The use of cyanoacrylate glue for skin grafts stabilisation: A retrospective multicenter study.

Cyanoacrylate (CA) tissue glue is frequently used in various surgical procedures, and it is simple to use and may save time during procedures. We report the use, effectiveness, and postoperative outcomes of patients who have undergone skin graft surgeries in which CA glue was used to stabilise the graft. A retrospective study of patients who underwent skin graft surgeries where CA was used to stabilise the grafts between January 2018 and August 2021 at different medical institutes in Riyadh, Saudi Arabia. The analysis was performed using the Statistical Package for Social Science, version 23.0 (IBM, Armonk, New York). A total of 36 cases were included. Five patients (13.9%) had diabetes. All cases received antibiotics preoperatively. Two types of harvested skin grafts were used: (a) a non-meshed split-thickness skin graft (n = 24, 66.7%), and (b) a meshed split-thickness skin graft (n = 12, 33.3%). The graft uptake outcome was 100% for 32 patients (88.9%). The most common underlying indication of skin grafting was burn 17 (47.2%), in which 5 (13.9%) developed partial graft loss. The percentage of skin grafts taken using CA was high and comparable to other fixation methods. Further studies may be needed to assess the long-term outcomes and cost-effectiveness.

The use of acellular dermal matrix in palatoplasty to decrease the rate of postoperative oronasal fistula.

Different cleft palate repair techniques have been described to achieve optimum results and minimise complications. Postoperative fistulae are one of the most challenging complications after palate repair. In this clinical study, we reviewed the records of patients who underwent palatoplasty using acellular dermal matrix (ADM) as an addition to facilitate difficult cleft palate and palatal fistula closure. It was a retrospective, comparative, single-centre study, in which records of patients who underwent cleft palate surgeries between 2015 and 2018 were reviewed. Patients who underwent cleft palate or palatal fistula repair with and without ADM were included. Fischer's exact test was used to compare the two groups (primary cleft palate repair with and without ADM) in relation to the rate of fistula occurrence postoperatively. Charts of a total of 31 patients were reviewed. ADM was used in 13 patients; 8(61.5%) were primary repairs and 5(38.5%) were fistula repairs. Eighteen patients were repaired without ADM, of whom 16(88.9%) were primary cleft palate repairs and 2(11.1%) were fistula repairs. The statistical analysis showed no significant difference in fistula formation rate or recurrence in both the groups. ADM is a simple, safe, and helpful tool for augmenting cleft palate repair, mainly in relatively wide and high-tension cleft palate repairs. In our study, a trend showing decreased complications with ADM was observed. Therefore, we recommend a multi-centre study with a larger sample to assess the significance of ADM in cleft palate and palatal fistulae repair.

Low-Cost Desktop-Based Three-Dimensional-Printed Patient-Specific Craniofacial Models in Surgical Counseling, Consent Taking, and Education of Parent of Craniosynostosis Patients: A Comparison With Conventional Visual Explanation Modalities.

BACKGROUND: Craniosynostosis is a complex craniofacial deformity. Surgical decision, if needed, is always hard on the parent and requires the use of multimodalities of explanation. To the authors' knowledge, there have been no studies tackling family counseling about the deformity and surgical decision-making process with the use of low-cost patient-specific three-dimensional (3D)-printed models. METHODS: A cross-sectional study investigating the utility of patient-specific 3D-printed models using a desktop-based 3D printer. Questionnaire was constructed and validated screening the demographics, knowledge, expectation, and surgical decision-making process supplied using Likert. Data were collected consecutively from each parent first after explanation with conventional 3D computed tomography (CT) images, and then repeated after the 3D-printed model has been presented. RESULTS: Fourteen parents were screened. Majority of parents considered the pathology to have a potential effect of child's functional and aesthetic outcomes. After using the 3D-printed models, the participants had a clear vision and needed not to read any more about the condition (P = 0.05, P = 0.019, respectively). Agreement for surgical management was in favor of the 3D-printed models compared with CT images (P = 0.028). Explanation with CT images yielded higher mean score in knowledge about potential complications compared with 3D models (P value = 0.007). For the 3D models, average printing time was 26 hours, and a mean cost of 5.2$. CONCLUSION: The utility of desktop 3D printing is an affordable modality to provide adequate information about craniosynostosis and can assist surgical decision-making. Knowledge and adaptation of such cheap technology represents a great skill aiding clinical practice.

Modified McKissock's Breast Reduction Technique: A Case Series and Description of Our Technique Modification.

