The Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Scarpa Fascia versus Rectus Sheath Plane in Lipoabdominoplasty Flap Dissection: Comparative Study11311918383010.21608/ejprs.2021.183830ENHelmy ElwakeelThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptMohamed HAbouarabThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptHassan M.KholosyThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt0000-0003-3266-2968Journal Article20210113Background: Abdominoplasty and lipoabdominoplasty<br />are frequently performed aesthetic procedures to improve the<br />contour of the abdomen and flanks. The improvement obtained<br />would positively impact the patient's self-image and life<br />quality. A lot of potential complications would compromise<br />surgeon/patient satisfaction, the most frequent being seroma<br />formation. A lot of measures/techniques were advocated to<br />reduce seroma incidence including the use of suction drain,<br />dead space obliteration by quilting sutures, and preservation<br />of infraumbilical Scarpa fascia/deep fat layer. The latter is<br />the focus of the current comparative study.<br />Patients and Methods: 40 full lipoabdominoplasty cases<br />were randomized into 2 equal groups based on the infraumbilical<br />dissection plane. Group A with traditional rectus sheath<br />dissection plane and group B with supra Scarpa dissection<br />plane. Post-operative drainage volume, time of drain removal,<br />and incidence of symptomatic seromas were documented.<br />Results: Drainage volume and duration of drainage were<br />significantly lower in the supra Scarpa dissection group (B)<br />than those of the rectus plane group (A) (p < 0.001). Clinically<br />evident seroma was detected in 3 cases of group (A) and one<br />case of group (B). All resolved after 2-3 aspirations in outpatient<br />settings. Both groups were homogenous regarding BMI,<br />age, volume of lipoaspirate, weight of excised dermofat and<br />mean operative time.<br />Conclusion: Scarpa fascia/deep fat preservation significantly<br />reduced the drainage volume and duration. A lower<br />seroma incidence was also observed.https://ejprs.journals.ekb.eg/article_183830_0fa4cfd950732db5871d161167adbe6c.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Aesthetic Unit-Based Reconstruction of Facial Defects with Local Flaps after Surgical Excision of Basal Cell Carcinoma12113118383610.21608/ejprs.2021.183836ENAhmed A. A.AliThe Department of Plastic Surgery, Faculty of Medicine, South Valley UniversityJournal Article20210213Background: Basal cell carcinoma (BCC) represents the<br />most common type of facial skin cancer in Middle East and<br />Egypt. It rarely metastasizes, but because of its locally destructive<br />nature, it can cause high morbidity. Reconstruction<br />by local flap after surgical excision depends on the size of<br />the defect and the affected facial aesthetic unit.<br />Aim: To reveal the prevalence of facial BCC, relation of<br />its site to facial aesthetic units and type of local flaps used<br />for reconstruction per units.<br />Patients and Methods: A retrospective study was conducted<br />on 80 patients with facial BCC that admitted to the outpatient<br />clinic, Plastic Surgery Department, Qena University Hospital<br />from June 2018 to May 2020 (2 years duration). Only earlystage<br />and primary tumors were included. Statistical analysis:<br />Data was analyzed using the Statistical Package for Social<br />Sciences (SPSS) version 24. A p-value significant.<br />Results: 80 patients with facial basal cell carcinoma (BCC)<br />were collected from medical records. 45 (56.25%) patients<br />were males and 35 (43.75%) patients were females (M:F =<br />1.3:1). Ages ranged from 52-78 years old (SD = 65±13).<br />Nodular subtype was the most common clinical type of BCC<br />and presented in 45 (56.25%) patients. Nasal unit was the<br />most common site in 18 (22.5%) patients. The most random<br />flap applied was the rhomboid (Limberg) flap in 15 cases.<br />The most axial flap used was the nasolabial flap in 9 cases.<br />Complications (6 cases, 7.5%) included: Wound dehiscence<br />in 3 cases, infection in 2 cases and skin slough in 1 case. The<br />SCAR scale score result ranged from 0-2 score.<br />Conclusion: Facial defects reconstruction after surgery<br />for basal cell carcinoma is a complex endeavor that requires<br />careful consideration. There are many different local flaps<br />available depending on the particular facial subunit that<br />requires reconstruction. Careful recognition of the principles<br />of the facial subunits will equip the surgeon to achieve the<br />best possible functional and aesthetic outcomes.https://ejprs.journals.ekb.eg/article_183836_b686f600c5610a44647c2aa84d14d9f5.