The Effect of Lavender on Anxiety and Hemodynamic Status Before Septorhinoplasy and Rhinoplasty.

PURPOSE: Anxiety is one of the most common problems before surgery and surgery of the nose is one of the most concerning and challenging surgeries among the plastic surgeries. The aim of this research is to consider the impact of lavender fragrance on anxiety and hemodynamics status before the septorhinoplasty and rhinoplasty. DESIGN: Parallel randomized control trial. METHODS: This research was done by testing thirty-four candidates who were about to have the surgery in two groups of lavender (intervention) and control. The anxiety before and after surgery was examined by the Speilberger State Anxiety Inventory questionnaire and the hemodynamics status. For the analysis, the T- Test, Mann Whitney Test and the χ2 Test were used. FINDINGS: The demographic features of the two groups were similar. Anxiety after the experiment was meaningful. The obvious anxiety in the lavender category was 25.8% and the controlled group had that decreased to 1.8%. The latent anxiety was reduced by 24.3% in the lavender group and increased by 8% in the controlled group. The systolic, diastolic and the heart rate after the intervention was less in the lavender group. CONCLUSIONS: Due to the ease of the inhalation of lavender and the lack of any report for the existence of any kind of side-effects for the prevention of anxiety during nose surgeries, it can be suggested that this approach can be effective for the controlling of the consistency of the patients' hemodynamics.

Nasal Reconstruction by Expanded Forehead Scalping Flap: Case Report with Literature Review.

Nasal reconstruction is a difficult and complex surgery due to highlights and shadows of three-dimensional central structure of the face. Similarity of tissues, units-subunits, and invisibility of the scar are very important principles for reconstruction. In this case report, we present reconstruction of subunits of the nose by an expanded forehead scalping flap in a 12-year-old boy, whose tip and columellar subunits had been avulsed by a dog bite, in a hidden scar manner.

Choosing Appropriate Technique for Nasal Reconstruction in Challenging Cases of Panfacial Burn: Treatment Algorithm.

The nose is one of the most challenging facial parts to reconstruct. Its asymmetries, defects, or disharmonies are easily noticeable. The complex contours, highlights, shadows, and special shape of its subunits make nasal reconstruction more difficult in panfacial burn than that of nonburned ones. This retrospective study was conducted at Zare Hospital. Twenty-five panfacial burn cases with nasal defects were studied from 2010 to 2019. Profile photos were manipulated by Adobe Photoshop. Based on the difference between the burn-related shortened nasal length and the expected photoshopped one, the severity of the short nose was detected, and the strategy of the surgery was determined. Of the 25 cases, 10 cases with normal nasal length and projection, or mild short nose with minimal alar rim, tip and/or columellar defect underwent nasal reconstruction with skin and/or composite graft. Nine patients with normal nasal length or mild to moderate short nose but moderate to severe alar defect underwent reconstruction with turndown flap plus skin and/or composite graft. Pre-expanded forehead flap (n = 1) and delayed scarred or skin grafted forehead flap (n = 5) were used for six patients with severe short nose defect. There are several procedural alternatives for the reconstruction of burn-related mild to moderate nasal deformity. For severe and deep panfacial burn, delayed forehead flap seems safe with acceptable color and texture harmony. Our designed algorithm could potentially improve the selection of proper nasal reconstruction techniques and assist novice surgeons.

A case series of concomitant burn and COVID-19.

BACKGROUND: The recently emerged severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) has become a human pandemic. Heightened inflammation, vascular hyperpermeability, acute lung injury, coagulopathy, and cardiovascular abnormalities are among the SARS-CoV-2 infection-related complications. Major burn is also associated with metabolic derangements, vascular leak, and hemodynamic instability. Burn patients are at high risk for infections and developing sepsis. COVID-19 in burn victims might worsen the clinical outcome and make their medical management challenging. RESULT: Here, we present four cases of concomitant burn and COVID-19 with different degrees of complications. They had no (three out of four) or multiple (one out of four) baseline comorbidities and all were admitted to hospital for further management. Three out of four cases demonstrated acute respiratory failure and were intubated (no longer than 7 days). It seems that one of them had COVID-19 on arrival, the other apparently contracted at outside hospital, and the last two infected during the index hospitalization. CONCLUSION: Concomitant severe burn and COVID-19 might complicate the clinical presentation and hospital course. Such combination was associated with poor outcome in a case with baseline comorbidities, beyond what was expected from the severity of burn injury. However, a more comprehensive study with larger sample size is required to make a valid conclusion. With an ongoing COVID-19 global pandemic, SARS-CoV-2 infection might be a concurrent disease with other illnesses or traumas such as burn. This dictate multidisciplinary approaches to risk stratify, screen, assess, and manage coexisting diseases. Additionally, appropriate preparations and careful precautions need to be executed in burn units to prevent COVID-19 exposure and transmission to limit potential adverse outcomes.

Supero-Septum Pedicle Mammaplasty: A New Modification for Reduction Mammaplasty.

BACKGROUND: Many techniques have been introduced for reduction mammaplasty and are utilized in diverse frequencies by different surgeons according to patient needs. Each technique is evaluated based on the aesthetic result, longevity, complication rate, and preservation of the nipple-areola complex (NAC) sensation. OBJECTIVES: The authors sought to introduce the new modified technique of supero-septum pedicle mammaplasty (SSPM) that utilizes both the septum and superior pedicle and is suitable for macromastia and gigantomastia cases. METHODS: Between 2015 and 2018, 60 women who underwent SSPM were evaluated in a prospective study after undergoing superior pedicle deepithelialization and resection of the inferior, lateral, and medial segments. In the lateral pillar, a tongue of tissue was preserved for fixation to the medial pectoral fascia through a window created in the superior pedicle at the third intercostal space. Finally, septum pedicle was sutured to the fascia and muscle at the upper border of the sixth rib somewhat medially. Patients were followed up for a minimum of 13 months. RESULTS: The mean nipple-to-sternal notch (N-SN) distance was 33.05 cm, and the mean NAC elevation was 10.92 cm. Breast reductions varied from 270 to 2800 g per breast. Complications included wound dehiscence (5%), wound infection (2.5%), and partial NAC necrosis (2.5%). At 6 months postoperation, the NAC sensation was significantly better compared with preoperative values (P < 0.005). CONCLUSIONS: SSPM is a relatively safe method of reduction mammaplasty, even for very large breasts, that leads to good aesthetic form along with preserving circulation and sensation of the NAC.