Candemir Ceran

Bilobed flap reconstruction in infraorbital skin defects.

Background: The infraorbital region is an important subunit for facial aesthetics. Improper closure of skin defects involving this region may lead to deformity in the lower lid and to ectropion. This report presents the authors’ experience with 15 patients who had infraorbital skin defects reconstructed with the bilobed flap from the zygomatic and lateral cheek regions. Methods: Most of the operations were performed under local anesthesia. Pathologic diagnoses included basal cell carcinoma, squamous cell carcinoma, melanoma, and hemangioma. Although we cannot deny that bilobed flaps used in this series were not random flaps, we would like to emphasize that when a flap with a bilobed design is chosen for reconstruction of an infraorbital defect, a superiorly based bilobed flap should be selected to avoid ectropion or any distortion in the middle face. As an adjunct procedure, a glabellar flap was used in some patients who had defects extending medially as well. Results: The results of the repair were satisfactory with respect to color match, texture, and functional properties. Conclusion: The superiorly based bilobed flap should be always kept in mind when planning a local flap in the infraorbital region.

Basal Cell Carcinoma of the Head and Neck Region: A Retrospective Analysis of Completely Excised 331 Cases

The aim of the study is to analyze all completely excised BCCs in the head and neck region with regard to age, sex, personal and familial history, skin type, tumor localization and size, histopathological subtype of tumor, reconstruction method, and recurrence rates. Incompletely excised BCCs were not included in this study since incomplete excision is the most important preventable risk factor for recurrence. In 320 patients, 331 lesions were retrospectively evaluated by dividing into the following 8 subunits: scalp, frontotemporal, orbital, nose, cheek, auricula, perioral, and chin-neck area. Most of the patients were in 60–70 age group (34.7%). The nose (32.3%) was the most common site of presentation. Clinically, all lesions and, histopathologically, most of the lesions (42.2%) presented were of the nodular type. All cases of recurrence after complete excision (n = 9, 2.7%) were located in the median parts of the head and neck region and were mainly diagnosed histopathologically as sclerotic and micronodular. Even though completely excised, head and neck region BCCs, especially which are more prone to recurrence due to anatomical and histopathological properties, should be more closely monitored in order to decrease morbidity and health care costs.

Tongue flap as a reconstructive option in intraoral defects.

AbstractThe reconstruction of intraoral defects can be challenging due to the different characteristics of the region, importance of preserving the anatomy and function, and shortage of available donor areas. The location and size of the defect guides the reconstructive surgeon through the treatment plan. Among the options available, tongue flaps have been found useful in intraoral defect reconstruction.In this study, we presented the use of tongue flaps in different kinds of intraoral defects, and compared the advantages and disadvantages with other methods. Between 2004 and 2011, tongue flaps were used in intraoral reconstruction of 11 patients (6 male and 5 female) with a mean age of 30.1. Six patients had palatal fistula, 3 had alveolar region and mouth floor defects, and 2 had lower lip defects. All of the tongue flaps planned were anterior based, 6 dorsal and 5 ventral. Second operations were carried out on the 15th or 20th postoperative days.Despite the disadvantages of being an interpolation flap which requires a second session and good patient cooperation, tongue flap is a choice for reconstruction of intraoral defects with its highly vascular structure, good mobility, localization, texture match, and low donor area morbidity.

Management of pulse oximeter probe–induced finger injuries in children: report of two consecutive cases and review of the literature

Pulse oximetry is a standard noninvasive procedure for monitoring arterial oxygen saturation. Finger injuries related to pulse oximeter use have been reported as chemical or thermal burns, sun-tanning, pressure erosion, sensory loss, and gangrene. The mechanisms of these complications have not been definitively explained; but pressure ischemia, prolonged use, overheating of the probe, inappropriate use of the probe, and short circuiting are considered to be the main factors. We describe 2 cases of pulse oximeter probe-induced finger injuries, propose the possible mechanisms and factors related to the injury, and discuss the management.

