WORLD JOURNAL OF PLASTIC SURGERY

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A suitable graft size is marked at the junction of helix and lobule. (b) The graft was harvested, (c) the donor site was closed primarily, and (d) the composite graft (e) was placed at the incised alar rim defect resulting in normal appearing nostrils.
A patient with facial burn scars, with a defect at the right alar margin, on profile view, (a) before and (b) after reconstruction with composite graft and z-plasties. Images (c) and (d) are three-quarters view of the same patient demonstrating acceptable take and appearance. 
A lady who complained of asymmetric nostrils and other deformities following rhinoplasty. Images (a) and (b) show her on frontal view, before and after tertiary rhinoplasty and surgical correction with small composite grafts on the right alar rim, respectively. Figures (c) and (d) show the same patient, on three-quarters view. Figure (e) shows a close-up view of the same patient 10 days after surgery. The site of graft is indicated by an arrow. Figures (f) and (g) show basal view (h) and (i) show profile view.
A lady presenting with asymmetry in nostrils in addition to dissatisfaction with previous rhinoplasty and face-lift, (a) before, and (b) after secondary rhinoplasty, reconstruction with a small composite graft, face-lift and lipoplasty, on frontal view. Additional images show frontal views of her, when presenting for the first time (c), after secondary rhinoplasty and face-lift (d), and three months after lipoplasty and implementing a composite graft on the right ala (e). Images (f), (g) and (h) show the same individual on profile view. 
A young lady who had undergone two previous rhinoplasties, and the surgical and unnatural appearance of nasal tip and nostrils was her main complaint. Images (a) and (b) show her after tertiary rhinoplasty and composite grafting, on both sides, on frontal view. Figures (c) and (d) show her on basal view (e) and (f) show profile view (g) and (h) show three-quarter view. 
The ala of the nose, with its particular texture and characteristics, poses both aesthetically and functionally intriguing challenges and is rather problematic regarding choices for reconstructive methods. Both flaps and grafts have been used to restore natural structure of nasal ala. The present study summarizes a ten-year experience of reconstructive surgery using small composite grafts from non-cartilage bearing tissues, and large composite grafts, containing cartilaginous tissue, with a mean follow-up of 4 years and 8 months. Cumulatively 56 patients were reported. Some of them required surgery due to previous cosmetic rhinoplasty. In 47 of the cases, a small graft from the non-cartilage bearing junction of ear lobule to helical rim sufficed. Nine patients had rather large defects for which grafts were harvested from the helical root. Donor sites were primarily closed and grafts were implanted in place in a single, rapid session. All small grafts had excellent take. Of 9 large grafts, 5 had excellent take, three had acceptable, and one, in a male smoker, failed to take. During follow-up, no gross deformity or poor scar was detected in either donor or recipient site. We have demonstrated that using both large and small auricular composite grafts has favorable long term results for reconstruction of alar rim deformities. However, use of small grafts seems more beneficial and applicability of large grafts requires further studies.
 
Nowadays, plastic surgeries are among the most popular types of surgeries around the world and Iran has one of the highest rankings in this respect regarding its population size. Based on these facts, the present study was conducted in order to evaluate the volunteers' motivations attitudes and informational sources in Tehran, Iran. The study was conducted on a cross-sectional basis. All patients who underwent plastic surgeries during years 2005 and 2006 were evaluated and all the required information was recorded and statistically analyzed. Seventy five patients were enrolled. Their average age was 33±13 years (minimum of 17 and maximum of 63 years old). Rhinoplasty (52%) and abdominoplasty (8%) were the most and least common performed surgeries, respectively. The major important motivators were family, friends, classmates, and colleagues (40%) and the least were magazines and journals (4%).10.7% oftheparticipants described theposture and function of the target organs as perfect, but they planned to improve its aesthetic or functional aspects by surgery. Those who achieve their information of aesthetic surgery from mass media have a better understanding of this field. Also, the motivational stimuli for performing aesthetic surgeries have shown to be different from what were previously deemed.
 
Burn contracture in a 24-year-old girl: the FTSG in the 4th finger was inset in the direction of the donor site and the 5th finger in the opposite direction. Six months following the operation, the graft in the 4th finger is more hyperpigmented. 
Some grafts harvested from the groin area do not become hyperpigmented and in an individual with multiple pieces of grafts, the hyperpigmentation of the pieces may vary. This study evaluates the orientation of the inset of groin grafts according to their donor sites (superior-inferior) and its role in graft hyperpigmentation. Patients with hand burn contracture or syndactyly who required at least 2 pieces of grafts were enrolled. In each patient, one piece of the graft was inset in the same direction of the orientation of the donor site and the other in the opposite direction. Six months after the operation, the pigmentation was scored by a subjective scaling from 1 to 5. Thirty-four fingers of 15 patients were included. The mean grade of pigmentation in grafts inset in the direction of the donor site was 3.00±1.118 and in those inset in the opposite direction was 2.88±1.409. This was not statistically significant. Our findings revealed that although the grafts inset in the opposite direction of the donor site, they were less pigmented. So orientation of full thickness groin grafts did not affect hyperpigmentation of the grafts in burn contracture and syndactyly hands.
 
Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic procedures. The collected data were statistically analyzed. Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery.
 
Injection of synthetic fillers for soft tissue augmentation is increasing over the last decade. One of the most common materials used is hyaluronic acid (HA) that is safe and temporary filler for soft tissue augmentation. We present a case of 54-year-old female who experienced vascular occlusion and nasal alar necrosis following HA injection to the nasolabial folds. She suffered from pain, necrosis, infection, and alar loss that finally required a reconstructive surgery for cosmetic appearance of the nose. The case highlights the importance of proper injection technique by an anesthesiologist, as well as the need for immediate recognition and treatment of vascular occlusion.
 
3 rd degree burn over upper back and 2 nd degree 
Comparison of healing of third-degree burns. 
Comparison of healing in second degree burns.
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. 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. Wound healing was more visible in aloe vera group. Also the speed of healing in aloe vera group was better than silver sulfadiazine group. Based on our findings, aloe vera can be a therapy of choice for burn injuries.
 
Large anaplastic cells with prominent nucleoli admixed with histiocytes and many eosinophils (A&B) show diffuse positive immunoreaction to Leukocyte common Antigen (LCA) (C). 
Positive immunoreactivity of lymphoma cells to CD30 (A) and Granzyme B (B) both with paranuclear pattern (arrows) and negative immunoreactivity to AlK (C). 
Primary breast lymphoma represents less than 1% of all primary breast malignancies and most primary breast lymphomas are of B-Cell origin. The association of anaplastic lymphoma kinase (ALK) negative anaplastic large cell lymphoma (ALCL), a very rare form of primary breast lymphoma, with silicone-filled breast implants has been suggested and several case reports supported this proposal, especially in Western countries. Here we describe one of the first cases of primary breast ALK-negative ALCL in association with saline-filled silicone breast implants evaluated in Iran, where the rising number of breast reconstructive and aesthetic surgeries would commit both surgical pathologists and plastic surgeons to be familiar with this entity.
 
