Effectiveness of ultrasound-guided rhomboid intercostal and sub-serratus block for perioperative analgesia in male patients undergoing combined power-assisted liposuction with pull-through excision of the gland for breast definition and reshaping.

BACKGROUND: The newly introduced ultrasound guided interfacial rhomboid intercostal and sub-serratus (RISS) block technique demonstrated promising efficacy in managing perioperative pain among patients undergoing abdominal and thoracic procedures. Thus, this study investigated the efficiency of bilateral ultrasound-guided RISS (US-RISS) as a perioperative pain control technique in male subjects receiving gynecomastia surgery. METHODS: This prospective randomized study involved sixty patients who underwent gynecomastia surgery. Individuals were randomly divided into two groups: the RISS group (N.=30) and the control group (N.=30). After anesthesia induction, the patients received bilateral US-RISS using 40 mL of 0.25% levobupivacaine, or conventional intravenous analgesia with no intervention, respectively. The primary outcome was the overall morphine consumption in 24 hours, and the secondary endpoints involved the time elapsed till rescue analgesia was requested, the quality of recovery after 24 hours and side effects' incidence. RESULTS: Morphine consumption was noticeably decreased in the RISS group compared to the control group, with 14.07±4.91 mg and 35.83±1.70 mg mean values, respectively (P<0.001). Furthermore, in the RISS group, the initial rescue analgesia request occurred significantly later than in the control group, with mean values of 15.58±1.41 hours and 0.96±0.63 hours, respectively (P<0.001). Additionally, within the RISS group, there was a high quality of recovery observed, with a low incidence of opioid-related adverse events in comparison to the control group. CONCLUSIONS: Bilateral US-RISS block is a beneficial intervention in gynecomastia surgery for pain management and improves the quality of recovery.

Forearm Granular Cell Tumor: A Rare Entity.

Granular cell tumors are uncommon benign masses. They occur rarely and are usually solitary, nontender lesions, with a tendency to occur in the head and neck region and a predilection for the tongue. A malignant variant is even less common. To date, its origin remains uncertain. We report the case of a 19-year-old Egyptian man who presented to the Kasr eini Plastic Surgery Clinic with a swelling on the posterior aspect of his right forearm. After surgical excision and histopathological examination, it was found to be a granular cell tumor. This finding was of interest because of the rarity of the neoplasm in general, but in particular because of the scarcity of its occurrence in this anatomic location and the patient's sex, and age group.

The Use of Multifilament Suture for SMAS Plication in Rytidectomy.

Background: In the public's mind, rhytidectomy, better known as a facelift procedure, is the technique most closely associated with plastic surgery. When done correctly, it yields highly satisfactory results. The aim of our study was to retrospectively review results of our patients whose procedures were performed using the superficial musculoaponeurotic system (SMAS) plication technique. Plication was performed with multifilament braided sutures, which provided a sustainable lift and satisfactory results. Methods: This study involves a retrospective review of 137 patients who underwent primary or secondary facelift procedures over a period of 46 months. The average patient age was 59 years, with ages ranging from 30 to 77. Patients were reviewed at 6 and 12 months postoperatively. Subjective evaluation based on photographic analysis was performed pre- and postoperatively. Results: All cases included in this study indicated satisfaction with postoperative results on 1 year postoperative review for both the patients and performing surgeons. Four patients presented with a postoperative hematoma that required surgical intervention. One patient developed skin infection that was followed by skin necrosis. Another patient presented with wound infection that resulted in partial wound dehiscence. Both cases were managed conservatively. Conclusions: With the abundance of techniques directed toward the SMAS layer, it has become a pivot point for facelift procedures. This expansion in approaches places emphasis on the SMAS layer and its manipulations. The type of suture material utilized in SMAS plication is, therefore, undoubtedly essential. Our use of braided multifilament sutures for SMAS plication provided satisfactory results at 1-year postoperative review.

Paracetamol Versus Ondansetron for Prevention of Postoperative Shivering in Liposuction Surgeries Under Combined General Epidural Anaesthesia: A Randomized Controlled Trial.

Objective: Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia. Methods: One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects. Results: The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (P <0.001). Tympanic temperature and complications were comparable between the groups with no significant differences. Conclusion: Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.

Facial Anthropometry and Analysis in Egyptian Women.

Human facial analysis can be considered both an art and a science, and is used extensively to measure soft tissue proportions. Remarkable changes exist in anthropometric measures due to changes over centuries of geographical, genetic, and environmental factors, as well as waves of migration causing facial proportions to vary among the different ethnic groups. The purpose of this study was to establish facial soft tissue norms for the Egyptian female population between the ages of 18 and 50, as well as several age-related changes in facial measurements that are described fairly scarcely in the literature. Methods: A prospective study was carried out on 300 Egyptian women between June 2019 and December 2020. All were volunteers and between 18 and 50 years old. Facial measurements were obtained by both direct (caliper-based) and indirect (3D Crisalix software) anthropometric analysis. Anthropometric measurements used in the study included seventeen facial measurements derived from different anthropometric soft tissue landmarks from each subject and eight measurements for analysis. Results: Our results were able to describe the average facial and nasal measurements of the Egyptian female population, as well as the horizontal and vertical analysis of facial proportions. We also determined similarities with other Middle Eastern female measurements, with subtle differences in facial width and nasal height and width compared with Turkish and Iranian women. Conclusions: The current study is valuable because it delivers facial anthropometric measures for Egyptian female faces. This can provide a database for a multitude of uses, including operative planning, postoperative measurements, and forensic and ergonomic purposes.