Ensar Zafer Barin

Nerve sparing-distally based sural flap.

The management of soft‐tissue defects in the ankle and foot area is a challenging task. Distally based sural flap is widely used, however it leaves donor area paresthesia. For this purpose, the sural nerve was dissected and preserved in the distally based sural flap in five cases of ankle and foot soft tissue reconstruction. This modification did not cause any compromise in flap circulation. All flaps survived with one partial distal necrosis. We suggest that, the distally based nerve sparing sural flap can be securely elevated with only a 3–4 cm wide subcutaneous pedicle without any compromise in flap circulation.

Latissimus dorsi flap harvest with a short incision.

Latissimus dorsi (LD) flap is one of the most common options utilized in reconstructive armamentarium. In this report, we present our experience on harvest of the full LD muscle flap through a short incision. Twelve free and two pedicled full LD muscle flaps were raised in 14 patients (9 males and 5 females). In this technique, an oblique incision was placed 5–7 cm caudal to axillary apex, beginning from the posterior axillary line, so as to center the neurovascular hilus. The length of incision was 10 cm in adults and 8 cm in children. Mean dissection time was 45 min. All flaps survived totally. Seroma formation developed in two cases and treated with syringe aspiration and compressive dressing. In late postoperative period, donor site scars became inconspicuous and patient satisfaction was high. Short incision technique may be a good option to overcome scar problems in donor site of the LD flap. The technique reduces the dissection time and does not require sophisticated surgical devices and skill, when compared to endoscopic LD flap harvesting from the literature.

Treatment of Linear Scleroderma (en Coup de Sabre) With Dermal Fat Grafting.

Background: Linear scleroderma, also known as “en coup de sabre,” is a subtype of localized scleroderma that warrants aesthetic correction because it appears on the forehead region in children. Objective: To report dermal fat grafting as a novel and effective surgical treatment option in linear scleroderma. Methods: Under local anesthesia, a dermal fat graft was successfully placed into a subcutaneous pocket that was prepared underneath the depressed scar. The donor site was closed primarily. Results: No early or late complications developed postoperatively. After 1-year follow-up, the dermal fat graft was viable, the depressed scar was adequately augmented, and a good aesthetic result and patient satisfaction were obtained. Conclusion: We believe that dermal fat grafting is a cost-effective option and provides a long-lasting aesthetic outcome in the management of linear scleroderma.

Total lower lip reconstruction using free neurotendinofasciocutaneous anterolateral thigh composite flap: a case report.

Total lower lip reconstructions are challenging procedures because of poor aesthetic and functional outcomes and limited availability of donor tissues that anatomically imitate the lip. We hereby report the free neurotendinofasciocutaneous anterolateral thigh composite flap as a new reconstructive option. A 48-year-old man presenting with a squamous cell carcinoma of the lower lip underwent wide resection of tumor, bilateral neck dissection, and lower lip reconstruction with the mentioned flap where the lateral femoral cutaneous nerve and tensor fascia lata tendon were included. No complication was encountered postoperatively. The flap survived totally. Understandable speech, oral competence, and uneventful nutrition were obtained. Furthermore, tactile, pain and heat sensations, and two-point discrimination of 12 mm at the flap were regained. In reconstruction of the lower lip, this flap was first described in the literature and can be a good candidate as a reconstructive option.

Versatile use of rhomboid flaps for closure of skin defects.

OBJECTIVE The aim of this study is to present our clinical experience with rhomboid flaps. MATERIALS AND METHODS Twenty-four patients who were operated on between January 2006 and October 2010 were included in the study. All defects were reconstructed using rhomboid flaps. RESULTS Twenty-four patients were operated on for various reasons, and 26 rhomboid flaps were performed. Eleven of the 24 cases were male, and the median age of participants was 47.5 years. Eight cases were operated on under general anesthesia, and 13 were locally anesthetized; the remaining cases were operated on under regional anesthesia. In 17 cases, the defect was due to a benign or malignant tumor excision, and five cases were operated on due to burn contracture. There were no occurrences of partial or total flap necrosis or hematoma in our series. CONCLUSION Our series indicates that rhomboid flaps can be safely used to reconstruct small to moderately sized skin defects.

