Erol Kozanoğlu

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.

Key and Keyhole Model for Dorsal Onlay Cartilage Grafts in Correcting Nasal Deformities.

BackgroundThe shaping of the cartilage and keeping it in place is very significant for patients who need nasal reconstruction with costal grafts at traumatic or secondary rhinoplasties. In this study, a template is prepared during the surgery that shows the dorsal defect in a 3-dimensional manner and acts as a guide while shaping the cartilage. MethodsSeventeen patients who required secondary rhinoplasties because of trauma or previous operations were included in this study. The patients were operated on between the years 2009 and 2013. The mean age of the patients was 24 years (19–38 years). According to the surgical technique, bone wax was placed in a sheath prepared from the finger of a sterile nylon surgical glove before the dorsal reconstruction. It was placed to the nasal dorsum and shaped over the skin with digital maneuvers. Afterward, the bone wax was stripped off the nylon glove, and it was used as a template to shape the cartilage graft. ResultsNo need for revision rhinoplasties was seen in any of the patients during the mean follow-up period of 19 months. The patients stated that they were satisfied by both the functional and the aesthetic results. ConclusionsThe bone wax template and the defect fit in a key and keyhole fashion. It is supported by multiple points on the nasal bone and the septum. Thus, it does not slide and its warping is avoided. We think that it gives satisfactory results and it shortens the learning process.

Use of Turn-in Skin Flaps for Nasal Lining Reconstruction

BACKGROUND Reconstruction of the nasal lining is the most difficult part of complex nasal reconstruction because the mucosa has a unique texture and fineness. Many techniques, ranging from skin grafts to local flaps, have been applied for the reconstruction of the mucosa. In some cases, even free flaps have been used. OBJECTIVE The aim of this study was to discuss the feasibility of using turn-in flaps in nasal reconstruction. MATERIALS AND METHODS Seventeen patients with full-thickness nasal defects underwent reconstruction with turn-in flaps. In all the patients, the bone structure was formed using cartilage grafts, and the skin defects were reconstructed using paramedian forehead flaps. A rhinoplasty procedure was added in 10 of the patients. RESULTS Necrosis was not observed in any of the flaps, and the results were satisfactory for all the patients. CONCLUSION This technique provided enough support for the onlay cartilage grafts, and the flap was thin enough to avoid any nasal airway obstruction. In selected patients, this technique can also be used in conjunction with a rhinoplasty procedure.

Calf restoration with asymmetric fat injection in polio sequelae.

BACKGROUND Many things cause leg asymmetry and sequelae seen after poliomyelitis infections are still a cause of leg deformities. In this study, lipofilling and liposuction combinations are performed on patients with poliomyelitis sequelae. Volume deficiency is not the only leg problem with polio sequelae, leg length is also a problem. For this reason, the length deficiency must be addressed in order to achieve the desired symmetry. The aim of this study is correcting limb asymmetry by a method addressing both limb length deficiency by heel raise and volume deficiency by injection of fat based on corrected limb length. PATIENTS AND METHODS From 2011 through 2013, 10 female patients who had unilateral leg atrophy as a result of paediatric polio infections were included in our study. All of the patients were treated with liposuction and lipofilling combinations. During planning, a ridge was placed under the affected leg in order to equalize the lengths of both legs. The fat injection sites on the affected leg were marked to mimic the unaffected leg. RESULTS All the patients stated that they were satisfied with the results. Transient hypoesthesia was seen in only one patient, but this was spontaneously resolved six months later. CONCLUSION The study results indicate that the asymmetric fat injection procedure can be a good technique to use with patients who have polio sequelae, both with short legs and volume deformities. LEVEL OF EVIDENCE 4.

Upper Trunk Emerging From the Sixth and Seventh Cervical Roots - Case Report of an Incidental Finding of a Rare Anomaly of the Brachial Plexus.

Dear sir, The brachial plexus is prone to exploration by the peripheral nerve surgeons for several pathologies of the upper extremity. Obstetric brachial plexus palsy, traumatic brachial plexus palsy and thoracic outlet syndrome are among the most frequent etiologies that yield to exploration. Surgeons should be aware of the possible aberrant neurological formations and variations at this anatomic site. A 45 years old female patient was referred to our hand surgery clinic because of gradual weakness in her right hand and an ongoing dull pain at her right upper extremity. The patient had these complaints for 2 years and she stated that her clinical condition was getting worse every day. During her physical examination, we found that there was a thenar atrophy on her right hand. The electrodiagnostic studies showed chronic axonal degeneration of the medial cord coming out of the lateral trunk, resembling neurogenic thoracic outlet syndrome. There were not any clues about the variations in the brachial plexus anatomy during the preoperative magnetic resonance imaging and the electrodiagnostic studies. The patient was informed about her pathology and a surgical repair was proposed. During the operation, the right brachial plexus was decompressed by the anterior scalenectomy and all the nerves were dissected free from all peripheral soft tissue attachments. There were overt signs of lower trunk entrapment and the rest of the plexus was free of any compressive signs. At the end of the dissection, it was found that there was an anatomic variation at the right upper trunk (Figure 1). The fifth root was not involved in the formation of the upper trunk. The suprascapular nerve emerged directly from the fifth cervical root. There was not any variation regarding the long thoracic nerve and the phrenic nerve. The subclavian artery was found to pass between the sixth and seventh cervical roots. The fifth cervical root was located between the anterior and middle scalene muscles. On the other hand, the sixth and the seventh cervical roots were located between the middle and posterior scalene muscles. The middle trunk was absent. The anatomy distal to this variation was in normal limits and no other variations were found distal to this point. The variations of the brachial plexus may be either asymptomatic, or they may be the reason of several pathologies of the upper extremity. In an anatomical dissection study, Yıldız et al. stressed that although there were major variations in the

