Wednesday, August 28, 2013

Asiatic Aesthetic Series 10:Using a SIM card to announce cleft charity camps to patients

One of the innovative ways of registering cleft lip and palate patients at Baadan government hospital is to use a five dollar SIM card to send text messages directly to many patients so that they can register for the three to four day camp. The number of registered patients is usually around 50, and the rest are informed in stages. This way, we are able to deliver more effective services to all our patients .
Out of the total number,at least 70%-75% will be fit for surgery.The others who may not be fit are given medical consultations,referred to the local child specialist and nutrition experts who help them with the next phase of treatment.
These days, most villagers are able to afford cheap GSM 2G phones which are manufactured in bulk by Chinese companies.Some phones are as cheap as $15-$20 and affordable by the poor.
The disadvantage of registering too many patients through the local media is that many register for surgery but do not get always get a chance for an early operation. Complications are also much higher in large volume work.
We find it easier on to limit the number of surgeries to 21 in each camp, over a three day period.The camps are usually repeated every 3-4 weeks across the governorates.

Tuesday, August 27, 2013

Asiatic Aesthetic Series 11: Social media advertising for cleft children

Social media advertising is one of the ways cleft groups advertise cleft charity services to families and communities that have members with cleft lip and palate problems. Facebook and Twitter are commonly used for this purpose.Many wellwishers and cleft patients are able to know about the charity services through these advertisements. A contact number from the smile units makes it easy for the patients to register for free consultations and surgeries.
In our situation, we find it useful to use mobile texting ,local newspapers,radio and TV to register hundreds of patients who would otherwise never get a chance to learn about the free smile surgeries.

As a result of the efforts of friends and well wishers, we were able to register thousands of children over the years and have completed a large list of smile operations. 
The most recent advertisements for the Smile Train US surgeries helped over a thousand children since January 2010 with consultations,and surgery.

Asiatic Aesthetic Series 12:lip and nose adjustments in secondary cleft surgery

In this adult patient, the left ala region is distorted and the left lip thinned out
The lip is augmented with a z plasty using a larger z flap from the opposite side to correct the defect-the swelling is because of saline adrenaline .The nose if equalized by correcting the left ala cartilage and excess skin removed. The fine procedures give some improvement .

Monday, August 26, 2013

Asiatic Aesthetic Series 13:Unilateral hinge flap and contralateral button hole release in 2nd stage hard palate closure

the unilateral hinge flap was designed here a few years ago during our mega volume cleft palate surgery camps.The opposite side is elevated by using a button hole incision near the rugae and the edges approximated easily to the hinge flap
The blood loss is much less as a result of this innovation.

Saturday, August 24, 2013

Asiatic Aesthetic Series14:Cleft children get a second chance at life from Smile Train at Baadan Governorate

After a long break from smile camps ,because of the deteriorating security situation across many governorates,we were able to register several cleft lip and palate children this week at the  smile centre in Baadan hospital for free Smile Train surgeries.
Due to the heavy rains and poor visibility on the roads some patients were late but six children were operated successfully on the first day.The other children will be operated over the next two and a half days.
The total number of cleft children spsonsored by the  Smile Train is now 929.
If the security situation improves, we should be able to register cleft children for regular monthly camps at the Baadan hospital for free plastic surgeries under the Smile Train programmes.

Tuesday, August 20, 2013

Asiatic Aesthetic Series15:MT microneedleing PRPM scar reduction methods in cleft lip surgery

Scar improvement and reduction in cleft lip surgery can be done for bad scars by micro needling using the 1.5mm MT roller along with PRPM injections every month till the scar becomes almost normal.
The microneedling procedure is done under local anesthesia,rolling the MT needler in a horizontal,vertical and oblique direction using about 10 passes each time till there is some spot bleeding
PRPM can be injected in small amounts using a 1cc insulin syringe ,or applied locally.

This method induces new collagen formation which remodels the scar.The overall results are a huge improvement in scar appearance.

