Gokce Yildiran

Dupuytren-Like Contracture of the Foot: Ledderhose Disease

Introduction  Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report  A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion  Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion  The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

V-Y and rectangular flap combination for syndactyly repair.

Abstract Objective: For syndactyly repair, several delicate, well-planned flap combination techniques have been reported. This study presents technique details with functional and aesthetic results of a dorsal rectangular and volar V-Y advancement flap combination for web reconstruction and S incisions for finger separation in patients with syndactyly. Method: Ten patients with 16 syndactyly webs were treated. Patients were examined in terms of function and aesthetic. Evaluation criteria included the Vancouver Scar Scale, range of motion, degree of web creeping, parent’s satisfaction rates, and finger abduction. During the initial period, vascular compromise of fingers, haematoma, infection, seroma, flap necrosis, or graft failures were not noted in any patients. No patients required revision surgery. During the later period, parent satisfaction scores were excellent or good, finger function was complete, and the Vancouver Scar Scale showed that two webs had hyperpigmented areas and two had supple pliability. Conclusion: This simple syndactyly release technique can provide a low rate of web creep, good scar quality, and optimal functional results.

Malign Differentiation of a Large Buschke Loewenstein Tumor in Penis

Buschke–Loewenstein tumor (BLT) is a giant condyloma acuminatum which is very rare and commonly affects the anogenital region. The malignant transformation and localization in penis is very rare. This article aims to present a case with BLT with malignant transformation in penis. A 59-year-old male patient was referred, who has have been suffering from a cauliflower-like lesion in the penis for 8 years. Biopsies revealed a BLT with malignant transformation. The lesion was excised largely and reconstructed with local flaps and skin grafts. Defined by Buschke and Loewenstein in 1925, giant condyloma acuminatum is a rare and important disorder because of the sexually transmitting capability.

Foot and ankle reconstruction with vertically designed deep inferior epigastric perforator flap

The deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap.

Palmar epidermoid inclusion cyst mimicking Dupuytren's contracture

Epidermoid inclusion cyst in palmar localization is very rare. We present an unusual case of palmar epidermoid inclusion cyst which causes Dupuytren-like contracture in hand. A 32-year-old male patient was complaining of the traction feeling of the mass. The mass was excised surgically, it was a hairy nodule like structure and reported as epidermoid inclusion cyst. Cystic lesions are very common masses. However epidermoid inclusion cysts in the palmar region are important because they may arise from the eccrine ducts and may be relevant with HPV infections. Thus, HPV screening should also be done in such a case.

Management of huge and extraordinary metal-penetrating injuries to the hand

Objective Foreign-body and penetration injuries of the hand are common emergencies. Metallic foreign bodies are common among all foreign masses; however, the examination of huge bodies differs from that of other metallic masses. The purpose of this study was to clarify an algorithm for the management of the huge metallic masses via our therapeutic approaches for metal-penetrating injuries. Material and Methods Seven patients who had a huge, metallic object-penetration injury to their upper extremity were included in our study. Patients were classified according to the age, injury type, character of metallic body, injury zone, diagnostic methods, anesthesia type, and treatment received, and an algorithm to approach the management of foreign metallic bodies was clarified. Results The causes of injury were knitting hook, iron fence, mixer, and metal nail. Plain radiography was performed for all patients. Prophylactic tetanus was administered and urgent exploration in the operation room under tourniquet followed by foreign-body extraction through cutting and not pulling were conducted. No residue was retained. Conclusion Many patients referred to emergency services with foreign bodies. For diagnosis, the patients history and a minimum of two-way radiograms are crucial. For treatment, we recommend surgical exploration under general anesthesia and tourniquet and extraction of the metallic body by cutting and not pulling without retaining any residual mass in the operation room.

An Overview of the Technical Details and Seven Cases of Lagophthalmos Treatment with Gold Implant

Üst gözkapağına altın ağırlık yerleştirilmesi, lagoftalmi tedavisinin genel kabul görmüş bir yöntemidir.2 Üst gözkapağına ağırlık yerleştirilmesi; ilk olarak 1950 yılında tanımlanmıştır.1 İngilizce literatürde “custom-made” olarak kullanımı bulunan, hastaya özel yapılan implantlar hem pahalı hem de ulaşımı güç olduğundan sıklıkla kullanılanlar ticari olarak üretilmiş hazır sentetik implantlar veya kuyumculardan yaptırılan implantlardır. Ne var ki, kuyumcu aracılığı ile elde edilen altın implantın standardize edilememesi çeşitli 207

