فهرست مطالب سید اسماعیل حسن پور

Introduction & Reconstruction of the ear is one of the major challenges in plastic and reconstructive surgery. Loss of all or part of the ear causes mood disorders, depression, and loss of self-confidence, anxiety and disturbance in patient's social interactions. Therefore, a study was conducted to determine the Statistical assessment of ear repair in terms of lesion size in patients referring to Center for Plastic Surgery 15 Khordad from July 2010 to December 2013.
This study is a descriptive cross-sectional study. The samples consisted of 126 patients referring to Center for Plastic Surgery 15 Khordad (from July 2010 to January 2013). A special surgical technique was used in each patient regarding the type of injury and ear lesion. Patients after the surgery were followed up to evaluate the effectiveness of the surgical technique. Finally, the data were analyzed using SPSS V .22.
In this study, the greatest cause of ear trauma was accidents with vehicles (39.5% in men, 42.8% in women and 75% in children). Also, the acceptance and satisfaction of patients in ears reimplantation method was significantly higher.
The use of ear replantation method has more advantages compared to other reconstructive methods. Also, the satisfaction and acceptance of patients in the replantation method is much more than other recent techniques.

Introduction & Reductive mammoplasty is one of the most common operations in plastic surgery and inferior pedicle is one of most common techniques. Bottoming out is considered as a long term sequel. Introduced solutions have had satisfactory results. This study wants to present Plication fixation (Pf) as a new technique for minimizing bottoming out. 66 patients who were candidates for inferior pedicle reduction mammoplasty were categorized randomly into simple reduction mammoplasty (as inferior pedicle) and inferior pedicle reduction mammoplasty with plication fixation, and underwent appropriate operation. Parameters like operation time, reduced tissue weight, nipple sense, and frequency of bottoming out, were recorded and analyzed. In group 2 (Pf) pedicle lengths was 10±2.2 cm. Asymmetry reduced from 5 to1. Seruma was seen in a patient. In the first group bottoming out was significantly more than in the second group (Pf). Pedicle has vital role in inferior pedicle reduction mammoplasty as far as blood supply and sensibility is concerned. One of its potential complications is bottoming out, as Plication fixation can reduce it significantly. So it seems that placation fixation with little complications, can lead to more long term results in inferior pedicle reduction mammoplasty.

Breast reduction is one of the most commonly performed plastic surgery procedures. Many approaches to breast reduction have been described, including medial pedicle and inferior pedicle. The aim of this study was to compare the results of medial pedicle mammoplasty method with inferior pedicle mammoplasty.
Thirty-three consecutive patients who had undergone medial pedicle mammoplasty at 15 khordad hospital were compared with 33 inferior pedicle mammoplasty. Patients age, breast resection weight, surgery length, the average distance from the sternal notch to the breast nipples, complication rate including bottoming out, need for re-operation, request for surgical site scar removal, breast contour, breast symmetry, nipple and areolar sensation, the frequency of complications, nipple-areolar complex necrosis and patients’ satisfaction from scar length and overall patients’ satisfaction were assessed.
Mean age was comparable in both groups. In medial pedicle, the surgery length (177.73±20.16 min vs. 221.06±26.77, P=0.01) and resected breast weight (respectively, 454.24±91.57 vs. 900.91±401.28 gr in the right side and 446.67±82.87 vs. 904.24±407.88 gr in the left side) and the average distance from the sternal notch to the breast nipples (29.09±3.37 vs. 35.33±3.36 cm, P=0.01) were significantly lower compared to inferior pedicle group. Yet, the frequency of bottoming out was significantly higher (30.3% vs. 0%, p=0.01) and the patients satisfaction from scar length was lower (54.5% vs. 87.9%, p=0. 003) in the medial pedicle group. There were no significant difference between the need for re-operation, request for surgical site scar removal, breast contour, breast symmetry, nipple and areolar sensation, the frequency of complications, nipple-areolar complex necrosis and patients’ satisfaction.
The results of the present study showed that, although the resected breast weight was lower in medial pedicle mammoplasty, the length of surgery was shorter and better results regarding aesthetic point of view and higher patients’ satisfaction are achieved.

