فهرست مطالب

  • Volume:7 Issue: 3, 2018
  • تاریخ انتشار: 1397/06/06
  • تعداد عناوین: 20
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  • Mimi R Borrelli Pages 275-282
    There is growing awareness of the substantial global burden of surgical disease. Conditions treated effectively by plastic and reconstructive procedures make a large proportion of the global surgical diseases, and disproportionately affect individuals at the lower end of the economic spectrum. This article reviews the role of plastic surgery in global health, highlights the ongoing need for plastic and reconstructive surgery globally, and increasing efforts that have been made to meet these needs. There global shortage of plastic surgeons in low and middle income countries, but plastic surgery has a long tradition of humanitarian aid, has been a leader in global surgery development. Plastic and reconstructive surgical care has increasingly been shown to be cost effective and to have an immense impact on the economy of a region, delivering a substantial return on investment. More sustainable global surgical care is essential in future, requiring ongoing efforts from the plastic surgery community, greater recognition of the problems that can be addressed at policy level, and research to help guide policy-makers when facing the decision of allocating scarce resources. There is a fundamental role of plastic surgery in global health.
    Keywords: Plastic, Reconstructive, Surgery, Global, Health
  • Massoud Seifi , Negin, Sadat Matini , Amir, Reza Motabar , Mahtab Motabar Pages 283-293
    For many years, the conventional approach to orthognathic surgery which was orthodontic treatment prior to orthognathic surgery has been the accepted method of treatment for skeletal class III malocclusion patients. This review compared the dentoskeletal stability of treatment results between conventional orthognathic surgery methods with presurgical orthodontic treatment and surgery-first approach in skeletal class III patients. The study protocol was based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement for systematic review and meta-analysis. Electronic and manual searches for literature since 2011 were conducted. PubMed and Medline databases were accessed. Data extraction and analysis were performed by two independent individuals. Seven studies out of hundred-fourteen articles met the inclusion criteria and were selected for qualitative analysis. The included studies were 494 patients with skeletal class-III malocclusion. Stability of treatment was compared between surgery-first approach and conventionally treated patients. The statistical analysis confirmed that surgery-first approach did not show more stability compared with presurgical orthodontics. The surgery-first approach shortened the overall treatment duration. However, more skeletal stability in conventional treatment was assessed. Both surgery-first approach and conventional treatment with presurgical orthodontics resulted in favorable skeletal changes in class-III malocclusion patients. Moreover, these findings should be discussed further due to the variety of study designs, outcomes and biases. Current evidence in this field still needs to be expanded. The authors wish to see more well-designed randomized controlled trials with long-term follow ups to confirm the results.
    Keywords: Surgery-first, Orthodontics, Orthognathic surgery, Conventional approach
  • Pablo Buono , Pascal Castus , Victor Dubois, Ferrière , Eva Meia Rüegg , Ilker Uçkay , Mathieu Assal , Brigitte Pittet, Cuénod , Ali Modarressi Pages 294-300
    BACKGROUND
    Eradication of chronic tibial osteomyelitis necessitates aggressive debridement often followed by soft tissue reconstruction. Muscular flaps are said to be more effective than non-muscular flaps for infection treatment, while fasciocutaneous and perforator flaps are considered being less invasive and offering a better aesthetic result.
    METHODS
    In this study we reviewed 24 consecutive cases of chronic tibial osteomyelitis treated according to a specific protocol in a tertiary hospital. Soft tissue coverage was done with either muscular or non-muscular free flaps. Infection recurrence and complications were compared between different flap types. Additionally, we assessed the long-term functional and aesthetic results and patient’s satisfaction.
    RESULTS
    Muscular flap was used in 13 patients (13 latissimus dorsi and 1 serratus anterior) and 11 patients underwent fasciocutaneous / perforator flaps (1 anterolateral thigh flap, 4 lateral arm flaps, 5 thoracodorsal artery perforator (TAP) flaps and 1 radial forearm flap).
