World Journal of Plastic Surgery
Volume:8 Issue: 3, Sep 2019

Patients with spinal cord injury (SCI) tend to develop pressure ulcers (PrUs) because of prolonged immobility. This study assessed the efficacy of vacuum assisted closure for healing of PrUs in individuals with SCI.

In a systematic review, CINAHL, PubMed, Cochrane Clinical Trials, DARE, MEDLINE, Scopus, Embase, Science Direct, PsycInfo and Spinal Cord Journal were searched in March 2019. The search combined related terms for pressure ulcer, spinal cord injury, and vacuum assisted closure. Each database was searched from its inception with no restrictions on year of publication. 

The search yielded 7 studies for inclusion in a qualitative analysis. The studies included a variety of methodologies, specifically 2 randomized controlled trials, 2 assessor-blinded crossover and retrospective cohort study, 1 prospective non-randomized trial, 1 randomized case study and 1 case report. The meta-analysis was unsuccessful. Only descriptive results mean±SD were reported as well as time to heal and time to discharge after admission. 

The studies that we included in our qualitative synthesis showed that vacuum assisted closure promoted the healing of PrUs in individuals with SCI.

The true effects of anemia on postoperative surgical outcomes in autologous breast reconstruction surgery are unknown. We intended to evaluate the effect of chronic anemia on surgical outcomes in autologous breast reconstruction surgeries using a large national database.

Using the Nationwide Inpatient Sample database, we examined the clinical data of patients who underwent immediate or delayed autologous breast reconstruction surgery from 2012 to 2014. Univariate and multivariate regression analyses were performed to independently evaluate the effect of chronic anemia on postoperative outcomes.

Totally, 55,839 patients underwent autologous breast reconstruction surgery (immediate: 40% vs. delayed: 60%) during this period. Overall, 6.0% of patients had chronic anemia at the time of surgery. Compared with patients without chronic anemia, patients with chronic anemia had a significantly higher complication rate (19.8% vs. 9.4%) and a longer mean length of hospital stay (5.4 vs. 3.7 days). Postoperative complications were significantly higher in patients with chronic anemia compared with patients without chronic anemia except for venous thromboembolism (VTE) and fat necrosis. Multivariate regression analyses demonstrated that chronic anemia was independently associated with an increased overall complication rate (adjusted odds ratio: 2.20). Also, multivariate regression analyses showed that chronic anemia was an independent risk factor of all the evaluated postoperative complications except VTE, stroke and fat necrosis.

This study demonstrated that chronic anemia was a significant predictor factor of morbidity in autologous breast reconstruction including flap failure. Correction of anemia prior to breast reconstruction may help reduce poor surgical outcomes related to chronic anemia.

Fire and burn-related injuries are a leading cause of morbidity and mortality worldwide, and is a serious public health problem in developing countries. Several studies showed causes such as low socioeconomic status, poor living conditions, illiteracy, and floor level cooking, however, very few studies stated severity of the burn injuries to be dependent on ignition of type clothing garment and fabric wore at the time of incident. 

A cross sectional observational study done on burn injury patients admitted from February 2014 to August 2016. Data were collected from the patients or their relatives and analysed. 

Among 224 burn injury patients, majority were females (59.3%) sustained burn injuries in the study population (p=0.005). Victims wearing long loose flowing garments such as sarees (41.1%), salwar (22.3%), and dupatta (9.8%) were caught fire easily and sustained more burn injuries, compared to clothes reaching down to the knee and short fitting dresses (p=0.004). Percentage of burn was higher among wearers of synthetic fabrics (50.89%) than that of cottons (20.53%, p=0.028]. 

Every year, thousands of people are injured when their clothing catches fire. The findings reported herein documented that public knowledge about clothing related fire risks was lacking. This can be reduced by bringing about stronger regulations by government and to educate about the magnitude of the problems inflicted by burn injuries and to oversight and to promote less inflammable fabrics to be worn at home, especially in kitchen.

Microsurgical lower extremity reconstruction is challenging because of high incidence of vascular thrombosis compared to microsurgical head and neck reconstruction. The risk of vascular pedicle thrombosis increases, if patients have arterial sclerosis or intimal dissection at the recipient artery. We performed selective and continuous transarterial heparin infusion for postoperative anticoagulant therapy. 

Fifteen patients (10 men and 5 women; mean age of 55.1 years; range of 16–86 years) received lower leg reconstruction using free flap. Postoperatively, a catheter was inserted into the femoral artery during surgery. Heparin infusion was performed through the catheter as a postoperative therapy for patients who had a risk factor of vascular pedicle thrombosis. Until two days post-operation, heparin was started between 5,000 and 10,000 IU per day. In postoperative days 3 and 4, half of the initial dose of heparin was administered. In postoperative days 5 and 6, 25% of the initial dose of heparin was administered. 

