Clinical decision support systems to optimize adherence to anticoagulant guidelines in patients with atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Clinical decision support systems (CDSS) have been utilized as a low-cost intervention to improve healthcare process measures. Thus, we aim to estimate CDSS efficacy to optimize adherence to oral anticoagulant guidelines in eligible patients with atrial fibrillation (AF). METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) with a 95% confidence interval (CI). PROSPERO ID: CRD42023471806. RESULTS: We included nine RCTs with a total of 25,573 patients. There was no significant difference, with the use of CDSS compared to routine care, in the number of patients prescribed anticoagulants (RR: 1.06, 95% CI [0.98, 1.14], P = 0.16), the number of patients prescribed antiplatelets (RR: 1.01 with 95% CI [0.97, 1.06], P = 0.59), all-cause mortality (RR: 1.19, 95% CI [0.31, 4.50], P = 0.80), major bleeding (RR: 0.84, 95% CI [0.21, 3.45], P = 0.81), and clinically relevant non-major bleeding (RR: 1.05, 95% CI [0.52, 2.16], P = 0.88). However, CDSS was significantly associated with reduced incidence of myocardial infarction (RR: 0.18, 95% CI [0.06, 0.54], P = 0.002) and cerebral or systemic embolic event (RR: 0.11, 95% CI [0.01, 0.83], P = 0.03). CONCLUSION: We report no significant difference with the use of CDSS compared to routine care in anticoagulant or antiplatelet prescription in eligible patients with AF. CDSS was associated with a reduced incidence of myocardial infarction and cerebral or systemic embolic events.

Modified Technique for Auricular Helical Rim Reconstruction in Adult Patients with Subtotal Helical Rim Defects.

BACKGROUND: In adults, the volume of costal cartilage is enough for reconstruction, but floating cartilage is hard, brittle, and easily broken due to calcification, in addition to being short, making it unsuitable for helical rim reconstruction in such age groups. AIM OF STUDY: This study describes a novel technique in which adult patients underwent 2-stage helical rim reconstruction using the syncytium of sixth and seventh costal cartilage. MATERIAL AND METHODS: A single-arm clinical trial involves 35 adults with total and subtotal helical rim defects, either congenital, post-traumatic, postburn, or postvascular malformation excision. Twenty-nine unilateral and 6 bilateral cases. The age of patients ranged between 19 and 40 years. In the period between April 2021 and April 2023. Follow-up was 6 months. RESULTS: There were no technique-related complications, such as broken helix. In most cases, scars were invisible, with the normal contour of helical rim. Among the 35 patients, 19 were graded as excellent, 13 as good, and 3 as fair. In objective photographic evaluation, all patients were evaluated with high (3 or 4) ratings; the score was 3 in 19 patients and 4 in 16 patients. All patients were satisfied with the size, contour, position and details of the new helix. CONCLUSION: Using the syncytium of the sixth and seventh costal cartilage to fabricate the helical rim in adult patients gives a suitable volume of cartilage graft as regards the length and width, which suits the reconstruction of the helical rim, and shows a good configuration with satisfactory surgical results.

Repurposing alagebrium for diabetic foot ulcer healing: Impact on AGEs/NFκB/NOX1 signaling.

BACKGROUND: Diabetic foot ulcer (DFU) is a common diabetic complication associated with disability and reduced quality of life. Available therapeutics are not sufficient to combat the spread of DFU. Here we aim to investigate the impact of alagebrium, an advanced glycation end product (AGE)-crosslink breaker, on the healing of DFU. METHODS: Diabetes was induced in Wistar rats by STZ, and after four weeks, wound was induced on the foot. Alagebrium (10 mg/kg) was administered orally for 14 days, and wound size was measured every 3 days. Behavioral tests i.e., hot plate and footprint tests, were performed to assess sensory function and gait. Blood was collected to assess HbA1c, serum AGEs, MDA and NOX1. Tissue was collected to assess histological changes and expression of NF-κB, iNOS, TNF-α, VEGF and EGF. In a subsequent set of experiments with similar design, alagebrium was applied topically as a film-forming gel. RESULTS: Systemic alagebrium treatment accelerated the healing of diabetic wound, improved sensory functions and gait, and ameliorated histological changes. It also reduced serum levels of AGEs, MDA and NOX1, and the tissue expression of NF-κB, iNOS, TNF-α, and increased VEGF and EGF in diabetic rats. Topical alagebrium led to similar beneficial effects i.e., accelerated diabetic wound healing, improved wound histological changes, reduced expression of NF-κB and iNOS and increased VEGF. CONCLUSIONS: Our findings suggest repurposing of alagebrium for the management of DFU to accelerate the healing process and improve the clinical outcomes in diabetic patients.

