The Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Metanalysis of Outcomes of Treatment of Mandibular Fractures3613646814910.21608/ejprs.2020.68149ENMohamed ElroubyThe Department of Plastic, Burn & Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed AbdelsalamThe Department of Plastic, Burn & Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed ElsherifThe Department of Plastic, Burn & Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: The exact timing of treatment of mandibular<br />fractures remains a source of debate. Immediate repair of<br />fractures is not always feasible; the existence of associated<br />injuries and bad general condition might make it not practical.<br />We performed this study to detect the difference of percentage<br />of complications between cases of early and delayed management<br />of mandibular fractures in order to set recommendations<br />of the appropriate timing of work on these cases.<br />Methods: A retrospective study included 180 patients<br />having isolated parasymphyseal mandibular fractures underwent<br />chart review to document the relevant data, including<br />the time of fracture, time of treatment and complications<br />recorded during post-operative follow-up. Patients were<br />categorized according to whether they had surgical intervention<br />early post-trauma or late.<br />Results: 90% were males and 10% were females. Mean<br />age of 28.74 years. 59% presented with associated zygomaticomaxillary<br />complex fractures. Follow-up time was 6 months.<br />No statistically significant difference in the development of<br />post-operative complications after mandible fracture repair<br />between the early and late treatment groups.<br />Conclusion: Our study has similar results to that ofhttps://ejprs.journals.ekb.eg/article_68149_610fdb7c0170d63b917785f84cbdc0cf.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Epidemiological Study of Mass Casualties at A Tertiary Burn Center in Ain-Shams University: Management and Outcomes3653696815010.21608/ejprs.2020.68150ENMohamed ElroubyThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed AbdelsalamThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Purpose: To report, analyze different aspects of mass<br />casualty incidents resulting from household fires due to<br />explosion of gas cylinders presented to our Burn Unit from<br />2013 to 2017.<br />Methods: Data of all burn mass casualty incidents from<br />admitted to the Burn Emergency Unit of Ain Shams University,<br />Cairo, Egypt; from January 2013 to December 2017 were<br />collected from the Burn Unit and its Intensive Care Unit<br />records, reviewed and described.<br />Results: Six incidents from flame burn caused by household<br />explosion of gas cylinders took place in the past 5 years.<br />33 victims were involved in the incidents and admitted to our<br />unit; male: female ratio was 2.7:1. The ages of the admitted<br />patients ranged from 2.6y-51y. The extent of burns ranged<br />from 10-68% of TBSA affecting head and neck, torso and<br />extremities. A total numbers of 44 operations were performed<br />to all the patients during their stay in the form of emergency<br />escharotomies in 12 patients and 32 sessions of excision of<br />the deep partial and full thickness burns and split-thickness<br />skin grafting in 19 patients. All patients survived and discharged<br />uneventfully except only for 4 deaths (12%) with<br />mean hospital stay duration of 30 days. Complications that<br />developed in the admitted cases include wound infections<br />(12.50%), hypertrophic scars (12.50%), altered skin color<br />(8.33%) and psychotic manifestations (6.24%).<br />Conclusion: Retrospective analysis of the therapeutic<br />data of these cases demonstrates that management of mass<br />burn causalities requires pre-designed disaster planning, well<br />equipped center, trained personnel and these are the key<br />elements in successful management.https://ejprs.journals.ekb.eg/article_68150_34c793991f14c027b0d6c71616a3a355.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001A New Technique for Pixie Ear Deformity after Lower Facelift Surgery3713746815510.21608/ejprs.2020.68155ENMohamed ElroubyThe Department of Plastic, Burn & Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptAhmed ElsherifThe Department of Plastic, Burn & Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Lower face and neck lift may be easily<br />noticed by most plastic surgeons as well as other individuals,<br />by spotting some peculiar landmarks. Besides obvious postoperative<br />scars or other major post-operative complications,<br />ear synkinesis, also called “operated look ear”, “stuck on”,<br />“pulled” or “pixie” ear, is among the prominent features [1].<br />Treating ear synkinesis may be challenging and unsatisfactory<br />for both patients and surgeons. It would be rather<br />avoidable than correctable [2].<br />The reported technique is a simple modification of the<br />incision around the ear lobe to prevent and treat pixie ear<br />deformity that may occur following lower facelift operations.https://ejprs.journals.ekb.eg/article_68155_bf09cd390def2964a19ed5056de489d1.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Double Purse String Closure Technique for Minimizing Post-Operative Widening of Periareolar Augmentation Mastopexy: A Comparative Study3753816816010.21608/ejprs.2020.68160ENNahed SBoughdadiThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Objectives: For management of mild degree breast ptosis<br />periareolar mastopexy had been commonly used. Since Benelli<br />1990 had confined the scar to the areola in his round-block<br />technique, several authors has adopted this technique. Whether<br />mastopexy had been done with or without augmentation, the<br />problems of breast shape, areolar irregularities,and stretch of<br />the areola had been annoying to both patients and surgeons.<br />These problems also represent a major challenge to this<br />technique. In this paper purse string closure was used in two<br />consecutive different layers one in dermal de-epithelized layer<br />and another in the deep dermis of the skin. The aim is to<br />minimize widening of scars of peri-areolar incision and<br />improve its long term appearance.<br />Patients and Methods: 50 cases underwent mastopexy<br />with breast augmentation. Cases were divided into two groups:<br />Group A: Underwent closure by single purse string layer and<br />Group B: Two consecutive purse string closure. The second<br />concentric row was applied to the deep dermal plane of the<br />normal non de-epthelialized skin similar to the classical purse<br />string closure described previously. Both subjective and<br />objective evaluation were done. Surgery was done by single<br />surgeon and two surgeons not involved in research evaluated<br />the post-operative photos. Follow-up was done at 3, 6 month<br />and at 1 year post-operative.<br />Results: Group B patients showed superior results as<br />regarding breast shape, contour, projection, superior fullness,<br />periareolar scar shape, regularity, areola width and position.<br />These results were followed-up for one year.<br />Conclusion: Decreasing the tension of the periareolar suture<br />by applying double purse string technique in two different<br />planes improved long term results of periareolar scar in order<br />to avoid widening, irregularities and hypertrophic scarring.https://ejprs.journals.ekb.eg/article_68160_024b5ec81c9df51f414ccb5b529727c2.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001High Definition Liposuction Using Third Generation Ultrasound Versus Conventional Liposuction of the Lower Back and Upper Thigh Region: A Comparative Study3833886816510.21608/ejprs.2020.68165ENNahed SBoughdadiThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Introduction: The accuracy of results of liposuction had<br />long been related to the aspiration cannulas as much as it is<br />related to surgeon experience. The cannulas tips, length,<br />diameter, design, number of holes shapes and negative pressure<br />had drawn the attention of all surgeons in order to modify<br />their outcomes. The addition of technologies that provide<br />energy based devices has enriched the procedure and improved<br />patient satisfaction. Ultrasound assisted liposuction had several<br />complications included severe burns and other problems, less<br />energy is used in third generation ultrasound assisted liposuction<br />than second generation liposound which make it safer<br />with better results. A much more accurate technique was<br />described by Hoyos to improve body contouring by using<br />VASER assisted liposuction.