World Journal of Plastic Surgery
Volume:9 Issue: 2, May 2020

Annually, an estimated 234 million major surgical operations occur worldwide, with concomitant seven million complications and one million deaths. It is now well established that technical competence is necessary, but not sufficient for modern surgical practice and outcomes. Breakdown in non-technical skills has been attributed as a key root cause for near misses and patient harm in the operating room. This article discusses the multi-faceted skills-set that is necessary for the modern surgeon to succeed and for optimal patient outcomes. This includes technical skills, non-technical skills, with a focus on key CanMEDS framework domains, including leadership, communication, evidence-based surgery and mentorship

Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone in reduction of the periorbital edema and ecchymosis.

Sixty patients who underwent primary rhinoplasty were randomly divided into 3 groups. Group H received hirudoid cream, 3 times per day for 5 days from postoperative-day (POD). Group D received 10 mg of dexamethasone IV, immediately before surgery; and group C (control) received neither dexamethasone nor hirudoid. Two surgeons who were unaware of administered medications rated the severity of edema and intensity of ecchymosis, on 2nd, 5th, and 7th POD.

On 2nd POD, the edema in group D was significantly lower than groups H and C; but there was no significant difference in severity and intensity of ecchymosis between 3 groups. On 7th POD, the intensity of ecchymosis was significantly lower in group H in comparison to group C. When the difference between 2nd and 7th POD was evaluated, the resolution of severity of edema and intensity of ecchymosis was significantly better in group H (p<0.001).

Hirudoid was shown to be effective in reducing edema and ecchymosis after rhinoplasty. The use of dexamethasone was effective in prevention of periorbital edema at early postoperative days, but it was not effective on resolution of ecchymosis.

National Institute for Health and Care Excellence (NICE) CG74 has set out evidence-based guidance on which types of surgery require antibiotic prophylaxis. Our aim was to establish what the current practice for antibiotic prophylaxis in Dupuytren’s surgery is amongst hand surgeons in the United Kingdom, through the British Society for Surgery of the Hand (BSSH).

Permission was granted for our online survey to be distributed to BSSH hand surgeons via consecutive BSSH e-bulletins. Hand surgeons who did not perform fasciectomy or dermofasciectomy were excluded from the study.

There were 64 respondents, represented an estimated 7.4-7.8% of membership. Eleven percent of respondents used antibiotics for fasciectomy, with an increasing trend towards revision surgery and dermofasciectomy. Over 30% prescribed them for revision dermofasciectomy. Dupuytren’s surgery was classified as clean, non-prosthetic and uncomplicated which National Institute for Health and Care Excellence (NICE) CG74 suggestions did not require antibiotic prophylaxis.

This study highlighted variation in practice amongst hand surgeons in the United Kingdom. Further consultation to create guidelines for hand surgery may help guide members and reduce potentially unnecessary prophylactic antibiotic use.

There are different questionnaires and approaches to evaluate the outcome of rhinoplasty operations. A short questionnaire, which can be completed in less than 2 minutes, is the Utrecht questionnaire that consists of a visual analogue scale (VAS) and five multiple-choice questions. In this study, we have translated the questionnaire in Persian and evaluated its reliability and validity.

Patients undergoing aesthetic rhinoplasty surgery in Firoozgar Hospital from January to March 2019 were enrolled. The questionnaire was translated to Persian and backward translated to English by independent medical extern Persian speakers with complete English proficiency. The internal consistency was measured by Cronbach’s alpha, repeatability by Student t test of test-retest 4 weeks and 12 weeks follow-up post-operatively, and validity by comparing pre- and post- operative results.

Thirty patients were included in the analysis. The Cronbach’s alpha was 0.925 as a marker for internal consistency. The test-retest was acceptable for all the questions accordingly (P>0.05). The p values for pre- vs. post-operative tests were also significant for either all of the questions and the sum score.

The translated questionnaire was internally consistent and repeatable. The questionnaire also seems to be valid for all questions and the sum score. According to our analysis, the translated Persian version of the Utrecht questionnaire seems to be internally consistence, reliable in test-retest analysis, and valid due to a pre-post operational analysis

Obstructive sleep apnea is a disorder of repetitive complete or partial airway obstruction during sleep. The aim of this study was to assess the impact of alveolar cleft reconstruction on the obstructive sleep apnea (OSA) condition and apnea/hypopnea index (AHI).

In a double-blinded prospective quasi-experimental study, all healthy systemic children (n=30 female cleft patients) with unilateral alveolar cleft defects within the age range of 8-14 years and BMI less than 30 kg/m2 who admitted for alveolar cleft repair were enrolled. OSA monitoring was performed one week before surgery, and 3 months postoperatively by Apnea Link device. Sleep apnea indices such as AHI, respiratory disturbance index (RDI), oxygen desaturation index (ODI) and oxyhemoglobin saturation (SpO2) as well as pulse rate (PR) and respiratory rate (RR) were the variables.

