نشریه جراحی ایران
سال سی و یکم شماره 3 (پاییز 1402)

Traumatic brachial plexus injuries in adults are destructive injuries that occur mostly in men aged 15 to 25 years. This damage leads to deep functional defects, debilitating pain, psychological and economic consequences and affects the quality of life of people. Usually, these injuries are caused by damage to the sensory and motor nerves caused by trauma, pressure, sports injuries, or excessive stretching, and lead to symptoms such as paralysis, lack of muscle control in the arm, hand, or wrist, or lack of sensation in arm or hand or sudden pain in the shoulder and arm and ... Although it is often not possible to prevent damage to the brachial plexus, it is possible to reduce the risk of further problems after the injury by taking some measures. There are different methods to diagnose the type and severity of brachial plexus injuries. Therefore, understanding the physiology of nerve damage and progress in brachial plexus reconstruction will lead to improved outcomes.

Assessing maternal satisfaction with spinal anesthesia is important for determining changes that is needed to improve the overall quality of patient care delivery. In this study, the aim of this study was to investigate the main complaints of mothers after cesarean surgery with spinal anesthesia.

This cross-sectional analytical study was performed on pregnant women undergoing caesarean section with spinal anesthesia in 2022 in Alzahra Hospital, Rasht. First, the purpose and method of the research was explained to the patients and informed consent was obtained. Then a questionnaire containing demographic data and patients complaints of spinal anesthesia was filled out.

The results of this study showed that 92 (38.5%) of the total 239 pregnant women mentioned complaints after the anesthesia procedure, while most of them 147 (61.5%) had no complaints. Nausea-vomiting (37.7%), shivering (23.9%) and repeated needling (16.7%) were the most common complaints mentioned by mothers. Based on the results of this study, there was no statistically significant relationship between complaints of spinal anesthesia and the variables of age, education, employment status, place of residency, number of pregnancies, BMI, time of termination of the pregnancy and history of spinal anesthesia (All P < 0.05).

Pregnant women who underwent cesarean section with spinal anesthesia in this center, reported limited and preventable complaints from this procedure. The mentioned complications did not lead to lasting and serious injury in mothers and were often controlled with routine therapeutic interventions without adverse consequences.

Diabetes is the most common endocrine disease, which has an increasing prevalence in the world and is the most important cause of non-traumatic limb amputation. Amputation is one of the problems that arise in these patients. Based on this, the present study was conducted with the aim of determining and comparing glycosylated hemoglobin between two groups with and without lower limb amputation in patients with diabetic ulcers referred to Shahid Beheshti Hospital in Qom.

This study was a case-control Study, the research population was patients with diabetic ulcers referred to Shahid Beheshti Hospital in Qom in 2018-2019. A total of 262 patients (127 in the group of diabetic patients with amputation and 135 in the group of diabetic patients without amputation) were examined. Finally, all the clinical and paraclinical information of the patients were extracted from the patients' files and were analyzed between the two groups.

There was no significant difference between gender, age and duration of hospitalization in the two groups (P > 0.005) and the two groups were homogeneous, but there was a significant difference between body mass index, hemoglobin A1C and fasting blood sugar in the two groups (P < 0.005) and was higher in the group of patients with diabetes with amputation.

According to our findings, there is a statistically significant difference in blood sugar and hemoglobin A1C as well as body mass index between the two groups with and without amputation. In this regard, it is necessary for patients not only to eat a balanced diet and correct their lifestyle according to the disease, but also to do proper sports.

Since sevoflurane is one of the most effective anesthetic gases in the occurrence of nausea and vomiting after anesthesia in children, and on the other hand, due to the lack of a systematic review study regarding the effective role of dexmedetomidine in preventing this complication, the aim of Conducting this study was the effectiveness of dexmedetomidine on the occurrence of vomiting after surgery in children with sevoflurane.

The current study is a systematic review and meta-analysis, which was designed and implemented based on the steps of the PRISMA statement, randomized controlled trials that were published before the beginning of 2022, from Web of Science, Embase, PubMed, and Cochrane Library, Mag Iran and SID were searched and selected. Search keywords were "dexmedetomidine", "children", "anaesthesia", "vomiting" and "sevoflurane". Meta-analysis was performed using Stata software. The statistical results of the two-category data comparison were presented in the form of odds ratios (RRs) and 95% confidence intervals. Statistical results for continuous data were presented as standardized mean difference (SMD). Heterogeneity between included studies was checked using the χ2 test (significance level of the test α = 0.1) and the I2 index was used to quantify the heterogeneity of the results.

A total of 672 participants from 10 randomized clinical trial articles were reviewed; the results were P = 0.898 and I = 0%. It was shown that dexmedetomidine is associated with a decrease in the incidence of vomiting compared to placebo (CI = 0.24-0.60-OR 0.40: P = 0.001).

Nausea and vomiting after anesthesia is one of the common and unpleasant side effects that may endanger the patient's safety. Knowledge of the effects of different drugs effective in the occurrence of this complication can change the occurrence of nausea and vomiting after anesthesia; the results of this meta-analysis showed that dexmedetomidine reduces vomiting after anesthesia of children with soflurane.

Burns is one of the most severe forms of trauma that cause damage to the skin and subcutaneous tissues in different ways with different severity and extent. Effective reduction of itching symptoms after burns is a major problem in rehabilitating all burn patients. However, although there are many potential treatments for pruritus, there is still no consensus on the best treatment. This study was conducted to investigate and compare the effects of cetirizine, gabapentin, and coconut oil in reducing skin itching after burn wound healing.

