فهرست مطالب

Plastic Surgery - Volume:6 Issue: 2, Jun 2017

World Journal of Plastic Surgery
Volume:6 Issue: 2, Jun 2017

  • تاریخ انتشار: 1396/04/10
  • تعداد عناوین: 25
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  • Ali Manafi, Ali Kaviani, Zahra Sadat Hamedi, Afsaneh Rajabiani, Navid Manafi Pages 137-143
    BACKGROUNDThere are numerous methods to mold and shape cartilage grafts for use in rhinoplasty. Each technique has advantages and disadvantages. We are going to introduce a new method for cartilage shaping with long lasting effects confirmed by follow up examination and pathologic evaluation.
    METHODSGrated cartilage was used in 483 patients. For 89 cases, it was wrapped in fascia and in 394 patients, used as a filler per se or in contiguity with solid structural grafts. In 51 patients, the operation was primary rhinoplasty and 432 cases, underwent secondary rhinoplasty. Postoperatively, there was a mean follow up of 2.8 years. Graft viability, and capability to maintain almost original volume, and general durability were assessed.
    RESULTSOut of 483 patients, only 23 cases (4.7%) needed later correction. In 11 cases (2%), it was due to overcorrection and some minor imperfections. In the rest 12 cases (2%), there was a need for more augmentation probably due to some degree of graft resorption. Three cases of these 12 patients, were corrected by outpatient shaved cartilage injection.
    CONCLUSIONAccording to the very low revision rate (less than 5%), we strongly recommend our grated cartilage graft for use in primary and secondary rhinoplasty. Our study showed that patient and surgeon`s satisfaction can be achieved with a high degree of confidence.
    Keywords: Autologous, Cartilage, Graft, Rhinoplasty
  • Richard Mcnally, Jonathan Rimler, Vincent Laurence, Keyianoosh Paydar, Garrett Wirth Pages 144-151
    BACKGROUNDCurrent teaching suggests increased perfusion in free transverse rectus abdominis myocutaneous (TRAM) flaps over pedicled TRAM flaps, broadening indications for its use in high risk patients. This study compared perfusion analysis of free muscle-sparing versus pedicle TRAM flaps in vivo in the peri-operative and late post-operative periods.
    METHODSThe SPY-Elite system using indocyanine green dye was used to analyze flap perfusion intra-operatively and at 1 week and 3 months post-operatively. Image analysis was completed by evaluating the perfusion maps from the SPY- Elite system with Image J software calculate maximum, minimum, and average luminescence over the surface area of the flaps. Student’s T-test was used for statistical analysis.
    RESULTSIntra-operatively, we found a 73.4% greater perfusion in the free muscle-sparing as compared to the pedicled TRAM. This increase in free muscle-sparing TRAM perfusion was not evident 1 week post-operatively, due to a relative increase in pedicle flap perfusion that coincided with a revision of the pedicled flap due to distal flap necrosis. At 3 months, the free muscle-sparing TRAM flap once again showed superior perfusion with a 15.7% increase over the pedicled flap.
    CONCLUSIONWe showed superior free muscle-sparing TRAM perfusion in the early peri-operative period which coincided with the time framein which flap loss was most common. Local swelling, pedicle rotation, tunneling, and dominance of the deep inferior epigastric circulation were potential causes of initial decreased pedicled TRAM perfusion. This analysis adds more objective data to the question of indications and relative strengths between free and pedicled TRAM flaps.
    Keywords: Perfusion, Free muscle-sparing, Pedicle transverse rectus abdominis myocutaneous, Flap, TRAM
  • Nikhil S. Panse, Sheetal B. Joshi, Parag B. Sahasrabudhe, B. Bahetee, Pradnya Gurude, Ajay Chandanwale Pages 152-158
    BACKGROUNDReconstruction of upper extremity deformities continues to be a challenge to the reconstructive surgeon. Various loco regional, distant and free flaps are available for reconstruction. However, each has its own set of advantages and disadvantages. Of the commonly performed local flaps, radial artery forearm flap, and the posterior interosseus artery flap stand out prominently. Recently, perforator propeller flaps have been used for resurfacing the upper extremity. The anterior interosseus artery perforator flap is an uncommonly used and described flap.
    METHODSThis study was divided into anatomical study and clinical application in a IV level of evidence. In the anatomical study, five upper extremities were studied. Clinically, 12 patients underwent reconstruction using the anterior interosseus artery perforator flap. Flaps were performed by a single surgeon. A retrospective review of these cases from November 2008 to May 2014 is presented.
