Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficult... more Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of suspicion and detailed history taking from the caregiver are mandatory to pick up these cases.There are a plethora of management options that have been reported in dealing with such fractures. They range from conservative management to internal fixation by absorbable plates. While conservative management does not interfere with mandibular growth and teeth development, any surgical intervention can carry this risk. Nevertheless, a severely displaced fracture may need anatomical reduction and fixation to allow early nutrition.This study reports a 3-month-old male infant with a fracture in the mandibular symphysis who underwent reduction of the fracture and circummandibular fixation using immobilisation by an acrylic splint for 4 weeks. His long-term follow-up after 20 months showed adequate dentition with proper healing of the fracture site.
The Egyptian Journal of Plastic and Reconstructive Surgery
Background: Because the FDP (flexor digitorum profundus) and the two slips of the FDS (flexor dig... more Background: Because the FDP (flexor digitorum profundus) and the two slips of the FDS (flexor digitorum superficialis) are crowded within a tight fibro-osseous tunnel, it has never been easy to have good functional results after flexor tendon restoration in zone II, elevating the possibility of postoperative adhesions and a decrease in post-operative range of motion and power. Main aims of tendon repair are improved tendon healing and adhesion reduction. Primary flexor tendon healing methods are still being refined to this day. Aim of the Work: The goal is to assess the outcomes of heparin injection into cut ends of flexor tendon zone II injuries both clinically and radiologically using musculoskeletal ultrasound. Patients and Methods: This is an interventional clinical trial including forty individuals with flexor tendon injuries zone II. The Patients were sampled randomly into two groups, group I twenty patients (study group) with heparin injection and group II twenty patients (control group) without heparin injection. Results: Forty cases were included in our study which had zone II flexor tendon injury repaired using four strand techniques. Both groups had the same protocol of physiotherapy and follow-up. Results were measured as regards the total range of motion according to Strickland criteria showing no significant change between the two groups. Heparin injection shows a higher rupture rate of flexor tendons which were injected also showing gap formation in MSK US. Also, heparin injection increases the formation of granulation tissue which negatively affects the gliding of tendon. So, heparin injection is not recommended in flexor tendon repair zone II. Conclusion: Heparin injection shows a higher rupture rate of flexor tendons which were injected also which reflect gap formation in MSK US. Also, heparin injection increases the formation of adhesive granulation tissue which negatively affects the gliding of tendon. So, heparin injection is not recommended in flexor tendon repair zone II. However, there were a few limitations to our 239 study such as poor compliance of some patients which is considered one of the major problems that affect the postoperative outcomes.
Background The propeller perforator flap is a variant of perforator flaps in which complete skele... more Background The propeller perforator flap is a variant of perforator flaps in which complete skeletonization of the perforator with venae commitantes is done to transfer the islanded flap on its pedicle with up to 180 degrees of twisting that predispose to its gradual occlusion by time. These flaps have been recently advocated for lower extremity reconstruction. However, reconstruction of the lower extremity especially in the distal third of the leg quite often involves multistage procedures that might necessitate flap re-elevation and little knowledge is available about postoperative patency of these flaps. Aim of the work The aim of this study is to assess the postoperative patency and flow pattern in twisted vascular pedicle of propeller perforator flaps used in lower extremity reconstruction. Materials and methods A Prospective study was conducted on 15 patients 18 years or older of both genders undergoing lower extremity soft tissue reconstruction by propeller perforator flaps r...
Plastic and Reconstructive Surgery - Global Open, 2016
Anchor points in the Colles' fascia elongated 17.4% further prior to failure than those in the pe... more Anchor points in the Colles' fascia elongated 17.4% further prior to failure than those in the periosteum.There was noticable variability between anchor points and across samples. The histologic sections suggest that Colles' fascia from the different regions of the ischiopubic ramus vary considerably both in continuity and collagen fiber content. The periosteal and muscular fascial layers were more continuous histologically with direct attachments into the pubis and ischium. conclusion: Anchoring of the SFS to the periosteum did not improve the complication profile when compared to the literature. Both the biomechanical and histologic analyses demonstrate that the Colles' fascia is highly variable in composition with coincident variability in tissue strength, which may account for the high complication profile of this procedure. Our results require further study to identify the optimal surgical technique for medial thighplasty.
