World Journal of Plastic Surgery
Volume:9 Issue: 1, Jan 2020

Immediate Breast Reconstruction (IBR) is an additional surgical procedure that may increase postoperative complications (such as flap necrosis, infection, and hematoma) and delay the initial time for adjuvant chemotherapy in some patients. In this systematic and meta-analysis, we provide overall survival rates of patients who underwent mastectomy with and without IBR.

The following databases were systematically searched between 2015 to 2019 without language restrictions in PUBMED, EMBASE, Web of Science, and Cochrane Library. In addition, the relevant references in the list of all included articles were also checked. The search term included “breast cancer” and “breast reconstruction” “mastectomy”.

The sample size was a range from 339 to 5644 patients. The median age was 46.3 years. The results showed no significant differences in terms of overall survival between two groups.

The results showed that IBR after mastectomy did not affect the overall survival

Various studies have reported different conclusions over the safety and benefits of early tracheostomy in burns. Our study aimed to assess the role of prophylactic tracheostomy in treatment and improvement of outcomes in inhalational burns in India.

In a retrospective descriptive analysis of burns admitted over 1 year in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Tertiary Burns Center in India, patients with thermal burns of TBSA less than 60% and those with indirect evidence of airway burns were enrolled and divided into two groups who underwent prophylactic tracheostomy vs. patients for whom prophylactic tracheostomy was not done. Mortality was the final point and primary variable measurement.

Totally, 10 patients with inhalational burns were admitted. Out of the 4 patients for whom prophylactic tracheostomy was undertaken, three patients survived, while one died. Out of the 6 patients for which prophylactic tracheostomy were not performed, 4 patients died; while 2 survived.  The average percentage of burns TBSA in the prophylactic tracheostomy group was 34%. Average age of patients in the prophylactic tracheostomy group was 31.3 years. The average percentage burns TBSA in the group, where prophylactic tracheostomy was not carried out was 42%. Average age of patients in the prophylactic tracheostomy group was 36.2 years.

Our study is a pilot study to investigate the possibility and a way to improve outcomes in patients with inhalational injuries. Larger trials may be needed to facilitate or disprove the same.

Electrical burns, although less prevalent, are devastating injuries and are associated with high morbidity and mortality. This study assessed the socio-demographic characteristics, complications, surgical interventions and outcomes among electrical burn victims.

From 2013 to 2018, patients who suffered from electric burns and were admitted to Burns Unit, Department of Plastic Surgery, Kasturba Hospital, Manipal, India were enrolled. The demographic data, as well as details regarding mode of injury, percentage of burns, specific areas injuries, complications, surgical treatment options utilized and treatment outcomes were recorded using a semi-structured questionnaire. The patients were followed up till 3 months post discharge.

The majority of electrical burn victims were men (99.0%) and were in the age group of 18-40 years (70.4%). Unskilled labourers (56.8%) were most commonly affected followed by employed linemen or electricians (29.6%) and farmers (11.1%). Highest proportion (81.0%) had involvement of less than 20% of their total body surface area. Occurrence of infections (41.9%) was the most common complication. Myoglobinuria (19.7%), amputations (18.5%), compartment syndrome (14.8%), and peripheral nerve injuries (13.5%) were recorded. Totally, 18.5% were reported with certain complications, 9.9% of them required neurosurgical interventions and 3.7% required active psychiatric interventions.

Most of the young men in their economically productive age group were affected with electrical burn injuries. Ensuring the work safety measures and education about the dangers and hazards associated with electrical equipment and infrastructure as well as their proper handling are vital.

Gastrocnemius muscle flap has been in vogue for approximately five decades. The current study was carried out to document the indications and outcome of proximally based medial gastrocnemius muscle flap in our patients.

This case series was conducted in Department of Plastic Surgery and Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan during 3 years. It included all patients who were managed with proximally based medial gastrocnemius muscle flap for various indications.

There were 31 patients with 24 (77.41%) males and 7 (22.58%) females. The age ranged between 16- and 53 years (mean: 27.47±10.33 years). The indications for gastrocnemius muscle flap included traumatic defects with exposed tibia/ knee joint (n=20; 64.51%), prophylactic coverage of megaprosthesis employed for knee joint reconstruction (n=9; 29%), excisional defect of cutaneous squamous cell carcinoma with exposed tibia (n=1; 3.22%), and salvage of infected total knee arthroplasty (n=1; 3.22%). The hospital stay was 7-16 days (mean: 12.41±2.87 days). The flap survival in our series was 100%.  There was partial skin graft in two patients (n=2; 6.45%).

