Harun Çöloğlu

V-Y rotation advancement fasciocutaneous flap for excisional defects of pilonidal sinus.

Background: Pilonidal sinus is a common disease that mostly affects young people. Despite numerous treatment modalities, the best technique has not yet been determined and there are many recurrences, causing economic losses and serious discomfort for the patients. Methods: The authors used V-Y rotation flaps for coverage of the defects after excision and debridement of chronic pilonidal sinuses in eight patients. The results were evaluated and compared with previously reported studies regarding the grade of disease at presentation, duration of surgery, blood loss, hospitalization period and active mobilization periods, complications, and loss of sensitivity. Results: No major complications occurred; hospitalization and immobilization periods were acceptably convenient. Recurrence was not seen, and sensitivity of the gluteal region did not diminish. The outcome was also satisfactory regarding aesthetics, and all the patients were satisfied with the result. Conclusion: The authors believe that the V-Y rotation advancement flap is a good alternative method for the treatment of pilonidal sinus.

Axial bilobed superficial temporal artery island flap (tulip flap): reconstruction of combined defects of the lateral canthus including the lower and upper eyelids.

Full-thickness and combined eyelid reconstruction that includes the lateral canthal region is complex and difficult because of the special skin characteristics and the different structures involved, which include the eyelashes, tarsal plate, conjunctiva, lateral palpebral commissure, lateral canthal tendon, and lateral fornix. To close defects in this region with good texture and color match and to obtain successful functional and aesthetic results, good vascularized skin and soft tissue play an important role. In recent practice, for large, full-thickness eyelid defects that cannot be closed primarily, different free composite grafts and local pedicled flaps have been used for reconstruction. Until now, island flaps based on terminal branches of the superficial temporal artery were used to reconstruct many different defects in the head and neck region.1 The use of island flaps, especially to reconstruct the lower eyelid, started nearly 100 years ago. In 1898, Monks2 reconstructed a full-thickness lower eyelid defect after malignant tumor excision with a flap based on the superficial temporal artery. In 1917, Eser3 reconstructed lower eyelid defects using the same technique and defined the term “island flap.” Three terminal branches of the superficial temporal artery–-the anterofrontal, centrofrontal, and posterofrontal branches–-have previously been defined.4 In this article, we aim to present our experience with the bilobed superficial temporal artery island flap, in which both lobes have two anterofrontal, centrofrontal, and posterofrontal branches as axial pedicles, for use in patients with lateral canthus defects involving both the upper and lower eyelids. We call this flap the tulip flap because its long name is difficult to abbreviate and the bilobed skin island resembles a tulip with its pedicle.

Rhinoplasty model in rabbit

Background: Rhinoplasty has become one of the most frequently requested and performed surgical procedures for both functional and aesthetic purposes. As an attention-attracting prominence, even the slightest disfigurement of the nose causes serious disturbance to the patient before or after the operation. Functional problems also cause discomfort. For these reasons, postrhinoplasty complications are regarded as challenging problems for both for the patient and the surgeon. Some cases necessitate grafts for better aesthetic or functional outcome, but there is still controversy over the preference for autogenous or allogenous grafts, both for primary and secondary cases. Evaluation of autogenous and allogenous grafts implanted in the nose is quite challenging for several reasons, including the possibility of unpredictable complications leading to catastrophic disfigurements, the impossibility of obtaining pathologic specimens, and the need for a long follow-up period for stable results. An experimental model for rhinoplasty, fulfilling the need for precise evaluation, was planned and performed after anatomical observation of the noses of rabbits. Methods: Fifteen adult New Zealand rabbits were used, five for the anatomical evaluation and 10 for the rhinoplasty model. Computed tomographic images and measurements were obtained before and after the surgical processes. Results and Conclusion: This experimental model for rhinoplasty has not been reported in any previous studies. This study demonstrates the surgical anatomy of the rabbit in detail and constitutes a guide for researchers as a convenient experimental model for rhinoplasty, with all stages similar to those performed on humans.

