[Cervicofacial angle reconstruction while insetting flaps to treat chronic burns]

Facial and cervical skin are prone to scar contracture due to extensibility and thin characteristic there. End points of scar contracture treatment in this area is to provide good texture and skin color which match with healthy peripheral skin and normal neck and mouth movement. Cervicofacial angle should be restored in every transferred flap as a major principle in aesthetic surgery. We assess cervicomandibular, cervicomental and infra auricular angles refinement while insetting flaps to treat chronic burn scar contractures. It is a prospective, descriptive study with 34 patients complaining of chronic burn scar contracture in Cervicofacial area that referred to 15 Khordad Hospital from 2004 to 2006. Designed flaps are basically as advancement, transposition and rotational, either random or axial flaps. Donor sites were expanded by tissue expander to inset the flaps after releasing scar contractures. We hatched the fibrous capsule underneath the flap and fixed it to mentum, mandibular body and ramus periosteium and platysma muscle in three rows in cervicomandibular angle to create impressive concavities there. Bulky non compressive dressing and drain were used in all cases. Mean age is [25.5 +/- 8.3] years and 29.4% patients are female and 70.6% are male. Lower facial scar in 24 patients, cervical scar in 8 patients, and Cervicofacial scar in 2 patients were observed. Ten patients had bilateral lower facial scars. Flame as the main etiology is observed in 47% of patients and boiling water in 26.5% of patients. The most popular flap is occipitocervico shoulder in 14 patients, and the second is occipitocervico pectoral in 12 patients based on occipital and supra clavicalar artery and pedicled axial flap based on transverse cervical artery in patients and as advancement flap in 8 patients. Advancement flaps were bilateral. The only observed complication is distal epidormolysis of flap which was managed conservatively in two cases. Postoperatively no blunting is considered at least in six months follow up. Cervicofacial angle refinement in flap transfer is an integral part of cosmetic operation in this area

[Evaluation of treatment techniques in finger tip injury during 3 years in 15 Khordad hospital, Shaheed Beheshti University]

Considering the massive number of patients referring to the emergency department of 15 Khordad hospital with finger tip injuries, we decided to statistically survey the treatment modality practiced and also the most prevalent finger involved and compare the results with that of referenced books. In the study 288 patients with finger tip injuries who were referred to 15 Khordad hospital in a period of 3 years were enrolled and treatment modality and the fingers involved were evaluated. 63% of the injuries due to trauma were treated conservatively, 21% by volar V-Y Advancement flap, 6% by kutler flaps, 6% by skin graft and the remining 9% with cross finger flap. The most common finger involved was the index finger. The selected treatment modality depended on the nature of injury and discretion of the surgeon, with due consideration to the published literature. The index finger however was the commonly involved finger, whereas the books refer to the middle finger as the common site of injury

Report a rare hemifacial atrophy-romberg disease

Romberg disease is a rare progressive disease with hemifacial atrophy of skin, soft tissue and bone. It was first described by parry in 1825 and later in 1846 by Romberg and in 1871 named as a progressive hemifacial atrophy by Eulenbery. First signs of this rare disease usually appear before the age of 20 and initially skin and subcutaneous parts are involved and later, there is muscle and bone involvement. In 95% of cases there is unilateral atrophy. Different theories are mentioned about the exact cause of this rare disease such as Rubeolla infection, trigeminal neuralgia, sclerodermia, cervical sympathetic anomaly, but the exact cause is not known yet. Progression of disease usually lasts between 2 to 10 years, but in some cases it takes longer. Treatment includes skeletal and soft tissue reconstruction, although in most of cases soft tissue rehabilitation is enough. The patient is a 20 year old woman who was suffering from atrophy of soft tissue and skull in the right frontal and parietal areas plus loss of eyebrow for the past 9 years. In biopsy skin and adnexal atrophyed was identified. The progression of disease ceased after 2 years and reached a steady state. The patient was a scheduled for tissue expander insertion in scalp area [left side] to expand hair full area and flap rotation and covering hairless area of scalp [right side]. In 2 steps operation minimal surgical scar with satisfaction of patient was achieved and this way may be an effective way for limited form of this disease

[ first report of aplasia cutis in Iran: unilateral preauricular localized skin atrophy]

The term aplasia cutis is used to describe congenital localized defects of the skin. The most common site is scalp. The preauricular location is a rare form of aplasia cutis. The presented patient in this paper had skin tag and atrophy in preauricular region from after birth. Skin biopsy was performed, but surgical wound site was not healed. The results of precise investigation, deep biopsy and existence of localized skin atrophy guided to aplasia cutis diagnosis. Aplasia cutis could be recommended in every patient with skin atrophy. The treatments include protection, excision and skin graft or flap