Sunday, August 18, 2013

Asiatic Aesthetic Series16:Isolated cleft children

Cleft children from impoverished backgrounds do not have access to plastic surgical facilities in bigger cities.Most of them live in isolation and are not even aware that plastic surgical missions exist for them.One of the biggest challenges we face in such missions is to raise patient awareness in such countries.
 Despite efforts by some government and private agencies to help these children,the villages are often inaccessible because there are no roads and mobile phones do not work in those remote regions.
Even if some are able to attend our charity camps,the follow up for further corrective surgeries is a logistical nightmare because of their impoverished lives.
Warring factions in some countries make this task even more daunting because expats are afraid to venture into such dangerous zones.Some medics have been gunned down by terrorists in recent years and as a result the focus has shifted from safari workshops to training local surgeons and medics to face the challenges  in their own regions.

Saturday, August 17, 2013

Asiatic Aesthetic Series17:A race well run

Thanks to all who ran this 15 year race with us
to those who took part in the grand mission
to the well wishers as well as spectators on the sidelines
a lot achieved over the years and many healed
God bless...

Sunday, August 11, 2013

Asiatic Aesthetic Series18:fingerstyle feature Guitar College CA

                     Rich Severson  Guitar College/GIT CA

June 7 2013

Thursday, August 8, 2013

Asiatic Aesthetic Series19:The price tag of instability in Arabia Felix

The face of Yemen has changed forever since the Arab uprisings of 2011 and copycat demonstrations in Sana'a. Speaking as an expat medic who has traveled extensively across the entire nation for plastic surgical patients from Saadah to Socotra, I notice the incredible changes since 2003 when HMA Frances Guy, HMA Mike and Trish Gifford, Total E&P ,DNO helped  a few of us conduct mission camps across the entire country .
When we first launched the charity at the Brit Pub Hadda in June 2003, all of us could travel around freely .

Things changed drastically in 2004 during the war in Saadah where thousands were massacred and hundreds of thousands displaced from the region.This went on for several years with heavy casualties on both sides.
2011 changed the face of Yemen forever. Today,millions of Yemenis are without jobs and there is little hope of any reconciliation between warring factions in the country.
A lot of the violence is not due to terrorist attacks, but  inter tribal blood feuds over many years.

We were often caught  between warring factions in Dhamar and elsewhere .Our team is happy to be alive to tell the tale . 
Although our smile team tried to make plastic,burns and cleft surgeries freely available to the entire nation through the US Smile Train and others, our work more or less ground to an abrupt halt  after a few camps when we ourselves were almost killed in action.Several expats have been mercilessly gunned down by radicals for no reason at all. We have held some of our camps under the protection of friends with automatics and other weapons. I do not think I would like to go through this kind of experience again.
Many patients from the inaccessible regions or disturbed zones find it impossible to attend any decent hospital for their free surgeries. 
The waiting list grows every week, but since there are no expat volunteers who want to take the risk,it will be a while before there are any major camps across the country.

Asiatic Aesthetic Series20:A day in the life of a poor Yemeni cleft child

What is life like for most cleft patients in impoverished regions of the world?
I met some patients from the villages of Yemen and found out just how poor they are.
When we asked some of the parents from the villages of Hodeidah to keep their children fasting in the morning of the operation,many of them told us that would not be a problem at all because they were so poor that they often ate only one meal a day.
That is what life is like for most of our poor cleft patients.
In the nearby gulf states of Saudi and others, people are feasting day and night,often wasting huge amounts of food, which is thrown away.
This is the sad reality in this part of the world where the poor,like elsewhere,have no one to reach out to them.

Asiatic Aesthetic Series20:Rural cleft and plastic surgery missions

Suggested timing for Lip and Palate Surgeries in rural missions:

Cleft Lip Surgery: child must weigh 10 kg or above/ at least 6 months of age
Cleft Palate: approx 1.2-2 years
The risks outweigh the benefits if the surgeries are done at a lower age ,and the
incidence of post operative complications like hypoxia and breathing problems are significantly higher especially for palates done before the age of one year.