Background: The modified McKissock breast reduction technique uses upper and lower vascular pedicles to reduce breast size and reshape the breasts. This technique has gained significant interest in recent years because of its potential to minimize surgical complications. The current study aims to report our experience and results with our refined version of the McKissock technique. Methods: We conducted a prospective cohort study on patients with breast hypertrophy between 2022 and 2023 to evaluate the modified McKissock breast reduction technique. Two main alterations were made to the original McKissock technique. First, the superior pedicle was modified to create a superomedial pedicle. Second, the inferior pedicle was thinned to form a dermoseptal pedicle with a 4 cm wide base. Results: A total of 13 patients underwent surgery using the modified McKissock breast reduction technique. The average age of the patients was 37.2 years. For the right breast, the weight of tissue resected during reduction ranged from 189 g to 695 g (average 379 g). For the left breast, the resection weight range was 160 g to 608 g (average 370 g). There were no complications except one patient who developed partial nipple necrosis on the left side. All patients expressed satisfaction with the outcomes. Conclusion: Our modified McKissock breast reduction technique shows promise as a method for reducing breast size. It offers several potential advantages, including improved preservation of the nipple and areola complex, more precise breast shaping, contouring capabilities, and reduced risk of complications. Although the early results of this technique are encouraging, further research is required to evaluate its long-term benefits and risks fully.

Development of Calvarial Bone Osteomyelitis in a Noonan Syndrome Patient Following Fronto-Orbital Advancement of Craniosynostosis: A Novel Technique of Treatment Using Povidone and Hydrogen Peroxide Solutions.

This is a case of a pediatric patient with Noonan syndrome (NS) and craniosynostosis who developed calvarial bone osteomyelitis following corrective surgery. Despite complications, such as postoperative bleeding and infections, including osteomyelitis, multidisciplinary management strategies were employed, including antibiotics, debridement, and novel use of hydrogen peroxide and povidone solutions due to bone thinning. The discussion highlights challenges in managing syndromic craniosynostosis, emphasizing the importance of tailored approaches and prophylactic antibiotics. The innovative treatment approach using hydrogen peroxide and povidone presents a potential alternative for bone infections and osteomyelitis post-cranial reconstruction, offering insights for future management strategies. Lessons learned regarding infection rates and novel treatment modalities contribute to evolving approaches in managing complications in syndromic craniosynostosis.

Pregnancy one month post abdominoplasty: a case report and review of literature.

Pregnancy post abdominoplasty may ruin the aesthetic result of the operation and may harm both mother and child. This report is about a 39-year-old lady who got pregnant a month after her abdominoplasty. Her pregnancy was uneventful, and she delivered a healthy baby at the gestational age of 38 weeks.

The Safety of Large-Amount Liposuction: A Retrospective Analysis of 28 Cases.

Aim: Our study aims to assess the safety of large amounts of liposuction in a new light. Materials and Methods: This is a retrospective review of patients who underwent large-volume liposuction from August 2020 to April 2021. Patient demographics, liposuction areas, the amount of infiltrate and aspirate, the surface area of liposuction areas, anesthesia duration, pain score after surgery, preoperative and 4-h postoperative hemoglobin, and basic metabolic panel (sodium, potassium, creatinine, urea) were measured. Results: Out of the 28 patients, 26 (92.85%) were females. The mean age was 37.1 years old. The mean preoperative hemoglobin was 13.73 g/dL. The average anesthesia time was 220.39 min. The average amount of liposuction infiltrated was 7.55 L, and the average amount of liposuction aspirate was 6.83 L. The mean hemoglobin 4 h postoperatively was 13.7 g/dL. Conclusions: With proper patient selection and a comprehensive physical exam with preoperative blood workup performed in an accredited facility with a highly experienced plastic surgeon and anesthesiologist, mega liposuction can be safely performed as a day surgery procedure.

The use of a single-piece bone flap for cranial reshaping in anterior craniosynostosis patients: clinical experience and a description of a novel technique.

BACKGROUND: Craniosynostosis is known as premature closure of one or more of the cranial sutures. Anterior craniosynostosis involves anterior plagiocephaly and trigonocephaly. One of the issues in anterior craniosynostosis skull reshaping is maintaining an aesthetically pleasing forehead curve. Therefore, in this article, we demonstrate our novel technique to use a single-piece bone flap for cranial reshaping of the anterior mold in patients diagnosed with anterior craniosynostosis. A retrospective record review of patients who underwent single piece bone flap cranial reshaping for correction of unicoronal synostosis (UCS) and metopic synostosis (MS) at an Academic Institute in Riyadh, Saudi Arabia, between 2018 and 2020, was conducted. RESULTS: Six non-syndromic consecutive patients were included. Three of the patients had MS. The mean age at surgery was 11.16 months (range, 6-19 months). The average OR time was 315 min (range, 263-368 min). The average intraoperative blood loss was 225 ml (range, 100-400 ml). All patients had achieved acceptable functional and aesthetic results. CONCLUSION: Our novel technique is an innovative and efficient reconstructive technique to simultaneously address MS and UCS and minimize intraoperative bleeding and surgery time. However, more studies with more cases are required.

