1 2228-7914 100 Special Tissue Engineered Scaffolds in Regenerative Medicine Hosseinkhani Mohsen b Mehrabani Davood c Karimfar Mohammad Hassan d Bakhtiyari Salar e Manafi Amir f Shirazi Reza g b Department of Anatomical Sciences, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran c Stem Cell and Transgenic Technology Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran d Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical sciences, Zahedan, Iran e Department of Clinical Biochemistry, School of Medicine, Ilam University of Medical sciences, Ilam, Iran f Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran g Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran 1 1 2014 3 1 3 7 07 12 2013 07 12 2013 Stem cells are self-renewing cells that can be differentiated into other cell types. Conventional in vitro models for studying stem cells differentiation are usually preformed in two-dimensional (2D) cultures. The design of three-dimensional (3D) in vitro models which ideally are supposed to mimic the in vivo stem cells microenvironment is potentially useful for inducing stem cell derived tissue formation. Biodegradable scaffolds play an important role in creating a 3D environment to induce tissue formation. The application of scaffolding materials together with stem cell technologies are believed to hold enormous potential for tissue regeneration. In this review, we provide an overview of application of tissue engineered scaffolds and stem cells for the development of stem cell-based engineered tissue replacements. In particular, we focus on bone marrow stem cells (BMSCs) and mesenchymal stem cell (MSCs) due to their extensive clinical applications.
101 Special The CC-V Flap: A Novel Technique for Augmenting a C-V Nipple Reconstruction Using a Free Dermal Graft Clark Sarah Elizabeth h Turton EPL i h The Breast Unit, St. James University Hospital, Leeds, UK i The Breast Unit, St. James University Hospital, Leeds, UK 1 1 2014 3 1 8 12 09 12 2013 09 12 2013 BACKGROUND We present a novel method for augmenting the standard C-V flap used for nipple reconstruction with a free dermal graft which aims to improve the appearance of the nipple reconstruction, decrease loss of projection and improve patient satisfaction overall. METHODS The surgical technique for performing a free dermal graft augmentation of a CV flap is described. All patients who underwent this technique between February 2009 and January 2012 at our unit were contacted by telephone, questioned about any complications and asked to rate their satisfaction with the technique. RESULTS In a series of 18 nipple reconstructions, there were no immediate post-operative complications and long term follow up shows that that this technique achieves high patient satisfaction scores. CONCLUSIONS The CC-V flap is a safe technique which scores highly with patients for cosmetic appearance after long term follow up. 92 Special Epidemiology and Management of Foreign Bodies in the Hand: Pakistani Perspective Saaiq Muhammad j j Department of Plastic Surgery, Burn Care Center, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan 1 1 2014 3 1 13 17 10 11 2013 10 11 2013 BACKGROUND Penetrating and impalement injuries of the hand and fingers are one of the commonest presentations at the hospital’s emergency rooms. This study assessed the characteristics of patients who suffered foreign body injuries to the hands and documented the pattern of diagnosis and management at a specialist plastic surgical facility. METHODS The study was conducted at the Department of Plastic and Reconstructive Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad over a period of six years (i.e. from September 1, 2007 to July 31, 2013). All adult patients (37 subjects) of either gender who were managed for hand foreign bodies during the study period were included by convenience sampling technique. The demographic profile of the patients, cause of injury, type of foreign body, occupation of the patient, diagnostic yield of plain x-rays, type of procedure undertaken for retrieval of foreign body, and complications were all recorded on a form. A follow-up of three months was done. RESULTS Eighteen (48.64%) were males while 51.35% (n=19) were female. The mean age was 26.789.94 years. The commonest sufferers were housewives 29.72% (n=11). Majority of patients (n=16 43.24%) presented on day 3 (i.e. >48-72 hours), among the injury causing mechanisms, the commonest were accidents with sewing machines 45.94% (n=17) and sewing machine needles 45.94% (n=17) were the commonest foreign bodies observed. The plain x-ray hands reveled the diagnosis in all patients except those with wooden foreign bodies (n=3 8.10%). All patients had successful surgical exploration and retrieval of the foreign bodies under local anesthesia and tourniquet control. In two cases, image intensifier was employed to locate the foreign bodies per-operatively. Wound infection was found in 0.8% (n=4) patients, all of whom were managed successfully with oral antibiotics. None of patients had hospitalization. All patients were fine at 3 months follow up. CONCLUSIONS Surgical exploration and careful retrieval under local anesthesia and tourniquet control suffice as the definitive treatment. Rarely intra-operative image intensifier is needed to locate foreign bodies per-operatively. 