<br />Aim of the Study: To investigate the superiority of high<br />definition liposuction using third generation liposound in<br />lower back and upper thigh region as regarding patient satisfaction<br />and their need for secondary procedures.<br />Patients and Methods: 20 patients with age ranged from<br />18-40 years old and BMI=25-30 having lipodystrophy of the<br />lower back and upper thigh and trochanteric areas with moderate<br />skin tone, only non-smoker-non diabetic-non hypertensive<br />were included in the study. Patients were divided into two<br />groups; Group A included 10 patients who undergone suction<br />assisted liposculpture and Group B: Included 10 patients who<br />had high definition liposuction using third generation internal<br />ultrasound machine. Both subjective and objective evaluation<br />was done. Objective evaluation was done by measurement of<br />both pre operative drawn line starting from mid sacral point<br />to highest point of iliac crest and post-operative measurement<br />at one and six month in both groups.<br />Results: This study involved 20 women divided into two<br />groups. Group B patients had less blood content of the aspirate,<br />longer time of the procedure (add ultrasound timing) more<br />post-operative edema, more obvious skin retraction along<br />post-operative period. While Group A patients showed overall<br />less edema and more ecchymosis with less satisfaction and<br />more irregularities and need for secondary procedures.<br />Conclusion: High definition liposcution using third generation<br />internal ultrasound showed higher skin contraction,<br />better body shape and contour.https://ejprs.journals.ekb.eg/article_68165_e05a112cd729ef22d016e23104efb6b0.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Ipsilateral Lateral Suture Suspension Platysmaplasty: A Modified Less Invasive Technique in Neck3893936816710.21608/ejprs.2020.68167ENNada AMahmoudThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptKarim SMAssoudThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Numerous techniques have been described<br />for neck lifting aiming at minimal access and limited downtime.<br />This study presents a surgical technique for patients with<br />considerable neck bands avoiding the anterior neck incision.<br />Patients and Methods: Thirteen female patients (mean<br />age 57 years) with considerable platysma laxity underwent<br />suture platysmaplasty during face lift procedures. Through a<br />face lift incision, the platysma was suspended to the ipsilateral<br />mastoid periosteum using permanent suture. The outcome<br />was rated according to a modified visual analogue scale for<br />neck bands and cervicomental angle.<br />Results: Twelve patients achieved satisfactory stable<br />improvement. One case had early recurrence of her platysma<br />bands that required surgical correction.<br />Conclusion: Modified ipsilateral suture suspension platysmaplasty,<br />through the facelift approach can improve platysma<br />bands without the need for additional anterior approach. This<br />modified technique makes the procedure easier and less<br />invasive.<br />Evidence Based Medicine: Level IV, case seriehttps://ejprs.journals.ekb.eg/article_68167_e651bb4efab07c8a78213b13c09f7b0e.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Correlating the Volume of Diced Cartilage Grafts and the Gain in Nasal Dorsal Height Following Nasal Dorsum Augmentation3963996816810.21608/ejprs.2020.68168ENNada AMahmoudThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptKarim SMassoudThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Dorsal nasal depression can be corrected<br />by various methods. In this study we aim to correlate the<br />height gain in the nasal dorsum with a fixed amount (1ml) of<br />diced cartilage grafts wrapped in deep temporal fascia used<br />for dorsal nasal correction.<br />Patients and Methods: In this study included 14 patients<br />with dorsal nasal depression treated by one ml of diced<br />cartilage grafts wrapped in 20 X 40mm deep temporal fascial<br />graft. We correlated the gained height with a determined<br />amount of diced cartilage grafts.<br />Results: The results were documented to correlate the<br />gained height in the nasal dorsum. Results were evaluated<br />objectively and subjectively.<br />Conclusion: Our findings show that there is a correlation<br />between the gained height of the nasal dorsum and the amount<br />of diced cartilage grafts used in nasal dorsal augmentation.<br />This preliminary finding needs further investigation on larger<br />patients' population and variable amount of cartilage grafts<br />to validate these data.https://ejprs.journals.ekb.eg/article_68168_6a078136588504e8908604764c7e20cf.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study4014086817010.21608/ejprs.2020.68170ENNada AMahmoudThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Many treatment options for Venous Malformations<br />(VM) has been documented in the literature but injection<br />sclerotherapy has been considered a current mainstay for their<br />treatment. We conducted this study to determine efficacy and<br />durability of different injectable forms of bleomycin sclerotherapy<br />in the treatment of VMs in cervico-facial region.<br />Patients and Methods: Thirty patients complaining of<br />venous malformation in the head and neck region, diagnosed<br />clinically and confirmed by magnetic resonance imaging, had<br />been injected with bleomycin sclerosing material. They were<br />divided into two equal groups according to the form of<br />bleomycin injected; Group A: Foam form was injected and<br />Group B: Liquid form was injected. Patient's data, anatomical<br />sites, type and volume of the VM, number of injection sessions<br />and the average dose of injected agents were documented and<br />statistically compared between the 2 groups.<br />Results: MRI imaging showed a decline of more than<br />90% from the initial size of lesions in 66.7% cases and<br />considerable decline (60%-90%) in 33.3% of cases. In Group<br />A the number of sessions were (1-4), while in Group B were<br />(1-6). the amount of sclerosing material injected in Group A<br />were (2-7.5mg), while in Group B were (3.5-13mg), which<br />was statistically significant. The cumulative dose in the equal<br />size lesions was lower in the foam form rather than the liquid<br />one, and show statistically significant difference.<br />Conclusion: Foam form has greater promise compared<br />with liquid form in the treatment of VMs and would encourage<br />us to continue use the bleomycin in its foam form in the future<br />on a bigger number of patients with larger size lesion and<br />different location without reaching to the toxic cumulative<br />life time dose.https://ejprs.journals.ekb.eg/article_68170_06920870213ec5d9ea4e4917c0da4377.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Pan Facial Fat Cells Transfer for Correction of Slim Face Deformity4094166817410.21608/ejprs.2020.68174ENDalia MRabehThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptIbrahim HKamelThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptAyman AShakerThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: There are many reports in the literature<br />describing how to slim down the face. These reports include<br />diet and nutritional control, facial exercises, camouflage<br />procedures by makeup and hair style and facial liposuction.<br />However, excessive slimming of the face is due to decreased<br />amount of subcutaneous fat cells in facial fat compartments.<br />Slim face deformity is the term which we applied to<br />describe diffuse symmetrical hollowing of the face of young<br />people without any apparent cause. It may be constitutional<br />or due to massive weight loss in some patients. Fat grafting<br />is one of many other techniques that were reported for correction<br />and enhancement of localized facial regions and<br />treatment of facial aging. However we could not find any<br />report in the literature describing how to correct slim face<br />deformity.<br />Obejective: The authors are going to describe slim face<br />deformity and experience in correction using fat cells transfer<br />in different facial fat compartments.<br />Patients and Methods: Thirty five patients with slim face<br />deformity were treated by full face fat injection. The technique<br />of fat harvesting, preparation and injection is illustrated. The<br />patients were followed-up for at least six months.<br />Results: All patients had initial dissatisfaction with early<br />post-operative appearance due to the surgical edema and<br />overcorrection. They became gradually satisfied within a<br />period of three months after surgery. 