Complications following Permanent Filler Injection: A Prospective Cohort Study and Protocol of Management.

Permanent filler (PF) substances are increasingly utilized in aesthetic procedures. Concurrently, complications related to fillers have also risen. This study aims to determine the rate of complications secondary to PF injections and develop a therapeutic approach for treating such complications. Methods: This cohort study was conducted by distributing a checklist form among all patients aged 18 years or older who arrived for a new cosmetic consultation between 2015 and 2019. The primary outcome was the occurrence of complications, which are defined as symptoms induced by the PF. The demographics, type of PF, injection site, the time for the complication to occur, and signs and symptoms were recorded and followed up. Results: In this study, 325 out of 503 (64.61%) patients presented with PF-related complications. About 92.8% were women. All patients with PF-related complications presented with a lump (n = 325, 100%). In regard to the anatomical area of injection, the most common areas were the cheeks (66.6%). The time it took for the complication to occur most commonly ranged from 1-5 years (39.2%, P < 0.001). Complications were significantly higher among patients who received the injection in a nonmedical facility (P < 0.0002). Seventy-seven cases (15.3%, P < 0.0001) underwent PF removal. Conclusions: PF-related complications in the body exhibit a wide range of onset and adverse events. The best method to prevent complications caused by permanent filling materials is to avoid them altogether. When it comes to permanent filling agents, we suggest extreme caution.

Intracranial Volume in Relation to Parent Satisfaction and Expert Opinion: A Novel Look at Surgical Outcomes.

Factors like parent satisfaction and expert opinion have been proposed as outcome measures related to craniosynostosis (CS) surgery. However, there is no real tangible score for CS surgery outcomes. In our study, we aimed to explore different factors considered as a tangible outcome measure of CS surgery. Methods: A retrospective cohort study of 23 patients with CS who were operated on in a tertiary care university hospital. Parents were interviewed to assess their satisfaction of aesthetic outcome. This was correlated to two expert opinions and to the amount of skull expansion. Results: The mean follow-up duration was 2.24 ± 1.12 years. Twelve of the 23 fathers were satisfied, whereas 11 of the 23 mothers were satisfied. The overall combined satisfaction rate of both parents was on the higher side with no difference in between. There was a significant association between expansion rate of 7.65 ± 4.99% and the overall parent's satisfaction (P = 0.002). Additionally, there was a good correlation between both experts with statistically significant association (P = 0.004). No correlation was found between the parents' satisfaction and the experts' opinions. Conclusions: The study is valuable, as it investigates the relationship between the expansion rate, parents' satisfaction, and expert opinion as predicted values of craniosynostosis surgery. The overall satisfaction correlated significantly well with the expansion rate. However, such numerical assessment is not a real guide for assessing clinical outcomes' as no association was found between expansion rate, satisfaction rate, and expert opinion.

Plastic Surgery in the Gulf Cooperation Council Countries: Role of Telemedicine.

Internationally, telemedicine is finding its way into common day plastic surgery practice as a result of the COVID-19 pandemic. Nonetheless, no data about its practice in the Gulf region are available to date. Methodology: This is a cross-sectional survey-based study that was sent online to the plastic surgeons practicing in the Gulf region. The study aimed to look into the integration of telemedicine into the practice and the surgeons' attitude and future vision about it. Participation was voluntary, and confidentiality was preserved. Results: A total of 229 plastic surgeons enrolled in this study in mid-2020. There were 192 male participants (83.8%) and 37 female participants (16.2%). Of these, 99 (43.2%) practiced in Saudi Arabia, 85 (37.1%) in the United Arab Emirates, 24 (10.5%) in Oman, 18 (7.9%) in Kuwait, and three (1.3%) in Bahrain. In total, 85 (37.1%) used telemedicine during lockdown, and 144 (62.9%) thought that its usage will remain beneficial in the future. There was no significant difference in practicing telemedicine in different plastic surgery subspecialties, varying level of experience, and country of practice. Among those who used virtual consultations, 62 (72.9%) did not charge for consultation fees. Conclusion: The tendency toward telemedicine integration in plastic surgery practice is growing worldwide, especially after COVID-19. Its limitations are outweighed by its advantages and, with time, many of these will be bypassed. New innovations driven by advancement in technology will further embed telemedicine into the practice.

