The first hand transplantation in iran.

Nowadays, hand transplantation is a very challenging procedure for surgeons and researchers worldwide. Despite many problems that may occur after this surgery, some centers continue to practice this highly sophisticated procedure. Herein, we report on a 38-year-old man who received hand transplant from a 24-year-old brain-dead man. This patient had lost his right hand from the lower one-third of forearm six years before after a trauma from a mincing machine. Team members organized pre-operative research, cadaver dissection, legal consultation, religious permission and discussion to patient. This procedure was done by 15 Khordad Plastic Surgery Transplant team on February 27, 2013 for the first time in Iran.

Upper limb functional restoration in old and complete brachial plexus paralysis.

Nineteen patients with longstanding and permanent brachial plexus injuries underwent a three-staged surgical reconstruction. First, a sural nerve was grafted from the contralateral intact medial pectoral nerve to the paralyzed arm. One year later, a free gracilis muscle was transferred and neurotized by the grafted sural nerve. This procedure results in reanimation of elbow flexion. Finally, the biceps tendon was transferred to the finger flexors using a fascia bundle of tensor fascia lata muscle. Two of the gracilis muscle free transfers failed. In the remaining 17 patients, the overall result was evaluated as satisfactory in 11 patients and good in 6.

Super-thin abdominal skin pedicle flap for the reconstruction of hypertrophic and contracted dorsal hand burn scars.

Dorsal contracture is one of the most common complications of burned hand and can result in a spectrum of deformities and functional disabilities. The injury usually necessitates surgical reconstruction and to the majority of patients, cosmetic end result is a very important issue. In this retrospective study, the authors present the technique of super-thin skin abdominal pedicle flap for the treatment of dorsal hand hypertrophic burn contracture, and review the results. Overall 42 medium or large hypertrophic and contracted scars of the dorsal hand in 34 patients were treated using this procedure. Generally, the functional and aesthetic outcomes were evaluated as good. The functional results were comparable to employment of other types of flap with no relapse of contracture. From the aesthetic point of view, the reconstructed skin was similar to the skin of the rest of the extremity, with good color match, bulkiness, laxity, and suppleness. The scar of the donor region was comparable to the scar of abdominoplasty procedures on the ipsi-lateral side of the lower abdomen. Therefore, this procedure can be considered a reliable and technically simple modality in the treatment of dorsal hand burn contractures.

Treatment of flexion contractures following burns in extremities.

In order to release and cover defects in burn contractures over joints, several surgical procedures have been proposed. Skin grafting is easy to do, but it requires immobilization, and tends to contract again, different types of flaps without skin grafting are alternatives. These flaps have their specific indications, limitations and some disadvantages such as a bulky, unattractive appearance in donor or recipient sites, partial necrosis, and sometimes patients dissatisfaction. Considering these points, the authors proposed a new technique composed of a Y-V advancement in the middle and two scar releases proximal and distal to the joint which were covered with full thickness skin grafts. This seems to have some advantages in both case of technique and more patients satisfaction. In the current study, the authors presented their results with different methods of treatment, which they performed for burn flexion contractures in limbs. Ninety-one operations were performed in 74 patients, the method of reconstruction included skin grafting in 43 contractures, local flaps in 16, pediculated flaps in 11, and the new combined approach in 21 cases. Width of scar was one of the main factors for selection of choice option. This proposed technique is especially appropriate for scars which cover 10-60% of joint surface area. Advantages of this combined technique are coverage of joint area with a pretty normal skin flap, and enough scar lengthening due to combination of Y-V advancement and skin grafted released areas.

Transfer of a single flexor carpi ulnaris tendon for treatment of radial nerve palsy.

Between 1993 and 2002, 108 patients with isolated and persisting radial nerve palsy, underwent transfer of the flexor carpi ulnaris tendon alone to extensor digitorum communis, extensor indicis proprius and extensor pollicis longus. Only patients with sufficient flexor carpi ulnaris muscle power (grade M5) underwent this procedure. Long-term functional results were reviewed at a mean postoperative follow up of 48 (range 3-120) months. In comparison with the contralateral hand, the range of extension of the wrist was less but extension of the fingers and the MCP joints were similar to that of the normal hand. All patients improved functionally and could cope with their routine activities. Most were able to return to their previous jobs. There was no obvious difference in the end result of using this single transfer from our previous results using the three tendon transfers which are commonly used to treat radial nerve palsy. The single flexor carpi ulnaris tendon transfer has some advantages in terms of simplicity, shorter operation time, less morbidity and less surgical scars.

Serial tissue expansion for reconstruction of burns of the head and neck.

There is little reported on serial tissue expansion for reconstruction of burns of the head and neck. Fourteen children (mean age 7.8 years, range 3-11 years) treated over almost an 11 year period, had a total of 67 expanders used. Fourteen children had expansion performed on the first occasion, 14 again on a second occasion, 10 on a third occasion and one on a fourth occasion. The major complication rate (expander extruded prior to completion of the expansion process) was 21,25 and 14%, respectively. In all cases, the burn scar was completely excised or reduced in size. Serial tissue expansion should be considered as a useful method of reconstruction burns of the head and neck.