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.

The purpose of this update is to discuss, in summary fashion, topics presented at selected orthopaedic meetings and published in related orthopaedic journals during 2004. The sources for this review are articles published in The Journal of bone and joint surgery (American edition) and the journal of arthroplasty. The podium presentations mentioned in this article those given at the American academy of orthopaedic surgeons (held in san Francisco, California, on march 10 through 14, 2004), on combined specialty day at the meeting of the knee society (held in san Francisco, California, on march 13, 2004), at the interim meeting of the knee society (held in Jackson, Wyoming, on September 9 through 11, 2004), and at the annual meeting of the American association of hip and knee surgeons (held in dallas, texas, on November 5 through 7, 2004).

Background: Orthopaedic surgeons rely on visual and tactile cues to guide performance in the operating room (OR). However, there is very little data on how sound changes during orthopaedic procedures and how surgeons incorporate audio feedback to guide performance. This study attempts to define meaningful changes in sound during vital aspects of total hip arthroplasty (THA) within the spectrum of human hearing. Methods: 84 audio recordings were obtained during primary elective THA procedures during sawing of the femoral neck, reaming of the acetabulum, acetabular cup impaction, polyethylene liner impaction, femoral broaching, planning of the femoral calcar and press-fit of a porous-coated stem in 14 patients. We graphed changes in frequency intensity across the human spectrum of hearing and sampled frequencies showing differences over time for statistically meaningful changes. Results: Sawing of the femoral neck, polyethylene impaction, and stem insertion showed significant temporal increases in overall sound intensity. Calcar planing showed a significant decrease in sound intensity. Moreover, spectrographic analysis showed that, for each of the critical tasks in THA, there were characteristic frequencies that showed maximal changes in loudness. These changes were above the 1 dB change in intensity required for detection by the human ear. Conclusion: Our results clearly demonstrate reproducible sound changes during total hip arthroplasty that are detectable by the human ear. Surgeons can incorporate sound as a valuable source of feedback while performing total hip arthroplasty to guide optimal performance in the OR. These findings can be extrapolated to other orthopaedic procedures that produce characteristic changes in sound. Moreover, it emphasizes the importance of limiting ambient noise in the OR that might make sound changes hard to distinguish.

Background and Aim: The tendency to be beautiful is one of the inner desires of human beings, for this purpose, cosmetic surgery is performed in addition to repairing the appearance defects, with the aim of maintaining the mental-psychological balance of the person. But the main challenge is that the pregnant lady (both the real mother and the contract mother) by insisting on the right to reign over her organs, due to the injuries caused by various accidents during pregnancy, intends to undergo cosmetic surgery in combination and at the same time. Do therapy along with surgery. This issue is incompatible with examining the statement that any positive or negative behavior of the mother affects the health of the fetus, thereby preventing the right of the fetus to health. The purpose of the discussion is to state which one is preferable in the conflict between the right to beauty of the pregnant mother and the right to the well-being of the fetus. Methods: The current research is evaluated with the descriptive-analytical method and the use of library studies, the solution to the clash of rights. Ethical Considerations: The current research has been compiled in compliance with the principles of ethics, trustworthiness, honesty and originality of the texts. Results: In solving the conflict between the rights of the mother and the fetus, taking into account the heavy weight of the right of the fetus, preferring the least harm to the most harm, taking the important and leaving the important and expedient rulings, the right to the well-being of the fetus is a priority. Relying on medical data, cosmetic procedures requiring the use of injectable anesthetics due to negative effects on the fetus, sclerotherapy due to passing through the placenta, fillers and waxing are not allowed due to the lack of evidence of their safety in pregnant patients. The use of local anesthetics and peels is relatively safe compared to the above; however, caution should be taken during pregnancy. Conclusion: The answer to the health of the fetus compared to the distorted symmetry habit of pregnant women, therefore, Reconstructive-cosmetic surgery during pregnancy is a priority for them. Please cite this article as: Amerian SH, Salarzaee AH, Heidari Z. Legitimacy of Reconstructive-Cosmetic Surgeries in Pregnant Women. Medical Law Journal. 2023; 17(58): e16.

