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.

Abstract: Introduction: Wound disinfection keeps the corner stone in treating of diabetic foot ulcer. Hydrogen Peroxide (H 2O2) and Povidone Iodine are topical antimicrobial agents however both known as be cytotoxic to cells implicated in the wound healing cascade. The major challenge to the physicians and nurses is search about safe, non- cytotoxic and effective technique for wound cleansing as Hypochlorous acid (HOCL). The aim of this study was to compare the efficacy of HOCL versus H 2O2 followed by Povidine Iodine as a wound care agent in treating infected diabetic foot ulcers. Patients and methods: Design: used a randomized clinical trial design to contrast the efficacy of HOCL versus H2O2 followed by Povidine Iodine as a wound care agent in treating infected diabetic foot ulcers. Setting: This research was executed in outpatient plastic and vascular surgery clinic at Assiut university Hospital. Subjects: A random selection was performed on 60 patients with infected diabetic foot ulcers divided evenly to control and study group. Methods: HOCL was applied for the study group, before covered the wound with sterile dressing the wound was rinse with HOCL in a concentration; sterile Nacl 0.9% to HOCL 50.5% at ratio 8:2 and leaved for 5 minutes. While H 2O2 followed by Povidine Iodine were us for the control group and the results were compared. Before start irrigation, bacterial cultures were obtained after five days thin each five days until the end of the study for the both groups. Results: HOCL was capable to be effective versus Candida, Proteus, Klebsella, Psudomonas, and Methicillin resistant staphylococcus aureus (MARSA) compare to H2O2 and Povidine iodine. There is a statistically significant difference between utilizing HOCL and H2O2 and Povidine iodine as a washing therapy in lowering bacterial numbers, wound pain, odor, discharge and improve wound healing in diabetic foot ulcer. Conclusion: Hypochlorous acid is a potent antimicrobial cleanser against a wide range of microorganisms. Hypochlorous Acid is simple to prepare, safely us, low cost, not painful, rapidly improve wound healing and faster preparing diabetic foot ulcer for skin flap or graft. Recommendation: The study recommended utilization of HOCL as a virtuous diabetic wound care washing therapy. More extensiveresearch is recommended on a larger scale to verify the effectiveness of Hypochlorous acid as a wound care agent in septic diabetic foot ulcers.

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