Cengiz Eser

Comparison of autologous and heterologous bone graft stability effects for filling maxillary bone gap after Le Fort I osteotomy.

BACKGROUND The amount of postoperative maxillary relapse of two different bone graft materials after Le Fort I osteotomy were compared in this study. OBJECTIVES The aim of this study is to compare postoperative maxillary relapse rates using heterologous and autologous graft materials after Le Fort I osteotomy. MATERIAL AND METHODS A total of 80 patients who had developmental malocclusion were analyzed retrospectively in this study. Twenty nine (36.2%) and 51 (63.8%) patients underwent Le Fort I osteotomy, and Le Fort I and bilateral sagittal split ramus osteotomy (two-jaw surgery), respectively. Forty two (52.5%) maxillary bone gaps were filled with heterologous bone grafts (group A) and 38 (47.5%) were filled with autologous bone grafts (group B) after Le Fort I osteotomy. The cephalometric graphics and measurements were taken before (T1), 1 week after (T2), and 1 year after (T3) the surgery. The results were documented and determined by the Dolphin imaging 10.5 (Dolphin Imaging, Chatsworth, Calif.) computer program for skeletal relapse. Whether or not the relationship between group As and Bs maxillary relapse rates was evaluated in the postoperative period. RESULTS It was observed that both graft materials have positive effects on maxillary relapse rate in the postoperative period. When the groups are compared to each other, the relapse rates were similar between group A (8.3%) and group B (10.8%) (p>0.05). CONCLUSIONS Heterologous bone graft material (Osteoplant®-Flex) is thought to be a good alternative to autologous grafts in decreasing the relapse rates and reducing the morbidity of the donor area of the patients who underwent Le Fort I osteotomy.

Total or Near-Total Lower Eyelid Defect Reconstruction Using Malar Myocutaneous Bridge and Nasojugal Flaps and Septal Chondromucosal Graft.

Purpose: The purpose of this study is to repair total or near-total lower eyelid defects by single-staged operative technique. Methods: The procedure was performed on 7 referred patients who had a total or near-total lower eyelid defects after tumor extirpation or trauma. Patients ages were between 13 and 67 years (average, 46.5). Defects were repaired by simultaneous reconstruction of anterior and posterior lamellae using a bipedicled malar myocutaneous bridge flap, a nasojugal transposition flap, and a septal chondromucosal graft in combination. Results: Patients were followed up for 12 to 24 months (average, 18 months). No necrosis, hematoma, or infection was observed in flaps, and no recurrence was observed in any patients. Mild scleral show was observed at postoperative 12 months in 2 cases. Conclusions: As an addition to classical methods, the present novel single-staged surgical procedure with the malar myocutaneous bridge flap, nasojugal transposition flap, and septal chondromucosal graft combination provides anatomical, functional, and stable reconstruction for total or near-total lower eyelid defects.

A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns.

BACKGROUND The management of a high voltage electrical injury and lower limb salvage remains a challenging task for plastic surgeons. Reconstruction with flaps is often the only alternative to limb amputation. The purpose of this study was to present a cross flow-through pedicle free latissimus dorsi muscle flap for the salvage of severely traumatized lower limbs perfused by one remaining vessel (a single vessel lower limb) in high voltage electrical injuries. METHODS In this retrospective study, between 2000 and 2014, six men underwent cross-leg free Latissimus dorsi muscle flap operations for limb salvage. They had soft tissue lower leg defects due to high voltage electrical injuries. Their medical records were retrospectively reviewed. All had only one artery that perfused the leg. Free pedicled thoracodorsal artery latissimus dorsi flaps were harvested and connected to the contralateral posterior tibial artery. RESULTS All defects were successfully covered. No flap loss or major amputation occurred during follow-up (mean; 5.9 years). A computerized tomography angiogram showed intact vessel continuity in the recipient vascular system. The patients were able to walk without any apparatus or assistance after long term follow-up. CONCLUSION We recommend that the cross flow-through pedicle free muscle flap should be considered as a salvage procedure for single vessel lower extremities resulting from high voltage electrical burns. Extremity perfusion was not compromised by this procedure.

