Caglayan Yagmur

Management of split-thickness skin graft donor site: A prospective clinical trial for comparison of five different dressing materials

INTRODUCTION Split-thickness skin grafting (STSG) is a frequently used reconstructive technique but is associated with a large variation regarding the management of the donor site. The aim of this study is to compare five different dressings for management of the STSG donor site in a prospective trial. PATIENTS AND METHODS 100 consecutive patients, in whom reconstruction with STSG was performed, were included into the study. The grafts are harvested in a standard manner and the donor sites were dressed with one of the following materials: Aquacel® Ag, Bactigras® with Melolin®, Comfeel® Plus Transparent, Opsite® Flexigrid and Adaptic®. The materials are compared regarding to the time required for complete epithelialization, pain sensed by the patients, incidence of infection, scar formation, ease of application and the cost. RESULTS The earliest complete epithelialization was observed for Aquacel® Ag and the latest for Bactigras® with Melolin®·Comfeel® Plus Transparent was the most painless dressing and Bactigras® with Melolin® was the most painful. The incidence of infection was highest for Bactigras® with Melolin®·Opsite® Flexigrid was the most economical dressing and Aquacel® Ag was the most expensive one. CONCLUSION The aim is to provide the earliest complete epithelialization with minimal patient discomfort and lower cost in management of the STSG donor sites. None of the tested materials were ideal regarding these criteria, but Comfeel® Plus Transparent, as the least painful and one of the most economical materials, may be offered as the dressing of choice among the tested materials.

Mechanical receptor-related mechanisms in scar management: a review and hypothesis.

Background: The physiopathogenesis of proliferative scarring in human skin is not well understood. Furthermore, knowledge of the precise mechanisms of action for physical treatment modalities is limited. Compression garments, occlusive/adhesive skin taping, and silicone gel sheets are applied to form an occlusion on the scar surface, reduce tension, and/or increase pressure on the scar itself. The mechanisms by which the external or superficial actions of these treatments cause remission of a protruding scar may be related to mechanoreceptor (nociceptor and cellular mechanoreceptor) responses. Methods: Basic research studies about mechanoreceptor-related (nociceptors and cellular mechanoreceptors, separately) events are reviewed and discussed based on proliferative scarring background. Scar management–related studies were corrected from the standpoint of mechanotransduction mechanisms. The methodologic quality of the clinical trials and basic studies was evaluated and reviewed. Results: It was suggested that many of the physical scar management methods, including compression therapy, silicone therapy, adhesive tape, and occlusive dressing therapy, are related to mechanotransduction mechanisms. Conclusions: A unifying perspective of basic research findings and clinical observations may be obtained by considering the mechanoreceptor-related events in scar management. Moreover, a precise understanding of the roles that cellular mechanoreceptors and mechanosensitive nociceptors play in proliferative scarring may lead to the development of innovative treatment strategies and new pharmacologic therapies targeting cellular mechanoreceptors and mechanosensitive nociceptors in fibroproliferative diseases.

Efficient Utility of WhatsApp: From Computer Screen to the Surgeon's Hand to Determine Maxillofacial Traumas.

To the Editor: Advances in communication technologies and mobile phones have been improving rapidly for 10 years. These advances and developed applications (Apps) compatible with smartphones have led them to be a crucial device for their users, especially that apps let people use smartphones like a computer. It is obvious that the smartphones are much more than just a phone. On the other hand, the smartphones are used commonly among doctors too, and there are lots of medical apps. WhatsApp (WhatsApp, Inc., Mountain View, CA) is the most popular instant messaging application for smartphones. The users may send and receive location information, images, video, audio, and text messages in real time to individuals and groups of friends at no cost. We used WhatsApp application as an image and video transfer program to send computerized tomography (CT) sequences between emergency service and plastic surgeons in the night-time consultations on the patients having maxillofacial traumas. For sending and receiving images and videos, the smartphones having both WhatsApp and high-definition camera were used. The physician at the emergency service took the view of CT images from a computer screen and sent the images (Fig. 1A), and serial images were recorded as videos (Fig. 1B) on app. Due to highdefinition cameras on the smartphones, it is possible to narrow and magnify the images. Moreover, sent images or videos did not need any specific programs to run them. It provided us to see the images immediately and to easily determine whether there was fracture. Plastic surgeons get benefits from technological advancements, and it is easy to adopt these advancements to their professional lives. Tele-consultation is a well-known and established way of evaluating patients. It is utilized in the examination of soft tissue injuries and burns at emergency services. For craniofacial traumas, telemedicine was used too. They needed personal computers, remote access to the server, and specific requirements. Although radiographic images such as CT scans may be viewed on smartphones, they need specific interfaces and apps that allow surgeons to view CT scans over a secure network from a remote location. For considering our needs, we thought that during tele-consultation, the fastest, easiest, and most common way should have been used. In our method, the smartphones which have a good quality camera and WhatsApp were used. They are very common recently and are also found in almost all doctors’ pockets. Capturing scan images and recording serial views of scans as a video are easy and do not need any specifications. Moreover, the receiver surgeon does not have to be in front of the computer or at home. Wherever he is, he may get and evaluate the views. It allows us to conclude the consultation rapidly. In conclusion, sending and receiving images and videos on WhatsApp is an easy, rapid way of evaluating of maxillofacial CT scans in the night-time tele-consultation.

Transaxillary-subclavian transfer of pedicled latissimus dorsi musculocutaneous flap to head and neck region.

