Comparison of the Never Repair with Fibrin Glue and Perineural Micro-Suture in Rat Model.

BACKGROUND: Many different methods for nerve repair have been introduced. Nerve repair with micro-suture is the gold standard one; however, the use of fibrin glue is a promising method. This study compared the never repair with fibrin glue and perineural micro-suture in rat model. METHODS: Ten 3-4 month old male rats, weighting between 250-300 grams were divided into two groups. Left sciatic nerves of the rats were transected and repaired with fibrin glue (TissucolR) in one group (A) and direct peri-neural micro-suture in another group (B). The time of nerve repair was compared between the two groups after 8 weeks. A biopsy from was taken from anastomosis site and the histopathological assessment was undertaken for axonal growth rate after anastomosis and compared between the two groups. RESULTS: The time of repair in group A was significantly lower than group B. Axonal growth rate was pretty similar between the two groups, and the difference was not significant. The mean (SD) time for repair of nerves with micro-sutures was 7.1 (1.5) minutes and the mean (SD) for repair of nerves with fibrin glue was 2.5 (0.5) minutes and the difference was significant. The number of calcification such as psammoma bodies was significantly higher in fibrin glue group. CONCLUSION: Nerve repair with fibrin glue was shown to be simpler and more time saving. The number of axons after the repair was not different in the two groups. We showed that fibrin glue may have more tissue reactions compared with micro-sutures.

Bone Marrow Stem Cells and Ear Framework Reconstruction.

BACKGROUND: Repair of total human ear loss or congenital lack of ears is one of the challenging issues in plastic and reconstructive surgery. OBJECTIVE: The aim of the present study was 3D reconstruction of the human ear with cadaveric ear cartilages seeded with human mesenchymal stem cells. METHOD: We used cadaveric ear cartilages with preserved perichondrium. The samples were divided into 2 groups: group A (cartilage alone) and group B (cartilage seeded with a mixture of fibrin powder and mesenchymal stem cell [1,000,000 cells/cm] used and implanted in back of 10 athymic rats). After 12 weeks, the cartilages were removed and shape, size, weight, flexibility, and chondrocyte viability were evaluated. P value <0.05 was considered significant. RESULTS: In group A, size and weight of cartilages clearly reduced (P < 0.05) and then shape and flexibility (torsion of cartilages in clockwise and counterclockwise directions) were evaluated, which were found to be significantly reduced (P > 0.05). After staining with hematoxylin and eosin and performing microscopic examination, very few live chondrocytes were found in group A. In group B, size and weight of samples were not changed (P < 0.05); the shape and flexibility of samples were well maintained (P < 0.05) and on performing microscopic examination of cartilage samples, many live chondrocytes were found in cartilage (15-20 chondrocytes in each microscopic field). CONCLUSION: In samples with human stem cell, all variables (size, shape, weight, and flexibility) were significantly maintained and abundant live chondrocytes were found on performing microscopic examination. This method may be used for reconstruction of full defect of auricles in humans.

Impact of reduction mammaplasty on sexuality in patients with macromastia and their partners.

AIM OF STUDY: Women with breast hypertrophy often experience a number of physical symptoms and psychological difficulties. The breasts are very important for the psychological well-being of women, which might be affected negatively because of breast size and shape distortions. Self-body dissatisfaction and, in this background, the breasts can lead to low levels of self-confidence and self-esteem, which might affect sexuality. MATERIALS AND METHODS: Thirty-five women with macromastia and their partners were evaluated for their sexual function and surgery satisfaction before and 6 months following reduction mammaplasty. Physical status and sexual satisfaction were assessed using a questionnaire. In addition, the sexual function of the women and their partners was evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF). RESULT: There was a significant improvement in the mean IFSF and IIEF scores after surgery in both patients and their partners. In addition, patients expressed high levels of satisfaction with the results of surgery in terms of physical and psychological scores. CONCLUSION: Reduction breast surgery has a positive impact on the health status and psychological function as well as on the sexual activity of patients and their partners.

A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities.

