World Journal of Plastic Surgery最新文献

Osteochondroma, the most common benign tumor in the axial and appendicular skeleton, presents a unique challenge when encountered in the craniofacial region. We report a rare case of a 35-year-old female with a massive osteochondroma located on the mandibular coronoid process, resulting in a 20-year history of progressive mouth opening limitation, facial asymmetry, and zygomatic deformity. Comprehensive diagnostic procedures, including panoramic radiography and computed tomography (CT) imaging, were employed to accurately assess the extent of the lesion. This case highlights the importance of CT scans and three-dimensional reconstructions in confirming the diagnosis, particularly when panoramic radiographs exhibit limitations. The patient underwent a successful extraoral approach for coronoidectomy and excision of the osteochondroma, addressing both the functional and cosmetic aspects of the condition. Postoperative evaluations revealed significant improvement in mouth opening capacity, with no signs of recurrence during a 12-month follow-up period.

The rise of standardized self-assessment tools and AI-driven preoperative evaluations lacks full acknowledgment of their limitations. A male patient with gynecomastia developed a hematoma post-liposuction and subcutaneous mastectomy, revealing undisclosed von Willebrand Disease. Thorough in-person anamnesis surpasses self-administered questionnaires by capturing implicit cues and deeper patient insights.

Background: We aimed to determine the effect of Zataria multiflora Nanoemulsion gel on surgical wound healing.

Methods: This experimental study was conducted in the years 2021-2022 at the Animal Research Center of Mazandaran University of Medical Sciences, northern Iran. Forty two male Westar rats were randomly divided into six groups (n=7). After a surgical incision of full thickness with a 3 cm diameter, they were treated for 21 days with diltiazem 2% (positive control), placebo, and Z. multiflora emulsions and nanoemulsions at 2% and 4%, respectively. Macroscopic parameters of wound area and contraction, as well as pathological factors such as granulation, angiogenesis, epithelialization, collagen organization, bacterial colony, inflammation, creatine and epidermal thickness, hair follicles, and lymphatic ducts, were examined.

Results: The mean wound size and contraction of the placebo group differed significantly from the other groups on all days, and on some days, the results indicated more favorable effects of nanoemulsions than Diltiazem. Based on the microscopic findings, the average scores on the seventh day were nearly different (P= 0.051); however, all groups scored higher than the placebo group. On the 21^st day, the best results were related to the 4% Nanoemulsion (242.5), 2% Nanoemulsion (159.4), and 4% emulsion (159.3), followed by diltiazem (154.60), 2% emulsion (146.5), and placebo (70.7).

Conclusion: Z. multiflora emulsions and nanoemulsions at 2% and 4% could be effective in healing surgical wounds, and the use of 4% Nanoemulsion yields the best results. This is recommended for use in clinical trial studies.

Background: The Altemeier procedure for rectal prolapse offers excellent results in all age groups with minimal complications and allows for short hospital stays and recovery periods. We aimed to evaluate the results of transperineal surgery for rectal prolapse.

Methods: In this case series study, 74 patients underwent perineal rectal prolapse surgery using Altemeier method and coloanal anastomosis at Ayottollah Taleghani Hospital, Tehran from 2013 to 2023 were enrolled.

Results: Overall, 48 patients were female (64.8%) and the mean age was 52 years (range 18 to 80). Common symptoms were constipation (62.1%), fecal incontinence (76.95%), rectal bleeding (41.85%), and difficult defecation (9.45%). The Jorge and Wexner incontinence score before and after the operation was 13.5 and 5.5, respectively, and no statistically significant difference was observed (P=0.41). No mortality was reported after surgery.

Conclusion: The long-term recurrence rate after Altemier's procedure was low. This method has a reasonable recurrence rate compared to other techniques, and is a good option for younger patients without underlying disease. Further multicenter studies with larger sample sizes are needed to evaluate the outcomes of transperineal surgery for rectal prolapse.