Recipient arteries were the posterior tibial (n=11), anterior tibial (n=2), lateral circumflex femoral (n=1), and medial sural (n=1) arteries. Thirteen of the 15 cases showed arterial sclerosis or intimal dissection at the recipient artery. There was no case of vascular thrombosis. Hematoma formation at flap recipient was observed in four cases. Their initial heparin dose was than 8.5±1.7 U/kg/h. 

Continuous transarterial heparin infusion was an effective anticoagulant therapy for the patients who had received free tissue transfer to a lower extremity. The initial dose of heparin should not exceed 6.5 U/kg/h.

The combination of the superomedial pedicle with the traditional Wise-pattern skin resection has gained increasing popularity for its versatility and ability to achieve significant reduction of breast parenchyma and skin envelope. 

The author describes a reproducible new dermal suspension technique for cranial stabilization and fixation of the superomedial pedicle in Wise inverted T breast reductions to prevent pseudoptosis.

One patient had a small dermal skin abscess caudal from the right areola as a tissue reaction on the remaining suture. The other peri- and post-operative cases were uncomplicated. Two patients experienced a two-week postoperative pain in the areas treated by liposuction. There was no reduced or increased sensibility of the nipple-areola complex. No signs of (pseudo) ptosis were seen. There was a 100% patient satisfaction rate. 

Our technique denoted to a direct support of the pedicle using a non-interrupted dermal suspension flap continued with the pedicle to be a medial, caudal and lateral support for the pedicle. The dermal sling reduced the anterior force generated by the pedicle. The pedicle enfolded by the dermal flap formed a vital basis for ingrowth in the surrounding tissue.

The incidence of breast cancer and immediate breast reconstruction is on the rise particularly in the US and Western Europe. Over the last decade, implant based breast reconstructions have gained popularity. The prepectoral breast reconstruction has emerged as a novel technique, minimally invasive, preserves the chest wall anatomy while restoring body image. However, implant rippling appears to be an adverse effect associated with this technique. 

We have described a new grading system for rippling following prepectoral implant breast reconstruction and discussed its management. We then evaluated the new grading system in our practice. 

We looked at the first 50 consecutive patients who underwent prepectoral implant based breast reconstruction. In our experience, 45 patients (90%) had grade 1, 3 patients (6%) had grade 2, 1 patient (2%) had grade 3 and 1 patient (2%) had grade 4 rippling. The observed rippling was seen more often in patients with low BMI<20 and in those who had poor subcutaneous fat preoperatively (pinch test<2 cm). 

Prepectoral implant based breast reconstruction adds a whole new dimension to breast reconstruction. However rippling can be an undesired adverse effect associated with this technique and patients need to be informed.

Complex soft-tissue defects of the distal third of the leg, proximal third of foot and similar wounds around the ankle represent formidable foes for plastic surgeons. This study compared the outcome of 2-staged interpolated flap design versus single stage islanded flap design of reverse flow superficial sural artery flap.

Thirty-four patients were enrolled, while half randomly underwent interpolated flap design (group A) and for half, islanded flap design (group B). The outcome measures were frequency of epidermolysis, flap-tip necrosis, partial flap loss, total flap loss and number of secondary procedures required for addressing these complications.

Among patients, 79.41% were male and 20.58% were females. The age range was 12-51 years (mean: 28.82±10.76 years). The wound locations were hind foot (50%), ankles (17.64%), heel (14.70%), distal third of leg (11.76%) and dorsum of proximal third of foot (5.88%). In group B, epidermolysis was noted in 35.29% of flaps, and flap tip necrosis and partial flap necrosis in 17.64%. In group A, 5.88% were tip necrosis with no other problems. In group B, 76.47% of secondary procedures were done to address various flap related complications, whereas in group A, 5.88% additional procedures were required to address the flap tip necrosis.

The reverse flow superficial sural artery flap constituted a practical solution to address complex defects of the distal leg, ankle, heel and proximal foot. The 2-staged interpolated flap design considerably enhanced the flap reliability and reduced the frequency of venous congestion and resultant flap necrosis of variable proportions

Ear reconstruction is one of the most challenging surgeries faced by reconstructive surgeons because of its complex three-dimensional structure. Various surgical methods and materials have been used over the years. The process of microtia reconstruction using tissue expander is performed in three stages of first that is implantation of tissue expander, second stage involves framework fabrication using autologous costal cartilage and implantation in the pocket and third stage involves tragus and concha reconstruction.

