Aesthetic and Functional Outcomes of Open Carpal Tunnel Release and Thread Carpal Tunnel Release: A Randomized Clinical Trial.

Background and Objectives Surgical techniques for carpal tunnel release (CTR) have gradually become less invasive. No substantial evidence supports replacing the open carpal tunnel release (OCTR) with novel minimally invasive approaches. Thread carpal tunnel release (TCTR) is a new minimally invasive CTR method associated with promising results. This study aimed to compare the aesthetic and functional outcomes of OCTR with TCTR. Materials and Methods This study was a randomized clinical trial conducted in a hospital in Tehran, Iran, in 2022. Patients were randomized to OCTR and TCTR groups through simple randomization. Data such as demographics, nerve conduction study, electromyography, pain, and sensory evaluation by monofilament test were recorded in patients at baseline and after 3 months. Aesthetic evaluation was conducted by assessing the scar length and patients' satisfaction 3 months after the surgery. Results Twenty patients (10 in each group) entered the final analysis. Nerve conduction study, electromyography, and sensory evaluation were similar between groups 3 months after the operation. The TCTR group had lower postsurgical pain ( p < 0.001) and lower scar length ( p < 0.001) compared to the OCTR group. Overall satisfaction was not statistically different between TCTR and OCTR. Conclusion The TCTR method is safe in patients with CTS, and its efficacy is similar to OCTR. It can be a good alternative for OCTR, with a better aesthetic outcome.

Successful Microsurgical Replantation of Amputated Penis: A Case Report and Review of Literature.

This study aims to explain microscopic replantation in a rare case of a wholly amputated penis after prolonged ischemia. A 36-year-old patient underwent microscopic replantation of the penis after 9 hours. The penis was completely amputated due to self-mutilation. Microvascular replantation was performed after pre-operative preparation. On the second day after surgery, congestion was observed in the penis, and three sessions of leech therapy were conducted each time the leeches were placed for 30 minutes and then detached by themselves. The patient was referred to a psychiatrist to continue treatment after discharge from the hospital. Penile amputation is a rare situation and has different causes. There are various treatments to repair the amputated penis, which are both microvascular and microvascular. The microsurgery methods have shown the best results. In the present case, due to microsurgical artery repair and the early start of leech therapy, there was limited and predictable necrosis in the area of the penoscrotal junction flap, which underwent debridement and skin graft. Complete amputation of the penis is a rare phenomenon. Efforts should be made to perform the replantation surgery as soon as possible. The venous outflow is an essential factor in the success of penile re-implantation, and completely restored vascular and sensory function in this case. Early initiation of psychological care to control underlying disease leads to further cooperation of the patient to handle complications and avoid the recurrence of self-injury.

The Comparison of A New Durable Coronaplasty Technique with Norfolk Method for Glans Reconstruction after Phalloplasty.

BACKGROUND: Phalloplasty is the most amazing reconstructive surgery, and has a vital role in the quality of life of transsexual patients. There are several techniques for glans sculpting, but none of them had long-lasting results. In the present study, a new technique was introduced and compared with Norfolk technique for coronaplasty following phalloplasty. METHODS: In the present randomized controlled study, 40 transgender patients were enrolled from February 2016 to December 2018, at St. Fatima Plastic and Reconstructive Surgery Center. The patients were randomly assigned in two groups including 20 patients with anterolateral thigh flap (ALT)/radial forearm free flap (RFFF) phalloplasty followed with our new coronaplasty technique (group 1) and 20 patients with ALT flap/RFFF phalloplasty followed with Norfolk technique (group 2). RESULTS: Almost 85% of the patients underwent the surgery with the new technique were satisfied with the outcome of surgery and considered it acceptable within 6-month follow-up, however, only 70% of the patients in Norfolk technique group reported acceptable results, which was significantly lower than the new technique. Similarly, within 12-month follow-up, 80 and 40% of the patients, respectively in new and Norfolk groups reported acceptable results, which was also significantly higher in the new technique. CONCLUSION: This new technique showed remarkably better results relative to the usual technique for glans sculpting in transsexual patients. Moreover, it had the ability to be easily applied along with ALT/RFFF flaps in both immediate and delayed situations.

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.

Lower Extremity Burns, Complications, and Outcome.

