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.
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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.

Abstract
Background: The most prevalent malignant tumors of the human face are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma.  BCC constitutes more than three quarters of skin cancers of the face and the rest primarily consist of SCC.
Objectives: The aim of our study is  to describe different  types of local cutaneous flaps that are versatile and reliable in reconstruction of post-oncological facial defects.
Patients and methods: This prospective study was conducted on patients admitted to the Plastic Surgery Department, Qena Faculty of Medicine, South Valley University from May 2019 to May 2020 (one-year duration). A total of fifty patients with malignant tumors of facial skin were included in  our study.
Results: Twenty nine patients had reconstructed their defects by local random flaps, while 21 patients had reconstructed their defects by local axial flaps. The most random flap applied was rhomboid flap in 14 (28%) patients  The most axial flap applied was forehead flap in 6 (12%)  patients and nasolabial flap in 6 (12%)  patients .
Conclusion: The reconstruction of post ablative face defects, using local flaps, is a real challenge from the perspective of surgical techniques, considering the difficulties determined by the restoring of three dimensional structures and the complexity of reconstructive methods.

Abstract
Background: Cleft lip & palate are among most common congenital craniofacial malformations, with global incidence of 1/1000 live births.  Goal of surgical repair is to enhance function & aesthetic presence of lip while providing appropriate anatomical reconstruction. Over time, numerous methods for cleft lip repair have been characterized.  Ideal lip repair has symmetrical nasolabial folds & alae of nose on sides, natural-looking philtrum & Cupid's bow in both static & dynamic states, & hidden scar.
Objectives: The purpose of this study is to compare esthetic results between Mohler & Fisher technique in unilateral cleft lip healing.
Patients and methods: Prospective, randomized controlled research of 30 studied cases with unilateral cleft lip & palate was performed; divided into two groups (Mohler and Fisher groups), admitted to Plastic Surgery Department; Qena University Hospital from May 2021 to April 2022 (one year duration). Studied cases with microform cleft lip, syndromic cases, & non- compliant studied cases for photography and follow up were excluded. Anthropometric measurements were taken manually and valuation of quality of cleft lip repair was performed based on Steffensen's grading criteria.
Results: Anthropometric measurements were taken postoperatively from patients photos and compared with the preoperative measurements taken manually and these measurements were compared between the two groups. Lip height and vermilion height were higher in Fisher group likened to Mohler group; however, there is no significant lip width and alar base length. Outcomes between the two groups were compared according to Steffensen's criteria, it showed that good outcomes were more frequent in Fisher group compared to Mohler group but without statistically significant difference. Assessment of patient satisfaction was compared between the two groups; it was more excellent score in Fisher's group than in Mohler's group.
Conclusion: Fisher technique was more favorable than Mohler technique. This was revealed from our results according to Steffensen's grading criteria. Also, patient satisfaction from esthetic outcomes was more desirable in Fisher than Mohler repair for a long time follow up.

Even for a highly skilled plastic surgeon, managing cleft-lip and nasal deformity is challenging.the deformity may be mostly addressed early at the time of cleft lip repair or later by secondary rhinoplasty procedure.However, it's crucial  to  remember  that  the  severity  of  the  abnormality,  the  consequences  of  growing  through  time,  and  the aftereffects  of  earlier  surgery's  scarring  might  influence  the  outcomes  of  secondary  cleft  nasal  repair.Primary, intermediate, and secondary or final repairs may be categorized according to the time of surgical intervention for correction  of  cleft  lip  nasal  deformity.  The  primary  cleft  rhinoplasty  is  commonly  performed  at  3 months of  age along with primary cheiloplasty.Intermediate rhinoplasty is referred as interventions that carried out before nose growth  is  complete,  between  definitive  lip  repair  and  secondary  rhinoplasty.  Once  the  maxillary  and  nasal development  stops,  which is  around  the  ages  of 14  to 16  for  girls  and  16  to 18  forboys,  secondary  or definitive rhinoplasty is performed.As a result, there is still no agreement on the best method, and the final aesthetics of cleft restoration are still hindered by the cleft nose. But for many, achieving total rectification of all nasal defects remains a distant dream

Abstract
Background: : Gynecomastia (GM) is the most common breast condition in males. The clinical evaluation and surgical management of different grades of Gynecomastia are described extensively throughout several previous literatures.
Objectives: The objective of our present study is to assess the epidemiological, clinical presentation, and the preferred type of surgical intervention along with evaluation of aesthetic outcomes of each procedure.
Patients and methods: This is a prospective descriptive case series study conducted on 30 patients who was presenting with different grades of true gynecomastia admitted to the Plastic Surgery department in Qena university hospital from the outpatient clinic and seeking surgical correction.
Results: Fifty eight breasts were operated upon in 30 patients; two cases (6.67%) had  unilateral Gynecomastia and 28 cases (93.33%) had bilateral lesion.Based on surgical intervention,  periareolar excision was performed in ten cases, liposuction was performed in six cases, periareolar excision combined with liposuction was done in 4 cases. While, circumareolar excision combined with liposuction was performed in two cases and, circumareolar concentric mastopexy without liposuction was performed in four cases. Four cases of grade III gynecomastia were treated with free nipple grafts.
Conclusion: Gynecomastia is a persistent growth of breast tissue in men and the most successful course of management is surgery. Liposuction and surgical resection and/or combined procedures are three main types for surgical alternative

Background: Tissue distortion and malposition cause clefts in stillborn foetuses. Facial growth complicates the basic cleft nasal deformity into the secondary deformity.
Objectives: The aim of this study was to Evaluation of the different rhinoplasty techniques in management of secondary cleft lip nasal deformity Comparing the results of the secondary rhinoplasty in patients who had primary correction and others with no prior correction.
Patients and methods: This Prospective study was carried out in Plastic surgery department, Qena university hospital, South Valley University on 20 patients with nasal deformities.
Results: There was a significant difference between the two groups with regard to the change in hemicollumellar length and tip height between before and after surgery. In group A, there were considerable variations in preoperative and postoperative results. The Postoperative Alar width were significantly different between the two groups. Regarding the Third Aesthetic rating, there were significant differences between the two groups. In group A, there were substantial differences in preoperative and postoperative satisfaction with appearance as well as contentment with appearance among family and friends.
Conclusion: Successful adjunctive surgery, rhinoplasty, strengthens the alar margin, prevents the alar rim from collapsing, and provides supports for the cleft-side alar rim. Stopping postoperative retraction can be done as a prophylactic treatment in people with damaged lower lateral cartilage.