    Infection was resolved for 84.6% of patients in the muscular flaps group and 90.9% in the non-muscular flaps group. None of the patients with muscular flaps were satisfied with the aesthetic appearance of their reconstructed leg compared to 83.3% of patients with non-muscular flaps. Also a slight regain of touch sensitivity was acknowledged in the non- muscular flap group compared to the muscular.
    CONCLUSION
    In this study of adult chronic tibial osteomyelitis cases, we demonstrated that fasciocutaneous and perforator free flaps offer a comparable efficacy to the muscle flaps for infection treatment, with a significantly higher patient satisfaction and aesthetic result
    Keywords: Inferior limb, Chronic osteomyelitis, Free flap, Reconstructive surgery, Microsurgery
  • Hesham Helal , Asser El Hilaly , Nahed Samir Boughdadi Pages 301-306
     
    BACKGROUND
    The augmented breast frequently becomes ptotic by time and most of the patients may seek mastopexy. Although the rate of breast lift surgeries after breast augmentation is increasing, there are few studies regarding the nature of these procedures.
    METHODS
    Sixty patients with moderate grade ptosis and previously augmented breast by breast implants seeking breast mastopexy. Group A included 30 patients who underwent intra-capsular circum-areolar mastopexy and Group B including another 30 patients who underwent extra-capsular circum-areolar mastopexy. Follow up after complete healing was scheduled at 3, 6, and 12 months post-operative. Frontal and lateral views photography were taken each visit and objective evaluation was carried on by a plastic surgeon not involved in the surgeries. A questionnaire was performed by using the Likert scale to assess patients’ satisfaction.
    RESULTS
    In group A; the overall rate of complications was 17%, while in group B; the overall rate of complications was 10%. Patients of group A showed overall satisfaction of 4.53±0.69 in comparison to 3.06±0.25 in group B. In group A; objective evaluation, was excellent in 87% while in group B it was excellent in 43%.
    CONCLUSION
    Reshaping of breast pillars mastopexy augmentation is very important to prevent bottoming-out of the breasts
    Keywords: Mastopexy, Breast augmentation, Bottoming out, Bbreast lift, Breast reshaping
  • Shadi Lalezari , Christine Lee , Keyianoosh Z. Paydar , Ashkaun Shaterian Pages 307-313
     
    BACKGROUND
    Poly-trauma patients often sustain complex head/neck injuries requiring prolonged hospitalizations and multiple operations. Few studies have evaluated the associated injury patterns and risk factors for poor clinical outcomes.
    METHODS
    Consecutive poly-trauma patients with operative maxillofacial fractures treated at a level 1 trauma medical center between 1995 and 2013 were evaluated. Concomitant head/neck injuries to identify potential injury patterns were numerated. Lastly, a multivariate analysis was performed to determine independent risk factors for complications during the acute hospitalization period.
    RESULTS
    Totally, 232 poly-trauma patients presented with operative maxillofacial fractures, while 38.8% of patients had a secondary maxillofacial fracture, 16.4% had intracranial hemorrhage, 23.7% had skull fractures, and 12.1% had spinal fractures. The rate of complication during admission was 28.3%. Multivariate analysis revealed advanced patient age and increased number of operations to predict the rate of complication. Patients requiring more than one operation had a 1.8-fold increase in complication rate (p<0.01) and older patients had a 4.5% increase in complication rate (p<0.05) for every year of increased age.
    CONCLUSION
    Poly-trauma patients have a high incidence of secondary maxillofacial fractures, concomitant head/neck injury, and inpatient complication rate. Knowledge of associated injury patterns can help increased awareness and can guide physician decision-making to avoid missed/delayed injuries
    Keywords: Poly-trauma, Facial fracture, Complication
  • Jagdeep Rao , Rakesh Tawar , Rakesh Dawar Pages 314-318
     
    BACKGROUND
    Large soft tissue leg defect involving upper and middle third remains a therapeutic challenge. The objective of this study was to evaluate the effectiveness and versatility gastrocnemius myocutaneous flap cover for post traumatic large defect of upper and middle third of leg.
