Highlights Zygomatic complex fractures can involve surrounding structures and cause serious ophthalmic and aesthetic complications. Radiological investigations is very useful in diagnosing and planning the reconstruction surgery. The goal of fracture reconstructions is to restore the appearance and skeletal anatomy before injury instead of bone healing. Immediate reconstruction is recommended to prevent more complications. 3-D model reconstruction can provide better accuracy but takes longer time.

The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.

Background Hypospadias, the most frequent congenital male external genitalia abnormality, is usually associated with curvature of the ventral penis, i.e. chordee. Abnormality of darto tissue has been suggested as the pathophysiology of chordees. Collagen is one of the most abundant fibrous proteins within the extracellular matrix. In this study, we determined the expression of collagen 1 (COL1A1) and COL6A1 in patients with hypospadias and associated them with the severity of penile curvature. Methods We included 60 children < 18 years old, consisting of 20 distal hypospadias, 20 proximal hypospadias patients, and 20 controls in our institution from 2017 – 2020. The expression of COL1A1 and COL6A1 in darto tissue was determined by reverse-transcriptase polymerase chain reaction (qPCR). The penile curvature severity was classified as mild (< 30 degrees), moderate (30–60 degrees), and severe (> 60 degrees). Results qPCR showed that COL1A1 and COL6A1 expression was significantly downregulated in the distal (0.88 (0.38–2.53) and 0.54 (0.16–4.35), respectively) and proximal 0.76 (0.33–2.57) and 0.57 (0.18–1.38), respectively) hypospadias groups compared to controls (1.85 (0.24–4.61) and 0.93 (0.17–4.06), respectively) with p-values of 0.024 and 0.018, respectively. Furthermore, there was a moderate correlation between COL1A1 and COL6A1 expression (r = 0.458, p < 0.0001). Interestingly, COL1A1 and COL6A1 were also significantly downregulated in the moderate and severe chordee groups compared to the mild chordee groups, with p-values of 0.003 and 0.037, respectively. Conclusions Aberrant COL1A1 and COL6A1 expression might affect abnormalities in darto tissue and penile curvature severity in hypospadias patients.

Introduction Invasive aspergillosis (IA) is a fungal infection caused by Aspergillus species (spp.). Aspergillosis is the most common source of opportunistic fungal infection in humans. IA can cause serious complications related to high morbidity and mortality in immunocompromised patients. Presentation of case We report a case of a 22-year-old female with a chief complaint of having a hole in the roof of her mouth. She was diagnosed with SLE in 2009. She had been consuming oral methylprednisolone ever since. In 2018, she experienced worsened symptoms and was hospitalized. She experienced swelling and bleeding of her gums and some of her teeth becoming loose and falling out, and then developing a hole in the roof of her mouth. Subsequently, she was treated with oral cyclophosphamide, oral mycophenolate sodium, and oral fluconazole. She was asked to stop taking oral methylprednisolone. In 2019, the palate biopsy was performed and showed Aspergillus spp. invading the palate. Afterward, the patient was referred to our clinic for defect closure. The patient was operated on for debridement and reconstruction of the defect. There was no recurrence of the defect or complications observed in the follow-up. The patient was satisfied with the surgical results. Discussion IA is a destructive and potentially harmful opportunistic fungal infection and treatments with surgical interventions should be well-thought-out in immunocompromised patients. Conclusion The management of IA are controlling any underlying diseases and surgical debridement or necrotomy. Generally, antifungal therapy and prompt surgical intervention are successful in managing invasive aspergillosis.

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BackgroundKeloids develop due to hyperactivity of keloid fibroblast (KF) in proliferation, migration, and collagen deposition along with low rates of collagen degradation. These are a result of the Wnt/β catenin signaling pathways under stimulation of TGF-β. 5α-oleandrin can suppress Wnt-targeted genes of osteosarcoma cells. We aimed to evaluate the anti-fibrotic effects of 5α-oleandrin on KF activities.MethodsWe collected the core of keloid materials from six patients who underwent keloid debulking surgery. Passage 4 of KF cells were then treated with mitomycin-C, 5α-oleandrin, and dilution medium as the negative control. To determine the effective dose of 5α-oleandrin, we diluted 5α-oleandrin into various concentrations. The incubation periods were 24 h, 48 h, and 72 h. The anti-proliferation and anti-fibrotic properties were measured using standard assay.ResultsBoth the mitomycin-C and 5α-oleandrin treated groups indicated decrease in proliferation index (86.16 ± 4.20% and 73.76 ± 4.94%, respectively), collagen deposition index (90.26 ± 1.72% and 71.35 ± 4.26%, respectively), and migration capacity (33.51 ± 1.50% and 28.57 ± 1.58%, respectively). These were significant changes (p ≤ 0.05) compared to the non-treated group. Antifibrotic activities of 5α-oleandrin in cellular proliferation and collagen deposition were better than mitomycin-C.ConclusionsThe 5α-oleandrin has good antifibrotic effect in keloid fibroblast activities.

