1 2228-7914 309 Special Demographic Characteristics of Patients Undergoing Rhinoplasty: A Single Center Two-Time-Period Comparison Loghmani Shirin b Loghmani Shahriar c Baghi Hebatollah d Hoghoughi Mohammad Ali e Dalvi Fariba f b Department of Plastic Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran c Ordibehesht Surgical Center, Isfahan, Iran d College of Health and Human Services, George Mason University, Fairfax, USA e Department of Plastic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran f Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 1 7 2017 6 3 275 279 05 01 2017 06 08 2017 BACKGROUND One of the most common cosmetic surgeries is rhinoplasty. Iran has the highest rate of rhinoplasty, worldwide. The aim of this study was to compare the demographic characteristics of patients’ undergone rhinoplasty during two-time-period with a 10-year-interval in a single surgical center in Isfahan, Iran. METHODS In a retrospective study, data of the patients who were scheduled for elective rhinoplasty including their age and gender in two-time-period (2005 and 2015) were collected and compared. RESULTS Data of the 470 and 472 patients’ undergone elective primary rhinoplasty during 2005 and 2015 were collected, respectively. In 2005, the age range of patients was 16-51 years. Frequency of patients aged less than 20 years and more than 40 years was 27.1% and 3%, respectively. In 2015, the age range of patients was 16-59 years. Frequency of patients aged less than 20 years and more than 40 years was 12.9% and 5.6%, respectively. Patients in the two studied periods were similar regarding gender, but the mean age of patients had a significant increase during the time. CONCLUSION Most of our patients were female and the female to male ratio was similar in two studied periods, but it seems that rhinoplasty request is higher in older age in recent years. It is recommended to plan a trend study and more studies considering other factors to be effective in epidemiologic feature of rhinoplasty in our community. 
255 Special Outcomes of Surgical Excision and Brachytherapy in Intractable Keloids Taheri Ahmadreza g Molaei Hojjat h Aghili Mehdi i Rahmanpanah Naser j Mirmohseni Atefeh k g Plastic and Reconstructive Surgery Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran h Plastic and Reconstructive Surgery Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran i Oncology and Radiotherapy Department, School of Medicine, Tehran University of Medical Sciences, Tehran Iran j Plastic and Reconstructive Surgery Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran k Plastic and Reconstructive Surgery Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 1 7 2017 6 3 280 284 24 06 2016 06 08 2017 BACKGROUND Keloids as unusual scars are injury remnants characterized by bizarre cosmetics and painful itching. This study assessed outcomes of surgical excision and brachytherapy in intractable keloids. METHODS Six patients with 10 keloid lesions were followed up. Surgical excision was done with 1-2 mm margin, and then radiotherapy was undertaken in 3 divided fractions on days 0, 1 and 2 after surgery. Scar improvement was evaluated by patients and observer with scar assessment scale (POSAS) RESULTS Median age of patients was 38.3±6.4, while 40% were male and 60% were female. The mean primary size of the lesion before brachytherapy was 325.18±426.16 mm2 and the median size was 153.48 mm2. The mean primary size of the lesions with recurrence before brachytherapy was 150.50±124.78 mm2. The clinical improvement of the scars with POSAS scoring by the observer was 17.1±3.2 and by the patients was 20.8±11.5. In 5 patients who were evaluated, two keloid lesions showed recurrence (20%), and 8 lesions had no recurrence (80%). No patients reported side effects, but only one patient, a 43 years old woman with 5 keloid lesions, suffered wound infection and local dehiscence of the wound, followed by the second session of brachytherapy. The average time of relapse was 26.3±0.9 months. CONCLUSION The use of surgical resection in combination with brachytherapy was demonstrated as a modality for treatment of refractory keloid scars that can be recommended to surgeons who deal with these patients. 