World Journal of Plastic Surgery
Volume:2 Issue: 1, Jan 2013

The skin is the largest tissue of man with several functions. Cosmetics/cosmeceuticals agents always are needed to be evaluated for their detrimental effects on the skin. Nowadays, the therapeutic potential of stem cells has and fibroblasts have increased the hope for a successful cell therapy in aesthetic medicine. Stem cells are unspecialized cells capable of renewing themselves through cell division without limit as long as the person is still alive. Each new cell has the potential either to re-main a stem cell or become another type of cell.

Autologous fat transfer offers many qualities of a ideal soft tissue filler. Main advantages of fat grafting ensue from the fact that the lipoaspirate tissue is an abundant source of regenerative pluripotential cells. However, the reported rates of fat cell survival vary greatly in the medical literature (10-90%). Different techniques of harvesting, processing, and reinjecting the fat cells are so claimed to be responsible for these differences, without any agreement concerning the best way to process. To address this important disadvantage, we propose the addition of autologous platelet rich plasma (PRP) which is known as a natural reservoir of growth factors stimulating tissue repair and regeneration. This approach is completely autologous and im-mediately employed without any type of preconditioning. Platelets rich plasma (PRP) preparation included bleeding of 8 ml of blood from patient’s peripheral vein in Regen Lab© tubes containing sodium citrate anticoagulant. The whole blood was centrifugated at 1500 g dur-ing 3 min. As Regen-tubes contained a special gel separator, 99 % of red blood cells were discarded from the plasma at the bottom of the gel, and >90% of platelets were harvested in 4 ml of plasma on the top of the gel, called the platelet-rich plasma (PRP). The purified fat prepared by Coleman technique was mixed with different amount of PRP for in vitro, in vivo (mice) and clinical experiments: >50% of PRP for skin rejuvenation, superficial scars correction, infraorbital region,. .., and for 20% of PRP with 80% of purified fat for deep filler indication (nasolabial folds, lips, or soft tissue defect). In vitro studies demonstrated that PRP increased fat cells survival rate and stem cells differentiation. Animal models showed that fat graft survival rate was significantly increased by addition of PRP. Several clinical cases confirmed the improvement of wound healing and fat grafting survival in facial reconstruction and aesthetic cases by association of fat grafting with PRP. The addition of PRP to fat grafts represented many advantages with a simple, cost-effective and safe method. In addition to its booster effect on fat grafts, PRP had a rejuvenation capacity per se. It is also used on nappage technique, on mask and as a temporary regenerative filler in combination with thrombin. So we consider the addition of 20% PRP to fat grafts offers a better fat grafting survival, a less bruis-ing and inflammation reaction, and easier application of fat grafts due to liquefaction effect of PRP.

Closure of donor site of the flap has special problems. Reduction of this site will decrease the morbidity of operation. In this study, we present our experience in donor site size reduction. METHODS Between 2006 and 2008, 15 patients with skin and soft tissue defects underwent operation. In all patients, coverage of defect was performed with various flaps. Substratum horizontal mat-tress suture was used to reduce donor site dimensions. In all 15 patients, size of the flaps, the defect after the flap elevation and the scar size were measured. RESULTS The mean size of the flap, the defect after flap elevation, and the scar after 3 months were 43.9 cm2, 69.4 cm2, and 32.2 cm2, respectively. There was 46.5% reduction in the donor site after using this suture. CONCLUSION The substratum horizontal mattress suture was shown to decrease the donor site dimensions and also its scar size in flap surgery. This suture is highly recommend in order to reduce donor site dimensions.