Objective: Pelvic organ prolapse is a common disorder in women over the world and its general treatment is surgery. Therefore it is important to consider if vaginal symptoms, quality of life and sexual function after surgery improve. The purpose of this study was to assess vaginal symptoms in women 3 months after surgery for pelvic organ prolapse.Materials and methods: In this study 50 eligible women were evaluated between March 2007 and May 2008. These women underwent physical examination for prolapse staging and medical status and completed the ICIQ-VS questionnaire pre- and post operation 3 months later).Results: Mean age was 44.86 (31-74) years and %72 were premenopausal. Vaginal symptoms, sexual function and quality of life scores improved in order (8.88 Vs 18.04, 17.16 Vs 34.48, 2.76 Vs 4.8, all P<0.05).Conclusion: Vaginal symptoms, sexual function and quality of life after surgery improved. It appears that in Iranian patients, the performance of reconstruction surgery alone results in satisfaction.

Background: Microtia is a congenital abnormality with low incidence but considerable morbidities. Reconstruction of the microtia deformity is a complex and difficult process that requires a proper planning. The primary technique of reconstruction employs patient’s own rib cartilage. Irradiated homograft cartilages previously have been used in facial reconstruction but its application in microtia surgery has not been reported yet. This study is designed to compare the results of autograft versus homograft auriculoplasty.Methods: Between 1992 – 2002, 23 patients underwent auricular Reconstructive surgery by the senior author in our department. Autograft implantation was performed in one stage but homograft auriculoplasty was done in two stages.Results: Auricular deformity was right-sided in 13, left-sided in 8, and bilateral in 2 cases. Implanted graft was autograft in 9 patients and homograft in 14 patients. During mean follow-up of 4 years, cartilage graft resorption was detected in two cases, one in autograft and one in homograft group (P>0.05). No postoperative infection was observed. Status of postauricular sulcus was optimal in 85.7% of homograft and 77.8% of autograft groups (P>0.05). The satisfaction score of the patients and/or parents was excellent in 66.7% of autograft and 92.9% of homograft groups (P<0.01).Conclusion: Based on better satisfaction score, equivalent aesthetic appearance, and absence of complications such as scaring and pain on the chest wall, homograft auriculoplasty is an appropriate option for Reconstructive surgery in patients with microtia.

Introduction: Little is known about the incidence of temporary kidney dysfunction following major vascular surgeries. We aimed to assess the frequency of temporary decreased kidney function following aortic surgeries. Materials and Methods: In a retrospective study, we assessed 108 hospital records of the patients who had undergone elective open abdominal surgery of aortic aneurysm. Preoperative and postoperative (days 1, 2, and 3) data on estimated glomerular filtration rate (GFR) were collected and evaluated in relation to the patients’ clinical characteristics and outcomes. A decline greater than 10% in GFR on day 1 or 2, and then, an increase of GFR to a level of maximum 10% below the baseline value on the third postoperative day was considered as temporary worsening of kidney function. Postoperative alterations of GFR not greater than 10% in relation to the baseline were considered as improved or unchanged kidney function. Two patients with persistent decrease in GFR were excluded. Results: Temporary worsening of kidney function was seen in 25 patients (23.6%). Short-term mortality rate was 44.0% in this group of patients, while it was 17.3% in those without decreased GFR (P=.006). According to the regression analysis, the only predictor of mortality was temporary worsening of kidney function, with a hazard ratio of 4.03 (95% confidence interval, 1.44 to 11.31; P=.008). Conclusions: Nearly 1 out of 4 aortic surgeries results in kidney dysfunction. Albeit temporary in most cases, it seems to be associated with a higher short-term mortality rate.