BSAPS Journal

Introduction: The lips have important functional and aesthetic roles in daily living¹. They are the focal point of the lower face, with several aesthetic units intricately controlled by a complex series of muscles. Restoration of the whole spectrum makes reconstruction of the lip especially challenging. Case Presentation: A 25 years old female presented with a severe tissue defect on her upper lip and left angle of mouth to Japan East West Medical College Hospital, Dhaka. She explained that 1 day back she had been involved in domestic violence and her husband had bitten her on lip. An orofacial examination revealed as Lackmann’s classification of facial bite wounds type IIIa². After a proper wound excision, lip defect was covered with a Facial Artery Musculomucosal (FAMM) flap in the first stage. Oral commissure reconstruction and scar revision was done after 2 weeks as second stage, to correct macrostomia and restoration of oral competence. Autologous fat graft was performed to ensure adequate volume enhancement of the newly reconstructed lip as the third and completion stage to achieve the final aesthetic goal and patient satisfaction. Conclusions: Patient satisfaction is a whole spectrum which encompass both functional and aesthetic restoration. Therefore, aesthetic adjunct procedures may play an important role in reconstructive surgeries, especially in severe deformities. 

Early, single stage reconstruction of hand wound with a well vascularised tissue carries the best possible result. It also enables to do any secondary procedures for tendon, nerve or joints. Free tissue transfer is only rarely indicated for the palm. when required, however, these procedures can limit hospital stay and overall cost. Commonly used free flap like radial forearm flap, dorsalis pedis flap, MSAP flap, and lateral arm flap can serve the purpose of resurfacing with good functional result, but they do not match the color and texture of the palm. In this article, we have discussed a case of post burn scar contracture of hand where the patient demanded a colour and texture match of palm and denied to do a conventional free flap. So we did a medial plantar free flap to resurface the palmar defect. The results were good in terms of functional gain and very satisfactory in like with like replacement with colour and texture match. 

Abstract: Breast-conserving surgery combined with postoperative radiotherapy has become the preferred treatment for the early-stage breast cancer as it has equivalent survival to that of mastectomy. It is sometime challenging to completely excise the cancer with adequate surgical margin while preserving the natural shape and appearance of the breast. Oncoplastic breast surgery emerged as an approach to allow wider excision when required to achieve clear margin without compromising acceptable breast volume and shape. It is based on the principle of plastic surgical techniques for reshaping the breast after oncological excision of breast cancer. This review article will focus on the basic surgical options and approaches to oncoplastic breast surgery. 

Women pursue hymen reconstruction for various personal and cultural reasons. Patients may seek to restore the native hymen following sexual violence, medical interventions, or other involuntary hymenal injuries to reclaim personal ownership of their bodies. Others wish to reexperience their first penetrative sexual encounter with a partner¹. Certainly the most commonly reported motivation is the restoration of physical virginity to align patients with the premarital expectations of their ethnic and religious backgrounds. The role and need of hymenoplasty is debatable. But that is not true for the revirgination procedure. In revirgination the tightness created cannot be denied to a patient by any law anywhere in the world, and it is the right of every woman to request this. Every married couple is entitled to the feel of vaginal tightness and accompanying intensified sexual pleasure. The concept of deception is not relevant. This operation is done for the patients, and the principle of confidentiality is as old as medicine itself but factors such as sporting activities and the use of tampons mean that bleeding with first sexual intercourse is not essential². Over and above, the method is consistent, reproducible and repeatable if required. The newly reconstructed hymen is strong enough to sustain daily activities, but at the same time weak enough to get ruptured at the time of sexual penetration³. 

Introduction: Plastic surgeons all over the world are challenged with a dramatically increased public interest and demand for aesthetic contouring surgery. There is growing advocacy for autologous fat transfer techniques for contouring various defects among surgeons due to its safety, flexibility and long-lasting results. Methods: This study was conducted between March 2017 to July 2019. Patients with contour deformities were enrolled consecutively. All participants were subjected to a full clinical history and general clinical examination with laboratory findings to confirm their fitness for surgery. Fat harvested and lipoinjection procedure performed. Patients were followed up for six months and beyond. Surgeon satisfaction and patient satisfaction assessment was performed by clinical examination and comparing the preoperative and six-month postoperative photographs. Results: Total 22 patients were included in the study of which 19 patients were female and 3 patients male. Indications of lipoinjection were-Facial rejuvenation¹¹, Hand rejuvenation⁴, Breast augmentation and asymmetry³, Facial Scar¹, Gluteal augmentation³. Overall results of the procedure were excellent. Conclusion: Soft tissue augmentation with autologous fat, which leaves no incisional scar and lacks the complications associated with foreign materials, can be an ideal procedure for plastic surgeons.

