Atay Atabey

Anatomic study of the vasculature of the submental artery flap.

The submental artery island flap is a versatile option in head and neck reconstruction. This flap may be used for the coverage of perioral, intraoral, and other facial defects, leaving a relatively acceptable donor-site scar. In this study, the submental region of 13 formalin-fixed cadavers was dissected bilaterally. Comprehensive anatomical information regarding the pedicle of the flap and its relationship with the important adjacent structures is provided. The mean values of the measurements of the facial and submental arteries were as follows: the facial artery was 2.7 mm in diameter at the origin, and it crossed the mandibular border 26.6 mm from the mandibular angle. The origin of the submental artery was 27.5 mm from the origin of the facial artery, 5.0 mm from the mandibular border, and 23.8 mm from the mandibular angle. The diameter of the submental artery was 1.7 mm at the origin. The artery was found mostly to course superficial to the submandibular gland. In one case, the artery passed through the gland. The total length of the submental artery was 58.9 mm. The artery anastomosed with the contralateral artery in 92 percent of the cadavers. The submental artery was deep to the anterior belly of the digastric muscle in 81 percent of the cases. This study presents detailed anatomical data about the location, dimension, and relationship of the facial artery, the submental artery, and the submental vein that may be useful during dissection of the submental artery island flap.

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.

Cadaveric study of the arterial anatomy of the upper lip.

Arterial distribution of the upper lip was investigated in this study. The location, course, length, and diameter of the superior labial artery and its alar and septal branches were determined on 14 preserved cadaver heads. Another cadaver head was used to show the arterial tree by the colored silicone injection technique. The superior labial artery was the main artery of the upper lip and always originated from the facial artery. The superior labial artery was 45.4 mm in length, with a range from 29 to 85 mm. The mean distance of the origin of the superior labial artery from the labial commissura was 12.1 mm. The superior labial artery was 1.3 mm in external diameter at its origin. The mean distance of origin of the superior labial artery from the lower border of the mandible was 46.4 mm. The alar division of the superior labial artery was mostly found as a single branch (82 percent). Its mean length was 14.8 mm and the mean diameter at the origin was 0.5 mm. The distance between the origins of the superior labial artery and the septal branch was 33.3 mm. The septal branch was single in most of the cases (90 percent). The mean length of the septal branch was 18.0 mm and the diameter at its origin was 0.9 mm. After all dissections, it was concluded that the arterial distribution of the upper lip was not constant. The superior labial artery can occur in different locations unilaterally and bilaterally, with the branches showing variability.

Arterial anatomy of the lower lip: A cadaveric study

The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.

A Case of Self-inflicted Intraorbital Injury: Wooden Foreign Body Introduced into the Ethmoidal Sinus

A patient with an intraorbital wooden foreign body is presented. A 43-year-old schizophrenic male patient purposely introduced a twig through his left medial canthus and into the orbital cavity 6 months before presentation. Magnetic resonance imaging showed a well-delineated intraorbital object that partially penetrated the ethmoidal sinus through the medial orbital wall. Under general anesthesia, a 55-mm-long and 6-mm-diameter twig was removed through an incision along the sulcus palpebromalaris. Thick capsule formation around the foreign body, fibrosis of the adjacent tissues, and severe infection were observed. Diagnosis and management of intraorbital foreign bodies are discussed.

Increasing the Viability of Fat Grafts by Vascular Endothelial Growth Factor

OBJECTIVE To increase the viability of fat grafts using vascular endothelial growth factor (VEGF) in a calcium alginate microsphere controlled release system. DESIGN Twenty-four rats were divided into 4 groups of 6 rats each. Group 1 was the preconditioning group in which VEGF was applied prior to the fat grafting. In group 2,VEGF was given at the time of the grafting. In group 3, an empty microsphere was added to the grafting material. The fourth group, which received the fat graft only, was the control group. At the 90th day, samples of the fat grafts were weighed and compared with preimplantation weights. RESULTS The graft viability ratios of the first 3 groups were significantly higher than those of the control group. The relative adipocyte index was significantly higher in the first and second groups compared with the control group and group 3. Consistent with the literature, VEGF used both in the preconditioning procedure and simultaneously with the grafting procedure increased the graft viability ratio and relative adipocyte index. CONCLUSION This study suggests that VEGF-induced preconditioning of the recipient bed improves fat graft viability via increased revascularization.

