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عضویت
فهرست مطالب نویسنده:

seyed esmail hassanpour

  • Naser Mozafari, Seyed Esmail Hassanpour, Abdolreza Rouientan, Arian Karimi Rouzbahani, Golnaz Mahmoudvand, Hormoz Mahmoudvand*

    Complete or total arhinia, in which nasal soft tissue is absent, is an extremely rare disease. The embryological origin of the defect is thought to be the maldevelopment of paired nasal placodes. In this article, we introduce nasal reconstruction with two forehead flaps. The reconstruction was done with two forehead flaps in a 20-year-old male patient with arhinia. Using one frontal flap of the forehead as the inner layer and the other one as the outer layer. The postoperative care was uneventful. He was able to breathe through the nose. No chest pain or any difficulty was mentioned in daily activities. The principal advantage of this technique over previous techniques is that the operation is performed in two stages and at the end of the procedure the patient has the final shape of the nose and is able to breathe normally. Furthermore, this technique could be performed for all age groups.

    Keywords: Ahrinia, Congenital malformation, Nasal reconstruction
  • Seyed Esmail Hassanpour, Hatef Zirakzadeh*, Yasaman Aghajani
    BACKGROUND

    Epinephrine is commonly used in plastic and reconstructive surgeries to reduce the blood loss, and to achieveing the lowest and the most effective dosage of epinephrine can improve the results of the surgery.

    METHODS

    Thirty two rats were divided in four groups. Local injection of epinephrine solution (3 mL) with concentrations of 1:200,000, 1:400,000 and 1:1,000,000 was undertaken in three different groups; and the fourth group was the control in which 3 mL of normal saline was administered 15 minutes before making the incision. The bleeding amount was compared in these groups.

    RESULTS

    A significant difference in blood loss was noted between the control and other groups, but no significant difference was present between epinephrine concentrations of 1:200,000, 1:400,000 and 1:1,000,000.

    CONCLUSION

    Local injection of epinephrine solution was shown to reduce bleeding from surgical incisions, but the difference between various pinephrine concentrations was not significant. The use of the lowest concentration (1:1,000,000) was suggested to decrease epinephrine side effects.

    Keywords: Epinephrine, Incision, Bleeding, Rat
  • Seyed Esmail Hassanpour, Nazila Farnoush*, MohammadYasin Karami, Alireza Makarem
    Background

    Wound healing is a process that has three overlapping inflammatory, proliferative, and reconstruction phases. Silicone gel and Contractubex (onion extract gel) are two main topical agents used for the prevention and treatment of hypertrophic scars. This clinical trial study aimed to evaluate the efficacy and safety of onion extract and silicone gel on hypertrophic scars of the upper extremity and compare it to non-treated patients.

    Methods

    This randomized, double-blind, parallel, clinical trial was done on 120 male patients who had undergone upper extremity sharp injury repair. Patients were assigned to three groups, i.e., Silicone gel (Kelo-cort™; WA, USA) (group 1; 40 patients), Onion extract (Contractubex™, Merz Pharma, Frankfurt, Germany) gel (group 2; 40 patients), and No Intervention (group 3; 40 patients), using drawing sealed envelopes and a computer-based table of randomization. Data were recorded using the Vancouver scale in each visit by two surgeons who were blinded to the study groups. IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp). Data were compared using the ANOVA test. A P-value of less than 0.05 was considered statistically significant.

    Results

    Vascularity (p=0.200), pliability (p=0.058), pigmentation (p=0.701), and height (p=0.438) as subjective scar parameters were approximately similar in post-upper extremity sharp injury wound hypertrophic scar among the three groups.

    Conclusion

    Vascularity, pliability, pigmentation and height, as subjective scar parameters, were not statistically different in post-upper extremity sharp injury wound hypertrophic scar among the groups. Even though onion extract gel and Silicone gel show preventive effects in the literature, especially in burns wounds, further studies are recommended to be conducted to prove the topical effects of above-mentioned gels in patients.

    Keywords: Contractubex gel, Silicone gel, Hypertrophic scar, Upper-extremity
  • Seyed Esmail Hassanpour, Khalil Rostami, Eznollah Azargashb, Kourosh Saberi, Seyyed Hosein Hamraz, Fatemeh Farajzadeh Vajari, Hojjat Molaei*
     
    BACKGROUND
    Ischemia 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.
    METHODS
    Twenty-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.
    RESULTS
    The 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.
    CONCLUSION
    Topical 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
  • Sadrolah Motamed, Feizollah Niazi, Seyed Esmail Hassanpour, Hormoz Mahmoudvand, Hadi Amali Amiri, Eznolah Azargashb, Sedigheh Nadri, Abdolreza Rouintan*
    Introduction

     Rhinoplasty is one of the most challenging plastic surgeries in which achieving the desired outcome requires high techniques as well as a great aesthetic vision. The aim of the current study is to compare the functional and aesthetical priority of the unilateral placement of the spreader graft in the concave side of the nose over the convex side.

