Hakan Sirinoglu

Extradigital glomus tumor revisited: Painful subcutaneous nodules located in various parts of the body

Background: Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. Patients and Methods: Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. Results: Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1st year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. Conclusions: Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented.

Isolated plexiform neurofibroma of the tongue.

A very rare case of isolated plexiform neurofibroma with a painless enlarging mass of the tongue of a 5-year-old girl is presented. This rare benign tumor has the potential for malignant transformation, and the diagnosis was difficult owing to the patients age and to the insidious clinical presentation.

Effects of Deferoxamine on Fat Graft Survival

The most important problem in fat transplantation is the unpredictable rates of resorption. Deferoxamine (DFO) is an iron-chelating agent with many useful functions including stimulating angiogenesis and antioxidant nature. The purpose of the study is to evaluate the effects of DFO on fat graft viability in rat model. A total of 24 Wistar rats were divided into three groups and 0.5 g of the left inguinal fat pad was extracted. In control group, fat grafts were implanted to the parascapular area without performing any procedure. In sham group, they were implanted in 0.2 mL saline solution followed by serial saline injections for 1 month. In the study group, fat grafts were implanted in 0.2 mL saline solution and 300 mg DFO followed by serial DFO injections for 1 month. At the postoperative second month, fat grafts were taken back and sent for histopathologic examination. The weight measurements of biopsy specimens in the study group demonstrated significantly higher than in the other two groups. Inflammation and fibrosis rates were also found to be significantly higher in the study group compared with the other groups; however, no significant difference in the apoptosis rates was detected between the groups. Fat grafts enriched with DFO showed significant increase in fatty tissue content in the study group compared with the control and sham groups. DFO increases the fat graft survival in rats and it may be a useful addition in autologous fat grafting procedures to increase fat graft viability and obtain maximal long-term durability.

Utilization of Postanastomotic Side Branches for the Assessment of Anastomotic Patency

The patency of the microvascular anastomosis is the most important issue by a successful microvascular reconstruction.1 The main reason of anastomotic failure is thrombosis, which commonly occurs due to endothelial damage.2 There are various methods for checking the anastomotic patency used both in the perioperative and postoperative period.3 The milking test is the most commonly performed method used for intraoperative assessment of anastomotic patency which is easy to perform and gives the surgeon the opportunity to control the blood stream under direct vision.4 This test is performed a few centimeters distal to the anastomosis.5 However, the study of Petry et al showed that milking test causes endothelial cell loss and thus increases the risk of anastomotic failure.6 Herewe perform a simple trickmaking it safe for a surgeon to perform themilking test. Sidebranches of arteries and vena in suitable length located at the postanastomotic area are marked with microvascular clamps or 8–0 nylon suture and used for the milking test. In this way, the possible endothelial damage just a few centimeters distal to the microvascular anastomosis is prevented (►Fig. 1). These side branches may also be used for perioperative cannulation and irrigation of the microvascular anastomosis.7 We also suggest clipping of the side branch after performing the milking test to prevent the risk of clot formation because of the endothelial damage caused by the test. This method is used in our institution since 2010 in various types of microvascular tissue transplantations and extremity replantations without any complication. However, it is not always possible to find suitable postanastomotic side branches with adequate caliber to perform the milking test. The utilization of postanastomotic side branches for the assessment of anastomotic patency is an easy, useful, and versatile method providing the surgeon to perform the safer milking test. It has also facilitated performing themilking test safely by preventing any possible damage to the microvascular anastomosis and the postanastomotic area. References

Late presentation of a case of high pressure cement injection injury to the hand

Abstract High-pressure injection injuries to the upper extremity cause potentially severe complications that result in multiple operations, amputations, and permanent functional deficits. Early exploration and debridement are the mainstays of treatment for optimal functional recovery. We describe the late presentation of a high-pressure cement injection injury to the hand, its management, and long term course.

A new experimental flap design: the saphenous artery periosto-fasciocutaneous flap of the rat.

