Papers by Dr-Nader Elmelegy
Annals of Plastic Surgery, Aug 1, 2020
Congenital melanocytic nevi, reported in 1% to 6% of newborns. There are many complications the m... more Congenital melanocytic nevi, reported in 1% to 6% of newborns. There are many complications the most dangerous is the malignant transformation, but the most depressive is the cosmetic one specially for facial lesions. There is a wide range of treatment modalities none of them provide an acceptable solution for facial lesions. In this study we provide a simple, cheap and effective treatment modality for nasal and perinasal congenital melanocytic nevi. In our study, significant improvement was observed with no repigmentation throughout the follow-up period. We conclude that carbon dioxide cryotherapy is an effective treatment modality for nasal and perinasal congenital melanocytic nevi that should be used by others to stand on its long-term persistence and possible complications.
Comparison of Nd:YAG Laser and Combined Intense Pulsed Light and Radiofrequency in the Treatment of Hypertrophic Scars
Annals of Plastic Surgery, May 1, 2020
Introduction Hypertrophic scars are fibroproliferative disorders, seen after burn, trauma, and/or... more Introduction Hypertrophic scars are fibroproliferative disorders, seen after burn, trauma, and/or surgery. We aimed to compare the clinical and histopathological results of 1064-nm Nd:YAG laser and combined intense pulsed light and radiofrequency in the treatment of hypertrophic scars. Methods Fifty patients with hypertrophic scars were included in this prospective, randomized study. Twenty-five patients were treated with Nd:YAG laser and 25 patients with combined intense pulsed light and radiofrequency (E-light). The scars were evaluated at baseline, during and at 3 months after the final treatment session using the Vancouver scar scale. Biopsy specimens from scars were obtained before, during, and 3 months after the final treatment session and were stained with hematoxylin and eosin stain, Masson's trichrome stain, and immunostaining procedures for collagen I, collagen III, and TGF-β1. Results Significant improvements in the total Vancouver scar scale scores before and after the treatment in both groups (P < 0.001); however, a significant difference between both groups (P < 0.001), regarding the E-light, which showed better response than Nd:YAG laser. Hematoxylin and eosin and Masson's trichrome staining showed arrangement and thinning of collagen bundles and reduction in collagen density by in both groups, but the collagen bundles thinning and parallelism were more obvious in the E-light group. Significant decrease in the concentration of collagen I, collagen III, and TGF-β1 in the E-light group as compared with the laser group (P = 0.005, P = 0.003 and P < 0.001, respectively). Conclusions Both modalities were successful in the treatment of hypertrophic scars; however, a significant improvement in the clinical and histopathological findings was detected with the E-light method.
The American Journal of Cosmetic Surgery, Aug 19, 2020
The measurements of beautiful buttocks have varied according to patient preference, different cul... more The measurements of beautiful buttocks have varied according to patient preference, different cultures, and ethnicity. There are great differences in the ideal aesthetic measurements of the buttocks among ethnic groups. In this work, the authors introduce an easy and versatile method for the assessment of "Gluteal-Related Aesthetic Subunits." This method works as a tool to perform liposuction and lipoinjection, to treat the variety of differences in patients' racial, cultural, personal preferences, and ethnic-related demands, thus improving the results of gluteal aesthetic surgery. This study was carried out on 148 patients, at plastic and reconstructive surgery department, Tanta University hospitals, and in private practice, in the period between 2010 and 2018. The aesthetic assessment and surgical planning were performed according to the criteria suggested by the authors of this work. Patient's satisfaction showed excellent results in 104 (70.2%) patients, good results in 39 (26.4%) patients, fair results in 5 (3.4%) patients, and no poor results. Clinical assessment showed excellent results in 96 (64.8%) patients, good results in 44 (29.7%) patients, fair results in 8 (5.5%) patients, and no poor results were reported. (1) We believe that this classification of buttock areas is a valuable step that could help in achieving the required results that are more satisfactory to different types of patients. (2) Despite all the merits of this analytical tool and the advantages of the innovations in liposuction, some limitations remain. Fat transfer alone will not treat and even may worsen ptosis.
