Objectives: Selective orbicularis neuromyectomy for postparetic periocular synkinesis was first reported in 2015. This study aims to statistically evaluate the accumulated outcomes and stability of this treatment.

Methods: Twenty-five patients with postparetic periocular synkinesis were treated with this procedure between March 2010 and February 2020. Every patient was evaluated using the Sunnybrook scale, and their palpebral fissure width was measured using preoperative and postoperative videos. Patients who underwent >1-year follow-up were included in the study. Chemodenervation or physical therapy was not performed during the follow-up periods.

Results: Of the 25 patients, 20 were included in this study. The follow-up period was 13-96 months (median 32 months). The mean of the patients' synkinesis scores fell by 4.6 points. Palpebral fissure width while puckering and at rest was significantly different between the preoperative and postoperative measurements (p < 0.01). Lower lid drooping gradually deteriorated in one patient 7 years after the treatment and was corrected secondarily.

Conclusions: This study demonstrates that selective orbicularis neuromyectomy is a simple and sustainable treatment for periocular synkinesis. However, further longer follow-up of elderly patients and objective analysis are warranted.

Objectives: Recent studies have reported that negative pressure wound therapy (NPWT) is useful for skin graft fixation. However, there is no reliable evidence of the optimal negative pressure strength during fixation. We verified the relationship between negative pressure strength and the engraftment rate retrospectively.

Methods: This study included 130 patients who underwent skin graft fixation using NPWT. All cases were divided into full-thickness skin graft (FTSG) and split-thickness skin graft (STSG) groups and further classified into three subgroups based on negative pressure strength as follows: high-pressure (≥100 mmHg), moderate-pressure (≥75, <100 mmHg), and low-pressure (<75 mmHg). The engraftment rates of each subgroup were compared and evaluated on a three-point scale of "good," "fair," and "poor"; the proportion of cases with "good" engraftment was defined as the engraftment rate.

Results: In the FTSG group, the engraftment rates were 40.0%, 82.4%, and 100% in the high-, moderate-, and low-pressure subgroups, respectively; in the STSG group, the engraftment rates were 85.9%, 70.8%, and 87.5% in the high-, moderate-, and low-pressure subgroups, respectively. The multiple comparison test observed no significant differences in both group. However, when FTSG was reclassified with a cutoff value of 100 mmHg, the engraftment rate was significantly lower in the high-pressure than in moderate- and low-pressure subgroups.

Conclusions: It is recommended to set negative pressure strength <100 mmHg for FTSG and to set that while prioritizing fixation for STSG.

Superficial ulnar artery is a rare arterial anomaly and is defined as an ulnar artery that courses over superficial forearm flexor muscles. Different from a popular ulnar artery that courses along the ulnar aspect of the forearm deep to the flexor muscles, it is one of many variations in the upper limb and has unilateral predominance. It has been reported that the superficial ulnar artery can coexist with unilateral absent of the palmaris longus muscle. We present a case of the superficial ulnar artery laceration that requires vascular anastomosis under an operative microscope. To the best of our knowledge, this is the first clinical case of recognizing the superficial ulnar artery anomaly and repairing of the vessel. We also visualized the superficial ulnar artery by contrasted computed tomography.

A 67-year-old man had a tumor on his right cheek. It was resected 15 years earlier but recurred 1 year before his first visit. He had a red papule on his right cheek and subcutaneous induration in the right preauricular area. A right cheek biopsy revealed a mucinous carcinoma. The positron emission tomography-computed tomography showed accumulation only in the right cheek and parotid gland lymph node; therefore, we diagnosed primary cutaneous mucinous carcinoma. Sentinel lymphoscintigraphy showed accumulation of parotid gland and level II lymph node. He underwent extended resection and sentinel-node biopsy. Both lymph nodes were metastatic, requiring the appropriate range of neck dissection. There were no recurrence and metastasis postoperatively. There is no effective treatment when distant metastasis occurs, and the prognosis is poor. Therefore, it is important to prevent metastasis. However, positron emission tomography-computed tomography could not reveal early micrometastases. Therefore, a sentinel-node biopsy can be key to early detection and treatment.

Microvascular anastomotic coupler system is used in vascular surgical procedures. By using this device, vascular anastomosis can be performed faster and more easily. It is often used for venous anastomosis during microsurgical reconstruction. We performed distal bypass surgery on two patients with critical limb ischemia with spliced vein grafts using the microvascular anastomotic coupler system. The blood vessel diameters were 2 and 2.5 mm, respectively. Both grafts showed obstruction at 3 and 1 months, respectively, after surgery. The microvascular anastomotic coupler system may not be suitable for small-diameter spliced vein grafts.

Vasovagal reflex may cause benign self-limiting syncope triggered by factors such as pain and emotional stress. However, rarely, it may cause cardiac arrest requiring urgent resuscitation, which has heretofore not been reported during blepharoplasty. In this report, the case of a 28-year-old man who underwent blepharoplasty under local anesthesia is presented. He suddenly experienced bradycardia and subsequent cardiac arrest during resection of the orbicularis oculi. He was fearful after smelling the unpleasant odor of burned tissue and fainted. He recovered consciousness within 1 min following prompt chest compression. Based on intraoperative conditions and cardiological examinations, vasovagal reflex was considered to be the cause of the cardiac arrest. Blepharoplasty involves multiple factors that can lead to neurocardiogenic syncope, thus increasing the risk for intraoperative syncope and circulatory collapse. Hence, the procedure should be performed under close monitoring with the preparation of staff, intravenous access, drugs, and resuscitation cart to manage possible cardiac arrest.

Surgical treatment of unilateral cleft lip is a difficult procedure, partly because many anatomical variants exist. The cleft lip has no excess tissue; hence, tissue from the cleft side cannot reach the normal side, even if all white lip tissue from the cleft side is preserved. Therefore, a basic concept is necessary to perform surgery according to a patient's anatomical diversity. Herein, we describe the essential concepts of unilateral cleft lip surgery. Specifically, the surgeon can insert the Millard's rotation advancement flap, Onizuka's small triangular flap, and Noordhoff's vermilion triangular flap into the median lip. An incision of the white lip should be made at the margin of the cleft to maximize tissue preservation. The amount of rotation and advancement is determined by the degree to which the contracture (hypoplasia of the lip tissue) can be released, and the median lip can be brought down to a normal level.

This study describes the benefits of using neurosurgical scalp hooks in harvesting an anterolateral thigh flap. Typically, scalp hooks retracting the surgical field are connected to cloth forceps with rubber bands, extending the surgical field to flat. A surgeon can use scalp hooks to retract multiple arbitrary points in any direction by retracting them with their fingers. Thus, the expanded operative field is much flatter than that retracted with fingers. As the dissection progresses, the hooks can be adjusted to maintain flatness. This technique allows easy, single-person harvesting of various musculocutaneous or perforator flaps. Furthermore, assistant surgeons can concentrate on cooperating safely in the flat surgical field. Potential limitations include needlestick injury, compression of vascular pedicles with rubber bands, and clamping skin with cloth forceps.