Wound Defect management
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This document provides information about Mohamed Ahmed El-Rouby, an assistant professor of plastic and reconstructive surgery, and summarizes his expertise in wound closure techniques. It discusses direct closure for linear wounds, skin grafts or flaps for wide area wounds and skin loss, and re-implantation for amputations. Skin grafts are described as tissue transferred without its own blood supply, while flaps have an intact vascular supply. Factors like thickness, origin, adherence and revascularization processes are reviewed for grafts. Complications and various applications of grafts and flaps for nerves, fat, tendons, cartilage, bone and more are outlined.
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2. There are two main types of skin grafts - split thickness and full thickness grafts. Split thickness grafts contain some dermis while full thickness grafts contain the full epidermis and dermis. Skin flaps can be local flaps that remain attached to their original blood supply or distant flaps that are tunneled to the recipient site.
3. Key factors for successful grafts and flaps include good contact between the graft
Flaps in ortho.pdf
The document discusses different types of flaps used in orthopaedics such as local flaps, regional flaps, distant flaps, cutaneous flaps, fasciocutaneous flaps, and musculocutaneous flaps which are classified based on circulation, composition, contiguity, contour, and conditioning. It also covers topics like preoperative requirements, general plan of procedure, selection of free flaps, applications in upper and lower extremities, advantages and disadvantages of flaps.
Flaps in plastic surgery
This document discusses different types of flaps used in plastic surgery for tissue reconstruction. It begins by explaining that flaps are vascularized tissue transferred from one part of the body to another to reconstruct areas of tissue loss. The document then categorizes flaps based on their components, configuration, congruity, circulation, and conditioning. It provides examples of various local, regional, pedicled, and free flaps. Key advantages and disadvantages of different flap types are highlighted. Monitoring techniques and potential complications of flap surgery are also summarized.
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More from Dr. Mohamed El-Rouby دكتور محمد الروبي
Otoplasty: New Modification of the Mustardé technique
Title: Otoplasty: New Modification of the Mustardé technique
Author: Mohamed A.S.M. El-Rouby, MD,
Assistant Professor of Plastic surgery, Ain Shams University, Cairo, Egypt.
Abstract
Background: one of the most established techniques for management of protruding ears is the Mustardé technique (1). Many modifications had been published for this technique; however, all these modifications started by retro-auricular incision. We modify the Mustardé technique using three retroauricular microincisions to correct several deformities of the auricular cartilage in protruding ears.
Patients and Methods: 46 patients (7unilateral, 39 bilateral) (85 ears) who were candidates for this technique, their age (25 ± 2.8 years), 38 males, 8 females. The operation time, steps, follow up sessions (2 weeks, 3, 6 and 18 months) data was recorded. Preoperative and postoperative (1,18 months) photos were compared and analyzed by custom made computer program the evaluated the results.
Results: 42 patients achieve a natural appearance. extrusion of threads occurred in 8 ears. Asymmetrical ears were noticed in 4 patients and recurrence in 11 patients. These patients were revised by Mustardé technique with retro-auricular incisions. None of the patients developed retro-auricular scars.
Conclusion: this versatile modification allows for better asthenic results of otoplasty and minimizes complications of skin incision unless cartilage and/or skin resection is needed.
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This study compared the efficacy of injectable collagenase versus partial fasciectomy in treating Dupuytren's contracture. 15 patients (33 rays) were divided into two groups: Group A underwent partial fasciectomy (26 rays) while Group B was treated with collagenase injections (7 rays). The collagenase treatment was found to be safe and effective, with contractures improving significantly and few complications. However, recurrence and failure rates were slightly higher compared to surgery. While collagenase injection is a good alternative to surgery, its higher cost should be considered, especially in developing countries.Necrotizing fasciitis
Gangrene is the death of body tissue due to loss of blood supply. It is caused by infection or reduced blood flow and can be dry, wet, or gas gangrene. Dry gangrene develops slowly in tissues like the feet of diabetics. Wet gangrene occurs rapidly in moist tissues and causes swelling and odor. Gas gangrene is a medical emergency caused by soil bacteria that produce tissue-damaging gases. Treatment involves antibiotics, surgery to remove dead tissue, and sometimes amputation.
Reconstruction of eyelids defects
This document discusses reconstruction of eyelid defects. It begins by describing the anatomy and functions of the eyelids. Eyelid defects can be anatomical, involving the structure of the eyelid, or functional, affecting eyelid movement. The objectives of reconstruction are to restore anatomical integrity, physiological function, and acceptable cosmetic appearance. Various surgical techniques are described for reconstructing different types and sizes of defects in the upper and lower eyelids. Key principles include documenting the defect, avoiding tension, and using similar tissue when possible. The timing, planning and postoperative care of reconstruction are also outlined.