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Bodybuilder Gynecomastia: Etiology, Characteristics, and Management13313918385310.21608/ejprs.2021.183853ENHelmy El WakeelThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptMohamed H.Abou ArabThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, EgyptHassan M.KholosyThe Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt0000-0003-3266-2968Journal Article20210213Background: Bodybuilder gynecomastia represent a special<br />entity, being secondary to use/abuse of anabolic steroids<br />leading to glandular enlargement as the sole or the main<br />underlying pathology with an occasional fatty element. Typical<br />management entails complete gland excision through the least<br />visible scar, (typically periareolar) with preservation of pectoral<br />muscle and fascia integrity. Adjuvant small volume liposuction<br />is needed in some cases with a fatty element.<br />Patients and Methods: The study enrolled a series of 13<br />bodybuilders with gynecomastia and a history of anabolic<br />steroids use/abuse. All cases presented with glandular tissue<br />enlargement, with fatty element noted in 4 cases. Operations<br />were done under general anesthesia with tumescent fluid<br />infiltration. Through an inferior periareolar incision, almost<br />the whole enlarged gland was excised, with adjuvant liposuction<br />as indicated. Meticulous hemostasis and preservation of<br />pectoral fascia integrity aimed to minimize excessive scaring<br />beneath a thin overlying areolar skin flap and possible subsequent<br />adhesions and contour irregularities.<br />Results: All cases achieved final satisfactory results with<br />high patients satisfaction. Early complications included minor<br />hematoma in one case. Probably this was the cause of later<br />dynamic depression seen with pectoral muscle contraction<br />noted at 6 months follow-up and resolved spontaneously<br />during the next year.<br />Conclusion: Bodybuilder gynecomastia management<br />entails almost complete glandular tissue excision with limited<br />liposuction in some cases. Meticulous technique including<br />proper hemostasis is important to avoid even the minor contour<br />irregularities and other complications in such demanding<br />cases seeking perfect shape.https://ejprs.journals.ekb.eg/article_183853_9268a19e838f85658b23c6a7a0e4faf5.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Case Reports of an Innovative Technique for Columellar Reconstruction in Children Using a Custom-Made Composite Graft from the Back of the Ear14114518385710.21608/ejprs.2021.183857ENMostafa A.ElsonbatyThe Department of Plastic and Reconstructive Surgery, Assiut University Hospital, EgyptMohamed Abd ElRahimThe Department of Plastic and Reconstructive Surgery, Assiut University Hospital, EgyptJournal Article20210413The columella is unique as a nasal subunit. The nasal<br />columella has traditionally been a difficult subunit to repair<br />because of its unique contours, tenuous vascularity, and limited<br />availability of adjacent skin. Columellar defects can significantly<br />impair aesthetic appearance. Columellar damage can<br />be caused by congenital loss, ischemic injuries, trauma, tumor<br />resection, and vascular malformations. Columella reconstruction<br />can be very challenging for plastic surgeons.<br />Defects of the nasal columella can be repaired using<br />various methods including composite free grafts from the ear<br />(1,2), nasolabial flaps (3), nasofacial sulcus flaps (4), forehead<br />flaps (5), extended Abbe flaps (6), and free flaps (7).<br />Auricular chondrocutaneous composite grafts have been<br />reported in the literature. The main advantage of these grafts<br />are avoidance of facial scars and provision of tip support.<br />However, risk of composite graft loss was reported as a main<br />complication.<br />Herein, we report two cases of columellar defect reconstructions<br />in children using a custom-made columella from<br />a conchal composite graft with the tongue-in-groove principle.<br />The main advantages of this technique are that it is a onestage<br />method; the custom-made columella depends on the<br />dimensions of the defect, so it can be tailored according to<br />the dimension of the columellar defect; the use of the tonguein-<br />groove principle increases the contact surface between the<br />graft and recipient, therefore, increase the possibility of<br />survival of the reconstructed columella; with minimal donor<br />site morbidity.https://ejprs.journals.ekb.eg/article_183857_62f1494c11d596ce822a714a04423d87.