javad rahmati

The purpose of this research was to formulate a prediction model for cosmetic surgery based on health literacy with the mediating role of moral foundations and social competence in women applying for cosmetic surgery.

The method of this research in terms of theoretical purpose and in terms of data collection method was descriptive correlation type based on structural equations. The statistical population of this research included all the women applying for cosmetic surgery who referred to cosmetic surgery centers in Tehran in 2023, and 285 people were selected as a sample. The sampling method was purposeful and based on inclusion and exclusion criteria. In order to collect information in the field section, the questionnaires of tendency towards cosmetic surgery by Etamidi Fard and Amani (2013), health literacy of Montazeri (2013), ethical foundations of Haight and Graham (2007) and social competence of Felner (1990) were used. At the inferential level, Pearson's correlation coefficient was used and structural equation method was used to check the presented model.

The results showed that the significance of the regression weights related to the measurement model of variables of health literacy, moral foundations, social competence and tendency to cosmetic surgery is a sign that all indicators are representative for the relevant variables.

These findings provide valuable insights for healthcare professionals and policymakers to develop targeted interventions that enhance health literacy and social skills, ultimately aiding women in making more informed choices about cosmetic surgery.

NAC reconstruction represents the final stage of breast reconstruction. This can be  accomplished thr ough non-surgical and surgical procedures, each with its own set of advantages and disadvantages. The majority of surgeons employ the Skate flap. The following is a de monstration of a modific ation to this flap.A woman, 56 years of age, who had previously undergone breast reconstruction using a TRAM flap, was admitted for nipple reconstruction. During the design of the star flap, a modification was executed, which involved reciprocally changing the orientation of the lateral flaps. Both flaps were properly positioned in their prepared locations during the flap inset and skin closure. The final outcome was satisfactory and aesthetically pleasing.The modification in the design of the Skate flap alters the orientation of the transferred flaps, making the final inse t feasible with less dis figurement.

The sphenopalatine ganglion nerve block (SPGB) in endoscopic sinus surgeries has beenshownto reduce postsurgery narcotic consumption.

This study aimed to investigate the effect of SPGB on bleeding and pain during and after rhinoplasty and septoplasty.

This study was conducted as a double-blind, randomized clinical trial and included 30 patients who were scheduled for elective rhinoplasty and septoplasty. All the participants received propofol/remifentanil anesthesia and similar intraoperative care. The patients were divided into 2 groups: the SPGB group, which received 0.5% bupivacaine, and the placebo group, which received normal saline. The study compared the amount of narcotics used during and after the operation, pain levels during and after the operation (at 2, 4, 6, and 24 hours after the operation), and bleeding during the operation between the 2 groups. The surgeon’s satisfaction with bleeding control was also recorded at 30, 60, and 90 minutes.

In the SPGB group, 86% of the participants had ASA (American Society of Anesthesiologists) class I, while in the placebo group, 80% had ASA class I. There was no significant difference in postoperative pain between the control and intervention groups (P> 0.05). However, the SPGB group showed a significant decrease in intraoperative pain based on the amount of narcotics received (P < 0.05). According to the Boezaart criterion, the control group had significantly higher rates of severe and moderate bleeding (P < 0.05), whereas the bupivacaine group had a lower total bleeding rate (P < 0.05).

The administration of bupivacainewaseffective in reducing pain, bleeding, andthe need for narcotics during surgery. The SPGB has the potential to decrease bleeding and drug utilization, making it a preferable option for anesthesiologists aiming to minimize the use of anesthetics.

Skin lesions and masses of forehead are challenging topics in the field of reconstruction. Skin grafts and local flaps have significant role in reconstruction of skin defects of forehead. Proper design of flap can save hairline configuration and symmetry of eyebrows.

Case report: 

A young woman with congenital sebaceous nevus-Jadassohn-wanted to remove this lesion. After excision, there was skin defect of 4 cm diameter. A O to T flap designed and incisions were on bilateral hairline. The defect was covered without any disruption of hairline.

Rotational-advancement flaps are among reliable flaps in reconstruction of forehead skin defects. O to T flap belongs to this category which is effective in traumatic patients and reconstruction following tumor resections.

Bleeding during rhinoplasty surgery has a negative effect on the quality of surgery; so, it is important to reduce bleeding during rhinoplasty. We aimed to evaluate the effect of injectable tranexamic acid (TXA) and nasal spray of desmopressin (DDAVP) on reduction in intraoperative bleeding and ecchymosis after open rhinoplasty.

  In a Randomized Clinical Trial ( RCT)  prepared since 2020 to 2021 in Razi Hospital and Imam Khomeini Hospital, Tehran, Iran on 42 patients who underwent open rhinoplasty were divided into three groups. In the first group, TXA was injected one hour before surgery at a dose of 10 mg / kg with a placebo inhalation spray. In the second group, DDAVP was administered as a nasal spray at a dose of 40 mcg with a placebo injection. The third group received a placebo spray and placebo injection. All required data were gathered and analyzed.