305 Special Role of Square Flap in Post Burn Axillary Contractures Karki Durga l Ravi Prakash m l Professor, Department of Burns , Plastic and Maxillofacial Surgery, Vardhaman Mahavoir Medical Collefe and Safdarjung Hospital, New Delhi, India m Professor and Head of department, Department of Burns , Plastic and Maxillofacial Surgery, Vardhaman Mahavoir Medical Collefe and Safdarjung Hospital, New Delhi, India 1 7 2017 6 3 285 291 12 12 2016 11 08 2017 BACKGROUND Post-burn contractures are a commonly encountered problem and many techniques have been described in their treatment. Z-plasties are the commonest local flap procedure done for linear bands with adjacent healthy tissue. Our aim was to assess the use of square flap technique in axillary contractures. METHODS Ten patients with type I and II axillary contractures underwent release by the square flap technique. All cases were followed up for at least one year and analysed for range of motion and aesthetic outcome. RESULTS All cases achieved full range of movement postoperatively with no recurrence during follow up period and a good cosmetic outcome. CONCLUSION Square flap was shown to be a reliable technique for mild to moderate axillary contractures of the anterior or posterior axillary folds even when there is significant adjacent scarring of chest wall or back of types I and II.  328 Special Effect of Multimedia Self-Care Education on Quality of Life in Burn Patients Mohaddes Ardebili Fatemeh n Najafi Ghezeljeh Tahereh o Bozorgnejad Mehri p Zarei Mohammadreza Ghorbani Hooman Manafi Farzad n Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran o Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran p Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran School of Medicine, Iran University of Medical Sciences, Tehran, Iran 1 7 2017 6 3 292 297 15 03 2017 11 08 2017 BACKGROUND Burn injuries can have adverse effects on quality of life of patients and can disturb their physiological, psychological, social and spiritual well-being. This study aimed to investigate the effect of multimedia self-care program on quality of life in burn patients. METHODS This Randomized controlled clinical trial was conducted from November 2015 to December 2016. The samples were hospitalized burn patients with 10% to 45% of 1st, 2nd and 3rd degree burns of total body surface area (TBSA). The patients were randomly allocated into experimental (n=50) and control (n=50) groups. Both groups received the routine in-person self-care trainings of the hospital and then the experimental group received self-care compact disks. The quality of life questionnaire in both groups were completed before intervention and after 3-months and statistically analyzed. RESULTS Accordingly, the changes in quality of life and the dimensions between both groups after 3 month of intervention were significant. The changes in quality of life in experiment group was significantly greater than control group for physical, psychological and social variables. CONCLUSION According to the findings, using multimedia self-care programs can improve burn patient’s quality of life, so it is recommended for nurses and hospital staffs of burn injury wards to use multimedia self-care programs as a complementary therapy measure. 318 Special Evaluation of Subclinical Extension of Basal Cell Carcinoma Beiraghi Toosi Arash Mohamadian Roshan Nema Ghoncheh Mahdi Endoscopic & Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran. Endoscopic & Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 1 7 2017 6 3 298 304 12 02 2017 11 08 2017 BACKGROUND Basal cell carcinoma (BCC) is the most common malignancy with increasing incidence worldwide. The tumor invades surrounding tissues in an irregular pattern via subclinical and microscopic finger-like growths known as subclinical extension. Subclinical extension may be responsible for incomplete resection of the tumor. This study investigates the subclinical extension of BCC. METHODS In a retrospective study for evaluation of subclinical extension of BCC, Patients’ demographic data and characteristics (disease duration, location, size, and history of radiotherapy) were documented. Pathology samples were assessed in terms of histological type, subclinical extension, depth, and involvement of margins. RESULTS The study