and computed tomography scan, but the difficulty was encountered due to nonspecific radiologic features of angioleiomyoa. Surgical intervention was performed for precise diagnosis and treatment. The tumors were fed from the STA, with the diagnosis of venous type parotid angioleiomyoma. To our knowledge, there have been only one previous report of angioleiomyoma of the parotid gland fed from STA in the literature. Once parotid tumor is discovered, although rare, the possibility of angioleiomyoma should be considered, and the authors recommend prompt surgical excision for accurate diagnosis and treatment.

Verapamil-containing silicone gel reduces scar hypertrophy.

A hypertrophic scar is a common dermal fibroproliferative lesion usually treated with topical silicone. Verapamil, a type of calcium channel blocker, is considered a candidate drug for the treatment of hypertrophic scars. Here, we report that the addition of verapamil to topical silicone gel enhances treatment outcomes of hypertrophic scars. Upon creation of hypertrophic scars with the rabbit ear model, varying concentrations of verapamil-added silicone gel (0.1, 1, and 10 mg/g) were applied daily for 28 days. After the animals were euthanised, microscopic measurement was performed for (a) scar elevation index (SEI), (b) fibroblast count, and (c) capillary count. On gross analysis, features of hypertrophic scars were significantly alleviated in the verapamil-added groups. On histologic examination, verapamil-added groups showed (a) reduced SEI (1.93 (1.79-2.67) for control vs 1.34 (1.21-1.51) for silicone only and 1.13 (1.01-1.65) for verapamil-added silicone), (b) fibroblast count 700.5 (599.5-838.5) for control, 613.25 (461-762.5) for silicone only, and 347.33 (182.5-527) for verapamil-added silicone), and (c) capillary formation (52 (35.5-96.5) for control, 46 (28-64.5) for silicone only, and 39.83(24-70) for verapamil-added silicone) (Kruskal-Wallis test, P < .05). On western blot, expression levels of collagen I protein was lower in the 1 mg/g and 10 mg/g verapamil-added silicone compared with control. Therefore, we suggest a therapeutic concentration of verapamil-added silicone gel of at least over 1 mg/g. Further study regarding maximally effective concentration and deeper insight into the mechanism of action should follow.

Angiotensin-Converting Enzyme Inhibitor, Captopril, Improves Scar Healing in Hypertensive Rats.

Pathological cutaneous scars, with aberrant extracellular matrix accumulation, have multiple origins. Antihypertensive medications, such as calcium channel blockers, have been used to treat pathological scars. However, a relationship between angiotensin-converting enzyme (ACE) inhibitors, pathological scars, and blood pressure (BP) has never been reported. Here, we aimed to compare the differences in scar development and the effects of the administration of systemic ACE inhibitor on scar tissue in a normotensive rat, the Wistar Kyoto rat (WKY), a hypertensive rat, and the spontaneously hypertensive rat (SHR). Using an 8-mm punch, we created two full-thickness skin defects in a total of 32 rats (16 WKY and 16 SHR) to obtain a total of 64 wounds. We established control WKY (n = 16), captopril-treated WKY (n = 16), control SHR (n = 16), and captopril-treated SHR (n = 16) groups and started captopril (100 mg/g per day) treatment on day 21 in the appropriate groups. The BP of all groups was measured at 0, 3, and 5 weeks. The scar area was measured by histopathological examination, and scarring was expressed in terms of scar area and fibroblast and capillary counts. The expression of heat shock protein (HSP) 47, type I and III collagens, alpha-smooth muscle actin (α-SMA), Ki67, and vascular endothelial growth factor (VEGF) was investigated using immunohistochemistry. The scar area and fibroblast count were significantly higher in control SHR than in control WKY. The scar area, fibroblast count, and capillary count were significantly smaller in captopril-treated SHR than in control SHR. Immunostaining for α-SMA, Ki67, and VEGF also showed a noticeable decrease in scarring in the treated SHR compared with that in control SHR. Thus, BP affects scar development in a rat model, and an ACE inhibitor is more effective at reducing scars in hypertensive rats than in normotensive rats.