Technology is likely to transform the way care is delivered at home and in the community. Telemedicine, the child of IT and Medicine sciences is the use of telecommunication equipment and information technology to provide clinical care to individuals at distant sites and the transmission of medical and surgical information and images needed to provide that care. Undoubtedly, the advantages outweight its disadvantages, but just like any other innovations, it has some drawbacks. The present study outlines telemedicine strong and weak points. In this regard a survey has been done in Tehran University of Medical Sciences in Iran. Between 14th May and 14th August 2012, 90 medical specialist men and 42 women from different hospitals of Tehran Medical Sciences University, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider what are telemedicine chances and challenges. Making use of telemedicine was a profitable alternative in remote, rural/urban places especially in new project of “family physician” presented by Iran Ministry of Health. The results also highlighted that security considerations was an inevitable challenge of telemedicine, while shorter hospital stays and reduced warm ischemic time, and reduced morbidity and mortality rates were telemedicine merits. Despite most previous studies results, telemedicine has been recognised as a cost-effective alternative. Cultural, language distinctions as well as the level of literacy were barriers on deploying telemedicine. There was no strong evidence showing that using telemedicine caused a decrease in tactile feedback. We need to fully understand and consider various outcomes and challenges of telemedicine before applying it.

Split- thickness skin graft is one of the most common operations in plastic surgery. It is always painful and patient discomfort from donor site often is more significant than recipient site. There is not still a standard method for treatment of the donor site. The purpose of this study was to determine the best method of dressing the donor site among three different methods with respect to the rate of healing, pain, secretion, infection and cost. The study includes 60 patients that were randomly divided into three groups. Donor site and thickness of the graft was the same and were dressed with one of the methods including Method A: Paraffin fine mesh gauze, Method B: Nitrofurazone soaked fine mesh gauze and Method C: Dry fine mesh gauze. Each method included an intermediate layer of sterile plastic sheet witch was covered with 10 layers of dry gauze. Comparison with respect to the rate of healing, pain, secretion, infection and cost was done. Thirty seven patients were men and 23 were women. The mean age of the patients was 27.2 years. There was a significant difference between three methods in average time of repair and superiority of dressing with Method B was noted. Pain severity was the least in Method B and difference between the methods was significant. Dressing with Method B had the least secretion and there was a statistically significant difference between three methods. There was no statistically significant difference in cost of the management. This study showed that dressing the donor site with nitrofurazone ointment soaked gauze used as the first layer of dressing and intermediate layer of sterile plastic sheet which was covered with 10 layers of dry gauze was the best method of dressing and had the least complications.

The ala of the nose, with its particular texture and characteristics, poses both aesthetically and functionally intriguing challenges and is rather problematic regarding choices for reconstructive methods. Both flaps and grafts have been used to restore natural structure of nasal ala. The present study summarizes a ten-year experience of reconstructive surgery using small composite grafts from non-cartilage bearing tissues, and large composite grafts, containing cartilaginous tissue, with a mean follow-up of 4 years and 8 months

Horse shoe shaped lipoma of the upper extremity is a very rare entity. We present a case of 45 years old female who presented with painless progressive swelling over the distal forearm and tingling and numbness over the ulnar nerve territory. MRI and surgical exploration showed a horse shoe shaped multilobulated lipoma encasing the distal ulna. The mass was excised in toto, and the sensory alterations were completely relieved at three months follow up. We would like to highlight this rare occurrence of a horse shoe lipoma and present a detailed history of this case to increase awareness amongst clinicians regarding this condition.

Permanent facial paralysis is a catastrophic event for involved patients. In long lasting paralysis with severe facial muscles atrophy, masseter muscle transfer is a very good choice. But its greatest problem is postoperative elongation of flap and gradual diminishing of early results and loss of symmetry. This article advocate a new modification for resolving this problem with concomitant elevation of mandibular periosteum with masseter muscle, as a unit for lip and midface elevation.

Local perforator flaps have evolved over the time to provide complete and stable coverage of soft tissue defects. Technical advances and experience with the perforator flaps have allowed the harvest of local perforator flaps in a free style manner by offering greater freedom in flap selection. We have proposed a technical modification in the harvest of a perforator flap by relo-cating the perforator to an anatomically favorable location. This has led to decreased traction over the perforator and provided some amount of added length to the perforator.

Standardization of photography in plastic surgery is fundamental for pre-operative surgical planning, comparative post-operative assessment, and demonstration of surgical results.1 In rhinoplasty, slight changes in patient or camera position can lessen nasal hump, vary nose size, and alter skin tension.2 In order to prevent these common errors, photographic standardization with high-quality equipment (camera, lens, and lighting), consistent room set up and systematic patient position are mandatory.2