This approach provides several advantages, including ease of exposure, and is more familiar to the plastic surgeon than the transconjunctival approach. There is little need to retract the globe laterally, thus minimizing postoperative inflammatory symptoms related to the eye. Therefore, the authors suggest that this method should be considered as a natural and useful surgical approach to medial orbital blowout fractures.

Testosterone is a representative sex hormone for men, and low testosterone causes erectile dysfunction and cardiovascular disease. The purpose of this study was to investigate the association between low testosterone (LTT) and health behaviors, such as alcohol, smoking, and exercise habits. We included 2980 men aged 65 to 80. Total serum testosterone and body composition were measured. A testosterone level less than 300 ng/dL was defined as low testosterone. A questionnaire on smoking, alcohol, and exercise was included. The odds ratio (OR) of LTT was calculated through logistic regression. Model 1 only used age as the adjustment variable, whereas Model 2 adjusted for age, waist circumference, and smoking. The prevalence of LTT was 626 (21.0%). The prevalence of LTT was significant in fat mass (Model 1: OR, 2.133) and muscle mass (Model 1: medium OR, 2.130 and low OR, 3.022; Model 2: medium OR, 1.638 and low OR, 1.740). The prevalence of LTT was also different based on smoking (Model 1: OR, 1.590; Model 2: OR, 1.629) and strength exercise (Model 1: OR, 0.849; Model 2: OR, 0.923). In conclusion, high frequency strength exercise and smoking cessation lower the prevalence of low testosterone, and obesity and low muscle mass increase the prevalence of low testosterone.

Elbow ligament injuries are commonly caused by overuse; degeneration; and trauma; such as from a fall or collision. The purpose of this study was to present the results of three cases involving patients undergoing early rehabilitation after surgical treatment for complex injury of the elbow medial collateral ligament (MCL) and lateral collateral ligament (LCL). Two patients were non-athlete middle-aged women and one was a recreational judo player. Surgery was performed through open incision or arthroscopically. Rehabilitation consisted of range of motion (ROM) exercise; muscle strength restoration; and neuromuscular training. Passive ROM exercise and isometric strength exercise began at 7 days; isotonic strength training at 6 weeks; and neuromuscular training at 3 months after operation. Center- and home-based methods of exercise participation were combined. Center-based exercises were performed 1–2 times per week for the first 6 months and 1–2 times per month for the next 6 months. Patients also performed home-based and self-monitoring exercise. Examinations included ROM using a goniometer; muscle strength test using isokinetic equipment; and Oxford elbow score. In the six months after surgery; flexion ROM was 130° for Case A (health side 145°), 110° for Case B (health side 145°), and 135° for Case C (health side 135°); grip strength was restored to 13 kg (health side 28 kg), 16 kg (health side 25 kg), and 38 kg (health side 52 kg); and isokinetic flexion strength was improved to 30 Nm (health side 58 Nm), 21 Nm (health side 50 Nm), and 72 Nm (health side 80 Nm), respectively. In conclusion; patients who underwent early rehabilitation recovered ROM and muscle strength and returned to daily activity without any side effects. This study showed that patients with elbow MCL and LCL injuries took approximately 3 months to recover meaningful ROM; approximately 6 months to recover muscle strength; and 4–8 months to play light recreational sports. In addition; it took patients 6 weeks to return to their daily activities and 6 months to improve questionnaire scores in their function and pain during daily activity. In follow-up two years after surgery; all three patients had full ROM and muscle strength within 10% of the healthy side

Perforator free flap (PFF) is now performed with increasing frequency for soft tissue reconstruction in adults. When compared with conventional free skin flaps, PFFs are thinner and have less donor-site morbidity because only the skin is harvested. The advancement of the PFF design has spurred the identification of many skin flaps based on the perforator principle. Although PFFs are used in adults, most reconstructive surgeons still hesitate to perform PFFs in children. The main cause of concern is the perceived high failure rate related to the small diameter of children's perforator vessels. We present 4 consecutive cases of successful transfer of thoracodorsal artery perforator flap in children. We present our flap design and surgical technique to highlight the usefulness of this flap for reconstructing soft tissue defects in children.