Background 

Pediatric patients with facial fractures are a unique challenge in terms of their treatment planning, which is different from that of adult patients. Early literature has advocated conservative closed management of pediatric facial fractures to prevent complications. However, recent advances in treatment have enabled us to use biodegradable plates and screws, which overcome the limitations of metallic plates.

Aim 

This study was conducted to evaluate the effectiveness of Inion CPS biodegradable plates and screws on pediatric facial fractures.

Patients and methods 

The study was conducted on 30 pediatric patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection and comminuted fractures were excluded. Patients were aged 3–12 years, 18 boys and 12 girls, with different types of trauma: 12 patients had suffered falls, 12 patients had middle cerebral artery (MCA), four patients had sports-related fracture; and two patients had assault-related fractures. The site of fracture was different: 18 patients had mandibular fractures, four patients had zygomatic complex fractures, four patients had orbital fractures, two patients had maxillary fractures (one isolated and the other with mandibular fracture), and one patient had frontal bone and sinus fractures (anterior wall). Fractures were plated with a biodegradable system (Inion CPS) using standard plating principles. Postoperative complications were assessed.

Results 

Satisfactory reduction was obtained in all patients, as judged from the position of the fracture segments in 24-h postoperative radiographs compared with all subsequently obtained images. The undisturbed reduction was considered as a marker of the stable fixation provided by the bioresorbable system. The screw holes visible as radiolucencies on the radiograph were also seen to maintain their position throughout the period of follow-up.

Conclusion 

In our study, we concluded that the use of Inion bioresorbable plates is effective in the treatment of facial fracture in pediatric patients. There was no complication and no growth disturbance in the follow-up period, which proves that bioresorbable plates provide stable fixation in children. Our data support the use of bioresorbable plate fixation in pediatric craniofacial surgery as a means of avoiding the potential and well-documented problems associated with rigid metal fixation.

Median cleft deformities of the lower lip and mandible are very rare congenital anomalies. Our patient had median cleft of the lower lip, mandible, and the chin with tongue duplication, ankyloglossia, and cleft strap muscles with 2 neck contracture bands. This anomaly was associated with congenital heart disease transposition of great vessels, large ventricular septal defect, and severe pulmonary stenosis. Early repair was done at 6 months to improve feeding.

Abstract:
Introduction: Reconstruction of soft tissue defects of the lower third leg and foot
presents a great challenge for the reconstructive surgeons. The distally based sural flap
provides a good option for coverage. However, some complications usually occur
specially venous congestion and edema, different modifications had made to reduce
complications and to increase the reliability and outcomes of the flap. Our goal is to
describe the most frequent errors and methods to overcome the incidence of these
complications. Some of these methods are supercharging the flap, delaying the
flap,exteriorize the lesser saphenous vein, leg elevation, orientation of the flap,
increasing the width of the pedicle, incorporating a gastrocnemius muscle cuff around
sural pedicle, lowering the pivot point or any other methods to overcome the incidence
of complication. Patients and methods: A total of 30 patients, there were 24 were
males(80%) and 6 were females(20%) , the average patient age was 37 yrs ( ranges from
5 to 69yrs ), in 14 patients defects were post traumatic skin defects (46%), in 6 patients
defects were due to unsteady scars(20%), in 5 patients skin defects were due to diabetic
ulcers(16.5%) , in 4 patients defects were trophic ulcers (13.5%) , and one patient had
post amputation raw area with exposed bone(4%).The reconstructed sites were the
weight-bearing heel in20 patients, the dorsum of the ankle in 4 patients, the dorsum of
the foot in 3 patients, and the mid foot in 1 patient, lower third of the leg in 2 patients.
Results: All patients were followed up for a period from 6 to 12 months (mean= 9
months), minor complications had occurred such as three cases (3cases) with superficial
epidermolysis (10%) (three cases need debridment one of them healed by secondary
intention and two need skin graft) , two cases (2cases) complicated with loss of the graft
on pedicle which need another skin graft(7%), one case (1case) with partial flap necrosis
at the distal part which need debridment and healed by secondary intention(3.5%), and
two cases (2cases) with partial dehiscence of the flap which treated by debridment and
restitch (7%) .The flaps usually healed eventually by 3rdto 4th week but full weight
bearing on them postponed up to 6th or 8th week and the patients were satisfied with the
functional and aesthetic outcomes. Conclusion: The distally based the sural flap is a
versatile flap for the reconstruction of soft tissue defects of the lower leg and heel.
Despite its complications, some modifications are available to overcome these
complications and increase its reliability.
Key words:
Sural flap, foot and
ankle
reconstruction
2
However, fasciocutaneous flaps; first
reported by
Ponten in 1981; are excellent option in
the repair of these soft-tissue defects,
(1).
The distally based
suralfasciocutaneous flap was;
introduced by Donski and Fogdestam
in 1983; one of the earliest
fasciocutaneous flaps used.(2).The
sural flap acts as an axial flap and has
3 sources of nutrition: the vascular
plexus of the deep fascia; the median
superficial sural artery, which follows
the medial sural nerve; and the arteries
that follow the lesser saphenous vein.
Venous return is ensured by the lesser
saphenous vein, which may be used as
a distal pedicle to provide reverse flow.
This vein must be preserved at least as
high as the caliber perforator of the
fibular artery, which is located 5 cm
above the lateral malleolus and spreads
with the medial superficial sural
artery,(3).Masquelet, et al then
reintroduced the sural flap in 1992
with a complete concise description of
the relevant anatomy and the surgical
procedure. After the work of
Masquelet, et al the distally based
suralfasciocutaneous flap has become a
mainstay in the reconstruction of the
lower leg, heel and foot, (4).
An advantage of the sural flap over
other flaps