European Journal of Pediatric Surgery Reports, 2022
Conjoined twining is one of the most fascinating and challenging situations which a pediatric sur... more Conjoined twining is one of the most fascinating and challenging situations which a pediatric surgeon may face in his career. Only few surgeons may have the opportunity to share in separation of such cases. In this report, we aim to share our experience with the successful separation of ventrally fused male conjoined twins (omphaloischiopagus). The case was thoroughly studied via preoperative cross-sectional imaging modalities (magnetic resonance imaging [MRI] and computed tomography [CT] angiography), complemented by data obtained from reviewing similar cases in the literature. A clear delineation of the complex anatomy was achieved preoperatively which proved to be well consistent with the operative findings. A detailed description of the operative procedure to divide/redistribute the shared abdominal/pelvic organs between both twins is provided. To the best of our knowledge, this is the first report to describe the detailed and unique internal anatomy of a common central phallus ...
Craniomaxillofacial Trauma and Reconstruction, 2015
Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique o... more Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular ...
Exhibiting many of the qualities of the ideal filler, fat grafting has been embraced among the mo... more Exhibiting many of the qualities of the ideal filler, fat grafting has been embraced among the most popular procedures in facial aesthetic surgery. This work emphasizes the implementation of fat grafting in the management of difficult facial reconstructive cases. Coleman’s principles for structural fat grafting were used to replenish volume in different aesthetic units of the face in 27 patients with age ranging from sixteen till twenty eight years presenting with facial soft tissue deficiencies and/or skeletal deficiencies. Three patients had only soft tissue deficiencies and they all belonged to the hemifacial atrophy category and were operated upon, with fat grafting only, after they have been in their stable phase of the disease for at least one year. The remaining 24 patients had both skeletal and soft tissue deficiencies. They included 7 repaired cleft lip and palate patients, 5 patients with hemifacial microsomia, 4 orthognathic and jaw deformity cases, 3 patients with Treach...
Craniosynostosis denotes the premature pathological fusion of one or more of the cranial sutures.... more Craniosynostosis denotes the premature pathological fusion of one or more of the cranial sutures. The treatment of these cases has advanced rather dramatically over the past thirty years. A better understanding of the neurocranial development and calvarial osteogenesis, the various osteotomies and procedures utilized, rigid internal fixation, use of resorbables and team approach has played a role in the advances of management of these cases. This article presents our surgical results of thirty-seven craniosynostotic patients of different age groups and different suture involvement treated by contemporary craniofacial osteotomies over the past three years at Ain-Shams University Hospital. The same craniofacial team treated all cases. All patients underwent in-depth clinical evaluation including anthropometric craniofacial measurements and received CT scans prior to surgery. Preoperative ophthalmologic evaluation, genetic counseling and intelligence quotient (I.Q) tests were conducted...
Overlooked injured structures in periorbital trauma could lead to aesthetic and functional defici... more Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and func...
Craniomaxillofacial Trauma and Reconstruction, 2010
The treatment of long-standing facial paralysis through temporalis muscle transfer has stood the ... more The treatment of long-standing facial paralysis through temporalis muscle transfer has stood the test of time. Herein, we present a modification in temporalis muscle transfer for lower facial reanimation. Instead of the traditional stripping of the temporalis muscle from its origin, its insertion is stripped from the coronoid process through an intraoral approach. The detached fibers were then sutured to a fascia lata graft, which was passed and secured to the orbicularis oris to reanimate the corner of the mouth. The procedure is less extensive and provides a direct ''orthodromic'' line of pull with good muscular excursion and power. This simple procedure has been applied to 12 consecutive cases with long-standing complete facial paralysis presenting to the Plastic and Reconstructive Surgery Clinic at the Ain-Shams University Hospital over the past 2 years. In addition to symmetry at rest, this easy procedure allowed for good movement of the corner of the mouth with restoration of a balanced smile.
Craniomaxillofacial Trauma and Reconstruction, 2012
From 1969, the senior author (H.B.) has developed a technique for the repair of alveolar clefts d... more From 1969, the senior author (H.B.) has developed a technique for the repair of alveolar clefts during primary cheiloplasty at patient age of 3 months. The operation used palatally hinged mucoperiosteal flaps from the edges of the cleft to reconstruct the posterior and inferior walls of the alveolar box. The roof was reconstructed by repairing the nasal floor, and the anterior wall was reconstructed using a buccal mucosal flap from the undersurface of the lateral lip segment. Fourteen operated patients were selected to scientifically follow the long-term results of the technique. The results indicated restoration of the arch form, varying degrees of ossification in the repaired alveolar box, and eruption of canines through the repaired alveolus. One case of anterior cross-bite was observed in these selected cases. However, a limited cross-bite was present at the site of the repaired cleft in many cases.
The results are consistent with those obtained by conventional histochemical techniques (immunofl... more The results are consistent with those obtained by conventional histochemical techniques (immunofluorescence and Western blot) and demonstrate that TR-LIFS is a potential tool for monitoring the expression of distinct collagen types and the formation of collagen cross-links in intact tissue constructs.
Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficult... more Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of suspicion and detailed history taking from the caregiver are mandatory to pick up these cases.There are a plethora of management options that have been reported in dealing with such fractures. They range from conservative management to internal fixation by absorbable plates. While conservative management does not interfere with mandibular growth and teeth development, any surgical intervention can carry this risk. Nevertheless, a severely displaced fracture may need anatomical reduction and fixation to allow early nutrition.This study reports a 3-month-old male infant with a fracture in the mandibular symphysis who underwent reduction of the fracture and circummandibular fixation using immobilisation by an acrylic splint for 4 weeks. His long-term follow-up after 20 months showed adequate dentition with proper healing of the fracture site.
The Egyptian Journal of Plastic and Reconstructive Surgery
Background: Because the FDP (flexor digitorum profundus) and the two slips of the FDS (flexor dig... more Background: Because the FDP (flexor digitorum profundus) and the two slips of the FDS (flexor digitorum superficialis) are crowded within a tight fibro-osseous tunnel, it has never been easy to have good functional results after flexor tendon restoration in zone II, elevating the possibility of postoperative adhesions and a decrease in post-operative range of motion and power. Main aims of tendon repair are improved tendon healing and adhesion reduction. Primary flexor tendon healing methods are still being refined to this day. Aim of the Work: The goal is to assess the outcomes of heparin injection into cut ends of flexor tendon zone II injuries both clinically and radiologically using musculoskeletal ultrasound. Patients and Methods: This is an interventional clinical trial including forty individuals with flexor tendon injuries zone II. The Patients were sampled randomly into two groups, group I twenty patients (study group) with heparin injection and group II twenty patients (control group) without heparin injection. Results: Forty cases were included in our study which had zone II flexor tendon injury repaired using four strand techniques. Both groups had the same protocol of physiotherapy and follow-up. Results were measured as regards the total range of motion according to Strickland criteria showing no significant change between the two groups. Heparin injection shows a higher rupture rate of flexor tendons which were injected also showing gap formation in MSK US. Also, heparin injection increases the formation of granulation tissue which negatively affects the gliding of tendon. So, heparin injection is not recommended in flexor tendon repair zone II. Conclusion: Heparin injection shows a higher rupture rate of flexor tendons which were injected also which reflect gap formation in MSK US. Also, heparin injection increases the formation of adhesive granulation tissue which negatively affects the gliding of tendon. So, heparin injection is not recommended in flexor tendon repair zone II. However, there were a few limitations to our 239 study such as poor compliance of some patients which is considered one of the major problems that affect the postoperative outcomes.
Background The propeller perforator flap is a variant of perforator flaps in which complete skele... more Background The propeller perforator flap is a variant of perforator flaps in which complete skeletonization of the perforator with venae commitantes is done to transfer the islanded flap on its pedicle with up to 180 degrees of twisting that predispose to its gradual occlusion by time. These flaps have been recently advocated for lower extremity reconstruction. However, reconstruction of the lower extremity especially in the distal third of the leg quite often involves multistage procedures that might necessitate flap re-elevation and little knowledge is available about postoperative patency of these flaps. Aim of the work The aim of this study is to assess the postoperative patency and flow pattern in twisted vascular pedicle of propeller perforator flaps used in lower extremity reconstruction. Materials and methods A Prospective study was conducted on 15 patients 18 years or older of both genders undergoing lower extremity soft tissue reconstruction by propeller perforator flaps r...
Plastic and Reconstructive Surgery - Global Open, 2016
Anchor points in the Colles' fascia elongated 17.4% further prior to failure than those in the pe... more Anchor points in the Colles' fascia elongated 17.4% further prior to failure than those in the periosteum.There was noticable variability between anchor points and across samples. The histologic sections suggest that Colles' fascia from the different regions of the ischiopubic ramus vary considerably both in continuity and collagen fiber content. The periosteal and muscular fascial layers were more continuous histologically with direct attachments into the pubis and ischium. conclusion: Anchoring of the SFS to the periosteum did not improve the complication profile when compared to the literature. Both the biomechanical and histologic analyses demonstrate that the Colles' fascia is highly variable in composition with coincident variability in tissue strength, which may account for the high complication profile of this procedure. Our results require further study to identify the optimal surgical technique for medial thighplasty.