Annals of Plastic Surgery, Sep 1, 2017
Background: Hypopigmentation is a troublesome often-permanent sequelae after burn injury, particu... more Background: Hypopigmentation is a troublesome often-permanent sequelae after burn injury, particularly in dark races. A number of methods have been described to treat this phenomenon. In this work, we are going to study the effect of E light (intensive pulsed light+radiofrequency+cooling) in repigmentation of partial thickness and full thickness burn wounds in adult patients and light microscopic changes of biopsy material at various stages of repigmentation. Patients and Methods: In this study, 24 patients with postburn hypopigmentation were selected and E light was used, using different filters, according to the skin color. The intensive pulsed light fluence varied between 38 and 42 J. Radiofrequency fluencies varied between 6 and 10 J, and the spot diameter was 8 Â 32 mm. Pulse durations of 2 to 7 milliseconds and pulse delays of 15 to 30 milliseconds were used on all patients. The patients were evaluated by comparing pretreatment and posttreatment photos. Skin biopsies were taken from depigmented area before and after interventions. Melanocytes were immunostained using Hwenty-four homatropine methylbromide 45 and were counted in Â200 magnification fields. Melanin can be demonstrated after staining with hematoxylin and eosin. Results: Seventeen cases were evaluated as excellent, 4 cases were evaluated as good, and 3 cases were evaluated as fair, but all patients stressed that their wounds have been improved. Light microscopy at 6 weeks posttreatment also confirmed the increased melanocyte number per field in all cases. Conclusions: E light induced significant overall clinical improvement in postburn hypopigmentation, particularly when E light was applied early after burn.
Isolated penile or scrotal post-Fournier’s gangrene sequelae, the role of electro-photo-biomodulation in conservative treatment
The Egyptian Journal of Plastic and Reconstructive Surgery, Apr 19, 2023
The Egyptian Journal of Plastic and Reconstructive Surgery
Background: The reconstructive ladder is an old concept that is familiar to all plastic surgeons.... more Background: The reconstructive ladder is an old concept that is familiar to all plastic surgeons. It is an arrangement of methods to reconstruct tissue defects from the easy to most complex one. With the advent of surgery, a lot of flimsy spots and difficulties showed up and yet showing up with the utilization of this old reconstructive stepping stool. Objective: In this work, the authors will present another view of the reconstructive ladder that they incited that is more valuable to the patient than the bygone one. Patients and Methods: The authors discussed six clinical cases. In each case, a travel study comparing the use of all the steps of the ladder to reach the best. Results: The discussion of the clinical cases that included other reconstructive options demonstrated and affirmed the requirement for modifications in the reconstructive ladder. Conclusion: The addition of the pedicled freestyle perforator flap would be a valuable update to the reconstructive ladder. The reconstructive Ladder is better viewed and organized as an order of beneficial priority to the patients rather than a classification of reconstructive options from simplicity to sophistication.
Electrophotobiomodulation in the treatment of facial post-burn hypertrophic scars in pediatric patients
Annals of burns and fire disasters, 2018
Hypertrophic scar continues to be one of the leading reasons for surgical and non-surgical treatm... more Hypertrophic scar continues to be one of the leading reasons for surgical and non-surgical treatments after burn healing. Facial post-burn hypertrophic scars can cause severe functional and emotional disability, as they are usually difficult to conceal. Numerous nonsurgical and surgical therapies have been used for the treatment of hypertrophic scars. This study describes the combination of bipolar radiofrequency, intense pulsed light and cooling (given the collective term 'E-light'), and reports the outcomes of its use in the treatment of post-burn facial hypertrophic scars in a series of sixty-five patients in the pediatric age group. There were no reports in the literature of the use of this modality (E-light) in the treatment of facial post-burn hypertrophic scars in pediatric patients. Results showed that the mean decrease in total VSS score for all patients was 5.8. Regarding the satisfaction of the parents of our patients, 66.15% rated the result excellent, 24.61% rat...
