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.

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.

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(®)).