European Journal of Pediatric Surgery Reports, 2022
Conjoined twining is one of the most fascinating and challenging situations which a pediatric sur... more Conjoined twining is one of the most fascinating and challenging situations which a pediatric surgeon may face in his career. Only few surgeons may have the opportunity to share in separation of such cases. In this report, we aim to share our experience with the successful separation of ventrally fused male conjoined twins (omphaloischiopagus). The case was thoroughly studied via preoperative cross-sectional imaging modalities (magnetic resonance imaging [MRI] and computed tomography [CT] angiography), complemented by data obtained from reviewing similar cases in the literature. A clear delineation of the complex anatomy was achieved preoperatively which proved to be well consistent with the operative findings. A detailed description of the operative procedure to divide/redistribute the shared abdominal/pelvic organs between both twins is provided. To the best of our knowledge, this is the first report to describe the detailed and unique internal anatomy of a common central phallus ...
Craniomaxillofacial Trauma and Reconstruction, 2015
Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique o... more Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular ...
Exhibiting many of the qualities of the ideal filler, fat grafting has been embraced among the mo... more Exhibiting many of the qualities of the ideal filler, fat grafting has been embraced among the most popular procedures in facial aesthetic surgery. This work emphasizes the implementation of fat grafting in the management of difficult facial reconstructive cases. Coleman’s principles for structural fat grafting were used to replenish volume in different aesthetic units of the face in 27 patients with age ranging from sixteen till twenty eight years presenting with facial soft tissue deficiencies and/or skeletal deficiencies. Three patients had only soft tissue deficiencies and they all belonged to the hemifacial atrophy category and were operated upon, with fat grafting only, after they have been in their stable phase of the disease for at least one year. The remaining 24 patients had both skeletal and soft tissue deficiencies. They included 7 repaired cleft lip and palate patients, 5 patients with hemifacial microsomia, 4 orthognathic and jaw deformity cases, 3 patients with Treach...
Craniosynostosis denotes the premature pathological fusion of one or more of the cranial sutures.... more Craniosynostosis denotes the premature pathological fusion of one or more of the cranial sutures. The treatment of these cases has advanced rather dramatically over the past thirty years. A better understanding of the neurocranial development and calvarial osteogenesis, the various osteotomies and procedures utilized, rigid internal fixation, use of resorbables and team approach has played a role in the advances of management of these cases. This article presents our surgical results of thirty-seven craniosynostotic patients of different age groups and different suture involvement treated by contemporary craniofacial osteotomies over the past three years at Ain-Shams University Hospital. The same craniofacial team treated all cases. All patients underwent in-depth clinical evaluation including anthropometric craniofacial measurements and received CT scans prior to surgery. Preoperative ophthalmologic evaluation, genetic counseling and intelligence quotient (I.Q) tests were conducted...
Overlooked injured structures in periorbital trauma could lead to aesthetic and functional defici... more Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and func...
Craniomaxillofacial Trauma and Reconstruction, 2010
The treatment of long-standing facial paralysis through temporalis muscle transfer has stood the ... more The treatment of long-standing facial paralysis through temporalis muscle transfer has stood the test of time. Herein, we present a modification in temporalis muscle transfer for lower facial reanimation. Instead of the traditional stripping of the temporalis muscle from its origin, its insertion is stripped from the coronoid process through an intraoral approach. The detached fibers were then sutured to a fascia lata graft, which was passed and secured to the orbicularis oris to reanimate the corner of the mouth. The procedure is less extensive and provides a direct ''orthodromic'' line of pull with good muscular excursion and power. This simple procedure has been applied to 12 consecutive cases with long-standing complete facial paralysis presenting to the Plastic and Reconstructive Surgery Clinic at the Ain-Shams University Hospital over the past 2 years. In addition to symmetry at rest, this easy procedure allowed for good movement of the corner of the mouth with restoration of a balanced smile.
Craniomaxillofacial Trauma and Reconstruction, 2012
From 1969, the senior author (H.B.) has developed a technique for the repair of alveolar clefts d... more From 1969, the senior author (H.B.) has developed a technique for the repair of alveolar clefts during primary cheiloplasty at patient age of 3 months. The operation used palatally hinged mucoperiosteal flaps from the edges of the cleft to reconstruct the posterior and inferior walls of the alveolar box. The roof was reconstructed by repairing the nasal floor, and the anterior wall was reconstructed using a buccal mucosal flap from the undersurface of the lateral lip segment. Fourteen operated patients were selected to scientifically follow the long-term results of the technique. The results indicated restoration of the arch form, varying degrees of ossification in the repaired alveolar box, and eruption of canines through the repaired alveolus. One case of anterior cross-bite was observed in these selected cases. However, a limited cross-bite was present at the site of the repaired cleft in many cases.
The results are consistent with those obtained by conventional histochemical techniques (immunofl... more The results are consistent with those obtained by conventional histochemical techniques (immunofluorescence and Western blot) and demonstrate that TR-LIFS is a potential tool for monitoring the expression of distinct collagen types and the formation of collagen cross-links in intact tissue constructs.
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Papers by Amir Elbarbary