    RESULTSThe anterior interosseus artery perforator was identified in four out of five cadaver limbs. The septocutaneous perforator was in the fifth extensor compartment around 4 cm proximal to the wrist joint. Of the twelve flaps, there was complete necrosis in one flap, and partial necrosis in one flap. The patient with complete necrosis underwent skin grafting at a later date. The wound healed secondarily in case of partial flap necrosis.
    CONCLUSIONAnterior interosseus artery perforator flap must be considered as an important reconstructive option in the armamentarium of the plastic surgeon, while managing hand and wrist defects.
    Keywords: Upper extremity, Perforator flap, Propeller flap, Anterior interosseus artery perforator flap
  • Rokhsareh Y. Yazdandoost, Niki Hayatbini, Mohammad Javad Fatemi Pages 159-163
    BACKGROUNDAesthetic surgery procedures have been performed at dramatically increased rates in recent years in Iran. Few researches exist documenting the usage of body image coping strategies and its relationship in seeking surgery.
    METHODSThe present research examined data from 90 aesthetic surgery participants (30 Subjects each in invasive, minimally-invasive, and control groups). Assessed subjects on body image coping strategies inventory (avoidance, appearance fixing and positive rational acceptance) provided dysfunctional usage of its variables among Iranian clients.
    RESULTSBetween the three groups, on variables of body image coping strategies, there was a significant difference. There was a significant difference on avoidance variable in three groups. On positive rational acceptance variable, there was a significant difference for invasive group with minimally-invasive and control groups. No significant difference was found on appearance fixing variable.
    CONCLUSIONThe study emphasizes on the role of psychological problems of aesthetic surgery clients that surgeons should be aware of them, which could inhibit the positive effects of aesthetic surgery. These results have implications for pre-surgical assessment along with psychological interventions at first step rather than invasive medical interventions.
    Keywords: Body Image coping strategies, Avoidance, Appearance fixing, Positive rational acceptance, Aesthetic surgery, Cosmetic surgery
  • Sadrollah Motamed, Alireza Saberi, Feyzollah Niazi, Hojjat Molaei Pages 164-169
    BACKGROUNDOsteotomy is one of the major steps in rhinoplasty. The aim of study was to compare edema and ecchymosis after external and internal lateral osteotomy in patients who underwent rhinoplasty.
    METHODSBased on a prospective randomized clinical trial, 168 osteotomies were performed through an external route in a perforating fashion and internal route in a continuous fashion at right or left side respectively in any patient. Subjective scoring system was applied to evaluate edema and ecchymosis on 1st, 3rd, 7th, and 30th days after surgery.
    RESULTSEdema and ecchymosis were the same in both types of osteotomies.
    CONCLUSIONRegarding edema and ecchymosis, there was not any significant difference between external and internal osteotomies in rhinoplasty.
    Keywords: Osteotomy, Rhinoplasty, Continuous, Perforating, Complication
  • Reza Vagardoost, Jafar Kazemzadeh, Mostafa Dahmardi, Soheila Rabiepoor, Ramyar Farzan, Ali Asghar Kheiri, Rahman Khosravy, Farzad Manafi Pages 170-175
    BACKGROUNDMost of the acid- burns are due to assault or accidental. The epidemiology of burns is diverse across the world and within a country. We evaluated the epidemiology and outcome of acid-burns in tertiary health care center in Tehran, Iran.
    METHODSThis study was retrospective descriptive among patients referred for acid-burn injury that was done in a referral Burn Care Center in Tehran, Iran, during a ten-year period since 2005 to 2014. Patient’s data collected by a specially designed check list. The subjects included 37 consecutive patients with various causes of acid burn injury. Descriptive statistics (means with standard deviations or frequency distribution) of sociodemographic variables were computed.
    RESULTSThe patients’ mean age was 31.97±11.02 years. The mean hospitalization period was 18.08±15.25 days. The grade of burn was III in 75.7% patients. Among the acid-burn patients, 64.8% suffered from CONCLUSIONThe results of this study showed high acid attacks rates. Prevention strategies must be coordinated at national level. So acid-burn patients have to receive the best medical care possible, first locally and then in a specialized center.
    Keywords: Burn, Acid, Injury, Epidemiology, Iran
  • Fatemeh Hosseinzadeh, Moosa Salehi, Nader Tanideh, Davood Mehrabani, Azadeh Sayarifard, Anahita Sedighi Pages 176-182
    BACKGROUNDInflammatory bowel diseases contain two digestive system diseases, ulcerative colitis (UC) and Crohn’s disease with unclear causes. The aim of present study was to investigate the therapeutic effects of administration of the Sesame oil (SO) and grape seed oil (GSO) as enema route in rats suffering from experimental acetic acid induced UC.
