Comparative Study of the Effectiveness of sub mucosal Partial Inferior Turbinectomy and Out fracture of Inferior Turbinate in the Nasal Respiratory Function of Rhinoplasty Patients.

INTRODUCTION: The inferior turbinate is a critical and dynamic structure during rhinoplasty in the internal valve. Many surgeons try to preventively reduce its resistance against the path in the post-rhinoplasty period. To this end, the two methods of "sub mucosal partial inferior turbinectomy" and "inferior turbinate out fracture" are compared in the present study. METHODS: In this clinical study, 110 rhinoplasty candidates were randomly divided into two groups, namely sub mucosal partial inferior turbinectomy and out fracture of the inferior turbinate. To assess the complications, the Sino-Nasal Outcome Test (SNOT-22) was used prior to surgical intervention, and 1, 2, 3, 6, and 12 months following the rhinoplasty procedures. RESULTS: Based on the results of this clinical study and according to the SNOT-22 questionnaire, there was no significant difference between the two groups prior to surgery and a month following the surgery (P > 0.05). However, the average SNOT-22 score for the sub mucosal partial inferior turbinectomy group was significantly lower than that of the group with the out fracture of the inferior turbinate, 2, 3, 6, and 12 months following the surgery. CONCLUSION: Both "sub mucosal partial inferior turbinectomy" and "out fracture of inferior turbinate" are effective methods in improving the respiratory function of rhinoplasty patients, yet the former method is more effective than the latter as regards improving the respiratory function of patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Classic high lateral tension and triangular resection methods to prevent dog ear and elongation scar in patients undergoing abdominoplasty: A comparative open-label clinical trial.

BACKGROUND: One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. In the present study, efficacy of a new method compared with classical high lateral tension on preventing dog ear and elongation scar was evaluated. MATERIALS AND METHODS: in an open-label, randomized clinical trial, seventy patients who were candidates for abdominoplasty were selected and randomly divided into two groups. The first group was operated by classic high lateral method and the second group was operated by a new method concentrating on changing incision line and angle. Dog ear prevention, length of scar, improvement, and postoperative complications were compared between the two groups. RESULTS: The mean ± standard deviation (SD) length of scar in treated patients with classical and new abdominoplasty surgical methods was 53.68 ± 6.34 and 41.71 ± 1.78 cm, respectively, and the length of scar in the group treated with the new method was significantly shorter (P < 0.001). The mean ± SD distance between two anterior superior iliac spine in group treated by new method was significantly decreased after surgery (31.3 ± 1.3 cm) compared to before intervention (36.7 ± 3.9 cm) (P < 0.01). CONCLUSION: The new method is more likely to be successful in patients with high lateral tension abdominoplasty. However, according to the lack of similar studies in this regard and the fact that this method was introduced for the first time, it is recommended that further studies in this area are needed and patients in term of complications after surgery need a longer period of follow-up.

The volume of fluid injected into the tissue expander and the tissue expansion.

BACKGROUND: Replacement of the lost tissue is the major concerns of the plastic surgeons. Expanded area should be coherent with the surrounding tissue. Tissue expansion technique is the reforming methods the skin tissue scarcities. Several methods for tissue expansion are available; including usage of silicon balloon and injecting fluid into the tissue expander. MATERIALS AND METHODS: In a clinical trial study, 35 patients, with burn scars, in the face, skull and neck area were studied. We provided a tissue expander device with capacities of 125, 250 and 350cc. Fluid was injected inside the device, 3 consecutive weeks with 1-week interval. After 3 months the device was set out and the tissue expansion was measured using a transparent board and the results were analyzed. Multiple regression was done by SPSS 20 to analyze the data. RESULTS: Regression model showed Skin expansion was positively correlated with the volume of the injected fluid. For each centimeter square of skin expansion, about 6-8 ml of fluid must be injected. CONCLUSION: Correction of skin defects resulting from burning scar is possible using tissue expanders. The tissue expansion is correlated with the amount of the injected fluid.

Recurrence rate of repaired hard palate oronasal fistula with conchal cartilage graft.

BACKGROUND: After cleft palate repair, oronasal fistula (ONF) formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. MATERIALS AND METHODS: In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months) after repair. RESULTS: The mean (range) age of studied samples was 10.7 (2-23) years. 16 patients (55.7%) were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68%) and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P < 0.001). The mean [±SD] age of failed and successfully repaired patients were 11.3 (±4.5) and 8.4 (±5.25) years, respectively (P > 0.1). CONCLUSION: Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure.

