WORLD JOURNAL OF PLASTIC SURGERY
Year:2016 | Volume:5 | Issue:2|Papers Count:17

It becomes necessary for every individual in his life to pause and look behind a man who had a positive impact on the lives of many patients, medical students and residents that may be the only thing a person can be proud of with high degree of confidence. We wish to write about him who had an immeasurable and indisputable contribution to the development of the field of plastic and reconstructive surgery in Iran.

The last decade has ushered in a rapidly expanding global discussion regarding acellular dermal matrix (ADM) applications, economic analyses, technical considerations, benefits, and risks, with recent emphasis on ADM use in breast surgery. This study aims to evaluate global trends in ADM research using bibliometric analysis. The top nine Plastic Surgery journals were determined by impact factor (IF). Each issue of the nine journals between 1999 and 2013 was accessed to compile a database of articles discussing ADM. Publications were further classified by IF, authors’ geographic location, study design, and level of evidence (LOE, I-V). Productivity index and productivity share were calculated for each region. In total, 256 ADM articles were accessed. The annual global publication volume increased significantly by 4.2 (0.87) articles per year (p<0.001), with a mean productivity index of 36.3 (59.0). The mean impact factor of the nine journals increased significantly from 0.61 (0.11) to 2.47 (0.99) from 1993 to 2013 (p<0.001). Despite this increase in the global ADM literature, the majority of research was of weaker LOE (level I: 2.29% and level II: 9.17%). USA contributed the most research (87%), followed by Asia (4.76%) and Western Europe (4.71%). USA contributed the greatest volume of research. Regarding clinical application of ADM, the majority of publications focused on ADM use in breast surgery, specifically breast reconstruction (154 articles, 60.2%). The majority of research was of lower LOE; thus, efforts should be made to strengthen the body of literature, particularly with regard to cost analysis.

In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority.

BACKGROUND: Post-mastectomy breast reconstruction is commonly performed in the United States with numerous options available to patients and providers. This study evaluated patient race and provider in prediction of patient satisfaction following post-mastectomy breast reconstruction.METHODS: The patient satisfaction for women who underwent post mastectomy breast reconstruction at University of California, Irvine Medical Center was evaluated between 2012 and 2014, randomly using Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Patient demographics and surgery related variables including type of reconstruction received were determined.RESULTS: Between 2012 and 2014, ninety breast reconstruction patients completed a HCAHPS satisfaction survey. Average satisfaction score was 9.67/10. Multivariate linear regression analyses revealed that 34% of the variability in satisfaction scores was accounted for by the variables included in our statistical model. Analyses revealed race/ethnicity and provider to be independent predictors of satisfaction (p<0.05). Satisfaction scores ranged from 6-10 and varied by 11.7% across different providers and 8.9% across different races. The following variables were included, but did not influence patient satisfaction: type, timing, or laterality of reconstruction, presence of post-operative complication, body mass index (BMI), age, presence of comorbidity, and insurance type.CONCLUSION: Achieving patient satisfaction is an important outcome of breast reconstruction. This study is one of the first to identify provider and race/ethnicity as predictors of patient satisfaction following breast reconstruction. The information provided here can help inform providers and improve satisfaction for patients undergoing breast reconstruction.

BACKGROUND: The platelet-rich plasma (PRP) and hyaluronic acid (HA) constitute a system of tissue growth that can regenerate damaged tissue. This study was performed to evaluate the effect of PRP and HA in treatment of complications of Achilles tendon reconstruction.METHODS: We selected ten patients affected by Achilles tendon injuries resulting from post-surgical complications subsequent to tenorrhaphy and have treated them with autologous PRP in combination with HA to evaluate the improvement of lesions with wound closure.RESULTS: The treatment with PRP and HA for post-surgical complications of Achilles tendon was effective in healing and regeneration of soft and hard tissues. The healing time was shortened, and the treated area preserved a satisfying strength in plantar flexion and extension of the ankle, denoting to a decisive improvement in texture and a more rapid healing and a good cutaneous elasticity, with a significant reduction of the costs of hospitalization and the pain already the immediate postoperatively. The functional rehabilitation in terms of deambulation and joint mobility was complete.CONCLUSION: The treatment we proposed allowed an easier and more rapid wound closure with excellent aesthetic improvement. Furthermore, the minimally invasive technique is well tolerated by patients.

