Hasan Utkan Aydin

The results of surgical repair of sciatic nerve injuries

OBJECTIVES The aim of this study was to evaluate surgical treatment and follow-up results of patients who presented to our department with sciatic nerve injuries. METHODS The study included 13 patients (12 males, 1 female; mean age 23 years; range 11 to 35 years) who underwent surgical treatment for sciatic nerve injuries. The etiologies of sciatic nerve injuries were penetrating trauma in five patients, firearm injuries in four patients, and motor vehicle accidents in four patients. Injuries involved the knee level in five patients, and above-the-knee level in eight patients. Peroneal nerve involvement was seen in all the patients, and the tibial nerve was involved in 11 patients. Primary repair was performed in six patients, neurolysis in three patients, and nerve grafting in three patients. One patient underwent neurolysis for the peroneal portion, and nerve grafting for the tibial portion. Muscle strength and reflex changes were recorded at every stage of the treatment. Muscle strength was assessed according to the British Medical Research Council scale. The Semmes-Weinstein monofilament test was used for sensory evaluation. The mean follow-up period was 4 years (range 1 to 6 years). RESULTS In 11 patients with tibial nerve injuries, the soleus/gastrocnemius strength was measured as follows: M1 in one patient, M3 in four patients, M4 in four patients, and M5 in two patients. Plantar sensation was absent in four patients, while seven patients had at least adequate protective sensation. In 13 patients with a peroneal nerve injury, the strength of the anterior tibial muscle was measured as follows: M0 in three patients, M2 in three patients, M3 in one patient, M4 in three patients, and M5 in three patients. Of these, four patients had persistent insensitivity in the dorsum of the foot, while six patients had protective sensation, and three patients had normal sensation. Two patients with inadequate anterior tibial muscle strength following nerve repair underwent posterior tibial tendon transfer for restoration of foot dorsiflexion. The greatest functional improvement was obtained in cases in which neurolysis was performed; patients undergoing primary repair had better outcomes compared to those where nerve grafts were used. The results were better in thigh level injuries than those in the gluteal region. CONCLUSION Low expectations after sciatic nerve repair in the past are now being rapidly replaced by a more optimistic approach. Advances in microsurgery and use of treatment algorithms based on scientific research account for this significant improvement in outcomes after sciatic nerve surgery. Tendon transfers can enhance the success rate and be combined with nerve repair in selected cases.

Facial contour reconstruction with temporoparietal prelaminated dermal–adipose flaps

AIM Compared with those for free-fat grafts, resorption rates for vascularized adipose tissue transfers are very low. We analysed benefits of transfer of dermal-adipose grafts after prelamination upon the temporal fascia in reconstruction of facial contour defects. PATIENTS AND METHODS Among 8 patients operated on between 2005 and 2008, facial contour anomalies had resulted from trauma in 5, while the remaining 3 had abnormalities with a congenital, postinfectious, or iatrogenic aetiology. In the first-stage operation, a dermal-adipose graft was taken from the inguinal region and prelamination upon the superior surface of the temporal fascia. After 5.5 months, the prelaminated dermal-adipose-fascial flap was raised as an island flap, passed through a subcutaneous tunnel in the temporal region, and set into the defect site. RESULTS Satisfactory cosmetic results were achieved in all patients. Except for a temporary frontal nerve palsy in 1 patient, no early or late complications resulted from this procedure. CONCLUSION Prelamination of dermal-adipose grafts upon the temporoparietal fascia is useful in reconstruction of soft tissue defects requiring volume augmentation.

A simple setup for easy infiltration of large volumes.

Subcutaneous infiltration of fluids in large volumes has become essential for a wide variety of plastic surgery procedures [4]. Many surgeons regard preoperative infiltration of the surgical field with solutions containing vasoconstrictors and local anesthetics as an indispensable step. Besides liposuction using the tumescent technique and procedures such as breast reduction, face-lift, and abdominoplasty often benefit from the bloodless operating field provided by preoperative infiltration. The necessary amount of solution to be infiltrated can be as large as several liters, and it is cumbersome for both the surgeon and the medical team to prepare and infiltrate such large volumes. Various infiltration systems are avaliable on the market, but their high cost precludes their wide use. Additionally, the use of motorized infiltration pumps for officebased procedures are not cost effective in most instances. Several authors addressed this issue previously in the context of tumescent infiltration for liposuction, proposing various designs as substitutes for infiltration pumps. However, a wound irrigation system [1], an arthroscopy set [2], a micromotor irrigation system [5], or a Jet Lavage System [3] is not avaliable in every setting, and some of these methods might be unsuitable for use in more delicate areas such as the face. We introduce a practical, low-cost setup for infiltration of large volumes. A three-way stopcock is positioned between the infiltration needle and a syringe, and an infusion set is connected to the stopcock (Fig. 1). By rotating the handle of the three-way stopcock, the syringe can be filled, with the solution coming through the infusion set. By rotating the handle again, the connection between the syringe and infusion set is blocked, and the solution can be injected. A longer needle or a larger syringe can be used if desired. With this simple method, the clinician can avoid changing syringes for refills and save time.