Anatomic localization of the radix. H. Steve Byrd, James D. Buri. Dimensional approach to Rhinoplsty: Perfecting the aesthetic balamce between the nose and chin. Dallas , Volume 1, Chapter 7. 2002: 120-121. 
Angle of internal nasal valve and determination of middle nasal vault respect to proximal and distal nasal vault. Rohrich RJ, Adams Jr WP, Gunter KP. Advanced rhinoplasty anatomy. Dallas, 2002;1:17. 
Determination of lower lateral cartilage axis respect to inner and outer canthus on the surface anatomic of nose. Constantian MB. Common problems in anatomy and proportion. Constantian Rhinoplasty. Chapetr 15, 2009;2:917. 
In rhinoplasty, functional and cosmetic problems including imbalance between the nasal subunits and face are aimed to be corrected. So there is a need for careful preoperative evaluation and treatment of these patients. According to functional and aesthetic effects of these variables in rhinoplasty, evaluation of the frequency with focus to diagnostic methods was undertaken. In a descriptive study, 100 volunteer patients for primary rhinoplasty were enrolled. After history taking, nasal examination, desirable paraclinical work up and photography taking, presence of 4 anatomical variants was evaluated on the base of definition about normal and abnormal characteristic of organ. Twenty nine male and 71 female patients underwent primary rhinoplasty. Open rhinoplasty was done in 85 and the close technique in 15 patients. 77% of patients had at least one of four anatomical nasal variations. The most common anomaly was alar cartilage malposition (51%) and frequency of others was low radix (36%), inadequate tip projection (35%) and middle vault collapse (15%). Frequency of low radix in male patients was 2.5 times more than females. Success in rhinoplasty needs careful nasal analysis and evaluation. As at least one of four anatomical nasal variations is diagnosed before surgery, the correction has an important role on the outcome. As frequency of middle vault narrowing was low, a definitive diagnosis of alar cartilage malpositioning seems necessary in surgical exploration. Needs for correction and methods of treatment of variants can be based on dynamic interplay between nasal subunits.
 
Necrosis of skin flaps is considered as an important complication in reconstructive surgery. We conducted an experimental study to investigate the efficacy of low-molecular weight heparin, clopidogrel and their combination to improve the flap survival. Forty male, adult Sprague-Dawlay rats were divided randomly into 4 groups. Standard rectangular, distally based dorsal random pattern skin flap was elevated. To prevent the graft effect, a sterile sheet was put under the flap. No pharmacological agent was administered for the control group. In group 2, single subcutaneous dose of enoxaparin (3.2 mg/kg) was immediately administrated after surgery. In group 3, clopidogrel (25 mg/kg) was given orally for 7 days. In group 4, both enoxaparin and clopidogrel were administrated. The rats were evaluated on post-operative day 7 for viable and necrotic portions of flaps. The mean and SD of necrosis was 17.79+2.5 cm in the control group, 16.20±3.1 cm in low-molecular weight heparin, 15.25+3.8 cm in combined therapy group and 13.69+2.7 cm in clopidogrel group. Clopidogrel was the only pharmaceutical agent that produced a significant increase in the flap survival area. Clopidogrel may be an effective pharmaceutical agent that significantly increases viability of random skin flaps in rats, but low-molecular weight heparin and their combination did not have any significant beneficial effects.
 
Cartilage tissue has limited regenerative capacity and the management of cartilage defects has always been a challenging issue. Platelet-rich plasma (PRP) has been recently been used to improve healing of cartilage defects. In the present experiment, we aimed to investigate the effects of PRP on regeneration capacity as well as survival of the cartilage grafts in a rabbit model. In 15 white New Zealand rabbits, auricular cartilage was used to produce 4 pieces of cartilage (each about 2×2 cm). Two samples were diced to small pieces and 2 samples left intact. PRP was prepared using 5 ml of auricular blood. After measuring of the weight and volume of cartilages, they mixed with either normal saline or PRP and then implanted on the back of the rabbit. After 12 weeks, the implants were removed and the weight and volume were measured and the numbers of nucleated lacunae were counted on H & E staining. Histological findings showed that in both the intact and diced cartilages, adding PRP resulted in increasing regeneration of chondrocytes. Moreover, adding PRP to intact cartilages had a significant effect in maintaining the grafts 'weight and volume (p<0.05) but in diced cartilages, this effect was not significant. Our findings yielded valuable information on the effect of PRP on survival and regeneration of autologous cartilage grafts as the extent of angiogenesis and the diameters of vessels were more pronounced in the side using PRP and markedly lesser reduction of weight and volume were visible in this group. PRP was effective in increasing survival and regeneration capacity of cartilage grafts in rabbit model.
 
Clinical photographs of craniofacial region: Upper left-top view, upper right-frontal view, lower left-right profile, lower right-left profile. 
Clinical photographs of hands: Upper left-right hand palmar, upper right-left hand palmar, lower leftright hand dorsal, lower right-left hand dorsal. 
CT scan of cranium and orbit. 
Digital x-ray of both hands (AP and oblique views). 
Apert syndrome is a congenital craniosynostosis syndrome comprising of bilateral coronal synostosis , symmetric syndactyly of hands and feet and midface hypoplasia. We present an atypical phenotype of this syndrome with right sided unilateral coronal synostosis. However, type I apert hand and other clinical and radiological features suggestthe diagnosis. Genetic analysis revealed an absence of the specific missense mutations in the FGFR 2 gene that is found in patients with this syndrome. We conclude that this patient represented a rare atypical variant of Apert syndrome. Further analysis is required to map the associated genotype.
 
