فهرست مطالب

Plastic Surgery - Volume:7 Issue: 1, Jan 2018

World Journal of Plastic Surgery
Volume:7 Issue: 1, Jan 2018

  • تاریخ انتشار: 1397/01/05
  • تعداد عناوین: 21
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  • Azizollah Khodakaram-Tafti, Davood Mehrabani, Hanieh Shaterzadeh-Yazdi, Barbad Zamiri, Mahsa Omidi Pages 3-11
    Background
    Restoration of craniofacial bone defects has been a concern for oral and maxillofacial surgeons. In this study, the healing effect of fibrin glue scaffold was compared with autologous bone graft in mandibular defects of rabbit.
    Methods
    Bilateral unicortical osteotomy was performed in the diastema region of 10 male Dutch rabbits. The subjects were randomly divided into 2 equal groups. The mandibular defect on the right side was treated with fibrin glue scaffold and the defect on the left side with autologous bone graft provided from iliac crest. After 4 and 8 weeks, five rabbits from each group were sacrificed and the defects were evaluated morphologically, by coronal computed tomography scanning (CT-scan) and by histological examinations.
    Results
    The healing effect of fibrin glue scaffold and autologous bone graft was similar with appropriate osteogenesis in comparison to the control group.
    Conclusion
    Using fibrin glue can be a non-invasive treatment of choice in mandibular defects and maxillofacial surgeries when compared with autologous bone graft.
    Keywords: Fibrin glue, Scaffold, Autologous bone graft, Mandibular defect, Rabbit
  • Seyed Esmail Hassanpour, Masoud Yavari, Amir Reza Motabar Pages 12-15
    Background
    Extended Soft tissue defect of leg including middle and distal parts always has been a challenge for many plastic surgeons and also a frustrated problem for patients and families. To introduce the use of the soleus muscle and reverse sural flaps as synchronous surgical treatment alternative of the leg bone exposure with large soft tissue defect, this study was conducted.
    Methods
    The medical records of patients undergoing transposition of the soleus muscle for treating exposed bone in the leg and simultaneous sural flap were retrospectively analyzed from January 2009 to July 2014, while gathering information on the used muscle was to cover the lesion.
    Results
    Twelve patients with varying ages between 22 and 58 years (10 males and 2 females) were enrolled. The main initial injury was trauma (84.8%), consisting of tibia and/or fibula fractures. Only 1 patient developed insignificant distal flap necrosis who was treated subsequently with surgical debridement and flap re-advancement.
    Conclusion
    The treatment of bone exposure with local muscle flaps (soleus and sural) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay. Sometimes, this method may be applied instead of free tissue transfer.
    Keywords: Wound, Soleus, Sural, Flap, Leg, Soft tissue, Reconstruction
  • Adil Ali, Umme Aiman, Mohd Azam Haseen, Mohd Altaf Mir, Imran Ghani, Ragya Bharadwaj, Mohd. Yaseen Pages 16-24
    Background
    Hemangiomas are the most common benign tumors of infancy. This study evaluated the efficacy of oral propranolol comparing to oral steroids in management of pediatric hemangiomas.
    Methods
    In North India from January 2012 to January 2015, sixty children
    Results
    The propranolol group mostly showed early response to the drug and needed the drug for less time compared to corticosteroid group. In propranolol group, 16.5%, 23% and 59% needed the drug to be continued for 8-12, 4-8 and 4 months. In corticosteroid group, the therapy was continued for 8-12, and 4-8 months in 76.8% and 16.5% and in 6.6% was stopped within 4 months. In propranolol group, the response was 70% compared to 40% in other group. The mean HAS decreased significantly in propranolol group when compared to steroid group. Three patients on prednisolone developed Cushingoid features, while 1 patient in propranolol group had mild flue like symptoms.
    Conclusion
    Two mg/kg of oral propranolol significantly decreased HAS, when compared to oral prednisolone, with good parent satisfaction, minimal adverse effects and no recurrence/relapse of hemangiomas after a follow up period of 6 months.
    Keywords: Pediatric hemangiomas, Propranolol, Corticosteroids
  • Aliasghar Hemmati, Forough Namjuyan, Sadegh Yousefi, Gholamreza Housmand, Hossein Khadem Haghighian, Anahita Rezaei Pages 25-33
    Background
    Wound healing is the process of repair following an injury to the skin and other soft tissues. In this study, the effect of n-hexane d-chloromethane extract (1: 1) of root Onosma bulbotrichum DC on the second degree burn in rabbit model was investigated.
    Methods
    Thirty-six adult rabbits of both sexes were randomly divided into six groups, control (without treatment), negative control (treatment with cold cream), positive control (treatment with silver sulfadiazine), and treatment groups with 5%, 1% and 2% O. bulbotrichum cream and assessed histologically.
    Results
    The best result was shown in 5% O. bulbotrichum group similar to silver sulfadiazine group. The maximum amount of collagen and the tensile strength of tissue were observed in 5% O. bulbotrichum and silver sulfadiazine groups. Histopathological examination showed that burn healing in treatment group with 5% O. bulbotrichum was faster than other groups.