BACKGROUND: Although the assignment and suturing of the spreader graft to the septum is a routine part of rhinoplasty, it is a time wasting procedure and some problems may occur. Rather, autospreader flap is a new method that the dorsal part of the upper lateral cartilage is used as its own graft. In the present study, we intended to compare the functional and aesthetic outcomes of these two techniques of rhinoplasty.METHODS: In a clinical trial, patients who referred to 15 Khordad Hospital for elective rhinoplasty during 2013-2014 were enrolled. The functional and aesthetic outcomes were compared between the two techniques of spreader graft and autospreader flap using rhinomanometry and satisfaction questionnaire in two stages before and one months after the surgery.RESULTS: Total nasal airway resistance increased significantly by both spreader graft and autospreader flap, but the difference between the two methods was not statistically significant. The total nasal flow before and after the surgery significantly decreased using both techniques, but this reduction was not significant between the two methods of surgery. When questioned about the satisfaction with the surgery outcomes, 18 subjects (36%) had complete aesthetic satisfaction, 25 (50%) were partial satisfied and 7 subjects (14%) were unsatisfied from aesthetic results. The rate of patient’s satisfaction in both groups was higher for functional outcome.Overall, 32 (64%) subjects were completely satisfied, 13 (26%) were partially satisfied and 5 (10%) subjects did not report satisfaction.Loss of respiratory function in both groups was inevitable due to short time post-operative period.CONCLUSION: Both spreader graft and autospreader flap techniques can be used in the preservation and restoration of the normal internal nasal valve angle, as well as restoration of dorsal aesthetic lines of the nasal dorsum.

BACKGROUND: Unlike congenital auricular malformations which are identified by underdevelopment of dermal and cartilaginous tissues, deformed ears are less sever congenital anomalies characterized only by a misshaped pinna structure and can be improved with acceptable cosmetic results and minimal cost through ear molding if treated in early neonatal period. In this study, authors present the first report of using splinting techniques for treatment of deformational auricular anomalies in Iranian children.METHODS: Our case load consisted of a series of 29 patients (Male=16, Female=13) who were referred to Plastic Surgery Unit of Shiraz University of Medical Sciences from September 2011 to December 2014. Children aged more than 6 moths were excluded.Twenty-nine children affected by various deformities including prominent ears (n=11), lop ears (n=8) and constricted ears (n=10) were treated by splintage as a nonsurgical technique. The mean time of treatment was 13.33±2 weeks.RESULTS: Eight (27.6%) patients did not complete the treatment. Splinting resulted in excellent or satisfactory results in 12 (57.14%) of treated cases. No improvement was observed at the end of the molding treatment in 9 patients. No complication was observed during the treatment in any of the patients.CONCLUSION: The nonsurgical molding can be used as an effective approach for achieving natural outcomes and correcting cosmetic abnormalities. Rate of satisfaction is dependent on type of deformity, the neonatal age in which treatment started and also parents’ adherence to treatment methods and principals.Concerning: the low rate of complications and high satisfactory results the method can be used instead of surgery in appropriate cases.

BACKGROUND: Elective aesthetic surgeries are increasing in the Iranian population with reasons linked to body image dissatisfaction and psychological symptoms. This study compared the body image dissatisfaction and psychological symptoms among invasive and minimally invasive aesthetic surgery patients and a control group.METHODS: Data from 90 participants (invasive aesthetic surgery=30 Ss, minimally invasive aesthetic surgery=30 Ss, and control group=30 Ss) were included. Subjects were assessed on body image dissatisfaction and psychological symptoms to provide an evidence for a continuum of body image dissatisfaction, anxiety, depression and interpersonal sensitivity in invasive and minimally invasive aesthetic surgery clients.RESULTS: Between the three groups of invasive, minimally invasive aesthetic surgeries and control on body image dissatisfaction and psychological symptoms (anxiety, depression and interpersonal sensitivity), there was a significant difference.CONCLUSION: These findings have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions at first step.

BACKGROUND: Lesions in perineal area are common. The usual treatment is coverage by skin graft and flaps which may be local, pedicled or free types. In this paper V-Y flaps were used to cover the defects.METHODS: V-Y flaps were used in the gluteal area in 15 patients. Lesions were due to different causes.RESULTS: Of 15 patients, 11 were males and 4 were females. Their ages ranged from 3 weeks to 52 years old. Two cases were due to myelomeningocele, necrotizing fasciitis (2 cases) and the rest were due to bed sores (11 cases). The flaps were located over the trochanter (3 cases), ischial (6 cases) and sacral (6 cases). Good healing and durable coverage were obtained in all cases except one case.CONCLUSION: V-Y flap as a working horse flap is recommended in the gluteal area.

