Mehdi Rasti Ardakani, Ahmed Al-Dam, Ashkan Rashad, Ali Shayesteh Moghadam,
Volume 6, Issue 1 (1-2017)
Abstract
BACKGROUND
It has been reported that systemic administration of allopurinol improves cell survival. This study was aimed to evaluate effects of allopurinol on skin flaps in dogs.
METHODS
Twenty dogs underwent one skin flap surgery with a 2-week interval. The first procedure was performed according to the standard protocols. The second phase was started by a 1-week pretreatment with allopurinol. Length of the necrotic zone was measured and recorded daily. At each phase, flaps were removed and sent for histopathological study after 1 week observation.
RESULTS
Mean length of the necrotic zone in allopurinol treated skin flaps has been significantly less than normal flaps over all 7 days of observation (p<0.0001). Histopathology study showed less inflammation and more normal tissue structure in the allopurinol treated skin flaps.
CONCLUSION
It was demonstrated that systemic administration of allopurinol significantly improved skin flap survival.
Mir Yasir, Adil Hafeez Wani, Haroon Rashid Zargar,
Volume 6, Issue 1 (1-2017)
Abstract
BACKGROUND
Reconstruction of soft tissue defects in the lower third of the leg remains challenging. Anatomical constraints limit the local options available for complex defects especially lower third of leg. Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. We present our experience with perforator flaps for reconstruction of soft tissue defects in the lower limb.
METHODS
The study was carried prospectively and 23 patients with lower limb defects treated with various perforator flaps (both elective as well as emergency) were included in the study. A hand-held ultrasound Doppler was used preoperatively and intraoperatively to detect the perforator vessels.
RESULTS
Out of 23 patients, we witnessed partial flap loss in 1 and distal flap necrosis in 3 patients. Four patients had minor complications which included infection, wound dehiscence and congestion of flap.
CONCLUSION
Perforator flaps may represent a good alternative to the free flaps in the areas were other local reconstructive procedures are not possible. This is a versatile technique and with decreased donor site morbidity limited to a single body area. There is a specific like to like soft tissue replacement leading to a better cosmetic and reconstructive outcome. The main drawback of the perforator flaps however is the higher risk of venous congestion.
Mohamed Makboul, Mahmoud Abdelhamid, Ghada Al-Attar,
Volume 6, Issue 1 (1-2017)
Abstract
BACKGROUND
Surgery for hypertrophied breast represents a challenge for plastic surgeons. The search for a good cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, with round shape, good projection, small cicatrices that are not very perceptible, and a lasting result.
METHODS
This study was carried out on 60 cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and asked for late post-operative results and overall patients' satisfaction.
RESULTS
Long term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistical significant difference. No statistical significant difference was observed between patients undergone either types of operations concerning breast symmetry, nipple symmetry and sensation. The mean score of satisfaction was higher among patients undergone superomedial pedicle than inferior pedicle.
CONCLUSION
The superomedial pedicle shows better long term cosmetic result in reduction mammoplasty.
Navid Kalani, Hasan Zabetian, Mohammad Sadegh Sanie, Mansour Deylami, Mohammad Radmehr, Reza Sahraei, Hossein Kargar Jahromi, Wesam Kooti,
Volume 6, Issue 1 (1-2017)
Abstract
BACKGROUND
During abdominal surgery under regional anesthesia, nausea may happen due to several contributing factors. This study compared the effects of ondansetron and dexamethasone on nausea and vomiting under spinal anesthesia.
METHODS
One hundred and twenty patients of 15 to 35 years old with ASA class I and II were enrolled. Before administering either ondansetron or dexamethasone, blood pressure and heart rate of the patients were recorded. The patients received 70 mg of 5% lidocaine for spinal anesthesia. Patients who received 6 mg of ondansetron were considered as group A, while group B received 8 mg of dexamethasone. The level of nausea and vomiting, blood pressure, heart rate and respiratory rate of each patient was measured at 1, 5, 10, 15 and 30 minutes after spinal anesthesia and during recovery (every 5 minutes).
RESULTS
There was a significant difference between nausea and vomiting between the two groups after spinal anesthesia within the first and fifth minutes. There was no significant difference between nausea and vomiting between the two groups within 10, 15 and 30 minutes and during recovery at 5, 10, 15 and 30 minutes.
CONCLUSION
Dexamethasone and ondansetron were shown to equally reduce the incidence of nausea and vomiting under spinal anesthesia and can be recommended as a good choice for prevention of nausea and vomiting during surgeries.
