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Three-dimensional measurement and characterization of facial surface anatomy are fundamental to the objective analysis of facial deformity. However, existing clinical tools are inadequate. Recent innovations in laser scanning technology provide a potentially useful technique for accurate three-dimensional documentation of the face. The purpose of this study is to evaluate the reliability of interactive anthropometric landmark localization based on digitized three-dimensional facial images and to identify sources of error associated with the technique. Three-dimensional surface data were acquired using a commercially available laser scanning device (Cyberware 3030RGB digitizer), and all subsequent anthropometric analyses were performed interactively on the computer monitor. Four experimental conditions were studied, with 10 observations for each condition. A stable anthropomorphic model with prelabeled anatomic landmarks was scanned repeatedly under varying conditions of head inclination and position within the scanning gantry to determine the effect of these variables on the reliability of the technique. The scanning protocol was then repeated with the labels removed to evaluate the reliability of interactive localization of anthropometric landmarks on a digitized three-dimensional image. Optimal results were obtained with the head positioned in the center of the scanning gantry and with the Frankfort plane elevated 10 degrees from the horizontal. Under these circumstances, all 22 labeled landmarks were visualized and the variance in landmark localization was less than 0.6 mm in the x (horizontal), y (vertical), and z (depth) dimensions. Varying head position or inclination caused significant degradation of the digitized image. The variance of interactive landmark localization was analyzed in three dimensions. The reliability and the spatial orientation of variability were determined for each anthropometric point. These findings have direct implications for the clinical adaptation of this diagnostic tool for quantitative evaluation of facial surface anatomy.

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Preoperative radiotherapy, free flap coverage, and soft tissue atrophy resulted in greater odds of titanium mesh exposure. The findings of this study provide important considerations for reconstructive surgeons using titanium mesh for cranioplasty.

Abdominal wall disruption following blunt trauma is a rare but challenging injury, both in the acute and convalescent phases. The present report describes the recent experience with this injury at a single adult trauma center. In a 22-month period, nine patients with traumatic abdominal wall disruption were managed. Flank and anteroinferior abdominal wall defects were most common. Associated injuries included 6 patients with a pelvic fracture and 4 patients with rectosigmoid injuries. Immediate primary repair of the defect was attempted in seven cases at the time of trauma laparotomy, but was difficult and often unsuccessful because of the related tissue destruction. Delayed abdominal wall repair was performed in patients with symptomatic disability (n = 5) and, if required, restoration of intestinal continuity was performed at a separate operation before abdominal wall repair. Delayed repair with autogenous tissue included the use of tensor fascia lata, rectus femoris muscle, rectus abdominis fascia, and latissimus dorsi muscle. Reconstruction with prosthetic mesh was required in two patients. One early and one late recurrence occurred, resulting in reoperation. In conclusion, traumatic abdominal wall disruption represents a complex challenge for both general and plastic surgeons. The key to successful surgical management seems to be a delayed staged repair with autogenous tissue when feasible.

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