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In the spring and summer of 2012, a survey was conducted to study the biological control agents of field bindweed (Convolvolus arvensis L.) in the city of Mashhad and its suburban areas. Lepidopteran larvae were observed feeding on the leaves of field bindweed. The larvae were collected and reared in an insectarium and later sent to Dr H. Alipanah (Iranian Research Institute of Plant Protection, Tehran, Iran). The species was identified as Bedellia somnulentella (Zeller) of the family Bedelliidae. This species is newly reported from Iran.

Oak acorn contains high levels of tannins which have capacity to form complexes with proteins and consequently reduce their availability and as a result it could reduce colostrum quality and immunoglobulin (Ig) synthesis. Thus, the aim of this experiment was to investigate the effects of dietary oak (Quercus persica) acorn (OA) level during the last 60 days of pregnancy on colostrum composition and plasma metabolites and IgG level of goats and their kids. In all, 24 multiparous pregnant goats (41.7±2.3 kg BW) were assigned into one of the three experimental diets consisted of control diet (without OA) and diets containing 20% (OA20) or 40% (OA40) OA on dry matter basis. Goats fed OA40 had lower BW change compared with other groups (P⩽0.05). Kids birth weight was not affected by experimental diets (P>0.05). Goats fed OA containing diets had lower plasma glucose, triglyceride and Fe concentrations compared with those fed the control diet (P0.05), whereas kids born from goats fed OA containing diets had lower plasma IgG level compared with the control diet (P

Background: This report describes the results of a surgical procedure for facial reanimation. This single-stage technique involves the orthodromic transfer of only a superficial segment of the temporalis tendon. This is extended with fascia lata to achieve elevation of the oral commissure along the desired vector in the paralysed hemi-face., Methods: A retrospective case note review was performed. Patients' photographs were objectively evaluated with Facial Assessment by Computer Evaluation (FACE) software., Results: Thirty-nine patients underwent the procedure from 2001 to 2011. Median age at the operation was 57.0 years (interquartile range (IQR) 38.2-66.3 years), and median duration of follow-up was 0.9 years (IQR 0.5-1.8 years). All patients achieved early improvements in appearance and function after surgery. Three patients underwent further, minor procedures for aesthetic and functional adjustments around the oral commissure. Complications occurred in three patients: two minor facial haematomas and one thigh wound infection. The surgery did not disturb natural temporalis muscle function. FACE analysis demonstrated that no significant movement of the oral commissure occurred during attempted smiling in the paralysed hemi-face before surgery. However, symmetry was achieved when the healthy and paralysed hemi-faces were compared post-operatively, both in repose and during controlled smiling., Conclusions: This modified, single-stage technique for facial reanimation improves commissure mobilisation and has been objectively shown to restore symmetry of the commissure to the reanimated hemi-face., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The extent of breast and chest-wall deformity varies widely in Poland syndrome, and a variety of techniques are required to correct them. The aim of this study is to analyse our experience and long-term follow-up, and to propose an algorithmic approach to this complex deformity., Patients and Methods: Retrospective case-note review from a prospectively maintained database was carried out on 37 patients. All patients treated between 1993 and 2013 were reviewed, and long-term outcome was assessed by an objective photographic documentation. The patients were invited to a photographic documentation, and the correlation between the subjective judgement and objective results in the late course was analysed. Based on our experience, we propose an algorithmic approach to this complex skeletal and soft-tissue deformity., Results: Medical photographs were obtained from 32 patients (22 females and 10 males). The age range was 11-44 years. Significant reduction in asymmetry was possible in all patients. The mean follow-up time was 8.5 years (range, 2.2-20). The complex developmental defect involved the skin, subcutaneous tissue, breast, muscle, ribs and other skeletal abnormalities. The following treatments were applied alone or in combination: lipomodelling, liposuction, tissue expansion and implants, custom-made prosthesis, islanded pedicled latissimus dorsi muscle flaps, pedicled and free muscle-sparing transverse rectus abdominis flaps, prosthetic chest-wall reconstruction and various combinations including multistage procedures. Surgery on the contralateral breast in female and male patients was necessary in 22 patients (20 female and two male). Assessment of the late result by four non-professionals (two females and two males) and one male plastic surgeon showed that the objective aesthetic results of the authors' reconstructions according to the proposed algorithm were sufficient., Conclusions: Poland syndrome is a complex developmental deformity in which several tissues are involved. It is crucial to have an armamentarium of techniques to tackle a variety of defects to meet patients' expectations, and to improve their quality of life. The clinical outcome of the currently presented algorithm proved beneficial in the decision process for the treatment of these congenital deformities., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Implant based breast reconstruction after risk reducing mastectomy (RRM) is challenging as implants are inadequately covered in their lower pole. Also complication rates with one stage procedures are significant. We describe a novel method of pre-expansion by inserting subpectoral anatomical expandable implants to prepare the breast mound before RRM is carried out. Lipomodelling is later used to enhance the overall result of the reconstruction. Six patients who were BRCA 1 mutation carriers requested bilateral RRM. Median age was 31. All were non-smokers. Anatomical expandable implants were inserted via an inframammary incision and were expanded in the next two months. RRM was carried out 6-13 months later and was followed by lipomodelling seven months afterwards. Four patients had a nipple sparing mastectomy. In three cases access was via the previous inframammary scar. In all cases complete implant cover had been achieved. There were no early postoperative complications but one patient has developed grade III capsular contracture on the side of previous wide local tumour excision and radiotherapy. Five patients have so far undergone post-mastectomy lipomodelling to improve breast contour. In conclusion, we believe that our technique provides better aesthetic results with reduced complication rates for these patients., (Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Medial displacement of T-tubes is rare and only 6 cases have been reported in literature. We report a case of a medial displacement of a T-tube in the middle ear behind an intact tympanic membrane with normal mobility. No treatment was undergone as the patient was asymptomatic and no hearing problems were detected. A brief overview of this unusual complication of tympanostomy tubes is presented and the management strategy is discussed.

