World Journal of Plastic Surgery最新文献

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: Implantology is a widely accepted treatment, as it restores aesthetics and function, and is the preferred option for replacing missing teeth. In mandibular implant surgery, the Inferior Alveolar Nerve Block (IANB) is the most common anesthetic technique, as it eliminates sensation on one side of the jaw, floor of the mouth, teeth, tongue, and gums. However, its high failure rate is due to the technical difficulty of the injection procedure. Additionally, deep anesthesia from IANB carries risks such as damage to the mandibular canal. In contrast, infiltration anesthesia desensitizes the inferior alveolar nerve locally, allowing patients to perceive pain and alert the dentist if the implant approaches the nerve. We aimed to compare the effects of IANB and local infiltration anesthesia for posterior mandibular implant surgery.

Methods: This prospective, randomized, double-blind clinical trial followed a split-mouth design, involving 29 patients undergoing bilateral implant surgery in the posterior mandible within a single session. On one side, IANB anesthesia was used, and on the other, infiltration was administered. Pain was assessed using the Visual Analog Scale (VAS).

Results: All 58 implants were analyzed. The VAS scores during surgery were significantly higher for the infiltration technique (P = 0.03). However, no significant difference in pain was observed 24 hours post-surgery (P = 0.223).

Conclusion: Both IANB and infiltration anesthesia are effective for mandibular implant surgery, but IANB offers more reliable pain control, making it preferable for complex cases, while infiltration is suitable for less invasive procedures.

Background: Contralateral breast symmetry procedure is often required to achieve symmetry following unilateral breast reconstruction. No consensus exists regarding timing of contralateral symmetry procedure. We investigated frequency and safety of simultaneous contralateral breast symmetry procedure in unilateral free flap breast reconstruction using a large nationwide database.

Methods: Using the American College of Surgeons National Surgery Quality Improvement Project database, we examined clinical data of patients who underwent immediate or delayed unilateral free flap breast reconstruction from 2016 to 2020 in the United States. Patients were divided in two groups: with or without simultaneous contralateral reduction mammoplasty or mastopexy.

Results: Overall, 5.429 patients underwent unilateral free flap-based breast reconstruction. Simultaneous symmetrization was reported in only 8% of these patients. There was no significant difference in overall complication rate (without: 15.9% vs. with: 15.2%), unplanned return to the operating room rate (without: 10.9% vs. with: 8.3%), mean length of hospital stay (without: 3.8 vs. with: 3.5 day) and unplanned re-admission rate (without: 5.5% vs. with: 4.1%) between two groups. Additionally, multivariate regression analyses showed simultaneous symmetrization was not associated with higher complication rate, higher unplanned return to the operating room rate, higher readmission rate, nor longer length of hospital stay after adjusting for patient's characteristics, comorbidities and immediate versus delayed breast reconstruction.

Conclusion: Simultaneous symmetrization was performed infrequently with unilateral free flap breast reconstruction. Our study showed simultaneous symmetrization is safe and associated with a comparable perioperative outcome. Consideration in appropriate patients will likely reduce the number of revisions for those undergoing unilateral free flap breast reconstruction.

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.

Backgrounds: Dental implants are often utilized to replace missing teeth in the maxillary posterior region. Following tooth extraction, bone grafting, and implant placement are carried out in stages. However, in medical procedures errors are inevitable; therefore, measures should be taken to address and reduce these errors in future treatments.

Methods: Implants displaced inside the maxillary sinus were reviewed to identify the best techniques for retrieving them. We conducted a comprehensive search in Scopus, PubMed, and Web of Science databases from January 2000 to January 2023. Inclusion criteria were original studies including original cohorts, case-controls, and clinical trials that evaluated methods of retrieving displaced maxillary implants.

Results: Overall, 258 publications were identified. After elimination of duplicates and those not meeting the inclusion criteria, full texts of 24 articles were reviewed. Of the 120 displaced implants, 57 were dislocated during surgery. The most common complication following implant displacement is maxillary sinusitis, which typically manifests a year post-op.

Conclusion: Displacement of implants in the maxillary sinus is a common occurrence caused by a variety of factors. Implant displacement could lead to complications in the maxillary sinuses, paranasal sinuses, and other adjacent anatomical spaces and structures.