Distally Based Sural Fasciocutaneous Flap and Cross-leg Method for Soft Tissue Reconstruction of the Distal Leg, Ankle, and Hind Foot Defects

This paper presents the authors’ experience of using cross-leg and direct sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. All surgeries were performed during 2010-2014. This nonrandomized descriptive prospective and retrospective study recruited 25 patients which consisted of 19 patients with direct sural fasciocutaneous flaps (age: 20-49 years) and six with cross-leg, indirect sural fasciocutaneous flaps (age: 6-48 years). The follow-up period ranged between six months - three years. The defects were located on calcaneus, malleolar area, tarsal area, and lower tibia. Out of 25 flaps, 22 showed complete survival (88%). Partial flap loss was found in five patients (20%) and complete loss in three patients (12%), including one (16.7%) using the cross-leg method and two (10.5%) using the ipsilateral flap. Out of 19 patients who underwent ipsilateral RSAFs, five patients had flap tip necrosis (< 10% flap area). Two of these patients were subjected to flap readvancement and reinsertion and three patients were managed with regular dressings. In one case, a superficial necrosis occurred and skin graft was required. The sural fasciocutaneous flap, even its cross-leg form, is useful for the treatment of severe and complex injuries and their complications in lower limbs. This type of flap offers excellent donor sites for repairing soft tissue defects in foot and ankle and distal leg

An Overview on Income Experiences and Procedures of Municipalities with an Emphasis on Their Sustainability

Nowadays, lack of financial resources is the most important constraint to overcome increasing municipal issues and service insufficiencies, especially in cities of developing countries such as Iran. This leads to failing of urban predicted prospects and citizens’ dissatisfaction. Unsustainable income sources and inappropriate procedures highlight the necessity of developing the strategies and solutions to achieve proper, adequate and sustainable financial resources for municipalities. Therefore, income resources of municipalities must be reliable, continuous and proportionally adequate for increasing needs and providing urban services. In addition, income procedures should not  present threats to sustainable urban development. For this, it is necessary to implement the principles of sustainable income, income sources, solutions to increase revenue and sustainable municipal income in the country. The present paper has used a descriptive-documentary survey method. Based on the research findings, three main sustainable income principles include utility, sustainability and flexibility. Sustainable income areas of the municipalities were characterized in Iran and countries studied. Based on principles of sustainable revenues, finally, several solutions were presented to increase revenue

Assessment of outcomes and complications of posterior pharyngeal wall augmentation with dermal fat graft in patients with Velopharyngeal Insufficiency (VPI) after primary cleft palate repair: A pilot study

Introduction: Materials used for posterior pharyngeal wall augmentation have been associated with important complications (exogenous materials) or variable and unpredictable durability (exogenous and endogenous materials); therefore, introducing a different material for augmenting the posterior pharyngeal wall seems necessary for reviving this relatively forgotten technique.The purpose of this study was to emphasize on the use of a material associated with minimal complications and maximum recovery and durability in correcting VPI and the use of evaluative adjuncts such as nasoendoscopy and videofluoroscopy to assess surgical outcomes. Methods: In a pilot study, 24 patients underwent posterior pharyngeal wall augmentation with dermal fat graft harvested from the low crease abdominal region. Early and late complications, autologous graft durability in posterior pharynx, and speech improvement were assessed. Results: There was a significant improvement in hypernasality, nasal emission, and nasal grimace after posterior pharyngeal wall augmentation with dermal fat graft (p<0.0001). The authors observed no significant life-threatening complication. The most evident short-term complication was snoring, which occurred in five patients, and all relieved uneventfully. Conclusion: The authors believe that augmenting the posterior pharyngeal wall with dermal fat graft is effective in improving hypernasality in patients with moderate velopharyngeal gap size and relatively adequate velar motion. This method has minimal complication profile because of autologous tissue application. Keywords: Velopharyngeal dysfunction, Velopharyngeal insufficiency, Dermal fat graft, Cleft palate, Resonance, Hypernasalit

Speech outcomes after palatal closure in 3–7-year-old children

Introduction: One of the main goals of the team approach in management of oro-facial clefts is to help the children with cleft palate have adequate speech development. Objective: The present study aimed to investigate the prevalence of articulation and resonance disorders following palate closure in children who were visited for routine examination by the Isfahan Cleft Care Team between 2011 and 2015, and to study the impact of cleft type and age at the time of palatoplasty on speech outcomes. Methods: Clinical records of 180 preschool children with repaired cleft palate were reviewed. The percentage of children demonstrating hypernasality, nasal emission, nasal turbulence, and compensatory misarticulations was calculated. The relationship between cleft type and age at the time of palatal surgery, as independent variables, and speech outcomes were examined. Results: 67.7 and 64.5 percent of the children demonstrated respectively moderate/severe hypernasality and nasal emission, and 71.1 percent produced compensatory misarticulations. Age at the time of palatal repair was significantly associated with compensatory misarticulations and also with moderate/severe hypernasality. The prevalence of compensatory misarticulations, significant hypernasality, nasal emission and also nasal turbulence was not significantly different in various types of cleft. Conclusions: We observed a high prevalence of different speech disorders in preschool children with repaired cleft palate compared to other studies. This can be partly due to late palatal repair in the studied population. Despite many advances in cleft palate management programs in Iran, there are still many children who do not access the interdisciplinary team cares in their early childhood. We should, therefore, try to increase accessibility of appropriate and timely management services to all Iranian children with cleft lip/palate

