Fatih Peker

Y-V advancement with Z-plasty: an effective combined model for the release of post-burn flexion contractures of the fingers

Volar contractures of the fingers are the commonest sequel to burns of the hands. These have been treated by using various basic techniques of Plastic Surgery. Recently, a combination of these techniques has been used for improving the results more. In the study, two well-known techniques, Y-V advancement and Z-plasty, were combined to improve release of linear flexion contractures of the fingers, including thumbs. Its mathematical representation is presented. Ninety-eight PIP joints (IP for thumb) of 37 patients were treated with this technique and their results were followed-up for about 8 months. The gains were greater using the combined technique than for the usage of either alone. It was concluded that this model could serve as one of the effective combinations of the basic techniques in the treatment of volar finger contractures.

Management of maxillofacial problems in self-inflicted rifle wounds

Severe gunshot wounds to the face, produced by high-velocity rifles or shotgun blasts, present a formidable challenge to reconstructive surgeons. In this study, the results of 14 cases with gunshot wounded faces caused by fire from rifles are presented, and the principles of the management of those victims were determined. These patients had attempted to commit suicide and placed the muzzles of the rifles beneath their chins. The ages of the patients ranged from 20 to 24 years, with a mean age of 22 years. These wounds were caused by close-range gunshots (<10 cm), and the missiles had high velocity (more than 800 m/second). All patients had wounds in their submental triangle areas. The exit sites of the missiles differed among patients. All exit wounds were in the angle limited by the deviation from the gun-barrel axis. After clinical and radiologic evaluation and conservative debridement of all devitalized tissues, the fractures were reduced and stabilized appropriately. Large bony defects were treated by bone grafting, and all soft tissue lesions were closed in layers. The entrance and exit sites were covered primarily after thorough debridement except one case whose defect was reconstructed with bilateral sternocleidomastoid (SCM) flaps, one for submental skin and the other for the mouth floor. Intraoral soft tissues were then repaired by primary closure, tongue flaps, or SCM flaps in case they were necessary. Free tissue transfers were not required for treatment of secondary soft-tissue problems. Resolution of tissue edema, softening of scars in time, and insertion of bone graft may improve the deformity significantly. The initial anatomic reconstruction of the existing bone skeleton and the maximal use of regional tissue for cutaneous reconstruction provide an esthetic appearance that can never be duplicated by secondary reconstruction.

Otoplasty: Anterior scoring and posterior rolling technique in adults

The corrective otoplasty is the aesthetic surgery most frequently performed in childhood. Some people neglect this deformity because it does not cause functional problems and seek treatment in their teen or adulthood. In this age group, the development of ear is no longer major concern. In this study, 178 adult patients were treated by using a modified form of anterior scoring technique for the correction of their prominent ears. In this method, after anterior scoring, as described by Chongchet, the free edge of ear cartilage was rolled over itself posteriorly and fixed. This cartilage structure was covered with subcutaneous and perichondrial flaps to establish a natural contour. The patients were followed for at least six months and their results were evaluated in terms of complications and patient satisfaction. This technique enhances the aesthetic results of otoplasty by making a smoother surface and eliminating sharp edges, and is a reliable choice in the correction of prominent ears.

Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury

Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.

Minced nerve tissue in vein grafts used as conduits in rat tibial nerves.