Multiple Primary Tumors: Evaluation Accompanied by a Rare Case

Multipl primer tumorler, ayni hastada es ya da farkli zamanda birbirinden farkli gelisen tumorlerdir. Bu yazida cok nadir rastlanan bazal hucreli karsinom, skuamoz hucreli karsinom ve akciger adenokarsinomu birlikteligi sunulmustur. 70 yasinda, erkek, sigara icicisi hastanin frontal cilt bolgesindeki tumoru eksize edilmis bazal hucreli karsinom olarak raporlanmistir. Fizik muayenesinde nefes darligi saptanan ve ileri tetkikler neticesinde akciger adenokarsinomu nedeni ile opere olan hastada eszamanli olarak temporal ciltte orbitaya invaze bazal hucreli karsinom saptanmis, goze ekzantarasyon ve anterolateral uyluk flebi ile rekonstruksiyon yapilmistir. Bu cerrahiden yaklasik 1 ay sonra mandibula uzerindeki ciltteki skuamoz hucreli karsinom nedeni ile hasta yeniden opere edilmistir. Bizim olgumuzdaki gibi akciger ve cildin primer kanserlerinin birlikteligi cok nadirdir. Kanserli bir hastada ikincil primer tumor olasiliginin yuksek oldugu her zaman goz onunde tutulmali, hastaliga degil hastaya yaklasim saglanmalidir.

Repair of a thrombosed pseudoaneurysm that developed after puncture for an arterial blood gas using a vein graf

Pseudoaneurysms involving the leakage of blood between the arterial wall and the peripheral parenchyma can occur as a result of an artery’s perforation. In this case report, we present a repair, using a vein graft, of a thrombosed pseudoa- neurysm that developed in a radial artery after a single puncture to obtain a sample for the determination of arterial blood gases. A 56-year-old female patient was admitted with a mass in her left wrist on the radial side. Upon examination, a sen- sitive and mobile mass was detected by palpation. The patient had no fever or any other symptoms of inflammation. Her detailed anamnesis revealed that the mass had developed after a puncture to obtain a blood sample for an arterial blood gas measurement. By using magnetic resonance imaging the mass was determined to be a thrombosed pseudoaneurysm. The mass was excised and the gap that had developed in the radial artery was repaired with a vein graft obtained from the forearm. Magnetic resonance angiography imaging after 1 month confirmed the vein graft’s patency. Cannulations for blood monitoring, blood gas analysis and interventional radiological procedures are indispensable processes used in medicine; however, they are not risk-free. Following these procedures, thromboses and pseudoaneurysms can develop. A number of treatment options exist, including bandaging, percutaneous thrombin injections, and surgical treatment for complicated cases. For pseudoaneurysms that create a mass effect, as in our case, surgery is needed. Such complications after interventional procedures involving the radial artery should be kept in mind.

A periodical increase in hand injuries: The sacrifice feast -

Objective: As an Islamic ritual, every year during the celebration of the Sacrifice Feast, animals, like cows, sheep or goats, are sacrificed and their meat donated to poor people. In this study, we present the cases of hand injuries that occurred during the Sacrifice Feast, along with their corresponding etiological and demographic information, and evaluate the surgical management of these hand injuries. Methods: 62 patients, who were referred to the Hand Surgery Division of our Plastic, Reconstructive and Aesthetic Surgery Department from the emergency room between 15-18 October 2013 and 04-07 October 2014, were included in our study. A total of 62 patients were classified and evaluated according to age, gender, etiology, date of injury, hand lateralization, injury type, level of injury and type of anesthesia. Results: All 14 female patients (100%) were injured by knives. A total of 7 of 13 pediatric patients (53,8%) were injured from meat grinders. Thirteen patients were injured by cleavers; all of them (100%) were male and were injured on the first day of the feast. A total of 47 of 62 patients (75,8%) and 45 of 48 male patients (93,7%) were injured on the 1st day of the feast. A total of 12 of 14 female patients (85,7%) were injured on the 2nd, 3rd and 4th days of the feast. A total of 39 of 62 patients (62,9%) injured their nondominant hands. Isolated tendon injuries were the most common injury type (29%). Conclusion: Although festivals are celebrated with much enthusiasm, carelessness or neglect may lead to undesirable results. Keeping children away from danger should be made a top priority during Sacrifice Feasts. In addition, not only should precautions be more intensively emphasized by the written and visual media, but special regulations should be implemented involving the transporting of amputated limbs. Furthermore, in some regions, many people, who are inexperienced butchers, sacrifice animals themselves, leading to numerous hand injuries. Consequently, in order to reduce the number of these hand injuries, animals should only be sacrificed by professionals.