Dogan Tuncali

Life satisfaction, self-esteem, and body image : A psychosocial evaluation of aesthetic and reconstructive surgery candidates

Abstract. Psychology should be an important part of a plastic surgery procedure in order to buoy up the patient so that he gains a consequent relief of psychiatric and social problems. It is a fact that reconstructive surgery patients also seek psychological stability and a better appearance that is acceptable to society. While the life satisfaction, self-esteem, and body image of the individual who seeks aesthetic plastic surgery has been a special concern in the plastic surgery literature, data about reconstructive surgery patients are usually lacking. To understand the factors influencing the aim of an individual seeking plastic surgery, this prospective controlled clinical study was designed. We hypothesized that they should have lower life satisfaction and self-esteem and more distorted body images than the ``normal population. Three hundred individuals were included in the study. Both the aesthetic surgery group (AG) and the reconstructive surgery group (RG) consist of 100 (n= 100) subjects. Individuals chosen randomly from the total population seen in the 12-month period were included regardless of the type of procedure, body region, or type of trauma as well as whether or not their wish for surgery was justified by the staff. The third group, the control group (CG), also consists of 100 (n= 100) subjects and was chosen from the ``normal population. All 300 subjects were asked to complete four scales: the Socio-Demographic Questionnaire, Life-Satisfaction Index (LSI), Self-Esteem Inventory (SEI), and Body-Image Inventory (BII). Results were collected and compared. The LSI results for the two surgical groups were found to be similar to those for the CG, with the RG demonstrating the lowest level. For the SEI there was a significant difference between the two surgical groups, being in favor of the AG, and a greater difference was noted between the CG and the RG. BII results showed no significant difference among the three groups. As a result, although there may be some, a regular person who seeks an aesthetic procedure should not be considered a psychologically disturbed individual at face value and each case should be evaluated individually in the preoperative consultation. Similarly, individuals who present for reconstructive procedures and wish further aesthetic refinements should be evaluated and treated exactly as pure aesthetic candidates.

The rate of upper-extremity deep-structure injuries through small penetrating lacerations.

Despite the abundance of epidemiologic studies concerning hand injuries, there is no study that emphasizes the significance of the initial laceration size. The aim of this study is to investigate the incidence of tendon, nerve, and artery injuries that may result from small, penetrating lacerations of the hand and forearm. A total of 226 patients with small lacerations were included in the study. Glass (68.7%) and knife (31.3%) lacerations were the only etiological factors. One hundred thirty-four patients (59.3%) had at least 1 deep-structure injury. One hundred twenty-four patients (92.5%) had at least 1 tendon, 25 patients (18.7%) had at least 1 nerve, and 20 patients (14.9%) had at least 1 artery injury. Extensor tendons were more commonly injured (61.3%). Combination injuries were found in 20 (14.9%) patients. The most-encountered combination was the injury of all 3 structures. Small laceration injuries of the upper extremity have the potential to conceal an underlying deep injury.

Spontaneous autoinflation of saline-filled mammary implants: postoperative volume determination by magnetic resonance imaging.

Abstract. Autoinflation of saline-filled mammary implants has recently been reported in the literature. Except for a few controversial hypotheses, the cause of autoinflation has not been clarified. The need to remove implants for accurate measurement of fill volume has been a deterrent to studies of autoinflation. To measure in situ volumes of saline-filled mammary implants, a noninvasive technique using magnetic resonance imaging (MRI) was developed. Measurements were performed manually on every MRI slice by tracing the outline of the implant with a hand-driven cursor. The accuracy of this MRI technique was assessed by measurements of tissue expanders containing known volumes of saline. To evaluate for autoinflation in mammary implants, a prospective clinical study to compare initial fill volumes of saline-filled mammary implants with 3- and 18-month postoperative volumes, calculated from magnetic resonance imaging (MRI) studies, was designed. A total of 12 patients (23 breast implants) implanted between 1994 and 1996 was included in the study. Volume data were compared by statistical analysis. MRI-determined volumes 3 months postoperatively were significantly larger than reported initial fill volumes, indicating that most saline-filled mammary implants included in the study autoinflated to some extent. Comparison of MRI-determined volumes 3 and 18 months postoperatively revealed no significant differences, indicating that saline-filled mammary implants remain stable and inflated between 3 and 18 months postoperatively. As a result of this study we believe that autoinflation of saline-filled mammary implants occurs more frequently than previously thought.

