Engin Yosma

The Effect of Chemodenervation by Botulinum Neurotoxin on the Degradation of Hyaluronic Acid Fillers: An Experimental Study.

Background: Early degradation is a common complaint for hyaluronic acid fillers. Although the combination of hyaluronic acid fillers with botulinum neurotoxin type A presented improved clinical results, objective measurement of hyaluronic acid volumes has not been previously assessed. Methods: In this study, the authors have split the calvaria of the rabbit to mimic the glabellar region in humans. In this model, the authors applied hyaluronic acid alone to one side and hyaluronic acid combined with botulinum neurotoxin type A to the contralateral side. Two days and 3 months after the filler injection, magnetic resonance imaging was performed to assess the filler volumes. Results: Average initial volume of filler only and filler combined with botulinum neurotoxin type A was 0.61 cm3 on both sides, and there was no difference between initial volumes of the two sides (p = 0.735). At the end of 3 months, average degraded volumes of filler-only and filler combined with botulinum neurotoxin sides were 0.33 cm3 and 0.19 cm3, respectively, and the degradation difference was significant between the two groups (p = 0.001). End volumes for the filler-only and filler combined with botulinum neurotoxin sides were 0.28 cm3 and 0.42 cm3, respectively, and end volumes between two sides were also statistically significant (p < 0.001). Conclusion: This study showed that hyaluronic acid filler application in combination with botulinum neurotoxin type A significantly decreases the degradation process and increases the remaining volume of the hyaluronic acid fillers at the end of the paralyzed period.

Our Treatment Approaches in Severe Maxillofacial Injuries Occurring After Failed Suicide Attempts Using Long-Barreled Guns.

AbstractMaxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

Multiple Subungual Pyogenic Granulomas Following Levothyroxine Treatment.

Abstract Pyogenic granulomas are benign vascular lesions that can result from a large number of etiological factors. Drugs are one etiological factor involved in pyogenic granuloma development. In this study we present our experience of multiple pyogenic granulomas following levothyroxine administration suggesting that levothyroxine hormone replacement therapy might play an important role in the formation of pyogenic granuloma. We also reviewed the literatures regarding drug-induced pyogenic granulomas.

A missed diagnosis: Acute encephalopathy with biphasic seizures and late reduced diffusion

Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a very rare encephalopathy subtype which is characterized by biphasic seizures and disturbance of consciousness in the acute stage followed in the subacute stage by restricted diffusion in the subcortical white matter and finally resulting in cerebral atrophy on magnetic resonance imaging. Although exact pathogenesis of AESD is uncertain, the etiology of AESD has been attributed to viral and bacterial infection. Here we report a case of AESD in a 15-year-old mentally and motor retarded patient, diagnosed based on clinicoradiological correlation.

Angiofibrolipoma of the tendon sheath.

Abstract We present a rare case of benign tumor of the hand.

A Rare Complication of Rhinoplasty: Periorbital Emphysema

Subcutaneous emphysema is a clinical entity that may be associated with trauma. Rhinoplasty is not an atraumatic procedure. This report presents a case of acute periorbital emphysema after cosmetic rhinoplasty.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Preventing Air Leakage in Negative Atmospheric Pressure Therapy for Open Fractures Treated With External Fixators

Preventing Air Leakage in Negative Atmospheric Pressure Therapy for Open Fractures Treated With External Fixators To the Editor: Negative atmospheric pressure therapy (NAPT) is a noninvasive technique for the treatment of acute and chronic wounds. NAPT consists of a sterile cell foam dressing wrapped with an adhesive covering and connected to a machine supplying a negative pressure. Blood flow to the treated area can be increased by up to 4-fold through the application of a negative pressure of 125 mm Hg. External fixators are frequently used in the treatment of open fractures in a variety of situations in both upper and lower extremities. However, external fixators make NAPT application difficult as a result of leakage from the pin sites and loosening of the adhesive covering. To prevent leakage around the pin sites, we use a commercially available hydrocolloid wound dressing material (Granuflex/DuoDERM, Convatec, Skillman, NJ), which we cut into narrow strips and wrap securely around the site where the pin penetrates the adhesive covering. The malleable structure of the dressing prevents loosening. In a previous study, cling film was used to prevent leakages in mobile parts of body by covering the whole extremity. The cling film, however, does not have strong adhesiveness to metals as Granuflex has. Owing to its adhesive

Caudal Septal Support Versus Strut Graft in Achieving the Desired Lateral Profile in Rhinoplasty

Abstract Nasal tip support is critical to achieve a lasting result in rhinoplasty. In this article, the authors compared the effects of strut grafts (SG) and caudal septum-based nasal tip supporting techniques (CSB-T) in terms of reaching the desired tip projection. Included in this study were 40 patients (24 women and 16 men) who underwent primary open rhinoplasty via transcolumellar incision between January and June 2012. To achieve a good nasal projection, SG and CSB-T were used for 15 and 25 of these patients, respectively. Certain anatomic landmarks were identified on preoperative, simulative, and 1-year follow-up photos. With these landmarks, certain angular and proportional values were calculated. In the SG, the authors found no statistically significant difference in between simulative goals and postoperative results regarding bending angle. Postoperative nasolabial angle (NLA), tip angle, subnasal-tip/subnasal-radix (SnT/SnR) ratios were significantly lower than the simulation values; radix angle and supratip index values were significantly higher. In the CSB-T group, the authors found no statistically significant difference in between preoperative values and postoperative results regarding NLA, tip angle, bending angle, (SnT/SnR) ratio values. Postoperative supratip index and radix angle measurements were found to be significantly higher than the simulation values. With these findings, the authors concluded that CSB-T support is superior than the SG for supporting the nasal tip in noses that also need shortening in caudal length. In noses that do not need caudal shortening, nasal tip projection can again be supported by the caudal septum by just forming a bridge between lower lateral cartilage and quadrangular septum using a wider SG that mimics septal extension grafts.

Evaluation of Forearm Arterial Repairs: Functional Outcomes Related to Arterial Repair

BACKGROUND There are few studies of single forearm arterial injury repair that compare long-term results of intact and obliterated forearm arterial repair. Aim of the present study was to compare long-term results of forearm arterial repair using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and color Doppler ultrasound (CDUS). METHODS Records of 166 consecutive patients with forearm arterial injury were reviewed, and 30 patients with same injury (ulnar artery, ulnar nerve, and tendon injuries at flexor zone V) were called back for CDUS and QuickDASH scoring. Patients evaluated with CDUS were divided into 2 groups according to results: patent vessels (Group 1) and obliterated vessels (Group 2), and statistical analysis was performed to compare QuickDASH scores of groups. RESULTS Difference in QuickDASH scores was statistically significant: Group 1 had lower score (24.27) than Group 2 (36.34), indicating better outcome in patients with patent vessels. CONCLUSION Vascular repair that achieved vessel patency led to better functional outcome with lower QuickDASH score and less cold intolerance.

Assessing the Expectations of Patients Demanding Rhinoplasty on Profile Photographs using Proportional Measurements and Simulation Programs

Material and Methods: Overall, 100 patients (60 women, 40 men) demanding rhinoplasty between January and December 2013 were included in this study. Standard profile photos were taken. Rhinoplasty and extra profile surgeries were simulated in those photos with both patient and surgeon decisions. These simulated photos were assumed as the desired profile view. In those photos, some angles or measurements were calculated to understand the desired proportions on the profile view. Then, these desired proportions were compared with the universal ideal proportions to understand the needs of extra profile surgeries in those patients.