    Conclusion
    The 5% O. bulbotrichum cream was shown to have healing, and anti-inflammatory effects when used in treatment of second degree burns.
    Keywords: Burn, Healing, Silver sulfadiazine, Onosma bulbotrichum, Rabbit
  • Hossein Asgarirad, Aroona Chabra, Mahnaz Rahimnejad, Ahmad Zaghi Hosseinzadeh, Ali Davoodi, Mohammad Azadbakht Pages 34-44
    Background
    Large numbers of population suffer from burn annually. The promising treatment of burn has not been identified yet. Albizia julibressin (A. julibressin) in Fabaceae family is popular for its antiseptic activity. This prospective study was designed to compare the wound healing effects of A. julibressin gel (AG) with silver sulfadiazine (SSD).
    Methods
    This single blind clinical trial was performed on 40 patients with second and third degree burns. 20 patients treated with SSD and 20 other patients received A. julibressin. The percentage of the wound healing was evaluated with pain, irritation, edema, itching, erythema, purulent discharges and skin discoloration symptoms. Also, the patients’ satisfaction and adverse drug reactions were determined.
    Results
    The severity of pain (p=0.03), inflammation (p=0.02) and purulent secretions (p=0.03) were significantly relieved in A. julibressin group. The healing time significantly reduced in second degree burns (p=0.03) and third degree burns (p=0.04) with treating by A. julibressin. No significant adverse drug reactions were detected with A. julibressin.
    Conclusion
    It seems that A. julibressin improves the different therapeutic aspects of burn injuries and could be considered as a new herbal remedy in wound healings.
    Keywords: Herbal Medicine, Burns, Wound, Healing, Albizia julibressin
  • Mohaddese Mahboubi, Mohsen Taghizadeh, Tahereh Khamechian, Omid Reza Tamtaji, Rasoul Mokhtari, Sayyed Alireza Talaei Pages 45-50
    Background
    The number of diabetic patients in adult population is increasing. All this population are at risk of developing diabetic foot ulcers (DFUs) that are associated with unwanted ailments and high mortality. In spite of current therapies for DFUs, further therapies are needed to help the patients.
    Methods
    The efficacy of herbal cream containing Pelargonium graveolens and Oliveria decombens essential oils was evaluated topically for treatment of DFUs in rat animal model in comparison with two other herbal formulas containing each essential oil alone, placebo (the basic formula without active ingredients) and normal saline as control groups. After anesthesia of diabetic rats (n=75) induced by streptozotocin (STZ), diabetic wounds were visible on the hind dorsal surface of the foot. The treatments were initiated on Day 1 and repeated 3 times a day for thirteen consecutive days. On day 1, 3, 5, 8 and 13, the wound sizes were determined and assessed histologically.
    Results
    Three herbal formulations reduced the size of wounds in rats with DFUs, while the cream containing combined herbals of O. decumbens and P. graveolens essential oils had the highest tissue repair in DFU rat models.
    Conclusion
    Due to better wound healing effects of combined herbal cream containing O. decumbens and P. graveolens essential oils, it can be recommended in treatment of DFUs.
    Keywords: Herbal, Oliveria decumbens, Pelargonium graveolens, Diabetic foot ulcer
  • Mehri Bozorg-Nejad, Hammed Azizkhani, Fatimah Mohaddes Ardebili, Sayed Kazem Mousavi, Farzad Manafi, Agha Fatemeh Hosseini Pages 51-57
    Background
    Burn is the worst tragedy among modern societies that individuals may experience. One of the most important problems of burns is pain; particularly at the time of treatment including burn dressings, debridement, surgical incisions and physiotherapy. The aim of this study was to determine the effect of rhythmic breathing on pain of dressing change in patients with burns.
    Methods
    This semi-experimental clinical trial study with a control group was conducted on 60 eligible burn patients who were selected using convenient sampling method and allocated randomly in two groups of test and control (each n=30). Data collection tools included demographic data and pain observation questionnaires. The rhythmic breathing was individually and orally trained to the patients of test group in a room separated by dividers for a 20-minute session. The pain intensity in test and control groups before and after dressing was investigated for three consecutive days.
    Results
    Friedman test results showed that pain intensity in both control and test groups had statistically significant differences. The pain intensity after rhythmic breathing reduced more in the test group, and this reduction was more significant during 3 days.
    Conclusion
    Rhythmic breathing is an effective method on pain reduction of dressing change in patients with burn injuries.
    Keywords: Rhythmic breathing, Pain, Burn, Dressing
  • Honnegowda Thittamaranahalli Muguregowda, Pramod Kumar, Padmanabha Udupa Echalasara Govindarama Pages 58-66
    Background