BACKGROUND: Tendon injuries are one of the most common injuries of the hand and challenging problems in trauma surgery. They usually require surgical repair and unlike the single tendon injuries, flexor tendon injuries have higher morbidities when accompanied with nerve injuries. In the present study, I aimed to report the clinical experiences and outcomes about tendon injuries.METHODS: A total of 180 patients (149 males, 31 females) between 17 and 56 years old were operated in the clinic due to tendon injury. Seventy isolated extensor tendon injuries, 60 isolated flexor tendon injuries, 30 multiple flexor tendon and major nerve injuries, 18 combined extensor and flexor tendon injuries, and 2 combined extensor, flexor and major nerve injuries were treated. All patients were admitted to the clinic in acute phase and operated immediately.Physiotherapy was started in the third day of the operation.RESULTS: Patients were followed up between 6 and 18 months (mean 12.4 months). There was not any major complications except one female patient (0.5%) who did not conform to the treatment protocol after flexor tendon injury. Fifteen patients (8.5%) had poor flexor range of motion. The other patients were healed uneventfully.CONCLUSION: Tendon healing may cause some complications from mild to severe degrees. However, atraumatic surgery and a comprehensive postoperative early physiotherapy could decrease these complication rates.

Osteoarthritis (OA) is a prevalent chronic disease impacting on quality of life and has societal and economical burden increasing with age. Yet, no confirmed pharmacological, biological or surgical therapy could prevent the progressive destruction of OA joint. Mesenchymal stem cells (MSCs) with immunosuppressive activities emerged a potential therapy. We describe a magnetic resonance images (MRI) approved 47 years old nomad female suffering from a severe right knee OA. After intra-articular injection of 36×106 passage 2 of bone marrow-derived stem cells (BMSCs), the patient’s functional status of the knee, the number of stairs she could climb, the pain on visual analog scale (VAS) and walking distance improved after two months post-transplantation. MRI revealed an extension of the repaired tissue over subchondral bone. So as MSC transplantation is a simple technique, resulted into pain relief, minimized donor-site morbidity, provided a better quality of life, significantly improved cartilage quality with no need to hospitalization or surgery, cell transplantation can be considered as a reliable alternative treatment for chronic knee OA. Therefore these findings can be added to the literature on using BMSCs for treatment of OA.

According to the National Institutes of Health and the Center for Disease and Prevention, it is estimated that 65 to 80 percent of the human infectious are caused by biofilms. Antibiotics and drainage of purulent discharge are the main treatment measures. But in chronic infections sometimes these findings are not easy to recognize. Biofilm is an extracellular polymeric conglomeration generally composed of extracellular DNA, proteins, and polysaccharides, which help bacteria to survive into the host. The following case is the example of chronic wound in burn patient, where biofilm gets involved and special attention is given to the relationship biofilm–chronic wound injury in a burn patient.

DEAR EDITOR: We describe a 90 year old lady presented with a 2 week history of a nonhealing and bleeding lesion on her right 2nd toe, on a background of one year’s history of chronic infection. The patient had not responded to oral antibiotics and was initially managed with fusidic acid and hydrocortisone acetate cream applied with daily to alternate-day dressings. A history of trauma as the cause of the lesion was given by the patient and her daughter. The nail was thought to be avulsed due to the injury and she was reviewed regularly and one month later a reddish, elevated lesion was noted at the apex where the nail had begun to splay.

DEAR EDITOR: Plastic surgeons are surgical artists and innovators who constantly strive for innovative solutions to the ever challenging management of both congenital and acquired defects and deformities.1-3 Historically reconstructive ladder was described as the standard algorithmic approach to choose the most appropriate solution in this regard.

DEAR EDITOR: The feast of sacrifice is a muslim tradition, celebrated by the muslims all around the world. Every year during the month of pilgrimage to Mecca (Hajj), the feast of sacrifice is celebrated. One specific part of this feast is to sacrifice animals such as sheep and cattle in the first three days of the feast. Most of the sacrifices were performed in the streets by non-professionals without proper security precautions.1 Cutting tools such as knives, cleavers and meat grinders are common tools both for sacrificing animals and processing the animal meat afterwards. As a result of mentioned reasons, plenty of accidental injuries occur during the feast of sacrifice. Hand injuries constitute the majority of these injuries. The aim of this study was to determine the rate of injuries in the first three days of the feast of sacrifice.

DEAR EDITOR; Diwali or deepavali (deep=lamp) also called “the festival of lights”, is an ancient Hindu festival that has been celebrated in the Indian subcontinent from centuries. Its origins have been mentioned in ancient Hindu scriptures like Padma Purana and Skanda Purana.

DEAR EDITOR: The radical surgery for fungating inguinal lymph nodes is commonly done in patients with penile and vulvar cancers, creating complex groin defects. These defects are managed most commonly with either pedicled ipsilateral anterolateral thigh (ATL) flap or tensor fascia lata (TFL) flap. The reconstruction with complex flaps provide durable coverage and prevent scar contractures, which tend to form in the flexural regions such as the groin.