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Article
Closure of A Large Complicated Pharyngocutaneous Fistula

Author: Zakaria Y.Arajy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 3 Pages: 272-276
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:Pectoralis major muscle or myocutaneous flap is usually used for closure of big pharyngocutaneous fistula. In case of partial or complete failure, the plastic surgeon should be well prepared to use a second option for closure weather using myocutaneous or fasciocutaneous flaps, alone or with combination. Deepithelialized Deltopectoral flap found to be a reliable option.

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Article
Nasal Layer Lengthening in Cleft Palate Repair Outcome of Two Techniques.

Authors: Zakaria Y. Arajy --- Dhafir Dawood Hanoon
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 2 Pages: 133-137
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Cleft palate repair aims at producing closure of the cleft with reasonably lengthy palate in order to have competent velopharyngeal closure. Various procedures have been described and used for this purpose. Primary lengthening of the nasal layer is one of these procedures.OBJECTIVE:The aim of this study is to evaluate two procedures of primary nasal layer lengthening, with or without a turned in buccal flap.METHODS:The total number of our patients is 36. Twelve patients of our study did not undergo nasal layer lengthening technique and considered as control ( group A). Twenty four patients underwent lengthening of nasal layer technique.In 12 of them (group B) the raw area of nasal layer was covered only by oral layer flaps and 12 cases of them (group C) the raw area of nasal layer was covered by unilateral buccal flap.RESULT:All patients who had this technique (group B&C) obtained an acceptable lengthening of the palate and it approached the posterior pharyngeal wall. Three patients to whom we used nasal layer lengthening technique without buccal flap developed complications; two fistulas and one case of infection, while patients with nasal layer lengthening with buccal flap and patient without nasal layer lengthening technique showed lower level of complications.CONCLUSION:Nasal layer lengthening technique is a favorable technique for palatal lengthening in cleft palate repair if accompanied by buccal flap.


Article
Primary Repair of Unilateral Cleft Lip Nasal Deformity

Authors: Zakaria Y.Arajy --- Ahmed A.M.Nawres**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 212-219
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.OBJECTIVE:This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.METHODS:A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.RESULTS:The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.CONCLUSION:Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.


Article
ASSESSMENT OF AMPLIFIED V-Y FLAPS FOR NASAL DEFECT RECONSTRUCTION

Authors: Zakaria Y Arajy --- Husam M H Alaamir
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2013 Volume: 19 Issue: 2 Pages: 3-8
Publisher: Basrah University جامعة البصرة

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Abstract

Husam M H Alaamir* & Zakaria Y Arajy#*MBChB, FICMS, Plastic Surgeon. #FRCS Assist. Prof. Plastic Surgeon, Baghdad Medical City (Al-Shaheed Gazi Al-Hariri) Hospital, Baghdad-IraqAbstract The skin of the nose is relatively adherent to the underlying structures secondary to deficient subcutaneous tissues. This may interfere with local flap recruitment, as in the nasal tip, and thus it is difficult to utilize traditional V-Y flaps to close large nasal defects. The addition of an amplified limb as a transposition flap onto the advancing edge of the V-Y flap is considered. This limb is utilized from the remaining nasal skin adjacent to the defect being reconstructed and is attached to the end of the V-Y flap after its advancement to close the remaining defect. The objective is to assess the use of amplified V-Y flap in closure of relatively large nasal defects incorporating nasal tissue itself on one session. Nasal defects as large as 3.2 cm have been closed with this flap following excision of skin tumors on the nose in 14 patients over 40 years old. Most of the patients were satisfied with aesthetic end results, except in two patients with only trivial complications.There was partial necrosis at the tip of the amplified portion of the flap in the nasal dorsum and sidewall regions. Other patients were concerned about dog ears at the base of the transposed flaps that settled later on spontaneously. Conclusion and recommendation: It is advisable to use the amplified V-Y flap in reconstruction of relatively large nasal defects as one stage procedure with expected good aesthetic outcome.

