World Journal of Plastic Surgery最新文献

Hemifacial spasm (HFS) is an important condition for plastic surgeons to understand, as it significantly affects patients' quality of life and can complicate aesthetic and reconstructive procedures. Magnetic resonance imaging (MRI) has become vital in diagnosing HFS, assessing neurovascular relationships, and planning treatment. Transverse MRI scans often show an upward displacement of the inferior pons at the facial nerve attachment point, signaling neurovascular compression (NVC) in HFS. Important anatomical features for neurosurgeons include cerebellar atrophy and a "small posterior fossa," which can lead to HFS by narrowing fluid spaces. The posterior fossa is often more congested in HFS patients, and anatomical flatness may exacerbate lateral deviation of the vertebrobasilar arteries. Additionally, evaluating sigmoid sinus dominance and other anatomical variations is crucial for surgical planning, particularly in cases of arterial hypertension that may affect medullary compression.

In this article, we describe the 'Artesian Perforator Concept', based on the idea that in clinical practice, there are multiple plexuses between perforasomes in addition to the supra-fascial direct and indirect linking vessels that are present within deeper soft tissue, which form part of a deeper vascular reservoir, the equivalent of a vascular 'aquifer'. We then demonstrate the use of this concept clinically for a 45-year-old male patient with median sternotomy wound dehiscence who was reconstructed using the Internal Mammary Artery Perforator and Lateral Thoracic Artery Perforator flaps.

Hypopharyngeal carcinoma is one of the most aggressive primary head and neck cancers, often managed through partial or total laryngopharyngectomy. Reconstruction after such surgeries remains a challenging procedure that often requires the use of free flaps. A 63-year-old male patient with in-situ squamous cell carcinoma of the left vocal cord treated with total pharyngolaryngectomy and primary reconstruction with a left radial forearm free flap, complicated by flap necrosis, which ended up in dismantling and gastrostomy. He was referred to the Plastic and Reconstructive Surgery Department at Centro Medico Nacional 20 de Noviembre, Mexico in 2023 to assess the reconstructive options for the hypopharynx and cervical esophagus defect. A tubular right radial forearm free flap was designed forming the anterior wall of the hypopharynx and cervical esophagus and a posterior wall for the external defect. Twelve months after his surgery, he continues tolerating oral intake without signs of stenosis or tumor recurrence. The objective in this case was based on restoring the continuity of the digestive tract and swallowing function, as well as providing skin coverage of the defects, and preventing serious complications. The radial forearm free flap has versatility in the tubular construction and a low leak rate, as well as an adequate skin island size. Conclusion: The pharyngoesophageal reconstruction with a tubed forearm free flap has favorable outcomes for restoring the gastrointestinal tract without further complications.

Background: Rhinoplasty has become a globally prevalent esthetic procedure, necessitating precise facial analysis and comprehensive preoperative planning for favorable postoperative outcomes. We aimed to assess patient satisfaction levels concerning nasal appearance following rhinoplasty.

Methods: A case series interventional study was conducted involving 52 subjects referred to Rhinoplasty Clinics of Taleghani Hospital, Tehran, Iran from Mar 2021 to Mar 2022. Patients' satisfaction levels were evaluated using a concise checklist before and three months after surgery.

Results: The mean age of the patients was 29.23 ± 7.26 years, with 19 (36.5%) being male. Statistically significant improvements were observed in all assessed factors, including nasal obstruction, nasal size, hump presence, nasal bridge width, nasal tip bulbosity, nasal deviation, radix, nostril asymmetry, and tip ptosis (P < 0.001). These findings reveal a consistent pattern of patients' satisfaction levels predominantly shifting from moderate to low across various aspects of nasal appearance post-rhinoplasty.

Conclusion: The study demonstrated a significant enhancement in patients' satisfaction with their nasal appearance following rhinoplasty, indicated by statistically significant changes across all assessed factors. However, certain aspects exhibit more limited enhancement.

