Previous investigators have not described some of the new anatomic variations or provided quantitative and analytical data of the arterial anatomy of the lips in as much depth as in this study. Dissections of 14 different facial sides of cadavers were done. Through investigating the arterial supply of the upper and lower lips, measurements were performed and statistically analyzed. The main arterial supply of the upper lip was from the superior labial artery (SLA, mean external diameter, 1.8 mm [SD, 0.74 mm]); in addition, the subalar and septal branches contributed to its vascularization. The origin of the SLA was above the labial commissure in 78.6%. The subalar branch was not found but replaced by the alar artery that arose from the infraorbital artery in 1 specimen. The main arterial supply of the lower lip was derived from 3 branches of the facial artery, the inferior labial artery (mean external diameters, 1.4 mm [SD, 0.31 mm]) and the horizontal and vertical labiomental arteries. The inferior labial artery originated mostly below the labial commissure in 42.9% and formed a common trunk with the SLA in 28.6%. The horizontal labiomental artery was present in all, but vertical labiomental artery was absent in 21.4% of specimens. Overall, observed anatomic variations were classified into types I to VIII. Significant relations between the demographic variables and measured parameters were reported including the correlation coefficient among evaluated parameters. In conclusion, this study provides various information that aids in creating new flaps and supports the vascular base for clinical procedures in reconstructive surgery of the lip.
The modiolus is of critical importance in aesthetic and reconstructive plastic surgery of the face.
This is the first time the concept of total quality management in burn injuries is proposed. This is a prospective study done in 1997-2003. All burn admissions to King Fahd Hospital of the University, Division of Plastic Surgery, were included. Total number of cases is 240. Male patients constituted 141 (59.2%); female patients, 97 (40.8%), and 2 cases were not specified in forms. There were 114 children (0-18 years, 50.2%) and 113 adults (19-99 years, 49.8%). The source of admission was mainly emergency room (197, 82%) followed by outpatient department (27, 11.3%), and other hospitals in 16 (6.7%). The type of burn was mainly scald (16.3%), then flame (6.98%), electrical (6.5%), chemical (2.8%), friction (0.47%), and not specified in 33% of recorded cases. The most encountered body percentage burn was 1% to 10% and 11% to 20% in 36.7% and 25.9% of cases, respectively. Sixty-six cases (28.2%) were operated on. The reason for nonoperation was not indicated in 78.5% and refusal in 1.8%. The most frequent operation was split-thickness skin grafting followed by tangential excision + split-thickness skin grafting. Operations took mostly about 2 hours (53.8%). The region operated on was mainly upper limbs (42.6%), then head and neck (27.7%). The affected body part in electrical burns was upper limb, then the head. Preoperative photography was done in 17% and post operatively in 9.4% of recorded cases. Consultations were needed in 39.4% and responded to in 48 hours in 98.2% of them. Discharge was home in 80.9%, against medical advice in 7.5%, died in 7%, transferred in 4%, and other ward in 0.5%. No significant difference was observed between pediatric age groups and adults (>18 years old), also for electrical versus nonelectrical burns in relation to total hospital stay. Similar observations were made among various age groups with respect to total hospital stay. The clinicopathologic typing relation to age groups, nationality, and sex was found significant. Recommendations and the newly proposed zone of practice and concept of total quality management in burn injuries are included.
A general approach and unifying the auditing process facilitates comparisons between departments in the same country and between different countries in the globe.
Sadat-Habdan mesenchymal stimulating peptide has potential of early healing of experimentally produced burns in rats. Healing was effective and better in the study group compared with the control group, in qualitative and quantitative measures.
Researchers did not describe before the process of self-audit as proposed in this research. A new concept of total quality management of personal professional practice (TQM-PPP) is introduced. A prospective audit of a personal professional practice, clinical and academic, for the first 7 years as a consultant plastic surgeon is described. The number of patients reported was 248; 145 (59.4%) were male patients and 99 (40.6%) were female patients, of whom 159 (65.2%) and 85 (34.8%) were Saudis and non-Saudis, respectively. Sources of admission were mainly emergency (118, 47.8%) and outpatient departments (115, 46.6%). Operations were performed in 177 (72%) of patients; the author was the actual surgeon in 155 (62.5%) of patients, which were classified as intermediate (48.3%), major (38.4%), minor (12.6%), and major complex (0.7%). Operations were elective in 109 patients (61.6%), and the rest were emergencies. Clinicopathologic typing was mostly traumatic in 108 patients (59%), followed by aesthetic in 42 patients (23.0%). The region most operated on was the upper limb and then the head and neck; 89 (70.6%) of operations were done in 2 hours. Six complications were detected. Significant relations observed between clinicopathologic typing and age groups, nationality, and sex. However, no significant difference was detected between adults and pediatric age groups or between elective and emergency cases with respect to total hospital stay. There was no significant difference in the mean length of stay in relation to age groups. Various academic achievements in the same period and the pyramid of TQM-PPP are included. In conclusion, it was a satisfying experience, and I encourage other colleagues to do the same. Identifying the zone of practice of the individual consultant/health professional, designing audit tools for each, and accurate record keeping; using specific staff for data collection, entry, and analysis; and developing outcome evaluation techniques from patients and health care providers are the tools to achieve TQM-PPP.
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