Abstract Background: The functional, cosmetic and psychological effects of longstanding facial palsy are considerable. Temporalis muscle has proven to be a reliable and versatile flap for muscle transposition in treatment of long-standing facial paralysis However temporalis muscle is short and failed to reach sufficiently large areas. Our goal is to use temporalis galea and periosteal extension as part of a comprehensive approach to facial reanimation to achieve a dynamic rehabilitation of the eyelids and mouth, to allow closure of eyes and symmetry and satisfactory when smiling. Patients and methods: This study included 16 patients presented by facial palsy in a period from January 2015 to February 2018. Their age ranged from 12 years to 65 years. 15 facial palsy patients were unilateral, and one was bilateral. 6 (37.5%) patients were males and 10(62.5%) were female. Results: good result was achieved in all patients during follow-up. One of the patients required a revision of surgery for unacceptable asymmetry. Bulging of the temporal and malar regions on eye closure was found in three patients, and hollow deformity of the temporal region was obvious in one patient. No muscle atrophy since vascularity and innervation is maintained. The follow-up time of patients ranged from 6 to 24 months, Conclusion: This simple procedure has helped reconstruction of natural symmetrical smile and closure of the eye with highly successful results.

Abstract Introduction: The thumb has a part in roughly 40% of hand capacity; traumatic loss brings about significant disability. A perfect reconstructed thumb would have satisfactory length, a sensate, non-tender tip, have security and be situated to meet alternate digits, with a sufficient first web space. Our objectives are study of different modalities of distal thumb reconstruction and evaluation of each modality regarding its sensation, stability, length, mobility, position, and pain-free function. Patients and methods: This study was conducted between January 2014 and January 2016 on 38 patients. These patients were presented with partial thumb amputation extends from the interphalangeal joint to the thumb tip secondary to trauma. The patients divided into four groups according to the method of reconstruction. assessment included measuring the static and moving 2 point discrimination, Semmes-Weinstien monofilament test, the grip and pinch strength, Kapandji score and stereognosis Results: It was found that there were statistical significant differences between affected and unaffected groups as regards static and moving 2 point discrimination, grip strength except V-Y flap group, Pinch strength except for pulp to lateral in patients underwent V-Y flap, stereognosis except cross finger flap group, Kapandji score Conclusion: The mean grip and pinch strength were lower in affected hands compared with the unaffected sides. Use of sensate homodigital flaps (Moberg and V-Y advancement) gives better results than heterodigital flaps (FDMA and Cross finger)

Abstract Introduction: The thumb has a part in roughly 40% of hand capacity; traumatic loss brings about significant disability. A perfect reconstructed thumb would have satisfactory length, a sensate, non-tender tip, have security and be situated to meet alternate digits, with a sufficient first web space. Our objectives are study of different modalities of distal thumb reconstruction and evaluation of each modality regarding its sensation, stability, length, mobility, position, and pain-free function. Patients and methods: This study was conducted between January 2014 and January 2016 on 38 patients. These patients were presented with partial thumb amputation extends from the interphalangeal joint to the thumb tip secondary to trauma. The patients divided into four groups according to the method of reconstruction. assessment included measuring the static and moving 2 point discrimination, Semmes-Weinstien monofilament test, the grip and pinch strength, Kapandji score and stereognosis Results: It was found that there were statistical significant differences between affected and unaffected groups as regards static and moving 2 point discrimination, grip strength except V-Y flap group, Pinch strength except for pulp to lateral in patients underwent V-Y flap, stereognosis except cross finger flap group, Kapandji score Conclusion: The mean grip and pinch strength were lower in affected hands compared with the unaffected sides. Use of sensate homodigital flaps (Moberg and V-Y advancement) gives better results than heterodigital flaps (FDMA and Cross finger)