    Material and Methods

    A descriptive study was conducted on 282 volunteer patients for primary rhinoplasty during from 2011 to 2013. Nasal examination and desirable lab data’s photography of face and nose was taken. Preoperative nasal deviation from midline of face was evaluated with the guide of preoperative photo. Then it was compared with intraoperative finding and nasal septal deviation evaluated with type  and  number of  cartilage graft .

    Results

    A total of 282 of patient consisting of 195 females and 87 males with a age range of 17-51 years old underwent primary rhinoplasty and were evaluated. Most operations performed on patients who are under 30 years old and 69.1% of patients were females. Two hundred and eighty cases were done through open rhinoplasty and 2 case closed rhinoplasty. One hundred and ninety one patients  (67.7%) for the cause of aesthetic and 91 patients  (32.3%) for the cause of aesthetic plus functional came for primary rhinoplasty.  Amount of pre-operative nasal deviation degree was (71.5%) and intra operative septal deviation was (91.5%), which septorhinoplasty was mostly performed  (91.5%). Fifty nine patients  (20.9%) had mild deviation and 146 (51.5%) had moderate and 77 (27.3%)  patients  had  sever  deviation.

    Conclusion

    Success in rhinoplasty needs to pay attention to the patients desire as well as careful nasal analysis  and  evaluation of  its  subunits together. More than 99% of patients had an open septorhinoplasty that mostly had moderate nasal deviation  (51.8%). These patients were treated with spreader graft (unilateral or bilateral) ± scoring   or batten graft usage of  different  surgical  techniques  was like  other  scientific  and  reliable  centers  in  world.

    Keywords: Rhinoplasty, Nasal deviation, Surgical method
  • Seyed Esmail Hassanpour, Abdolreza Rouientan, Iraj Pourahmadian, Hojjat Molaei *
    Background

    Syndactyly, as one of the most common congenital hand abnormalities, requires surgical repair according to various approaches.

    Case Report

    We report a 28-year-old man with simple syndactyly in his third web.

    Conclusions

    The common concern is about skin defect coverage, and we illustrated in a mathematical objective survey, if distance between to phalanxes’ center was more than 1.5 times diameter (each of phalanxes), then there would not necessary to use skin graft.

    Keywords: Skin transplantation, Syndactyly, Repair
  • Seyed Esmail Hassanpour, Masoud Yavari, Amir Reza Motabar
    Background
    Extended Soft tissue defect of leg including middle and distal parts always has been a challenge for many plastic surgeons and also a frustrated problem for patients and families. To introduce the use of the soleus muscle and reverse sural flaps as synchronous surgical treatment alternative of the leg bone exposure with large soft tissue defect, this study was conducted.
    Methods
    The medical records of patients undergoing transposition of the soleus muscle for treating exposed bone in the leg and simultaneous sural flap were retrospectively analyzed from January 2009 to July 2014, while gathering information on the used muscle was to cover the lesion.
    Results
    Twelve patients with varying ages between 22 and 58 years (10 males and 2 females) were enrolled. The main initial injury was trauma (84.8%), consisting of tibia and/or fibula fractures. Only 1 patient developed insignificant distal flap necrosis who was treated subsequently with surgical debridement and flap re-advancement.
    Conclusion
    The treatment of bone exposure with local muscle flaps (soleus and sural) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay. Sometimes, this method may be applied instead of free tissue transfer.
    Keywords: Wound, Soleus, Sural, Flap, Leg, Soft tissue, Reconstruction
  • Seyed Esmail Hassanpour, Khalil Rostami, Fatemeh Farajzadeh-Vajari, Seyed Hossein Hamraz, Hojjat Molaei
    Background
    Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.
    Methods
    A number of 39 white albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.
    Results
    The mean values of necrosis in the flaps were 603.33 ± 116 mm2, 665.00 ± 220.26 mm2, and 920.00 ± 247.31 mm2 in the EMLA, capsaicin, and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).
    Conclusions
    EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards.
    Keywords: Eutectic mixture of lidocaine, prilocaine, Capsaicin, Random skin flap, Flap
  • Seyed Esmail Hassanpour, Khalil Rostami, Fatemeh Farajzadeh-Vajari, Seyed Hossein Hamraz, Hojjat Molaei *
    Background

    Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.