Totally 180 cases of microtia reconstruction using tissue expander and autologous costal cartilage over 2 years were enrolled, while two age groups were compared regarding operative time, tissue expansion, number of autologous costal cartilage harvested and complications during and after reconstruction.

The overall complication in microtia reconstruction was 25%. No major difference was found between complication rates among the 2 age groups. Similarly, no significant difference was found between two groups in term of surgical time and tissue expansion. The major difference was found in number of costal cartilage harvested for the framework fabrication among the two groups. 

Microtia reconstruction using tissue expander and autologous costal cartilage is a standard method of ear reconstruction with good satisfaction rate for surgeons and patients. Although the complication rate was high in our study, most of the cases were managed with acceptable results. Therefore, a standard protocol should be developed regarding the timing of the surgery for microtia reconstruction, considering pre-operative radiological analysis of the costal cartilage development along with age and weight of the patient.

Closure of skin defects after scalp surgery may be accomplished by grafting; either split- or full-thickness. Both methods are used in Denmark, and the optimal approach on scalp defects without exposed bone is not known. This study aimed to investigate if the two methods were equal regarding graft take as primary outcome and as secondary outcomes complications and number of outpatient visits/ number of days from surgery until the last outpatient visit for the recipient site (as a proxy for time to healing), hypothesizing that they were.
The present retrospective single-center case series reported our experience using the two types of skin grafts after scalp surgery in the inclusion period from 1.1.2014 to 30.09.2015. Data were analyzed according to graft type with a full-thickness skin graft (FTSG-group) or a split-thickness skin graft (STSG-group).
In the inclusion period, 106 patients had surgery (28 with a FTSG and 78 with a STSG). Irrespectively of which skin graft that was used, we found no statistically significant difference regarding percentage of adherence, complications or number of outpatient visits and time from operation until last outpatient visit regarding the recipient site (p>0.05).
Our findings supported that use of either FTSG or STSG in scalp lesions were equal choices.

Ear keloids are a challenging problem that affect people of different races with substantial aesthetic consequences. Various types of adjuvant therapies, including intralesional corticosteroid injection are advocated to lower recurrence following excision. We investigated the efficacy of a protocol combined of excision and postoperative intralesional triamcinolone acetonide (TA) injection for treating earlobe keloids in a group of Iranian female patients.

A retrospective analysis of 21 patients representing 31 ear keloids treated by a single physician between 2013 and 2017 was conducted. All keloids occurred after ear piercing in female cases. Postoperative intralesional TA injection was administered once monthly and continued for several months based on the patients’ clinical progress. Results were assessed according to Kyoto scar scale.

The patients’ mean age was 24.29 years and ranged from 16 to 40 years. After the surgery, the follow-up period ranged from 10 to 29 months (mean: 15.93 months) and patients were given TA intralesional injections 3 to 6 times (mean: 4.22 times) with no complication or adverse effect. Of the treated keloids, success was achieved in all of 31 keloids (100%) and final evaluation revealed that the mean Kyoto scar scale was significantly decreased. No recurrence occurred. 

Surgical excision followed by postoperative intralesional TA injection can be suggested as the primary protocol for the treatment of ear keloids considering its durable results and economic advantage.

Periorbital edema and ecchymosis are considered as the main complications of rhinoplasty. The current study was conducted to compare the effects of internal and external lateral osteotomies on ecchymosis, periorbital edema, and step off deformity after rhinoplasty. 

This double-blind randomized clinical trial was conducted on 69 patients (including 37 and 32 cases undergoing external and internal lateral osteotomies, respectively), between the fall of 2016 and 2018. The participants were randomly divided into two groups and matched by gender and age for rhinoplasty. In addition, all surgeries were performed by the same surgeon to control the confounding variables. Edema, ecchymosis, and step off deformity were evaluated by a researcher blind to the methods of rhinoplasty 2, 7, and 21 days after the surgery. 

There was no significant difference between the two groups regarding postoperative edema on days 2, 7, and 21 post-operation. Similarly, the postoperative ecchymosis demonstrated no significant difference between the two groups on the 2nd, 7th, and 21st days post-surgery. No significant difference was noted between the two groups in terms of step off deformity on day 21st. 

