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Cartilage tissue has a limited capacity for healing with the consequence that patients are often treated symptomatically until they become candidates for osteotomy or total joint replacement. Alternative biological therapies, for example, application of platelet-rich plasma and implantation of chondrocytes and mesenchymal stem cells, have emerged as a new treatment modality to repair articular cartilage. In addition, autologous fat transfer is performed for treatment of cartilage defects, example given, in osteoarthrosis, but several questions regarding basic biochemical properties of the transplant remain unanswered. Bone morphogenetic protein 4 (BMP4), matrix metalloproteinase (MMP)-8, cartilage oligomeric matrix protein (COMP), and chitinase-3-like protein 1 (CHI3L1) have been shown to be involved in chondrogenic regeneration and represent potential therapeutic agents for cartilage repair. However, no study regarding naturally occurring levels of these soluble factors in transplanted adipose tissue has yet been performed.To investigate the influence of age, body mass index, donor site, and sex on the concentration of BMP4, MMP-8, COMP, and CHI3L1 in freshly aspirated adipose tissue, their content was measured by means of enzyme-linked immunosorbent assay readings.There were significant quantities of BMP4, MMP-8, COMP, and CHI3L1 (23.6, 249.9, 298.0, and 540.6 pg/mg, respectively) in the lipoaspirate harvested for transplantation. There was no correlation between the content of soluble factors and the patients' age or body mass index. Furthermore, the sex did not affect the amount of the investigated factors. However, there were significantly lower contents of BMP4, COMP, and CHI3L1 found in lipoaspirates harvested from the abdomen compared with nonabdominal donor sites.Naturally occurring differences in the concentrations of the investigated soluble factors will favor certain donor sites for autologous fat transfer in the field of cartilage repair. Thus, increasing knowledge will enable researchers and clinicians to make autologous fat transfer procedures more reliable and efficient for treatment of articular cartilage defects.

There is an increased risk for burn injuries associated with home oxygen therapy of patients with chronic obstructive pulmonary disease (COPD) since 10% to 50% of these patients continue to smoke. Enzymatic eschar removal of facial burns is gaining popularity but intubation of this specific patient group often leads to prolonged weaning and can require tracheostomy. This study dealt with the question if enzymatic debridement in these patients can also be performed in analgosedation. A selective review of the literature regarding burn trauma associated with home oxygen use in patients with COPD was performed, as well as a retrospective analysis of all patients with burn injuries associated with home oxygen use and COPD that were admitted to the study clinic. In the literature, 1746 patients with burns associated with home oxygen use are described, but none of them received enzymatic debridement. In this study, 17 patients were included. All three patients in this study with facial full-thickness burn injuries received enzymatic debridement. The mortality rate in this cohort was 17.6% (3/17). Up to date, there is limited experience performing regional anesthesia debridement in patients with COPD. This is the first manuscript describing the use of enzymatic debridement in patients with COPD and home oxygen therapy. We could confirm other studies that intubation of these patients leads to prolonged ventilation hours and increases the probability for poor prognosis. Therefore, we described the treatment of enzymatic debridement in analgosedation without intubation.

Introduction The aesthetic outcome after burn of exposed areas such as the hand and face is of high importance. A number of wound dressings used for the treatment of superficial and partial thickness burns promise rapid wound healing and reduced scarring. Previously, wound healing of hands and faces with superficial burns treated with Dressilk® compared to Biobrane® was evaluated intra-individually with similar results. Nevertheless, up to date objective information regarding the scarring after superficial burns treated with Dressilk® does not exist. Methods Therefore, 30 patients with superficial burns of the hand and face that were treated with Dressilk® and Biobrane® simultaneously were included in the study. An objective scar evaluation was performed analyzing melanin and erythema levels, skin elasticity, trans-epidermal water loss and scar perfusion three and six and 12 months after injury. Furthermore, a subjective scar evaluation was performed with the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS). Results Dressilk® and Biobrane® both lead to an aesthetic pleasing outcome after superficial burns of the hands and faces. Regarding the objective scar evaluation only trans-epidermal water loss of burned hands after 6 months showed significant differences between the two dressings. However, these differences were not detected in the 12-month follow up examination. In the subjective scar evaluation no statistical differences could be found between the dressings. All patients stated high satisfaction of scar quality. Conclusion Dressilk® is an interesting alternative to Biobrane® for the treatment of superficial burns of aesthetic and functional important areas.