    Methods

    A number of 39 white-albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.

    Results

    The mean values of necrosis in the flaps were 603.33 ± 116.00 mm2, 665.00 ± 220.26 mm2, and 920.00 ± 247.31 mm2 in the EMLA, capsaicin and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).

    Conclusions

    EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards.

    Keywords: Eutectic mixture of lidocaine, prilocaine, Capsaicin, Random skin flap, Flap survival
  • Seyed Esmail Hassanpour, Seyed Mahdi Moosavizadeh, Mohammad Reza Hadi Sichani, Hamidreza Alizadeh Otaghvar, Mohammadreza Tarahomi, Daryanaz Shojaei, Amir Molaei, Leili Mohajerzadeh
    Background
    undiagnosed metopic synostosis (Trigonocephaly) have many complications for infant such as Brian damage and cognitive & behavioral disorders also aesthetic malformations.There are a lot of surgical techniques for it that have their advantages and disadvantages but with this new method we can solve some of these problems and minimize damages.
    Method
    In this study, 45 infants with Metopicsynostosis underwent surgery in Tehran Mofid Hospital. The Minimum of age were 4 months and Maximum 9 months with average of 6.72 months .Our cases in this study are infants with trigonicephaly that their diagnosis is confirmed with clinical symptoms & signs also with CTScan and paraclinical findings. The most common classification of surgical revision of Craniosynostosis named Whitaker, has been c as follows.
    Results
    After analysis in this study we find significant differences in anthropometric indeces before & after surgery such as lowering of biparietal width after surgery and elevating of frontoparital index after surgery. As in this procedure, we don’t separate the frontal bone segments and it keeps its frame , so less plaques and screws are needed which will decrease the costs of the surgery and the surgical time is much more fewer than the other techniques.And last but not the least, the satisfactions of parents were high and there was no need for secondary surgery.
    Conclusion
    Based on all the perfect results we got , it is safe to say that,Staggered osteotomy as a surgical method for correction of trigonocephaly is useful method and we can use it as a new method in correction of metopic synostosis.
    Keywords: Metopic, synostosis, Trigonocephaly, Staggered osteotomy
  • Masoud Yavari, Seyed Esmail Hassanpour, Marzieh Naghavi Ravandi *, Feizollah Niazi
    Background
    Crushed fingers are one of the most common reasons that patients visit the emergency centers for hand surgery, and based on the level of injury, it can cause many disabilities for patients. It is difficult to decide the treatment strategies (amputation, aggressive revascularization, immediate or delayed complex reconstruction and immediate conservative treatment) for crushed fingers..
    Objectives
    The current study aimed to compare the blood sugar (BS) levels measured by the glucometer in healthy and crushed fingers to predict gangrene in patients referred to 15 Khordad Hospital in Tehran, Iran..
    Methods
    This cohort study was conducted on 265 patients with crushed fingers referred to the emergency center of 15 Khordad hospital in Tehran, Iran, from March 2015 to March 2016. Blood glucose levels were measured by glucometer in the crushed fingers and in the finger of the opposite side at the same time and measurements were recorded. Data were analyzed using t-test and chi-square test with SPSS software version 22..
    Results
    The results showed that 317 crushed fingers of 265 patients were ischemic based on the color, temperature, capillary refill time and pulse oximetry and accordingly the vascular reconstruction was not possible. Of 317 crushed fingers, 61 (19.24%) became gangrene (all with sugar levels lower than 37). The mean BS levels of the amputated and non-amputated fingers were 33.5 ± 1.52 and 111.04 ± 15.27 mg/dL, respectively. Therefore, there was a significant difference in the mean BS level between the patients with amputated and non-amputated fingers (P
    Conclusions