    METHODSEighty male rats were randomly allocated into 8 equal groups as health control (HC1) without any disease treated with 1 ml of normal saline as enema; HC2 received SO; HC3 received GSO; negative control (NC) with induced UC receiving 1 ml of normal saline as enema; and positive control (PC) with induced UC treated by asacol. All treatments were performed identically with 4 mg/kg of medication except for asacol that was 100 mg/kg for 7 days. The weight changes was recorded after seven days. The serum levels of malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6, and c-reactive protein (CRP) were measured. Colon macroscopic and microscopic histological changes were also measured at the end of 7th day.
    RESULTSNo significant changes were detected in weight in neither groups on day 0 nor at the end of study. No beneficial effects were seen for all treatments regarding healing process and the decrease in inflammation. Between treatment groups, the lowest MDA (7.40±0.98 U/ml), CRP (83.20±10.01 mg/l) and IL-6 levels (130.86±10.70 mU/ml) and highest TAC (1.91±0.43 mmol/l) belonged to GSO group.
    CONCLUSIONGSO enema alone can be considered as a treatment of choice for UC due to its antioxidant properties
    Keywords: Grape seed oil, Sesame oil, Ulcerative colitis, Enema
  • Fatemeh Mortazavi, Hajar Shafaei, Jafar Soleimani Rad, Leila Rushangar, Azadeh Montaceri, Masoud Jamshidi Pages 183-189
    BACKGROUNDTissue engineering is used for the treatment of many diseases, and the ideal cell source for cartilage tissue engineering is chondrocytes. The main limitation of chondrocyte is the low number of cells in cartilage tissue engineering. This study investigated a suitable cell source with high proliferation rate to obtain a large number of chondrocytes.
    METHODSAdult cartilage tissue samples were obtained from adult patients undergoing surgical procedure, and infant cartilage tissue samples were obtained from polydactyly surgical waste. After isolation and expansion of chondrocytes, the proliferation rate was evaluated by calculating population doubling time (PDT) and MTT assay for both types of cells. Cartilage film was prepared with sheets of over confluent chondrocytes. The cartilage tissue film from infant and adult chondrocytes were evaluated histologically and by immunefluorescent staining collagen type 2.
    RESULTSPDT and MTT assays revealed that the growth rate of the infant chondrocytes was significantly higher than adult chondrocytes. Histological findings showed that sheets were thicker in the cartilage film of infant chondrocytes and they had more extracellular matrix between the sheets of cells than the cartilage film of adult chondrocytes. The findings of the immunofluorescent staining of cartilage film indicated that collagen type II film of polyductily was more positive than adult chondrocytes.
    CONCLUSIONThe recent study presented a new cell source to overcome the limitation of low number of chondrocytes for cell therapy of cartilage defects in adults and also sheets of cells able to overcome the problems of scaffolds.
    Keywords: Cartilage, Cell sheet, Tissue engineering, Infant, Chondrocytes, Adult
  • Kamyar Iravani, Arash Sobhanmanesh, Mohammad Javad Ashraf, Seyed Basir Hashemi, Davood Mehrabani, Shahrokh Zare Pages 190-197
    BACKGROUNDDifferences in causes, severities, areas of stenosis, and the association with swallowing and phonation of larynx and trachea can result into Laryngotracheal stenosis (LTS).This study evaluated the healing effect of bone marrow stem cells (BMSCs) in experimentally induced LTS dog model.
    METHODSSeven dogs were enrolled. BMSCs were isolated from proximal humerus and shoulder of a dog and cultured in media containing alpha minimal essential medium, fetal bovine serum, penicillin and streptomycin, and L-glutamine. BMSCs were characterized morphologically, by RT-PCR, and osteogenic induction. Karyotyping was undertaken for chromosomal stability. Mechanical trauma to laryngeal mucosa was identically conducted by Tru-cut punch forceps in right and left vocal folds. Two milliliter of conditioned media or BMSCs (2×106) were injected in the right site of the tissue and the left side was considered as control after LTS induction. The larynx was visualized 2, 4 and 6 weeks after treatment. Six weeks post-treatment, the larynges were evaluated histologically.
    RESULTSBMSCs were adhered to culture flasks, spindle shape and positive for mesenchymal marker and negative for hematopoietic markers. Osteogenic induction was verified by Alizarin red staining. Karyotype was normal. A complete epithelialization and minimal chronic inflammatory cell infiltration were noted in submucosa of both left (control) and right (cases) vocal folds. The healing effect of conditioned media and BMSCs in comparison to the control group was more prominent.