Background: Although chemical antiseptics are the most basic measure to control wound infection and frequently come into contact with subcutaneous adipose tissue, no studies have evaluated their toxicity on adipose tissue and its cell fractions. In the present study, the effects of five different antiseptics on adipose-derived stem cells were evaluated. Methods: Human adipose-derived stem cells were harvested from healthy donors. Adipose-derived stem cell viability was measured after treatment with different concentrations of antiseptics over 5 days. Furthermore, the effect on the proliferation, adipogenic differentiation, and apoptosis/necrosis of adipose-derived stem cells was analyzed. Finally, the mRNA expression of the stem cell markers CD29, CD34, CD73, CD90, and CD105 was detected. Results: Octenisept and Betaisodona significantly reduced cell proliferation and differentiation and led to considerable adipose-derived stem cell necrosis. Octenisept decreased stem cell viability at the lowest concentrations tested, and all stem cell markers were down-regulated by Octeniseptr and Betaisodona. Lavasept and Prontosan both led to reduced stem cell viability, proliferation, and differentiation, and increased apoptosis/necrosis, although the effects were less pronounced compared with Octenisept and Betaisodona. Adipose-derived stem cells survived treatment with mafenide acetate even at high concentrations, and mafenide acetate showed minimal negative effects on their proliferation, adipogenic differentiation, cell death, and stem cell marker expression. Conclusions: Mafenide acetate may be regarded as a feasible antiseptic for the treatment of wounds with exposed adipose tissue because of its low adipose-derived stem cell toxicity. Lavasept and Prontosan are possible alternatives to mafenide acetate. Octenisept and Betaisodona, by contrast, may be used only in highly diluted solutions.

Summary The incidence of skin cancer, which often affects the facial skin, has risen worldwide. After resecting such facial lesions, plastic reconstruction is necessary in most cases. The paramedian forehead flap (PFF) and the bilobed flap (BF) are commonly used for nasal reconstruction, but whether patients and physicians are satisfied with the esthetics is undetermined? In this study, scar questionnaires (Manchester Scar Scale, Vancouver Scar Scale, and Patient and Observer Scar Assessment Scale) and optical three-dimensional (3D) imaging were used for subjective and objective evaluation of esthetical outcomes after plastic reconstruction of the nose in 30 patients. The distances between landmarks and changes in volume between the treated and both the mirrored, healthy side of the face as well as an untreated, matched control group were measured using the optical (3D) scans. The questionnaires ascertained whether the patient was content with the esthetical outcome of both flaps. In the opinion of the observer, the esthetical outcome of both flaps was sufficient; only a few of the measured distances differed significantly between the patients and the control group. However, the measured volume differences of the donor site of the flap differed significantly between the PFF group and the control group (p = 0.0078). The BF was used for smaller defects, while the PFF was used for major defects. Besides a greater donor-side morbidity for the PFF, both flaps led to esthetically sufficient results and could be used for the reconstruction of the nose depending on the defect size and localization.

Background The aim of this study was to assess the impact of two teaching interventions (ultrasound and arthroscopy) in a peer teaching (PT) environment on anatomy examination scores and also to examine the influence of gender and learning style on these scores. Methods We randomly assigned 484 second year medical students to one of three groups: musculoskeletal ultrasound (MSUS), arthroscopy (ASC) and control (CON). The MSUS- and the ASC-group attended two additional training sessions in ultrasound or arthroscopy; the CON-group received no additional lessons. Students were asked to complete Kolb's Learning Style Inventory test. We assessed differences in anatomical knowledge (multiple choice (MC) exam) and subjective evaluation with respect to gender and learning style. Results There were no relevant differences between the three groups regarding the MC exam. Acceptance of the peer teaching concept was good. All students preferred ultrasound to arthroscopy and thought that they learned more from ultrasound despite the fact that they rated the instructors as less competent and needed more time to gain in-depth knowledge. There was no significant effect of gender on evaluation results. Arthroscopy was best enjoyed by accommodators according to Kolb's Inventory and least by divergers, who found that they had learned a lot through ultrasound. The improvement in spatial conceptualization was greatest for accommodators and worst for assimilators. Conclusion Gender and learning style had no impact on quantitative parameters. Qualitative analysis, however, revealed differences for learning style and further evaluation is warranted to assess the impact on medical education.

