Mohamed Makboul

Soft Tissue Defects of the Heel: A Surgical Reconstruction Algorithm Based on a Retrospective Cohort Study

UNLABELLED The hindfoot is a special anatomical location, requiring unique forms of reconstruction of the thick, durable heel pad, the underlying calcaneus, and the Achilles tendon and its thin, pliable soft tissue envelope. Perhaps more than in any other region of the foot, the heel poses a reconstructive challenge to the surgeon who must consider both form and function when repairing wounds in this location. There are many possible reconstructive options, including local, distant, and free flaps. These flaps could be of muscular, myocutaneous or fasciocutaneous tissues. We reconstructed heel defects in 46 consecutive patients using several reconstructive options, and reviewed the results. Patients were classified according to preoperative demographic variables, including size, depth, site, etiology, age, vascularity, sensation, Achilles tendon condition, bone exposure or bone loss, and the patients functional needs. Neither partial nor total flap losses were observed; the reconstructions were evaluated and considered satisfactory both by surgeons and patients if they fulfilled certain criteria, namely complete coverage, durability upon weight bearing and walking, sensation, donor site morbidity, and cosmetic appearance. No recurrences of the defects were observed during the follow-up period. Heel reconstruction is a challenging task for foot and ankle reconstructive surgeons. Every step should be taken to avoid recurrences and ulcerations. In this article we present a surgical reconstruction algorithm that may allow easy and reliable decision making based on the preoperative assessment of the defect and other clinical features. LEVEL OF CLINICAL EVIDENCE 2.

Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar

Hypertrophic scar is a form of abnormal wound healing process in which tissue repair regulating mechanism is disrupted. Transforming growth factor β1 has a particular importance in the fibrotic scarring response. Treatment of hypertrophic scar included many chemical, physical, and surgical options. Fractional CO2 laser devices have gained acceptance as a way for managing hypertrophic scar. Aims of this study are: (a) to determine the clinical and histopathological effects of fractional CO2 laser on hypertrophic scar, (b) to evaluate the expression pattern of transforming growth factor‐β1 (TGF‐β1) as an important fibrogenic factor before and 6 months after fractional CO2 laser treatment.

Is myocutaneous flap alone sufficient for reconstruction of chest wall osteoradionecrosis

OBJECTIVES This study was carried out to determine whether the myocutaneous flap, alone, is sufficient to reconstruct a chest wall defect after osteoradionecrosis and provide satisfactory stability to the chest wall. METHODS This study involved five patients who were subjected to post-mastectomy radiotherapy as a treatment for breast cancer. Excision of the ulcer and all the necrotic ribs, with preservation of the parietal pleura and reconstruction with the latissimus dorsi flap, was done without the use of either an artificial prosthesis or autologous rib to reconstruct the chest wall defect. RESULTS Clinical and radiological follow-up showed no complications regarding respiratory impairment or pleural complications. CONCLUSIONS The use of myocutaneous flap in patients with chest wall defect following osteoradionecrosis is satisfactory to cover the chest wall defect and provide satisfactory stability to the chest wall.

Long Term Follow up and Patient Satisfaction after Reduction Mammoplasty: Superomedial versus Inferior Pedicle

BACKGROUND Surgery for hypertrophied breast represents a challenge for plastic surgeons. The search for a good cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, with round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. METHODS This study was carried out on 60 cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and asked for late post-operative results and overall patients’ satisfaction. RESULTS Long term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistical significant difference. No statistical significant difference was observed between patients undergone either types of operations concerning breast symmetry, nipple symmetry and sensation. The mean score of satisfaction was higher among patients undergone superomedial pedicle than inferior pedicle. CONCLUSION The superomedial pedicle shows better long term cosmetic result in reduction mammoplasty.

Classification of post-burn contracture neck

Post-burn neck contracture (PBC) is one of the most common burn sequela. These contractures affect the patient significantly causing both functional limitations and esthetic disfigurements. Hence, the reconstruction of this area is a challenge to surgeons who must choose a technique, which restores the function and also improves the esthetic appearance. Aims: The aims of this study are to provide a simple classification of PBC and offer surgical solutions for each section of our classification. Materials and Methods: This retrospective study was carried out on 140 patients with PBC neck who were classified according to the functional defect and the anatomical type of scar. Results: We offer a simple classification system for PBC neck depending on the degree of contracture into mild, moderate and severe and also according to the type of the scar into linear, band or broad type.

The impact of antidepressant drugs on the psychological status of the hospitalized burn patients

Burn injury is often a devastating event with long-term psychosocial effects. Selective Serotonin Reuptake Inhibitors (SSRIs) antidepressants alleviate depressive symptoms by preventing serotonin that has been released into the brain by nerve cells from being taken back into the cells. This study investigated the impact of antidepressant drugs on the psychological status of hospitalized burn patients. This study was conducted on two equal groups of 60 adult patients in the burn unit at Assiut University Hospital, Egypt. The control group received the hospital routine medical and nursing managements, while the second group received the antidepressant drug after the third day post burn and continued to 6 weeks in addition to the routine medical and nursing managements. Studying the relations among scores of patient cooperation, nurse satisfaction, and levels of depression in the study and control groups showed that, at admission all the patients in both groups suffered from severe depression. From the second to the sixth week, the depression level in the study group changed to normal, the patients were cooperative and the nurses were satisfied.