The surgery-first approach (SFA) is gaining popularity in orthognathic surgery because it makes treatment duration shorter and more satisfying for patients. However, its effectiveness in complex cases isn't fully understood. Here, we describe a rare case where SFA was used to fix problems caused by missing posterior teeth and a deep bite, which made traditional pre-surgery orthodontic treatment impractical. A 34-year-old woman had facial asymmetry, bite issues, and trouble chewing due to a misaligned jaw. X-rays showed the problem, confirming that orthognathic surgery was needed. Planning for the surgery involved moving the upper jaw forward and the lower jaw backward, using specific bone-cutting techniques. The surgery, done with the patient under general anesthesia, went well. Orthodontic brackets were added during surgery which was aided by an orthodontist to make follow-up orthodontic treatment easier. The patient recovered uneventfully and saw improvements in how her face looked, how her teeth fit together, and how well she could chew. Later, more orthodontic work fine-tuned her bite, making sure the changes lasted and kept her satisfied. This case shows how combining orthodontics with the surgery-first method can be successful in orthognathic surgery. It brings benefits like shorter treatment times and immediate improvements in appearance. Our results match other recent studies that also found good outcomes with the surgery-first approach and quicker recovery times. While more research is needed, our case adds to the evidence that SFA can lead to successful orthognathic surgery results.

Background: Brachial plexus injury (BPI), as one of the most devastating injuries in adults, has various negative consequences such as profound functional impairment, debilitating pain, significant mental health consequences, and economic impacts. We aimed to review the evaluation and diagnostic-treatment Approaches of BPI in adults through a review study.

Methods: An electronic literature search was completed in Google Scholar, Springer, PubMed, and Science Direct databases from 1980 to 2023. Various keywords related to the purpose such as Brachial plexus, surgical strategy, adult were used.

Results: 1.2% of people with multiple traumas had BPIs. BPI is more common in young adult males. For brachial plexus palsy, preoperative evaluation of nerve root avulsion is helpful in surgical planning. . EMG is useful in confirming a diagnosis, localizing the lesion level, estimating the extent of axon loss, and determining whether the lesion is complete. There are different options available for BPI, such as coordinating care, rehabilitation and psychosocial support. In recent times, significant advancements have been made in surgical techniques for nerve repairs.

Conclusion: Although it is often not possible to prevent damage to the brachial plexus, it is possible to reduce the risk of further problems after the injury by taking some measures.

Background: In Sub-Saharan Africa, which already faces challenges due to a lack of surgeons and facilities, the COVID-19 pandemic could significantly disrupt surgical activities and training programs. "2^nd Chance", a non-governmental organization providing training program to enhance local reconstructive surgery capacity in this region since 2015, could play a crucial role in addressing these issues. We aimed to investigate the impact of the COVID-19 on the activity of sub-Saharan African reconstructive surgeons collaborating with "2^nd Chance" organization and evaluate its effect on the organization's training programs.

Methods: In the course of 2022, an online cross-sectional survey was conducted among reconstructive surgeons working in sub-Saharan African countries and collaborating with "2^nd Chance". The survey consisted of 57 questions covering demographics, impacts of COVID-19 on personal life, clinical and training activities.

Results: Of 469 surgeons eligible for the study, 240 were included and 51 responded. The impact of COVID-19 was felt personally in terms of health and stress. Clinical activities were severely affected, with some reporting higher mortality due to surgical cancellations and delays. Regarding training, there was a shift from practical to theoretical learning, though overall impact was moderate. One-third of participants were able to attend "2^nd Chance" workshops. Among the 17 planned workshops, 9 were successfully conducted, and 4 of them exclusively featured African trainers.

Conclusion: The COVID-19 pandemic had substantial consequences on reconstructive surgery in sub-Saharan Africa, impacting more clinical practices than training programs. Collaboration between African and European trainers proved essential during the pandemic. In future pandemics, South-South collaborations should be prioritized.

