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Background Plastic surgery practices have changed drastically during the coronavirus disease 2019 (COVID-19) pandemic, as most non-elective surgeries were deferred owing to the high presumed risk of infection transmission. Therefore, this study aimed to assess the impact of the COVID-19 pandemic on the patterns and characteristics of plastic surgery in an academic medical city. Methods This retrospective comparative study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. We reviewed data from patient medical records during the pandemic period (from March 2, 2020, to December 31, 2020) and the corresponding pre-pandemic period, defined as the same timeframe in the preceding year (from March 2, 2019, to December 31, 2019). Results The total number of admitted patients in the pre-pandemic period was 479 and in the during-pandemic period was 254, indicating a 46.97% reduction in admission frequency. The median length of hospital stay was significantly shorter in 2020 than in 2019 (1.62 ± 1.74 days versus 2.13 ± 4.18, respectively, p = 0.011). The during-pandemic period was characterized by significantly higher frequencies of urgent procedures (9.8% versus 5.4% in 2020 and 2019, respectively, p = 0.025) and lower frequencies of elective procedures (90.2% vs. 94.4% in 2020 and 2019, respectively, p = 0.035) than the pre-pandemic period. Conclusion The number of plastic surgeries performed has decreased since the onset of the pandemic. However, the impact of the pandemic on plastic surgery practices remains unclear. Further studies are needed to determine the effects of this pandemic on patient outcomes.

Cyanoacrylate (CA) tissue glue is frequently used in various surgical procedures, and it is simple to use and may save time during procedures. We report the use, effectiveness, and postoperative outcomes of patients who have undergone skin graft surgeries in which CA glue was used to stabilise the graft. A retrospective study of patients who underwent skin graft surgeries where CA was used to stabilise the grafts between January 2018 and August 2021 at different medical institutes in Riyadh, Saudi Arabia. The analysis was performed using the Statistical Package for Social Science, version 23.0 (IBM, Armonk, New York). A total of 36 cases were included. Five patients (13.9%) had diabetes. All cases received antibiotics preoperatively. Two types of harvested skin grafts were used: (a) a non-meshed split-thickness skin graft (n = 24, 66.7%), and (b) a meshed split-thickness skin graft (n = 12, 33.3%). The graft uptake outcome was 100% for 32 patients (88.9%). The most common underlying indication of skin grafting was burn 17 (47.2%), in which 5 (13.9%) developed partial graft loss. The percentage of skin grafts taken using CA was high and comparable to other fixation methods. Further studies may be needed to assess the long-term outcomes and cost-effectiveness.

Highlights • Angioleiomyoma is a rare benign tumor comprised of smooth muscle cells. • Other than biopsy, no modality of investigation can conclude the diagnosis. • Favorable prognosis can be obtained by simple local excision. • This case report presents a condition in which this tumor emerged from hand’s artery - An extraordinary observation., Introduction With the rarity and benign nature, angioleiomyoma is a tumor of disputed etiology that originates from the tunica media of the blood vessels. Lacking any characteristic clinical or radiological features, often leading to preoperative misdiagnosis, it is only diagnosed confidently on the basis of histopathology; for this reason combined with the rarity, angioleiomyoma would not be usually found at the top of the differential diagnosis list. Local excision is usually curative with excellent prognosis. Case This report discusses a case of a 60-year-old healthy lady who complained of a chronic painless mass in the right 2nd digit. Originating from the proper ulnar digital artery, it was excised with no complications. Histopathology results confirmed the diagnosis of angioleiomyoma. No recurrence was observed 6 months following the procedure. Discussion Out of the handful published papers concerned with angioleiomyoma in hands, few report the origin to be the digital artery. Conclusion Further awareness about this tumor is required and it should be included in the differential diagnoses list of the treating surgeon.

Highlights • Scaphoid is the most common carpal bone involved in fractures. • Presentation of bilateral scaphoid fracture is extremely rare. • Bilateral scaphoid fractures rarely occur after RTA. • High index of suspicion and good clinical judgment are required to detect bilateral scaphoid fractures., Background Traumatic bilateral scaphoid fractures are extremely rare. Here, we report an unusual mechanism of bilateral scaphoid fracture after road traffic accident. Case report A 32-year-old male presented with bilateral wrist pain to our plastic surgery clinic six months after he was involved in a road traffic accident. He was diagnosed with bilateral scaphoid fracture based on his CT scan findings. It is noteworthy that at the time of collision, he had grasped the steering wheel strongly to brace himself and had suffered no significant injuries except for bilateral wrist pain. Discussion The diagnosis may be missed in our case because of bilateral hand pain complaints and normal X-ray report. Thus, we suggest that CT scan should be performed in similar incidents, particularly in case of normal X-ray reports. Conclusion It is recommended that CT scan should be performed in similar mechanism of injury with a high index of suspicion.