Burn wound infections carry considerable mortality and morbidity amongst burn injury victims who have been successfully rescued through the initial resuscitation. This study assessed the prevalent microrganisms causing burn wound infections among hospitalized patients; their susceptibility pattern to commonly used antibiotics; and the frequency of infections with respect to the duration of the burn wounds. This study was carried out at Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan over a period of two years (i.e. from June 2010 to May 2012). The study included all wound-culture-positive patients of either gender and all ages, who had sustained deep burns and underwent definitive management with wound excisions and skin auto-grafting. Patients with negative cultures of the wounds were excluded. Tissue specimens for culture and sensitivity were collected from burn wounds using standard collection techniques and analyzed at microbiological laboratory. Out of a total of 95 positive microbial growths, 36 were Pseudomonas aeruginosa (35.29%) as the most frequent isolate found, followed by 21 Klebsiella pneumoniae (20.58%), 19 Staphylococcus aureaus (18.62%), 10 Proteus (9.80%), 7 E. coli (6.86%), 7 Acinetobacter (6.86%), and 4 Candida (3.92%). A variable antibiotic susceptibility pattern was observed among the grown microbes. Positive cultures were significantly more frequent among patients with over two weeks duration of burn wounds. P. aeruginosa, K. pneumoniae and S. aureus constituted the most common bacterial microbes of burn wounds in our in-patients cases. Positive cultures were more frequent among patients with over two weeks duration of burn wounds. Early excision and skin grafting of deep burns and adherence to infection control measures can help to effectively reduce the burden of these infections.
 
Hemangioma is the most common tumor of neonatal period and it is almost always appeared by the end of the first week of life and can be found mostly in head and neck area. This study evaluated the synergistic effect of bleomycin, triamcinolone and epinephrine in treatment of hemangioma and arteriovenous malformations. In this multicenter study, a combination of bleomycin, triamcinolone and epinephrine was injected intralesionaly for treatment of hemangiomas and arteriovenous malformations and their synergistic effect was evaluated in 32 patients. Hemangiomas and low-flow arteriovenous malformations were treated well with their combination while port-wine spots and high-flow lesions response were relatively poor. It seems that the combination of bleomycin, triamcinolone and epinephrine may be a good choice in treatment of hemangioma and arteriovenous malformations.
 
The nasal septal deviation (NSD) is one of the major causes of nasal obstruction. This condition increases upper airway resistance. In This study we evaluated the mean pulmonary artery pressure (MPAP) in patients with markedly deviated septum. Sixty two patients with NSD (Age range: 26-45 years, 34 men and 28 women) were included in the study. Mean pulmonary artery pressure was measured in preoperative period by Doppler echocardiography with the assistance of an expert cardiologist. The mean preoperative MPAP value (22.5 mmHg in men and 20.03 mmHg in women) of the patients in this study was higher than normal population (20 mmHg). The MPAP of nine patients (14.5%) was greater than 25 mmHg. This value was significantly higher than values for normal population. Markedly deviated septum had improper effects in cardiovascular system due to increase in MPAP.
 
Preoperative and postoperative results of fasciotomy wound. 
Preoperative and postoperative results among male patients with wound on dorsum of foot. 
The vacuum assisted closure (VAC) therapy has revolutionized the modern wound care. We developed a new concept of 'VAC at home' in order to decrease the hospital cost. The study was conducted in a private hospital from January 2009 to December 2010. Only those patients were included among whom the wounds were not complicated by concomitant injury and the patients were otherwise fit to be discharged from the hospital. The VAC was applied in the hospital. The VAC changes were done after 48-72 hours depending on the general wound conditions. The cost of the VAC changes during the therapy at home was compared with the expected cost of hospital stay. Thirteen patients were enrolled with a female to male ratio of 1.6:1. The mean age of male patients was 22.4 years as compared to 29.6 years in females. Road traffic accident was the most common cause. Leg (16.2%) was the commonly affected area. The average number of VACs was 15.8. The average cost of the suction machine was 100.1 USD. The average cost of the expected hospital stay during the whole therapy was 68 USD per day. The mean duration of therapy was 35.8 days. The average total cost to be paid to the hospital was 2434.4 USD. Each patient had definitely saved a net of 2739.7 USD. With the increasing experiences of VAC, it can safely be instituted as an 'outpatient' procedure to decrease the hospital cost at home.
 
Breast augmentation is the most frequent procedure performed according to the 2009 Quick Facts report of the American Society of Plastic Surgeons. This study presents the periareolar extra-glandular breast augmentation. From 2004 to 2010 among 32 female patients, peri-areolar incision was performed for breast augmentation. Dissection was performed in subcutaneous plane towards the inferior pole to reach the inframammary fold and was continued in the upwards direction in the subglandular plane to create a pocket. Once the implant of desired size was in place, three sutures fixed the inframammary fold. The skin incision was closed using 4-0 non-absorbable suture. The mean age of patients was 30.7 years and the average incision length was 5.8 cm. 59.4% of patients had an implant size of more than 305 ml and less than 10% of patients had drains which were removed the next morning. All patients were followed regularly and no case of implant infection or removal was seen and only 2 patients had slight stretched scars. In one patient, the implant was high riding and no case of the capsular contracture was noticed. Changes in sensation were noted in 21.9% patients at 3 month interval which was reduced to 6.3% at 6 months interval. Similarly no case of rippling or other visible deformity was noted. The extra-glandular periareolar approach for the breast augmentation can be a good option with few side-effects even it is associated with a higher level of surgical expertise.
 
We present a novel method for augmenting the standard C-V flap used for nipple reconstruction with a free dermal graft which aims to improve the appearance of the nipple reconstruction, decrease loss of projection and improve patient satisfaction overall. The surgical technique for performing a free dermal graft augmentation of a CV flap is described. All patients who underwent this technique between February 2009 and January 2012 at our unit were contacted by telephone, questioned about any complications and asked to rate their satisfaction with the technique. In a series of 18 nipple reconstructions, there were no immediate post-operative complications and long term follow up shows that that this technique achieves high patient satisfaction scores. The CC-V flap is a safe technique which scores highly with patients for cosmetic appearance after long term follow up.
 
Platelet rich plasma is known for its hemostatic, adhesive and healing properties in view of the multiple growth factors released from the platelets to the site of wound. The primary objective of this study was to use autologous platelet rich plasma (PRP) in wound beds for anchorage of skin grafts instead of conventional methods like sutures, staplers or glue. In a single center based randomized controlled prospective study of nine months duration, 200 patients with wounds were divided into two equal groups. Autologous PRP was applied on wound beds in PRP group and conventional methods like staples/sutures used to anchor the skin grafts in a control group. Instant graft adherence to wound bed was statistically significant in the PRP group. Time of first post-graft inspection was delayed, and hematoma, graft edema, discharge from graft site, frequency of dressings and duration of stay in plastic surgery unit were significantly less in the PRP group. Autologous PRP ensured instant skin graft adherence to wound bed in comparison to conventional methods of anchorage. Hence, we recommend the use of autologous PRP routinely on wounds prior to resurfacing to ensure the benefits of early healing.
 