    Malondialdehyde (MDA) is an oxidant that causes damage to membranes, DNA, proteins, and lipids at the cellular level. Antioxidants minimize the effects of oxidants and thus help in formation of healthy granulation tissues with higher level of hydroxyproline and total protein. This study compared the effect of limited access dressing (LAD) with conventional closed dressing biochemically and histopathologically.

    Methods

    Seventy-two 12-65 years old burn patients with mean wound size of 14 cm2 were divided to two groups of LAD (n=37), and conventional dressing groups (n=35). Various biochemical parameters were measured in granulation tissue. Histopathological analysis of the granulation tissue was studied too.

    Results

    LAD group showed significant increase in hydroxyproline, total protein, GSH, and GPx and decrease in MDA levels compared to conventional dressing group. A significant negative correlation between GSH and MDA was noted in LAD group, but in conventional dressing group there was no significant correlation. A significant negative correlation between GPx and MDA was noticed in LAD group, but in conventional dressing group was not significant. There was a histologically fewer inflammatory cells, increased and well organized extracellular matrix deposit, more angiogenesis in LAD group after 10 days while the difference was significant between the groups.

    Conclusion

    Our study showed a significant reduction in oxidative stress biomarker of MDA, increase in hydroxyproline, total protein, antioxidants and amount of ECM deposition, number of blood vessels and a decrease in the amount of inflammatory cells and necrotic tissues in LAD group indicating the better healing effect of burn wounds.