The obtained results demonstrated no significant difference between the internal and external lateral osteotomy techniques. Based on our findings, surgeons should apply a procedure with the lowest side effects according to their experiences

Collagen is the main product in pharmaceutics and food industry with a high demand. Collagen can be extracted from several tissues such as skin, bone and tendon, etc. Collagen can be used in tissue engineering researches as a substrate of wound healing and nerve regeneration. Extraction methods of collagen are various with different purities. In this research, we aimed to extract collagen from human placenta with a modified method. 
This modified approach was used for extracting of collagen from human placenta with acetic acid and NaCl treatment using different concentrations. 
SDS page showed three different bands that reflected two alpha-chains and one beta-chain with molecular weights of 102, 118 and 220 kDa, respectively. There was no significant difference between extracted collagen from human placenta and standard collagen in western blot analysis. 
It was concluded that human placenta can be an alternative source of collagen with high purity for biomedical applications such as tissue engineering, stem cell therapy and research.

Burn is the fourth most common cause of trauma worldwide and is the fourth among the injuries and surgeries requiring medical care. This study was designed to determine the effect of a short-term training course by nurses on body image in patients with burn injuries.
This study was a semi-experimental single-group survey assessing before and after interventions. Totally, 130 subjects (65 women and 65 men) were enrolled. The training course was held in 3 sessions of two hours. The contents of the group training course (a group of 5 people) were in relation to the body image and the factors affecting it, and the ways to improve the body image. The data collection instrument was the satisfaction with appearance scale (SWAP).
The mean scores of the body image of patients before and after the intervention were 49.44±11.39 and 41.63±11.89, respectively. There was a significant difference between the mean scores of body image before and after educational interventions (T=6.013, P≤0.001). The mean score of body image in women before and after intervention was 49.2±10.9 and 41.2±11.65, respectively (T=4.51, P≤0.000). The mean score of body image in men before and after intervention was 49.6±11.89 and 42.07±12.19, respectively (T=4.51, P≤0.000).
Short-term courses held by nurses were shown to have a significant role in improving the body image of burn patients.

Although electrical burns are less prevalent than other types, they put socioeconomic burden on communities, yielding higher mortalities. Therefore, the frequency and causes of electrical burns in the largest burn center in northern Iran were studied.

All patients with electrical burn injuries admitted to Velayat Hospital, Rasht, Iran participated in this descriptive cross-sectional study. The data collection tool was a checklist including demographic data, damage mechanism, voltage classification (high or low), injured organ, ICU need, length of stay (LOC), electrical burn severity (degree and area of burns based on TBSA), surgical interventions, and return to work. All data were gathered through HIS system and analyzed.

Most electrical burns occurred in men (99.4%) and most of whom had electricity-related jobs (26%). The majority of victims had third-degree burns (63%), and electrical current-induced burns in entry points occurred in the upper and lower extremities, head and other organs ranked the first to fourth, respectively. Most burns happened due to abrupt contact with electrical current (83.33%) in routine home activities (52.78%). The mean LOC was 8.73 days, suggesting that LOC increased significantly, if the electrical current entered the body through lower extremities, while it decreased significantly, if the electrical current exited through lower extremities. 

The majority of electrical burn victims were men. Most burns occurred in urban communities in summer. Most people were affected by high voltage electricity.

Burns patients often encounter lots of psychological problems affecting all parts of life. This study investigated the psychosocial empowerment interventions through multimedia education in burn patients.

 In a randomized clinical trial study undertaken in Shahid Motahari Burn Center in Tehran, Iran in 2016, 50 patients were selected as control and 50 patients as intervention group. The demographic characteristics and the quality of life questionnaires (BSHS-B) were used. Patients in the control group received only routine educational self-care, but the intervention group received routine cares as well as the multimedia trainings. Then, the psychological quality of life was evaluated in both groups before the interventions and after three and six months.

Before interventions, the mean of mental dimension in intervention and control groups were 2.08±0.59 and 1.64±0.47, respectively (p<0.001). Three and six months after the intervention, they were 3.37±0.93 and 2.24±0.4, 4.11±0.74 and 2.75±0.58, respectively (p<0.001).

The multimedia intervention was shown to be effective in empowering the psychology of burn patients.

The role of obesity has been widely studied as a determinant factor of increasing mortality in surgical patients. In this study we aimed to investigate the association of mortality determinants with obesity classification and BMI score in burn patients admitted to a tertiary referral center in Southern Iran. 

In this retrospective cross-sectional study, medical profiles of burn patients admitted from 2016 to 2017 were obtained from Amiralmomenin Burn Hospital, a tertiary referral burn center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Demographic, and clinical characteristics as well as patient outcomes were recorded to determine prognostic factors in fatal burns based on anthropometric measurements. 