Hemifacial degloving in the patient. 
Intra-operative picture showing canthopexy, harvested nasolabial flap and forehead flap. 
Well settled flaps and position of medial and lateral canthi. 
Harvested costal cartilage for nasal dorsum and columella augmentation. 
After nasal dorsum debulking of nasolabial flap. 
There have been sparse reports in literature of avulsion and degloving injuries of individual areas of face like the nose, eyelids, ear and even mandible. Hemi-facial degloving is extremely rare. We present a case of post-assault degloving of the nose, part of forehead with anterior wall of frontal sinus, entire upper and lower eyelids and the cheek. Proper planning and staging of the surgical procedures and use of local flaps, meticulous and proper alignment of tissues gave us good aesthetic and functional outcome with a satisfied patient.
 
Pseudocode of the basic bees algorithm. 
Healthcare professionals usually should make complex decisions with far reaching consequences and associated risks in health care fields. As it was demonstrated in other industries, the ability to drill down into pertinent data to explore knowledge behind the data can greatly facilitate superior, informed decisions to ensue the facts. Nature has always inspired researchers to develop models of solving the problems. Bee colony algorithm (BCA), based on the self-organized behavior of social insects is one of the most popular member of the family of population oriented, nature inspired meta-heuristic swarm intelligence method which has been proved its superiority over some other nature inspired algorithms. The objective of this model was to identify valid novel, potentially useful, and understandable correlations and patterns in existing data. This review employs a thematic analysis of online series of academic papers to outline BCA in medical hive, reducing the response and computational time and optimizing the problems. To illustrate the benefits of this model, the cases of disease diagnose system are presented.
 
Nanotechnology is an emerging discipline, having power to revolutionarize every scientific field to a very deep level which previously thought to be a science fiction. Having a great potential to beneficially change the way a disease is diagnosed, treated and prevented, nanotechnology practically impacts on state of the art healthcare technologies and plays a crucial role in changing the field of surgery. Surgeons are constantly looking for minimally invasive ways to treat their patients, as recovery is faster when a lesser trauma is inflicted upon a patient, scarring is lessened and there are usually fewer complications in the aftermath of the operation. Through nanotechnology, tiny biosensors could be constructed which could take these factors into account, thus shortening the patient recovery period and saving hospitals money, reducing infection rates within the hospital, reducing the waiting lists for operation and allowing doctors to treat more patients in the same period of time. This review employs a thematic analysis of online series of academic papers focuses on the potentials of nanotechnology in surgery, especially in plastic surgery and addresses the possible future prospects of nanotechnology in this field.
 
In recent years, there is an increasing tendency to use diced cartilage grafts in rhinoplasty surgery for improving dorsum contour irregularities. This study was designed to compare graft resorption between three techniques of diced cartilage using surgical blade, electrical grinder and grater in rabbit model. Thirteen New Zealand rabbits were divided into three groups. Three 2×2 cm cartilage specimens were harvested from one of their ears. In group one, the cartilage was diced by use of No:11 surgical blade to o.5 to 1 mm cube pieces. In group two, an electrical grinder was used and in group three, a grater was applied. The grafts were placed in three subcutaneous pockets in the back of rabbits and after 12 weeks, the implants were removed and their weight and volume were recorded and were evaluated by histological techniques. There was no difference between the three methods in the 3 groups for graft resorption. There was no change in the volume, but the weight showed a decrease in the control group. As the histological results had no statistically difference between groups, we may recommend use of these two techniques in reconstructive and in aesthetic cases.
 
The infant at initial presentation with extensive hemangioma involving most of the right cheek and right eyelids. There were five ulcerated, hemorrhagic spots which had been covered with dressings by the parents.
Three hemangiomatous lesions on the right side of palate and adjacent buccogingival surfaces could be also be visualized as the child cried.
Small hemangioma was also present on the right third toe.
Three days after initiation of the propranolol therapy, there was visible alteration in the color of the lesion, softening in texture and the infant could slightly open the right eye. 
There was considerable improvement after completing four weeks therapy. 
A 29 days old Pakistani female infant was presented to our outpatient department with two weeks history of a rapidly progressing large size facial hemangioma involving most of the right cheek and right eyelids. The infant was unable to open the right eye. There was also a small hemangioma on the right second toe. Additionally, three similar lesions were found on the right side of the palate and adjoining buccogingival surfaces. The parents were particularly concerned about the explosive progression of the lesions, recurrent bleeding episodes from ulcerated areas of the cheek lesion and complete occlusion of the right eye. Following four weeks therapy with propranolol in a dose of 2 mg/kg/day, the hemangiomas rapidly regressed, the bleeding episodes ceased and the infant started opening the eye.
 
Reduction mammaplasty (RM) is among the commonly performed procedures by plastic surgeons. Occult breast cancers are rarely detected in these specimens. The purpose of the study was to describe histopathological evaluation of reduction mammaplasty specimens to detect occult breast cancer in Southern Iran. The histological diagnosis of 350 RM specimens from 175 patients to detect occult breast cancer was evaluated retrospectively. This study determines the incidence of breast cancer too. Microscopic examination revealed that 233 specimens had no pathological changes, 106 showed evidences of fibrocystic disease, 2 were diagnosed as fibroadenoma, 4 were diagnosed as adenosis and one was diagnosed as a phylloides tumor. Furthermore, 4 specimens were diagnosed as carcinomas; 2 as medullary carcinoma and 2 as intraductal carcinoma. Four occult carcinomas were detected in young, unmarried women. Thorough gross and microscopic examination helped to detect these occult carcinomas and also helped in planning futuretreatments. We consider a thorough gross examination and sampling of mammaplasty specimens to be mandatory.
 
Neck reconstruction is considered as one of the most important surgeries in cosmetic and reconstructive surgery. The present study aimed to assess the results of reconstructive surgery of extensive face and neck burning scars using tissue expanders. This descriptive prospective study was conducted on 36 patients with extensive burning scars on the neck and face. Operation for tissue expander insertion was performed and tissue distension started two or three weeks later, depending on the patients' incisions. After sufficient time for tissue expansion, while removing the expander and excision of the lesion, the expanded flap was used to cover the lesion. Overall, 43 cosmetic surgeries were done. Rectangular expanders were employed in most patients (73.81%) and were located in the neck in most of them (60.78%). Complications were detected in five patients (13.89%), with exposure of the prosthesis being the most common one. Scar tissues at the reconstruction site and the flap donor site were acceptable in 94.44% and 98.18% of the cases, respectively. Overall, most of the patients (77.78%) were satisfied with the operation results. Using tissue expanders in tissue reconstruction of extensive neck and facial burning scars results in highly desirable outcomes.
 
