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.

Scalp reconstruction is challenging because the scalp is inelastic, stiff, and has hair follicles. Tissue expansion offers aesthetically pleasing outcomes with minimal donor-site morbidity. However, in a scarred scalp, the extent of possible dissection for the expander insertion may be limited and surgeons must make use of the limited scalp tissue. We successfully reconstructed scarred scalps using rectangular expanders. This report presents two cases: a 4 × 3 cm chronic defect with widespread scarring and osteomyelitis and an 11 × 7.5 cm scar tissue following a skin graft. Tissue expanders were inserted in the subgaleal plane and were inflated by 195 mL and 400 mL over periods of 2 and 3 months, respectively. Subgaleal elevation of a fasciocutaneous flap was achieved with the expanded tissue. The defects were well covered, with good color, texture, and hair-bearing tissue. There were no complications involving the tissue expanders. Rectangular expanders yield more available tissue than round or crescent-shaped expanders. Moreover, since the base of the flap is well defined, the expander can be easily inserted in a limited space. Therefore, rectangular expanders are recommended for the reconstruction of scarred scalps.

Barbed thread lifting is a widely used method because it is easier to learn, faster, and the lower frequency of complications than the invasive lifting technique. The number of reported cases about complication requiring an invasive procedure is very small, and most cases are limited to minor complications. The authors introduce a chronic, recurrent epidermal inclusion cyst that occurs after Barbed thread lifting. A 61-year-old woman visited the hospital with recurrent inflammation and scar accompanied by discharge in the temporal area lasting 2 years. She had barbed thread lifting in the area of inflammation 4 years ago. CT images showed soft tissue infiltration invading superficial fascia. intraoperative view, A multi directional barbed thread was anchored in the scar tissue. The barbed thread was pulled out and cut off inflammatory lesions, including scarring wounds, were totally excised. Histopathological examination confirmed the epidermal inclusion cyst and polydioxanone suture. After surgery, the patient recovered without any complications. In this case, the cause of epidermoid cyst is considered iatrogenic concerning history of barbed thread lifting

A full-thickness skin graft (FTSG) is useful for covering small skin and soft tissue defects. In this paper, we suggest FTSG in consideration of the relaxed skin tension line (RSTL) concept for scar quality improvement since FTSG has disadvantages, including contour irregularities and mismatches of color and texture. We conducted a retrospective chart review of twenty-one patients with skin cancer on the face who underwent wide excision and FTSG by a single surgeon from October 2013 to July 2019. Twenty-one patients with skin cancer on the face were divided into RSTL-matched and RSTL-unmatched groups, and FTSG was performed. Each group was subjected to scar assessment three months after surgery. Observer assessment was performed by five independent observers using the observer component of the patient and observer scar assessment scale (POSAS) and Vancouver scar scale (VSS). Our results indicate that there were significant differences between the RSTL-matched and RSTL-unmatched groups in the VSS and POSAS components. In addition, the RSTL-matched group showed a natural appearance with surrounding tissue in the dynamic animation phase compared to the unmatched group. RSTL-matched FTSG can be an attractive option for face skin and soft tissue defect coverage. (An earlier version of this paper has been presented at the International Conference on PRS Korea 2020.)