    METHODS
    This prospective study was conducted from January 2015 to January 2017 on 25 consecutive cases of post-traumatic upper and middle third leg defect who were treated with gastrocnemius myocutaneous flap and the functional and aesthetic outcome were evaluated.
    RESULTS
    There was no case of complete flap failure. Partial skin necrosis occurred in 2 patients (8%). There was no postoperative hematoma while mild discharge was seen in only 4(16%) patients. With regard to the donor site morbidity, no functional deformity was seen in follow up period. The procedure was found to be reliable, technically easy and aesthetically acceptable.
    CONCLUSION
    Post-traumatic large defects of leg extending in upper and middle third were easily covered with the help of regional gastrocnemius myocutaneous flap with excellent outcome and aesthetically acceptable coverage of skin without any major complications or long term morbidity
    Keywords: Gastrocnemius, Leg defect, Myocutaneous flap, Reconstruction, Trauma
  • Nikhil Panse , Rahul Bhadgale , Ankur Karanjkar , Rohit Phulwer , Parag Sahasrabudhe , Chaitanya Ramteke Pages 319-325
     
    BACKGROUND
    Gastrocnemius muscle and musculocutaneous flaps are very versatile and one of the commonly used flaps for lower extremity reconstruction. There is significant literature available on the use of these flaps. However, we feel that the potential of the gastrocnemius musculocutaneous (GMC) flaps has not yet been fully explored in terms of increasing their reach, viability and arc of rotation. An attempt is made to refine the technique of flap harvestation to optimize outcomes of this versatile flap.
    METHODS
    Six patients of complex lower limb defects were managed using the GMC flaps. Harvesting of the flap was always initiated from the posterior midline to include the proximal sural pedicle, sural nerve, short saphenous vein and the muscle belly of either the medial or the lateral gastrocnemius muscle along with the cutaneous paddle. All the flaps were islanded and denervated. The origin of the gastrocnemius muscle was detached in all cases to increase the reach of this flap.
    RESULTS
    The flap can reliably and comfortably cover defects from middle third-lower third junction of thigh and the entire posterior aspect of the thigh. Such a local option offers relatively simple but more cost-effective approach to complex clinical problem with tolerable impairment of the donor site.
    CONCLUSION
    The GMC flap can be considered as a worthwhile alternative to free-tissue transfer for limb salvage.
    Keywords: Gastrocnemius muscle, Musculocutaneous, Thigh, Flap, Defect
  • Ali Akbar Mohammadi , Ali Parand , Sina Kardeh , Mansour Janati , Soheil Mohammadi Pages 326-331
    BACKGROUND
    Angiotensin II activation by angiotensin-converting enzyme (ACE) is a significant mediator in wound healing and collagen production. In this study, the effect of topical application of ACE on hypertrophic scar formation has been studied in a clinical trial.
    METHODS
    Thirty patients with hypertrophic scar and itching after treatment of 2nd or 3rd degree burns participated in this double-blinded clinical trial. Subjects had two same-degree scars on symmetrical sites of body which were randomly allocated into two groups. One side was treated with 1% enalapril ointment and the other side with placebo twice daily. During a 6-months follow-up, a scoring table for itching was completed on a daily basis by patients. Furthermore, a single surgeon measured size of scars once a month. The mean size, thickness and itching score were calculated for each scar and compared between medication and placebo-treated scars.
    RESULTS
    The mean size of scars in enalapril treated side was significantly less than scars in the placebo side. Additionally, enalapril treated scars had significantly lower itching scores compared to the placebo group.
    CONCLUSION
    Topical enalapril significantly decreases the clinical parameters of hypertrophic scar and also itching as an indirect indicative of scar improvement. Furthermore, enalapril proved to be clinically safe for patients with low incidence of adverse drug reactions and acceptable cost effectiveness
    Keywords: Hypertrophic scar, Enalapril, Burn
  • Mohammad, Reza Akhoondinasab , Sharyar Sadeghi , Iraj Mirzaii, Dizgah Pages 332-336
     
    BACKGROUND
    Endoscopic method for many surgeries with minimal access is proposed to be effective for preventing the excessive scar formation, reducing pain, cosmesis, and the early return to work. Surgical outcomes of endoscopic and open methods for tendon harvest in treatment of radial nerve palsy were evaluated.