Basic skills in medicine
This document provides information on various topics related to wound management and suturing techniques. It begins with an introduction and contact information for Dr. Mohamed Ahmed El-Rouby. It then covers topics such as sterilization, wound classification, tetanus prophylaxis, wound healing, closure techniques, suture materials and types, and various suturing methods. Diagrams are provided to illustrate different suture patterns. The document aims to be a comprehensive reference on wound management and suturing.
Gynecomastia
The document discusses copyright law and ownership. It notes that the content is copyrighted by Dr. M.A. El-Rouby from 1999 to 2009. The summary provides the key details that the content is copyrighted material and identifies the owner and timeframe of the copyright.
Gynecomastia with local anesthesia
Liposuction causes an increase in coagulative factors in the treated area, helping to stop bleeding and allowing for minimal bleeding in additional surgery. Liposuction also leaves connections between skin and fascia intact, which is why sensation in the region is much less affected than with surgical excision that severs those connections.
Chemical peel
Dr. Mohamed Ahmed El Rouby is a consultant of plastic and reconstruction surgery at Ain shams University in Cairo, Egypt. He can be contacted via his website www.elroubyegypt.com or by email at ELROUBYEGYPT@gmail.com. Potential patients can also reach Dr. El Rouby by phone at +20101556023 or +20126531265.
Bone and cartilage healing
This document discusses bone structure, types, healing, and grafting. It describes that bone is composed of cells integrated into a rigid calcium framework. There are two main types of ossification - endochondral, where bone forms within cartilage templates in long bones, and membranous, where bone forms directly in flat bones. Fracture healing can occur directly through bony reconstruction or indirectly through soft and hard callus formation. Bone grafts are used for nonunions, defects, and augmentation, and work through osteogenesis, osteoinduction and osteoconduction. Autogenous grafts from sites like the iliac crest are commonly used but allografts and substitutes like BMP are also options.
Hemofilteration uses in burn
Burn injuries do not just cause local skin damage, but impair the function of many organs and systems through the release of inflammatory mediators into the bloodstream. Haemofiltration is a renal replacement therapy that can remove these inflammatory mediators, as well as urea, creatinine, and toxins from patients with severe burns. Indications for its use include renal failure, sepsis, respiratory distress syndrome, and refractory electrolyte imbalances or fever. The document evaluates the efficacy of haemofiltration in removing inflammatory mediators of varying molecular weights and its role in treating systemic inflammatory response syndrome in burned patients.
Aging upper face
This document does not contain any text to summarize. It appears to be blank or contain only formatting characters. A 3 sentence summary cannot be generated without substantive content in the source document.
Chronic leg ulcers & pressure sore
Chronic leg ulcer - definition, Causes, diagnosis and treatment
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Systemic Inflammatory Response Syndrome
This document provides an overview of systemic inflammatory response syndrome (SIRS) authored by Professor Dr. Mohamed El Rouby. It defines SIRS as a severe systemic response to a critical incidence characterized by disseminated immune activation and capillary dysfunction, which can result in organ dysfunction. The pathophysiology of SIRS involves the release of lipopolysaccharides and lipid-protein complexes from infected or burned tissues, triggering cytokine cascades and immune responses that can lead to multiple organ dysfunction syndrome if not controlled. Treatment focuses on eliminating triggers through antibiotics, wound excision, and supporting organ functions through ventilation, fluids, and inotropes.
Renal Failure in Burn
Renal failure is a major systemic complication that can occur after severe burns. The kidneys play important roles in excretion, regulation, and endocrine functions that are disrupted in renal failure. Acute renal failure occurs most commonly due to hypovolemia, massive dead tissue, sepsis, or hypercatabolic states. It is important to provide adequate fluid resuscitation to prevent renal failure. If it occurs, management involves clinical nutrition, renal replacement therapies like hemodialysis or hemofiltration, and treating underlying issues.
Rhytidectomy (Face Lift)
Rhytidectomy, also known as a face lift, has evolved over time from early procedures that were viewed negatively to becoming more accepted. The classic facelift technique developed in the 1950s, while newer deep plane techniques emerged in the 1990s. A thorough preoperative evaluation assesses medical history, expectations, and identifies asymmetries to plan the optimal procedure. The surgery involves incisions and redistribution of the superficial musculoaponeurotic system to improve contours, while minimizing risks like hematoma and nerve injury.