Background:. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was first reported in 1997. Since then, the number of reported cases has been increasing, and patients’ knowledge and perceptions about this condition are unclear. This study aimed to evaluate the public knowledge and perceptions toward BIA-ALCL and its association with cosmetic/reconstructive breast implants in Saudi Arabia. Methods:. In this cross-sectional, online survey–based study, women aged 18–60 years in Saudi Arabia were the target population on social media platforms. Questions included data on demographics, experience of implants, and knowledge and concerns regarding BIA-ALCL. Results:. A total of 543 women participated in this study, with a mean age of 34 years. Only 1.9% had breast implants due to cosmetic or reconstructive reasons, whereas 9.8% expressed their desire of having implants in the future. More than half (57.3%) of the respondents had never heard of BIA-ALCL in comparison with 21.7% who had an established background. After reading the highlights on BIA-ALCL, 60% of the women with breast implants still wanted to keep their implants and 42.5% of the ones who desired breast implants would still aim to have them. Almost all the sample stated that BIA-ALCL should be included in the written consent. Conclusions:. Nearly half of Saudi women have not heard of BIA-ALCL, and report that it is an important part of the surgical consultation and informed consent. Our role as plastic surgeons is to raise the awareness of BIA-ALCL through social media and health care settings to maximize the safety of women with breast implants.

Background:. The cochlear implant (CI) procedure is one of the most efficient surgical options for the management of patients suffering from severe bilateral sensorineural hearing loss. Notably, CI exposure is one of the most commonly reported complications. Herein, we report our experience in the management of three patients with CIs complicated by implant exposure. Methods:. We present a retrospective review-based case series of three patients with exposed CIs requiring soft tissue coverage who were referred to plastic surgery care. These patients underwent their CI procedures at a university hospital specializing in ear, nose, and throat, after which they were referred for plastic surgery care at our university hospital for reconstruction after exposure. Each patient was managed through different surgical techniques based on the size, site, and condition of the surrounding tissue. The management options are discussed in this article. Results:. Three patients with exposed cochlear implants were treated with different surgical techniques. During the 1-year follow-up period, the patients made an uneventful recovery with fully functional cochlear implants. Conclusions:. The management of CI extrusion with local scalp flaps can constitute an effective and reliable option to salvage CI with a good prognosis and a lower incidence of exposure recurrence. Optimal results for establishing effective soft tissue coverage can be achieved by choosing the appropriate technique according to the clinical presentation.

Background:. The world has faced an unprecedented challenge in controlling the spread of COVID-19—a rapid reshaping of the healthcare system and education was inevitable. Consequently, residency programs adopted e-learning as a social distancing tool for the continuity of the learning process. In this study, we explore the opinions and perspectives of plastic surgery attending doctors and residents on the implications of e-learning. Methods:. After obtaining ethical approval, this cross-sectional study was conducted electronically between October and December 2020 among plastic surgery residents and board-certified plastic surgeons in Saudi Arabia. Participants completed a validated, anonymous, self-administered questionnaire. The questionnaire gathered participants’ demographic data, perceptions of online webinars, and audiovisual evaluations. Finally, we compared traditional (in-person) teaching with online webinars. The analysis was performed at a 95% confidence interval using the Statistical Package for Social Sciences (SPSS), version 23.0 (IBM, Armonk, N.Y.). Results:. A total of 61 responses were included in this study. The majority of respondents (78.7%) were comfortable during webinars, with 38 (62.3%) believing they should supplement traditional teaching methods. Overall, 50.8% were satisfied with the webinars. However, 37.7% were neutral. Most believed that the webinars increased their clinical (67.2%) and surgical skills (67.2%) to reasonable levels. Conclusions:. Online education provided an excellent educational tool as a viable option to supplement traditional face-to-face training, with most residents being satisfied, supporting the use of this educational tool. More objective research is required to refine existing online plastic surgery teaching methods while creating novel distance e-learning approaches for the future.

