فهرست مطالب

Plastic Surgery - Volume:7 Issue: 2, May 2018

World Journal of Plastic Surgery
Volume:7 Issue: 2, May 2018

  • تاریخ انتشار: 1397/02/20
  • تعداد عناوین: 20
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  • Samir M. Ghoraba, Wael Hussein Pages 151-158
    Background
    Reconstruction of complex soft tissue defects of the thumb, with exposure of tendons, joints or bones, has always been a difficult task. We evaluated the functional and esthetic outcomes of 1st dorsal metacarpal artery island flap in reconstruction of post-traumatic soft tissue defects of the thumb.
    Methods
    Between January 2012 and June 2014, fifteen patients with complex post-traumatic soft tissue thumb defects underwent 1st dorsal metacarpal artery island flap. Sensory function was evaluated with static 2-point discrimination and cortical reorientation. The mobility of the thumb was tested by the Kapandji score. The esthetic outcome was assessed. Patient's subjective satisfaction was evaluated by the visual analogue scale.
    Results
    The mean flap size was 33.3×17.7 mm. All donor sites were grafted by full-thickness skin grafts from the groin. Fourteen flaps survived completely and one had distal flap necrosis was treated conservatively. The mean static two-point discrimination was 10.4 mm. Cortical reorientation was complete in 40%. The average Kapandji score was 7.1. The esthetic outcome was excellent in six, good in eight and poor in one subject. After a mean follow up period of 18.2 months, the mean subjective satisfaction score was 8.1; most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.
    Conclusion
    First dorsal metacarpal artery flap offers a sensate, pliable and versatile coverage for small to moderate sized thumb defects. Moreover, it provides good functional and esthetic outcomes with minimal donor site morbidity.
    Keywords: Thumb, Soft tissue, Defect, First dorsal metacarpal artery flap, Reconstruction
  • Osman Fathy Osman, Sherif Emara Pages 159-165
    Background
    Full-thickness skin graft (FTSG) is a very versatile tool regularly used in small sizes. With the established knowledge of the graft take through the margins as well as wound bed, we extended the use of the FTSG for reconstruction of large-sized defects with satisfactory results.
    Methods
    We presented our experience in wound reconstruction using FTSG in 28 patients. We selected cases with graft size equal to or more than 130 cm2. Seven patients had chronic but healthy granulating wounds and 21 patients had fresh raw areas. Sizes of FTSG used varied between 130 to 452 cm2 of outstretched skin at donor sites. We used subgluteal skin crease in most of cases, though groin, upper medial thigh and medial arm aspects were also used.
    Results
    There was no difference in graft take between fresh and chronic wound sites. Almost complete graft take was the rule in all cases apart from mild epidermal skin peeling in four cases and small spots of graft necrosis in three cases. Primary wound healing at donor sites was the rule with scar hypertrophy in six cases necessitating scar conservative care for few months.
    Conclusion
    Use of FTSG for reconstructing raw areas in acute and chronic wounds has to be safely reconsidered regardless of wound size. It’s still a sound and reliable tool which can decrease the necessity of complex flap coverage. Subgluteal skin crease is relatively a new donor site to be considered for large grafts with primary direct closure.
    Keywords: Skin graft, Full, thickness, Reconstruction, Donor
  • Guillermo Ramos-Gallardo, Gabriel Angel Mecott-Rivera, R. Limon-Cervantes, M. Garcla-Perez, E. Rodrlguez-Olivares Pages 166-170
    Background
    Little is known about educational games in Plastic Surgery training. Pecha kucha game has proved to be helpful tool to improve communicative skills. This study survey in resident participants in Pecha Kucha contest assessed how to improve speaking skills in plastic surgery training.
    Methods
    In the second edition of Pecha Kucha contest of the Mexican Society of Plastic Surgery, a survey was conducted with the residents to know the utility of this educational game.
    Results
    Twenty-six residents participated in the survey. Most of them from the Universidad Nacional Autonoma de México. Most of the residents considered it to be a good tool in order to improve communication skills and helpful for their future practice. The amount of time to present an idea was considered enough to express an idea. The most common proportion between words and images was 20-80% in the presentation.
    Conclusion
    Pecha Kucha helped to improve communication skills during residents’ training. We encourage other plastic surgery societies to incorporate educational games in their national and international meetings.
