Effect of foam and liquid bleomycin in the management of venous malformations in head and neck region: A comparative study.

BACKGROUND: Many treatment options for venous malformations (VMs) have been documented in the literature, but injection sclerotherapy has been considered a current mainstay for their treatment. We conducted this study to determine the efficacy and durability of injection of different forms of bleomycin sclerotherapy in the treatment of VMs in the cervico-facial region. PATIENTS AND METHODS: Thirty patients with clinically diagnosed VMs of the head and neck region, confirmed by magnetic resonance imaging, had been injected with the bleomycin sclerosing material. They were divided into 2 groups according to the form of bleomycin injected: in Group A, the foam form was injected, and in Group B, the liquid form was injected. Data of patients' demographics, anatomical sites, type and volume of the VMs, number of injection sessions and the average dose of injected agents were documented and statistically compared between the 2 groups. RESULTS: MRI showed a decline of more than 90% from the initial size of the lesions in 66.7% of the cases and considerable decline (60-90%) in 33.3% of the cases. In Group A, the number of sessions and the amount of sclerosant material injected were lower than those in Group B. The cumulative dose in the equal-sized lesions was lower in the foam form than in the liquid form. CONCLUSION: We recommend using bleomycin in its foam form on a greater number of patients with larger VMs and in different sites, as the results are more promising in this form than in the liquid form.

Histological and Anthropometric Changes in the Aging Nose.

BACKGROUND: Rhinoplasty in the elderly requires different surgical approaches due to the morphological and structural changes affecting the nose over time. OBJECTIVES: In this study, the authors aimed to evaluate the age-related cellular and architectural changes of nasal cartilages and soft tissue attachments. METHODS: This prospective study included 80 patients who underwent rhinoplasty. Patients were divided into 2 groups according to age. Group I included 40 patients ranging in age from 19 to 39 years. Group II included 40 patients aged at least 40 years. Samples from nasal cartilages (upper lateral, lower lateral, and septum) and nasal attachments (interdomal, inter-cartilaginous, and septo-crural) were taken. All specimens were evaluated histologically to detect age-related changes. A modified version of the Mankin grading scale was used to score each nasal cartilage sample. All attachment samples were examined by image analysis for quantitative assessment. The results were correlated to preoperative anthropometric measurements of nasolabial angle and nasal projection. RESULTS: Histologically, in group II, the cartilage matrix showed fibrinoid degeneration with a significant decrease in the number of chondrocytes and increased perichondrial fibrosis compared with group I. Attachments in group II showed a lower number of blood vessels and decreased percentage of collagen bundles. Modified Mankin scores were significantly higher in group II, indicating weak cartilages compared with group I. There was negative correlation and significance between projection, nasolabial angle, cartilages, and attachments in study groups. The linear regression model revealed that the lower lateral cartilage is the cartilage that is most affected by the aging process. CONCLUSIONS: These findings not only enhance our current understanding of the natural changes that occur in the nose during aging but may also affect surgical decision-making when grafting or suturing are considered during rhinoplasty.Level of Evidence: 2.

Impact of nasalis muscle repair in unilateral cleft lip patients.

BACKGROUND: Although the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry. PATIENTS AND METHODS: A controlled prospective randomized study was conducted on 45 cases of unilateral complete pre-alveolar cleft. Patients were divided into two groups; Group 1 (repair of the Orbicularis muscle only), Group 2 was further divided into 2 subgroups: Subgroup A (repair of the orbicularis oris muscle and dissection and repair the origin of the nasalis muscle). Subgroup B (repair of the orbicularis oris muscle and dissection of both origin and abnormal insertion of the nasalis and repair of the origin). Evaluation was conducted both subjectively and objectively through cleft lip evaluation profile and nostril angles measurement. RESULTS: Group 2B patients showed significantly better shape and symmetry of nasal tip, size and symmetry of nostrils and size, form and lateral displacement of the ala. Objective evaluation showed that group 2B had the closest results to the non-cleft side, with statistically significant difference, when compared to other groups. CONCLUSION: Dissection and repair of both origin and insertion of nasalis muscle produced a nasal width, columellar height, and nasal tip projection close to the normal population of the same age.