We have encountered many burn cases with lower extremity burn with adverse outcome. The study was a retrospective cohort study in 2 years, mean (SD) of follow up was 12(7) months. All demographic data, cause burn, time, total burn surface area (TBSA), presence lower extremity burn and its burn surface area (BSA), foot burn, delay in treatment, smoking, infection, morbidity, co-morbid diseases, length of stay (LOS), amputation, mortality, and outcome were gathered from patients' files. Statistical analysis was done with SPSS 21software. We had 14,215 burn patients, of them 995 were admitted according to criteria of ABA. Six hundred and ten (61.3%) were male and 358 (37%) female. Male to female ratio was 1.58:1. The mean age ± SD was 33.64 ±23.45. Mean (SD) of lower extremity BSA was 12.09 ± 9.18%. The patients who had 10 to 19% burn, had 3 times more risk of mortality than patients with 0 to 9% burn (P < .018). And those with 20 to 29% burn had 35 times more risk of mortality comparing to patients with 0 to 9% burn. The difference was significant too. (P < .000). Delay in treatment, presence of co-morbid diseases and diabetes would not do any increase in mortality. The sex, weight, cause of burn, diabetes, and delay in treatment have not any influence on the death risk. But age and lower extremity BSA have influence on the risk of death. According to statistical study: with every 1-year increase in age, death rate increased by 4% (P < .0001). With every 1% increase in lower extremity BSA, death rate increase by 9% (P < .0005) and with every 1 day increase in LOS, the death rate increase by 4%. Statistical study shows lower extremity burn, TBSA, age, and LOS have great influence on the outcome of these patients. Sex, weight, cause of burn, and delay in treatment have not affected the risk of mortality.

Tissue expanders; review of indications, results and outcome during 15 years' experience.

BACKGROUND: Tissue expanders (TE) are frequently used worldwide. In this study we surveyed outcome of our patients retrospectively during 15 years. MATERIALS AND METHODS: We had 1105 patients for whom 3059 TEs have been used. Demographic data, age, sex, indications, type of tissue expander devices, volume of devices, site of scar and site TE insertion, our technique for tissue expander insertion and flap design, complications and outcome were gathered. A complete and through technical points and tips will be discussed. RESULTS: In 91% of patients overexpansion was done. (Expansion ratio=2.1-4.5). Re-expansion has been done in about 12% of patients. Complications were perforation of skin of pocket (11%) or exposure, infection (6%), dehiscence of the wound (1.5%), perforation of the port or disconnection of the tubes (2.1%), expansion of the scar itself (1%), saggy flap (3%), dog ear (5%), lack of adhesions of flap to its new site (4%). OUTCOME: In 93% of the patients we could totally remove the scar. Around 9.1% of our patients had two sessions of expansion in the same area and 2.9% had three sessions of expansion. 51% of our patients were highly satisfied and 42% were satisfied of the results of expansion. CONCLUSION: Our patients were satisfied with the results. In 12% cases we have done re-expansion. Re-expansion is possible as long as you have enough thickness of dermis in the skin. More than 50% of our patients were optimistic for 2nd or 3rd session of re-expansion.

Tendon Harvest for Treatment of Radial Nerve Palsy Using Endoscopic Technique.

BACKGROUND: Endoscopic method for many surgeries with minimal access is proposed to be effective for preventing the excessive scar formation, reducing pain, cosmesis, and the early return to work. Surgical outcomes of endoscopic and open methods for tendon harvest in treatment of radial nerve palsy were evaluated. METHODS: In a randomized single-blind clinical trial study, 10 patients with radial nerve palsy who referred to the Plastic Surgery Department of the Fatimah Zahra Hospital, Iran University of Medical Sciences, Tehran, Iran were divided into two equal groups. Flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and the palmaris longus (PL) tendons were harvested by endoscopic or open techniques. The outcomes (tendon harvest time, rate of post-surgical pain, amount of pain medication, patient satisfaction, amount of scar, and length of scar) are measured. RESULTS: There was no significant difference in time of surgery between two methods. Vancouver scar scale, cosmetic satisfaction, severity of postoperative pain and also drugs for pain relief after tendon harvest surgery were significantly lower in endoscopic method than open method. CONCLUSION: Regarding the low invasiveness, high satisfaction rate of patients, low pain severity, low scar and the little need for opiate to reduce pain in the endoscopic method, endoscopic tendon harvest technique for radial nerve palsy seems to have priority over open method.

Comparing the effect of two types of silver nano-crystalline dressings (acticoat and agcoat) in the treatment of full thickness burn wound.