Numerous studies were carried out to develop more sophisticated dressings to expedite healing processes and diminish the bacterial burden in burn wounds. This study assessed the healing effect of nettle extract on second degree burns wound in rats in comparison with silver sulfadiazine and vaseline. Forty rats were randomly assigned to four equal groups. A deep second-degree burn was created on the back of each rat using a standard burning procedure. The burns were dressed daily with nettle extract in group 1, silver sulfadiazine in group 2, vaseline in group 3 and without any medication in group 4 as control group. The response to treatment was assessed by digital photography during the treatment until day 42. Histological scoring was undertaken for scar tissue samples on days 10 and 42. A statistically significant difference was observed in group 1 compared with other groups regarding 4 scoring parameters after 10 days. A statistically significant difference was seen for fibrosis parameter after 42 days. In terms of difference of wound surface area, maximal healing was noticed at the same time in nettle group and minimal repair in the control group. Our findings showed maximal rate of healing in the nettle group. So it may be a suitable substitute for silver sulfadiazine and vaseline when available.
 
Mainstay of post-burn reconstruction is release and split skin grafting. Pedicle flaps are cumbersome to the patient, require multiple procedures and hospitalization. Free flaps are technically demanding and facilities are not universally available. Here we evaluated the local perforator flaps for post-burn reconstruction. We have used sixteen perforator propellar flaps for post-burn reconstruction for various areas of body. All flaps did well without any recontracture and need of splintage. Local perforator flaps should be considered as one of the primary treatment options for post burn reconstruction.
 
pCO2 values in both hands before and after tourniquet application.  
Bicarbonate values in both hands before and after tourniquet application.  
Despite several studies investigating the pathophysiologic effects of tourniquet usage in extremity surgeries, there are not enough data about these effects in adhesion release surgeries of burn patients. In the light of numerous metabolic changes of burn tissues, we tried to determine whether there are any significant differences in metabolic responses of burn tissues to tourniquet ischemia in comparison to the findings of other studies in non burn tissue responses during tourniquet usage in extremity surgeries. From March 2009 to April 2011, eighteen patients who were candidates for performing upper extremity adhesion release surgeries were enrolled. Patients with renal, hepatic, metabolic and any other underlying diseases were excluded from the study. Blood samples for determination of pH, pCO2 and HCO3 were obtained from the occluded hand (as the local response indicator of the body to ischemia) and the other hand too (as the systemic response indicator). The time for blood sampling was just before tourniquet inflation, 30 seconds, one minute, three minutes and five minutes after cuff inflation. Thirty seconds after tourniquet release, a rapid decrease was noticed in pH values (7.38±0.04-->7.21±0.08). This decrease was seen after 60s in the opposite hand (7.38±0.04-->7.27±0.01) and returned to the baseline values after 5 minutes in both hands. The blood PCO2 value in the occluded hand was found to be increased 30s after tourniquet release (34.93±3.96-->50.06±11.78), while this increase was seen after 180s in the opposite hand too (34.93±3.96-->38.98±9.21). HCO3 value increased after 30s (19.79±2.31-->20.62±2.37) in the occluded hand, but this increase was visible after 60s in the opposite hand. We found no significant difference in the response of burn patients to tourniquet ischemia in comparison to non-burn patients. There was no extra risk in the application of tourniquet in extremity surgeries of burn patients in comparison to non-burn patients. So current protocols of tourniquet application in non-burn patients can be used for adhesion release surgeries in burn patients without any extra caution.
 
Frequency Distribution of burned patients in two test and control groups in terms of motor function in range of motion. 
Hands burn was associated with significant functional disorders that severely affected patient's quality of life. The aim of this study was to examine the effect of educational program based on exercise therapy on burned hand function. This experimental research was conducted in a period of ten months in 2010-2011 in Mottahari Hospital in Tehran in Iran. The sample included 60 patients, who were randomly assigned into experimental and control groups, half in intervention and half in control group. Educational program was implemented on experimental group. The data collection tools were two observational checklists about determining of hand function. Both groups were matched in characteristic of demographic and burn injury. Subjects in experimental group demonstrated significant improvements in range of motion and hand function balance from admission to discharge. In order to reduce the hand functional impairment caused by burns, it is recommended that special attention be paid to patient education about exercise therapy.
 
Number of deaths in relation to the number of days following burn injury (n=79). 
Self-inflicted burn injuries carry considerable mortality and morbidity among otherwise fit young individuals. This study assessed the epidemiologic pattern and outcome of these injuries in a burn care facility in Pakistan. The study was carried out at Pakistan Institute of Medical Sciences (PIMS) Burn Care Centre in Islamabad over a period of 2 years. It included all adult patients of either gender, aged over 14 years who presented as cases of burn suicides and attempted burn suicides during the study period. Convenience sampling technique was employed. The sociodemographic profile of the patients, motives underlying the act of self-immolation, any underlying psychiatric illness, alcohol abuse, total body surface area (TBSA) burnt, depth of burn injury, associated inhalation injury, duration of hospital stay, and mortality were all recorded. Seventy five patients (80.64%) were female while 18 patients (19.35%) were male. The overall mean age was 26.89±6.1 years (range=15-52 years). The affected TBSA ranged from 15%-100% with an overall mean of 69.30±25.42%. The hospital stay ranged from 1-37 days with a mean of 7.16±6.60 days. Marital conflicts constituted the most frequent motive underlying the suicidal attempts (n=57; 61.29%) followed by failed love affairs (n=9; 9.67%). There was an overall mortality of 84.95%. The most common sufferers of self inflicted burn injuries were young, married, illiterate housewives who were resident of rural area. Getting marriage was the most common triggering cause for such injuries. There is need to institute appropriate preventive measures to address the issue in a national perspective.
 
Domenico Ghirlandaio depicts a patrician with a large rhinophyma. 
The central facial distribution of rosacea. 
Rhinophyma is a severe late complication of rosacea, which is characterized by progressive hyperplasia of sebaceous glands and connective tissue involving the lower two-thirds of the nose. It can be an emotionally devastating disorder, and serve as a medium for occult cancers and other health problems. Many surgical treatments have been advocated, as well as dermabrasion and laser therapy. In light of the problems faced with these individual therapy modalities, we advocate a combination therapy of surgical debulking and fractionated Carbon dioxide laser therapy. By excising the tissue first, we not only decreased the amount of time needed for the procedure, we were also able to preserve a histopathologic specimen that can be examined for occult cancers. After debulking, the fractionated carbon dioxide laser is then used to blend. By using fractionated carbon dioxide, we avoided the complications associated with non-fractionated carbon dioxide lasers, such as delayed healing times, hypopigmentation, hyperpigmentation, scarring, and persistent redness. We report our experience in two patients with rhinophyma who underwent a combination of surgical excision and fractional Co2 laser therapy for treatment. Pre- and postoperative protocols and treatment parameters are discussed. Both patients had excellent cosmetic and functional results and were followed for at least one year.
 
