World Journal of Plastic Surgery
Volume:10 Issue: 2, May 2021

The facet of breast reconstruction has evolved from complex surgery to simple implant-based breast reconstruction. Minimal invasive surgery or Prepectoral breast reconstruction has revolutionised the surgical treatment for breast cancer and became a reality due to advances in meshes and implants. In this review, we have looked at the journey of Prepectoral implant beast reconstruction through time.

We conducted a literature review on pre-pectoral breast reconstruction, emphasising types of cover, its outcomes, complications, and the effect of postmastectomy radiotherapy.

Prepectoral breast reconstruction had advanced with time and appears to be a safe and effective method of breast reconstruction and is associated with minimal morbidity whilst providing adequate cosmesis. Radiotherapy seems to be well tolerated with early favourable results. The Implant loss rates in the Acellular Dermal Matrix (ADM) to be around 5%-6% and rippling appear to be a common adverse effect of this technique ranging from 0%-35% in various studies.

Prepectoral implant-based breast reconstruction has emerged as a successful method of breast reconstruction.

Chest masculinization is aimed at aligning physical appearance of female-to-male (FtM) transgender patients to their identifying gender. Despite limited evidence, obese FtM patients have historically been denied this procedure due to concerns of complications. We reviewed chest masculinization in the high body mass in-dex (BMI) population to analyze the outcomes.

A Medstar system single surgeon retrospective case review was performed of all FtM patients who underwent chest masculinization from Jan 2018 to Dec 2019 with a BMI greater than 30 kg/m2. Primary outcomes were mastectomy-site com-plications.

Twenty-seven obese FtM patients who underwent bilateral chest masculinization were identified. Mean BMI was 39.2 kg/m2 (SD 5.2). Preoperatively, the majority of patients had a cup size of D or larger (77.3%) and grade 3 ptosis (80.0%). Overall rate of complications was 31.5% at median follow-up of 2.1 months. Individual complications included: partial nipple graft loss 18.5%, total nipple graft loss 5.6%, seroma 3.7%, hematoma 3.7%, infection 2.9%. No complications necessitated return to the operating room. However, the majority of patients (77.8%) were completely satisfied with their aesthetic outcome.

Mastectomy can be safely performed for chest masculinization in obese FtM patients. The rate of acute complications is comparable to that of non-obese pa-tients despite a mean BMI near 40 kg/m2 in this case series. A safe procedure with high satisfaction, obese FtM patients should not be excluded from the in-creased quality of life and dysphoria reduction chest wall masculinization offers.

Partial-thickness skin graft is the cornerstone for scalp defect repair. Routine donor sites include abdomen, thighs and buttocks.  Given the potential side effects following harvesting from these sites and the potential advantages of harvesting from scalp (broad surface, rapid healing and better cosmetics results) this study is trying to compare the outcomes of graft harvesting from scalp and lower limb.

This clinical trial is conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to plastic surgery clinic at Besat hospital during the time period between 2018 and 2019. Sampling was done by simple randomization using random digit table. Data gathering was performed using a designated checklist. The donor site in case group and control group was scalp and lower limb respectively. The resultant data was analyzed using chi-squared and t-test and SPPS version 21 (SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp).

Of the total 40 patients participating in this study 28 patients (70%) were male and 12 (30%) were female with and mean age of 63.62±09.73 years. Hypertension and diabetes mellitus were the most common comorbidities among the patients with basal cell carcinoma (BCC) and trauma being the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The most common anatomic location of defect for case and control groups was temporal and parietal respectively. Most of the defects were deep to Galea zone. The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameter of defect in both groups were statistically meaningful while no such difference between graft diameter was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale.

Scalp can safely be used as donor site for skin graft to be used for scalp defects which is associated with better results and lower complication rates compared to other donor sites.

Diabetes is a leading cause of foot ulcers and lower limb amputation throughout the world. Adequate wound debridement and cover is the standard of care, but lack of adequate vascularised local tissue poses a major challenge. The gracilis flap offers various advantages in this respect, which we would like to discuss in this study, and hence makes it an attractive option in diabetic foot patients.

