1 2228-7914 248 Special Memorial of Professor Jamal Gousheh (1930-2016): Biography of A Man with Effective Role in the Development of the Field of Plastic Surgery in Iran Manafi Ali b Ghorbani Sara c Gousheh Sohrab d Manafi Amir e b Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran c Sheikh Bahaei medical center, Tehran, Iran d Sheikh Bahaei medical center, Tehran, Iran e Shahid Beheshti University of Medical Sciences Tehran, Iran 1 4 2016 5 2 93 96 30 05 2016 30 05 2016
230 General Plastic Surgery and Acellular Dermal Matrix: Highlighting Trends from 1999 to 2013 Daar David f Gandy Jessica g Clark Emily h Mowlds Donald i Paydar Keyianoosh j Wirth Garrett k f University of California Irvine Department of Plastic Surgery g University of California Irvine Department of Plastic Surgery h University of California Irvine Department of Plastic Surgery i University of California Irvine Department of Plastic Surgery j University of California Irvine Department of Plastic Surgery k University of California Irvine Department of Plastic Surgery 1 4 2016 5 2 97 108 13 02 2016 25 04 2016 The last decade has ushered in a rapidly expanding global discussion regarding acellular dermal matrix (ADM) applications, economic analyses, technical considerations, benefits, and risks, with recent emphasis on ADM use in breast surgery. This study aims to evaluate global trends in ADM research using bibliometric analysis. The top nine Plastic Surgery journals were determined by impact factor (IF). Each issue of the nine journals between 1999 and 2013 was accessed to compile a database of articles discussing ADM. Publications were further classified by IF, authors’ geographic location, study design, and level of evidence (LOE, I-V). Productivity index and productivity share were calculated for each region. In total, 256 ADM articles were accessed. The annual global publication volume increased significantly by 4.2 (0.87) articles per year (p<0.001), with a mean productivity index of 36.3 (59.0). The mean impact factor of the nine journals increased significantly from 0.61 (0.11) to 2.47 (0.99) from 1993 to 2013 (p<0.001). Despite this increase in the global ADM literature, the majority of research was of weaker LOE (level I: 2.29% and level II: 9.17%). USA contributed the most research (87%), followed by Asia (4.76%) and Western Europe (4.71%). USA contributed the greatest volume of research. Regarding clinical application of ADM, the majority of publications focused on ADM use in breast surgery, specifically breast reconstruction (154 articles, 60.2%). The majority of research was of lower LOE; thus, efforts should be made to strengthen the body of literature, particularly with regard to cost analysis. 214 Special The Role of Plastic Surgeons in Advancing Development Global Broer Peter Niclas l Jenny Hillary E m Ng-Kamstra Joshua S n Juran Sabrina o l Bogenhausen Teaching Hospital Technical University Munich, Germany m Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA n Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA o United Nations Population Fund, Technical Division, Population and Development Branch, New York, NY 1 4 2016 5 2 109 113 16 01 2016 23 04 2016 In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority.  191 General Patient Race and Provider Predict Patient Satisfaction Following Post-Mastectomy Breast Reconstruction Shaterian Ashkaun p Gandy Jessica Lalezari Shadi Smith Sarah Keyianoosh Paydar p University of California Irvine 1 4 2016 5 2 114 123 09 10 2015 30 01 2016 BACKGROUND Post-mastectomy breast reconstruction is commonly performed in the United States with numerous options available to patients and providers. This study evaluated patient race and provider in prediction of patient satisfaction following post-mastectomy breast reconstruction. METHODS The patient satisfaction for women who underwent post mastectomy breast reconstruction at University of California, Irvine Medical Center was evaluated between 2012 and 2014,  randomly using Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Patient demographics and surgery related variables including type of reconstruction received were determined. RESULTS Between 2012 and 2014, ninety breast reconstruction patients completed a HCAHPS satisfaction survey.  Average satisfaction score was 9.67/10. Multivariate linear regression analyses revealed that 34% of the variability in satisfaction scores was accounted for by the variables included in our statistical model.  