    METHODS
    In a randomized single-blind clinical trial study, 10 patients with radial nerve palsy who referred to the Plastic Surgery Department of the Fatimah Zahra Hospital, Iran University of Medical Sciences, Tehran, Iran were divided into two equal groups. Flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and the palmaris longus (PL) tendons were harvested by endoscopic or open techniques. The outcomes (tendon harvest time, rate of post-surgical pain, amount of pain medication, patient satisfaction, amount of scar, and length of scar) are measured.
    RESULTS
    There was no significant difference in time of surgery between two methods. Vancouver scar scale, cosmetic satisfaction, severity of postoperative pain and also drugs for pain relief after tendon harvest surgery were significantly lower in endoscopic method than open method.
    CONCLUSION
    Regarding the low invasiveness, high satisfaction rate of patients, low pain severity, low scar and the little need for opiate to reduce pain in the endoscopic method, endoscopic tendon harvest technique for radial nerve palsy seems to have priority over open method
    Keywords: Endoscopic technique, Tendon harvest, Radial nerve palsy
  • Nazanin Rita Davai , Abdoljalil Kalantar, Hormozi , Kamran Ganji , Ali Abbaszadeh, Kasbi Pages 337-344
     
    BACKGROUND
    Today, cosmetic surgery is one of the most common procedures worldwide, and its use is increasing. This study aimed to identify the impact of cosmetic surgery on married women’s marital satisfaction and self-concept.
    METHODS
    From January 1st, 2015 to June 6th, 2015, 44 married women operated in a plastic surgery clinic or seeking for a cosmetic surgery and 55 non-applicants as general population were enrolled. ENRICH marital satisfaction questionnaire and Rogers’ Self-concept Inventory were used to compare groups.
    RESULTS
    Operated applicants revealed a significant higher level of satisfaction in comparison with other groups regarding personality, conflict and leisure. Compared to control group, the surgical group had significantly higher satisfaction in marital and familial relationship, friendship, and financial management.
    CONCLUSION
    It can be drawn that expectation for postoperative positive outcome probably is an important factor affecting high level of marital satisfaction in cosmetic surgery applicants. Furthermore, the self-concept is significant predictor of applying for cosmetic surgery
    Keywords: Marital satisfaction, Self-concept, Women, Cosmetic surgery
  • Afshin Zare , Zabihollah Khaksar , Zahra Sobhani , Masood Amini Pages 345-350
     
    BACKGROUND
    Medicinal plants are considered as one of the important sources of chemical substances with therapeutic effects. This study aimed to compare the analgesic effects of alcoholic extract of valerian root and turnip in rats.
    METHODS
    Fifty female Wistar rats weighing 190 g were divided into 5 equal groups of control (subcutaneous injection of 2.5% formalin in the right foot), sham (subcutaneous injection of 2.5% formalin+distilled water), experimental 1 (subcutaneous injection of 2.5% formalin+200 mg/kg turnip extract), experimental 2 (subcutaneous injection of 2.5% formalin 2+200 mg/kg valerian root extract) and experimental 3 (subcutaneous injection of 2.5% formalin+200 mg/kg turnip extract+200 mg/kg valerian root extract). The time duration of 0-5 and 16-60 minutes after injection of formalin were respectively considered as acute and chronic phases. Injection of distilled water and the extracts was conducted 30 minutes before assessing the analgesic effects.
    RESULTS
    A significant decrease in pain score in the acute phase was observed in the group received valerian root extract compared to the control group. Also, a significant reduction in pain score was noted in the acute and chronic phases of the group receiving simultaneous administration of valerian root and turnip extracts when compared to the control group.