Abdoljalil Kalantar Hormozi, Nastaran Mahdavi, Mohammad Mehdi Foroozanfar, Seyed Sajad Razavi, Seyed Amir Mohajerani, Ahmad Eghbali, Amir Ali Mafi, Haleh Hashemzadeh, Alireza Mahdavi,
Volume 6, Issue 1 (1-2017)
Abstract
BACKGROUND
Craniosynostosis results from premature closure of one or more cranial sutures, leading to deformed calvaria and craniofacial skeleton at birth. Postoperative complications and outcome in intensive care unit (ICU) is related to surgical method and perioperative management. This study determined the perioperative risk factors, which affect outcome of patients after craniosynostosis surgery.
METHODS
In a retrospective study, 178 patients with craniosynostosis who underwent primary cranial reconstruction were included. Postoperative complications following neurosurgical procedures including fever in ICU, level of consciousness, re-intubation, and blood, urine, and other cultures were also performed and their association with the main outcomes (length of ICU stay) were analyzed.
RESULTS
Factors independently associated with a longer pediatric ICU stay were fever (OR=1.59, 95% CI=1.25-4.32; p=0.001), perioperative bleeding (OR=2.25, 95% CI=1.65-3.65; p=0.01), age (having surgery after the first 5 years) (OR=1.59, 95% CI=1.33-3.54, p=0.016) and infection (OR=2.17, 95% CI=1.83-7.46; p=0.002). Mean blood loss during surgery was significantly higher in patients whose duration of ICU was longer than 4 days compare to less than 4 day (p=0.026). Amount of bleeding significantly was correlated to duration of surgery (r=0.70, p=0.001) and patient's age (r=0.23, p=0.44).
CONCLUSION
perioperative management particularly blood loss could deteriorate patients outcome and length of stay in ICU and hospital. Infections in ICU could deteriorate outcomes.
Shabeer Wani, Ovais Matto, Doaa Andejani, Faris Akmugarian, Faris Aldhagri, Ahmad Wafa,
Volume 6, Issue 2 (4-2017)
Abstract
Chetan Satish, Subhash Reddy,
Volume 6, Issue 2 (4-2017)
Abstract
Stephanie Au, Ali Yousif, Suresh Anandan,
Volume 6, Issue 2 (4-2017)
Abstract
Luis Parra,
Volume 6, Issue 2 (4-2017)
Abstract
Fatemeh Hosseinzadeh, Moosa Salehi, Nader Tanideh, Davood Mehrabani, Azadeh Sayarifard, Anahita Sedighi,
Volume 6, Issue 2 (4-2017)
Abstract
BACKGROUND
Inflammatory bowel diseases contain two digestive system diseases, ulcerative colitis (UC) and Crohn’s disease with unclear causes. The aim of present study was to investigate the therapeutic effects of administration of the Sesame oil (SO) and grape seed oil (GSO) as enema route in rats suffering from experimental acetic acid induced UC.
METHODS
Eighty male rats were randomly allocated into 8 equal groups as health control (HC1) without any disease treated with 1 ml of normal saline as enema; HC2 received SO; HC3 received GSO; negative control (NC) with induced UC receiving 1 ml of normal saline as enema; and positive control (PC) with induced UC treated by asacol. All treatments were performed identically with 4 mg/kg of medication except for asacol that was 100 mg/kg for 7 days. The weight changes was recorded after seven days. The serum levels of malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6, and c-reactive protein (CRP) were measured. Colon macroscopic and microscopic histological changes were also measured at the end of 7th day.
RESULTS
No significant changes were detected in weight in neither groups on day 0 nor at the end of study. No beneficial effects were seen for all treatments regarding healing process and the decrease in inflammation. Between treatment groups, the lowest MDA (7.40±0.98 U/ml), CRP (83.20±10.01 mg/l) and IL-6 levels (130.86±10.70 mU/ml) and highest TAC (1.91±0.43 mmol/l) belonged to GSO group.
CONCLUSION
GSO enema alone can be considered as a treatment of choice for UC due to its antioxidant properties
Mehmet Can Sak, Selcuk Akin, Burak Ersen, Orhan Tuanli, Aksu Ismail,
Volume 6, Issue 2 (4-2017)
Abstract
BACKGROUND
Gigantomastia is a rare condition characterized by excessive breast growth and can be physically and psychosocially disabling for the patient. Regarding management of gigantomastia, this study evaluates the outcomes of superomedial pedicle with vertical scar or wise pattern skin excision.
METHODS
A total of 425 patients who underwent reduction mammoplasty in our institution were reviewed. Forty eight reduction mammoplasty patients with resection weights greater than 1 kg per breast and treated with superomedial dermoglandular pedicle technique combined with vertical or wise-pattern skin excision were included.
RESULTS
The patients were between 19 and 66 years old, with an average of 41 years. Total weight of resection was between 1000 and 2600 g, with an average of 1384 grams for right breast and between 1000 and 3000g, with an average of 1434 grams for left breast. The secondary revisions and wound healing complications were extremely high in vertical scar group compared to wise pattern group (87,5% and 12,5%, respectively).