Analyses revealed race/ethnicity and provider to be independent predictors of satisfaction (p<0.05). Satisfaction scores ranged from 6-10 and varied by 11.7% across different providers and 8.9% across different races.  The following variables were included, but did not influence patient satisfaction: type, timing, or laterality of reconstruction, presence of post-operative complication, body mass index (BMI), age, presence of comorbidity, and insurance type. CONCLUSION Achieving patient satisfaction is an important outcome of breast reconstruction.  This study is one of the first to identify provider and race/ethnicity as predictors of patient satisfaction following breast reconstruction. The information provided here can help inform providers and improve satisfaction for patients undergoing breast reconstruction. 167 General Use of Platelet Rich Plasma and Hyaluronic Acid in the Treatment of Complications of Achilles Tendon Reconstruction Gentile Pietro De Angelis Barbara Agovino Annarita Orlandi Fabrizio Migner Alessandra Di Pasquali Camilla Cervelli Valerio 1 4 2016 5 2 124 132 28 05 2015 24 04 2016 BACKGROUND The platelet-rich plasma (PRP) and hyaluronic acid (HA) constitute a system of tissue growth that can regenerate damaged tissue. This study was performed to evaluate the effect of PRP and HA in treatment of complications of Achilles tendon reconstruction. METHODS We selected ten patients affected by Achilles tendon injuries resulting from post-surgical complications subsequent to tenorrhaphy and have treated them with autologous PRP in combination with HA to evaluate the improvement of lesions with wound closure. RESULTS The treatment with PRP and HA for post-surgical complications of Achilles tendon was effective in healing and regeneration of soft and hard tissues. The healing time was shortened, and the treated area preserved a satisfying strength in plantar flexion and extension of the ankle, denoting to a decisive improvement in texture and a more rapid healing and a good cutaneous elasticity, with a significant reduction of the costs of hospitalization and the pain already the immediate postoperatively. The functional rehabilitation in terms of deambulation and joint mobility was complete. CONCLUSION The treatment we proposed allowed an easier and more rapid wound closure with excellent aesthetic improvement. Furthermore, the minimally invasive technique is well tolerated by patients. 231 Special Comparison of Aesthetic and Functional Outcomes of Spreader Graft and Autospreader Flap in Rhinoplasty Hassanpour Seyed Esmail Heidari Ataollah Moosavizadeh Seyed Mehdi Tarahomi Mohammad Reza Goljanian Ali Tavakoli Sanaz 1 4 2016 5 2 133 138 13 02 2016 13 02 2016 BACKGROUND Although the assignment and suturing of the spreader graft to the septum is a routine part of rhinoplasty, it is a time wasting procedure and some problems may occur. Rather, autospreader flap is a new method that the dorsal part of the upper lateral cartilage is used as its own graft. In the present study, we intended to compare the functional and aesthetic outcomes of these two techniques of rhinoplasty. METHODS In a clinical trial, patients who referred to 15 Khordad Hospital for elective rhinoplasty during 2013-2014 were enrolled. The functional and aesthetic outcomes were compared between the two techniques of spreader and autospreader graft using rhinomanometry and satisfaction questionnaire in two stages before and one months after the surgery. RESULTS Total nasal airway resistance increased significantly by both spreader and autospreader, but the difference between the two methods was not statistically significant. The total nasal flow before and after the surgery significantly decreased using both techniques, but this reduction was not significant between the two methods of surgery. When questioned about the satisfaction with the surgery outcomes, 18 subjects (36%) had complete aesthetic satisfaction, 25 (50%) were partial satisfied and 7 subjects (14%) were unsatisfied from aesthetic results.  