Background One increasingly important trend in plastic, reconstructive, and aesthetic surgery is the use of fat grafts to improve cutaneous wound healing. In clinical practice, lipoaspirates (adipose tissue harvested by liposuction) are re-injected in a procedure called lipofilling. Previous studies, however, mainly evaluated the regenerative effect of isolated adipocytes, adipose-derived stem cells, and excised en bloc adipose tissue on keratinocytes, whereas no study to date has examined the effect of lipoaspirates. Objectives The authors aimed to investigate differences in the regenerative property of en bloc adipose tissue and lipoaspirates on keratinocytes. Methods Human keratinocytes, lipoaspirates, and en bloc adipose tissue from 36 healthy donors were isolated. In vitro proliferation, differentiation, migration, stratification, and wound healing of keratinocyte monolayers were measured. Furthermore, secreted levels of VEGF, bFGF, IGF-1, MMP-9, and MIF were detected by ELISA. Results Migration, proliferation, and wound healing of keratinocytes were increased by lipoaspirates. Interestingly, the effect of lipoaspirates on keratinocyte proliferation was significantly higher than by en bloc adipose tissue after 5 days. The differentiation of keratinocytes was equally attenuated by lipoaspirates and en bloc adipose tissue. Stratification of keratinocyte layers was enhanced by lipoaspirates and en bloc fat when compared to controls. Lipoaspirates secrete higher levels of bFGF, whereas higher levels of VEGF and IGF-1 are released by en bloc adipose tissue. Conclusion We show that lipoaspirates and en bloc adipose tissue have a regenerative effect on keratinocytes. One reason for the higher effect of lipoaspirates on keratinocyte proliferation may be the secretion of different cytokines. [10.1093/asj/sjw076][1] [1]: /lookup/doi/10.1093/asj/sjw076

An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The computational model is based on the multi-body simulation software AnyBody. Multi body dynamic musculoskeletal models capable of predicting muscle forces and joint contact pressures simultaneously would be valuable for studying clinical issues related to wrist joint degeneration and restoration. In this study, the simulation model of the wrist joint was used for investigating deeper the biomechanical function of the wrist joint. In representative physiological scenarios, the joint behavior and muscle forces were computed. Furthermore, the load transmission of the proximal wrist joint was investigated. The model was able to calculate the parameters of interest that are not easily obtainable experimentally, such as muscle forces and proximal wrist joint forces. In the case of muscle force investigation, the computational model was able to accurately predict the computational outcome for flexion and extension motion. In the case of force distribution of the proximal wrist joint, the model was able to predict accurately the computational outcome for an axial load of 140 N. The presented model and approach of using a multi-body simulation model are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient-specific planning and custom implant design. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.

Hintergrund: Der Fachbereich der Plastischen Chirurgie weist eine deutlich zunehmende Bandbreite der Forschungsaktivitat in den vergangenen Jahrzenten auf. Im Vergleich zu anderen Fachdisziplinen scheint es gleichzeitig an zentraler Koordination in den unterschiedlichen Forschungsbereichen zu fehlen. Bis dato fehlt es hier auch an einer umfangreichen, regelmasigen Auswertung der Forschungsaktivitat. Diese Studie dient einer Ubersicht der deutschen, universitaren Forschungsaktivitat im Bereich der Plastischen Chirurgie. Material und Methoden: Wir fuhrten eine retrospektive Analyse im 5-Jahresintervall (01/2010–12/2014) von PubMed gelisteten Publikationen deutscher, universitarer Kliniken fur Plastische Chirurgie durch. Es erfolgte fur jede Universitat (n=11) eine statistische Auswertung der folgenden Parameter: Verteilung des Forschungsschwerpunktes, Anzahl der Publikationen, jahrliche kumulative Impact-Summe (IS) und Impact-Factor (IF). Ergebnisse: Fur den o. g. Zeitraum wurden insgesamt n=904 Publikationen ausgewertet. Ein Ranking der akademischen Kliniken ergab sich wie folgt: Anzahl an Publikationen: 1. MH-Hannover 178 (jahrlicher Durchschnitt x=36/Median x=34); 2. Universitat Erlangen 115 (x=23/x=23); 3. Bergmannsheil Bochum 90 (x=18/x=19). Die durchschnittliche IS ergab: 33,51 (SD 11,088, p Schlussfolgerung: Basierend auf dieser umfangreichen Auswertung scheint eine zentrierte, periodische Auswertung der aktuellen Forschungsaktivitat in Zukunft nutzlich. Datenauswertungen sollten sowohl auf europaischer als auch auf internationaler Ebene begonnen und auf andere chirurgische und medizinische Disziplinen ubertragen werden.

