Bülent Erdoğan

Augmentation rhinoplasty with dermal graft and review of the literature

Nasal augmentation required following a trauma or a rhinoplasty operation poses a challenging problem to many plastic surgeons. Currently, allografts and autologous tissues are used for nasal augmentation; however, an ideal technique has not yet been described. Although preferred for augmentation of different parts of the body, pure dermal graft use has not been described for nasal augmentation. The authors performed nasal augmentation using a dermal graft in 90 patients in their hospital between 1994 and 2000, and they followed up the patients for 6 months to 8 years. In this article, the early and late results of dermal grafts for nasal augmentation are presented, and their advantages and disadvantages are discussed with a review of the literature. It was concluded that the easily obtained dermal graft could be an appropriate alternative in nasal augmentation, though it has not been used widely for this purpose.

Multiple Occurrence of Pilomatrixoma

Multiple occurrences of pilomatrixoma are rare. Although it has been known as a benign lesion, there are reports of some tumors that have histopathologic features of malignancy. A case of a 68-year-old Caucasian women with multiple pilomatrixoma is presented. She was operated on to remove three other pilomatrixomas on the arms 3 years after the initial excision from the face. Two years after excision of the lesions on the arms, no recurrences were evident.

Late and long-standing capsular hematoma after aesthetic breast augmentation with a saline-filled silicone prosthesis: A case report.

Abstract. Late capsular hematoma is an extremely rare complication after the implantation of silicone breast prostheses for aesthetic or reconstructive objectives. We present a unique case of late capsular hematoma in an aesthetic breast augmentation with a saline-filled, textured silicone implant, which remained for a year after formation.

Augmentation mammaplasty: retrospective analysis of 210 cases.

Since its introduction in 1895, augmentation mammaplasty has gained widespread acceptance. The choice of breast augmentation procedure is determined almost entirely by three variables: the selection of incision location, the pocket plane for implant placement (either subpectoral or completely subglandular), and the appropriate implant. The current study evaluated 210 cases of augmentation mammaplasty retrospectively. A capsular contracture rate of 8% was found. Rupture and gel bleeding were observed in eight cases (4%). For various reasons, such as capsular contracture or implant rupture, the prostheses were renewed once in 16 patients (8%) and twice in 5 patients (2%). Submammary incision was used in 42 cases (20%). The patients in 23 cases responded that they had implant folds or edges they could feel (11%). Only 4 of these 23 patients stated that feeling the edge of the implant was a concern for them. Of the 210 augmented breasts, 5 had diminished sensation postoperatively (2%), as interpreted by the patient.

Bilaterally involved Tessier No. 4 cleft: case report.

Craniofacial clefts are rare among facial anomalies, with an incidence of 1.5 to 5 per 100,000 births, and 1 per 100 cases of cleft lip and palate. The Tessier No. 4 oro-ocular cleft is one of the rarest, with 33 unilateral and bilateral clefts reported in the literature. Among the bilateral clefts only 3 of 9 involved Tessier No. 4 cleft bilaterally. We report a case of bilateral Tessier No. 4 craniofacial cleft and our approach to surgical correction.

Dual synergistic effect: the effect of dexamethasone plus carnitine on skin flap survival.

Dexamethasone has well-known useful effects in dealing with the progression of necrosis. Carnitine is an endogenous cofactor, for having a regulatory action on the energy flow from different oxidative sources. The aim of this study was to determine whether combined local dexamethasone and systemic carnitine administration would result in an additive enhancement of skin flap survival in the rat model. A rectangular (3 cm × 11 cm) dorsal random skin flap was elevated on the rats and then sutured back into its original site with separate sutures. Overall, 40 rats were allocated randomly into 4 groups: Group 1 (control group, n = 10), group 2 (Dexamethasone group, n = 10, 2.5 mg/kg), group 3 (carnitine group, n = 10, 100 mg/kg), group 4 (dexamethasone plus carnitine group, n = 10). The mean flap survival area was 57.50 ± 5.2% (mean survival area ± SD) in control group (group 1), 71.5 ± 4.8% in the dexamethasone group (group 2), 73.0 ± 5.5% in the carnitine group (group 3), 85.30 ± 6.1% in the dexamethasone plus carnitine group (group 4). In conclusion, based on the findings of this experimental study, the synergistic effect of carnitine and dexamethasone on skin flap viability is determined.

