فهرست مطالب
World Journal of Plastic Surgery
Volume:8 Issue: 1, Jan 2019
- تاریخ انتشار: 1398/01/20
- تعداد عناوین: 21
-
-
Pages 3-11BACKGROUNDThe reconstructive options for the soft tissues in extremities present serious challenges due to thin non-expendable soft tissues and predisposition to massive edema formation, thus frequently requiring flap cover. This study was undertaken to assess the outcome of a modified version of the sural artery flap with that of propeller perforator flaps for the reconstruction of lower extremities, particularly the heel defects.METHODSThis prospective study was conducted on 40 consecutive patients, of which 20 treated with sural artery flap and another 20 with perforator based propeller flap cover for soft tissue reconstruction in extremities based on predefined inclusion criteria. The clinical outcome of the flap was assessed after three months.RESULTSInclusion of the posterior tibial perforators (along with the sural artery and the peroneal artery) was shown to enhance the flap territory. The raising of the flap was quick with minimal blood loss and the modified flap had a wide arc of rotation for reconstruction of the heel defects. The younger patients regained sensation on the flap earlier, while the durability of the fasciocutaneous flap was excellent in the heel weight bearing areas. The success rate was 95% flap take.CONCLUSIONCareful selection of the perforator and optimal designing of the flap result in favorable outcomes with the use of local perforator flaps for reconstruction in extremities. It provides predictable clinical outcomes with minimal donor site morbidity, is cost-effective, relatively easy technique and requires no special microsurgical setup or instruments.Keywords: Propeller flap, Subcutaneous pedicled propeller flap, Perforator pedicled propeller flap
-
Pages 12-17BACKGROUNDGingival recession is a frequent issue encountered by both the clinician and the patient. This study was aimed to assess the predictability of the free gingival graft as a single step procedure in terms of root coverage and aesthetics in Miller Class I and II mandibular gingival recession.METHODSTen patients (4 males, 6 females) aged 25-30 years with a total of 12 mandibular sites having Miller class I and II recession were selected. All recession sites were treated with single step free gingival graft procedure. Clinical parameters like recession depth, recession width, width of attached gingiva, probing depth and clinical attachment level were recorded at baseline, 6 and 9 months. Visual analog score at 1, 6 and 9 months postoperatively was provided.RESULTSThere was a reduction in mean recession depth from 3.66±1.20 to 0.91±0.99 mm suggesting coverage of 82% over a period of 9 months. There was statistically significant gain in clinical attachment level and width of attached gingiva. Aesthetically, it was acceptable by patients as measured by visual analog scores.CONCLUSIONFree gingival graft as a single step procedure is acceptable in terms of root coverage and aestheticsKeywords: Perioplastic surgery, Aethetics, Gingival recession
-
Pages 18-24BACKGROUNDMortality in burn patients has several contributing factors as sex, age, degree of burns, or inhalation injuries. Usefulness of Candida antigen (CAG) titer is still being under debate to predict mortality. This study assessed correlation between CAG titer and mortality in burn patients.METHODSFrom 1988 to 2011, 877 burn intensive care patients were evaluated for age, sex, total burn surface area (TBSA), multi organ failure (MOF), burn depth, escharotomy, fasciotomy, antibiotic use, co-morbidities, CAG titer and intubation.RESULTSFrom 870 admitted patients, 190 patients were not enrolled. Increasing age was correlated with a higher mortality. The ABSI score of the deceased was 4 points and the TBSA was 20% higher than the survivors. The correlation for age, intubation, TBSA, inhalation injury, MOF, CAG titer, antibiotic use and escharotomy was significant. An increasing mortality was noted with antibiotic use and a CAG titer of 1:8 and higher. CAG titer of 1:8 and higher had a sensitivity of 51.1% and specificity of 86.3% for mortality. Multivariate analysis confirmed high influence of older age, MOF, comorbidities, antibiotic use and CAG titer of 1:8 and higher on mortality. There was a significant correlation for sex, younger age and CAG titer.CONCLUSIONCAG titers of 1:8 and higher might warrant beginning of antimycotic treatment in elderly patients with high TBSA to avoid increase in mortality.Keywords: Candida, Burn, Mortality, CAG titer
-