Abstract Introduction: The thumb has a part in roughly 40% of hand capacity; traumatic loss brings about significant disability. A perfect reconstructed thumb would have satisfactory length, a sensate, non-tender tip, have security and be situated to meet alternate digits, with a sufficient first web space. Our objectives are study of different modalities of distal thumb reconstruction and evaluation of each modality regarding its sensation, stability, length, mobility, position, and pain-free function. Patients and methods: This study was conducted between January 2014 and January 2016 on 38 patients. These patients were presented with partial thumb amputation extends from the interphalangeal joint to the thumb tip secondary to trauma. The patients divided into four groups according to the method of reconstruction. assessment included measuring the static and moving 2 point discrimination, Semmes-Weinstien monofilament test, the grip and pinch strength, Kapandji score and stereognosis Results: It was found that there were statistical significant differences between affected and unaffected groups as regards static and moving 2 point discrimination, grip strength except V-Y flap group, Pinch strength except for pulp to lateral in patients underwent V-Y flap, stereognosis except cross finger flap group, Kapandji score Conclusion: The mean grip and pinch strength were lower in affected hands compared with the unaffected sides. Use of sensate homodigital flaps (Moberg and V-Y advancement) gives better results than heterodigital flaps (FDMA and Cross finger)

Abstract Introduction: The thumb has a part in roughly 40% of hand capacity; traumatic loss brings about significant disability. A perfect reconstructed thumb would have satisfactory length, a sensate, non-tender tip, have security and be situated to meet alternate digits, with a sufficient first web space. Our objectives are study of different modalities of distal thumb reconstruction and evaluation of each modality regarding its sensation, stability, length, mobility, position, and pain-free function. Patients and methods: This study was conducted between January 2014 and January 2016 on 38 patients. These patients were presented with partial thumb amputation extends from the interphalangeal joint to the thumb tip secondary to trauma. The patients divided into four groups according to the method of reconstruction. assessment included measuring the static and moving 2 point discrimination, Semmes-Weinstien monofilament test, the grip and pinch strength, Kapandji score and stereognosis Results: It was found that there were statistical significant differences between affected and unaffected groups as regards static and moving 2 point discrimination, grip strength except V-Y flap group, Pinch strength except for pulp to lateral in patients underwent V-Y flap, stereognosis except cross finger flap group, Kapandji score Conclusion: The mean grip and pinch strength were lower in affected hands compared with the unaffected sides. Use of sensate homodigital flaps (Moberg and V-Y advancement) gives better results than heterodigital flaps (FDMA and Cross finger)

Abstract Background: Difficult and problematic hemangiomas need early management to stop growth and prevent or reduce functional and aesthetic deformities. Because of rapid growth,complication and/or location of infantile hemangioma, approximately one in ten require treatment. Oral propranolol is an exceptionally encouraging treatment for problematic infantile hemangiomas. The main purpose of this paper is to evaluate the adequacy of propranolol as a first line treatment for difficult and complicated infantile hemangioma. Patients and methods: Sixty-four infants, mean age 3.5 months, with rapidly proliferating difficult and complicated infantile hemangioma were included in this study. All patients had cardiovascular work-up before treatment. Propranolol was administered in a dosage 0f 2 mg/kg/day. Result: Excellent regression was achieved in 60 cases (93.75%). with no significant response in four cases (6.25%). There were rapid opening of eye within 2 weeks in cases of periorbital hemangiomas and rapid relief of micturition within 1 week of treatment, in cases of vulval hemangioma. Epithelialization was achieved within five weeks of beginning of treatment in all cases of ulceration. Conclusion: Propranolol is highly effective against difficult and complicated hemangioma with low adverse events rates.

