World Journal of Plastic Surgery最新文献

Background: The aim of this study was to compare the dento-skeletal stability between one and three-screw fixation of mandible following bilateral sagittal split osteotomy (BSSO) in skeletal class 3 patients.

Methods: Healthy patients with skeletal class 3 malocclusion in Mashhad, Iran, from August 2020 to May 2021 were undergone mandibular setback through bilateral sagittal split osteotomy. Rigid fixation was performed in one group with one-screw technique, and three-screw fixation was done in another group. Cephalogram x-rays were prepared and analyzed in three stages: before surgery (T0), one week after the surgery (T1), and six months postoperatively (T2). The linear and angular alterations of chosen multivariate skeletal and dental variables were evaluated and statistically compared in all three periods.

Results: This study included a total of 20 patients, 12 of them were female (60%). Patients in the one-screw fixation group had a mean age of 20.6 ± 2.2 years old, whereas those in the three-screw fixation group were 21.5 ± 2.8 years old, with no statistically significant difference. Both groups had excellent mandibular stability six months following surgery. No statistically significant differences were observed in the postoperative skeletal and dental changes between the two techniques.

Conclusion: Fixation of the mandible following the setback surgery by the BSSO technique with the one-screw fixation method may be accomplished effectively, and the therapeutic outcomes are comparable to those obtained with the traditional 3-screw fixation approach.

Background: Repairing of a wide cleft palate faces with several problems, e.g. medialization of palatal flaps, lack of tissue for repair, and fistula formation. We aimed at quantitative and qualitative evaluation of medial osteotomy of the greater palatine foramen for patients with wide cleft palate and its postoperative outcomes.

Methods: Eight patients 4 males, 4 females with wide cleft palate and the median age of 1.5 year were operated using medial osteotomy of the greater palatine foramen from 2018-2020. In this technique, the osteotomy was carried in the outlet of vascular pedicle medially and posteriorly. This led to more degrees of freedom for the vascular pedicle and a palatoplasty without tension through mucoperiosteal flap movement toward the medial direction.

Results: After osteotomy and repairing for 8 patients (16 flaps), the mean (SD) length of mucoperiosteal flap pedicle was significantly increased from 2.78 mm to 6.09 mm (P<0.001). All patients were successfully repaired with no major complications, and none of them required any secondary repair. Three weeks postoperatively, all patients showed normal feeding, normal nasal resonance of speech with normal palatal mobility.

Conclusion: Osteotomy of the greater palatine foramen for the closure of wide palatal clefts showed a good efficiency, quantitatively and qualitatively. The mean length of mucoperiosteal pedicle increased by 3.22 mm (6.44 mm for bilateral) after repairing, which helps to more freely medial movement of the palatal flap and lesser tension across its closure. All patients were successfully improved without any major complications.

Background: Body Dysmorphic Disorder (BDD) is a psychic disorder in which a person is dissatisfied with their normal appearance. Identifying these people among the applicants for cosmetic surgery leads to the proper decision about the cosmetic procedure of these patients and their postoperative consequences.

Methods: This cross-sectional study was performed on 250 women referred to a private Plastic Surgery Clinic in Mashhad, Iran from 2016 to 2017. Applicants were divided into two groups as abdominoplasty and other cosmetic surgeries. BDD was assessed using the modified form of the Bill Brown Questionnaire. Applicants' information including age, marital status, number of children, education level, and history of cosmetic surgeries were recorded.

Results: The mean BDD score in the abdominoplasty group and another group was 93.6 ± 23.5 and 75.5 ± 25.8, respectively. There was a significant difference between the two groups in terms of the BDD score (P-value < 0.001). Although there was a notable relation between BDD score and marital status, no significant association between BDD score, age, and education level was found.

Conclusion: Considering the exact criteria of BDD, we noticed a significant increase in the frequency of BDD in abdominoplasty applicants. It was erroneous and could be explained by not applying the accurate diagnostic criteria of BDD.

Background: Rhinoplasty is one of the most common plastic surgeries and a challenging procedure for people with thick nasal skin. There are several techniques to improve the outcome of the operation.

Methods: Our study is a double-blind randomized controlled trial conducted in Esfahan, Iran in 2020. Seventy participants were equally divided into two groups (35 people). In the control group, only rhinoplasty was performed without SMASectomy and in the intervention group, rhinoplasty was performed with SMASectomy. The results were obtained and the satisfaction of patients and physicians was collected through patient examination and a questionnaire. Statistical analysis of data was calculated by SPSS software version 23 at a significance level of less than 0.05.