Short- and Long-term Outcomes of Percutaneous Coronary Interventions in Chronic and Non-chronic Total Occlusions: A Meta-analysis of 690,123 Patients.

The use of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still a subject of debate, with conflicting outcomes reported in different studies when compared to non-CTO lesions. This meta-analysis aims to clarify the clinical outcomes of PCI in CTO cases compared to non-CTO lesions, both in the short and long-term. PubMed, Scopus, Web of Science, Ovid, and Cochrane Central were searched until March 2023 for relevant studies addressing short- and long-term outcomes of PCI in CTO vs non-CTO lesions. Dichotomous data were pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random Der-Simonian lair effect model using STATA 17 MP. Eight studies with a total of 690,123 patients were included. In terms of short-term outcomes, CTO PCI was associated with higher rates of vessel perforation (OR = 2.16, 95% CI: 1.31-3.57) and cardiac tamponade (OR = 5.19, 95% CI: 4.29-6.28). Additionally, CTO PCI showed lower rates of procedural success (OR = 0.84, 95% CI: 0.73-0.96). Moreover, in the long-term, CTO PCI had higher rates of MACE (OR = 1.02, 95% CI: 1.01-1.04), however, it showed lower rates of cardiac death (OR = 0.61, 95% CI: 0.38-0.98), with no significant difference in other reported outcomes. Our findings underscore the challenges and adverse outcomes associated with using PCI to treat CTO lesions in the short term. This suggests that interventional cardiologists should carefully evaluate the risks and benefits before proceeding with PCI in CTO lesions.

Postoperative Psychological Impact on Teenagers after Gynecomastia Correction.

Gynecomastia is common among teenagers. Most published research focused on how surgery is effective in enhancing the aesthetic appearance of the breast. Limited information is already known about the psychosocial benefits of surgical interventions. This study explores and assesses the surgical, cosmetic, and psychological outcome of gynecomastia correction in teenagers. Methods: This prospective study included 20 teenagers with Simon grade IIA gynecomastia. The assessment included complications, patients' satisfaction, Manchester Scar Scale, and Li et al questionnaire at 12 months postoperative. Rosenberg Self-Esteem Scale, 36-Item Short Form Survey (SF-36) for quality of life, and school achievement level were evaluated 1 month preoperative and 12 months postoperative. Statistical analysis was done. Results: Patients were aged 13-19 years old. The follow-up period was 12 ± 36 months. Postoperative complications included seroma formation (n = 1) and mild asymmetry (n = 3). Results were "uniformly good to excellent" on a satisfaction scale. The Manchester Scar Scale shows the lowest score, which denotes the highest outcomes. The Li et al questionnaire showed a positive overall change. Comparing Rosenberg Scale scores pre- and postoperatively revealed higher scores postoperatively, which indicate higher self esteem. Comparing SF-36 pre- and postoperatively showed a significant increase in postoperative quality of life. Comparing school achievement pre- and postoperatively showed marked improvement postoperatively. Results were highly statistically significant. Conclusions: Surgical treatment of teenage gynecomastia is beneficial for different psychosocial domains. Pull-through of the mammary gland combined with liposuction provides satisfactory cosmetic results. Patients who underwent surgery reported a significant improvement in psychosocial load, better school achievement, higher quality of life, and better self-esteem.

Modified Reconstruction Technique to Adapt Management of Severe Group IIB Tanzer Constricted Ear Deformity.

