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Background: After cleft palate repair, oronasal fistula (ONF) formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. Materials and Methods: In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months) after repair. Results: The mean (range) age of studied samples was 10.7 (2-23) years. 16 patients (55.7%) were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68%) and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P < 0.001). The mean [±SD] age of failed and successfully repaired patients were 11.3 (±4.5) and 8.4 (±5.25) years, respectively (P > 0.1). Conclusion: Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure.

Background: Tracheal anastomoses are common parts of upper respiratory airway surgeries. Anastomosis is currently performed using Vicryl sutures or staples. Due to the high prevalence of postoperative tracheal stenosis, efforts have been made to find alternative methods. This study compared the use of new fibrin glue in tracheal anastomosis with the classic method. Methods: Eight dogs of similar sex, weight, and race were included in this experimental trial. The surgery was performed in two different stages. In each stage, two rings of trachea were resected. In the first stage, anastomosis was performed with the new fibrin glue. In the second stage, the anastomosis was performed classically. After two weeks, the regions of anastomosis were resected for pathologic evaluations. Findings: There was a statistically significant difference in the mean duration of operation between the two methods (5.94 minutes using the fibrin glue method and 9.75 minutes using the classic method) and the mean tracheal diameter after anastomosis (25.59 mm and using the fibrin glue method and 24.14 mm using the classic method). In gross evaluation, there was not a significant difference between two different types of anastomosis. According to microscopic study, attachment was performed completely in all cases. Conclusion: Anastomosis with new fibrin glue was faster and with less postoperative stenosis and fewer complications compared to the classic method. Therefore, we claim this method as a suitable substitute for the classic method of tracheal anastomosis.

Background: Acne vulgaris is one of the most common diseases of pilosebaceous unit characterized by papules and pustules on the face and trunk of young people. Different factors have been suggested to influence acne including diet, stress, changes in hormonal cycles, and some medications. In fact, the authors have recently received numerous complaints regarding the exacerbation of acne in patients who have undergone rhinoplasty surgery. Accordingly, we determined to compare the severity of acne before and after the surgery. Methods: This prospective analytical study was performed on 32 patients referred to plastic surgery clinics of Alzahra hospital during 2010-2011. Acne severity preoperatively and within one week, one month and four months after surgery was assessed using the acne severity index. Findings: The mean acne severity index before and one week, one month and four months after surgery were significantly different (P < 0.001). However, the severity one month after surgery was significantly higher than the other time-points (P < 0.05). Conclusion: Because rhinoplasty surgery is often performed to improve the appearance of people, the exacerbation of acne after this type of surgery affects patient satisfaction. Therefore, considering acne preventive measures before the surgery is recommended. Keywords: Acne vulgaris, Rhinoplasty, Severity of illness index

Background: Vascular anastomosis is considered as a difficult surgical procedure. Although different alternative methods have been tried to tackle these difficulties, none were found to be successful. Commercial fibrin glue has recently been used for vascular anastomosis. However, it did not gain popularity due to some limitations such as low tensile strength, rapid removal by the immune system, and risk of transmission of blood-borne viral infections. In this article, we presented a novel method for producing single-donor human fibrin glue and determined its success rate for vascular anastomosis in an animal model. Materials ans Methods : In this study, 3 mL of single-donor fibrin sealant was prepared from 150 mL of whole blood containing 50-70 mg/mL of fibrinogen. The study was performed on 10 dogs and 5 cats. After transection of the carotid artery, both ends were anastomosed by means of 3-4 sutures (Prolene 8-0). The suture line was then sealed with one layer of the new fibrin sealant. After 3-8 weeks, the site of anastomosis was evaluated angiographically and morphologically for healing and possible complications such as thrombosis or aneurysm. Results: In evaluations 3 weeks after the surgery, all arterial anastomoses were patent in dogs, but some degree of subintimal hyperplasia was noted. After 8 weeks, all anastomoses were patent and the degree of subintimal hyperplasia was decreased. In cats on the other hand, after 4 weeks, all anastomoses were patent and subintimal hyperplasia was absent. Conclusions: Single-donor fibrin glue was a quite reliable and practical alternative to minimize suturing and therefore operative time in our animal model. This sealant can easily be obtained from the patient′s whole blood. Its application in humans would require further studies.

Background: In many surgical procedures in pelvic and abdomen, gastrointestinal anastomosis has a main role.These days, bowel anastomosis is done with some techniques like handsewn and stapler anastomosis. In some research, the use of fibrin glue in abdomen is convenient, operation time is reduced, and intra abdominal adhesion is lower than standard manner. In this research we evaluated new fibrin glue for small bowel anastomosis in animal model. Methods: In this experimental study, we operated 5 dogs in same race, age and gender. After laparatomy under general anesthesia 5 cm of small intestine resected, then anastomos with new fibrin glue was done. After 15 days, the dogs were reoperated and surgical site was evaluated and then anastomosis was done by handsewn method. PASW version 18 was used for data analysis. Finding: Mean time for anastomosis with fibrin glue was 6:47 and 11:11 for handsewn. Mortality and peritonitis didn’t occur. After second operation there was no any sign of leakage, intraperitoneal inflammation and abscess. In microscopic only one case attachment wasn’t seen in mucosa and submucosal layers but it was occurred in muscular and serosal layers. Conclusion: The mean time of FG anastomosis was shorter than handsewn and the patency of surgical site was favorable beause there was no significant different between diameters of proximal and distal lumens compare whit normal bowel diameter. Our data reveals that we can use FG (that reinforced by nano particles) for reinforcement of GI anastomosis with high safety level, especially in high risk situation.