Vascularized periosteal graft is a frequently applied flap model for bone prefabrication studies due to its inhabitance of osteoprogenitor cells and osteoinductive potential. Various bones such as rib and fibula are reported as a potential source for the harvest of the periosteal flap in experimental studies on higher species such as dogs and pigs, which necessitates a rather complicated and expensive experimental setting. Therefore a reliable and inexpensive small animal model on vascularized periosteal flaps is necessary for future research. A new saphenous artery based periosto-fasciocutaneous flap model in rats is described here, which is easily dissected and monitorized. In this experimental study, 15 male Sprague Dawley rats were operated and killed following a 3-month-long follow-up period . The histological analysis revealed heterotopic osteoneogenesis in 12 of 15 flaps (80%), whereas 14 flaps (93.3%) exhibited signs of angioneogenesis originating from the periostofasciocutaneous flap. The presented flap model promises to be an appropriate alternative for new studies where bone prefabrication methods are evaluated.

Benign nodular hidradenoma of the face.

A very rare case of nodular hidradenoma with an atypical clinical presentation of the face of a 70-year-old woman is presented. Although this rare benign tumor has the potential of local recurrence and malignant transformation, it is commonly reported in the dermatology, pathology, and oncology literature, with limited clinical information. The purpose of this report was to emphasize the clinical features of this lesion for plastic surgeons.

Effects of Tumescent Solution on Fat Survival

Abstract Autologous fat transfer is a commonly used procedure in plastic surgery practice. The long‐term survival rate of fat grafts is the most important issue for satisfactory results. The presented study includes the effects of different tumescent solutions on long‐term fat graft survival. A total of 24 rats were divided into four groups: sham, lidocaine, adrenaline, and lidocaine + adrenaline groups. In all groups except the sham group, right inguinal fat pad was harvested 10 minutes after injecting 5 cc of the appropriate tumescent solution. The fat pad was trimmed and reimplanted to the interscapular area. After 3 months, fat pad was reharvested and sent for histopathologic evaluation. The harvested fat grafts were weighted in both surgical sessions. A significant difference was observed in comparison of fat grafts weights between the initial operation and the postoperative third month (p = 0.002). By intergroup comparisons, a significant difference was observed between sham and adrenaline groups (p = 0.002) and between sham and lidocaine + adrenaline groups (p = 0.007). No statistical difference was observed by the comparison of TUNNEL results (p = 0.663). The histopathologic evaluation of the specimens revealed similar results between groups. The injection of tumescent solutions containing only lidocaine before fat harvesting yields similar long‐term fat graft survival rates in comparison to the conduction of surgical procedure without injecting any tumescent fluid. However, the injection of solutions containing adrenaline with or without lidocaine may decrease the long‐term survival rates of fat autografts.

A new method for obtaining mesenchymal stem cells in children with burn injury: Tibial bone marrow aspiration by using the C-arm guidance scopy

The utilization of stem cell therapies is a trending topic in plastic surgery and fat tissue is the most commonly used stem cell source. Stem cell injection has become popular in the treatment of burn wound, especially in the late term scar modulation. However, insufficient amounts of fat tissue in the pediatric age group is a major limitation. The present study reports the utilization of tibial bone marrow aspiration as a source of mesenchymal stem cells in the pediatric age group with the simultaneous usage of x-ray examination to avoid epiphyseal damage.

A Diagnostic and Therapeutic Algorithm for Impacted Teeth for Plastic Surgeons: Outcomes of 242 Extracted Teeth

Amac: Cene ve yuz kemiklerinin cerrahisi ile siklikla ugrasan plastik cerrahlar icin gomulu dislere yaklasim, kendi basina tasidigi riskler ve olasi komplikasyonlar nedeniyle ozellikle uzerinde durulmasi ve tarafimizca sahiplenilmesi gereken konular arasinda gelmektedir. Bu calismamizda klinigimizde tedavi gormus 242 gomulu dis ve baska merkezlerde cekimi gerceklestirilememis yirmi bir dis koku geriye donuk olarak degerlendirilmis ve degisik tip ve konumda- ki gomulu dislere yaklasimda bir algoritma olusturulmustur. Olasi komplikasyonlar ve kurtarma girisimleri tartisilmistir.