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Background Epinephrine is commonly used in plastic and reconstructive surgeries to reduce the blood loss, and to achieveing the lowest and the most effective dosage of epinephrine can improve the results of the surgery. Methods Thirty two rats were divided in four groups. Local injection of epinephrine solution (3 mL) with concentrations of 1:200,000, 1:400,000 and 1:1,000,000 was undertaken in three different groups; and the fourth group was the control in which 3 mL of normal saline was administered 15 minutes before making the incision. The bleeding amount was compared in these groups. Results A significant difference in blood loss was noted between the control and other groups, but no significant difference was present between epinephrine concentrations of 1:200,000, 1:400,000 and 1:1,000,000. Conclusion Local injection of epinephrine solution was shown to reduce bleeding from surgical incisions, but the difference between various pinephrine concentrations was not significant. The use of the lowest concentration (1:1,000,000) was suggested to decrease epinephrine side effects.

Background: Nowadays, peritendinous adhesions after flexor tendons surgery are still a formidable challenge. In this trial, we aim to assess the effects of oral and local tamoxifen administration in prevention of adhesions after flexor tendons surgery in rabbits. Material and Methods: This study was performed on 40 rabbits (10 animals in each group) underwent flexor tendon incision and then randomly subdivided into four groups. Exploratory incision was done after third postoperative day for macroscopic assessment of adhesions. Finally, we compared the properties of oral and local routs of tamoxifen administration at 2.5 mg/kg/day or both of them with the control group 1. Results: Adhesion characteristic and adhesion tenacity score was measured as the last adhesion mark. The results showed that local tamoxifen was more effective than oral tamoxifen application in prevention of adhesion formation. Conclusion: Our present results confirm that local tamoxifen administration can reduce the postoperative flexor tendon adhesion scores significantly; thus it might have a great benefit in patient’s outcome after surgery.

Background: During recent decades open approach rhinoplasty and then, to obtain better transcolumellar scar results, some incisions like z, v, and reversed v were introduced. Different authors describe step and inverted v incisions as the two most common transcolumellar incisions. Thus, the present study was conducted to compare postoperative transcolumellar scars using these two patterns. Methods: A total of 62 aesthetic rhinoplasty candidates were randomly divided into two groups of step pattern and inverted v pattern. Then, all the patients were operated by one surgeon in similar operative conditions using similar suture materials and operation techniques. Patient follow-ups for transcolumellar scars were done in three ways: 1. According to the clinical scar assessment scale (SCAS), 2. According to the observer team scores (1-10 scoring system) (Two plastic surgeons, an aesthetic ward nurse, and a non-aesthetic ward nurse) 3. According to patient’s evaluation (1-10 scoring system). Finally, data were collected and submitted for analysis. Results: Both groups had similar mean ages. After six months, analysis of transcolumllar scars were done according to the three criteria previously mentioned. According to the findings, compared with step incision, inverted v incision produced higher scores and better quality for both patients and observer team. Conclusion: The results of the present study showed that inverted v transcolumellar incision produces better scars in comparison to step incision in the views of patients and observer team. As a result, we advise inverted v pattern for transcolumellar incision in open rhinoplasty.

Background: Wound healing is a process that has three overlapping inflammatory, proliferative, and reconstruction phases. Silicone gel and Contractubex (onion extract gel) are two main topical agents used for the prevention and treatment of hypertrophic scars. This clinical trial study aimed to evaluate the efficacy and safety of onion extract and silicone gel on hypertrophic scars of the upper extremity and compare it to non-treated patients. Methods: This randomized, double-blind, parallel, clinical trial was done on 120 male patients who had undergone upper extremity sharp injury repair. Patients were assigned to three groups, i.e., Silicone gel (Kelo-cortTM; WA, USA) (group 1; 40 patients), Onion extract (ContractubexTM, Merz Pharma, Frankfurt, Germany) gel (group 2; 40 patients), and No Intervention (group 3; 40 patients), using drawing sealed envelopes and a computer-based table of randomization. Data were recorded using the Vancouver scale in each visit by two surgeons who were blinded to the study groups. IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp). Data were compared using the ANOVA test. A P-value of less than 0.05 was considered statistically significant. Results: Vascularity (p=0.200), pliability (p=0.058), pigmentation (p=0.701), and height (p=0.438) as subjective scar parameters were approximately similar in post-upper extremity sharp injury wound hypertrophic scar among the three groups. Conclusion: Vascularity, pliability, pigmentation and height, as subjective scar parameters, were not statistically different in post-upper extremity sharp injury wound hypertrophic scar among the groups. Even though onion extract gel and Silicone gel show preventive effects in the literature, especially in burns wounds, further studies are recommended to be conducted to prove the topical effects of above-mentioned gels in patients.

