World Journal of Plastic Surgery
Volume:4 Issue: 2, Jun 2015

Filler materials are gaining popularity in nonsurgical rhinoplasty the major advantages are the ability to camouflage the surface deformities, and also the soft and malleable consistency; while the major drawback of the safe fillers such as hyaluronic acid is short durability. In this study, we evaluated the injectable cartilage shaving as an autologous filler material for correction of minor contour deformities in rhinoplasty. Injectable cartilage shaving was used for correction of surface irregularities in primary or secondary rhinoplasty, and long term results of 128 patients were evaluated. The source of cartilage was autologous septum, rib or less frequently, the ear concha. The material was injected with 14 to 18 gauge needles or blunted tip lipofilling cannulas with 1.3-1.7 mm internal diameters. It was performed whether during the septorhinoplasty or as a separate single procedure without elevation of the flap. Success was defined as the long term survival of the graft in the desired site and absence of recurrent deformity or complications such as extrusion, infection or displacement. Twenty seven males and 101 females underwent the procedure from May 2008 to January 2014. Mean follow up period was 31 (13-58) months. Ninety five percent of patients were satisfied or very satisfied with the results at the last follow up visits and touch up procedure was performed for the unsatisfied patients. Injectable cartilage shaving is a reliable filler to correct and camouflage the surface irregularities, and it is durable and predictable in long term follow ups.

Autologous platelet concentrate has been used to improve the function and regeneration of injured tissues. Tendinopathies are common in clinical practice, although long-term treatment is required. On the basis of lead time, we compared the effect of using platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in repairing rat Achilles tendon. The effectiveness of using PRP and PRF was evaluated after 14 and 28 postoperative days by histological analysis. The quantification of collagen types I and III was performed by Sirius red staining. Qualitatively, the data were verified with hematoxylin-eosin (H&E) staining. In Sirius red staining, no significant treatment differences were found between groups. Statistical difference was observed only between PRP (37.2% collagen) and the control group (16.2%) 14 days after treatment. Intra-groups compared twice showed a difference for collagen I (27.8% and 47.7%) and III (66.9% and 46.0%) in the PRF group. The control group showed differences only in collagen I (14.2% and 40.9%) and no other finding was observed in the PRP group. In H&E staining, PRF showed a better cellular organization when compared to the other groups at 28 days. Our study suggests that PRF promotes accelerated regeneration of the Achilles tendon in rats, offering promising prospects for future clinical use.

Many young women are satisfied with their large breasts but suffer from sagging due to heaviness. In this article; we present a novel modification of vertical scar breast reduction based on a special indication. From January 2006 to May 2012, twenty five individual patients underwent operation using modified technique with superior pedicle and vertical scar. Young women between ages 25-35 years with voluminous breasts who requested mastopexy rather than reduction were selected for the surgery. The mean patient age was 30 years and body mass index (BMI) was 27.8±1.07 kg/m2. Mean nipple transposition was 6.5 cm. Mean weight for resected tissue was 415 g for left and 419 g for right breast. Mean operative time was 125 minutes. Patients were followed up for 9-22 months. No serious complications encountered in consecutive patient series. The only complication was permanent wrinkling probably due to vertical closure in 5 of 25 patients which did not resolve during the follow-up period. We recommend that the Snowman design is a useful tool for superior pedicle breast reduction technique providing good projection and a short scar in selected patients.