In TXA group and DDAVP groups, the volume of bleeding during surgery significantly (P=0.022) decreased compared to placebo group, also, the quality of the surgical field and the surgeon's satisfaction significantly (P=0.007) improved compared to the placebo group but not with each other. Unlike placebo group, there were no reports of postoperative bleeding in the TXA and DDAVP groups. Duration of surgery, ecchymosis on the day after surgery and coagulation tests before and after surgery were not significantly different in three groups.

Use of DDAVP and TXA can both reduce the amount of bleeding during surgery and postoperative bleeding in rhinoplasty and improve the quality of the surgical field and the surgeon 's satisfaction during surgery.

 Granuloma faciale (GF) is a rare benign cutaneous vasculitis that manifests as plaques or papules on exposed areas of the face. Infiltration of inflammation in the superficial layers of the skin is typical and predisposes the skin to medical treatment. The majority of previous studies have focused on case reports and their definitions.

 Due to resistance to traditional therapies, a 52-year-old woman was consulted for a large growing nasal dorsum lesion. She had received all the available medical treatments, such as corticosteroid injections, PDL, Rituximab, and fractional CO2 laser, which failed. Her defect was reconstructed with partial thickness skin grafts following wide local excision.

 Granuloma faciale is a rare vasculitis in the face that requires medical therapies, although in rare cases may need excisional surgery to be cured.

Skin lesions and need for tissue evaluation, makes skin surgery an important part of treatment. Each excision is accompanied by skin repair. One of side effects of lesion excision is dog ear and cosmetic problems, particulary on face.

 A middle age woman presented with an old leishmaniosis scar in her face. she asked how can we remove the lesion with minimal scar. In the planned operation the lesion was excised some deeper fatty tissues at both ends. At the end of wound closure, there was not ant dog ear around wound.

There are numerous options to prevent and correct dog ears at the end of skin closure- depending on size and location of the lesion. in our recommended technique, subdermal fatty excision attached to the lesion, may remain minimal extra skin at the end of skin closure.

This study is executed to compare two common reconstructive surgeries in suppurative hidradenitis.

Patients with severe supporutive hidradenitis who had operations to excise their axillary lesions and then treated with two standard surgical repair techniques (lateral thoracic flap vs parascapular pedicle flap) were evaluated in a retrospective cohort study. Assessments included range of motion of shoulder, scar objective measurments, and Dermatology Quality of Life Index questionnaire.  

Mean range of motion in flexion of parascapular flap and lateral thoracic flap were 176 and 175 degrees, respectively. Range of motion in abduction of parascapular flap and lateral thoracic flap were 166 and 147 degrees, respectively which is interesting according to future disabilities. Pigmentation, thickness, pliability and vascularization were objective scar measurements which there were not significant differences between groups. Patients` responses to questionnaire on their satisfaction of surgery did not differ significantly between two groups in any items of questionnaire. But summation of items took lower points in parascapular flap group versus lateral thoracic flap group. 

Despite various reconstructive options in axillary skin defects following suppurative hidradenitis surgery, there is not a generalized agreement on best choice, and each technique has its advantages and disadvantages.

The main need of sufferes in natural disasters, is to provide housing, especially to determine the place of temporary residence in critical situations. After the incident, it is not possible to provide suitable places for the injured immediately. Before such crises occur, proper planning must be done to determine the temporary residence so that the necessary infrastructure can be provided and in case of an accident in a crisis situation, it is possible to quickly set up camps for the injured. In this study, to determine the optimal location of temporary residence in Tabriz, various standards effect have been considered such as medical centers, fire brigade, faults, fuel stations, infrastructure facilities, worn-out tissue, watercourse complications. The desired standards were completed at first by experts and once again by experts in this field based on form of a questionnaire, then using the fuzzy hierarchical analysis method, the final weights of each standard were determined. Experts attributed the closeness to the worn-out texture and the second group of experts to the standard of avoiding faults the highest weight. That was important the avoiding standards to hazardous site and the river, for the both experts group. Finally, the last weights obtained the opinions of experts groups from fuzzy hierarchical analysis have been entered in Arc GIS software and the relevant maps that have been prepared using weight overlap in this research. The results show that before the incident, the western part of the city has suitable for temporary accommodation, and after the incident, the central part of the city is appropriate for settlement site. In addition, by comparing the vulnerability maps of Tabriz, the necessary locations for the construction of a temporary housing site were prioritized.