    The lower levels of sugar in crushed fingers compared to healthy fingers can help to diagnose gangrene in crushed fingers..
    Keywords: Ischemic, Gangrene, Blood Sugar, Glucometer
  • Seyed Esmail Hassanpour, Ataollah Heidari, Seyed Mehdi Moosavizadeh, Mohammad Reza Tarahomi, Ali Goljanian, Sanaz Tavakoli
    Background
    Although the assignment and suturing of the spreader graft to the septum is a routine part of rhinoplasty, it is a time wasting procedure and some problems may occur. Rather, autospreader flap is a new method that the dorsal part of the upper lateral cartilage is used as its own graft. In the present study, we intended to compare the functional and aesthetic outcomes of these two techniques of rhinoplasty.
    Methods
    In a clinical trial, patients who referred to 15 Khordad Hospital for elective rhinoplasty during 2013-2014 were enrolled. The functional and aesthetic outcomes were compared between the two techniques of spreader and autospreader graft using rhinomanometry and satisfaction questionnaire in two stages before and one months after the surgery.
    Results
    Total nasal airway resistance increased significantly by both spreader and autospreader, but the difference between the two methods was not statistically significant. The total nasal flow before and after the surgery significantly decreased using both techniques, but this reduction was not significant between the two methods of surgery. When questioned about the satisfaction with the surgery outcomes, 18 subjects (36%) had complete aesthetic satisfaction, 25 (50%) were partial satisfied and 7 subjects (14%) were unsatisfied from aesthetic results. The rate of patient’s satisfaction in both groups was higher for functional outcome. Overall, 32 (64%) subjects were completely satisfied, 13 (26%) were partially satisfied and 5 (10%) subjects did not report satisfaction. Loss of respiratory function in both groups was inevitable due to short time post-operative period.
    Conclusion
    Both spreader graft and autospreader graft techniques can be used in the preservation and restoration of the normal internal nasal valve angle, as well as restoration of dorsal aesthetic lines of the nasal dorsum.
    Keywords: Spreader graft, Autospreader flap, Rhinomanometry, Rhinoplasty
  • Masoud Yavari, Seyed Esmail Hassanpour, Mohammad Khodayari
    Background
    In the restoration of elbow flexion, the phrenic nerve has proven to be a good donor, but considering the role of the phrenic nerve in respiratory function, we cannot disregard the potential dangers of this method..
    Objectives
    In the current study, we reviewed the results of pulmonary function tests (PFT) in four patients who underwent phrenic nerve transfer..Patients and
    Methods
    We reviewed the results of serial spirometry tests, which were performed before and after phrenic nerve transfer surgery..
    Results
    All patients regained Biceps power to M3 strength or above. None of our patients experienced pulmonary problems or respiratory complaints, but a significant reduction of spirometric parameters occurred after surgery..
    Conclusions
    This study highlights the close link between the role of the phrenic nerve and pulmonary function, such that the use of this nerve as a transfer donor leads to spirometric impairments..
    Keywords: Phrenic Nerve Transfer, Pulmonary Function Tests, Elbow
  • Seyed Esmail Hassanpour, Houman Khajouei Kermani
    Background
    Brow ptosis is a potential complication after upper eyelid blepharoplasty. The aim of this study was to analyze the effect of upper blepharoplasty on eyebrow position.
    Methods
    In this Between April 2011 and March 2013, eighty three patients (166 eyes with mean age of 49.7 years) underwent upper eyelid blepharoplasty. The patients were assessed using pre- and post-operatively digital photographs, in the primary position of the eye while the distance between the upper lid margin and the brow were measured before surgery. The postoperative degree of brow ptosis was evaluated as being mild (<2 mm), moderate (2-4 mm), and marked (>4 mm).