Concurrent Excision of Dorsal Nasal Scars and Reduction Rhinoplasty: A Retrospective Cross-sectional Study.

Skin lesions and traumas can affect the skin by leaving scars. The purpose of this study was evaluating the results of a new technique in reconstructive surgery of scars on the nose. In this technique, extra skin remaining from reduction rhinoplasty is applied to the defect remained from removing the scar. METHODS: This is a retrospective cross-sectional study performed on 33 patients who underwent reduction rhinoplasty from 2013 to 2018 due to scars on the dorsal nasal skin. Five sets of standards, criteria, and questionnaires were used to evaluate the cosmetic outcomes, scars, and nasal function. These included the Cakir concept, visual analogue scale, patient reported outcome measurement, Stony Brook scar evaluation scale, and sino-nasal outcome test-22. RESULTS: According to the surface polygon concept, or Cakir concept, the number of affected polygons due to scars decreased in all included patients (P < 0.05). In addition, constant improvement in patients' satisfaction, based on patient reported outcome measurement (P < 0.001) and visual analogue scale (P ≤ 0.05), as well as physicians' satisfaction, based on Stony Brook scar evaluation scale, were determined. Furthermore, evaluating the patients' breathing, based on sino-nasal outcome test-22 criteria (P < 0.09), indicated no adverse effects. CONCLUSION: Excision of scars from dorsal nasal skin and conducting rhinoplasty surgery from the same access can be considered an option for reconstructing nasal scars.

Comparative Experimental Study of Dermal Stability: Acellular Dermal Matrix versus Crayopreserved Dermis.

BACKGROUND: Given the potential usefulness of Acellular Dermal Matrices (ADM) for wound healing, we aimed to evaluate the stability, histological characteristics, and effectiveness of ADM compared with cryopreserved dermis (CPD) in rat models. METHODS: This experimental study was conducted in the Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran, from January to March 2015. The prepared ADM and CPD were transplanted to the full-thickness skin defects on the back of Sprague-Dawley rats. Forty-five days after grafting, the tissues were harvested for histological examination. These two types of the dermis' quality and stability were compared with consideration of the following factors; inflammation, fibroblasts migration, vascularization, collagen formation, capsule formation, and microabscess formation. RESULTS: From 19 selected rates, nine received CPD, and ten were treated with ADM. After transplantation, the mean (SD) weight of ADM and CPD grafts were 1.74 (0.07) and 1.45 (0.77), respectively (P<0.001). The frequency of inflammation was significantly higher in CPD grafts (P<0.01). Higher grades of collagen organization, fibroblast spreading, and vascularization were more frequent in ADM grafts (P<0.01). The frequency of capsule and microabscesses formation was not significantly different between studied groups. CONCLUSION: ADM have a superior effect than CPD in the wound healing process. Both samples had a similar effect in capsule and microabscesses formation and higher costs of ADM preparation. According to the physicians' decision and evaluation of the process's cost-effectiveness, CPD could be appropriately used as an alternative to ADM.

A comparison of outcome of medical and surgical treatment of migraine headache: In 1 year follow-up.

BACKGROUND: This study was designed to compare the efficacy of the medical treatment versus the surgical treatment approach to decompression of trigger point nerves in patients with migraine headaches. MATERIALS AND METHODS: Fifty volunteers were randomly assigned to the medical treatment group (n = 25) or the surgical treatment group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. All patients received botulinum toxin type A to confirm the trigger sites. The surgical treatment group underwent surgical deactivation of the trigger site(s). The medical treatment group underwent prophylactic pharmacologic interventions by the neurologist. Pretreatment and 12-month posttreatment migraine headache frequency, duration, and intensity were analyzed and compared to determine the success of the treatments. RESULTS: Nineteen of the 25 patients (76%) in the surgical treatment group and 10 of the 25 patients (40%) in the medical treatment group experienced a successful outcome (at least a 50% decrease in migraine frequency, duration, or intensity) after 1 year from surgery. Surgical treatment had a significantly higher success rate than medical treatment (P < 0.001). Nine patients (36%) in the surgical treatment group and one patient (4%) in the medical treatment group experienced cessation of migraine headaches. The elimination rate was significantly higher in the surgical treatment group than in the medical treatment group (P < 0.001). CONCLUSIONS: Based on the 1-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headaches in a lasting manner.