Among 101 patients who were enrolled in this study including 73 males and 28 females, mean age was 34.85±12.04 years, total burn surface area (TBSA) was 37.37 (10.50%), BMI was 25.46±5.33 kg/m2 and hospital stay was 22.28±13.62 days. Overall mortality rate was 24.7% with 25 expired cases. Logistic regression demonstrated significant association of older age, male gender, and greater TBSA with mortality. However, difference in mortality rate in patients with BMI of 25 kg/m2 (27.4%) in comparison to patients with BMI<25 kg/m2 (18%) did not reach statistical significance.

Although patients with higher BMI had increased mortality rate following burn injury, this finding showed no significant association. Further studies with larger samples may be necessary to conclude a causal association between BMI and mortality in burn patients.

There is need for a coding system for categorizing the plastic surgery conditions to facilitate efficient data exchange, retrieval, research, time-series analysis, clinical audit, insurance and legal purposes. This is a pilot study to assess feasibility of newly proposed 5-D coding system in categorizing the plastic surgery conditions.

Retrospective analysis of records of plastic surgery patients visited in last 15 months was done. Each patient was assigned a code according to the newly proposed 5-D system of coding and recorded in excel sheet. Data analysis was done to categorize various plastic surgery conditions. Results of analysis were shown to 11 plastic surgeons and their feedback was taken.

Feedback taken from participants showed 5-D coding system was useful and practically easy to categorize the plastic surgery conditions.

Proposed new 5-D coding system is easy and useful in categorization of plastic surgery conditions.

Breast reconstruction is distinct among plastic surgery techniques. This study analysed the results of breast reconstruction with the Latissimus dorsi (LD) myocutaneous flap as a strategy for better coverage and positioning of the implant.

Twenty patients who underwent surgery between September 2013 and September 2016 were enrolled. Fourteen patients underwent reconstruction with LD and tissue expander (TE) exchanged later with implant. Six patients were reconstructed with LD and implant. The complications, problems, and aesthetic improvement associated with the use of implants placed under LD muscle were assessed.

0ne case required an expander removal because of deflation of TE, also one case had seroma formation due to recurrence of breast cancer and also one case had seroma in donor site. No asymmetry was detected in the inframammary fold (IMF) position between reconstructed and normal regions. After the procedure, 80% of the patients reported that their expectations were met, 95% reported no functional limitations, and 5% reported mild limitations that ameliorated with physiotherapy. The placement of implants (prostheses or expanders) under the muscle with using the LD muscle flap to cover the implant improved the breast contour by softening the inframammary crease and positioning the implants in the upper and medial quadrants of the new breasts.

Breast reconstruction using silicone implants and the LD muscle flap can have excellent outcomes with low rates of complications. Placing the implant under a layer of muscle improved the harmony of the upper quadrants during breast reconstruction.

The main complication in patients with combined treatment of head, neck, mandibular and maxillary tumors is osteoradionecrosis, which appears after radiation therapy. Radiation therapy is widely used to treat cancer, but growing concern is related to the risk of osteoradionecrosis after treatment. This can occur after radiation therapy. Below, we would like to describe the treatment of osteoradionecrosis, which appeared 5 years after radiation therapy in a 54-year-old male patient. In 2012, a patient in Turkey was diagnosed with adenocystic carcinoma of the tongue base, and surgery was performed to remove the tumor after the patient underwent a course of radiotherapy. In 2016, the patient underwent again a surgery for tumor recurrence. In December 2017, the patient was admitted to our clinic with osteoradionecrosis. We performed segmental resection of the mandible, type I right-sided modified neck dissection, reconstruction of the mandible with a titanium plate and a pectoralis major muscle skin flap. The technique described in this case is the insertion of a well-vascularized tissue into the pre-irradiated and necrotic hypovascular region of the mandible with a skin-muscle flap of the pectoralis major muscle wrapped around the plate for reconstruction. As a result, a pectoralis major flap coverred the mouth floor on internal side and the outside skin defect was covered with a deltopectoral one. The viability of the skin-muscle flap of the pectoralis major muscle was assessed using clinical monitoring, checking the flap every four hours for the first 3 days. This study describes a successful outcome.

Fungal infections are becoming increasingly recognized among burn patients. Infection with Fusarium, a filamentous mold, is rarely encountered and mainly seen in immunocompromised patients. High mortality and morbidity were reported with these virulent infections. We present a rare case of refractory septic shock from upper extremity fungal infection with Fusarium solani in a burn patient. Multiple operative debridements and below elbow amputation caused resolution of septic shock. Closure was achieved with a split thickness skin graft. Aggressive approach should be adopted in managing burn patients with Fusarium infection. Serial debridements and extremity amputation should be considered in attempts to improve survival.