Reconstruction of the Wide Scalp Defects Using Free Latissimus Dorsi Flap Assisted With Arteriovenous Loop

Reconstructions of the wide scalp defects are still a challenging task because of the accompanied recipient vessel issues. Arteriovenous loop (AVL) grafts are a suitable vascular conduit that can be used to support free tissue transfer, when adjacent blood supply is inadequate. We report 2 patients of successful wide scalp reconstruction, using a free latissimus dorsi (LD) flap assisted with AVL. Both flaps and AVL grafts fully survived postoperatively. No complications related to the recipient and donor areas developed. The flaps obtained a durable barrier and an acceptable aesthetic appearance. We believe that AVL can be a useful adjunct for increasing the success rate of wide scalp reconstructions with inadequate adjacent arterial inflow or venous outflow. The free LD flap is a good option with its wide surface, rich vascularity and relatively low donor morbidity in such reconstructions.

Maxillofacial Fracture Experiences: A Review of 152 Cases

OBJECTIVE The fractures of facial structures lead to great morbidity. Cross-sectional studies are needed to evaluate the current state of maxillofacial traumas. Thus, this study aims to evaluate these experiences and to compare these results with the current literature. MATERIALS AND METHODS The medical records of the maxillofacial fracture cases hospitalized between January 2004 and November 2011 were examined. The age, sex, etiology, fracture localization and treatment method for each case were documented. The affected facial bones were grouped as mandible, maxilla, zygoma, naso-orbitoethmoid complex (NOEC) and blow-out. Nasal fractures were excluded. The cases were assigned to 3 groups with respect to age (below 16, above 65 and between 17 and 64). The chi Square test was used to assess the significance of the difference in mandibular fracture rates in the pediatric population compared to others. RESULTS The total number of cases was 152. The total number of fractures was 185. Of the 152 cases, 117 were male and 35 were female. The average age was 31.4 (±18.3), ranging between 2 and 81. Thirty-one cases were 16 years old or less. Nine cases were 65 years old or more. Mandibular and zygomatic fractures were the most prevalent fractures in the adult group. Mandibular fractures were significantly more common in the pediatric age group compared to rest of the population (X(2), p<0.05). Traffic accidents were the most common etiological factor, with a 55.3% ratio. Open reduction and internal fixation was the most frequently conducted treatment modality in all age groups. CONCLUSION Retrospective studies are important for the projection of future prospects. In summary, our results indicate that pediatric fractures are mostly in the lower face and usually affect the condylar region, which is consistent with the literature.

Reconstruction of an Extensive Plantar Defect with Two Simultaneous Free Flaps

Heel reconstruction after tumor ablative surgery or trauma presents the patient and the clinician with difficult treatment choices1-3. The heel region has complex osseous interactions, ligamentous slings, and unique skin coverage that provides sufficient cushion, all of which are crucial for normal gait4. Although there are regional pedicle flap options, reconstruction of these complex tissue defects usually requires free flaps. Regional fasciocutaneous flaps can resurface the defect efficiently. However, when there is a complex tissue defect that includes the calcaneus, more complex treatment options are needed5. In this case report, we describe how we reconstructed the heel region in a patient with an extensive plantar defect, with simultaneous use of free iliac crest and latissimus dorsi muscle flaps. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-nine year-old man presented with a Marjolin ulcer on the right heel. He had an ulcerated and vegetating mass that measured 14 × 7 cm (Fig. 1). An incisional biopsy revealed squamous-cell cancer. Physical examination and preoperative computed tomography (CT) demonstrated calcaneal invasion and excluded lymph node involvement. He had difficulty walking and had moderate pain. The American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score was 626. The tumor was stage III, which necessitated amputation of the foot. However, because the patient would not consent to amputation, the surgical team formulated an alternative plan. Fig. 1 Preoperative photograph of the ulcerated mass, which covered nearly the entire sole region. The calcaneus, the flexor hallucis longus tendon, the posterior tibial tendon, and the flexor digitorum longus tendon were resected along with two-thirds of the sole of the foot. The Achilles tendon was stripped off of the calcaneus. After wide resection of the tumor and …