Pages 25-32BACKGROUNDBurn injuries still negatively influence the various aspects of life like physical performance and quality of life. This study was conducted to investigate at-dismissal self-care compact disk-based instruction program on the physical performance life quality of the patients with burns.METHODSOne-hundred burn patients in Shahid Motahhari Burn Center, Tehran, Iran were randomly assigned to two equal groups of intervention (n=50) and control (n=50). The latter received only routine dismissal self-care program and the former an instruction compact disc plus the routine self-care program at dismissal. The demographic information and burn patients’ quality of life questionnaires were completed before and at months three and six after the intervention self-report program.RESULTSThe physical performance of the intervention and control groups before intervention was 1.61±0.71 and 1.45±0.47, respectively (p=0.41). The physical performance of the intervention group was higher than the control group at three and six months after the intervention (p<0.001).CONCLUSIONAt-dismissal self-care compact disk-based instruction program can increase physical performance and quality of life in patients with burns. Therefore, the burn patients can be instructed based on self-care compact disk-based instruction program as an easy, available and less-costly method to take part in more satisfied treatment.Keywords: Self-care, Burn, Physical performance, Quality of life, Iran
-
Pages 33-42BACKGROUNDSevere and extensive burns and the consequent burn scars have a profound impact on various aspects of the patients’, especially women’s quality of life (QOL). Although burn is considered as a common phenomenon in Iran, few studies are conducted to investigate the QOL in women with burn scars. Thus, the present study aimed at investigating the quality of life of married women with severe burns.METHODSThe present study was a descriptive-analytic study conducted on 101 patients with severe burns who referred in 2016 to Imam Khomeini Hospital, Tehran, Iran. The Burn Specific Health Scale (BSHS) and a demographic questionnaire were used to collect and analyze the data.RESULTSBurns had a significant negative impact on the life quality of women with burns. The average score of quality of life in women was obtained as 51.47±10.44. The most difficult in the quality of life of the patients were in skin sensitivity to heat and treatment regimens and the least difficulty was in simple abilities and hand function.CONCLUSIONThe interventions to improve the quality of life is of high importance in the patients with burns. The findings of this study can help us in designing care plans for women with burnsKeywords: Burn, Quality of life, Women, Iran
-
Pages 43-50BACKGROUNDBurn is one of the most common injuries and the 4th common cause of trauma globally. This study was designed to evaluate the effect of the Mentha pulegium extract on second degree burn injuries in rats assessing histopathologic and macroscopic.METHODSM. Pulegium extract dressings was used as a treatment to deep dermal contact burns in rats, compared with two control groups of vaseline dressing and simple dressing by normal saline. After creating second-degree burn on the dorsum of rats, the treatments were applied for 15 min in three groups. Wound dressings were performed on days 1, 3, 7, 14 and 21st and at the same time macroscopic assessment was performed using a digital camera and software processing of photos. Pathologic evaluation of skin specimens was undertaken on days 1, 3,7, 14 and 21st. Wound healing parameters such as epithelialization, angiogenesis, granulation tissue formation, inflammatory cells were compared between these 3 groups.RESULTSApplication of M. Pulegium extract on second degree burn wounds significantly decreased burn surface area and increased fibroblasts in comparison to simple dressing. There was not any statistically significant relationship between M. Pulegium extract treated group and vaseline treated or simple dressing groups on other wound healing parameters.CONCLUSIONThis study delineated that M. Pulegium extract had a positive effect on healing process of second degree burnsKeywords: Mentha pulegium, Burn, Wound, Healing, Rat
-
Pages 51-57BACKGROUNDPrevious studies indicated that both Plantago major and Aloe vera have anti-inflammatory, tissue regeneration, antioxidant, and immune-stimulatory effects. It is assumed that a mixture of these two herbal medicines may provide a potent material in treatment of skin wound injuries. Therefore, in this study we investigated the effects of Plantago major and Aloe vera mixture in the process of wound healing in rat models according to stereological parameters.METHODSIn an experiential study, 36 male Sprague-Dawley rats (200±20 g) were randomly assigned into three groups (n=12): The control group which received no treatment, gel base treated group, and the 5% Plantago major and 5% Aloe vera mixture gel treated group (PA group). Treatments were done every 24 hrs for 15 days. Wound closure rate, volume densities of the collagen bundles and the vessels, vessel’s length density and mean diameter, and fibroblast populations were estimated using stereological methods.RESULTSPA treated group showed faster wound closure rate in comparison with control and gel-base groups (p<0.05). Numerical density of fibroblasts, volume density of collagen bundles, mean diameter, and volume densities of the vessels in PA group were significantly higher than the control and the gel-base treated groups (p<0.05).CONCLUSIONWe showed that Plantago major and Aloe vera mixture has the ability to improve wound healing by enhancing fibroblast proliferation, collagen bundle synthesis and re-vascularization in skin injuriesKeywords: Wound healing, Fibroblast, Collagen, Vascularization, Plantago major, Aloevera, Stereology, Rat