Background Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the efficacy of topical vitamins A and E on improving flap survival. Methods Twenty-four white-albino male rats were randomly divided into two groups of treatment and control. Standard rectangular, distally based dorsal random pattern skin flap was elevated. Intra-peritoneal cephazoline was administered to prevent any unexpected infection. No pharmaceutical agent was administered for the control group, but pure vaseline ointment. In treatment group, vaseline plus vitamins A and E were administrated daily after surgery for 10 days. The rats were evaluated on the 10th day after surgery for viable and necrotic portions of the flaps. Results The mean values of necrosis in the flaps were 625±189.56 and 920.00±247.31 in the treatment and control groups, respectively. Vaseline plus vitamins increased flap survival significantly. Conclusion Topical vitamins A and E may be effective pharmaceutical agents to increase viability of random skin flaps in rats. They can be added to vasoactive topical agents to reach better results.

Background. Craniosynostosis is the premature fusion of one or more cranial sutures that produce abnormal head shape. Plagiocephaly is a general term that describes unilateral flattening of the anterior or posterior quarter of the cranium. Anterior plagiocephaly is almost always due to unilateral coronal synostosis. Early surgical treatment is the best option for these patients. The aim of this study was to investigate the surgical correction results of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies. Methods. All unicoronal craniosynostosis cases treated surgically from 2013 to 2016 at our hospital, with frontal bone symmetrization and staggered osteotomies and fronto-orbital advancement, were reviewed. The following variables were analyzed: sex, age, weight, hospital stay time, ICU stay time, per os (PO) starting time, anesthetic time, estimated blood loss volume (ml), estimated blood loss as percentage of total volume, surgical complication, follow-up time, and Whitaker grade. All data were analyzed with SPSS. Results. The study consisted of 33 patients (19 females, 14 males). Average age was 10.24 months, average weight was 8.97 Kg, average hospital stay time was 7.84 days, average ICU stay time was 1.69 days, average PO starting time was 1.24 days after surgery, average anesthetic time was 397.72 minutes, average estimated blood loss was 213.78 ml, and estimated blood loss as percentage of total volume was 31.69%. One case (3.03%) needed reoperation and two cases had postoperative seizure. No mortality was seen. Conclusion. It is supposed that surgical correction of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies results in lower blood loss, lower complication rate and reoperation, and more durable results.

Background Crushed fingers are one of the most common reasons that patients visit the emergency centers for hand surgery, and based on the level of injury, it can cause many disabilities for patients. It is difficult to decide the treatment strategies (amputation, aggressive revascularization, immediate or delayed complex reconstruction and immediate conservative treatment) for crushed fingers. Objectives The current study aimed to compare the blood sugar (BS) levels measured by the glucometer in healthy and crushed fingers to predict gangrene in patients referred to 15 Khordad Hospital in Tehran, Iran. Methods This cohort study was conducted on 265 patients with crushed fingers referred to the emergency center of 15 Khordad hospital in Tehran, Iran, from March 2015 to March 2016. Blood glucose levels were measured by glucometer in the crushed fingers and in the finger of the opposite side at the same time and measurements were recorded. Data were analyzed using t-test and chi-square test with SPSS software version 22. Results The results showed that 317 crushed fingers of 265 patients were ischemic based on the color, temperature, capillary refill time and pulse oximetry and accordingly the vascular reconstruction was not possible. Of 317 crushed fingers, 61 (19.24%) became gangrene (all with sugar levels lower than 37). The mean BS levels of the amputated and non-amputated fingers were 33.5 ± 1.52 and 111.04 ± 15.27 mg/dL, respectively. Therefore, there was a significant difference in the mean BS level between the patients with amputated and non-amputated fingers (P < 0.001). Conclusions The lower levels of sugar in crushed fingers compared to healthy fingers can help to diagnose gangrene in crushed fingers.