Antihelical Auricular Reconstruction With Adipoperichondrial Turnover Flap and Full-thickness Skin Graft.

ABSTRACT: Reconstruction of the antihelical area can be challenging because the cartilage can be easily exposed due to the thin overlying soft tissue, and it has a lack of tissue mobility. Skin graft can be hesitant to perform in antihelical defects where the bare cartilage is exposed.A 70-year-old male with squamous cell carcinoma of the antihelix of the left ear was referred to our department for surgical excision. Wide excision with tumor-free margins resulted in a defect of 2.0 × 1.0 cm with exposed bare cartilage. The authors covered the defect using adipoperichondrial turnover flap from cephalic portion of the earlobe followed by full thickness skin graft. The skin graft took well with no complication. Aesthetic result was satisfactory with no auricular deformity.This adipoperichondrial turnover flap is simple, easy, can be performed in one stage, and produces good esthetic results with no disfiguration of the ear shape.

Quadrangular Fixation of Pectus Bars to Prevent Displacement in Nuss Procedure.

BACKGROUND: Double pectus bars are sometimes inserted to correct pectus excavatum. Method of double-bar fixation to prevent bar displacement has been rarely reported. We have used quadrangular fixation of the double pectus bars. The objective of this study was to compare results of the quadrangular fixation procedure with those of the classic separate fixation procedure. METHODS: From September 2011 to January 2016, 86 patients underwent Nuss procedure with double-bar insertion. In 44 patients, each bar was fixed separately (group A). In 42 patients, quadrangular fixation of the bars was performed with metal plates (group B). Patient demographics, Haller index (HI), bar displacement index (BDI), and reoperation rate were compared between the two groups. RESULTS: The mean patient age was 17.2 years (range: 3-40 years) in group A and 17.8 years (range: 4-30 years) in group B. There was no significant difference in preoperative or postoperative HIs between the two groups (all p >0.05). Early complication rates were 15.9% in group A and 9.5% in group B (p > 0.05). In group A, three patients underwent surgery to correct bar displacement (6.8% of reoperation rate), whereas there was no corrective surgery in group B. BDIs of the two groups were significantly different (p < 0.01). CONCLUSIONS: When quadrangular fixation was performed with upper and lower pectus bars bilaterally fixed by connecting each bar with plates, bar displacement was prevented more effectively than separate fixation, thus minimizing reoperation.

Acellular dermal matrix (Insuregraf) in the prevention of Frey's syndrome and surgical site depression after parotidectomy.

BACKGROUND: Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS: From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey's syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS: The incidence of Frey's syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION: Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey's syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.

Identifying Preoperative Factors Associated with the Volume Discrepancy in Patients Undergoing Breast Reconstruction with the Extended Latissimus Dorsi Musculocutaneous Flap Coverage.

BACKGROUND: The latissimus dorsi (LD) flap is a versatile option for breast reconstruction. However, the indications are limited because of volume discrepancy between the breast and the flap. We conducted this study to identify preoperative factors associated with the volume discrepancy in patients undergoing breast reconstruction with the extended LD flap. METHODS: A retrospective study was performed in 69 patients (69 breasts) who underwent breast reconstruction with the extended LD flap between March 2015 and March 2018. We evaluated age, body weight, height, preoperative body mass index (BMI), postoperative BMI, breast skin defect size, breast volume, flap volume, and volume discrepancy [breast volume - flap volume]. RESULTS: Mean age, height, body weight, preoperative BMI, postoperative BMI, skin defect size, breast volume, flap volume, and volume discrepancy were 45.6 ± 7.1, 157.8 ± 0.1, 59 ± 8.1, 23.7 ± 3.2, 23.5 ± 3.3, 16.5 ± 9.3, 252.2 ± 107.1, 229.4 ± 95.6, and 32.6 ± 31.4, respectively. Spearman's rank correlation coefficients indicated significant positive linear correlations between volume discrepancy and preoperative BMI (correlation coefficient = 0.267, P = 0.027), volume discrepancy and breast volume (correlation coefficient = 0.472, P < 0.001), and between volume discrepancy and skin defect size (correlation coefficient = 0.609, P < 0.001). Stepwise multiple regression analysis yielded the following formula: predicted log volume discrepancy (ml) = 1.2891 + 0.0639 × skin defect size + 0.0025 × breast volume (R2 = 0.421). CONCLUSION: Skin defect size and breast volume were preoperative factors associated with volume discrepancy in patients who have undergone breast reconstruction with the extended LD flap. Considering these factors, we can predict the lack of volume and plan any necessary secondary procedures. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cosmetic Reconstruction of Frontotemporal Depression Using Polyethylene Implant after Pterional Craniotomy.

