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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 Revascularized digits may fail because of vessel thrombosis. The current study aimed to develop a standard model for crush injury in the rat femoral artery to evaluate the antithrombotic effect of perivascular botulinum toxin A (BTX-A) injection. Methods We explored bilateral femoral arteries of 10 rats using a microscopic technique. The crush injury was reproduced using a bulldog clamp. One randomly chosen leg of each rat was injected with BTX-A. The other side received normal saline as its own control. After 24 hours, the femoral arteries were ligated distal to the trauma site and were divided between the traumatized and ligated sites. Results All arteries injected with BTX-A had pulsatile bleeding without thrombosis. Arteries injected with normal saline had thrombosis without bleeding, except for one with oozing. The results showed the efficacy of BTX-A and its potential use in microvascular trauma (p Conclusion The use of BTX-A preoperatively in the emergency department may help reduce traumatic stress and subsequent thrombosis and improve trauma management results. Complementary studies are needed to assess the ability of BTX-A to reduce thrombosis and vasospasm and improve survival of traumatized digits.

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.

The main aim of the treatment in fingertip amputations is to establish the functional and aesthetic construction of the fingertip. The aim of this study is to discuss how to use purse-string suture as a complementary technique accompanying conventional flaps repair in fingertip amputation. Fifty-four patients with fingertip amputations on the nail bed referred to our center for fingertip reconstruction. From which 41 patients who had at least one-third of their nail remained (to preserve the nail) were chosen to undergo this new technique. Patient's satisfaction of the achieved functional results (in case of pain and motion) was as follows: 32 responded excellent, 8 good, and 1 fair. Also, patient's satisfaction of the achieved aesthetic results were Excellent = 7 and Good = 2 in females (n = 9) and Excellent = 19, Good = 7 and Fair = 6 in males (n = 32). 93% (38 patients) of the patients had two-point discriminationof less than 3 mm. No flap necrosis was observed in this study. The flap donor site was covered by primary closure (in 24 cases), secondary intention (in 11 cases), and skin graft (in 6 cases). The nail and finger contour are important for achieving a satisfying aesthetic and functional result. We believe that this new complementary technique could be an easy way for reaching this end. It is recommended that this technique be applied to all fingertip injuries to preserve the nail.

Summary Numerous otoplasty techniques have been developed during the past decade. However, no single ideal technique is universally adopted. The creation of a normal scapha with prevention of retroprotrusion of the helix after creation of an aesthetically well-folded antihelix remains controversial and is regarded as a neglected aspect of otoplasty. The present study is a report of creating a natural fold of cartilage using a combination technique of cartilage incision at the border between the antihelix and scapha, with medial scoring of the scapha and lateral scoring of the antihelix region. Sutures were used to preserve the created fold. In a retrospective study, 45 cases of prominent ear corrections, after an average of 1 year follow-up using a four-scale grading system, were: very good, good, satisfactory and poor. The results indicated that 95% of the patients regarded the operation as very good and good, 22 patients were extremely satisfied and three were satisfied. There were no major complications. None of the patients developed a recurrence, or retroprotrusion of the helix, and none required a further operation for correction. The proposed procedure is a simple surgical technique. The reconstructed ear shows reliable results in stability, size and normal convolutions. Furthermore, sharp cartilaginous ridges and hidden helix are avoided. We propose this technique as an alternative approach to manage the antihelix–scapha–helix complex during otoplasty.

Aesthetic surgery for correction of the lower lid bulge can be classified into 3 groups of subtractive surgery, redraping, and repositioning. The authors present a new repositioning technique with vertical plication of the orbital septum for correction of lower lid bulge. This procedure was performed on 30 individuals during a 3-year period between March 2003 and March 2006. The length of follow-up varied from 3 months to 1 year, with an average of 6 months. There was no lower lid retraction or ectropion. Contour was smooth without any visible deformation or palpable suture line along the vertical plication. In the follow-up visits of minimum of 3 months, no recurrence of bulge was present and the scar was inconspicuous. Vertical plication of the orbital septum is an effective way to reposition the orbital fat inside the orbit. It anatomically corrects lower lid bulge, preserves the orbital fat pad and the vertical dimension of the lower lid, and provides a smooth contour in the periorbital area without the need to penetrate the orbital septum or manipulate the fat pad. Morbidity is minimal and transient, and the results are satisfactory. We suggest this technique for correction of lower lid bulge when there is excess lower lid skin and a subciliary approach is selected.

