Background: 

Despite the continued refinement of numerous hypospadias repair techniques, there is no completely satisfactory technique in terms of complications and cosmesis. Through our experience in hypospadias surgery, we developed a new simple technique named “anchored urethral glanular advancement (AUGA)” and the current study is trying to evaluate this technique in the treatment of more proximal degrees of anterior hypospadias than the reported before with selective criteria and modified technique steps to reach more proximal degrees.

Materials and Methods: 

This is a prospective case series study on 43 patients with hypospadias from April 2019 to December 2021. Cases with glanular, coronal, subcoronal and distal penile hypospadias and revision cases with the same postoperative meatus positions were included.

Results: 

Hypospadias objective scoring evaluation score was between 11 and 16 with a mean of 14.56 ± 1.29. The majority of patients (83.7%) had reported no complications.

Conclusion: 

The AUGA technique is a simple rapid single-stage technique for distal forms of hypospadias.

Abstract
Trichinella spiralis infection is a food-borne zoonotic disease caused by nematodes
that dwell in the tissues, presenting a significant public health concern. This study
aimed to evaluate the effectiveness of different treatments including silver nanoparticles
(AgNPs), myrrh biosynthesized AgNPs “AgNPs synthesized using plant-based
green technologies”, myrrh extract, and myrrh essential oil, as alternative treatments
against T. spiralis infection. Parasitological, histopathological, and cytotoxicity assessments
were conducted to investigate the effects of various concentrations of these
treatments in reducing the populations of adult worms and larvae during both the
intestinal and muscular phases of T. spiralis-infected mice. The results showed that
the highest antihelminthic efficacy against the intestinal phase of T. spiralis was
achieved by myrrh extract (86.66%), followed closely by AgNPs (84.96%) and myrrh
AgNPs (82.51%) at higher concentrations (800 mg/kg for myrrh extract, 40 μg/mL
for AgNPs, and 40 μg/mL for myrrh AgNPs). While the group treated with myrrh
essential oil showed the lowest percentage of adult reduction (78.14%). However, all
treatments demonstrated comparable effects in reducing the larvae population in the
muscle phase. Histopathological examination of the tissues revealed compelling evidence
of the effectiveness of AgNPs, particularly when prepared with myrrh. Additionally,
a comprehensive assessment of the cytotoxicity of AgNPs indicated low
toxicity levels. This study supports that AgNPs synthesized using plant-based green
technologies hold therapeutic potential for the treatment of T. spiralis infectionThese findings present a promising avenue for the development of novel antiparasitic
drugs that are both effective and safe.

t is the aim of the study to provide a detailed intraoperative assessment of the masseteric nerve and the facial
branch of the smiling muscles complex through the same superficial musculoaponeurotic system (SMAS)
incision.
This observational retrospective study aimed to define the straightest and safest surgical route to identify the
facial nerve for the smiling muscles complex and the masseteric nerve, using distance from the tragus and
zygomatic arch as anatomical landmarks.
30 patients were included in the study. The mean distance from the tragus to the masseteric nerve was 40.03
mm, the mean distance from the zygomatic arch was 12.24 mm, and the mean depth from the SMAS was 10.84
mm. Data were consistent, with little variation. The distance from the zygoma was found to be higher in male
patients. There was a positive correlation between the depth to the nerve and the distance from the zygoma, but
no correlation between body mass index and the other parameters studied.
Within the limitations of the study it seems that the proposed standardized direct approach to the masseteric
nerve is a reproducible technique that may be used to increase the safety of the procedure, reduce the operating
time, and decrease the amount of dissection and related postoperative scarring, thereby fostering positive results.
 

Repair of cleft palate after 6 years of age is controversial in regard to the surgical procedure and the speech outcome. Primary repair alone may not be considered sufficient to achieve intelligible speech. The authors consider addition of pharyngeal flap at the time of primary repair to be a significant factor in improving speech.

Methods

Prospectively maintained data of all cleft palate patients operated from 2013 to 2017 (5 years) was analyzed to identify patients older than 6 years. Complete cleft palate, incomplete cleft palate, and cleft of the soft palate were further stratified according to different Randall types. They were divided into 2 main types: primary palate repair only and primary palate repair with pharyngeal flap. Speech was assessed preoperatively and 12 months postoperatively by Pittsburgh weighted speech scale.

Results

A total of 139 patients were analyzed. There were 78 males and 61 females. Their ages ranged from 6 to 60 years (mean age, 12.5 years). The overall preoperative speech score in palate repair–only group was 12.15, whereas the postoperative score was 7.32. In patients who underwent primary pharyngeal flap along with palate repair, the preoperative speech score was 11.3, and the postoperative score was 3.76.

Conclusions

In select group of patients who report late for palate repair, addition of pharyngeal flap along with the primary palate repair improves the speech outcome in all Randall groups.