Classic high lateral tension and triangular resection methods to prevent dog ear and elongation scar in patients undergoing abdominoplasty: A comparative open-label clinical trial

Background: One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. In the present study, efficacy of a new method compared with classical high lateral tension on preventing dog ear and elongation scar was evaluated. Materials and Methods: in an open-label, randomized clinical trial, seventy patients who were candidates for abdominoplasty were selected and randomly divided into two groups. The first group was operated by classic high lateral method and the second group was operated by a new method concentrating on changing incision line and angle. Dog ear prevention, length of scar, improvement, and postoperative complications were compared between the two groups. Results: The mean ± standard deviation (SD) length of scar in treated patients with classical and new abdominoplasty surgical methods was 53.68 ± 6.34 and 41.71 ± 1.78 cm, respectively, and the length of scar in the group treated with the new method was significantly shorter (P < 0.001). The mean ± SD distance between two anterior superior iliac spine in group treated by new method was significantly decreased after surgery (31.3 ± 1.3 cm) compared to before intervention (36.7 ± 3.9 cm) (P < 0.01). Conclusion: The new method is more likely to be successful in patients with high lateral tension abdominoplasty. However, according to the lack of similar studies in this regard and the fact that this method was introduced for the first time, it is recommended that further studies in this area are needed and patients in term of complications after surgery need a longer period of follow-up

Stuttering: Genetic updates and a case report

Developmental stuttering is a common disorder of speech dissiliency that is characterized by excessive repetitions of sounds, syllables, and monosyllabic words, as well as sound prolongations and complete blockages of the vocal tract. About 60 million people are affected and it is more common between the age of 3 and 6, when children begin forming sentences and connecting thoughts verbally. There are three types of stuttering known as developmental stuttering, neurogenic stuttering, and psychogenic stuttering. The exact pathophysiology of developmental stuttering is unknown; however, various family and twin studies have repeatedly implicated heredity as a major factor in the etiology of stuttering. It is clear that the genetic influence is not in the form of an exact single gene effect such as autosomal recessive, autosomal dominant, or x-linked in all families; however, in all of the inheritance forms it is influenced by sex with higher occurrence in males than females at a ratio of 4:1 in older children and adults. Recently special genetic locus has been determined on several autosomal chromosomes related to developmental stuttering. In this report, the proband is a 20-year-old boy was referred to our clinic for premarriage genetic counseling; he has been affected since 3 years and now is under cure. three generation study of his family show 13 individuals are affected by stuttering. For the first it occurred in the proband′s grandfather and after this time about all of affected cases has been seen in consanguineous marriages. Therefore, the genetical inheritance of stuttering is crystal clear in this family and autosomal recessive inheritance pattern is proposed. Totally in such families with repeated occur of stuttering, we cannot account it as a multifactorial disorder

Liposuction versus periareolar excision approach for gynecomastia treatment

Background: Gynecomastia (GM) is the increased fibroglandular tissue in the male breast by more than 2 cm, which is palpated under the nipple and areola. An ideal surgical approach aims to reduce the breast size, reach an acceptable breast shape, resect excessive glandular tissue, fatty tissue, and skin fatty tissue and excess skin, relocate the nipple-areolar complex, and avoid scars. Based on its importance, we aimed to compare outcomes of liposuction with and without periareolar incision in patients with GM. Materials and Methods: This was a randomized clinical trial on patients referred for plastic surgery. Patients with GM were allocated into two treatment groups. Group A underwent liposuction without any areolar skin incision and group B had liposuction with the areolar skin incision. Patients were followed-up after surgery. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 20. Results: Sixty patients aged between 20 and 27 years old participated in this study. Three hematomas, two surgical site infections, one nipple hypopigmentation after surgery, and one seroma formation were noted in group B. On the other hand, one hematoma and one seroma formation were noted in group A. The patients in group A were highly satisfied after the liposuction without skin incision procedure compared with group B (P = 0.01). Conclusions: The management of GM by liposuction, either with the periareolar excision technique or without skin incision, allows the effective removal of fat and glandular tissue of the male breast. Although there was no significant difference regarding postoperation complications between groups, patients' satisfaction should be considered