Elif Sari

Combination of rhomboid flap and double Z-plasty technique for reconstruction of palmar and dorsal web space burn contractures

BACKGROUND Web space contractures after a burn can cause severe impairments in hand function along with esthetic deformities. In this study we present our experience with the combined treatment technique consisted of rhomboid flap and double Z-plasty for palmar and dorsal web space contractures. MATERIALS AND METHODS Combined rhomboid flap and double Z-plasty was performed in eight patients with eleven web space contractures occurred after burn. The average follow-up was 10.9 months. RESULTS The average age of 8 patients was 16.3 years. The average duration of burn contractures was 6 years (range 1-13 years). The right third web of the patients was the most common contracted web space. In the postoperative period hematoma, infection, partial or total flap loss was not observed in any patient. Web and hand function and esthetic appearance of web spaces were satisfactory in the late postoperative period. CONCLUSION Rhomboid flap combined with a double Z-plasty technique was an effective choice for the treatment of palmar and dorsal web space contracture after burn.

The Versatile Facial Artery Perforator-Based Nasolabial Flap in Midface Reconstruction.

Introduction:Defects in the lower two thirds of the face occur due to trauma, tumoral masses, or infections. In this study, repairs of various defects located in the midface using facial artery perforator-based nasolabial flaps are presented. Patients and Methods:Between January 2009 and June 2013, 15 patients with defects in the lower two thirds of the face or the intraoral region underwent repairs with facial artery perforator-based nasolabial flaps. The etiology was malignant skin tumor excisions in 11 patients, infection in 2 patients, and trauma in 2 patients. Among the patients, 10 were male and 5 were female. Their mean age was 65.1 (range: 20–86) years. The mean duration of follow-up was 14 (7–24) months. The defects were located at the upper lip, cheek, lower lip, intraoral region, and the nasal area. The size of the defects varied between 10 × 10 mm and 40 × 50 mm. All the flaps were prepared as perforator flaps. The flap donor area was primarily closed. Results:No partial or total flap loss was observed in any of the flaps. The flap donor areas healed without problem. Full patient satisfaction was achieved both aesthetically and functionally. Conclusion:The nasolabial perforator flap has certain advantages such as the 1-stage application, repair using a similar tissue, a wider rotation arc around the pedicle compared to the other regional flaps, and the primary closure of the donor area. Based on these characteristics, it is an ideal alternative for the repairs of the defects located in the lower two thirds of the face or the intraoral region.

Suprathel®‐assisted surgical treatment of the hand in a dystrophic epidermolysis bullosa patient

Epidermolysis bullosa (EB) is a progressive familial disorder composed of dermal mucosal blisters, flexion contractures and pseudosyndactylies. Flexion contractures and pseudosyndactyly can be treated with surgery but usually require skin grafting. Because of poor wound healing, skin graft harvesting is a challenge in these patients. In order to prevent donor‐site morbidities due to skin graft harvesting some alloplastic materials were introduced. In this study, we focused on Suprathel® as a new allograft material for covering the skin defects of a patient with dystrophic EB.

Effects of DMSO on a rabbit ear hypertrophic scar model: A controlled randomized experimental study