was conducted on 102 pathological samples of 84 patients (49 males, 35 females) with BCC. The mean age was 65.4±12.55 years. Overall, 83% of pathology samples had subclinical extension. Subclinical extension had no correlation with lesion size (p=0.591; r=0.056), but had a direct correlation with lesion depth (p=0.033; r=0.220). Resection of the tumor with a margin of 5.5 mm eliminated the entire lesion and its subclinical extension area with a confidence rate of 95%. CONCLUSION Based on this study, resection of BCC lesions with a margin of 5.5 mm will eradicate the whole lesion including the subclinical extension area with 95% confidence rate. Depth of the tumor, not its size or histologic subtype, affects the required margin of excision 338 Special Non-metastatic Non-melanoma Skin Cancers: Our 3 Years of Clinical Experiences Sari Elif Kirikkale University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery 1 7 2017 6 3 305 312 09 05 2017 15 08 2017 BACKGROUND Nonmelanoma skin cancers (NMSC) constitute the largest group of skin cancers. In this study, NMSCs were analyzed retrospectively. METHODS Between June 2013 and March 2017, demographics and comorbidities of patients underwent reconstructive surgery for NMSC; their risk factors, types, diameters, differentiation, localizations, follow-up times, treatment methods and complications were compared and statistically analyzed. RESULTS Totally, 163 tumors [111 basal cell carcinoma and 52 cutaneous squamous cell carcinoma (cSCC)] were excized from 148 patients (63 females, 85 males). Mean age was 70.8 years. Fitzpatrick skin types were between 2-4 and 74 patients. Comorbidities were detected in 63 patients. Tumors were mostly localized in head and neck regions. Forty two lesions in cSCC group were good and 10 were medium differentiated. Defects were reconstructed with flaps in 108 patients. Others underwent primer suturation and grafting. Mean follow-up time was 16.2 months. There was not any complication except one graft failure. There were not significant statistical differences between two groups in terms of skin type, comorbidity, tumor size, fallow-up time and gender values. Conversely, differences of risk factor and age values between the groups were significant. There was a positive correlation between the tumor diameter and poor differentiation in cSCC group. Moreover, there was a negative correlation between tumor size and skin type values in groups. CONCLUSION Our results are quite different from literature needing further multicentric studies on NMSC to clarify the difference. 358 Special The Effect of Lithospermum officinale, Silver Sulfadiazine and Alpha Ointments in Healing of Burn Wound Injuries in Rat Mohtasham Amiri Zahra Tanideh Nader Seddighi Anahita Mokhtari Manadana Amini Masoud Shakouri Partovi Alborz Manafi Amir Hashemi Seyedeh Sara Mehrabani Davood Department of Community Medicine, School of Medicine, Gilan University of Medical Sciences, Rasht, Iran Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Department of Genetics, Tehran Branch, Islamic Azad University, Tehran, Iran Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Minimal Invasive Laparascopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 3. Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Iran University of Medical Sciences, Tehran, Iran Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 3. Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 1 7 2017 6 3 313 318 18 08 2017 18 08 2017 BACKGROUND  Burn is the most devastating condition in emergency medicine leading to chronic disabilities. This study aimed to compare the effect of Lithospermum officinale, silver sulfadiazine and alpha ointments on healing of burn wounds in rat.  