Background The spontaneous reinnervation of free flaps, such as deep inferior epigastric perforator (DIEP) flaps, is not fully understood, and few publications have investigated this issue. The aim of this study was to examine spontaneous reinnervation following breast reconstruction with autologous DIEP flaps without an additional nerve transfer. Methods In a retrospective clinical study, 18 female patients were investigated for a mean of 49.59 months (range, 12–88 months) following breast reconstruction with a unilateral DIEP flap. Five sensory modalities were tested: pressure perception, dynamic two-point discrimination, sharp-blunt discrimination, hot and cold discrimination, and vibration perception threshold (VPT). The measurements were performed on the reconstructed breast, flap surrounding transition zone, healthy contralateral breast, and the donor site. For a more precise analysis all breasts have been divided into five different segments (mediocranial, laterocranial, mediocaudal, laterocaudal, and reconstructed nipple–areola complex, if present). Additionally, tissue oxygen saturation and tissue hemoglobin were measured by laser Doppler spectroscopy. Results Spontaneous reinnervation of at least one modality tested was observed in all DIEP flaps ( n = 18). This sensitive recovery increases over the postoperative period. The maximum difference between the controls and DIEP flaps was observed in cold perception, whereas the least difference was observed in the VPT. Regarding the different segments, we observed better sensitive recovery in the cranial parts of the DIEP flaps and the transition zone. Conclusion This study provides certain predictions for patients and surgeons, when and to which extent spontaneous reinnervation can be expected.

BACKGROUND A variety of therapeutic procedures for treating keloids have been previously reported, with varying success and recurrence rates. As a monotherapy, intralesional cryosurgery has yielded convincing clinical results. OBJECTIVE We combined intralesional cryosurgery with the application of topical silicone gel sheeting. MATERIALS AND METHODS In this retrospective study, which was conducted between 2008 and 2012, 21 patients with 32 keloids were enrolled. Twenty-five lesions were treated with intralesional cryotherapy combined with postoperative silicone gel sheeting (the cryotherapy + silicone group), and 7 keloids were treated with intralesional cryotherapy alone (the cryotherapy group). The scar volume reduction was assessed, and the patients' subjective and objective parameters were evaluated. Additionally, patient satisfaction was estimated using a modified Gorney Gram scale (0-3). RESULTS In all cases (n = 32 for both groups), a significant keloid volume reduction was observed. The patients' subjective complaints were significantly improved, whereas the combined therapy showed slightly better results in hardness (p < .0012), pain (p < .0233), and discomfort (p < .0029), whereas monotherapy achieved higher satisfaction scores in redness (p < .0220) and pruritus (p < .0206), although these differences were not significant between the treatment modalities. CONCLUSION The results of this study support the use of combined intralesional cryosurgery followed by the application of silicone gel sheeting to treat refractory keloids.

Summary Fordyce spots are ectopic sebaceous glands, ranging between 2 and 3 mm in diameter. These benign lesions are most frequently located in the oral mucosa and the genital skin. Especially in the male genital region they can cause itching, discomfort during sexual activities and are aesthetically unpleasant. So far, a variety of therapeutic procedures have been reported with varying success and recurrence rates. In the present retrospective study ( n = 23 patients between 2003 and 2011), we present our surgical approach by means of the micro-punch technique. Using this effective method, we achieved very satisfactory functional and cosmetic results. There were no signs of recurrence during postoperative observations from 12 up to 84 months (median = 51.3 months).

Background: Macrophage migration inhibitory factor (MIF) was firstly described in the 1960s as a pleiotropic cytokine affecting a variety of immune cells. Different physiological functions mainly involving inflammatory reactions such as chemokine-like function and regulating systemic stress responses have been reported. Objective: In several clinical studies the use of MIF as a biomarker has been investigated promising support for diseases with an inflammatory aspect such as sepsis, systemic infections and autoimmune diseases. This article in detail reviews clinical data and evaluates the function as biomarker focusing on inflammatory and autoimmune diseases. Conclusion: Recent studies suggest MIF to be a marker for different inflammatory diseases and might serve as therapeutic target in the future.

An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The developed computational model features the two forearm bones radius and ulna, the eight wrist bones, the five metacarpal bones, and a soft tissue apparatus. Validation of the model was based on information taken from the literature as well as own experimental passive in vitro motion analysis of eight cadaver specimens. The computational model is based on the multi-body simulation software AnyBody. A comprehensive ligamentous apparatus was implemented allowing the investigation of ligament function. The model can easily patient specific personalized on the basis of image information. The model enables simulation of individual wrist motion and predicts trends correctly in the case of changing kinematics. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.