-
Pages 58-61BACKGROUNDIschemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the efficacy of topical vitamins A and E on improving flap survival.METHODSTwenty-four white-albino male rats were randomly divided into two groups of treatment and control. Standard rectangular, distally based dorsal random pattern skin flap was elevated. Intra-peritoneal cephazoline was administered to prevent any unexpected infection. No pharmaceutical agent was administered for the control group, but pure vaseline ointment. In treatment group, vaseline plus vitamins A and E were administrated daily after surgery for 10 days. The rats were evaluated on the 10th day after surgery for viable and necrotic portions of the flaps.RESULTSThe mean values of necrosis in the flaps were 625±189.56 and 920.00±247.31 in the treatment and control groups, respectively. Vaseline plus vitamins increased flap survival significantly.CONCLUSIONTopical vitamins A and E may be effective pharmaceutical agents to increase viability of random skin flaps in rats. They can be added to vasoactive topical agents to reach better results.Keywords: Vitamin A, Vitamin E, Ischemia, Skin flap, Survival, Ra
-
Pages 62-68BACKGROUNDThe demand for facial plastic surgery has dramatically been increased in recent years. Over the last decade, numerous methods have been improved for facelift surgery. Despite these modifications, skin excision technique has not changed significantly. In this study, authors have tried to introduce a new technique regarding skin excision at the initial step of facelift surgery.METHODSA prospective study from 2012 to 2017 on 52 patients was carried out to apply a new technique for facelift ‘’Prefabricated skin excision method’’ for all eligible patients undergoing facelift surgery. The skin calling for excision was marked by the surgeon, and then, an analgesic drug was administered. Then, excision of the marked part of the skin was performed and afterward the dissection of the superficial musculoaponeurotic system (SMAS) was performed with the direct exposure.RESULTSAll patients were female, and 50 (96.1%) cases were primary face lift and 2 (3.9%) cases were secondary. There were no complications among the patients.CONCLUSIONFacilitating the manipulation of deep layer, using this technique led to the further exposure of the surgical site, and more preferable hemostasis was achieved as well.Keywords: Face lift, Rhytidectomy, Facial cosmetic surgery
-
Pages 69-77BACKGROUNDCurrently, becoming beautiful is a value among Iranian society, although experts have suggested several complications of cosmetic surgery, but decision to have these surgeries has been dramatically increased in recent years. This increase has imposed high workload and costs on the health care system of the country. This study was conducted to explore the reasons why people perform cosmetic surgery in an Iranian context.METHODSTwenty-one subjects from both sexes who were 22-52 year-old and had undergone face plastic surgery between 1-5 years ago were enrolled and semi-structured data was collected via open interviews, while qualitative content were analyzed utilizing conventional analysis methods. Data analysis considered the theme “my face, my destiny” which contained 2 subcategories of “obtaining a chance for a better life “and” obtaining acceptance in society”.RESULTSThe participants considered cosmetic surgery as a blessing from God that played a major role in their future, so they accepted the risks of the surgery.CONCLUSIONUnderstanding experiences of these individuals may help health care team particularly nurses to consult them and other individuals who might think about doing cosmetic surgery through education to help them make a better decision for to do cosmetic surgery.Keywords: Face, Destiny, Content analysis, Decision, Cosmetic surgery, Iran
-
Pages 78-84BACKGROUNDBeauty is a universal phenomenon and debate over what constitutes beauty particularly beauty to human body, has raged since philosophy began. The beauty of individual features depends on “ideal” proportions, and it is suggested that expressing beauty in terms of geometry is possible. Assessment of some used parameters in facial surgeries and harmony of various facial features are essential to surgeon, who requires facial analysis. One of these parameters, is nasolabial angle, in patients undergoing rhinoplasty. This study based on theoretical definitions of beauty and proportions performed the search for the application of this numerical proportions in modern cosmetic surgery.METHODSTwenty-three samples [16 (69.5%) female and 7 (30.5%)] male] were enrolled from patients who underwent rhinoplasty, by a single surgeon. The nasolabial angle was measured in these patients from their lateral profile photographs with adobe Photoshop, before and after surgery.RESULTSIdeal post-operative angle was 111.54±26.5 degrees from this study and 18.8◦ increase in male and 14.68◦ increase in female were seen. There was no significant difference between men and women.CONCLUSIONOur results showed that an ideal proportion can be very useful and practical to assess patient’s preoperative expectations and to evaluate the results after surgery and satisfaction of cosmetic surgery process.Keywords: Aesthetic, Numerical proportions, Rhinoplasty, Nasolabial angle