Dimethyl sulfoxide (DMSO) is an anti-inflammatory, antibacterial, analgesic drug widely used to treat several diseases as reported in the literature. It has a detractive effect on collagen deposition in the abnormal tissue. This study aimed to investigate the possible therapeutic effects of DMSO on hypertrophic scar formation in rabbits. Twenty-four New Zealand male albino rabbits were randomly divided into four groups: control, sham, DMSO, and TRA (triamcinolone acetonide). Except the control group, punch biopsy defects were created on each animals right ear. Following the hypertrophic scar formation on day 28, intralesional DMSO and triamcinolone acetonide were administered once a week for 4 weeks into these scars of the DMSO and TRA groups, respectively. No therapeutic agent was administered to the control and sham groups. One week after the last injection, ear samples were collected for histopathological, immunohistochemical, and real-time polymerase chain reaction gene expression analyses. Histopathological examination revealed that the epithelium in the DMSO group was thicker than that in the control and TRA groups, but thinner than that in the sham group. Connective tissue thickness and vascularity level of the sham group were higher than those of the control, DMSO, and TRA groups. The collagen type I immunoreactivity level of the sham and TRA groups was higher than those of the control and DMSO groups. The collagen type III immunoreactivity level was higher in the sham group than in all other groups. Collagen type I/type III immunoreactivity ratios were lower in the DMSO group. The alignment of collagen fibers was normal in the DMSO group, but was irregular in the sham and TRA groups. The collagen type I gene expression levels of the DMSO and TRA groups were lower than that of the sham group. Collagen type III and IFN-γ mRNA expression levels were almost similar among the groups. TGF-1β mRNA expression levels were higher in the DMSO and TRA groups than in the control and sham groups. On the basis of the results, it can be concluded that intralesional administration of DMSO decreases hypertrophic scar formation easily and safely.

Intranasal Extramucosal Access: A New Access for Lateral Osteotomy in Open Rhinoplasty.

Background and Objective: Different accesses have been used to perform lateral osteotomies in rhinoplasty. All of them have some disadvantages. The aim of this paper was to report a new access to overcome drawbacks of the other techniques in lateral osteotomy during open rhinoplasty. Methods: An anatomical study was designed to search possibility of intranasal extramucosal access (open sky access) for the lateral osteotomy in open rhinoplasty. It was performed directly on the lateral wall of piriform aperture, and then possible advantages of this technique were investigated. Five fixed cadavers were used for this purpose. No drawbacks were observed during procedure in cadavers. Then the same procedure was performed in 23 consecutive rhinoplasty patients. Nineteen operations were primary and 4 operations were secondary. Median oblique osteotomies were added to the procedure in all patients. The mean follow-up was 17 months. Results: Intranasal extramucosal access during lateral osteotomy was easily performed in all patients. Hemorrhage due to angular vessel injury was not occurred during intraoperative period. Edema and ecchymosis was minimal. Intranasal examination did not show any sign for nasal mucosal tearing in all patients. Residual bone spurs or bone irregularities were not observed in any patients. Conclusion: Intranasal extramucosal access that produces precise, predictable, and reproducible aesthetic and functional results could also provide better exposure during lateral osteotomy. Additionally, open sky access minimizes scars because it does not need additional incisions on the skin and mucosa. Protection of the internal periosteum of the nasal bones may be the main advantages of this technique.

New autologous material for the frontalis suspension technique: superficial temporal fascia

The frontalis suspension technique, which is a well-known surgical procedure, has been used for congenital ptosis for many years[1]. Several autologous and foreign grafts or materials have been preferred for this suspension, such as collagen, tensor fascia lata, palmaris longus tendon, deep temporal fascia, catgut, prolene, silicone, stainless steel, and supramid suture[2]–[3]. Each of these have their own advantages and disadvantages; however, the superficial temporal fascia has not been used for the frontalis suspension method before. This article reports the case of a child with congenital blepharoptosis, who was treated with the superficial temporal fascia, which is a new autologous graft for the frontalis suspension technique.

Estimated beginning time of local anesthesia effectiveness in forced cold air application: A preliminary study

Background: The literature has reported that forced cold air anesthesia decreases the discomfort effect of various laser therapies. The aim of this preliminary study was to determine the average beginning time of the local anesthetic effect of the forced cold air application when it is applied to all body surfaces except the face. Materials and methods: A total of 52 participants (26 females and 26 males) were included in this study. During application of the forced cold air, the beginning time of local anesthesia effectiveness for each volunteer was determined by giving painful stimuli. The results were then analyzed statistically. Results: The mean beginning time value of the local anesthesia was 52.88 (ranging between 30 and 60) seconds in the female group and 56.34 (ranging between 30 and 60) seconds in the male group. The mean beginning time value of the local anesthesia was 54.61 (ranging between 30 and 60) seconds in both genders. There was no statistical difference between the two groups (Z = − 0.834, p = 0.404). Conclusion: Forced cold air anesthesia—which is a quick, safe, cost-effective, and practical local anesthesia method—seems to be useful and effective when used alone in laser treatment.