Burn Injury Due to Cyanoacrylate-Based Nail Glue: A Case Report and Literature Review.

Cyanoacrylate is used in the manufacturing of surgical adhesives, nail glue, and super glue. After contact with cotton or wool, among other catalysts, an exothermic reaction is ignited, inflicting thermal damage to the skin underlying clothes. Nine papers have been published about such an incidence, majority of which involve children. This is the first paper that presents the case of such a burn condition in Saudi Arabia. A four-year-old girl suffered a mix of first- and second-degree burns due to cyanoacrylate spillage over the digits, anterior aspect of the right thigh, and a patch of the skin on the left upper abdomen, spanning 4% of the total body surface area. The clothes were forcefully removed by the mother, and shampoo was applied over the area. At the emergency department, irrigation with normal saline was performed followed by dressing with paraffin-impregnated gauzes and silver sulfadiazine. Volar slabs were placed on the hands. The dressing in the hands was later changed to fusidic acid as the burn healed. Silicone sheet dressing was initiated 28 days later after the burned skin had healed. At one-year follow-up, the wounds were fully healed with no abnormal scar formation. This paper aims to improve awareness about proper first-aid burn management, which determines the quality of the outcome. Further emphasis is required on providing a safe environment for the children and clear, comprehensible warning of hazards on the label of the cyanoacrylate based-products.

Assessment of the Academic Productivity of Plastic Surgeons in Saudi Arabia Using the h-index.

Hirsch-index (or h-index) is a bibliometric measure calculated for researchers based on number of publications and their citations. This study examined the h-index of board-certified plastic surgeons in Saudi Arabia and the different factors that may influence it. METHOD: In this cross-sectional study, an electronic questionnaire was sent to 156 board-certified plastic surgeons practicing in Saudi Arabia. Using their names, we conducted an online search on Scopus, Semantic scholar, and Google scholar to calculate their h-index. Bivariate and multiple regression analyses were conducted to determine the relationship of those factors with the index. RESULTS: A total of 84 surgeons participated in this study, of whom 83.3% were men. Our sample scored a mean index of 1.7 and published a mean of 5 articles. More publications and a higher academic rank predicted a higher h-index, (ß = 0.79, P < 0.001) and (ß = 0.14, P 0.017), respectively. On the other end of the spectrum, the country of residency training (P 0.33), the year of training completion (P 0.95), attaining fellowship training (P 0.95), the number of fellowships (P 0.20), interest in research (P 0.74), working in an academic hospital (P 0.44), or attaining a higher degree (P 0.61) were not significant independent predictors of the index. CONCLUSIONS: More publications and a higher rank predicted increased academic productivity among the plastic surgeons in Saudi Arabia. Despite its limitations, h-index is a useful measure that can be considered in promotions and applications to prestigious plastic surgery centers in adjunct to other factors.

Clinical and Genetic Characterization of Craniosynostosis in Saudi Arabia.

Background: Craniosynostosis (CS) is defined as pre-mature fusion of one or more of the cranial sutures. CS is classified surgically as either simple or complex based on the number of cranial sutures involved. CS can also be classified genetically as isolated CS or syndromic CS if the patient has extracranial deformities. Currently, the link between clinical and genetic patterns of CS in the Saudi population is poorly understood. Methodology: We conducted a retrospective cohort study among 28 CS patients, of which 24 were operated and four were not. Clinical and genetic data were collected between February 2015 and February 2019, from consenting patient's families. The electronic chart data were collected and analyzed including patient demographics, craniofacial features, other anomalies and dysmorphic features, operative data, intra cranial pressure (ICP), parent consanguinity and genetic testing results. Results: The most common deformity in our population was trigonocephaly. The most performed procedure was cranial vault reconstruction with fronto-orbital advancement, followed by posterior vault distraction osteogenesis and suturectomy with barrel staving. Genetics analysis revealed pathogenic mutations in FGFR2 (6 cases), TWIST1 (3 cases), ALPL (2 cases), and TCF12 (2 cases), and FREM1 (2 case). Conclusion: Compared to Western countries, our Saudi cohort displays significant differences in the prevalence of CS features, such as the types of sutures and prevalence of inherited CS. The genomic background allows our phenotype-genotype study to reclassify variants of unknown significance. Worldwide, the sagittal suture is the most commonly affected suture in simple CS, but in the Saudi population, the metopic suture fusion was most commonly seen in our clinic. Further studies are needed to investigate the characteristics of CS in our population in a multicenter setting.