Restoration of Pronation and Radial Deviation in “The Beggar’s Hand” Deformity by Switch Technique

Objective/Hypothesis: In this study, our aim is to present our results with the “switch technique” in the dynamic restoration of forearm pronation and wrist radial deviation in patients with “the beggar’s hand” caused by obstetric brachial plexus palsy. In the “switch technique,” the tendons of two functional muscles are sectioned at two different levels, and the proximal muscular units are transposed to the presectioned distal tendon ends in a cross fashion. This technique enables the dynamic restoration of the paralytic and complex deformity. Materials and Methods: Eleven obstetric palsy patients (6 male, 5 female) with ages ranging between 5 and 10 years (mean age of 7.6 years) were operated for the correction of supination deformity and ulnar deviation of the wrist. Soft tissue releases were performed at the forearm and the wrist. Extensor carpi ulnaris (ECU), brachioradialis (BR), abductor pollicis longus (APL), and the flexor carpi ulnaris (FCU) muscles were prepared. The ECU tendon was sectioned and disinserted from its insertion whereas the BR tendon was sectioned just distal to the myotendinous junction. The distal end of the BR tendon was rotated around the radius from the dorsal to the volar, and then, it was advanced proximally along the interosseous membrane after being passed through a pulley that was prepared from the distal end of the FCU tendon. The ECU tendon was advanced from the dorsal to the volar, and it was sutured to the BR tendon as a pronator. The APL tendon was sectioned from a proximal level, and the distal end of this tendon was sutured to the proximal end of the BR tendon as a wrist radial deviator. The mean follow-up time was 14 months (4-31 months). Forearm pronosupination, wrist flexion-extension, and ulnar-radial deviation were assessed by goniometric measurements. Results: Mean active forearm pronation was −42.5° preoperatively. After the surgery, 38.75° degrees of active forearm pronation was achieved. Preoperative and postoperative mean active radial deviation values were −7.5° and 10.75°, respectively. All patients reported that they became more capable in activities such as turning pages and holding a mug. Conclusions: The tendons that are used in the “switch technique” are not paralytic, and they are functional. In fact, this is a major difference with classic tendon transfers. With this technique, the original muscle bellies and the routes of the tendons are switched. They are used for impaired targets, and they are reorganized for the restoration of insufficient functions. Correction of the deformity improves the appearance of the limb and the self-confidence of the child and allows the patients to integrate well into the society. These results suggest that selected cases may benefit from restoration of “the beggar’s hand” deformity with the “switch technique” that may produce a critical improvement in functional capabilities.

High pressure paint gun injury of the index finger: a case report

Injuries to the hand secondary to high pressure paint guns are considered to be true hand emergencies. These rare injuries may have serious outcomes, and a critical step in their management is extensive debridement performed within the first six hours following injury. For this reason, their diagnosis should not be delayed, and the hand surgeon should be informed immediately to initiate appropriate treatment. In this report, the authors describe a patient who was injured with a chemical paint gun, and whose injury was not diagnosed in the emergency department. The patient subsequently developed tenosynovitis. His treatment is reported herein.

Functional Sharing of the Upper Orbicularis Oris Muscle for the Reconstruction of the Lower Lip.

Abstract The lip reconstruction is a very controversial topic in plastic surgery and many flaps have been described for this purpose. Despite all of the interventions, some patients still have problems such as drooling and gingival show that decrease their quality of life. In this study, the authors report a patient whose lower lip was resected totally for squamous cell carcinoma. His lip was reconstructed with radial forearm flap and the patient was referred to our clinic with the aforementioned complaints. A portion of the orbicularis oris muscle of the upper lip was designed as a bipedicled flap, and it was transposed to the lower lip to make the initial flap functional. After the operation, the sphincteric function of the lip was better, and the problems as drooling and gingival show were absent. In conclusion, this flap can be a good option to make the initial nonfunctional flaps (such as radial forearm flap), functional in the aspect of lower lip reconstruction. It has a function, and it is concordant with the principle of “reconstructing like with like.” The native muscle tissue of the upper lip can be transferred partially to maintain physiologic oral competency.

A modification of the posterior auricular flap used for scapha and helix middle one-third defects of the auricle.

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How were lipofilling cannulae designed and are they as safe as we believe

Background: Most practitioners in plastic surgery believe that blunt tipped cannulae are safer. Interestingly, there is no study about their safety, and the problem is exactly this. As the use of blunt tipped cannulae is somehow difficult, some surgeons try other extreme alternatives, such as sharp and cutting tipped injection needles. But, they can cause complications such as vessel damage. According to these hypotheses, we tried to design a cannula which would ease the application of lipofilling and which would minimise the trauma. Contrary to the injection needle, the tips of the cannula would be blunter, and trauma would be diminished. Objectives: After designing such a cannula, we compared it with the most frequently used Coleman type cannulae with regard to ease in utilisation, and safety. We also tried to evaluate the potential for trauma, of the regularly used cannulae. Materials and Methods: In the first part, the penetration capacity of all cannulae was measured and compared, and in the second part, the tissue damage was evaluated in an experimental model. Results: According to the statistical and histological findings, the pointed-tip cannulae, blunted to a certain degree, can be applied easily through the tissues. The surgeon works more comfortably and we have noted that these cannulae cause less tissue damage.