Erdem Yormuk

viability of Diced, Crushed Cartilage Grafts and the Effects of Surgicel (oxidized Regenerated Cellulose) on Cartilage Grafts

The viability of cartilage grafts has been well documented; however, controversy still exists about the viability of crushed cartilage. Recently, there has been a tendency to use diced cartilage grafts wrapped with oxidized regenerated cellulose (Surgicel) sheets for improving dorsal contour in rhinoplasty. The viability of diced cartilage grafts and the effect of Surgicel on cartilage grafts are not well known. In this study, we used ear cartilage from 18 New Zealand rabbits. Cartilage grafts were transplanted to surgically created subcutaneous pockets on the back of the rabbits on both the left and right sides. There were three groups: (1) intact cartilage grafts, (2) crushed cartilage grafts, and (3) diced cartilage grafts. The grafts that were transplanted to the right side were wrapped with Surgicel. Cartilage grafts in all groups were viable. In grafts that were wrapped with Surgicel, a marked increase in the collagen content was investigated. Grafts that were wrapped with Surgicel demonstrated no evidence of proliferation, whereas the bare cartilage grafts demonstrated significant amounts of proliferation.

THE EFFECTS OF L-ARGININE AND ILOPROST ON THE VIABILITY OF RANDOM SKIN FLAPS IN RATS

The effects of an intravenous infusion of L-arginine as a physiological precursor of endothelium-derived relaxing factor/nitric oxide (EDRF/NO), iloprost (a stable prostacyclin (PGI2) analogue), and L-arginine combined with iloprost on skin viability were studied in 9 x 3 cm random pattern skin flaps in rats. Intravenous infusion of all drugs was started at the beginning of the operation and continued for 60 minutes. At the end of infusion period the depth of fluorescein dye penetration in the skin flap was assessed visually from photographic records, and the flap survival area was measured by the grid method at the seventh postoperative day. There was a significant reduction in distal necrosis of random skin flaps after intravenous infusion of L-arginine, iloprost, and L-arginine combined with iloprost (p < 0.01). Possible mechanisms that may be responsible for impairment of endothelium-dependent vasodilation and vasospasm in the microvasculature of random skin flap and their prevention with L-arginine and iloprost include restoration of the depleted stores of NO which in turn causes vasodilatation and has an antithrombotic effect.

Pilomatrixoma of the earlobe.

BACKGROUND Pilomatrixoma most commonly occurs in the head and neck region, appearing primarily in the first two decades of life. The lesion is described as a tumor with differentiation toward hair cells and surgical excision is the treatment of choice. OBJECTIVE We report an uncommon localization of a perforating type pilomatrixorna of 5 × 4 × 4 cm in size that developed from the earlobe. METHODS Histopathological examination revealed pilomatrixorna. Total resection of the tumor was performed. The earlobe was reconstructed by forming a posterior‐superior pedicled skin flap. RESULTS No recurrence was observed and a good cosmetic result was obtained. CONCLUSION Local recurrence does not generally occur if the tumor is completely removed. The case we present is of interest in having a history of trauma to the region and a relatively rapid growth with perforation of the overlying skin.

Island V-Y tensor fasciae latae fasciocutaneous flap for coverage of trochanteric pressure sores

&NA; The distal fasciocutaneous portion of the lateral thigh is supplied by the direct cutaneous branch of the lateral descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. This consistent vascular anatomy allows raising a distal skin island based on both arteries on the lateral thigh, and this flap can be advanced into a trochanteric defect according to the V‐Y technique. Based on anatomic and clinical study, a new design has been developed of the tensor fasciae latae fasciocutaneous flap, which is supplied by two pedicles. Seven island V‐Y tensor fasciae latae fasciocutaneous flaps have been used for the coverage of trochanteric pressure sores in six patients. It is believed that the island V‐Y tensor fasciae latae fasciocutaneous flap could overcome the traditional drawbacks of the conventional tensor fasciae latae flap and its modifications, and this is an ideal flap for covering trochanteric pressure sores without any donor site deformity and morbidity, which greatly improves the aesthetic result. (Plast. Reconstr. Surg. 102: 1524, 1998.)

