Reconstructive Plastic Surgery Research Articles

Sliding Flap for the Wide Upper Eyelid Margin Defect After Cancer Removal.

*Department of Plastic Reconstructive and Aesthetic Surgery, Kocaeli University Faculty of Medicine †Department of Plastic Reconstructive and Aesthetic Surgery, Derince Training and Research Hospital, Kocaeli, Turkey The authors report no conflicts of interest. Address correspondence and reprint requests to Halil Işik, MD, Clinic of Plastic Reconstructive and Esthetic Surgery, University of Kocaeli, İzmit/Kocaeli 41380, Turkey; E-mail: [email protected]

Peculiarities of MRI in patients with Charcot’s foot in the active stage

Purpose of the study: Explore the role of MRI in the diagnosis of Charcot foot in patients with active diabetic osteoarthropathy. Material and methods research: 35 patients (prospectively) with type 2 diabetes mellitus and Charcot foot in the active phase were examined in the period 2022-2023 at the Acad. Y.H. Turakulova, in the department reconstructive plastic surgery of complications of diabetes mellitus. The control group consisted of 20 people with type 2 diabetes mellitus without Charcot foot in compensation. Of the 35 patients, there were 28 men and 7 women. Average age: men was 64.12 ± 5.8 years, women - 62.15 ± 4.6 years. The duration of type 2 diabetes mellitus ranged from 17 to 20 years. Research methods included: biochemical, hormonal and instrumental: ECG, MRI of the feet, ultrasound of the internal organs, DECA of the body, fundus. Research results: All patients were in a state of carbohydrate metabolism decompensation. In addition, pathological changes in bone tissue increased as the average values ​​of glycated hemoglobin increased. As the level of carbohydrate metabolism decompensation increased, the degree of bone tissue recovery decreased (inverse correlation). Conclusions: 1. An early symptom on MRI with Charcot foot was the presence ofconcavity of the articular surface of the talus against the background of sclerosis in the talonavicular joint. 2. Pathological changes in the bone tissue increased as the average values ​​of the level of glycated hemoglobin increased. 3. A direct correlation was found between the MRI parameters in Charcot foot and the HbA1c level: as the level of carbohydrate metabolism decompensation increased, the degree of bone tissue recovery decreased.

THE EPIDEMIOLOGY OF PLASTIC SURGERY CASES IN A TERTIARY GENERAL HOSPITAL IN SURABAYA, INDONESIA

Highlights: Medical data registries play a crucial role in improving medical knowledge and enhancing patient care. Burn injuries, microtia, and orofacial clefts were identified as the most common occurrences among the patients The demographic patterns observed provide valuable insights into the patient population seeking plastic surgery services. Abstract: Introduction: Medical data registries are useful databases with well-defined data collection mechanisms. A well-designed and implemented registry can give surgeons a wealth of data for research and quality improvement efforts. The aim is describe the epidemiology of plastic surgery cases in a tertiary general hospital in Surabaya, Indonesia. Methods: A retrospective assessment of patients' medical records from 2016 to 2019 at Plastic Reconstructive and Aesthetic Surgery Unit, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia was conducted. A variety of factors were recorded and evaluated, including the patients' age, gender, diagnosis, and year. Results: We found that among 736 individuals' medical records during a four-year period, burn injuries (17.4%), microtia (11.7%), and orofacial clefts (11.5%) were the most prevalent occurrences. The majority of patients with burn injuries (31.3%), those with microtia (39.5%), those with cleft lip and palate (33%), and those with microtia (between the ages of 15 and 24) were all between the ages of 45 and 64. Patients who were men (52.6%) outnumbered those who were women (47.4%). This data indicates that there were more patients in 2019 than in previous years (397.%). Conclusion: The analysis of plastic surgery cases revealed a steady increase in the number of cases each year. Burns accounted for the biggest percentage of patient requests for care (17.4%). The majority of patients were male, and 21.9% of them were between the ages of 15 and 24 who were seeking care most frequently.