80% of patients had only<br />one session of fat injection and only 20% of them asked for<br />further fat injection and this was usually done eight to ten<br />months after surgery.<br />Conclusion: Fat cell transfer, can be used as a safe long<br />lasting procedure for correction of slim face deformity in<br />patients who need full facial augmentation. It is a more natural<br />and relatively cheaper technique in comparison to the use of<br />other dermal fillershttps://ejprs.journals.ekb.eg/article_68174_371453007976a777cf7f5d9c6b5a2d42.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair4174246817710.21608/ejprs.2020.68177ENOmar OsmanThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Minia* UniversityIbrahim HKamelThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams UniversityAhmed ElshereifThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams UniversityAhmed MMohamedThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Minia UniversityAmr MagdyThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20200114Background: Ultimate repair of alveolar defects is a great<br />challenge in practical field, many bone graft materials have<br />been evolved in the literatures for alveolar defect reconstruction<br />as autogenous, allogenic, xenogenic, and alloplastic grafts<br />[1], autogenous iliac crest bone graft is the gold standard<br />among other graft materials evaluated. However, the procedure<br />associated with a potential risk of early complications such<br />as graft resorption, graft leakage, infection, or graft failure,<br />failure rate is about 30% [2].<br />Objectives: To assess the efficacy of using Platelet Rich<br />Plasma (PRP) in alveolar cleft reconstruction; in combination<br />with Iliac Crest Bone Graft (ICBG) in comparison to the<br />conventional Iliac Crest Bone Grafting (ICBG).<br />Patients and Methods: 20 patients underwent alveolar<br />cleft reconstruction at the age of mixed dentition over a 3-<br />year's period; their mean age was 8.8±2.3 years years and<br />their mean post-operative follow-up was 13.4 months. Of<br />these, 10 patients treated with ICBG combined with PRP<br />(Group I), and 10 patients repaired by ICBG alone Group II<br />(control group) results were assessed by rating the radiographs<br />obtained 3, 6, and 12 months post-operatively according to<br />cone beam CT (CBCT) volume and density assessment.<br />Results: Alveolar cleft repairs using PRP combined cancellous<br />bone (Group I) were 90 percent successful, alveolar<br />cleft repairs using cancellous bone (Group I) were 70 percent<br />successful as regard; bone resorption reduction, bone volume<br />gaining and improved bone density in CBCT at 3, 6, and 12<br />months post-operative with decreased post-operative complication<br />rates.<br />Conclusion: Application of PRP enhances bone formation<br />in alveolar clefts when admixed with autologous bone graft<br />harvested from the iliac crest as it leads to early bone formation,<br />increased bone density, decreases bone resorption, low infection<br />rate and least post-operative complications.https://ejprs.journals.ekb.eg/article_68177_d731e4566a222fb6cd0312b4dac88085.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Evaluation of Deformities, Procedures and Cosmetic Outcomes of Post-Bariatric Mammoplasty4254316818010.21608/ejprs.2020.68180ENFouad MGharibThe Department of Plastic Surgery, Faculty of Medicine, Menoufia University, EgyptDalia MAlsakaThe Department of Plastic Surgery, Faculty of Medicine, Menoufia University, EgyptAhmed TNasserThe Department of Plastic Surgery, Faculty of Medicine, Menoufia University, EgyptMahmoud MElrefaiThe Department of Plastic Surgery, Faculty of Medicine, Menoufia University, EgyptJournal Article20200114Objectives: The aim of this work is to evaluate the different<br />modalities of post-bariatric breast reshaping in females and<br />their aesthetic outcomes and rate of complications.<br />Background: The post-bariatric breast is a real problem<br />after massive weight loss especially in females. Different<br />modalities for the reshaping of post-bariatric breast were used.<br />Patients and Methods: This a prospective cohort study<br />statistical technique, descriptive statistics as numbers and<br />percentages were used, conducted over 20 post-bariatric breast<br />patients requesting breast contouring in the period from<br />January 2016 to January 2019. Operations were done in<br />Menoufia University and Railways Hospitals. Patient's age<br />ranged from 21-49 years. A total of 20 procedures were<br />performed; reduction mammoplasty in 5 patients, auto augmentation<br />in 8 patients, augmentation mastopexy in 5 patients,<br />and implant augmentation in 2 patients.<br />Results: Patient's satisfaction was measured by aesthetic<br />rating scale as follow; 1- Very satisfied, 2- Satisfied, 3- Fair,<br />and 4- Dissatisfied regarding improvement in size, shape,<br />and quality of scar. 14 patients were very satisfied (70%), 4<br />patients were satisfied (20%), and 2 patients were fairly<br />satisfied (10%). And out of the 20 patients, the overall complication<br />rate was 30%.<br />Conclusion: Breast auto augmentation for breast reshaping<br />in post bariatric patients is an ideal and long life technique<br />comparable to other techniques used to address this issue.https://ejprs.journals.ekb.eg/article_68180_afec45bd77ababeeb6ca54b366a90102.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Impact of Changing Post-Operative Flexor Tendon Rehabilitation Program with Early Detection of Complications4334366818310.21608/ejprs.2020.68183ENKhlaed ReyadThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine,
Ain Shams University, Cairo, EgyptNiveen FElmahmoudyThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine,
Ain Shams University, Cairo, EgyptHala AbdelsabourThe Department of Physical Medicine and Rehabilitation; Faculty of Medicine,
Ain Shams University, Cairo, EgyptJournal Article20200114Background: Hand injuries are among the most frequent<br />injuries worldwide, constituting between 6.65% to 28.6% of<br />all injuries and 28% of injuries to the musculoskeletal system.<br />Early post-operative rehabilitation and splinting after flexor<br />tendon repair is very important to improve tendon healing.<br />Presence of dedicated physical therapists play a golden role<br />in early rehabilitation and diagnosis of tendon complications.<br />Patients and Methods: Data collected from all admitted<br />cases with hand injuries during the period (from January 2016<br />to December 2017). In late 2016, a dedicated physical rehabilitation<br />hand subunit was created in Physical Medicine and<br />Rehabilitation Department. Hand ultrasound was done to<br />exclude tendon rupture or tendon adhesions.<br />Results: 475 cases of flexor tendon injury, zone II injuries<br />for fingers were the most common meanwhile, for thumb<br />injuries; zone III in 2016 and zone II in 2017 were the most<br />common, the rate of flexor tendon rupture in 2016 was 4.32%<br />(3.3% was early rupture within three weeks) while in 2017<br />was 2.87% (2.6% were early rupture after three weeks),<br />Tendon adhesions occurred in 7.32% of total cased in 2016<br />while in 2017 was 4.76%.<br />Conclusion: Epidemiological data enhances our knowledge<br />of injury patterns and may play a role in the treatment of<br />tendon injuries. With early physical rehabilitation, better<br />prognosis was achieved and hence better functional outcome.https://ejprs.journals.ekb.eg/article_68183_ef2f41b2368883141a28514504a57545.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Lag Screw in Mandibular Plate Technique for Sagittal Splitting Mandibular Fractures4374396818410.21608/ejprs.2020.68184ENKhaled AReyadThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptNiveen FAlmahmoudyThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Mandibular fractures with sagittal splitting<br />and splaying of both the lingual and buccal cortices poses a<br />challenge in their fixation as screws may push the lingual<br />cortex during screw tightening resulting in widening of the<br />mandible.<br />Methods: Screw lagging inside the lower mandibular plate<br />technique may help approximation of the near and far cortices<br />during screw tightening, this was applied for eight cases with<br />mandibular fractures.<br />Results: The splaying between the two cortices was<br />prevented regaining its normal medullary space width.<br />Conclusion: Using the screw lagging inside the plate<br />technique may be a safe technique used in mandibular fractures<br />that have cortical splayinghttps://ejprs.journals.ekb.eg/article_68184_072ccd571edb4bf669dac370df6c1a52.