Adem Özkan

Survival of Minced Cartilage Grafts with Comparison Surgicel® Original and Fibrillar

BackgroundCartilage grafts are commonly used in nasal surgery for structural and/or esthetic purposes. The viability of cartilage grafts has been investigated in many forms since the use of cartilage grafts in surgical procedures.ObjectivesThe objective of this study was to investigate the viability of minced cartilage grafts and whether there is a difference between grafts wrapped in Surgicel® Original and Surgicel Fibrillar.MethodsA total of ten New Zealand rabbits were used for the study. Cartilage grafts were harvested from one side ear. Four groups were formed. Group 1: minced cartilage graft wrapped in Surgicel Fibrillar; Group 2: minced cartilage graft wrapped in Surgicel Original; Group 3: bare minced cartilage graft; and Group 4: bare diced cartilage graft. Four small subcutaneous pockets were made in the backs of the rabbits, and the grafts were placed in these pockets. All of the rabbits were sacrificed at the end of 3 months, and the samples were collected. The sections were stained with hematoxylin and eosin (H&E), toluidin blue, safranin-O, masson trichrome, and glial fibrillary acidic protein immunohistochemical. All specimens were assessed histopathologically under a light microscope.ResultsThere was no statistically significant difference between the Surgicel Fibrillar and Surgicel Original groups with respect to any of the parameters. Bone formation, calcification, inflammation, fibrosis, and basophilia were similar in all groups, with no significant difference among them. In the Surgicel Fibrillar and Surgicel Original groups, a heavy chondrocyte nucleus loss accompanied by a minimal peripheral proliferation was observed.ConclusionsThe viability of bare minced cartilage grafts was found to be similar to that of bare diced cartilage in this study. Minced cartilage grafts can be used in the correction of minor dorsal defects and irregularities in persons with thin nasal skins, especially in primary and revision rhinoplasty. Although there is no statistically significant difference between the Surgicel Fibrillary and Surgicel Original groups, we think that, if it is necessary to use oxidized regenerated cellulose, it should be in the fibrillar form.No Level AssignedThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Effectiveness of Palatal Mucosa Graft in Surgical Treatment of Sub-Glottic Stenosis

Objectives Mucosal free grafts may be successfully applied in many surgical interventions. This study aims at investigating the feasibility of palatal mucosa graft in sub-glottic field in an animal model. Methods This randomized prospective controlled study was conducted with an animal model. Sub-glottic inflammation was created in 15 adult rabbits in each group and sub-glottic stenosis surgery was applied thereafter. The rabbits in group 1 (control group) underwent segmental resection, partial cricoidectomy, and trachea-thyroid cartilage anastomosis; the rabbits in group 2 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free buccal mucosa graft; and the rabbits in group 3 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free palatal mucosa graft. Re-stenosis was evaluated after 42 days. Results The percentages of stenosis were 27%±20%, 40%±20%, and 34%±23% for group 1, 2, and 3, respectively and the difference was not statistically significant (P=0.29). Intensive and tight fibrosis was observed in 2 rabbits (13%) in group 1, in 5 rabbits (33%) in group 2, and in 3 rabbits (20%) in group 3. There was not a statistically significant difference between groups (P=0.41). Excessive inflammation was observed in 3 rabbits (20%) in group 1, in 7 rabbits (47%) in group 2, and 3 rabbits (20%) in group 3. There was no a statistically significant difference between groups although inflammation rate was higher in the rabbits which underwent buccal mucosa graft (P=0.18). Conclusion The surgical treatments applied with free mucosa graft reduced anastomosis tension through enabling anastomosis to the distal of cricoid instead of thyroid cartilage. Free palatal mucosa grafts may be used in sub-glottic field, one of the most challenging fields of trachea surgery, due to ease of application and rapid vascularization.

The Use of the PlasmaBlade and Acellular Dermal Matrix in Rhinophyma Surgery A Case Report

Background: Rhinophyma is a rare, disfiguring disease characterized by a slow progressive overgrowth of the soft tissue of the nose associated with end-stage severe acne rosacea. Objective: We present a case of severe rhinophyma treated successfully using PlasmaBlade and acellular dermal matrix with split-thickness skin graft. Methods: This procedure combines deep excision with PlasmaBlade followed by coverage with an acellular dermal matrix for dermal substitution and split-thickness skin graft. Results: Functional and aesthetic results were satisfactory. Conclusion: We offer a new approach to surgical treatment of rhinophyma. Total excision of phymatous tissue and single session replacement of epidermal-dermal components is an effective treatment for patients with severe rhinophyma, resulting in satisfactory functional and aesthetic outcome. This combined treatment modality prevents the recurrence of rhinophyma. It should be considered an appropriate alternative in cases of severe rhinophyma.