Management of blowout fracture with iliac bone graft

Introduction: Blowout fracture is a traumatic deformity of the orbital wall and the repair is indicated when enophthalmos is troublesome to the patient, or when diplopia interferes patient’s activities. Iliac bone has been reported in the immediate and secondary repair of orbital wall deformities following blowout fracture. This case is to report blowout fracture management using iliac bone graft. Case Illustration: A 35 years old man complains pain on his left eye when moving his eye and diplopia in upgazed since 4 months after fell down from stairs. Eye position is orthophoria, visual acuity 6/6 on both eye, anterior and posterior segments are normal, restricted movement to superior on left eye, Hertel exophthalmometry examination on right eye 15 mm and left eye 10 mm (base 90). On CT-scan examination, it was found that an orbital floor fracture was characterized by herniation of the orbital tissue. The patient was diagnosed with left eye enophthalmos, suspect inferior rectus muscle and adnexal entrapment and neglected blow out fracture. LE Repair Orbital Floor Fracture, Release Muscle Rectus Inferior, Exploration (join op with Plastic Reconstructive and Aesthetic Surgery Department) is done to this patient. Conclusion: Iliac bone graft can be used as an alternative in orbital floor reconstruction, since it easy to harvest, low risk to rejected or extruded and can be used in large defect. Optimal outcome of blowout fracture repair can be achieved if the surgical management is done before two weeks after the incidence.

Gangrenous Bowel Obstruction Managed With Local Tumescent Anesthesia and MAC

Since the mid-1980s, Klein’s tumescent anesthesia has been used routinely in different surgical specialties such as cosmetic surgery, dermatology, vascular surgery, reconstructive plastic surgery, and breast surgery. The tumescent anesthesia technique was developed by Dr Jeffrey Klein, a board-certified dermatologist. The technique was first published in 1987. Tumescent means “swelling.” This technique involves injection of an ultra-dilute lidocaine and epinephrine solution into the surgical planes offering multiple advantages including, but not limited to, postoperative analgesia, reduced blood loss, and avoidance of general anesthesia. The standard liter of Klein’s solution contains lidocaine 1 g, epinephrine 1 mg, and sodium bicarbonate 12.5 mg. Multiple modifications and variations have been implemented and used over the years, an evolution from Klein’s original description. While tumescent anesthesia started in liposuction procedures, its application has now extended into a wider variety of procedures and specialties. In this article, we present a case of tumescent anesthesia in a critically ill general surgery patient who presented with an acute life-threatening surgical emergency. The patient was assessed to be a very high risk for general anesthesia, and after collaborative discussion between the surgical and anesthesia teams and taking informed consent from the patient, the decision was made to proceed with surgery under monitored intravenous sedation with tumescent anesthesia. The patient had an uneventful recovery and survived a very high mortality surgical emergency. He was subsequently discharged back to his nursing home in stable condition. Tumescent anesthesia has become tremendously popular in cosmetic surgery. Tumescent anesthesia allows patients to have surgical procedures in an ambulatory setting, avoid general anesthesia, and allow for better pain control postoperatively. While tumescent anesthesia is used in other specialties, the field of general surgery has not widely adopted tumescent anesthesia. Many general surgeons and anesthesiologists are not familiar with the technique and how to implement it in their practice. It is of utmost importance to understand the pharmacokinetics of tumescent solution and safe implementation. Tumescent anesthesia with monitored anesthesia care is here reported as an alternative to general anesthesia in the care of a moribund patient with multiple comorbidities requiring open abdominal surgery. Close cooperation between the surgeon and the anesthesiologist made the successful conduct of this case possible.

Features of the use of regional anesthesia in the surgical correction of traumatic defects of the bones of the skull and spine reconstructive plastic surgery

This article discusses the features of the use of regional anesthesia in the surgical correction of traumatic defects of the skull bones and reconstructive plastic surgery. Regional anesthesia is a safe and effective method of anesthesia, which reduces the risk of complications and speeds up the recovery process after surgery. The authors describe in detail various types of regional anesthesia, such as facial nerve blockade, blockage of the frontal branch of the trigeminal nerve, etc. The paper also discusses indications and contraindications to the use of regional anesthesia, as well as possible complications. In conclusion, it is noted that regional anesthesia is an important element in surgical practice during operations for the operative correction of traumatic defects of the skull bones and reconstructive plastic surgery. Keywords Regional anesthesia, Surgical correction, Traumatic defects of the skull bones, Reconstructive plastic surgery.

