Basar Kaya

Suction-Assisted Lipectomy for Treatment of Lower-Extremity Lymphedema

Lymphedema typically occurs on the extremities and affects millions of people throughout the world. Although currently there is no single treatment proven effective for lymphedema in every patient, suction-assisted lipectomy has been shown to be effective in some patients. Suction-assisted lipectomy offers patients with lower-extremity lymphedema a less invasive, less morbid surgical option compared with traditional excisional techniques. In this article we present a case of lymphedema reduction with suction-assisted lipectomy in a patient with bilateral lower-extremity lymphedema.

Giant temporalis muscle metastasis of esophageal carcinoma.

Temporalis muscle metastasis of a tumor is a rare condition. Basaloid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma, which often occurs in the aerodigestive tract. To the best of our knowledge, there have been no previous reports dealing with temporalis muscle metastasis from esophageal carcinoma in the literature.

Effects of different surgical techniques on cephalic index and intracranial volume in isolated bilateral coronal synostosis model.

Background Bilateral coronal synostosis (brachycephaly) is the most common single-suture synostosis that may lead to functional deficits such as mental retardation. This increases the importance of volume gain during surgery. This study was designed to understand the differences in volume gain, cranial index (CI), and aesthetic outcomes when additional osteotomies or rotations are applied on the frontoparietal segment. Methods Acrylic brachycephaly models were prepared. Frontoparietal osteotomy was standard in all models. Frontoparietal segment was fixed: to the same position in surgical control model, after 1.2-cm advancement in advancement model, after 180-degree rotation without advancement in rotation model, after 180-degree rotation plus a horizontal osteotomy and 1.2-cm advancement in rotation plus angled advancement model, and after a horizontal osteotomy without rotation and 1.2-cm advancement and in angled advancement model. Results Intracranial volume changes (in milliliters) and CIs were as follows between groups: control group, 828/94.1; surgical control group, 830/93.8; advancement model, 900/84.5; rotation model, 834/89.1; rotation plus angled advancement model, 897/82.7; angled advancement model, 902/81.8. Conclusions Advancement of the frontoparietal segment is the keystone of surgery in brachycephaly treatment. Making an additional horizontal osteotomy can angle this segment and may supply additional volume gain. Rotation of the frontoparietal segment does not provide additional volume or CI gain but increase better aesthetic outcomes.

Evaluation of the nose profile after maxillary advancement with impaction surgeries.

ObjectiveThe aim of this study was to identify and quantify nasal profile changes following maxillary advancement (MA) and maxillary advancement with impaction (MAI) with Le Fort I osteotomies. MethodsThe study consisted of preoperative and postoperative lateral cephalograms of 42 class III adult patients. The study sample was divided into 2 groups, with the first group composed of 22 patients who underwent MA surgery and the second group composed of 20 patients who underwent MAI surgery. In total, 7 skeletal parameters and 17 soft-tissue parameters related to nasal projection, hump, dorsal convexity, and the nasolabial region were evaluated on the cephalograms, and hard- and soft-tissue relationships were assessed. ResultsNasal length, hump, nasal depths, distance from the most convex point of the Alar curvature to the most inferior point of the nostril, alar curvature-subnasale, and subnasale-pronasale measurements decreased postoperatively. In the MAI group, MA correlated with significant decreases in nasal length and hump. In the MA group, MA correlated with pronasale position (P < 0.05); significant decreases in nasal depth, columella convexity, and subnasale-pronasale length; and significant changes in subnasale position. ConclusionsThere is little difference in the effects of the 2 different maxillary surgeries on the postoperative nasal profile.

Reconstruction of the left thumb with a second toe transfer in a musician's hand

Abstract The free microvascular transfer of toes for reconstruction of the thumb remains to be an area of interest in microsurgery. The goal of reconstruction is to restore the prehensile abilities of the thumb, while achieving acceptable appearance and minimizing morbidity at the donor site. We report the case of a 21-year-old man who had second toe-to-thumb reconstruction after post-traumatic amputation of his left thumb at the metacarpophalangeal level. Before the accident, he played a musical string instrument, the “Saz”, regularly. The traditional method of playing the Saz is to pluck the strings with the fingers of the right hand and pick the strings with the thumb and fingers of the left hand. Three months after the operation, he was playing the saz again, proving that he had sufficient strength in opposition, adduction, and flexion force in the transferred toe.

The effect of regional block over pain levels during vacuum-assisted wound closure

Despite being a wound treatment method with a broad spectrum of indications, vacuum‐assisted wound closure (VAWC) can be a painful treatment modality which may even result with patient unwillingness for the continuation of treatment. A prospective study was undertaken to determine the effect of regional pain blocks (RPB) for patients who wanted to abandon treatment due to pain after the first application. Patients were asked to score their pain using a visual analogue scale for two different time frames (i) during dressing changes and (ii) while daytime treatment. This evaluation was carried out for conventional wound dressings, VAWC before RPB and finally for VAWC after RPB. The pain experienced with blocks was significantly lesser than conventional and VAWC dressing changes that were applied without pain blocks. Also, the pain was significantly lesser under pain blocks for daytime treatment. For patients with refractory pain where VAWC would prove to be of most benefit, RPB can be discussed with the patient and used. This study has shown that effective pain control can be obtained through regional blocks for patients with excruciating pain undergoing VAWC treatment.

Reconstruction of a lumbosacral defect using free latissimus dorsi flap with arteriovenous‐loop: impact of preserving serratus branch temporarily

Dear Editors, In comparison with other regions of the trunk, defects located in the lumbosacral region are rare (1). Various flaps such as local or regional have been designed to reconstruct the defects in this area (2). There are some difficulties in reconstruction arising from the quality of the surrounding tissue, and hence free flaps such as latissimus dorsi muscle flap may be a good option for reconstructing these defects. Free tissue transfer for coverage of complex wounds in the lumbosacral region can be limited by the lack of adequate recipient vessels. Suitable vessels may be at a considerable distance from the defect to be reconstructed in these situations and long vein grafts are needed for the pedicles to reach the recipient vessels, which reportedly increases the failure rate (3). In an attempt to reduce the complication rate, vein grafts and arteriovenous loops (AVLs) have been described for complex cases of free flap transfer in various body regions (4–6). In this article, we present a case with a large lumbosacral defect reconstructed with free latissimus dorsi flap (LDF) with an AVL and lesser ischaemia time while preserving the serratus branch of thoracodorsal vessels during loop maturation.

Scalp located hemangiopericytomas and review of the literature

Hemangiopericytoma is an uncommon mesenchymal vascular sarcoma which originates from the pericytes of Zimmermann and accounts for 1% of vasoformative tumors [1]. They are typically described as soft, painless, slowgrowing masses which can be misdiagnosed as a benign entity [1, 2]. Hemangiopericytoma usually arises in the deep soft tissues of the lower extremities, axilla, pelvic fossa, retroperitoneum, and head and neck [3]. Cutaneous hemangiopericytomas are rare except for infantile hemangiopericytomas [4]. The occurrence of hemangiopericytoma in the skin has been reported in not more than 20 cases [5]. In this study, we present two cases of scalp located cutaneous hemangiopericytomas.