Introduction Locked minimally invasive plating and fourth generation nailing potentially could reduce the complication rate in the treatment of trochanteric femur fractures by its rotational stability and providing better lateral cortical support. The purpose of this study was (1) to compare the biomechanical properties of the Percutaneous compression plate (PCCP) and the Intertan nail (IT) with regards to implant failure and (2) to assess dynamic stability coefficients in an unstable AO/OTA 31A2.2 fracture model. Methods In paired femurs, a standardised unstable trochanteric femur fracture was induced by an oscillating saw. The fractures were stabilised by either the PCCP (Orthofix, McKinney, TX, USA) or the IT (Smith & Nephew, Memphis, TN, USA). All femurs were loaded with 300 N, followed by an increase in load until failure using 300 N each time (2000 cycles each, 0.5 Hz). After every load step the samples were assessed visually and radiographically. We measured migration and performed a survival analysis. Results 16 fractures were induced in 8 paired human specimens (mean age: 84 years, 61–100 years). The mean stiffness (PCCP vs. IT: 249 ± 124 N/mm vs. 273 ± 153 N/mm; p = 0.737) was comparable. The IT proved superior to the PCCP with regard to the number of cycles reached before failure occurred (PCCP vs. IT: 12,691 ± 4733 vs. 15,313 ± 4875 cycles; p = 0.023). Except for a higher axial migration of the IT at failure point (PCCP vs. IT: 1.3 mm vs. 4.3 mm; p = 0.028) there were no differences between the intra- and extramedullary implants, not even in terms of rotational stability along the femoral neck axis. A fracture of the femoral neck caused test abortion in both implants in most cases. Conclusion This study showed a superiority of the IT compared with the PCCP with regards to number of cycles achieved under sequential load increases for unstable trochanteric femur fractures. The stiffness was comparable. Both implants showed a high rotational stability and a support of the lateral wall. Study type Biomechanical study.

International journal of surgery case reports 4(1), 23-25 (2013). doi:10.1016/j.ijscr.2012.09.008, Published by Elsevier B.V., [Amsterdam]

The objective of this study was to evaluate the role of intraalveolar tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in a combination of skin burn and smoke inhalation injuries because this combined trauma is associated with an increased morbidity and mortality compared with either of these traumas alone. We used a standardized small animal model (rats n = 84) to investigate the early intraalveolar excretion of TNF-α during the first one, three, and six hours after a singular skin burn injury, singular smoke inhalation injury, and a combination involving both the traumas. The data were compared with the data from control rats that only received preparation and mechanical ventilation. The TNF-α serum levels and intraalveolar IL-6 concentrations were also measured. One hour after trauma, there was a significant difference in the TNF-α concentration between the controls and both the singular traumas (control vs burn P < .0444 and control vs smoke P < .005) and between the inhalation injury and the combined trauma (smoke vs burn + smoke P < .0084). After three and six hours, no significant differences among the groups were observed. Compared with the controls, both the singular skin burn and smoke inhalation injuries led to increased intraalveolar TNF-α excretion, whereas the combined trauma showed the least intraalveolar TNF-α levels at three and six hours post-trauma. These findings differed from the serum TNF-α levels. Compared with the IL-6 levels, we observed a negative correlation within the intraalveolar cytokine concentrations after one hour (r = -.809), three hours (r = -.627), and six hours (r = -.746). This study confirms the importance of the intraalveolar cytokine reaction in the early posttraumatic stage after a combined burn and inhalation injury. The differences between the combined and singular traumas indicate that TNF-α plays a role in the immunologic hyporesponsiveness of the lung and therefore in the systemic pathophysiological pathway, that often leads to patient mortality. In addition, an inverse correlation between TNF-α and IL-6, both classical markers of inflammation, in the intraalveolar space was observed.