HISTOLOGICAL AND MORPHOMETRIC STUDIES OF BONE TISSUE AUTOGRAFTS FROM INTRAORAL AND EXTRAORAL DONOR ZONES

Major research carried out in modern dentistry and maxillofacial surgery is commonly focused on long-term and stable results for implant rehabilitation of jaw defects and deformities in patients with bone and soft tissue losses at the site of planned implantation. Various osteoplastic materials, donor or the patient’s own bone, tissue-engineering and cellular products are common in clinical medicine, since guided regeneration can help not only recover the volume of bone tissue once lost, yet also ensure an outcome acceptable from both functional and aesthetic view. Guided bone regeneration employs methods of regenerative medicine and tissue engineering, with transplantation of native bone tissue and cell transplants, as well as various osteoplastic materials with osteoinductive and osteoconductive properties. In order to compare the structure of intact bone tissue obtained from intraoral and extraoral donor zones, histological and morphometric studies of bone autografts in 4 certified male cadavers with intact dentition were carried out. The results of histological studies in bone tissue autografts from intraoral and extraoral donor zones revealed that the highest density of bone rods could be observed in biopsies taken from the mandible outer oblique line area and chin symphysis. Whereas the lowest rate of the said factor we observed in the biopsies obtained from the iliac crest area. The highest rate of the inter-rod girder space was found in the area of the iliac crest, and the minimal – in biopsies from the parietal bone. The highest bone vascularization level was identified at the iliac crest and the parietal bone, while its lowest levels were seen in biopsies taken from the area of the mandible outer oblique line. The density of cellular elements was found to be highest at the iliac crest. The lowest density level was registered in biopsies from the area of the mandible outer oblique line. The high rates of cellular elements in autografts from the iliac crest area can be accounted for by the predominance of spongy substance over cortical, while in bone biopsies taken from the mandible outer oblique line, chin symphysis, maxillary tuberosity and parietal bone, the share of cellular elements failed to exceed 27% within the total data set. This points at the predominance of cortical rather than spongy substance. In reconstructive bone plastic surgery for augmentation of the maxillary alveolar process and the mandible alveolar part with significant atrophy, it is reasonable to use autogenous transplants taken from intraoral donor zones. The autogenous transplants have cortical morphology and embryological origin similar to the jaw bones. Bone blocks from the donor zones of the mandible outer oblique line, the chin symphysis and the maxillary tuberosity have the highest density of the bone cortical substance and the duly sufficient amount of spongy substance.

Редкий случай синдрома аблефарона макростомии

Ablepharon-macrostomia syndrome (AMS) is a very rare genetic pathology characterized by abnormal phenotypic manifestations that primarily affect the head and face. The most noticeable anomaly is absent (ablepharon) or underdeveloped eyelids and a large mouth (fish-mouth syndrome) — macrostomia. The article presents a case report in a one-and-a-half-year-old girl with eyelid aplasia of both eyes, which required reconstructive plastic surgery. For this purpose, a plastic surgery with a free flap was successfully performed, and after 4 months a frame protection plastic surgery using the «Alloplant» biomaterial was done to eliminate recurrent lagophthalmos, to form the cartilage of the eyelids and to strengthen them. A few years later, the Alloplant dispersed biomaterial was used in the cicatricial parts of the eyelids and palpebral fissure was lengthened. Keywords: Ablepharon macrostomia syndrome, genetic disorders, eyelid anomalies, eyelid reconstructive surgery

Status of Body Contouring Following Metabolic Bariatric Surgery in a Tertiary Hospital of Greece-Still a Long Way to Go.