Handling of upper lateral cartilages (ULCs) is of prime importance in rhinoplasty. This study presents the experiences among 2500 cases of rhinoplasty in the past 10 years for managing of ULCs to minimize unwilling results of the shape and functional problems of the nose. All cases of rhinoplasties were done by the same surgeon from 2002 to 2013. Management of ULCs changed from resection to preserving the ULCs and to enhance their structural and functional roles. The techniques were spreader grafts, suturing of ULC together at the level or above the septum, using ULCs as auto-spreader flaps and very rarely trimming of ULCs unilaterally or bilaterally for making symmetric dorsal aesthetic lines. Fifty cases were operated based on this classification. Most cases were in type II and III. There were 7 cases in type I and 8 cases in type IV. Among most cases, the results were satisfactory although there were 8 cases for revision and among them, 2 cases had some fullness on dorsum and supra-tip because of inappropriate judgment on keeping the relationship between dorsum and tip. The problems in the shape and airways role of the nose reduced dramatically and a useful algorithm was presented. ULCs have great important roles in shape and function of nose. Preserving methods to keep these structures are of importance in surgical treatments of primary rhinoplasties. The presented algorithm helps to manage the ULCs in different anatomic types of the noses especially for surgeons who are in learning curve period.
 
Venous thromboembolism at lower age groups and in the absence of other known risk factors should raise doubt of underlying genetic disorders and thombophilia. It is discovered unexpectedly in various medical procedures and may cause severe complications and life threatening problems. In the current study, potentially life threatening complications of a genetic disorder in a previously healthy case is discussed. The important point in this case was delay onset of complication and its severity when was unexpectedly discovered. This situation may happen in almost every cosmetic operation and when the surgeon is not well prepared for managing this medical condition that it may lead to a dramatically poor prognosis for the patient.
 
Analysis of using telemedicine and increase in treatment/rehabilitation costs. 
Technology is likely to transform the way care is delivered at home and in the community. Telemedicine, the child of IT and Medicine sciences is the use of telecommunication equipment and information technology to provide clinical care to individuals at distant sites and the transmission of medical and surgical information and images needed to provide that care. Undoubtedly, the advantages outweight its disadvantages, but just like any other innovations, it has some drawbacks. The present study outlines telemedicine strong and weak points. In this regard a survey has been done in Tehran University of Medical Sciences in Iran. Between 14(th) May and 14(th) August 2012, 90 medical specialist men and 42 women from different hospitals of Tehran Medical Sciences University, Iran were enrolled by a simple ran- dom sampling method. They all completed a questionnaire to consider what are telemedicine chances and challenges. Making use of telemedicine was a profitable alternative in remote, rural/urban places especially in new project of "family physician" presented by Iran Ministry of Health. The results also highlighted that security considerations was an inevitable challenge of telemedicine, while shorter hospital stays and reduced warm ischemic time, and reduced morbidity and mortality rates were telemedicine merits. Despite most previous studies results, telemedicine has been recognised as a cost-effective alternative. Cultural, language distinctions as well as the level of literacy were barriers on deploying tele- medicine. There was no strong evidence showing that using telemedicine caused a decrease in tactile feedback. We need to fully understand and consider various outcomes and challenges of telemedicine before applying it.
 
The questionnaire consisted of nine questions regarding the basic knowledge about plastic surgery.
Regarding the future of plastic surgery, if students were given an opportunity to select the profession. how many would report previous observation of some kinds of plastic surgery? 
Number of students undergone some kinds of plastic surgery in relation to gender. 
Ideas of the students about scar after plastic surgery. 
Various studies have been conducted in many countries to determine the perception/awareness about plastic surgery. The present study assessed the views of college students about plastic surgery. A questionnaire consisted of nine questions regarding the basic knowledge about plastic surgery was randomly distributed among college students. The students were given 20 minutes to fill out the forms. A total of 250 male and 250 female college students were randomly included in the study. The mean age of the male students was 21.1 years as compared to 20.7 years of female students. The top five conditions named were related to hair (89.8%) followed by face scars (88%). The most common procedure named by the students was liposuction (88.2%) followed by hair transplantation. 80.2% of the students opted not to be a plastic surgeon if given an opportunity to select the profession. 33.8% of the students had seen some kinds of plastic surgery operation. Only 5.6% of the students (3.4% male and 2.2% female) had seen some kinds of plastic surgery procedure. 68% of male students and 48% of female students wished to have a plastic surgery procedure sometime in their lives. Majority of the students (88%) got the information from the internet. The second most common source was magazines (85.2%). Majority of the students (53.4%) had an idea of an invisible scar as a result of having a plastic surgery procedure. Only 22% thought to have no scar. Late Michael Jackson was at the top of the list of celebrities having a plastic surgery procedure (97.8%) followed by Nawaz Shariff (92.4%). Despite the rapid growth of plastic surgery in the last two decades, a large portion of population remains unaware of the spatiality. It is essential to institute programs to educate healthcare consumers and providers about the plastic surgery.
 
Lesions in peripheral nerves are highly prevalent in the upper extremity. The present study compares different tendon transfer surgeries in patients with radial nerve palsy. Fifty patients with radial nerve palsy were randomly selected among patients who referred to Tehran 15(th) Khordad Hospital during 2006-2011. They were divided into two groups of 17 and 33 subjects. Single tendon transfer surgery was performed on 33 and ternary tendon transfer surgery on 17 patients and were compared. No significant difference was noticed in the range of motion of metacarpophalangeal joint, proximal interphalangeal joint and distal interphalangeal joint joints between the two groups. There was also no significant difference in the results of single tendon and ternary tendon transfer surgeries between the two groups. There was no need to sacrifice three tendons in tendon transfer surgeries on patients with radial nerve palsy. Single tendon transfer surgery may help establishing a finger extension while indicates to its considerable advantages of surgical simplicity, shorter surgery time, less complications and surgery scars.
 