Burn management
- Burn injuries occur when skin comes into contact with heat, chemicals, electricity or radiation. The severity depends on the intensity and duration of exposure.
- Most burns occur in the home, especially for young children and the elderly, and are often caused by cooking or hot liquids. For teenagers, burns sometimes result from suicide attempts.
- Burn management involves three phases: emergent, acute, and rehabilitative. In the emergent phase, risks include shock, respiratory complications, and kidney problems, so large burns require fluid resuscitation, airway management, and wound care. Proper treatment helps prevent infection and scarring. Referral to a burn center is advised for severe or complicated burns.
Rhinoplasty - all You want to know about rhinoplasty or nose job
Rhinoplasty - all You want to know about rhinoplasty or nose jobDr. Mohamed El-Rouby دكتور محمد الروبي
Dr. Mohamed Ahmed Sayed Mostafa El-Rouby
Professor of Plastic and Reconstructive Surgery, Maxillofacial Surgery and Burn management - Faculty of Medicine - Ain Shams University
Nationality: Egyptian
Location: Cairo - EGYPT.
Address: Heliopolis, Cairo, Egypt.
Language: Arabic, mother language and English.
Telephone: +2-01001556023 or +2-01226531265
Fax: (+2)(02)(27716563)
Clinic Address: 107 El Hegaz Street, Heliopolis, Cairo, EGYPT
E-mail: DR.MOHAMED_ELROUBY@MED.ASU.EDU.EG ELROUBYEGYPT@ELROYBYEGYPT.COM
Website: www.elrouby-clinic.com
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
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10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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Wound Defect management
- 1. Mohamed Ahmed El-Rouby, MD Assistant Professor of Plastic and Reconstructive Surgery Faculty of Medicine - Ain Shams University http://www.elroubyegypt.com ELROUBYEGYPT@GMAIL.COM Mobile No.: 01001556023
- 2. Linear Wounds: direct closure Wide Area Wounds: (Defect or Skin loss): Graft or Flap Amputation: Re-implantation
- 3. Linear Wounds: direct closure Wide Area Wounds: (Defect or Skin loss): Graft or Flap Amputation: Re-implantation
- 4. •Procedures: • Skin Graft • Skin Flaps • Tissue expansion •Clinical applications •Reconstructive thinking
- 5. • Flaps with an intact vascular supply. • Grafts without its own blood supply. Any Tissue could be transferred from a donor site to a recipient site as:
- 7. according to: Thickness/composition: • split thickness, • full thickness, • composite (more than one type of tissue). Origin: • autograft, • allograft, • xenograft.
- 11. •Adherence •Plasmatic imbibition (diffusion) (<3 days) •Inosculation (3-7 days) •Revascularization (> 7 days) •Remodelling (maturation) (6m - years)
- 12. • Appendages: sweat glands and hair follicles. • Re-innervation: more in FTSG, Sensory (3–4 weeks). • Pigmentation: ☻ ☺ ☼ • Contraction: Primary contraction • immediate • due to the elastin fibre content of the dermis • is greater in FTSG. Secondary contraction • 10th day - 6th month • the recipient bed, not the skin graft, is the site of contracture. • is lesser in FTSG
- 13. • Poor recipient bed tendons or bone radiation • Sheer (Tie-over ?) • Hematoma/seroma • Infection (Bacterial level > 105 in tissue biopsy)
- 14. Nerve Fat Fat injection Tendon Cartilage ear and nose Bone Muscle Composite-graft Micrograft or Stamp graft
- 15. • Artificial Skin • Artificial Bone and Cartilages • Artificial Vessels graft • Fillers • Others ?!!
- 24. • the wound bed is unable to support a skin graft • a more complex reconstruction is needed.
- 25. A. By composition : 1. Single component Skin Fascia Muscle bone 2. Multiple components Fasciocutaneous flap Myocutanoeus flap Osseomyocutanous flap
- 26. B. By location : 1. Local 2. Regional 3. Distant 4. Free
- 27. e.g. V-Y flap, Z-plasty, rhomboid, and bilobed flaps advancement, rotation, transposition.
- 38. C. By vascular pattern Random vs. Axial Random pattern flaps: no specific or named blood vessel in pedicle. limited in dimensions, length: breadth ratio: 1:1 in limbs 1:2 in torso 1:3 in face Axial pattern flaps: designed on specific named vascular system that enters the base and runs along its axis. greater length : • Peninsular • Island • free flap
- 40. The failure of a flap: A. Vascular pedicle compromise: Tension Kinking Compression Vascular thrombosis Infection B. inability to achieve the goals of reconstruction