World Journal of Plastic Surgery最新文献

Background: Bilateral sagittal split osteotomy (BSSO) is the most common procedure in orthognathic Surgey of mandible also in asymmetries. However, the methods of fixation are different. Few studies worked on asymmetric cases especially with the use of finite element analysis (FEA). We aimed to evaluate stress distribution of two different Fixation techniques in mandibular setback surgery in asymmetric cases using FEA.

Methods: A 3-dimensional model of asymmetric mandible was obtained. SSRO with modified osteotomy was simulated unilaterally and another side osteotomized as common. Then differential set back was done and rigid fixation of that modified side with miniplate and monocortical screws was simulated then rigid fixation of other side by different fixation technics include 2 or 3 bicortical screws. With the force of 132N and 300N on the occlusal surface of first molars, the Von Mises Stress (VMS) distribution was calculated.

Results: Stress distribution in threads of screws in use of three bicortical screws was higher than two bicortical screws (161%). VMS distribution in spongy bone of left ramus in use of three bicortical screws was higher than the use of two bicortical screws (78% difference). VMS distribution in cortical bone of mandible body in use of three bicortical screws was significantly higher than the use of two bicortical screws (1.3% difference) (P<0.5).

Conclusion: The use of modified osteotomy and fixation with rigid fixation of two bicortical screws can create a more predictable and uniform stress distribution in mandibular setback surgery in asymmetric cases.

Background: Adjuvant-induced autoimmune syndrome (ASIA), described in 2011, includes autoimmune reactions triggered by environmental adjuvants, such as silicone breast implants (SBI). Symptoms include fatigue, sleep disturbances, appetite changes, muscle pain, fever, among others, with pathophysiology involving a combination of genetic predisposition and adjuvant exposure, leading to abnormal immune responses. We aimed to define clinical profiles and outcomes of patients with SBI, clarify ASIA's clinical implications, and guide future research.

Methods: Using the PRISMA-ScR framework, a scoping review was conducted to identify clinical profiles, preexisting conditions, prosthetic anomalies, and outcomes of patients with ASIA syndrome associated with SBI. Searches were performed in Medline, Scopus, Lilacs, and Google Scholar to locate relevant studies.

Results: Of 35 selected studies, 21 were case reports, 6 case series, and 8 cohort studies, identifying 848 patients, predominantly from the Netherlands (n=513), with an average age of 45-47 yr. Common medical histories included autoimmune diseases and breast cancer, while frequent implant-related anomalies were capsular contracture and rupture. Musculoskeletal symptoms and fatigue were the most prevalent, and implant explantation was the primary treatment, resulting in symptom improvement for most patients.

Conclusion: This review highlights the clinical features of ASIA syndrome in patients with SBI, particularly musculoskeletal symptoms, fatigue, and the presence of positive antinuclear antibody as a potential marker. However, the relationship between SBI and ASIA remains controversial. Despite limitations in current evidence, ongoing clinical monitoring and further research are crucial to better understanding and managing ASIA syndrome in patients with SBI.

Background: Cleft lip in infants is associated with severe morphological and functional disorders. Cleft lip is particularly important, which can lead to psychological changes in the patient if the treatment result is not satisfactory. Different surgical methods have been developed in the past decades. We aimed to investigating cleft lip techniques and surgical outcome in patients.

Methods: In this cross-sectional analytical study, 32 patients undergoing cleft lip surgery referred to Abuzar Children's Hospital in Ahvaz, southern Iran between 2022 and 2023 were enrolled. According to the surgeon's opinion, the patients underwent cleft lip surgery using the Sommerlad technique. (n=18 or Millard technique (n=14). Surgical Ooutcomes were compared between the two groups.

Results: The mean age was 33.58±59.14 months. 65.6% of patients were boys (n=21). The need for rhinoplasty in the Sommerlad and Millard groups was 100% and 84.6%, respectively, and no significant difference was observed between the two groups (P=0.17). The cupids bow was estimated to be good in 28.6% and 38.9% of patients in the Millard and Sommerlad groups, respectively, while this difference between the two groups was not significant (P=0.51). There was no significant difference between the two groups in the vermilion border (P=0.31). No significant difference was observed between the two groups in terms of white roll match, lip length and Scar appearance (P>0.05).

Conclusion: No significant difference was observed in the results of lip surgery between the Sommerlad and Millard techniques. Further multicenter studies with larger sample sizes are recommended to validate these results.