This retrospective study was conducted over a period of 2 years, from 2018 to 2020 in the Department of Plastic Surgery, Kauvery Hospital, Trichy, India. The flap harvest time, total operation time, flap take and complications associated with the procedure were noted.

Overall, 56 patients were enrolled. The average flap harvest time was 55 +/- 10 min and the average overall operation time was 240+/- 30 minutes. There was complete flap survival in 42 (75%) patients, a partial survival in 12 (21.42%) patients and complete flap loss in 2 (3.57%) patients. In the donor site complications hypertrophic scarring was reported in 5 (8.92%) and donor site seroma in 3(5.3%) patients.

The free gracilis flap offers good wound healing and excellent foot contour besides being safe and effective in small to medium sized defects makes it an excellent free flap in diabetic foot reconstruction.

Chronic leg ulcers are defects in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Zinc is a necessary component of several DNA & RNA polymerases and transferases essential for cell proliferation. Zinc deficiency is known to retard wound healing by preventing cellular mitosis and disturbance of fibroblast function and collagen synthesis. This study compares zinc levels in patients with chronic leg ulcers with apparently healthy individuals.

Five milliliters of venous blood samples was taken from twelve patients with chronic leg ulcers. Five milliliters of venous blood samples was also taken from a control group, who do not have chronic leg ulcers, but are matched with the cases in age (± 5 yr), sex, socioeconomic status and body mass index (± 3 kg/m2). Plasma zinc levels was determined by atomic absorption spectrophotometry. Principal exposure include the socio-demographic characteristics  of patients, duration of symptoms before presentation, signs of ulcer–site, number, size, depth, base, edge, presence of discharge, enlarged lymph nodesand local neurovascular integrity. The outcome variables include plasma levels of biochemical markers measured –Zinc, serum albumin, total protein.

The plasma zinc levels was significantly lower (P<0.01) in patients with chronic leg ulcer (92.808±16.689 μg/dl) as compared with control subjects (109.413 ± 9.304 μg/dl). There was no statistical differrence in albumin and protein levels in both groups.

Patients with chronic leg ulcers have significantly lower plasma zinc levels than apparently healthy individuals.

This study aimed to investigate the positional changes of the hyoid bone following orthognathic surgery in skeletal class III patients.

This double-blinded quasi-experimental study was carried out in Mashhad University of Medical Sciences, Iran, from Apr 2019 to Jun 2020. All skeletal Class III patients who were candidates for orthogenetic surgery were included. They underwent mandibular setback surgery using bilateral sagittal split osteotomy. Cephalometric assessments in relation to hyoid bone position and posterior airway space (PAS) were conducted one day preoperatively (T0), as well as one week (T1), six months (T2) and one year (T3) postoperatively, determining the parameters like the Long axis of the hyoid bone (LAH), Retrognation (RGn), Hyoidale (H), Palatal plane (PP), Mandibular plane (MP) and C3 Vertebrae (C3). All cephalograms were examined using AudaxCeph, Planmeca software. The data analysis was performed via SPSS-19
(P<0.05)

25 class III patients, including 18 females (72%) and 7 males (28%) with a mean age of 24.32±5.87, were studied. The cephalometric analysis demonstrated significant decreases in variable angles during the follow-up periods, except for LAH-MP angle (P<0.001). The hyoid bone moved downward and backward relative to its original position following the mandibular setback surgery. However, the bone gradually returned to the preoperative location between 6 to 12 months postoperatively.

The findings revealed the downward and backward movement of the hyoid bone following the mandibular setback surgery, returned near to its  preoperative position after 1 year, postoperatively.

Body dysmorphic disorder (BDD) is one of the obsessive-compulsive disor-ders (OCD) which is very common in populations. However, the diagnosis rate is lower than the reality. BDD may lead to loneliness, jobless, avoidance of daily life and public activities. The Body Dysmorphic Disorder Question-naire-Aesthetic Surgery (BDDQ-AS) is the validated questionnaire used to screen the BBD in patients seeking cosmetic surgeries. This study aimed to translate and validate a Persian version of the BDDQ-AS.

