Unacceptable results with an accepted soft tissue filler: polyacrylamide hydrogel.

BACKGROUND: Polyacrylamide hydrogel, considered a safe and biocompatible soft tissue filler, is widely used in cosmetic procedures. Its use for facial contouring and breast augmentation in Iran has increased dramatically in recent years. Most patients and many doctors are unaware of possible and reported adverse effects related to its administration. METHODS: This study enrolled 98 patients experiencing unsatisfactory results and complications of polyacrylamide hydrogel. Adverse effects related to gel administration were documented for all the patients. Lab values were requested together with related medical care and surgical treatments, and gel was extracted by incision, milking, and irrigation. RESULTS: The most common findings at the time of presentation were inflammation (n = 51), asymmetry (n = 31), irregularity (n = 18), infection and abscess formation (n = 11), and gel migration (n = 8). In one patient, severe anaphylactoid reaction was observed 1 week after gel injection, which led to significant complications for the patient. Histologic findings showed granuloma formation (n = 17), fat necrosis (n = 9), and fibrosis (n = 17). Macroscopic gel-related complications resolved after extraction of the injected material, except for skin necrosis and hyperpigmentation, which remained unchanged. For eight patients, the gel could not be extracted by squeezing and irrigation entirely. Three patients experienced gel reaccumulation after seemingly complete removal of the gel. CONCLUSIONS: A wide range of complications seen among our patients showed that polyacrylamide hydrogel may not be as safe and biocompatible as it was thought previously. Both patients and physicians must be aware of the potential side effects of polyacrylamide hydrogel before gel administration.

Toward shortening interoperation period in two-stage cross facial nerve graft with muscle transfer.

Cross facial nerve graft with free muscle transfer is a well-accepted method to deal with the long-standing facial paralysis, which is usually carried out in 2 separate operations including the nerve graft in first operation followed by a muscle transfer 10 to 12 months later. However, delayed rehabilitation of the nerve graft because of its long length leads to considerable interval between first and second operations. Nine patients with long-standing unilateral facial paralysis underwent 2-stage cross facial nerve graft with some modifications in techniques. In this new technique, by placing the end of the nerve graft in nasolabial fold in the first stage, we used shorter nerve grafts and reduced the interval between operations from 3.5 to 5 months. We believe that by using shorter nerve grafts in this technique, we can perform second-stage operation pretty earlier, and placing the end of nerve graft in nasolabial fold reduces the risk of nerve graft traumatization in preauricular dissection during the second stage.

Concomitant vesicoureteral reflux and gastroesophageal reflux: an analytic cross-sectional study.

PURPOSE: Vesicoureteral reflux (VUR) and Gastroesophageal reflux (GER) are both common disorders in children and could be associated with significant morbidities. Although they appear to be separate entities, their natural history and underlying pathophysiology are the same and they both tend to resolve over time. We aimed to appraise their concurrent occurrence and prevalence of GER in VUR patients to understand whether they can be considered different manifestations of a syndrome mainly caused by developmental delay resulting in dysfunction of the sphincters. METHODS: Totally, 174 children ≤ 2 years of age were enrolled and 87 of them with primary VUR constituted patients group. The rest of the cases with the same age and sex distribution entered control group. All the study population underwent ultrasonographic evaluation to detect GER. RESULTS: GER was more frequent in patients with primary VUR. GER was more prevalent in higher grades of VUR. We observed higher prevalence of GER and higher grades of VUR in younger infants demonstrating the tendency of both conditions to resolve overtime. Bilateral VUR was more prevalent among patients with higher grades of VUR. GER was more prevalent in patients with bilateral VUR and Prevalence of bilateral VUR decreased with increase in age. These findings show that the chance of concomitant GER and VUR is higher in children with more severe developmental defect of sphincters. CONCLUSIONS: Regarding the higher prevalence of GER among VUR patients and correlation of VUR severity with co-occurrence of GER, besides the natural tendency of both conditions to resolve overtime, they may be considered parts of developmental delay syndrome of sphincters.

Significant reduction of wound infections with daily probing of contaminated wounds: a prospective randomized clinical trial.