Combined procedures involving elective breast surgery at the time of abdominoplasty are frequently performed procedures in aesthetic plastic surgery. While found to be safe outpatient procedures, many surgeons elect to perform combined abdominoplasty/breast surgery as inpatient surgery. This study was performed to explore the practice of performing the combined procedure as an inpatient in the United States. The Nationwide Inpatient Sample database was evaluated using ICD-9CM procedural codes to identify hospitalizations where patients underwent abdominoplasty combined with breast surgery. We trended the frequency of this combined procedure, and evaluated the rate of acute post-operative complications, length of inpatient hospitalization, and total hospital charges. Between 2004 and 2011, 29,235 combined abdominoplasty/breast procedures were performed as inpatient in United States. The rate of major post-operative complications in the acute hospitalization period was 1.12% and included CVA (0.02%), respiratory failure (0.6%), pneumonia (0.3%), VTE (0.1%), and myocardial infarction (0.1%). Hospitalization averaged 1.8 days and resulted in $31,177 of hospital charges. The demographics of the combined procedure transitioned as i) frequency of inpatient surgeries decreased, ii) percent of patients >50 yr increased, and iii) hospital charges increased from 2004 to 2011. A significant number of surgeons are performing combined abdominoplasty and elective breast surgery as inpatient procedures in United States. The combined surgery is safe but is associated with small risk of major post-operative complications. A short inpatient hospitalization may be beneficial for high-risk patients interested in combined procedures, but must be analyzed against the rising costs of inpatient surgery.

Facial telangiectasias are superficial cutaneous vessels that can result in noticeable aesthetical imperfections. This study presents a technique for the removal of facial telangiectasias using hand cautery. Twenty-five patients with facial telangiectasias were treated using hand cautery (Medicell Inc, Athens, Greece) during 2009-2013. Photo documentation was performed for each patient before and immediately after treatment. Treatment was performed by cauterization at 800°C, delivered via a 30G tip directly to the lesions for milliseconds. Twenty two out of 25 patients (88%) exhibited complete resolution of telangiectasias using hand cautery. In 5 (20%) patients, single application achieved complete resolution of lesions and in 10 patients (40%) re-treatment was required after 3 weeks. Four patients (16%) required 3 consecutive treatments from which 2 patients (8%) showed slight improvement and one patient (4%) no improvement. No major complications were associated with this procedure except the formation of a white scar in two patients that became inconspicuous after 3 months. Minor complications included skin irritation and edema immediately after the treatment, which resolved within 2-3 days without intervention. Hand cautery is a very safe, effective and inexpensive tool for the treatment of facial telangiectasias. It is simple, cheap, and requires minimal training, although it is limited to the treatment of more superficial and small lesions. We believe that this technique is suitable for office based setting. The advantage of using inexpensive and portable instruments will also be beneficial in developing counties where access to more expensive equipment is limited. Results are satisfactory but more patients are needed to validate the technique.

Burn is still a majordevastating condition in emergency medicine departments among both genders and all age groups in all developed and developing countries, leading to physical, psychological scars and economical burden. The present study aimed to determine the healing effect of topical treatment with Arnebia euchroma on second-degree burn wound in rats. Fifty rats were divided into 4 equal groups receiving the ointment base, normal saline (NS), standard 1% silver sulfadiazine (SSD), and 5% and 10% Arnebia euchroma ointments (AEO). The mean of burn area, percentage of wound contraction, histopathological and bacteriological assessments in the injured area were dtermined during the study. Average area of wound on the 10th day was 10.2±2.3, 8.4±2.6, 12.4±2.5, 5.9±2.2 and 5.7±2 cm2 for ointment base, NS, 1% SSD, and 5% and 10% AEO, respectively. Wound size was significantly lower in 10% AEO than 1% SSD and control groups on the 10th day post-burn injury. On day 11, the percentage of wound contraction in 5% and 10% AEO was 53.9%±14.7% and 55.9±10.5% which was more than 1% SSD (15.3±10.8%). The collagen fibers were well formed and horizontally-oriented in 5% and 10% AEO groups when compared with other groups. Arnebia euchroma ointment was an effective treatment for healing of burn wounds in comparison with SSD and can be regarded as an alternative topical treatment for burn wounds.