Obesity is a disease rather than a state, and metabolic bariatric surgery (MBS) is its most effective treatment. Body contouring surgery (BCS) is an integral part of the continuum of care following MBS, provided that the body mass index (BMI) has stabilized for an adequate period. This study is an attempt to capture the current status of BCS following MBS in Greece, based on data from one of the country's highest-volume hospitals. We recruited patients from the Bariatric and Plastic-Reconstructive Surgery registries who had undergone both MBS and BCS and invited them to answer a structured questionnaire with components on demographics, safety and effectiveness of previous operations, quality of life (QoL), body image, social activity, sexual activity, and doctor-patient communication. Twenty-four patients participated in the survey (response rate 88.1%). The mean BMI pre-MBS was 43.8 kg/m2 and that pre-BCS was 28.6 kg/m2. Based on the Bariatric sub-cohort, only 2.5% of post-bariatric patients underwent BCS. The mean interval between MBS and BCS was 2.9 years. The distribution of patients by MBS was as follows: sleeve gastrectomy 8 (33.3%), gastric band 7 (29.2%), gastric bypass 5 (20.8%), and gastric plication 2 (8.3%). The distribution of patients by BCS was as follows: abdominoplasty 23 (94.7%), breast contouring 8 (33.3%), thigh contouring 3 (12.5%), and arm contouring 5 (20.8%). Most positive components (70.6%) regarding QoL were appraised by >80% of the participants, indicating overall satisfaction after BCS. Conversely, only 12.5% of negative components were endorsed by >20% of patients. In conclusion, BCS has a low prevalence after MBS, although it is related to an improved quality of life and body image.

Three-Dimensional Volumetric Analysis of the Effect of Interval Time in Autologous Fat Graft Breast Augmentation.

Autologous adipose tissue has become increasingly popular in cosmetic and plastic reconstructive surgery, especially breast augmentation surgery. However, the volume retention rate after transplantation significantly varies and may be unsatisfactory. Many patients need two or more autologous fat graft breast augmentations to achieve the expected effect. There are currently no studies on optimal timing between fat injections. We identified target patients with secondary or multiple autologous fat transplantations by inclusion and exclusion criteria and used three-dimensional scanning technology to calculate the volume retention. Patients were divided into two groups according to the dates of the first and second operations (group A: interoperative time < 120 days, group B: interoperative time ≥ 120 days). We used SPSS 26 for statistical calculations. We included 161 patients in this retrospective study, with an average volume retention rate of 36.56% in group A (n = 85) and 27.45% in group B (n = 76). The independent sample t test showed that the volume retention rate in group A was higher than that in group B (P < 0.001). And the paired t test showed there is a significant improvement of volume retention rate after the second fat graft session (P < 0.001). Multivariate regression analysis showed that the interval time was an independent factor affecting the postoperative volume retention rate. The interval time between autologous fat transplantation for augmentation mammaplasty was an independent factor affecting the postoperative volume retention rate. The postoperative volume retention rate of the < 120 days group was higher than that of the ≥ 120 days group. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of Ranolazine on random pattern skin flap survival in rats

Objective: Flap surgery is widely used in the field of plastic surgery for defect reconstruction. The most important problem of this surgery is ischemic necrosis which may occur in the distal of the flap. For this reason, studies have been conducted to develop many treatment methods to solve this problem. Our study aimed to investigate the effects of different doses of ranolazine, a selective late sodium current blocker, on the viability of skin flaps prepared from the back of the rat. Material and Methods: A total of 32 rats, including 8 rats in each group, were included in the study. A random patterned caudal base 3x9 cm width : length modified McFarlane skin flap was elevated from the backs of all rats and adapted back to its place For 7 days postoperatively, 1 cc of saline was added to the control group (Group A), and 45 mg/kg, 90 mg/kg, and 180 mg/kg of ranolazine were added to the study groups (Group B, C, D), respectively, and administered daily with gastric lavage On the 7th postoperative day, photographs were taken to evaluate the viability of the flaps and scintigraphic evaluations were made. After the rats were sacrificed, the flaps were separated from their bases and evaluated histopathologically. Results: As a result of the evaluations, the viable flap area was calculated as 12.7548 cm2 for Group A, 14.9533 cm2, 16.494 cm2 and 16.7599 cm2 for Groups B, C and D, respectively, and a statistically significant difference was found between the groups (P = 0.00 &lt;0.05 ). The viable flap area percentages were calculated as 57.486% for Group A, 68.908% for Group B, 70.174% for Group C and 74.603% for Group D, and a statistically significant difference was found between the groups (P = 0.00 &lt;0.05). As a result of scintigraphic evaluation, the viable flap area was found to be 61.57% for Group A, 71.04% for Group B, 70.21% for Group C and 73.85% for Group D, and a statistically significant difference was found between the groups (P = 0.03 &lt;0.05). Histopathological evaluation revealed a decrease in the flaps' inflammation, edema and necrosis scores with the increasing drug dose. Conclusion: As a result, although flap viability increased with increasing doses in the group given ranolazine, more detailed studies are needed before it can be used clinically.