    CONCLUSIONAs thickness of fibrosis in cases were less than control group, conditioned media and BMSCs were shown to be good choices in healing of LTS.
    Keywords: Healing, Conditioned media, Bone marrow, Stem cell, Laryngotracheal stenosis, Dog
  • Seyedeh-Sara Hashemi, Mahdokht Mahmoodi, Ali Reza Rafati, Davood Mehrabani Pages 198-205
    BACKGROUNDWound healing is a complex and dynamic process following damage in tissue structures. Due to extensive skin damage caused by burn injuries, this study determined the role of human adult peripheral and umbilical cord blood platelet-rich plasma on proliferation and migration in human skin fibroblasts.
    METHODSPlatelet-rich plasma (5, 10, 15, 20 and 50% PRP) from human umbilical cord blood and adult peripheral blood were provided and added to fibroblasts cultured from a human skin sample. Migration and proliferation of fibroblasts were assessed in comparison to 10% FBS and by the fibroblast responses to a concentration gradient.
    RESULTSAll components of the umbilical cord blood PRP significantly stimulated the growth of fibroblasts when compared to the negative control. Fibroblast growth was enhanced in a dose dependent manner. All fibroblast cultures retained normal morphology. No significant difference was noted between umbilical cord blood and adult peripheral blood PRP preparations regarding cell proliferation and migration, but the difference to 10% FBS was significant. 1% and 50% PRP reduced cellular proliferation. The 20% umbilical cord blood PRP and 10% adult peripheral blood PRP had a significant stimulatory effect on the migration of the skin fibroblast cells in comparison with 10% FBS.
    CONCLUSIONAs PRP could promote the migration and proliferation of dermal fibroblasts, it can be safely added in cultures when treatment of chronic wounds without triggering the immune response is needed.
    Keywords: Umbilical cord blood, Platelet rich plasma, Proliferation, Migration, Skin fibroblast
  • Mehmet Can Sak, Selcuk Akin, Burak Ersen, Orhan Tuanli, Aksu Ismail Pages 206-211
    BACKGROUNDGigantomastia is a rare condition characterized by excessive breast growth and can be physically and psychosocially disabling for the patient. Regarding management of gigantomastia, this study evaluates the outcomes of superomedial pedicle with vertical scar or wise pattern skin excision.
    METHODSA total of 425 patients who underwent reduction mammoplasty in our institution were reviewed. Forty eight reduction mammoplasty patients with resection weights greater than 1 kg per breast and treated with superomedial dermoglandular pedicle technique combined with vertical or wise-pattern skin excision were included.
    RESULTSThe patients were between 19 and 66 years old, with an average of 41 years. Total weight of resection was between 1000 and 2600 g, with an average of 1384 grams for right breast and between 1000 and 3000g, with an average of 1434 grams for left breast. The secondary revisions and wound healing complications were extremely high in vertical scar group compared to wise pattern group (87,5% and 12,5%, respectively).
    CONCLUSIONThe authors concluded that superomedial dermoglandular pedicle in the addition of a wise pattern is an appropriate, safe and reliable method when dealing with significantly larger breasts (>1000g).
    Keywords: Gigantomastia, Breast, Skin, Excision, Pedicle, Scar
  • Yogesh C. Bhatt, Sumer Singh, Piyush Doshi, Sanjay G. Vaghani Pages 212-219
    BACKGROUNDLarge soft tissue defects of ankle and foot always have been challenging to reconstruct. Reverse sural flaps, free flaps have been used for this problem with variable success. Reverse peroneal artery flap is an option to use with reliability without microvascular repair. Connections of peroneal artery around talus and ankle joint are deep and reliable with anterior tibial and posterior tibial artery. Arterial inflow and venous drainage improved with including short saphenous vein and reverse sural artery in the flap.
    METHODSTen patients with large defects around heel underwent reconstruction with (RPAF) reverse peroneal artery flap (pedicled) over a period of 2 years. Final inset given after 18-21 days of primary surgery. The mean age of these patients was 45 years.
    RESULTSOf the 10 flaps, all showed complete survival without even marginal necrosis. Two patients had minor donor site problems that settled with conservative management.
    CONCLUSIONRPAF is a very reliable flap for the coverage of large soft tissue defects of the heel and sole. Large defects can be reconstructed without microvascular surgery and without compromising major vessel of foot region. If some experience with perforator flaps and free fibula is there then RPAF is easy to execute with reliability.