METHODS  Ninety-five rats were divided into 5 groups. Group 1 just underwent burn injury, and groups 2-5 received alpha ointment, silver sulfadiazine (SSD), gel base and L. officinale extract, respectively. A hot plate was used for induction of a standard 3rd degree burn wound. Burn wounds were macroscopically and microscopically evaluated on days 7th, 14th and 21th after burn induction. RESULTS  A decrease in the number of inflammatory cells was noted when L. officinale and SSD were applied while the most inflammatory response was seen after administration of alpha ointment. The number of macrophages alone decreased after burn injury, while the frequency was the most when L. officinale and alpha ointment were applied. Re-epithelialization, angiogenesis and formation of granulation tissue were the best in relation to L. officinale and alpha ointment while, the worst results belonged to burn injury group and SSD regarding granulation tissue formation. Considering histological assessment, the best results were observed for scoring of inflammation, re-epithelialization, angiogenesis, formation of granulation tissue and number of macrophage when L. officinale and alpha ointment were used after burn injury.  CONCLUSION  It can be concluded that topical application of L. officinale as a non-toxic, inexpensive and easy to produce herbal can lead to a rapid epithelialization and wound healing and these findings can be added to the literature on burn wound healing. 257 General Palate Mucoperosteum: An Usefull Adjunct in Buccal Mucosa Reconstruction KN Manjunath Prabhakar Waiker Veena Department of Plastic and Reconstructive Surgery, MSRMC, BENGALURU, Karnataka, India Department of Plastic and Reconstructive Surgery, MSRMC, BENGALURU, Karnataka, India 1 7 2017 6 3 319 323 05 07 2016 29 08 2017 Background: Palate is a complex structure separating oro- and nasopharynx. However, reconstruction of the defects of palate is much simpler because of the versatile mucoperiosteal flaps. Here, we present our experience of palatal mucoperiosteal flap used in different situations. Methods: Fifteen patients of palatal as well as buccal mucosa defects were reconstructed using either free or pedicled mucoperiosteum. Results: All patients recovered well. No flap loss or secondary procedure were required. Conclusion: Success in Reconstruction of the palatal defects depends on creation of good nasal as well as buccal mucosal lining. The rich vascular macronet in the palatal mucosa makes it an ideal donor site for local reconstruction. The mucoperiosteum harvested either as a free graft or as pedicled flap serves the purpose well leaving no donor site deformity. 278 Special Which Tissue Should Be Removed in Upper Blepharoplasty? Analysis and Evaluation of Satisfaction Saalabian Ali A Liebmann Paul Deutinger Maria Krankenanstalt Rudolfstiftung Wien - Department of Plastic, Reconstructive and Aesthetic Surgery Krankenanstalt Rudolfstiftung Wien - Department of Plastic, Reconstructive and Aesthetic Surgery Krankenanstalt Rudolfstiftung Wien - Department of Plastic, Reconstructive and Aesthetic Surgery 1 7 2017 6 3 324 331 01 09 2016 29 08 2017 BACKGROUND Due to various options for tissue resection and preoperative markings, many different reports on aesthetics and patient’s satisfaction exist. To assess differences among tissue resections and risk factors, we herein analyzed satisfaction levels of patients that underwent upper blepharoplasty. METHODS A retrospective analysis during the period from January 2006 to June 2013 was conducted by reviewing patient’s electronic medical files. All patients underwent medically indicated upper blepharoplasty at our department. We classified patients relating to resected tissues; hence the categories created were skin, skin/muscle, skin/muscle/fat and skin/fat. Furthermore, an evaluation of risk factors according to the patient’s number of present medical preconditions ranging from 0 (none) to 4 was performed. Data collection was conducted by reviewing patient’s electronic medical files. Moreover, a questionnaire concerning patient’s satisfaction was forwarded. RESULTS No significant differences in patient’s satisfaction and complication rates comparing the different groups of tissue resection were noted. However, we found a significantly higher complication rate at a presence of 2 risk factors. In addition, a significantly worse scar outcome and longer recovery periods in patients with 4 risk factors were observed. CONCLUSION The extent of tissue resection has no statistically quantifiable effect on patient’s satisfaction ratings and complications. For this reason, we believe cautious resection of muscle and fat is only indicated if pathologies are present. Moreover, patients with 2 risk factors or more shall be rigorously evaluated preoperatively to avoid complicating events. An abbreviated form of this manuscript was presented at the conjoint 52nd and 45th annual meeting of the Austrian and German Society of Plastic, Aesthetic and Reconstructive Surgery, September 11th-13th 2014 in Munich, Germany. 