D125. Effect of Plastic Surgery Electives and Home Programs on Match Rates

PURPOSE: Medical school curricula for plastic & reconstructive surgery (PRS) exposure are highly inconsistent, which may impact match rate for students applying to PRS. We investigated whether the presence of PRS elective rotations and home programs influences match rates into integrated PRS residency. METHODS: A list of 198 medical schools was compiled from the Association for American Medical Colleges’s Medical School Members and from the American Association of Colleges of Osteopathic Medicine. PRS elective rotation offerings and match rates were obtained from school websites. Non-US schools and schools which lack public match lists were excluded. A list of PRS residency programs was obtained from the National Resident Match Program. T-tests were performed using IBM SPSS Statistics Software for any significant differences in match rates. RESULTS: 158 medical schools were included in this study. 123 (78%) offered PRS elective rotations and 77 (49%) had integrated and/or independent home PRS residency programs. 71 (45%) had both elective PRS rotations and a home residency program and 30 (19%) had neither. Mean match rates were analyzed based on presence of elective PRS rotations and/or home PRS residency programs. CONCLUSION: Presence of elective PRS rotations and home PRS residency programs significantly affects a medical student’s match into an integrated PRS residency. These findings highlight the importance of standardizing medical school curricula to provide exposure to PRS during medical school.

PC28. Retrospective Analysis of Plastic Reconstructive Surgery Incidence of Retained Surgical Items as Confirmed on X-rays

PURPOSE: In the event of missing surgical counts, obtaining x-rays to rule out retained surgical items (RSI) is a standard practice. However, these additional safety measures come with risks. This study investigated the incidence of actual RSI on plastic reconstructive surgery (PRS) intra-operative x-rays and its associated modifiable risk factors METHODS: X-rays with indication of “foreign body” in PRS procedures from 2012 to 2022 were obtained. Reports with “incorrect surgical counts” and associated peri-operative records were retrospectively analyzed to determine the incidence of RSI. RESULTS: Among 257 x-rays, 55 (21.4%) indicated incorrect counts during PRS operations. None were positive for RSIs. The average number of staff (physicians, nurses and technicians) present was 12.01. This correlated to an average of 6.98 staff turnovers. The average case lasted 8.7 hours. X-rays prolonged the time under anesthesia by an average of 24.3 minutes (p < 0.0001). Free flap surgeries had 70.9% prevalence of missing counts (lower extremity 43%, breast 27%), followed by craniofacial (12.7%), hand (12.7%), breast reductions (3.6%), and lipo-abdominoplasty (3.6%). CONCLUSION: While x-rays for missing counts intend to prevent catastrophic sequela of inadvertent RSIs, study results suggest the true incidence of RSI in PRS is negligible. However, intra-operative x-rays have potentially harmful and pervasive consequences for patients including increased anesthesia time, radiation exposure, and overall cost. Case complexity, duration and staff turnover appear to correlate with incorrect counts. Therefore, addressing modifiable risk factors to minimize unnecessary intra-operative x-rays is imperative.

