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Summary We assessed whether nicorandil, an adenosine triphosphate–sensitive K + channel opener, reduces burn wound progression in a rat comb burn model. A total of 24 rats were used. Following thermal injury, one dose of nicorandil (10 or 30 mg/kg) was administered intragastrically twice daily for 3 days. At days 1 and 3 after injury, skin was harvested for histopathological examination and protein isolation. Rats treated with the 10-mg/kg and 30-mg/kg doses of nicorandil exhibited significantly increased tissue survival in the zone of stasis at days 1 and 3 after injury. The 10-mg/kg and 30-mg/kg nicorandil doses also significantly increased skin perfusion in the zone of stasis at days 1 and 3 after injury. At 30 mg/kg, nicorandil significantly reduced hypoxia-inducible factor-1α expression in the zone of stasis at day 1 after injury and reduced inflammatory responses in the zone of stasis. The latter effect included decreased polymorphonuclear neutrophil leukocyte infiltration and interleukin-1β release at day 1 after injury. At 30 mg/kg, nicorandil also significantly reduced expression of nuclear factor-κB p65, akey transcriptional factor in the regulation of inflammatory mediators, in the zone of stasis at day 1 after injury. Our study demonstrates that a 30 mg/kg dosing schedule of nicorandil increases tissue survival in the zone of stasis by attenuating ischemia–reperfusion injury. This effect is mediated by the enhancement of skin blood flow and reduction in the inflammatory response. Therefore, our findings suggest that nicorandil has potential clinical applications for patients with burns.

Summary In this study, details of the infraorbital nerve's (ION's) anatomical course variants were compared using computed tomography (CT), and relationships between the variants and fracture patterns in the orbital floor were investigated. Fifty-two normal individuals and 50 patients with unilateral isolated orbital floor fractures were enrolled in this study. Four measurements in normal individuals and five measurements in fracture patients were obtained in parasagittal sections. The anatomical variations of the ION were categorized into three types according to the classification by Ferences et al. Among the normal individuals, 42 orbits were classified as type 1 ION, 48 orbits as type 2, and 14 orbits as type 3. The distance from the inferior orbital rim to the upper border of the inferior orbital foramen and the length of descension portion of the ION in type 1 ION were significantly shorter than in type 2 and type 3 IONs. In patients with orbital floor fractures, the distance from the inferior orbital rim to the upper border of the inferior orbital foramen was positively correlated with herniation level of bone and soft tissue. The ION had three anatomical variants according to the degree of descension in the anterior portion of the orbit. When fracture of the orbital floor occurs in patients with type 1 ION, inferior displacement of the fractured orbital bone and orbital soft tissue may be less severe than in patients with other ION types.

We introduce a method to extract the maximum amount of cancellous bone from the calvarium and analyze the outcomes using plain radiography and computed tomography.We retrospectively analyzed the medical records of patients who underwent secondary alveolar bone grafts using a maximal harvesting technique for calvarial cancellous bone. Bone survival was determined based on Enemark's grading system using plain radiographs. Alveolar thickness and height were analyzed by computed tomography and compared with radiographic measurements.Our study enrolled 27 patients, 22 unilateral and 5 bilateral, for a total of 32 alveolar clefts. The mean age at surgery was 9.04 ± 0.41 years (range: 6-12 years). Donor sites were successfully recovered without complications, such as hematomas, seromas, infections, or tears in the dura mater. The mean follow-up duration for obtaining plain radiographs was 6.90 ± 0.61 years (range: 2.0-18.50 years). The mean follow-up duration for computed tomography was 6.51 ± 0.99 years (range: 2.0-14.83 years). A canine tooth erupted in 30 cases. Success (Enemark's grades I or II) was achieved in 26 cases. Alveolar height was strongly correlated with the Enemark scale results (γ = 0.878, p 0.001), but alveolar thickness was not correlated (γ = 0.4575, p = 0.08).Our cancellous bone harvesting technique resulted in successful graft survival without serious complications, including dural or brain injuries. Although the ilium is widely accepted as the optimal donor site for secondary alveolar bone grafting, the calvarium could be an alternative donor site that results in equivalent outcomes.

Summary Introduction The purpose of this study was to compare the strength of the relationships between predictors and late-onset enophthalmos in medial and inferior orbital wall fractures and to determine the most significant predictive factor of enophthalmos in medial or inferior orbital wall fracture. Methods Sixty-three adult patients with unilateral medial or inferior orbital wall fracture who had been left untreated for more than two months were enrolled in this study. Patients who had accompanying multiple orbital wall fractures and those with orbital-zygomatic fractures were excluded. Orbital defect area and herniated muscle and fat volumes were evaluated using computed tomography. The degree of enophthalmos was measured using a Hertel exophthalmometer. Results Herniated muscle and fat volumes were positively correlated with defect area in the medial orbital wall fracture but showed no positive correlation with inferior orbital wall fracture. In the medial orbital wall fracture group, enophthalmos was positively correlated with defect area and herniated muscle and fat volumes. Defect area was more highly related to enophthalmos than other analyzed metrics. The defect area predictive of enophthalmos was 1.98 cm 2 . However, enophthalmos was positively correlated only with herniated fat volume in inferior orbital wall fracture. The herniated fat volume predictive of enophthalmos was 343.50 mm 3 . Conclusion Orbital defect area in medial orbital wall fracture and herniated fat volume in inferior orbital wall fracture were the most significant predictors of late-onset enophthalmos.