236 Special Early Reconstructions of Complex Lower Extremity Battlefield Soft Tissue Wounds Ebrahimi Ali Nejadsarvari Nasrin Ebrahimi Azin rasouli Hamid Reza Department of Plastic Surgery, Baqiyatallah University of Medical Sciences, Tehran, Iran Department of Medical Ethics, Iran University of Medical Sciences, Tehran, Iran Tehran university of Medical Sciences, Tehran, Iran Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 1 7 2017 6 3 332 342 08 04 2016 01 09 2017 BACKGROUND Severe lower extremity trauma as a devastating combat related injury is on the rise and this presents reconstructive surgeons with significant challenges to reach optimal cosmetic and functional outcomes. This study assessed early reconstructions of complex lower extremity battlefield soft tissue wounds. METHODS  This was a prospective case series study of battled field injured patients which was done in the Department of Plastic Surgery, Baqiyatallah University of Medical Sciences hospitals, Tehran, Iran between 2013-2015. In this survey, 73 patients were operated for reconstruction of lower extremity soft tissue defects due to battlefield injuries RESULTS Seventy-three patients (65 men, 8 womens) ranging from 21-48 years old (mean: 35 years) were enrolled. Our study showed that early debridement and bone stabilization and later coverage  of complex battlefields soft tissue wounds with suitable flaps and grafts of lower extremity were effective method for difficult wounds managements with less amputation and infections. CONCLUSION Serial debridement and bone stabilization before early soft tissue reconstruction according to reconstructive ladder were shown to be essential steps.  308 General How Much Can We do by Reverse Superficial Sural Artery Flap to Potentiate Its Effects: Introducing Spout Sural Flap as a New Modification Khoshnevis Jalaluddin dashti Terifeh Azargashb Eznollah MohamadReza Kalantar Motamedi Department of General and Vascular Surgery, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Health Service Management, Clinical Research Development Center of Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Community Medicine, Shahid Beheshti University of Medical Sciences and Health Services, Shohadaye Tajrish Hospital, Tehran, Iran Department of General and Vascular Surgery, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 1 7 2017 6 3 343 350 28 12 2016 23 10 2017 BACKGROUND Due to shortage of local donor tissue and unreliable blood supply, free flaps were the mainstay of treatment for tissue defects in the lower leg and foot region, but it requires a qualified microvascular surgeon. Recently, attention has been paid to reverse superficial sural artery flap (RSSAF) and its modifications as a good alternative to pave the way to simple and friendly techniques. METHODS Excluding each patient with septic and severely ischemic foot, every patient with tissue defect in distal leg and proximal foot region were studied. Various methods were applied including spout technique with sufficient follow up. No imaging was used to evaluate the blood supply. RESULTS Five patients underwent spout technique with excellent results in four cases. Spout technique in one case failed due to narrow base. In five cases, RSSAF was performed with creating skin tunnel and very good results. CONCLUSION RSSAF is a good alternative for free flap to cover the leg and foot tissue defects. We also advise wide base pedicle (>4 cm) in every patient.  154 General Efficacy of Digital Anesthesia: Comparison of Two Techniques Ahmad Muhammad 1 7 2017 6 3 351 355 27 03 2015 31 10 2016 BACKGROUND Digital nerve block is commonly performed by care providers in medical fields. This study compares the blocks in terms of effectiveness of anesthesia and pain. METHODS Patients were divided into two groups. First group underwent digital block whereas 2nd group had transmetacarpal digital block. The subcutaneous ring block was performed by two injections of 3 ml of 2% lignocaine in a 3 ml syringe with a 26G needle at the level of phalangeal/palmer crease. One prick was performed on either side of the finger base extending on dorsal and volar aspects of the digit. The transmetacarpal block received lignocaine identically at dorsal aspect of metacarpo-phalangeal joint. 