Abstract
Background: Soft tissue defect reconstruction in foot and
ankle represents a significant challenge for the reconstructive
surgeons. The distally based sural flap provides a good option
for coverage. Its main disadvantage is the reverse venous
flow with frequent venous congestion. Many efforts made to
overcome this problem such as super draining the vein through
supercharging it to any superficial vein or intermittent drainage
by venous cannulation.
Patients and Methods: A comparative study was performed
on diabetic patients with defects on the foot and ankle at
Plastic Surgery Department, Qena University Hospital, from
May 2017 to April 2019. Twenty patients were divided into
two groups; Group (A): Defects had reconstructed with super
drainage reversed sural flap technique (10 cases) and Group
(B): Defects had reconstructed with standard reversed sural
flap technique (10 cases). They were 14 (70%) males and 6
(30%) females. Ages of them ranged from 25-65 years old
(mean 45 years). Different sites of defect sites had encountered
in the study: Heel in 15 cases (75%), ankle in 3 cases (15%)
and distal leg in 2 cases (10%).
Statistical analysis: Data was analyzed using the Statistical
Package for Social Sciences (SPSS) version 20. A p-value
<0.005 was considered significant.
Results:
• In Group (A) patients: At the second day post-operative,
two cases (20%) had slight venous congestion which not
relieved by local injection of subcutaneous heparin. A partial
flap necrosis occurred only in one of them and the other
had complete flap necrosis and flap loss (another flap
reconstruction was done). This case also showed wound
dehiscence, and graft loss at the pedicle and the donor site
areas. All other flaps showed complete healing without
complications.
• In Group (B) patient: Venous congestion occurred in seven
cases (70%) which ended in partial flap necrosis in four
cases (40%) and complete flap necrosis in three cases (30%).
Also, wound dehiscence was reported in the three cases
with complete flap loss that underwent secondary surgery
for re-stitching. Skin regrafting was performed in 2 (20%)
cases at the pedicle and the donor site area.
137
The flaps usually healed eventually by 3rd week, but full
weight bearing on them postponed up to 6th week and all
patients were satisfied with the good functional and aesthetic
outcomes.
Conclusion: The distally based the sural flap is a versatile
flap for the reconstruction of soft tissue defects of the lower
leg and heel. Despite its big problem concerning the reverse
venous flow, superdrainage of the lesser saphenous vein either
by supercharging or catheterization, provides an effective
solution to keep away from venous congestion.

Background: Frontal sinus fractures are relatively common
with high-velocity injury trauma. Isolated anterior wall fractures
represent one third of all cases. The main goals of
fixation are to restore the premorbid aesthetic condition and
to preserve a safe and functional sinus. The ideal plating
system used for fixation of the anterior frontal wall fractures
is the micro plating system owing to its many advantages.
However, it is also feasible to utilize the low-profile miniplating
system as it has the same advantages.
Patients and Methods: A prospective study conducted on
patients admitted to trauma unit in two departments (Maxillofacial
department; Assiut University Hospital and Plastic
Surgery Department; Qena University Hospital) from August
2017 to July 2019 (two years’ duration). The study included
all patients with anterior wall fracture of frontal sinus that
needed open reduction and internal fixation (ORIF) with sinus
preservation. Materials used: Low profile miniplate system;
KLS Martin compact system; 1.5mm craniofacial plates with
thickness 0.7mm, miniscrew 1.5mm with 5mm in length and
drill bit 1.1mm diameter. Statistical analysis: Data was analyzed
using the Statistical Package for Social Sciences (SPSS)
version 22. p-value <0.05 was considered significant.
Results: Follow-up period ranged from 6-12 months.
Clinical data revealed that none of the patients complained
from these miniplates concerning its palpability under the
skin, sensitivity to temperature changes. No plate exposure
or extrusion recorded. Only two patients had wound infections
that resolved by antibiotic therapy. Patients complained only
from minor symptoms such as pain, supraorbital paresthesia
and facial edema. CT imaging showed good fracture healing,
good alignment of the anterior wall and no plate failure
(fracture). Patients were satisfied with restoration of the
forehead contour and excellent aesthetic results.
Conclusion: Isolated anterior wall frontal sinus fractures
are common due to high incidence rate of motor car accidents
in our country. Main lines of treatment aimed to restore a safe
functional sinus, prevent forehead contour deformity and
obtain good aesthetic results. These goals can be obtained by
fracture fixation with this low profile miniplate system with
resultant patient satisfaction.