This analytical-descriptive cross-sectional study was conducted at Firoozgar Hospital, Tehran, Iran to validate the BDDQ-AS in Iranian society in 2020. A standard forward and back-translation procedure was followed. Overall, 79 Persian-speaking patients of both sexes referred to rhinoplasty surgery de-partment at Firoozgar hospital were recruited. The control group consisted of 70 patients who also completed the final questionnaire. The BDDQ-AS was translated into Farsi. The final version was tested for reliability and validity in both groups.

The internal consistency and split-half test were 89.2% and 92% respectively in rhinoplasty group. The spearman`s correlation coefficient between the scores obtained in BDD-YBOCS and BDDQ-AS was 0.757 (P<0.001) which confirmed the criterion validity and the minimum value of CVI was 0.79 that all items were relevant, transparent and simple.

The Persian version of the BDDQ-AS questionnaire consist of 6 short yes/no questions which is less time-consuming and reliable for interpreting and screening. The sensitivity and specificity of this version are 85.71% and 81% respectively, which are adequate for screening.

The aim of the presented study was to investigate the inhibitory effect of diltiazem on the microcirculation of the tissue flaps created in the delay phe-nomenon applied rabbits.

The experiment was performed in Central Research Laboratory of Azerbai-jan Medical University, Baku, Azerbaijan in 2018. Ischemia model on the flaps were formed in 30 rabbits for experiment. The subjects were divided into three groups: I (control) group - consists of 10 rabbits who underwent ischemia model, but no medication had been used during the duration of the experiment; II (comparative) group - consists of 10 rabbits who underwent ischemia model, and during 14 d, with a daily dose of 60 mсg nitroglycerin had been applied; III (main) group - consists of 10 rabbits who underwent ischemia model, and during 14 d, with a daily dose of 45 mg diltiazem had been applied.

There was statistically significant difference between the control and the main groups when comparing the mean values of endothelial hyperplasia (P=0.001). However, we found a statistically significant difference when compared the mean values of the arterial vessel wall thickening in the main and the control groups (P=0.022); and the mean values of thrombosis in the main and the comparative groups (P=0.001).

With prescription of diltiazem, endothelial hyperplasia on microcirculatory system, the thickening of arterial vessel walls, the thrombosis in vessel’s passage was rarely seen by statistical difference. The main achievement of our study was to discover the correlation between diltiazem and endothelial hyperplasia.

This study was designed for the evaluation of Acellular Dermal Matrix (ADM) as a scaffold for adipose-derived stem cell transferring in the rat model.

This experimental study was done in the Burn Research Center of Iran University of Medical Sciences and Bonyakhteh Research Center, Tehran, Iran according to the standards of laboratory animals. Overall, 26 healthy Sprague-Dawley rats were used. Two of them were used to prepare ADM. In group one, the first wound on each, rat was spread with the mixture of fibrin gel and autologous stem cell. Only the stem cells combined with fibrinogen were spread on the other wound. In group two, the first wound on each rat was covered only with ADM, and the second wound was covered with gauze Vaseline. To perform sampling we used observation and photography at 7-30 days. Overall, 48 samples were taken of all the rats using skin punch biopsy on the 30th day for histopathology evaluation.

There were significant differences in each group; however, the difference between different groups on days was not significant. In pathology, epithelialization, vascularization, the amount of collagen, collagen arrangement, the number of fibroblasts, and inflammation indices were investigated. The total score in each group was used for analysis. In statistical analysis, there was no pathology score difference among groups.

Using stem cells with or without ADM could not enhance the process of wound healing or improve pathology indices.

Randomized skin flaps have been used as a basic treatment modality for covering skin defects for a long time but they have always been in the risk of an inherent ischemia. Fibroblast growth factor 1 is a known angiogenic factor in in vitro studies which has shown conflicting results in in vivo investigation. We aimed to determine the effect of recombinant fibroblast growth factor on the angiogenesis rate of random cutaneous flap in animal model of rats.

This experimental study was conducted on 24 adult male rats randomized to 2 groups. In the first group FGF1 was injected subdermally in equally divided doses and distances of random flap surface in days 1, 3 and 5. In second group, normal saline was injected as control. Flap surgery was done on day 21 after first injection. The extent of necrosis and angiogenesis (mean vessel density) were assessed in day 14 after surgery.