Consequences of radiation accidents.

Radiation injury attributable to radiotherapy is a topic that has attracted ample attention in the literature, especially in a vast number of publications in plastic surgery. However, the literature is clearly devoid of compilations regarding the effects of ionized radiation accidents. A case of a radiation accident is presented. It is nearly impossible to anticipate the extent of effects of external irradiation of the skin and subcutaneous tissues. The initially healed area should be expected to show late recurrent necrosis. Patients exposed to ionized external irradiation are no longer radioactive and can be treated as ordinary patients. However, these patients should be followed closely for years, keeping in mind the onset of late radiation effects like skin necrosis in various parts of the body, skin and other organ cancers, leukemia, infertility, hypothyroidism, and cataracts.

The prepuce and circumcision: Dual application as a graft

Circumcision is probably one of the first plastic surgery operations that has been used for centuries. The aim of this study was to apply the bilamellar tissue (skin and mucosa) obtained from circumcision to various defects and to evaluate the clinical results. During the last 2 years, 19 patients have been operated, and the skin and mucosal grafts were applied individually or simultaneously. The etiology was trauma for the whole series of patients (12 burns and 7 strap injuries). In 15 patients the defect was localized to the hand whereas in 4 patients it was located on the dorsum of the foot. In 10 patients, mucosa and skin graft were applied to the same defect as a single, compact layer. In 9 patients, skin and mucosa were applied separately to multiple defects. Using these methods, comparative evaluation of the consequences of prepuce mucosal and skin graft applications could be made. Four obvious differences were observed: (1) in mucosal grafts, early graft edema that resolves spontaneously after 48 hours; (2) better adaptation of the mucosal grafts to the recipient bed; (3) hyperpigmentation in both graft types, but the skin part was slightly darker than the mucosa; and (4) less secondary contraction was seen in mucosal grafts. The results were evaluated in light of the authors’ knowledge of the prepuce as an alternative full-thickness donor site. The relative differences in the dual anatomic structure of mucosa and skin, and the role of circumcision as a medical, cultural, and religious application in some societies are discussed.

Infantile digital fibromatosis: late results of two different treatment approaches

Infantile digital fibromatosis is a rare childhood benign tumor that mainly affects digits of hands and feet. Spontaneous regression has been reported, leaving the treatment options of observation or surgery a controversial topic. In this article, two cases of infantile digital fibromatosis treated with different approaches are presented. Observation alone was utilized in the first case. No spontaneous regression was observed after 2xa0years of follow up. In the second case, extended tumor excision and grafting was the chosen treatment. Recurrence was not observed at the 24th month postsurgery.We believe that to prevent recurrence, the tumor must be widely excised.

Osseous destruction and rupture of the extensor tendon caused by sarcoidosis of the finger

We describe a woman with osseous destruction and rupture of the extensor tendon as a result of sarcoidosis in the left third finger with no evidence of systemic involvement. The tendon was repaired and she was successfully treated with prednisone.

Open rhinoplasty through a forked flap incision.

Abstract. Surgical elongation of the short columella is a challenging problem for the surgeon. Although some flaps from the upper lip are successfully used to correct this deformity on cleft lip patients with a scarred upper lip, these methods cannot be applied to noncleft patients with a smooth upper lip. Distant flaps and composite grafts do not give the best aesthetic results. The use of an external approach for rhinoplasty is preferred by many surgeons, especially for difficult or secondary cases. Most incisions for open rhinoplasty are placed on the columella. This report describes a new incision for open rhinoplasty to be used on patients with a short columella. The incision is a standard forked flap with a columellar base but the legs of the flap extend to the nostril bases instead of to the upper lip. This method was used on eight aesthetic rhinoplasty patients with a short columella between March 1995 and March 1998. The results of the method are discussed.