The estriol use in the perioperative period by patients with genital prolapse

Introduction. Postmenopausal women in a state of oestrogen deficiency often experience pelvic prolapse with underlying genitourinary menopausal syndrome, when the progression of atrophic processes in the vaginal mucosa comes to the forefront.Aim. To evaluate the results of the use of topical hormonal therapy in the perioperative period to improve the vaginal epithelial surface appearance in postmenopausal women who need surgical treatment of pelvic prolapse.Materials and methods. A comparative prospective randomized clinical trial included 60 postmenopausal patients aged 60 to 69 years with a postmenopausal period of 10 to 20 years, suffering from POP-Q stage II–IV pelvic prolapse (ICS, 1996). All patients were recommended surgical treatment using vaginal approach. The treatment group (Group 1) included 30 patients who received topical hormonal therapy with an estriol drug (Ovestin cream, 1 mg/g) within 1 month before reconstructive plastic surgery. The comparison group (Group 2) included 30 patients who did not receive hormonal treatment in the perioperative period.Results. No complications were observed in the treatment group after reconstructive plastic surgery in the early and late postoperative periods. In the comparison group, natural urination was not achieved in 9 of 30 (35.0%) women on Day 2 after surgery, in 4 of 30 (13.3%) patients on Day 3. Also in that group, 4 of 30 (13.3%) patients experienced infectious and inflammatory complications in the postoperative period, the mucous membrane healing in 5/30 (16.6%) patients took a long time, over 1 month.Conclusions. The use of topical hormonal therapy with an estriol drug in the perioperative period in patients who require surgical treatment of pelvic prolapse results in the relief of vulvovaginal atrophy symptoms and adequate regeneration of the vaginal mucosa, which helps reduce the likelihood of complications in both early and late postoperative periods.

Anatomical Considerations and Plastic Surgery Reconstruction Options of Sacral Chordoma Resection.

Introduction Chordomas are slow-growing malignant bone tumors arising from remnant embryonic notochord cells with predilection for the sacrum. They rarely metastasize, and early surgical resection with clear margins is the treatment of choice followed by plastic surgery reconstruction supplemented with adjuvant radiotherapy based on the local treatment protocol or in cases with a contaminated surgical field. Aim The aim of the present study is to present our experience in surgical management of sacral chordomas and propose a surgical reconstruction algorithmconsidering anatomical parameters after partial or total sacrectomy. Materials and methods Twenty-seven patients with sacral chordomas were treated in our Orthopaedic Surgery Department between January 1997 and September 2022, and 10 of them had plastic surgery reconstruction. Patients were divided into groups based on the type of sacrectomy, sacrum anatomical vascular or neural variations, partial or total, and the type of soft tissue reconstruction. The postoperative complications and the functional outcomes in each patient were assessed. Results Bilateral gluteal advancement flaps or gluteal perforator flaps are the first choice in patients with partial sacrectomy, intact gluteal vessels, and without preoperative radiotherapy followed by transpelvic vertical rectus abdominis myocutaneous flap or free flaps in those patients with near total sacrectomy and preoperative radiation therapy. Conclusion There are four reliable options for patients after sacral chordomaresection: direct closure, bilateral gluteal advancement flaps, transpelvic vertical rectus abdominis myocutaneous flaps,and free flaps. Each time, tumor-free margins and a good reconstructive plan according to the defect and patient characteristics are mandatory.

The misconception of plastic surgery scope amongst general practitioners in East Nusa Tenggara, Indonesia

The scope of plastic reconstructive and aesthetic surgery is often misunderstood amongst both public and professionals, including the general practitioners (GP) who play vital roles in referring patients. Unlike other subspecialties, which are circumscribed by subgroup patients, specific organs, or diseases, the versatility of plastic surgery is driven by the principle of the surgical technique being malleable to each clinical case. This study aimed to demonstrate how well general practitioners in Kupang City acknowledge the scope of plastic surgery. The 30-Question electronic survey was filled out by GPs in several hospitals, PHCs, and clinics whose certificate of registration is based in Kupang City. Respondents should match the given cases to one subspecialist surgeon that the GPs think fits best. In total, 83 GPs participated; 63.9% (n=53) were female, aged 27.95 (±3.53 years), 77.1% (n=64) practised in a hospital, and 67.5% (n=56) graduated from medical school in Java. Only 2.4% (n=2) chose a plastic surgeon whom they will refer to among three hand cases, 6% (n=5) in four craniomaxillofacial cases, and 10.8% (n=9) in five reconstructive cases. The GPs tend to associate cosmetic procedures with plastic surgeons, while reconstructive surgery cases like hand or craniomaxillofacial cases were correlated with non-plastic surgeons. The scope of plastic surgery needs to be further introduced in the medical student curriculum; thus, GP can be more exposed to the field and refer patients accurately.