It has been shown that topical nanoliposomal formulations improve burn healing process. On the other hand, it has been shown that liposomal formulations increase drug deposition in the normal skin while decrease their systemic absorption; there is not such data available for burn eschar. Present investigation studies permeation of clindamycin phosphate (CP) through burn eschar from liposomal formulations to answer this question. In this investigation, permeation of CP through fully hydrated third-degree burn eschar was evaluated using solution, normal nanoliposomes and ultradeformable nanoliposomes. Liposomal CP were prepared by thin-film hydration and characterized in terms of size, size distribution, zeta potential, encapsulation efficiency and short-time stability. Then the effect of liposomal lipid concentration on CP absorption was investigated. The permeability coefficient ratio (liposome/solution) and permeation lag-time ratio (liposome/solution) of CP through burn eschar at 20 Mm lipid concentration were 0.81±0.21 and 1.19±1.30 respectively, indicating the retardation effects of liposomes. Data also showed that increasing liposomal lipid concentration from 20 to 100 mM, clindamycin permeation decreased by about 2 times. There was no difference between normal liposome and ultradeformable liposome in terms of clindamycin absorption. Nanoliposomes could decrease trans-eschar absorption of CP, in good agreement with normal skin data, and might indicate CP deposition in the eschar tissue.

Advances in burn care over the past 50 years have brought about remarkable improvement in mortality rates such that survival has become an expected outcome even in patients with extensive injuries. Although these improvements have occurred in all age groups, survival in older adults still lags far behind that in younger cohorts. This study determines the outcomes of older adults with burn injury in University Clinical Center of Kosovo. This is a retrospective study that includes 56 burn patients, older than 60 years who were admitted at the Department of Plastic Surgery, between 1 January 2004 and 31 December 2013. Data processing was done with the statistical package of Stat 3. From the statistical parameters the structural index, arithmetic median, and standard deviation were calculated. Fifty six burned patient older than 60 years were included during a 10-year period. Of the 56 elderly patients 29 were women and 27 were men with a mean age of 66.7 years (range, 60-85 years). The differences were not statistically significant for both genders regarding the causes of burn injury. Considering the gradual increase of the elderly population in our country based on the data of the Ministry of Public Services, an increase is expected to the incidence of burn injuries in the population of this category of our country.

Giant condylomata are not usually seen nowadays in developed nations, but such cases are still seen in the under-resourced countries. Condylomata acuminata are commonly transmitted through sexual intercourse. Generally diagnosed based on their appearance. Giant condyloma acuminata also named Buschke- Löwenstein tumour (BLT) is a slow growing cauliflower-like tumor, locally aggressive and destructive, with possible malignant transformation. Common clinical treatment of anogenital warts is conservative, however, in extreme cases conservative therapy is insufficient and surgical excision is required. A case of common presentation of giant condylomata in a 50 years old, divorced, multiparous woman is presented and the literature is reviewed. She presented with 15 years history of slowly progressive vulval lesion and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin and cryosurgery without success. The growth measured 30×10 cm in each side and was successfully excised with no evidence of malignancy concomitant and reconstruction also done.

There are many surgical techniques for treating gynecomastia. We report a new surgical technique in an adolescent with fatty glandular gynecomastia grade III, who was referred from an endocrinologist to our clinic. We excised the gynecomastia with nipple repositioning utilizing the dermoglandular flap (about 1 cm thickness and 10 cm width). After one month, no complication was detected and the patient was satisfied with his new breasts. We suggest this technique for fatty glandular gynecomastia grade III.

Capsular contraction is a frequent complication following breast augmentation. On the other hand, capsular weakness, a not widely recognized complication, may occur around the implant. A weak capsule allows the migration of the prosthesis to the lateral region of the thoracic region or inferiorly, towards the abdomen, due to gravitational forces. The cause of capsular weakness remains unresolved. Implant malposition, with lateral or downward displacement, breast asymmetry, improper contour, with implants moving in the pocket that compromise the aesthetic outcome of breast augmentation and require surgical correction may be different symptoms from the same clinical problem. Capsular weakness is a short or mid-term complication of breast augmentation. Most techniques aim to correct the malposition by making sutures to increase the resistance to the displacement of the implant, rearrange the structures using the capsule as flaps to remodel the envelope of the new pocket, obtaining a more stable and reliable result. In this article, four cases of displacement of breast prosthesis with capsular weakness are described and the surgical treatment that included a capsulotomy and capsulorraphy is described.