Ayhan Numanoğlu

The effects of the size of liposuction cannula on adipocyte survival and the optimum temperature for fat graft storage: an experimental study

BACKGROUND Determining the most advantageous size of liposuction cannula and injection needles in terms of adipocyte viability could help to increase fat graft survival. When recurrent injections are necessary, storing fat tissue which is harvested during the first operation could be a practical solution if it is stored at an appropriate temperature providing the highest amount of viable fat cells. METHODS Fat tissue was removed from the abdomen of 10 consecutive female patients by 6-, 4- and 2-mm-diameter liposuction cannulas. Fat tissue harvested with the 6mm cannula was injected through 14, 16 and 20 g needles and collected in separate tubes. An additional three tubes of fat samples were prepared from fat tissue obtained with the 6mm cannula to be stored at +4, -20 and -80 degrees C for 2 weeks. Viability of the fat grafts was evaluated by fat cell isolation with collagenase digestion and staining with supravital dye and counting adipocytes with a haemocytometer. RESULTS The viability of fat grafts harvested with the 6mm cannula was higher than grafts obtained with smaller cannulas. The viability of fat grafts injected through 14, 16 and 20 g needles were similar to each other. The viability of fat grafts stored at +4 degrees C was similar to fresh tissue whereas freezing fat grafts caused significant loss of viable adipocytes compared to fresh tissue. CONCLUSIONS The use of larger liposuction cannulas for fat tissue harvesting provides more viable fat grafts. A temperature of +4 degrees C could be proposed as an effective and easily available way of storing fat grafts for at least 2 weeks.

The mental V-Y island advancement flap in functional lower lip reconstruction.

&NA; Various flap procedures for the reconstruction of lower lip defects have been described to achieve the basic requirements of a functional repair, namely muscle function and sensation. Flaps elevated from the upper lip or the adjacent cheek may provide a solution, but for larger lower lip defects, preservation of function is difficult. In this article, a new functional lower lip reconstruction technique that includes the transfer of a myocutaneous flap based on the mental neurovascular bundle and on the branches of the facial artery is described. The principle of this reconstructive procedure is to advance the tissues from both sides of the chin as myocutaneous flaps upward to the lip defect, reorienting the muscles of the flap for sphincteric function, and preserving the mental nerve for sensation. The depressor anguli oris and remnants of the orbicularis muscle together with their motor nerve branches are included in the V‐Y advancement flap. (Plast. Reconstr. Surg. 100: 1682, 1997.)

Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps

Neurotized fasciocutaneous flaps and split-skin grafted muscle flaps are the most frequently used free flap alternatives for the reconstruction of weight-bearing surfaces of the foot. An objective comparison of the innate characteristics of these two flap types, with respect to long-term stability, has not been possible because sensory reinnervation in the fasciocutaneous flaps has been a confounding factor. This study compares nonsensate fasciocutaneous flaps (n = 9) with nonsensate split-skin grafted muscle flaps (n = 11), with mean follow-up periods of 34.3 and 31.3 months, respectively. Patients completed a form that included questions regarding degree of pain at the operative site, presence of ulcers, ability to wear normal shoes, employment status, and time spent standing on foot. Touch and deep sensation were evaluated with Semmes-Weinstein and vibration tests, respectively. Significantly less pain and less ulceration (p < 0.05) were observed in the fasciocutaneous group. Semmes-Weinstein monofilament tests revealed poorer results with split-skin grafted muscle flaps, compared with fasciocutaneous flaps. These results indicate that even if the sensory protection of fasciocutaneous flaps is not considered, these flaps have superior properties, compared with split-skin grafted muscle flaps.

Plastic surgical techniques in the fifteenth century by Serafeddin Sabuncuoğlu.

Serafeddin Sabuncuoğlu (A.D. 1385-1468) is the author of the first illustrated surgical textbook in the Turkish-Islamic literature, namely, Cerrahiyet-ül Haniyye (Imperial Surgery). A pioneer in all fields of surgery. Sabuncuoğlu developed numerous original techniques. He was a keen observer and inventor and a prolific writer who combined his fortune with knowledge of his era. He described a mass reduction procedure for the management of gynecomastia, probably one of the first attempts at reduction mammaplasty. He gave detailed descriptions of different eyelid pathologies and their surgical managements. The aim of this study is to investigate the contributions of this remarkable pioneer to the field of plastic surgery.

Patients' and surgeons' perspectives on the scar components after inferior pedicle breast reduction surgery.

