BACKGROUND Eyelid reconstruction is an intricate process,addressing both aesthetic and functional aspects post-trauma or oncological surgery.Aesthetic concerns and oncological radicality guide personalized approaches....BACKGROUND Eyelid reconstruction is an intricate process,addressing both aesthetic and functional aspects post-trauma or oncological surgery.Aesthetic concerns and oncological radicality guide personalized approaches.The complex anatomy,involving anterior and posterior lamellae,requires tailored reconstruction for optimal functionality.AIM To formulate an eyelid reconstruction algorithm through an extensive literature review and to validate it by juxtaposing surgical outcomes from Cattinara Hos-in dry eye and tears,which may lead to long-term consequences such as chronic conjunctivitis,discomfort,or photo-phobia.To prevent this issue,scars should be oriented vertically or perpendicularly to the free eyelid margin when the size of the tumor allows.In employing a malar flap to repair a lower eyelid defect,the malar incision must ascend diagonally;this facilitates enhanced flap advancement and mitigates ectropion by restricting vertical traction.Conse-quently,it is imperative to maintain that the generated tension remains consistently horizontal and never vertical[9].Lagophthalmos is a disorder characterized by the inability to completely close the eyelids,leading to corneal exposure and an increased risk of keratitis or ulceration;it may arise following upper eyelid surgery.To avert this issue,it is essential to preserve a minimum of 1 cm of skin between the superior edge of the excision and the inferior boundary of the eyebrow.Epiphora may occur in cancers involving the lacrimal puncta,requiring their removal.As previously stated,when employing a glabellar flap to rectify medial canthal abnormalities,it is essential to prevent a trapdoor effect or thickening of the flap relative to the eyelid skin to which it is affixed.Constraints about our proposed algorithm enco-mpass limited sample sizes and possible publication biases in existing studies.Subsequent investigations ought to examine long-term results to further refine the algorithm.Future research should evaluate the algorithm across varied populations and examine the impact of novel graft materials on enhancing reconstructive outcomes.CONCLUSION Eyelid reconstruction remains one of the most intriguing challenges for a plastic surgeon today.The most fascinating aspect of this discipline is the need to restore the functionality of such an essential structure while maintaining its aesthetics.In our opinion,creating decision-making algorithms can facilitate reaching this goal by allowing for the individualization of the reconstructive path while minimizing the incidence of complications.The fact that we have decreased the incidence of severe complications is a sign that the work is moving in the right direction.The fact that there has been no need for reintervention,neither for reconstructive issues nor for inadequate oncological radicality,overall signifies greater patient satisfaction as they do not have to undergo the stress of new surgeries.Even the minor complic-ations recorded are in line with those reported in the literature,and,even more importantly for patients,they are of limited duration.In our experience,after a year of application,we can say that the objective has been achieved,but much more can still be done.Behind every work,a scientific basis must be continually renewed and refreshed to maintain high-quality standards.Therefore,searching for possible alternative solutions to be included in one’s surgical armamentarium is fundamental to providing the patient with a fully personalized option.展开更多
Reconstructive surgery of the eyelid after tumor excision,trauma or other causes can be challenging,especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic s...Reconstructive surgery of the eyelid after tumor excision,trauma or other causes can be challenging,especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes.The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction.Surgical procedures are various,based on the use of both flaps,pedicled or free,and grafts,in order to guarantee adequate tissue reconstruction and blood supply,which are necessary for correct healing.Common techniques normally include the use of local tissues,combining non-vascularized grafts with a vascularized flap for the two lamellae repair,to attempt a reconstruction similar to the original anatomy.When defects are too wide,vast,deep,and complex or when no adjacent healthy tissues are available,distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction.With regards to the anterior lamella,full thickness skin grafts are commonly preferred.With regards to the reconstruction of posterior lamella,there are different graft options,which include conjunctival or tarsoconjunctival,mucosal or palatal or cartilaginous grafts usually combined with local flaps.Free flap transplantation,normally reserved for rare select cases,include the use of the radial forearm and anterolateral flaps combined with mucosal grafts,which are surgical options currently reported in the literature.展开更多
The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years.Blepharoplasty is one of the most frequently performed procedures world...The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years.Blepharoplasty is one of the most frequently performed procedures worldwide to date.Surgery is currently the first choice in order to achieve permanent and effective results;however,it is burdened by potential surgical complications feared by patients.There is an increasing trend in individuals to request less invasive,non-surgical,effective,and safe procedures for eyelid treatment.The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years.Numerous modern techniques that provide a rejuvenation of the entire area have been described.Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings.Dermal fillers are a commonly chosen option for providing enhanced aesthetic results,especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging.Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits.The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis.Furthermore,techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.展开更多