1.5ml of the solution was injected in dorsal and 1.5ml in palmer side on either side of the finger. When sensation of needle was felt, 1ml of the solution was injected. Then the needle was withdrawn injecting another 1ml and finally the last 1ml was injected close to the dorsal skin. The pain prick was recorded after 30 seconds. RESULTS The mean time to complete abolition of sensation was 9.1 minutes in group I and 9.0 minutes in group II. The mean duration of anaesthesia was 202 minutes in group I and 206.8 minutes in group II. The mean pain scale was 5.67 (range=4–7) in group I and 4.2 (range=3–7) in group II. CONCLUSION Subcutaneous ring block and transmetacarpal techniques are good in digital anesthesia and involve the administration of the local anaesthetic through two injections. 259 Special Experience of Breast Augmentation in Pakistani Females Ahmad Muhammad Aesthetic Plastic Surgery and Hair Transplant Institute, Islamabad, Pakistan 1 7 2017 6 3 356 360 11 07 2016 29 08 2017 BACKGROUND Breast augmentation is an elective surgery used to increase the size of the breast in females. This study was undertaken to determine the breast augmentation in Pakistani females. METHODS From 2006 to 2011, 43 female patients who underwent breast augmentation via infra-mammary, periareolar, trans-umbilical and fat transfer were enrolled. For augmentation, saline-filled or gel-filled implants were used in the supine position under general anesthesia and local infiltration of adrenaline (1:100,000 dilution) on each side. After the surgery, postoperative dressing was changed after 3-5 days and post-op bra was used for next 3-4 weeks. The patients were followed up for any complications too. RESULTS The majority of patients (60.4%) were less than 30 years (mean age: 27.51 years). Most of patients (70%) had infra-mammary incision, 13.9% had periareolar, 9.3% had trans-umbilical and 4.7% had fat transfer. Saline-filled implants were used in 30.2%, whereas gel-filled implants in 69.8% of patients. Implant volume in infra-mammary, periareolar, trans-umbilical and fat transfer approaches was 278.9, 291.7, 277.5 and 325 mL, respectively. Only two cases of infection were recorded in early postop period. One patient responded to conservative treatment and in 2nd patient, implants were removed. There was only one case of hypertrophic scar. No case of capsular contracture was seen. Quality of scar was satisfactory in infra-mammary and periareolar incisions. Changes in sensations were noted in 6 cases, 4 of them had periareolar incision. CONCLUSION Properly performed breast augmentation results in restoration of physical and psychological well-being of the patient and less complication rates.  327 Special Use of Forehead Flap for Nasal Tip Reconstruction after Traumatic Nasal Amputation Ahmadi Moghadam Mohamad Ahmadi Moghadam Shokofeh 1 7 2017 6 3 361 364 11 03 2017 25 07 2017 Nose is one of the most important aesthetic unit of the face.Management of nasal trauma plays a significant role in the practices of the majority of facial and reconstructive surgeons. Replantation, although technically very challenging, is undoubtedly the procedure of choice following traumatic nasal amputation. Here we present an illustrative case report of the traumatic amputation of a nasal tip that was treated successfully with a paramedian forehead flap and further nasal reconstructive surgery. Use of the forehead flap was performed five hours after the occurrence of trauma and was followed by surgical repair about three weeks later. This case presents evidence that a forehead flap as a full-thickness composite graft can survive with an acceptable clinical outcome. In this particular case, the final result was satisfactory. 