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Article
CO2 Laser Evaluation as a Surgical Aid in the Management of Oro-Facial Lesions
تقييم أستخدام ليزر ثنائي اوكسيد الكاربون كأداة جراحية في معالجة الاصابات المرضية في الفم والوجه

Authors: Zakaria Y. Arajy --- Ahmed A. H. Hindy --- Nafie A. Tilfah
Journal: Iraqi Journal of Laser المجلة العراقية لليزر ISSN: 18121195 Year: 2003 Volume: 2 Issue: 1 Pages: 39-46
Publisher: Baghdad University جامعة بغداد

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Abstract

Abstract: The biological effects of the carbon dioxide (CO2) laser were evaluated using the specific absorptionof CO2 laser by biological tissue to achieve temperature – mediated localized injury. The clinical application ofCO2 laser as a surgical aid in the treatment of several oral and maxillofacial tumours and lesions was evaluated,by using the laser in the focusing mode as a cutting tool, and the defocusing mode as a photocoagulator.Thirteen patients were included (having 14 lesions, 7 of these lesions were intra oral and 7 extra oral). The CO2laser was used as a cutting and photocoagulating tool. The results showed that the CO2 laser was effective inminimizing the intra operative blood loss, especially in the treating of highly vascular lesions, it was alsoeffective in reducing the post operative pain and swelling or edema, and on follow up, the patients haduneventful healing.

في هذا البحث ، تم تقييم التأثيرات الحيوية لليزر ثنائي اوكسيد الكاربون من خلال استغلالالامتصاص المميز لهذا الليزر من قبل الانسجة الحية لتحقيق جرح موقعي حراري محدد . أستخدمهذا الليزر كأداة جراحية مساعدة في معالجة بعض الاصابات المرضية والاورام في الفم والوجه والفكين ، وكانعدد الاصابات المرضية التي عولجت هي اربعة عشر اصابة مرضية ، سبعة منها داخل الفم والاخرى خارجه ،حيث استخدم الليزر كآلة قطع وتخثير ضوئي معا". النتائج اظهرت ان ليزر ثنائي اوكسيد الكاربون كان مؤثرا فيتقليل النزف الدموي خلال العمل الجراحي ، اضافة الى كونه عامل مساعد في تقليل الاستسقاء والالم ما بعدالجراحة

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Article
Outcome of Levator Advancement Procedure for Treatment of Congenital Blepharoptosis

Author: Zakaria Y. Arajy*,Sabir O. Mustafa**,Nuas Hasab Jaafar*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 4 Pages: 389-396
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Eyelid Ptosis is classified according to etiology as congenital or acquired, simple congenital ptosis is the most common form characterized by fatty dystrophy and fibrosis of the levator muscle which leads to a restricted elevation in upgaze and a lid lag in downgaze. The choice of operation depends on the grade of ptosis and the levator function.OBJECTIVE: To evaluate the effectiveness of levator advancement technique for treatment of congenital blepharoptosis.PATIENTS AND METHODS: A prospective study done in Surgical Specialities Hospital-Medical City and Rizgary Teaching Hospital between June 2012 -June 2016; levator advancement technique was applied for treating all patients with congenital blepharoptosis with fair to excellent levator function. In this study 69 patients (77 eyelids) were included, 8 patients (11.6%) had bilateral ptosis and 61 patients (88.4%) had unilateral ptosis, some cases presented primarily for revision of ptosis. Patients ages range is (4.5-52 years), the post-operative follow up period was from 3 months up to 24 months . RESULT: In the 69 patients with congenital ptosis who were treated by levator advancement technique 7 eyelids (9% of total operated eyelids) was found to have levator dehiscence ,we found that success rate was (80.5%) as a final outcome after both the primary and revision surgery , the most common complication was under-correction in 8 cases, surgical revision performed in 8 cases (10.3%) for different reasons. Statistically significant relationship between preoperative and post-operative vertical palpebral fissure height (P < 0.0001) and degree of ptosis (P <0.0001) was observed. CONCLUSION: Levator advancement with/without resection has a high success rate and few complications in the surgical treatment of congenital ptosis with all degree of ptosis with fair to good levator function..