Background: We aimed to compare the effect of 0.75% ropivacaine and 2% lidocaine with 1:100,000 epinephrine on intraoperative bleeding and postoperative pain following mandibular third molar surgery.

Methods: In this split-mouth clinical trial, 60 patients required bilateral impacted third molar of the mandible were prepared for operation in the Department of Maxillofacial Surgery of Mashhad Dental Faculty, Mashhad, Iran. Surgery was performed randomly on one side using ropivacaine and on the other side with lidocaine with epinephrine. The intraoperative bleeding, the postoperative pain (at 3, 6, 12, 18, and 24 hours after the operation), and the difficulty of the surgery were measured in each group and compared.

Results: In all postoperative time intervals, the pain was lower in the ropivacaine group than in the lidocaine group. The rate of intraoperative bleeding in the ropivacaine group was lower than in the lidocaine group. In the lidocaine group, pain initially increased and reached its maximum value after three hours, but decreased after the sixth hour and reached its minimum value 24 hours after surgery. In the ropivacaine group, the pain increased initially and was at its peak at 3 and 6 hours, after which it decreased and reached its lowest value at 24 hours.

Conclusion: Postoperative pain was less in the 0.75% ropivacaine group than in the 2% lidocaine with 1:100,000 epinephrine group during all postoperative periods. Also, the amount of bleeding during the operation was less in the ropivacaine group.

Background: Policy makers, researchers and health care professionals are faced daily with the challenge of how to prioritize their activities and actions in different areas of their responsibilities. In the field of health, their decisions are often influenced by the reality of population needs on the one hand and limited resources on the other. The correctness of decisions is completely dependent on the quality and accuracy of information from the target population. Patient registries, have for decades been an important source of data needed to evaluate clinical practice, evaluate health service delivery, and assess policy implications at the local, regional, national, and international levels.

Method: Based on the research objectives, fourteen registration forms consisting of 790 variables were designed. The data of cleft lip and palate patients who underwent surgery in Hazrat Fatemeh Hospital during the year 2022, in Tehran, Iran, were collected and entered into the registration system, and then the amount of recorded data was assessed based on the research objectives.

Results: Only 28% of the data of cleft lip and palate patients were recorded in the clinical files during their hospital stay, and 72% of the required data are not recorded. However, the accuracy of the recorded data and their validity has not been evaluated.

Conclusion: In order to obtain the necessary data for the designed objectives, the data recorded in the hospital are not sufficient and accurate, and a registry is needed to record accurately the data of cleft lip and palate patients.

Necrotising fasciitis (NF) is a rare, severe, rapidly progressive, and life-threatening synergistic infection that primarily affects the superficial fascia. Although unusual in head and neck surgeries, necrotizing fasciitis may have drastic consequences. Dental problems, burns, trauma, and peritonsillar abscesses often cause the condition. We describe a rare case of extensive facial necrotising fasciitis secondary to carbimazole-induced agranulocytosis. A protective tracheostomy, prophylactic thyroidectomy, serial surgical debridement, and broad-spectrum antibiotics therapy were initiated. Our team referred the patient for subsequent soft tissue reconstruction. Reconstruction was challenging as it involved a full-thickness cheek defect extending to the oral commissure, lower lip, and anterior neck. In a single-stage procedure, we utilised a transverse upper gracilis free flap to reconstruct full-thickness tissue loss, provide tissue bulk, and seal the dead space. Reconstructing various parts of the face and lips while ensuring aesthetic and functional results can be difficult..

Background: We investigated the therapeutic outcomes of trapezius muscle transfer in individuals diagnosed with brachial plexus damage.

Methods: We examined patients diagnosed with brachial plexus palsy referred to 15 Khordad Hospital in Tehran, Iran during 2018-20. The patients considered for inclusion in the study were those who were eligible for trapezius muscle transfer surgery, either on the affected side or the unaffected side. The evaluation focused on various aspects, including shoulder range of motion, muscle strength, shoulder pain, age and gender distribution, as well as satisfaction and function levels of the shoulder.