    Keywords: Burn, Wound, ROS, Limited access dressing, Malondialdhyde, Antioxidant
  • Reza Vaghardoost, Gholamreza Mousavi Majd Seyed, Hamid Tebyanian, Hamid Babavalian, Leila Malaei, Mitra Niazi, Ali Javdani Pages 67-71
    Background
    Many studies were carried out to improve sophisticated dressings to accelerate healing processes and reduce the microbial burden in burn wounds. This study evaluated the healing effect of herbal ointment containing extract of sesame oil, camphor and honey on second degree burn wounds in rats in comparison with daily dressing oil vaseline.
    Methods
    Forty rats were randomly assigned to two equal groups. A deep second degree burn was formed on the back of each rat with using a standard burning technique. The burns were dressed daily with herbal ointment containing extract of sesame oil, camphor and honey in group 1, dressing oil vaseline in group 2. The response to treatment was evaluated by digital photography during the treatment on 0, 7, 14, 21, 28 days. Histological scoring was undertaken for scar tissue samples on 0, 7, 14, 21, 28 days.
    Results
    Considerable epithelization in the herbal ointment group vs. the control group over the study period was noted. Neovascularization was significantly higher in herbal ointment treated rats as well. In terms of difference of wound surface area, maximal healing was noticed in herbal ointment extract of sesame oil, camphor and honey group and the minimal repair in the control group.
    Conclusion
    The greatest rate of healing was in the herbal ointment group containing sesame oil, camphor and honey, so the herbal ointment as a suitable substitute for dressing and healing of burn wound injuries is recommended.
    Keywords: Sesame oil, Camphor, Honey, Burn, Wound, Healing
  • Claudio Silva-Vergara, Joan Fontdevila, Omar Weshahy Pages 72-77
    Background
    The tuberous breast syndrome is a condition that affects young women and can bring on serious disorders of self-esteem. There are numerous surgical techniques to correct this condition, but most of them include the use of breast implants to replace lack of volume. Nowadays, patients are increasingly becoming more demanding to get a definitive solution with minimal aesthetic sequelae.
    Methods
    We present a series of 11 patients with tuberous breast deformities treated with lipofilling technique. Fat harvest was performed by conventional lipoaspiration with 3 mm cannulas, centrifuged at 2000 rpm for 2 minutes and injected in the breast were was needed with 1.9 mm blunt cannulas.
    Results
    The patient’s average age was 24 year old with a BMI of 23.4 kg/m2. Volumes between 80 and 250 ml per breast were injected in every session, requiring a total volume of 413 ml per breast. Most patients required up to two procedures to achieve the complete breast correction. The mean follow-up was 29.7 months. All patients had good aesthetics results with minimal complications.
    Conclusion
    Natural breast mound with excellent cosmetic result can be achieved with fat grafting. Fat grafting main advantage is to respond to physiological changes in weight over time. In addition, lipofilling do not carry the inherent complications of implants. We strongly believe it is a safe and easy technique to reproduce in properly selected patients and with minimal morbidity it can cause the best natural result.
    Keywords: Tuberous breast, Lipofilling, Fat graft
  • Seyed Nejat Hosseini, Ali Ammari, Seyed Mehdi Mousavizadeh Pages 78-88
    Background
    Nowadays obesity is a common problem as it leads to abdominal deformation and people’s dissatisfaction of their own body. This study has explored using a new surgical technique based on a different incision to reform the flank skin laxity and dog ear plus aggressive liposuction on women with abdominal deformities.
    Methods
    From May 2014 to February 2016, 25 women were chosen for this study. All women had a body mass index more than 28 kg/m2, flank folding, bulging and excess fat, abdominal and flank skin sagging and laxity. An important point of the new technique was that the paramedian perforator was preserved.
    Results
    All women were between 33 and 62 years old (mean age of 47±7.2 years old). The average amount of liposuction aspirate was 2,350 mL (1700-3200 mL), and the size of average excised skin ellipse was 23.62×16.08 cm (from 19×15 to 27×18 cm). Dog ear, skin laxity, bulging and fat deposit correction were assessed and scored in two and four months after the surgery.
    Conclusion
    Aggressive abdominal and flank liposuction can be safely done when paramedian perforator is preserved. This has a good cosmetic result in the abdomen and flank and prevents bulging in the incision end and flank. Using this abdominoplasty technique is recommended on patients with high body mass indexes.