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 Basal cell carcinoma (BCC) is the most common human malignant neoplasm. Some patients with scalp BCC have had a history of childhood scalp radiation for the treatment of tinea capitis. It is not clear whether BCC in these cases has a more aggressive nature and requires a more aggressive resection. We performed a retrospective study to compare BCC tumor specification and treatment results between irradiated and nonirradiated patients. Materials and methods From 1995 to 2005, a total of 74 patients were diagnosed with scalp BCC. Thirty-eight patients (group A) had a history of childhood radiation to the scalp for the treatment of tinea capitis, and the other 36 (group B) did not. We compared these 2 groups in 16 different parameters, which included general information (age, sex), disease history (time interval from onset of lesion to the first office visit, number of admissions, total length of hospital stay), tumor specifications (number of primary lesions, invasion depth, histologic subtypes, location), surgical history (number of operations in our center and other hospitals, type of surgical treatment, margins of resection), recurrences, new lesions, and metastasis. Statistical analysis was performed using SPSS 13.0 software. Results No significant difference in gender and age was observed between the 2 groups (P = 0.06 and P = 0.35, respectively). Patients in group A had a longer history of scalp lesions (P = 0.001). They also had more hospital admissions (P = 0.008) and operations (P = 0.01) in our center, with a longer period of hospitalization (P = 0.01). Mean number of primary lesions, the location of tumor, and the depth of invasion did not differ significantly between the 2 groups (P = 0.34, P = 0.78, and P = 0.73, respectively). There was no meaningful difference in safe resection margin for the first lesion between the 2 groups (P = 0.27); however, the number of recurrent lesions was significantly higher in group A (P = 0.003). Also, need for more aggressive resection and more complicated reconstruction was more in group A patients (P = 0.01 and P = 0.015, respectively). Only in group A new lesions and metastasis were found. Conclusion BCC in irradiated scalp has a more aggressive behavior and may need a more aggressive surgical resection. Also, these patients should be under close observation because there is a higher chance for tumor recurrence and also new lesions occurring elsewhere in the scalp.

Electrical burn injuries occur worldwide and constitute 5–10% of all occupational fatalities. An analysis of human factors contributing to electrocutions has shown that carelessness is a major contributor. The management of these acute wounds has progressed over time, with the emphasis changing from a conservative approach to wound closure, then to the more aggressive doctrine of improving the functional and aesthetic outcome of the patients [1]. Factors that determine the type and extent of electrical burn injuries include voltage and current flow [1,2]. The spectrum of anatomic sites involved from electrical trauma is quite varied. The head is not a usual contact or entry point in high-tension burns but if involved, lips, nose and commissures may be affected. Young children usually aged between 1 and 3 years are frequent victims of electric burns of the lips [3]. It is rarely seen in adults. Several options are available for reconstruction of lips according to the extent of injury. Subtotal lip reconstruction can be performed using local flaps such as cross-lip and fan flaps. Total lip reconstructive efforts usually are suboptimal in providing an adequate oral sphincter, an acceptable aesthetic result or both. For total upper, lower or extensive combined soft-tissue defects that include both lips, traditional methods of reconstruction include the use of regional flaps such as the deltopectoral flap [4,5]. A more recent application is the use of the folded forearm flap to replace both the skin and inner lining, simultaneously, in full-thickness cheek and lip defects [6].

A reverse flow retroauricular island flap was successfully used for reconstruction of nasal defects as a one stage procedure in three cases. The length of the pedicle allows its transfer to cover defects of the nose. There was no partial or total flap necrosis and scars were inconspicuous. The patients were very satisfied with the result. Although this technique is of a higher level of difficulty than a conventional washio flap, it allows aesthetically favourable nasal reconstruction by a single stage operation in selected cases.

Purpose To determine the clinical characteristics of 12 patients with Mycobacterium tuberculosis –induced carpal tunnel syndrome. This article also presents our intraoperative findings and surgical treatment results. Methods Twelve patients with tuberculosis-induced carpal tunnel syndrome who had surgery during a 10-year period that began in March 1991 were reviewed. The entrance criterion was a positive histologic report of tuberculosis for surgical specimens. The preoperative evaluation leading to diagnosis was reviewed for all patients. Transection of the transverse carpal ligament and complete synovectomy were performed for all patients. After surgery the patients were given an antituberculosis regimen for 1 year and were followed up for an average of 6 years. Results Twelve cases from a total of 1,180 patients with carpal tunnel syndrome were traced to M tuberculosis involvement of synovial tissue of the flexor tendons. Ten patients had large rice bodies in thick synovial membranes, and in the other 2 patients thick synovial tissue with yellow exudates were observed during surgery. In contrast to tendon involvement with rupture, no direct median nerve involvement was noted. Histopathologic study results of surgical specimens were positive for tuberculosis in all patients. Eight of 10 initial smears showed acid-fast bacillus and all 10 cultures of the specimens were positive for tubercle bacilli. Surgery and antituberculosis therapy were associated with a desirable outcome and sensory disturbance in the median nerve distribution resolved in all patients. Anterior wrist swelling disappeared and there has been no clinical or laboratory evidence of recurrence in all treated patients. Conclusions Early diagnosis and surgical treatment combined with antituberculosis medical treatment are important in treating this condition. All patients treated were relieved of symptoms of synovial proliferation at the wrist, with no recurrence of the condition during the follow-up period. Type of study/level of evidence Therapeutic, Level IV.