Trauma, burn, neoplastic resections, congenital lesions and etc. cause scalp defects. Full thickness involvement or bone exposure needs coverage with vascularized tissues or flap. Repairing with local flaps causes dog ears. This problem is more prevalent in the base of the transposition scalp flaps. Dog-ear in trunk or extremities can be repaired in the same surgery but in scalp due to possibility of pedicle injury, correction of dog-ear is postponed to second stage. This article explains a new technique to repair dog-ear of scalp flap in the first surgery without injury to neurovascular plexus of the flap. This retrospective study consisted of 16 male patients with scalp defects. The dog-ear of the scalp flaps was corrected by this technique. At first the skin and subcutaneous layers were removed. Galea and neurovascular plexus were preserved, next galea was plicated under the flap and skin defect was repaired. The mean age of patients was 40 years. The mean size of defects was 190 cm. No complication or necrosis was detected during follow up period of at least 6 month. This technique is suggested for dog-ear correction in scalp flaps without sacrifice of neurovascular bundles and in the same surgery.

Fascia lata as a graft can be used in different circumstances. Several techniques have been described to harvest the graft. Those techniques either need special instruments or have been associated with complications. Here we describe a new surgical technique, which is simple, less expensive and with minimal morbidity. Two small parallel incisions are made in lateral thigh. The distance between these incisions is equal to the graft length. The dissection of fascia from the underneath tissue is made with nylon zero and then it is cut as such as needed. 32 patients with mean age of 30 years were operated to harvest fascial lata. The graft was applied to correct the nasolabial fold due to facial nerve plasty, flexor tendon reconstructions and dura reconstruction. The patients were followed for one year. The functional and aesthetic results were acceptable. The presented technique needs no professional instrument, less surgical time and with least functional and aesthetic complications.

The burned face involved with lip, chin and upper neck causes many problems in natural appearance. The treatment of drooped lip and disturbed cervicomental angle is difficult. The aim of this article is to introduce a new technique for recreation of this angle. In a clinical research 14 patients underwent to use a triangular fatty dermal flap and full thickness skin graft (FTSG) after releasing scar tissue. Wilcoxon test used to determine for correcting neck face angle. This study was conducted on 14 patients involved lower face, upper neck scar contracture. These patients gained a good functional and aesthetic result without complication. This study revealed a simple and reliable method in burned lower face, neck. It provides to restore movement and contour in spite of sever tissue deficiency for reconstruction.

Goal: The rate of plastic surgery in Iran relative to it’s population is one of the highest in the world،knowing the psychcosocial factors that effect this kind of surgery on the people and also why people decide to under go such a procedure is of great importance، this research was conducted to study the causes of people’s tendency to undergo rhinoplasty in Tehran between years2011-2012. this study was a cross sectional study which all of 16-50 years old Tehran resident who wants rhinoplasty between years 2011 and 2012 had constitute its study population. After listing all hospitals and surgical centers in which surgery was performed،research location was randomly selected. Overall 800 patients during 8 months had been entered into the study. Data collection instrument in this study was questionnaire which it’s validity and reliability have been confirmed. 132 (16. 5%) of the study subjects were male and 668 (84. 5%) were female. The mean and standard deviation of age was 23. 65_+2. 87،and people between 18 -25 years old had the highest frequency. Among all parameters،self esteem and peer advices had shown a significant difference between male and female groups [p<0. 05]. Low self esteem was the most important factor in motivation for rhinoplasty among the participants in this study. Low self esteem، peer advices and social attitude toward themselves، were the most significant factors in tendency for this kind of surgery. assessment of the the motivation of the people for rhinoplasty should be done by the surgeon before rhinoplasty، in order to increases the patient’s satisfaction and at the same time reduces the direct and indirect costs of this surgery.

Face and neck reconstruction in burn contracture scar is very difficult and needs many surgical techniques and may have unfavorable results. This case series was ran on patients with total burn of face and neck who had contracture scar and were visited in 15 Khordad Hospital during a period of 3 years، from 2008 to 2011. We introduced a technique of FTSG coverage on the defect area after meticulous releasing of contracture scar. The donor site graft was medial arm. During this time period، 21 patients with mean age of 28 years entered the study. There were 9 men، 10 women and two children. In total burn of face and neck، there is no option for local or regional flaps. Thus، the nose unit was reconstructed by FTSG from medial arm. The final color، texture and appearance was good. We have introduced FTSG for nose skin defect in total burn of face and neck، in which flap is not available. We suggest all nose scars to be removed at the level of epidermis and dermis and turn down ala flap، followed by meticulous release of scar tissue especially side wall and careful homeostasis.