The American Journal of Cosmetic Surgery, 2020
Congenital melanocytic nevi of the face cause substantial psychological and cosmetic problems in ... more Congenital melanocytic nevi of the face cause substantial psychological and cosmetic problems in affected patients. The treatment of giant congenital nevi has been a long-standing challenge, but currently, various treatment options, such as cryotherapy, chemical peeling, electrical cautery, laser therapy, and surgery, have been tried for the treatment of congenital melanocytic nevi. In this article, we present our experience and the outcomes of the use of controlled carbon dioxide gas as a cryogen in the treatment of congenital melanocytic nevi. This study included 42 patients with varying sizes of congenital melanocytic nevi seen from January 2014 to April 2019. Cryocarboxy surgery was performed in all cases. The average evaluation score of our patients was excellent in 28 (66.6%) cases, good in 9 (21.4%) cases, satisfactory in 5 (12%) cases, and we had no poor results. Cryocarboxy surgery is a good addition to the armamentarium for the treatment of congenital melanocytic nevi. Car...
Aesthetic Plastic Surgery, 2020
Background Freckles are typical epidermal pigmented disorders that occur at sun-exposed areas, pr... more Background Freckles are typical epidermal pigmented disorders that occur at sun-exposed areas, presenting with dark-brown or light-brown circular hyperpigmentation. A lot of treatment modalities have been used for treatment of freckles like chemicals, electrosurgery and cryotherapy. These treatments may cause undesirable side effects such as scaring (Sarkar et al. in Indian J Dermatol 62(6):578-584, 2017). Microdermabrasion has been used in treatment of freckles; however, the results are not satisfactory, as it removes the outermost layer of the epidermis only (El-Domyati et al. in J Cosmet Dermatol 15(4):503-513, 2016). Also ablative lasers and non-ablative lasers have been used but have not proved to be completely satisfactory and share a common risk of postinflammatory hyperpigmentation (Jang et al. in Dermatol Surg 26:231-234, 2000). In our study, we have used epiderm-abrasion-assisted intensive pulsed light (IPL) and radiofrequency (RF) to study their effect in treatment of freckles. Patients and methods: this prospective controlled clinical trial was carried out on 48 patients, who presented with extensive facial freckles, in the period between March 2015 and April 2018. The epiderm-abrasion procedure was performed first, and then, electro-photobiomodulation sessions were started two weeks later. Results This study was carried out on 48 patients, 39 female and 9 males. Their age ranged between 12 and 58 years old. According to Fitzpatrick classification, four patients were type II, 30 patients were type III, and 14 patients were type IV. The results were excellent in 32 cases, good in 12 cases, fair in four cases, and we have no poor results. Side effects like hyperpigmentation were reported in three patients (6.3%), one case grade III and two cases grade IV Fitzpatrick skin type. No cases with hypopigmentation, or scars, were reported. Conclusions Epiderm-abrasion and electro-photobiomodulation (IPL&RF) are effective methods in treatment of facial freckles. Some complications may occur post-procedure such as hyperpigmentation, hypopigmentation and abnormal scarring.
European Journal of Plastic Surgery, 2018
Background Ever since the beginning of recorded history, beauty has played a major social role. A... more Background Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment. Methods Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis. Results The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery. Conclusions The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results. Level of Evidence: Level IV, therapeutic study.