Intra-Capsular Versus Extra-Capsular Breast Mastopexy of Previously Augmented Breast.

BACKGROUND: The augmented breast frequently becomes ptotic by time and most of the patients may seek mastopexy. Although the rate of breast lift surgeries after breast augmentation is increasing, there are few studies regarding the nature of these procedures. METHODS: Sixty patients with moderate grade ptosis and previously augmented breast by breast implants seeking breast mastopexy. Group A included 30 patients who underwent intra-capsular circum-areolar mastopexy and Group B including another 30 patients who underwent extra-capsular circum-areolar mastopexy. Follow up after complete healing was scheduled at 3, 6, and 12 months post-operative. Frontal and lateral views photography were taken each visit and objective evaluation was carried on by a plastic surgeon not involved in the surgeries. A questionnaire was performed by using the Likert scale to assess patients' satisfaction. RESULTS: In group A; the overall rate of complications was 17%, while in group B; the overall rate of complications was 10%. Patients of group A showed overall satisfaction of 4.53±0.69 in comparison to 3.06±0.25 in group B. In group A; objective evaluation, was excellent in 87% while in group B it was excellent in 43%. CONCLUSION: Reshaping of breast pillars mastopexy augmentation is very important to prevent bottoming-out of the breasts.

A New Septum in the Female Breast.

BACKGROUND: Understanding the female breast fascial system is of paramount importance in breast surgery. Little was written about breast ligaments. Most articles refer to Cooper's work without further anatomical studies. Lately, a horizontal septum has been described conveying nerves and vessels to the nipple areola complex. METHODS: During the surgical dissection of the lower part of the breast, in supero-medial technique for breast reduction operations, a fascial septum between the lower two quadrants was detected. This fibrous septum was studied through anatomic dissection of breast tissues during routine breast reshaping procedures that was done on 30 female patients. Magnetic resonance imaging (MRI) was performed preoperatively in all cases and correlated with the intraoperative findings. In the other five cases, outside the clinical study, the imaging was done during routine investigation for breast swellings. RESULTS: A vertical septum was identified in the lower part of the breast, lying at the breast meridian between the two lower quadrants. It is a tough bi-laminated structure that extends from the middle of the infra-mammary crease caudally to nipple-areola complex cranially and from the pectoral fascia posteriorly to the overlying skin anteriorly. This was proved by MRI findings. CONCLUSIONS: This study describes a new inferior vertical septum which separates the lower half of the breast into two definite anatomical compartments: medial and lateral.

Reconstruction of post-traumatic full-thickness defects of the upper one-third of the auricle.

BACKGROUND: Reconstruction of partial ear defects represents a difficult challenge to the plastic surgeon due to the delicate and intricate architecture of the chondrocutaneous sandwich of the external ear. METHODS: Fourteen patients with acute or previous traumatic subtotal loss of the upper one-third of the auricle were treated with autologous contralateral conchal cartilage graft and superficial temporoparietal fascia flaps. RESULTS: The symmetry of the reconstructed ears was satisfactory and the cosmetic appearance was acceptable for 13 patients. Minor hematoma at the conchal cartilage graft donor site occurred in one (7.1%) patient and marginal loss of temporoparietal flap in another (7.1%). Revision surgery was required for widening of the scar and obscuring of the upper pole contour in one (7.1%) patient. No additional complications were encountered. CONCLUSION: The authors recommend using this combined technique for reconstruction of full-thickness auricular defects.