Abstract:
Background: Zygomatic complex and arch fractures remain one of the most common maxillofacial fractures. Epidemiological studies of theses fractures vary by geographic region, socioeconomic, environmental and cultural factors. Its importance is confirmed by their implication in the clinical practice and prevention.
Patients and Methods: Five-year retrospective study; from May 2015 to April 2020; was conducted on 120 patients with zygomatic fractures in our department. Fracture sites were classified into five types (I-V) based on the number of fractured processes and comminution. Data collected in a clinical sheet and analyzed using Statistical Package for Social Sciences version 20. P- value < 0.05 was considered significant. Chi square test was used to compare between 2 or more qualitative variables.
Results: Patients aged from 15-78 years old and divided into 4 age groups (A-D). Group B (21- 40 years) was the commonest affected. Males were predominant than females with ratio M: F = (7:1). Motor car accidents was the commonest etiology of trauma (56.60%). Left sided fracture (52.5%) was involved more than right sided one (45%) and fracture was bilateral in 2.5% of cases. Type-IV fracture (classic tetrapod) was the commonest type reported (42 cases, 35 %). Most common fractured process was zygomatic-maxillary buttress (ZM) in 90 cases (75%). Mandibular fracture (15%) was the most common associated facial fractures. Most common accessed approach was the upper buccal in 80 cases (66.6 %). Access through a pre-existing wound was encountered in 10 cases (8.3 %). Four-point fixation (40%) was the commonest point fixation for these fractures. Infra orbital paresthesia (42 cases) was the most common complications encountered.
Conclusion: Zygomatic fractures have high morbidity and cost of life. Use of protective devices, strict laws and severe punishments must be implemented to reduce its frequency.

Xeroderma pigmentosum is an autosomal recessive genetic disease that accompanied by abnormalities in deletion and repair of DNA due to enzymatic damage by ultraviolet radiation. It is described by photo hypersensitivity of areas exposed to sun radiation, changes in the skin pigmentation, cutaneous premature aging and increased risk of developing cutaneous and ocular malignant tumors early in life. Most common types of malignant cutaneous tumors detected are basal cell and squamous cell carcinoma and less commonly malignant melanoma. It is very frequent in certain areas of the world, most markedly Middle East, like Egypt and North Africa with positive consanguinity. In patients with Xeroderma pigmentosum prior to the age of 20 years, the risk of developing skin cancer is several thousand times greater. In patients with XP for non-melanoma skin cancers, the median age of onset is eight years relative to the non-XP population with a median age of onset of sixty years. This research study presents two siblings; 18-years-old sister and 16-years-old brother; from relative parents that had xeroderma pigmentosum with development of different malignant skin tumors. Treatment protocol was surgical excision of the malignant tumor with adequate safety margin and removal of enlarged lymph nodes. Reconstruction options were directed mainly to flap surgery. Postoperative follow up revealed no recurrence.

Abstract
Background: Basal cell carcinoma (BCC) represents the
most common type of facial skin cancer in Middle East and
Egypt. It rarely metastasizes, but because of its locally destructive
nature, it can cause high morbidity. Reconstruction
by local flap after surgical excision depends on the size of
the defect and the affected facial aesthetic unit.
Aim: To reveal the prevalence of facial BCC, relation of
its site to facial aesthetic units and type of local flaps used
for reconstruction per units.
Patients and Methods: A retrospective study was conducted
on 80 patients with facial BCC that admitted to the outpatient
clinic, Plastic Surgery Department, Qena University Hospital
from June 2018 to May 2020 (2 years duration). Only earlystage
and primary tumors were included. Statistical analysis:
Data was analyzed using the Statistical Package for Social
Sciences (SPSS) version 24. A p-value significant.
Results: 80 patients with facial basal cell carcinoma (BCC)
were collected from medical records. 45 (56.25%) patients
were males and 35 (43.75%) patients were females (M:F =
1.3:1). Ages ranged from 52-78 years old (SD = 65±13).
Nodular subtype was the most common clinical type of BCC
and presented in 45 (56.25%) patients. Nasal unit was the
most common site in 18 (22.5%) patients. The most random
flap applied was the rhomboid (Limberg) flap in 15 cases.
The most axial flap used was the nasolabial flap in 9 cases.
Complications (6 cases, 7.5%) included: Wound dehiscence
in 3 cases, infection in 2 cases and skin slough in 1 case. The
SCAR scale score result ranged from 0-2 score.
Conclusion: Facial defects reconstruction after surgery
for basal cell carcinoma is a complex endeavor that requires
careful consideration. There are many different local flaps
available depending on the particular facial subunit that
requires reconstruction. Careful recognition of the principles
of the facial subunits will equip the surgeon to achieve the
best possible functional and aesthetic outcomes.