BACKGROUND AND OBJECTIVES: This study was conducted to compare the effect of acticoat and agcoat dressing (2 types of silver nano-crystalline dressings) in the treatment of burn wounds. Infection is one of the most important causes of death in patients with major burn. Despite using different prevention methods, including prophylaxis antibiotics with broad-spectrum antibiotics, no method has been found to prevent this dangerous complication for burn patients. Topical silver sulfadiazine is one of the best topical antibiotics in infection control of burn wounds, and other forms of AG dressings are also useful. Their advantages are slow releasing, further-half-life, less frequent dressing change, and less pain during replacement. MATERIALS AND METHODS: In this study, 30 patients with infected full thickness burn wound were selected. The patients' age range was 18-85 years, with the mean age of 39.7-17.27. Every patient's wound was divided into 2 parts randomly, one part was dressed with agcoat and the other with acticoat. Sampling of the 2 parts was done before dressing and after the third and seventh day of dressing. RESULTS: The positive outcome of the first day culturing before silver dressing was 80% and 76.7% for agcoat and acticoat, respectively. However, on the third day, it decreased to 30% and 33.3%, respectively. On the seventh day, it further decreased to 20% in both groups, and the percentage of bacterial growth reduction was not significant. CONCLUSION: Based on the results of this study, silver agcoat dressing was as effective as acticoat dressing in preventing burn wound infection.

Comparison of the Results of Early Flap Coverage with Late Flap Coverage in High-Voltage Electrical Injury.

Patients with high-voltage electrical injuries had very high rates of infection, morbidity, and limb amputation. The results of early and late flap coverage in these patients were prospectively compared. The patients were divided into two groups, early flap group (≤3 weeks) and late flap group (>3 weeks), according to the length of time from injury to wound coverage with flap. Age, sex, demographic data, time taken for flap coverage, time taken for pedicle division, time taken to discharge, wound infection, range of motion in joints, amputation, mortality, and outcome were gathered in a special questionnaire. This study included 55 patients, 31 within the early flap group and 24 within the late flap group. Of the 55 patients, 94.6% were male; mean (SD) of age was 29.04 (10.11) and of TBSA was 13.8 (10.07). Length of stay was significantly longer in the late flap group. The rates of infection and amputation were lower in the early flap group. There was no correlation between the type and the number of flaps and amputations. Early flap repair reduces the length of stay by 56%, rate of amputation by 54%, and also 86.1% in the rate of infection in the burn site.

Assessing effect of three herbal medicines in second and third degree burns in rats and comparison with silver sulfadiazine ointment.

INTRODUCTION: Assessing effect of three herbal medicines on healing of deep second and third degree burns in rats and their comparison with silver sulfadiazine group. METHODS AND MATERIALS: 40 rats were randomly assigned to one of the four groups, each group 10 rats. A deep second degree burn and a third degree burn were induced on the lower back and upper back of each rat under standard burning procedure, respectively. The burns were daily dressed with Robacin in group 1, silver sulfadiazine in group 2, aloe vera extract in group 3, and Rimojen in group 4. Responses to the treatment were assessed by digital photography during the treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis, and angiogenesis) were assessed after the scar biopsy at the end of the research. RESULTS: On the basis of the taken photos, the wound had better healing in Robacin group. Also, speed of healing was better in aloe vera group than silver sulfadiazine and Rimojen groups. In terms of wound surface area maximal improvement was observed at the same time in the second and third degree burn wounds in Robacin group, in the second degree wound of aloe vera and Rimojen groups, and in the third degree wound of aloe vera and silver sulfadiazine groups. In pathological respects, epithelialization was more evident in both wounds of aloe vera group and third degree burn of Robacin group. In both wounds of Robacin group (second and third degree), the extend of angiogenesis and fibrosis was significantly less than other groups; but, inflammation was at a less level in third degree of silver, second degree of Rimogen and aloe vera, and third degree of aloe vera groups. CONCLUSION: In histological survey, minimal rate of angiogenesis and fibrosis was seen in Robacin group, which indicated less wound scar in this group. Healing speed of the burn wound was also higher in Robacin group.

Comparison of healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model.

BACKGROUND: Wound healing is widely discussed in the medical literature. This study compared the healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. METHODS: Sixteen rats were randomly assigned to one of two groups, each group 8 rats. A deep second-degree burn on the lower back and 3(rd) degree burn on upper back of each rat were created with a standard burning procedure. Burns were dressed daily with aloe vera extract in group 2 and silver sulfadiazine in group 1. Response to treatment was assessed by digital photography during treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis and angiogenesis) were assessed after biopsy of scar at the end of research. RESULTS: Wound healing was more visible in aloe vera group. Also the speed of healing in aloe vera group was better than silver sulfadiazine group. CONCLUSIONS: Based on our findings, aloe vera can be a therapy of choice for burn injuries.

Huge retroperitoneal liposarcoma.

Liposarcoma are one of the common soft tissue sarcomas of adulthood which are remarkable because of their frequently large size. We report a case with an extremely large well-differentiated retroperitoneal liposarcoma that weighted 32 kilograms. The patient had relapse about one year later and two recurrent tumors were successfully excised.