Background: At the forearm level, Martin-Gruber anastomosis is described as the most common anatomic variation. Early recognition of this anastomosis in patients with peripheral nerve lesions and preserved function of the hand musculature lowers the rate of misdiagnosis and prevents unnecessary treatment approaches. We aimed to determine the prevalence and characteristics of Martin-Gruber anastomosis in a Mexican cohort and discuss its impact on clinical diagnostics and approach.

Methods: We conducted a cross-sectional dissection study on 40 inert anatomical models at the National Forensic Sciences Institute in Mexico City. Each model was dissected to trace and measure Martin-Gruber anastomoses from the median nerve to the ulnar nerve. Measurements were recorded using a digital Vernier caliper, and the presence of anastomosis, its length, nerve of origin, and side were analyzed. Chi-square tests evaluated the association between the presence of anastomoses and sex, and nerve origin and arm side.

Results: Martin-Gruber anastomosis was found in 47.5% of the specimens, with bilateral anastomoses in 11 and unilateral in eight. The majority of anastomoses (62.5%) originated from the left arm. There was no significant association between the presence of anastomosis and sex (P=0.093) or between the nerve origin and arm side (P=0.809).

Conclusion: The high prevalence of Martin-Gruber anastomosis in this study highlights its clinical importance, particularly in preventing misdiagnoses of ulnar nerve injuries and unnecessary surgical interventions. Anatomical variations like Martin-Gruber anastomosis should be considered in clinical assessments of peripheral nerve injuries to enhance diagnostic accuracy and treatment outcomes.

Background: Vitiligo, a pigmentary skin disorder, poses therapeutic challenges due to its progressive nature and varied treatment responses. We aimed to investigate the efficacy of a novel approach, combining microneedling with topical 5-Fluorouracil (5-FU), compared with microneedling with Fluocinolone and microneedling alone for treating vitiligo lesions.

Methods: A single-blinded clinical trial was conducted from Aug 2022 to Feb 2023 at Ahvaz University of Medical Sciences, Ahvaz, Iran. Twenty patients with persistent vitiligo lesions were randomly assigned to three treatment groups. Microneedling was performed using Dermapen cartridge 36 once a week for 12 wk. In patch A, 5% 5-FU cream was applied immediately after microneedling; in patch B, patients used fluocinolone 0.025% cream twice daily; and in patch C, microneedling was performed alone. Clinical repigmentation was evaluated using the G-score scale, and treatment side effects were recorded.

Results: Microneedling combined with 5-FU demonstrated significantly higher repigmentation rates, with 70% of lesions showing moderate to excellent responses (P<0.001). In contrast, microneedling with Fluocinolone and microneedling alone exhibited lower response frequencies. Side effects were minimal, with only one patient experiencing burning and itching in the microneedling and 5-FU group. No corticosteroid-related complications were observed. Six months follow-up revealed sustained repigmentation in the microneedling and 5-FU group, contrasting with no response or recurrence in microneedling alone-treated lesions.

Conclusion: Microneedling combined with topical 5-FU presents a promising therapeutic strategy for vitiligo lesions, yielding superior repigmentation outcomes compared to other treatments.

Background: Nipple sparing mastectomy has become a preferred method in breast cancer patients but safety of this procedure in large ptotic breasts needs to be documented to broaden its application. We aimed to assess complication rates of patients undergoing NSM and immediate implant-based reconstruction with skin reduction to determine the safety of reduction in this patient group.

Methods: Patient with breast cancer and ptotic breasts whom received nipple sparing mastectomy and immediate implant-based breast reconstructions were analyzed, operated between April 2020 to last month of 2023 in Shiraz, Iran. Post-operative complications were recorded and analyzed.

Results: The mean age and BMI of patients were 40.76 ± 5.0 and 23.72 ± 3.27 year, respectively. The median post-operative24 months (min 14, max 34). None of patients had disease recurrence. The most common complication was the flap full thickness necrosis, occurring in a total of 7 (20%) breasts. The incidence of full thickness necrosis was just seen in patients with ptosis grade III, and the most common site for the necrosis was the suture line [4/7 (12%)]. The other 3 patients had full thickness partial necrosis of NAC. We did not have any complete NAC necrosis.

Conclusion: Nipple sparing mastectomy and immediate implant insertion in ptotic breasts, is a valuable method of reconstruction with acceptable rate of complications.

Background: Although many previous studies verified the role of BTX-A in the augmentation of flap survival and decreasing the rate of necrosis in random pattern cutaneous flaps, drug injection at different times has not been investigated in this regard. This study compares the effect of BTX- A injection time at 0, 3, and 7 days before surgery to determine the best and most effective injection time.

