Use of FACIAL ARTERY MUSCULOMUCOSAL and Turbinate Flaps for Rapp Hodgkin Syndrome.

Rapp Hodgkin Syndrome (RHS), is a subtype of Ectodermal Dysplasias (EDs), which has various manifestation. Here, we report a case on repair of the palatal cleft in an 18 year old girl, having RHS, with combination of facial artery musculomucosal (FAMM) flap and inferior turbinate flaps (ITF), at Hazrat Fatima Hospital, Tehran, Iran in 2021.

Underestimated Craniomaxillofacial Fractures Due to Firework.

BACKGROUND: Iranian people celebrate the last Wednesday of the year also known as Chahar Shambeh Soori (CSS) using low explosive pyrotechnics classified as fireworks. Mishaps and accidents are common and maxillofacial fractures may occur which have a negative impact on the quality of life. This study aimed to assess maxillofacial fractures (fx) caused by explosive agents. METHODS: This cross-sectional descriptive study assessed 283 patients suffering maxillofacial fxs caused by explosive agents during CSS ceremonies between 2009 and 2019 referred to our craniomaxillofacial (CMF) surgery center. The data assessed included age, sex, cause, type, site, and severity of injury, fracture patterns, treatment modalities, and complications. All maxillofacial injuries were evaluated and treated by Craniomaxillofacial staff surgeons. RESULTS: Among 283 patients, 72.8% (206) and 27.2% (77) were men and women, respectively. The mean age of patients was 17.35 years. The most common maxillofacial fracture was in the mid-face; with the distribution of fractures being: 39.9% zygomatic fractures, 32.1% nasal bone fractures, 63.2% dentoalveolar fracture, 43.1% Le Fort (Le Fort I, Le Fort II, Le Fort III), 31.4% orbital, and 43.1% mandible fractures. The most frequent type of treatment was Open Reduction and Internal Fixation (ORIF) (77.4%). CONCLUSION: The most common site of maxillofacial fractures and most frequent treatment used were similar to military or ballistic injuries. ORIF was common treatment.

Pregnancy and burns: Guidelines for safe management.

BACKGROUND: IThe incidence of burns in pregnancy is very low, therefore little is confirmed in the specific management of pregnant women who are burned. PURPOSE: We conducted a study to survey the frequency of pregnancy in our patients and evaluate the risk factors of mortality for mother and foetus. Finally we provide recommendations about management of mother and child. MATERIALS AND METHODS: Retrospectively, we surveyed data of our pregnant patients for an 18 year period. All demographic data, gestational age, history of previous pregnancy or miscarriage, diabetes, suicide, number of operations, presence of inhalation injury, TBSA, percentage of burn in abdomen and lower extremity, early excision and outcome of mother and foetus were gathered in a special questionnaire. Uni-variate regression and multi-variate regression were done for mortality of mother and child. RESULTS: We treated 89 pregnant patients. Mean (SD) of mother's age and their pregnancy age were 24.08±5.56 years and 19.18±9.24 weeks, respectively. Mean TBSA (SD) was 36 (18%). Median of TBSA was 38 (IQR: 25, 70). Median of TBSA in Abdomen was 8 (IQR: 7, 9). Median of TBSA in lower extremities was 18 (IQR: 9, 34). Nine cases were due to attempted suicide. For 34 patients skin grafting was done. The main cause of death of the mothers was sepsis. The infections were due to Pseudomonas aeruginosa, Acinetobacter, E. coli, Klebsiella and Staphylococcus. In uni-variate regression model, TBSA, gestational week, and burns involving the abdomenwere related to maternal mortality. In multi-variate regression model, TBSA had high influence on maternal mortality, with every percent of burn surface area, the risk of mortality increased by 3.4% (p-value <0.005). In a uni-variate regression, TBSA and abdominal burn was associated with foetal mortality. However, in the multi-variate regression, only inhalation injury and TBSA had association with foetal mortality. Inhalation injury increased foetal mortality up to 16 times (p-value <0.05). CONCLUSION: TBSA burned is the only major risk factor of maternal mortality. TBSA burned and inhalation injury are the main risk factors of foetal mortality.

Histopathological Changes of Organs (Lungs, Liver, Kidney, and Brain) After Using Two Types of AgiCoat and Acticoat Nanosilver Dressings on Deep Second-Degree Burn in Rat.