BACKGROUND: Tissue expansion has evolved reconstruction surgery by providing a great source of additional tissue for large skin defects. Nevertheless, wide application of tissue expander reconstruction is challenging due to high complication rates and uncertainty about final outcomes. Recently, endoscopy has shown promise in reconstructive surgeries using tissue expander placement. AIMS: This study aimed to compare outcomes between open and endoscopic-assisted neck tissue expander placement in reconstruction of post-burn facial scar deformities. METHODS: Through a randomized clinical trial, 63 patients with facial burn scars were assigned to an open group or endoscopic group for placement of 81 tissue expanders. The complication rate, operative time, length of hospital stay, and time to full expansion were compared between the two groups. RESULTS: Thirty-one patients were assigned to the open group and 32 patients to the endoscopic group. The average operative time was significantly reduced in the endoscopic group compared with the open group (42.2 ± 3.6, 56.5 ± 4.5 min, p < 0.05). The complication rate was significantly lower in the endoscopic group than the open group (6 vs. 16, p < 0.05). Hospital stay was also significantly diminished from 26.3 ± 7.7 h in open group to 7.4 ± 4.5 h in endoscopic group (p < 0.0001). There was a significant reduction in time to full expansion in the endoscopic group as compared with the open group (93.5 ± 10.2 vs. 112.1 ± 14.2 days, p = 0.002). CONCLUSION: Endoscopic neck tissue expander placement significantly reduced operative time, the postoperative complication rate, length of hospital stay, and time to achieve full expansion and allowed early initiation of expansion and remote placement of the port in relation to the expander pocket. LEVEL OF EVIDENCE I: 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 .

The epidemiology of geriatric burns in Iran: A national burn registry-based study.

Defining the epidemiology and outcome of geriatric burn patients is critical for specialized burn centers, health-care workers, and governments. Better resource use and effective guidelines are some of the advantages of studies focusing on this aspect. The outcome of these patients serves as an objective criterion for quality control, research, and preventive programs. We used data from the burn registry program in our country. For 2 years, >28,700 burn patients were recorded, 1721 of whom were admitted. Among them, 187 patients were ≥55 years old. Sixty-nine percent of patients were male and 31% female, with a male to female ratio of 2.22:1. The mean±standard deviation (SD) of age was 63.4±8.1. The cause of burns was flame (58.2%) and scalds (20.3%). Most of the burns were sustained at home. The mean duration of hospital stay was 19.5 days (range 3-59 days). The mean (SD) of the total body surface area (TBSA) was 20.3% (8.4%). The median hospital stay (length of stay (LOS)) was 11 days (SD=14). The increase in TBSA was related to a longer LOS (p<0.02). Burn wound infection developed in 44.3% of patients. The presence of inhalation injury was significantly related to mortality (p<0.001). Among the patients, 9% recovered completely, 74.9% recovered partially (requiring further treatment), 1% underwent amputation, and 12.8% died. The lack of insurance coverage did not affect the survival of our geriatric burn patients. However, being alone or single, ignition of clothing, cause of burn, comorbid illnesses, complications following the burn, TBSA, age, and sepsis were positively correlated with mortality. The mean cost of treatment for each patient was about $7450.

Closure of complicated palatal fistula with facial artery musculomucosal flap.

BACKGROUND: Palatal fistulas occur most commonly as a complication of cleft palate surgery. Treatment of these fistulas, especially when they are wide and scarred, is a challenge for both patients and plastic surgeons, with a high rate of recurrence. METHODS: The authors have operated on 22 cases of wide, scarred, recurrent palatal fistula with the use of the facial artery musculomucosal flap, first introduced by Pribaz et al. in 1992. The patients were operated on from March of 2001 to December of 2002 and ranged in age from 2 to 21 years. This flap is axial, centered over the facial artery, and can be raised inferiorly based or superiorly based. All of these patients with cleft palate had been operated on before. In one case, because of a very wide fistula, a bilateral facial artery musculomucosal flap was used. RESULTS: There were two cases of partial necrosis and one case of complete failure, probably caused by twisting of the whole pedicle. The nasal lining was made using turndown flaps of the fistula margin. Because of hanging the base of the flap (inferiorly based) and producing bite block during mastication, the pedicle had to be divided and the flap inset secondarily 1 month later. CONCLUSIONS: The facial artery musculomucosal flap is an alternative for closing the scarred, wide, recurrent fistula, and is associated with a high rate of success. The flap should be included among the techniques of any plastic surgeon who performs palatal surgery.