Considering the advantages of wound treatment in moist-state, many practitioners always keep the wound in the moist condition. One of the alternatives is by using aloe vera. It has moisturizing effect, anti inflammatory and can stimulate growth factor and fibroblast. In this study, the authors aim to compare the effect of the wound dressing with the dry gauze, moist gauze and aloe vera toward the tensile strength. Thirty Rattus Novergicus were divided into two experimental groups and 1 control group. We performed full thickness skin incision on the back of the rats, and then we sutured and nursed them by using moist gauze and Aloe Vera while the dry gauze group treated as the control. On the 10th day, we decapitated the rats and we took the trace of incisional skin for the tensile strength test. At last, the samples were measured by Zwick universal tensile strength testing machine. This research show that the group treated by dry gauze had tensile strength (35 ± 7 N/cm2) , with moist gauze (41 ± 7 N/cm2), and with Aloe Vera (68 ±17 N/cm2). There was a significant difference between the three groups regarding the tensile strength (p<0.001). Treatment of wound by using Aloe Vera is proven to be more effective than the dry gauze and moist gauze to increase the tensile strength.

Keloid occurs due to hyperactivity of keloid fibroblast (KF) in proliferation, migration, collagen deposition, together with low rates of collagen degradation. These are under the responsibility of TGF-b. Mitomycin C (MC) is used for treating keloid by a topical application during surgery at the level of 0.02% to 0.08%. Unfortunately, the lowest effective level of MC for keloid has not been determined yet. We aimed to determine the lowest effective level of MC in the suppression of KF activities. Various levels of MC diluted in growth medium were administered on KF that were isolated from six patients. After 24 hours and 72 hours of incubation, cellular proliferation, collagen deposition, cellular migration and level of TGF-b, were analyzed. Application of 120 uM MC on KF culture for 24 hours could significantly reduce TGF-b production from 1265.74 ± 274.81 pg/mL to 265.17 ± 12.20 pg/mL; proliferation index from 100% to 84.01 ± 12.91%; inhibit cellular migration to 64.38 ± 3.66%; but reduce collagen depositions from 100% to only 91.13 ± 10.19%. The lowest MC level is on 30 uM or equal with 0.001%. In conclusion, the lowest level of MC can suppress the activities of KF is 0.001%. Moreover, due to low activity in inhibiting collagen deposition, MC would be better as an adjuvant drug for keloid surgery. ABSTRAKKeloid timbul karena proliferasi, migrasi, dan sintesis kolagen oleh fibroblas keloid (FK) secara berlebihan diikuti dengan rendahnya degradasi kolagen. Semua itu terjadi karena pacuan TGF-b. Olesan mitomycin C (MC) 0,02% sampai 0,08% digunakan untuk mengobati dan mencegah kekambuhan keloid yang dioperasi. Sayangnya, dosis terendah yang masih efektif belum pernah diteliti. Penelitian ini bertujuan untuk menentukan kadar terendah MC yang masih efektif untuk mengobati keloid. MC dilarutkan dalam medium pertumbuhan dalam berbagai kadar dan diberikan pada biakan FK yang diisolasi dari material keloid enam orang pasien. Setelah inkubasi 24 jam dan 72 jam, proliferasi, migrasi, timbunan kolagen dan kadar TGF-b, dianalisis dan dibandingkan. Pemberian 120 uM MC pada biakan FK ternyata dapat menurunkan produksi TGF-b dari 1265,74 ± J Med Sci, Volume 48, No. 3, 2016 168 274,81 pg/mL menjadi 265.17 ± 12.20 pg/mL; indek proliferasi dari 100% menjadi 84,01 ± 12.91%; menghambat migrasi sampai 64,38 ± 3.66%, tetapi daya hambat timbunan kolagen hanya dari 100% menjadi 91.13 ± 10.19%. Kadar MC terendah yang masih efektif adalah 30 uM atau setara dengan 0.001%. Kadar MC di bawah itu tidak lagi efektif. Kesimpulan, kadar MC terendah yang masih efektif sebesar 0,001% dan karena daya hambat timbunan kolagen yang rendah, MC sebaiknya digabung dengan operasi keloid.