Background: Lower limb defects may be present due to various causes including infections, vascular diseases, tumor resections, and crush or
avulsion injuries. Management of lower leg defects is a complex problem, especially when they are large with deep soft tissue loss. These wounds
are difficult to be covered with local skin flaps, distant skin flaps or even conventional free flaps because of the compromised recipient vessels.
In such cases, the vascular pedicle of the free flap could be anastomosed to the recipient vessels of the contralateral healthy leg temporarily and
then divided after adequate neo­vascularization of the flap from the wound bed. The ideal time to divide such pedicles should be investigated
and accurately assessed to have the maximum success rate possible for these challenging conditions and procedures. Methods: Sixteen patients
who did not have a suitable adjacent recipient vessel for free flap reconstruction had been operated with cross leg free latissimus dorsi flap
between February 2017 and June 2021. The mean soft tissue defect dimension was 12 × 11 cm (the smallest 6 × 7 cm; the largest 20 × 14 cm).
Gustilo type 3B tibial fractures were present in 12 patients, while no fractures were present in the other 4 patients. Preoperatively, arterial
angiography was performed on all patients. After the fourth week post­operatively, non­crushing clamp was applied around the pedicle for
15 minutes. The clamping time was increased by 15 minutes on each consequent day (average 14 days). On the last 2 days, the pedicle was
clamped for 2 hours, and bleeding was assessed by a needle prick test. Results: Clamping time was assessed in each case to reach a scientific
calculation of the adequate vascular perfusion time needed for full flap nourishment. All flaps survived completely except two cases of distal
flaps necrosis. Conclusion: Cross­leg free latissimus dorsi can provide a solution for large soft­tissue defects in lower extremities especially with
absence of any suitable recipient vessels or when the use of vein grafts would not be feasible. However, ideal time before dividing the cross
vascular pedicle should be identified to have the maximum success rate possible.
Key words
vascular – perfusion – cross­leg – free flap
 

Abstract: The keystone flap has become an established option
that has been utilized recently to close significant myelomeningocele defects. Although the keystone flaps can be adapted
to repair myelomeningocele defects of different sizes, the shape
of the defect is also an essential factor to consider. In this study,
the authors proposed an algorithmic approach for reconstructing significant meningomyelocele defects utilizing different types
of keystone flaps based on the shape of the resulting defect.
From September 2016 to March 2022, the authors retrospectively reviewed the medical records of 28 patients with
meningomyelocele who underwent repair with the keystone
flaps. The mean age was 28 days (3 days to 4.5 months).
Twenty-one meningomyelocele defects were in the lumbosacral
(75%) and 7 in the thoracolumbar regions (25%).
The defect sizes ranged from 3.5 × 5 cm (area, 13.4 cm2) to
9 × 7 cm (area, 49.5 cm2), with an average of 26.2 cm2. Ten
meningomyelocele defects were a vertically oriented oval shape,
16 defects were a transversely oriented oval shape, and 2 defects
were circular. In addition, unilateral keystone flap was used in
7.1% of the patients (2 patients), bilateral keystone flap in 28.6%
(8 patients), and rotation advancement keystone flaps in 64.3%
(18 patients). According to these findings, an algorithm was
created based on the defect shape.
This algorithmic approach is used as a decision-making
guide to select the correct type of keystone flaps to repair
myelomeningocele according to the defect shape.
Key Words: Algorithm approach, keystone flap, myelomeningocele, reconstruction, rotation advancement keystone flap
 

Background: Several assessment systems of the cleft-related facial deformity have been reported in the medical literature. Assessments have been made from direct clinical evaluations, photographs, on-screen digital images, and 3-dimensional imaging. An evaluation method based on standardized photographic views is developed to evaluate the most common postoperative deformities and to detect the responsible factors for occurrence of these deformities and how to avoid them.
Materials and Methods: One hundred forty-five cleft lip cases (105 unilateral and 40 bilateral) were evaluated by using standard sheet and scoring system designed by Operation Smile Inc (Virginia Beach). The scoring system is based on photographic analysis of items including Cupid's bow, nasal symmetry, vermilion contour, white roll continuity, and scar quality.
Results: In the unilateral cleft cases, we found 0.4% excellent, 48.57% good, 38% fair, and 2.85% poor cases. For bilateral clef lip cases, we found 27.5% excellent, 47.5% good, 17.5% fair, and 7.5% poor outcomes. The most common postoperative deformities were nasal asymmetry, scar hypertrophy, deformed Cupid's bow, and vermilion contour asymmetry.
Conclusions: This objective evaluation system can determine the common cleft lip nasal deformities with detection of the responsible factors. Principles that guide optimum surgical repair have been advocated to avoid the common postoperative deformities. Scar formation is an independent factor that must be managed early and separately to maintain surgical outcomes.
Key Words: cleft lip deformities, cleft lip evaluation, cleft lip repair, cleft lip
scoring system