Autologous Fat Injection into the Pectoralis Major as an Adjunct to Surgical Correction of Gynecomastia

BACKGROUND Correction of gynecomastia in males is a frequently performed aesthetic procedure. Various surgical options involving the removal of excess skin, fat, or glandular tissue have been described. However, poor aesthetic outcomes, including a flat or depressed pectoral area, limit the success of these techniques. OBJECTIVES The authors sought to determine patient satisfaction with the results of upper chest augmentation by direct intrapectoral fat injection in conjunction with surgical correction of gynecomastia. METHODS In this prospective study, 26 patients underwent liposuction and glandular excision, glandular excision alone, or Benelli-type skin excision. All patients received intramuscular fat injections in predetermined zones of the pectoralis major (PM). The mean volume of fat injected was 160 mL (range, 80-220 mL per breast) bilaterally. Patients were monitored for an average of 16 months (range, 8-24 months). RESULTS Hematoma formation and consequent infraareolar depression was noted in 1 patient and was corrected by secondary lipografting. Mean patient satisfaction was rated as 8.4 on a scale of 1 (unsatisfactory) to 10 (highly satisfactory). CONCLUSIONS Autologous intrapectoral fat injection performed simultaneously with gynecomastia correction can produce a masculine appearance. The long-term viability of fat cells injected into the PM needs to be determined. LEVEL OF EVIDENCE 4 Therapeutic.

Effects of microarterial anastomosis torsion on survival of oblique groin flap in rats

Abstract A microanastomosis might tolerate a torsion up to 360°, but the effects of arterial microanastomosis torsion on the survival of the flap it supplies are unclear. The aim of this study was to investigate the consequences of microarterial anastomosis torsion on the groin flap in rats. Forty Sprague-Dawley rats were divided into five groups. An oblique groin flap was harvested as an island flap and a patch-to-side arterial anastomosis was performed with torsion angles of 0°, 90°, 180°, 270°, and 360°. Six of eight flaps in Group I (0° torsion), six of eight flaps in Group II (90°), three of eight flaps in Group III (180°), and none of the flaps in Groups IV and V (270° and 360°) were found to be viable after 1 week. The patency and flap survival rates observed in Groups II, III, IV, and V were compared with those in Group I using Fishers exact test. The patency rates and flap survival rates in Groups IV and V were significantly lower compared with those in Group I. Our data show that skin flaps can survive even if their arterial pedicle is anastomosed with a torsion of up to 180°.

BİRİNCİ PARMAK ARALIĞI KONTRAKTÜRLERİNİN BİLOBE FLEPLER İLE TEDAVİSİ

Amac: Birinci parmak araligi (web) bolgesi el islevleri acisindan buyuk onem tasir. Bu bolgedeki kontrakturlerin giderilmesi icin en sik kullanilan yontemlerden biri isaret parmagi dorsalinden cevrilen transpozisyon flebidir. Bu calismada, dorsoradyal rotasyon flebinin verici alaninda ortaya cikan kontur deformitesini gidermek ve flebin transpozisyonunu kolaylastirmak icin kullandigimiz bilobe flep yontemine ait sonuclari ortaya koymayi amacladik. Gerec ve Yontem: Bu yontem kullanilarak birinci parmak araligi kontrakturu acilmis sekiz hastaya ait tedavi ve takip bilgileri retrospektif olarak incelendi. Bulgular: Bu yontemin uygulandigi sekiz hastalik (toplam on el) serimizde ortalama takip suresi 15,3 aydi. Olgularin takiplerinde onemli bir komplikasyon gorulmedi ve yeterli birinci parmak araligi acikligi elde edilebildi. Sonuc: Dorsoradyal transpozisyon flebinin bilobe olarak modifiye edilmesi bu fleple ilgili verici saha sorunlarini guvenli bir bicimde azaltmakta ve flebin daha rahat transpoze edilmesine olanak vermektedir.

Tacking the pinna with external mattress sutures to facilitate correction of prominent ears

Surgical correction of prominent ears is a highly rewarding procedure for both patient and surgeon. It is a common procedure and the involvement of trainee plastic surgeons is also frequent. As with any cosmetic procedure, the key to excellent results is careful preoperative planning. In cases where the main deformity is an underdeveloped antihelical fold, placement of Mustarde sutures is usually preferred. We found it beneficial to tack the pinna with external mattress sutures prior placement of permanent Mustarde sutures, to simulate the effects of scaphaconchal sutures. The external mattress sutures are placed after undermining the posterior auricular skin. This way, the extent of correction which is possible by placing only Mustarde sutures can be