Gastrocnemius muscle flap was a quick, easy and reliable coverage tool for small to moderate sized defects around the knee, the proximal third of the tibia as well as coverage of prosthesesis employed for knee arthroplasty. Inclusion of 2-4 cm tendon enhances the flap dimension without causing any additional morbidity.

Split thickness skin graft is a widely accepted technique to cover large defects. Shearing, hematoma and infection have often been attributed as major causes for graft loss. Autologous platelet rich plasma (PRP) has been used in various treatment modalities in the field of plastic surgery for its healing, adhesive and hemostatic properties owing to the growth factors that are released. This Study primarily throws light on the usage of PRP over difficult Burn wound beds to augment graft uptake and attenuate complications.

The patients were divided into two groups of those who were subjected to use of autologous PRP as a preparative burn surfacing and the control group who underwent standard method of treatment.

Patients in PRP group significantly showed a higher graft adherence rate as compared to those with other method. It also reduced pain, and hematoma formation.

Application of PRP is a safe, cost effective, easy method to increase graft adherence rate in patients with burns where graft loss is noticed and there is shortage of donor sites.

Gynecomastia is a common cosmetic issue in India. Many combinations of liposuction and excision of the gland have been advocated. Complete removal of the breast leaves behind a contour deformity and hence a sliver of it needs to be left behind. This study used a consistent and versatile technique for correction of gynecomastia by a superior dynamic flap method.

A retrospective study was conducted in 1159 gynecomastia surgeries done from March 2013 to February 2019. All these patients were treated by a single surgeon using the superior dynamic flap method in a single center and the results were assessed with patient and surgeon satisfaction scores. The technique involved leaving behind a thin sliver of the gland in order to avoid contour deformity and achieve a smoother shape overall.

Minor complications were seen in 27 patients and the satisfaction scores were 8.9 and 8.79 in patients and surgeon, respectively. There was no incidence of contour deformity after the procedure.

Superior dynamic flap method was a versatile technique and allowed the surgeon not only to avoid contour deformities, but also to correct asymmetries.

Phalloplasty is the most amazing reconstructive surgery, and has a vital role in the quality of life of transsexual patients. There are several techniques for glans sculpting, but none of them had long-lasting results. In the present study, a new technique was introduced and compared with Norfolk technique for coronaplasty following phalloplasty.

In the present randomized controlled study, 40 transgender patients were enrolled from February 2016 to December 2018, at St. Fatima Plastic and Reconstructive Surgery Center. The patients were randomly assigned in two groups including 20 patients with anterolateral thigh flap (ALT)/radial forearm free flap (RFFF) phalloplasty followed with our new coronaplasty technique (group 1) and 20 patients with ALT flap/RFFF phalloplasty followed with Norfolk technique (group 2).

Almost 85% of the patients underwent the surgery with the new technique were satisfied with the outcome of surgery and considered it acceptable within 6-month follow-up, however, only 70% of the patients in Norfolk technique  group reported acceptable results, which was significantly lower than the new technique. Similarly, within 12-month follow-up, 80 and 40% of the patients, respectively in new and Norfolk groups reported acceptable results, which was also significantly higher in the new technique.

This new technique showed remarkably better results relative to the usual technique for glans sculpting in transsexual patients. Moreover, it had the ability to be easily applied along with ALT/RFFF flaps in both immediate and delayed situations.

Many different methods for nerve repair have been introduced. Nerve repair with micro-suture is the gold standard one; however, the use of fibrin glue is a promising method. This study compared the never repair with fibrin glue and perineural micro-suture in rat model.

Ten 3-4 month old male rats, weighting between 250-300 grams were divided into two groups. Left sciatic nerves of the rats were transected and repaired with fibrin glue (TissucolR) in one group (A) and direct peri-neural micro-suture in another group (B). The time of nerve repair was compared between the two groups after 8 weeks. A biopsy from was taken from anastomosis site and the histopathological assessment was undertaken for axonal growth rate after anastomosis and compared between the two groups.

The time of repair in group A was significantly lower than group B. Axonal growth rate was pretty similar between the two groups, and the difference was not significant. The mean (SD) time for repair of nerves with micro-sutures was 7.1 (1.5) minutes and the mean (SD) for repair of nerves with fibrin glue was 2.5 (0.5) minutes and the difference was significant. The number of calcification such as psammoma bodies was significantly higher in fibrin glue group. 