Results: The mean total skin thickness before surgery in the two groups was equally, which showed a significant difference between the two groups at after 12 months (P <0.05). Comparison of 3, 6 and 12 months after rhinoplasty in the two groups showed that the percentage of patient, doctor, hairdresser and nurse satisfaction, in 12 months after rhinoplasty, in the intervention group compared to the control group had a significant increase (P <0.05). Furthermore, in the control group 2.85% and in the intervention group 5.71% bleeding was observed. No other complications were observed in any of the groups.

Conclusion: Overall, SMASectomy, which is performed simultaneously with rhinoplasty, is considered as an important technique in rhinoplasty. As we observed in our study, the complications of these surgeries in patients were very small.

Background: Bilateral Sagittal Split Osteotomy (BSSO) is one of the treatment options for Class III maxillary deficiency which may affect the condylar position and the patient's occlusion. We aimed to evaluate the clinical and radiographic changes of temporomandibular joint (TMJ) following mandibular set back surgery by BSSO.

Methods: In this retrospective study, All Class III patients, aged between 18-30 years old who underwent bimaxillary orthognathic surgery in the Oral and Maxillofacial Surgery Ward of Ghaem Hospital, Mashhad, Iran from January 2018- January 2020 were enrolled. Radiographic changes of joint space, condylar position and clinical changes for maximal mouth opening and joint sound were examined before and 6 months after surgery. Data were analyzed by SPSS16 software and the significance level of the data was set at P-value < 0.05.

Results: Twenty-five patients were recruited. The axial angle of the left and right condyle and condylar inclination on both sides reduced but this reduction was not statistically significant. While the anterior joint space was reduced and posterior joint space was increased in both sides, the changes on the right side were only significant (P = 0.039). In clinical examinations maximum mouth opening, lateral and protrusive movements were also decreased but this reduction was not statistically significant.

Conclusion: The mandibular set back with BSSO surgery in class III skeletal patients had no significant effect on the position of the condyle in the glenoid fossa as well as clinical symptoms.

Background: Preventing perineural adhesions and scars formation in the traumatic peripheral injuries is very important on the recovery process. We aimed to evaluate the effect of using the amniotic membrane wrapping on the results of surgical treatment of damaged peripheral nerves.

Methods: This cohort study included 30 patients with symptoms of acute peripheral nerve injuries due to penetrating trauma in the forearm or wrist in January 2019 to November 2020 referred to the Hand and Microsurgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In 15 patients, after nerve repair, amniotic membrane coverage was used around the nerve, all patients were followed for 12 months. Ultrasound study for neuroma formation and nerve regeneration was determined based on EMG and NCV findings. The modified Medical Research Councile classification (MRCC) was used to evaluate of motor and sensory recovery.

Results: In the amniotic membrane wrapping group, all patients had nerve regeneration and functional nerve recovery occurred after 12 months. In the control group, 5 patients (33.4%) did not have nerve recovery and had functional and sensory impairment. In terms of functional capabilities; there was a significant difference in pinch strength, grip power and MRCC scoring between the two groups. Moreover, the mean volume of neuroma in these patients who used amniotic membrane covering was 2.7 mm³ and in the control group, it was 3.9 mm³ (P=0.001). Five patients who did not have a damaged nerve, the neuroma volume was 4.8 ± 0.9 mm³.

Conclusion: The use of amniotic membrane covering is effective methods in the improve results of peripheral nerve repair and nerve function recovery.

Background: Burn is one of the most significant injuries in industrial and developing societies and is one of the most important traumas leading to hospitalization. The aim of this study was to identify the epidemiology, geographical distribution, and outcome of electric burns in Fars province and to present the distribution map.

Methods: In this descriptive-analytical study, the study population involved all electrical burn victims admitted to Amir al-Momenin and Ghotbeddin Hospitals from 2008 to 2019 in Fars province in the south of Iran. Data were analyzed using SPSS software version 22.

Results: Among a total of 246 patients, the average age was 30.78 ± 11.07. The highest frequency among educational levels was among under-diploma patients (38.6%), and the majority were employed (87.4%). Also, most of the patients were from urban areas (70.3%). The majority of burn incidences occurred at the workplace (57.7%). Also, among the high voltage patients, 25 patients (30.9%) had an amputation, while among low voltage only 12 patients (16.2%) had an amputation. Non-surgical treatment was applied in 68 (28%) cases, while Escharotomy was performed in 28 (11.4%) patients. There was also a statistically significant association between burn voltage and amputation (P= 0.039).

