World Journal of Plastic Surgery最新文献

Background: The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques.

Methods: This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022. The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded.

Results: The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings.

Conclusion: Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.

Oral submucous fibrosis (OSF) is a chronic, irreversible disease. The etiology of OSF has been linked to several risk factors, including local factors, systemic factors, and immunological disorders. We report a 22-year-young male patient case of Oral submucous fibrosis, referred to the Maxillofacial Surgery Department of Zahedan University of Medical Sciences, Zahedan, Iran. Treatment for oral submucous fibrosis is based on the disease's clinical involvement and rate of advancement. Even though there are numerous innovative therapeutic techniques for this illness, none of them can cure it. Early diagnosis and treatment can improve the quality of life of a person. Some of the findings of this study are different from reference texts and other studies.

Swellings of the hand are commonly seen in routine clinical practuce. Ninety five percent of them are benign and most common diagnoses include ganglions, epidermoid inclusion cysts, and giant cell tumours of the tendon sheath. It is very uncommon to find true digital aneuryms in the hand. In this clinical vignette I present a case of true digital artery aneurysm, with the tell tale clinical features and the photographs which help to identify such cases in a 22 yr married female from India.

Schwannomas constitute only 5% of tumors of upper limb. Schwannoma of the posterior interosseous nerve is rare. A thorough search of literature revealed only three case reports of this entity. A 33-year old female presented with insidious onset swelling over extensor aspect of right forearm for one year and deficit of extension of fourth and fifth finger for a month. Magnetic Resonance Imaging and Fine Needle Aspiration Cytology were suggestive of low- grade nerve sheath tumor. The tumor was excised under tourniquet control and magnification, using microsurgical technique. Histopathology confirmed schwannoma. Result. Patient regained her full extension of fourth and fifth finger within 1.5 months. As schwannoma does not infiltrate the nerve fibers, so a complete surgical excision is the treatment of choice. We wrote this article to draw clinicians' attention to this unusual entity. Schwannoma of PIN is a relatively rare condition. Till date, there are only three cases reported in literature. Meticulous attention to detail is required while excising large schwannomas, as there is a risk of fascicular injury during dissection. Use of magnification and microsurgical technique prevents inadvertent nerve injury.

Revascularization surgery was first considered for the treatment of ulcers in patients with critical limb ischemia (CLI). However, it may not be indicated for patients with severe infections or peripheral vascular occlusions. Although blood purification therapy is adjuvant therapy for such patients, it is not yet widely used due to insurance coverage. We report a case of a refractory heel ulcer with moderate osteomyelitis and cellulitis that was not amenable to revascularization. Treatment with the adsorptive blood purifier rheocarna® (Kaneka Corporation; Osaka, Japan) resulted in complete epithelialization of the ulcer and control of inflammation. Although this case required careful follow-up, we believe rheocarna might be a promising treatment option for patients with CLI who do not respond to revascularization. Rheocarna could improve peripheral blood flow and control inflammation by improving antibiotic drug delivery.

Background: The management of deformities of the nasal soft triangle (ST) is a difficult and very sensitive discussion in rhinoplasty. So far, the standard method for correcting these deformities has yet to be introduced. We aimed to introduce a new technique using modified fine graft (MMG) for correcting nasal ST triangle deformity and evaluate the effects of using this method.

Methods: This prospective study was conducted on 20 rhinoplasty candidates who underwent surgery at 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran between August 2021 to the February 2022 with the new technique of using an MMG to correct nasal ST triangle deformities. Follow-up was performed immediately after surgery, 3 and 6 months after surgery. Post-operative findings included ST deformity correction, graft exposure, graft visibility, recurrence rate, and the need for revision were evaluated by photography for all patients.

Results: The mean age of patients was 33.65± 11.047 years, 85% of the cases were female and 90% of surgeries were primal rhinoplasties. The ST triangle deformity was not corrected in 2 cases (10%). Both patients were women with primary rhinoplasty, and cartilage was removed from the septum in both. Graft exposure, recurrence, and visibility were not reported in any cases.

Conclusion: MFG was highly effective in correcting the deformity of the nasal ST triangle and did not cause serious complications in patients. This method is a suitable method with high efficiency for correcting nasal ST triangle deformity.