Clinical Experience With the Combination of a Biceps Femoris Muscle Turnover Flap and a Posterior Thigh Fasciocutaneous Hatchet Flap for the Reconstruction of Ischial Pressure Ulcers.

BackgroundThe reconstruction of ischial pressure ulcers is problematic because of the distinctive anatomical properties of the region and high recurrence rates. To date, no single technique has been proven to be effective in reducing recurrence of the ulcers. We present our experience with the combination of a biceps femoris muscle turnover flap and a posterior thigh fasciocutaneous hatchet flap and discuss the long-term results. MethodsA retrospective clinical analysis of 15 patients with grade 4 ischial pressure ulcers reconstructed with biceps femoris muscle turnover flaps and laterally based posterior thigh fasciocutaneous hatchet flaps was carried out between January 2010 and January 2013. Debridement and reconstruction of the ulcers were accomplished in a single stage. The posterior thigh fasciocutaneous flap was elevated in a hatchet style. The long and/or short head of the biceps femoris muscle were dissected from their insertions, turned over on their major pedicles, and their distal portions were used to obliterate the cavitary defect. The skin defect over the muscles was covered by the fasciocutaneous hatchet flap. The average age of the patients was 42.6 years and the mean follow-up time was 27.2 months. ResultsThree patients had the following early postoperative complications: hematoma, suture dehiscence, and the necrosis of the short head of biceps muscle. Only 1 patient had a recurrent ulcer 15 months after surgery, which was treated with debridement and the readvancement of the fasciocutaneous flap. The overall recurrence rate was 6.6%. ConclusionsThe biceps femoris muscle turnover flap combined with the posterior thigh fasciocutaneous hatchet flap is a worthwhile option to consider for the reconstruction of ischial pressure ulcers and this technique produces favorable results in terms of the lack of recurrence and complications. The use of the muscle and fasciocutaneous tissue as 2 different flaps, which have different roles in the early and late postoperative period, reduces the recurrence rate.

Selective Nerve Block Combined With Tumescent Anesthesia.

PURPOSE To evaluate the effect of selective nerve blocks before tumescent anesthesia on the pain and anxiety levels of patients. METHODS A prospective study was performed with 80 patients. Forty consecutive patients received tumescent anesthesia, and 40 consecutive patients received selective nerve blocks followed by tumescent anesthesia. Patients filled out a questionnaire regarding their preoperative, intraoperative, and postoperative pain and anxiety levels. The results of the questionnaire were evaluated with an independent samples t test. RESULTS The 2 study groups showed similar distribution in age, sex, and diagnosis. No complications related to tumescent anesthesia or nerve blocks were observed. The group that received tumescent anesthesia with selective nerve blocks reported lower pain scores in anesthesia injections than the group that received tumescent anesthesia alone. The intraoperative and postoperative pain and anxiety levels between the groups were not different. CONCLUSION Tumescent anesthesia combined with selective nerve blocks in hand surgery decreased the pain associated with injections and increased patient satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.

Reconstruction of an infraorbital defect with deepithelialized forehead flap.

