Fatma Bilgen

Nicolau Syndrome after Intramuscular Injection of Non-Steroidal Anti-Inflammatory Drugs (NSAID)

Nicolau syndrome is a rare complication of intramuscular injection that leads to local ischemic necrosis of the skin and adipose tissue. In this paper, we discuss etiologies, risk factors, and treatment options for gluteal Nicolau syndrome referring to patients treated in our hospital. Our study includes 17 women who visited our clinic with symptoms of gluteal necrosis secondary to intramuscular injection. The following variables were taken into account: injection site, drug administered, frequency of injections, the person who administered the injections, needle size, and needle tip color. Magnetic resonance images obtained in the aftermath of intramuscular injection application were carefully analyzed for presence of necrosis, cyst formation and the thickness of the gluteal fat tissue layer. Drugs that had been received in intramuscular injection were exclusively non-steroidal anti-inflammatory drugs. Mean patient BMI was 41.8 (all patients were considered as obese), and mean gluteal fat thickness was 54 mm. Standard length of needles (3.8 cm) had been used in procedures. The wounds were treated with primary closure in 11 patients and with local flap therapy in 6 patients. The observed necrosis was a consequence of misplaced gluteal injection, where drugs were injected into the adipose tissue instead of the muscle due to the extreme thickness of the fat layer, on one hand, and the inappropriate length of standard needles, on the other hand. Intramuscular injection should be avoided in obese patients whenever possible: if it is necessary, proper injection technique should be used.

Comparison between knot and Winograd techniques on ingrown nail treatment

OBJECTIVE The aim of this study was to compare the Winograd and knot techniques based on efficiency, complication rate, surgery time, and amount of local anesthetic required. This study also aimed to determine the etiology of ingrown nails, whether due to involvement of the nail or soft tissue. METHODS Seventy-five patients with a total of 90 ingrown nails (stages 2 and 3) who presented at our clinic between 2012-2014 were included in this study. Patients were divided into 2 groups: those treated with the knot technique and those treated with the Winograd technique. Patients in both groups were evaluated for the amount of local anesthetic required, intraoperative pain, effectiveness of preventing/stopping hemorrhage, surgery time, complications, postoperative nail size, recurrence, nail deformities, and secondary surgery rates. RESULTS The mean surgical time, relapse rate, number of additional surgeries required, and amount of local anesthetic were significantly greater in the Winograd group than in the knot group. The mean nail diameter was significantly decreased, with a mean of 3 mm in the Winograd group. No statistically significant differences were found between the groups in the incidence of infection, intraoperative pain, hematoma, or nail deformity. CONCLUSION This study demonstrated that the knot technique, consisting of wedge excision of soft tissue without affecting the nail itself, is a simple technique to treat ingrown nails with a lower complication rate and shorter surgical time. We believe that successful treatment of ingrown nails depends only on excision of soft tissue, with no need to operate on the nail bed.

Glial heterotopia of the lip: A rare presentation

Glial heterotopia represents collections of normal glial tissue in an abnormal location distant to the central nervous system or spinal canal with no intracranial connectivity. Nasal gliomas are non-neoplastic midline tumours, with limited growth potential and no similarity to the central nervous system gliomas. The nose and the nasopharynx are the most common sites of location. Existence of glial heterotopia in the lip region is a rare developmental disorder. We report a case of large glial heterotopia in the upper lip region in a full-term female newborn which had intracranial extension with a fibrotic band. After the surgery, there was no recurrence in the follow-up period of 3 years. When glial heterotopia, which is a rare midline anomaly, is suspected, possible intracranial connection and properties of the mass should be evaluated by magnetic resonance imaging. By this way, lower complication rate and better aesthetic results can be achieved with early diagnosis and proper surgery.