Introduction & The purpose of this study was to compare the effect of two methods of tendon retrieval in the outcome of the repair of retracted flexor tendons in zone II flexor tendon laceration. In a randomized controlled trial, the Hemi Kessler core suture tendon retrieval was compared with the innovative method of retrieval by long loop of nylon suture without Pulling out the tendons from their sheath. Between September 2009 and July 2010 a total of 253 patients (307 fingers) with flexor tendon injury in zone II referred to the hand surgery ward in 15 Khordad hospital for whom if tendon was retracted to the palm and could not be brought into view by massage at the time of operation, joint flexion and other simple methods were included in our study. A small transverse incision was made over distal palmar crease and both flexor tendons were visualized and flexor tendons were randomly retrieved by two methods. In 36 patients (38 fingers) of control group tendon retrieval was done by Hemi Kessler core suture method and in 34 patients (37 fingers) of study group tendon retrieval was done by the use of long loop of nylon and nelaton chateter, without Pulling out the tendons from the sheath. The TAM (Total Active Motion) of the repaired fingers in both groups were calculated and scoring was done according to ASSH system. In all of our patients the contralateral finger was normal and accessible for comparison. The average follow up time was 368 days (ranging from 274 to 450 days). The average TAM was 208.1o in study group and 201.5o in control group. There was no statistically significant difference in the end results of both groups which was evaluated according to TAM (ASSH) system (P = o.408). The outcome of two groups were compared, according to the ASSH scoring of excellent, good, fair and poor. The results in the study group were: 2 excellent (5.2 %), 27 good (73%), 7 fair (18.9%) and 1 poor (2.7%). Results in the control group were 3 excellent (7.9%), 24 good (63.2%), 10 fair (26.3%) and 1 poor (2.6%). There was no statistically significant different between the two groups) P = 0.827(. Despite the fact that there was no significant differences in the results, we suggest retrieving of proximal tendon stump of retracted severed flexor tendons in zone II, without bringing them out of the sheath, thereby avoiding excessive trauma to the tendon and preserving its blood supply and tendon sheath integrity.

Introduction & Fronto-orbital remodeling is the procedure of choice for the treatment of craniosynostosis, affecting the anterior area of the skull and orbital regions. The resorbable plating systems provide rigid fixation while potentially minimizing the long term drawbacks of permanent plating systems. However, plate palpability, visibility, skin breakdown over the plate, encapsulated foreign body and osteolytic changes have been reported. The absorbable fixation systems are composed of either a plate or a mesh and screws. In this clinical trial, we have used plates prepared by cutting a row of mesh for fixation, reducing the palpability and visibility of the implant. In this Q experimental study from May 2006 to May 2009, 20 patients (14 males, 6 female) aged 4 to 19 months (mean 6±3 months) underwent operation. Indications for operation were Metopic suture in 8 patients, unicoronal suture in 5 patients, Bicoronal suture in 3 patients, Sagittal suture in 1 patients, Multiple suture suture in 3 patients. All patients underwent fronto-orbital remodeling with cranial reshaping. Through bicoronal approach, once the supra orbital bar is remodeled, a new forehead is created by remodeling the rest of it.Symmetrical repositioning and fixation of supraorbital bar was done, and frontal bone segments were fixed in to position by handmade resorbable mesh plates and screws. The temporal muscle was then advanced to lateral orbital rim and temporal crest, and the priosteum was advanced for the coverage of reconstructed forehead region. The results of treatment, at aminimal follow-up of 6 months were assessed, based on preoperative and postoperative photographs and direct patient examination. The follow-up of the patients ranged from 6 to 36 months (mean 15±6 months). All patients were studied, using photography, radiography, and 3-D CTscans preoperatively and were visited in the clinic 1, 2, 3, 6 week and up to36 months after their operations. During the observation period of up to 36 months, no infection, visibility, exposure, instability or dislocation was observed. The results aesthetically were satisfactory in 90% and good in 10% of patients, according to Bartlett categorization. Absorbable fixation devices in the fronto-orbital remodeling surgery of patients affected by craniosynostosis provides secure fixation while avoiding the potential and well-documented problems with rigid metal fixation. Using a row of absorbable mesh, instead of conventional plate, could effectively reduce visibility and even the palpability of the normal fixation device.