    Keywords: Speaking skill, Plastic surgery, Training, Pecha Kucha contest
  • Nazanin Rita Davai, Kamran Ganji, Abdoljalil Kalantar-Hormozi, Ali Abbaszadeh-Kasbi Pages 171-178
    Background
    This study aimed to identify the impact of cosmetic surgery on married women's marital satisfaction and self-concept in Tehran.
    Methods
    This study was causal-comparative research. The study population consisted of all women having or applying for cosmetic surgery in Tehran over the second half of 2015. Convenient random sampling was used to select the participants. Enriching and Nurturing Relationship Issues Communication and Happiness (ENRICH) marital satisfaction questionnaire and Roger's Self-concept Inventory were used to collect data.
    Results
    The study sample included 44 individuals having facial cosmetic procedures, 51 individuals applying for cosmetic surgery and 55 non-applicants (ordinary people). There were significant differences in terms of marital satisfaction and its components between the cosmetic surgery applicants and surgery group and control group. The cosmetic surgery applicants revealed higher levels of satisfaction in comparison with the surgery and control groups regarding the components’ personality, conflict and leisure. Considering the component marital relationship, the applicant group had higher satisfaction than control group. With regard to the components financial management and relatives and friends, the applicant group had higher satisfaction, in comparison to the control group. The control group had better self-concept than the surgery and applicant groups.
    Conclusion
    Expectation for postoperative positive outcome is an important factor affecting high level of marital satisfaction in surgery applicants. Furthermore, the component self-concept is also a significant predictor of having or applying for cosmetic surgery.
    Keywords: Marital satisfaction, Self, concept, Married women, Cosmetic surgery
  • Amir Ali Mafi, Reza Shahverdiani, Parviz Mafi Pages 179-185
    Background
    Proper pre-operative facial analysis that includes a thorough evaluation of both the bony and soft tissue anatomy is paramount to success in performing aesthetic surgery of the face. Ethnic variations in soft tissue profile add an important variable to pre-operative facial analysis. The aim of our study was to determine the role of ethnic variations in soft tissue facial profiles through profile analysis of Iranian male and female patients.
    Methods
    Photographs of 100 Iranian males and 100 Iranian females (16 to 40 years old) were carried out. A review committee selected 10 male images and 10 female images, which they believed to be most ideal. The soft tissue profiles were then analyzed. A total of 21 measurements were analyzed and statistically compared with North American Caucasian males and females.
    Results
    The upper lip projection and lower lip projection were significantly more prominent in Iranian males as compared with North American Caucasian males. In addition, Iranian males had longer face as compared with North American Caucasian males along with a more drooping nasal tip. The frontonasal area is straighter and the lower face is longer in Iranian females compared with North American Caucasian in addition to more convex faces along with a shorter upper face.
    Conclusion
    Significant differences in ideal soft tissue profiles exist between Iranian and Caucasian males. These differences should be recognized as they may play an important role in performing facial aesthetic and reconstructive procedures, particularly rhinoplasty, genioplasty, midface/facelifts, lip augmentation, and maxillofacial surgery.
    Keywords: Soft tissue, Facial profile, Caucasian, Aesthetic surgery
  • Sanaz Jamshidi, Najmeh Hejazi, Ali Reza Zimorovat Pages 186-192
    Background
    Malnutrition leads to decreased survival rate, quality of life and the response to treatment and increases the risk of mortality in patients with cancer. Clinical evaluation is essential for ontime detection and treatment of malnutrition in these patients. On the other hand, patients with gastrointestinal (GI) cancers are expected to have a higher risk of malnutrition due to the poor digestion and malabsorption. Therefore, the purpose of this study was to compare the nutritional status in patients with GI tract cancers with non-GI cancers.
    Methods
    Sixty-nine patients with GI cancers and 65 patients with other types of cancer participated in this case-control study. Anthropometric evaluation [weight, body mass index (BMI)], mid arm circumference, calf circumference) and biochemical indices [albumin, C-Reactive Protein (CRP)] were measured and the Subjective Global Assessment (SGA) questionnaire was completed to assess the nutritional status of the patients.
    Results
    BMI, weight and serum albumin levels were significantly lower in patients with GI cancers. Other anthropometric measurements were lower in the case group and the serum CRP level was higher than the control group, although they were not statistically significant. The incidence of malnutrition was higher in case group compared to the control group, but it was not statistically significant.
    Conclusion
    Anthropometric, biochemical and SGA evaluation showed a poor nutritional status in patients with GI cancer compared to other forms of cancer. Therefore, early assessment of the nutritional status of patients with cancer can be effective in order to initiate a nutritional intervention.