A novel technique for distal fingertip replantation: Polypropylene suture guided interpositional vein graft

Abstract Background: Despite current advances in microsurgery, fingertip replantation is still controversial, mainly due to its difficulty and cost. The purpose of this study is to describe a new technique of interposition vein graft guided by polypropylene suture in distal fingertip replantation. Methods: A total of eight consecutive Tamai zone 1 fingertip replantations performed by the same author were included. All replantations were performed using interposition vein graft guided by polypropylene suture. This technique involved a vein graft of ∼ 2 cm, with appropriate calibration, obtained from the volar part of the forearm and a 2-0 polyprolene suture passed through the interposition vein graft. Then, a polypropylene suture guide carrying the vein graft was inserted into the artery. The anastomosis was easily performed with the aid of 10-0 or 11-0 nylon in a bloodless medium and without encountering the posterior wall problem. Results: Average surgery time was 2.5 hours (range = 2–3 hours). Among eight Tamai zone 1 replantations, six were successful (75%). There were two replantations lost because of arterial failure. Conclusion: This technique may ease fingertip replantations and increase the success rate for Tamai zone 1 injuries.

Cleft lip nose correction combining open rhinoplasty with the Dibbel technique.

AbstractCleft lip nose rhinoplasty is a challenging procedure because of the different presentation and severity of the deformity. Due to this presentation type, there is still no standard procedure correcting all the components of the deformity although a number of techniques have been published in literature. In this study, the effectiveness of the combination of open rhinoplasty and the Dibbel technique with nasal sill augmentation was evaluated.We hereby report our experience with 7 patients who had unilateral cleft lip nose deformity with slumped lower lateral cartilage and underprojected and deformed dome, operated on between September 2010 and April 2013 by 1 surgeon. The mean age of the patients at the time of surgery was 24.5 years (18–38 years) and the patients were followed up for an average of 18.5 months (6–31 months). All patients were operated on with open rhinoplasty and Dibbel technique combination with nasal sill augmentation. Frontal, lateral, oblique, and basilar photographs were obtained preoperatively and postoperatively for each patient. Nasal projection, columella height, nasolabial angle, nasal sill symmetry, and base width were measured on the photographs for comparison of preoperative and postoperative results. All patients’ medial and lateral cantus distances were used for photographic standardization.The results demonstrated that there was a statistically significant increase in nasal projection (2.13 ± 0.28 mm preoperatively versus 2.31 ± 0.08 mm postoperatively; P = 0.018), columella height (1.07 ± 0.25 mm preoperatively versus 1.21 ± 0.18 mm postoperatively; P = 0.028), nostril apex height (1.11 ± 0.15 mm preoperatively versus 1.22 ± 0.11 mm postoperatively, P < 0.028), nasolabial angle (77.71 ± 8.74 mm preoperatively versus 91.33 ± 6.49 mm postoperatively; P < 0.05), and nasal sill symmetry (0.42 ± 0.15 mm preoperatively versus 0.27 ± 0.07 mm postoperatively; P < 0.05), and a significant decrease of alar width (2.35 ± 0.44 mm versus 2.16 ± 0.32 mm postoperatively; P = 0.018) on the affected side in response to surgery.The results of this study demonstrated that the Dibbel technique and open rhinoplasty combination with nasal sill augmentation is an effective and safe method for the correction of cleft lip nose deformity in respect to nasal symmetry.

A Rare Location: Actinomyces in Tongue

Aktinomikozis, kulturde zor uretilebilen gram pozitif anaerobik bir bakterinin neden oldugu kronik supuratif bir infeksiyondur. Siklikla servikofasial, respiratuar ve gastrointestinal sistemdenizole edilmektedir. Servikofasial yerlesimli olanlara siklikla maksillafasiyal travma ve dis manipulasyonu eslik etmektedir. Calismada, 45 yasinda bayan hasta travma, dental girisim ve aile oykusunde anlamli bulgu olmayan aktinomices vakasi sunulmaktadir.Aktinomikozis, kültürde zor üretilebilen gram pozitif anaerobik bir bakterinin neden olduğu kronik süpüratif bir infeksiyondur. Sıklıkla servikofasial, respiratuar ve gastrointestinal sistemden izole edilmektedir. Servikofasial yerleşimli olanlara sıklıkla maksillafasiyal travma ve diş manipulasyonu eşlik etmektedir. Çalışmada, 45 yaşında bayan hasta travma, dental girişim ve aile öyküsünde anlamlı bulgu olmayan aktinomiçes vakası sunulmaktadır.