104 Special Component Rhinoplasty Mohmand Muhammad Humayun k Ahmad Muhammad l k Cosmetic Plastic Surgeon, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan l Cosmetic Plastic Surgeon, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan 1 1 2014 3 1 18 23 15 12 2013 15 12 2013 BACKGROUND According to statistics of American Society of Plastic Surgeons, cosmetic rhinoplasty was the second most frequently performed cosmetic surgery. This study shares the experiences with component rhinoplasty. METHODS From 2004 to 2010, all patients underwent aesthetic nasal surgery were enrolled. The patients requiring only correction of septal deviation and those presenting with cleft lip nasal deformity were excluded. All procedures were performed under general anaesthesia with open technique using transcolumellar and infra-cartilageous incisions. The transculomelalr incision was closed with 6-0 polypropylene and infra-cartilagenous incisions by 5-0 absorbable sutures. Non-absorbable sutures were removed on the fifth postoperative day. The septum was fixed by ‘quilting sutures’. Both nostrils were packed with antibiotic ointment containing paraffin gauzes which were removed after 24-48 hours. External nasal splint was applied to be removed on the fifth postoperative day. RESULTS A total of 191 patients were enrolled (male:female ratio=1:1.47). The mean age of female patients was 25.3 years and 29.4 years in males. Among 50.8% of patients, the cause of deformity was not known. Only 21.5% patients had a positive history of trauma. Majority of patients (90.6%) underwent septoplasty. Twenty percent of surgeries were secondary. Spreader grafts were used in 85% of patients. In 11% of patients, conchal grafts were used. For none of patients, the inferior turbinectomy was performed. No case of costal cartilage graft or silicone implant was used. Only 5.6% of patients had redo-surgeries. No abnormal scarring was noted during follow-up. CONCLUSIONS Dorsal hump reduction can be recommended with accuracy and safety without compromising the nasal airway. 87 Special Metabolic Effects of Tourniquet Application in Burn Patients Mohammadi Ali Akbar m Pakyari Mohammad Reza n Seyed Jafari Seyed Morteza o Jannati Mansour p Dastgerdi Vahid m Shiraz Burn Research Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran n Shiraz Burn Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran o Shiraz Burn Research Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran p Cardiovascular Surgery Ward, Shiraz University of Medical Sciences, Shiraz, IranSurgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran Shiraz Burn Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran 1 1 2014 3 1 24 28 04 10 2013 15 10 2013 BACKGROUND Despite several studies investigating the pathophysiologic effects of tourniquet usage in extremity surgeries, there are not enough data about these effects in adhesion release surgeries of burn patients. In the light of numerous metabolic changes of burn tissues, we tried to determine whether there are any significant differences in metabolic responses of burn tissues to tourniquet ischemia in comparison to the findings of other studies in non burn tissue responses during tourniquet usage in extremity surgeries. METHODS From March 2009 to April 2011, eighteen patients who were candidates for performing upper extremity adhesion release surgeries were enrolled. Patients with renal, hepatic, metabolic and any other underlying diseases were excluded from the study. Blood samples for determination of pH, pCO2 and HCO3 were obtained from the occluded hand (as the local response indicator of the body to ischemia) and the other hand too (as the systemic response indicator). The time for blood sampling was just before tourniquet inflation, 30 seconds, one minute, three minutes and five minutes after cuff inflation. RESULTS Thirty seconds after tourniquet release, a rapid decrease was noticed in pH values (7.38±0.04-->7.21±0.08). This decrease was seen after 60s in the opposite hand (7.38±0.04-->7.27±0.01) and returned to the baseline values after 5 minutes in both hands. The blood PCO2 value in the occluded hand was found to be increased 30s after tourniquet release (34.93±3.96-->50.06±11.78), while this increase was seen after 180s in the opposite hand too (34.93±3.96-->38.98±9.21). HCO3 value increased after 30s (19.79±2.31-->20.62±2.37) in the occluded hand, but this increase was visible after 60s in the opposite hand. We found no significant difference in the response of burn patients to tourniquet ischemia in comparison to non-burn patients. CONCLUSION There was no extra risk in the application of tourniquet in extremity surgeries of burn patients in comparison to non-burn patients. So current protocols of tourniquet application in non-burn patients can be used for adhesion release surgeries in burn patients without any extra caution. 