    Keywords: Malnutrition, Cancer, Anthropometry, Nutrition
  • Muhamamd Humayun Mohmand, Muhammad Ahmad Pages 193-197
    Background
    Hair restoration surgery is one of the most commonly performed cosmetic surgery procedure in men. The main aim of the study was to know the effect of follicular unit extraction (FUE) follicular unit extraction (FUE) on donor area in terms of hair mass/density.
    Methods
    Ten male patients undergoing hair restoration by FUE were included. In each patient, ten boxes of 1 cm2 each were marked. The first box was marked in the midline and the 2nd and 3rd boxes were marked about 3 cm from the midline. Another two boxes, each of 1 cm2 were also marked at the distance of 3 cm. Two boxes of 1 cm2 were marked on either side. The extraction was performed using 0.9 mm punch. The number of extracted hair were counted.
    Results
    The mean age of the patients was 31.7 years. The average hair count in the donor area was 154.76 hair per cm2. The extracted hair count was 54.85 hair per cm2 which was about 35.44% of the total donor density (range: 28.9-42.8%). The graft to hair ratio in the extracted follicular units was 1:2.3 (range: 1:1.65-1:2.75).
    Conclusion
    As the donor density varies, the FUE should be performed with caution.
    Keywords: Follicular unit extraction, Hair restoration, Donor
  • Sajjad Hattami, Behzad Khalatbari, Mona Karimi Pages 198-203
    Background
    One of the weaknesses of recovering the skin defects by tissue expander device is that it needs relatively long time and it has complications. Since verapamil gel reduces the production of these capsules around silicone prosthesis and reduces the formation of collagen in the capsule areas. The aim of this study was to examine the effect of verapamil gel on efficiency of tissue expander device.
    Methods
    Twenty patients were allocated equally into control and case groups based on age, sex, and location of the device. In both groups, the devices were placed in the areas needed and the conditions were identical. During the first operation, the length and width of the flaps and the initial size of prosthesis were determined. In the case group, verapamil gel was used daily, while a hydrogel was used as placebo locally in the control group. Then, other indicators were assessed.
    Results
    Verapamil gel had no impact on the length, width, area, and size of placed flaps. The opening degree and necrosis of tissue were not improved in patients of case group after using the gel. The effect of verapamil gel in different age groups and gender of people had no significant difference.
    Conclusion
    Verapamil gel was shown not to have any significant impact on efficiency of tissue expander device.
    Keywords: Verapamil, Tissue expander, Plastic surgery, Reconstructive surgery
  • Seyede-Sara Hashemi, Somayeh Jowkar, Mahdokht Mahmoodi, Ali Reza Rafati, Davood Mehrabani, Masoumeh Zarei, Abdolkhalegh Keshavarzi Pages 204-211
    Background
    Use of matrix-derived biologic scaffolds has become a treatment of choice in several clinical issues. This study assessed biochemical methods in production of three-dimensional scaffolds from human skin.
    Methods
    Human skin was prepared from circumcisions, washed in phosphate buffer saline (PBS) and kept at -20ºC until use. The skin samples underwent various methods. In group A, NaCl, Triton X100 and EDTA solution were used for removal of epidermis and was subdivided to three subgroups. The solution for removal of epidermis was similar for all subgroups, but decellularization was different. Group B was subdivided into 6 subgroups, NaCl in different concentrations was used for removal of epidermis and decellularization happened using SDS in various concentrations and different time intervals. Group C was subdivided to 3 subgroups, trypsin was used for removal of epidermis and decellularization was conducted applying NaOH or SDS. Washing was performed using only PBS. In group D, decellularization was done applying SDS. Histomorphometric study was conducted to compare the groups.
    Results
    No fibroblast was present in A2, B2, B4, and C3 subgroups after decellularization. Histological photographs from subgroups A1 to A3 revealed several cells and collagen fibers. Dense collagen fibers in pink color were noted in all subgroups; but, epidermis was absent.
    Conclusion
    It was shown that 1M NaCl was the best solution for removal of epidermis, 0.5% SDS for 2 h was the most effective solution for decellularization and PBS was the best solution for washing, while the solutions are easily available and cost-effective.