Effectiveness of the Biophysical Barriers to the Peridural Fibrosis in Rat Laminectomy Model

ABSTRACT Purpose: Peridural fibrosis which could occur after the spinal surgery could adhere neural tissue closely and may cause to neural entrapment symptoms and require surgical reintervention. Aim of the study: Present study was designed to reduce occurrence of peridural fibrosis in rat laminectomy model by using biophysical barriers called hyaluronic acid (HAS) dural barrier, activated polyethylene glycol and polyethylene imine (PEG) dural barrier, and platelet-rich plasma (PRP). Materials and methods: In this study, 2 of 26 male Wistar albino rats (325–350 g body weight), which were not included into study groups were sacrificed by removing their total blood and their blood was used for preparation of PRP, and remaining rats were randomly delivered into four groups called SHAM, HAS, PEG, and PRP groups. Then L3-4-5 laminectomy was performed to all animals and experimental agents were administered to the selected groups mentioned above. Spinal colons of all animals were removed gross total after 6-week period and investigated histopathologically. Additionally, real-time-polymerase chain reaction was used to obtain collagen type I and type III, transforming growth factor-1β, and tumor necrosis factor-α gene expressions. Results: All results demonstrated that polyethylene glycol and polyethylene imine dural barrier and PRP could decrease peridural fibrosis formation efficiently in rat. Conclusion: Present study results suggested that to reduce or block formation of peridural fibrosis, either polyethylene glycol and polyethylene imine dural barrier or PRP could be used effectively in human subjects after they will be closely investigated in future studies.

Which is more effective for pain relief during fractionated carbon dioxide laser treatment: EMLA cream or forced cold air anesthesia?

ABSTRACT Background and aim: The aim of this study was to compare the effectiveness of a eutectic mixture of local anesthetic (EMLA) cream and forced cold air anesthesia (FCAA) on pain control during ablative fractionated carbon dioxide (CO2) laser treatment. Methods: Fifteen volunteers participated in this prospective, controlled, split-face clinical study. EMLA cream was applied 60 minutes before the laser procedure on half of the face, and FCAA was performed on each subunit of the other half of the face. The laser procedure was performed on each half of the face. Patients rated their pain during the procedure using a pain scale scored from 0–10. Both doctor and nurse rated patient discomfort during the procedure using a scale scored from 0–10. The pain scores associated with both EMLA and FCAA sides of the face were compared statistically. Results: Patient pain scores and discomfort scores detected by doctor and nurse were not statistically different between EMLA and FCAA. There was no statistically significant difference between males and females. Conclusion: Instead of using EMLA, FCAA—which can be applied in a shorter time—may be a cost-effective, simple, and safe local anesthesia method used in the ablative fractionated CO2 laser procedure.

Trigger thumb and finger in pediatric patients

Objectives: Trigger finger in pediatric patients is not as commonly seen as it is in adults. With that, it is ten times less likely to be seen than trigger thumb. Trigger finger usually presents in children less than 8 years old. It may be associated with anatomic, metabolic, inflammatory, and central nerve disorders. Flexion deformity of the finger is reported as the most frequent presentation of triggering. Diagnosis may be delayed because of the characteristic flexion posture of the newborn. Material and Methods: Between 2009 and 2014, we treated 37 trigger thumbs and fingers in 28 children. Results: Standard surgical techniques were used to release the A1 pulley in 32 digits of 27 patients. One patient that had five trigger digits was treated with steroid injections. Conclusion: Surgical release is recommended by many for the treatment of trigger finger in children if there is no discernible connection with either metabolic or inflammatory disease. We did not prefer conservative treatment after one year of age because of its failure and recurrence rates with the misbehavior and disobedience of children during physical therapy. Therefore, we maintain the recommendation of the standard surgical technique to release the A1 pulley for the treatment of triggering in childhood.