Background After the laws regulating emergency medicine were amended in 2012, regional trauma centers were established in South Korea. Plastic surgeons specialize in the simultaneous surgical care of patients with facial trauma, burns, and complicated wounds. The objective of this study was to evaluate the role of the plastic surgery department in treating severe trauma patients.Methods From January 2012 to December 2018, we enrolled 366 severe trauma patients with an Injury Severity Score (ISS) over 15 who received treatment by specialists in the plastic surgery department. Of these patients, 298 (81.4%) were male, and their mean age was 51.35 years (range, 6–91 years). The average ISS was 22.01 points (range, 16–75 points).Results The most common diagnosis was facial trauma (95.1%), and facial bone fracture (65.9%) was most common injury within this subgroup. Patients were referred to 1.8 departments on average, with the neurosurgery department accounting for a high proportion of collaborations (37.0%). The most common cause of trauma was traffic accidents (62.3%), and the average length of stay in the general ward and intensive care unit was 36.90 and 8.01 days, respectively. Most patients were discharged home (62.0%) without additional transfer or readmission.Conclusions Through this study, we scoped out the role of the specialty of plastic surgery in the multidisciplinary team at regional trauma centers. These results may have implications for trauma system planning.

Background: We have reported orbital wall restoration surgery with primary orbital wall fragment in pure blowout fractures using a combination of transorbital and transnasal approach in pure blow out fractures. However, this method was thought to be difficult to use for complex orbital wall fractures, since the sharp screw tip that fixate the maxillary wall increases the risk of balloon ruptures. In this study, we reviewed 23 cases of complex orbital fractures that underwent orbital wall restoration surgery with primary orbital wall fragment and evaluated the result. Methods: A retrospective review was conducted of 23 patients with complex orbital fracture who underwent orbital restoration surgery with primary orbital wall fragments between 2012 and 2019. The patients underwent orbital wall restoration surgery with primary orbital wall fragment with temporary balloon support. The surgical results were evaluated by the Naugle scale and a comparison of preoperative and postoperative orbital volume ratio. Complex fracture type, type of screw used for fixation and complications such as balloon rupture were also investigated. Results: There were 23 patients with complex orbital fracture that used transnasal balloon technique for restoration. 17 cases had a successful outcome with no complications, three patients had postoperative balloon rupture, two patients had soft-tissue infection, and one patient had balloon malposition. Conclusion: The orbital wall restoration technique with temporary balloon support can produce favorable results when done correctly even in complex orbital wall fracture. Seventeen cases had favorable results, six cases had postoperative complications thus additional procedure seems necessary to complement this method.

Cutis verticis gyrata (CVG) is an unusual morphological condition of the scalp characterized by ridges and furrows resembling the surface of the brain. Most patients have lesions on the scalp, and only a few cases with forehead lesions have been described in literature. We report an extremely rare case of secondary CVG on the forehead. A 61-year-old female patient was referred to our outpatient clinic with a large area of hypertrophic skin on the forehead. A lesion measuring 12×3 cm extended across both eyebrows, the glabella, and the forehead. The patient reported that a pruritic erythematous lesion in that region had occurred 10 years ago after she performed acupuncture on herself on the forehead several times. She had no underlying diseases and no relevant family history. We removed the entire lesion and covered the defect with a forehead advancement flap. This solved the initial aesthetic problem. Her forehead skin became flattened, and the sagging upper eyelid skin was aesthetically corrected. Pathological findings showed nodular lesions with dense collagen fibers and microvascular proliferation, supporting the diagnosis of CVG. We achieved good results through surgical treatment for the extremely rare case of CVG on the forehead.

Purpose: The global trend of resident work-hour restrictions requires a more time efficient way of resident training. Among many training programs for learning the facial anatomy, the cadaver is the most similar to live patients. A cadaver should be used as efficiently as possible due to human dignity as well as the consideration of cost. The authors designed an effective cadaver dissection method in learning facial anatomy using the plastic surgery approach. Method: A 51-year-old male cadaver was used for dissection. The program was proceeded 6 times over 6 weeks, and 4 to 8 hours each day. We used standard surgical instruments with magnifying loupes. The results were analyzed through a numerical scale survey. Result: We planned to dissect the face from medial to lateral, cephalic to caudal, and superficial to deep portion. The overall knowledge and confidence level of the face were increased in all 7 participants. The mean knowledge level before and after the seminar was 3.00 and 4.03, respectively. Confidence level also increased through the seminar from 1.86 to 2.86. Conclusion: The authors believe this cadaver dissection program could optimize learning anatomical knowledge and improve resident's surgical confidence through a wide range of procedures.