Tongue Flap for Total Full Thickness Upper Lip with Vermillion Reconstruction: Case Report.

Lips play an important role in the function of the oral stoma. Lips also have a vital aesthetic role in the face. Lips are typically reconstructed by local, regional, or free flaps. Tongue flaps have been used for reconstruction of oral and palate defects resulting from congenital disorders, trauma, infection, and surgery. Because of its versatility, rich blood supply, and position, the tongue flap is reliable for defect reconstruction. In this study, we report a case of an upper lip full thickness defect managed with a tongue flap. The results were functionally and aesthetically excellent. To the best of our knowledge, this is the first attempt to reconstruct a full upper lip defect using the tongue.

The pedicled lateral forehead flap in reconstructing oral floor defect - The last resort; case report.

INTRODUCTION AND IMPORTANCE: Locoregional flaps, particularly the pedicled lateral forehead flap, are not usually used in reconstructing oral floor defects following oncologic resection. Rather, microscopic free flaps have evolved to be the standard of care in head and neck reconstruction. However, the pedicled lateral forehead flap could be valuable in floor of the mouth reconstruction in the absence of resources or other options. CASE PRESENTATION: A-56 years old lady with multiple comorbidities who underwent near total glossectomy, bilateral supraomohyoid neck dissection, and right lateral mandibulotomy due to a locally advanced lingual squamous carcinoma. The last resort was the pedicled lateral forehead flap after many unsuccessful reconstructive attempts utilizing the free anterolateral flap, free radial forearm flap, and pedicled pectoralis major flap. CLINICAL DISCUSSION: Decreased donor site morbidity and reliable anatomy are among many of the advantages that made free flaps favorable over locoregional pedicled flaps, especially in oral cavity defects coverage. Of the latter, the pedicled forehead flap, rich in vascularity and neighboring the oropharyngeal defects, could be used with different techniques and modifications. Close monitoring and patient condition optimization is required. CONCLUSION: Choosing a particular reconstructive option should be done considering the available resources and expertise and the patient's condition. The pedicled forehead flap remains valuable when other options are inappropriate or have failed.

Role of the Pedicled Mentalis Muscle Flap in Closure of Chin Implants in Genioplasty.

With the purpose of obtaining an aesthetically pleasing chin appearance, genioplasty or chin augmentation can be performed through osteotomy or chin implantation, with the latter available in different sizes and materials such as silicone and porous polyethylene. The implants are traditionally placed in a subperiosteal or supraperiosteal plane with different advantages and disadvantages to each. This procedure has evolved through time with many techniques and modifications; and this article is an addition to this ongoing refinement by advocating for closure of the mentalis muscle (a paired chin muscle originating from the incisor fossa to the chin skin) over the implant after securing its position with screws (in the case of porous polyethylene) or creating a snug pocket (in the case of silicone). In this retrospective analysis, 15 patients underwent this procedure with an excellent outcome. A single patient developed numbness in the mandibular nerve territory, while another one developed a fistulating radicular cyst that was unrelated to this technique. In addition to the simple learning curve, the potential advantages of this technique include less chances of fistula formation, implant exposure, infection, extrusion, or malpositioning. Prospective studies with more subjects are required to cement our findings.

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.

The Ideal Applicant to the Saudi Plastic Surgery Residency Program.

