Fikret Eren

Nerve regeneration through a healthy nerve trunk: a new and hopeful conduit for bridging nerve defects.

Background: Considering a healthy nerve trunk as the hypothetically ideal conduit, a new experimental model using an intact nerve for bridging a nerve defect was contemplated. Methods: Thirty rats were used. In group I (double coaptation), a segment was removed from the peroneal nerve. Both the proximal and distal stumps were repaired end-to-side to the tibial nerve. In group II (only distal coaptation), only the distal nerve stump was repaired. In group III (control), the transected segment was immediately repaired primarily in its original orientation as a nerve graft. A walking track analysis was conducted periodically for 28 months. The horseradish peroxidase retrograde labeling technique was used for tracking the origin of the axons presented in the distal stump of the peroneal nerve in group I, and morphologic studies were also carried out for all the groups. Results: Functional assessment revealed that the difference between group I and group II was significant. The horseradish peroxidase labeling test suggested that the nerve fibers in the distal stump of the peroneal nerve were mostly from its original proximal stump passed by the way of the tibial nerve bridge. Conclusion: This study suggested that the axons of the proximal stump of a sectioned nerve can sprout into another intact nerve trunk by the way of an end-to-side repair site, regenerate, and advance in its epineurium distally for a distance and pass into its original distal stump if it was repaired end-to-side. It was thought that the technique could be used in clinical cases with short nerve defects as an alternative method to grafts and conduits.

Free Temporoparietal Fascial Flaps and Full-Thickness Skin Grafts in Aesthetic Restoration of the Nose

Free tissue transfers have been rapidly replacing distant flaps for use in nasal reconstruction. The temporoparietal fascial flap is a thin, broad, pliable, and well-vascularized flap. It can be used to drape over the cartilaginous and bony framework of the nasal skeleton and nourish the underlying primary cartilage grafts as well as the overlying full-thickness skin graft. The thin contour of the flap is aesthetically superior to thicker skin flaps and eliminates the need for secondary defatting or touch-up procedures. A large, single sheet of full-thickness skin graft, harvested from the supraclavicular region, can be applied over the fascial flap in the same session and provide a quite acceptable color match. The authors present a case whose alar margins and atrophic nasal skin were restored in one session by primary conchal cartilage grafts, a free temporoparietal fascial flap, and a full-thickness supraclavicular skin graft.

Reconstruction of postburn cervical contractures using expanded supraclavicular artery flap.

Postburn cervical contractures involving the anterior neck represent a serious social, public, and medical problem. The expanded supraclavicular artery flap is a good reconstructive option for these defects to improve functional and aesthetic appearance. Its main vascular supply is the supraclavicular artery, and it may be harvested as either a skin pedicled flap or an island flap. In our clinic, 10 patients with severe cervical burn contractures were reconstructed with preexpanded supraclavicular artery flaps between 2005 and 2012. All the flaps primarily healed with good functional and cosmetic results, and the donor sites primarily closed without any tension. A complete range of motion at the cervical region was obtained in all patients by the end of the reconstruction period. The preexpanded supraclavicular artery flap is a suitable alternative for coverage of the cervical defects after the release of the burn contractures. It is a thin tissue of both good color and texture, and is easy to harvest.

Use of the lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap for treatment of antecubital burn contractures

We describe a lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap for coverage of the antecubital fossa after burn scar release. In this study we describe raising and insetting the flap and reported our clinical results and observations. Antecubital contracture release was carried out in six patients, and the lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap was raised based on the anterolateral cutaneous perforator of the appropriate intercostal artery. The defects were repaired with this flap. All the flaps survived and antecubital contractures were repaired successfully. No recurrent contracture occurred in any of the patients at a mean of 15.3 months. The lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap can be used effectively for repair of antecubital tissue defects as an alternative to other reconstructive methods.

Use of axial pattern cervico-occipital flaps in restoration of beard defects.

Large skin and soft-tissue defects of the beard that may cause significant cosmetic and psychological problems should be restored with similar tissues in terms of hair pattern, color, and texture match. Relatively small beard defects can be reconstructed by direct approximation, serial excision, or some local flaps such as the submental artery island flap.1 However, restoration of larger defects using residual beard tissue may result in distortion of facial landmarks and additional scars on the face. The scalp is the single donor area for hairbearing pedicled or free flaps such as the visor flap,2 the L-shaped scalp flap,3 the bipedicled fronto-occipital flap,4 the midline forehead flap,5 and the frontotemporal fasciocutaneous island flap6 that can be used for beard, moustache, or eyebrow reconstruction. In the present study, we evaluated the efficiency of the cervico-occipital flap7 in restoration of moderate-size beard defects.

TRICHILEMMAL CYST OF THE THIRD FINGERTIP: A CASE REPORT

INTRODUCTION Trichilemmal cysts (TCs) are common skin lesions that occur in hairy areas. A TC involving a fingertip has not been previously described in the literature. We herein report a case of a TC occupying a fingertip region. CASE PRESENTATION A 43-year-old woman presented with a 1.5 × 1.5 cm nodular lesion on the third fingertip. The lesion was completely excised, and histopathological examination revealed a TC. CONCLUSION TCs may involve atypical locations, such as fingertips, where there are no hair follicles. After surgical excision, a careful histopathological examination should be performed to differentiate TCs from proliferating pilar tumors.

Finger injury from over-exposure to an industrial gamma radiation source

The aim of this paper was to report a rare cause of radionecrosis and its long-term results. Iridium-192 ((192)Ir) is commonly used for radiography as a gamma ray source to locate flaws in welds and metal components in gas and oil industry. A 38-year-old man was subjected to radiation unintentionally. One month after the exposure wounds were appeared on the second and third fingers, and they were treated by conventional wound care and hyperbaric oxygen therapy. However wounds were relapsed one year later that brought the patient to us. The wounds were treated by wound care and hyperbaric oxygen therapy. When the patient was brought to us one year later the result was interesting. The third fingers pulp (there was not any wound one year before) was contracted and one third of the distal phalanx was exposed.

Repair of Pretibial Atonic Wound With Long Cross-Leg Flap

Soft-tissue defects of the pretibial region constitute a major reconstructive challenge because of the insufficiency of the local tissues. In such cases, a long cross-leg flap may be an alternative option. This study presents a case with an atonic wound in the pretibial region caused by a previous traffic accident, which had received cross-leg flap repair following the excision.

Management of Median Lower Lip Fissures

Median lip fissures are rare benign lesions of the lower lip with a prevalence in the general population of six in 1,000. This condition affects the upper and lower lips but the lower lip more so. These fissures are four times as common in men and cause soreness and episodes of spontaneous bleeding. There is no direct correlation between smoking and lip fissure development. In our present report, we present four cases of inferior lip fissure treated using excision and Z-plasty.

Congenital bilateral isolated fifth metacarpal agenesis

2. Koshima I, Moriguchi T, Soeda S, et al. The gluteal perforator based flap for repair of sacral pressure sores. Plast Reconstr Surg 1993;91:678e83. 3. Verpaele AM, Blondeel PN, Van Landuyt K, et al. The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores. Br J Plast Surg 1999;52:385e91. 4. Leow M, Lim J, Lim TC. The superior gluteal artery perforator flap for the closure of sacral sores. Singapore Med J 2004;Vol 45(1):37e9. 5. Verhaegen P, Stekelenburg C, van Trier A, et al. Perforatorbased interposition flaps for sustainable scar contracture release: a versatile, practical, and safe technique. Plast Reconstr Surg April 2011;127(4):1524e32.