Prevention of infections is a very important issue in treating the burn wounds. The nanosilver dressings have many promising advantages, but absorption of silver ions and its adverse effects to the body were always a question. The aim of this study was to compare Silver serum levels and acute toxic effects of nanosilver on histopathology of organs (lungs, liver, kidney, spleen, and brain) in two types of AgiCoat and Acticoat (nanosilver) dressings on second-degree deep burn in rat. This is an experimental study conducted in our animal laboratory. We divided 24 Sprague-Dawley male rats weighing 300 to 350 randomly into two groups. After anesthesia, a second deep-degree burn was made over dorsal skins of rats by standard method. For group A, Agicoat and, for group B, Acticoat dressings were used. The dressings were changed every 3 days with AgiCoat and Acticoat, respectively. After 14 days, we got blood samples and tissue samples taken from heart, liver, kidneys, spleen, lungs, and brain and a sample from dorsal skin of the rat for histopathological examinations. The results showed that the levels of serum silver in both groups were significantly higher than the standard level (1.22 part per million (PM); AgiCoat, P = .017; Acticoat, P = .000), but there was no significant difference between the groups (P = .551). Examination of the relationship between the level of serum silver and histopathological changes in liver showed that hepatotoxicity of AgiCoat was higher compared with Acticoat and the difference was significant (P = .002). There were no pathological changes in brain, kidneys, spleen, heart, and lungs. Wound healing was faster in Acticoat group. The nanosilver dressings can cause toxicity in liver but not in kidney, brain, spleen, heart, and lungs. Liver pathology and hepatotoxicity were more prominent in AgiCoat group. Wound healing was faster in Acticoat group.

Tissue expanders; review of indications, results and outcome during 15 years' experience.

BACKGROUND: Tissue expanders (TE) are frequently used worldwide. In this study we surveyed outcome of our patients retrospectively during 15 years. MATERIALS AND METHODS: We had 1105 patients for whom 3059 TEs have been used. Demographic data, age, sex, indications, type of tissue expander devices, volume of devices, site of scar and site TE insertion, our technique for tissue expander insertion and flap design, complications and outcome were gathered. A complete and through technical points and tips will be discussed. RESULTS: In 91% of patients overexpansion was done. (Expansion ratio=2.1-4.5). Re-expansion has been done in about 12% of patients. Complications were perforation of skin of pocket (11%) or exposure, infection (6%), dehiscence of the wound (1.5%), perforation of the port or disconnection of the tubes (2.1%), expansion of the scar itself (1%), saggy flap (3%), dog ear (5%), lack of adhesions of flap to its new site (4%). OUTCOME: In 93% of the patients we could totally remove the scar. Around 9.1% of our patients had two sessions of expansion in the same area and 2.9% had three sessions of expansion. 51% of our patients were highly satisfied and 42% were satisfied of the results of expansion. CONCLUSION: Our patients were satisfied with the results. In 12% cases we have done re-expansion. Re-expansion is possible as long as you have enough thickness of dermis in the skin. More than 50% of our patients were optimistic for 2nd or 3rd session of re-expansion.

Unilateral Buccinator Flap for Lengthening of Short Palate.

BACKGROUND: Velopharyngeal insufficiency is one of the most frequent complications after cleft palate repair. PURPOSE: To evaluate the results and complications of unilateral Buccinator flap (BMF) in velopharyngeal insufficiency. MATERIALS AND METHODS: During 4 years the authors performed unilateral BMF in all short palates. Age, sex, demographic data, length of palate, cause of short palate, nasopharyngoscopy and videofluroscopy results, hyper nasality, nasal escape, nasal emission, nasal fluid leak, speech evaluation and results, outcome and complications of the treatment were surveyed before surgery and in 1, 3, 6 months after treatment. RESULTS: The authors had 43 patients, 29 below 8 years old and 14 adults. Velopharyngeal gap was between 10 and 27 mm, mean 21 mm. Buccinator flap were measuring 15 to 19 mm in width and 32 to 56 mm in length. The operation time was 80 to 100 minutes, mean 86 minutes.Nasal emission, nasal escape, and nasal leak were treated in all patients.Hyper nasality was completely improved in all of the patients below 8 years old (29 patients) and in 10 patients of the adults (totally 39 patients, 90.6%). And it was improved significantly in other 4 patients (9.4%). The speech evaluation reported between 70% and 86% improvements.The lengthening of the palate was between 12 and 19 mm, mean 17 mm.The satisfaction of the patients was as 0% poor, 2.3% fair, 72.1% good, and 25.6% excellent. CONCLUSION: Unilateral BMF is reliable, promising, and safe flap for lengthening of short palate and it can lengthen the palate up to 19 mm. The time of surgery is very short compared with other methods. It is an anatomical treatment versus pharyngeal flap which is not an anatomical one. Speech improvement will achieve in 70% to 86% patients.