PURPOSE: Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression reconstruction using a high-density porous polyethylene (HDPE) implant (Medpor®; Stryker, Kalamazoo, MI) after pterional craniotomy. MATERIALS AND METHODS: The patients had undergone reconstruction of frontotemporal depression using Medpor® implants after pterional craniotomy at our medical institution during the period from February 2010 to March 2014. We evaluated the thickness and volume of both the temporalis muscle and Medpor® implant through a retrospective review of the medical records and computed tomography (CT) scans of 92 patients. RESULTS: The mean temporalis muscle thickness ratio (muscle thickness of the affected side/nonaffected side) was 0.61 ± 0.16. The mean reconstructed temporalis muscle thickness ratio (muscle and Medpor® implant thickness of affected side/muscle thickness of nonaffected side) was 1.15 ± 0.02. The mean temporalis muscle volume ratio (muscle volume of affected side/nonaffected side) was 0.67 ± 0.02. The mean reconstructed temporalis muscle volume ratio (muscle and Medpor® implant volume of affected side/muscle volume of nonaffected side) was 1.18 ± 0.02. CONCLUSIONS: Temporalis muscle thickness and volume were significantly decreased on the affected side after pterional craniotomy. Reconstruction of frontotemporal lesions using Medpor® implants after the pterional approach improved temporal hollowing without additional complications.

Changes in thoracic cavity dimensions of pectus excavatum patients following Nuss procedure.

BACKGROUND: Using a simple and intuitive method, we evaluated changes in the dimensions of the thoracic cavity of pectus excavatum (PE) patients following the Nuss procedure. METHODS: We performed a retrospective review of 141 patients who had undergone the Nuss procedure. The thoracic cavity was visualized using computed tomography (CT) scans and its dimensions determined by measuring the anteroposterior (AP) and transverse (T) diameters at three anatomical landmarks (the jugular notch, and manubriosternal and xiphisternal joints). The Wilcoxon signed-rank test was used to compare differences between preoperative and postoperative parameters. Kruskal-Wallis tests were performed to compare differences among groups in patient age, type of PE, and number of inserted bars. RESULTS: Of the 141 patients (115 men, 26 women), 87 had symmetric and 54 had asymmetric defects. The postoperative AP diameters at the manubriosternal and xiphisternal joints were significantly higher than their preoperative values, whereas the Haller indices and T diameters at the three anatomical landmarks were significantly lower than their preoperative values. In the multiple bars group, the postoperative AP diameters increased significantly compared with their preoperative values. In the multiple bars group, and in patients aged above 13 years, the postoperative T diameters at all three anatomical landmarks decreased significantly compared with their preoperative values. CONCLUSIONS: Correction of anterior depression of the sternum and compensatory narrowing of the chest width were observed in PE patients following the Nuss procedure. Further research will be necessary to determine the relationship between these observations and postoperative changes in chest volume.

Gender-specific relationship between alcohol consumption and injury in the South Korean adults: A nationwide cross-sectional study.

