Sagittal split ramus osteotomy is a fundamental procedure in orthognathic surgery. Precise identification of the mandibular foramen is critical for achieving optimal splitting patterns and minimizing neurosensory deficits. Preoperative cone-beam computed tomography assessment is a current method for foramen identification; however, radiographic images do not represent the intraoperative anatomical conditions. Visual access interference and anatomical constraints from the internal oblique ridge make foramen identification challenging. To address this unmet need, we developed a specialized instrument, the mandibular foramen probe. This instrument features a spherical tip and laser markings on the shank. The shank is designed to be parallel to the occlusal plane once the probe is seated on the foramen. Our technique provides safe and precise guidance to bridge the gap between planning and surgical reality during sagittal split ramus osteotomy.

Pediatric lower extremity lawnmower injuries are high-energy traumas that often result in severe composite tissue loss and require advanced reconstruction. Compared with other mechanisms of pediatric lower extremity trauma, these injuries have a higher incidence of amputation and complex reconstruction. This case series describes 3 pediatric patients, aged 2.5-10 years, who sustained severe lower extremity lawnmower injuries that were managed with free tissue transfer (FTT). Reconstructions included a tensor fasciae latae perforator flap, a latissimus dorsi myocutaneous flap, and an anterolateral thigh perforator flap. These cases demonstrate the practical importance of early escalation to FTT, judicious reconstructive timing, appropriate flap selection between fasciocutaneous and musculocutaneous options, recognition of the indications and limitations of preoperative vascular imaging, and consideration of the unique perioperative challenges associated with FTT.

Autologous breast reconstruction depends on intact wound healing. Chronic granulomatous disease (CGD) results from nicotinamide adenine dinucleotide phosphate oxidase dysfunction and predisposes patients to opportunistic infections; acquired forms can transiently mimic the congenital disorder. We report a case of transient phagocytic dysfunction that complicated delayed transverse rectus abdominis myocutaneous flap reconstruction. A 43-year-old woman with Stage IIB breast cancer underwent delayed reconstruction 18 months after cytotoxic chemotherapy. A delay procedure (inferior epigastric vessel ligation) was performed 14 days before flap elevation to reduce ischemic risk. When atypical wound failure developed postoperatively, deep tissue biopsies grew opportunistic pathogens (Pseudomonas putida, Staphylococcus epidermidis, and Candida tropicalis) and immune workup was initiated. Neutrophil oxidative function was assessed by dihydrorhodamine (DHR) 123 flow cytometry. Initial DHR testing showed absent oxidative burst (oxidation index <1.0; reference >5.0), indicating severe phagocytic dysfunction. Targeted antimicrobials (levofloxacin, fluconazole) and negative pressure wound therapy were started. Repeat DHR at 6 weeks was fully normal (oxidation index 58.80), excluding genetic CGD. The patient healed completely by secondary intention without further surgery. Phagocytic dysfunction can emerge as a late sequela of cytotoxic therapy and complicate autologous reconstruction, mimicking genetic CGD. When flap failure is unexplained and opportunistic organisms are recovered despite intact perfusion, DHR testing should be part of the workup. Serial assays distinguish transient acquired dysfunction from a permanent genetic defect and determine how aggressively to intervene.

Reconstruction of extensive chest wall skin defects following mastectomy remains challenging, and a variety of reconstructive options have been reported. Although skin grafts, local flaps, and pedicled musculocutaneous flaps are widely used, these approaches may result in suboptimal cosmetic or functional outcomes, carry a relatively high risk of partial flap necrosis, and require sacrifice of muscle tissue. Additionally, achieving stable wound closure without delaying the initiation of postoperative radiotherapy or chemotherapy is particularly important in such cases. Here, we report five patients who underwent immediate reconstruction with a free superficial circumflex iliac artery perforator flap for extensive postmastectomy skin defects. Complete flap survival and timely wound healing were achieved in all cases. Postoperative radiotherapy and chemotherapy were initiated as scheduled in every patient. During the follow-up period, no cases of local recurrence or significant functional impairment were observed. Free superficial circumflex iliac artery perforator flap reconstruction provides reliable coverage for extensive postmastectomy skin defects with minimal donor-site morbidity, enabling early wound healing while preserving the option of future autologous breast reconstruction. The approach represents a valuable addition to reconstructive strategies for breast cancer patients.

Asian facial anatomy is often characterized by flatter midfaces, wider zygomatic arches, and reduced projection, leading to diminished contour definition. Aesthetic goals therefore emphasize smooth transitions and balanced facial proportions. The V-line concept represents a structured approach integrating point-, line-, and plane-based augmentation to enhance facial support and contour. This preliminary case report describes a 39-year-old woman who underwent facial rejuvenation using a polycaprolactone (PCL)-based filler with a 3-stage V-line layered injection technique. The protocol targeted the jawline, midface, and T-zone in a single treatment session using a layer-specific approach. Improvements were observed immediately and maintained at 1-, 3-, and 6-month follow-ups. Lower facial contour and jawline definition improved, midface support was restored with smoother transitions, and upper facial projection was enhanced. No complications were observed. This preliminary report suggests that the 3-stage V-line technique using PCL filler may provide effective and natural facial rejuvenation tailored to Asian facial morphology. Further studies with larger sample sizes, objective outcome measures, and longer follow-up are warranted.