Aesthetic plastic surgery, 2018
The purpose of this study is to introduce a breast reduction technique designed to reduce the inc... more The purpose of this study is to introduce a breast reduction technique designed to reduce the incidence of postoperative nipple-areola complex ischemia and necrosis following reduction mammoplasty, while at the same time allowing all the other goals of breast reduction to be realized. This is achieved through preoperative detection of perforating vessels supplying the nipple-areola complex using a hand-held Doppler. The horizontally based parenchymal pedicle is designed to include these perforators whether originating from the internal mammary artery, lateral thoracic artery or both. This technique provides freedom in pedicle shaping and fixation to the pectoral fascia to achieve the best breast contour. The study included 50 patients equally divided into two groups: the study group (using preoperative Doppler for detection of perforators) and control group (without preoperative Doppler). The average body mass index of our patients was 32.4 and 29.8 for study and control groups, res...
Annals of Plastic Surgery, 2017
Introduction: Multiple techniques have been used for reconstruction of large defects of the lower... more Introduction: Multiple techniques have been used for reconstruction of large defects of the lower lip. However, some complications, such as microstomia, distortion of oral commissure, lip functional problems, and sensory loss might occur with these techniques. The aim of this work is to evaluate a new method of reconstruction of large lower lip defects after excision of squamous cell carcinoma. Patients and Methods: Eighteen patients with lower lip squamous cell carcinomas were managed with this new technique of reconstruction using dermal fat flap, mucobuccal flap, and muscle transfer after excision of the tumor with 1-cm safety margin on both sides. The functional and aesthetic assessments were performed at least 6 months after surgery, and the results were compared statistically with a control group. Results: Of the 18 patients, sensibility was normal in 16 (89%) and complete competence was determined in all cases (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Interlabial measurements would be better in all patients. Nasolabial asymmetry was detected in 1 patient (6%) and apparent mentolabial scar tissue was detected in 2 patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). Conclusions: Based on our results, this technique could be considered a good choice for repair of major lip defects. In addition, using this technique will give good aesthetic and functional results.
The Egyptian Journal of Plastic and Reconstructive Surgery, Jul 1, 2018
Objectives: Abdominoplasty is one of the most common aesthetic operations. Using selective underm... more Objectives: Abdominoplasty is one of the most common aesthetic operations. Using selective undermining, it is possible to preserve at least 80 percent of the blood supply in the abdominal wall, preserving the great majority of the lymphatic vessels, and resulting in few complications compared with traditional abdominoplasty. Material and Methods: In this study, lipoabdominoplasty was performed on 10 patients from January 2015 to December 2015. Results: The results are good and excellent, especially regarding patient evaluation, better body contour, shorter scars, the form of the umbilicus, and a decrease in the abdominal measures. With a progressive adaptation of this technique, it is possible to achieve a harmonious body contour using a safe liposuction method on the abdominal and costal areas, with fast recovery and good to excellent results.
Hypertrophic Scars of the Hand: The Role of Electrophotobiomodulation Theory as a Recent Line of Treatment
Plastic & Reconstructive Surgery
Cryocarboxy surgery for the aesthetic removal of congenital melanocytic nevi types I, II, and III
European Journal of Plastic Surgery
Aesthetic Treatment of Acute Burns of the Face Using Electro-Photobiomodulation
Journal of Burn Care & Research
The quicker a second-degree burn wound heals, the less surgery is required. Low-energy laser ther... more The quicker a second-degree burn wound heals, the less surgery is required. Low-energy laser therapy may expedite the healing of wounds, according to recent literature findings. To establish this, it was decided to carry out a clinical trial on acute burn patients to demonstrate whether electro-photobiomodulation (EPBM) therapy can hasten wound closure, thereby obviating the need for surgery without worsening hypertrophic scarring and contracture. In clinical prospective analysis, 42 acute burn patients with recent burns to the face alone (13) or the face and additional areas (29). Twenty-six males and 16 women were included. All patients received twice-weekly sessions of intense pulsed light (IPL) and radiofrequency for the face and other areas. Clinical assessment showed excellent results in 34 (81%) patients, good results in 6 (14.3%) patients, fair results in two (4.7%) patients, and no poor results were reported. The results of this clinical trial showed that IPL and radiofrequ...