Background: The purpose of the present study was to evaluate the changes in maxillofacial fracture epidemiology and etiology regarding Covid-19-related social distancing restrictions in an Iranian population.

Methods: A retrospective cross-sectional study was undertaken in six major trauma center hospitals in Iran in a period of two years (March 2018 until March 2020). The primary outcome variable was the maxillofacial fractures incidence. Patients' demographic data, date of injury as well as fracture characteristics, fracture etiology, type, and site were all recorded, compared, and analyzed in the control and experimental groups.

Results: The patients consisted of 520 (83.6%) males and 102 (16.4%) females. Patients sustaining maxillofacial fractures over this two-year period displayed a mean age of 31.24±14.44, with an age range of 2 to 88 years. The incidence of maxillofacial fractures significantly decreased in all age groups (p<0.001). After social distancing restrictions were placed; there was a significant drop in the number of subjects attending due to motorcycle collisions and road traffic accidents, whereas the number of fractures caused by assaults and domestic violence significantly increased (p<0.001 for each).

Conclusion: The investigators realized that social distancing restrictions were able to change the trends and patterns in maxillofacial fracture incidence and etiology.

Background: Tonsillectomy-related bleeding is one of the most prevalent and potentially fatal complications of this common surgical procedure. We aimed to assess the effect of tranexamic acid (TXA) local injection on bleeding during and after tonsillectomy.

Methods: This double-blind, randomized placebo-controlled trial included 20 candidates for tonsillectomy referred to Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The subjects were randomized into two groups. Ten patients received TXA on their left side and the other ten on their right side 10 min before surgery. Placebo was administered to the contralateral side. The primary outcome was the volume of blood loss during tonsillectomy and up to 24 hours post-tonsillectomy. The secondary outcomes were surgeon satisfaction (rated 0-10), hemodynamic complications (patients' heart rate (HR) and mean arterial pressure (MAP) were recorded every 10 min), and rebleeding. The duration of surgery was also noted.

Results: The mean age of the patients was 21.35 ± 3.16 years, of whom 8 (30%) were male and 12 (60%) were female. there was no significant difference between groups in terms of HR and MAP at any time point. The median of surgery duration did not differ significantly between the two groups; however, the surgeon satisfaction with the procedure was significantly higher with TXA compared to placebo. None of the patients developed hemodynamic complications, and rebleeding did not occur in any of the subjects.

Conclusions: TXA local injection was not superior to placebo in terms of bleeding control during and after tonsillectomy, hemodynamic complications, rebleeding, and surgery duration.

Background: Treating burn scar contractures remains challenging for reconstructive surgeons; no clear guidelines declare the optimal and most effective technique. We evaluated the efficacy of local flaps in treating patients with post-burn contractures.

Methods: This retrospective study included 243 patients with post-burn contractures referred to Taleghani Hospital (Khuzestan, southwest Iran) for local flap reconstruction from 2011 to 2020. Patients' demographic data, detailed descriptions of scars, surgical procedures, and flap outcomes were assessed. A plastic surgeon conducted all surgical procedures, the goals of which were to release the scar and cover the defect. Joint range of motion (ROM) (according to goniometric measurements), complications, need for second-stage surgery, and patient satisfaction were assessed.

Results: After scar release, 70.4% of joints were covered with a Z-plasty and similar local flaps, 26.1% with a Z-plasty plus skin grafts, and 3.5% with only skin grafts. The outcome after one year revealed a significant improvement in mean ROM (by 45.80% of the normal ROM; P< 0.001). The mean functional and aesthetic satisfaction scores were 9.45 and 7.61 out of 10, respectively. The complication rate was 10.82%: re-contracture occurred in 3.82%, flap tip necrosis in 1.27%, and partial flap necrosis in 0.31%.

Conclusion: Simple local flaps such as the Z-plasty are safe and effective in covering the joint following post-burn contracture release. Due to the feasibility, minimal need for facilities, steep learning curve, acceptable functional and aesthetic outcomes, and low complication rate, we strongly recommend the Z-plasty for reconstructing burn contractures, particularly in LMICs.