The mean percentage of clinically apparent necrosis was 35.2% (±10.5) in intervention (FGF1) group and 38.1% (±8.7) in control (normal saline), re-spectively. Mean vessel density was 86.20±5.6/mm2 in control group and 90.17±5.5/mm2 in intervention group, which showed no statistically signifi-cant difference.

Mean vessel density and mean percentage of clinically apparent necrosis area were similar in 2 groups of rats with random cutaneous flaps receiving FGF1 or normal saline.

Given the potential usefulness of Acellular Dermal Matrices (ADM) for wound healing, we aimed to evaluate the stability, histological characteristics, and effectiveness of ADM compared with cryopreserved dermis (CPD) in rat models.

This experimental study was conducted in the Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran, from January to March 2015. The prepared ADM and CPD were transplanted to the full-thickness skin defects on the back of Sprague-Dawley rats. Forty-five days after grafting, the tissues were harvested for histological examination. These two types of the dermischr('39') quality and stability were compared with consideration of the following factors; inflammation, fibroblasts migration, vascularization, collagen formation, capsule formation, and microabscess formation.

From 19 selected rates, nine received CPD, and ten were treated with ADM. After transplantation, the mean (SD) weight of ADM and CPD grafts were 1.74 (0.07) and 1.45 (0.77), respectively (P<0.001). The frequency of inflammation was significantly higher in CPD grafts (P<0.01). Higher grades of collagen organization, fibroblast spreading, and vascularization were more frequent in ADM grafts (P<0.01). The frequency of capsule and microabscesses formation was not significantly different between studied groups.

ADM have a superior effect than CPD in the wound healing process. Both samples had a similar effect in capsule and microabscesses formation and higher costs of ADM preparation. According to the physicianschr('39') decision and evaluation of the processchr('39')s cost-effectiveness, CPD could be appropriately used as an alternative to ADM.

Facial nerve (FN) impacts the function of the facial musculature by creat-ing muscle tone at rest as well as the muscles’ voluntary and involuntary contractions. Temporary or permanent loss of FN function could be due to different etiologic factors. Acute facial paralysis (FP) could be signifi-cantly stressful for the patient and the family and apart from supportive measures management options are quite restricted. While botulinum tox-in (BTX) injection in the FP setting has been used mostly to address the compensatory hyperkinesia in the non-paralyzed side of the face, there are evidence to suggest contralateral injection of the non-paralyzed face with BTX may improve/enhance the recovery time of the FP in cases where the FP has a reversible cause. While further studies are underway, using the current evidence as discussed could potentially justify the cur-rent usage of contralateral BTX injection and biofeedback exercises in the setting of the temporary FP specialty due to lack of effective alterna-tive management options

The adhesion of mandibular condyle to the glenoid fossa by bone or fibroblastic tissue is called temporomandibular joint (TMJ) ankylosis. Trauma and infection are the main reasons for affecting TMJ ankylosis. TMJ arthroplasty is the treatment of choice for this situation. We aimed at reporting a new technique for the treatment of chronic TMJ ankylosis caused as a result of a car accident in a 54 –yr- old man who referred to Ghaem Teaching Hospital, Mashhad, Iran. The primary Maximum Mouth Opening (MMO) of the patient was equal to 2.5 mm. Interpositional arthroplasty was done using Temporoparietal Fascia Flap (TPFF) based on the superficial temporal artery. The MMO was increased to 35 mm after regular post-operative physiotherapy and a one-year follow-up. There was no sign of reanykylosis during this time. Interpositional arthroplasty using TPFF could be an appropriate treatment option. TPFF is thin and has a reliable blood supply. It seems that TPFF has less complication compared to other Interpositional materials like temporalis muscle flap.

Basal cell carcinoma (BCC) is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma and ma-lignant melanoma. These eyelid malignancies represent main reason for eye-lid reconstruction in ophthalmoplastic surgery which can be challeng-ing.Lower eyelid orbicularis oculi myocutaneous flap was used for recon-structive purpose in four consecutive patients with a full thickness upper eyelid BCC. Digital photographs were taken at baseline, 1 month, 3 and 6 months after surgery to assess clinical outcome.Four patients underwent full thickness upper eyelid reconstruction with a lower eyelid orbicularis oculi myocutaneous flap after BCC radical resection with 3-mm safe margins. Histological subtypes showed tumor complete excision in all cases. No pa-tient showed local recurrence at a mean 12 months follow-up.The high functional-esthetical success rate of the modified Hughes procedure corre-sponds with the beneficial results, which have been reported in previous publications. None of the treated patients complained about forced tempo-rary closure of eyelid. In all four cases treated, aesthetic and functional out-come were satisfactory.