To the Editor: A 65-year-old woman was admitted to the dermatology department with erythema and induration in the left infraorbital region. Punch biopsy of the lesion revealed squamous cell carcinoma. The patient had consulted to our department for surgical management. The lesion had first been noticed 15 years ago and had grown rapidly from 1 to 4 cm in diameter in the last year. Ulceration was noticed in the last few months. Surgical excision of the lesion and reconstruction with malar advancement flap were performed 3 months ago in another clinic. An erythematous and indurated C-shaped scar with a downward concavity was present in the left infraorbital region upon physical examination (Fig. 1). No pathologic lymph nodes were found in clinical and ultrasonographic examination. Computed tomography revealed no maxillary bone invasion. The patient’s medical history included hypertension and chronic renal failure as comorbidities. Reexcision was planned with a diagnosis of recurrent squamous cell carcinoma. An extensive excision in the supraperiosteal plane was done under general anesthesia. The frozen section revealed clear surgical margins. The vertical and horizontal dimensions of the defect were 3 and 5 cm, respectively, with a caudally increasing depth up to 2 cm. The existing scar of the previous operation precluded planning of a reliable local flap from the malar region. Ipsilateral paramedian forehead flap was chosen as the reconstruction method. First, the flap was deepithelialized and turned 180 degrees horizontally at the supraorbital rim level.While the flapwas inset into the cavity, the distal portion of the flap was turned over to obtain more adequate thickness for filling the deeper caudal part of the defect (Figs. 2, 3). The skin graft obtained by the deepitheliazation process was used to cover the subcutaneous part of the flap. The flap donor areawas closed primarily. Daily wound dressings with topical antibiotics were made after the surgery. The pedicle was divided at the 16th postoperative day under local anesthesia. No complication was seen in the early postoperative period. In the 1-year follow-up, there was no sign of recurrence and the result was found to be aesthetically and functionally satisfactory (Fig. 4).

Excised Abdominoplasty Material as a Systematic Plastic Surgical Training Model

Achieving a level of technical skill and confidence in surgical operations is the main goal of plastic surgical training. Operating rooms were accepted as the practical teaching venues of the traditional apprenticeship model. However, increased patient population, time, and ethical and legal considerations made preoperation room practical work a must for plastic surgical training. There are several plastic surgical teaching models and simulators which are very useful in preoperation room practical training and the evaluation of plastic surgery residents. The full thickness skin with its vascular network excised in abdominoplasty procedures is an easily obtainable real human tissue which could be used as a training model in plastic surgery.

Tamoxifen-Related Thrombosis: An Experimental Study in Rat Venous Microvascular Anastomosis Model.

Abstract Tamoxifen is an estrogen receptor modulator and has been shown to increase risk for microvascular flap complications. This study aimed to investigate the clinical and histopathological effects of tamoxifen use in venous microvascular anastomosis model in rats. The role of vitamin E combination therapy and discontinuing tamoxifen therapy preoperatively were also evaluated. Forty rats were equally divided into 4 groups as follows: group 1 was given saline by oral gavage, group 2 was given tamoxifen citrate, group 3 was given tamoxifen citrate and vitamin E, and in group 4, tamoxifen citrate was given everyday except between days 12 and 16. In each group, femoral veins were dissected in each side and end-to-end anastomosis was performed in one side. Clinical and histopathological evaluations were performed. The ratio of total endothelial area to total vein area in a cross-sectional view of the vein was evaluated and compared. All veins with anastomosis in postoperative 15 minutes were found to be patent. In postoperative 1 week in groups 1 to 4, visible thrombus were present in 1, 3, 2, and 3 samples, respectively. Vitamin E group showed similar histopathological findings with control group. The ratio of endothelial layer to total vein cross-sectional area was increased in groups 2 and 4 in all samples. The increase was statistically significant between groups 2NA and 3NA (P = 0.023) and 2A and 1A (P = 0.006). Chronic tamoxifen consumption in the presence of anastomosis have led to prominent endothelial proliferation in rat femoral veins. Vitamin E combination therapy reversed this endothelial proliferation and should be focused in future studies.

An Algorithmic Approach for the Reconstruction of Nasal Skin Defects: Retrospective Analysis of 130 Cases

Bulgular: Çalışmada 70 kadın, 60 erkek olmak üzere toplam 130 hasta incelendi. Ortalama yaş 67,8 idi. Tümörlerin en sık dorsum, alar bölgeler ve burun ucunda olduğu görüldü. Rekonstrüksiyon yöntemleri değerlendirildiğinde; %14,6 hastada primer onarım, %25,3’ünde tam kalınlıkta deri grefti, %60’ında fleple onarım tercih edildi. Alt bölgelere göre farklı flepler tercih edildi. En sık dorsal nazal, iki loblu, nazolabial flep ve alın flebinin kullanıldığı görüldü.