Alcohol-related injuries have been concerned worldwide. However, there have been no large cross-sectional epidemiologic studies. The aim of this study was to investigate the association between alcohol and the prevalence of injury according to gender in a representative sample of the South Korean population. This cross-sectional study was based on data obtained in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. In total, 15,249 Korean adults (7128 men and 8112 women) aged 19 years or older were enrolled. Injury was defined as the incidence of an injury or intoxication within the year before completing the survey questionnaire. Univariate and multiple logistic regression analyses were conducted to analyze the relationship between alcohol consumption and the prevalence of injury. Heavy alcohol consumption and high-risk drinking were associated with a higher prevalence of injury in women (adjusted odds ratio [aOR] and corresponding 95% confidence interval [CI]: 2.48 [1.321, 4.656], 1.816 [1.136, 2.929], respectively), and Alcohol Use Disorders Identification Test (AUDIT) scores ≥20 were associated with a higher prevalence of injury in both men and women (aOR and 95% CI: 1.425 [1.004, 2.024] and 3.71 [2.067, 6.66], respectively). According to the AUDIT scores results, women who were injured reported significantly more high-risk drinking behaviors per month compared with those who were not injured. Gender disparities in the relationship between alcohol and the prevalence of injury were found. Indeed, future research using a prospective design should examine the causal relationship between alcohol consumption and the prevalence injury according to gender to confirm that alcohol is a risk factor for injury and to identify the possible mechanisms underlying this phenomenon.

Leiomyoma originating from axilla: A rare case report and differential diagnosis.

INTRODUCTION: Leiomyoma is a form of benign tumor originated in hypertrophy of the smooth muscles, which is most prevalent in the uterus and gastrointestinal tract. However, Leiomyoma originating from smooth muscle at the vessels lying on deep soft tissue is very rare. CASE REPORT: Our case was a rare case of leiomyoma originating from the axillary region, which was initially diagnosed as a fibroadenoma on radiological examination. The mass was separated from surrounding tissues and totally resected. Pathologically, hematoxylin-eosin-stained biopsy tissue showed the typical findings of leiomyoma. Postoperative follow-up observation was done for 1 year, without any complications or recurrence. CONCLUSION: Notably, a leiomyoma in the axillary region is difficult to differentiate from other benign or malignant tumors on preoperative radiological examinations such as ultrasonography or computed tomgraphy. Therefore, when an indefinite asymptomatic mass that is not lymphadenopathy or common benign tumor is identified in the axillary region, leiomyoma can be considered as one of the differential diagnoses.

Is breast asymmetry caused by volume differences in women with pectus excavatum?

This study determined the breast volumes of female patients with pectus excavatum that led to asymmetry and hypoplasia compared with normal women. This retrospective study enrolled 13 patients diagnosed with pectus excavatum and 13 normal women, randomly selected from a healthcare centre (n = 26), between January 2012 and December 2014. We measured breast volumes (n = 52) based on chest computed tomography (CT) of all patients using Image J software and divided them into four groups according to the side and presence of pectus excavatum. The mean volumes of the right and left breasts of patients with pectus excavatum were 209 ± 64 mL and 218 ± 67 mL, respectively, with no significant difference between the two groups (P = 0.736). The mean volumes of the right and left breasts of normal women were 415 ± 197 mL and 439 ± 197 mL, respectively, with no significant difference between the two groups (P = 0.754). The breasts of patients with pectus excavatum were significantly smaller than those of normal women (P < 0.001). Both breasts of patients with pectus excavatum were similar in size but were smaller than the breasts of normal women. Skeletal correction for breast asymmetry correction, followed by breast augmentation for breast hypoplasty correction, with a one- or two-step approach may be useful to improve the aesthetics of breast deformities in women with pectus excavatum.

Socioeconomic Disparities in the Prevalence of Blepharoptosis in the South Korean Adult Population Based on a Nationwide Cross-Sectional Study.