Lower eyelid orbicularis oculi musculocutaneous flap for reconstruction of nasal tip and supratip defects

Background: In clinical practice, there are many ways to reconstruct nasal defects. Despite this fact, achieving a desirable image and better functional results is still a problem. Banner, bilobed, and dorsal nasal flaps have recently been used to reconstruct defects up to 2 cm2. For defects larger than 2 cm2, flaps raised from the frontal region and face are used. The major disadvantages of these flaps are the visible scar and the frequent need for a second session. Methods: The authors used orbicularis oculi musculocutaneous flaps raised from the lower eyelid, containing branches of the angular artery and the infraorbital artery in its pedicle, to reconstruct nasal tip and supratip defects. Between February of 2002 and March of 2004, reconstruction with orbicularis oculi musculocutaneous island flaps raised from the lower eyelid was performed on 15 patients (eight men and seven women) with nasal tip and supratip defects. Thirteen defects were secondary to basal cell carcinoma and two were secondary to congenital melanocytic nevus. The diameter of the defects ranged between 2.1 and 3.1 cm (average diameter, 2.5 cm). Patients were between 25 and 72 years old (average age, 52 years). Results: Patients were followed up for an average period of 6 months (range, 1 to 12 months). In two patients (13.3 percent), postoperative venous problems were seen but resolved in 3 days. Partial necrosis developed in one patient (6.6 percent). In one patient (6.6 percent), minimal scleral show was seen in tolerable ranges. Neither ectropion nor other eyelid deformities were seen. Conclusions: The authors believe that this flap is a good alternative for reconstruction of nasal defects because of its advantages, namely, the need for only a single session, minimal donor-site morbidity, better color and thickness match, and easy and faster surgery.

Frontal Scalp Flap for Aesthetic Eyebrow Reconstruction

The eyebrow is an important subunit of facial aesthetics and expression. Partial or total absence of the eyebrow is an unacceptable and disturbing condition. Aesthetic eyebrow reconstruction is a challenging problem for the reconstructive surgeon. In this paper a simple and reliable procedure for eyebrow reconstruction is presented. An aesthetically satisfactory result was obtained and a perfect match with the undamaged eyebrow was achieved. In selected cases this technique may be a strong alternative to the procedures that had been defined earlier.

Bilateral Propeller Flap Closure of Large Meningomyelocele Defects

BackgroundMeningomyelocele is a defect of the spinal cord, vertebral spine, and overlying skin and is the most common form of spinal dysraphism. Multiple methods of soft tissue closure for larger myelomeningocele defects have been described, including skin grafting, random fasciocutaneous flaps, skin undermining with relaxing incisions, and musculocutaneous flaps. Most current methods for closure of defects of 8 cm and greater and kyphotic spines usually remains inadequate. In this study, we present our clinical experience with a new surgical procedure, bilateral propeller (BP) flaps based on dorsal intercostal and lumbar artery perforator, for the closure of large thoracolumbar meningomyelocele defects. Patients and MethodBetween January 2011 and April 2012, 7 newborns (5 males and 2 females) with thoracolumbar large meningomyelocele were included in the study. Six patients had lumbar kyphosis. Myelomeningocele defects with a mean size of 89.3 cm2 (range, 58.9–136.8) were closed with BP flaps. ResultsAll flaps survived; hematoma, seroma, wound dehiscence, flap necrosis, or infection was not observed. No patients required any surgical revisions. The patients had a follow-up of 4 to 16 months with a mean of 10 months, and no long-term complications, including necrosis of flap edges, wound breakdown, or instability, have been apparent in our series. ConclusionsWe believe that the BP flaps represent a useful tool in the management of soft tissue defects associated with especially kyphotic large thoracolumbar and lumbosacral myelomeningoceles.

Anterior superficial temporal artery island flap: intraoral defect repair.