Hand surgery is a unique field that incorporates multiple specialties, aiming to provide the patient with a best possible functional and aesthetic results. Hand surgeons deal with different pathologies that require skills in several aspects of surgery. The field of hand surgery has evolved significantly over the past decades across the globe. This specialty has also been evolving in Saudi Arabia over the past 25 years. Some of the services offered to patients include specialized centers for brachial plexus, peripheral nerve, and pediatric hand surgery as well as centers for work-related hand injuries. There has also been significant contribution to the hand surgery literature from the hand surgeons working in Saudi Arabia, with hundreds of papers published in journals pertaining to hand surgery, orthopedic surgery, and plastic surgery, as well as the publication of several novel mutations causing congenital hand defects in journals concerned with genetics. The recent approval of a hand and microsurgery fellowship program in Saudi Arabia will also help boost this field in the country and the region.

Background:. In March 2020, the Saudi Ministry of Health implemented mitigation measures to control the Coronavirus Disease 2019 (COVID-19) pandemic, including media campaigns, a nationwide lockdown, and closures of plastic surgery clinics. The aim of this study was to explore the public’s knowledge of COVID-19, their willingness to undergo cosmetic surgery during the pandemic, and the factors influencing their decisions. Methods:. An internet-based cross-sectional survey was conducted. We collected data on demographic information, knowledge about COVID-19, and willingness to undergo cosmetic procedures. Participants also completed the cosmetic procedure screening questionnaire to assess body dysmorphic disorder. Results:. The sample included a total of 1643 participants (women, n = 1002; 61%). A total of 613 (37.3%) participants were aged between 30 and 40 years. The majority (n = 1472; 89.6%) referred to official government accounts for information regarding COVID-19. Most participants (n = 1451; 88.3%) felt that the pandemic was serious, and 1387 (85%) said they would not leave home to undergo cosmetic procedures during the outbreak. Being women, the presence of body-image concerns, and higher cosmetic procedure screening questionnaire scores were associated with an increased willingness to undergo cosmetic procedures. Conclusions:. This is the first study to explore the public’s willingness to undergo cosmetic procedures during the COVID-19 pandemic. The public was well educated about the pandemic, via government actions. This was reflected in participants who wished to undergo a cosmetic plastic procedure; we identified factors associated with an increased willingness to undergo procedures, which may help design awareness initiatives.

Background:. With the labeling of Coronavirus Disease 2019 (COVID-19) as a pandemic by the World Health Organization, national directives were issued instructing to close all cosmetic clinics, suspend all cosmetic procedures, and only operate on an emergency basis. As a result, many plastic surgeons faced challenges sustaining their practice. We aimed to investigate the effect of these national directive instructions on the surgeons and to review their strategies for adapting their practices during this new pandemic. Methods:. A cross-sectional descriptive study was conducted using an online questionnaire. It was constructed to assess the attitudes and practices of plastic surgeons in the Gulf Cooperation Council countries during the COVID-19 lockdown. It also explored their strategies on reopening their practice, as well as their plans on modifications of practice during and after the lockdown. Results:. In total, 197 surgeons responded to the survey. The majority were from Saudi Arabia (42.1%), followed by the United Arab Emirates (37.6%), with relatively smaller participation from the remaining countries. Over two-thirds (69.5%) indicated that the pandemic had affected their practice. Surgeons in private practices were significantly affected (P < 0.001) compared with those in the public sector. Only 39% of respondents mentioned COVID-19 testing as part of their post-pandemic surgical protocol. Conclusions:. Surgeons’ responses to the pandemic varied. Fear and future uncertainty significantly led to a surge in the utilization of different technical means to maintain the patient pool. Surgeons’ education about post-pandemic precautions is essential to maintain high standards of care in the region.

Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, “Saudi Arabia,” coupled with the search terms “burn,” “thermal burn,” “flame burn,” “chemical burn,” “electrical burn,” and “contact burn” to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10–12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to

Body Dysmorphic Disorder (BDD) is defined as a constant obsession with one’s external appearance and flaws, and it falls under the criteria of neuropsychiatric disorders. Individuals suffering from this disorder may seek unnecessary cosmetic procedures from cosmetic treatment providers such as dermatologists or plastic surgeons. Cosmetic treatments have become readily available, which has led to an influx of undiagnosed BDD patients electing to undergo such treatments. Therefore, physicians should have the clinical knowledge about BDD to diagnose and manage these cases to avoid psychological and physical harm to these patients. However, there were no studies conducted in our region to assess the awareness of BDD among physicians who provide cosmetic treatments with regards to their attitude toward such cases and how they would manage it. This study aims to assess the awareness of Body Dysmorphic Disorder among Saudi physicians who provide cosmetic treatments. We conducted an observational cross-sectional study among physicians practicing in hospitals and cosmetic clinics in Riyadh and Jeddah city (Saudi Arabia), who perform cosmetic procedures, namely dermatologists, plastic surgeons, and otorhinolaryngologists. A paper-based questionnaire consisting of multiple-choice questions was distributed among them. The total number of participants was 155 physicians: 113 (72.9%) males and 42 (27.1%) females. Eighty-two (52.9%) participants reported that they have been familiar with the diagnostic criteria of BDD for a long time and ninety-nine (63.8%) reported being familiar with the clinical picture of BDD. Sixty-three (40.6%) participants estimated the prevalence of BDD cases seen in cosmetic practice to range from 1%-5%, and most agreed on an equal prevalence of BDD among female and male patients. Half of the participants (n = 76) (49%) reported that they sometimes share knowledge about BDD with patients whom they suspect to suffer from this condition. In conclusion, cosmetic treatment providers in Saudi Arabia are aware of BDD, but we have identified a discrepancy between the self-reported participant knowledge of diagnostic criteria and their ability to accurately estimate the prevalence of BDD cases seen in clinical practice.