-
Pages 85-92BACKGROUNDAdherence has been defined as the degree to which a patient’s voluntary behavior corresponds with the clinical recommendations of health care providers. The aim of this study was to predict self-management behaviors in obese patients undergoing surgery based on general and specific adherence scales.METHODSAll obese patients who underwent bariatric surgery in Ghadir Mother and Child Hospital, Shiraz, Iran from April 2017 to September 2017 were enrolled. By using available sampling method, 201 patients with BMI above 35 (36.43±35.11) and in the age range of18-65 years (13.38±80/5) were selected. A questionnaire containing general adherence scale (GAS), specific adherence scale (SAS) and post-surgery self-management behaviors questionnaire (BSSQ) was completed by all patients.RESULTSThe general and specific adherence scales were significant predictors for self-management behaviors after surgery, and positive relation was found for general and specific adherence scales with self-management behaviors.CONCLUSIONSelf-management behaviors regarding eating behaviors, supplements, fruits, vegetables, grains, protein and fluid intake, physical activity, dumping syndrome management have significant relationship with general and specific adherence scales. So increasing knowledge, skills, motivation, self-confidence, self-efficacy and self-monitoring of obese patients after surgery seem necessaryKeywords: General adherence, Specific adherence, Self-management behaviors, Surgery, Obesity
-
Pages 93-96BACKGROUNDFace mask is considered to be an integral part of a surgeon’s dress in operating room. The following study was carried out among the plastic surgeons to know their views about the wearing the face masks in operating room (OR).METHODSA questionnaire was developed and was sent to the 2 groups of plastic surgeons which included 8 questions. Group A consisted of 100 plastic surgeons from the subcontinent. Group B consisted of 100 plastic surgeons of USA and European origins. The questionnaires were sent by emails and the data was analyzed. The questionnaire was consisted of 8 questions.RESULTSAbout 93% of the plastic surgeons in group A wore the mask and 86% in group B. About 96% of plastic surgeon in group A and 99% in group B used disposable masks and only 4% in group A and 1% in group B used re-usable/washable face masks. About 59% in group A and 63% in group B covered the nose. Botox and filler injections were the commonest procedures in which the surgeons opted to perform without face mask (74% in group A and 68% in group B), followed by liposuction (41% in group A and 34% in group B). The majority in both groups believed that face mask decreases the surgical site infection.CONCLUSIONMost of the plastic surgeons wore the face masks in the OR. Care must be taken to ensure that properly designed studies that determine if surgical masks prevent post-operative wound infectionKeywords: : Plastic surgeon, Wear, Mask, Operating room
-
Pages 97-102Thumb hypoplasia, a congenital deficiency of bony and soft tissue of thumb, is often associated with systemic syndromes like Holt-Oram syndrome, and is the second most common thumb anomaly after duplicated thumb. It has traditionally been classified into six categories, which help guide treatment including reconstruction versus pollicization (transfer of the index finger to thumb). Amputation of the thumb and pollicization is the traditional treatment for a IIIB hypoplastic thumb. A five-year-old girl presented with a classic type IIIB hypoplastic thumb in which she has absent motor function, aplasia of the metacarpal, shortened first web space, and an unstable but present carpometacarpal (CMC) joint. Instead of amputation, the thumb was reconstructed by capsulodesis to stabilize the CMC joint, Huber Transfer Opponensplasty and abductor pollicis longus transfer to restore motor function, W-plasty to deepen the first web space, and distraction to lengthen the metacarpal. The patient tolerated the multi-stage reconstruction and bony distraction well. She was followed for one year postoperatively and has demonstrated a functional thumb. This case questions the surgical algorithm for hypoplastic thumbs and suggests a revised classification system for hypoplastic thumbs which would further divide class III based on not only the stability of the CMC joint but the presence or absence of the joint as well. We propose that amputation be reserved for type III hypoplastic thumbs in which the CMC joint is absent, (revised class IIIC) and reconstruction be attempted when the joint is present irrespective of stability (revised classes IIIA and IIIB).Keywords: Congenital hand deformity, Hypoplastic thumb, Huber opposition transfer
-