IntroductionPeripheral nerve injuries are encountered frequently in clinical practice. In nerve repair, an end-to-end suture is the preferable choice of treatment. However, where primary closure is not possible, the defect is to be repaired with a nerve graft. MethodsA total of 21 female Wistar rats weighing 230 to 290 g were used in the study. They were classified into the following 3 groups: (I) nerve graft, (II) vein graft, and (III) minced nerve graft. In group I, after exposure of the tibial nerve, a 1-cm-long nerve gap was created on the tibial nerve, and the defect was repaired epineurally by using the autogenous nerve. In group II, the 1-cm tibial nerve defect was repaired by using an autogenous vein graft. In group III, a 1-cm nerve graft was divided to 3 equal parts, with one of the nerve parts being minced with microscissors and placed in the vein graft lumen. Thereafter, a 1-cm tibial nerve defect was repaired by the vein graft filled with minced nerve tissue. The tibial function indices (TFIs) were calculated for functional assessment using the Bain-Mackinnon-Hunter formula. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated fibers were counted in all groups. ResultsThe TFIs of group II were found to be the lowest among all the groups after the sixth week, whereas the TFI of group I was found to be better than the other groups after the sixth week. There was no difference in TFIs between group I and group III. On the basis of the number of myelinated fibers, there was no statistically significant difference between group I and group III, whereas the difference was significant (P < 0.05) between groups I/III and group II. Presence of peripheral nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in all groups. The myelinated axon profile was near normal in the nerve graft group in electron microscopic evaluation. However, there were more degenerated axons with disturbed contours and vacuolizations in the vein graft group compared to the minced nerve graft group. ConclusionsWe can conclude that using minced nerve tissue in vein grafts as a conduit increases the regeneration of nerves (almost like the nerve graft group) and it may not be caused by donor-site morbidity. It can be used in the repair of nerve defects instead of autogenous nerve grafts after further experimental evidence and clinical trials.

Skin grafting of the naso-orbital region as a single aesthetic unit.

With improved acute care, a higher percentage of more severely injured facial burn patients are surviving their burns. When the full face needs resurfacing, total facial resurfacing should ideally be done with a single sheet of full-thickness skin. Unfortunately, this type of single sheet total facial resurfacing is rarely possible or practical in the case of acute extensive burns. The nasoorbital region is a focal point of interpersonal communication and needs special emphasis. This report presents two patients with deep facial burns whose midface regions were resurfaced with thick split-thickness skin graft as a single aesthetic unit. Since there is no skin graft junction line on this region, a more homogeneous appearance and an aesthetically superior result could be achieved.

Breast reconstruction using de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy in macromastia

Prophylactic mastectomy is performed to reduce the risk of breast cancer in high‐risk conditions, and expectations about reconstruction are too high. Implant coverage with healthy tissue and skin reducing as an envelope are two concerns in the treatment of macromastia cases. We present our results obtained with a prosthetic reconstruction technique using an inferior pedicled de‐epithelialized dermal flap after vertical‐pattern skin‐sparing mastectomy in this retrospective study.

Bilateral macrostomia as an isolated deformity and its repair with a modified technique

A 3-year-old boy with bilateral congenital macrostomia as an isolated clinical entity is presented. Although this is a rare deformity, it causes functional and cosmetic problems which are difficult to correct. The skin, muscle, and mucosal components of the deformity were separately repaired using a modification of Kaplans technique.

Superior Pedicle Reduction Mammoplasty Supported with Inferior Pedicle Chest Wall-Based Flap: Refinements to the Technique

Breast reduction techniques strive to obtain a final aesthetic breast shape. The most difficult issues to address after breast surgery are providing consistent upper pole fullness and preventing recurrent ptosis. Our surgical approach is a superior pedicle vertical scar breast reduction with an inferior pedicle chest wall-based flap to enhance the projection of the breast. We describe our refinements to the previously described similar techniques to provide upper pole fullness with long-lasting breast shape and prevent the bottoming out deformity. Twenty-five patients underwent reduction mammoplasty and/or mastopexy (15 mastopexy, 10 reduction mammoplasty) using modified superior pedicle reduction mammoplasty supported with inferior pedicle chest wall-based flaps between 2009 and 2013. Medical records and follow-up outcomes were retrospectively analyzed. Scar widening was acceptable even for larger reduction cases. The aesthetic results of both reduction and mastopexy cases were satisfying. Upper pole fullness was maintained in the long-term follow-up. Significant bottoming out was not observed. No skin excess was noted at the inferior fold region in any of the cases. In our modified technique, tissue is excised in a beveled fashion under the superior pedicle and pillars, particularly from the lateral; hence, the chest wall flap does not cause tissue excess at the upper infra-areolar site of the vertical scar. Flexibility in choosing the location from which to remove the breast tissue provides a custom-made approach to shape each breast. The long-term results of our technique demonstrate minimal breast descent and sufficient upper pole fullness.Level of Evidence IVThis 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.