WORLD JOURNAL OF PLASTIC SURGERY
Year:2022 | Volume:11 | Issue:2|Papers Count:20

Background: The prevalence of osteoarthritis (OA) of the first carpometacarpal (CMC) joint and subsequent thumb disability is rising. Abductor pollicis longus tendon interposition arthroplasty (APLTIA) has gained popularity as a procedure to alleviate pain and restore thumb function. Methods: A systematic review was performed to assess the current reported outcomes of APLTIA. Inclusion criteria involved clinical studies with caseseries as the minimal accepted level of evidence. Our primary outcome focussed on PROMs data, whilst secondary outcomes focussed on objective measures of function and complications. Papers investigating pathologies other than CMC OA or procedures other than APLTIA were excluded. Results: Twelve studies were included (485 thumbs), all of which were observational in study design. APLTIA appears to be associated with a reduction in pain and functional improvement. APLTIA was not found to complicate further surgery. Conclusion: APLTIA may be associated with improvement in short-term pain relief and functional status. Further research is required to evaluate the benefits, duration of relief and long-term outcomes of APLTIA.

Background: Surgeons frequently perform rhinoplasty on individuals who have facial asymmetry. Patients’,discontent following rhinoplasty has been linked to facial asymmetry. On the other hand, correction of a deviated nose is a tough procedure, and it is not the same as septal deviation correction. Surgeons, who often perform rhinoplasty for deviated nose in people with asymmetrical faces, focus primarily on correcting nasal defects and overlook such facial asymmetry. Aim: We aimed to summarize and review the prevalence of facial asymmetry in patients subjected for rhinoplasty for deviated nose correction. Methods: A systematic search was conducted covering PubMed, Scopus, ISI, and Google Scholar using related key words and MeSH (Medical Subject Headings) terms from 2000 until November 2021 for English published articles. Results: The majority of subjects had more facial asymmetry such as chin deviation, nasal deviation, and face breadth. Facial asymmetry is typically found in patients undergoing rhinoplasty for a deviated nose, and its presence frequently results in the failure to achieve a straight-looking nose. Conclusion: Patients considering rhinoplasty frequently have facial asymmetries, and careful attention should be devoted to these elements in both surgical planning and patient counseling. In order to create facial harmony and apparent symmetry after rhinoplasty, it is critical to center the nose on the midglabellar to mid–, bow Cupid’, s line.

BACKGROUND We aimed to provide a single, viable and user-friendly operative protocol for preoperative antibiotic prophylaxis that meets the needs of all plastic surgery practitioners. METHODS The research was conducted through the abstract and citation databases of peer-reviewed literature Pubmed®,(National Center for Biotechnology Information), Medscape®,(General Surgery) and Scopus®,(Elsevier), comparing existing data from 2010 to 2020. A separated and dedicated research was accomplished for each of 8 macroareas such as: skin and soft tissue, hand, breast, aesthetics, head and neck, trauma, burns and miscellaneous. RESULTS The findings for each macroareas included the choice of the antibiotic, the route and timing of administration and the clinical applications. Finally, the review has been condensed in an operative algorithm for antibiotic use to apply in each field of plastic surgery. CONCLUSION We could provide plastic surgeon an effective, easy-to-use operative protocol for antibiotic prophylaxis in daily activity.

Background: We aimed to investigate the effect of preoperative administration of oral tizanidine on postoperative pain intensity after bimaxillary orthognathic surgery. Methods: All healthy skeletal class III patients who were candidates for bimaxillary orthognathic surgery were enrolled in this triple-blind randomized clinical trial. The study was carried out in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran,from January 2021 to November 2021. The consecutive patients were randomly divided into tizanidine and placebo groups. One hour prior to anesthesia induction, the tizanidine group received 4 mg Tizanidine dissolved in 10 ml apple juice, whereas the placebo group received an identical glass of plain apple juice. All operations were performed by the same surgical team, under the same general anesthesia protocol. Postoperative pain was measured using the Visual Analogue Scale (VAS) at 3, 6, 12, 18, and 24 hours. For statistical analysis,the significance level was set at 0. 05 using SPSS 23. Results: A total of 60 consecutive patients, consisting of 36 females (60%) and 24 males (40%) with an average age of 25. 4 ±,6. 0 were recruited. An increasing trend was noticed in the amount of perceived postoperative pain from the 3rd till 12th hour, and then decreased afterward. Nevertheless, the average amount of pain was significantly lower in the tizanidine compared to the placebo group, in all the evaluated time intervals (P<0. 001). Moreover, there was a significantly higher requirement for postoperative opioid analgesics in the placebo compared to the tizanidine group (P=0. 011). Conclusion: The addition of oral tizanidine was effective in reducing postoperative pain following bimaxillary orthognathic surgery. Further studies are necessary for more relevancy.