Highlights • Grade V post-circumcision penile injury is known as “total phallic loss”. • We present a case reconstructed with release of the subcutaneous corporal remnant. • The outcome was excellent functionally and cosmetically., Introduction Grade V post-circumcision penile injury is known as “total phallic loss”. It is usually seen with the use of mono-polar electro-cautery for circumcision resulting in penile necrosis. We report on a newborn treated by release of the subcutaneous corporal remnant and explain why this option should be considered of choice in cautery-related Grade V injuries. Report of a case A 25-day old Saudi Arabian newborn with Grade V penile injury underwent reconstruction at our tertiary-care center. Upon exploration, the remnant part of the penis under the suprapubic skin was 2.6 cm. This included the root of the penis (estimated to be 1.8 cm long in the newborn) as well as an extra 0.8 cm of corporal length from the pendulous part of the penis which has retracted under the skin. Full release of the suspensory ligament was done. The result at 6 months was satisfactory both functionally and cosmetically. Discussion Options of management of Grade V injuries include sex-reassignment, phallic reconstruction using flaps, and release of the subcutaneous corporal remnant. We demonstrate that the latter option should be considered of choice in cautery-related Grade V injuries because there is usually preservation of the most proximal part of the corpora of the shaft which becomes retracted under the skin. Hence, the released remnant is of adequate length. Conclusion Post-circumcision Grade V penile injuries of the newborn are best reconstructed with release of the subcutaneous corporal remnant. The neophallus is erectile and has an acceptable length and appearance.

Summary:. With the purpose of obtaining an aesthetically pleasing chin appearance, genioplasty or chin augmentation can be performed through osteotomy or chin implantation, with the latter available in different sizes and materials such as silicone and porous polyethylene. The implants are traditionally placed in a subperiosteal or supraperiosteal plane with different advantages and disadvantages to each. This procedure has evolved through time with many techniques and modifications; and this article is an addition to this ongoing refinement by advocating for closure of the mentalis muscle (a paired chin muscle originating from the incisor fossa to the chin skin) over the implant after securing its position with screws (in the case of porous polyethylene) or creating a snug pocket (in the case of silicone). In this retrospective analysis, 15 patients underwent this procedure with an excellent outcome. A single patient developed numbness in the mandibular nerve territory, while another one developed a fistulating radicular cyst that was unrelated to this technique. In addition to the simple learning curve, the potential advantages of this technique include less chances of fistula formation, implant exposure, infection, extrusion, or malpositioning. Prospective studies with more subjects are required to cement our findings.

Highlights • We would like to thank the journal and potential reviewers for assessing this manuscript. • The article showed a causal relation with the use of Hoverboards and Seymour Fractures in pediatric population. • Parental supervision and faulty design checkup are recommended prior to operate such machinery., Background Several recreational activities such as roller skating, skateboarding, and scooter riding create the risk for hand injuries, which are the fourth most commonly injured body part in relation to their use. Seymour first identified a specific pattern of digit injury as an open fracture affecting the distal phalangeal physis associated with nail avulsion from the eponychial fold. In this article, we report a series of Seymour fractures associated with misuse of the newly emerging recreational/transportation vehicle, the hoverboard. Method The study includes a retrospective chart review of patients who presented to a tertiary hospital between December 2015 and October 2016 with a Seymour fracture caused while operating a hoverboard. Results A total of 13 patients were treated for Seymour fractures. The majority were male patients, and the group had a mean age of 10.3 years (±2.21). The affected digits were primarily the middle and ring fingers of the non-dominant hand. The injury mechanism reported by patients or families indicated that the child was operating the hoverboard in a sitting position with the hands grasping the wheel rim parts. Conclusion We report a case series of a fracture pattern resulting from the improper/unsafe use of a hoverboard. This type of fracture occurs with a tremendous load of energy. Although improper use was a factor, design fault also plays a role in causing the injury. Parent awareness and supervision are important to prevent such injuries.

