Adnan Menderes

Submental artery island flap for reconstruction of the lower and mid face.

Ideal reconstruction of facial defects should be accomplished by like tissue. The submental artery island flap has the same characteristics as facial tissue, consisting of thin, pliable tissue with a perfect color match. The flap can be manipulated in different configurations employing skin, the platysma, the rim of the mandible, and the anterior belly of the digastric muscle to be utilized in the reconstruction of complex defects. The pedicle of the flap is quite reliable and enables a wide range of applicability. We have used this versatile flap successfully for various defects in 14 patients and our results are presented. Ten of the 14 flaps consisted of the skin and platysma, two flaps also included the anterior belly of the digastric muscle, one flap was elevated with the rim of the mandible, and one flap consisted of skin, the platysma, bone, and muscle.

Craniofacial reconstruction with high-density porous polyethylene implants.

Deformities of the facial skeleton may be reconstructed using autogenic or allogenic materials. Porous polyethylene is one of the few alloplastic materials currently in use having a well-documented history of reconstruction or augmentation in the maxillofacial region. High-density porous polyethylene, which is shown to be effective as a biomaterial, has additional advantages like tissue ingrowth, no capsule formation around it, and easy fixation. In this study, 83 implants in 71 patients were evaluated. Seven patients were in need of a second intervention. Three of the seven secondary interventions were for contour alignment, and four interventions were for extraction of the implants because of extrusion or infection. Placement of porous polyethylene implants directly under the skin without coverage of periosteum or another fascial envelope has an increased risk of early and especially late exposure. In cases like nasal dorsum or microtia reconstruction, we prefer autogenic grafts instead of allogenic materials.

Prevention of peritendinous adhesions following flexor tendon injury with seprafilm.

Peritendinous adhesions are the most important complication of flexor tendon injury. In this study, Seprafilm was used for the prevention of peritendinous adhesions following flexor tendon repair. Seprafilm Bioresorbable Membrane (Genzyme Corporation, Cambridge, MA) contains sodium hyaluronate and carboxymethyl cellulose. Thirty New Zealand white male rabbits were divided equally into 3 groups. In all groups, the deep flexor tendon of the third finger of the left back foot was cut and repaired by Kessler-Tajima suture technique. In the first study group following tendon repair, Seprafilm was wrapped around the repaired tendon. In the second study group, sodium hyaluronate gel was injected to the operation field after tendon repair. In the control group, no external material was applied to the field. The study groups had better range of motion. Histopathologically, study groups had less adhesions compared with the control groups. As a result, it was concluded that in rabbit the peritendinous adhesions following flexor tendon repairs could be lowered with Seprafilm and hyaluronic acid.

Reconstruction of soft tissue defects following total knee arthroplasty

Soft tissue defects following total knee arthroplasty can represent serious problems for the patient and the surgeon. Perioperative soft tissue complications can result in loss of the prosthesis or limb. In this study, we present 17 cases with complex wounds following total knee arthroplasty who had surgery between May-1994 and July-2001. Patient-related factors, wound factors, surgical operation, secondary procedures, and duration of follow-up have been analysed for each patient. After local wound care and debridement, soft tissue defects have been covered with either a fasciocutaneous or gastrocnemius myocutaneous flap. All the knees (100%) have been salvaged although in 1 patient (6%) replacement of the prosthesis was necessary. In 5 patients (30%) secondary surgical procedures have been performed. Even though there is no consensus in the management of soft tissue defects following total knee arthroplasty, adequate wound care, including identification of infection, debridement, and early appropriate defect coverage should be the main points to consider.

Reverse temporalis muscle flap for the reconstruction of orbital exenteration defects.

Orbital exenteration is a surgical procedure that results in devastating functional and aesthetic losses. Many reconstructive techniques, ranging from spontaneous epithelialization to free flaps, have been described for orbital exenteration defects. The temporalis muscle flap is one of the most frequently used flaps to obliterate the orbital cavity, but only a small portion of the muscle can be used for this purpose because most of the muscle is used as the pedicle. The reverse temporalis muscle flap based on the superficial temporal vessels is a versatile flap by which the entire temporalis muscle can be elevated and carried to defects beyond the midline. The authors have used this flap for orbital reconstruction after exenteration in 6 patients with successful results. This flap enables placement of highly vascularized tissue that provides the reconstructive goals of primary healing, obliterates dead space with separation of the orbit from the nasal cavity or sinuses, provides the potential for early postoperative radiotherapy, and offers possible flaps that can be used in combination for complex, wide defects.

Management of close-range, high-energy shotgun and rifle wounds to the face.