Background: The aim of this study was to compare the dento-skeletal stability between one and three-screw fixation of mandible following bilateral sagittal split osteotomy (BSSO) in skeletal class 3 patients. Methods: Healthy patients with skeletal class 3 malocclusion in Mashhad, Iran, from August 2020 to May 2021 were undergone mandibular setback through bilateral sagittal split osteotomy. Rigid fixation was performed in one group with one-screw technique, and three-screw fixation was done in another group. Cephalogram x-rays were prepared and analyzed in three stages: before surgery (T0), one week after the surgery (T1), and six months postoperatively (T2). The linear and angular alterations of chosen multivariate skeletal and dental variables were evaluated and statistically compared in all three periods. Results: This study included a total of 20 patients, 12 of them were female (60%). Patients in the one-screw fixation group had a mean age of 20. 6 ±,2. 2 years old, whereas those in the three-screw fixation group were 21. 5 ±,2. 8 years old, with no statistically significant difference. Both groups had excellent mandibular stability six months following surgery. No statistically significant differences were observed in the postoperative skeletal and dental changes between the two techniques. Conclusion: Fixation of the mandible following the setback surgery by the BSSO technique with the one-screw fixation method may be accomplished effectively, and the therapeutic outcomes are comparable to those obtained with the traditional 3-screw fixation approach.

Background: Single suture craniosynostosis (SSC) is a disorder, affecting brain growth. Reviewing literature reveals controversialists of papers in this field. Methods: This prospective study was conducted from 2014 to 2016. All the individuals, aged 2 to 16 years, whose medical records files were complete, with SSC from 1999 to 2013 were included. All patients had undergone cranial vault remodeling at Mofid Hospital, Tehran, Iran. Wechsler questionnaires, WPPSIIII and WISC-IV, were completed for each child based on his/her age. Results: Seventy children were included, with the mean age of 6. 7 (±, 2. 9) years. Forty-six (65. 7%) children were boys while 24 (34. 3%) were girls. Mean FSIQ for all of children was 95. 5 (±, 13. 2). Mean verbal IQ, performance IQ, verbal comprehension, perceptual reasoning, processing speed, and working memory are 93. 4 (±, 14. 1), 96. 1 (±, 13. 3), 97. 5 (±, 13. 9), 102. 2 (±, 12. 5), 94. 5 (±, 9. 8), and 97. 5 (±, 12. 9), respectively. There was statistically significant difference between FSIQ of children with SSC and that of unaffected children (P-value<0. 05). There was significant difference between verbal IQ of children with SSC and that of unaffected ones (P-value< 0. 007). There was significant difference between in processing speed between affected children and unaffected children (P-value<0. 012). Conclusion: Children, aged 2 to 6 years, with SSC had a significantly lower Verbal IQ, and children, aged 6 to 16 years, with SSC had a significantly lower processing speed than their healthy counterparts. Though FSIQ of children with SSC falls within normal range, it is a little lower than healthy peers.