TISSUE ENGINEERING OF HIGH DENSITY POROUS POLYETHYLENE IMPLANT FOR THREE-DIMENSIONAL RECONSTRUCTION: AN EXPERIMENTAL STUDY

Three-dimensional defects have been reconstructed with carved and remodelled frameworks wrapped within vascular carriers. If sufficient vascular penetration can be established without any change in the size and shape of an implant, it will be possible to cover it with a skin graft and aesthetically important fine details can be obtained. To achieve this, we first prefabricated high-density porous polyethylene implant in rabbits. Secondly, we applied full-thickness skin grafts over the anterior surface of the prefabricated implant. The implants were placed and anchored underneath the superficial inferior epigastric artery and vein pedicle bilaterally. A total of 10 implants were prefabricated and then grafted in five rabbits. The implants were evaluated by perfusion scintigraphy and histological examination. Results showed that the implants were invaded by fibroneovascular tissue, and that this tissue, which can be transferred as a pedicled or a free flap, was sufficient to sustain a skin graft.Three-dimensional defects have been reconstructed with carved and remodelled frameworks wrapped within vascular carriers. If sufficient vascular penetration can be established without any change in the size and shape of an implant, it will be possible to cover it with a skin graft and aesthetically important fine details can be obtained. To achieve this, we first prefabricated high-density porous polyethylene implant in rabbits. Secondly, we applied full-thickness skin grafts over the anterior surface of the prefabricated implant. The implants were placed and anchored underneath the superficial inferior epigastric artery and vein pedicle bilaterally. A total of 10 implants were prefabricated and then grafted in five rabbits. The implants were evaluated by perfusion scintigraphy and histological examination. Results showed that the implants were invaded by fibroneo-vascular tissue, and that this tissue, which can be transferred as a pedicled or a free flap, was sufficient to sustain a skin graft.

A NEW SURGICAL APPROACH IN GENITAL LYMPHEDEMA

A new surgical approach has been used in a case of genital lymphedema. After resection of the lymphedematous mass, U-shaped flaps were made from the suprapubic region anteriorly and the posterior scrotal skin posteriorly. The denuded penis was transposed to its original place by passing it through a buttonhole incision made on the anterior flap. The testicles were placed and fixed in pouches prepared between the anterior and posterior flaps. The patient had an acceptable postoperative outcome both in testicular function and habitual sexual activities.

The lateral calcaneal island flap for sensate coverage of heel defects

Abstract The lateral calcaneal island flap is a modification of the lateral calcaneal artery skin flap. It has been used successfully in nine patients. It is a simple, stable, sensate, and yet a safe and versatile flap to cover defects around the ankle and heel. In comparison to the skin pedicle flap, it has distinct advantages of more versatile clinical applications, better aesthetic result of the donor and recipient site, and avoids sacrifice of a normal skin bridge for flap insetting. In the present series, the absolute indication for repair with the lateral calcaneal island flap lies in reconstruction of heel defects smaller than 6 cm in diameter.

Effects of free perichondrial graft replacement of epiphyseal cartilage on bone growth.

An experimental study in 24 lambs was carried out to find an alternative tissue for the distal epiphyseal cartilage of the femur. The animals were divided into three groups. In the first group (n = 12) the left femoral distal epiphyseal cartilage was completely removed and replaced by a free perichondrial graft taken from the distal half of the scapula. In the second group (n = 6) the epiphyseal cartilage was removed and was not replaced by any tissue. The third group (n = 6) was used as control. After six months the legs in the first and third groups were of the same normal length while the legs in the second group were significantly shorter. We conclude that free perichondrial graft seems to be able to replace the epiphyseal cartilage and prevent retardation of growth.

Hemimandibular reconstruction with bipedicled scapular osteocutaneous free flap

A case report is presented on the successful use of a bipedicled scapular osteocutaneous free flap in a young woman, whose hemimandible was resected because of sarcoma, 1 year prior to presentation. The postoperative course was uneventful and donor site morbidity minimal.

Free vascularized osteocutaneous flap from scapula to the tibia

SummaryMicrovascular transfer of a free vascularized osteocutaneous flap from the scapula to the tibia is presented. The patient had a 10 cm tibial bone defect and also required overlying soft tissue reconstruction. A scapular osteocutaneous flap was successfully transferred to the proximal tibial defect. No complications were seen during an 18 month follow-up. Although the contralateral fibula is a popular choice for tibial reconstruction, if it is not available, the free vascularized scapular osteocutaneous flap may be an alternative choice of treatment.