Emin Sir

A Simplified Use of Septal Extension Graft to Control Nasal Tip Location

BackgroundFor defining the shape and projection of the nasal tip, the bilateral and symmetric batten-type septal extension grafts proposed by Byrd and colleagues have drawbacks. The main problems are stiffness of the nasal tip and thickening of the septum in the nasal valve area.MethodsSince 1998, unilateral single-batten grafts, and more frequently, bilateral asymmetric batten grafts as compared with Byrd’s bilateral symmetric application, have been used for 72 patients in our facility.ResultsAt the 6-month postoperative follow-up assessment, tip projection was found to be satisfactory in 61 patients. Less than desired projection occurred in three cases and overprojection in two cases. Nasal lobule deviation was evident in one patient. The loss of the columellar break point was evident in five cases.ConclusionUnilateral or asymmetric bilateral batten grafts facilitate adjustment of the nasal tip intraoperatively. This technique results in a more pliable nasal tip in the horizontal plane. Construction of a three-layered cartilage in the nasal valve area is not needed, and the nasal airway is preserved. With this modification, a reliable and predictable nasal tip location is obtained with a minimum of graft usage.

Three-dimensional modeling of nasal septal deviation.

Background:Some deviated nasal septa can never be straightened completely due to their 3-dimensional (3-D) nature. Based on a study of models and clinical cases, a basic classification and treatment strategy was proposed for 3-D septal deviations. Methods:Basic types of 3-D septal L struts were crafted from pieces of thick plastic sheeting. By a carefully placed through-and-through incision in the angle area and overlapping the resultant segments, the models became 2 dimensional (2-D). We used this technique intraoperatively, in some cases resecting the overlapping area of septal tissue, along with a septal extension graft, in 11 patients who were followed up for more than 6 months. Results:External nasal deviation due to a deviated septum was obvious in 5 cases, and all were relieved postoperatively. Preoperative breathing difficulties were improved in 7 of 8 patients. Conclusion:Correction of 3-D septal L deformity can be successfully performed by constructing 2-D L struts by making a full-thickness incision of the angle area and then overlapping the segments. This approach is especially beneficial in those having a septal extension graft that need a perfectly straight caudal septum upon which to fix the extension graft.

Fingertip Replantation Without and With Palmar Venous Anastomosis: Analysis of the Survival Rates and Vein Distribution.

Background The purpose of this study was to compare the results of fingertip replantations without (artery anastomosis only replantations) and with venous anastomosis (replantations in which both arterial and palmar venous anastomoses were performed). Also, distribution of the veins used for anastomosis was analyzed retrospectively. Patients and Methods First 53 digits (47 patients) received only arterial anastomosis (group 1). For relieving venous congestion, external bleeding method was used. Last 41 digits (38 patients) received both arterial and palmar venous anastomoses without external bleeding (group 2). Results There was statistical significance of the survival rate between group 1 [77.3% (41/53)] and group 2 [92.6% (38/41)] (P = 0.039). Venous congestion was encountered at 10 digits in group 1 (all underwent necrosis totally) and at 3 digits in group 2 (both were moderate and could be salvaged partially) (P = 0.094, no statistical significance). There was statistical significance of the mean operation time for single-fingertip replantation between group 1 (80 ± 7.8 minutes) and group 2 (105 ± 14.5 minutes) (P < 0.001). The average external bleeding period was 7.2 days. The mean hospital stay was 12.4 ± 1.5 days for group 1, which was significantly longer when compared with group 2 (5.2 ± 0.5 days, P < 0.001). Conclusions Although palmar vein anastomosis did not show a statistically significant effect on relieving venous congestion, it reduced the rate and the severity of venous congestion. Also, replantations with palmar venous anastomosis have simpler postoperative care and lower drawbacks as compared with artery anastomosis–only replantations.

Effect of Reduction Mammaplasty on Sexual Activity.

AimThis study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. Materials and MethodsThirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls’ scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. ResultsThe mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). ConclusionsWe found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners’ erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

BACKGROUND Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures. METHODS Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2nd, 3rd, and 4th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9-23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes-Weinstein monofilament test, and cold intolerance test for the development of neuroma on the donor site. RESULTS In 5 patients, replantation procedure failed. In such failed patients, after the removal of necrotic tissues, the stump was either repaired or reconstruction with a flap was applied. Wound dehiscence was observed at the lateral sides of the flaps in 2 patients who underwent reposition procedures. CONCLUSION Reposition flap repair can be a good cost-effective alternative to other fingertip repair procedures in appropriately selected patients who are not amenable to microsurgery. It preserves the length and sensory functions of fingertips and enables patients to return to their daily life as soon as possible.

Evaluation of sexual function in women with labia minora hypertrophy: A preliminary study

OBJECTIVE To compare the sexual functions in women with labia minora hypertrophy and age-matched healthy controls. MATERIAL AND METHOD 43 patients with labia minora hypertrophy and 30 age-matched healthy controls were enrolled in the present study. The sexual functions of the women were evaluated by using the index of female sexual function (IFSF). RESULTS Mean ages of the patients and controls were 30.06±7.11 and 31.34±4.12 (p=0.41), respectively. Mean total IFSF scores of the patients and controls were 24.18±3.24 and 27.53±4.43 (p<0.05), respectively. The subscale scores of IFSF-lubrication, orgasm, satisfaction and pain in the patient group were significantly lower than in the control group (respectively, p<0.001, p<0.05, p<0.001 and p<0.05). There was no statistically significant difference between IFSF-arousal scores of the patient and control groups (p=0.30). The mean IFSF-desire scores of the patient group was higher than the controls (p<0.001). Labia minora hypertrophy was significantly associated with female sexual dysfunction (odds ratio [OR]=14.97, 95% confidence interval [Cl]=[3.66-61.21], p<0.001). CONCLUSION This study suggests that patients with labia minora hypertrophy have poorer lubrication, satisfaction, pain, and orgasm scores on the IFSF scale compared to age-matched healthy controls.

Invasive squamous cell carcinoma originating from a giant penile condyloma

In this case study, we present an unusual case with squamous cell carcinoma originating from a giant condyloma acuminata completely surrounding the penis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 20 years. Incisional biopsy revealed acanthosis of the squamous epithelium. The patient was operated on under spinal anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. The penile skin was constructed with a split thickness skin graft. Histopathological analysis of the lesion revealed an invasive and well-differentiated squamous cell carcinoma arising on a condyloma, and the surgical margins were free from tumour. The patient was staged as G2 T1 N0 M0 and was followed for one year. He did not have any erectile dysfunction and could engage in intercourse. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. When encountering patients with giant condyloma acuminata, it should not be forgotten that it may be accompanied by squamous cell carcinoma. In addition, tissue excision should be as extensive as possible while keeping in mind the importance of the function. This is the first case of a penile-degloving surgery for giant penile condyloma, supporting conservative and preserving penile surgery for such tumours.