Securing a plastic surgery position is a demanding task for students. Although many papers have been published internationally discussing the traits and features deemed important from the point of view of plastic surgery program directors, a gap exists in the literature where this aspect is not covered in Saudi Arabia. The aim of this study was to fill this gap. METHODS: In this cross-sectional study, a survey was developed targeting all current and former Saudi plastic surgery training program directors. SPSS was used to calculate frequencies and present percentages; independent t-test was done to look for mean differences. Ethical approval was obtained from a local institution. RESULTS: All current and former Saudi plastic surgery program directors participated (n = 17), including the 8 (47.1%) current directors. When asked to rank 7 items on a scale of importance, they scored a mean of 6.2, 5.8, 5.4, 4.88, 4.82, 4.6, and 3.7 for good impression on interviews, prior experience, research experience, the grade point average (GPA), oral or poster presentations on events, the Saudi Medical Licensing Examination (SMLE), and attaining a post-graduate degree, respectively. The majority [n = 7 (41%)] considers the mode of communication, such as phone calls, as the most important aspect in recommendations. They prefer candidates who took electives/rotations at their department [n = 12 (71%)] and give more value to high-quality publications [n = 9 (47%)]. Applicant's gender was not important. CONCLUSION: With early planning, this article could serve as a guide for medical students interested in plastic surgery to build their assets toward a successful interview.

The Epidemiology of Burn Injuries in Saudi Arabia: A Systematic Review.

Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, "Saudi Arabia," coupled with the search terms "burn," "thermal burn," "flame burn," "chemical burn," "electrical burn," and "contact burn" to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10-12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to <40% total body surface area, while roughly 60% were second-degree burns. Most patients remain in the hospital for 1 to 4 weeks. The overall mortality across studies including patients of all ages was 6.9%, while just 0.76% in the two studies restricted to pediatric patients. Scald injuries involving young children comprise the lion's share of burn injuries in Saudi Arabia. Increased public awareness is necessary to reduce the incidence and severity of these potentially catastrophic injuries.

Masson's tumor involving the hand: A case report.

INTRODUCTION: Masson's tumor or IPEH represents a rare exuberant endothelial proliferation within a thrombus through an uncomprehended phenomenon. Being reported for the 1st time in Saudi Arabia, plastic surgeons should keep it in the list of differential diagnosis. CASE: We report a case of 17-year-old-girl who presented with a 6-month-old, painful mass on the volar side of her left 4th MCP. Radiology was inconclusive. Histopathology reported Masson's tumor following surgical excision with good functional outcome and no recurrence. DISCUSSION: Comprising 2%-4% of overall skin vascular tumor and with no identifying clinical or radiological feature, IPEH poses as a diagnostic challenge. The literature reports similar tumors in the hand with different locations and presentations. Surgical excision remains the cornerstone of management, yet the role of radiotherapy remains undefined. Incomplete excision may result in recurrence, which requires a consensus on the extend of marginal excision. Rare cases of recurrence were reported. Histopathology is the only reliable method of diagnosis. CONCLUSION: We present the 1st reported case of IPEH involving the hand in Saudi Arabia. Plastic surgeons should be aware of such rare conditions and be able to differentiate them from relatively identical yet more sinister tumors, especially angiosarcoma.

Plastic Surgery on YouTube.

YouTube is the most accessed video website in the world. It hosts a variety of medical content. Plastic surgery-related content on YouTube has not been investigated before. In this study, we analyzed the most prevalent plastic surgery-related content available on YouTube. METHODS: Search terms were selected to cover the broad topics of plastic surgery. The top 20 most-viewed videos returned for each search term were analyzed. The videos were classified by the type of content, authorship, number of views, and number of likes. Data were collected and analyzed using Microsoft Excel (2016) program. RESULTS: Out of the 280 videos analyzed, "patient experience" was the most prevalent content type. Thirty percent of the analyzed videos were uploaded by medical centers, and 29% were uploaded from personal accounts. Educational video content constituted 6% of the total videos analyzed. Entertainment was the most prevalent (60%) content type returned when "plastic surgery" was used as the search term. CONCLUSIONS: YouTube is an underutilized social media platform by plastic surgeons. The entertainment industry is taking advantage of the social media platform to attract and gain millions of views. Educational videos are low in number and quality.

Bilateral scaphoid fractures: Case report and literature review.