Background: Surgical reconstruction is the gold standard of treatment for Peyronie’, s disease (PD). Grafting procedures provide satisfactory outcomes in patients with complex curvature, short penile length, and without previous erectile dysfunction (ED). We aimed to compare two different grafting methods of reconstruction in patients with PD. Method: Fifty-two PD patients at Imam-Reza hospital of Mashhad from October 2011 to January 2019 with stable plaque, penile angulation of >60˚, , complex curvature, and without ED who consented to cooperate, included in our study and divided into two groups. The first group consists of 26 patients, undergone grafting through a double-Y incision and a single saphenous graft placed within the incision. For the second group, two smaller saphenous vein grafts were placed in the two parallel incisions. ED assessed pre-and postoperational via the International index of erectile function. Penile angulation less than 20 degrees was considered a favorable outcome. Patients followed for 18 months, and sacculation, penile shortening, post-operation infection, and penile hypoesthesia were assessed as complications. We used a paired t-test to compare these two groups. Results: ED was 25% and 12% in the first and the second group, respectively. Statistics showed no difference between the two groups regarding pre and post-operational ED (P=0. 1). Regarding complications during follow-up, sacculation occurred in four patients of the first group and none of the second group patients but no significant difference (P=0. 23). Conclusion: We found no superiority to declare between these two procedures, although regarding the small sample size of our study, further evaluations are needed to establish more reliable results.

BACKGROUND: Rhinoplasty Outcome Evaluation (ROE) is an easy-to-use questionnaire that allows comprehensive assessment of rhinoplasty-related patient satisfaction. However, the normal values for this questionnaire are not known. Therefore, we aim to validate the ROE questionnaire adapted to Iranian culture. METHOD: In this cross-sectional descriptive study, the statistical population consisted of applicants for cosmetic surgery referred to Shahid Rajaee Hospital, Shiraz, Iran, in the autumn and winter of 2017. Two hundred individuals participated in this research by a convenience sampling method. The questionnaire (ROE) was translated to Persian and backward translated to English by independent medical extern Persian speakers with complete English proficiency. The data were analyzed using SPSS software version 23 using exploratory factor analysis. RESULTS: The findings showed that the Cronbach’, s Alpha of composite reliability (CR) and average variance extracted (AVE),overall, values above 0. 4 were favorable in this measure. In addition, the AVE ranged from 0. 50 to 0. 59, which confirmed convergent validity. The AVEs of each factor was higher than the squared correlations and confirmed discriminant validity within the constructs. In the presence of significant factor loadings and composite reliability greater than 0. 70, convergence validity was confirmed. Furthermore, the higher AVEs for each factor were compared to the squared correlations to confirm discriminant validity. CONCLUSION: The Iranian version of ROE is a valid instrument to assess results in rhinoplasty patients.

BACKGROUND Burns are one of the most important health problems in communities. Traumatic injuries, especially Traumatic Brain Injury (TBI) associated with burns, may increase disability and mortality. In addition to preventing burns, any action for a better treatment approach and early detection of concomitant traumatic injuries can reduce complications, disability, and treatment costs. We aimed to investigate the outcome of children with burn injury with and without TBI. METHODS In this cross-sectional study, 392 children with burn injuries treated at Motahari Hospital in Tehran, Iran from 2018-2019 were enrolled. Patient demographics, burn injury information and TBI-related information including head trauma and fracture were recorded in a checklist. Patients were divided into two groups of death (24 people) or discharge (368 people) in terms of outcome and the underlying variables were compared in the two groups. RESULTS There was no significant difference between the mean age of patients and gender in the two groups. The difference in the length of hospital stay, inhalation injury and skull fracture in the two groups was not statistically significant. The mean burn severity based on Total Body Surface Area (TBSA) and the frequency of TBI in the deceased group was significantly higher (P=0. 001). CONCLUSION The severity of burns based on TBSA and TBI is associated with increased mortality among children with burn injuries. The results suggest the need to examine children with burn injuries for TBI using clinical examination or imaging.