Intramuscular arteriovenous malformation of the deltoid muscle

Arteriovenous malformations (AVM) originating primarily from the skeletal muscles are very rare. Intramuscular AVMs may be cured by complete excision of the muscle and by preserving adjacent vital structures, which will help to reduce postoperative morbidity. In the current case report, we present a case that was operated due to intramuscular AVM located in the deltoid muscle, which has not been previously described in the literature, and we describe the methods of diagnosis and treatment in a 4-year-old male patient.

Amniotic band and foot polydactyly: A rare case

Amniotic band syndrome (ABS) is defined as the triad of fetal deformation, malformation, and amputation caused by adhesions and entanglement of the fetal parts by the placenta, lacking an amniotic membrane and the remnants of amniotic membrane. The current case report presents a rare case with amniotic band syndrome, in whom constriction bands in the left hand second finger and left foot second and fourth toes are accompanied by preaxial polydactyly in the left foot. ABS is a rare condition observed in infants and it is frequently accompanied by other extremity anomalies. Appropriate treatment options allow better functional and cosmetic outcomes.

Parotid duct cyst in a child.

Sir, Cystic lesions localised in salivary gland are commonly of neoplastic origin, whereas non-neoplastic cysts are quite rare, and constitute approximately 2-5% of all salivary gland lesions. Salivary gland duct cysts in non-neoplastic group are mass lesions with an epithelium lining inside, and these are also named as mucous retention cyst or mucous duct cyst. These are true cysts that can be congenital or acquired. The most common type is the acquired type, which develops due to obstruction of the duct. Salivary gland duct cysts are generally observed in minor salivary glands. They are rarely seen in major salivary glands and are commonly localised in the superficial lobe. Cystic lesions of the salivary gland are commonly seen between the ages of 30 and 40. They are rarely observed in childhood.[1-5] In this case, a 6-year-old child was admitted to the polyclinic due to painless swelling on the right side of the face, which had been present since birth and gradually increased in size in the last year. Upon physical examination, an immobile, uniformly consistent , soft mass that was approximately 6 cm × 7 cm in size and painless on palpation was detected in the preauricular region [Figure 1]. A cystic mass was observed in the superficial lobe of the right parotid gland of the patient on ultrasonographic examination. The magnetic resonance imaging revealed a multiloculated, sharplycircumscribed cystic mass of 5.5 cm × 5 cm × 4 cm in size that partially extend from the superficial lobe to the deep lobe was detected and a second cystic lesion of 2.5 cm × 2 cm × 2 cm in size extending to retroauricular region was detected in the deep lobe [Figure 2]. In the fine needle aspiration biopsy, the lesion was considered to have benign cyst content. Exploration was done, and a superficial parotidectomy was performed, preserving the facial nerve,. The removed cystic tissue was examined using frozen section . It was found to be benign, and the cyst extending to the deep lobe was totally excised, and the deep lobe was preserved [Figure 3]. No postoperative complications developed. No Letters to Editor

A mobile mass in the wrist and palmar regions: A case presentation

This paper presents a rare case of a mass located on the volar face of the wrist, which translocated to the palmar region under pressure. An examination revealed a 3x3 cm mass on the palmar face of the wrist that was painless and soft on palpation. A region measuring 2x2 cm on the skin of the palmar region whitened when pressure was applied to the mass. The mass was removed and a pathological examination confirmed the presence of a cystic foreign body reaction secondary to the presence of wooden foreign bodies.