Group IIB constricted ear is described as a deformity of helix, antihelix, and scapha (deficient upper third of ear). The length of the ear is markedly shortened, and the skin cover is insufficient to cover the cartilaginous framework after refashioning. The current study described certain modifications to the known autologous auricular reconstruction technique to adapt specific anatomical features of severe group IIB Tanzer constricted ear and reviewed the postoperative surgical outcomes and complications. It also evaluates the postoperative patient satisfaction. Methods: A prospective study includes 20 patients who underwent modified autologous reconstruction using costal cartilage for unilateral severe grade IIB constricted ears in the period between October 2018 and November 2021. Mean follow-up period was 6 months. Satisfaction was recorded using a questionnaire form 4 months after second-stage surgery. Results: Patients reported excellent (n = 14) and good (n = 7) results. According to a four-point Likert scale, the average aesthetic outcome score was 3.8. No complications were recorded, except in one patient who shows postoperative collection. The helix, concha, and lobule were the most satisfying parts to patients. The least pleasing subunit to patients was the antihelix. All patients were satisfied with the elevation of the auricle. They reported symmetry in size, shape, and position in 14 of 20 (70%) patients. Conclusions: Modified autogenous auricular reconstruction is useful in correcting severe group IIB Tanzer constricted ear deformities. Because it addresses all the anatomical features of this deformity, this technique is reproducible and reliable and has offered consistently effective results.

Segmentation of the 3D printed mirror image auricular model to ease sculpture of the costal cartilages in total auricular aesthetic reconstruction.

BACKGROUND: Recently, three-dimensional (3D) models have been used more frequently than the traditional two-dimensional (2D) models as an intraoperative guide to ease sculpture of costal cartilages in total auricular aesthetic reconstruction in cases of microtia. Usually, 3D imaging techniques are used to create compact ear models, however, there is insufficient clinical knowledge of using them to create segmented 3D auricular models for cartilage framework reconstruction. IN THIS STUDY: assessment of the advantages of segmentation of 3D models over the traditional compact 3D models in total auricular aesthetic reconstruction has been discussed. PATIENTS AND METHODS: In the current study, 16 patients who underwent total auricular aesthetic reconstruction using 3D models were included, patients were divided into two groups (Group I, 8 patients had total auricular aesthetic reconstruction using compact 3D printed mirror image model). Whereas (Group II, 8 patients had total auricular aesthetic reconstruction using segmented 3D printed mirror image model into auricular subunits. Then, each subunit was used for reconstruction of the corresponding part of the auricle. In both groups the patient's unaffected ear was mirrored and used as a reference to reconstruct the affected side. RESULTS: The results were evaluated in both groups. The overall operative and carving times were found to be less in Group II; Also, postoperative aesthetic outcome and patient satisfaction were favorable in this group. CONCLUSION: Using segmentation of 3D printed models in total auricular aesthetic reconstruction had less intraoperative time, better aesthetic results, and high postoperative patient satisfaction.

Comparison between platelet-rich plasma (PRP) and mechanically emulsified fat grafts in management of chronic wounds.

BACKGROUND: chronic wounds represent a challenge in treatment, due to diverse pathogenesis, resistance to ordinary treatment complex and lack of direct methods of treatment In this study, the aim is to compare the effect of Platelet -rich plasma (PRP) and mechanically emulsified fat grafts on the outcome of the healing process of chronic wounds. PATIENTS AND METHODS: In the current study, 30 patients with chronic wounds were divided into two groups (Group I, 15 patients had application of PRP on chronic wounds). Whereas (Group II, 15 patients had application of mechanically emulsified fat on chronic wounds). In both groups assessment of the healing rates and histopathological changes that were determined by observing the parameters of wound healing, including peri-lesional skin quality, observation of the wound size and depth, assessment of the pain indicated by Visual analog scale score. RESULTS: Patient were followed up for 6 months. Group II showed a better healing rate 64% in comparison to Group I 55%. Wound parameters and pain score were recorded in both groups with no statistically significant difference. CONCLUSION: Both PRP and mechanically emulsified fat grafts were found to be efficient treatment modalities in management of chronic "non-healing" wounds. But mechanically emulsified fat grafts represent a better treatment method for chronic wounds.

Evaluation of Ocular Residual Astigmatism in Eyes with Myopia and Myopic Astigmatism and Its Interaction with Other Forms of Astigmatism.

