Comparison of the Application of Allogeneic Fibroblast and Autologous Mesh Grafting With the Conventional Method in the Treatment of Third-Degree Burns.

Wound healing is a multipart process involving different cell types and growth factors. Third-degree burns are usually treated by early excision and skin grafting. Tissue engineering has been developed in this field in response to limitations associated with autografts. Allogeneic fibroblasts on meshed split thickness skin grafts (STSGs) are known to have useful properties in wound healing and can be used to construct a new model of living skin substitute. Fourteen patients were chosen from June 2009 until December 2010 as the sample for this study. After debridement and wound excision, meshed STSG was used to cover the entire wound. Alloskin (allofibroblasts cultured on a combination of silicone and glycosaminoglycan) was applied on one side and petroleum jelly-impregnated gauze (Iran Polymer and Petrochemical Institute) was applied on the other. The healing time, scar formation, and pigmentation score were assessed for the patients. All analyses were undertaken with SPSS 17 software. Alloskin demonstrated good properties compared to petroleum jelly-impregnated gauze. The average healing time and hypertrophic scar formation were significantly different between the two groups. In addition, the skin pigmentation score in the alloskin group was closer to normal. Alloskin grafting, including fibroblasts on meshed STSG, may be a useful method to reduce healing time and scar size and may require less autologous STSG in extensive burns where a high percentage of skin is burned and there is a lack of available donor sites.

Introduction of a potent single-donor fibrin glue for vascular anastomosis: An animal study.

BACKGROUND: Vascular anastomosis is considered as a difficult surgical procedure. Although different alternative methods have been tried to tackle these difficulties, none were found to be successful. Commercial fibrin glue has recently been used for vascular anastomosis. However, it did not gain popularity due to some limitations such as low tensile strength, rapid removal by the immune system, and risk of transmission of blood-borne viral infections. In this article, we presented a novel method for producing single-donor human fibrin glue and determined its success rate for vascular anastomosis in an animal model. MATERIALS AND METHODS: [corrected] In this study, 3 mL of single-donor fibrin sealant was prepared from 150 mL of whole blood containing 50-70 mg/mL of fibrinogen. The study was performed on 10 dogs and 5 cats. After transection of the carotid artery, both ends were anastomosed by means of 3-4 sutures (Prolene 8-0). The suture line was then sealed with one layer of the new fibrin sealant. After 3-8 weeks, the site of anastomosis was evaluated angiographically and morphologically for healing and possible complications such as thrombosis or aneurysm. RESULTS: In evaluations 3 weeks after the surgery, all arterial anastomoses were patent in dogs, but some degree of subintimal hyperplasia was noted. After 8 weeks, all anastomoses were patent and the degree of subintimal hyperplasia was decreased. In cats on the other hand, after 4 weeks, all anastomoses were patent and subintimal hyperplasia was absent. CONCLUSIONS: Single-donor fibrin glue was a quite reliable and practical alternative to minimize suturing and therefore operative time in our animal model. This sealant can easily be obtained from the patient's whole blood. Its application in humans would require further studies.

Supraclavicular flap: reconstructive strategy for massive facial arteriovenous malformations.

Arteriovenous malformations (AVMs) are uncommon errors of vascular morphogenesis. Hemodynamically, they are high-flow lesions. Approximately 50% of AVMs are located in the craniofacial region. The successful treatment of vascular anomalies depends on the profound knowledge of the biologic behavior of vascular lesions and their correct classification. Vascular malformations that persist lifelong require treatment in most cases, especially when clinical symptoms occur. On the basis of individual parameters such as the diameter, location, or growth behavior, different therapeutic options such as cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgical intervention, and/or embolization can be performed successfully. Subtotal excision or proximal ligation of the feeding vessel frequently results in rapid progression of the AVMs. Hence, the correct treatment consists of highly selective embolization (superselective) followed by complete resection 24 to 48 hours later. Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly fasciocutaneous flaps and skin grafts, to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. The supraclavicular flap has been used successfully for difficult facial reconstruction cases, providing acceptable results without using microsurgical techniques. We treated 2 patients with facial AVM by this method. Both of the lesions were located within the cheek and lip. There were no procedure-related complications, and the cosmetic results were excellent.

Surgical treatment of metopic synostosis.

Metopic synostosis is characterized by keel-shaped forehead (trigonocephaly), prominent midline ridge of the forehead, bitemporal narrowing, bilateral retrusion of supraorbits, egg-shaped orbits, low nasal dorsum, and reduced volume of the anterior cranial fossa. The mainstay treatment is early surgical intervention before the age of 12 months, which usually consists of bifrontal craniotomy with bilateral recontouring, lateral advancement, and lateral displacement of the superior orbital rims. Here, we have developed a new simplified technique for surgical treatment of trigonocephaly. A total of 60 cases of trigonocephaly were operated on between January 1995 and January 2010 by the first author. Surgical outcomes were evaluated 6 months after surgery using postoperative photographs and clinical examination notes, and scaling was made using the Whitaker classification. The evaluation showed that 85% of them were in class I, 11.6% were in class II, and 3.3% were in class III. No case was in class IV. Only the last 10 cases received the new surgical technique, and all were in class I. Complication rate was 38.3% for all cases and was only 20% for the last 10 cases, that is, the new technique group. Revision rate for trigonocephaly surgery was 13.3%, and the most common reason was hardware removal. None of the patients from the new technique group underwent revision surgery. We believe that our new technique is fast and easy, can provide sufficient bone graft, and is more useful for older patients (>1 y). Early postoperative results have been promising.