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Infra-Auricular Flap for Single Stage Ear Lobe Reconstruction4414446818610.21608/ejprs.2020.68186ENKhaled MHassanThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptJournal Article20200114Background: Ear lobe deformity may be congenital or<br />more often acquired due to trauma, burns or surgery. Losing<br />them represents an obvious aesthetic abnormality. Its surgical<br />repair places a challenge due to the difficulty of obtaining a<br />natural appearing and durable outcome. Several methods<br />developed to reconstruct this deformity have presented various<br />advantages and disadvantages. We present the results of a<br />relatively simple technique to reconstruct ear lobe in a single<br />stage.<br />Patients and Methods: In this study, we used proximally<br />based infra auricular flap to reconstruct 5 ear lobes in the<br />period from February 2015 to July 2016 in Plastic Surgery<br />Department, Minia University Hospital and private sector.<br />Surgical procedure was performed under local anaesthesia in<br />all cases. Except one case, we followed cases for 6 months<br />post-operatively.<br />Results: Mean operative time was 40 minutes. Mean age<br />was 32 years. All flaps survived. One patient required secondary<br />sutures for partial ear wound dehiscence due to early<br />removal of stitches.<br />Conclusion: The author outlines a simple method for<br />reconstructing the entire lobe in one stage, without grafts,<br />whilst offering a pleasant appearance with minimal donor site<br />morbidity. The technique is suggested to reconstruct all cases<br />of ear lobe defects.https://ejprs.journals.ekb.eg/article_68186_d3af4d70179d305b474c8f21264b0360.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001The Efficacy of Autologous Nanofat Injection in the Treatment of Infraorbital Dark Colouration4454526818810.21608/ejprs.2020.68188ENEhab ZzamThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptHassan MKhlosyThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptMohamed HAbouarabThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptJournal Article20200114Background: Periorbital hyperpigmentation is a common<br />worldwide problem, which makes a person appear tired, sad,<br />and aged. A number of factors can cause dark circles around<br />the eyes including excessive pigmentation, thin and translucent<br />lower eyelid skin overlying the orbicularis oculi muscle, and<br />shadowing due to skin laxity and tear trough. Although a<br />number of treatment options are available, autologous fat<br />transplantation is an effective method for the treatment of<br />lower lid dark circles, but irregularities caused by leaving<br />visible lumps of the fat can occur. Mechanical emulsification<br />of harvested fat achieves much more finer fat particles than<br />micro-fat called nano-fat which acts primarily by the plenty<br />the active transplanted stem cells the purpose of this study is<br />to evaluate the effectiveness of the nanofat grafting technique<br />in correcting infraorbital dark circles.<br />Pateints and Methods: Nanofat grafting was performed<br />in 10 female patients for dark lower eyelids. The grafts were<br />injected into intra-dermal and sub-dermal layers using sharp<br />27G needle and were harvested from different sites according<br />to the ease of accessibility and to improve the patient's body<br />contours. The mean follow-up period was 4.6 months, ranging<br />from 2 to 8 months. All patients were clinically evaluated<br />using standardized serial digital photographs by two plastic<br />surgeons, who were blinded to the type of procedure performed<br />at each of the follow-up visits.<br />Results: In this study, there was significant improvement<br />of the peri-ocular dark halos in 5 cases (50%), moderate<br />improvement was encountered in 2 cases (20%), 2 cases (20%)<br />showed mild improvement and no improvement in one case<br />(10%). As regards patient satisfaction, 8 cases (80%) were<br />satisfied with the final result, while 2 patients (20%) were<br />not satisfied. Post-operative edema and ecchymosis were<br />minimal in 5 cases (50%) and mild in 5 cases (50%). No cases<br />were presented with either post injection infection or lumps<br />and contour irregularities during the follow-up period.<br />Conclusion: In conclusion, nano fat injections for the<br />treatment of infra orbital dark circles is a simple, cost effective<br />procedure. In addition, nanofat grafting technique provided<br />a significant improvement in skin quality. Our results suggest<br />that the stem cell activity of the nanofat grafting technique<br />has great potential as a treatment modality for dark circles as<br />well as for skin rejuvenation in general.https://ejprs.journals.ekb.eg/article_68188_8bad0d8d613cd3067d4d5b15f8e3d68c.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Lateral Wings Suspension Technique for Improving the Results of Inferior-Pedicle Breast Reduction in Patients Attending Main University Hospital of Alexandria, Egypt4534626819110.21608/ejprs.2020.68191ENAdham FaroukThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptAhmed AZidanThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptAli Gaber AMohamedThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptJournal Article20200114Background: The inferior pedicle wise pattern breast<br />reduction is one of the most popular techniques used. However,<br />a major criticism of inferior pedicle technique is bottoming<br />out of the breast and lack of upper pole fullness. This is caused<br />by gravitational pressure of the breast parenchyma/pedicle<br />on the inferior pole with subsequent scaphoid appearance in<br />the upper pole and lengthening of the vertical scar. In this<br />study, a modification of the inferior pedicle technique will be<br />done by creation of two lateral dermal flaps alongside with<br />the inferior pedicle, and using these flaps to suspend the<br />pedicle to the chest wall and prevent its descent to evaluate<br />its effect on prevention of bottoming out of the breast.<br />Patients and Methods: This is a prospective randomized<br />study that included 20 healthy female patients suffering from<br />breast hypertrophy and they are candidate for reduction<br />mammoplasty by the proposed technique. Design of skin<br />marking for inferior pedicle breast reduction technique was<br />carried out with the standard wise pattern with the creation<br />of two wings (medial and lateral) at the middle of the inferior<br />pedicle; composed of de-epithelialized dermal flaps. Buttressing<br />these two wings to the pectoral fascia at the suitable<br />distances would create a sort of an internal bra effect; which<br />supports the inferior pedicle. During the follow up, the length<br />of the vertical scar (as an indicator of bottoming out) was<br />measured immediately postoperative and every 3 months in<br />the follow-up period.<br /> Results: This study includes 20 female patients of an age<br />ranged between 22-51 years old and a breast size (suprasternal<br />notch to nipple distance) ranging from 31 to 44cm. The followup<br />for 1-year post-operative shows change in the areola to<br />fold distance by a ratio satisfaction reaching 60%.<br />Conclusion: From this study we concluded that the inferior<br />pedicle suspension to pectoral fascia improve the result shape<br />of the breast and decrease the bottoming out of the breast.https://ejprs.journals.ekb.eg/article_68191_fea024f31dc349b17cfcb8e61b41a51a.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Keyhole Pattern with Superior-Medial Pedicle in Large Breast Reduction4634686819510.21608/ejprs.2020.68195ENAhmed ZidanThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptEhab ZAzzamThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptHossam ElkafrawyThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptJournal Article20200114Background: Breast surgery is one of the most difficult<br />fields of aesthetic surgery, because of the complexity of<br />surgical procedures and the relative guidelines defining the<br />aesthetically perfect breast.<br />The goal in reduction mammaplasty is to achieve a pleasing<br />balance among size, shape, and projection of the breast with<br />optimal sensation and appropriate blood supply for the nippleareola<br />and breast. These goals are challenged by the amount<br />of excess tissue and severely distorted breast landmarks in<br />massive breast hypertrophy and severe breast ptosis.