Background:Burn first aid awareness has been shown to reduce morbidity and mortality.We present a report on the knowledge and practices of the Saudi population with regard to burn first aid and the application of trad...Background:Burn first aid awareness has been shown to reduce morbidity and mortality.We present a report on the knowledge and practices of the Saudi population with regard to burn first aid and the application of traditional remedies.Methods:An internet-based survey was conducted to assess the public’s knowledge on first aid practices and home remedies applied for burn injuries among Saudi adults.Results:A total of 2758 individuals responded to the survey.There were 1178(42.7%)respondents who had previously received burn first aid information.One thousand five hundred fifty respondents had a history of burn exposure in which burn injury first aid was applied as follows:1118(72.1%)removed clothing and accessories from the injured area;water was applied by 990(63.9%);among those who applied water,877(88.6%)applied cold water;and only 57(5.8%)did so for more than 15 min.Wrapping the burn area was performed by 526(33.9%),and 985(63.5%)sought medical assistance.When it comes to traditional remedies,2134(77.4%)knew of and/or implemented these remedies as first aid or to treat burns.Honey and toothpaste were the commonest among these remedies with 1491(69.9%)and 1147(53.7%),respectively.This was associated with female gender(r=0.87,P<0.001),younger age group(19–25 years)(r=0.077,P<0.001),from central region(r=0.012,P<0.001),and university graduate(r=0.05,P=0.002).Nearly half of those who knew of traditional remedies did not have previous knowledge of burn first aid.Conclusions:Proper burn first aid is a simple,cheap,and accessible means of managing burns initially.Although the majority of the respondents were university graduates(51.1%),knowledge and implementation of burn first aid was very poor.Major healthcare agencies should review and promote a consistent guideline for burn first aid in an effort to tackle and minimize the effect of this grave injury.展开更多
Background: Adipose-derived stem cells (ASCs) are considered ideal candidates for both research and cellular therapydue to ease of access, large yield, feasibility, and efficacy in preclinical and clinical studies. Un...Background: Adipose-derived stem cells (ASCs) are considered ideal candidates for both research and cellular therapydue to ease of access, large yield, feasibility, and efficacy in preclinical and clinical studies. Unlike the subcutaneousabdominal fat depot, breast ASCs features are still not well recognized, limiting their possible therapeutic use. ASCswere found to exert immunomodulatory and antioxidative activities for maintaining homeostasis and functionality ofdiseased/damaged tissues. This study aims to investigate the immunomodulatory and antioxidative potentials of breastversus abdominal isolated ASCs to find out which anatomical site provides ASCs with better immunoregulatory andoxidative stress resistance capabilities.Methods: ASCs were isolated from abdominal and breast tissues. Gene expression analysis was conducted for a panelof immunomodulatory and antioxidative genes, as well as adipokines and proliferation genes. Flow cytometric analysisof a group of immunomodulatory surface proteins was also performed. Finally, the significantly expressed genes haveundergone protein-protein interaction and functional enrichment in silico analyses.Results: Our results revealed similar morphological and phenotypic characteristics for both breast and abdominalASCs. However, a significant elevation in the expression of two potent immunosuppressive genes, IL-10 and IDO aswell as the expression of the multifaceted immunomodulatory adipokine, visfatin, was detected in breast versusabdominal ASCs. Moreover, a significant overexpression of the antioxidative genes, GPX1, SIRT5, and STAT3 and theproliferation marker, Ki67, was also observed in breast ASCs relative to abdominal ones. In silico analysis showed thatboth of the differentially upregulated immunomodulatory and antioxidative mediators integratively involved inmultiple biological processes and pathways indicating their functional association.Conclusion: Breast ASCs possess superior immunomodulatory and antioxidative capabilities over abdominal ASCs. Ourfindings shed light on the possible therapeutic applications of breast ASCs in immune-related and oxidative stressassociateddiseases.展开更多
Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be ...Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.展开更多
Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of post...Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of postoperative lymphatic vessel obstruction and lymph node sclerosis.We report a case of lymph flow bypass reconstruction using a superficial circumflex Iliac artery perforator(SCIP)flap,including VLNT with efferent lymphatico-lymphatic anastomosis.A 63-year-old female with severe right upper extremity lymphedema after mastectomy was reconstructed using a SCIP free flap,which included a vascularized lymph node elevated from the left groin area and transferred to the right axilla area.The SCIP vessels were anastomosed to the medial intercostal artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to the internal mammary lymphatic vessels using supermicrosurgical technique.Indocyanine green lymphography showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through the transferred flap.Postoperatively,lymphedema improved and there was no lymphedema at the donor site with a 2-year follow-up.Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic anastomosis may provide a useful option for the treatment of severe lymphedema.展开更多