The effects of the helium neon laser on wound healing in rabbits and on human skin fibroblasts in vitro

Helium-neon laser irradiation was applied to the denuded dermis and full-thickness open wounds on rabbit skin and cell cultures of human skin fibroblasts to investigate its effects on the wound healing process. To determine the effects of He-Ne laser radiation on epithelialization rate, 3×3 cm denuded dermis areas on the flank of 16 rabbits were irradiated daily until complete epithelialization occurred. For histopathological evaluation biopsies were taken on the first day and on the day on which epithelialization was complete. As a second part of in vivo study, identical full-thickness skin wounds were created bilaterally on the middle flank area of 12 rabbits. He-Ne laser irradiation was applied daily to the wounds until complete healing occurred to determine the effects of the low-energy laser on the contraction of open wounds. The contralateral wounds were left untreated, serving as controls. In a separate in vitro study, the effect of single or multiple applications of He-Ne laser irradiation on normal human skin fibroblasts in cell cultures was evaluated using growth measurement. The mean epithelialization time was 11±0.63 days for the laser-treated wounds and 12±0.12 days for the control wounds. The difference was not significant. No significant difference was found between the contraction rates of the full-thickness wounds (e.g., on the seventh postoperative day, the average wound area was 70.2±6.75% of original wound area in the laser-treated group and 66.±8.75% in the control group). Histopathologically, epidermal thickening and an increase in dermal vascularity were observed in healed wounds of the laser-treated groups. However, in vitro, this low-energy laser promoted cell growth in human fibroblast cell cultures in 2-and 3-day treated groups (p>0.05).

Delayed prefabricated arterial composite venous flaps: an experimental study in rabbits.

&NA; Prefabrication of composite arteriovenous flaps with implantation of an autologous graft (cartilage) or an alloplastic material (porous polyethylene) was studied in 40 rabbits. Abdominal flaps based on bilateral epigastric pedicles were elevated. An ear cartilage graft or a porous polyethylene implant was inserted under the flap. Two weeks after the operation, 10 flaps with cartilage graft and 10 flaps with porous polyethylene were raised, converted to arteriovenous flaps, and resutured in place in the experimental groups. In the other 20 rabbits of the control groups, the flaps (10 with cartilage graft and 10 with porous polyethylene) were raised and resutured in place as conventional axial flaps. At the end of the second and fourth week postoperatively, samples were obtained from the flap tissues (including a part of the graft or implantation material) and were prepared for histologic examination in all rabbits. The viable areas of all flaps were assessed at the end of fourth week after the second operation. The mean survival rates were 99.4%, 99.7%, 99.5%, and 99.8% in the arteriovenous and control flaps prefabricated with cartilage graft and the arteriovenous and control flaps prefabricated with porous polyethylene respectively. The features of wound healing in the experimental and control groups were similar. The study showed that arteriovenous perfusion can nourish a prefabricated flap containing an implanted material (autologous or alloplastic) and these 2‐week delayed composite flaps have a similar survival rate to delayed prefabricated conventional axial flaps. Karataş Ö, Atabey A, Demirdöver C, Barutçu A. Delayed prefabricated arterialized composite venous flaps: an experimental study in rabbits. Ann Plast Surg 2000;44:44‐52

Anatomy of Gracilis Muscle Flap

Abstract Gracilis muscle flap is commonly used in reconstructive surgery. The gracilis muscles of 15 formalin-fixed adult cadavers (30 cases) were dissected with 4× loupe magnification. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. It was located 60 mm from the pubic tubercle and had a diameter of 0.9 m on the average. The second pedicle was the medial circumflex femoral artery. It was the dominant pedicle in 13% of the cases. The mean diameter of the artery was 1.2 mm, and it entered the muscle 98 mm from the pubic tubercle. The third artery that nourished the muscle was deep femoral artery. It was the dominant pedicle in 87% of the cases. It had a mean diameter of 1.6 mm with a length of 54 mm. The most distant pedicles originated from the superficial femoral artery. They were present in all cases and were double in 77% of the cases. Mean diameter and length of the artery were 1.4 and 52 mm, respectively. They entered the muscle 266 mm from the pubic tubercle. These distal pedicles seem to be large enough to elevate the middle part of the muscle as a free flap.

The effects of tumescent solutions containing lidocaine and epinephrine on skin flap survival in rats.

The effects of tumescent solutions consisting of lidocaine and epinephrine on skin flap survival in rats were studied. Dorsal skin flaps of rats were infiltrated using lidocaine (1%) with epinephrine in concentrations of 1:100,000, 1:200,000, 1:400,000, and 1:800,000 prior to elevating flaps of the different experimental groups. The solutions were applied intradermally or subcutaneously, and the flaps were raised “immediately” or “delayed” after injection in the different groups. Control flaps were infiltrated by lidocaine (1%) only. The survival of the flaps was assessed on the seventh day after the operation. As a result, the flaps showed higher necrosis rates in the groups injected by lidocaine with epinephrine in concentration of 1:100,000 and 1:200,000 than of the other experimental or all control groups (P < 0.01). In conclusion, lidocaine with epinephrine in concentrations of 1:400,000 and 1:800,000 was found safe on skin flap survival for tumescent technique in rats.