BACKGROUND Conventional technique of flap inset in buccal mucosa reconstruction is by direct suturing of cutaneous margin of Pectoralis Major Myocutaneous (PMMC) flap to hard and soft palate mucosa and margin of floor of mouth with simple interrupted sutures. We have done a prospective study of the efficacy of anchoring the upper margin of PMMC flap to the hard palate by a modified method in reconstruction of buccal mucosa defects following tumour excision. This is to prevent disruption of suture line from the mucoperiosteum of hard palate and resultant oro-cutaneous fistula. METHODS This hospital-based prospective study was carried out in the Department of Plastic Surgery at Bangalore, India for a period of 18 months (2015–, 2017). Patients (N=48) with buccal mucosa defects requiring reconstruction with PMMC flap either with conventional (n=24) or modified method (n=24) following tumour excision were included. Clinico-demographic profile of the patients including age, gender, size of defect, staging of illness, site and type of reconstruction, disruption of suture margin in the hard palate, development of oro-cutaneous fistula (OCF), day of starting oral feeds, removal of Ryle’, s tube and post-operative average length of stay in the hospital were recorded. RESULTS Disruption of suture line in hard palate and Oro-cutaneous fistula were statistically significant in study group in both the variables (P-0. 033, P-0. 033). The median days on which patients were started with oral clear liquids and removal of Ryle’, s tube were also statistically significant between study and control groups. Post-operative average length of hospital stay which is the outcome of favourable results in the study group was found to be statistically significant (P-0. 021) between the groups. CONCLUSION Overall, modified technique of anchorage of PMMC flap can be considered as a reliable technique in buccal mucosa reconstruction because of its stability, lower complication rates and shorter length of hospital stay.

BACKGROUND Preventing perineural adhesions and scars formation in the traumatic peripheral injuries is very important on the recovery process. We aimed to evaluate the effect of using the amniotic membrane wrapping on the results of surgical treatment of damaged peripheral nerves. METHODS This cohort study included 30 patients with symptoms of acute peripheral nerve injuries due to penetrating trauma in the forearm or wrist in January 2019 to November 2020 referred to the Hand and Microsurgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In 15 patients, after nerve repair, amniotic membrane coverage was used around the nerve, all patients were followed for 12 months. Ultrasound study for neuroma formation and nerve regeneration was determined based on EMG and NCV findings. The modified Medical Research Councile classification (MRCC) was used to evaluate of motor and sensory recovery. RESULTS In the amniotic membrane wrapping group, all patients had nerve regeneration and functional nerve recovery occurred after 12 months. In the control group, 5 patients (33. 4%) did not have nerve recovery and had functional and sensory impairment. In terms of functional capabilities,there was a significant difference in pinch strength, grip power and MRCC scoring between the two groups. Moreover, the mean volume of neuroma in these patients who used amniotic membrane covering was 2. 7 mm3 and in the control group, it was 3. 9 mm3 (P=0. 001). Five patients who did not have a damaged nerve, the neuroma volume was 4. 8 ±,0. 9 mm3. CONCLUSION The use of amniotic membrane covering is effective methods in the improve results of peripheral nerve repair and nerve function recovery.

BACKGROUND Body Dysmorphic Disorder (BDD) is a psychic disorder in which a person is dissatisfied with their normal appearance. Identifying these people among the applicants for cosmetic surgery leads to the proper decision about the cosmetic procedure of these patients and their postoperative consequences. METHODS This cross-sectional study was performed on 250 women referred to a private Plastic Surgery Clinic in Mashhad, Iran from 2016 to 2017. Applicants were divided into two groups as abdominoplasty and other cosmetic surgeries. BDD was assessed using the modified form of the Bill Brown Questionnaire. Applicants’,information including age, marital status, number of children, education level, and history of cosmetic surgeries were recorded. RESULTS The mean BDD score in the abdominoplasty group and another group was 93. 6 ±,23. 5 and 75. 5 ±,25. 8, respectively. There was a significant difference between the two groups in terms of the BDD score (P-value < 0. 001). Although there was a notable relation between BDD score and marital status, no significant association between BDD score, age, and education level was found. CONCLUSION Considering the exact criteria of BDD, we noticed a significant increase in the frequency of BDD in abdominoplasty applicants. It was erroneous and could be explained by not applying the accurate diagnostic criteria of BDD.

Background: Burn is one of the most significant injuries in industrial and developing societies and is one of the most important traumas leading to hospitalization. The aim of this study was to identify the epidemiology, geographical distribution, and outcome of electric burns in Fars province and to present the distribution map. Methods: In this descriptive-analytical study, the study population involved all electrical burn victims admitted to Amir al-Momenin and Ghotbeddin Hospitals from 2008 to 2019 in Fars province in the south of Iran. Data were analyzed using SPSS software version 22. Results: Among a total of 246 patients, the average age was 30. 78 ±,11. 07. The highest frequency among educational levels was among under-diploma patients (38. 6%), and the majority were employed (87. 4%). Also, most of the patients were from urban areas (70. 3%). The majority of burn incidences occurred at the workplace (57. 7%). Also, among the high voltage patients, 25 patients (30. 9%) had an amputation, while among low voltage only 12 patients (16. 2%) had an amputation. Non-surgical treatment was applied in 68 (28%) cases, while Escharotomy was performed in 28 (11. 4%) patients. There was also a statistically significant association between burn voltage and amputation (P= 0. 039). Conclusion: Based on our report, the rate of electrical burn injuries in Iran is still high, which underlines the need for stronger efforts in effective prevention, such as better public education and the establishment of strict regulations regarding the distribution and use of electricity.