BACKGROUND Although the assignment and suturing of the spreader graft to the septum is a routine part of rhinoplasty, it is a time wasting procedure and some problems may occur. Rather, autospreader flap is a new method that the dorsal part of the upper lateral cartilage is used as its own graft. In the present study, we intended to compare the functional and aesthetic outcomes of these two techniques of rhinoplasty. METHODS In a clinical trial, patients who referred to 15 Khordad Hospital for elective rhinoplasty during 2013-2014 were enrolled. The functional and aesthetic outcomes were compared between the two techniques of spreader graft and autospreader flap using rhinomanometry and satisfaction questionnaire in two stages before and one months after the surgery. RESULTS Total nasal airway resistance increased significantly by both spreader graft and autospreader flap, but the difference between the two methods was not statistically significant. The total nasal flow before and after the surgery significantly decreased using both techniques, but this reduction was not significant between the two methods of surgery. When questioned about the satisfaction with the surgery outcomes, 18 subjects (36%) had complete aesthetic satisfaction, 25 (50%) were partial satisfied and 7 subjects (14%) were unsatisfied from aesthetic results. The rate of patient’s satisfaction in both groups was higher for functional outcome. Overall, 32 (64%) subjects were completely satisfied, 13 (26%) were partially satisfied and 5 (10%) subjects did not report satisfaction. Loss of respiratory function in both groups was inevitable due to short time post-operative period. CONCLUSION Both spreader graft and autospreader flap techniques can be used in the preservation and restoration of the normal internal nasal valve angle, as well as restoration of dorsal aesthetic lines of the nasal dorsum.

BACKGROUND Brow ptosis is a potential complication after upper eyelid blepharoplasty. The aim of this study was to analyze the effect of upper blepharoplasty on eyebrow position. METHODS In this Between April 2011 and March 2013, eighty three patients (166 eyes with mean age of 49.7 years) underwent upper eyelid blepharoplasty. The patients were assessed using pre- and post-operatively digital photographs, in the primary position of the eye while the distance between the upper lid margin and the brow were measured before surgery. The postoperative degree of brow ptosis was evaluated as being mild (4 mm). RESULTS The postoperative brow position was unchanged in 46 cases (65.8%), and brow depression was noted in 24 cases ( 34.2%), including 7 males (58.3%) , and 17 females (29.3%). CONCLUSION Our study shows that postoperative brow position should be explained to patients before surgery, particularly in male and senile patients as concomitant brow lift or internal brow fixation through the blepharoplasty incision can help to stabilize the eyebrow in the proper position and to prevent this complication.

Background In the restoration of elbow flexion, the phrenic nerve has proven to be a good donor, but considering the role of the phrenic nerve in respiratory function, we cannot disregard the potential dangers of this method. Objectives In the current study, we reviewed the results of pulmonary function tests (PFT) in four patients who underwent phrenic nerve transfer. Patients and Methods We reviewed the results of serial spirometry tests, which were performed before and after phrenic nerve transfer surgery. Results All patients regained Biceps power to M3 strength or above. None of our patients experienced pulmonary problems or respiratory complaints, but a significant reduction of spirometric parameters occurred after surgery. Conclusions This study highlights the close link between the role of the phrenic nerve and pulmonary function, such that the use of this nerve as a transfer donor leads to spirometric impairments.

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION Markedly deviated septum had improper effects in cardiovascular system due to increase in MPAP.

Trigger finger is a common disease which particularly occurs in middle-aged women. We present a rare case of a male musician with six trigger fingers (five in the left hand and one in the right hand). Mostly these fingers had been used for playing the guitar. The patient had previously been treated with local steroid injections in his fingers, however no response was seen. Therefore, we performed a surgical procedure. Four weeks after surgery, the patient could play the guitar without discomfort in his hands.