The rate of patient’s satisfaction in both groups was higher for functional outcome. Overall, 32 (64%) subjects were completely satisfied, 13 (26%) were partially satisfied and 5 (10%) subjects did not report satisfaction. Loss of respiratory function in both groups was inevitable due to short time post-operative period. CONCLUSION Both spreader graft and autospreader graft techniques can be used in the preservation and restoration of the normal internal nasal valve angle, as well as restoration of dorsal aesthetic lines of the nasal dorsum.  129 Special The Body Image Dissatisfaction and Psychological Symptoms among Invasive and Minimally Invasive Aesthetic Surgery Patients Yazdandoost Rokhsareh Hayatbini Niki Asgharnejad Farid Ali Asghar Gharaee Banafsheh Latifi Noor Ahmad Member of Scientific Board Member of Scientific Board Member of Scientific Board Member of Scientific Board 1 4 2016 5 2 148 153 22 11 2014 30 01 2016 BACKGROUND Elective aesthetic surgeries are increasing in the Iranian population with reasons linked to body image dissatisfaction and psychological symptoms. This study compared the body image dissatisfaction and psychological symptoms among invasive and minimally invasive aesthetic surgery patients and a control group. METHODS Data from 90 participants (invasive aesthetic surgery=30 Ss, minimally invasive aesthetic surgery=30 Ss, and control group=30 Ss) were included. Subjects were assessed on body image dissatisfaction and psychological symptoms to provide an evidence for a continuum of body image dissatisfaction, anxiety, depression and interpersonal sensitivity in invasive and minimally invasive aesthetic surgery clients. RESULTS Between the three groups of invasive, minimally invasive aesthetic surgeries and control on body image dissatisfaction and psychological symptoms (anxiety, depression and interpersonal sensitivity), there was a significant difference. CONCLUSION These findings have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions at first step. 190 General Versatility of V-Y Flap in Gluteal Area el-sabbagh ahmed mansoura university 1 4 2016 5 2 154 159 02 10 2015 13 12 2015 BACKGROUND Lesions in perineal area are common. The usual treatment is coverage by skin graft and flaps which may be local, pedicled or free types. In this paper V-Y flaps were used to cover the defects. METHODS V-Y flaps were used in the gluteal area in 15 patients. Lesions were due to different causes. RESULTS Of 15 patients, 11 were males and 4 were females. Their ages ranged from 3 weeks to 52 years old. Two cases were due to myelomeningocele, necrotizing fasciitis (2 cases) and the rest were due to bed sores (11 cases).  The flaps were located over the trochanter (3 cases), ischial (6 cases) and sacral (6 cases). Good healing and durable coverage were obtained in all cases except one case.   CONCLUSION V-Y flap as a working horse flap is recommended in the gluteal area. 166 Special Tendon Injuries of the Hand in Kirikkale, Turkey Sari Elif Department of Plastic, Reconstructive and Aesthetic Surgery 1 4 2016 5 2 160 167 20 05 2015 06 12 2015 BACKGROUND Tendon injuries are one of the most common injuries of the hand and challenging problems in trauma surgery. They usually require surgical repair and unlike the single tendon injuries, flexor tendon injuries have higher morbidities when accompanied with nerve injuries. In the present study, I aimed to report the clinical experiences and outcomes about tendon injuries. METHODS A total of 180 patients (149 males, 31 females) between 17 and 56 years old were operated in the clinic due to tendon injury. Seventy isolated extensor tendon injuries, 60 isolated flexor tendon injuries, 30 multiple flexor tendon and major nerve injuries, 18 combined extensor and flexor tendon injuries, and 2 combined extensor, flexor and major nerve injuries were treated. All patients were admitted to the clinic in acute phase and operated immediately. Physiotherapy was started in the third day of the operation. RESULTS Patients were followed up between 6 and 18 months (mean 12.4 months). There was not any major complications except one female patient (0.5%) who did not conform to the treatment protocol after flexor tendon injury. Fifteen patients (8.5%) had poor flexor range of motion. The other patients were healed uneventfully. CONCLUSİON Tendon healing may cause some complications from mild to severe degrees. However, atraumatic surgery and a comprehensive postoperative early physiotherapy could decrease these complication rates. 