Dermatography has been used in medicine both for aesthetic purposes as permanent make-up or for coverage of scars, defects and skin colour abnormalities. These procedures demand skill and usually more than one session to achieve the desired result. We present an innovative idea from some of our plastic surgery patients to camouflage their scars using decorative tattooing done by non-medical professional tattooists. Long abdominal scars were covered with symmetrical tattoo designs rendering the scars inconspicuous even on close inspection. As tattooing is less of a social taboo nowadays and, indeed, quite acceptable among many of the younger generations, this method could be presented as an option to camouflage scars of the trunk and the limbs that are unacceptable or undesirable, especially in patients who already have tattoos on other parts of their bodies.

Gender reassignment procedures are performed more frequently nowadays due to a multidisciplinary approach and improved techniques and selection process. Many male-to-female patients require bilateral breast augmentation as part of the transformation following the gender reassignment if they fail to develop female breast features after hormonal treatment. We report on a very rare incidence of male-to-female gender reassignment in a patient with Poland syndrome. A male-to-female transsexual on hormonal therapy for gender reassignment developed one normal female-shaped breast whereas the other breast remained hypoplastic. As a male, he was not aware of his chest wall deformity but it became a major issue after successful gender reassignment surgery. Our experience with the specific reconstructive considerations and recommendations regarding our surgical approach to this complex reconstructive problem are discussed.

Summary: Breast cancer is the most common cancer in the UK, and a significant number of breast cancers are hereditary. Identification of BRCA1/2 genes and the high-risk patients for developing breast cancer would allow a better understanding of the natural history and pathogenesis of breast cancer. Genetically predisposed patients and their families are managed differently than sporadic cases. Management of these individuals is decided in a multidisciplinary setting, which includes medical oncologists, clinical geneticists, psychologists, breast surgeons, plastic and reconstructive surgeons, clinical nurses and family planning specialists. This article reviews and highlights the current knowledge of hereditary breast cancer syndromes, the clinical implications of carrying a genetic predisposition and how it influences the management of the patient and the effect it has on breast reconstructive surgery services.