Background: Scarring is the most frequent cause of dissatisfaction both for the surgeons and for the patients in breast reduction surgery. Some of the techniques used today use the classic inverted T scar. An inverted T scar is a combination of three separate scars (periareolar, vertical, and inframammary). To the authors’ knowledge, no study has investigated the cosmetic outcome of these three scar components separately. The aim of this study was to determine the surgeons’ and patients’ perspectives on the cosmetic outcome of these three scar components. Methods: A total of 19 patients who had inferior pedicle reduction mammaplasties were included in the study. The patients’ perspectives on their reduction mammaplasty scars and the surgeons’ evaluations of scar hypertrophy, widening, and color match were assessed by Likert scales. Results: Patient evaluations revealed that periareolar scars were the most pleasing, whereas the inframammary scars were the least pleasing. Surgeon evaluations revealed no significant difference in scar hypertrophy, color match, or widening for the three scar components. However, the vertical scar had a tendency to widen and the inframammary scar color tended to match poorly. Conclusions: In this study, patients were most pleased with the periareolar scars and least pleased with the inframammary scars. Surgeons need to find ways of getting rid of the inframammary scar and should also deal with vertical scar widening. Scar hypertrophy was not a problem in this patient population.

Two Patients With Penile Keloids: A Review of the Literature

Keloid formation on the penis is exceptionally rare even though the penis is frequently subjected to surgical manipulations such as circumcision. Review of the literature revealed a few reports of patients with penile keloids. A 13-year-old Caucasian boy who had a pronounced penile keloid after circumcision and a 56-year-old Caucasian male who had keloid formation on the dorsum of the shaft of the penis after several attacks of penoscrotal hidradenitis suppurativa are presented. They comprise the fifth and the sixth cases of keloid formation in the literature to our knowledge. Intralesional steroid injection and surgical excision are the treatment modalities for this malady. Surgical excision appears to be the choice of treatment for larger lesions that are disabling. Recurrence is still possible, of course.

Commissure-based buccal mucosal flap

&NA; Commissure‐based buccal mucosal flaps extending to the retromolar trigone have been used for anterior intraoral mucosal defects. The flap was utilized successfully in 26 patients who had vermilion defect (14 cases), obliteration of the anterior gingivobuccal sulcus (8 cases), and anterior maxillary defect (4 cases). (Plast. Reconstr. Surg. 101: 1223, 1998.)

Subepineural hyperplastic pacinian corpuscle: an unusual cause of digital pain.

A case is presented in which the patients chief complaint was severe digital pain radiating to the arm. Even light touch was enough to produce unbearable pain, which prevented the patient from carrying out simple daily tasks. She had complete relief of her symptoms following removal of the hyperplastic pacinian corpuscle and returned to her normal life. A review of the literature revealed few reported cases of hypertrophied pacinian corpuscles in the hand. We believe that this diagnosis must be considered in the differential diagnosis of digital pain of unknown etiology.

Septocolumellar suture in closed rhinoplasty.

Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of them and can be described as a loop suture between the medial crura and caudal septum. Although some of the articles mention that it can be applied in closed rhinoplasty, there is no description of the technical details. This paper presents indications, technical steps, and advantages of the septocolumellar suture in closed rhinoplasty. After completing the classic sequence of the endonasal extramucous technique, the medial crural cartilages are dissected from the overlying skin at the midcolumellar level, keeping the distal fibrous attachments between the anterior columellar skin and these cartilages intact. A 5/0 or 4/0 Prolene (Ethicon Ltd, UK) with a round needle is passed, penetrating both the medial crura and then the caudal septum. Depending on the penetration level of this suture, the tip projection can be increased or decreased, the tip can be rotated, and columellar show can be corrected. This suture also makes the medial crura of the alar cartilages and septum rigidly fixed together, thus providing stability. Depending on the experience gained in 433 primary and 62 secondary rhinoplasty cases since 2000, it can be claimed that this technique, presenting an alternative to the open approach in many cases and expanding the borders of closed approach, allows one to manipulate the tip and columella easily with closed rhinoplasty and provides a significant decrease in the suboptimal results and number of complications.

Closure of infratip nasal defect by two triangular flaps.

The nasal lobule is subdivided into the supratip, tip, and infratip. Various local flaps derived from the dorsal aspect of the nose are often used for resurfacing nasal tip defects, including some parts of the infratip and/or the supratip region.1–5 Isolated infratip defects after excisional therapies are less commonly encountered. In our opinion, it does not seem reasonable to reconstruct an isolated infratip defect with dorsal flaps. This article describes the use of two triangular skin flaps based on the columella for the reconstruction of such defects.