CONCLUSION
The authors concluded that superomedial dermoglandular pedicle in the addition of a wise pattern is an appropriate, safe and reliable method when dealing with significantly larger breasts (>1000g).
Husnu Tokgoz, Gulsum Tetik, Soner Yalcinkaya, Ali Yildiz, Murat Savas,
Volume 6, Issue 2 (4-2017)
Abstract
Urethral fistula formation after urethroplasty for hypospadias is a frequent complication. Repeated failures can occur even after multiple attempts at repair. A surgical procedure is described for a problematic resistant urethrocutaneous fistula (UF) with the transverse turnover flap using the Buck’s fascia of the corpus cavernosum. A 23-year-old male was admitted to our hospital with recurrent coronal UF. We placed a suprapubic catheter in the bladder and operated the patient with the flap technique combined with glanuloplasty. In 3rd month follow up, the patient had no fistula with normal voiding.
Rokhsareh Y. Yazdandoost, Niki Hayatbini, Mohammad Javad Fatemi,
Volume 6, Issue 2 (4-2017)
Abstract
BACKGROUND
Aesthetic surgery procedures have been performed at dramatically increased rates in recent years in Iran. Few researches exist documenting the usage of body image coping strategies and its relationship in seeking surgery.
METHODS
The present research examined data from 90 aesthetic surgery participants (30 Subjects each in invasive, minimally-invasive, and control groups). Assessed subjects on body image coping strategies inventory (avoidance, appearance fixing and positive rational acceptance) provided dysfunctional usage of its variables among Iranian clients.
RESULTS
Between the three groups, on variables of body image coping strategies, there was a significant difference. There was a significant difference on avoidance variable in three groups. On positive rational acceptance variable, there was a significant difference for invasive group with minimally-invasive and control groups. No significant difference was found on appearance fixing variable.
CONCLUSION
The study emphasizes on the role of psychological problems of aesthetic surgery clients that surgeons should be aware of them, which could inhibit the positive effects of aesthetic surgery. These results have implications for pre-surgical assessment along with psychological interventions at first step rather than invasive medical interventions.
Richard McNally, Jonathan Rimler, Vincent Laurence, Keyianoosh Paydar, Garrett Wirth,
Volume 6, Issue 2 (4-2017)
Abstract
BACKGROUND
Current teaching suggests increased perfusion in free transverse rectus abdominis myocutaneous (TRAM) flaps over pedicled TRAM flaps, broadening indications for its use in high risk patients. This study compared perfusion analysis of free muscle-sparing versus pedicle TRAM flaps in vivo in the peri-operative and late post-operative periods.
METHODS
The SPY-Elite system using indocyanine green dye was used to analyze flap perfusion intra-operatively and at 1 week and 3 months post-operatively. Image analysis was completed by evaluating the perfusion maps from the SPY- Elite system with Image J software calculate maximum, minimum, and average luminescence over the surface area of the flaps. Student’s T-test was used for statistical analysis.
RESULTS
Intra-operatively, we found a 73.4% greater perfusion in the free muscle-sparing as compared to the pedicled TRAM. This increase in free muscle-sparing TRAM perfusion was not evident 1 week post-operatively, due to a relative increase in pedicle flap perfusion that coincided with a revision of the pedicled flap due to distal flap necrosis. At 3 months, the free muscle-sparing TRAM flap once again showed superior perfusion with a 15.7% increase over the pedicled flap.
CONCLUSION
We showed superior free muscle-sparing TRAM perfusion in the early peri-operative period which coincided with the time framein which flap loss was most common. Local swelling, pedicle rotation, tunneling, and dominance of the deep inferior epigastric circulation were potential causes of initial decreased pedicled TRAM perfusion. This analysis adds more objective data to the question of indications and relative strengths between free and pedicled TRAM flaps.
Matthew Jones, Akira Wiberg,
Volume 6, Issue 3 (7-2017)
Abstract
Muhammad Ahmad,
Volume 6, Issue 3 (7-2017)
Abstract
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.
Bharat Mishra, Jerry R. John, Satyaswarup Tripathy, Ramesh Kumar Sharma,
Volume 6, Issue 3 (7-2017)
Abstract
Neeraj Bhaban, Maksud Devale, Amarnath Munoli,
Volume 6, Issue 3 (7-2017)
Abstract
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.
Manjunath Kn, Dr. Veena Prabhakar Waiker,
Volume 6, Issue 3 (7-2017)
Abstract
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.
Jalaluddin Khoshnevis, Terifeh Dashti, Eznollah Azargashb, Kalantar Motamedi Mohamadreza,
Volume 6, Issue 3 (7-2017)
Abstract
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.