Introduction: Plagiarism is 'The wrongful appropriation or purloining and publication as one's own, of the ideas, or the expression of the ideas'. It is the most commonly committed research misconduct with the prevalence of 2%. Its effect can be devastating and damaging to science, indicating the need to recognise and curb such an act. Methodology: A cross-sectional survey was distributed to in-training residents from all specialities in one academic hospital using the attitude towards plagiarism questionnaire. Results: A total of 221 physicians in-training participated in this study. 52.2% were males and 47.5% were females. About half of the respondents (48.9%) had attended a medical writing course, 45.2% published manuscripts and 67% had attended courses in medical research ethics. Respondents had a mean positive attitude towards plagiarism score of 29.56 ± 6.81, indicating an inclination towards plagiarism. Moreover, the mean negative attitude towards plagiarism score was 26.26 ± 3.78, indicating the tendency towards diminished tolerance of plagiarism. Furthermore, subjective norms score showed a mean value of 24.84 ± 5.47, representing an inclination towards personal approval of plagiarism practice in society. No strong correlation was found between attending research ethics course and plagiarism. However, we found that having a previous publication or attending medical writing courses was significantly associated with positive leaning towards plagiarism. Conclusions: Despite having had courses in medical writing, research ethics and/or published a scientific manuscript before; we still found a positive lean towards plagiarism. This emphasises the importance of tackling such behaviour by increasing the level of awareness among trainees to avoid such misconduct.

Highlights • A man presented with a partial upper lip defect. • Reconstruction was done with a pedicle superficial temporal artery flap. • We demonstrate that the pedicle flap is adequate. • We report an excellent cosmetic and functional outcome., Introduction The hair-bearing superficial temporal artery free flap has been used in men for total upper lip reconstruction. In this paper we present a case of a partial upper lip defect in a man that was reconstructed with a pedicle superficial temporal artery flap. Presentation of case Following a car accident, a 35-year old man sustained a partial upper defect. The defect included the entire “outer lamella” (i.e. the skin and red lip) of the right hemi-lip as well as the outer part of the muscle (i.e. partial defect of the middle lamella). A pedicle superficial temporal artery flap was raised and utilized to reconstruct the upper lip defect. There were no post-operative complications. The cosmetic and functional outcomes were excellent. Discussion The hair-bearing pedicle superficial temporal artery flap is commonly used for eye-brow and beard reconstruction. Free superficial temporal artery flaps have also been utilized to reconstruct total upper lip defects. For the first time in the literature, our report introduces the use of the pedicle flap in partial upper lip defects. Conclusion We demonstrate that the pedicle flap is much simpler than the free flap and is adequate for reconstruction of partial upper lip defects. We also demonstrate a good cosmetic and functional outcome; and highlight several technical points to ensure a satisfactory outcome.

Highlights • A man presented with a deep burn of the right side of the face. • Reconstruction was initially done with a latissimus dorsi free flap. • The aesthetic outcome was poor. • Salvage was done using a superficial temporal artery flap., Introduction The face is unique because functional and aesthetic considerations are equally important. Extensive deep chemical burns of the face are usually reconstructed with flaps. In males, the use of the hair – bearing superficial temporal artery flap has the advantage of achieving a satisfactory outcome with regards to both function and aesthetics. Presentation of case A 49-year-old man sustained a deep chemical burn to the right side of the face and neck. The resulting right peri-oral and neck contractures were initially reconstructed with a latissimus dorsi myo-cutaneous free flap. The functional outcome was satisfactory. The cosmetic outcome was poor and caused the patient to go into depression. Salvage was done using a hair-bearing superficial temporal artery flap. Discussion In males, the use of the hair-bearing superficial temporal artery flap in facial reconstruction respects the aesthetic units and is also able to achieve a satisfactory functional outcome. Conclusion We stress that aesthetic and functional considerations are equally important in facial reconstruction. In males, the hair-bearing superficial temporal artery flap is the flap of choice if the beard/moustache areas are involved.