315 General Giant Anterior Neck Lipoma with Bleeding Pressure Ulcer in an Elderly Man: A Rare Entity Jain Gaurav Tyagi Ila Pant Leela Nargotra Namrata Department of Pathology, NDMC Medical College, Hindu Rao Hospital,Malkagunj, New Delhi, 110002, India Department of Pathology, NDMC Medical College, Hindu Rao Hospital,Malkagunj, New Delhi, 110002, India Department of Pathology, NDMC Medical College, Hindu Rao Hospital,Malkagunj, New Delhi, 110002, India Department of Pathology, NDMC Medical College, Hindu Rao Hospital,Malkagunj, New Delhi, 110002, India 1 7 2017 6 3 365 368 02 02 2017 11 08 2017 Giant lipomas are benign soft tissue tumors found rarely in the neck and are still rarer in the anterior part of the neck. A 70-year-old male patient was presented with a huge swelling measuring 35 cm in maximum dimension, in the front of the neck, reaching up till the umbilicus. The swelling was painless, slow growing and acquired the huge size in approximately 20 years. Ultrasound and CT scan findings were suggestive of a soft tissue lesion. Fine needle aspiration cytology yielded mature adipose tissue fragments. A complete surgical removal of the mass was done which on gross examination, measured 32 cms in longest diameter and weighed 2500 grams. Diagnosis of giant anterior neck lipoma with pressure ulcer was confirmed on histopathology. We described a case of excessively large lipoma of anterior neck, which is the largest anterior neck lipoma with pressure ulcer reported till date. 251 Special Craniofacial Fibrous Dysplasia of Zygomaticomaxillary Complex Nilesh Kumar Punde Prashant Parkar M I School of Dental Sciences, KIMSDU, Karad, Maharashtra, India School of Dental Sciences, KIMSDU, Karad, Maharashtra, India School of Dental Sciences, KIMSDU, Karad, Maharashtra, India 1 7 2017 6 3 369 374 07 06 2016 29 08 2017 Fibrous dysplasia is a benign bone disease first described by Lichtenstein in 1938. It is characterized by progressive replacement of normal bone with fibro-osseous connective tissue. When the disease involves craniofacial skeleton, it results in significant disfigurement and other functional problems. This paper reports a case of large craniofacial fibrous dysplasia involving zygomaticomaxillary complex in a 24-year old male patient. Clinical presentation and imaging characteristics of the pathology is discussed in detail. The disease caused significant facial asymmetry which was satisfactorily managed by surgical recontouring. 271 Special Critical Upper Limb Ischemia Due to Brachial Tourniquet in Misdiagnosed Thoracic Outlet Syndrome after Carpal Tunnel Decompression: A Case Report Tiengo Cesare Monticelli Andrea Bonvini Stefano Wassermann Valentina Dalla Venezia Erica Bassetto Franco Plastic and Reconstructive Surgery Unit Padova University Hospital Plastic and Reconstructive Surgery Unit Padova University Hospital Vascular and Endovascular Surgery Unit Padova University Hospital Vascular and Endovascular Surgery Unit Padova University Hospital Plastic and Reconstructive Surgery Unit Padova University Hospital Plastic and Reconstructive Surgery Unit Padova University Hospital 1 7 2017 6 3 375 379 07 08 2016 29 08 2017 We present the case of a 68-year-old woman, referred to our department for critical upper limb ischemia, which had occurred a few days after homolateral surgical ligamentotomy for carpal tunnel syndrome, diagnosed and confirmed by electromyography, and performed with a brachial tourniquet. The patient was later admitted for subsequent progressive necrosis of the first three fingers of the left hand, accompanied by signs of upper limb ischemia. An accessory cervical rib was identified, completely obliterating the subclavian artery distally at the origin of the suprascapular artery. A complete humeral artery occlusion was also found at the middle third of the humerus. The accessory rib was resected and the subclavian artery recanalized. A few days later, necrosis of the distal third of the first two fingers appeared and surgical resection was performed. Despite this chronic condition, the acute occlusion of collateral circles was probably induced by the brachial tourniquet. This represents a rare event, never previously reported in the literature: a case of critical upper limb ischemia due to a brachial tourniquet in a patient with misdiagnosed thoracic outlet syndrome. Until specific electrophysiological criteria for this syndrome can be found, attention should focus on history and clinical examination in patients with suspected carpal tunnel syndrome. 