Background Bilateral Sagittal Split Osteotomy (BSSO) is one of the treatment options for Class III maxillary deficiency which may affect the condylar position and the patient’, s occlusion. We aimed to evaluate the clinical and radiographic changes of temporomandibular joint (TMJ) following mandibular set back surgery by BSSO. Methods In this retrospective study, All Class III patients, aged between 18-30 years old who underwent bimaxillary orthognathic surgery in the Oral and Maxillofacial Surgery Ward of Ghaem Hospital, Mashhad, Iran from January 2018-January 2020 were enrolled. Radiographic changes of joint space, condylar position and clinical changes for maximal mouth opening and joint sound were examined before and 6 months after surgery. Data were analyzed by SPSS16 software and the significance level of the data was set at P-value < 0. 05. Results Twenty-five patients were recruited. The axial angle of the left and right condyle and condylar inclination on both sides reduced but this reduction was not statistically significant. While the anterior joint space was reduced and posterior joint space was increased in both sides, the changes on the right side were only significant (P = 0. 039). In clinical examinations maximum mouth opening, lateral and protrusive movements were also decreased but this reduction was not statistically significant. Conclusion The mandibular set back with BSSO surgery in class III skeletal patients had no significant effect on the position of the condyle in the glenoid fossa as well as clinical symptoms.

Background: Rhinoplasty is one of the most common plastic surgeries and a challenging procedure for people with thick nasal skin. There are several techniques to improve the outcome of the operation. Methods: Our study is a double-blind randomized controlled trial conducted in Esfahan, Iran in 2020. Seventy participants were equally divided into two groups (35 people). In the control group, only rhinoplasty was performed without SMASectomy and in the intervention group, rhinoplasty was performed with SMASectomy. The results were obtained and the satisfaction of patients and physicians was collected through patient examination and a questionnaire. Statistical analysis of data was calculated by SPSS software version 23 at a significance level of less than 0. 05. Results: The mean total skin thickness before surgery in the two groups was equally, which showed a significant difference between the two groups at after 12 months (P <0. 05). Comparison of 3, 6 and 12 months after rhinoplasty in the two groups showed that the percentage of patient, doctor, hairdresser and nurse satisfaction, in 12 months after rhinoplasty, in the intervention group compared to the control group had a significant increase (P <0. 05). Furthermore, in the control group 2. 85% and in the intervention group 5. 71% bleeding was observed. No other complications were observed in any of the groups. Conclusion: Overall, SMASectomy, which is performed simultaneously with rhinoplasty, is considered as an important technique in rhinoplasty. As we observed in our study, the complications of these surgeries in patients were very small.

Background: Repairing of a wide cleft palate faces with several problems, e. g. medialization of palatal flaps, lack of tissue for repair, and fistula formation. We aimed at quantitative and qualitative evaluation of medial osteotomy of the greater palatine foramen for patients with wide cleft palate and its postoperative outcomes. Methods: Eight patients 4 males, 4 females with wide cleft palate and the median age of 1. 5 year were operated using medial osteotomy of the greater palatine foramen from 2018-2020. In this technique, the osteotomy was carried in the outlet of vascular pedicle medially and posteriorly. This led to more degrees of freedom for the vascular pedicle and a palatoplasty without tension through mucoperiosteal flap movement toward the medial direction. Results: After osteotomy and repairing for 8 patients (16 flaps), the mean (SD) length of mucoperiosteal flap pedicle was significantly increased from 2. 78 mm to 6. 09 mm (P<0. 001). All patients were successfully repaired with no major complications, and none of them required any secondary repair. Three weeks postoperatively, all patients showed normal feeding, normal nasal resonance of speech with normal palatal mobility. Conclusion: Osteotomy of the greater palatine foramen for the closure of wide palatal clefts showed a good efficiency, quantitatively and qualitatively. The mean length of mucoperiosteal pedicle increased by 3. 22 mm (6. 44 mm for bilateral) after repairing, which helps to more freely medial movement of the palatal flap and lesser tension across its closure. All patients were successfully improved without any major complications.