Close-range, high-energy shotgun wounds of the face are life-threatening and devastating traumas of the face. Suicidal attempts are the main reason in the great majority of the patients in civilian life. There is no consensus on the timing of reconstruction for bone and soft tissue defects resulting from high-energy shotgun wounds. The conventional method is primary repair as soon as possible and serial debridements and definitive reconstruction in the delayed stage. An alternative to this approach is the immediate definitive surgical reconstruction of the patient during the first operation for acute management of trauma. We had 15 patients with close-range, high-energy shotgun wounds in 10 years. Six of 15 patients referred to our center for definitive reconstruction after the acute management of the patients were performed in another center and the rest were all admitted in the acute period. Either conventional approach with delayed reconstruction for 10 patients or immediate definitive surgical reconstruction for 5 patients was used. Immediate reconstruction eliminated disadvantages of the conventional method such as high infection and scarring rate and deformities resulting from contraction of tissues. The emotional conditions of the patients were evaluated and major depression signs were determined. Functional evaluation showed that there was great correlation between facial appearance after reconstruction and social activity level.

Dermalipectomy for Body Contouring after Bariatric Surgery in Aegean Region of Turkey

Background: The only proven effective long-term treatment for morbid obesity is bariatric surgery. After surgery, additional problems may arise such as redundant hanging skin and a poor body image. The patients quality of life and social acceptance may thus still be hindered. Body contouring operations remain the only hope here. Methods: Body contouring surgery was performed on 11 patients out of 38 who had had vertical banded gastroplasty. General self-consciousness, social self-consciousness of appearance and sexual and bodily self-consciousness of appearance were measured with a retrospective questionnaire. Results: Timing of body contouring surgery was determined according to the demand of the patient and stabilization of the patients weight status. On average the first plastic surgery operation was performed after 17 (12-25) months. Mean age was 37.4 (34-65) and mean excess weight loss was 57.6 (37-129). In the 11 patients who underwent plastic procedures, a total of 23 such operations were performed, and 8 complications were encountered in these 23 operations. General self-consciousness and sexual bodily self-consciousness of appearance showed improvement after bariatric surgery and further improvement after the plastic surgery. Conclusion: For markedly redundant skin after massive weight loss, dermalipectomy is the only treatment. This improves the patients general, sexual and bodily self-consciousness.

Free arterialised venous forearm flaps for limb reconstruction

Arterialised venous flaps are an alternative method to conventional flaps. Arterialised venous flaps include only the venous network and afferent blood comes from the arterial system. Arterialised venous flaps have been mostly used for closure of small defects. We have designed an arterialised venous flap utilising the venous network of the forearm and applied this flap in 5 patients with various defects in the extremities ranging in size from 6 x 8 cm to 10 x 12 cm. Four flaps totally survived. One flap had 30% partial necrosis. Overall clinical results were successful. The free arterialised venous forearm flap provides large, thin, good quality tissue with less morbidity at the donor site without sacrificing one major artery of the hand and can be an alternative for the conventional radial forearm flap.

Effects of Nerve Growth Factor on the Neurotization of Denervated Muscles

Studies on surgical repair techniques of the peripheral nerve are still trying to improve the outcome. There are many studies on the effects of various neurotrophic factors on the transected peripheral nerve. Muscular neurotization, which is the direct implantation of the nerve to the target denervated skeletal muscle, is one of the techniques used when the primary repair of the peripheral nerves is not possible. The effects of nerve growth factor (NGF), which is one of the primary neurotrophic factors, on the reinnervation of denervated muscles by neurotization is investigated in this experimental study. The denervated soleus muscle was neurotized via peroneal nerve implantation (group 1), and NGF was administered to the neurotized muscle (group 2). All animals were evaluated at weeks 8, 10, and 12 using electromyography. Muscle contractility, muscle weight, and histological morphometric tests were performed at week 12. The experimental groups were compared with each other and normal control values. Electromyographically, group 2 (direct nerve implantation + NGF) demonstrated better reinnervation in all evaluations. The study of muscle weight showed that the muscle mass was 75% of the normal soleus muscle in group 1 and was 85% of the normal side in group 2 at the end of week 12. In group 1, the twitch force was 56% of the normal soleus muscle and was 71% in group 2. Tetanic force was 53% of the normal soleus muscle in group 1 and 68% in group 2. Histological morphometric studies revealed that there was a decrease in the density of the motor end plates in group 1, but there was no statistically significant difference between the normal soleus muscles and the NGF applied to group 2. The positive effects of NGF on the neurotization of denervated muscles seen in this study suggest that it may be useful for treating some difficult reconstructions caused by denervation.

Inverted, T-shaped silicone implant for the treatment of temporomandibular joint ankylosis.

Reconstruction of the ankylosed temporomandibular joint is a challenging task. Speech impairment, difficulties with mastication, poor oral hygiene, facial asymmetry, and mandibular micrognathia results in physical and psychologic disabilities. Various surgical techniques with varying success rates have been reported. Many autogenous and alloplastic materials have been proposed. The authors used an inverted, T-shaped silicone implant for the reconstruction of the temporomandibular joint after the release of the ankylosis in 10 patients without any complications in the postoperative period. The authors assert that the reconstruction of the ankylosed temporomandibular joint with an inverted, T-shaped silicone implant is a reliable and effective alternative. This technique can be used according to the special requirements of each patient and obviating the need for the fixation of the implant and is a safer and better way of using silicone for the treatment of temporomandibular joint ankylosis.