Ayse Sencan

Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery.

Congenital anatomic deformities or acquired weakness of the lateral crura of the lower lateral cartilages after rhinoplasty could cause alar rim deformities. As lower lateral cartilages are the structural cornerstone of the ala and tip support, deformities and weakness of the alar cartilages might lead to both functional and esthetic problems. In this article, we are introducing sliding alar cartilage flap as a new technique to reshape and support nasal tip.One hundred sixty consecutive patients between 18 and 55 years of age (mean age: 27.51) were included in the study between January 2007 and May 2008. Of the total number of patients 60 were male and 100 of them were female. None of the patients had rhinoplasty procedure including lower lateral cartilage excision previously.Sliding alar cartilage technique was used in an open rhinoplasty approach to shape the nasal tip in all patients. This technique necessitates about 2 to 3 minutes for suturing and undermining the alar cartilages. The follow-up period was between 4 and 18 months. In no patients any revision related to the sliding alar cartilage technique was required. Revision was applied in 3 patients due to thick nasal tip skin and in one patient due to unpleasant columellar scar.In this article, we are presenting the “sliding alar cartilage flap” as a new technique for creating natural looking nasal tip. This technique shapes and supports nasal tip by spontaneous sliding of the cephalic portion of the lower lateral cartilage beneath the caudal alar cartilage, with minimal manipulation, without any cartilage resection, or cartilage grafting.

Hypercoagulability in microvascular breast reconstruction: an algorithmic approach for an underestimated situation.

Despite appropriate surgical technique and follow-up, flap failures can be encountered for which no valid reason is evident. Current literature states that these unpredictable flap failures can be caused by unknown patient factors, such as undiagnosed hypercoagulability. Our approach and experience utilizing an algorithm to minimize unpredictable failures in microvascular breast reconstruction by predetermining hypercoagulation risk factors in preoperative patients is presented. A prospective assessment of microsurgical breast reconstruction candidates between October 2007 and December 2010 was conducted. Patients were questioned about their tendency toward hypercoagulation. A thrombophilia panel was requested for patients confirming any risk factors. Appropriate surgical planning was conducted according to results of the panel. Of the 60 patients thoroughly questioned about hypercoagulation tendency, 21 (35%) confirmed having prothrombotic tendency and were referred to the thrombophilia testing. The results indicated hypercoagulation in 9 (15%) patients. The primary reconstruction plan of utilizing free flaps was abandoned for these patients and pedicled flaps or implants were preferred for reconstruction. These percentages emphasize the value of questioning risk factors and testing for hypercoagulation in patients seeking microsurgical breast reconstruction. We believe that detailed preoperative questioning of risk factors and appropriate testing according to prothrombotic tendency is beneficial in minimizing unpredictable flap failures and increasing rates of success.

Salvage of a congested DIEAP flap with subcutaneous recombinant tissue plasminogen activator treatment.

Thrombolytic agents are frequently employed in the treatment of thrombosis in combination with early surgical exploration and management. Recombinant tissue plasminogen activator is a second generation thrombolytic agent, which acts specifically at the site of the haemostatic clot with minimal side effects. In this paper, we present a case with venous congestion of the deep inferior epigastric artery perforator (DIEAP) flap, despite a patent anastomosis, in which we achieved a successful outcome with subcutaneous recombinant tissue plasminogen activator treatment.

Selfie stick: An extension of the photographer's hand in operation room conditions

Best photographs are captured by professional photographers in standard conditions. Medical photographers are professionalists who photograph patients in clinics and operation rooms and aware of sterile procedures. Unfortunately, not every medical facility employs a medical photographer. Shooting a picture intraoperatively can sometimes become a challenge when there is no one but untrained staff available.

Triggering of the Digits After Carpal Tunnel Surgery.

To the Editor: I t was nothing short of refreshing to read a reality-based, appropriately researched, honest appraisal of the Affordable Care Act (ACA) in Annals. Although there undoubtedly will be evolution regarding some of the details of that law, such as use of hospital readmission rates and some of the other specific measures used in its implementation, the institution of a system that facilitates access to health care for citizens of the most economically developed country in the world is long overdue. To have a plan that uses a market approach is uniquely American, and the staying power of that aspect of US health care will be tested over the next several years. Here in Middle Tennessee, for better or for worse, it is not uncommon to hear the ACA disparaged. It is always tempting to ask, what part of the ACA is so objectionable? Is it:

Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities.

AbstractCleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.