The patients’ mean age was 11.0±1.4 years, and BMI average was 21.48±4.4 kg/m2. Mean AHI was 21.6±5.0 events/hour, preoperatively; which decreased significantly and reached 4.4±2.5 events/hour after alveolar cleft reconstruction surgery (p=0.005). Moreover, the other OSA variables (SpO2, RDI, and ODI), as well as vital signs (PR, and RR) improved postoperatively (p=0.005). In other words, the preoperative moderate OSA status relieved after alveolar cleft repair and reconstruction.

Our study showed that the OSA and AHI ameliorated after bone graft surgery in alveolar cleft repair. More clinical trials including larger sample sizes may be required for relevancy.

Nowadays in different communities, we are confronting an ever-increasing trend of cosmetic surgeries. The present research was carried out with the aim of investigating sexual self-esteem, attitude to body image and well-being in married women aged from 20 to 30 years old before and after cosmetic surgery in Tehran, Iran.

The research was a semi-experimental design with pre- and post-test. The statistical population consisted 80 married women. The research sample was selected by means of the convenience sampling approach. This group was similar in terms of age, education, and marital status. The research data were accumulated using the Zeanah and Schwarz sexual self-esteem questionnaire, the Fisher body image questionnaire and the Ryff psychological well-being questionnaire, and were analyzed by multivariate analysis of variance.

The average scores of all three variables, involving "sexual self-esteem", "body image" and "well-being" were dramatically different before and after cosmetic surgery (p<0.05).

It can be ascertained that people after cosmetic surgery had higher sexual self-esteem, were more satisfied with their body image, and experienced more well-being.

Dorsal augmentation of the nose for aesthetic and reconstructive purposes is an important issue in rhinoplasty surgery. This study aimed to compare the two methods of dice cartilage wrapping for dorsal augmentation of the nose including temporalis fascia and alloderm.

In a clinical trial study, 50 patients who needed to augment the nasal dorsum, were enrolled and randomly allocated to two equal groups. In the first group, diced cartilage graft of the patient was wrapped in temporalis fascia and in the second group, a thin sheet of alloderm was used for this purpose. After one year follow up, satisfaction of patients and the expert panel were compared in two groups. Also mean increase in dorsal height was measured and compared in two groups.

The mean increase of dorsal nasal height one year after surgery in the alloderm and temporalis fascia was 3.13±0.49 and 3.42±0.33, respectively and in the fascia group was significantly higher (p=0.02). The mean of patients’ satisfaction in the two groups of alloderm and temporal fascia groups was 7.48±0.92 and 8.04±0.89, respectively (p=0.03). The mean satisfaction of expert panel in the two methods was 7.56±0.81 and 7.7±0.63, respectively (p=0.5).

The use of temporal fascia for covering the diced cartilage in augmentation of nasal dorsum had better results than the alloderm. Patients satisfaction and mean dorsal height was higher in temporal fascia group.

Established Volkmann’s ischemic contractures (VICs) represent the eventuality of neglected acute compartment syndrome (ACS) of the forearm. This study assessed the clinical and demographic presentation of VICs.

This study was conducted at Department of Plastic Surgery, National Institute of Rehabilitation Medicine, Islamabad, Pakistan over a period of three years and included all patients of either gender who presented with VICs and analyzed various corrective procedures instituted as surgical remedies.

Among 37 included patients, 83.78% were male and 16.21% were female (mean age: 16.51±9.1 years). The underlying causes of the initial traumatic insults were tight bandages employed by traditional bone setters for treating forearm fractures (83.78%), high voltage electric burns involving hands/forearms (13.51%) and supracondylar fracture with vascular compromise (2.70%). Majority of patients belonged to Holden type 2 (97.29%) and Tsuge type 2 VICs (48.68%). The most common sufferers of VICs were young, illiterate males coming from rural regions. Treatment for forearm fractures by traditional bonesetters constituted the most common underlying cause. Most of the patients were managed with combination of procedures including tendon transfers, excision of the fibrosed muscles, tenolysis and neurolysis of median and ulnar nerves. Tendon transfers were the commonest corrective procedures instituted.

This study highlighted the gravity of this largely preventable but neglected catastrophe and there is a need to institute robust preventive measures to address the issue. Emphasis should be on creation of public awareness and robust education of health care providers to ensure correct primary management of upper limb trauma.

Carpal tunnel release (CTR) is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after CTR surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of CTR as a risk factor of the development of the trigger finger.