Summary Background Autologous lipofilling has become a standard procedure for many indications in plastic surgery. Single-case studies have reported improvements in scars, especially in burn patients, after autologous lipofilling. Despite its widespread use, little is known about the mechanisms responsible for this improvement. It is hypothesized that the mesenchymal stem cells and numerous growth factors contained in the lipoaspirate contribute to the skin and scar remodeling. Material and methods Between 2008 and 2012, 35 facial scars ( n = 35) on 26 patients ( n = 26) were treated by autologous lipofilling. The preoperative examinations and postoperative follow-up included use of the patient and observer scar assessment scale (POSAS), photo documentation, and laser Doppler spectrometry (O 2 C) measurements of tissue oxygen saturation, hemoglobin levels, and microcirculation on the second, seventh, and ninetieth postoperative days. Results The scar quality improved in all cases, leading to a high patient satisfaction rate at the final follow-up examination. The POSAS scores were significantly increased for pain ( p = 0.0331), color ( p = 0.0007), stiffness ( p = 0.0030), irregularity ( p = 0.0039), pigmentation ( p = 0.0282), and pliability ( p = 0.0404). In addition, we observed increased hemoglobin levels in the early postoperative period (second day) and a reduction in the microcirculation, which normalized to the preoperative values after 7–90 days. Conclusions We demonstrated that autologous lipofilling represents a valuable technique for the treatment of facial scars. Further prospective observational studies are needed to better understand the mechanisms leading to scar enhancement and to make this procedure more reliable and predictable for patients.

Cornstarch is a white, taste- and odorless powder widely used for food processing, papermaking, production of industrial adhesives, and is also a component of many cosmetic products. We herein report a case of severe cornstarch inhalation in a 49-year-old male who was exposed to high amounts of cornstarch powder while unloading a cornstarch transporter system. To our knowledge this is the first report on a high-pressure cornstarch inhalation during occupational activities. This report demonstrates the initial clinical situation, the patient's symptoms, and the severe clinical course. Finally the problems during the management of this rare but life-threatening accident are discussed.

According to data published by the Centers for Disease Control and Prevention, over 6 million people undergo a variety of medical procedures for the repair of articular cartilage defects in the U.S. each year. Trauma, tumor, and age-related degeneration can cause major defects in articular cartilage, which has a poor intrinsic capacity for healing. Therefore, there is substantial interest in the development of novel cartilage tissue engineering strategies to restore articular cartilage defects to a normal or prediseased state. Special attention has been paid to the expansion of chondrocytes, which produce and maintain the cartilaginous matrix in healthy cartilage. This review summarizes the current efforts to generate chondrocytes from adipose-derived stem cells (ASCs) and provides an outlook on promising future strategies.

The reconstruction of zygoma is a challenge with regard to aesthetic and reconstructive demands.Pre-operative CT data were imported into specific surgical planning software. The mirror-imaging technique was used. A surgical guide transferred the virtual surgery plan to the operation site, whereby it fitted uniquely to the iliac donor site. A postoperative CT scan was obtained for comparing the actual postoperative graft position and shape with the pre-operative virtual simulation.A mean difference of 0.71 mm (SD ± 1.42) for the shape analysis and 3.53 mm (SD ± 3.14) for the graft position was determined. The calculation of the closest point distance showed a surface deviation of 2 mm for the shape analysis with 83.6% of values and for the graft position with 35.7% of values.Virtual surgical planning is a suitable method for zygoma reconstruction with vascularized iliac crest bone graft, with good accuracy for restoring the three-dimensional anatomy.

Journal of brachial plexus and peripheral nerve injury 7(1), 5 (2012). doi:10.1186/1749-7221-7-5, Published by Biomed Central, London

European journal of medical research 22(1), 10 (2017). doi:10.1186/s40001-017-0251-3, Published by BioMed Central, London

Purpose Neonatal mastitis is a rare but challenging problem that commonly appears within the first 8 weeks after birth. Abscess formation in an infant's breast can lead to acute complications and longterm dysfunction. To our knowledge, no publication focuses on surgical techniques and postoperative care to avoid breast scarring in neonates. We herein present our surgical approach by periareolar drainage to avoid this long term complications. Methods After reviewing the medical database of our hospital from 2002 to 2012, 11 cases (6 females and 5 males; 10 unilateral and 1 bilateral) of neonatal mastitis were found. Four cases required surgery, performed by periareolar drainage (n = 4, 4:11). Our data were compared with data obtained from a literature review using Medline and Cochrane databases. Results In all our patients that underwent surgery, clinical symptoms were reduced directly after surgery. Our results were comparable with those reported in the literature, which included 163 patients (105 [64.42%] required surgery) from seven publications. Regarding our surgical technique, we have not observed any long-term complications during follow up examinations (range 12-116 months postoperative; mean, 77.36 months), which have been reported in the literature. Conclusions Even if the acute infection can be cured by parenteral antibiotics and surgical incision if necessary, the longterm problems of scarring after mastitis, especially from surgical incisions at the site of maximum swelling, can lead to severe functional and aesthetic problems. To avoid such scarring, we herein present our surgical approach to mastitis by periareolar drainage.