Background
This study aimed to evaluate the use of fat grafting enriched with platelet-rich plasma through a computerized-assisted mapping for esthetic restoration in progressive hemifacial atrophy (Parry-Romberg disease).
Methods
This prospective study was conducted on 53 patients presented by Parry-Romberg disease and was corrected by facial fat grafting (FFG) enriched with platelet-rich plasma (PRP). A computerized software program was used to design a detailed map to achieve clinical symmetry with fat grafting application, as the anatomical subunits direct 3-dimensional volumetric symmetric, and compartments direct isolated recipient-specific grafting. Also, volumetric asymmetry was assessed through outlines of facial contour, projection, and proportions for both sides and comparing the mirror image of unaffected side as a template.
Results
Objective ultrasound and photogrammetric measurements showed a significant improvement in facial symmetry postoperatively compared to preoperative (P < 0.05), with no significant differences between 12 and 18 months after surgery. The FACE-Q score regarding comparison before surgery and 18 months after surgery showed a statistically significant improvement in all modules (P < 0.001) with overall satisfaction concerning outcome of 82.7 ± 0.8.
Conclusion
Enriched fat grafting with platelet-rich plasma (PRP) is a good alternative to reconstruct soft tissue defects for patients with progressive hemifacial atrophy (Parry-Romberg disease) with a minimally invasive approach and low complications. It provides volumetric replacement, enhancement of skin texture, and improvement of hyperpigmentation with restoration of facial contour for an esthetic pleasing appearance. Isolated replacement in accordance with the anatomical facial subunits and fat compartments allows three-dimensional reconstruction and maximizes fat retention.
Graphical abstract
The article Esthetic restoration of progressive hemifacial atrophy (Parry-Romberg disease) by free fat grafting using computerized-assisted mapping, written by Mohammed Saad AboShaban and Fouad Mohammed Ghareeb, was originally published online on the publisher's internet portal
Background: Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. Methods: The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. Results: The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. Conclusion: Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction.
Background The ideal skin substitute should be more similar to normal skin function while causing fewer reactions. The purpose of this study was to assess the effect of radiotherapy on minimizing acute rejection and enhancing wound healing in children with deep burns.
Patients and Methods A prospective randomized control study included 34 children admitted to the burn unit with deep burns under the age of 12 years. Through the tomotherapy device, a skin homograft from a related living donor was exposed to a local dose of radiotherapy of 500 centigray (cGy). It was immediately used for coverage of the prepared bed after the irradiation was completed.
Results The mean values of the laboratory parameters (ESR, CRP, IL-6, and TNF) for all burn patients in the study showed a significant difference, with p < 0.001. The mean ± standard deviation (SD) of the time from homograft coverage to the appearance of rejection was 9.62 ± 1.45 in group 1 and 14.35 ± 2.8 in group 2, with p < 0.001 (highly significant difference), indicating that exposure to radiotherapy can reduce graft rejection.
Conclusions The exposure of skin homografts from related living donors to a local low dose of radiotherapy can reduce a graft's ability to initiate inflammatory and immunological reactions, thereby minimizing rejection of a graft and enhancing epithelialization in children with deep second- and third-degree burns.
Introduction:
Secondary cleft rhinoplasty is a challenge due to the complex anatomy of the nose, with structural deformity and difficulty in surgical management. This study aimed to evaluate the effect of an anatomical-based approach on enhancing tip and alar symmetry in secondary unilateral cleft rhinoplasty using photogrammetric evaluation.
Methods:
The study was conducted on 57 adult patients seeking rhinoplasty after primary repair of congenital unilateral cleft lip deformity. All patients were operated upon using an external open rhinoplasty approach using an anatomical-based surgical technique. The cases were periodically followed up at three, six, 12 and 18 months for both aesthetic and functional outcomes with photogrammetric analysis of facial profile using the software Mirror Suite programme to compare before and after the surgical procedure.
Results:
The photogrammetric analysis showed a significant improvement of facial angles (P = 0.05). The nasofrontal angle changed from a median of 146° to 132.5°, nasolabial angle of 73° to 95°, nasofacial angle of 21.5° to 32° and nasomental angle of 105° to 130°. The rotation angle of the nasal tip showed a significant cephalic rotation with a mean increase of the tip elongation of 1.8 cm achieved per lateralised millimetre.
Discussion:
Secondary rhinoplasty in unilateral cleft deformities needs accurate evaluation of the anatomical and pathological abnormalities. Open approach is preferred with using costal cartilage graft allowing adequate columellar lengthening, maxillary enhancement and alar repositioning which leads to optimise the definition, projection and cephalic rotation with better stabilisation and symmetry of the nasal tip.
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