Methods: In 20 male rats, divided into four equal groups, on different days of pre-operation (0, 3, or 7 days) BTX-A or saline was administered to the whole length of the flap. Random pattern dorsal skin flaps with 4:1 length-to-width ratios were elevated and returned to the original position. Flap survival was evaluated on day 10 and 20 after surgery and a histopathological examination were performed 20 days after flap elevation.

Results: The BTX-A group had a greater survival mean compared with the saline group (87.92±16.30 vs 65.60±30.71 or 1.34 fold increase in survival rate) in flaps with a length-to-width ratio of 4:1 (P = 0.05), and If botulinum toxin is injected 7 days before flap elevation, this increase in survival will be 1.5 times (97.5±4.06 vs 65.60±30.71) compared to the saline group (P = 0.02).

Conclusion: Preoperative injection of botulinum toxin type A in random pattern skin flaps increases skin flap survival in rats, and the best time for injections is 7 days before flap elevation. We found a reduction in the proliferation of cutaneous myofibroblasts in flaps by injecting BTX-A. It could play a role in increasing blood flow and survival by reducing wound contraction, however, more studies should be conducted to determine the possible mechanism.

Background: Bell's palsy is an acute, asymmetrical paralysis of facial muscles resulting from peripheral facial nerve dysfunction without a discernible origin. Combination therapy, which leverages the benefits of both antivirals and steroids, may be an effective treatment for Bell's palsy. We aimed to evaluate the effectiveness of steroids antiviral treatments for facial paralysis.

Methods: A systematic search was conducted using the Scopus, PubMed, and Web of Science databases. The search terms used were: (Bell's palsy OR facial palsy) AND (steroids OR corticosteroids) AND antiviral. All selected articles were published between 1990 and Jan 2023. Comprehensive Meta-Analysis (CMA) version 3 was used for statistical analysis and graph construction.

Results: After a full-text evaluation, 14 studies were included. The comparison of patient outcomes between the two treatment groups indicated that combination therapy was more effective than single therapy. Famciclovir, valacyclovir, and acyclovir, respectively, showed the most significant synergistic effect with corticosteroids. According to Egger's test, no significant bias was found in the comparison of the two treatment groups.

Conclusion: Combination therapy (corticosteroid and antiviral) is significantly more effective than single corticosteroid therapy. Among the antiviral agents, famciclovir, valacyclovir, and acyclovir demonstrated the highest efficacy in combination with corticosteroids.

Background: Graphene oxide (GO) and reduced graphene oxide (rGO) are graphene-based nanomaterials (GBNs) gained a lot of interest in biomedical tissue engineering due to their large specific surface area, unique structure, excellent photo-thermal effect, pH response, and broad-spectrum antibacterial properties. We aimed to modify the properties of graphene oxide/polycaprolactone (GO/ PCL) scaffold by laser irradiation.

Methods: The scaffold was fabricated by electrospinning method and then laser irradiation was applied to improve the scaffold's properties. The solution containing of PCL and graphene oxide was combined in an optimized ratio and then transferred to an electrospinning syringe. The temperature distribution affected by laser energy on a scaffold was predicted by heat equation. The Crank-Nicholson numerical method in two dimensions was used in this regard. The morphological properties were evaluated by SEM, XRD, and IDFIX. MTT assay was applied for biocompatibility evaluation.

Results: The 808 nm wavelength and 800 mW power was ideal laser irradiation. SEM results showed the appropriateness of fibres. MTT results showed a significantly higher cell viability in PCL/rGO group compared to PCL/GO and PCL scaffolds (p≤0.001).

Conclusion: The conversion of GO into rGO led to the better morphology and the reduction of cytotoxicity that gave the scaffold superior properties. Hence, it is justifiable to construct a composite scaffold, enhanced with rGO, to improve its conductivity, mechanical properties, and biocompatibility in the context of tissue engineering.

The chondrocutaneous sandwich of the external ear has a delicate and complicated design, making partial ear reconstruction a challenging task for plastic surgeons. In this study, 12 patients who had surgery utilizing the conchal rotational flap and grafting approach were monitored for 1 year after surgery. The upper third of ear deformities have been repaired using a cartilaginous composite flap. Following the procedure, a year later, there were no signs of a seroma, infection, hematoma, deformity, or flap ischemia. All patients had pleasing cosmetic outcomes. The findings of this study suggest that full-thickness upper third auricular abnormalities be repaired utilizing this combination method.