Scalp defects have various etiologies which included scalp cancers, trauma, burns, congentital vascular lesions (Hemangioma & arteriovenous malformations), acquired & congenital skin defect such as aplasia cutis and infections. These defects need different reconstructive methods. The aime of this study was to determine the etiology of scalp defects and out come of various reconstructive methods. This was a descriptive study and based on the patient's files during two years from 2004 to 2006. All patients operated for scalp defects were included in the study. Different methods of reconstructive surgery were considered and results analyzed using descriptive statistics. The study included 75 patients, (52 males and 23 females) with the mean age of 42 years old. In most cases the scalp defect was in the temporoparietal region and most defects were reconstructed using tissue expander (TE). The most common cause of scalp defects was Basal cell corconoma (primary and recurrence) and the most common primary reconstructive method was skin graft. The second cause of scalp defects was burn scar and in these cases the most common reconstructive method was TE. Operative complications in this study were partial necrosis of the graft or distal flap that was repaired by using the repeated skin graft. In one case there was infection of tissue expander that was extracted. The most common cause of scalp defect were Basal Cell Carcinoma and burn respectively and in these cases the skin graft and TE were the most common reconstructive methods respectively.

Abstract Loss of active abduction and forward flexion of shoulder in brachial plexus injury (BPI) is a severe disability in daily life and employment. Several methods of tendon transfer, such as Saha, Hartman and Bateman procedure, have been described with a limited function. In this study, 4 cases treated with functioning free Gracilis muscle transplantation for BPI were reported. In this clinical trial, four patients with upper roots of brachial plexus injury treated with functioning free Gracilis muscle transplantation were studied. Patients lower than 40 years and without vascular injury or limitation of shoulder were enrolled in the study. After muscle transplantation, patients had splint for 3 weeks. They received physiotherapy for 4 weeks, and then were followed up to evaluate failure of surgery and active abduction and forward flexion of shoulder for one year. 4 patients with mean age of 31 years were studied. All of them were male. Time to first contraction was 3.4±0.8 months. The mean shoulder abduction and forward flexion due to free Gracilis muscle transplantation was 90◦±14◦ and about 90◦, respectively. It seems that functioning free Gracilis muscle transplantation has satisfactory results on increasing shoulder abduction and forward flexion

Cutaneous flaps are frequently used in plastic surgery and ischemic necrosis is still a complication as a clinical problem. Different methods have been attempted in order to enhance flap survival including: hyperbaric oxygen, angiogenesis therapy (FGF, VEGF), pharmacologic agents such as sympatholitic, vasodilators, calcium channel blockers, hormonal agents, prostaglandin inhibitors, anticoagulants, oxygen-derived free radical scavengers, corticosteroids, delayed flap surgery, etc. In an experimental study it has been observed that topical application of oleic acid postoperatively on random skin flap increases survival of the flap. We have investigated the effect of prophylactic use of oleic acid on the survival of the rabbits’ random skin flap. A total of 46 adult white New Zealand rabbits having a 3×10.5cm dorsal thoracic skin flap were selected. Flaps were assigned in 3 groups: for the first group topical oleic acid 75% (10% by volume) was applied ipsilaterally, while for the second group it was applied contralaterally and in the third group (control) the dorsal flap was treated with a basic ointment (a medical pure Vaseline). Having elevated each flap, it was sutured into its bed. On the 6th postoperative day, area of flap survival was measured based on clinical evaluation. The average of total skin flap survival was 11 cm2 in the first, 13.2 cm2 in the second (p=0.65), and 20.7cm2 in third group (control) (p<0.05). Although skin flap survival increases when topical oleic acid is used after surgery and flap elevation, prophylactic use of topical oleic acid decreases flap survival in the rabbits’ random skin flap.

Hand injuries due to lacerations are one of the most common causes of hand emergencies which are due to diverse reasons as occupational, sport injuries or self mutilation. Tendons’ damages are the most common injuries of hand. Precise preoperative examination may reduce diagnostic errors. This study evaluated the accuracy of preoperative examinations of flexor tendons injuries in zone 4 and 5 of hand. In a cross-sectional descriptive study, preoperative physical examination by plastic surgery team and findings during the surgery were compared in 61 cases referring to hand emergency operating room of 15 Khordad Hospital, Tehran. Data collection was preformed by means of questionnaires pre and post operation. All cases with hand lacerations of zone 4 & 5 were enrolled; whereas children younger than 3 years of age, and the non-cooperative cases and those of any history of previous handsurgery, were excluded from the study. Sensitivity, specificity, positive and negative predictive values were analyzed, using SPSS software. The accuracy of preoperative examination findings for all tendons was 88.52%. This was more accurate in flexor digitorum profundus (FDP) (96.72%) than flexor digitorum superficialis (FDS) tendons (78.27%). The specificity of preoperative examination (99.50%) was more than sensitivity (57.63%) for all tendons. Sensitivity of examination for FDS and FDP was 40.69% and 82.75% respectively and specificity was 98.73% and 100% for FDS and FDP respectively. More attention is mandatory during preoperative examination of the hand with zone 4 & 5 injuries. Surgeons need a low exploratory threshold, and in cases with any positive finding of tendon injury, explorative surgery is recommended.