102 Special Comparison of Healing Effect of Aloe Vera Extract and Silver Sulfadiazine in Burn Injuries in Experimental Rat Model Akhoondinasab Mohammad Reza Akhoondinasab Motahhare Saberi Mohsen Faculty of Plastic and Reconstructive Surgery, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Medicine, Quran and Hadith Research Center, Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 1 1 2014 3 1 29 34 09 12 2013 09 12 2013 BACKGROUND Wound healing is widely discussed in the medical literature. This study compared the healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. METHODS Sixteen rats were randomly assigned to one of two groups, each group 8 rats. A deep second-degree burn on the lower back and 3rd degree burn on upper back of each rat were created with a standard burning procedure. Burns were dressed daily with aloe vera extract in group 2 and silver sulfadiazine in group 1. Response to treatment was assessed by digital photography during treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis and angiogenesis) were assessed after biopsy of scar at the end of research. RESULTS Wound healing was more visible in aloe vera group. Also the speed of healing in aloe vera group was better than silver sulfadiazine group. CONCLUSIONS Based on our findings, aloe vera can be a therapy of choice for burn injuries. 96 Special Does Orientation of Full-Thickness Groin Grafts Affect Hyperpigmentation in Burn Contracture and Syndactyly Hands? Motamedolshariati Mohammad Rezaei Ezzatollah Shakeri Maryam-Sadat Beiraghi-Toosi Arash Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Iran; Medical student, Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran; Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 1 1 2014 3 1 35 38 18 11 2013 18 11 2013 BACKGROUND Some grafts harvested from the groin area do not become hyperpigmented and in an individual with multiple pieces of grafts, the hyperpigmentation of the pieces may vary. This study evaluates the orientation of the inset of groin grafts according to their donor sites (superior-inferior) and its role in graft hyperpigmentation. METHODS Patients with hand burn contracture or syndactyly who required at least 2 pieces of grafts were enrolled. In each patient, one piece of the graft was inset in the same direction of the orientation of the donor site and the other in the opposite direction. Six months after the operation, the pigmentation was scored by a subjective scaling from 1 to 5. RESULTS Thirty-four fingers of 15 patients were included. The mean grade of pigmentation in grafts inset in the direction of the donor site was 3.00±1.118 and in those inset in the opposite direction was 2.88±1.409. This was not statistically significant. CONCLUSION Our findings revealed that although the grafts inset in the opposite direction of the donor site, they were less pigmented. So orientation of full thickness groin grafts did not affect hyperpigmentation of the grafts in burn contracture and syndactyly hands. 98 Special Effect of Educational Program Based On Exercise Therapy on Burned Hand Function Mohaddes Ardebili Fatemeh Manzari Zahra Sadat Bozorgnejad Mehri Medico-Surgical Group, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran Medico-Surgical Group, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran Medico-Surgical Group, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran 1 1 2014 3 1 39 46 28 11 2013 11 12 2013 BACKGROUND Hands burn was associated with significant functional disorders that severely affected patient’s quality of life. The aim of this study was to examine the effect of educational program based on exercise therapy on burned hand function. METHODS This experimental research was conducted in a period of ten months in 2010-2011 in Mottahari Hospital in Tehran in Iran. The sample included 60 patients, who were randomly assigned into experimental and control groups, half in intervention and half in control group. Educational program was implemented on experimental group. The data collection tools were two observational checklists about determining of hand function. RESULTS Both groups were matched in characteristic of demographic and burn injury. Subjects in experimental group demonstrated significant improvements in range of motion and hand function balance from admission to discharge. CONCLUSION In order to reduce the hand functional impairment caused by burns, it is recommended that special attention be paid to patient education about exercise therapy. 