    CONCLUSION
    Simultaneous use of valerian root and turnip extracts is recommended for analgesic effects in both acute and chronic phases of the pain
    Keywords: Analgesia, Valerian root, Turnip, Formalin test, Pain, Rat
  • Jalaluddin Khoshnevis , Terifeh Dashti , Mohammad Ebrahimi , Eznillah Azargashb , Mohammadreza Kalantarmotamedi Pages 351-356
     
    BACKGROUND
    Free Flaps are viable option to cover the tissue defect. Pedicle anastomosis to vessel branches has excellent result. In some situations which there is a possibility of flap failure like shortage of vessel branches, possibility of pedicle kinking or need to vein graft, anastomosis to great vessels is justified.
    METHODS
    Six patients were allocated to study. Five cases for free jejunal flap and one case for free latissimus flap. In free jejunal flap group, pedicle anastomosis was performed as an end-side fashion to common carotid artery and internal jugular vein and in free latissimus flap, pedicle was anastomosed as an end-side fashion to superficial femoral artery and superficial femoral vein. Follow up was regular up to 20 years.
    RESULTS
    In free jejunal flap group, there were three female and two male with age from 30 to 59 years. The sixth case was a thirteen years old male with flexion contracture of right knee who underwent free latissimus flap. Follow up was regular for 20 years. All flaps survived, and good functional result was obtained in all except one.
    CONCLUSION
    Choosing great vessels as one side of anastomosis is safe and can be done as a primary approach due to technical demand or as a final resort when there is shortage of side branches
    Keywords: Free jejunal, Flap, Great vessels, Latissimus
  • Beydolah Shahouzehi , Gholamreza Sepehri , Sakine Sadeghiyan , Yaser Masoomi, Ardakani Pages 357-363
     
    BACKGROUND
    Severe burn damage and its consequences are life threatening which can complicate patients’ health. Medicinal and traditional plants are considered as safe, natural and inexpensive source of treatment for wide variety of diseases. This study assessed beneficial effect of Pistacia atlantica oil on rats burn wound healing and its potential effects on malondialdehyde (MDA), vasculoendothelial growth factor (VEGF), hydroxyprolin and antioxidant status in wound area.
    METHODS
    Thirty male rats weighing 200±10 g were randomly divided into three groups (n=10) as follows. Group 1 underwent just burn injury, Group 2 underwent burn injury and received 150 mg/kg/day P. atlantica oil topically, and Group 3 underwent burn injury and received 150 mg/kg/day sulfadiazine cream topically. At the end of the study (day 14), wounded areas were measured and then skin in the burn damage were dissected and anti-oxidative parameter, MDA, VEGF and hydroxyprolin were evaluated.
    RESULTS
    P. Atlantica oil significantly increased antioxidant defense, VEGF, hydroxyprolin and reduced MDA levels. It could remarkably reduce wound size compared to burn control group. P. Atlantica oil showed more beneficial effects than sulfadiazine.
    CONCLUSION
    P. atlantica resin oil could be considered as a new therapeutic agent for treatment of injuries
    Keywords: Pistacia atlantica, VEGF, Anti-oxidant, Burn injury, MDA
  • Amitabh Thacoor , Saif Ramman , Norbert Kang Pages 364-367
    Compartment syndrome of the forearm or leg has been well documented in the literature. However, there have been few published reports of hand compartment syndrome. We hereby present the first reported case in the literature of hand compartment syndrome secondary to an epileptic seizure. A 50-year old gentleman with known epilepsy presented to the Emergency Department following a witnessed tonic-clonic seizure. The patient’s chief complaints were a grossly swollen and excruciatingly painful dominant right hand. Examination revealed severely reduced range of motion and neurovascular compromise. An emergency decompression fasciotomy was performed in the operating theatre, where severe oedema was noted with viable muscle throughout. Compartment syndrome can occur in any muscle compartment of the body, including in the hand. Any crush injury to the hand should trigger a high index of suspicion by the clinician to enable prompt recognition of this surgical emergency and initiate timely management.