Background: This study was designed to compare the efficacy of the medical treatment versus the surgical treatment approach to decompression of trigger point nerves in patients with migraine headaches. Materials and Methods: Fifty volunteers were randomly assigned to the medical treatment group (n = 25) or the surgical treatment group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. All patients received botulinum toxin type A to confirm the trigger sites. The surgical treatment group underwent surgical deactivation of the trigger site(s). The medical treatment group underwent prophylactic pharmacologic interventions by the neurologist. Pretreatment and 12-month posttreatment migraine headache frequency, duration, and intensity were analyzed and compared to determine the success of the treatments. Results: Nineteen of the 25 patients (76%) in the surgical treatment group and 10 of the 25 patients (40%) in the medical treatment group experienced a successful outcome (at least a 50% decrease in migraine frequency, duration, or intensity) after 1 year from surgery. Surgical treatment had a significantly higher success rate than medical treatment (P < 0.001). Nine patients (36%) in the surgical treatment group and one patient (4%) in the medical treatment group experienced cessation of migraine headaches. The elimination rate was significantly higher in the surgical treatment group than in the medical treatment group (P < 0.001). Conclusions: Based on the 1-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headaches in a lasting manner.

Background: Using autologous tissue is a simple process and ideal choice for augmentation of the soft facial tissue. In this regard, platelet-rich fibrin matrix (PRFM) is used for the correction of fine rhytids and nasolabial folds (NLFs) as well as facial augmentation. This study tries to evaluate the tangibility of PRFM for facial augmentation. Materials and Methods: In this study, 20 patients (20–45 years) were studied to examine the augmentation (4 patients were excluded). For each, 3cc of PRFM provided by using 35cc of autologous blood and injected through subdermal technique into NLFs. Thickness and volume of the tissue were measured before and 3 months after treatment by sonography. The collected data were analyzed through paired t-test and independent t- test by using SPSS version 19.0 (SPSS Inc., Chicago, IL, USA). Results: The study included 16 women, with average of 39.43 ± 6.84 years (age range, 20–45 years). The thickness and the volume of subcutaneous tissue in NLFs before and after treatment show no significant difference on the right side rather than on the left side (P > 0.05), but the thickness and the volume of the tissue on both sides after treatment shows significant increase rather than before treatment, so that this increase was significant statistically. This study shows that different right and left thickness was 0.54 ± 0.51 and 0.51 ± 0.38 (P ≤ 0.001). Further, different right and left volume was 0.25 ± 0.20 and 0.26 ± 0.22, respectively (P < 0.001). Conclusion: According to the results, the increased tissue volume by PRFM still persists after 3 months of treatment and its retention has been effective on the healing process.

Background: Tuberous breast disorder (TBD), is manifested usually in small or asymmetric breasts after puberty, which makes patients candidates for breast augmentation surgery. Yet, its diagnosis may be difficult due to a wide variety of diagnostic criteria and severity of the disorder. So, the aim of this study -which to our knowledge stands as the first epidemiologic study about TBD in Iran, is estimation of the relative frequency of TBD among candidates for breast augmentation surgery.Methods: In a descriptive cross-sectional study, profiles and real-size photograms of anteroposterior and lateral views of 732 referral candidates for breast augmentation surgery aged 18 years or older to clinics of two plastic surgeons in the city of [Isfahan] over a period of 9 years were enrolled. Relative frequency of TBD and its subtypes from I to III based on Grolleau et al. criteria, patients fulfilling at least one of the described features of the TBD, and breast asymmetry were estimated among the study population.Findings: Among the study population 78% experienced asymmetry and 28.9% were diagnosed with TBD with a distribution of 50.9%, 39.1%, and 9.9% in the groups I to III respectively. 73.9% of patients fulfilled at least one of the TBD features.Conclusion: Relative frequencies of 28.9% and 73.9% for TBD and its criteria respectively, show considerable prevalence among candidates for breast augmentation surgery.

Background: The aims of soft-tissue reconstruction of lower leg defects are covering and repairing wounds, maintaining limb function, preventing amputation, and improving quality of life. Methods: In this cross-sectional study, 27 patients underwent soft-tissue reconstruction of lower extremities with free flaps were enrolled. The cause and the site of defects, free flap types, anastomosis types, survival rate, and complications were assessed. Findings: 27 patients with mean age of 31 years with large lower extremity defects with at least 2 months follow up were assessed. The sites of defects were middle and distal one-third of the legs (21 cases), foot and heel (4 cases), and knees (2 cases), and causes of defects were trauma (21 cases), and chronic wounds (2 cases). Used musculocutaneous free flaps were for latissimus dorsi (15 cases), rctus abdominis (8 cases), and gracilis (4 cases). 43 and 11 cases had end-to-end and end-to-site anastomosis, respectively. Survival rate was 88.9 percent and 3 flaps were failed due to thrombosis. Conclusion: Using free flaps with appropriate vascular pedicles is a reliable and effective method for reconstruction of lower leg large defects.