    Keywords: Liposuction, Flank skin laxity, Dog ear, Middle east, Women, Obesity
  • Pauline Joy Santos, David A. Daar, Keyianoosh Paydar, Garrett A. Wirth Pages 89-96
    Background
    Rhinoplasty is a popular aesthetic and reconstructive surgical procedure. However, little is known about the content and readability of online materials for patient education. The recommended grade level for educational materials is 7th to 8th grade according to the National Institutes of Health (NIH). This study aims to assess the readability of online patient resources for rhinoplasty.
    Methods
    The largest public search engine, Google, was queried using the term “rhinoplasty” on February 26, 2016. Location filters were disabled and sponsored results excluded to avoid any inadvertent search bias. The 10 most popular websites were identified and all relevant, patient-directed information within one click from the original site was downloaded and saved as plain text. Readability was analyzed using five established analyses (Readability-score.com, Added Bytes, Ltd., Sussex, UK).
    Results
    Analysis of ten websites demonstrates an average grade level of at least 12th grade. No material was at the recommended 7th to 8th grade reading level (Flesch-Kincaid, 11.1; Gunning-Fog, 14.1; Coleman-Liau, 14.5; SMOG 10.4; Automated Readability, 10.7; Average Grade Level, 12.2). Overall Flesch-Kincaid Reading Ease Index was 43.5, which is rated as “difficult.”
    Conclusion
    Online materials available for rhinoplasty exceed NIH-recommended reading levels, which may prevent appropriate decision-making in patients considering these types of surgery. Outcomes of this study identify that Plastic Surgeons should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. Readability results can also contribute to marketing strategy and attracting a more widespread interest in the procedure.
    Keywords: Readability, Rhinoplasty, Patient, Education
  • Abdoljalil Kalantar-Hormozi, Roozbeh Rahbar, Ali Abbaszadeh-Kasbi, Nazanin Rita Davai Pages 97-102
    Background
    Rhinoplasty is among the most popular aesthetic surgical procedures selected by teenagers. When it comes to teenagers’ rhinoplasty, almost all surgeons believe that modified techniques should be considered because the nose is still growing. In this article, we prospectively followed teenagers who had undergone septorhinoplasty to assess the safety of procedure and its possible complications.
    Methods
    All the patients who were under 18 years old but for those who had a bleeding disorder, allergic rhinitis, and cleft lip nose were included in the study. All the patients were operated by the Senior author through closed rhinoplasty. Age, gender, indication for surgery, postoperative complications, need for revision surgery, postoperative satisfaction, and disturbance in facial growth until puberty were gathered for each of patients.
    Results
    Of all 40 patients, 38 (95%) patients were female and 2 (5%) patients were male. Mean age and follow up of patients was 16.1±0.8 years and 29.5±12.1 months, respectively. Fourteen (35%) patients had some degrees of nasal obstruction. Thirty-five (87.5%) patients expressed complete satisfaction with their rhinoplasty outcome. None of patients underwent revision rhinoplasty.
    Conclusion
    The study indicates that patients’ craniofacial growth was not affected by the procedure, and it seems that septorhinoplasty is safe in teenagers.
    Keywords: Rhioplasty, Septorhinoplasty, Teenagers, Pediatric, Nasoseptal growth
  • Ali Kavyani, Ali Manafi Pages 103-108
    There are some rare but probable devastating complications following any rhinoplasty. Charlin’s syndrome is a typical one. It is completely related to the external nasal nerve. In this report, we are presenting a 21-year-old female with signs and symptoms of Charlin’s syndrome, persisting for 4 years after a routine septorhinoplasty operation. Surgery was uneventful and the patient underwent bony septal resection and caudal septal relocation. Osteotomy was internal low to low and external transverse bilaterally. Overall, a routine septorhinoplasty was executed. Everything went well postoperatively, until 4 months after surgery, when some irritating symptoms developed and gradually intensified.
    Keywords: Septorhinoplasty, Complication, Charlin's syndrome
  • Danielle Atwood, Pallavi Kumbla, Brian Yuen, James Yuen Pages 109-112