Background: Hand injury as an important concern for the surgeon and the patient requires proper and timely treatment to prevent complications such as infection and adhesions, and with a proper rehabilitation program, the patient returns to maximum function as soon as possible. We aimed to investigate the short-term and long-term treatment results of deep flexor tendon repair in in zone II.

Methods: This retrospective study was performed on 34 patients with 45 injured fingers in the zone II referred to Ahvaz Imam Khomeini Hospital, Ahvaz, Iran during 2017-2019. The results of deep flexor tendons repair in two groups, immediate and delayed primary repair were assessed.

Results: The mean age of the patients was 27.76 years. There was no significant remarkable between male and female in the incidence of complications such as infection, tendon rupture and adhesions. 29.4% (n=10) had poor outcome, 8.8% (n=3) had fair outcome, 29.4% (n=10) had good outcome and 32.4% (n=11) had excellent outcomes. 26.5% had adhesion and infection rate was 11.8%.

Conclusion: Among surgeons, there is consensus for the primary repair of tendon injury, but there was no significant difference between the results of immediate and delayed primary repair. Although physiotherapy has been suggested as an effective factor in improving hand function, its positive effect on the range of motion of the fingers has not been proven.

Background: We aimed to assess the satisfaction level of patients with the outcome of genioplasty and the influential parameters in this respect.

Methods: This retrospective study was conducted on 70 patients between 18 to 59 years, who underwent genioplasty in the Oral and Maxillofacial Surgery Department at Shariati and Sina Hospitals, Tehran, Iran, between 2010 and 2020. Patient records were evaluated and a questionnaire was filled out over the phone to assess the influential parameters on the satisfaction level of patients with the outcome of genioplasty. Data were analyzed by PASS 11 (alpha=0.1).

Results: Seventy patients were evaluated including 56 (80%) females and 14 (20%) males. Forty patients (52.6%) had no complaint with regard to the outcome of genioplasty. Postoperative chin deviation (not correcting the initial complaint) (10.52%), postoperative pain in the chin area (10.52%), and lower lip paresthesia (9.21%) were the most common patient complaints. The minimum and maximum satisfaction scores were 22 and 80, respectively. Number of follow-up sessions had a significant effect on satisfaction with the outcome of genioplasty (P=0.076). Patients who underwent advancement genioplasty alone had the highest level of long-term satisfaction with the outcome while those who underwent setback genioplasty alone had the lowest level of long-term satisfaction.

Conclusion: Advancement genioplasty had the highest rate of patient satisfaction, and chin asymmetry in the frontal view was the most common patient complaint after genioplasty.

Background: The nasal obstruction symptom evaluation (NOSE) scale is a valid and specific questionnaire for evaluating nasal obstruction. The present study aimed to assess the validity of the Persian version of the NOSE questionnaire.

Methods: The present study is a cross-sectional study conducted from December 2018 to April 2019. In the study group, eligible individuals referred to one clinic and Firoozgar Hospital, Tehran, Iran (a tertiary referral center) were asked to complete the questionnaire once on the first visit and once 3 months after the surgery. In the control group, healthy adults (above 18 years old) were selected among staff, students, residents, or relatives of the project executors. The NOSE questionnaire has 5 questions and a quality chart. The results were compared with the short form of the 12-item GHQ-12 questionnaire that had previously been translated and validated. SPSS 20 software was used to calculate Cronbach's alpha and intra-class correlation coefficient and to examine the convergent and discriminative validities.

Results: The results obtained are consistent with the results of the primary research when developing the questionnaire and the results of studies conducted with different versions of the questionnaire in different languages and cultures. Analysis of research data showed that the Persian version of the NOSE questionnaire has acceptable internal consistency, repeatability, convergent validity, and discriminant validity.

Conclusion: The Persian version of the NOSE questionnaire has good validity and reliability.