<br />The traditional treatment for massive breast hypertrophy<br />or severe breast ptosis is breast amputation with free grafting<br />of the nipple-areola or inverted T, inferior pedicle used to<br />have a relatively high number of complications and the<br />disadvantage. On the other hand, relying on inverted T,<br />superior-medial pedicle can avoid the disadvantage of the<br />previse techniques and give reliable, stable and pleasant results<br />in large reduction mammoplasties.<br />Patients and Methods: This is a prospective randomized<br />study that included 20 healthy female patients suffering from<br />breast hypertrophy and they are candidate for reduction<br />mammoplasty by the proposed technique. Design of skin<br />marking for superior-medial pedicle breast reduction technique<br />was carried out with the standard Wise pattern. The amount<br />of removed tissue was recorded, the aesthetic result and patient<br />satisfaction was estimated for the results.<br />Results: This study includes 20 female patients of an age<br />ranged between 24-45 years old and a breast size (suprasternal<br />notch to nipple distance) ranging from 33 to 42cm. The weight<br />of removed tissues during surgery in our study was ranging<br />from 1210 to 1970. We found that 75% of our results are of<br />excellent aesthetic results, 15% good and 10% fair with 70%<br />of patients were satisfied, 20% of patients were somewhat<br />satisfied/somewhat dissatisfied and 10% of patients were<br />dissatisfied.<br />Conclusion: From this study we concluded that the keyhole<br />pattern with superior medial pedicle was an efficient technique<br />for excising more tissue in large breasts with pleasant aesthetic<br />results.https://ejprs.journals.ekb.eg/article_68195_78974c601ffff99862921cb450e956b5.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001YAG Laser Versus Ultrasound Assisted Liposuction in the Management of Grade II Gynecomastia (Comparative Study)4694746819810.21608/ejprs.2020.68198ENHany SSettaThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptKhaled AReyadThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptNiveen FAlMahmoudyThe Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Introduction: Gynecomastia is a common condition encountered<br />nowadays. Many surgical treatment options are<br />available yet the best modality is still controversial. ND: YAG<br />laser assisted and ultrasound (VASER) assisted liposuction<br />are well defined and respected tools for liposuction yet no<br />one proved to be superior over the other. This study's proposal<br />is to compare the post-operative results for patients treated<br />with both modalities concerning the complications and patient<br />satisfaction.<br />Patients and Methods: Patients with gynecomastia (grade<br />2) were randomly divided to ND: YAG laser liposuction (group<br />1) and ultrasound assisted (VASER) liposuction (group 2),<br />where liposuction zones were marked in all patients. Complications<br />and satisfaction scores were recorded and statistically<br />analyzed.<br />Results: Twenty patients were in this study; 10 in each<br />group. The median satisfaction score for laser assisted group<br />was 4.5 while for ultrasound group was 3.4.<br />Conclusion: Both ND: YAG laser and VASER are powerful<br />tools in management of gynecomastia (grade 2) with more<br />satisfaction and less complications in the laser group.https://ejprs.journals.ekb.eg/article_68198_f6d3aa4ca8a8852ce23201de065eb97b.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Dermo-Fascial Suspension in Mastopexy for Improvement of Aesthetic Outcomes4754816820010.21608/ejprs.2020.68200ENIbrahim HKamelThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Mastopexy is the art of restoring breast<br />volume and its youthful appearance.<br />Aim: We present a surgical technique for simultaneous<br />mastopexy using auto-augmentation by superiorly based<br />dermoglandular flap. In addition, we use two dermo-facial<br />flaps to support the breast tissue in high position to restore<br />and maintain central mound projection and elevate inframammary<br />fold.<br />Patients and Methods: Auto-augmentation mastopexy<br />was performed for 36 patients using vertical superior pedicle<br />deepithelialized dermoglandular flap that inserted beneath<br />the breast tissue. Two opposing dermo-facial flaps based on<br />medial and lateral pillars along the vertical line were used to<br />support the deepithelialized dermoglandular tissue that sutured<br />to anterior chest wall and to each other.<br />Results: During follow-up period there was no bottoming<br />out of breast tissues or other major adverse effects except for<br />mild asymmetry in early 3 patients and patients showed high<br />rate of satisfaction by the results. The results confirmed that<br />this technique corrects ptosis while increasing the projection<br />and apparent volume of the breast and keep inframammary<br />fold (IMF) in high position with minimal degree of descend<br />which is parallel to that of the nipple.<br />Conclusion: The combined use of dermo-fascial flap to<br />support the glandular tissue with auto-augmentation mastopexy<br />improves the shape; projection and contour of the breast and<br />it also help to have long lasting results. The advantage of the<br />technique is that it optimizes the shape and volume of the<br />breast and creating a narrow breast base with a new high<br />inframammary fold without the use of an implant. With this<br />technique recurrent breast ptosis can be minimized after<br />mastopexy procedures.<br />Evidence Based Medicine: Level IV, case series.https://ejprs.journals.ekb.eg/article_68200_7145c4ec101c6f81ed539c683953e48d.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Reconstruction of Tendon Sheath by a Vein Graft in Flexor Tendon Repair in Adjacent Digits4834886820210.21608/ejprs.2020.68202ENIbrahim HusseinKamelThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Adhesion formation after tendon injury is<br />a challenging clinical problem.<br />Aim: We compare the outcome of reconstructing the flexor<br />tendon sheath after primary flexor tendon repair using an<br />autogenous vein graft to reduce post-operative peritendinious<br />adhesions.<br />Methods: Eight patients have acute flexor tendon injuries<br />of both FDS and FDP in zone II in more than one digit.<br />Primary tenorrhaphy was done using traditional technique.<br />In one-digit vein graft was used to reconstruct tendon sheath<br />window, while in the other digit, the tendon sheath left<br />untreated. Post-operative physiotherapy program of controlled<br />active motion is used for both group. All patients were assessed<br />using the second Buck-Gramcko scale at 2 and 6 months.<br />Results: For the vein graft group, 2 patient had excellent<br />result, 2 had very good, and 4 patients had good result. In<br />group II, 2 patients had very good result, 2 patients had good<br />result, and 4 patients had fair result.<br />Conclusion: The use of autologous vein graft as a substitute<br />of tendon sheath is a good treatment modality. Compared to<br />conventional tendon repair technique, it was associated with<br />less adhesion formation and less joint contracture.<br />Evidence Based Medicine: Level IV, vase series.https://ejprs.journals.ekb.eg/article_68202_7f30e2770013e74ee15eac9e98fe7d24.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Tuberous Breast: Combined Approach to Correct Underlying Pathology and Achieve Satisfactory Aesthetic Outcome4894956820310.21608/ejprs.2020.68203ENIbrahim KamelThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114https://ejprs.journals.ekb.eg/article_68203_8ba7c27d5b0aec58756f6bac34783001.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Safety and Efficacy of Combined Gluteal Lipofilling with Silicone Cohesive Implants for Gluteal Enhancement in an Egyptian Population4975016820510.21608/ejprs.2020.68205ENAmr AEl NaggaryThe Departments of Plastic Surgery, Faculty of Medicine, Fayoum UniversityWael N. T.AzizThe Department of General Surgery,