Purpose: To evaluate the prevalence, magnitude, and direction of ocular residual astigmatism (ORA) in eyes with myopia and myopic astigmatism, and its interaction with refractive, anterior corneal, posterior corneal, and true net power astigmatism. Patients and Methods: Refractive surgery candidates with myopia and myopic astigmatism were studied. Refractive astigmatism (RA) was measured using the Nidek® AR-310A autorefractometer. Anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), and true net power astigmatism (TNP) were measured using the Wavelight® Oculyzer II. Astigmatism was converted from polar to vector notation. ORA was calculated by vector subtraction of ACA from RA vertexed to corneal plane. Compensation factor (CF) was calculated as the ratio of ORA that compensates ACA for both J0 and J45. Results: 154 eyes of 88 patients (mean age 31.7±7.1 years) were included. With-the-rule (WTR) astigmatism was the most common for both RA (55.6%) and ACA (74%), while against-the-rule (ATR) was the most common for PCA (87.7%) and ORA (74.0%). The axes of RA and ACA were within 10° of each other in 46.8% of the eyes, and within 30° of each other in 76.0%. The mean difference in value between the axis of RA and ACA was 25.6°. 71.4% of eyes in the study had an ORA ≥ 0.5D, 44.1% had ORA ≥ 0.75D and 26% had ORA ≥ 1D. There was a statistically significant difference between ACA and each of RA and TNP. Using TNP to calculate ORA instead of ACA reduced its magnitude. RA is positively correlated to ACA and more strongly to TNP. The most common pattern of compensation between ORA and ACA was under-compensation for J0 (49%) and same-axis-augmentation for J45 (35%). Conclusion: ORA, PCA, and the interaction between ORA and ACA can affect results during refractive planning.

Effect of Dexmedetomidine in Sub-Tenon's Block on Emergence Agitation in Pediatric Strabismus Surgery under Sevoflurane Anesthesia.

Background: Numerous unfavorable complications may occur with strabismus surgery as emergency agitation (EA), oculocardiac reflex (OCR), postoperative pain, and postoperative nausea and vomiting (PONV). Aims: This study was designed to evaluate the dexmedetomidine effect in sub-Tenon's block on EA in strabismus surgery in the pediatric population under sevoflurane anesthesia. Design: This was a prospective randomized double-blind clinical trial. Patients and Methods: Eighty American Society of Anesthesiologists (ASA) Physical Status Class I and II pediatric patients, in an age group ranging from 2 to 8 years of either sex, had strabismus surgery under sevoflurane anesthesia using laryngeal mask airway. Patients were divided randomly into two groups (each = 40). Sub-Tenon's block is performed in the operated eye with 0.5% bupivacaine (0.08 mL.kg-1) alone in Group B (bupivacaine group), and with 0.5% bupivacaine (0.08 mL.kg-1) and dexmedetomidine (0.5 µg.kg-1) in Group D (dexmedetomidine group). Hemodynamics were monitored, and OCR was recorded. Furthermore, postoperative EA (Pediatric Anesthesia Emergence Delirium and Cravero Scales), pain (Face, Legs, Activity, Cry, and Consolability), and incidence of PONV were recorded as well. Statistical Analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 26). Results: The dexmedetomidine group exhibited a lower EA incidence, pain, and PONV as compared to the bupivacaine group. No statistically significant differences regarding hemodynamics, OCR, or emergence time were found between both the groups. Conclusion: The addition of dexmedetomidine to bupivacaine in sub-Tenon's block can alleviate postoperative EA and nausea and vomiting with better pain management and hemodynamic stability in pediatric strabismus surgery under sevoflurane anesthesia.

Viability of Fat Cells in Frozen Fat Tissue in Relation to Thawing Technique.