Background:. YouTube is the most accessed video website in the world. It hosts a variety of medical content. Plastic surgery-related content on YouTube has not been investigated before. In this study, we analyzed the most prevalent plastic surgery-related content available on YouTube. Methods:. Search terms were selected to cover the broad topics of plastic surgery. The top 20 most-viewed videos returned for each search term were analyzed. The videos were classified by the type of content, authorship, number of views, and number of likes. Data were collected and analyzed using Microsoft Excel (2016) program. Results:. Out of the 280 videos analyzed, “patient experience” was the most prevalent content type. Thirty percent of the analyzed videos were uploaded by medical centers, and 29% were uploaded from personal accounts. Educational video content constituted 6% of the total videos analyzed. Entertainment was the most prevalent (60%) content type returned when “plastic surgery” was used as the search term. Conclusions:. YouTube is an underutilized social media platform by plastic surgeons. The entertainment industry is taking advantage of the social media platform to attract and gain millions of views. Educational videos are low in number and quality.

Background:. The second-to-fourth digit ratio is measured by dividing the length of the index finger by the length of the ring finger. A ratio 1 means that the index finger is longer; this is known as the female pattern or “C” pattern. When both fingers are equal in length (ratio = 1), the pattern is labeled as “B” pattern; this may be seen in both sexes. None of the previously reported studies on this topic were reported in the plastic or hand surgery literature. Our aim is to increase the awareness of plastic and hand surgeons to these types of hand patterns and to correlate such patterns to sex, body mass index (BMI), and physical activity in a group of healthy medical students and interns. Methods:. We conducted a cross-sectional study on 160 healthy medical students/interns. There were 82 females and 78 males between the ages of 20 and 30. A male pattern (pattern A) was defined as pattern A in both hands or pattern A in one hand and pattern B in the other hand. A female pattern (pattern C) was defined as pattern C in both hands or pattern C in one hand and pattern B in the other hand. The correlation between hand pattern and sex, BMI, and physical activity was done using the chi-square test and Fisher’s exact test. A P value of

Background Huge craniofacial tumors represent a real challenge to surgeons from several aspects; total excision of tumor, preservation and restoration of physiological functions of sensitive organs in the region, acceptable cosmetic outcome, and avoidance of complications. Tumors larger than 30 mm in diameter are considered giant tumors. The objectives of surgery in such tumors are to overcome those challenges. Case Description In this article we present a 22-year-old female patient with a huge frontal sinus osteoma, probably the largest reported in the literature so far, measuring 10 cm × 8 cm × 8 cm, and causing recurrent peri-orbital cellulitis and severe disfigurement of the face. It took us 3 months of multidisciplinary preoperative planning for surgical excision of the tumor and 1ry reconstruction using custom-made PEEK prosthesis. Surgery went smoothly, the postoperative hospital stay was short (22 days), and there were no postoperative complications. Histology confirmed cancellous (sponge) osteoma. The outcome was excellent and satisfactory for both patient and the surgeons. Conclusions Giant osteoma can be safely removed by craniotomy, planning and simulation of surgery on 3-D skull model, and preparing custom-made prosthesis, preferably titanium, for primary reconstruction is the key for successful treatment of such challenging tumors with good outcome.

Rationale, aims and objectives Surgical site infections are the most common healthcare-associated infections. Appropriate surgical antimicrobial prophylaxis (SAP), which is an integral part of surgical site infection SSI prevention, is one of the major preventable risks to surgical patient safety. Several clinical practice guidelines (CPGs) for SAP have been published. The aim of this study was to adapt a CPG for SAP and to assess its implementability. Methods The methodology was based on two validated tools for CPGs, namely, the ADAPTE and the Guideline Implementability Appraisal (GLIA). Results The ADAPTE CPG adaptation process methodology was utilized to produce an adapted CPG for SAP based on the American Society of Health System Pharmacists 2013 CPG. The finalized CPG was then assessed to identify any possible intrinsic barriers for implementation. Conclusions In conclusion, the ADAPTE tool is a practical and successful tool for production of CPGs. The GLIA tool is useful for assessing and preparing the finalized adapted CPG for the transition from the production stage to the implementation stage. GLIA could be added to the ADAPTE process either as a final step or to check the draft of the CPG before finalization.

