Reliability of Chest Wall Perforator Flaps for Breast Reshaping following Massive Weight Loss.

BACKGROUND: Breast deformity following massive weight loss poses a unique challenge inadequately managed by traditional methods. Patients also have considerable lateral and posterior upper trunk tissue surplus. Multiple studies have used chest wall flaps for auto-augmentation with mastopexy to tackle this problem. However, the outcome measures did not include any objective tools to assess the reliability of these flaps. Hence, in this study sono-mammography and breast anthropometric measurements are used for evaluation of the added volume and long-term sustainability of chest wall perforator flaps. METHODOLOGY: Twenty massive weight loss patients with Pittsburgh Rating Scale score 2-3 underwent mastopexy with autologous augmentation through perforator flaps encompassing lateral chest wall skin. Outcome measures were breast volume, and the presence of fat necrosis on mammography, and direct breast anthropometry. CONCLUSION: All patients showed a consistent increase in volume postoperatively and no fat necrosis in postoperative mammography, reflecting flap reliability over one year of follow-up. All postoperative anthropometric measurements showed improvement in the breast deformities addressed. 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 .

Burns During Pregnancy: Is the outcome still Gloomy? A follow-up case series.

BACKGROUND: Despite the incidence of burns in pregnancy not being high, its occurrence leads to high morbidity and mortality for both mother and fetus.In 1997, we published a series of 27 cases of pregnant women who were managed and followed up for fetal and maternal outcomes at Ain Shams University's burn unit and Maternity Hospital during the period from October 1995 to September 1996. Now, two decades later, we report on seven cases of burns admitted to the Burn unit and the Maternity Hospital at Ain Shams University, during the period from January 2019 through June 2022. METHODS: Pregnant patients admitted to the Burn unit and the Maternity Hospital at Ain Shams University during the period from January 2019 through June 2022 were included in this case series.Demographic data and obstetric history were documented for each patient as well as total body surface area burned, degree, cause and type of burn, maternal mortalities, fetal mortalities, obstetric interventions, and surgical interventions. CONCLUSION: The total burned surface area ranged from 12-40%; No maternal mortalities occurred in this series, three miscarriages, one preterm labor and three term pregnancies with four surviving neonates.

Epilepsy as a Cause of Burns: Our Experience in Ain Shams University Burn Unit.

Lack of patient education, and unaffordable or inaccessible medications, especially in low- and middle-income countries such as Egypt, leave patients with epilepsy at a higher risk of suffering burn-related injuries, especially with the unpredictable nature of seizures, which leads to accidental burns. We present this study to investigate all epileptic patients whose seizures were involved in the burn injury who presented to the Ain Shams University Burn Unit from January 2019 to July 2022, examining the epidemiology and outcome. A total of 369 burn patients were admitted to out unit during the study period (1st of January 2019 to 31st of July 2022), 5 (1.35%) of which sustained the burn during an epileptic seizure. The parameters assessed were patient demographics, location where burn injury occurred, type and extent of burns, treatment and hospital stay, and morbidity/ mortality rates. The mean age was 24.6 years. A total of 80% lived in low-income areas. Scalding was the most common cause followed by flame. The mean total body surface area and full-thickness burned surface area were 16.2% and 8.6%, respectively. The mean hospital stay was 34.4 days. None of the patients died. However, 1 case had to have an above-elbow amputation.

Evaluation of Fat Excision versus Sparing in Lower Blepharoplasty Using Orbital Gray Scale Analysis.

Orbital septum plication provides various benefits, including eliminating the necessity for a septal incision and the ability to relocate infraorbital fat in a more anatomically suitable manner. This study aimed to compare the results of traditional lower blepharoplasty with fat excision and the orbital septal plication method using orbital grey scale analysis as a new objective method for assessment. Methods: We conducted a prospective cohort study on patients with bilateral baggy lower eyelids who underwent traditional lower blepharoplasty with fat excision or fat-sparing technique using orbital septal plication. All patients were followed up closely for 1 week and then after 1, 3, and 6 months postoperatively to evaluate the study's outcomes. Results: The study was conducted using 40 patients (20 patients per group). The total (medial, central, and lateral) orbital grey scale analysis showed a significant reduction in the fat-sparing and traditional groups (P < 0.001, each). However, the percentage of reduction was significantly higher in the fat-sparing group (34.6 ± 2.9 versus 15.5 ± 3.3 in the traditional groups; P < 0.001). Conclusions: The application of the fat-sparing technique is associated with favorable cosmetic outcomes and a lower complication rate than those of the traditional technique with fat excision. Further studies with a longer duration of follow-up and a larger sample size are required to estimate the risk of recurrence and the need for a revision procedure.

Retroposition of the Vestigial Cartilage in Patients With Microtia: A Novel Technique to Enhance Projection of the Reconstructed Ear.

BACKGROUND: The projection of the reconstructed auricle is an important step in ear reconstruction. The novel use of the vestigial cartilage can successfully replace the projection piece harvested from the costal cartilage, improve the three-dimensional contour of the reconstructed auricle, and help deepening of the concha, compensate for mastoid atrophy in patients with hemifacial microsomia. METHODS: A total of 34 patients with microtia were included and classified according to the Nagata classification. Anotia and atypical cases with deficient cartilage are excluded. Two-stage auricle reconstruction was performed. The first stage included retroposition of the vestigial cartilage, framework implantation and lobule transposition. After 3 to 6 months, the second stage was performed and included elevation of the reconstructed auricle and coverage by split-thickness skin graft. RESULTS: The results were satisfactory regarding the shape, symmetry, maintenance of the auriculocephalic angle, and stability of the reconstructed ear. The vestigial cartilage was classified into 3 different types according to its shape. Type 1(V1) cartilage is a sausage-shaped cartilage that can be directly used as a projection piece. Type 2(V2) cartilage is a flat-shaped cartilage that should be folded upon itself. Type 3(V3) cartilage is an atypical type where the cartilage does not have a specific shape. This type can be used as it is or reconfigured with sutures according to the amount of projection needed. Moreover, 87% of patients were satisfied with the appearance of their new ears, 90% of patients can wear their glasses or sunglasses, and 94% of patients can easily clean their new ear. CONCLUSIONS: According to the shape and amount of the available vestigial cartilage, it can be used as a projection piece either alone or with an augmentation piece from the costal cartilage.