Unusual presentation of peripheral primitive neuroectodermal tumor of the maxilla.

The peripheral primitive neuroectodermal tumor (pPNET) is a rare and highly malignant soft tissue neoplasm in children and young adults. Fewer than 10 reported cases of pPNET of maxilla are available in the English literature. A 28-year-old woman was presented with the pPNET of the maxilla and metastasis. Two years after diagnosis, she experienced diplopia, and then magnetic resonance imaging was done, which showed a mass in the optic chiasma and parasellar region. The typical appearance resembled large noncalcified soft tissue masses in the magnetic resonance image and computed tomographic scan of the maxilla. Diagnosis was established by immunohistochemical features. She was treated with surgery, chemotherapy, radiation therapy, and gamma knife. She was under close observation since then (approximately 8 mo), and there has been no recurrence of tumor up to now.

Bilateral tunneled supraclavicular island flaps for simultaneous reconstruction of massive facial defect and intraoral lining.

Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. The supraclavicular island flap has been used successfully for difficult facial reconstruction cases, providing acceptable results without using microsurgical techniques. As a complementary study to the publication by Heitland and Pallua (Plast Reconstr Surg 2005;115:1591), we report our preliminary clinical experience with bilateral tunneled supraclavicular island flaps for simultaneous reconstruction of massive facial defect and intraoral lining in massively progressed invasive squamous cell carcinoma of the lower lip with severe intraoral extension. This thin flap is easy and quick to harvest, has a reliable pedicle, and has minimal donor-site morbidity. It is now the authors' flap of choice for many common head and neck reconstructive problems.

Epinephrine's effect in varying concentrations on the end artery organ in an animal model.

OBJECTIVE: To determine the concentration of epinephrine that causes end artery necrosis and ischemia. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Animal Laboratory of Khordad Hospital, Tehran, Iran, from September 2007 to June 2008. METHODOLOGY: This study was done on 54 ear flaps from 9 rabbits [9 (rabbits) x2 (ears) x3 (splits) =54] divided into three groups of 18 ear flaps each. Nine of the ear flaps were randomized as control and nine of them were randomized as study group. The different concentrations of epinephrine and lidocaine 1% were injected in study groups but only 1% lidocaine was injected in control groups. Study group 1 received 1/200000, group 2 received 1/100000 and group 3 received 1/500000 concentration of epinephrine respectively. RESULTS: There was no evidence of necrosis in the control and study groups 1 and 2. However, 4 out of 9 of the ear flaps showed clear evidence of tissue necrosis in group 3. CONCLUSION: Injecting epinephrine in 1/200000 and 1/100000 concentrations had no side effect for the end artery of the rabbit ear flaps, but 1/50000 concentration is shown that it can cause tissue necrosis. Further studies need to be done in order to find out the effects of epinephrine with the same concentrations on the human end artery.

Rhinometry: an important clinical index for evaluation of the nose before and after rhinoplasty.

BACKGROUND: Preoperative planning and postoperative outcome assessment in rhinoplasty are important. For preoperative planning, some standard relationships are defined and evaluated primarily with standard photographs, but photographs do not necessarily reflect reality. Outcome assessment, on the other hand, is mostly subjective, and again, even photographic analyses may not address real changes after rhinoplasty. METHODS: "Rhinometry" is introduced as a clinical method for preoperative evaluations and postoperative judgments, and rhinometric parameters are defined. Measurements of these parameters were performed for 300 patients before rhinoplasty and in the follow-up visits 3 months postoperatively. RESULTS: Preoperatively, the nasal length and tip projection for most patients were more than ideal. There was moderate reduction in nasal length (mean, 9.21 mm) and a decrease in tip projection (mean, 3.34 mm) for the majority of the patients after rhinoplasty. Reductions in nasal length, tip projection, bony base width, alar base width, and alar base width during a smile were statistically significant. Patients who underwent surgery using the closed approach had significantly more reduction in nasal length and less reduction in tip projection. All the patients were satisfied with these pre- and postoperative data. Rhinometry changed the ideas of the authors about some changes that their operative approaches produce. CONCLUSIONS: Rhinometry can change the ideas of plastic surgeons about the changes their operative approaches accomplish and can be a very useful guide for patients. It is recommended as a part of the pre- and postoperative physical examination of patients undergoing rhinoplasty.