Effect of reduction mammoplasty on the pulmonary function tests

Introduction Bilateral breast reduction surgery is the surgical treatment of bilateral breast hypertrophy. This is one of the most common breast surgery requested by women, and performed by plastic surgeons. The reasons that patients want this surgery are to re-size sagging breasts aesthetically, and to get rid of somatic symptoms such as shoulder, chest, back, and neck pain. We believe that the objective positive effects of breast reduction surgery exist beside aesthetic. In our study, our aim is to elicit positive effects of surgery on lungs, if there are, by making pulmonary function test and carbon monoxide diffusion test before surgery and after 6 months of surgery. Materials and Methods Thirty patients agreed to participate in the study. Study is completed with 19 patients. Pulmonary function test and carbon monoxide diffusion test were made to all patients in preoperative and 6 months of postoperative period. Lung roentgenogram of all patients was performed and height, weight, body mass index were measured. Saturation level was measured. Result There was a meaningful increase in FEV1 and FVC values in the postoperative period in comparison with pulmonary function test performed in preoperative period. DLCO in postoperative period decreased meaningfully as compared to the preoperative period. Conclusions Breast reduction surgery seems to have positive effects on pulmonary function test values and relaxes patients clinically. Patients with big breasts should be evaluated from this perspective if they apply chest diseases clinic with shortness of breath.

Surgical Treatment of Classic Kaposi’s Sarcoma in the Lower Extremity

Objective: Classic Kaposi’s sarcoma is an indolent, angioproliferative tumor that is usually observed in the lower extremities of elderly men. Depending on their stages, skin lesions are maculonodular or vegetative ulcerated masses. Visceral organ or lymph node involvement may rarely occur. There is no gold standard treatment for local diseases. Surgical excision, radiotherapy, chemotherapy, and cryotherapy can be performed. This retrospective study aimed to evaluate the long-term results of surgical excision and skin graft repair of stage I and II classic Kaposi’s sarcoma skin lesions around the foot and ankle.

A rare cause of carpal tunnel syndrome: Fibroma of the tendon sheath

A fibroma of tendon sheath (FTS) is most commonly found in the hand. FTSs are usually seen in the fingers after the age of fifty and are clinically slow-growing well-defined mass. Here, we report the case of a 26-year-old man who featured a compression of the median nerve at the carpal tunnel secondary to a FTS of the flexor digitorum superficialis. Fibromas of a tendon sheath that compress the median nerve (MN) are rare causes of carpal tunnel syndrome (CTS). The patient was admitted with chief complaints of a growing bulge, numbness and pain in the left palm for 6 months (Figure 1A). There was a history of wrist fracture w8 months prior. Upon examination of the left-hypothenar region, a nonmobile, solid mass was detected, with no associated edema, erythema, or increased warmth. Following magnetic resonance imaging (MRI) the diagnosis of a regular soft-tissue mass under the hypothenar muscle, which was applying pressure to the carpal tunnel (Figure 1B) was suspected. Neurological and vascular examinations were unremarkable, and electrophysiological studies were not performed. The mass was totally excised under regional anesthesia. Macroscopically, the tumor was a smooth, dense, well-circumscribed, multinodular mass (Figure 1C). Final histological examination showed a circumscribed and lobulated hypocellular mass containing dense fibrocollagenous stroma with scattered spindleshaped fibroblasts without inflammatory cells. Narrow, slit-like vascular spaces were also present (Figure 1D). These histological findings were diagnostic of FTS. There were no operative or postoperative complications, and after surgery, the patient’s complaints of pain and numbness passed. Two years later, the patient remained free of symptoms and showed no recurrence.

Surgical repair of the isolated incomplete median cleft lip

Median cleft lip refers to a vertical cleft on the midline of the upper lip. It is a rare congenital craniofacial anomaly brought about by a fusion failure in the medial nasal prominence. A novel surgical approach to median cleft lips and their repair is reported herein, with reference to a clinical case. The patient had a cleft in the lower half of the upper lip. There were no other craniofacial anomalies in this patient other than the cleft. Within the framework of the patients surgical treatment, a functional and cosmetically satisfactory result was achieved by performing a V-Y advancement flap on the columella base, Z-plasty in the vermillion zone, and Z pattern muscular tissue repair, without having to resort to any tissue excisions.

The treatment of tissue defects related to the compartment syndrome occurring in the fibula osteocutaneous free flap donor area with vacuum assisted closure therapy.

Today, fibula osteocutaneous flap is commonly used for the reconstruction of segmental mandible defect. Early and late donor site complications have been reported in the literature. The most serious early complication of flap donor sites is compartment syndrome. Compartment syndrome in the donor area may develop depending on the increase in the intracompartmental pressure as a result of the largeness of skin flap and the primary closure of the donor area. In this letter, we present a case of the compartment syndrome which is developed in osteocutaneous fibula flap donor area containing 4-cm wide skin area, and the treatment of related tissue defect with vacuum-assisted closure (VAC) therapy. A 58-year-old male patient applied to our clinic complaining of wounds in the jaw and mouth existing for 5 months. In physical examination, a 9 3 6 cm expansive mass was identified as fixed to mandible and invaded in the mouth. Bone destruction was observed in radiological examination. Routine laboratory examinations were in normal range. In surgical treatment, segmental mandibulectomy and unilateral neck dissection was performed. Fibula osteocutaneous flap was planned for oral cavity mucosa defect and segmental mandible reconstruction. On the posterior crural intermuscular septum, perforator artery was determined with Doppler ultrasound. Under the pneumatic tourniquet, with standard lateral approach 12 3 4 cm flap