Rhinoplasties:  late teens

Monday, August 5, 2013

Asiatic Aesthetic Series21:Topic Discussion:Simplified Distraction Device for craniofacial microsomia

A Simplified Distraction Device for craniofacial microsomia

Phases of  distraction osteogenesis:

In 1992,McCarthy reported the first application of distraction osteogenesis to lengthen the human
Latent phase: immediately following the osteotomy and application of the distractor:ranges from 1-7 days
Activation phase:the device is activated by distracting it at 1mm per day:in response to the force,the callus elongates
Consolidation phase: once activation is complete,the phase of consolidation -6-8 weeks

Simplified design:

flexible and stable bone distraction device
Stainless steel intraosseous screws, 2mm diameter
Different lengths-35,45 and 55mm
Three sections:
1.a distal end with a sharp self tapping cortical screw
2.proximal end with a conventional screw that fits into the disks
3.a flattened section in between both ends
Distraction is a less aggressive procedure,allows great precision and allows fast recovery

The disks have a threaded central hole that receives the distal end of the anchoring screws
The active disk has a transverse threaded passage whose thread matches that of the distracting screw
The passive disk is also perforated transversely by a passage without threads that ends blindly and receives
 the end of the distracting screw
The distracting screw has a slotted head so that a conventional screwdriver can be used to activate it;this
screw comes in 100,120 and 150 mm lengths

Incision:4 cm long in the depth of the mandibular buccal sulcus
Subperiosteal dissection to expose corticotomy site
Sleeve protector when inserting screws at a distance of 15mm in between ;through buccal and lingual cortex
Take care of dental germs,tooth roots and nv bundle
Complete corticotomy with burrs and saws taking care to protect the nv bundle

One turn of the screw/day =1mm /per day
After the desired correction is achieved, leave the distractor for another 6-8 weeks to allow for bone consolidation
X ray check before removal
Cephalometric x rays, dental casts, photos used for pre and post op evaluation

Suggested reading:

Jaime G : Distraction osteogenesis-multiplanar mandibular distractor: PRS 2000 105:883
Antonio FD :Simplified bone distractor for induced osteogenesis: PRS 2002Nov 1487
Jack CYu ,Jeffry F:distraction osteogenesis of the craniofacial skeleton:PRS 2004:114:1e
M Suhr,Technical considerations in distraction osteogenesis :Intl J Oral Maxfacial Surg 2004: 33:89-94

Asiatic Aesthetic Series22:Checklist for cleft missions in poor regions

What you require in a cleft mission recovery room/ ICU:  Checklist
It may save a life!Thousand of patients have been saved using this method...

A. First Line Drugs in a medicine tray -these are what you call the essential and life saving drugs in any emergency
1. Adrenaline ampoules
2. Atropine
3. Lidocaine
4.dexamethasone vials
5.hydrocortisone vials
6.dopamine ampoules
7.Deriphylline ampoules
8.Aminophylline ampoules
9.50 % dextrose vials
10. IV fluids. Dextrose saline, 5 % dextrose, Ringer Lactate
11.sodium bicarbonate vials
12. Calcium gluconate/chloride vials
13. Lasix ampoules
14. Morphine vial
15.Manintol bottle
16.Diazepam ampoules
17 Phenobarbital ampoules

B.  An Electrocardiogram machine and a defibrillator; multiparameter monitor,  finger pulse Oximeters for the nurse on duty in the room

C. A ventilator, suction unit and at least 2-3 oxygen cylinders with all connector masks, an IV fluid warmer, warm blankets for children,

D. An Ambu bag resuscitation kit for adults and child/ keep a bed pan and also some plastic bins in case patient vomits

E. Plastic disposable airways , laryngeal masks, suction catheters different sizes, Foleys catheters child and adult with urine bags, disposable gowns,masks,and caps, disposable syringes 3cc, 5cc and 10cc,naso gastric tubes different sizes

F. Headlights for emergency (LED)/ one portable light source

G. Nursing station with table, chair and records for ready reference

H. Laryngoscopes adult and child, Maegel forceps, dressing trays, sterile gauze in a drum, plaster, cutting scissors, rubbish bins 2

This would be enough for a very good recovery and ICU room

Keep one duty nurse there at all times.. Different shifts

Sunday, August 4, 2013

Asiatic Aesthetic Series23:PDF lessons for the benefit of cleft trainess in developing nations

With the deteriorating security situations across many developing nations, cleft lip and palate missions are unable to function at full capacity and many cleft children cannot receive the much needed treatment .

The free academy of aesthetic cleft surgery was designed using over 2500 well standardized and even improved aesthetic cleft surgeries over several years. The modules are easy to understand and hands on sessions easy to follow.
The main aim of this training is to increase the availability of expertise across the developing world so that cleft surgeons are well trained to help their rural patients.

The lessons are in PDF format and can be requested from my website.Hands on sessions are held at selected hospitals.

Thanks and bon chance to all,