Background: Patients’,attitudes about their nose changes after orthognathic surgeries. We aimed to evaluate the patient’, s opinion about nasal change and morphologic changes following orthognathic surgery. Methods: This was a cross-sectional study. The sample was derived from the population of patients who underwent orthognathic surgery in the Oral and Maxillofacial Surgery Department of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2019. Subjects who underwent orthognathic surgery were studied. Subjects filled a modified nose evaluation form before and nine months after orthognathic surgery. For objective assessment, the nasolabial angle, nasofrontal angle, nasofacial angle, tip projection, and tip deviation and alar width were evaluated. Sixtytwo patients were studied. Results: Forty (64. 5%) patients did not absolutely like their nose before orthognathic surgeries, two (3. 2 %) expressed a little satisfaction, 17(27. 4%) answered they liked more or less, and three liked very much. Nine months after orthognathic surgeries, 4 (6. 5%) patients did not like their nose, nine patients (14. 5%) liked a little, 30 (48. 4%) liked more or less, and 19 liked very much. Analysis of the data demonstrated a significant difference in patients’,satisfaction with their noses before and nine months after orthognathic surgeries (P<0. 001). Patients’,satisfaction nine months after orthognathic surgery was not affected by nasal morphologic changes. Conclusion: It seems, patients’,satisfaction with their nose improved after orthognathic surgeries. Patients’,attitude was not associated with nasal morphologic changes.

Background: We aimed to compare the emergence from anesthesia between the isolated mandibular setback and bimaxillary orthognathic surgeries in Skeletal Class III Patients. Methods: All healthy patients with skeletal class III deformity admitted to Mashhad Dental School, Mashhad, Iran from the years 2017 to 2018 were included in this study. They were candidates for either bimaxillary orthognathic surgery (Bimax surgery) through a combination of mandibular setback surgery plus maxillary advancement or isolated mandibular setback (Monomax surgery). The predictor variable was the type of jaw displacement and anesthesia duration, while the outcome variable was the duration of emergence from general anesthesia. The duration of emergence from anesthesia was calculated from the time the patient was transported to the recovery room until the time of safely discharging from the recovery room. For statistical analysis, the significance level was set at 0. 05 using SPSS 21. Results: A total of 81 consecutive patients, comprising 45 (55. 6%) males and 36 (44. 4%) females, with an average age of 23. 15±, 4. 58 years were recruited. Among the participating patients, 56 (69. 1%) underwent bimaxillary surgery while the other 25 (30. 9%) were treated with Monomax surgery. Regardless of the type of performed surgery, the duration of general anesthesia was the only factor to be significantly correlated to the length of emergence from anesthesia (P= 0. 001). Conclusion: Increased exposure time to general anesthesia might result in a longer emergence from anesthesia, despite the type of performed orthognathic surgery. Further clinical trials are needed to support the relevancy.

We present the case of a 33-year-old female referred with a 13x10 mm surgical defect immediately after Mohs micrographic surgery for excision of basal cell carcinoma. Functional considerations for the external nasal valve were accounted for using free alar rim cartilage graft, soft tissue tunnels, and pre-auricular full-thickness skin grafts. Our post-operative experience demonstrates excellent nasal valve integrity and acceptable aesthetic outcomes for the patient by providing structural support for the nasal ala. Our management has minimal additional morbidity and minimizes the risk of external nasal valve compromise in the long-term.

Rapp Hodgkin Syndrome (RHS), is a subtype of Ectodermal Dysplasias (EDs), which has various manifestation. Here, we report a case on repair of the palatal cleft in an 18 year old girl, having RHS, with combination of facial artery musculomucosal (FAMM) flap and inferior turbinate flaps (ITF), at Hazrat Fatima Hospital, Tehran, Iran in 2021.