    Results
    The postoperative brow position was unchanged in 46 cases (65.8%), and brow depression was noted in 24 cases (34.2%), including 7 males (58.3%), and 17 females (29.3%).
    Conclusion
    Our study shows that postoperative brow position should be explained to patients before surgery, particularly in male and senile patients as concomitant brow lift or internal brow fixation through the blepharoplasty incision can help to stabilize the eyebrow in the proper position and to prevent this complication.
    Keywords: Upper blepharoplasty, Brow ptosis, Complication
  • Sadrollah Motamed, Seyed Esmail Hassanpour, Seyed Mehdi Moosavizadeh, Ataollah Heidari, Abdoreza Rouientan, Mahmood Nazemian
    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.
    Keywords: Gynecomastia, Nipple repositioning, Dermoglandular flap
  • سید اسماعیل حسن پور*، صدرالله معتمد، عبدالحمید قلی زاده پاشا
    سابقه و هدف
    ضایعات مادرزادی ایجاد شود. در مواردی که عمق زخم ها به ناحیه ی استخوانی رسیده یا بافت های زیرین را نیز درگیر کرده است، اغلب به پوشش فوری با بافت های عروق دار به صورت فلپ های گوناگون نیاز است. ضمن انجام فلپ های موضعی، یکی از مسایلی که اغلب جراحان با آن مواجه می شوند، پیدایش گوش سگی (dog-ear) در انتهای زخم است. پیدایش گوش سگی به علت افزایش تراکم بافت لبه های زخم در حین اعمال جراحی فلپ های انتقالی (transposition) در ناحیه ی پایه ی فلپ شایع است. این عارضه، در تنه و اندام ها، اغلب به علت عدم اهمیت پایه ی فلپ، در همان مرحله ی اول، با رزکسیون مستقیم قابل درمان است. اصلاح گوش سگی در صورت و اسکالپ، به جهت باریک بودن پایه ی فلپ و احتمال آسیب عروقی پایه ی فلپ، باید به صورت تاخیری و در مرحله ی دوم انجام گردد (1). با روش ارایه شده در این مقاله، اصلاح گوش سگی در همان مرحله ی اول با حفظ خون رسانی فلپ (شبکه ی عروقی همراه گالیا) انجام می گیرد. ضمنا با این روش، در مناطقی که اعصاب حسی یا حرکتی نیز در ناحیه ی پایه ی فلپ در محل گوش سگی می باشند، مثل ناحیه ی فرونتال یا ناحیه ی تمپورال، از آسیب به آنها خودداری می شود.
    مواد و روش ها
    این مطالعه به صورت گذشته نگر، برای بررسی میزان موفقیت این روش در برداشتن گوش سگی در 16 بیمار که به علت دفکت های اسکالپ، با فلپ چرخشی اسکالپ توسط مولف ترمیم شده بودند، انجام شد. روش عمل به این صورت بود که در قسمت داخلی فلپ ها، رزکسیون پوست و زیر جلد تا زیر فولیکول مو انجام گرفت ولی لایه گالیا و عروق و اعصاب حفظ شده و با پلیکاسیون این قسمت به زیر فلپ پوست ترمیم شد.
    یافته ها
    16 بیمار با میانگین سنی 40 سال، بررسی شدند. بیماران همگی مرد بودند. اندازه ی دیفکت بطور متوسط 190 سانتی متر مربع بود و به مدت حداقل 6 ماه، پیگیری شدند. عوارضی از قبیل نکروز فلپ، اختلال حسی- حرکتی ملاحظه نگردید. در این سری از بیماران، نیاز به عمل مجدد بعد از برداشتن گوش سگی دیده نشد.
    نتیجه گیری
    با انجام روش ارایه شده در این بررسی، درمان گوش سگی بدون عارضه ی خون رسانی فلپ و بدون اختلال حسی و حرکتی، نیاز به عمل دوم را هم مرتفع می کند.
    کلید واژگان: گوش سگی, فلپ های چرخشی, فلپ های انتقالی, دیفکت پوست سر
    Seyed Esmail Hassanpour *, Sadrollah Motamed, Abdolhamid Gholizadeh Pasha
    Background And Aim
    Trauma, burn, neoplastic resections, congenital lesions and etc. cause scalp defects. Full thickness involvement or bone exposure needs coverage with vascularized tissues or flap. Repairing with local flaps causes dog ears. This problem is more prevalent in the base of the transposition scalp flaps. Dog-ear in trunk or extremities can be repaired in the same surgery but in scalp due to possibility of pedicle injury, correction of dog-ear is postponed to second stage. This article explains a new technique to repair dog-ear of scalp flap in the first surgery without injury to neurovascular plexus of the flap.
    Materials And Methods
    This retrospective study consisted of 16 male patients with scalp defects. The dog-ear of the scalp flaps was corrected by this technique. At first the skin and subcutaneous layers were removed. Galea and neurovascular plexus were preserved, next galea was plicated under the flap and skin defect was repaired.
    Results
    The mean age of patients was 40 years. The mean size of defects was 190 cm. No complication or necrosis was detected during follow up period of at least 6 month.
    Conclusion
