WORLD JOURNAL OF PLASTIC SURGERY
Year:2013 | Volume:2 | Issue:1|Papers Count:10

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 remain a stem cell or become another type of cell.In a healthy individual, skin integrity is supported by epidermal stem cells that self-renew and generate daughter cells undergoing terminal differentiation. In addition to accumulation of senescence markers in aged skin, epidermal stem cells are maintained at normal levels throughout life. So, skin ageing is provided by an impair in stem cell mobilization or a reduction in the number of stem cells being capable to respond to proliferative signals. The self-renewal and multi-lineage differentiation of skin stem cells make these cells attractive for ageing process studies but also for regenerative medicine, tissue repair, gene therapy and cell-based therapy with autologous adult stem cells.

Platelets work via the degranulation of theα-granules containing pre-packed growth factors including PDGF, TGFb, IGF, VEFG and EGF. Autologous platelet-rich plasma (PRP) is considered safe due to its autologous nature, and is produced simply as needed from the patient's blood. This review covers data on role of PRP in improvement of fat grafting outcomes.

BACKGROUND: 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 mattress 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.

BACKGROUND: 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 out weight 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.METHODS: 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.RESULTS: 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.CONCLUSION: We need to fully understand and consider various outcomes and challenges of telemedicine before applying it.

BACKGROUND: Post-burn flexion contracture of the knee joint is a disabling condition which interferes with upright posture and bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect produced as a result of contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation while retaining the merits of islanded perforator flaps.METHODS: Nineteen patients with post flame burn flexion contracture of the knee joint underwent surgical release and coverage by various local fasciocutaneous perforator-plus flaps. Patients were followed up for 6 months and the various aspects of functional and aesthetic rehabilitation were assessed.RESULTS: All local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good color and texture match and maintenance of contour. None of the flaps had any significant early or delayed complications (including venous congestion) to necessitate reoperation. All patients were satisfied with the functional and aesthetic outcome.CONCLUSION: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for surgical release and reconstruction of post burn flexion contracture of the knee.

BACKGROUND: The ala of the nose, with its particular texture and characteristics, poses both aesthetically and functionally intriguing, 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 period of reconstructive surgery, using skin/dense subcutaneous tissue/skin grafts, with a mean of 4 years and 8 month-follow-up.METHODS: Cumulatively 56 patients were reported. Some of them required surgery due to previous cosmetic rhinoplasty. In 47 of the cases, a small graft from the non-cartilage bearing junction of ear lobule to helical rim sufficed, but 9 patients had rather large defects, for which grafts were harvested from the helical root. Donor sites were primarily closed, and grafts were implanted in place in a single, rapid surgery.RESULTS: All small grafts had excellent take. Of 9 large grafts, 5 had excellent, three had acceptable, and one, in a male smoker, had a failure to take. During follow-up, no gross deformity or scar was detected in either donor or recipient site.CONCLUSIONS: We have demonstrated that using auricular skin/dense subcutaneous tissue/skin composite grafts has favorable long term results for reconstruction of alar rim deformities in both large and small grafts. However, its advantages lean more towards small grafts and applicability of large grafts requires further studies.

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 relocating 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.

Dear EditorStandardization 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