Faculty of Medicine, Cairo UniversityJournal Article20200114Background: Buttock augmentation surgery is on the rise<br />in the recent years. Different approaches exist with different<br />advantages and complication rates. Furthermore, ethnic groups<br />might have different aesthetic demands.<br />Material and Methods: Here, we describe our experience<br />with a combined lipofilling and silicone implant approach in<br />20 female Egyptian patients.<br />Results: Our results reveal both an objective success with<br />an average achieved waist-to-hip ratio of 0.78 after 6 months<br />post-operatively, together with a subjective success with<br />statistically-significantly higher scores reported by both the<br />patients and two independent aesthetic surgeons. Our complication<br />rates were minimal and planned for.<br />Conclusion: Gluteal lipofilling can thus safely and effectively<br />be combined with silicone implants for gluteal enhancement,<br />giving better shape and projection and avoiding implant<br />dissatisfaction.https://ejprs.journals.ekb.eg/article_68205_54b03adec7b759a1e1ff55db94bf90c5.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001The Department of General Surgery, Faculty of Medicine, Cairo University5035086820610.21608/ejprs.2020.68206ENAbdelrahman MohamedThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptNiveen FAl MahmoudyThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptEman NMohamedThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200114Background: Post-bariatric patients suffer from laxity of<br />skin and redundancy in different parts of the body, with<br />resultant unaesthetic appearance. Concerning the lower body,<br />different surgeons have introduced lower body lift and buttock<br />augmentation and have discussed different approaches and<br />techniques. In this study, we compare between buttock autoaugmentation<br />with fat injection and buttock auto-augmentation<br />with gluteal implant application as regards the maximum<br />aesthetic outcome in post-bariatric patients.<br />Patients and Methods: 26 post-bariatric patients with<br />redundancy of the skin of the abdomen and buttocks. All<br />patients had belt lipectomy/abdominoplasty and buttock<br />augmentation (auto-augmentation) in addition to fat injection<br />(Group A, 15 cases), or application of intramuscular gluteal<br />implants (Group B, 11 cases).<br />Results: All patients had follow-up for one year with no<br />major complications. The p-value was calculated for both<br />groups and was found that there is a highly significant statistical<br />difference in the post-operative measurements in Group A<br />(fat injection).<br />Conclusion: Dual autoaugmentation for post bariatric<br />ptotic buttocks give more appealing results for patients, either<br />objectively by measurements or subjectively by high satisfaction<br />scores with a higher preference for fat injection.https://ejprs.journals.ekb.eg/article_68206_73bae9fab0bdb421c4cda54ac49ef216.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Neurotization for Elbow Flexion Restoration after Brachial Plexus Injury5095156821010.21608/ejprs.2020.68210ENFawzi AHamzaThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityMagdy AAbdel MoktaderThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar universityReda MAhmedThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Zagazig UniversityHegazy MALTAMIMYThe Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Al-Azhar UniversityMahmoud ANassefThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar universityMahmoud AEldosokeyThe Department of Plastic & Reconstructive Surgery, Al-Ahrar Teaching Hospital4, Cairo, EgyptJournal Article20200114Background: Restoration of elbow flexion after brachial<br />plexus injury has the first priority in adults. Nerve transfers<br />(neurotization) involves taking nerves with less important<br />functions or branches of a nerve that perform redundant<br />functions to restore important function in a more crucial nerve<br />that has been severely damaged. There are many described<br />neurotization methods for elbow flexion restoration like<br />Oberlin method, Double Fascicular Transfer (DFT) and Intercostal<br />Nerves (ICN) transfer. The aim of this study was to<br />evaluate different methods of nerve transfer for restoration<br />of elbow flexion after brachial plexus injury.<br />Patients and Methods: 21traumatic BPI were included in<br />this study (19 unilateral BPI and 1 bilateral BPI). 4 patients<br />were operated by Oberlin method, 5 by DFT and 12 by ICN<br />transfer.<br />Results: 3 primary procedures were used. Oberlin method<br />in 4 cases (19.0%) 3 cases (75%) give results M3 or more.<br />DFT method in 5 cases (23.8%) all of them give results M3<br />or more. ICN transfer in 12 cases (57.1%) 9 cases (75%) give<br />results M3 or more.<br />Conclusion: In upper BPI, DFT is the first option due to<br />effectiveness without noticeable donor functional affection<br />and Oberlin method is the 2nd option if median nerve has<br />functional deficit or not well recovered or has been used in<br />another transfer as in (c5, c6 and c7) cases. Three ICNs transfer<br />to musculocutaneous nerve without nerve graft in total BPI<br />is advisable due to effectiveness and least morbidity.https://ejprs.journals.ekb.eg/article_68210_5afe9925cec12baa0dd77fbc3e91f52e.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Micro-Autologous Fat Transplantation (MAFT) for Dorsal Hand Rejuvenation5175256821210.21608/ejprs.2020.68212ENEhab ZAzzamThe Department of Plastic and Reconstructive Surgery, Main University Hospital, Alexandria UniversityWalid MElmidanyThe Department of Plastic and Reconstructive Surgery, School Children Hospital, Health Insurance Authority, AlexandriaAhmed AZidanThe Department of Plastic and Reconstructive Surgery, Main University Hospital, Alexandria UniversityJournal Article20200114Introduction: The dorsal surfaces of our hands are highly<br />visible parts of the body. However with ageing, the aesthetic<br />aspects of the hand deteriorate both in skin quality and contour<br />with obvious appearance of dorsal blue veins and extensor<br />tendons and loss or absence of subcutaneous fat tissue. The<br />literature reports multiple options for addressing this problem,<br />yet, all of these choices come with their own complications.<br />Micro-autologous fat transplantation (MAFT) can be used in<br />hand rejuvenation by a combined effect. First, it is possible<br />to augment the dorsum of the hand and enabling visible blue<br />and tortious veins as well as extensor tendons to be covered,<br />resulting in a hand with uniform contour. Second, the fat cells<br />have a beneficial effect on deep and superficial skin tissue<br />via adipocytes derived stem cells (ASCs), thereby rejuvenating<br />the hand. In this study, we performed (MAFT) technique to<br />the three dorsal subcutaneous laminae for the rejuvenation of<br />dorsal hand surfaces and determined its clinical results.<br />Patients and Methods: MAFT was performed in 10 female<br />patients. Fat was harvested by performing liposuction from<br />different body sites, then processed, and refined by decantation.<br />Purified fat was micro-transplanted to the dorsal surface of<br />the hand in parcels of small volume. Post treatment checkups<br />were performed at 24h, 7 days, 1 month, 3 months, and<br />6 months after treatment to evaluate the healing cascade of<br />the hand. Patient-rated satisfaction was reported during the<br />patient's final visit (at least 6 months after MAFT) using a 5-<br />point scale. The Merz Hand Grading Scale (MHGS) was used<br />to grade the appearance of the dorsal hand preoperatively and<br />6 months after MAFT.<br />Results: The mean age was 46 years (range, 36-60 years).<br />The time taken for MAFT injection of both hands was in an<br />average of 30min. On average, the fat volume delivered was<br />20 and 18.5mL for the right and left hands, respectively. No<br />major complications were reported, only mild to moderate<br />swelling was noted, which subsided after 7 to 10 days postoperatively.<br />Favorable outcomes were noted in patients which<br />was reflected on the patient satisfaction rate (very satisfied,<br />60% and satisfied, 30%) and the remarkable up grading in<br />the Merz Hand Grading Scale.<br />Conclusion: In conclusion, the clinical results obtained<br />using MAFT have demonstrated the feasibility and effectiveness<br />of this approach in creating a younger and more beautiful<br />dorsal hand appearance. However, longer studies in a larger<br />patient population are required to assess long-term outcomes.https://ejprs.journals.ekb.eg/article_68212_3479b5a45f0dbcc1c924086adb27c62f.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Optimizing the Aesthetic Result and Safety of Inferior Pedicle Reduction Mammaplasty5275326821310.21608/ejprs.2020.68213ENHossam YElkafrawyThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University , EgyptAhmed ZidanThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University , EgyptAdham FaroukThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University , EgyptJournal Article20200114Background: The inferior pedicle Wise pattern breast<br />reduction is one of the most popular techniques used. However,<br />some criticism and disadvantages of the technique needs to<br />be revised and modified to reach better results.