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Adding Monspexy (Pubic Suspension) Step to Abdominoplasty, Does this Benefit in Management of Urinary Stress Incontinence in Females with Redundant Abdomen and Mons Pubis?14715518386310.21608/ejprs.2021.183863ENAyman M.AbdelMofeedThe Department of General Surgery, Plastic Surgery Unit , Faculty of Medicine, Benha University, EgyptOla SeifThe Department of General Surgery, Plastic Surgery Unit , Faculty of Medicine, Benha University, EgyptMohamed T.YounesThe Department of General Surgery, Plastic Surgery Unit , Faculty of Medicine, Benha University, EgyptShabieb A.AbdelbakiThe Department of Urology, , Faculty of Medicine, Benha University, EgyptJournal Article20210113Background: Abdominoplasty is a surgical procedure that<br />removes excess skin and fat from the abdominal wall. Aside<br />from cosmetic concerns, some females, particularly those<br />with redundant Mons pubis, experience stress urinary incontinence<br />(SUI).<br />Objectives: The aim of current study is to evaluate the<br />procedure of ordinary abdominoplasty with added monsplasty<br />(monspexy) by a simple technique to restore the natural<br />urethral angle, in management of female stress urinary incontinence<br />due to redundant abdomen and Mons pubis besides<br />the aesthetic outcomes.<br />Patients and Methods: From August 2017 to August 2020,<br />29 cases of females complaining of redundant abdomen and<br />Mons pubis with some degree of stress urinary incontinence<br />were enrolled in the study. The mean age of patients was 35<br />years. Intraoperative lower resection level marked at pubic<br />hairline which should about 7cm from anterior commissure<br />of vulva and the upper resection limit marked at level of<br />umbilicus.<br />Results: All surgeries passed smoothly without intraoperative<br />complications with a mean operative time of 194±30;<br />range 150-250 minutes and excised tissue weight 4560±55;<br />Range 3000-5500 grams. Mean hospital stay was 2.8±0.7<br />days with a range of 2-3.5 days, one patient developed hematoma<br />in mons area. As regard stress urinary incontinence<br />the results at 8 weeks postoperative showed significant improvement<br />of Quality of life.<br />Conclusions: Females who undergo abdominoplasty combined<br />with monspexy in redundant abdomen and Mons pubis<br />benefit from this procedure aesthetically and functionally<br />from added monsplasy which reduces symptoms of stress<br />urinary incontinence.https://ejprs.journals.ekb.eg/article_183863_e39b2372d9823044f235727e796eefd6.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Lower Pole Dermoglandular Flap Autoaugmentation versus Mastopexy Augmentation with Subpectoral Implants: Outcomes after Reshaping of Ptotic Breasts15716718386610.21608/ejprs.2021.183866ENIssam MohamedElmekkawySpecialist of Plastic Surgery, Ministry of HealthShabieb A.AbdelbakiThe Department of Urology, , Faculty of Medicine, Benha University, EgyptAhmed MohamedBahaa EldinDepartment of Plastic & Reconstructive Surgery, Faculty of Medicine,
Mansoura University, EgyptMohamed RadwanEl HadidyDepartment of Plastic & Reconstructive Surgery, Faculty of Medicine,
Mansoura University, EgyptAhmed M.ZeinaDepartment of Plastic & Reconstructive Surgery, Faculty of Medicine,
Mansoura University, EgyptJournal Article20210213Background: Single stage augmentation mastopexy is a<br />challenging procedure for both volume expansion and skin<br />envelope reduction. Also, the patient experience is an important<br />issue after mastopexy as it affects the patient physical functioning,<br />psychosocial wellbeing, and the aesthetic result.<br />Aim: To assess the outcomes of reshaping of a ptotic<br />breast and its impact on the quality of life.<br />Patients and Methods: This prospective comparative study<br />was conducted over a 2-year period in 32 female patients with<br />different degrees of breast ptosis. Patients were divided into<br />two groups according to their desire to increase breast volume<br />either using or not using an implant. Standard breast measurements<br />as well as early and late complications were recorded,<br />and patient satisfaction was assessed using the BREAST-Q.<br />Results: Postoperatively, both the groups showed significant<br />improvements in ptosis and in the BREAST-Q scores<br />compared to pre-operative scores in all domains (p£0.001).<br />However, regarding post-operative satisfaction with breast<br />volume, psychosocial wellbeing, and outcomes, the autoaugmentation<br />group showed a significantly higher BREAST-Q<br />score compared with the implant augmentation group (p£0.05).<br />Conclusion: The BREAST-Q provides significant clinical<br />information and evaluates the influence of the surgical procedure<br />on the patient's regular life activities. Mastopexy autoaugmentation<br />using the lower pole dermoglandular flap is a<br />reliable technique for enhancing the projection of the breast,<br />improving the upper pole shape, and creating an adequate<br />breast volume with a low complication rate and high patient<br />satisfaction.https://ejprs.journals.ekb.eg/article_183866_2709c027d0ed562f61f9a203d2196f76.