    Keywords: Scaffold, ADM, Human skin, Aesthetic medicine
  • Sunil Srivastava, Aditya Patil, Chaitra Prakash, Hiranmayi Kumari Pages 212-219
    Background
    Despite the myriad options available, there is no universally accepted treatment for keloids. This study has compared intralesional triamcinolone acetonide, 5-fluorouracil, and their combination in treatment of keloids.
    Methods
    In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU and a combination in Group T every 3 weeks till 24 weeks or till the keloid resolved.
    Results
    There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity and pliability was fastest with 5FU, TAC and T group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group.
    Conclusion
    TAC, 5FU and their combination are all effective in keloid scars. A combination of TAC seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.
    Keywords: Keloid, Triamcinolone, Fluorouracil
  • Karthik Rao, Mohan Jagade, Vitthal Kale, Dev Kumar, Amol Hekare Pages 220-225
    Background
    Pseudocyst of the auricle is a common benign disease. Many treatment modalities have been described for this benign condition ranging from simple aspiration to complex cutaneous surgeries involving skin de-roofing and debridement with diamond burr. the aim of treatment is to successfully resolve the seroma without damaging the underlying healthy cartilage, thus maintaining the normal contour of the auricle, and to prevent its recurrence.
    Methods
    In this study we describe incision and drainage of the pseudocyst with auricular splinting.
    Results
    Resolution was seen in 100.00 %, skin discolouration in 33.33%, skin thickening in 29.63% and deformity in 25.93% of the patients.
    Conclusion
    The use of corrugated drain sheet splint is an ingenious method of aural pseudocyst management. This method is simple and can be performed by even less experienced surgeons and highly economical which prevents the recurrence and maintains the auricular aesthetics
    Keywords: Auricular, Splinting, Pseudocyst, Management
  • Varun Singh Chauhan, Mohd Altaf Mir Pages 226-230
    Background
    The thermal burn is accidental and also is the hidden and worst complication of medical plaster application. This study evaluated clinical and aetiological profile and severity of plaster burns.
    Methods
    In Department of Burns, Plastic and Reconstructive Surgery from 1st August 2014 to 31st December 2015, six patients with plaster burn were assessed for total body surface area and depth of burn. The wounds were cultured and dressed with moist dressings daily till the surgical procedure and satisfactory healing.
    Results
    The youngest patient was 10 and oldest 65 years (mean age: 40.20±6.67 years, 4 males and two females with ratio of 2:1). Three patients sustained plaster burn injury accidentally at home and 3 developed burn after medical application of plaster. The hands burns were observed commonly in accidental plaster burns, while ankle was often involved in iatrogenic plaster burns. The iatrogenic burns were mostly deep in thickness varying 2nd to 4th degree, while accidental burns were often 2nd degree. Superficial 2nd degree burns were managed conservatively, and deep 2nd degree burns were skin grafted. Fourth degree burn was managed with reverse sural flap alone and another with vacuum-assisted closure followed by reverse sural flap and skin grafting.
    Conclusion
    Plaster burn is still a challenge to plastic surgeon and it is advised for applying casts to utilize all available means to limit the amount of casting material provided. It can be accomplished without compromising the cast strength to minimize the risk of thermal injury when applying plaster or composite casts.
    Keywords: Plaster, Burn, Skin, Grafting, Flap
  • Aravind Menon, Alagesan G Pages 231-234
    Traumatic injuries of ear range from simple lacerations to complex avulsions and crush injuries. The complicating factors involved are cartilage involvement, poor vascularity of the region and need for high cosmetic satisfaction. Various techniques have been described for reconstruction of earlobe after traumatic injuries. Here, we describe the reconstruction of a partially avulsed pinna using the versatile Limberg flap with superior cosmetic outcomes. This is probably the first case to be described in literature to utilizing the Limberg flap for reconstruction of a traumatic avulsion of pinna.
    Keywords: Pinna, Avulsion, Limberg flap, Reconstruction
  • Saulius Viksraitis, Ernest Zacharevskij, Gytis Baranauskas, Rytis Rimdeika Pages 235-239
    Breast augmentation with implants is one of the most commonly performed plastic surgery procedures. The goal of the operation is to increase the size, shape or fullness of the breast. It is accomplished by placing silicone, saline or alternative composite breast implants under the chest muscles, fascia or the mammary gland. This type of operation is no exception concerning the occurrence of complications. The most common early complications include an infectious process, a seroma, and a hematoma, and the late ones are capsular contracture, reoperation, implant removal, breast asymmetry, and rupture or deflation of the implant. The authors present a case of subacute arterial bleeding after simultaneous mastopexy and breast augmentation with silicone implants in a 27-year-old woman. The patient complained of worsening swelling and soreness in the right breast. The patient denied having had any traumas. Ultrasonography indicated 2.5 cm heterogeneous fluid sections around the implant. Therefore, revision surgery was performed, and a hematoma of 650 mL was removed. Hemorrhaging from a branch of an internal mammary artery was found. After the revision, the implant was returned to the lodge. The postoperative period was uneventful. This case report presents a description of a subacute hematoma after simultaneous mastopexy and breast augmentation with silicone implants, which is an extremely rare complication in esthetic surgery.