237 Special The Healing Effect of Bone Marrow-Derived Stem Cells in Knee Osteoarthritis: A Case Report Mehrabani Davood Mojtahed Jaberi Fereidoon Zakerinia Maryam Hadianfard Mohammad Javad Jalli Reza Tanideh Nader Zare Shahrokh 1 4 2016 5 2 168 174 10 04 2016 10 04 2016 Osteoarthritis (OA) is a prevalent chronic disease impacting on quality of life and has societal and economical burden increasing with age. Yet, no confirmed pharmacological, biological or surgical therapy could prevent the progressive destruction of OA joint. Mesenchymal stem cells (MSCs) with immunosuppressive activities emerged a potential therapy. We describe a magnetic resonance images (MRI) approved 47 years old nomad female suffering from a severe right knee OA. After intra-articular injection of 36×106 passage 2 of bone marrow-derived stem cells (BMSCs), the patient’s functional status of the knee, the number of stairs she could climb, the pain on visual analog scale (VAS) and walking distance improved after two months post-transplantation. MRI revealed an extension of the repaired tissue over subchondral bone. So as MSC transplantation is a simple technique, resulted into pain relief, minimized donor-site morbidity, provided a better quality of life, significantly improved cartilage quality with no need to hospitalization or surgery, cell transplantation can be considered as a reliable alternative treatment for chronic knee OA. Therefore these findings can be added to the literature on using BMSCs for treatment of OA. 220 Special Chronic Wounds in Burn Injury: A Case Report on Importance of Biofilms Ramos-Gallardo Guillermo 1 4 2016 5 2 175 180 28 01 2016 25 04 2016 According to the National Institutes of Health and the Center for Disease and Prevention, it is estimated that 65 to 80 percent of the human infectious are caused by biofilms. Antibiotics and drainage of purulent discharge are the main treatment measures. But in chronic infections sometimes these findings are not easy to recognize. Biofilm is an extracellular polymeric conglomeration generally composed of extracellular DNA, proteins, and polysaccharides, which help bacteria to survive into the host. The following case is the example of chronic wound in burn patient, where biofilm gets involved and special attention is given to the relationship biofilm–chronic wound injury in a burn patient. 156 General Trauma or Tumor? The Nail Splay Sign Crouch Carina Madhavan Anandan Suresh Al Basri Isam Park Hospital Wexham 1 4 2016 5 2 181 182 29 03 2015 18 10 2015 151 General A Short Introduction to Clinical Photography for the Plastic Surgeon Jabir Shehab 1 4 2016 5 2 183 184 16 03 2015 18 10 2015 141 Special From Reconstructive Triangle to Reconstructive Quadrangle: Time to Include Tissue Distraction in the Reconstructive Algorithms Saaiq Muhammad Ashraf Bushra Department of Plastic Surgery and Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Pakistan Institute of Medical Sciences (PIMS), Islamabad. 1 4 2016 5 2 185 186 11 01 2015 18 10 2015 173 Special 195 Hand Injuries in 12 Days: The Outcomes of the Feast of Sacrifice Ersen Burak Akin Selcuk Saki Mehmet Can Tunali Orhan Aksu Ismail Kose Mehmet Uludag University Faculty of Medicine, Plastic Aesthetic And reconstrcutive Surgery department Uludag University Faculty of Medicine, Plastic Aesthetic And reconstrcutive Surgery department Uludag University Faculty of Medicine, Plastic Aesthetic And reconstrcutive Surgery department Uludag University Faculty of Medicine, Plastic Aesthetic And reconstrcutive Surgery department Uludag University Faculty of Medicine, Plastic Aesthetic And reconstrcutive Surgery department Uludag University Faculty of Medicine, Plastic Aesthetic And reconstrcutive Surgery department 1 4 2016 5 2 187 189 10 06 2015 21 11 2015 211 Special Wish You a Happy and Safe Diwali: From a Plastic Surgeon Mir Mohd Altaf Mahmud Ali Adil Singh Chauhan Varun Khurram Mohd Fahud Yaseen Mohd Department of Burns Plastic and reconstructive surgery Department of Burns Plastic and reconstructive surgery Department of Burns Plastic and reconstructive surgery Department of Burns Plastic and reconstructive surgery Department of Burns Plastic and reconstructive surgery 1 4 2016 5 2 190 193 10 01 2016 30 01 2016 212 Special Contralateral Pedicled Anterolateral Thigh Flap (ATL) for Upper Thigh Defect in the Era of Free ATL? Hulikal Narendra Reddy Naru Ramana Inamdar MD Basheeruddin Chandra Abha Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India 1 4 2016 5 2 194 197 10 01 2016 30 01 2016