Erdem Tezel

The effects of the size of liposuction cannula on adipocyte survival and the optimum temperature for fat graft storage: an experimental study

BACKGROUND Determining the most advantageous size of liposuction cannula and injection needles in terms of adipocyte viability could help to increase fat graft survival. When recurrent injections are necessary, storing fat tissue which is harvested during the first operation could be a practical solution if it is stored at an appropriate temperature providing the highest amount of viable fat cells. METHODS Fat tissue was removed from the abdomen of 10 consecutive female patients by 6-, 4- and 2-mm-diameter liposuction cannulas. Fat tissue harvested with the 6mm cannula was injected through 14, 16 and 20 g needles and collected in separate tubes. An additional three tubes of fat samples were prepared from fat tissue obtained with the 6mm cannula to be stored at +4, -20 and -80 degrees C for 2 weeks. Viability of the fat grafts was evaluated by fat cell isolation with collagenase digestion and staining with supravital dye and counting adipocytes with a haemocytometer. RESULTS The viability of fat grafts harvested with the 6mm cannula was higher than grafts obtained with smaller cannulas. The viability of fat grafts injected through 14, 16 and 20 g needles were similar to each other. The viability of fat grafts stored at +4 degrees C was similar to fresh tissue whereas freezing fat grafts caused significant loss of viable adipocytes compared to fresh tissue. CONCLUSIONS The use of larger liposuction cannulas for fat tissue harvesting provides more viable fat grafts. A temperature of +4 degrees C could be proposed as an effective and easily available way of storing fat grafts for at least 2 weeks.

The mental V-Y island advancement flap in functional lower lip reconstruction.

&NA; Various flap procedures for the reconstruction of lower lip defects have been described to achieve the basic requirements of a functional repair, namely muscle function and sensation. Flaps elevated from the upper lip or the adjacent cheek may provide a solution, but for larger lower lip defects, preservation of function is difficult. In this article, a new functional lower lip reconstruction technique that includes the transfer of a myocutaneous flap based on the mental neurovascular bundle and on the branches of the facial artery is described. The principle of this reconstructive procedure is to advance the tissues from both sides of the chin as myocutaneous flaps upward to the lip defect, reorienting the muscles of the flap for sphincteric function, and preserving the mental nerve for sensation. The depressor anguli oris and remnants of the orbicularis muscle together with their motor nerve branches are included in the V‐Y advancement flap. (Plast. Reconstr. Surg. 100: 1682, 1997.)

Buccal mucosal flaps: A review

The defects of mucosal surfaces of the face, either congenital, traumatic, or postoperative, have been prominent subjects of plastic surgery. Local skin flaps and free flaps have been used to repair these defects. Because the face is the most vascularized portion of the body, skin flaps in this area have a great chance for viability. Buccal mucosa also shares the same feature of vascularity and thus has the capability of amazingly fast healing. Taking into consideration these features, and the idea of using the most similar tissue for reconstruction, it is easy to understand why plastic surgeons have described many oral mucosal flaps. The purpose of this article is to collate, summarize, and critique the information available on the mucosal flaps. I reviewed the buccal mucosal flaps according to their sites of use.

Commissure-based buccal mucosal flap

&NA; Commissure‐based buccal mucosal flaps extending to the retromolar trigone have been used for anterior intraoral mucosal defects. The flap was utilized successfully in 26 patients who had vermilion defect (14 cases), obliteration of the anterior gingivobuccal sulcus (8 cases), and anterior maxillary defect (4 cases). (Plast. Reconstr. Surg. 101: 1223, 1998.)

Septocolumellar suture in closed rhinoplasty.

Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of them and can be described as a loop suture between the medial crura and caudal septum. Although some of the articles mention that it can be applied in closed rhinoplasty, there is no description of the technical details. This paper presents indications, technical steps, and advantages of the septocolumellar suture in closed rhinoplasty. After completing the classic sequence of the endonasal extramucous technique, the medial crural cartilages are dissected from the overlying skin at the midcolumellar level, keeping the distal fibrous attachments between the anterior columellar skin and these cartilages intact. A 5/0 or 4/0 Prolene (Ethicon Ltd, UK) with a round needle is passed, penetrating both the medial crura and then the caudal septum. Depending on the penetration level of this suture, the tip projection can be increased or decreased, the tip can be rotated, and columellar show can be corrected. This suture also makes the medial crura of the alar cartilages and septum rigidly fixed together, thus providing stability. Depending on the experience gained in 433 primary and 62 secondary rhinoplasty cases since 2000, it can be claimed that this technique, presenting an alternative to the open approach in many cases and expanding the borders of closed approach, allows one to manipulate the tip and columella easily with closed rhinoplasty and provides a significant decrease in the suboptimal results and number of complications.

The Peruvian Fisherman's Knot A New, Simple, and Versatile Self-Locking Sliding Knot

Background:In many plastic surgery operations that are undertaken through relatively small incisions resulting in deep-seated operating fields, sliding knots with a self-locking property are preferred by plastic surgeons for 3 reasons: simplicity, reliability, and versatility. We describe a new and versatile sliding knot that can be easily sledded and locked. Methods:The technique of knot tying is described in detail as a stepwise approach with photographs. The main advantages of the Peruvian fishermans knot are compared with other methods and summarized. Results:In addition to its adjustment-related properties, knot security has been adequate with this knot as evidenced by its clinical performance and the authors’ experiences to date. Conclusion:The Peruvian fishermans knot is especially useful while working in deep seated operating fields through a small incision. Tension created during knot tying is adjustable, which makes it an ideal choice for various lifting procedures in plastic surgery.

