Emre Hocaoğlu

Improving bony stability in maxillofacial surgery: use of osteogenetic materials in patients with profound (≥5 mm) maxillary advancement, a clinical study

PURPOSE LeFort I osteotomy is a part of the standard surgical regimen in the treatment of patients with Class III dentofacial deformity. Inadequate osteosynthesis between the segments is a problem in patients with profound (> or =5mm) maxillary advancement. In this study an ideal ossification is aimed for by applying a combination of osteoinductive and osteoconductive materials. PATIENTS AND METHODS Ten patients with Class III deformity were included in this study. At least 5mm of advancement was performed on each patient, while mean maxillary advancement was 5.7 mm. Human demineralised bone matrix (DBM, 1 cc) and 20 mg bovine bone collagen-protein extracts (Colloss) were applied in between the segments following rigid fixation. Recurrence rates were calculated via cephalometric analyses. Multislice tomography images were collected after the 3 and 12 months in an effort to document ectopic or abnormal bone growth patterns, if any present. Four patients underwent a second operation for plate removal 12 months postoperatively. Bone biopsies were collected from the anterior maxillary wall. RESULTS The cephalometric analyses performed after 3 and 12 months were identical to the analyses calculated 1 week postoperatively for each patient, ruling out recurrences. No abnormal or ectopic bone growth was observed. Peroperative examination of four patients revealed a complete or near to complete osteosynthesis line at the anterior maxillary wall. The microscopic examinations of the bony samples retrieved from these borders revealed abundant osteoblasts, osteocytes, osteoclasts and a bony regeneration mimicking intramembranous ossification with its trabecular organisation. CONCLUSIONS It is possible to achieve an acceptable line of osteosynthesis in cases in need of profound maxillary advancement by applying DBM and Colloss inbetween the bony segments.

External decontamination of wild leeches with hypochloric acid.

BackgroundMedicinal leech, Hirudo medicinalis, has been used in plastic and reconstructive surgery, to relieve venous congestion and to improve the microrevascularization of flaps. In many countries, wild leeches are still provided from local markets and utilised with antibiotic prophylaxies. In this research, results of identification of bacteria in the transport fluid is reported, oral and intestinal floras and the antibiograms of the identified microorganisms are investigated. Also, to avoid possible infections, the ability of hypochloric acid, a disinfectant, to suppress the relevant microorganisms without changing the life style and behavior of leeches in terms of sucking function, is investigated.MethodsBacterial identifications and antibiograms of oral and intestinal flora and transport medium were performed for 10 leeches. The optimum concentration of hypochloric acid which eliminated microorganisms without affecting the viability and sucking function of the leeches were determined by dilution of hypochloric acid to 100, 50, 25, 12.5, 6.25 ppm concentrations in different groups of 25 leeches. Finally, 20 leeches were applied atraumatically to the bleeding areas of rats, the duration of suction was determined and compared statistically between the leeches treated and not treated with hypochloric acid solution.ResultsAeromonas hydrophilia was the most commonly identified microorganism and found to be resistant to first generation cephalosporins, frequently used in prophylaxis at surgical wards. In the next stages of the study, the leeches were subjected to a series of diluted hypochloric acid solutions. Although disinfection of the transport material and suppression of the oral flora of hirudo medicinalis were successful in 100, 50, 25, 12.5, 6.25 ppm concentrations; 12.5 ppm solution was the greatest concentration in which hirudo medicinalis could survive and sucking function was not affected significantly.ConclusionsExternal decontamination of wild leeches with 12.5 ppm hypochloric acid enables bacterial suppression without causing negative effects on leech sucking function and life.

Free pre-expanded lateral circumflex femoral artery perforator flap for extensive resurfacing and reconstruction of the hand

Resurfacing and reconstruction of extensive scars, severe contractures and deformities of the hand are still challenging cases for plastic surgeons. Treatments usually necessitate thin, pliable and broad flaps. Additionally, minimising the donor-site morbidity is an indisputable requisite. The pre-expanded perforator flap technique has been shown to provide extensive, thin and pliable skin with increased vascularity while reducing the donor-site morbidity. Utilisation of free pre-expanded lateral circumflex femoral artery perforator flap in an aesthetic and functional reconstruction of severe post-burn hand deformity is demonstrated. The successful functional and aesthetic outcome that was achieved in the early postoperative period and which still persists after 23 months of follow-up indicates that our technique could be preferably used in the extensive coverage of the hand.