Киста орбиты, птоз верхнего века, обусловленные ранее проведенной витреоретинальной хирургией: клинический случай

Purpose. To present a clinical case of detection of a tamponing substance in the anterior parts of the orbit and retrobulbar tissue, upper eyelid tissues, subconjunctivally after vitreoretinal surgery. Material and methods. In the Kuzbass Regional Clinical Hospital named after S.V. Belyaev, under the supervision of 2019–2022, there was a patient who revealed elements of a tamponing substance in the tissues of the orbit, conjunctiva, upper eyelid after surgical treatment for regmatogenic retinal detachment. Standard ophthalmological examination, ultrasound examinations, magnetic resonance imaging were performed. Results. As a result of reconstructive plastic surgery, the anatomical position of the upper eyelid and orbital tissues was restored. Conclusion. In the presented clinical case, options for the migration of silicone oil into the structures of the accessory apparatus of the eye and orbit, which caused additional surgical interventions, are described. Keywords: vitreoretinal surgery, tamponing agent, silicone oil, cyst of the orbit, ptosis of the upper eyelid

THE USE OF HYALURONIC ACID FOR CORRECTING FACE DEFORMITIES

The use of injectable hyaluronic acid (HA) fillers has become increasingly widespread in facial contouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools in addition to aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but a new potential horizon could be their application in traumatic, reconstructive and craniofacial surgeries. This study was carried out retrospectively through a bibliographic survey of books, public health manuals and scientific articles in Portuguese and English published in the databases of VHL (Virtual Health Library), SciELO (Scientific Electronic Library Online) and PUBMED. The search for references was developed by looking for publications referring to the period of the last 10 years. Visual analogue scale (VAS) assessment was performed to assess patient satisfaction. No major complications (ie impending necrosis or visual loss) were reported. Bruising and swelling have been reported for 48 hours after lip injection. In the immediate VAS assessment, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS assessment (contextually for improvement in flexibility, elasticity, and aesthetic appearance of the tissue). The results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications may be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.

Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years.

Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.

Comparison between transdermal buprenorphine and intravenous paracetamol for post-operative analgesia after major plastic reconstructive surgery under general anesthesia – A randomized double-blind controlled trial

Background: Adequate pain management is an essential entity in reconstructive surgery to prevent adverse physiological and psychological outcome. Transdermal buprenorphine has been mostly studied in chronic pain and cancer related pain but hardly studies in acute pain are available. Aims and Objectives: The aims of this study were to compare post-operative pain relief achieved by transdermal buprenorphine and IV paracetamol in terms of safety and efficacy. Sedation and adverse effects were also studied. Materials and Methods: This is a prospective, parallel group, double-blind, and randomized trial. After ethics, clearance and consent from 46 patients undergoing major reconstructive surgery were allotted into Group B, (n=23) who received transdermal buprenorphine and Group P (n=23) who received m IV paracetamol 6 hourly. IV Paracetamol was taken as active control. Standard institutional protocol for general anesthesia was followed. Visual analog scale (VAS) score was measured postoperatively for 48 h. Diclofenac sodium was the rescue analgesic. Sedation was assessed by Ramsay Sedation score. Results: Transdermal buprenorphine patch (TDB) gave superior pain relief in comparison to intravenous paracetamol 48 h postoperatively, P≤0.0.5 pin VAS score. The total amount of rescue analgesic required was high in Group P than Group B (P=0.034). Hemodynamic stability was better maintained with TDB with minimal sedation and side effect. Conclusion: TDB (20 μg/h; 20 mg) can be safely used for post-operative analgesia with greater efficacy and minimal side effects when compared to intravenous paracetamol.