文摘BACKGROUND Eyelid reconstruction is an intricate process,addressing both aesthetic and functional aspects post-trauma or oncological surgery.Aesthetic concerns and oncological radicality guide personalized approaches.The complex anatomy,involving anterior and posterior lamellae,requires tailored reconstruction for optimal functionality.AIM To formulate an eyelid reconstruction algorithm through an extensive literature review and to validate it by juxtaposing surgical outcomes from Cattinara Hos-in dry eye and tears,which may lead to long-term consequences such as chronic conjunctivitis,discomfort,or photo-phobia.To prevent this issue,scars should be oriented vertically or perpendicularly to the free eyelid margin when the size of the tumor allows.In employing a malar flap to repair a lower eyelid defect,the malar incision must ascend diagonally;this facilitates enhanced flap advancement and mitigates ectropion by restricting vertical traction.Conse-quently,it is imperative to maintain that the generated tension remains consistently horizontal and never vertical[9].Lagophthalmos is a disorder characterized by the inability to completely close the eyelids,leading to corneal exposure and an increased risk of keratitis or ulceration;it may arise following upper eyelid surgery.To avert this issue,it is essential to preserve a minimum of 1 cm of skin between the superior edge of the excision and the inferior boundary of the eyebrow.Epiphora may occur in cancers involving the lacrimal puncta,requiring their removal.As previously stated,when employing a glabellar flap to rectify medial canthal abnormalities,it is essential to prevent a trapdoor effect or thickening of the flap relative to the eyelid skin to which it is affixed.Constraints about our proposed algorithm enco-mpass limited sample sizes and possible publication biases in existing studies.Subsequent investigations ought to examine long-term results to further refine the algorithm.Future research should evaluate the algorithm across varied populations and examine the impact of novel graft materials on enhancing reconstructive outcomes.CONCLUSION Eyelid reconstruction remains one of the most intriguing challenges for a plastic surgeon today.The most fascinating aspect of this discipline is the need to restore the functionality of such an essential structure while maintaining its aesthetics.In our opinion,creating decision-making algorithms can facilitate reaching this goal by allowing for the individualization of the reconstructive path while minimizing the incidence of complications.The fact that we have decreased the incidence of severe complications is a sign that the work is moving in the right direction.The fact that there has been no need for reintervention,neither for reconstructive issues nor for inadequate oncological radicality,overall signifies greater patient satisfaction as they do not have to undergo the stress of new surgeries.Even the minor complic-ations recorded are in line with those reported in the literature,and,even more importantly for patients,they are of limited duration.In our experience,after a year of application,we can say that the objective has been achieved,but much more can still be done.Behind every work,a scientific basis must be continually renewed and refreshed to maintain high-quality standards.Therefore,searching for possible alternative solutions to be included in one’s surgical armamentarium is fundamental to providing the patient with a fully personalized option.
文摘Reconstructive surgery of the eyelid after tumor excision,trauma or other causes can be challenging,especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes.The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction.Surgical procedures are various,based on the use of both flaps,pedicled or free,and grafts,in order to guarantee adequate tissue reconstruction and blood supply,which are necessary for correct healing.Common techniques normally include the use of local tissues,combining non-vascularized grafts with a vascularized flap for the two lamellae repair,to attempt a reconstruction similar to the original anatomy.When defects are too wide,vast,deep,and complex or when no adjacent healthy tissues are available,distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction.With regards to the anterior lamella,full thickness skin grafts are commonly preferred.With regards to the reconstruction of posterior lamella,there are different graft options,which include conjunctival or tarsoconjunctival,mucosal or palatal or cartilaginous grafts usually combined with local flaps.Free flap transplantation,normally reserved for rare select cases,include the use of the radial forearm and anterolateral flaps combined with mucosal grafts,which are surgical options currently reported in the literature.
文摘The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years.Blepharoplasty is one of the most frequently performed procedures worldwide to date.Surgery is currently the first choice in order to achieve permanent and effective results;however,it is burdened by potential surgical complications feared by patients.There is an increasing trend in individuals to request less invasive,non-surgical,effective,and safe procedures for eyelid treatment.The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years.Numerous modern techniques that provide a rejuvenation of the entire area have been described.Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings.Dermal fillers are a commonly chosen option for providing enhanced aesthetic results,especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging.Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits.The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis.Furthermore,techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.
