World Journal of Plastic Surgery
Volume:1 Issue: 1, Jan 2012

Vermilion irregularities are common secondary deformities after cleft lip repair, regressed or resected hemangiomas, trauma and tumor surgeries. Vermilion deficiency attracts considerable attention and detracts from an otherwise excellent lip repair. Minor and moderate vermilion defects can be corrected with upper lip advancement, rotation flaps, tongue flaps or grafts. Major defects defy correction with local flaps. A technique is described for correction of large absolute tissue defects of the vermilion using Mutual Cross-Lip Musculomucosal Flaps (MCLMF) Or Ahmad-Ali's flaps. This technique was applied in eight patients with major vermilion defects secondary to hemangioma regression, neoplasia, and trauma. Reconstruction with MCLMF led to create a balanced donor and recipient lips appearance and function. There were no postoperative complications. Surgical results were satisfactory in all patients, and sufficient lip mobility with adequate bulk was maintained. One patient demonstrated minimal transient lip tightening. Use of Ahmad-Ali's flaps in selected patients resulted in successful reconstruction of severe vermilion defects.

There are two main surgical approaches, simple ulnar nerve decompression at the elbow, and anterior transposition of the nerve in treatment of cubital tunnel syndrome. Both techniques were reported in literature in details with similar reported success rates. Here, we present a modified simple de-compression surgical technique in treatment of cubital tunnel syndrome. Fifty eight patients diagnosed with cubital tunnel syndrome undergoing the presented technique were enrolled. This procedure consisted of ulnar nerve decompression at the elbow and a supplementary procedure of inter-muscular septum transverse cut between triceps and brachialis muscle above the elbow. Complete sensory recovery was observed in 35 (60.3%) patients, however, mild and occasional sensory symptoms remained in 15 (25.9%), and moderate symptoms persisted in 6 (10.3%) patients. In two patients (3.4%), no sensory improvement was recorded. Post-operatively, muscular hypotrophy improved completely in 5 out of 12 patients (41.7%). However, in the remaining 7 patients (58.3%) with muscular atrophy, motor recovery never took place. The presented modified simple decompression technique was shown to be an effective and safe procedure for the treatment of cubital tunnel syndrome without any complications.

Breast cancer is still considered as one of the most common female cancers worldwide regardless of the countries’ level of development. This study determines the incidence of breast cancer in Fars Province, Southern Iran. This study used patient's records from Shiraz University of Medical Sciences Cancer Registry Centre, which is a Hospital-Based Registry of Nemazee Hospital. Data were recorded based on International Classification of Diseases for Oncology (ICD-O) and compromised all invasive cancers in ICD-10 categories of C-00 to C-80. The findings were shown as the number of cases by site (ICD-10) and gender, with crude incidence (CRs), age-specific incidence and age-standardized incidence rates (ASRs) per 100,000 persons per year, performed by direct method using the world standard population. The age group of 40-49 years had the highest rate of breast cancer and naturally most cases were post-menopause ones. Most cases were diagnosed in moderate differentiated state with an increasing trend. Early diagnosis of in situ neoplasms has not increased over time in comprised with malignant cases. The number of diagnosed cases has sharply increased after year 2004 especially during post-menopause period. As the number of diagnosed cases has increased during post-menopausal period, screening and health programs seem necessary for menopause women.

Mainstay of post-burn reconstruction is release and split skin grafting. Pedicle flaps are cumbersome to the patient, require multiple procedures and hospitalization. Free flaps are technically demanding and facilities are not universally available. Here we evaluated the local perforator flaps for post-burn reconstruction. We have used sixteen perforator propellar flaps for post-burn reconstruction for various areas of body. All flaps did well without any recontracture and need of splintage. Local perforator flaps should be considered as one of the primary treatment options for post burn reconstruction.

A forty two years old woman with a history of bilateral breast augmentation for cosmetic reasons was presented for poor healing of the surgical site. Tissue and periprosthetic fluid were removed from the wound site revealing an atypical lymphoid infiltrate. Subsequently the patient developed axillary lymph adenopathy. Excisional biopsy was performed. Flow cytometry was non-diagnostic. She continued to heal poorly and eventually had removal of implant during a simple mastectomy. A nodular area in the breast specimen showed ALK negative anaplastic large cell lymphoma (ALCL). The patient was treated in the private section, with only a pathology consultation being done at our institution (Figures 1-3).

Rhinophyma is a severe late complication of rosacea, which is characterized by progressive hyperplasia of sebaceous glands and connective tissue involving the lower two-thirds of the nose. It can be an emotionally devastating disorder, and serve as a medium for occult cancers and other health problems. Many surgical treatments have been advocated, as well as dermabrasion and laser therapy. In light of the problems faced with these individual therapy modalities, we advocate a combination therapy of surgical debulking and fractionated Carbon dioxide laser therapy. By excising the tissue first, we not only decreased the amount of time needed for the procedure, we were also able to preserve a histopathologic specimen that can be examined for occult cancers. After debulking, the fractionated carbon dioxide laser is then used to blend. By using fractionated carbon dioxide, we avoided the complications associated with non-fractionated carbon dioxide lasers, such as delayed healing times, hypopigmentation, hyperpigmentation, scarring, and persistent redness. We report our experience in two patients with rhinophyma who underwent a combination of surgical excision and fractional Co2 laser therapy for treatment. Pre- and postoperative protocols and treatment parameters are discussed. Both patients had excellent cosmetic and functional results and were followed for at least one year.

Rhinoplasty is one of the most common aesthetic procedures in the world. It is the most common aesthetic surgery procedure in Iran. Achieving complete patient satisfaction is almost impossible but improving the aesthetics and function of the nose is the aim of surgery. This report describes a 34 years old woman with a large bump in the tip of the nose after three times cosmetic rhinoplasties. The first time was done 4 years before referral to our center as a reduction rhinoplasty operation. The next two subsequent surgeries were performed for revision and correcting the dorsal irregularities and supra tip bulge. Unfortunately the supratip bulge persisted and subsequent subcutaneous injections of corticosteroids and fibrinolysin were carried out. She developed a bulbous tip nose deformity. Therefore, after a few months; she was referred to our center. Surgical exploration showed a lesion in the supratip region and histopathologic examination showed a foreign body reaction and granuloma formation.

Primary breast lymphoma represents less than 1% of all primary breast malignancies and most primary breast lymphomas are of B-Cell origin. The association of anaplastic lymphoma kinase (ALK) negative anaplastic large cell lymphoma (ALCL), a very rare form of primary breast lymphoma, with silicone-filled breast implants has been suggested and several case reports supported this proposal, especially in Western countries. Here we describe one of the first cases of primary breast ALK-negative ALCL in association with saline-filled silicone breast implants evaluated in Iran, where the rising number of breast reconstructive and aesthetic surgeries would commit both surgical pathologists and plastic surgeons to be familiar with this entity.