Effects of the Human Amniotic Membrane on the Cartilage Graft: Prognosis and Absorption in White Rabbits.

BACKGROUND: Cartilage grafts are generally accepted for the restoration and reconstruction of nasal contours. The main concern that plastic surgeons may need to address after surgery pertains to the resorption and disfigurement of the grafted cartilage, especially in allogenic and heterogenic grafts. METHODS: A total of 12 white rabbits were divided into three groups according to the types of graft including autograft, allograft, and heterograft. We used three shapes of grafts, including block, crushed, and diced cartilage in the upper, middle, and lower rows. However, in each rabbit, these grafts were divided into two columns of wrapped and unwrapped grafts, with human amniotic membrane (HAM) grafted on each side of the rabbit's back. RESULTS: In total, 60 specimens underwent histopathological examination. No inflammation was observed in about 50% of the block-shaped conchal cartilages with HAM, and in 50%, less than 25 inflammatory cells per unit were seen. The prognosis and absorption of autograft specimens in block-shaped cartilages with HAM were significantly better compared with other shapes of cartilages with HAM and without HAM. The proliferation rate of fibroblasts in autograft and allograft specimens was more than that in heterograft specimens with HAM. CONCLUSION: Our findings have demonstrated the new role of HAM in clinical applications, indicating that HAM may be used as a low-cost, easily accessible alternative for wrapping in cartilage grafts instead of fascia or surgicel in early future. It is useful for improving the long-term outcomes and decreasing the resorption rate.

Dentoskeletal Stability in Conventional Orthognathic Surgery, Presurgical Orthodontic Treatment and Surgery-First Approach in Class-III Patients.

For many years, the conventional approach to orthognathic surgery which was orthodontic treatment prior to orthognathic surgery has been the accepted method of treatment for skeletal class III malocclusion patients. This review compared the dentoskeletal stability of treatment results between conventional orthognathic surgery methods with presurgical orthodontic treatment and surgery-first approach in skeletal class III patients. The study protocol was based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement for systematic review and meta-analysis. Electronic and manual searches for literature since 2011 were conducted. PubMed and Medline databases were accessed. Data extraction and analysis were performed by two independent individuals. Seven studies out of hundred-fourteen articles met the inclusion criteria and were selected for qualitative analysis. The included studies were 494 patients with skeletal class-III malocclusion. Stability of treatment was compared between surgery-first approach and conventionally treated patients. The statistical analysis confirmed that surgery-first approach did not show more stability compared with presurgical orthodontics. The surgery-first approach shortened the overall treatment duration. However, more skeletal stability in conventional treatment was assessed. Both surgery-first approach and conventional treatment with presurgical orthodontics resulted in favorable skeletal changes in class-III malocclusion patients. Moreover, these findings should be discussed further due to the variety of study designs, outcomes and biases. Current evidence in this field still needs to be expanded. The authors wish to see more well-designed randomized controlled trials with long-term follow ups to confirm the results.

Synchronous Soleus and Reverse Sural Flap for Large Soft Tissue Defect Reconstruction of Leg.

BACKGROUND: Extended Soft tissue defect of leg including middle and distal parts always has been a challenge for many plastic surgeons and also a frustrated problem for patients and families. To introduce the use of the soleus muscle and reverse sural flaps as synchronous surgical treatment alternative of the leg bone exposure with large soft tissue defect, this study was conducted. METHODS: The medical records of patients undergoing transposition of the soleus muscle for treating exposed bone in the leg and simultaneous sural flap were retrospectively analyzed from January 2009 to July 2014, while gathering information on the used muscle was to cover the lesion. RESULTS: Twelve patients with varying ages between 22 and 58 years (10 males and 2 females) were enrolled. The main initial injury was trauma (84.8%), consisting of tibia and/or fibula fractures. Only 1 patient developed insignificant distal flap necrosis who was treated subsequently with surgical debridement and flap re-advancement. CONCLUSION: The treatment of bone exposure with local muscle flaps (soleus and sural) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay. Sometimes, this method may be applied instead of free tissue transfer.

Giant Condyloma Acuminatum of Vulva Frustrating Treatment Challenge.

Giant condylomata are not usually seen nowadays in developed nations, but such cases are still seen in the under-resourced countries. Condylomata acuminata are commonly transmitted through sexual intercourse. Generally diagnosed based on their appearance. Giant condyloma acuminata also named Buschke- Löwenstein tumour (BLT) is a slow growing cauliflower-like tumor, locally aggressive and destructive, with possible malignant transformation. Common clinical treatment of anogenital warts is conservative, however, in extreme cases conservative therapy is insufficient and surgical excision is required. A case of common presentation of giant condylomata in a 50 years old, divorced, multiparous woman is presented and the literature is reviewed. She presented with 15 years history of slowly progressive vulval lesion and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin and cryosurgery without success. The growth measured 30×10 cm in each side and was successfully excised with no evidence of malignancy concomitant and reconstruction also done.

Prediction of mortality in pediatric burn injuries: R-baux score to be applied in children (pediatrics-baux score).

OBJECTIVE: R-Baux score has obtained an acceptable validity and accuracy in predicting burn-related mortality. However, its usage and efficacy among pediatric burn patients has not been well documented. The aim of this study was to employ Pediatrics-Baux (P-Buax) score as modified version of R-Baux score in these patients to determine how it could be applicable in this population. METHODS: Through a prospective study, 870 pediatric burn patients were enrolled. P-Baux and R-Baux scores were calculated for each patient and they were categorized to different groups according to these scores. Mortality and further death probability were measured for each subject and then analyzed by logistic regression model to reveal how they change in relation with age in pediatric burn patients. FINDINGS: R-Baux score for 95% probability of death revealed a mean of 73 among patients of this study. Also P-Baux score was measured in these patients with inhalation injury which showed to be 55 for 95% probability of death. Results showed that age had a positive prognostic value in contrast to the negative prognostic value of Total Body Surface Area (TBSA) and inhalation injury. CONCLUSION: Our analysis showed that in children under the age of 15 years, age has a positive prognostic value while TBSA and inhalation injuries had negative prognostic values in relation to mortality. Hence, in contrast to the adult population, burn injury related mortality may be predicted by modified R-Baux score as (TBSA - age + [18×R]) which could be named as P-Baux score.