Background: Rhinoplasty can be either reconstructive or aesthetic. The history of rhinoplasty dates back to 2500 years. It was first documented in the Indian subcontinent by Sushruta, a case of reconstructive rhinoplasty on 600 BC, whereas John Orlando Roe performed the first cosmetic rhinoplasty in 1887 in New York1. In the West, rhinoplasty is a very commonly performed operation, but it has not gained popularity in Bangladesh yet. This study was carried out to assess the outcome in our cases of rhinoplasty, especially with regard to complication and their management. Methods: The period of study was from January 2000 to November 2018. 457 cases of rhinoplasty were done. The desires and expectations of the patients were noted; and probable results were discussed before surgery. The procedure for augmentation rhinoplasty consisted of reconstruction of the dorsum of the nose by conchal cartilage graft taken from the external ear, ulnar bone graft, or silicone (nasal) implant. Other cosmetic rhinoplasty procedures included dorsal hump reduction, tip plasty for the bifid or broad tip and Alar Base Reduction for wide nose with afar prominence. Combination procedures were done frequently. Reconstructive rhinoplasty was performed with median/paramedian forehead flap or composite auricular graft. Results: Excellent results were found in 409 cases, satisfactory in 39 cases and unsatisfactory in 09 cases. Complications were minimal and insignificant. Conclusion: We conclude that if expertise is developed rhinoplasty, whether cosmetic or reconstructive, can be performed more frequently and with more satisfactory results. Hands on training, workshops and initial supervision is very important.

This paper aimed at a newer technique for dorsal augmentation during rhinoplasty using diced cartilage wrapped in fascia. The usage of diced cartilage has been variously described in the literature with consistently satisfactory results. We present our early experience with patients undergoing dorsal augmentation during rhinoplasty using an updated method of diced cartilage wrapped in fascia with a single incision at donor site. The term is broadly descriptive and there remains a wide-range of ways to execute. Updating and enhancing the technique with greater attention to create precision, and creating an aesthetically optimal and predictable result, may improve outcomes for future patients. 

Breast reduction is a highly effecaceous procedure for macromastia with a great amount of patient satisfaction and low rate of complications. In this study reduction mammoplasty was carried out by inferior and superior or superomedial pedicle. In all patients inverted T or wise pattern technique was used. Study Population comprises of 09 patients in whom inferior pedicle was carried out in in 05 patients and superior or superomedial pedicle was used in 04 patients. Both Pedicles have their own advantages and disadvantage, although superior of superomedial pedicle is more popular now a days. In this study the complications were minor which were easily dealt with. 

Introduction: The use of drains during lipoabdominoplasty operation has been a routine procedure all along. This is done to prevent seroma formation. But there are problems associated with drains, such as, pain, difficulty in patient mobilization, blockage, and infection¹. Strategies to prevent seroma has been tried². But with improvement in dissection technique along with other strategies to prevent seroma, surgeons have now started to avoid using drains. The aim of this study is to see the incidence of complications especially when drain is not employed. Materials and Methods: The study was carried out in Cosmetic Surgery Centre Ltd and Bangladesh Specialized Hospital Ltd, Dhaka. Period of study 2y 06 month from June 2017 to December 2019. Number of Lipoabdominoplasties done was 47. Females were 44 and males were 03. All the patients were operated under spinal anesthesia except 3, in whom general anesthesia was applied for additional procedures Fascia Scarpa sparing lipoabdominoplasties were performed in all cases. No drains were used in 46 patients. But in one case, drain had to be employed due to excessive preoperative oozing. Postoperatively patients were evaluated for seroma formation, wound dehiscence, flap necrosis and infection. Results: Only 4 patients amongst drainless abdominoplasty had seroma formation and one patient in whom drain was used had a minor wound dehiscence. None of the patients had flap necrosis or infection. Early mobilization was easier in patients without drain. Conclusions: We found that sparing the infraumbilical fascia Scarpa during dissection along with wound closure without tension and avoidance of gliding surfaces with the use of quilting sutures can help avoid the use of drain in lipoabdominoplasty operation. Avoiding drains permits better patients comfort and early ambulation. 

Background: There are multiple options for surgical treatment of gynecomastia including liposuction, subcutaneous mastectomy and combination of both. In this study we observed the outcome of the options of surgical treatment of Simons Grade I and Grade IIA gynecomastia. Methods: This is an observational study of 26 patients who underwent surgery for gynecomastia. Surgical management was planned according to grading of gynecomastia, amount of fatty tissue and glandular tissue present in the enlarged breast. Outcome was assessed and patient satisfaction was surveyed with regards to palpable lump, size, shape, scaring and overall outcome. Results: Out of 26 patients 25 had bilateral gynecomastia, 1 had unilateral gynecomastia. So, total 51 breasts were operated. Of them 23 breasts where Grade L 28 breast were Grade IIA. 21 breasts were treated with liposuction only, 30 were treated with combination of liposuction and subcutaneous mastectomy. More satisfactory results were observed in combination group with liposuction and subcutaneous mastectomy. Conclusion: Our study shows that combination treatment with liposuction and subcutaneous mastectomy results in satisfactory outcome.