It is believed that the subcutaneous fat of the skin compositae grafts acts as a mechanical barrier limiting vascularisation. This study aims to determine a new mechanism associated with compositae graft take. Ten 3×3 cm rectangular full-thickness skin compositae grafts on the back of a pig were taken and then randomly changed to another place. Silicone sheets were then inserted between the graft and the recipient to block the direct contact of the dermis at the lateral surface of the graft and control the number of surface contacts. The take rate was measured using the digital VISITRAK(®). The microcirculation of the graft was evaluated by microangiograms using a latex-lead oxide solution. There was a 20.5% graft take in all four surface-blocked groups. The microangiograms showed vessel connections not only between the vessels of the dermis, but also between the subcutaneous fat of the graft and perforators from the basal surface of the wound. The subcutaneous layer does not produce a barrier but works as a significant source of vessel communication. Direct vessel-to-vessel anastomosis between the vessels of the subcutaneous fat at the graft and the basal surface of the recipient wound are another important mechanism for the success of compositae grafts.

Septal extension grafts are performed in order to correct the conformation of the nasal tip and columella. The more strongly the graft is fixed to the columellar L-strut of the septal cartilage, the better is the outcome of grafting. This article reports the development of a vertical figure-of-eight locking suture technique and its biomechanical comparison with other suture techniques. Pieces of porcine rib cartilage 20 x 15 x 1 mm (or 2 mm) in size were used for the study. Two pieces of cartilage were fixed using two simple interrupted sutures in the first group, two horizontal figure-of-eight locking sutures in the second group and the vertical figure-of-eight locking suture in the third group. Shearing, buckling and tensile forces were measured with respect to the direction of forces that occur in vivo. The mean shearing force for cartilages that were 1 mm in thickness was 0.70, 0.74 and 1.04 N (P=0.056) in the first, second and third group, respectively. The mean buckling force was 1.10, 1.09 and 1.39 N (P=0.030), and the mean tensile force was 1.86, 1.78 and 2.24 (P=0.042), respectively. For cartilages that were 2 mm in thickness, the mean shearing force was 1.19, 1.29 and 1.54 N (P=0.216), the mean buckling force was 1.74, 1.50 and 2.25 (P=0.002) and the mean tensile force was 2.00, 1.81 and 2.29 (P=0.023) in the first, second and third group, respectively. The vertical figure-of-eight locking suture technique was developed as an alternative technique for suturing a septal extension graft to the columellar L-strut, and it enables firm fixation with the use of the fewest number of stitches.

Summary Using the conchal cartilage as a graft has been widely accepted, but the deformities that can result have been underestimated. The deformities range from a visible scar to the total collapse of the ear framework. A simplified technique of harvesting the maximal amount of the conchal cartilage graft is suggested, based on the results of 16 consecutive cases. The technique involved (1) using a postauricular incision to minimise visible scars, (2) harvesting the entire cymba concha and cavum concha separately, with at least 5mm of the helical crus, leaving a lateral extension as a strut between them, as well as a 2mm outer rim along the conchal wall, and (3) by using a tie-over bolster dressing that can serve as a mould for the conchal bowl. This technique has been used on 16 patients with neither contour irregularity nor any deformity, from a case of a step deformity to the total collapse of the ear.

Summary The tongue has important roles in deglutition, speech, airway protection, taste, and sexual function, and its amputation is very serious. Using supermicrosurgical techniques, we replanted successfully a patient's tongue, the distal part of which had been amputated by the bite of another person, through the anastomosis of a blood vessel that was only 0.7–0.8mm. The result was that the state of the replanted tongue was relatively good both functionally and aesthetically, and the patient was very satisfied.

The nose of most Koreans is characterised by a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a complete septal extension graft, along with augmentation rhinoplasty has been developed. However, the use of this type of graft is frequently problematic because the septal cartilage is not large enough. In a study involving 10 cadavers, a complete septal extension graft was achieved in two of them by using septal cartilage harvested according to standard techniques. Therefore, the septal cartilage was harvested, leaving a 5-mm L-shaped strut, and a complete septal extension graft was implanted. The present report describes the results obtained in 34 patients and offers an analysis of the results as judged by the columella-labial angle and three proportional indices (nose height index, nasal bridge length index, and nasal tip projection index), measured by photogrammetry. The postoperative values obtained in these four categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally. Moreover, these positive outcomes were maintained during long-term follow-up, and no side effects, such as saddle nose deformity, were reported.