Economical Burden of Burn Injuries in a Developing Country.

Burn injuries have economical impacts on patients in several ways. Understanding the charges of burn treatment is very important for patients, families, governmental authorities, and insurance companies. During the protocol of their treatment, they may be admitted several times for treatment of acute burn and then for reconstructive treatments of burn's complications. Calculating the hospital burn charges can serve as an objective criteria for authorities to plan for a sufficient budget for acute burn treatment, for additional management for chronic complications, and as a guide for planning preventive and public educational programs. The authors used data of their burn registry program. During more than 3 years, the authors had 912 patients with multiple admissions for burns. All of hospital costs during several admissions were recorded. Men were 71% and women were 29% of the patients. Burns caused by flame were the most frequent (50.1%) followed by scald (34.0%). Mean hospital stay was 14.1 days (range, 0-64 days). Patients with TBSA equal to or less than 10% were 38.8%, TBSA between 11 and 22% were 29.1%, and TBSA more than 23% were 32.1%. Those who were admitted for 30 days or less were 34.1%, those between 31 and 131 days were 32.7%, and those with more than 132 days of admission were 33.2%. Mean hospital cost for all patients during the 3 years was about $2766 (range, from $143 to $33,566; median = 1586.93; SE = 93.84). The patients were admitted for treatment of acute burns and later admitted for reconstruction of the burn sequels. Total number of admissions was up to six times (median = 2). About 66.27% of the total charges were the cost of first admission, 19.39% the cost of second admission, 7.34% the cost of third admission, 3.56% for fourth admission, 2.3% for fifth admission, and 1.15% for last or sixth admission. The authors conducted a multiple linear regression test. Male sex, TBSA, length of stay, and number of admissions were significantly related to total treatment charges. But "age" did not influence the charges. Mean total cost of several burn admissions in one patient was around $2766. TBSA, length of stay, male sex, and number of admissions were significantly related to the hospital costs.

Why burn patients are referred?

BACKGROUND: Many burn patients are needed to be referred to a tertiary burn hospital according to the American Burn Association (ABA) criteria. The purpose of this study was to verify the reasons for referring of the burn patients to the hospital. MATERIALS AND METHODS: For 2 years, we prospectively surveyed the burn patients referred to a tertiary teaching burn hospital. Data for the following variables were collected and analyzed with SPSS software V21.0: causes of burn; age; gender; total body surface area (TBSA) measured at the referring center; TBSA measured at the receiving center; concomitant diseases and traumas; the reason for referral; condition of patients before and during the transportation; transportation time; presence of infection; presence of inhalation injury, electrical injury, and chemical injury; child abuse; insurance coverage; and results and outcomes of patients. RESULTS: A total of 578 burn patients (33.6% of the total admissions) were referred in the study period. Among these patients, 70.9% were females. The mean (SD) age of the patients was 35.3 (19.69) years. The mean (SD) of TBSA was 45.2 (26.3). Of the 578 patients, 45% were referred by request of the family or patients; 9% were referred because lack of diagnostic facility, approximately 43% were referred because of the need to be admitted in a tertiary burn center, 0.7% were referred because of a lack of capacity at other hospitals, and 0.5% were referred because of an error in the estimation of TBSA. CONCLUSIONS: A total of 45% of the referrals were by request of the family and patients. Tele-medicine may help to establish a direct contact between expert burn physicians and the patients and thus reduce unnecessary transfers. Approximately 9% of the referrals were because of lack of some diagnostic facilities.

The Body Image Dissatisfaction and Psychological Symptoms among Invasive and Minimally Invasive Aesthetic Surgery Patients.

BACKGROUND: Elective aesthetic surgeries are increasing in the Iranian population with reasons linked to body image dissatisfaction and psychological symptoms. This study compared the body image dissatisfaction and psychological symptoms among invasive and minimally invasive aesthetic surgery patients and a control group. METHODS: Data from 90 participants (invasive aesthetic surgery=30 Ss, minimally invasive aesthetic surgery=30 Ss, and control group=30 Ss) were included. Subjects were assessed on body image dissatisfaction and psychological symptoms to provide an evidence for a continuum of body image dissatisfaction, anxiety, depression and interpersonal sensitivity in invasive and minimally invasive aesthetic surgery clients. RESULTS: Between the three groups of invasive, minimally invasive aesthetic surgeries and control on body image dissatisfaction and psychological symptoms (anxiety, depression and interpersonal sensitivity), there was a significant difference. CONCLUSION: These findings have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions at first step.