Article
An In Vitro Histological Study of Human Skin Wound Soldering Using 980 nm Diode Laser in Continuous versus Pulsed Modes.
دراسة نسيجية خارج الجسم الحي للصاق جروح جلد الانسان باستخدام ليزر اشباه الموصلات 980 نانومتر بنمط عمل مستمر مقارنة بنمط عمل نبضي .

Authors: Ahmed A. Abbood أحمد عبد الرزاق عبود --- Khalil I. Hajim خليل ابراهيم حاجم --- Zakaria Y. Arajy زكريا العريجي
Journal: Iraqi Journal of Laser المجلة العراقية لليزر ISSN: 18121195 Year: 2015 Volume: 14 Issue: B Pages: 1-10
Publisher: Baghdad University جامعة بغداد

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Abstract

Abstract: Background: Laser skin wound soldering offers many distinct advantages over conventional closure and laser welding techniques. Objective : to compare the histological effects of human skin wound soldering using 50 % human albumin solder and compound charcoal photosensitiser with 980 nm diode laser acting in various modes of action and parameters. Study Design/Materials and Methods: In this in vitro experimental study , Multiple 3-4 cm long full thickness incisions in a specimen of human skin were soldered using a 4 mm spot diameter beam of 980 nm diode laser(at different laser parameters and modes of action) with 50 % human albumin solder mixed with the compound charcoal at 5 % W/V concentration .After obtaining a successful wound soldering , the wound edge were excised and then studied histologically. Results: Although a single pulse per shot , spot by spot soldering technique has resulted in a weaker soldering of the wound experimentally, yet it was less tissue harmful than the continuous mode laser, inspite that the later had resulted in a stronger wound soldering. A strong wound closure didn't happen using repetitive pulsed laser mode at any of the tested parameters or action modes. Conclusion: A single spot by spot , pulsed 980 nm laser wound soldering is less tissue harmful than the continuous mode laser soldering although it has resulted in a weaker soldered wound initial tensile strength.

الخلاصة: المقدمة : الصاق الجروح بمساعدة الليزر ذو مزايا وفوائد عديدة مقارنة باغلاق الجروح بالطرق التقليدية أواللحام بالليزر. الغاية:دراسه التاثير النسيجي للصاق جروح جلد الانسان باستخدام خليط من لاصق 50% البومين بشري و كاربون مركب بمساعدة ليزر أشباه الموصلات 980 نانومتر باستخدام انماط عمل وطاقات ليزر مختلفة. المواد وطرائق العمل: لقد استخدم في هذه الدراسة خارج الجسم الحي عينات من جلد الانسان حيث تم استحداث عدة جروح طولية قطعية بطول 3-4 سم كاملة العمق خلال عينة الجلد هذه ثم تمت محاولة غلقها باللصق بتعريضها لليزر اشباه الموصلات بطول موجي 980 نانو متر وقطر البقعة 4 ملم باستخدام طاقات وأنماط عمل ليزر مختلفة مع اضافة 50% ألبومين بشري يحتوي على 5 % كربون مركب كعامل متحسس للضوء.لقد تمت مقارنة وتحليل النتائج مختبريا ونسيجيا. النتائج: ان لصاق الجروح بالليزر تكون اقل ضررا على الانسجه عندما يستخدم نمط عمل نبضي بطريقة نقطية منفرده ولكنها اضعف من حيث المتانه مقارنة باللصق بالليزر عندما يعمل الليزر بنمط عمل مستمر . لم ينجح اللصق بالليزر عندما يعمل بطريقة النبض المتكرر . ألأستنتاجات: أن لصق جروج جلد الانسان باستخدام الليزر تكون اقل ضررا على الانسجه ولكنها اقل متانة ايضا عندما يعمل الليزر بنمط عمل نبضي بطريقة لصق نقطية مقارنة بانماط العمل الاخرى.هناك الحاجة لإجراء المزيد من الدراسات المستقبلية قبل الاستخدام والتطبيق الفعلي ألسريري لهذه الطريقة الجديدة .

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