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Primary Cleft Repair in Adult Patients with Untreated Cleft Lip and Palate Deformity16917418387010.21608/ejprs.2021.183870ENKaram A.AllamThe Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt0000-0001-5718-8110Mostafa M.HaredyThe Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt0000-0001-9089-7891Ahmed G.AbdelMegeedThe Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20210713Background: Referring cleft patients to a specialized<br />medical center at the earliest possible time after birth provides<br />the best outcome and minimizes possible complications. For<br />diversity of economic and social factors, some patients may<br />not receive the adequate care and surgical repair at the proper<br />time and present late in adulthood with totally or partially<br />unrepaired clefts.<br />Patients and Methods: Patients with untreated primary<br />cleft deformity older than 16 years, who were treated at The<br />Department of Plastic Surgery, Sohag University, in the period<br />between 2009 and 2019, were retrospectively reviewed. The<br />assessment included evaluation of demographic data (age at<br />first consultation and sex distribution), type and laterality of<br />cleft, patients' social and educational status, and previous<br />cleft surgeries. Patients' satisfaction following surgery was<br />also assessed.<br />Results: All adult patients with untreated primary cleft<br />deformity in this study were males, unilateral cleft lip and<br />palate was the commonest deformity. Majority of patients had<br />no education. Marriage was the main motive for having surgery<br />done. All patients were moderately to highly satisfied with<br />surgical outcomes.<br />Conclusions: Although uncommon nowadays, unrepaired<br />primary cleft deformity in adults can still be seldom reported<br />in some patients especially in lower socioeconomic classes.<br />Surgical repair is more challenging and need more radical<br />solutions, but it achieves good satisfaction in all patients.https://ejprs.journals.ekb.eg/article_183870_5f75d5bcd931be3092ed9d68b2a512fe.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Three-Dimensional Printing as a Potentially Effective Strategy for Improving the Outcomes in Microtia Reconstruction17518318387610.21608/ejprs.2021.183876ENOmar M. A.El BayoumiThe Departments of Plastic Surgery, Faculty of Medicine, Mansoura UniversityAhmed M.Bahaa El DInThe Departments of Plastic Surgery, Faculty of Medicine, Mansoura UniversityFayez ShahattoMahmoudThe Departments of General Surgery, Faculty of Medicine, Mansoura UniversityAhmed M.ZeinaThe Departments of Plastic Surgery, Faculty of Medicine, Mansoura UniversityMostafa M.AbdelhalimThe Departments of Plastic Surgery, Faculty of Medicine, Mansoura UniversityJournal Article20210313Aim: The reconstruction of microtia cases is a challenging<br />topic and auricular reconstruction is a unique area of facial<br />plastic surgery where a wide array of reconstructive options<br />often must be considered. The goal is to assess the use of<br />three-dimensional (3D) printing to create a 3D model for use<br />during reconstruction to achieve better aesthetic results.<br />Patients and Methods: This study included ten patients<br />with microtia. Utilizing two stages of ear reconstruction, the<br />authors used a 3D printed auricular model of the contralateral<br />ear as an intraoperative guide. The Mansoura ear reconstruction<br />scale was conceptualized and used by the authors to assess<br />the final aesthetic outcomes.<br />Results: In total there were 10 patients with 11 affected<br />auricles. Results were 6 patients with an excellent result, 3<br />patients with a very good result and one patient with a fair<br />result according to Mansoura ear reconstruction scale.<br />Conclusions: The use of 3D printed models for microtia<br />reconstruction resulted in an overall increahttps://ejprs.journals.ekb.eg/article_183876_cc9fb005d8bbeb08963bb66c16dddfdd.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Superior Pedicle Reduction Mammoplasty Supported by Central Glandular Pedicle18519118388110.21608/ejprs.2021.183881ENMohamed A.MegahedThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University*, EgyptYaser ElsheikhThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University*, EgyptQutaibah AlKindariAl Babtain Center for Burn, Plastic and Reconstructive Surgery, Ministry of Health**, KuwaitMohammad S.IsmailAl Babtain Center for Burn, Plastic and Reconstructive Surgery, Ministry of Health, KuwaitJournal Article20210113Objectives: To evaluate effect of supporting superior<br />pedicle by central glandular pedicle in reduction mammoplasty<br />in improving aesthetic outcome and reducing the incidence<br />of nipple areola necrosis and postoperative NAC loss of<br />sensation.