Background: Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. Methods: The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. Results: The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. Conclusion: Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential.

Foreign body (FB) impaction in the maxillofacial area could be caused by knives, glass fragments, and vegetative materials. We present the rare case of a 62-year-old man with a large glass FB in the left cheek retained for over 40 years. He had traffic accident over 40 years ago and glass fragments impacted on his left cheek. Glass fragments were retained around the zygomatic arch with dimpled scar and unclear serous discharge, but other facial motor or sensory dysfunction was not observed. We confirmed three glass fragments with radiologic examination including plain radiograph and computed tomographic image. Under general anesthesia, impacted glass fragments were removed through the direct incision on the dimpled scar and the additional incision on the left lateral canthal area. Remnant FBs were not seen on an intraoperative C-arm radiograph. After 2 days of irrigation for inflammation control, the dimpled wound was sutured. The wound was healed without major complication and the original dimpled scar was much improved.

Reconstruction of posterior ankle defects with Achilles tendon exposure caused by compromised medical conditions or trauma is a challenging issue. We present 2 cases which were successfully covered using negative pressure wound therapy (NPWT). In case 1, a 66-year-old man with a compromised status was referred for treatment of a diabetic ulcer on the right posterior ankle. Copious debridement resulted in Achilles tendon exposure. Eight weeks of NPWT followed by a split-thickness skin graft resulted in healing of the defect. In case 2, a 79-year-old male presented with a thermal burn from contact with a motorcycle muffler. Repetitive debridement exposed the Achilles tendon. Successful granulation tissue coverage was observed after 8 weeks of NPWT. There are many surgical methods to cover the exposed Achilles tendon including a local flap, free flap, or cross-leg flap, but these methods require some period of bed rest, which increases the risk of deep vein thrombosis, bedsores, and pneumonia. Bed rest also increases bone resorption and decreases bone formation, inducing osteoporosis and renal stones. However, healing by secondary intention using NPWT does not require any ambulation limitation and may be an effective reconstructive method in cardiovascularly compromised and elderly patients.

Conventional concept of tissue expansion includes expander insertion, expander removal with wound coverage and intermittent expander inflations. Tissue expansion has been used in the various reconstruction area but high complication rates had been reported in the pediatric population. It may attribute to the inexperience of the medical team, poor education, improper follow-up and low compliance. Rapid intra-operative tissue expansion is a modified concept which utilizes the immediate expandability of the skin. Expansion forces are applied solely in the operative field and for only a short period of time. Ample volume of expansion has been reported in literature. We present the case of a 31-monthold female child with a giant nevus on the left upper arm. The nevus was excised and closed using a simple fabricated tissue expander. Expansion forces were applied only 25 minutes (15 minutes and 10 minutes with 5 minutes of intermittent break time) and the tissue was extended enough for tension free closure. The wound healed well without the complications like hematoma, seroma, wound dehiscence or necrosis.