Nerve repair with fibrin glue was shown to be simpler and more time saving. The number of axons after the repair was not different in the two groups. We showed that fibrin glue may have more tissue reactions compared with micro-sutures.

Delay phenomenon can be used for better blood supply of the flap in plastic surgery. Effects of Montelukast have been observed to reduce ischemia/reperfusion injury in various organs due to angiogenic and anti-oxidant effects. The present study aimed to determine the role of Montelukast as medical delay of the flaps.

In this experimental study, 42 Wistar rats were divided into 3 equal groups. These groups were Surgical Delay Group (SDG), Medical Delay Group (MDG) and Control Group (CG). In SDG, 8×3 cm rectangular randomized random skin flap was first surgically delayed at rats’ back. The MDG received 10 mg/kg oral Montelukast via orogastric tube for 5 days as medical delay. In MDG and SDG flap, harvesting was undertaken after a delayed period, but there was not any delayed period in CG. After delayed period, a segment of the skin flap was biopsied for assessing angiogenesis. After 14th days, the photos were taken and the size of the necrotic area of the flap was measured.

A significant difference was observed between the mean survival and angiogenesis (p=0.002). The same performance was reported between MDG and SDG, which were alike regarding survival and angiogenesis (p>0.05); while there was a significant difference between the control and surgical groups, as well as control and medical groups (p<0.05). Finally, the inflammation showed no significant difference (p>0.05).

Regarding positive effects of Montelukast on survival and angiogenesis, it is recommended to be used as a medication for larger studies.

Hidradenitis suppurativa is a chronic inflammatory disease with multiple inflammatory nodules and abscesses. We aimed to compare split thickness skin graft (STSG) and flaps in bilateral chronic refractory axillary hidradenitis suppurativa.

Thirty patients were investigated from March 21, 2010 to March 20, 2015. Debridement of involved skin and subcutaneous fat was done until deep fascia. The second operation was a reconstructive procedure to cover bilateral axillary wounds with STSG in left side and random fasciocutaneous flaps in the right side.

Mean age of patients was 35.2±9.3 years. There were 16 men (53.3%) and 14 women (46.7%). Duration of the disease before trial was 6.5±2.1 years. The association between pain at one-month follow-up for graft or flap sites was not significant. The patients did not have pain at flap and graft sites at three-month, six-month and one-year follow-ups. Twenty-four patients (80.0%) had normal ranges of motion at one-month follow-up. At six-month and one-year follow-ups, all patients had bilateral normal ranges of motion. All patients were satisfied from symmetry of flap and graft sites at six-month and one-year follow-ups. All patients were satisfied from graft and flap donor sites at six-month and one-year follow-ups. At one-month, three-month, six-month and one-year follow-ups, recurrence of hidradenitis suppurativa was not seen.

Both STSGs and fasciocutaneous flaps were successful and satisfactory for tissue coverage in patients with axillary hidradenitis suppurativa. We recommend this technique in cases of bilateral axillary hidradenitis suppurativa.

Cleft lip and palate (CLP) is a common congenital anomaly. Efficient surgical management of CLP is challenging in severe cases with wide clefts. Use of primary vomer flap simultaneous with cleft lip repair is effective in some cases, but remains a challenging topic.

This study evaluated 81 non-syndromic CLP patients with extensive palatal cleft and no other underlying condition. Thirty-nine patients (group A) who were infants over 6 months of age underwent primary vomer flap during lip repair to decrease the size of their extensive palatal cleft. The results in this group were compared with group B (n=42) who did not receive primary vomer flap.

Comparison of the two groups showed that although maxillary growth impairment and maxillary constriction had a higher frequency in group A, the palatal cleft was smaller among them, which enabled easier and more efficient cleft repair in the next step. The difference in maxillary growth impairment was not significant between the two groups. However, the prevalence of some complications such as velopharyngeal incompetence and maxillary growth impairment was slightly higher in group A compared with group B.

Use of primary vomer flap at the time of lip repair can decrease the size of palatal cleft and enhance its later closure. However, since impairment of the maxillary growth was slightly (but insignificantly) higher in the vomer flap group, it should be performed at ages over 6 months of age, and in certain cases.