<br />Patients and Methods: This is a prospective randomized<br />study that included 30 female patients suffering from breast<br />hypertrophy and they are candidate for the proposed technique.<br />They under go breast reduction procedure with modified<br />inverted T/inferior pedicle technique.<br />Results: This study includes 30 female patients of an age<br />ranged between 24-53 years old and a breast size (suprasternal<br />notch to nipple distance) ranging from 30 to 43cm. The weight<br />of removed tissues during surgery in our study was ranging<br />from 650 to 1980 grams. The follow-up for 1-year postoperative<br />shows patient satisfaction reaching 70%.<br />Conclusion: Modification and refining the inverted<br />T/inferior pedicle technique could give us a better aesthetic<br />and functional results with minimization of the problems<br />associated with this technique.https://ejprs.journals.ekb.eg/article_68213_4c257a5b2070c86c889ca52eeaf6b6a0.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Assessment of Microneedling Devices as Transepidermal Drug Delivering System for Corticosteroid in Treatment of Hypertrophic Scars5335376821410.21608/ejprs.2020.68214ENAhmed AZidanThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptEhab ZAzzamThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptHelmy ElwakeelThe Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Alexandria University, EgyptJournal Article20200114Background: Hypertrophic scars are one of dermal fibroproliferative<br />disorders which can lead to pruritus, disfigurement<br />and pain. The use of microneedling to introduce topical agents<br />or drugs into the dermis is a rapidly growing and popular<br />skin/scar treatment.<br />Patients and Methods: This is a prospective randomized<br />study that included 30 patients suffering from Hypertrophic<br />scars and they are candidate for the proposed technique.<br />Microneedling by Dermapen device with application of topical<br />triamcinolone acetonide solution on scar tissue for three<br />sessions with 3 weeks interval in between.<br />Results: During one year, 30 patients were recruited in<br />our study, the mean age of the patients was 28.16±11.24 (range<br />21-58 year) and 52% of patients were female. Lesions location<br />were anterior chest (8), extremities (18) and back (4). Mean<br />zero VSS scores were achieved with triamcinolone transepidermal<br />injection in respect of scar height (week 15th) and<br />pliability (week 15th).<br />Conclusion: Our results did support the capability of<br />triamcinolone transepidermal injection using Dermapen in<br />treatment of hypertrophic scars, with an efficient, less painful<br />and cost-effective procedure.https://ejprs.journals.ekb.eg/article_68214_e5e686a2c83620d010b92e628a4a6252.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Modification of Rectal Myofascial Repair in Abdominoplasty for Patients with Widely Divaricated Recti5395446821510.21608/ejprs.2020.68215ENMedhat SHassanThe Department of Plastic, Reconstructive & Burn Surgery, Faculty of Medicine, Menoufia University, EgyptJournal Article20200114Background: To gain the best aesthetic outcome after<br />abdominoplasty for patients with weak abdominal wall muscles<br />has been the ultimate goal for plastic surgeons and patients.<br />Myofascial repair is one of the modern techniques to have a<br />flat abdomen and a perfect waist with accepted rehabilitative<br />outcome. But as any technique, it has its benefits and drawbacks.<br />Aim of the Study: This study aims to document and evaluate<br />the durability of modified myofascial repair as a method for<br />musculoapneurotic reconstruction in abdominoplasty for<br />patients with moderate to severe weak lax abdomen.<br />Patients and Methods: Thirteen patients were included<br />in this study for the purpose of performing abdominoplasty<br />to treat weak lax abdomen over the period of 2 years from<br />January 2017 to February 2019. Follow-up period for each<br />case was at least 6 months for the functional outcome and<br />patient satisfaction.<br />Results: Changes in spirometry values before and after<br />operation were recorded and tolerated by all patients. Waist<br />measures taken before and after operation showed great<br />improvement. Patients satisfaction was extremely high and<br />there were no evidences for secondary hernias.<br />Conclusion: Myofacial repair modification is a durable<br />method to gain a good aesthetic and functional output in<br />abdominoplasty for patients with severe abdominal laxity.https://ejprs.journals.ekb.eg/article_68215_2659b3f20adef3f2c422f90353949087.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Bilateral Combined Groin and Hypogastric Flap for Coverage of Extremely Huge Combined Hand, Forearm and Elbow Defects5455476821710.21608/ejprs.2020.68217ENKhaled AREyadThe Department of Plastic and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, EgyptRaghda STalalThe Department of Plastic and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, EgyptJournal Article20200114https://ejprs.journals.ekb.eg/article_68217_cc1fc652b6e92878f869c52163e43183.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Functional and Aesthetic Outcome of Fingertip Injuries' Management5495556821810.21608/ejprs.2020.68218ENKarim AElshishtawyThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, EgyptWael HMahmoudThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, EgyptGamal IMousaThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, EgyptHashem MAyadThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, EgyptJournal Article20200114Background: Fingertip injuries are the most common<br />injuries that occur to the hand, accounting for 4.8 million<br />Emergency Department visits per year. Fingertip injuries<br />requires immediate intervention to avoid any complications<br />or deformities. Several therapeutic modalities have been used<br />for treatment; either surgical or conservative treatment and<br />each of them has its own advantages and disadvantages.<br />However, evidence is still lacking in the literature supporting<br />either surgical or conservative lines of treatment. The purpose<br />of the present study is to compare functional and aesthetic<br />outcomes between surgical and conservative treatment of<br />fingertip injuries.<br />Methods: This prospective study included 50 patients<br />with Allen's type II and III of fingertip injuries divided into<br />two groups; Group I included 20 patients treated surgically<br />and Group II included 30 patients treated conservatively which<br />is further subdivided into subgroup I (Platelet Gel), subgroup<br />II (Hyaluronic acid) and subgroup III (Fucidic acid).<br />Results: The conservative treatment showed a significant<br />improvement regarding the sensory outcome, the range of<br />motion, rate of complications, the aesthetic outcome and the<br />patients' satisfaction (p=0.002, 0.001, 0.021, 0.035, 0.026<br />respectively). The platelet gel in the conservative treatment<br />showed a significantly shorter time of healing compared to<br />other modalities of conservative treatment (p=0.004) thus a<br />significant faster recovery and shorter time off-work (p=0.001).<br />Conclusion: We concluded that the conservative treatment<br />provides better functional and aesthetic outcome in treating<br />fingertip injuries. The use of platelet gel in fingertip injuries<br />is associated with decreased time of healing and early return<br />to work.https://ejprs.journals.ekb.eg/article_68218_11eadbff902fd29c290506e37dcf8476.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Clinical Evaluation of Peroneous Brevis Muscle Flap as a Reconstructive Tool for Defects Around the Ankle5575646822010.21608/ejprs.2020.68220ENKhaled MHassanThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptAhmed MMohamedThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptMostafa SMohamedThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptJournal Article20200114Background: Soft tissue defects of the distal lower extremity<br />are notoriously difficult wounds to treat. This is due<br />to the paucity of soft tissue in this area and the thin integument<br />as well as the relatively superficial tendons. Those defects<br />often require local rotation flaps, the reverse flow flap or free<br />tissue transfer. The success of local tissue rotation flaps can<br />be improved with supercharging techniques; however, just as<br />with free tissue transfers, these techniques require special<br />surgical skills. One excellent alternative within the reconstructive<br />spectrum of the lower leg is the distally based peroneus<br />brevis muscle flap. This muscle flap is a viable option in<br />properly selected patients for coverage of wounds about the<br />ankle.