    Keywords: Breast augmentation, Hematoma, Complication, Esthetic, Breast
  • Franco Bassetto, Vincenzo Vindigni, G. Tanzillo Pages 240-242
    In the last years, number of rhinoplasty operations is ever increasing, but what can be done when there is a contraindication to use a vasoconstrictor?2 In our case, we presented our perioperative management of a female patient, epinephrine intolerant, who was arranged for rhinoplasty.
    Keywords: Perioperative management, Rhinoplasty, Epinephrine
  • Ritesh Panda, Mahesh Mangal, Sasidhar Reddy, Anubhav Gupta, Swaroop Singh Gambhir, Bheem Singh Nanda Pages 243-248
    We describe a case of intramuscular vascular malformation with extensive ossification within the posterior compartment muscles of leg which grossly mimicked long bone leading to equinus deformity of foot. Phleboliths and calcifications are characteristic of vascular malformations, while massive ossification is rare. To our knowledge, no extensive ossified vascular malformation within the leg muscle has been reported. Intramuscular vascular lesions occur with an incidence of 0.8%, most frequent in upper and lower extremities. Most are venous malformations. The diagnosis is rarely made before surgery and requires a definitive histological analysis, as there are no pathognomonic clinical or radiographic findings, especially with extensive ossification. Spontaneous regression does not occur, and excision of lesion is due to aesthetic and functional disturbances.
    Keywords: Vascular malformation, Ossification, Equinus deformity foot, Osseous metaplasia
  • Prashant Moon, N. Jithendran Pages 249-252
    Invasive fungal infection in burn injury is caused by inoculation of fungal spore from patient skin, respiratory tract or from care giver. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonization, hyperglycemic episodes and other immunosuppressive disorders. Invasive fungal infection with Absidia corymbifera is rare opportunistic infection encountered in patient with burn injury. The key for treatment is early clinical diagnosis, wide and repeated debridement and systemic and local antifungal treatment. We describe a case of invasive fungal infection with A. corymbifera in a patient with post-electrical scalp burn with late presentation after 10 days of injury in an immunocompetent patient.
    Keywords: Fungus, Absidia corymbifera, Immunocompetent, Scalp, Electrical burn
  • Fatih Ozdogan, Halil Erdem Ozel, Erkan Esen, Serdar Baser, Selahattin Genc, Adin Selcuk Pages 253-255
    Since identical twins occur as a result of the division of one egg, they have the same genetic structure. Therefore, their phenotypes and sex are also always the same. However, due to the effect of environmental factors, some of the characteristics of twins living in different regions appear to develop differently. In our case of 17-year-old maternal twins, we emphasized that nasal pathologies carried a genetic background in terms of their similarity in septum deviation and external nasal deformity, which were determined to have occurred without a history of trauma.
    Keywords: Nasal deformıty, Monozıgotıc twıns, Paranasal, Computed tomography analysıs
  • Ankit Gupta, Shyam Gupta, Akhil Kumar, Sameek Bhattacharaya, Manoj Jha, Vinay Tiwari Pages 256-260
    Vascular anomalies are categorized into vascular tumours or vascular malformations on the basis of clinical features and histopathology. The literature regarding high flow arteriovenous malformations of the auricle is rare. A case of a patient clinically diagnosed with an arteriovenous malformation of the external ear and was managed with preoperative embolization, surgical excision and reconstruction of ear with split thickness skin graft, is presented. The pathogenesis, clinical presentation, diagnostic work up, radiological intervention and management options regarding arteriovenous malformations are discussed. Total cure is an illusion and rarely achieved in high flow high grade vascular malformation with nearly 98% recurrence reported in 5 years. Patient followed for next 3 months with no evidence of recurrence.
    Keywords: Arteriovenous, Vascular, Malformation, External ear, Embolization
  • Chetan Satish Pages 261-262