91 Special A Comparative Study on Tendon Transfer Surgery in Patients with Radial Nerve Palsy Yavari Masoud Abdolrazaghi Hossein Ali Riahi Azadeh Department of Hand Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Hand Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Occupational Therapy, 15th Khordad Hospital, Tehran, Iran 1 1 2014 3 1 47 51 04 11 2013 21 12 2013 BACKGROUND Lesions in peripheral nerves are highly prevalent in the upper extremity. The present study compares different tendon transfer surgeries in patients with radial nerve palsy. METHODS Fifty patients with radial nerve palsy were randomly selected among patients who referred to Tehran 15th Khordad Hospital during 2006-2011. They were divided into two groups of 17 and 33 subjects. Single tendon transfer surgery was performed on 33 and ternary tendon transfer surgery on 17 patients and were compared. RESULTS No significant difference was noticed in the range of motion of metacarpophalangeal joint, proximal interphalangeal joint and distal interphalangeal joint joints between the two groups. There was also no significant difference in the results of single tendon and ternary tendon transfer surgeries between the two groups. There was no need to sacrifice three tendons in tendon transfer surgeries on patients with radial nerve palsy. CONCLUSION Single tendon transfer surgery may help establishing a finger extension while indicates to its considerable advantages of surgical simplicity, shorter surgery time, less complications and surgery scars. 90 Special A Comparasion in Graft Resorption between Three Techniques of Diced Cartilage Using Surgical Blade, Electrical Grinder and Grater in Rabbit Manafi Ali Sabet Mohammad Emami Abolhasan Vasei Mohammad Mosavi Jaber Manafi Amir Hamedi Zahra Sadat Manafi Farzad Mehrabani Golnoush Manafi Navid Department of Plastic Surgery, Tehran University of Medical Sciences, Tehran, Iran; Department of Plastic Surgery, Tehran University of Medical Sciences, Tehran, Iran; Department of Plastic Surgery, Tehran University of Medical Sciences, Tehran, Iran Department of Pathology, Tehran University of Medical Sciences, Teharn, Iran Department of Plastic Surgery, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, Shahid Beheshti University of Medical Sciences, Teharn, Iran Student Research Committee, Shahid Beheshti University of Medical Sciences, Teharn, Iran Student Research Committee, Iran University of Medical Sciences, Teharn, Iran Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran 1 1 2014 3 1 52 63 04 11 2013 04 11 2013 BACKGROUND In recent years, there is an increasing tendency to use diced cartilage grafts in rhinoplasty surgery for improving dorsum contour irregularities. This study was designed to compare graft resorption between three techniques of diced cartilage using surgical blade, electrical grinder and grater in rabbit model. METHODS Thirteen New Zealand rabbits were divided into three groups. Three 2×2 cm cartilage specimens were harvested from one of their ears. In group one, the cartilage was diced by use of No:11 surgical blade to o.5 to 1 mm cube pieces. In group two, an electrical grinder was used and in group three, a grater was applied. The grafts were placed in three subcutaneous pockets in the back of rabbits and after 12 weeks, the implants were removed and their weight and volume were recorded and were evaluated by histological techniques. RESULTS There was no difference between the three methods in the 3 groups for graft resorption. There was no change in the volume, but the weight showed a decrease in the control group. CONCLUSIONS As the histological results had no statistically difference between groups, we may recommend use of these two techniques in reconstructive and in aesthetic cases. 85 Special Face Avulsion and Degloving Panse Nikhil Sahasrabudhe Parag Joshi Namrata Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India 1 1 2014 3 1 64 67 04 10 2013 12 10 2013 There have been sparse reports in literature of avulsion and degloving injuries of individual areas of face like the nose, eyelids, ear and even mandible. Hemi-facial degloving is extremely rare. We present a case of post-assault degloving of the nose, part of forehead with anterior wall of frontal sinus, entire upper and lower eyelids and the cheek. Proper planning and staging of the surgical procedures and use of local flaps, meticulous and proper alignment of tissues gave us good aesthetic and functional outcome with a satisfied patient. 93 Special Facebook Platform as the Social Business and Marketing Model for Cosmetic Surgery: An Online Study Javed Muhammad Wilson-Jones Nick The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom 1 1 2014 3 1 68 69 11 11 2013 11 11 2013 86 Special Telemedicine and Plastic Surgery in India Panse Nikhil Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India; 1 1 2014 3 1 70 71 04 10 2013 12 10 2013