Haldun Onuralp Kamburoğlu

Postoperative Satisfaction and the Patient’s Body Image, Life Satisfaction, and Self-Esteem: A Retrospective Study Comparing Adolescent Girls and Boys After Cosmetic Surgery

BackgroundCosmetic surgery procedures are more complex for adolescents than for adults because there are more factors affecting patient satisfaction, especially psychological factors. This study was designed to find answers to four main questions: (1) whether postoperative satisfaction rates differ statistically between males and females, (2) whether postoperative satisfaction correlates significantly with the self-esteem, body image, life satisfaction trilogy, (3) what the postoperative patient satisfaction and cosmetic procedure rates are among adolescents by years, and (4) whether a statistically significant relationship exists between postoperative satisfaction and a willingness of adolescents to undergo another cosmetic surgery.MethodsThe study enrolled 86 of 165 patients who underwent surgery between January 2001 and June 2005. A simple poll consisting of 12 simple questions was used to collect data.ResultsNo statistically significant difference was found in postoperative satisfaction rates between males and females. The findings show that postoperative satisfaction is significantly related to self-esteem, body image, and life satisfaction. The patient satisfaction rate was 93.83%, and there was no increase in adolescent cosmetic surgery rates over the years.ConclusionAdolescents are good candidates for cosmetic surgery, but patients must be evaluated carefully. Any suspicion about a patient’s psychological status must result in a psychiatric consultation.

Revisiting the role of columellar strut graft in primary open approach rhinoplasty

Background: The effect of a columellar strut graft on final nasal tip position has been a subject of ongoing debate. The purpose of this study was to retrospectively analyze a series of 100 consecutive primary rhinoplasty cases performed without the use of columellar strut grafts, with a specific focus directed toward comparing preoperative, morphed, and actual postoperative changes in nasal tip position. Methods: Data were collected from patient charts and digital images of 100 consecutive primary open rhinoplasty patients. Preoperative, morphed, and actual postoperative digital images were quantitatively analyzed using image-processing software to compare various anatomical features, including nasal tip projection, nasolabial angle, and Goode ratio. Patient satisfaction regarding long-term postoperative results was also surveyed. Results: Primary rhinoplasty did not demonstrate a universal trend toward either an increase or a decrease in nasal tip projection. The planned changes in nasal tip projection, nasal tip rotation, and nasal profile proportions were obtained with statistically significant accuracy without the use of columellar strut grafts. The overall incidence of columellar contour irregularities was 3 percent. Conclusion: In primary open approach rhinoplasty, if native anatomical support structures of the nasal tip are preserved or reconstructed, preoperative goals regarding nasal tip projection, nasal profile proportions, and columellar integrity can be consistently achieved without using columellar strut grafts. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Osteoid osteoma of the lunatum mimicking Kienböck’s disease

Abstract Hands, especially lunatum, are involved very rarely with osteoid osteoma. This report presents an osteoid osteoma of the lunatum, which was previously misdiagnosed as Kienböck’s disease and had undergone surgery. Magnetic resonance imaging may lead the clinician to misdiagnose because of the excessive bone edema around the carpus. The operation should be planned according to radiography and computed tomography findings.

Wrist Tenosynovitis due to Mycobacterium bovis Infection: Case Series and Review of the Literature.

Summary: Tuberculosis infections are still one of the most important public health problems among developing countries. Musculoskeletal involvement represents 10–15% of all extrapulmonary cases. Tuberculosis tenosynovitis is usually misdiagnosed as nonspecific tenosynovitis. To avoid misdiagnosis and mistreatment, it is important to be alert for mycobacterial infections. This article presents 3 patients with wrist tenosynovitis, which was caused by Mycobacterium bovis infection. The article also includes review of the literature.

Skin bridging secondary to ingrown toenail.

Ingrown toenails are painful conditions that especially affect young people and may become chronic if not treated. We describe a case of chronically inflamed ingrown toenail left untreated for three years. In the physical examination, skin bridging and epithelialization was observed in midline secondary to soft tissue hypertrophy of the lateral nail matrixes. Epithelized fibrous tissue was cut across the lateral nail matrix and left for secondary healing. Partial matrixectomy was applied and the remnants were cauterized in compliance with the Winograd procedure after removal of the nail. Our case is an advanced condition which is the second report in the literature. Skin bridging secondary to excess soft tissue hypertrophy can be observed in untreated bilateral Heinfert or Frost stage 3 ingrown nails. This rare case can be classified as advanced stage 3 disease or stage 4.