Conclusion: Based on our report, the rate of electrical burn injuries in Iran is still high, which underlines the need for stronger efforts in effective prevention, such as better public education and the establishment of strict regulations regarding the distribution and use of electricity.

Background: The prevalence of osteoarthritis (OA) of the first carpometacarpal (CMC) joint and subsequent thumb disability is rising. Abductor pollicis longus tendon interposition arthroplasty (APLTIA) has gained popularity as a procedure to alleviate pain and restore thumb function.

Methods: A systematic review was performed to assess the current reported outcomes of APLTIA. Inclusion criteria involved clinical studies with case-series as the minimal accepted level of evidence. Our primary outcome focussed on PROMs data, whilst secondary outcomes focussed on objective measures of function and complications. Papers investigating pathologies other than CMC OA or procedures other than APLTIA were excluded.

Results: Twelve studies were included (485 thumbs), all of which were observational in study design. APLTIA appears to be associated with a reduction in pain and functional improvement. APLTIA was not found to complicate further surgery.

Conclusion: APLTIA may be associated with improvement in short-term pain relief and functional status. Further research is required to evaluate the benefits, duration of relief and long-term outcomes of APLTIA.

Background: We aimed to investigate the effect of preoperative administration of oral tizanidine on postoperative pain intensity after bimaxillary orthognathic surgery.

Methods: All healthy skeletal class III patients who were candidates for bimaxillary orthognathic surgery were enrolled in this triple-blind randomized clinical trial. The study was carried out in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from January 2021 to November 2021. The consecutive patients were randomly divided into tizanidine and placebo groups. One hour prior to anesthesia induction, the tizanidine group received 4 mg Tizanidine dissolved in 10 ml apple juice, whereas the placebo group received an identical glass of plain apple juice. All operations were performed by the same surgical team, under the same general anesthesia protocol. Postoperative pain was measured using the Visual Analogue Scale (VAS) at 3, 6, 12, 18, and 24 hours. For statistical analysis; the significance level was set at 0.05 using SPSS 23.

Results: A total of 60 consecutive patients, consisting of 36 females (60%) and 24 males (40%) with an average age of 25.4 ± 6.0 were recruited. An increasing trend was noticed in the amount of perceived postoperative pain from the 3^rd till 12^th hour, and then decreased afterward. Nevertheless, the average amount of pain was significantly lower in the tizanidine compared to the placebo group, in all the evaluated time intervals (P<0.001). Moreover, there was a significantly higher requirement for postoperative opioid analgesics in the placebo compared to the tizanidine group (P=0.011).

Conclusion: The addition of oral tizanidine was effective in reducing postoperative pain following bimaxillary orthognathic surgery. Further studies are necessary for more relevancy.

Background: Surgical reconstruction is the gold standard of treatment for Peyronie's disease (PD). Grafting procedures provide satisfactory outcomes in patients with complex curvature, short penile length, and without previous erectile dysfunction (ED). We aimed to compare two different grafting methods of reconstruction in patients with PD.

Method: Fifty-two PD patients at Imam-Reza hospital of Mashhad from October 2011 to January 2019 with stable plaque, penile angulation of >60˚, complex curvature, and without ED who consented to cooperate, included in our study and divided into two groups. The first group consists of 26 patients, undergone grafting through a double-Y incision and a single saphenous graft placed within the incision. For the second group, two smaller saphenous vein grafts were placed in the two parallel incisions. ED assessed pre- and post-operational via the International index of erectile function. Penile angulation less than 20 degrees was considered a favorable outcome. Patients followed for 18 months, and sacculation, penile shortening, post-operation infection, and penile hypoesthesia were assessed as complications. We used a paired t-test to compare these two groups.

Results: ED was 25% and 12% in the first and the second group, respectively. Statistics showed no difference between the two groups regarding pre and post-operational ED (P=0.1). Regarding complications during follow-up, sacculation occurred in four patients of the first group and none of the second group patients but no significant difference (P=0.23).

Conclusion: We found no superiority to declare between these two procedures, although regarding the small sample size of our study, further evaluations are needed to establish more reliable results.