Non healing diabetic foot ulcers and the resulting potential amputations present significant costs to the health care system and reduce patient quality of life. The goal of diabetic foot ulcer treatment is to obtain wound closure as expeditiously as possible. The use of platelet-rich plasma (PRP) to enhance wound healing has increased dramatically over the last decade. However, controversies exist in the literature regarding the added benefit of this procedure. The aim of this study is to investigate the efficiency of platelet releasate on the healing of chronic diabetic ulcers in comparison with platelet-poor plasma (PPP). This study included 24 patients with chronic diabetic ulcers. They were systematically randomised into two groups: PRP group (n = 12) and PPP group (n = 12). The results showed that healing in PRP group was significantly faster (P < 0·005). PRP enhances healing of chronic diabetic foot ulcers.
Background: Orbital floor fractures always represent a challenge for reconstruction. Various techniques for treatment had evolved over the past years, each with their strengths and weaknesses. The main aim of surgical repair is to relocate herniated orbital tissue and fat back into the orbit restoring both the function and aesthetic aspect. Reconstruction of orbital floor can be performed using various types of materials, either autologous as rib grafts or cartilage grafts or alloplastic as titanium mesh. Aim of the Study:The aim of this study is to compare the results of using autologous cartilage grafts with those of split rib graft in small posttraumatic orbital floor defects reconstruction.Patients and Methods: 30 patients with orbital floor defects due to maxillofacial trauma. They were divided into 2 groups according to the technique of reconstruction: Group 1: 15 patients who had reconstruction by onlay split rib grafts Group 2: 15 patients who had reconstruction by conchal cartilage grafts, using either unilateral or sutured bilateral conchal cartilage grafts in large defects. Both methods were analyzed clinically and radiologically and were compared as regards, their advantages and disadvantages Postoperative assessment using CT scan were used.Results: With the conchal cartilage grafts, the results were more favorable with statistically significant decrease in complications.Conclusion: Reconstruction of orbital floor fractures using conchal cartilage grafts represents a safe and reliable method of reconstruction with less complications.
Background: Crushing injuries of the lower 1/3 of the lower limb always represent a challenge for reconstruction. Reconstructive options diminish with the injury of one or more of the major vessels of the lower limb. This is a revisit of distally based medial hemi-soleus muscle flap as a valuable option in such reconstruction.Patients and Methods: 16 patients with skin loss over lower one third of leg of various causes had pre-operative duplex done to detect affection of anterior tibial and/or peroneal vessels and confirm patency of the posterior tibial vessels. CT angiography was done for confirmation. In case of one or two vessels affection, sparing the posterior tibial artery, the defects in the distal one third of the leg were reconstructed by distally based hemi-soleus muscle flap; based on the distal perforators of the medial head of the soleus muscle from the posterior tibial artery. Results:The flap survived completely in twelve cases with total loss in one patient, partial loss in two case and local recurrence of the excised tumour in one case. Conclusion:The distally based medial hemi-soleus muscle flap is a very good option in reconstruction of problematic lower one third skin defects especially that associated with vascular injury other than the posterior tibial vessels.
Background: With the aging process, changes in the facial proportions occurs. The auricular lobule has a significant role in the ear and facial aesthetics. With aging, the ear lobule gets distorted in shape. Objective:The aim of this study is to address the ear lobule ptosis with primary facelift procedure.Patients and Methods: Fifteen patients with facial skin redundancy and true ear lobule ptosis having primary facelift, were operated in Ain Shams University Hospital and Private Hospital from September 2020 to May 2022. An informed consent was obtained from all patients. Preoperative evaluation was done for the face and ptotic ear lobule was examined for its deflation, width and length measurements. Pre operative and post operative photography were taken. Primary facelift was done and ear lobule management according to degree of ptosis.Results: Fifteen patients underwent primary facelift procedure, age was ranging from 48-60 years (average 53), with ear lobule management (nine cases had fat injection for correction of loss of volume and six cases had surgical reduction for ptosis correction) with high satisfaction scores (13/15) with no lobuloplasty complications. Conclusion:Aesthetic consideration of ear lobule rejuvenation in primary facelift procedure augments the final aesthetic outcome of the procedure and patients' satisfaction.
Background: Use of fascio-cutaneous or fascial flaps are well known methods of reconstruction of dorsal hand defects to preserve the gliding movement of the extensor tendons. Whilst reconstruction of large hand defects extending to the wrist or the distal forearm entails use of larger flaps with large donor sites, so muscle flaps may have an advantage over the fascial or fascio-cutaneous flaps in coverage of these large defects. The aim of this study is to compare the gliding of the extensor tendons underneath fascio-cutaneous and muscle flaps on the dorsum of the hand. Patients and Methods: The study included 20 patients with dorsal hand trauma with exposed extensor tendons, ten defects were reconstructed by free muscles flap and split thickness skin graft and the other ten were reconstructed with fascio-cutaneous flaps. Early rehabilitation in all cases was done by a single dedicated physiotherapist. Tendon gliding was assessed by measurement of active flexion and extension at the metacarpo-phalangeal joint using goniometer after complete flap healing four months following flap inset. Results: There was no statistically significant difference in gliding for extensor tendons in patients with hand defects reconstructed by free muscle flaps and skin graft versus fasciocutaneous flaps. Conclusion: Both fascio-cutaneous and free muscle flaps had comparable results concerning the extensor tendons gliding underneath.
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