HYPOTHESIS: Local wound management using a simple wound-probing protocol (WPP) reduces surgical site infection (SSI) in contaminated wounds, with less postoperative pain, shorter hospital stay, and improved patient satisfaction. DESIGN: Prospective randomized clinical trial. SETTING: Academic medical center. PATIENTS: Adult patients undergoing open appendectomy for perforated appendicitis were enrolled from January 1, 2007, through December 31, 2009. INTERVENTIONS: Study patients were randomized to the control arm (loose wound closure with staples every 2 cm) or the WPP arm (loosely stapled closure with daily probing between staples with a cotton-tipped applicator until the wound is impenetrable). Intravenous antibiotic therapy was initiated preoperatively and continued until resolution of fever and normalization of the white blood cell count. Follow-up was at 2 weeks and at 3 months. OUTCOME MEASURES: Wound pain, SSI, length of hospital stay, other complications, and patient satisfaction. RESULTS: Seventy-six patients were enrolled (38 in the WPP arm and 38 in the control arm), and 49 (64%) completed the 3-month follow-up. The patients in the WPP arm had a significantly lower SSI rate (3% vs 19%; P = .03) and shorter hospital stays (5 vs 7 days; P = .049) with no increase in pain (P = .63). Other complications were similar (P = .63). On regression analysis, only WPP significantly affected SSI rates (P = .02). Age, wound length, body mass index, abdominal circumference, and diabetes mellitus had no effect on SSI. Patient satisfaction at 3 months was similar (P = .69). CONCLUSIONS: Surgical site infection in contaminated wounds can be dramatically reduced by a simple daily WPP. This technique is not painful and can shorten the hospital stay. Its positive effect is independent of age, diabetes, body mass index, abdominal girth, and wound length. We recommend wound probing for management of contaminated abdominal wounds.

Segmental excision of the distal phalanx with sparing of neurovascular bundle in macrodactyly: a report of two cases.

Macrodactyly is a rare congenital condition in which overgrowth of one or more digits is seen. In this article, we introduce two patients with macrodactyly simplex congenita for which we used segmental excision of the distal phalanx with sparing of neurovascular bundles, eliminating the need for a secondary operation.

Retrusive chin reconstruction after burn injuries using submental and labiomental fat flaps: an innovative method.

OBJECTIVE: A simple method has been introduced for augmentation and restoration of normal chin protrusion as an important element of facial contour in patients suffering from severe skin retraction and scar resulting from head and neck area burns. PATIENTS AND METHODS: For releasing skin retraction and compression of the mental area subcutaneous fat tissues, under general anesthesia, 2 incisions were made in the submental and labiomental areas, each about 3 to 5 cm. After dissection of the superior portions of labiomental and inferior pedicle of submental fat pads, turning over and attaching them together, the skin over the area was reconstructed as needed. RESULTS: Thirty-four patients with pseudomicrogenia were involved. In 32 patients, the procedure was performed successfully and the results were evaluated as excellent in 15 cases and good in 17 cases. However, in 2 patients, suboptimal results were obtained, which were corrected using genioplasty in one of them. The other one did not consent for any further surgeries. Split-thickness skin grafting was performed in 3 cases. Tissue expansion and full-thickness skin grafting were used in 3 others for resurfacing the area. CONCLUSION: Taken together, the current technique might be helpful in restoring normal chin protrusion and can be used besides available methods for resurfacing and reconstruction of the defective skin for enhancing the facial appearance.

Cross-facial nerve graft: a report of chronically paralyzed facial muscle neurotization by a nerve graft.

A 21-year-old housewife with long-standing hemifacial paralysis on the left side decided to undergo the classic two-stage cross-facial nerve graft with muscle transfer. The first stage of the operation was performed successfully with the use of a sural nerve graft. After the appearance of Tinel's sign 8 months later, gain of function in the muscles of the paralyzed side was observed and negated the need for the second-stage muscle transfer.

Nail changes in pemphigus vulgaris.

BACKGROUND: The frequency and types of nail changes in pemphigus vulgaris (PV) are unclear. Aim To determine the frequency and types of nail changes, and their correlation with the number of skin and periungual bullae. METHODS: Seventy-nine patients with PV, including 59 new patients and 20 patients in relapse, were entered into the study. Microscopic examination in potassium hydroxide and culture for fungus were performed on all clinically abnormal nails. RESULTS: Twenty-five (31.6%) of 79 patients showed nail changes, with paronychia (n = 8) and onychomadesis (n = 6) being the most common. One patient in relapse had onychomycosis. The frequency of nail changes in fingers affected by periungual bullae was significantly higher than in other fingers (P < 0.05). The number of nail changes was higher in patients with a larger number of skin bullae and in those with a longer duration of disease (P < 0.05). CONCLUSIONS: Nail changes in PV are common and related to the number of skin bullae and the presence of periungual bullae.