Barış Keklik

Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction

OBJECTIVE The aim was to compare the short- and medium-term results of arthrocentesis and conventional treatment (splint, heat, and exercise) in patients with early temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR). STUDY DESIGN One hundred twenty consecutive patients (104 female, 16 male), who had been followed by a multidisciplinary TMJ unit with the diagnosis of DDw/oR were enrolled in this single-blind prospective study. Patients either underwent arthrocentesis or they were given a combination of splint, hot pack, and home exercise program. Visual analog scale (VAS) was used for pain assessment. Maximal mouth opening (MMO), lateral movement, and protrusion were measured. Repeat measurements were performed on the first, third, and sixth months following treatments. RESULTS Arthrocentesis group consisted of 54 individuals (51 female, 3 male), and the conventional treatment group consisted of 56 individuals (49 female, 7 male). The mean age values of the groups were 33.4 years (range 15-63 years) and 34.8 years (range 17-61 years), respectively. Baseline VAS and MMO values of the arthrocentesis and conventional treatment groups were similar (P > .05). Regarding VAS and MMO, lateral movement, and protrusion, the intragroup analyses showed a statistically significant reduction in both groups compared with baseline values (all P < .01). Regarding VAS values, the difference values between each evaluation and the baseline measurement were significantly higher in the arthrocentesis group, except for the first-month difference. Regarding MMO, lateral movements, and protrusion, the differences between the baseline values and each evaluation thereafter were statistically similar between the 2 groups (P > .05). CONCLUSION We conclude that early treatment either with conservative methods or with arthrocentesis is beneficial in DDw/oR. However, arthrocentesis seems to be superior regarding pain management. Therefore, arthrocentesis may be indicated in patients where painful complaints overwhelm despite other conservative treatments.

TRICHILEMMAL CYST OF THE THIRD FINGERTIP: A CASE REPORT

INTRODUCTION Trichilemmal cysts (TCs) are common skin lesions that occur in hairy areas. A TC involving a fingertip has not been previously described in the literature. We herein report a case of a TC occupying a fingertip region. CASE PRESENTATION A 43-year-old woman presented with a 1.5 × 1.5 cm nodular lesion on the third fingertip. The lesion was completely excised, and histopathological examination revealed a TC. CONCLUSION TCs may involve atypical locations, such as fingertips, where there are no hair follicles. After surgical excision, a careful histopathological examination should be performed to differentiate TCs from proliferating pilar tumors.

Posterior tibial artery cross-leg perforator flap: a case report.

Lower extremity traumatic injuries with exposed vessels mandate prompt repair. Here the authors present a traumatic case in which a contralateral “septocutaneous tibialis posterior artery perforator”–based cross-leg flap was used to cover an open wound.

Basal Cell Carcinoma in a Child

Basal cell carcinoma is the most commonly seen nonmelanoma skin cancer which is rarely encountered in the childhood period. An 11-year old child was admitted to our clinic due to an erythematous and a slightly pigmented lesion with a 3 × 4 cm diameter on his posterior scalp. Macroscopically, the lesion was excised with a 10 mm safety margin. Pathologic examination revealed a basal cell carcinoma. No symptoms or signs of a syndrome were observed both in the patient and his family.

A painful subungual lesion with a surprising diagnosis: Molluscum contagiosum

A 33-year-old female dermatologist presented to us with complaints of a painful subungual mass of 2 weeks duration on the middle finger of her right hand. On examination, a brownish, oval, lesion resembling an ‘oil spot’ located at the distal part of the nail was observed. In the following 2 weeks, the lesion grew and reached a size of 4 mm across and simultaneously a 2 mm keratotic papule formed on the hyponychium [Figure 1]. The lesion was significantly tender. Dermoscopic examination revealed brown-black vertical lines resembling splinter hemorrhages on the oil drop-like discoloration. The patient had no similar lesions anywhere else on her body and no history of any significant trauma to her hand. The list of differential diagnoses considered included subungual keratoacanthoma, fibrokeratoma, foreign body tumor, and glomus tumor. The lesion was completely excised by a plastic surgeon; a complete nail plate avulsion was done because of suspicion of a tumor [Figure 2].

Replantation of scalp avulsion following a go-kart accident: a case report.

With the development of microsurgery, successfully replanted cases of scalp avulsions have been reported. In spite of previous publications of replantations based on a single artery and vein, it is now accepted that multiple anastomoses increase the success rate. We present herein the case of a successfully replanted avulsion in a child who caught her hair in a go-kart motor belt, and we discuss the mechanism of injury and number of anastomoses.

