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.

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.

Ileocecal valve atresia: introduction of a new surgical approach.

Ileocecal valve atresia is a very rare anomaly with only a few cases reported in the literature. The conventional therapy includes ileocecal resection and ileocolic anastomosis. Here, we present a patient with inborn ileocecal valve atresia in whom we successfully preserved the ileocecal valve and the terminal ileum through opening a valve and tapering the ileum in one operation.