Extensive cervicofacial necrotizing fasciitis of odontogenic origin: case report and literature review

Necrotizing fasciitis is a potentially fatal soft tissue infection characterized by generalized necrosis and gas formation in the subcutaneous tissues and fascia. It is rarely seen in the head and neck area. This report presents the case of a 62-year-old diabetic female patient with generalized cervicofacial necrotizing fasciitis extending to the front chest wall. The cause of the disease was the extraction of the infected second molar tooth. Debridement was performed on the generalized necrotic fascia, subcutaneous tissue, and the skin extending from the preauricular area to the front chest wall and nipples. A series of debridement procedures were necessary because of generalized necrosis. The patient received intensive medical supportive treatment. Following the debridement procedures, the defective area from the neck to the front chest wall was closed up with split-thickness skin graft. Abscessed tooth extraction can lead to cervicofacial necrotizing fasciitis. Necrotizing fasciitis still remains as a potentially fatal disease. Early diagnosis, early radical surgical debridement, and a multidisciplinary approach constitute the significant factors in preventing mortality in such patients.Level of Evidence: Level V, therapeutic study

Familial bilateral peritrochanteric lipomatosis

Sir, An unusual abnormal fat distribution of the lower part of the body is characterized by massive and symmetric deposits in the groins, trochanters, buttocks, and hips, which contrast sharply with the normal upper part of the body. The massive lipomatosis of the lower part of the body can be classified into three types: type 1, the familial symmetrical lipomatosis that affects the groins, trochanters, hips, buttocks, and thighs; type 2, the bilateral peritrochanteric familial lipomatosis; and type 3, the unilateral peritrochanteric lipomatosis. This deformity affects only women aged between 18 and 50 in the Mediterranean region [1]. Further, isolated abnormal bilateral peritrochanteric lipomatosis has rarely been reported in literature. We report two patients, a mother and her daughter, with isolated bilateral peritrochanteric lipomatosis, who had normal fat distribution of the upper half of the body which was in contrast with the abnormal lower half. The mother, a 42-year-old patient, presented with bilateral abnormal fat distribution of the lower part of the body. Peritrochanteric fat deposits had appeared at the age of 13 and increased with time. The physical examination revealed bilateral isolated, well-demarcated peritrochanteric lipomatosis and normal fat distribution of the upper half of the body (Fig. 1a). The patient was 167 cm tall and weighed 72 kg (body mass index [BMI]=25.8 kg/m). Laboratory and endocrinologic tests included the serum concentrations of lipoprotein, lipoprotein lipase activity, cholesterol, triglycerides, uric acid, fasting glucose, serum estradiol, and testosterone levels, and thyroid function parameters were within normal limits. Histological study of lipoaspirate showed subcutaneous fatty tissue. The daugther, a 22-year-old patient, also presented with bilateral abnormal fat distribution of the lower part of the body. The patients signs had appeared at age of 12 also increasing with time. The physical examination revealed bilateral isolated, well-demarcated peritrochanteric lipomatosis although it was more evident on the left side (Fig. 2a). The patient was 169 cm tall and weighed 67 kg (BMI=23.5 kg/m). Laboratory and endocrinological tests were within normal limits. Histological study of lipoaspirate showed subcutaneous fatty tissue. Both patients underwent general anesthesia and all procedures were initiated with infusion of tumescent solution (1 L normal saline solution, 30 mg lidocaine, and 1 mL of 1:1,000 epinephrine) [2]. A suction-assisted liposuction method was employed using 4and 6-mm cannulae. Suction started deep into the superficial fascia and ended with superficial liposuction [3]. Incisionswere closedwith6-0 polyprolene and dressings were applied. A second limited liposuction was planned to treat the irregularities in the first case. Results were satisfactory in both cases (Figs. 1b and 2b). Isolated abnormal bilateral peritrochanteric lipomatosis has rarely been reported in literature. In 2006, Goshtasby et al. presented a case of isolated bilateral peritrochanteric lipomatosis of the soft tissue overlying the trochanters [4]. The unusual distribution of fat in the lower body should be differentiated from the familial multiple nodular symmetrical lipomatosis, where the lipomas are nodular, circumscribed, subcutaneous in location, and more common on the extremities and trunk rather than around the neck, shoulder, or the upper torso [5]. Stavropoulos and his colleagues have suggested that the term symmetric lipomatosis referred to two separate disorders, benign multiple symmetric lipomatosis and female S. Şenturk (*) Department of Plastic and Reconstructive Surgery, Mevlana (Rumi) University Hospital, Konya, Turkey e-mail: drssenturk@hotmail.com