Undesirable appearance of the scar tissue after aesthetic surgery can affect the outcomes and patient satisfaction. In recent years, early laser therapy had been encouraged to reduce the scar tissue formation. However, the available evidence regarding the outcomes of laser therapy utilizing combined lasers are limited. In the current study, the effects of combined laser therapy using pulsed dye laser (PDL) and fractional CO2 laser on the appearance of the scar tissue after aesthetic surgeries were investigated.

There were 15 patients enrolled in the current study including 13 mammoplasty and 2 abdominoplasty patients. In mammoplasty, each breast was randomly assigned to the laser therapy or control group. In abdominoplasty, split scar design was used. In laser therapy group, at the end of the third postoperative week, PDL 585 nm was radiated. Furthermore, at the end of the sixth week, fractional CO2 laser was radiated. The patients were followed for 6 months after the last laser therapy session. Visual analogue scale was used to rate the appearance of the scar tissues by 3 surgeons blinded to the treatment of scars. The appearance of the scars was determined as poor, fair, good or excellent.

VAS averaged 5.5±0.8 in laser therapy group and 4.8±0.8 in the control group. The difference was not statistically significant (P=0.057). There was no scar with excellent appearance in the current study. All of the scars were fair and good in the laser therapy group. In the control group, 13 scars were fair. The difference was not significant (P=0.227).

Early combined laser therapy using PDL and fractional CO2 laser was associated with improved appearance of the scar tissue in short-term follow up, however, the effects were not statistically significant.

Minimally invasive surgeries are widespread and technically enhancing. Thyroidectomy is a common surgery and non-invasive adjustments make it more interesting. Neighbor neurovascular bundles need to be protected during minimally invasive thyroidectomy. A 15 yr old female who underwent minimally invasive thyroidectomy due to nodule, had presented with upper brachial plexus injury, without proper recovery despite physiotherapy cessions. She was operated in 2 stage reconstructive surgeries. First, musculocutaneous nerve innervated by 2 branches of median and ulnar nerves. Then, in a compound operation, axillary nerve innervated by long head branch of triceps nerve and suprascapular nerve by accessory nerve. She gained good function of upper limb. Minimally invasive operations in head and neck area can be disastrous, if surgeons do not consider anatomical points. Brachial plexus reconstructive surgeries are complicated operations to preserve hand functions following iatrogenic injuries.

Auricular reconstruction of partial ear defects is usually challenging, especially in extended resections or traumas. Helical rim is the most noticeable part of ear with aesthetic significance, which demands detailed procedures. Helical rim advancement is a known procedure to reshape lacerated rim. In the original technique, a chondrocutaneous flap is raised in order to preserve the posterior skin and consequently, the blood supply.

Due to auricle’s rich blood supply, we selected an inferiorly based flap of helical rim, which we incised completely, even the posterior skin, in order to advance the flap more freely to the cephalic side and relaxed cephalically. In five patients with helix tumors, this reconstructive procedure was done without threatening the blood supply and flap ischemia. Moreover, posterior skin traction or subsequent deformity, as one of concerns of reconstructive surgeons, were also eradicated.

It appears that this modification can be noteworthy in auricular reconstruction.

 This study aimed to compare the analgesic effect of single-dose spinal versus epidural analgesia for labor pain to verify if applying a single dose spinal analgesia is an efficient technique for labor pain management as an alternative for epidural analgesia.

 A total of 128 women in the active phase of labor were randomly allocated into two groups of spinal analgesia (n = 64) and epidural analgesia (n = 64). The latter received a bolus dose of 16 mL of 0.125% bupivacaine and 50 μg fentanyl and repeated 5 - 10 mL of bolus dose. The former received 2.5 mg hyperbaric bupivacaine plus 50μg fentanyl. Pain intensity was measured using the visual analog scale (VAS). The duration of analgesia, mode of delivery, the duration of labor, side effects, and maternal satisfaction were also compared.

 There were no significant differences in the rate of cesarean section, duration of labor, postpartum hemorrhage, and the frequency of the fetal heart deceleration until 30 min after analgesia between the two groups. Measured pain after 30 (P = 0.0001) and 90 min (P = 0.01) was significantly lower in the spinal group than the epidural group. However, there was no significant difference between the spinal and epidural groups concerning the VAS scores at 150, 210, and 270 minutes. Maternal satisfaction was higher in the spinal group (P = 0.002). The mean duration of analgesia was longer in the spinal group than the epidural group (P = 0.0001).

 According to the findings, single-dose spinal analgesia, compared to epidural analgesia, is a safe, fast, and efficient technique for labor analgesia, which can be easily performed. In addition, it provides a high satisfaction level in the parturient.

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Medial canthus area, as one of most common sites of facial skin cancers, is notified for reconstruction. There are numerous reconstructive options to cover resulted skin defects, which have their own advantages and disadvantages. Here, we decided to present our experience in medial canthal area with amazing result.