Damage of frozen fat, which will be used for retransplantation, is inevitable. Reuse of frozen fat requires a thawing process. No standardized method has yet been established for thawing frozen fat. Methods: Microscopic analysis of count and viability of frozen fat of 21 patients. Two fat samples from each patient were harvested and frozen at -20°C in a common commercial refrigerator for different freezing durations. Thawing of fat samples was done. There was one (3 mL) sample for each thawing technique; technique A included natural thawing at 25°C for 15 minutes, while rapid thawing at 37°C for 10 minutes in a water bath was included in technique B. Survival rates of adipocytes were assessed with trypan blue staining. Culturing of adipose-derived stem cells to assess their ability to divide was done. Relating survival rate of frozen fat to patients' age and to duration of freezing was done. Results were statistically analyzed. Results: The count of viable adipocytes is higher in technique A. Adipose-derived stem cells of frozen fat do not have the ability to divide in culture media. Viable adipocytes were higher in younger ages and in shorter freezing duration. Conclusion: Natural thawing is better in maintaining frozen adipocyte viability. Younger patients will benefit from frozen fat more than older ones. Duration of freezing should not exceed 7 months.

Retroposition of the Vestigial Cartilage in Patients With Microtia: A Novel Technique to Enhance Projection of the Reconstructed Ear.

BACKGROUND: The projection of the reconstructed auricle is an important step in ear reconstruction. The novel use of the vestigial cartilage can successfully replace the projection piece harvested from the costal cartilage, improve the three-dimensional contour of the reconstructed auricle, and help deepening of the concha, compensate for mastoid atrophy in patients with hemifacial microsomia. METHODS: A total of 34 patients with microtia were included and classified according to the Nagata classification. Anotia and atypical cases with deficient cartilage are excluded. Two-stage auricle reconstruction was performed. The first stage included retroposition of the vestigial cartilage, framework implantation and lobule transposition. After 3 to 6 months, the second stage was performed and included elevation of the reconstructed auricle and coverage by split-thickness skin graft. RESULTS: The results were satisfactory regarding the shape, symmetry, maintenance of the auriculocephalic angle, and stability of the reconstructed ear. The vestigial cartilage was classified into 3 different types according to its shape. Type 1(V1) cartilage is a sausage-shaped cartilage that can be directly used as a projection piece. Type 2(V2) cartilage is a flat-shaped cartilage that should be folded upon itself. Type 3(V3) cartilage is an atypical type where the cartilage does not have a specific shape. This type can be used as it is or reconfigured with sutures according to the amount of projection needed. Moreover, 87% of patients were satisfied with the appearance of their new ears, 90% of patients can wear their glasses or sunglasses, and 94% of patients can easily clean their new ear. CONCLUSIONS: According to the shape and amount of the available vestigial cartilage, it can be used as a projection piece either alone or with an augmentation piece from the costal cartilage.

Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties.

During smiling, the prominent action of nasal tip depressors (NTDs) antagonizes the rhinoplasty nasal tip support maneuvers and favors scarring forces' pulling the nasal tip in a less projecting vector. The NTDs' disinsertion is feasible through the open rhinoplasty approach. Yet, the reliability of the open approach to manipulate all NTD attachments is still questionable. The upper buccal sulcus approach (UBSA) is a reliable approach to manipulate variable anatomy of the NTDs. Methods: Thirty-two patients had primary open rhinoplasty between 2016 and 2020. All patients showed hyperactive NTDs during smile preoperatively. Through UBSA, disruption of NTDs was done. Aesthetic outcome was evaluated by comparing the pre/postoperative nasal tip projection (NTP) and nasolabial angle (NLA) in lateral views. Results: The sample included 28 women and four men, and the mean age was 30.7 years. The mean follow-up period was 23.8 months. Preoperatively, 53% (n = 17) of patients showed normal NTP measurements; this percentage increased to 87.5% (n = 28) postoperatively. The mean NLA for the 32 patients was 91.0 degrees preoperatively' which was increased to 102.5 degrees postoperatively. These aesthetic results were maintained throughout the follow-up period' with no significant increase in the incidence of complications. Conclusions: The combination of the UBSA with open rhinoplasty resulted in objective visualization and manipulation of the NTDs. This was proven by the maintained NTP and NLA in aesthetic optimum values throughout the follow-up period. We believe that UBSA can be safely combined with open rhinoplasty as a reliable hidden approach to manipulate hyperactive NTD cases.

Comparison of Refractive Outcomes in Small-Incision Lenticule Extraction Performed with One or Two Incisions.