Reconstruction of transhumeral amputation stumps with ipsilateral pedicled latissimus dorsi myocutaneous flap in high voltage electrical burns.

Injury due to high-voltage (>1000V) electricity is one of the most challenging problems in emergency medicine and plastic surgery. Extremity amputation because of electrical injury yields a stump that leaves vital structures, such as bone, muscle, blood vessels, and nerves, exposed; these structures should be covered with appropriate tissue. We designed a retrospective study that included twelve patients with a high-voltage electrical injury followed by trans-humeral amputation who were evaluated between 2004 and 2013. The ages of the patients ranged between 8 and 35 years (mean, 16.9 years). Following amputation, the defects were covered with an ipsilateral pedicled latissimus dorsi (LD) myocutaneous flap for stump protection and functional transfer. We concluded that the use of an ipsilateral LD myocutaneous flap is an adequate surgical operation in upper extremity amputations resulting from high-voltage electrical burn injuries and that this procedure permits stump length maintenance, contributes to arm functioning, avoids extended operation times, and prepares patients for prosthesis usage.

A useful option to obtain maximal foreign body removal and better prognosis in high pressure injection injuries: Negative pressure wound therapy with instillation

High pressure injection injuries to the hand are quite rare and they should be evaluated as a surgical emergency. Delay in the diagnosis and treatment usually occur if high pressure injection injuries does not present with an emergent clinical situation such as compartment syndrome. The prognosis depends on the features and the volume of the injected substance but it should be stated that amputation rates up to 48% were reported in previous publications. All foreign substances should be removed and copious irrigation in conjunction with debridement of all necrotic tissues should be performed. We present a useful technique including the utilization of vacuum therapy to remove maximum possible foreign body after adequate debridement as a preliminary study. Five patients with high pressure dye injection injuries treated between years 2011e2014 were presented in the paper (Table 1). The average age of the patients was 35,8 and the entry wounds of two patients were located in the palmar area, three patients in the volar surface of the fingers. In all patients, immediate debridement was performed and negative pressure wound therapy (NPWT) with instillation (wound irrigation) was applied to the open wound area with a mean pressure of 50 mmHg initially to prevent any possible obstruction of neurovascular bundles and circulatory problems. The pressure was increased to 75 mmHg in the postoperative first day, 100 mmHg in the postoperative second day and 125 mmHd in the postoperative third day. If no sign of circulation problems were encountered, NPWTwas continued with 125 mmHg pressure for the remaining days of the treatment. The extremity was

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

BACKGROUND High voltage electrical injuries can cause devastating results especially in distal extremities. Although free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF), which can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury. The purpose of this study was to evaluate long term results of eleven patients who underwent a reconstruction to the lower extremity with cross-leg DBSF due to high voltage electrical burn injury between the years of 2003-2013. METHODS Eleven patients suffering from high voltage electrical injury from 2003 to 2013 were evaluated retrospectively. All patients were male and had deep 2nd and 3rd degree electrical burns on many parts of their bodies, including their lower legs and feet. Seven of the defects were located on the right limb and four of them on the left. Defects were located in the ankle area in five patients, dorsum of the foot in four patients, achilles area in one patient, and the plantar region in one patient. RESULTS The adaptation of flaps to the recipient site, colour, and quality were all acceptable. CONCLUSION As an alternative to free flaps, the cross-leg DBSF has good tissue compliance, provides tissue of adequate quantity and quality, and has low complication rates in the long term in high voltage electrical injuries of the leg and foot.

Outcomes of Anatomic Reconstruction of Gunshot-Inflicted Lower Face Defects by Free Osteoseptocutaneous Fibula Flap and Expanded or Nonexpanded Temporal Scalp Flap Combination in Males.

