Background: This study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy. Methods: A prospective observational study was conducted to verify the hypothesized algorithm. The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5). We divided the patients into 4 groups depending on the site of injury. Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve. The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale. Results: The mean values of the disabilities of the arm, shoulder, and hand score, key pinch strength, and hand grip strength showed a statistically significant improvement across all patient groups (P < 0.05). Of those with zone (I) injury, postoperatively, 79.9% patients attained a first dorsal interosseous muscle power grade >3 on the Medical Research Council scale, while 93.9% of patients with zone (II) damage achieved the same result. Surprisingly, 84% of patients included in both zones (III) and (IV) also recovered to the same extent. Conclusions: This prospective observational study examined and successfully confirmed the validity of our proposed novel algorithm for the management of ulnar nerve injuries (Sunderland grade 5).
Background: Acne scarring is a visible reminder of acne vulgaris resulting from inappropriate healing of active lesions. Yet, no golden standard is present. Nanofat is an emulsified homogenous suspension of adipose tissue rich in adipose derived stem cells (ADSCs). Its application serves regenerative purposes. Objective: To evaluate efficacy of nanofat versus enhanced nanofat with adipose-derived stem cells transfer in treating atrophic acne scars. Methods and Materials: This study was carried on 40 patients with atrophic acne scars; grouped into two groups. Group A: 20 patients; treated with nanofat with platelet-rich plasma (PRP) and group B: 20 patients; treated with enhanced nanofat with ADSCs and PRP. Histopathological examination was done before and 6-months after treatment, specimens were stained by haematoxylin and eosin, Mallory trichrome and Verhoeff-Van Gieson. Results: In both groups; 70% showed excellent and very good improvement and patients’ satisfaction was 60% for both groups. Histopathological examination revealed increase in epidermal thickness, formation of new collagen and elastic fibers without significant difference between both groups. Conclusion: Nanofat transfer is easy, cost-effective, and safe for treating acne scars, compared to enhanced nanofat with ADSCs transfer which is costly and time consuming
Abstract:Background: About 50% of peripheral nerve injuries leave permenant disability. Trials to enhance nerve repair using stem cells are undergoing. Adipose derived mesenchymal stem cells (ADSCs) are good candidates for cellular-induced regeneration. Aim of the Work: The aim of the present work is to evaluate the effect of ADSCs on enhancing repair of peripheral nerve injuries. Subjects and Methods: This study was conducted on 18 patients with recent trauma involving nerve injuries at the wrist region. Patients were divided into: Group I: underwent surgical end-to-end closure GroupII: underwent surgical end-to-end closure and injection of ADSCs into the nerve sheath and surrounding tissue. Both groups were followed up using clinical assessment using Sensory Recovery Grading and Muscle Strength Grading systems in addition to electrophysiological nerve conduction tests. Results and Conclusions: This study collected a range of 1 to 2 x10 6 ADSCs from an average of 100-150 ml fat. After 1 year, stem cell group showed significantly higher motor and sensory improvement in ulnar nerve injury; while in the median nerve injury, stem cell group showed higher motor recovery with no difference in sensory recovery.
Background: Platelet-rich plasma has been extensively used in several clinical settings. However, there still a lack of conclusive evidence concerning the benefits of platelet-rich plasma in the field of wound healing. We aimed to evaluate the safety and the efficacy of autologous platelet-rich plasma in acute wound healing. Methods: This prospective study enrolled forty adult patients of both sexes and aged between 18 -50 years. All patients in need for split-thickness skin graft were included in our study. The donor sites were randomly divided into two equal halves: the platelet-rich plasma side, which was injected with recently activated platelet-rich plasma; and the control side, in which the conventional method of dressing was used. Measurement of the platelet count and transforming growth factor-B1 concentration in each platelet-rich plasma preparation and the whole blood was done for all patients. Clinical monitoring of the donor sites was done every 7 days for 3 weeks, regarding pain perception, epithelialization surface area and possible side effects of the platelet-rich plasma. Histopathological monitoring was done on the 7 th postoperative day. Results:The platelet count was increased about 3.5 folds and transforming growth factor-B1 was increased 2.4 folds in the platelet-rich plasma compared to the patients' blood. The platelet-rich plasma side had significantly lower pain scores at day 7 (4.8 ± 0.18 vs 5.9 ± 0.07) and day 14 (1.4 ± 0.11 vs 1.9 ± 0.09) postoperative (p = 0.002 and p = 0.004, respectively) and had significantly higher rate of epithelialization at day 7 (9.8 ± 0.35 cm 2 vs 7.5 ± 0.32 cm 2 ) and day 14 (38.4 ± 0.36 cm 2 vs 36.9 ± 0.42 cm 2 ) postoperative (p < 0.001 and p = 0.039, respectively), while at day 21 postoperative, there was no significant difference between both sides. There was no significant difference between both sides regarding the incidence of complications. The platelet-rich plasma side showed intact epithelium, differentiation of the cells in stratum spongiosum and stratum granulosum, neovascularization and earlier collagen deposition. Conclusion:The platelet-rich plasma is safe and effective adjuvant in the management of acute wounds. However, we recommend for larger clinical trials for standardized method for PRP preparation and better understanding of the efficacy of this blood product.
Background: Fingertip injuries are the most common injuries that occur to the hand, accounting for 4.8 million Emergency Department visits per year. Fingertip injuries requires immediate intervention to avoid any complications or deformities. Several therapeutic modalities have been used for treatment; either surgical or conservative treatment and each of them has its own advantages and disadvantages. However, evidence is still lacking in the literature supporting either surgical or conservative lines of treatment. The purpose of the present study is to compare functional and aesthetic outcomes between surgical and conservative treatment of fingertip injuries.Methods: This prospective study included 50 patients with Allen's type II and III of fingertip injuries divided into two groups; Group I included 20 patients treated surgically and Group II included 30 patients treated conservatively which is further subdivided into subgroup I (Platelet Gel), subgroup II (Hyaluronic acid) and subgroup III (Fucidic acid). Results:The conservative treatment showed a significant improvement regarding the sensory outcome, the range of motion, rate of complications, the aesthetic outcome and the patients' satisfaction (p=0.002, 0.001, 0.021, 0.035, 0.026 respectively). The platelet gel in the conservative treatment showed a significantly shorter time of healing compared to other modalities of conservative treatment (p=0.004) thus a significant faster recovery and shorter time off-work (p=0.001). Conclusion:We concluded that the conservative treatment provides better functional and aesthetic outcome in treating fingertip injuries. The use of platelet gel in fingertip injuries is associated with decreased time of healing and early return to work.
Background: In this study, we present our technique of the septum-based superomedial pedicle reduction mammoplasty using an inverted T scar pattern. It is based on the Wuringer's horizontal breast septum, through which run the main neurovascular supply to the nipple-areola complex (NAC). Patients and Methods: The study included 35 cases with bilateral breast hypertrophy. The mean suprasternal notch to nipple (SSN-N) distance in our cases was 39.7±5.6cm. The mean nipple elevation in our cases was 17.9±4.6cm. Our mean resection weight was 764±160 grams per side. We had 6 cases with resection weight exceeding 1500 grams per side. Results: We had no cases of partial or total necrosis of the NAC. Immediate postoperative breast sensation was preserved in 26 cases and was impaired in 9 cases but it was regained spontaneously within 6 months. Conclusion: The septum-based superomedial pedicle technique of reduction mammoplasty is safe technique with improved NAC vascularity and sensation, even in cases of gigantomastia, owing to the preservation of the important neurovascular structures related to the breast septum.
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