The present research population was selected from among the patients of Amir-Al-Momenin burn hospital affiliated with Shiraz University of Medical Sciences who suffered from mild to severe burns that are resistant to treatment and sometimes have bleeding. In this study, after the approval of the ethical committee of the University Research Council and the consent of the patients, 150 people were selected by random sampling. To collect data from the studied sample, the questionnaire of Khars Yusipovich et al. (2001) was used. The obtained data were statistically analyzed using t-correlated and covariance analysis and with the help of SPSS.

The average and standard deviation of the itchiness of the burn site before the cetirizine drug is 4.32 and 0.74. Also, the average and standard deviation of the itchiness of the burn site after the cetirizine drug is equal to 3.04 and 1.57. The mean and standard deviation of the itchiness of the burn site before the gabapentin drug are equal to 4.98 and 0.82. Also, the average and standard deviation of the itchiness of the burn site after the gabapentin drug is equal to 1.66 and 0.47. The average and standard deviation of the itchiness of the burn site before coconut oil is equal to 4.40 and 1.76. Also, the mean and standard deviation of the itchiness of the burn site after coconut oil is equal to 1.60 and 0.49. The intensity of itching was measured before and after the administration of cetirizine, gabapentin, and coconut oil, and there was a significant difference between all three groups.

This study showed that all three drugs, cetirizine, gabapentin, and coconut oil, reduce itching after burns and coconut oil showed the greatest effect, followed by gabapentin and finally cetirizine. The long-term follow-up of patients after discharge from the hospital showed that after transplant surgery, itching was less and that patients who lived in cold areas experienced less itching after burns.

The purpose of this study is to answer the following PICO question: "What is the risk of bleeding in patients who take oral anticoagulants and undergo oral surgery with or without discontinuation of antithrombotic therapy?" Accordingly, by conducting this systematic review, we aim to determine the risk of bleeding during and after dental surgery in patients receiving anticoagulation therapy, as well as provide guidance that will assist dental professionals in making informed clinical decisions.

In this meta-analysis study, we performed searches for eligible clinical trial studies in the Cochrane Library (Cochrane Central Unit for Controlled Trials) and Medline (Ovid and EMBASE) from the databases listed with the keywords oral surgery, extradontia and implants. We performed dental implants, the risk of bleeding events and their synonyms, and oral anticoagulants (vitamin K antagonists). Analyzes were performed for each anticoagulant and expected outcome. For studies that reported dichotomous outcomes, relative risk (RR) with 95% confidence interval was calculated. Random effects associated with meta-analysis were determined using STATA software (version 10/1).

One to three times higher risk of bleeding in patients taking warfarin compared to patients who stopped using anticoagulants during the operation (RR=1.67 and CI: 0.97-2-2.89) and after surgery (RR=1.44 and CI: 0.71-0.2-92) have shown.

There is a risk of bleeding during and after surgery in patients who do not discontinue their anticoagulant medication compared to patients who discontinue their medication during minor oral and dental surgery; however, the findings should be interpreted with caution and new studies on this topic should be initiated.

Soft tissue coverspecially in lower extremity and leg is a challenag for all reconstructive surgeons. Many methods and flaps have been introduced and used in this area. In this study we discussed about some unusual flaps that we used in our cases in 15 khordad hospital.

In this study according to ourresults in our cases, the leg divides into three subarea. We used Distal & lateral thigh flap in proximal third, free gracilis flap for the middle third and Medial plantar flap andmedial pedis flap for lower third defect.

Our results suggest that these less common flaps have comparable results VS common flaps, and can be used as first step for leg reconstruction.

In some cases, this study showed that the desired flops have received less attention; their results are comparable to the more common flops in terms of performance and appearance. This study emphasizes that the common methods should not necessarily be recognized as the best method and the best decision should be made for each disease based on the existing conditions.

Negative pressure wound therapy (NPWT), has revolutionized wound care over the last 15 years, Dressings to treat complex wounds have traditionally been made of cotton gauze ,The use of negative pressure wound therapy (NPWT) has become increasingly popular in the Management of complex wounds. There are many increasing indications for NPWT such as treatment of chronic ulcers, preparation of wound for skin graft or flaps and even closed surgical wounds management.
In this article we are going to review the literature to show all indications of NPWT in orthopedic
surgeries.

Human resources play a significant role in the development and progress of care and treatment and are considered as one of the important pillars of any organization, which has always been emphasized by experts. Joint research between religious and professional groups in the field of mental health and medicine has found that spirituality and religious attitude are associated with positive results in physical and mental health. Based on this, the present research was conducted under the title of "investigating the role of spirituality and beliefs in the performance of hospital operating room personnel in providing services to patients".

The method of this descriptive study was a survey that included 92 hospital operating room personnel. The data was collected using a 35-question researcher-made questionnaire. Data analysis was done using Pearson's correlation coefficient statistical test and SPSS version 28 software.

The results of the research showed that spirituality and beliefs are effective in the personal and social life of operating room personnel. This means that spirituality and beliefs make a person see God as a watcher of his actions and behavior in his personal and social life and act carefully in the smallest issues. Also, spirituality and beliefs have been effective in the responsibility of operating room personnel. Other results showed that spirituality and beliefs are effective in patience and tolerance, work discipline and developing the spirit of gratitude. A person who sees himself in front of God every moment and sees him as the supervisor of all his actions and behavior, surely the performance of such a person should also be affected. Also, spirituality and beliefs reduce anxiety, and as a result, it has a great impact on his performance in the work environment.

The results showed that spirituality and beliefs have been effective in the performance of operating room personnel in all dimensions investigated in this study and strengthening this can be effective in improving the performance of personnel