PURPOSE: We investigated the association between socioeconomic status (SES) and the prevalence of blepharoptosis in a representative South Korean population. METHODS: This cross-sectional study was based on data obtained in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. In total, 17,178 Korean adults (7,261 men and 9,917 women) aged 19 years or older were enrolled. Blepharoptosis was defined as a marginal reflex distance 1 (MDR 1) lower than 2 mm. Household income and education level were used as indicators of SES. Univariate and multiple logistic regression analyses were conducted to analyze the relationship between SES and the prevalence of blepharoptosis. RESULTS: Household income was inversely associated with the prevalence of blepharoptosis in women [adjusted odds ratio (aOR) and corresponding 95% confidence interval (95% CI) was 1.894 (1.336, 2.685)], and educational level was inversely associated with blepharoptosis in both men and women [aORs and 95% CIs were 1.572 (1.113, 2.219) and 1.973 (1.153, 3.376), respectively]. After adjusting for household income and educational level, low SES was associated with a high prevalence of blepharoptosis in women only. CONCLUSIONS: Socioeconomic disparities in the prevalence of blepharoptosis were found among women. Indeed, future research using a prospective design to determine the causal relationship between SES and blepharoptosis may identify SES as a risk factor for this condition.

Emerging Fixation Technique to Prevent Pectus Bar Displacement: Needlescope-Assisted 3-Point Fixation.

BACKGROUND: Bar flipping displacement is one of the most common complications after the Nuss procedure for pectus excavatum. We evaluated the results of a modified Nuss procedure with needlescope-assisted bar fixation. METHODS: The records of 41 patients with pectus excavatum who underwent single pectus bar insertion with the Nuss procedure between July 2011 and August 2014 were retrospectively reviewed. The patients were divided into two groups: those who did not undergo 3-point fixation (group A) and those who did undergo 3-point fixation (group B). RESULTS: There were 36 male patients and 5 female patients with a mean age of 10.7 ± 8.3 years (range: 3-36 years). The postoperative Haller index (HI) (2.61 ± 0.42) was significantly lower than the preoperative HI (3.91 ± 1.07; p < 0.01). The angle of the initial bar position was 5.59 ± 7.37 degrees in group A and 8.52 ± 9.61 degrees in group B, with no significant difference between the groups (p > 0.05). The rate of reoperation to correct bar displacement was lower in group B (3.3%) than in group A (9.1%). CONCLUSION: Needlescope-assisted 3-point fixation of the bar was performed without an additional skin incision and showed a low rate of reoperation to correct displacement of the pectus bar.

Topical Application of a Silicone Gel Sheet with Verapamil Microparticles in a Rabbit Model of Hypertrophic Scar.

BACKGROUND: The authors developed a novel treatment based on the topical application of a silicone gel sheet containing verapamil microparticles. The ability of these silicone gel sheets to inhibit hypertrophic scar in a rabbit ear wound model was examined. METHODS: Ten New Zealand White rabbits with a total of 80 wounds in both ears were used in this study. The rabbits were divided into five groups (control; silicone gel sheet; and silicone gel sheet plus 0.25, 2.5, and 25 mg of verapamil per gram). Histopathologic findings were quantified. RESULTS: The mean scar elevation index, fibroblast counts, and capillary counts differed significantly among the five groups (p < 0.05). The median scar elevation index was significantly lower in the silicone gel sheet plus 2.5 mg of verapamil per gram group than in the silicone gel sheet group (1.2 versus 2.2). The median number of fibroblasts was significantly lower in the silicone gel sheet plus 0.25 mg of verapamil per gram group than in the silicone gel sheet group (172.5 versus 243). In the median number of capillary lumina, there was no significant difference between the silicone gel sheet group and the silicone gel sheet plus 0.25, 2.5, and 25 mg of verapamil per gram groups (28.5, 18, 20, and 18, respectively). CONCLUSION: Topical application of a silicone gel sheet with verapamil microparticles may be a novel, effective treatment method for hypertrophic scar, but its safety and efficacy in humans must be tested in clinical trials.