In a retrospective study, 57 consecutive patients who underwent surgery for the treatment of trigger finger were included. The severity of carpal tunnel syndrome (CTS) was determined using the electromyogram test and nerve conduction study. The clinical and demographic characteristics of the patients were extracted from their medical profiles and compared between patients who did and did not develop a trigger finger after CTR.

Post-CTR trigger finger was detected in 15 (26.3%) patients. The trigger finger occurred approximately six months after CTR surgery. The thumb and ring fingers were the most commonly involved fingers. Ten out of 15 (66.7%) patients who developed a post-CTR trigger finger had mild-to-moderate CTS, and five (33.3%) patients had severe CTS. No significant difference was found between the patients who did and did not develop a trigger finger after CTR.

The rate of developing a post-CTR trigger finger was remarkable in our study. Therefore, the potential sequelae should be discussed with patients, preoperatively.

Large ear defects (>3 cm) present a significant reconstructive challenge and often require extensive operations, which can lead to donor-site morbidity and contour abnormalities. Through our case series, we propose a limited Tanzer reduction, a novel modification of the well-recognized Tanzer technique, as a potential reconstructive option for traumatic and oncologic upper third ear defects.

We retrospectively reviewed patients who underwent planned ear reconstruction for large ear defects (>3 cm) at a university center by a single surgeon (WPT) over a five-year period. Demographics, complications, and need for revision surgery were recorded. A satisfaction survey was also completed.

Five patients met our inclusion criteria as they underwent ear reconstruction with the limited Tanzer reduction. All reconstructions followed oncologic resection for cutaneous malignancy. The mean follow-up was 760.2 days. No complications were encountered, and no revisions were required. All cases had good aesthetic outcomes. The satisfaction survey revealed no self-image distortion or social obstacles following the reconstruction.

The proposed limited Tanzer reduction technique was shown to be a safe, viable, functionally and aesthetically pleasing option for the reconstruction of large defects of the ear and thus should be part of the armamentarium of the reconstructive surgeon.

Nowadays, cosmetic surgery is one of the most common types of surgeries all around the world including Iran and those demanding such surgeries are also growing in number. The present study is an attempt to determine the factors in the tendency towards cosmetic surgery in Iranian students.

In a descriptive-analytical study, all students at Guilan University of Medical Sciences related to health issues were enrolled. The participants (n=314) were selected through census sampling. Data was garnered using a multi-section questionnaire including socio-demographic variables, body image, body satisfaction, and cosmetic surgery intention. The questionnaires were completed as self-statement.

The age range of the students was 18-55 years and the mean age was 25.07±7.41 years. Body mass index (BMI) of the participants was 23±3.82. Among socio-demographic variables, BMI, gender, family revenue, father’s job, marital status, mother’s job, and fathers’ literacy level were the predictors of intention for cosmetic surgery. In addition, among psychological variables, body satisfaction and image, and attitudes were predictors of intention for cosmetic surgery.

Educational and psychological interventions are recommended to create body satisfaction, to develop positive attitudes toward one’s body, and to develop negative attitudes toward cosmetic surgery and the side effects. Apparently, providing an environment for physical activity and exercise, especially for girls would help the students in losing weight, remaining in shape and attenuating the tendency toward cosmetic surgery.

Self-management programs on needs of burn patients are still essential. So this study determined the effect of self-management training on anxiety and comfort of burn patients who were candidate for skin grafting.

In a continuous sampling method in Shahid Motahari Burn Center affiliated to Iran University of Medical Sciences, 80 burn patients candidate for skin grafting were divided into equal groups of intervention and control. Educational intervention was undertaken in the form of booklet during two sessions before and after skin grafting. Visual comfort scale questionnaire and Spiel Berger state-trait anxiety inventory were completed by patients before training and one month after intervention.

There was a significant difference between the frequency of comfort level in both groups before and after the intervention. The level of comfort in the intervention group increased more than control group. The mean level of patients' anxiety showed a significant difference between groups and scores in intervention group were significantly more than control group.

Attention and control of anxiety and comfort in burn patients are one of the essential elements of their care. It can be suggested that self-management training can reduce anxiety and increase burn patients’ comfort.

Complex defects of the forearm and arm are best reconstructed with free flaps. Free flaps are however not universally available. They require long operative time and may be contraindicated in patients with extensive injuries due to a lack of good recipient vessels. The alternatives to free flaps are distant flaps such as groin flaps, random abdominal flaps, thoracoepigastric flaps and paraumbilical perforator flaps. These are axial flaps that are limited by the angiosomes supplied by a given perforator or blood vessel. To improve the extent and reliabilities of the paraumbilical flaps, we incorporated two perforators in the flap.