Three-dimensional computed tomography in evaluation of ankylosis of the temporomandibular joint.

Ankylosis is an uncommon disease of the temporomandibular joint (TMJ), the effective treatment of which requires detailed preoperative evaluation of the type and extent of the deformity. As well as lateral radiographs and computed tomography (CT), three-dimensional CT has been introduced to improve the preoperative evaluation. We present six patients with ankylosis of the TMJ who were evaluated by three-dimensional CT before and after condylectomy. Preoperative findings were compared with operative findings. Three-dimensional CT provides a detailed three-dimensional image of the TMJ non-invasively and we suggest that it is a valuable tool for evaluation of ankylosis in the TMJ.Ankylosis is an uncommon disease of the temporomandibular joint (TMJ), the effective treatment of which requires detailed preoperative evaluation of the type and extent of the deformity. As well as lateral radiographs and computed tomography (CT), three-dimensional CT has been introduced to improve the preoperative evaluation. We present six patients with ankylosis of the TMJ who were evaluated by three-dimensional CT before and after condylectomy. Preoperative findings were compared with operative findings. Three-dimensional CT provides a detailed three-dimensional image of the TMJ non-invasively and we suggest that it is a valuable tool for evaluation of ankylosis in the TMJ.

Application of external fixators in major foot contractures

Extremity contractures are one of the most common deformities faced by the reconstructive surgeon. Major deformities with ankylosis of the related joint have to be managed by both soft tissue and bone operations. Contractures existing for a long period of time cannot be brought into anatomic position easily because of shortened tendons, nerves, and vessels or ankylosed joints. Although tendons can be lengthened in one operation, this is not the case for neural and vascular structures. The authors use external fixators associated with soft tissue procedures to gradually correct major foot dorsiflexion contractures.

A new, T-shaped adaptor for easy, quick and efficient fat harvesting during liposuction.

Although there is a controversy about success and failure of autologous fat tissue transfers, it is a widely accepted method for soft tissue augmentation and is performed by many plastic surgeons as well as dermatologists all around the world. Its advantages are that it does not cause reactions, its absorption rates have been reduced by increased knowledge, experience, and techniques, it can yield good, long-term results, and there are now preservation techniques that allow reinjections when necessary. However, no single ideal technique has been determined. In this paper a new, simple, T-shaped adaptor for easy, quick, and efficient fat harvesting during liposuction is described. This study not only describes the clinical use of the adaptor, but also histologically examines its effects on fat cells under various vacuum pressures (?250 mmHg, ?500 mmHg, ?700 mmHg). The study shows that the cell structure of fat tissue harvested under medium power (with vacuum pressures of ?250 mmHg and –500 mmHg) is not disrupted, while that of tissue harvested with a vacuum pressure of ?700 mmHg was traumatized and occasional cell wall fragmentation occurred. In conclusion, it is shown that the T-shaped adaptor allows harvesting of the desired amount of fat tissue without causing trauma to fat cells when it is used with medium-power suction.

Nonsurgical delay of cutaneous flaps using the flashlamp pumped pulsed dye laser

&NA; The surgical delay procedure is an effective method for improving skin flap survival. However, it has many disadvantages, such as bleeding, infection, and pain. It also requires an additional operation and a long time for wound management. Nonsurgical delay has a great importance, but pharmacological efforts for delay phenomena have never found clinical application. In this study, the authors attempted to reproduce the delay phenomena via the flashlamp pumped dye laser. Forty Sprague‐Dawley rats were studied in four groups of 10 rats each. The experimental and control flaps were on the same rat. Flaps were planned on the ventral skin of the rats, and were symmetrical, three sided, based caudally, and were 2 cm in width, extended to the measured midpoint between the xiphoid and the sternal notch. The laser was applied to the different areas of the experimental flaps 15 days before flap elevation. A week later flap survival was determined by overlaying millimeter‐grid acetate paper. Full‐surface and perimeter “lased” experimental flaps showed a marked increase in surviving areas when compared with the control flaps. This kind of flap delay has a great potential in clinic application. Aslan G, Karaçal N, Görgü M, Erdoğan B. Nonsurgical delay of cutaneous flaps using the flashlamp pumped pulsed dye laser. Ann Plast Surg 2000;44:277‐281