Burn is one of the most traumatic injuries and life-threatening states which expose children at a higher risk. The aim of this study was evaluating the epidemiology of pediatric burns in age less than eighteen years old during the last decade.

This cross-sectional study was carried out during 2008-2017 in Amir-al Momenin Burn Center, affiliated by Shiraz University of Medical Sciences, Shiraz, Iran. The subjects consisted of burn victims under 18 years old who were registered as outpatients and inpatients.

During the study period, 1893 and 12431 patient were registered as inpatients and outpatients of the hospital. The burn victims were males. Children under 5 years old were prone to scald injuries more than children in any other age. More than 90% of inpatients children burned accidentally, while 116 (6.12%) burn injuries were suicidal; which was mostly seen in girls (75%, 87 out of 116).

Most burns involved scalds from hot liquids especially in children age less than 5 years. Different strategies can be executed by means of broadcast flashes in mass media and educational programs through schools to show risk situation and statements calling attention to prevent childhood burn injuries.

Accessory lower limb with spinal dysraphism are amongst the rarest known anomalies. We successfully managed a 5-months old female infant with surgical ablation of the accessory lower limb and repair of the associated large lipomyelomeningocele. A comprehensive review of the relevant literature was undertaken and presented herein. A classification system for accessory lower limb is also proposed.

Burn injuries in newborns are particularly complex cases. Since these patients are rare, there is little experience and no existing standardized treatment. This report examines a case of accidental second to third-degree burning of the heel and toes on the left foot in a new-born girl. The burns covered an estimated 1% of the total body surface area (TBSA). After an initial debridement and 32 days of non-surgical wound therapy with Adaptic® fat gauze dressings, we were able to achieve an aesthetically and functionally satisfactory result including the complete preservation of all toes. Modern wound treatment following the principle of less frequent dressing changes allows the burn wound to have better re-epithelialization. New findings in stem cell research indicate that the high proportion of mesenchymal stem cells (MSC) in postnatal blood is also involved in the regeneration and healing of burns. To our knowledge, this is the first case report dealing with initial non-surgical combustion therapy in a newborn. In order to eliminate a scar contracture, we carried out a Z-plasty one year later

Soft tissue sarcomas of the upper extremities are very rare tumors. Due to the complex anatomy of the arm, the management of the soft tissue sarcoma becomes very challenging for the operating surgeons. Nonetheless, a large portion of the patients can be treated in a limb-sparing manner ,if surgical expertises are present .We report a case of 30 years old lady with soft tissue sarcoma of right arm operated in an another hospital, came to our institute  with pain in the operated site and positive histological margins. The patient had feeble radial and ulnar artery pulses. We had done a MR angiography of that limb and it showed no flow from mid arm level in the brachial artery, but presence of collaterals around elbow joint. We had removed the residual tumor and also excised 14 cm of right brachial artery. On opening the brachial artery, tumor thrombus was seen along the whole length of the excised segment. The defect was reconstructed with reverse great saphenous vein graft taken from left leg. Post-operative period was uneventful. Doppler ultrasonography done at 6 and 12 months later showed good flow in the grafted segment with minimal narrowing of the anastomosis sites.

The mental nerve is a sensory nerve which traverses through mental foramen to innervate the lower lip, chin skin and the mandibular labial gingiva. Interestingly, it’s variant such as the accessory mental foramen (AMF) was described as an unusual finding in the recent literature. Hereby, we reported a patient who was operated to treat the mandibular bisphosphonate-related osteonecrosis of the jaw (BRONJ) lesion. Intraoperatively, an accessory mental foramen was detected posterior to the main foramen and nerve, on the right side of the mandible. This case report highlighted the necessity for proper radiological and clinical evaluation of mental foramina in order to avoid nerve injury and postoperative paresthesia. The review of the literature and the clinical findings were also discussed in this article.

Cavernous hemangioma is an encapsulated nodular mass composed of dilated, cavernous vascular space separated by connective tissue stroma. Flattened endothelial cells line the vascular spaces, which were filled with blood. Though hemangiomas are the mast common benign neoplasms seen in children, they rarely occur in adults. In the head and neck region, the masseter and trapezius muscles are most commonly involved. Herein, the case is a 64 years old male who presented with a round, painless mass in the right temporal fossa with extension to infratemporal fossa. The lesion was surgically excised and histopathology confirmed the diagnosis of cavernous hemangioma.