<br />Background: Superior pedicle reduction mammoplasty<br />provides good aesthetic outcome, but has high possibility of<br />nipple areola complex loss of sensation, there for keeping the<br />central glandular portion as support to superior pedicle ensures<br />good blood and sensory supply to NAC.<br />Methods: This study included 37 patients presented by<br />breasts hypertrophy from March 2019 to March 2021. All<br />patients' breasts were examined for suprasternal notch to<br />nipple distance, areolar diameter, nipple to infra mammary<br />fold distance. Postoperative assessment included: Nipple<br />areola complex vascularity, nipple areola complex sensitivity<br />and patients' satisfaction about breast contour, projection,<br />symmetry, scars and overall aesthetic outcome using a score<br />out of 4. Patients underwent marking using wise pattern for<br />skin incision. Intraoperative; excision of skin, fat and glandular<br />tissue inferior to NAC, starting from skin and went directly<br />to chest wall keeping central breast mound with the superior<br />pedicle. Finally closure was in vertical or inverted T pattern<br />according to skin excess to be removed.<br />Results: In this study we operated upon 37 patients who<br />were asking for breast reduction aged between 20 and 57<br />years with mean age 39.6 years. The overall complication<br />percentage 14.8% excluding poor scarring. We had no cases<br />of total Nipple areola complex loss, low incidence of nipple<br />areola complex persistent reduced sensation after 1 year of<br />follow-up (2.7%) and no complete loss of sensation in any<br />patient. Aesthetic outcome accepted by 97.3% of patients.<br />Conclusion: Superior pedicle reduction mammoplasty<br />supported by central glandular pedicle helps in ensuring<br />reliable blood perfusion and sensory nerve supply to nipple<br />areola complex which reduces possibility of post-operative<br />nipple areola complex necrosis and loss of sensation, while<br />patient gets pleasant and long standing aesthetic outcome.https://ejprs.journals.ekb.eg/article_183881_736fb74d812baee57108176a18751bf1.pdfThe Egyptian Society of Plastic and Reconstructive SurgeryThe Egyptian Journal of Plastic and Reconstructive Surgery1110-004445320210701Versatility of the Superior Lateral Genicular Artery Perforator Flap for Coverage of Soft Tissue Defects Around the Knee19319918388310.21608/ejprs.2021.183883ENSherif M.El KashtyThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, EgyptMohamed AboShabanThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, EgyptAhmed A.TaalabThe Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, EgyptJournal Article20210113Background: Coverage of soft tissue defects around the<br />knee is a reconstructive challenge. The superior lateral genicular<br />artery perforator (SLGAp) flap provides an excellent<br />alternative to muscle and musclocutaneous flaps with less<br />morbidity, for coverage of these defects, especially when the<br />gastrocnemius muscle flap is not available. The vascular basis<br />of this flap, SLGA perforators, have consistent and reliable<br />anatomy.<br />Aim of the Study: This study is a retrospective analysis<br />of our clinical experience with the superior lateral genicular<br />artery perforator flap for coverage of soft tissue defects of<br />the knee.<br />Patients and Methods: This study was done at The Department<br />of Plastic and Reconstructive Surgery, Menofia<br />University Hospitals, from January 2017 to November 2018,<br />with follow-up period of 12 months. It included 7 patients,<br />6 males, and 1 female, with their age ranged from 19 to 46<br />years. The around-knee defects were due to different etiologies,<br />1 patient due to shotgun, 1 patient with post-burn contracture<br />of the lateral popliteal fossa, and 5 patients with traffic<br />accidents. The defects were reconstructed by the superior<br />lateral genicular artery perforator (SLGAp) flap.<br />Results: All flaps survived, except in 2 cases, 1 case<br />managed conservatively and healed well, and in the second,<br />the necrotic part was debrided and skin grafted. The donor<br />site was closed primarily in 2 cases and skin grafted in 5<br />cases. Skin graft take was perfect, except in 3 cases with<br />minor patches of graft loss and healed spontaneously.<br />Infection around the defect site occurred in 2 cases and<br />managed conservatively. The flap provided stable and<br />durable coverage with minimal donor site morbidity and<br />no functional loss.<br />Conclusion: The superior lateral genicular artery perforator<br />flap is a versatile option for reconstruction of soft tissue<br />defects around the knee or popliteal fossa. The anatomy of<br />the flap perforators is consistent and reliable. The flap is thin,<br />pliable and provides stable coverage with adequate match of<br />the surroundings. Donor site morbidity is minimal with no<br />functional loss.https://ejprs.journals.ekb.eg/article_183883_6d1f9a670bdda32e1010c9cf899456fe.pdf