<br />Patients and Methods: In this study, we used the distally<br />based peroneous brevis muscle flap to reconstruct 20 cases<br />of defects around the ankle. Cases presented to Plastic Surgery<br />Department, Minia University Hospital in period between<br />January to October 2017. Surgical procedure was performed<br />under spinal anaesthesia in all cases. We followed cases for<br />6 months postoperatively.<br />Results: The mean age was 35 years old, 16 patients<br />were males and 4 were female. 55% of patients had complete<br />flap viability, 15% of cases had partial graft loss and 20%<br />with partial flap necrosis and 10% of cases had complete<br />flap loss.<br />Conclusion: We can suggest that the peroneus brevis<br />muscle flap is an additional valuable option for reconstruction<br />of defects around the ankle because of its adjacent location,<br />reliability, and the relative simplicity of technique. The surgical<br />technique is relatively easy, safe, and suitable for reconstruction<br />of soft-tissue defects in a single stage.https://ejprs.journals.ekb.eg/article_68220_3e47a493905af3472295cda6aeb5b4ad.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320191001Neurovascular Anatomy of the Split Latissimus Dorsi Muscle Flap for the Purpose of Smile Restoration5655736822210.21608/ejprs.2020.68222ENKhaled MHassanThe Departments of Plastic & Reconstructive Surgery* and Anatomy**, Faculty of Medicine, Minia University, EgyptAbdelrahman AwadeinThe Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar UniversityMostafa AbdelhamidThe Departments of Anatomy, Faculty of Medicine ; Minia UniversityJournal Article20190414Background: Patients with facial paralysis experience<br />functional and cosmetic problems related to facial muscles<br />inactivity. Free micro neurovascular functional muscle transfer<br />offers the best prospect for restoring both voluntary and<br />emotional facial expressions. The transferred muscle replaces<br />some of the paralyzed muscles, mainly the lip elevators. If<br />the lip depressors are not replaced, asymmetry of the mouth<br />persists. This study investigates splitting of the latissimus<br />dorsi muscle to replace lip elevators and depressors in different<br />vectors to reanimate the smile.<br />Methods: We studied 10 latissimus dorsi muscle specimens<br />obtained from five fresh cadavers. Intramuscular dissection<br />for the branches of the nerve and blood vessels was performed.<br />A radio-opaque lead oxide mixture was injected to obtain<br />radiograms. Splitting of the muscle was done parallel to the<br />muscle fibers and neurovascular branches. The nerve pedicle<br />was split into two fascicles by intrafascicular dissection along<br />its whole length.<br />Results: We split all muscle specimens into neurologically<br />independent segments with each segment containing one of<br />the main branches of the neurovascular bundle. Splitting of<br />the whole length of the thoracodorsal nerve into two branches<br />was performed in all specimens.<br />Conclusions: This study suggests that the latissimus dorsi<br />muscle is suitable for segmental splitting into completely<br />independent muscle slips that can be rotated into entirely<br />different vectors to reanimate the smile, including both upward<br />and downward pulls on the oral commissure.https://ejprs.journals.ekb.eg/article_68222_52a67fb9636165ad4fe1546d49a843ef.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001The Role of Reversed Homodigital Island Flap in Digital Reconstruction5755806822310.21608/ejprs.2020.68223ENKhaled HassanThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptJournal Article20200114Background: Fingertip injuries are very common. Reconstruction<br />of extensive distal phalangeal defects with exposure<br />of tendon, bone, or joint can be particularly a difficult problem.<br />Options are local, regional and free flaps. SSG on bone and<br />tendon is unsuccessful and nondurable. The primary goals of<br />digital reconstruction are to preserve digital length and maintain<br />full mobility of the digit with providing adequate protective<br />cover of the deeper vital structures with soft tissue and skin<br />of good quality. Homodigital artery island flap has been found<br />to be very useful and is commonly used for the reconstruction<br />of fingertip amputations.<br />Patients and Methods: We used the reversed homodigital<br />artery island flap to reconstruct fingertip injuries in 8 patients<br />at Minia University Hospital and private sector in the period<br />between January to December 2017. We retrospectively<br />analyzed patients for: Age, sex, mechanism of injury, location<br />of defect, flap survival, sensory recovery and donor site<br />coverage.<br />Results: Five patients were males and 3 females. Age<br />from 18 to 42 years mean (27.3 years). Six patients had<br />complete flap survival and two patients suffered venous<br />congestion that resolved completely by conservative measures.<br />Donor site closure was directly closed in all cases. Near<br />normal sensory recovery was noted.<br />Conclusion: The reverse homodigital island flap is a safe<br />method for distal phalangeal reconstruction offering multiple<br />advantages over other local, regional and free flaps with an<br />almost negligible donor site defect. Venous congestion and<br />inability to reconstruct proximal finger defects are drawbackshttps://ejprs.journals.ekb.eg/article_68223_13114771497132c9e7ecfbd9c2970eee.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004443320201001Biodegradable Plates Versus Titanium Mini-Plates for Fixation of Metacarpal and Phalangeal Fractures5815896822410.21608/ejprs.2020.68224ENKhaled MHassanThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptAhmed MMohamedThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptHesham AEissaThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, EgyptJournal Article20200114Background: Metacarpal and phalangeal bones are prone<br />to injury in daily work and life and hand fractures account<br />for about 1.5% of all emergency room visits. Problems associated<br />with those fractures relate to shortening, rotation, and<br />dorsal apex angulation. If closed methods of treatment fail to<br />achieve or maintain reduction, surgery could be used. Oblique<br />and spiral fractures are prone to mal-rotation so operative<br />fixation could be necessary. Commonly used surgical techniques<br />are Kirschner-wire, miniplate, and screw fixations.<br />Biodegradable materials such as Polyglycolic acid (PGA) and<br />Poly-L-lactic acid (PLA) implants have been widely used for<br />hand fracture fixation including pins, rods, screws and plates.<br />Patients and Methods: In this study, we compare the<br />results of fixation of metacarpal fractures by titanium metal<br />plates (group A) with the results of biodegradable plates<br />(group B). This study involved twenty patients who presented<br />with metacarpal and phalangeal fractures who presented to<br />the Plastic Surgery Department of Minia University Hospital<br />between March 2016 and December 2016. Surgical procedure<br />was performed under local intravenous or general anaesthesia.<br />We followed cases for 6 months postoperatively.<br />Results: Mean age = 38.9±14.9 and 35.7±13.1 years old<br />for group A and B respectively. 13 patients were males and<br />7 were female. Operative time in group A was 55±19.4 minutes<br />while in group B, it was 84.5±21.2 minutes. In group A, total<br />range of motion was 234±15.05 degrees while in group B, it<br />was 133±17.02 degrees as measured by goniometer. In group<br />A, time for union was 7.5±1.7 weeks while in group B,<br />unfortunately no union occurred. In group A, one case (10%<br />of cases) was complicated with delayed union and another<br />case of infection (10% of cases), while in group B all cases<br />were complicated with non-union and fracture displacement<br />which forced us to replace with K-wire fixation.<br />Conclusion: In this series of metacarpal and phalangeal<br />fractures treated with titanium or biodegradable plates and<br />screws, titanium plates (group A) showed more favorable<br />outcomes. The stable bony construct achievable by using<br />titanium plates and screws (group A) is the key to good<br />functional results compared with the bad results using biodegradable<br />plates and screws (group B). Further studies are<br />required.<br />Disclosure: The authors have no financial interest to<br />declare in relation to the content of this articlhttps://ejprs.journals.ekb.eg/article_68224_fefcaddca02b8a8cb8b241923f2107bf.pdf