Background:. Myelomeningocele is the most common phenotype of congenital neural tube defects. Various reconstructive techniques have been described for soft tissue coverage following myelomeningocele repair, one of which is the use of dorsal intercostal artery perforator based flaps. The aim of this study was to describe our experience with the use of a transverse-oblique back flap that can be reliably extended to the anterior axillary line for closure of myelomeningocele defect. This pedicle transposition flap is based on thoracic or lumbar paraspinal perforators that originate from the dorsal intercostal arteries. Methods:. This is a retrospective two center case-series where all patients who underwent myelomeningocele defect closure with extended transverse-oblique flap over three years period were included. Patients’ clinical data, surgical variables, and outcomes were documented and analyzed using descriptive measures. Flap harvest technique is also delineated in the present study. Result:. Ten newborns (7 baby girls and 3 baby boys) who underwent a surgical closure of the myelomeningocele defect with an extended transverse-oblique back flap during the first week of life were included in the analysis. The defect was most commonly located in the lumbosacral area (50%) followed by the lumbar area (40%), with an overall average surface area of 22 ± 8.32 cm2. Common encountered complications include venous congestion to the distal part of the flap and minor wound dehiscence of less than 0.5 cm, all were managed conservatively. There were no incidences of flap loss or full necrosis. Primary closure of the donor site was possible in all cases. Conclusions:. In the current series, the extended transverse-oblique back flap provided a safe and reliable coverage for myelomeningocele defect. Such a flap does not jeopardize other regional fasciocutanous or musclocutaneous flaps that might be needed for soft tissue coverage later in life for this population. It also obviates the placement of skin suture line over the repaired neural tube, thus yielding a durable coverage with no major complications or functional disability.

Purpose In our experience, and from the personal report of others, children with obstetrical brachial plexus palsy appear to lose some of their initially recovered active range of motion over the time in both operated and nonsurgical patients. This study investigates whether such a diminution of active movement occurs over time. Methods We performed a retrospective analysis of data from our obstetrical brachial plexus clinic. Between 1991 and 2000, 139 patients with a minimum follow-up of 10 years were included in the study. Patients were divided into a nonsurgical group (n = 42) and a group who underwent either primary or secondary brachial plexus reconstruction or both (n = 97). Fifteen joint movements were assessed at 2, 4 to 6, and 9 to 11 years of age and at later final follow-up using the Active Movement Scale. Repeated measures analysis using age at each visit as the repeated measures covariate was undertaken. Results Active movement scores were not diminished when patients were evaluated at the 10-year follow-up visit. Conclusions The suggested loss of active range of motion over time is not demonstrated at 10-year follow-up. Type of study/level of evidence Prognostic III.

Background:. A review of the English literature over the least 43 years revealed only a total of 53 cases of Wassel types III, IV, and VII treated by the Bilhaut–Cloquet (B–C) procedure. Furthermore, the detailed results and range of motion were only given in 2 series (a total of 9 cases). Methods:. Four cases of Wassel types III and IV thumb duplications with zigzag deformity were treated with a modified B–C procedure. The main modification was minimal central resections at the joints aiming for joint preservation to improve the postoperative range of motion of the new thumb. Results:. The results showed an excellent overall functional score (Tada score of 5 of 5 in all cases). The mean range of motion at the metacarpophalangeal joint was excellent (60°), but the mean at the interphalangeal joint was only 20°. Cosmetically, all thumbs were “too wide” and a panel of 3 hand surgeons scored the cosmetic result (0–10 scoring system) between 5.7 and 6.7. No secondary procedures were done, and all parents were “very satisfied” despite the wide thumbs and split nails. This was attributed to the presence of an ugly preoperative zigzag appearance, and hence the comparative postoperative appearance was satisfactory. Conclusion:. The modified B–C procedure gives a satisfactory function, but the cosmetic outcome is suboptimal.

Objectives (Background): Patients are often bothered by excess skin laxity and redundancy after weight loss. Body-contouring surgery offers a solution. This study assessed the psychosocial impact of body-contouring surgery on patients after weight loss. Methods (Settings, Design): In this cross-sectional study, a specifically designed questionnaire developed in collaboration with psychiatric department for our research was used for 43 patients who underwent body-contouring surgery. Data were collected during single visit to the plastic surgery clinic. All the patients had lost 20 kg or less before the surgery and were interviewed at least 6 months after the surgery. The questionnaire was used to compare the psychosocial status of the patients before and after surgery. Data were analyzed appropriately using Statistical Package for the Social Sciences. Results: The participants’ mean age was 34 ± 10 years; the sample included 24 (55.8%) women and 19 (44.2%) men (total N = 43). The patients’ quality of life improved significantly in the areas of social life (P < .001), job performance (P < .002), and sexual activity (P < .001). Moreover, while 17 (39.5%) patients suffered symptoms of depression before surgery, only 1 (2.3%) patient suffered symptoms of depression after surgery. The overall satisfaction was found to be 62.8%, with mammoplasty being the procedure with the highest satisfaction (66.6%). Conclusion: Body-contouring surgery after weight loss has shown to improve both psychological and social aspects of the patients’ lives. Recall bias is the main limitation in our study.