Benign Chondroid Syringoma: Atypical Presentation of a Rare Eccrine Tumor

Chondroid syringoma is a rare eccrine tumor that is often benign but has the potential for malignant transformation and distant metastasis. Histopathological analysis may not be definitive, and any patient with atypical features, an accelerated clinical course, or high suspicion for malignant transformation is a candidate for immediate surgical intervention and close follow-up. The purpose of this article is to review the clinical features of this rare tumor with a special emphasis on its atypical presentation.

Double helical rim advancement flaps with scaphal resection: selected cases over 10 years and review of the literature.

BackgroundAuricular surgery is a challenging subject in plastic surgery due to the complicated surface topography of the external ear. Although various techniques for ear reduction and helical rim reconstruction have been reported in the literature, an ideal method is yet to be defined. Double helical rim advancement flaps with scaphal resection presented in this report represent a practical technique for correcting macrotia and reconstructing helical rim defects.MethodsThe amount of full-thickness resection at the helical rim is planned according to the desired reduction or extent of tumor. After helical excision, an incision that transects all the layers of the ear is carried out along the helical sulcus inferiorly and superiorly to yield two advancement flaps. Using scissors, a crescent from the scapha is excised through the full thickness of the ear. The flaps are approximated and sutured to the scapha by means of stitches that pass through skin and cartilage.ResultsThe described technique has been performed successfully since 1998. It has been used for 12 cases of macrotia, 28 cases of tumor surgery, and 7 cases of ear reduction for asymmetric ears. No major complications have been encountered. Three cases are reported as examples of the procedure.ConclusionsDouble helical rim advancement flaps with scaphal resection represent a versatile and safe technique that can be used for ear reduction, helical rim reconstruction, and correction for discrepancy in size of ears.

Rotation ligamentoplasty for the correction of epicanthus inversus.

&NA; Epicanthus, with its various types, is characterized by an arching fold at the sides of the nose, with a concavity directed laterally. Epicanthus inversus, one of these types, which occurs with varying frequency in all races, is most common among Asians. In epicanthus inversus, the medial canthus is displaced laterally and the medial canthal depression is shallow or absent. The lower puncta is displaced laterally as well. Correction of epicanthus is easy with Z‐plasties or with the four‐flap technique of Mustardé. However, inverted epicanthus cannot be repaired using these techniques, as proved by others. The authors suggest rotating the medial canthal ligament during transnasal wiring to support the eversion of the laterally displaced medial lower lid, lower puncta, and surrounding skin. Eight patients with epicanthus inversus were operated and followed for at least 15 months. The results were satisfactory according to a graded scale. Karacaoğlu E, Tezel E, Güler MM. Rotation ligamentoplasty for the correction of epicanthus inversus. Ann Plast Surg 2000;45:140‐144

Tip-Oriented Closed Rhinoplasty Built on Septocolumellar Suture and a New Caudal Septal Graft Technique.

BackgroundA beautiful and appealing nose receives the greatest contribution from the nasal tip subunit, which should be regarded as the primary center of attention during a rhinoplasty procedure. In achieving the desired shape and position of the nasal tip during closed rhinoplasty, the septocolumellar suture functions as the major determinant together with the caudal portion of the septal cartilage, which has a significant influence on the versatility of the septocolumellar suture. The purpose of this study was to present the analysis of the indications, the technical steps, and the advantages of caudal septal graft and septocolumellar suture utilization in closed rhinoplasty. MethodsThe septocolumellar suture with or without the caudal septal graft combination procedure has been performed in 2286 patients via a closed rhinoplasty approach. Intraoperatively, the septal cartilage at hand was thoroughly evaluated and one of the 5 types of caudal septal grafts was used when necessary. After the establishment of a strong and straight septal cartilage with sufficient height and length, 4 different septocolumellar sutures in a specific order were used to modify the relationship between the lower lateral cartilages and the nasal septum. ResultsOf the 2286 cases, 1837 (80.3%) were primary and 449 (19.7%) secondary rhinoplasties, which have been followed up for 9 to 48 months. The caudal septal graft was combined to the septocolumellar suture in 621 (27.1%) patients. Of the caudal septal grafts, 69.7% were used for primary rhinoplasty cases, and 30.3% for secondary rhinoplasties. At the 18th month postoperatively, tip projection was found to be satisfactory for 98% of the patients. ConclusionsThe septocolumellar suture combined with caudal septal graft in closed rhinoplasty substantially facilitates the achievement of a cosmetically and functionally pleasing end result, bringing the solution for a wide array of problems such as short nose, supratip deformity, nasolabial angle change, or columellar bowing. Nevertheless, the technique has a steep learning curve; therefore, a meticulous preoperative evaluation should be exerted, a precise surgical planning should be prosecuted, and an excessive reduction of the nasal tip or exaggerated columellar retraction should be avoided.