    Keywords: Compartment syndrome, Hand, Plastic surgery, Epilepsy
  • Joseph Ricci Pages 368-371
    Lipomas are the most common benign mesenchymal tumors found in humans, with a prevalance rate of 2.1 per 1000 tumors. Most of them are small, weighing only a few grams and measuring less than 2 centimeters in diameter. However, those weighing upwards of 200 grams and exceeding 10 centimeters have only been described in different anatomic locations on occasion in the literature. A 54-year-old man presented with a large soft tissue growth over the lower back, present for the past 20 years and rapidly enlarging over the past 3 years. A diagnosis of giant lipoma was made. Six hours and several surgical teams were required to remove the 14 kilogram mass. During excision, the skin flaps overlying the mass were preserved and were ultimately used to reconstruct the surgical site defect in a layered fashion once intraoperative frozen pathology confirmed the pre-operative diagnosis. Benign lipomas of the size reported in this case have rarely been described in the literature, as lipomatous masses of this size are often found to instead be either atypical lipomatous tumors or high-grade liposarcomas. In this case, we describe one of the largest of these giant benign lipomas ever reported to date. The case also illustrates the use of an interdisciplanary, multi-team approach to undertake the high-risk operation of removing such a mass from a patient safely. Finally, the case describes aninteresting approach toward reconstructing the large soft tissue defect that remained once the tumor had been removed from the patient.
    Keywords: Giant lipoma, Multi-disciplanary approach, Reconstructive surgery, Liposarcoma, Teratoma
  • Christian Weinand Pages 372-376
    Degloving injuries of the upper extremity during work are rare nowadays, because of effective worker protection devices. However, these devastating injuries still occur today during motor vehicle car accidents and surgeons have to be aware of the possibilities of wound coverage for these large, contaminated wounds. We present two cases of degloving injuries of the hand and entire forearm using degloved skin as meshed full thickness skin graft to cover the entire wound. Two patients were admitted to our hospital, presenting large degloving injuries of the entire forearm and hands. Both patients sustained their injuries by being dragged by moving trains and presented additional fractures of the metacarpal bones and in both cases the little finger had to be amputated. The degloved skin was cleansed and meshed as a full thickness skin graft 1:3, using a Brennen Mesher. In both patients, complete wound coverage was achieved using the degloved skin as meshed full thickness skin graft. Attachment to the wound was achieved by vacuum closure device, however, ninety percent of the graft did attach. In both cases, shrinking of the full thickness skin grafts was noted. Both of them received physiotherapy and gained nearly complete function of the injured hand and wrist. When larger parts of skin are lost in degloving injuries meshing the degloved skin as full thickness skin grafts good wound coverage of larger, contaminated defects can be achieved.
    Keywords: Degloving, Injury, Extremity, Skin, Mesh, Graft, Defect
  • Luis Parra , Juan Andrés , Manuel Robustillo , Carlos Garc?a , Israel Iglesias , Antonio D?az Pages 377-381
    Herein, we report an unusual indication of an arteriovenous (AV) loop with a latissimus dorsi free flap after wound-edge necrosis in an 81 year old patient. The patient underwent multiple revision procedures after total knee arthroplasty and total hip arthroplasty. After a dramatic reduction of femoral bone, a total femoral replacement was performed. The lateral knee incision wound was broke down and the hardware became exposed. Local flaps were not available and a free flap with an ipsilateral AV loop from the great saphenous vein was used to cover the large defect. The functional status of the hip and knee joints was good after 6 months, and enough the patient was able to ambulate without any assistance. The patient did not show any signs of infection
    Keywords: Ipsilateral arteriovenous, Loop, Latissimus, Flap, Reconstruction
  • Gholamreza Motazedian , Aliakbar Mohammadi , Soheil Mohammadi Pages 382-384
    Nasal septoplasty is a common procedure performed in plastic surgery and otorhinolaryngology. Many complications after septoplasty have been reported. Palatal perforation is one of the rarest complications with only a few cases reported in the literature. The reported cases had misdiagnosed submucousal cleft palate or high arched palate, but a patient with palatal perforation after septoplasty is presented here which have had neither evidence of submucousal cleft palate nor high arched palate.
    Keywords: Septoplasty, Palatal Fistula, Iran
  • Yakup Cil Pages 385-386
  • Shabeer Ahmad Wani , Loai Abdullah Al Salmi , Ovais Habib , Mir Uzair ul Huq Pages 387-388