AbstractReconstruction of gunshot-inflicted composite lower face defects is a challenge for plastic surgeons. Functional and aesthetic repair of such defects mostly requires free or pedicled flap applications or combinations of both.In this study, the authors evaluated 7 males with gunshot-inflicted composite mandibular defects. All patients underwent reconstruction with a free osteoseptocutaneous fibula flap (FOCF) for the composite mandibular defect and a pre or nonexpanded temporal artery-based scalp flap for beardless facial skin. All patients were evaluated aesthetically and functionally with a postoperative evaluation scale. Average patient follow-up time was 3.5 years.All FOCFs survived completely. Expander exposition was observed in 2 preexpanded temporal scalp flaps. The problem was solved by rapid expansion and early flap application. All patients had acceptable functional and aesthetic results.In conclusion, the scalp flap should be considered in male beardless skin reconstruction due to its ease of application, reliability, and proximity to the defect. Preexpansion of this flap can decrease donor area morbidities. Moreover, the FOCF and scalp flap combination is a convenient procedure for gunshot-inflicted lower face defects, and such procedures produce good aesthetic and functional long-term outcomes.

Salvage of a free osteocutaneous fibula flap by creating a distal arteriovenous fistula in facial reconstruction.

The case of a 25-year-old male with a facial gunshot wound is reported. A free fibula flap was performed for facial reconstruction. At 48 h after the operation, a thrombotic event was observed in the anastomosis. A distal arteriovenous (AV) fistula was performed to regulate the blood flow in the flap, and a combination of flaps (forehead flap and internal mammary artery perforator (IMAP) flap) was used for the skin defects. After creating the distal AV fistula, the blood flow was regulated and the free flap salvaged. No bone healing problem was observed in the free fibula flap and there were no complications related to the forehead and IMAP flaps. The fistula was patent at 2 years postoperative. Although all high-resistance flap conditions cannot be corrected with a distal AV fistula, the method presented in this case could be used as a last resort procedure for free flap salvage.

Radial kollateral arter perforatör bazlı propellar flep ile dirsek bölgesi rekonstrüksiyonu

Perforatör bazlı propellar flepler (RKAP) 180 dereceye kadar flep rotasyonuna izin vererek defekt onarımlarında kolaylık sağlamaktadır. Bunun yanında diğer fleplere nazaran donör alan morbiditesinin minimal olması özellikle alt ekstremite rekonstrüksiyonda bu fleplerin yaygın olarak kullanılmasını sağlamıştır. Ancak bu fleplerin üst ekstremitelerde kullanımı hala sınırlıdır. Özellikle dirsek bölgesi gibi onarımın zor olduğu bölgelerde bu fleplerin son yıllarda kullanımı gittikçe artmaktadır.Bu çalışmada dirsek bölgesinde kemiği açıkta bırakan defekti olan bir hastaya radial kollateral arter RKAP ile onarım yaptığımız bir olgu sunulmaktadır.

Use of Thompson Procedure in Pubic Massive Lymphedema

Objective: Massive Localized Lymphedema (MLL) is a benign soft tissue mass with unknown etiology and especially occurs in morbid obese patients. MLL generally appears in the medial thigh, but can rarely occur in the suprapubic area and lower abdominal region. MLL can develop into angiosarcoma. Predisposing risk factors should be taken into consideration for operative treatment. Material and Methods: We evaluated a 50-year-old female patient who had a 30-cm MLL area in her suprapubic area. Her Body Mass Index was 51.4. We performed suprapubic mass excision combined with abdominal dermal pedicled Thompson Procedure. Results: There was no suture dehiscence, seroma or infection in the postoperative 6-month period. We did not encounter recurrence during postoperative follow-up. Conclusion: Excisional methods such as the Thompson Procedure may be a convenient choice for suprapubic MLL via decreasing malignant potential by excision and improving lymphatic drainage.