The aim of this study was to identify overall recurrence rates after reconstructive surgery in patients with pressure ulcers and to identify risk factors that associated with recurrence after reconstructive surgery. This study was done in Faculty of Medicine Chiang Mai University, including recurrence at the same site as well as on new sites, between January 1998 and December 2015. 165 patients with 272 pressure ulcers were retrospectively collected and analyzed. The overall pressure ulcer recurrence rate was 16.54% (45 from 272 ulcers) from an overall patient recurrence of 19.39% (32 from 165 patients). From multivariable analysis, we found 9 prognostic factors that were statistically significant for recurrence after surgery, divided into 2 groups: uncontrollable and controllable factors. Uncontrollable factors consisted of being female (hazard ratio [HR]=1.90;95%CI=1.54-2.34), being older than 45 years (HR=1.67;95%CI=1.40-2.0), and location of pressure ulcers on ischium (HR=1.65; 95% CI=1.51-1.80) and sacrum (HR=1.17;95%CI=1.10-1.23). Controllable factors included spasticity (HR=1.11;95%CI=1.04-1.20), incomplete healing before discharge (HR=5.42;95% CI=3.95-7.44), serum albumin level ≤3 g/dL (HR=1.27;95%CI=1.13-1.43), pressure ulcer stage 4 (HR=1.90;95%CI=1.41-2.54), non -muscle-based procedure (HR=3.82;95%CI=2.54-5.76), and length of hospitalization >21 days (HR=2.94;95%CI=1.60-5.40). Patients with these factors were strongly advised to address and improve all these factors for decreasing the recurrence rate after reconstructive surgery.

Orofacial clefts are among the most common craniofacial anomalies with multifactorial etiologies, including genetics and environments. DNA methylation, one of the most acknowledged mechanisms of epigenetics, is involved in the development of orofacial clefts. DNA methylation has been examined in patients with non-syndromic cleft lip with cleft palate (nsCL/P) from multiple specimens, including blood, saliva, lip, and palate, as well as experimental studies in mice. The results can be reported in two different trends: hypomethylation and hypermethylation. Both hypomethylation and hypermethylation can potentially increase the risk of nsCL/P depending on the types of specimens and the specific regions on each gene and chromosome. This is the most up-to-date review, intending to summarize evidence of the alterations of DNA methylation in association with the occurrence of orofacial clefts. To make things straightforward to understand, we have systematically categorized the data into four main groups: human blood, human tissues, animal models, and the factors associated with DNA methylation. With this review, we are moving closer to the core of DNA methylation associated with nsCL/P development; we hope this is the initial step to find a genetic tool for early detection and prevention of the occurrence of nsCL/P.

Frontoethmoidal encephalomeningocele (FEEM) is a rare congenital craniofacial malformation with increased incidence in Southeast Asia, especially in Thailand. Because of its rarity, main treatment obstacles include the lack of surgical treatment techniques and long-term postoperative follow-up data. The authors present the case of a 9-month-old boy who was born with a large isolated nasoorbital type of FEEM, which had a pressure effect on his right eye, nose, and facial complex. Preoperative computed tomography of the facial bone was performed to evaluate the external bony defect. This study aims to present surgical correction of FEEM with Chula's technique and long-term 7-year postoperative follow-up including both clinical and imaging aspects.