Transcolumellar and infracartilagenous incision.
Nasal dorsum anatomy.
Patient with dorsal nasal hump and deviated septum. 
A young female with dorsal hump and dorsal nasal septal deviation. 
A young female with depressed nasal dorsum. 
According to statistics of American Society of Plastic Surgeons, cosmetic rhinoplasty was the second most frequently performed cosmetic surgery. This study shares the experiences with component rhinoplasty. From 2004 to 2010, all patients underwent aesthetic nasal surgery were enrolled. The patients requiring only correction of septal deviation and those presenting with cleft lip nasal deformity were excluded. All procedures were performed under general anaesthesia with open technique using transcolumellar and infra-cartilageous incisions. The transculomelalr incision was closed with 6-0 polypropylene and infra-cartilagenous incisions by 5-0 absorbable sutures. Non-absorbable sutures were removed on the fifth postoperative day. The septum was fixed by 'quilting sutures'. Both nostrils were packed with antibiotic ointment containing paraffin gauzes which were removed after 24-48 hours. External nasal splint was applied to be removed on the fifth postoperative day. A total of 191 patients were enrolled (male:female ratio=1:1.47). The mean age of female patients was 25.3 years and 29.4 years in males. Among 50.8% of patients, the cause of deformity was not known. Only 21.5% patients had a positive history of trauma. Majority of patients (90.6%) underwent septoplasty. Twenty percent of surgeries were secondary. Spreader grafts were used in 85% of patients. In 11% of patients, conchal grafts were used. For none of patients, the inferior turbinectomy was performed. No case of costal cartilage graft or silicone implant was used. Only 5.6% of patients had redo-surgeries. No abnormal scarring was noted during follow-up. Dorsal hump reduction can be recommended with accuracy and safety without compromising the nasal airway.
 
Hypospadisis correction (Inverted V shaped incision was marked on the base of both scrotal half, with both V joining in middle over the ventrum at the base of penis making it M shape). Fig. 3: Scrotal halves were brought posterior to penis while more caudal.
Dissection of both scrotal halves.
Penoscrotal transposition (PST) is a rare anomaly of the external genitalia that can be complete or incomplete while incomplete type is more common. Various surgical methods are described for correction of incomplete PST. Modified Glenn Anderson's method is commonly used. This method is known to cause major penile lymphoedema following surgery. Various modifications have been described to preserve the dorsal penile skin to reduce this lymphoedema. We present here our experience with M-Plasty, where the dorsal penile skin is cut in the form of V so that it breaks the constricting effect of circumferential incision and prevents lymphoedema.
 
In crooked noses, the lateral walls are different in shape and symmetry. Although the septum is very important to obtain a straight nose, identical and symmetrical lateral walls are needed for a straight looking nasal dorsum. As well as the septum, lateral walls also contribute in nasal skeletal support and stability. Thus, obtaining identical and symmetrical lateral walls is important. In order to obtain symmetrical and stable lateral walls, the requirements are to equalize the height, to set in a symmetric location and finally to stabilize the symmetry. These requirements must be taken into consideration while performing the steps of rhinoplasty, namely, hump resection, osteotomies and stabilization by spreader grafts or flaps. Here, we describe the management of the lateral walls in crooked nose in 7 cases.
 
Family tree–15 members in this family affected with trichoepithelioma were shown in black.  
A 48-year old woman with trichoepithelioma of the upper lip, nasal dorsum and eyebrow areas that were electrocauterized 5 years ago with relatively acceptable results.  
A 26-year old woman with trichoepithelioma.
Trichoepithelioma is a rare benign skin lesion that originates from hair follicles. Trichoepitheliomas are mostly seen in the scalp, nose, forehead, and upper lip. We present a large family of Iranian origin with 15 individuals affected with multiple familial trichoepithelioma in four generations, and treated with three different methods. Trichoepithelioma is histologically similar to basal cell carcinoma and has a rare risk of malignant transformation. In addition, most frequent incidence of this disease in young to elderly women may lead to social and psychological issues. Precise diagnosis and management of this rare disease seem necessary.
 
Nasal valve collapse and especially internal nasal valve insufficiency is a common cause of nasal airway obstruction. This study compares the effects of spreader graft and overlapping lateral crural technique on rhinoplasty by rhinomanometry. Fifty patients were randomly assigned into two groups and underwent spreader graft or overlapping lateral crural technique. Objective assessment was performed by clinical examination and rhinomanometry before and after rhinoplasty. Nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between surgical techniques. Right, left and total nasal flow and resistance were different before and after surgery but were not significant. Base of the nose was not significantly different between two groups, but nasal projection was 2 mm in the the group who underwent overlapping lateral crura technique and the difference was statistically significant. Our study showed that both overlapping lateral crura and spreader graft technique were beneficial in rhinoplasty and they could provide enough internal nasal valve support. The overlapping lateral crura was an appropriate surgical technique for tip projection in comparison to spreader graft. The overlapping lateral crura technique was shown to be a better surgical way for tip projection in comparison to spreader graft.
 
The defective lip flap sutured the bed of the donor flap. 
Donor flap sutured to the recipient site (upper lip). 
Both flaps were insected to be transferred. Each surgical instrument was inserted underneath of each flap. 
Wound healing of flaps are acceptable and the patient is ready to divide the flap pedicles and to open the mouth. 
The pedicles were divided and complete inset of flaps were performed. 
Vermilion irregularities are common secondary deformities after cleft lip repair, regressed or resected hemangiomas, trauma and tumor surgeries. Vermilion deficiency attracts considerable attention and detracts from an otherwise excellent lip repair. Minor and moderate vermilion defects can be corrected with upper lip advancement, rotation flaps, tongue flaps or grafts. Major defects defy correction with local flaps. A technique is described for correction of large absolute tissue defects of the vermilion using Mutual Cross-Lip Musculomucosal Flaps (MCLMF) Or Ahmad-Ali's flaps. This technique was applied in eight patients with major vermilion defects secondary to hemangioma regression, neoplasia, and trauma. Reconstruction with MCLMF led to create a balanced donor and recipient lips appearance and function. There were no postoperative complications. Surgical results were satisfactory in all patients, and sufficient lip mobility with adequate bulk was maintained. One patient demonstrated minimal transient lip tightening. Use of Ahmad-Ali's flaps in selected patients resulted in successful reconstruction of severe vermilion defects.
 