Results: The suitability of shoulder motions, shoulder abduction, and muscular strength in patients who underwent ipsilateral side trapezius muscle transfer surgery was greater compared to those who underwent contralateral side trapezius transfer. In the investigation of postoperative shoulder function among patients who underwent trapezius muscle transfer surgery on the ipsilateral side, it was shown that 3 patients (25%) exhibited favorable function, while 6 patients (50%) demonstrated acceptable function, and 3 patients (25%) displayed excellent function. Out of the total sample size of 9 patients who underwent surgery for trapezius muscle transfer on the contralateral side, 6 patients (66.7%) exhibited favorable function, while 3 patients (33.3%) demonstrated acceptable function.

Conclusion: Employing the contralateral trapezius muscle as a substitute when utilizing the ipsilateral trapezius muscle is not feasible is a viable alternative with favorable function.

Background: Mucormycosis is a fungal infection with diverse clinical manifestations, the most common of which, i.e., the classical form of rhino-orbital cerebral mucormycosis (ROCM), has had a significant prevalence among patients recovered from COVID-19. We aimed to investigate the findings of ROCM imaging recorded at Imam Khomeini Hospital in Ahvaz, Iran, in 2022.

Methods: This retrospective study reviewed the files of patients definitively diagnosed with mucormycosis and COVID-19. Imaging procedures performed on patients included non-contrast CT scans (CT imaging protocol: from vertex to mandible without contrast for evaluating sinus contents, bone erosion, osteomyelitis, pre-sinus or orbital invasion). Key imaging findings were assessed and documented, and findings were evaluated.

Results: The mean age of subjects was 53.11 ± 14 years, with the majority being male (55.3%). All subjects had nasal and sinus involvement, but their brains were unaffected. Approximately 36% of subjects had ocular involvement. In imaging findings, left pterygopalatine involvement had the highest prevalence (27.7%), while left extraocular muscle involvement had the lowest prevalence (4.3%). Patients with lamina papyracea and extraocular muscle involvement all had ocular involvement, which was statistically significant. Additionally, those with hard palate erosion had significantly higher ocular involvement rates (5 out of 6 cases with hard palate erosion).

Conclusion: Rhino-orbital cerebral mucormycosis is associated with nasal and sinus involvement, and diabetes and male gender are predisposing factors to this disease. CT, as a complement to other clinical evaluations, dramatically aids in diagnosing and identifying the extent and complications of the disease.

We aimed to review the clinical approach to diagnos and surgical management of traumatic extraocular rectus muscle disruptions, a rare but significant cause of strabismus and diplopia in the adult trauma patients. This review examined the anatomy of the four rectus muscles, mechanisms of injury, clinical presentation, imaging evaluation, classification of injury types, management strategies, outcomes, and future directions in treatment. Extraocular rectus muscle disruptions occur through blunt trauma (typically causing muscle entrapment in the orbital fractures) or penetrating trauma (causing laceration or avulsion). Clinical features include diplopia, restricted eye movement, and in some cases, visible muscle prolapse. Imaging evaluation includes computed tomographyas first-line approach, with magnetic resonance imaging providing superior soft tissue detail, and anterior segment optical coherence tomography offering valuable information for surgical planning. Management focuses on early intervention, with surgical repair ideally performed within 24-48 hours for entrapped muscles and within days for lacerations or avulsions. Outcomes vary based on injury severity and timing of treatment, with better prognosis associated with early intervention. While traumatic extraocular rectus muscle disruptions present complex challenges, prompt diagnosis and surgical management often yield favorable results. Future advances in treatment might involve advanced imaging techniques, engineered tissue for muscle reconstruction, refined surgical approaches, and improved interdisciplinary trauma care protocols.