BACKGROUND: Traumatic bilateral scaphoid fractures are extremely rare. Here, we report an unusual mechanism of bilateral scaphoid fracture after road traffic accident. CASE REPORT: A 32-year-old male presented with bilateral wrist pain to our plastic surgery clinic six months after he was involved in a road traffic accident. He was diagnosed with bilateral scaphoid fracture based on his CT scan findings. It is noteworthy that at the time of collision, he had grasped the steering wheel strongly to brace himself and had suffered no significant injuries except for bilateral wrist pain. DISCUSSION: The diagnosis may be missed in our case because of bilateral hand pain complaints and normal X-ray report. Thus, we suggest that CT scan should be performed in similar incidents, particularly in case of normal X-ray reports. CONCLUSION: It is recommended that CT scan should be performed in similar mechanism of injury with a high index of suspicion.

Primary actinomycosis of the big toe: a case report and literature review.

Actinomyces are Gram-positive branching bacteria that are part of the human gastrointestinal microflora. These organisms can cause actinomycosis, which is a slowly progressive suppurative infection involving the cervicofacial region. Primary involvement of extremities is very rare. Here, we present primary actinomycosis of the lower extremity and a review of related literature. A 35-year-old female from Al-Kharj City (agricultural area) presented to our plastic surgery clinic with complaints of a large mass on the left big toe that caused embarrassment and difficulty in wearing footwear. The patient underwent wide local excision and coverage of the big toe defect with Kutler bilateral V-Y advancement flaps. A high index of suspicion is required to diagnose actinomycosis in subacute or chronic inflammatory soft tissue lesions. Proper surgical intervention and antimicrobial are essential to treat the disease. We conclude that a high index of suspicion is required to diagnose actinomycosis in subacute or chronic inflammatory soft tissue lesions.

Public Perception of Plastic Surgery in Saudi Arabia.

BACKGROUND: The general public perceives plastic surgeons as cosmetic surgeons. This study aimed to assess the general public's awareness of the field of plastic and reconstructive surgery in Saudi Arabia. METHODS: A short, anonymous, web-based survey was distributed to the public using SurveyMonkey as a platform. Participants were asked to choose the surgeon for managing 16 case scenarios, 11 of which were commonly managed by plastic surgeons. RESULTS: In total, 2,116 participants completed the survey. The participants correctly chose plastic surgery as the specialty for managing 3 of the 11 listed plastic surgery case scenarios. CONCLUSION: More efforts are needed from plastic surgeons and media to educate the public about the scope of plastic and reconstructive surgery.

A Simple and Cost-effective Method for Practicing Microsurgery.

Practicing microsurgery is usually expensive. This is because living animals, artificial vessels, and synthetic models are not always available. Here, I report a simple and cost-effective method to practice microsurgical techniques by using sterile gloves.

Skin Necrosis following Rhinoplasty.

Rhinoplasty is one of the most common cosmetic procedures performed by plastic surgeons worldwide. It is among the top 5 common aesthetic procedures in the United States. The complications rate in rhinoplasty is 8-15%, and a majority of these complications are not life-threatening. One of the rare complications reported is skin necrosis. In our article, we report 2 cases that developed skin necrosis on the nasal dorsum following rhinoplasty.

Publications from Saudi Arabia in Plastic Surgery in the Recent Five Years.

In the last 5 years, many universities and medical centers have contributed immensely to medical research in Saudi Arabia. The aim of this study is to review the publications in the last 5 years in the field of plastic and reconstructive surgery from Saudi Arabia. METHODS: An electronic search was carried out using PubMed website for all plastic and reconstructive surgery-related articles published from Saudi Arabia. The type, subject, region, institute, and subspecialty were collected from the articles. RESULTS: A total of 142 articles were found, of which 45 were case reports (31.9%). The highest number of publications was 35 papers in 2018. Most of the papers were published from King Saud University (59.6%). A total of 123 articles (87.2%) were published from the central region of the kingdom. Hand surgery was the most common published topic, with 60 articles (43%). CONCLUSIONS: We concluded that there is an increase in the number of publications in the recent 5 years. However, most of these publications are case reports and series, which are low-quality researches in the era of evidence-based medicine.