Case Report: 

A 47-year-old man with basal cell carcinoma (BCC) of right medial canthus, without extra involvement, was admitted. Following lesion excision with safe margin, the resulted skin defect in 30 mm diameter was reconstructed with full thickness skin graft from posterior auricular area. Several months later, it was really difficult to find scar or operated skin, as supported by complete patient`s satisfaction.

The space between eyes has unbelievable aesthetic and social importance. Any added scar or incision to this area is always challenging. It seems full thickness skin graft - if harvested from proper donor site - can be acceptable in long term aesthetic outcome compared to other reconstructive options.

Skin defect reconstruction following tumor resection, is a challenge for surgeons. Nose as a key point of aesthetics has a significant role in this scenario. One of the practical approaches is dorsal nasal flap (Rintala) to cover lower 1/3 nasal defects. The disadvantages of this method are limitation to reach lower areas, especially nose tip, flap ischemia and wound dehiscence.

Case report: 

A 47 years old man with supratip BCC lesion underwent tumor resection and prepared for dorsal nasal flap reconstructive surgery, in which dorsal hump resection caused relaxed flap transfer and ultimately more acceptable profile view.

Advancement of the dorsal nasal flap more distally can be achieved by dorsal hump reduction in selected patients, which makes patients more satisfied with their new nasal form and appearance and reduces the risk of distal flap ischemia.

The study aimed to compare the efficacy and side effects of intravenous magnesium sulfate (MgSO4) and oral nifedipine for inhibition of preterm labor.
This randomized controlled trial was performed on 220 women with preterm labor between 32 and 34 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. The primary outcome was inhibition of preterm labor, defined as prevention of delivery for 48 hours with inhibition of uterine contraction, and the secondary outcome was maternal side effects.
From 220 patients, 110 received nifedipine and 110 received MgSO4. There were no differences in suppression of labor pain in 24 hours and 48 hours between the two groups. Also, there were not statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome, and NICU admission between the two groups. Maternal hypotension was higher in the nifedipine group, but the difference was not significant (P = 0.08). Dyspnea (P = 0.01) and minor maternal side effects (P ≤ 0.001) were significantly higher in the MgSO4 group than the nifedipine group. Serious maternal adverse effects and severe hypotension were not seen in any of the groups.
Nifedipine is as effective as MgSO4 in arresting labor and delaying delivery for 48 hours. However, nifedipine is associated with significantly fewer maternal adverse effects.

Obtaining a good sensory and motor block is the goal of performing spinal anesthesia for surgeries. The aim of this study is to compare the effect of trendelenburg position on sensory block level after spinal anesthesia with intrathecal hyperbaric bupivacine. We enrolled 80 men, classified as ASA I, scheduled for elective hernia repair under spinal anesthesia. Participants were randomly allocated equally to one of the two groups, horizontal or trendelenburg position. Spinal anesthesia was performed in the sitting position using 15 mg of 0.5% hyperbaric bupivacaine. Then the patients were turned to supine position. In trendelenburg position group, a 20 degree head tilt position was performed for 40 seconds, then the patients were returned to horizontal position and 30 mg ephedrine was administered intramuscularly. Sensory block level and incidence of hypotension were recorded in the two groups. There were significant effects of trendelenburg position on sensory block heights during the study period (10.61 ± 0.32segments blocked above the injection point versus 7.24 ± 0.51 in horizontal group). No episodes of severe hypotension were seen among the patients. Six patients in horizontal group experienced intraoperative discomfort or pain, versus no patient in Trendelenburg group. (p=0001). A higher level of sensory block can be obtained with performing a short time head down position after intrathecal injection.

Subarachnoid block with local anesthetics and opioids enable efficacious spinal anesthesia because of their synergistic effect and permit the use of low-dose local anesthetics, which results in a stable hemodynamic state. The purpose of this study was to describe the cardiovascular effects of spinal anesthesia with low-dose bupivacaine and sufentanil on patients with coronary artery disease. This study was a double-blind randomized clinical trial. A total of 18 patients who had known coronary artery disease were enrolled. Our subjects underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded. The average mean arterial pressure decreased 15% in the first 15 min of spinal block in our cases. No patients presented with hypotension and the subjects were without complaints during the spinal anesthesia. All patients remained alert, and no ST segment changes were observed intraoperatively and until 6 h after the operation. Baseline ejection fraction (EF) 40% or less was observed in 10 patients and these subjects were compared with other patients. Systolic and diastolic blood pressures, mean arterial pressure, and heart rate decreased during the first 15 min in response to spinal anesthesia in both groups of patients, but decreased more significantly in patients with EF >40%. We recommend spinal block with low-dose bupivacaine and sufentanil in patients with coronary artery disease and especially in patients with low EF.