Can Karaca

Free arterialised venous forearm flaps for limb reconstruction

Arterialised venous flaps are an alternative method to conventional flaps. Arterialised venous flaps include only the venous network and afferent blood comes from the arterial system. Arterialised venous flaps have been mostly used for closure of small defects. We have designed an arterialised venous flap utilising the venous network of the forearm and applied this flap in 5 patients with various defects in the extremities ranging in size from 6 x 8 cm to 10 x 12 cm. Four flaps totally survived. One flap had 30% partial necrosis. Overall clinical results were successful. The free arterialised venous forearm flap provides large, thin, good quality tissue with less morbidity at the donor site without sacrificing one major artery of the hand and can be an alternative for the conventional radial forearm flap.

Adolescent growth patterns of the bony and cartilaginous framework of the nose: a cephalometric study.

Adolescent growth changes in the nose were studied for 140 female and 140 male subjects between the ages of 11 and 17 years who had class 1 skeletal and dental patterns. Age-related growth changes in the bony and cartilaginous framework of the nose were evaluated. Nasal height and nasal bridge length became fully mature in males at 15 years and fully mature in females at 12 years. The upper nasal dorsum, lower nasal dorsum, anterior nasal depth, and posterior nasal depth exhibited continuous growth up to 14 years in males and 2 years earlier in females. Nasal tip protrusion approached its mature size in males at 15 years and at 13 years in females. Although the lower dorsum rotated forward slightly, rotation of the upper dorsum was not significant during adolescence. Knowledge of these age-related growth changes of the nose may be useful in planning the time of aesthetic or reconstructive nose surgery.

Inverted, T-shaped silicone implant for the treatment of temporomandibular joint ankylosis.

Reconstruction of the ankylosed temporomandibular joint is a challenging task. Speech impairment, difficulties with mastication, poor oral hygiene, facial asymmetry, and mandibular micrognathia results in physical and psychologic disabilities. Various surgical techniques with varying success rates have been reported. Many autogenous and alloplastic materials have been proposed. The authors used an inverted, T-shaped silicone implant for the reconstruction of the temporomandibular joint after the release of the ankylosis in 10 patients without any complications in the postoperative period. The authors assert that the reconstruction of the ankylosed temporomandibular joint with an inverted, T-shaped silicone implant is a reliable and effective alternative. This technique can be used according to the special requirements of each patient and obviating the need for the fixation of the implant and is a safer and better way of using silicone for the treatment of temporomandibular joint ankylosis.

Free Arterialized Venous Forearm Flap

Arterialized venous flaps are the result of the search for new flap techniques because conventional flaps are sometimes insufficient and have donor-site morbidity problems. In the patient presented here, a free arterialized venous flap measuring 12 x 8 cm was transferred from the forearm to a burn-scarred area on the face. This flap contained two parallel main veins, one was arterialized for perfusion and one was for the venous drainage. The flap we have designed is advantageous in that it is not bulky, it has less donor-site morbidity, it does not sacrifice one major artery, and it uses the rich venous network of the forearm. The operative and postoperative results are satisfactory.

Necrotising fasciitis in the central part of the body: diagnosis, management and review of the literature

Necrotising fasciitis (NF) is characterised by rapidly spreading necrosis of the soft tissue and fascia. It is rare but can be fatal when not managed properly. The aim of this study is to evaluate the diagnosis, treatment and results such as mortality, morbidity and reconstructive options of NF localised in the central part of the body. The main goal is to emphasise upon the clinical symptoms for early diagnosis which is the most important factor in saving the lives of these patients. Between January 2000 and December 2010, 30 patients with NF localised in central parts of the body were treated. Six of the patients were female (20%) and the others were male (80%). The mean age was 54·03 years (ranged between 26 and 83 years). The average time from the onset of symptoms to diagnosis was 6 days, ranging from 2 to 11 days. The localisation of NF was perineum in 24 patients (80%); inguinal and thigh region in 5 patients (16·7); and back in 1 patient (3·3%). The hospitalisation time was varying between 17 and 32 days (mean 23 days). Six patients (20%) died and 24 patients (80%) survived. All non‐survivors had risk factors and secondary comorbidities such as immunosuppression, chronic cardiac failure, and diabetes with high glucose level. Survivors also underwent repeated debridement operation 2–4 times. Reconstructive procedures were split‐thickness skin graft (STSG) in eight patients (33·3%), fasciocutaneous flaps in four patients (16·6%), fasciocutaneous flap + STSG in six patients (25%), scrotal flap + STSG in two patients (6·6%), scrotal flap in two patients (6·6%) and musculocutaneous flap + STSG in one patient (3·3%). There was no major complication such as flap and graft loss, after reconstructive procedures. Early diagnosis of NF may be the lifesaving factor. Amuputation can save the patients life in the case of NF in the extremities; however, this is not an option for NF in central parts of the body. In these cases, when NF is suspected, early debridement of necrotic tissues should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.

Abdominal cocoon syndrome as a rare cause of mechanical bowel obstruction: report of two cases.

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.