A total of 17 patients with extensive forearm defects were managed by two vessel paraumbilical perforator flaps between January 2013 and December 2018. The perforators were identified by a hand-held Doppler and the flap was fashioned with the perforators at the base.

The mean length of the flap raised was 19.5 cm and width was 8.3 cm. The median age was 39 years. All the flaps were successful with no incidence of flap necrosis and no dehiscence.

Two vessel perforator flaps improved the reliability of the paraumbilical perforator flap, allowing for a bigger flap to be harvested and thus ensuring a cover of larger defects. The flaps were easy to raise and were easily tolerated by the patients.

Although, the lateral thoracodorsal flap is a well described technique, its utility seems to be lost in the ever evolving world of oncoplastic breast surgery. This study reviews the technique, its indications and limitations and the advantage of this technique.

Between January 2016 and January 2018, data from 7 consecutive patients who underwent partial breast mastectomy with lateral thoracodorsal flap were enrolled.  A wedge shaped flap was designed using the pinch test using the index finger and the thumb in small defects, while larger defects required a convex shaped incision with curved superior and inferior borders. Incision was made along the marked margins of the proposed flap and deepened to the underlying serratus anterior and latissimus dorsii muscle. The flap was transposed in the defect and the symmetry of mound between the two breasts confirmed in sitting and supine position.

All patients were satisfied by cosmetic outcomes on visual analog scale (VAS). Cosmetic results based on Harvard scale showed good to excellent scores. Evaluation by Breast Cancer Conservation Treatment (BCCT) core software illustrated good to excellent cosmetic outcomes. There was no delayed wound healing, marginal skin ornecrosis and no evidence of any fat necrosis in the follow up period.

The versatility of latissimus dorsii flap, good aesthetic and functional results and its simple execution made it an important option in the armamentarium of the oncoplastic breast surgeon. Also, morbidity of the donor site was minimized without sacrificing muscles or nerves.

Carpal tunnel syndrome is the most common peripheral neuropathy affecting patients at productive age and has an important economical impact on those who suffer it. This study assessed the diagnostic performance of carpal tunnel syndrome´s signs and described the epidemiology at a tertiary care center in Mexico City.

All patients diagnosed with carpal tunnel syndrome during a five-year period were included. Demographic data, electromyography results, positive clinical signs and the severity score according to the Italian scale were recorded. Diagnostic accuracy of Tinel and Phalen´s signs were calculated via odds ratio.

Totally, 650 patients were diagnosed and treated during a five-year period, 84% were female and 16% male, and the mean age was 55.8 years. The associated comorbidities were trigger finger (36.1%), thyroid disease (25.6%) and diabetes (20%). Diagnosis yielded for Phalen and Tinel signs were variable in each of the study groups (males and females) and showed to be beneficial in diagnosis of the disease.

Carpal tunnel syndrome is a complex disease in which clinical signs remain the cornerstone of diagnosis. Extension studies are useful to assess the severity of the disease.

The desire for aesthetic surgery in Iran has increased. The relationship between spirituality and body image has not been studied simultaneously with the desire for aesthetic surgery. The present study aimed to examine this relationship among students of Hamadan University of Medical Sciences, Hamadan, Iran.

In this analytical cross-sectional study in 2019, 397 students were enrolled by stratified random sampling. The data were collected using the Paloutzian and Ellison’s spiritual health questionnaire and Appearance Schemas Inventory. Data were analyzed using Pearson correlation, independent t-test and logistic regression.

The mean age of the subjects was 22.26±4.24 years, while 26.7% of the subjects had desire for aesthetic surgery. There was a significant negative correlation between body image and spiritual health (p<0.001). The mean score of spiritual health and its dimensions in female students were higher than males. Based on logistic regression model, age (p=0.018, 95% CI: 0.341-0.904) and body image (p<0.001, 95% CI: 1.05-1.112) had significant correlation with the desire for aesthetic surgery.

According to the results; it is necessary to make plans for the promotion of spirituality and the strengthening of a positive body image among students residing in student homes, male students and those who desire to engage aesthetic surgery.

Scalp arteriovenous malformations (AVMs) are abnormal vascular lesions, which can be managed effectively and safely with surgical or endovascular approaches. Here, we discuss a case of scalp AVM malformation in a 25-year-old female, in which due to the proximity of the feeder artery to right orbit, surgical excision was preferred and the AVM was excised with an uneventful post-op course.

We reported a 38 year old male patient who suffered from electric burn 2 years ago, and came with complaints of recurrent profuse bleeding from post electric burn scar over left wrist area since last 6-8 months. We successfully used the dorsal ulnar artery flap to cover the arterio-cutaneous fistula over the post-electrical burn scar.