    This technique is suggested for dog-ear correction in scalp flaps without sacrifice of neurovascular bundles and in the same surgery.
    Keywords: Dog, ear, Rotation flap, Transposition flap, Scalp defect
  • صدر الله معتمد*، سید اسماعیل حسن پور، ناصر مظفری، عبدالحمید قلی زاده پاشا، اذن الله آذرگشب
    سابقه و هدف
    ترمیم و اصلاح سوختگی های صورت با درگیری لب و چانه و بالای گردن، به علت از بین رفتن کنتور طبیعی، بسیار مشکل می باشد. سوختگی با ایجاد کشیدگی، لب ها را آویخته کرده و زاویهی بین چانه و گردن بههم می خورد و برجستگی چانه و تیروئید با حذف فرو رفتگی زیر چانه، در یک سطح قرار گرفته و باعث اختلال ظاهری و فانکشنال در حرکات سر و لب تحتانی گردن می شود. هدف از این مقاله، ارائه ی روش ساده و جدید برای ایجاد کنتور مناسب، ایجاد برآمدگی چانه، فرورفتگی زیر چانه، از بین بردن کشیدگی گردن و صورت و اصلاح زاویهی چانه/گردن می باشد.
    مواد و روش ها
    این تحقیق و عمل جراحی، روی بیماران دچار عوارض سوختگی ناحیهی لب ها، چانه، زیر چانه و فوقانی گردن که به صورت جمع شدگی (فلکسیون) بود، انجام گرفت. در روند درمانی، عملکرد و ظاهر لب تحتانی و زاویهی ساب منتال و حرکات گردن و فک تحتانی، مورد مطالعه قرار گرفتند. روش درمانی با استفاده از فلاپ درمال بر پایهی فوقانی و تثبیت آن به پریوست قسمت تحتانی فک تحتانی و بازسازی دفکت ایجاد شده بعد از آزاد سازی کنتراکچر، با گرافت تمام ضخامت پوستی بود. برای تحلیل آماری تغییرات اصلاحی زاویه گردن، از تست wilcoxon استفاده شد.
    یافته ها
    یافته های اولیه در 14 بیمار، باعث ایجاد ساختار مناسب ناحیهی چانه و زیر چانه با عملکرد خوب لب تحتانی و حرکات سر و گردن به صورت افزایش فلکسیون و اکستانسیون بوده است. این روش، با توجه به هزینهی کم، سادگی و یک مرحله ای بودن، نسبت به سایر روش ها از جمله فلاپ موضعی و دور دست و اتساع بافتی (tissue expander) کاربردی تر است.
    نتیجه گیری
    بازسازی سوختگی های صورت و گردن، با توجه به محدودیت های بافتی در این نواحی از موارد مشکل در جراحی پلاستیک ترمیمی می باشد. با توجه به اهمیت ظاهری و عملکردی در این نواحی، طراحی روش های ساده و کاربردی مثل روش درمانی پیشنهادی، بسیار راه گشا می باشد.
    کلید واژگان: سوختگی صورت و گردن, yoke deformity, زاویهی چانه, گردن, فلاپ درمال, گرافت تمام ضخامت
    Sadrollah Motamed *, Seyed Esmail Hassanpour, Naser Mozafari, Abdolhamid Gholizadeh Pasha, Eznollah Azargashb
    Background And Aim
    The burned face involved with lip, chin and upper neck causes many problems in natural appearance. The treatment of drooped lip and disturbed cervicomental angle is difficult. The aim of this article is to introduce a new technique for recreation of this angle.
    Materials And Methods
    In a clinical research 14 patients underwent to use a triangular fatty dermal flap and full thickness skin graft (FTSG) after releasing scar tissue. Wilcoxon test used to determine for correcting neck face angle.
    Results
    This study was conducted on 14 patients involved lower face, upper neck scar contracture. These patients gained a good functional and aesthetic result without complication.
    Conclusion
    This study revealed a simple and reliable method in burned lower face, neck. It provides to restore movement and contour in spite of sever tissue deficiency for reconstruction.
    Keywords: Burned lower face, neck, fatty dermal flap, FTSG
  • Seyed Esmail Hassanpour, Seyed Mehdi Moosavizadeh, Mohsen Fadaei Araghi, Bahram Eshraghi
    Background
    The nasal septal deviation (NSD) is one of the major causes of nasal obstruction. This condition increases upper airway resistance. In This study we evaluated the mean pulmonary artery pressure (MPAP) in patients with markedly deviated septum.
    Methods
    Sixty two patients with NSD (Age range: 26-45 years, 34 men and 28 women) were included in the study. Mean pulmonary artery pressure was measured in preoperative period by Doppler echocardiography with the assistance of an expert cardiologist.
    Results
    The mean preoperative MPAP value (22.5 mmHg in men and 20.03 mmHg in women) of the patients in this study was higher than normal population (20 mmHg). The MPAP of nine patients (14.5%) was greater than 25 mmHg. This value was significantly higher than values for normal population.
    Conclusion
    Markedly deviated septum had improper effects in cardiovascular system due to increase in MPAP.