Above, left: Large hand soft tissue defect. Above, middle: Abdominal flap (10x9 cm). Above, right: Donor site after flap elevation (15.7x10 cm). Below, left: Donor site reduction whit three 0 nylon sutures. Below, middle: Complete coverage of defect. Below, right: Donor scar after three months (6.3x9.8 cm). 
Left: Defect size of the skin and soft tissue. Right: Defect size after substratum suture. 
A: Large heel area soft tissue defect and RISF design (Flap size is 6x5 cm). Middle: Flap inset and donor site reduction with substratum horizontal matters suture. Right: Scar size at the time of pedicle division (After 3 months). 
Closure of donor site of the flap has special problems. Reduction of this site will decrease the morbidity of operation. In this study, we present our experience in donor site size reduction. Between 2006 and 2008, 15 patients with skin and soft tissue defects underwent operation. In all patients, coverage of defect was performed with various flaps. Substratum horizontal mattress suture was used to reduce donor site dimensions. In all 15 patients, size of the flaps, the defect after the flap elevation and the scar size were measured. The mean size of the flap, the defect after flap elevation, and the scar after 3 months were 43.9 cm(2), 69.4 cm(2), and 32.2 cm(2), respectively. There was 46.5% reduction in the donor site after using this suture. The substratum horizontal mattress suture was shown to de- crease the donor site dimensions and also its scar size in flap surgery. This suture is highly recommend in order to reduce donor site dimensions.
 
Dressing method of donor site. (Above left) Donor site wound. (Above right) First layer of dressing with method A&C. (Center left) Intermediate separating plastic sheet is applied. (Center right) Ten layers of fine mesh gauze is applied. (Below) Ten days after operation. 
Duration of complete healing process in deferent methods.
Comparison of Pain severity scores as recorded by patients. 
Comparison of average amount of secretion between methods. 
Overall success of management between methods. 
Split- thickness skin graft is one of the most common operations in plastic surgery. It is always painful and patient discomfort from donor site often is more significant than recipient site. There is not still a standard method for treatment of the donor site. The purpose of this study was to determine the best method of dressing the donor site among three different methods with respect to the rate of healing, pain, secretion, infection and cost. The study includes 60 patients that were randomly divided into three groups. Donor site and thickness of the graft was the same and were dressed with one of the methods including Method A: Paraffin fine mesh gauze, Method B: Nitrofurazone soaked fine mesh gauze and Method C: Dry fine mesh gauze. Each method included an intermediate layer of sterile plastic sheet witch was covered with 10 layers of dry gauze. Comparison with respect to the rate of healing, pain, secretion, infection and cost was done. Thirty seven patients were men and 23 were women. The mean age of the patients was 27.2 years. There was a significant difference between three methods in average time of repair and superiority of dressing with Method B was noted. Pain severity was the least in Method B and difference between the methods was significant. Dressing with Method B had the least secretion and there was a statistically significant difference between three methods. There was no statistically significant difference in cost of the management. This study showed that dressing the donor site with nitrofurazone ointment soaked gauze used as the first layer of dressing and intermediate layer of sterile plastic sheet which was covered with 10 layers of dry gauze was the best method of dressing and had the least complications.
 
Gross appearance of bulged tumor. 
MRI revealed a horse shoe soft tissue mass encasing the distal ulna. 
Lipomatous appearance of the tumor. 
Resected lipoma on the table. 
Horse shoe shaped lipoma of the upper extremity is a very rare entity. We present a case of 45 years old female who presented with painless progressive swelling over the distal forearm and tingling and numbness over the ulnar nerve territory. MRI and surgical exploration showed a horse shoe shaped multilobulated lipoma encasing the distal ulna. The mass was excised in toto, and the sensory alterations were completely relieved at three months follow up. We would like to highlight this rare occurrence of a horse shoe lipoma and present a detailed history of this case to increase awareness amongst clinicians regarding this condition.
 
One year after surgery with counter pressure of upper and lower jaws. The patient is edentulous, so some internal distortion of inferior right lower lip behind the upper lip is seen. 
Permanent facial paralysis is a catastrophic event for involved patients. In long lasting paralysis with severe facial muscles atrophy, masseter muscle transfer is a very good choice. But its greatest problem is postoperative elongation of flap and gradual diminishing of early results and loss of symmetry. This article advocate a new modification for resolving this problem with concomitant elevation of mandibular periosteum with masseter muscle, as a unit for lip and midface elevation.
 
Harvested fat after centrifugation: 1) Upper part: Oil from damages adipocytes, 2) Middle part: Purified fat, and 3) Lowest part: Red cells, cell ’ s debris and liquids. 
Purified fat transfer from 10 ml Luer Lock ® syringe to a 1 ml Luer Lock ® syringe through a 3- ways connector. 
Autologous fat transfer offers many qualities of a ideal soft tissue filler. Main advantages of fat grafting ensue from the fact that the lipoaspirate tissue is an abundant source of regenerative pluripotential cells. However, the reported rates of fat cell survival vary greatly in the medical literature (10-90%). Different techniques of harvesting, processing, and reinjecting the fat cells are so claimed to be responsible for these differences, without any agreement concerning the best way to process. To address this important disadvantage, we propose the addition of autologous platelet rich plasma (PRP) which is known as a natural reservoir of growth factors stimulating tissue repair and regeneration. This approach is completely autologous and immediately employed without any type of preconditioning. Platelets rich plasma (PRP) preparation included bleeding of 8 ml of blood from patient's peripheral vein in Regen Lab© tubes containing sodium citrate anticoagulant. The whole blood was centrifugated at 1500 g during 3 min. As Regen-tubes contained a special gel separator, 99 % of red blood cells were discarded from the plasma at the bottom of the gel, and >90% of platelets were harvested in 4 ml of plasma on the top of the gel, called the platelet-rich plasma (PRP). The purified fat prepared by Coleman technique was mixed with different amount of PRP for in vitro, in vivo (mice) and clinical experiments: >50% of PRP for skin rejuvenation, superficial scars correction, infraorbital region, ..., and for 20% of PRP with 80% of purified fat for deep filler indication (nasolabial folds, lips, or soft tissue defect). In vitro studies demonstrated that PRP increased fat cells survival rate and stem cells differentiation. Animal models showed that fat graft survival rate was significantly increased by addition of PRP. Several clinical cases confirmed the improvement of wound healing and fat grafting survival in facial reconstruction and aesthetic cases by association of fat grafting with PRP. The addition of PRP to fat grafts represented many advantages with a simple, cost-effective and safe method. In addition to its booster effect on fat grafts, PRP had a rejuvenation capacity per se. It is also used on nappage technique, on mask and as a temporary regenerative filler in combination with thrombin. So we consider the addition of 20% PRP to fat grafts offers a better fat grafting survival, a less bruising and inflammation reaction, and easier application of fat grafts due to liquefaction effect of PRP.
 
Top-cited authors
Davood Mehrabani
  • Shiraz University of Medical Sciences
Ali Manafi
  • Iran University of Medical Sciences
Nader Tanideh
  • Shiraz University of Medical Sciences
Muhammad Saaiq
  • National Institute of Rehabilitation Medicine, Islamabad
Reza Shirazi
  • UNSW Sydney