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a popular choice for patients requesting breast reconstruction. Criticism of all techniques that harvest the rectus abdominis muscle centre on abdominal wall weakness.[Dulin WA, Avila RA, Verheyden CN, Grossman L. Evaluation of abdominal wall strength after TRAM flap surgery. Plast Reconstr Surg 2004; 113: 1662-1665] Primary fascial closure of the donor site has been shown to reduce abdominal wall weakness and the subsequent risk of hernia and bulge. [Mizgala CL, Hartrampf CR Jr, Bennett GK. Abdominal function after pedicled TRAM flap surgery. Clin Plast Surg 1994; 21: 255-272]2 Primary fascial closure of all uni-lateral and most bilateral muscle preserving TRAM flap donor sites is possible. In a series of 23 bilateral TRAM flaps, excessive abdominal tension prevented direct fascial closure of the donor site in seven. Using a technique that includes muscle preservation, muscle relaxation and mesh assistance; tensionfree, direct fascial closure was achieved in all. The mesh buttress supports the rectus sheath during closure and provides long term shape and stability.

Immediate reconstruction (IR) of the breast following mastectomy is not available to all appropriate patients. Previous studies have examined general surgeons attitudes toward reconstruction but have not assessed how these translate into surgical practice. We investigated the current rates of referral for, and availability of, IR across the West Midlands region.A postal questionnaire was sent to all breast surgery units in the region. Out of 20 units 19 responded. Units where IR was performed in-house were likely to have more breast surgeons (2.3 vs. 1.5, p=0.0106), and a higher annual workload (222 new cases vs. 174). Only two of 19 surgeons said they did not discuss IR with appropriate patients. Selection criteria in the other units included age, lack of co-morbidity, favourable pathology, smoking habit, and in one unit, only small-breasted women were offered IR. IR is performed in 13 of 19 units. Reconstructive procedures range from implants to deep inferior epigastric artery perforator (DIEP) flaps; the surgery is performed by breast and plastic surgeons together in seven units, breast surgeons alone in five and plastic surgeons alone in one. Six units do not carry out reconstruction. These units referred between two and 10 patients (average five) for IR in 2001. Units where some types of IR were available referred between three and 35 patients for surgery not performed in-house, and there was no relationship between complexity of surgery available in-house and referral rates. Reasons for low referral rates included: surgeons' attitudes; geographical isolation; long waiting times for plastic surgical opinion and for surgery; and loss of control of patients' management. Although surgeons' attitudes in the West Midlands are generally positive toward IR, availability and referral rates vary widely. Reconstructive surgeons should encourage referrals by increasing contact with general surgeons to overcome logistical problems and by ensuring appropriate systems for referral exist.

The closed-anterior-scoring technique has been used over the past 3 years to correct 56 prominent ears in 32 patients at the West Midlands Regional Plastic Surgery Unit at Wordsley Hospital. A review was carried out to assess the result of this surgical procedure. We briefly discuss the historical development of other surgical techniques for prominent-ear correction, and describe in detail the operative technique for this procedure, which includes closed scoring and suturing of the cartilage. We used this technique to treat 24 patients with bilateral prominent ears and eight patients with unilateral prominent ears. The series comprised 20 females and 12 males, 26 children and six adults. The age range was from 4 to 24 years old. There were two complications (an upper-pole recurrence and protrusion of a buried prolene suture). Patients were followed up for between 6 months and 3 years (mean: 1.5 years). This procedure is quick and technically easy to learn, with no anterior scars or posterior cartilage overlap. Minimal dissection is involved, leading to a low rate of complications. The learning curve is rapid; this paper represents the experience of a specialist trainee (SST) after he was taught the technique by the senior author., (Copyright 2001 The British Association of Plastic Surgeons.)

A new method for the measurement of the interdigital webs of the hand is described and is shown to be reproducible. Measurements are taken from photographs and the method would be suitable for the comparison of post-operative appearances in the evaluation of "web creep" after surgery.

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.