Pages 103-107Head and neck squamous cell carcinoma (HNSCC) is the most frequent carcinoma of the head and neck region. For coverage of an entire resected mandible with floor of the mouth, 3/4 of the tongue and soft tissue of cheeks and neck bony reconstruction of the mandible and soft tissue reconstruction of tongue, cheeks and a neck large flap are needed. A patient with a superinfected T4 HNSCC was presented to our outpatient clinic. Complete resection of the mandible, bilateral neck dissection and 3/4 resection of the tongue were performed. A complex reconstruction using two free flaps was not feasable, so a large, folded, suprafascial Antero Lateral Thigh Perforator (ALTP) flap for immediate soft tissue reconstruction was used. Because of the anatomy, no reconstruction plate was inserted. On postop day 11, an understandable speaking was possible using a speach canula. Swallowing was possible without regurgitation. Eight months postoperatively, the patients mimic and closure of the mouth were satisfactory. The flap was viable throughout the entire time. It was shown that the suprafascial ALTP flap was a versatile part in the armamentarium for complex mandible soft tissue reconstruction.Keywords: Flap, Mandible, Tongue, Reconstruction, Sqamous cell carcinoma, Surgery
-
Pages 108-111Rhinoplasty is the most common aesthetic surgical procedure in Iran. Dorsal bony and cartilaginous structures of the nose play an important role in nasal esthetics and function. Manipulation of nasal dorsum is one of the cardinal procedures during rhinoplasty operation. Some cases of primary rhinoplasty lead to various post-operative nasal imperfections. One of the most common imperfections is dorsal nasal spur which can cause dorsal irregularities. The accurate rate of imperfections relates to some factors like the surgeon’s experience and his/her precision, and appropriate post-operative patient care. Alomost 15%of revision or secondary surgical manipulations are acceptable for an experienced plastic surgeon. Most of the revision rhinoplasties are due to minor deformities in nasal dorsum like cartilaginous spur or mild focal depression. We have introduced an innovative device “Closed Nasal Chondrotome” that can ease the procedure for treating of minor nasal dorsal deformities. we propose the use of closed nasal chondrotome for mild dorsal spurs and have presented the effectiveness of this device in one patient. This simple but very effective instrument can be an alternative for a revision rhinoplasty procedure in the operating room to an outpatient procedure with local anesthesia. This method has been used in one patient with the satisfactory result, permitting corrections of minor cartilaginous excess deformities, with a less invasive procedure.Keywords: Closed nasal chondrotome, Revision rhinoplasty, Dorsal spur
-
Pages 112-115Dorsal dimelia (the appearance of dorsal hand structures on the palmar aspect of the hand) and ventral dimelia (the appearance of ventral hand structures on the dorsal aspect of the hand) are rare congenital anomalies of the hand. None of the previously reported cases had combined dorsal and ventral dimelia in the same patient. Here, we report a case of severe ulnar ray deficiency. The hand had two digits: the radial digit had a palmar nail (dorsal dimelia) and the ulnar digit had absence of the normal dorsal nail along with the appearance of an ectopic pulp on the dorsal aspect of the digit (ventral dimelia). Ulnar ray deficiency is an error of sonic hedgehog (SHH) responsible for antero-posterior patterning of the limb in-utero. Ventral and dorsal dimelia are errors of dorso-ventral patterning of the hand. The complex interactions of SHH with the dorso-ventral axis of development may explain the concurrent dimelia in our patient.Keywords: Dorsal dimelia, Palmar nail, Ventral dimelia, Congenital, Hand
-
Pages 116-119Botulinum toxin (BTX) is also well-known as Botox is produced by a gram-positive anaerobic bacterium called Clostridium botulinum. Generally, clinical manifestations of BTX can be observed after consumption of contaminated food, from colonization of the infant gastrointestinal tract, as well as following the infection of the wound to this bacterium. There are seven types of this neurotoxin labeled as A, B, C (C1, C2), D, E, and F. Human botulinum is caused by types A, B, E and rarely F. The most common clinical symptoms of BTX in cosmetic goals are cervical dystonia, severe primary axillary hyperhidrosis, strabismus, neurogenic detrusor over-activity, chronic migraine, upper limb spasticity and blepharospasm. Botox has a wide range of therapeutic uses and occasionally patients receiving this treatment may experience botulism symptom including local and even distant and autonomic symptoms. Despite the efficacies of Botox in treatment of myriad neurologic and cosmetic conditions, it may carry some risk of sever adverse effects which may be the result of local or systemic spreading of the drug. Our patient was a 22 years old man who received Botox for axillary hyperhidrosis after two weeks, when most of generalized complications of botulinum toxin appeared. This case was introduced for being aware of dangerous complication of Botox. Pyridostigmine could relieve symptoms of the patient.Keywords: Botulinum, Toxin, Botox, Complication, Iran
-
Page 125This article has been retracted by the editorial due wrong inclusion and the mistake by the publisher in
World J Plast Surg.
Date of Retraction: 01.08.2018