Abstract Background: Difficult and problematic hemangiomas need early management to stop growth and prevent or reduce functional and aesthetic deformities. Because of rapid growth,complication and/or location of infantile hemangioma, approximately one in ten require treatment. Oral propranolol is an exceptionally encouraging treatment for problematic infantile hemangiomas. The main purpose of this paper is to evaluate the adequacy of propranolol as a first line treatment for difficult and complicated infantile hemangioma. Patients and methods: Sixty-four infants, mean age 3.5 months, with rapidly proliferating difficult and complicated infantile hemangioma were included in this study. All patients had cardiovascular work-up before treatment. Propranolol was administered in a dosage 0f 2 mg/kg/day. Result: Excellent regression was achieved in 60 cases (93.75%). with no significant response in four cases (6.25%). There were rapid opening of eye within 2 weeks in cases of periorbital hemangiomas and rapid relief of micturition within 1 week of treatment, in cases of vulval hemangioma. Epithelialization was achieved within five weeks of beginning of treatment in all cases of ulceration. Conclusion: Propranolol is highly effective against difficult and complicated hemangioma with low adverse events rates.

Abstract Background: Difficult and problematic hemangiomas need early management to stop growth and prevent or reduce functional and aesthetic deformities. Because of rapid growth,complication and/or location of infantile hemangioma, approximately one in ten require treatment. Oral propranolol is an exceptionally encouraging treatment for problematic infantile hemangiomas. The main purpose of this paper is to evaluate the adequacy of propranolol as a first line treatment for difficult and complicated infantile hemangioma. Patients and methods: Sixty-four infants, mean age 3.5 months, with rapidly proliferating difficult and complicated infantile hemangioma were included in this study. All patients had cardiovascular work-up before treatment. Propranolol was administered in a dosage 0f 2 mg/kg/day. Result: Excellent regression was achieved in 60 cases (93.75%). with no significant response in four cases (6.25%). There were rapid opening of eye within 2 weeks in cases of periorbital hemangiomas and rapid relief of micturition within 1 week of treatment, in cases of vulval hemangioma. Epithelialization was achieved within five weeks of beginning of treatment in all cases of ulceration. Conclusion: Propranolol is highly effective against difficult and complicated hemangioma with low adverse events rates.

Abstract Background: Difficult and problematic hemangiomas need early management to stop growth and prevent or reduce functional and aesthetic deformities. Because of rapid growth,complication and/or location of infantile hemangioma, approximately one in ten require treatment. Oral propranolol is an exceptionally encouraging treatment for problematic infantile hemangiomas. The main purpose of this paper is to evaluate the adequacy of propranolol as a first line treatment for difficult and complicated infantile hemangioma. Patients and methods: Sixty-four infants, mean age 3.5 months, with rapidly proliferating difficult and complicated infantile hemangioma were included in this study. All patients had cardiovascular work-up before treatment. Propranolol was administered in a dosage 0f 2 mg/kg/day. Result: Excellent regression was achieved in 60 cases (93.75%). with no significant response in four cases (6.25%). There were rapid opening of eye within 2 weeks in cases of periorbital hemangiomas and rapid relief of micturition within 1 week of treatment, in cases of vulval hemangioma. Epithelialization was achieved within five weeks of beginning of treatment in all cases of ulceration. Conclusion: Propranolol is highly effective against difficult and complicated hemangioma with low adverse events rates.

Abstract Objective: To compare the efficacy 0f follicular hair transplantation and mini punch graft in the treatment of stable vitiligo. Patient and Methods: Thirty to patients with stable vitiligo were included in this comparative study. A single patch from each patient was divided into two halves; one half was treated by punch graft while the other half was treated by follicular hair transplantation followed by excimer light twice weekly and the outcome were assessed at 0, 1, 3and 6 months post operatively by photography and quartile scale. Results At the final visit, the percentage of improvement of vitiligo in punch graft treated side was significantly higher than follicular hair transplantation treated side (P0.05). Also, repigmentation after punch grafting occurred after a mean period 2.5 ± 0.5 weeks (range, 2-3 weeks), while after follicular hair transplantation, repigmentati0n occurred after 5.2 ± 1.9 weeks (range, 5-8 weeks) (P0.05). Cobble stone appearance was the most common complication after punch graft; it occurred in 29 patients (90%) while no reported side effects occurred after follicular graft technique. Conclusion Punch grafting is more effective than follicular grafting in the treatment of stable vitilligo, however, follicular hair transplantation is cosmetically better so we recommend it in exposed areas as face.