Preexpanded perforator flaps of the dorsolateral trunk in pediatric patients.

Background: Contractures and broad scars of the axilla, anterior chest wall, and neck have detrimental effects on functional, physical, and psychological development of children. Perforator flaps have already been shown to be reliable options for the reconstruction of contractures, but there have been no reports demonstrating the value of preexpanded perforator flaps of the dorsolateral trunk region in the treatment of extensive contractures and scars of pediatric patients. The purpose of this study was to demonstrate these techniques by a case series formed of pediatric patients with broad scars and contractures of the anterior chest wall, axilla, neck, and breasts. Methods: Seven pediatric patients (mean age, 11.6 years) who were treated by preexpanded perforator flaps are presented. By this means, clinical experience regarding the intercostal artery perforator, thoracodorsal artery perforator, circumflex scapular artery perforator, and lumbar artery perforator flaps was shared. Results: Flaps as large as 21 × 11 cm could be successfully transferred in pediatric patients. Broad scar tissues were resurfaced with broad flaps carrying similar characteristics with the uninjured anterior chest wall and neck skin in six of the authors’ patients. In one patient with partial necrosis, a full-thickness skin graft was used for the residual defect. The mean duration of postoperative (after flap transfer) follow-up was 17.2 months. Conclusions: The preexpanded thoracodorsal artery perforator, intercostal artery perforator, and circumflex scapular artery perforator flaps are useful and effective reconstructive options for the treatment of scars and contractures of the anterior chest wall, axilla, neck, and breast in pediatric patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Body fat composition and weight changes after double-jaw osteotomy.

Nutritional problems might be observed after surgical procedures. In this study, body weight and fat composition changes have been investigated in dentofacial deformity patients after the double-jaw osteotomy procedure.Thirty Angle class 3 patients operated on with double-jaw osteotomies during the period of March 2006 to July 2008 were included in the study. Interocclusal splints were applied continuously in the first 2 weeks after surgery, whereas intermittent splint was used for the next 2 weeks. Patients were analyzed before surgery and on the first month after surgery with the help of Tanita Composition Analyzer 310 bioimpedance method for weight, fat mass, and fat-free mass values. Results were evaluated statistically with the paired-sample test using SPSS version 13.0.Although significant results were obtained in female patients before surgery (weight [P = 0.011], body mass index [BMI; P = 0.012], fat mass [P = 0.010], and fat-free mass [P = 0.051, not significant]), none of the values were significant for male patients (P = 0.747, P = 0.747, P = 0.645, and P = 0.803, respectively). Weight gain was observed in 9 patients (30%). In contrast, weight gain was not seen in underweight patients. No sex differences in terms of weight gain/loss and fat composition have been observed.Interocclusal splint in female patients operated on with double-jaw osteotomies might cause nutritional deficiency in the first month after surgery. This eventually causes fat and weight loss, which may lead to poor wound healing and recovery later.

Lower eyelid reconstruction in a paediatric face: A one-stage aesthetic approach using the versatile temporoparietal fascia flap

There are many different lower eyelid reconstruction techniques defined in the literature. Almost all of the published techniques have been described on elderly patients and use upper eyelid, periorbital or facial tissues as donor sites. However, in case of a paediatric patient or a young adult who has a crease-free and scarless face, camouflage of the facial donor-site scar is usually impossible. In order to avoid possible facial donor-site scars and upper eyelid deformities, a technique which uses the temporoparietal fascia (TPF) flap as the framework of a new eyelid was used for the reconstruction of an adolescent patients postoncologic defect. The inner side of the flap was covered with nasal septal chondromucosal graft and the external side was covered with a retroauricular full-thickness skin graft. Eighteen months of unproblematic follow-up of this overlooked usage of the versatile TPF flap indicates that our technique has proved successful in terms of good functional and cosmetic outcome that is obtained at one stage.

