World Journal of Plastic Surgery
Volume:1 Issue: 2, Jul 2012

Necrosis of skin flaps is considered as an important complication in reconstructive surgery. We conducted an experimental study to investigate the efficacy of low-molecular weight heparin, clopidogrel and their combination to improve the flap survival. Forty male, adult Sprague-Dawlay rats were divided randomly into 4 groups. Standard rectangular, distally based dorsal random pattern skin flap was elevated. To prevent the graft effect, a sterile sheet was put under the flap. No pharmacological agent was administered for the control group. In group 2, single subcutaneous dose of enoxaparin (3.2 mg/kg) was immediately administrated after surgery. In group 3, clopidogrel (25 mg/kg) was given orally for 7 days. In group 4, both enoxaparin and clopidogrel were administrated. The rats were evaluated on post-operative day 7 for viable and necrotic portions of flaps. The mean and SD of necrosis was 17.79+2.5 cm in the control group, 16.20±3.1 cm in low-molecular weight heparin, 15.25+3.8 cm in combined therapy group and 13.69+2.7 cm in clopidogrel group. Clopidogrel was the only pharmaceutical agent that produced a significant increase in the flap survival area. Clopidogrel may be an effective pharmaceutical agent that significantly increases viability of random skin flaps in rats, but low-molecular weight heparin and their combination did not have any significant beneficial effects.

Reduction mammaplasty (RM) is among the commonly performed procedures by plastic surgeons. Occult breast cancers are rarely detected in these specimens. The purpose of the study was to describe histopathological evaluation of reduction mammaplasty specimens to detect occult breast cancer in Southern Iran. The histological diagnosis of 350 RM specimens from 175 patients to detect occult breast cancer was evaluated retrospectively. This study determines the incidence of breast cancer too. Microscopic examination revealed that 233 specimens had no pathological changes, 106 showed evidences of fibrocystic disease, 2 were diagnosed as fibroadenoma, 4 were diagnosed as adenosis and one was diagnosed as a phylloides tumor. Furthermore, 4 specimens were diagnosed as carcinomas; 2 as medullary carcinoma and 2 as intraductal carcinoma. Four occult carcinomas were detected in young, unmarried women. Thorough gross and microscopic examination helped to detect these occult carcinomas and also helped in planning future treatments. We consider a thorough gross examination and sampling of mammaplasty specimens to be mandatory.

Nowadays, plastic surgeries are among the most popular types of surgeries around the world and Iran has one of the highest rankings in this respect regarding its population size. Based on these facts, the present study was conducted in order to evaluate the volunteers’ motivations attitudes and informational sources in Tehran, Iran. The study was conducted on a cross-sectional basis. All patients who underwent plastic surgeries during years 2005 and 2006 were evaluated and all the required information was recorded and statistically analyzed. Seventy five patients were enrolled. Their average age was 33±13 years (minimum of 17 and maximum of 63 years old). Rhinoplasty (52%) and abdominoplasty (8%) were the most and least common performed surgeries, respectively. The major important motivators were family, friends, classmates, and colleagues (40%) and the least were magazines and journals (4%). 10.7% of the participants described the posture and function of the target organs as perfect, but they planned to improve its aesthetic or functional aspects by surgery. Those who achieve their information of aesthetic surgery from mass media have a better understanding of this field. Also, the motivational stimuli for performing aesthetic surgeries have shown to be different from what were previously deemed.

Hemangioma is the most common tumor of neonatal period and it is almost always appeared by the end of the first week of life and can be found mostly in head and neck area. This study evaluated the synergistic effect of bleomycin, triamcinolone and epinephrine in treatment of hemangioma and arte-riovenous malformations. In this multicenter study, a combination of bleomycin, triamcinolone and epinephrine was injected intralesionaly for treatment of hemangiomas and arteriovenous malformations and their synergistic effect was evaluated in 32 patients. Hemangiomas and low-flow arteriovenous malformations were treated well with their combination while port-wine spots and high-flow lesions response were relatively poor. It seems that the combination of bleomycin, triamcinolone and epinephrine may be a good choice in treatment of hemangioma and arteriovenous malformations.

Cartilage tissue has limited regenerative capacity and the management of cartilage defects has always been a challenging issue. Platelet-rich plasma (PRP) has been recently been used to improve healing of cartilage defects. In the present experiment, we aimed to investigate the effects of PRP on regeneration capacity as well as survival of the cartilage grafts in a rabbit model. In 15 white New Zealand rabbits, auricular cartilage was used to produce 4 pieces of cartilage (each about 2×2 cm). Two samples were diced to small pieces and 2 samples left intact. PRP was prepared using 5 ml of auricular blood. After measuring of the weight and volume of cartilages, they mixed with either normal saline or PRP and then implanted on the back of the rabbit. After 12 weeks, the implants were removed and the weight and volume were measured and the numbers of nucleated lacunae were counted on H & E staining. Histological findings showed that in both the intact and diced cartilages, adding PRP resulted in increasing regeneration of chondrocytes. Moreover, adding PRP to intact cartilages had a significant effect in maintaining the grafts ‘weight and volume (p<0.05) but in diced cartilages, this effect was not significant. Our findings yielded valuable information on the effect of PRP on survival and regeneration of autologous cartilage grafts as the extent of angiogenesis and the diameters of vessels were more pronounced in the side using PRP and markedly lesser reduction of weight and volume were visible in this group. PRP was effective in increasing survival and regeneration capacity of cartilage grafts in rabbit model.

Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic proce-dures. The collected data were statistically analyzed. Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery.

Venous thromboembolism at lower age groups and in the absence of other known risk factors should raise doubt of underlying genetic disorders and thombophilia. It is discovered unexpectedly in various medical procedures and may cause severe complications and life threatening problems. In the current study, potentially life threatening complications of a genetic disorder in a previously healthy case is discussed. The important point in this case was delay onset of complication and its severity when was unexpectedly discovered. This situation may happen in almost every cosmetic operation and when the surgeon is not well prepared for managing this medical condition that it may lead to a dramatically poor prognosis for the patient.

In crooked noses, the lateral walls are different in shape and symmetry. Although the septum is very important to obtain a straight nose, identical and symmetrical lateral walls are needed for a straight looking nasal dorsum. As well as the septum, lateral walls also contribute in nasal skeletal support and stability. Thus, obtaining identical and symmetrical lateral walls is important. In order to obtain symmetrical and stable lateral walls, the requirements are to equalize the height, to set in a symmetric location and finally to stabilize the symmetry. These requirements must be taken into consideration while performing the steps of rhinoplasty, namely, hump resection, osteotomies and stabilization by spreader grafts or flaps. Here, we describe the management of the lateral walls in crooked nose in 7 cases.

Facial reconstruction is one of the most challenging problems faced by a reconstructive surgeon. We present a case of complex facial reconstruction with a composite trauma to the nose resulting in near total loss of skin and lining along with complete loss of left eyebrow with exposed frontal bone and partial loss of the left eyelid. We combined a temporoparietal fascial flap for reconstruction of the eyebrows and covering the exposed frontal bone and prefabricated forehead flap with skin graft for nasal reconstruction. Proper planning and staging of the surgical procedures and use of local flaps gave us good aesthetic and functional outcome with a satisfied patient.