The Use of Intraoperative Radiography for Osteotomy Planning in Craniosynostosis Posterior Cranial Vault Distractor Application, Technique Description.

Posterior cranial vault distraction osteogenesis (PVDO) is evolving as one of the first-line treatments in managing craniosynostosis. Intraoperative decision for sites of osteotomies requires precise planning and accurate placement of distractors. OBJECTIVE: This technique helps in determining and confirming the pre-surgical planned osteotomy sites along with the distraction vectors. TECHNIQUE: intraoperative plain skull radiography is used to determine the osteotomy site guiding placement of distractors using radio-opaque instrument. RESULT AND DISCUSSION: we believe this technique helps translate the planned osteotomy sites and distraction vectors accurately to the skull and minimizes intra-operative error which will subsequently improve outcomes. CONCLUSION: This technique is a quick and safe tool for proper placement of posterior cranial vault distractor. However, further comparative studies are needed in addition to measuring cost, time added to the procedure, and radiation exposure.

Plastic Surgery and COVID-19 in the GCC: Fears, Lessons Learned, and the Plan for the Future.

BACKGROUND: With the labeling of Coronavirus Disease 2019 (COVID-19) as a pandemic by the World Health Organization, national directives were issued instructing to close all cosmetic clinics, suspend all cosmetic procedures, and only operate on an emergency basis. As a result, many plastic surgeons faced challenges sustaining their practice. We aimed to investigate the effect of these national directive instructions on the surgeons and to review their strategies for adapting their practices during this new pandemic. METHODS: A cross-sectional descriptive study was conducted using an online questionnaire. It was constructed to assess the attitudes and practices of plastic surgeons in the Gulf Cooperation Council countries during the COVID-19 lockdown. It also explored their strategies on reopening their practice, as well as their plans on modifications of practice during and after the lockdown. RESULTS: In total, 197 surgeons responded to the survey. The majority were from Saudi Arabia (42.1%), followed by the United Arab Emirates (37.6%), with relatively smaller participation from the remaining countries. Over two-thirds (69.5%) indicated that the pandemic had affected their practice. Surgeons in private practices were significantly affected (P < 0.001) compared with those in the public sector. Only 39% of respondents mentioned COVID-19 testing as part of their post-pandemic surgical protocol. CONCLUSIONS: Surgeons' responses to the pandemic varied. Fear and future uncertainty significantly led to a surge in the utilization of different technical means to maintain the patient pool. Surgeons' education about post-pandemic precautions is essential to maintain high standards of care in the region.

Heterotopic respiratory mucosa in the scalp overlying abnormal bony island in the skull linked to maternal misoprostol use, literature review and surgical experience.

BACKGROUND: Congenital scalp lesions rarely occur in children. These lesions are usually noticed at birth and mostly comprise skin and bone tissue loss in the form of acutis aplasia congenita. The management of these lesions is highly dependent on their location and the affected underlying structures. CASE REPORT: We report the case of a baby girl who was referred to us after a normal full-term delivery and who had an area of an abnormal overgrowth of skin (skin tag) on the vertex of the scalp, with an area of surrounding alopecia. She was otherwise healthy with no noted congenital anomalies. Apart from a prenatal history of attempted abortion using misoprostol, she had no significant history or congenital anomalies. She underwent a CT scan and an MRI. She also underwent an operation to excise the overgrowth and to address the underlying bone tissue anomaly. Histopathology showed respiratory mucosa heterotopia. We report this unusual case that suggests the need for an algorithm to manage such cases, as well as the need to investigate the possibility of misoprostol teratogenicity and a probable link to heterotopia. CONCLUSION: Congenital skin lesions on the scalp should be approached in a multidisciplinary manner to guide their treatment.

Current management of facial fractures in the preadolescent.

PURPOSE OF REVIEW: This article reviews the trends in management of preadolescent facial fractures - a challenging population because of the need to consider growth, dynamic changes in dentition, and evolving fracture patterns. RECENT FINDINGS: Recent findings are a more thorough understanding of fracture patterns and distribution because of recent comprehensive studies isolating the preadolescent age cohort; the role of rigid internal fixation for significantly displaced fractures; and the potential applications and indications for the use of resorbable hardware for fracture fixation in the preadolescent. SUMMARY: As preadolescent fractures occur in a period of growth and evolving dentition in the facial skeleton, it is mandatory for the treating surgeon to have a thorough knowledge of standard and alternative treatment options to optimally manage these patients.