    Keywords: Nasal septum, Deviation, Septorhinoplasty, Pulmonary artery pressure
  • صدرالله معتمد، سید اسماعیل حسن پور، سید مهدی موسوی زاده، هادی آمالی امیری
    سابقه و هدف
    درمان بیماران دچار سوختگی های صورت و گردن و اسکارهای کنتراکچر منتج از آنها بسیار مشکل بوده و نیاز به جراحی های زیاد طی سالهای متمادی دارد که اغلب نتایج دلخواه ایده آل نیز حاصل نمی شود.
    مواد و روش ها
    این تحقیق با روش Case series روی کلیه بیماران با سوختگی قدیمی توتال صورت و گردن با اسکارهای کنتراکچر که طی سه سال جهت درمان جراحی ترمیمی به بیمارستان 15 خرداد مراجعه نمودند انجام شد. در این تحقیق پس از برداشتن کامل اسکارهای کنتراکچر، همه بینی با گرافت FTSG از مدیال بازو ترمیم و بازسازی گردید.
    یافته ها
    طی این مدت، 21 بیمار با میانگین سنی 28 سال بررسی شدند. از این میان، 9 نفر مرد، 10 نفر زن و 2 نفر بچه بودند. نتایج عمل طی 3 ماه تا یک سال بعد از عمل مقایسه گردید که رضایت بخش بود.
    نتیجه گیری
    در درمان این بیماران با سوختگی کامل صورت و گردن استفاده از فلپ های رژیونال ممکن نبود و ترمیم و بازسازی unit بینی با گرافت های تمام ضخامت از مدیال بازو انجام شد. نتیجه از نظر رنگ، قوام و ظاهر کلی رضایت بخش و قابل قبول بود و در یک مرحله انجام پذیر است.
    کلید واژگان: سوختگی, روش های جراحی, ترنسپلانت, گرفت تمام ضخامت
    Sadrollah Motamed, Seyed Esmail Hassanpour, Seyed Mehdi Mosavizadeh, Hadi Amali Amiri
    Background And Aim
    Face and neck reconstruction in burn contracture scar is very difficult and needs many surgical techniques and may have unfavorable results.
    Materials And Methods
    This case series was ran on patients with total burn of face and neck who had contracture scar and were visited in 15 Khordad Hospital during a period of 3 years، from 2008 to 2011. We introduced a technique of FTSG coverage on the defect area after meticulous releasing of contracture scar. The donor site graft was medial arm.
    Results
    During this time period، 21 patients with mean age of 28 years entered the study. There were 9 men، 10 women and two children. In total burn of face and neck، there is no option for local or regional flaps. Thus، the nose unit was reconstructed by FTSG from medial arm. The final color، texture and appearance was good.
    Conclusion
    We have introduced FTSG for nose skin defect in total burn of face and neck، in which flap is not available. We suggest all nose scars to be removed at the level of epidermis and dermis and turn down ala flap، followed by meticulous release of scar tissue especially side wall and careful homeostasis.
    Keywords: Burns, Surgical Procedures, Operative, Transplants, Full Thickness Graft
  • Seyed Esmail Hassanpour, Seyed Mehdi Moosavizadeh, Masoud Yavari, Hamid Reza Hallaj Mofrad, Alireza Fadaei
    Background
    Split- thickness skin graft is one of the most common operations in plastic surgery. It is always painful and patient discomfort from donor site often is more significant than recipient site. There is not still a standard method for treatment of the donor site. The purpose of this study was to determine the best method of dressing the donor site among three different methods with respect to the rate of healing, pain, secretion, infection and cost.
    Methods
    The study includes 60 patients that were randomly divided into three groups. Donor site and thickness of the graft was the same and were dressed with one of the methods including Method A: Paraffin fine mesh gauze, Method B: Nitrofurazone soaked fine mesh gauze and Method C: Dry fine mesh gauze. Each method included an intermediate layer of sterile plastic sheet witch was covered with 10 layers of dry gauze. Comparison with respect to the rate of healing, pain, secretion, infection and cost was done.
    Results
    Thirty seven patients were men and 23 were women. The mean age of the patients was 27.2 years. There was a significant difference between three methods in average time of repair and superiority of dressing with Method B was noted. Pain severity was the least in Method B and difference between the methods was significant. Dressing with Method B had the least secretion and there was a statistically significant difference between three methods. There was no statistically significant difference in cost of the management.
