Bilge Kagan Aysal

Is It Possible to Increase Flap Viability by Hydrostatic Dilation?: An Experimental Study in the Rat Abdominal Fasciocutaneous Flap Model.

IntroductionErgun et al previously demonstrated the efficacy of hydrostatic dilation in a TRAM flap model in an experimental study. We investigated the effect of hydrostatic dilation on a fasciocutaneous flap model. MethodsEighteen female Wistar rats were equally divided into 3 groups, of which 1 served as a control. In the second, the abdominal fasciocutaneous flap surgical delay procedure was performed by division of the left superficial inferior epigastric (SIE) vessels. In the third, hydrostatic dilation was performed on the left SIE artery and vein, with a mean pressure of 300 mm Hg, while elevating the flap on the right-sided SIE pedicle. The groups were compared by microangiography and by the survival ratio of abdominal flaps 7 days after elevation. ResultsThe mean (SD) flap necrosis rates were as follows: control group, 44.75% (4.31%); delay group, 33.32% (7.11%); and hydrostatic dilation group, 32.51% (5.03%). There was a significant difference between the control group and the other 2 groups (P < 0.05). There was no difference between the delay and hydrostatic dilation groups with respect to surface area necrosis. The microangiographies showed remarkable increased vascularity in the delay and hydrostatic dilation groups. ConclusionsHydrostatic dilation is a new method of enhancing flap viability that could be used in clinical cases in place of surgical delay once further studies and clinical trials are completed.

Useful Method for Intraoperative Monitoring of Facial Nerve in a Scarred Bed

Facial nerve is the main cranial nerve for the innervation of facial expression muscles. Main trunk of facial nerve passes approximately 1 to 2 cm deep to tragal pointer. In some patients, where a patient has multiple operations, fibrosis due to previous operations may change the natural anatomy and direction of the branches of facial nerve. A 22-year-old male patient had 2 operations for mandibular reconstruction after gunshot wound. During the second operation, there was a possible injury to the marginal mandibular nerve and a nerve stimulator was used intraoperatively to monitor the nerve at the tragal pointer because the excitability of the distal segments remains intact for 24 to 48 hours after nerve injuries. Thus, using a nerve stimulator at the operational site may lead to false-positive muscle movements in case of injuries. Using the nerve stimulator to stimulate the main trunk at the tragal point may help to distinguish the presence of possible injuries. A reliable method for intraoperative facial nerve monitoring in a scarred operational site was introduced in this letter.

An easy way to remove solid chemical substances from skin

Fig. 1 – The chemical substance (sulfur) on the right hemifacial region of the patient. Sulfur compounds have acidifying characteristics in the environment. Sources of SO2, one of the sulfur compounds, include sulfidic metal processing and oil refining. Hydrogen sulfide, another sulfur compound, can be found in the wastewaters as dissolved sulfide, and can be accessed in biogas, natural gas, syngas or refinery gases as H2S [1]. Chronic exposure to the sulfur containing gases, i.e., sulfur dioxide, via inhalation route may cause chronic airflow obstructions. Bronchiolitis obliterans was also reported as the possible outcome of sulfur dioxide exposure [2]. Organic sulfur compounds may exist in commercial gasoline and diesel in large amounts, and those compounds may cause severe corrosion of equipment and reactors in oil processing [3]. Due to this, injury of the skin following the acute exposure to sulfur compounds would not be surprising. In this letter, a chemical burn after exposing an organic sulfur compound is presented. A 50-year-old man who works in a petrol refinery was admitted with a second-degree chemical burn located on the face; the entire right hemifacial area was covered with a yellowish semi-solid chemical material (Fig. 1). Adhesion between the hairy skin of the face and the chemical was noted. The patient stated that the corrosive agent was liquid sulfur and that agent was solidified rapidly after contacting to skin. Attempts at removing the material failed due to adhesion. To help the cleaning the skin, the chemical was broken into small pieces with a surgical forceps (Fig. 2A). The small fragments were easily removed from the skin by using an electric razor without injury (Figs. 2B and 3). The lesions were epithelized spontaneously with regular dressing changes. In conclusion, exposing to chemical materials that cause solidification after contacting to air rapidly may cause major injuries. The solid forms of those materials should be cleaned from the skin, but this process can be

DİZ ÇEVRESİ ONARIMI İÇİN AKILDA BULUNDURULMASI GEREKEN BİR ALTERNATİF: PROKSİMAL TABANLI SAFEN FLEP

Local soft tissue reconstruction options of middle third of the lower extremity are relatively limited. The saphenous flap that is an option for this region of lower extremity is more popular in recent years as a reverse flow and has used for the distal part of the lower extremity. For the reconstruction of soft tissue defects around the knee proximally- based saphenousflap can easily be applied without causing any loss of function and seems to be a suitable alternative.