Nasal Tip Suspending Transfixion Suture

AbstractBackgroundAnterior septal height is an important determinant of nasal tip projection. Accordingly, the anterior septal extension technique has proven itself to be a powerful tool for achieving long-lasting nasal tip projection in rhinoplasty. However, anterior septal extension does not protect against postoperative loss of nasal tip rotation unless an additional suspension strategy is used. A tip-suspending transfixion suture is the authors’ strategy for supporting nasal tip rotation whenever an anterior septal extension technique is performed. MethodsOf 156 rhinoplasties performed by the authors between 2010 and 2012, a cohort of 22 droopy-tip rhinoplasties was extracted in which the described technique was used. The patients in this cohort were included in a retrospective nasal tip projection and rotation analysis. The nasolabial angle (NLA) and Goode ratio measurements were compared between preoperative, 3-week postoperative, and 1-year postoperative profile-view photographs.ResultsThe NLA and the Goode ratio measurements were significantly higher in the 3-week postoperative group than in the preoperative group, indicating an effective gain in both tip projection and rotation. The NLA and the Goode ratio measurements did not differ statistically between the postoperative 3-week and postoperative 1-year groups, indicating long-term maintenance of nasal tip position.ConclusionA tip-suspending transfixion suture is an easy method for securing nasal tip rotation when used in conjunction with an anterior septal extension.Level of Evidence VThis 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.

Which instrument should we use to assess hand function after digital replantation

The functional recovery of a replanted body part is as important as its viability. We compared four instruments frequently used for the evaluation of hand function after digital replantation. The functional results of 17 patients at least one year after replantation of a total digital amputation between 2004 and 2007 were evaluated according to the Tamai, Ipsen, Chen and Disabilities of the Arm, Shoulder and Hand questionnaires. Scores of each patient for each test were calculated and intra-individual comparisons were made. Correlation was significant at the 0.05 level (two tailed) for all tests. A high correlation (>0.71) was found between the Ipsen, Tamai and DASH tests. The Chen test had a moderate correlation with the other tests. We determined that Ipsen, Tamai and DASH tests have similar effectiveness in assessing hand function after replantation.

A rare poland syndrome deformity: humero-pectoral band.

Since Dr. Lallemand has defined isolated pectoral muscle absence in 1826 [1], many articles have been published about Poland Syndrome. Ipsilateral syndactyly with pectoralis major muscle agenesis has been defined by Dr.Froriep in 1839 [1]. Dr. Alfred Poland has defined same entity in 1841 while he was a medical student [1]. Agenesis of the pectoralis major muscle’s sternal head is the major finding in diagnosis of Poland Syndrome. Additionally, scoliosis, lung, rib cage (two to four or three to five costal cartilages), breast and nipple-areolar hypoplasia, ipsilateral brachysynphalangism, serratus, pectoralis minor, latissimus dorsi and external oblique muscles hypoplasia, absence of axillary hairs and sweet glands and decreased subcutaneous tissue would be seen together in Poland Syndrome [1, 2].

Assessment of survival rates compared according to the Tamai and Yamano classifications in fingertip replantations.

Background: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. Materials and Methods: 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions. Results: Of the 34 fingertips, 26 (76.4%) survived. Ten (66.6%) of 15 digits replanted in Tamai zone 1 and 16 (84.2%) of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100%) and only two failed in Yamano type 2 (75%). Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%). The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different. Conclusions: The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.

The effects of hyperhomocysteinemia on the microcirculation of skin flaps.

Background: Hyperhomocysteinemia is an independent risk factor for atherothrombotic disease and venous thrombosis. The effects of hyperhomocysteinemia on the microcirculation were studied in vascular diseases. The authors aimed to investigate the effects of hyperhomocysteinemia on the microcirculation of random-pattern skin flaps. Methods: Twenty-two male Sprague-Dawley rats, divided into two groups, were used in this study. The rats in group 1 (control) were fed the TD.07112 diet, and the rats in group 2 (experimental group) were fed the TD.07114 diet, enriched in methionine for 30 days, to induce severe hyperhomocysteinemia. The plasma homocysteine, folic acid, vitamin B12, and vitamin B6 levels were evaluated on days 0 and 30. Distally based skin flaps were elevated on day 30 and evaluated by direct observation, microangiography, and light microscopy on day 37. Results: Mean homocysteine blood levels were 211.76 ± 56.55 &mgr;M/liter in group 2 and 14.48 ± 2.00 &mgr;M/liter in group 1 on day 30. The rate of necrosis was significantly higher in group 2 (59.00 ± 4.38 percent) compared with group 1 (32.54 ± 6.13 percent; p < 0.01). Microangiographic findings were similar to direct observation results. Microvessel calibration was reduced in group 2. In group 1, structures of epidermis and dermis were normal; however, there was a slight mononuclear cell infiltration along with thick collagen fibers. A more prominent mononuclear cell infiltration with fields of loose epidermis, associated with inflammation and infiltration, were observed in group 2. Conclusion: The authors demonstrated, for the first time, that hyperhomocysteinemia severely suppressed the microvasculature of skin flaps, as shown by increased flap necrosis and reduced microvessel calibration in the experimental group.