    Mucormycosis has a mortality rate reaching 90%, and is imperative that therapy be initiated rapidly once a diagnosis is made. Successful treatment consists of management of underlying risk factors, surgical debridement, and antifungal therapies. The dilemma whether or not to pursue extensive debridement presents when the wound is cultured positive but the patient is not systemically ill. We present the first reported case of successful medical treatment of a seroma pocket colonized with mucor in a patient undergoing bilateral reconstruction with tissue expander and acellular dermal matrix.
    Keywords: Mucormycosis, Mucor, Breast reconstruction, Expander site infection
  • Mahnaz Arshad, Gholamreza Shirani, Sina Refoua Pages 113-117
    Reconstruction of a facial defect is a complex modality either surgically or prosthetically, depending on the site, size, etiology, severity, age, and the patient’s expectation. Loss of an auricle, in the presence of an auditory canal, affects hearing, because the auricle gathers sound and directs it into the canal. The auricle acts as a resonator to slightly amplify lower frequency sounds and helps to localize sounds, especially in conjunction with the other ear. Osseointegrated implants have an important role in prosthetic reconstruction of patients with craniofacial defects. The main indications of this treatment plan are lack of local tissue for autogenous reconstruction, previous reconstruction failure and selection of this technique by the patient. This paper presents a clinical case and advantages of the osseointegrated implant technique for retention of auricular prostheses.
    Keywords: Implant, Dental prosthesis, Ear implant, Ossicular replacement
  • Chenyang Ji, Ruiting Li, Jinming Zhang, Ganlin Zhang, Weiqiang Liang, Yuhong Chen Pages 118-121
    A 39-year-old male patient presented with an extensive putrescent ulceration of abdominoperineal region infiltrated by advanced penile squamous cell carcinoma. To our knowledge, it is the largest defect after aggressive palliative resection of penile squamous cell carcinoma (pSCC) in the literature, which was 36×23 cm. The defect was divided into three sub-defects, and was repaired by bilateral anteromedial thigh (AMT) and left deep circumflex iliac artery (DCIA) flaps. The postoperative course was uneventful and no flap necrosis occurred. The symptom relief was excellent.
    Keywords: Penile, Squamous cell carcinoma, Abdominoperineal defect, Anteromedial thigh flap, Deep circumflex iliac artery flap
  • Masood Amini, Mohammad Hassan Hashemizadeh, Seyedeh Leila Poorbaghi Pages 122-127
    Leiomyoma is a rare esophageal tumor that constitutes less than 1% of esophageal malignancies. It should be removed when diagnosed even if asymptomatic. This study presents two cases of esophageal leiomyoma in 38 and 62 years old men who presented with dysphagia and evaluated for diagnosis and location of related tumors. Patients were clinically examined and upper gastrointestinal endoscopy, chest computerized tomography scan, barium swallow and endoscopic ultrasonography were performed. The masses were diagnosed and both patients underwent 3-port right videothoracoscopic enucleation of esophageal leiomyoma with sleeve calibration tube (SCT) assistance. SCT was used to protrude out the mass from surrounding tissues. Also immunohistochemistry was done after mass enucleation. Two patients were operated routinely without any unpredictable events by help of SCT assistance. Mass size was 3.5×2.5×1 cm in one case and 1.5×1×0.5 cm in another patient. Positive smooth muscle antigen, desmin and ki67 and negative CD34, CD117 and S100 in both cases were obtained in immunohistochemistry. Patients were followed after surgery for 3 months and no complications were detected in none of them. Thoracoscopic enucleation of esophageal leiomyoma is a safe and feasible procedure which can decrease hospitalization and operation time. Based on our findings, the use of esophageal SCT help to detect smaller tumor without need of intra-operative endoscopy, facilitates separation of the tumor mass from both esophageal mucosal and muscular layers, and may prevent perforation. Finally, use of SCT makes the operation faster and safer.
    Keywords: Video assisted thoracoscopic surgery, Leiomyoma, Esophageal sleeve calibration tube
  • Amine Rafik, Mounia Diouri, Naima Bahechar, Abdessamad Chlihi Pages 128-131
    The neurofibromatosis is a frequent and polymorphic genetic disorder. The severity is related to the complications. The degeneration of neurofibroma is a very rare complication of neurofibromatosis. In the literature, a few cases of solitary neurofibroma, which turned into a malignant tumor were reported. In our case, we described a very rare clinical case of neurofibrosarcoma in the scalp, and surgical treatment.
    Keywords: Neurofibroma, Neurofibromatosis, Scalp, Schwannoma, Surgery
  • Fatih Ozdogan, Halil Erdem Ozel, Erkan Esen, Selahattin Genc, Adin Selcuk Pages 132-135
  • Gholamhossein Ghaffarpour, Zahra Azizian, Mohammad Reza Ghasemi Pages 136-138