    Keywords: Peroneal artery flap, Sural flap, Foot, Heel, Reconstruction
  • Yakup Cil Pages 220-224
    Although various techniques have been described for treatment of severe nose deformities, these problems have high revision rates. Conventional nasal septal surgery may not be adequate for all cases. A 21-year-old male patient with nose deformity underwent a nasal surgery. Patient had both functional and aesthetic nasal problems. Rigid fibular bone graft was used for corrective nasal surgery. Duration of the operation was three hours. Patient recovered without problems. Aesthetic and functional results of the operation were acceptable. Fibular bone graft may offer a long lasting support in treatment of severe nose deformity.
    Keywords: Fibula, Bone graft, Nose deformity
  • Mohd Altaf Mir, Adil Mahmud Ali, Mohd Yaseen, Arshad Hafeez Khan Pages 225-229
    Although hand injuries due to kite strings seem to be trivial, these injuries could be serious enough to lose the function of hand. This case series in the division of Plastic and Reconstructive Surgery of our institution from August 2014 to January 2016 evaluated the clinic-etiological profile, severity and management of hand injuries due to kite strings assessed clinically and radiologically. Eleven patients reported kite related injuries during two years, and 5 presented during 17 months. Of 11 patients, 8 were male and 3 were female with a M:F ratio of 2.66:1. The majority of patients presented with the mean age of 19.9±4.27 years. Eight patients presented acutely to the emergency while 3 believed the injury to be trivial and had delayed presentation. Injuries in the right hand were 8 and 3 in the left hand. Seven patients had injuries in zone II of the hand while 4 presented with zone III injuries. Total number of injured digits was 14 (1.4±1.11), total number of injured tendons was 26 (2.36±2.18), only one patient had nerve injury (mean=0.09), and no patient had any major vessel injury. So strict attention to safety measures and parental/guardian supervision while flying kites can avoid many preventable injuries to life and limb and also let the sport be an enjoyable and safe.
    Keywords: Kite string, Hand injury, Tendon: Nerve, Digit
  • Husnu Tokgoz, Gulsum Tetik, Soner Yalcinkaya, Ali Yildiz, Murat Savas Pages 230-232
    Urethral fistula formation after urethroplasty for hypospadias is a frequent complication. Repeated failures can occur even after multiple attempts at repair. A surgical procedure is described for a problematic resistant urethrocutaneous fistula (UF) with the transverse turnover flap using the Buck’s fascia of the corpus cavernosum. A 23-year-old male was admitted to our hospital with recurrent coronal UF. We placed a suprapubic catheter in the bladder and operated the patient with the flap technique combined with glanuloplasty. In 3rd month follow up, the patient had no fistula with normal voiding.
    Keywords: Buck's fascia, Fistula, Hypospadias, Transverse turnover flap
  • Vassilis Pitsinis, Osama Moussa, Fiona Hogg, Jane Mccaskill Pages 233-237
    Phyllodes tumors are biphasic fibroepithelial neoplasms of the breast. While the surgical management of these relatively uncommon tumors has been addressed in the literature, few reports have commented on the surgical approach to tumors greater than ten centimetres in diameter – the giant phyllodes tumor. We report a case of giant breast tumors and discuss the techniques utilized for pre-operative diagnosis, tumor removal, and breast reconstruction. A review of the literature on the surgical management of phyllodes tumors was performed.
    Management of the large phyllodes tumors presents the surgeon with unique challenges. The majority of these tumors can be managed by simple mastectomy but reconstruction and even oncoplastic conservative management is for selective consideration.
    Keywords: Reconstructive Surgery, Oncoplastic surgery, Giant phyllodes tumors
  • Mir Yasir, Adil Hafeez Wani, Haroon Zargar Rashid Pages 238-242
  • Chetan Satish, Subhash Reddy Pages 246-247
  • Veena Singh, Vijay Kumar, Arun K. Singh Pages 248-250
  • Shahrokh Attarian, Fereidoon Sirati Pages 251-253
  • Shokoh Varaei, Fatheme Mohaddes Ardabili, Parichehr Sabaghzadeh Irani, Hadi Ranjbar Pages 254-256
  • Shabeer Wani, Ovais Matto, Doaa Andejani, Faris Akmugarian, Faris Aldhagri, Ahmad Wafa Pages 257-259
  • Stephanie Au, Ali Yousif, Suresh Anandan Pages 260-262
  • Sunil Gaba, Naveen John, Sandeep Bhogesha, Onkar Singh, Guru Karna Vemula Pages 263-265