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis, characterized by painful ulcerative, bullous, or pustular skin conditions. Pathergy is usually used to describe PG which refers to initiation or exacerbation of the disease after accidental or iatrogenic skin trauma. Diagnosis of postoperative PG is challenging not only due to its presentation mimics infectious wounds, but also because there are no standard laboratory parameters for diagnosis. Herein, we present a case of a 46-year-old female patient who had recurrent bilateral breast wound erythema, swelling, pain and necrosis after breast reduction mammoplasty at Centro Hospitalar Conde São Januário Macau SAR in 2018. We diagnosed her postoperative PG and successfully treated her with oral prednisolone with significant therapy response.

Pure periorbital electrical injuries are uncommonly reported and may cause both immediate and delayed complications. These injuries are rare and pose a difficult challenge for both ophthalmologist and plastic surgeon. Here we report an unusual case of pure periorbital electrical injury in a 12-yr old boy while drinking water from water dispenser.

Although trigger finger is common, pediatric trigger thumb is uncommon. In the trigger thumb the finger is held in flexed position and in examination a nodule in the palmar aspect of trigger finger is palpated  called Notta node. The etiology of trigger finger is unknown and can occur isolated without relation to any syndrome, however there are some evidences that suggest genetic etiology. We reported 2.5 yr old twin toddlers who both had bilateral trigger thumb. Grandfather of the twins had the disease.Pediatric trigger thumb is uncommon. Although trigger thumb and finger have the same presentation, they can involve different anatomical structures. Notta nodule is palpable in both. Bent or straightening of thumb or finger would produce painful popping and clicking and the affected finger or thumb can get stuck in bent and extended position. Based on physical examination and symptoms trigger finger are classified in to four stages and each has its own treatment. There are evidences that support congenital hypothesis in pediatric trigger thumb such as bilateral presentation in identical twins, first degree familiar association and etc. Before the 1st year of life, 30% of trigger thumb will get resolved and it is better to postpone the surgery until 2 yr of age .A1 pulley release has a good result in pediatric trigger thumb treatment. Trigger thumb is a multifactorial disease without clear pattern but involvement of twins, siblings and family members suggest the effect of genetic and hereditary in this problem but further researches are needed to prove this theory.

Knee rotationplasty is a suitable reconstructive and limb salvage procedure for infected femur and knee prostheses. It involves external rotation of the lower limb with an intact neurovascular bundle to function as a knee joint. Functionally, it has better outcomes when compared to alternate options like above knee amputation. It results in better cortical reorganization and superior stance mechanics, enabling a more efficient gait and better quality of life. We report a patient who underwent modified rotationplasty for an infected knee endoprosthesis as a composite lower leg free flap.

Congenital anomalies of the nose are rare but may be associated with syndromes affecting craniofacial structures. Herein, we report a case of a congenital absence of lower lateral cartilage seen during an open rhinoplasty in a 23-year-old lady with no underlying health conditions. Medical and surgical history were unremarkable and there were no evidences conducted of any previous traumatic facial injuries. During physical examination, a significant nostril asymmetry was noted to be present. In addition, cotton test showed no evidence of obstruction. The absence of lower lateral cartilage on the right side was noted during the degloving stage of the open rhinoplasty. Absence of lower lateral cartilage poses a technical challenge in surgery and in order to reconstruct this structure, cartilage can be harvested from concha, lower lateral cartilage, septum and cartilaginous dorsal hump during an open approach rhinoplasty.

Abrasions and laceration of face are very common injury in a road traffic accident. Complex Hemi-facial Degloving injury of face is very rare injury in road traffic accident. Reconstruction of face and rehabilitation of patient poses a great challenge to treating surgeon. Here a case of hemifacial Degloving injury of face in A 45-year-old female patient from India is reported.