Reconstruction of complex facial defects has always been a challenge for plastic surgeons. The reconstruction can be done by use of local, regional, distant and free flaps; each of these has its own advantages and disadvantages. In this article a technique is presented about how to reconstruct complex facial defects simultaneously. This presented technique has been used for a 45-year-old woman with severe destruction of nose, upper lip and right side of cheek due to progressive ulcerating lesion that had begun since about 20 years ago. By expansion of normal neck skin and suitable design and taking surgical steps in sequence, the nose, upper lip and left side of cheek were reconstructed by a cylindrical cervical flap. The result was satisfactory and donor site morbidity was minimal. The use of this flap can be feasible in selected cases in which the extent of facial injury is great but the neck is not damaged.

Facial nerve palsy can occur due to several causes and accordingly, several treatments have been proposed by plastic surgeons. This study is to determine the efficacy of temporal myoplasty in correcting the facial deformity of patients suffering from hemi-facial palsy whom were referred to “15 Khordad” hospital between 1381- 1385. Participants were 6 patients with hemi-facial palsy who referred continuously and were neither candidated for microscopic surgery, nor can tolerate free muscle transposition surgery. We conducted a clinical case study to compare pre and post-operation stages. In these patients, the new one-stage method of temporal tendon transposition to lip's commissure (without any grafting) was performed. They were followed for an average of 2 years. Assessments were made in terms of their age, sex, facial palsy cause, palsy duration, complications, and lip's commissure range of motion. Pre and post-operation photos were taken and physical examination was documented and analyzed for each case. Two cases (out of six ones) were men and the others were women. Their age range was 38.2 ±14 years old. In three cases, facial palsy was a post-traumatic result. One patient had congenital form. In another one it was due to tumor resection complications. The last patient was a tympanoplasty case. Palsy duration range was 28.7 ± 11 months. No complication was seen after the operation. In early post-operation stage, 50% of patients had good static facial position and in remained 50% the result was excellent. However, in delayed stages, the percentages for excellent, good and moderate outcomes were 66, 17 and 17, respectively. Despite the well dynamic facial position in early post-operation stages among all the cases, in delayed stages the percentages for excellent, good and moderate results were reduced to 50, 33 and 17, respectively. It seems that for those who can not tolerate long operations nor like to do so, temporal myoplasty might be an acceptable method as an alternative for the standard surgical methods applied for hemi-facial palsy (i.e. the microscopy procedure). It is recommended to conduct an absolute experimental study in this regard.

Reconstruction of defects in heel and malleoli with exposed bone has always been a challenge. Heel is a weight bearing region which needs sensation. Distally-based sural island flap is one of the options available for these kinds of defects. Here, in this study we have paid special attention to how these flaps become sensate.

This case-series study carried out on 14 patients who reffered to 15 Khordad Hospital, Tehran, from 2000 to 2003 and their defects had been covered with distally based sural island flap. Appearance of pain, temperature, light touch and two - point discrimination evaluated in flap region and compared with the contralateral site.

From 14 patients with this flap; 11 subjects (9 males and 2 females) entered into the study. Seven subjects had been injured during motorcycle accident. In 10 patients (91%), two-point discrimination in flap region was.13.2 mm, which was the same as the other side.

Covering the defects in heel, malleoli and distal third of leg with sural island flap is technically easy and with minimal donor site morbidity. Major vessels in the lower extremities are spared and this flap can be used in weight bearing areas with relatively good sensation.

Similar to some other country prevalence of Hepatitis B, Hepatitis C, in Iran is considerable. Health care personnel, especially members of surgical teams are at risk for occupational transmission. In this survey we studied prevalence of seropositivity for all those three viruses in admitted patients in hand trauma unit at 15 Khordad hospital. In Tehran and compared the results with other domestic and international reports. From March 2001 to March 2003, 3714 patients who were 15 year and older were operated in this unit and ELISA serologic test were done for all of them. In 126 cases, (3.4%) at least one of the three serologic tests were positive. HBS-Ag in 2%, Anti HCV-Ab in 1.5%, and Anti HIV-Ab in 0.13% of cases were reported as positive. Compared with other studies in many countries which have been performed in emergency or trauma patients, blood donators, or general population prevalence of seropositivity to these viruses were different in our study in 15 Khordad Hospital.