Free-tissue transfer is the reconstruction of choice for most head and neck defects. However, pedicled flaps are also used, especially in high-risk patients and after failure of a free flap. The aim of this study was to compare transaxillary-subclavian pedicled latissimus dorsi musculocutaneous (PLDMC) flap, pectoralis major musculocutaneous flap, and free-tissue transfer for head and neck reconstruction in American Society of Anesthesiologists grades II and III patients. During the last 4 years, PLDMC flap with a modified transaxillary-subclavian route for transfer to the neck was used in 8 patients, pectoralis major musculocutaneous flap was used in 7 patients, and free flaps were used in 12 patients for head and neck reconstructions. These 3 methods were compared regarding the flap dimensions, complications, flap outcome scores, hospitalization time, and cost of the treatment. Mean age of the patients, mean American Society of Anesthesiologists scores, mean dimensions of the flaps, and mean hospitalization time did not differ significantly among the 3 groups. Regarding the operation time, flap complications, outcomes, and cost of total treatment, although statistically not significant, PLDMC group offered the fastest reconstruction with highest flap outcome scores and minimum cost. Free-tissue transfer is the procedure of choice especially for functional reconstruction of head and neck region. Occasionally, there exist cases in whom a pedicled flap could offer a safer option. The PLDMC flap transferred via the transaxillary-subclavian route may be preferred than, with advantages including increased arc of rotation, safer pedicle location, shorter duration of the procedure, and reduced complication rates and costs.

Spreader flap correction of dorsal septal deviations.

A good rhinoplasty dissection is crucial to identify and release the vectoral forces on a deviated septum before correction.1 Even after completing the dissection, dorsal hump reduction, septoplasty, and osteotomy, there may be persisting septal deviation. A number of techniques have been identified to correct various kinds of deviations that persist after release. Cartilage grafts from the septum itself, or from other regions (concha or ribs), or alloplastic materials are used to correct the dorsum.2 The spreader flap technique (so-called autospreader, turnover flap, or fold-in flap)3 may also be used for this purpose. In this technique, the upper lateral cartilage is separated from the septum and folded medially and dorsally following meticulous dissection of the mucoperichondrial flaps. Longitudinal scoring of the dorsal …

A simple concept for covering pressure sores: wound edge-based propeller perforator flap†

We present a new surgical modification to allow propeller perforator flaps to cover pressure sores at various locations. We used a propeller perforator flap concept based on the detection of newly formed perforator vessels located 1 cm from the wound margin and stimulated by the chronic inflammation process.

Unintentional Complications After Uneventful Rhinoplasty Operations: Case Reports and a Review of the Literature

IntroductionNo surgical procedure is free of complications; however, some of these complications are unintentional. Plastic surgeons may be unfamiliar with certain complications after rhinoplasty operations. In this study, we aimed to present four unintentional complications that have occurred in our patients and review the literature related to these complications.Materials and MethodsIn this study, we conducted a review of 1400 patients who were operated on from 2007 to 2015. The medical recordings of all patients were investigated. Four patients with unintentional complications after rhinoplasty operations are presented and the related literature was reviewed.CasesCases 1 and 2: These patients included a 26-year-old woman and a 30-year-old man who developed herpes simplex virus (HSV) infections after a primary septorhinoplasty. Case 3: This was a 25-year-old woman who developed periorbital emphysema after a primary rhinoplasty operation. Case 4: This was a 22-year-old woman who developed a second-degree burn on the nasal dorsum. All patients healed without sequel or scars.DiscussionMany unexpected complications have been reported in the literature. Some of these complications include bleeding disorders, allergic reactions, dermatitis, visual loss, gastric bleeding, benign paroxysmal positional vertigo, false aneurysm after rhinoplasty, pneumocephalus, Tapia’s syndrome, cavernous sinus syndrome, and skin reactions to prolene.ConclusionMeticulous patient histories, consistent surgical routines, careful radiologic examinations, and frequent patient visits can help surgeons control these types of complications.No Level AssignedThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The synergy between endoscopic assistance and extraoral approach in subcondylar fracture repair: a report of 13 cases

BACKGROUND We aimed to present the primary experience of one surgeon with a new surgical technique performed on the first 13 cases and to evaluate outcomes following an extraoral endoscopic approach to subcondylar fractures. METHODS Fifteen subcondylar fractures in 13 patients, who were treated at Ondokuz Mayis University Hospital between January 2010 and June 2011, were included in this study. Patients were operated on using either endoscopic or open approach. RESULTS Rigid plate fixation was completed endoscopically using extraoral approach in nine fractures, while six fractures were plated by conversion to a full-open approach. In all six fractures that could not be fixed endoscopically, the proximal fragments were medially displaced, whereas seven of nine fractures that were successfully fixed endoscopically were laterally displaced. CONCLUSION An extraoral endoscopic approach for subcondylar fractures is feasible and can be carried out with decreased morbidity. This approach is recommended for those with limited experience in endoscopy to treat low laterally displaced subcondylar fractures as their initial cases.

The Most Econoplastic Way of the Nasal Splinting.

To the Editor: An external nasal splint is generally applied to provide stabilization to the osteotomized bony components following rhinoplasty to the bony nasal framework. It is an important part of rhinoplasty procedure and preserves the final aesthetic appearance by acting like a scaffold. According to the surgeon’s preference, the type of splint used may be changed. An ideal splint should be light, adaptable, inextensible, easy to remove, and inexpensive. There are three main categories of splints commercially available: metallic, thermoplastic, and plaster. All of them have constitutional advantages and disadvantages. The metallic splints are expensive (average cost US

Consecutive formation of extensive late seromas with sudden onset: a breast augmentation patient with a puzzling clinical presentation

12) and because of their hardness, these are difficult to be molded. On the contrary, these can be applied fast and easy. Plaster is the cheapest material (average cost