Evaluation of velopharyngeal pathophysiology and velopharyngeal insufficiency with magnetic resonance imaging

Abstract The disadvantages and limitations of imaging methods to investigate velopharyngeal incompetence have created some difficulties in the management of this condition. Seven normal volunteers and seven patients who were suffering from a speech disorder were examined using magnetic resonance imaging. The velopharyngeal aperture was evaluated at rest and during phonation. In normal volunteers, the velopharyngeal aperture area had a mean value of 1.632 cm2 while at rest and complete closure was obtained during the phonation of /s/ sound. Detailed information was obtained about the function of the levator palati muscle. In five patients during the phonation of /s/ sound there was an increase in the area of the velopharyngeal aperture when compared to the volunteers. Investigation with magnetic resonance imaging is helpful in the pretreatment evaluation and postopertive follow-up examination of velopharyngeal insufficiency. As a result, this noninvasive method can be used as an alternative to conventional radiological investigations.

Question mark ear deformity and a modified surgical correction method: a case report.

Question mark ear (Cosman ear) deformity, a rare congenital malformation, is characterized by a cleft between the helix and the ear lobe and marked prominence of the auricles. Although the features of question mark ear deformity are well described in the literature, there is no definitive surgical technique for repair of this deformity, Several surgical methods have been introduced for the correction of the deformity. These techniques mainly provide for repair of the cleft between the helix and ear lobe. However, marked prominence of the upper auricle usually is also present with the cleft. We modified the surgical technique to correct the cleft and the upper prominence at the same time. With this procedure, the cleft is exposed by raising a vertical cutaneous flap based on the cleft on the posterior side of the ear, After anterior scoring to form the antihelix and cleft repair using an ipsilateral conchal cartilage graft, the cutaneous flap is used to cover the cartilage graft and the flap donor site is closed primarily to facilitate restoration of the antihelix. The authors report on a patient with Cosman ear and introduce their modified technique that can be used for repair of the cleft between the helix and ear lobe and the prominence of the upper helix in the same procedure.

Postauricular dermoid cyst: a case report

A rare localization of dermoid cyst in the postauricular region is presented.

Nekrotizan fasiit: Tanı, Tedavi ve Literatürün Gözden Geçirilmesi

BACKGROUND Necrotizing fasciitis (NF) is characterized by rapidly spreading necrosis of the soft tissue and fascia. It is rare, but can be fatal if not managed properly. The aim of this study was to discuss the morbidity and mortality in NF patients in terms of evaluating early diagnostic techniques and reconstructive options. METHODS Sixty-eight patients (59 male, 9 female; mean age 55.9 years; range 28 to 88 years) with localized NF who were treated between 2000 and 2010 were assessed retrospectively for age, sex, localization, time elapsed between onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, isolated microbiological agents, surgical intervention, complications, and mortality rate. RESULTS In 52 patients (76.4%), comorbidities such as diabetes, obesity, smoking, and corticosteroid use were present. The most common localization was the perineum and inguinal region (n=48, 70.5%). Time elapsed between onset of symptoms and diagnosis was 6.2 days (1-12 days). The mean size of tissue defect after the first debridement procedure was 54.2 cm2 (28-82 cm2). The most common isolated microbiological agents were as follows: Escherichia coli, Enterococci, and Pseudomonas aeruginosa. Polymicrobial infections were encountered in 54 patients (79.4%). The most common reconstructive procedures were fasciocutaneous flap + split-thickness skin grafting (n=39, 57.3%). No major complication was observed; minor complications included wound dehiscence and partial graft loss. The mortality rate was 13.2% (n=9). CONCLUSION The early diagnosis of NF may be lifesaving. When NF is suspected, early debridement of necrotic tissues should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.BACKGROUND Necrotizing fasciitis (NF) is characterized by rapidly spreading necrosis of the soft tissue and fascia. It is rare, but can be fatal if not managed properly. The aim of this study was to discuss the morbidity and mortality in NF patients in terms of evaluating early diagnostic techniques and reconstructive options. METHODS Sixty-eight patients (59 male, 9 female; mean age 55.9 years; range 28 to 88 years) with localized NF who were treated between 2000 and 2010 were assessed retrospectively for age, sex, localization, time elapsed between onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, isolated microbiological agents, surgical intervention, complications, and mortality rate. RESULTS In 52 patients (76.4%), comorbidities such as diabetes, obesity, smoking, and corticosteroid use were present. The most common localization was the perineum and inguinal region (n=48, 70.5%). Time elapsed between onset of symptoms and diagnosis was 6.2 days (1-12 days). The mean size of tissue defect after the first debridement procedure was 54.2 cm2 (28-82 cm2). The most common isolated microbiological agents were as follows: Escherichia coli, Enterococci, and Pseudomonas aeruginosa. Polymicrobial infections were encountered in 54 patients (79.4%). The most common reconstructive procedures were fasciocutaneous flap + split-thickness skin grafting (n=39, 57.3%). No major complication was observed; minor complications included wound dehiscence and partial graft loss. The mortality rate was 13.2% (n=9). CONCLUSION The early diagnosis of NF may be lifesaving. When NF is suspected, early debridement of necrotic tissues should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.