Delayed deepithelization of the chestwall skin: A cautious approach in perforator flap breast reconstruction

Superior results in autologous breast reconstruction have been achieved by the elimination of the lower mastectomy flap and the use of the donor skin island to reconstruct the whole subunit, thus avoiding a patchy appearance and/or double-bubble contour deformity. However, while perforator flap surgery remains the gold standard, it has a steep learning curve during which the flap survival rates vary. Young surgeons may be reluctant to discard or deepithelize the lower mastectomy skin since a tragic loss of valuable tissue ensues in case of flap failure. Split thickness skin grafts taken from the failed flap or a suitable donor site are used for the supposedly temporary coverage of the chest wall, however, such discouraged patients may never return for another reconstructive attempt and are left with actually worse cosmesis than their starting point. To prevent such a deleterious outcome, we propose a safe and practical method of briefly delaying the deepithelization step. After excising the mastectomy scar and developing the upper pocket, the superior flap inset is performed and the remaining flap tissue is inserted directly on the inferior mastectomy flap. Prior to suturing the inferior border of the flap, the intact chest wall skin is prepped once again with betadine and rifampicin and an extra drain is inserted along the inframammary fold. Following the operation, the patient undergoes a 5to 8-day hospitalization period with parenteral antibiotics and close monitoring of the flap. After a secure flap circulation is established, the lower fold sutures are taken, inferior mastectomy flap is deepithelized (see Fig. 1) and the flap is reinserted to its final position under local anesthesia. At this stage, ischemic or congested flap areas are meticilously excised to prevent future fat necrosis (see Fig. 2). The main advantage of this approach is the elimination of additional procedures for chestwall coverage in case of flap failure. This is particularly important for breast cancer patients the majority of whom are quite vulnerable both physically and psychologically. The proposed method also allows for the overall evaluation of the established flap perfusion. This obviates the Figure 1. Delayed deepithelization of the inferior chest wall skin. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Effects of Zafirlukast on the Capsular Fibrosis of Silicone Breast Implants

Objective: Capsular contracture is the most common complication reported after breast augmentation. Recent studies have established the role of leukotriene receptors in capsular contracture formation. Zafirlukast is a leukotriene receptor antagonist, and its effects on experimental models of periprosthetic capsular fibrosis have been shown to decrease capsule thickness and reduce factors that are directly and indirectly involved in capsular contracture. The goal of this study was to improve the periprosthetic capsular formation model in rats and demonstrate the effects of oral Zafirlukast administration on capsular fibrosis. Methods: Forty-eight adult female Sprague-Dawley rats were divided into four groups. Smooth-surfaced, gel-filled prostheses were implanted in 36 rats. Group A: The day of the operation, 12 animals received Zafirlukast treatment for 14 weeks (oral gavage, once a day, 6 days a week, 4 mg/kg/day); Group B: 10 weeks after the operation, 12 animals received Zafirlukast treatment for 4 weeks; Group C: 12 animals were implanted but did not receive treatment; Group D: 12 animals did not have an operation, but for 14 weeks received oral gavage containing water instead of Zafirlukast. At the end of the 14 weeks, the implants with the surrounding capsules were extracted. Blind macroscopic inspectional evaluation of the capsules was performed, and microscopic capsular thickness measurements were made. Results: The mean capsular thickness was 0.033 mm (SD: 0.011) in Group A, and 0.089 mm (SD: 0.023) and 0.125 mm (SD: 0.025) in Groups B and C, respectively. Differences between Groups A and C and between Groups A and B were significant (p0.05). Similarly, Macroscopic Inspectional Fibrosis Scoring showed a significant difference between Groups A and C and a non-significant difference between Groups B and C. Conclusion: Daily prophylactic oral administration of Zafirlukast immediately after implantation significantly diminishes the development of fibrotic capsules around the silicone prostheses.

Pressure sore of the forehead as a complication of middle ear surgery

To the Editor: Pressure sores are lesions caused by unrelieved pressure to any part of the body, especially portions over bony or cartilaginous areas. The formation of a pressure sore is a result of decreased tissue tolerance in the face of applied pressure of a defined duration and intensity [1]. The most frequent sites for pressure ulcers are the occiput, sacrum, ischial tuberosities, trochanters, lateral malleoli, and posterior heels of nonambulatory patients. However, the surgeon must be cognizant that other locations of the body can undergo stress necrosis due to prolonged external pressure. Examples include arms leaning over bed rails, nasal alae due to upward taping of nasogastric and feeding tubes, malar prominences due to inaccurate positioning during surgery, cervical region secondary to prolonged collar usage, and medial thighs due to indwelling urethral catheters [2-4]. Here, we report yet another atypically located pressure sore on forehead region secondary to prolonged and unintervened elastic bandage application following middle ear surgery. A 25-year-old woman was admitted to our plastic surgery clinic with a horizontal scar of 3×12 cm on her forehead (Fig. 1). She had undergone mastoidectomy a year ago for chronic otitis media. An elastic bandage had been applied continuously for 2 days (Fig. 2). A pressure ulcer was observed after its removal. Healing by secondary intention resulted in the aforementioned scar. After evaluation, excision of the scar was offered, but the patient refused it. Therefore, conservative measures were taken with limited success. Pressure sores are most commonly seen in dependent locations of the body in patients confined to bed. However, unusual sites may as well be candidates for iatrogenically induced pressure sore formation, and health care workers Eur J Plast Surg (2008) 31:151–152 DOI 10.1007/s00238-008-0228-0

Neonatal Forearm Compartment Syndrome

Neonatal kompartman sendromu cogu zaman ust ekstremitede ulserasyon, nekroz ve doku kaybiyla seyreden nadir bir durumdur. Nekrotizan fasiit, neonatal gangren, konjenital varisella ve buna benzer klinik tablolarla karismasi nedeniyle detayli bir arastirma gerektirmekte ve iyi sonuc acisindan da erken tani ve tedavi onemli olmaktadir. Bunu vurgulamak amaciyla erken tani koyup, cerrahi olarak tedavi ettigimiz bir neonatal kompartman sendromu olgusunu sunduk.