Abstract There are many options for the repair of intraoral defects. Today, free radial forearm or anterolateral thigh perforator flap is the first choice for the repair of intraoral defects. However, the importance of regional flaps is still maintained for patients whose medical condition is inappropriate for a long surgery and anesthesia time. In this report, we present our clinical experience with 9 patients who underwent retromolar trigone, buccal mucosal, gingival, and mouth floor reconstruction with anterior superficial temporal artery island flap (ASTIF) which has not been described in the literature before. Their mean age is 49 (27–85) years. ASTIF dimensions used for the reconstructions ranged from 3 × 5 to 8 × 16 cm. No partial or total flap necrosis was seen in any of the patients; only 3 patients had venous congestion problem for the first 3 days of the surgery, but they all healed well. Five patients had squamous cell carcinoma, 2 patients had squamous cell carcinoma with local recurrence, 1 patient had adenocarcinoma, and 1 patient had mandibular osteocarcinoma. Patients were followed for a minimum of 6 months postoperatively (average 12 months, range 6 to 24 months). ASTIF provides an excellent alternative for reconstructing defects of the oral cavity for some patients who have significant comorbid conditions or specific contraindications to free tissue transfer. At the same time, the combination with the free flaps increases the success of the restoration. Level of Evidence: Level IV therapeutic study.

The management of non-melanocytic skin malignancies of the scalp and calvarium

Background: The management of advanced cutaneous malignancies has been controversial. Thirteen patients with nonmelanoma skin neoplasias that had invaded the bone of the calvarium and scalp were treated in our centre. Objective: The purpose of this study was to evaluate our experience in treating these malignancies with scalp resection and full or partial thickness cranium reconstruction. Patients and Methods: From June 2008 to March 2012, thirteen patients with locally advanced tumours of the scalp invading the calvarium were treated with wide local excision of the scalp combined with an underlying craniectomy and dural resection if needed. Results: Using histopathological diagnosis eleven patients were diagnosed with basal cell carcinoma and two patients with squamous cell carcinoma. A full thickness cranium resection was performed in seven patients and partial in six patients. Conclusion: These large cancers occasionally invade adjacent structures, as well as bone, presenting a challenging surgical problem. In general, giant rotational or island scalp flaps and free tissue transfers are needed to close the area. Finding clean margins are an important part of treating patients with bone involvement and can usually be attained using outer tabula curettage thus preventing unnecessary morbidity.

Multi-centric basal and squamous cell skin malignancies of the craniofacial region.

The etiology of skin malignancies is evaluated as multi-factorial. The human phenotype, syndromes, precursor lesions, and immunologic differences play as risk factors as well as environment. Twenty-seven patients with multi-centric skin malignancies investigated as if having predisposing syndromes. The etiological factors and the classification of skin malignancies are assessed. We last discussed about the management options. The mean age was 47 (9-91). Men to women ratio was 16:11. Four out of 27 patients having multi-centric skin malignancies were realized as syndromic. The localization of these tumors was entirely at the head and neck region. Ninety-eight areas were distinguished as having skin malignancies in 27 patients. Sixty-one incisional biopsies for type analysis and 37 excisional biopsies were handled. Of the 98 malignancies, 24 were squamous cell cancer, 67 were basal cell cancer, and seven were basosquamous cell cancer pathologically. Wound closures were carried out as primarily in 39 excisions; using skin grafts in 21 excisions, local flaps in 28 excisions, and distant flap procedures in 10 regions. The follow-up period was between six and 25 months. No complications or recurrences were seen. Eight patients applied with new lesions on new regions, six patients had excision, and two were treated with radiotherapy.

ISOLATED UPPER EYELID COLOBOMA

Etiology of congenital eyelid coloboma is still unclear. It is a formation anomaly of complete or partial eyelid defect that can accompany other systemic diseases. 19 month old girl had an isolated congenital upper eyelid coloboma without any additional medical conditions. Defect was corrected with pentagonal incisions and advancement flaps. In our study we like to emphasize the importance of systemic analyze for additional conditions and to show that single stage repair is adequate.