PURPOSE: To retrospectively compare the refractive outcomes between two groups of small-incision lenticule extraction (SMILE), one with a single incision and the second one with dual-incisions. SETTING: Ebsar Eye Center, Benha, Qalyopia, Egypt. DESIGN: A retrospective cohort study. METHODS: This study was made up of two groups (162 eyes each): all eyes in group 1 had one SMILE cut at 120°, and all eyes in group 2 had double SMILE incisions, the first incision at 120° and the second one at 270°. Refractive outcomes between the two groups were compared at 3, 6, and 12 months after surgery. RESULTS: The mean preoperative refractive spherical equivalent (MRSE) was -5.75 ± 2.59 D and -6.38 ± 2.18 D in group 1 and 2, respectively (P = 0.73), and a cylinder of 1.25 ± 0.83 D and 0.75 ± 0.81 D, respectively (P = 0.85). At 12 months postoperatively, in group 1, 162 eyes (100%) achieved a UCVA of 20/25, 154 eyes (95.06%) achieved a UCVA of 20/20, and 110 eyes (67.90%) achieved 20/16. In group 2, 162 eyes (100%) achieved a UCVA of 20/25, 156 eyes (96.29%) achieved a UCVA of 20/20, and 113 eyes (69.75%) achieved 20/16. The mean MRSE at 12 months postoperatively was -0.25 ± 0.33 D in group 1 and -0.5 ± 0.33 D in group 2 (P = 0.62). CONCLUSION: Dual-incision SMILE is safe and effective as single-incision SMILE, with a predictable and stable effect in correcting myopia and myopic astigmatism.

A Staged Approach for Contouring of Temporal Deformities Using Porous Polyethylene and Lipofilling.

ABSTRACT: Many studies evaluated the effectiveness of a single reconstructive material during temporal cranioplasty, or in comparison to the outcome of another material. To our knowledge, no previous study evaluated a staged combination of reconstruction modalities during temporal cranioplasty. In a prospective interventional study, the authors combined high-density porous polyethylene (HDPP) implant insertion (stage I) with a following lipofilling session (stage II) in 8 patients scheduled for temporal cranioplasties. This two-staged approach was evaluated 6 months after each stage independently. The patients' satisfaction as regards the aesthetic outcome was evaluated through a 5-points Likert scale by the patients themselves. For every individual patient, this psychometric analysis was repeated by medical staff from other departments. Statistical analysis of the patients and medical staff satisfaction scores showed a statistically significant increase after the addition of lipofilling session (stage II) if compared to implant insertion only (stage I). Clinically, this outcome was maintained in a long-term follow-up ranged from 1 - 8 years. Nevertheless, 2 patients needed one more lipofilling session to obtain their satisfaction as regards the final aesthetic outcome. No other complications were recorded in this study. In conclusion, combining alloplastic and autogenous reconstruction modalities in a staged approach can suffice the reconstruction requirements for such temporal defects. After a long follow-up period, the insertion of high-density porous polyethylene implant with the addition of a following lipofilling session showed more evaluators' satisfaction in terms of the final aesthetic outcome.

Outcomes of Small Incision Lenticule Extraction with Dual-Incisions in Myopic Patients.

PURPOSE: To assess the stability, safety, predictability, and efficacy of small incision lenticule extraction (SMILE) with dual-incisions in myopic patients. SETTING: Ebsar Eye center, Benha, Qalyopia, Egypt. DESIGN: Single-center, retrospective, COHORT study. PATIENTS AND METHODS: The study was conducted as a retrospective non-comparative analysis of the records of 105 eyes of 53 patients treated by the SMILE with a dual-incisions technique for a mean spherical myopic error of -5.05 ± 1.93 D (range: -1.38 to -9.0 D) with or without astigmatism and the mean astigmatism of -0.90 ± 0.83 D. The mean LogMAR corrected distance visual acuity (CDVA) was -0.04 ± 0.07. RESULTS: One month after surgery, the mean refractive error was -0.03 ± 0.56 D (range: 0.88 to -1.50 D), and the mean postoperative astigmatism was 0.20 ± 0.31 D. The mean LogMAR UDVA was 0.07 ± 0.18 in the last follow-up visit, 12 months after surgery. At the end of the follow-up period, approximately 91.43% of patients had unchanged CDVA or gained one or more lines, 8.57% lost one line of CDVA, and 0.0% lost 2 lines. CONCLUSION: SMILE with dual-incisions is effective and safe, with a stable and predictable outcome for correction of myopia and myopic astigmatism.