Foreign Body Penetrations of Hand and Wrist; a Retrospective Study

BACKGROUND Despite significant practical knowledge and experience on foreign body penetration injuries to the hand and/or wrist, deficient management and complications can still be encountered, and ignorance of its causative and eventual social aspects unfortunately is a substantial fact. This study aims to cover the clinical and social properties and the management of these kinds of injuries. METHODS A retrospective analysis of 86 patients requiring evaluation and treatment in a Hand Surgery Division of a university hospital was performed. RESULTS The median age was 32 (min: 4, max: 63). Industrial workers constituted the largest occupational group (n=22, 25.6%). Twenty-three (26.7%) of the cases were elective admissions. Thirteen (15.1%) patients had various comorbidities, and five (5.8%) had psychiatric diagnoses at the time of the injury. The index finger was the most frequent site of injury (n=29, 33.7%). General anesthesia was not necessary for the management of 94.2% of the cases. In 26 (30%) of the patients, neural, tendinous or osseous damage was observed. Twenty-four (30%) patients were included in a postoperative hand physiotherapy program. CONCLUSION The practically well-known general features of the issue and those aspects that may still be overlooked currently are reevaluated herein, in light of our observational data.

A distinctive presentation of diplopodia: a Y-metatarsal combining the extra foot and the extra digit of the main foot.

Diplopodia is a rare congenital anomaly and has been described as extra digits, metatarsals, and tarsal bones that form an extra foot or foot-like structure. Various skeletal deformities and anomalies involving other organ systems can accompany diplopodia. Treatment consists of surgery, splinting, and physical therapy, planned according to each patients specific condition. We present a patient who had diplopodia with distinctive anatomic features (with postaxial polydactyly and without any anomaly of the tibia or fibula) compared with the previously reported cases, and concomitant anomalies, including left renal agenesis and anal atresia.

Ultrasound-Guided Bilateral Thoracic Paravertebral Blocks as an Adjunct to General Anesthesia in Patients Undergoing Reduction Mammaplasty: A Historical Cohort Study.

Background: This study investigates whether ultrasound-guided thoracic paravertebral blocks would improve postoperative analgesia in patients undergoing bilateral reduction mammaplasty. Methods: After obtaining ethics committee approval, data of 70 patients who underwent bilateral reduction mammaplasty were reviewed. Sixty-four patients’ data were evaluable; 30 were in the general anesthesia group and 34 were in the thoracic paravertebral block group. Data such as time to first pain, intraoperative fentanyl requirement, postoperative numeric rating scale scores, number of patients who required tramadol in the postoperative care unit, and rescue analgesic consumption through the first 2 postoperative days were analyzed. Results: Time to first pain was 311 minutes (range, 0 to 1605 minutes) and 20 minutes (range, 0 to 120 minutes) in the thoracic paravertebral block and general anesthesia groups, respectively (p < 0.001). Fentanyl requirement was 52.94 ± 11.94 µg and 115 ± 29.79 µg in the thoracic paravertebral block and general anesthesia groups, respectively (p < 0.001). Numeric rating scale scores were lower in the thoracic paravertebral block group through the first 2 postoperative hours (p < 0.001), and only two of 34 patients required tramadol in the postoperative care unit (p < 0.001). On postoperative day 1, both metamizole sodium (p < 0.001) and paracetamol (p = 0.018), and on day 2, only metamizole sodium (p < 0.001) consumption was lower in the thoracic paravertebral block group. Conclusion: Adding ultrasound-guided thoracic paravertebral blocks to general anesthesia postponed time to first pain and reduced analgesic consumption in patients undergoing bilateral reduction mammaplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Pre-expanded Free Perforator Flaps

Pre-expanded perforator flaps are the most recent technical way to shape tissue for exact needs. Reconstruction with pre-expanded free perforator flaps has proven successful in terms of obtaining more extensive, more pliable, and thinner flaps that have increased vascularity, and also causing less donor site morbidity. In this article the authors experience with the clinical application of such flaps and the relevant published literature are reviewed.