277 General Congenital Bilateral Multiple Trigger Fingers in A 5-Year-Old Child Bhaban Neeraj Devale Maksud Munoli Amarnath Department of plastic and reconstructive surgery ,LTMGH, sion, Mumbai. Department of plastic and reconstructive surgery ,LTMGH, sion, Mumbai. Department of plastic and reconstructive surgery ,LTMGH, sion, Mumbai. 1 7 2017 6 3 380 382 31 08 2016 29 08 2017 Paediatric bilateral multiple trigger fingers are extremely rare. The underlying etiopathogenesis and hence the surgical principles of management of trigger finger in children are different from those of pediatric trigger thumb and adult trigger finger. In this paper, we report the case of a 5 year old girl with congenital trigger digits involving the middle, ring and little fingers of both hands. She did not have any episode of trauma, viral or bacterial infections or any metabolic disorder. Following lack of any improvement with a physiotherapy and a splintage regime for 6 weeks, we offered surgical management for the affected digits. Release was done in step-wise pattern. We present the intraoperative findings and surgical management of congenital trigger finger. 283 Special Primary One Stage Reconstruction in Complex Facial Avulsion Injury Ghosh Abhishek Poona hospital, Noble hospital 1 7 2017 6 3 383 386 11 09 2016 29 08 2017 Complex facial injuries with soft tissue degloving and bony avulsion are very devastating to the patient. Partial degloving injuries are described but hemifacial degloving with zygoma avulsion are rare. The author presents a case of post-traumatic degloving of the left upper lip, nose, part of forehead, upper and lower eyelids and cheek with avulsion of the left zygoma. The management included immediate resuscitation and early surgery to reposition the skeletal as well as soft tissue avulsion. The wound was thoroughly washed and primary repositioning and fixation were done. Early one stage surgery with meticulous debridement and alignment of the anatomical landmarks results in very good aesthetic and functional outcome. 200 Special Acral Hypomelanocytic Melanoma of Left Great Toe: A Rare Cancer Mir Mohd Altaf Chauhan Varun Mahmud Ali Adil Bariar Lalit Mohan Rehman Suhailur Aligarh Muslim University Aligarh India Aligarh Muslim University Aligarh Indi Aligarh Muslim University Aligarh Indi Aligarh Muslim University Aligarh Indi Aligarh Muslim University Aligarh Indi 1 7 2017 6 3 387 389 05 12 2015 04 06 2016 295 Special Modifying “Pico” Question into “Picos” Model for More Robust and Reproducible Presentation of the Methodology Employed in A Scientific Study Saaiq Muhammad Ashraf Bushra Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, 44000, Pakistan Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, 44000, Pakistan 1 7 2017 6 3 390 392 22 10 2016 14 12 2016 316 Special Absence of the Labiomental Groove: A Common but Preventable Unpleasant Aesthetic Problem of the Lower Lip-Chin Burn Reconstruction Mohammadi Ali Akbar Mohammadi Soheil Burn and Wound healing research center,Plastic and reconstructive surgery ward,Shiraz university of medical sciences, Shiraz ,Iran Tehran university of medical sciences,Tehran,iran 1 7 2017 6 3 393 395 04 02 2017 18 08 2017 250 General Evaluating Youtube as A Source of Patient Information on Dupuytren’s Disease Jones Matthew Wiberg Akira Orthopaedic Department, Princess Elizabeth Orthopaedic Centre, RD;E, Exeter Botnar Research Centre, NDORMS, University of Oxford, Nuffield Orthopaedic Centre, Oxford2 1 7 2017 6 3 396 398 07 06 2016 29 08 2017 256 General Median Nerve Lipofibrohamartoma: A Treatment Dilemma Mishra Bharat John Jerry R. Tripathy Satyaswarup Sharma Ramesh Kumar PGIMER, Chandigarh, India. PGIMER, Chandigarh, India. PGIMER, Chandigarh, India. PGIMER, Chandigarh, India. 1 7 2017 6 3 399 401 25 06 2016 29 08 2017 276 Special Digital Necrosis: A Hoarder’s Tale Mohan Arvind Wormald Justin Park Chang Smith Gill Plastic Surgery Ward, Chelsea and Westminster NHS Foundation Trust, London, UK Plastic Surgery Ward, Chelsea and Westminster NHS Foundation Trust, London, UK Plastic Surgery Ward, Chelsea and Westminster NHS Foundation Trust, London, UK Plastic Surgery Ward, Chelsea and Westminster NHS Foundation Trust, London, UK 1 7 2017 6 3 402 404 25 08 2016 29 08 2017