    Conclusion
    This study showed that dressing the donor site with nitrofurazone ointment soaked gauze used as the first layer of dressing and intermediate layer of sterile plastic sheet which was covered with 10 layers of dry gauze was the best method of dressing and had the least complications.
    Keywords: Skin Graft, Donor Site, Dressing
  • مسعود یاوری، سیداسماعیل حسن پور، محمدرضا قاضی سعیدی، شکوفه حسینی زحمتکش
    سابقه و هدف
    از دست دادن دور کردن و خم کردن مفصل شانه در ضایعات شبکه بازویی زندگی روزمره را تحت تاثیر خود قرار می دهد و چندین روش انتقال تاندون برای اعاده عملکرد شانه از قبیل روش های Bateman، Hartman، Saha و آرترودز مفصل شانه استفاده شده است که خیلی موثر نبوده-اند. در این مطالعه، برای برقراری و اعاده عملکرد مفصل شانه از انتقال آزاد عضله گراسیلیس استفاده شد.
    روش بررسی
    تحقیق به روش کارآزمایی بالینی روی چهار بیمار با آسیب در ریشه های فوقانی شبکه بازویی و به منظور اعاده عملکرد مفصل شانه با استفاده از انتقال آزاد عضله گراسیلیس انجام شد. بیماران با آسیب ریشه های فوقانی شبکه بازویی که زیر 40 سال سن داشتند، ولی ضایعه عروقی و یا محدودیت حرکت در مفصل شانه نداشتند، برای این منظور انتخاب شدند. بیماران پس از انتقال عضله به مدت 3 هفته آتل داشته و سپس به مدت چهار هفته تحت فیزیوتراپی قرار گرفته و به مدت یک سال تحت پیگیری قرار گرفتند و نتایج آن بر روی شکست جراحی و میزان ابداکشن و فلکشن به جلوی شانه مورد ارزیابی قرار گرفت.
    یافته ها
    4 بیمار با میانگین 31 سال مورد بررسی قرار گرفتند. همگی آنها مرد بودند. شکست جراحی وجود نداشت. زمان ایجاد اولین انقباض 8/0±4/3 ماه و میزان ابداکشن برابر 14±90 درجه و خم شدن به سمت جلو شانه نیز حدود 90 درجه به دست آمد.
    نتیجه گیری
    به نظر می رسد که استفاده از انتقال آزاد عضله گراسیلیس برای برقراری ابداکشن و فلکشن به قدام شانه در صورتی که از تکنیک مناسب استفاده شود، مفید خواهد بود.
    کلید واژگان: آسیب شبکه بازویی, ابداکشن, فلکشن به جلوی شانه
    Masoud Yavari *, Seyed Esmail Hassanpour, Mohammad Reza Ghazi Saeidi, Shokoufeh Hossseini Zahmatkesh
    Abstract
    Background
    Loss of active abduction and forward flexion of shoulder in brachial plexus injury (BPI) is a severe disability in daily life and employment. Several methods of tendon transfer, such as Saha, Hartman and Bateman procedure, have been described with a limited function. In this study, 4 cases treated with functioning free Gracilis muscle transplantation for BPI were reported.
    Methods
    In this clinical trial, four patients with upper roots of brachial plexus injury treated with functioning free Gracilis muscle transplantation were studied. Patients lower than 40 years and without vascular injury or limitation of shoulder were enrolled in the study. After muscle transplantation, patients had splint for 3 weeks. They received physiotherapy for 4 weeks, and then were followed up to evaluate failure of surgery and active abduction and forward flexion of shoulder for one year.
    Results
    4 patients with mean age of 31 years were studied. All of them were male. Time to first contraction was 3.4±0.8 months. The mean shoulder abduction and forward flexion due to free Gracilis muscle transplantation was 90◦±14◦ and about 90◦, respectively.
    Conclusion
    It seems that functioning free Gracilis muscle transplantation has satisfactory results on increasing shoulder abduction and forward flexion
  • Seyed Esmail Hassanpour, Saied Mehdi Moosavizadeh, Abduljalil Kalantar Hormozi, Behzad Khorvash
  • Seyed Esmail Hassanpour, Mehdi Rasti
    We have performed the ipsilateral vascularized fibular transfer for the treatment of congenital pseudoarthrosis of the tibia (CPT). In the case under study, the conventional treatment by intramedullary rod and autogenous iliac bone grafting had failed. The follow up took place during the next 4 years and the patient can now walk without assistance. Combining a pedicle ipsilateral fibular transfer with an internal fixation and iliac bone graft may be a good option for the treatment of congenital pseudoarthrosis of tibia.
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