Follicular isolation technique with de-epithelialization for eyebrow and eyelash reconstruction.

BACKGROUND: The eyebrow and eyelash are two major sites in facial hair transplantation. Different methods have been experienced for better results. Surgeons tend to use smaller grafts. The authors modified the follicular isolation technique and added de-epithelialization to reduce complications and improve outcomes. METHODS: Sixty patients were allocated to either the isolation group or the isolation plus de-epithelialization group. Some patients underwent both eyebrow and eyelash transplantation; therefore, 79 procedures were performed on 60 patients. Scar formation, number and percentage of surviving transplanted hairs, hair growth orientation, and satisfaction with outcome were reviewed at 6 months. RESULTS: The mean number of preserved transplanted hairs in eyebrow transplantation at follow-up was not significantly different between the two groups, but the mean percentage of preserved transplanted hairs was significantly higher in the isolation plus de-epithelialization group. In eyelash reconstruction, the mean number and percentage of surviving hairs were significantly higher in the isolation + de-epithelialization group than in the isolation-only group. The isolation + de-epithelialization group had more cases of normal hair growth direction in both eyebrow and eyelash transplantation cases, although the difference was statistically significant only in eyebrow reconstruction. CONCLUSIONS: This study showed that follicular isolation plus de-epithelialization had better outcomes and fewer complications than did follicular isolation alone. This could be due to less need for suture in recipient sites, less risk for burying of epithelium of graft in the recipient site, less need for manipulation, lower graft volume, and less need for blood for survival and for removal of sweat glands. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, II.

Filler augmentation, safe or unsafe: A case series of severe complications of fillers.

BACKGROUND: The growing interest in filler injection requires a more comprehensive knowledge about the complications of this procedure. METHODS: A total of 5 cases with debilitating chronic complications following filler injection referred to Al-Zahra hospital, Isfahan are presented in this report. RESULTS: The outcome of treatment for two of the cases was satisfactory. In one case the treatment led to failure. A case committed suicide, the remaining case had received vitamin E injection which caused severe necrosis and scaring. CONCLUSIONS: All fillers are considered foreign bodies and may provoke the immune system to varying degrees. Most complications are, however, caused by the technique of injection not the filler itself. Experience of physicians along with adequate knowledge about fillers and their complications can definitely guarantee a better outcome.

A trial on subcutaneous pedicle island flap for eyebrow reconstruction.

INTRODUCTION: Severe burn is a common problem affecting victim's eyebrows. This study aims to assess the effectiveness, complications and patients' satisfaction in two eyebrow reconstruction surgical methods. Up to now, many reconstruction methods, their specific advantages and complications have been introduced. This study compares a new method (subcutaneous pedicle island flap), which is scarcely discussed, with a standard method (superficial temporal artery island flap). METHOD: This is a clinical trial conducted during 2003-2005 at the Al' Zahra' Hospital. Forty patients with eyebrow defect due to burn injuries were selected by convenience sampling. They were allocated to two groups randomly. The control group underwent a surgery for 'superficial temporal artery island flap' and the case group for 'subcutaneous pedicle island flap'. Data were gathered using two questionnaires. The first one included demographic data, patient history and condition of the eyebrows prior to surgery, effectiveness of surgery and complications. The second was a smiley face visual scale for patient's satisfaction. Data analysis was done using SPSS software (version 12; SPSS Inc., Chicago, IL, USA). RESULT: Findings showed that in the control group, 80% were female of a mean age of 22 years (SD=6/30) and in the case group 75% were female, of a mean age of 21/80 years (SD=8/28). Fisher's exact test showed a significant difference between the type of surgery and hair-growth direction (p=0.003). In addition, Mann-Whitney U test showed a significant difference between the type of surgery and patient satisfaction (p=0.002). Analysis showed that there is no significant difference between the type of surgery and bleeding, congestion, flap necrosis, temporary hair loss in flap and donor-site alopecia (p>0.05). Surgeon's experience shows that surgery time and learning curve in the case group is lower than that in the control group. DISCUSSION: Subcutaneous pedicle island flap is an appropriate and easy method with good efficacy, lower complication and more reasonable and acceptable patient's satisfaction. Therefore, this method is recommended for burn patients with eyebrow defects.