European Journal of Plastic Surgery, 2020
Background Nasal reconstruction is one of the most challenging procedures for plastic surgeons, a... more Background Nasal reconstruction is one of the most challenging procedures for plastic surgeons, and whether it should be performed using the subunit principle versus the defect-only principle remains a matter of debate. Skin grafting and local flaps such as dorsal nasal, bi-lobed, V-Y advancement, glabellar, nasolabial, forehead, and para-median forehead flaps have been used in nasal reconstruction. Another style of flap that has also been used for nasal reconstruction is the perforator flap. In this work, we will evaluate the utility of unilateral or bilateral freestyle infra-orbital perforator flaps in the reconstruction of nasal skin defects. Methods This prospective clinical study was conducted in the plastic surgery department of Tanta University Hospital, Egypt, between February 2015 and April 2019. A total of 34 patients who presented with nasal skin tumours that did not invade the nasal bones or cartilage were ultimately enrolled in the study. Results The age of the patients ranged from 43 to 78 years, with a mean of 53 years. Clinical assessment was performed by three plastic surgeons who did not share in this study using a four-point scale. The assessment indicated excellent results in 22 (64.7%) patients, good results in 7 (20.6%) patients, fair results in 5 (14.7%) patients, and no poor results. No significant complications were observed in our experience. Conclusions We believe that unilateral and bilateral infra-orbital perforator flaps may provide an alternative reconstruction method for different nasal defects. Level of Evidence: Level IV; therapeutic study.
Research Article Open Access Introduction: The lips carry a major role in speech articulation, fa... more Research Article Open Access Introduction: The lips carry a major role in speech articulation, facial features, deglutition, aesthetic look of and oral competence. Lip Reconstruction is of great challenge to the surgeon. It needs a great attention to the precise details of
A n Egyptian papyrus document describes the use of cold as an anti-inflammatory, and Hippocrates,... more A n Egyptian papyrus document describes the use of cold as an anti-inflammatory, and Hippocrates, back in fifth century BC, recommended cold for reducing bleeding, bruising, and swelling. Cryosurgery technique involves performance of one or more freeze-thaw cycles. This causes tissue damage, vascular stasis and inflammatory response upon freezing a certain area with cryospray or cryoprobe. Furthermore, organization of polar water molecules into a clathrate around proteins will facilitate cold denaturation. In these conditions, protein loses its tertiary structure or three-dimensional shape, because non-covalent hydrophobic bonds are ruptured. Upon losing its tertiary structure, the protein is no longer able to perform its functions including the enzymatic ones. In vivo research of mouse oocytes has established that if tissue temperature is above-40°C, then formation of the intracellular is directly dependent on frozen extracellular water fraction. For intracellular crystals start to...
Background: Congenital melanocytic nevi (CMN) of the face cause substantial psychological and cos... more Background: Congenital melanocytic nevi (CMN) of the face cause substantial psychological and cosmetic problems in affected patients. The treatment of giant congenital nevi has been a longstanding challenge, but currently, various treatment options, such as cryotherapy, chemical peeling, electrical cautery, laser therapy, and surgery, have been tried for the treatment of CMN. In this article, we present our experience and the outcomes of the use of controlled CO2 gas as a cryogen in the treatment of CMN. Methods: This study included 28 patients with varying sizes of CMN seen from January 2014 to December 2017. Cryocarboxy surgery was performed in all cases. Results: The average evaluation score of our patients was excellent in 22 (78.6%) cases, good in 4 (14.3%) cases, satisfactory in two (7.1%) cases, and we had no poor results. Conclusions: Cryocarboxy surgery is a good addition to the armamentarium for the treatment of CMN. CO2 is a cheap, non-explosive, and readily available gas...
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Papers by Dr-Nader Elmelegy