Highlights • We present 3 cases of late distal nerve transfer to deltoid. • The outcome was excellent despite the delay from time of injury. • This was explained by the presence of partial muscle innervation., Introduction Our literature review did not reveal any study on the results of triceps to deltoid nerve transfer done as a secondary procedure after an unsatisfactory primary intraplexus neurotization of the posterior division of the upper trunk. Presentation of cases We report on three adults with C5-C6 brachial plexus injury who had an unsatisfactory deltoid function following primary intraplexus neurotization. Patients presented to our clinic late (14–16 months after injury). All patients had poor shoulder abduction ( 150°) in all patients. Discussion The primary surgery in our patients acted as a “baby-sitter” procedure; explaining the good results of the late secondary distal nerve transfer. Conclusion Good results may be obtained from a late distal nerve transfer for the deltoid muscle as long as there is partial innervation of the muscle.

Background: Studies have shown that scarring is a primary reason for patient dissatisfaction with reduction mammaplasty. Objectives: The authors prospectively evaluated patient preferences for the 3 most common breast reduction scar patterns: horizontal, vertical, and Wise. Methods: Sixty-six patients were recruited for the study before receiving their reduction mammaplasty consultation. Each patient was shown line drawings and postoperative photographs of the 3 breast reduction techniques and scored the scars on a modified 10-point Likert scale (1 = unacceptable; 10 = acceptable). The survey responses had no impact on the patients' medical care. A nonparametric Friedman test was used to compare the mean scores, and univariate generalized linear regression analysis was performed to adjust for confounding factors. Post hoc analysis was performed using the Bonferroni method. Significance was set at P < .001. Results: Sixty patients completed the study. The mean preference ranking was significantly higher for the horizontal scar pattern versus vertical and Wise ( P < .001). The mean score difference between the horizontal and Wise patterns was 2.982. The mean difference between the horizontal and vertical patterns was 2.27. There was no significant difference in preference between the vertical and Wise patterns. Linear regression analysis showed that age, body mass index, and torso/bra size had no significant effect on preference. Conclusions: To our knowledge, this is the first study designed to prospectively evaluate patient preferences regarding postoperative scars. Results indicate that the horizontal technique is preferable with respect to scar placement.

This study compares two methods of administration of non-alkalinised lidocaine for carpal tunnel decompression in volunteers as well as in patients undergoing carpal tunnel release: The Gale subcutaneous injection technique and another subcutaneous injection technique known as the "advancing wheal" technique. The comparison was done in nine male volunteers and in 20 patients. In the volunteer part of the study, both hands were injected and, hence, each volunteer acted as his own control. In the clinical part of the study, the 20 patients were randomised, with 10 patients receiving the Gale technique and the other 10 receiving the wheal technique.In volunteers, the advancing wheal technique was associated with less pain; but with a longer duration of injection and a higher number of needle pricks when compared with the Gale technique. Eight volunteers preferred the advancing wheal technique because the overall pain experience was less. One volunteer preferred the Gale technique because it took less time to complete the injection procedure. Clinically, the wheal technique also had a significantly lower mean pain score than the Gale technique.It was concluded that the advancing wheal technique is associated with less pain than the Gale technique.

Studies have shown that scarring is a primary reason for patient dissatisfaction with reduction mammaplasty.The authors prospectively evaluated patient preferences for the 3 most common breast reduction scar patterns: horizontal, vertical, and Wise.Sixty-six patients were recruited for the study before receiving their reduction mammaplasty consultation. Each patient was shown line drawings and postoperative photographs of the 3 breast reduction techniques and scored the scars on a modified 10-point Likert scale (1 = unacceptable; 10 = acceptable). The survey responses had no impact on the patients' medical care. A nonparametric Friedman test was used to compare the mean scores, and univariate generalized linear regression analysis was performed to adjust for confounding factors. Post hoc analysis was performed using the Bonferroni method. Significance was set at P.001.Sixty patients completed the study. The mean preference ranking was significantly higher for the horizontal scar pattern versus vertical and Wise (P.001). The mean score difference between the horizontal and Wise patterns was 2.982. The mean difference between the horizontal and vertical patterns was 2.27. There was no significant difference in preference between the vertical and Wise patterns. Linear regression analysis showed that age, body mass index, and torso/bra size had no significant effect on preference.To our knowledge, this is the first study designed to prospectively evaluate patient preferences regarding postoperative scars. Results indicate that the horizontal technique is preferable with respect to scar placement.