文摘Background:Burn first aid awareness has been shown to reduce morbidity and mortality.We present a report on the knowledge and practices of the Saudi population with regard to burn first aid and the application of traditional remedies.Methods:An internet-based survey was conducted to assess the public’s knowledge on first aid practices and home remedies applied for burn injuries among Saudi adults.Results:A total of 2758 individuals responded to the survey.There were 1178(42.7%)respondents who had previously received burn first aid information.One thousand five hundred fifty respondents had a history of burn exposure in which burn injury first aid was applied as follows:1118(72.1%)removed clothing and accessories from the injured area;water was applied by 990(63.9%);among those who applied water,877(88.6%)applied cold water;and only 57(5.8%)did so for more than 15 min.Wrapping the burn area was performed by 526(33.9%),and 985(63.5%)sought medical assistance.When it comes to traditional remedies,2134(77.4%)knew of and/or implemented these remedies as first aid or to treat burns.Honey and toothpaste were the commonest among these remedies with 1491(69.9%)and 1147(53.7%),respectively.This was associated with female gender(r=0.87,P<0.001),younger age group(19–25 years)(r=0.077,P<0.001),from central region(r=0.012,P<0.001),and university graduate(r=0.05,P=0.002).Nearly half of those who knew of traditional remedies did not have previous knowledge of burn first aid.Conclusions:Proper burn first aid is a simple,cheap,and accessible means of managing burns initially.Although the majority of the respondents were university graduates(51.1%),knowledge and implementation of burn first aid was very poor.Major healthcare agencies should review and promote a consistent guideline for burn first aid in an effort to tackle and minimize the effect of this grave injury.
基金This work was funded by the National Research Centre,Cairo,Egypt(grant no.11010122)the Academy of Scientific Research and Technology in Egypt“Jesor initiative”(grant no.1057).
文摘Background: Adipose-derived stem cells (ASCs) are considered ideal candidates for both research and cellular therapydue to ease of access, large yield, feasibility, and efficacy in preclinical and clinical studies. Unlike the subcutaneousabdominal fat depot, breast ASCs features are still not well recognized, limiting their possible therapeutic use. ASCswere found to exert immunomodulatory and antioxidative activities for maintaining homeostasis and functionality ofdiseased/damaged tissues. This study aims to investigate the immunomodulatory and antioxidative potentials of breastversus abdominal isolated ASCs to find out which anatomical site provides ASCs with better immunoregulatory andoxidative stress resistance capabilities.Methods: ASCs were isolated from abdominal and breast tissues. Gene expression analysis was conducted for a panelof immunomodulatory and antioxidative genes, as well as adipokines and proliferation genes. Flow cytometric analysisof a group of immunomodulatory surface proteins was also performed. Finally, the significantly expressed genes haveundergone protein-protein interaction and functional enrichment in silico analyses.Results: Our results revealed similar morphological and phenotypic characteristics for both breast and abdominalASCs. However, a significant elevation in the expression of two potent immunosuppressive genes, IL-10 and IDO aswell as the expression of the multifaceted immunomodulatory adipokine, visfatin, was detected in breast versusabdominal ASCs. Moreover, a significant overexpression of the antioxidative genes, GPX1, SIRT5, and STAT3 and theproliferation marker, Ki67, was also observed in breast ASCs relative to abdominal ones. In silico analysis showed thatboth of the differentially upregulated immunomodulatory and antioxidative mediators integratively involved inmultiple biological processes and pathways indicating their functional association.Conclusion: Breast ASCs possess superior immunomodulatory and antioxidative capabilities over abdominal ASCs. Ourfindings shed light on the possible therapeutic applications of breast ASCs in immune-related and oxidative stressassociateddiseases.
文摘Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.
文摘Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of postoperative lymphatic vessel obstruction and lymph node sclerosis.We report a case of lymph flow bypass reconstruction using a superficial circumflex Iliac artery perforator(SCIP)flap,including VLNT with efferent lymphatico-lymphatic anastomosis.A 63-year-old female with severe right upper extremity lymphedema after mastectomy was reconstructed using a SCIP free flap,which included a vascularized lymph node elevated from the left groin area and transferred to the right axilla area.The SCIP vessels were anastomosed to the medial intercostal artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to the internal mammary lymphatic vessels using supermicrosurgical technique.Indocyanine green lymphography showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through the transferred flap.Postoperatively,lymphedema improved and there was no lymphedema at the donor site with a 2-year follow-up.Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic anastomosis may provide a useful option for the treatment of severe lymphedema.