In Vitro Comparative Study of Emulsified Fat Grafts.

Introduction: Fat grafting is considered one of the most precious armamentarium in the hand of plastic surgeons. The fat grafts consist of 2 components, adipocytes and stromal cells. The adipose tissue is a reserve of stem cells. Aim: The aim of this study was to compare the adipocyte and stem cell viability in both mechanically processed and enzymatically digested fats. Patients and Methods: This in vitro study was conducted using 40 specimens collected from 20 patients who underwent liposuction procedures. Twenty specimens were mechanically processed (group A), whereas the remaining specimens were processed enzymetically (group B). Results: There were no statistically significant differences between fat cell viability between the 2 groups. On the contrary, there was statistically significant increase in stem cells in mechanically processed fat specimens (P = .001). Conclusion: Both the mechanically and chemically processed fat techniques are reliable techniques that provide fat and stem cells. Mechanical processing is easier and provides more stem cells.

Supernumerary Nostril: Two Years Follow-Up.

Supernumerary nostril is a very rare congenital anomaly of the nose. Since the first patient reported by Lindsay in 1906, few number of patients were reported in the literature. Various types had been described with different surgical modalities for correction. It can be isolated or associated with other malformations such as facial cleft, esophageal atresia, and imperforate anus. Most of the patients are unilateral, but it may be bilateral. It may have a communication with a normal nasal cavity or not.In this study, the authors present a case of a 1-year-old male with a positive perinatal history of teratogen exposure had isolated supernumerary left nostril with communication to the nasal cavity.The authors will discuss different theories related to supernumerary nostril development, differences between published reports, the proposed surgical techniques, and the outcome of their treatment approach.

The Subunit Principle in Scar Face Revision.

Facial scaring is considered one of the most difficult cosmetic problems for any plastic surgeon to solve. The condition is more difficult if the direction of the scar is not parallel to relaxed skin tension lines. Attempts to manage this difficult situation included revisions using geometric designs, Z plasties or W plasties to camouflage the straight line visible scaring. The use of long-lasting resorbable sutures was tried too. Recently, the use of botulinum toxin during revision improved the results. Fractional CO2 lasers, microfat grafts, and platelet-rich plasma were added to the armamentarium. The scar is least visible if placed in the junction between the facial subunits. The aim of this study is to investigate the use of the subunit principle to improve the results of scar revision. Four patients were included in this study. Tissue expansion of the intact part of the subunit allowed shifting the scar to the junction between the affected subunit and the adjacent one. Tissue expansion, delivery of the expanders, and advancement of the flaps were successful in all patients. The fact that this is a 2-stage procedure and sacrifices some of the intact skin from the affected facial subunit, makes this technique reserved to patients with ugly facial scars who are ambitious to improve their appearance.

Reconstruction of Moderately Constricted Ears by Combining V-Y Advancement of Helical Root, Conchal Cartilage Graft, and Mastoid Hitch.

OBJECTIVE: Despite the multitude of corrective procedures described in the literature, adequate surgical correction of the congenital constricted ear remains a challenge. The maintenance of the shape and size of the reconstructed upper neohelix poses a particular problem. METHODS: In the present study, a total of 12 cases of reconstruction were undertaken. All of them were moderate (type IIA Tanzer classification) deformities. A combined procedure was adopted using a V-Y advancement of the helical root, cartilage scoring, and cartilage grafting from the contralateral concha to reconstruct the upper helix. A mastoid hitch was used as an adjunct to these procedures to maintain helical elevation and prevent recurrence. Mean follow-up period was 6 months. RESULTS: RESULTS were excellent (n = 7), good (n = 4), and fair (n = 1). Paired t test showed a significant increase in the height of the constricted ear postoperatively (P < .001) and a nonsignificant difference between the height of the constricted and contralateral ears postoperatively (P > .05). Apart from dislodgment of the mastoid hitch suture in 1 patient, no complications were recorded. CONCLUSION: This combined technique is useful in correcting moderately constricted ear deformities.