HISTORIQUE: La reconstruction d'anomalies partielles de l'oreille pose un défi particulier au chirurgien plasticien en raison de l'architecture délicate et complexe du bourgeonnement chondrocutané de l'oreille externe. MÉTHODOLOGIE: Quatorze patients ayant subi une perte traumatique subtotale aiguë ou antérieure du tiers supérieur de l'oreille se sont fait traiter par une greffe du cartilage de la conque controlatérale autologue et des lambeaux superficiels de fascia temporopariétal. RÉSULTATS: Treize patients ont trouvé la symétrie de l'oreille reconstruite satisfaisante et leur aspect esthétique acceptable. Un patient (7,1 %) a présenté un hématome mineur au foyer de la greffe de cartilage de la conque et un autre (7,1 %), une perte marginale du lambeau temporopariétal. Un patient (7,1 %) a dû subir une opération de reprise pour élargir la cicatrice et occulter le contour du pôle supérieur. Aucune autre complication ne s'est produite. CONCLUSION: Les auteurs recommandent cette technique combinée pour la reconstruction des anomalies de toute l'épaisseur de l'oreille.

Incidence, etiology, and patterns of maxillofacial fractures in ain-shams university, cairo, egypt: a 4-year retrospective study.

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients' data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.

Fibrin sealant and lipoabdominoplasty in obese grade 1 and 2 patients.

BACKGROUND: Ever since lipoabdominoplasty was first developed to achieve better aesthetic outcomes and less morbidity, the rate of seroma formation, especially in obese patients, has disturbed plastic surgeons. The aim of this study was to evaluate the effect of fibrin sealant in the prevention of seroma formation after lipoabdominoplasty in obese patients. METHODS: Sixty patients with a body mass index (BMI) between 30 and 39.9 were assigned randomly to 1 of 2 groups (30 patients each). Group A underwent lipoabdominoplasty with fibrin glue, while group B underwent traditional lipoabdominoplasty; both had closed suction drainage applied to the abdomen. The patients' demographics and postoperative complications were recorded. Seroma was detected using abdominal ultrasound examinations at two postoperative periods: between postoperative days 10 and 12 and, between postoperative days 18 and 21. RESULTS: The age range was 31 to 55 years (38.5±9.5 years) in group A and 25 to 58 years (37.8±9.1 years) in group B, while the mean BMI was 31.4 to 39.9 kg/m(2) (32.6 kg/m(2)) in group A and 32.7 to 37.4 kg/m(2) (31.5 kg/m(2)) in group B. In group A, the patients had a complication rate of 10% in group A versus 43% in group B (P<0.05). The incidence of seroma formation was 3% in the fibrin glue group but 37% in the lipoabdominoplasty-alone group (P<0.05). CONCLUSIONS: Lipoabdominoplasty with the use of autologous fibrin sealant is a very effective method that significantly reduces the rate of postoperative seroma.

Moist occlusive dressing (Aquacel(®) Ag) versus moist open dressing (MEBO(®)) in the management of partial-thickness facial burns: a comparative study in Ain Shams University.

INTRODUCTION: The face is the central point of the physical features; it transmits expressions and emotions, communicates feelings and allows for individual identity. Facial burns are very common and are devastating to the affected patient and results into numerous physical, emotional and psychosocial sequels. Partial thickness facial burns are very common especially among children. This study compares the effect of standard moist open technique management and a moist closed technique for partial thickness burns of the face. PATIENTS AND METHODS: Patients with partial-thickness facial burns admitted in the burn unit, Ain Shams University, Cairo, Egypt in the period from April 2009 to December 2009 were included in this study. They were divided into two groups to receive either open treatment with MEBO(®) (n=20) or coverage with Aquacel(®) Ag (n=20). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections, time to total healing, frequency of dressing changes, pain, cost benefit and patient discomfort were compared between the two groups. The long-term outcome (incidence of hypertrophic scarring) was assessed for up to 6 months follow-up period. RESULTS: There were no significant differences in demographics between the two groups. In the group treated with the Aquacel(®) Ag, the mean time for re-epithelialization was 10.5 days, while it was 12.4 days in the MEBO(®) group (p<0.05). Frequency of changes, pain and patient discomfort were less with Aquacel(®) Ag. Cost was of no significant difference between the two groups. Scar quality improved in the Aquacel(®) Ag treatment group. Three and 6 months follow-up was done and long-term outcomes were recorded in both groups. CONCLUSION: Moist occlusive dressing (Aquacel(®) Ag) significantly improves the management and healing rate of partial thickness facial burns with better long-term outcome compared to moist open dressing (MEBO(®)).