Hidir Kilinc

Anatomicohistologic study of the retaining ligaments of the face and use in face lift: retaining ligament correction and SMAS plication.

Plastic surgeons have sought to improve nasolabial folds, jowls, jaw lines, and cervical contour with face-lifting procedures that are abundant in the literature. The retaining ligaments of the face support facial soft tissue in normal anatomic position, resisting gravitational change. As this ligamentous system attenuates, facial fat descends into the plane between the superficial and deep facial fascia, and the stigmata of facial age develop. In this study, surgical correction of the retaining ligaments and plication of the superficial musculoaponeurotic system (SMAS) to reposition the structures that have descended with gravitation are discussed. The anatomy of the facial retaining ligaments was studied in 22 half-faces of 11 fresh cadavers, and the localization, extension, and width of the ligaments were examined macroscopically and histologically. Surgical correction of the retaining ligaments and plication of the SMAS have been accomplished in 27 face-lift patients with this anatomicohistologic study taken into consideration. There was hematoma in one patient at the cheek region and a permanent dimple caused by postoperative edema in two patients, with a localization of one zygomatic and two parotidomasseteric ligaments. In one patient, hypesthesia in the mandibular nerve region was seen, which remitted at 14 weeks. There were no other complications, and with a follow-up of 24 months, excellent aesthetic results and a high level of patient satisfaction were encountered.

Examination of the skin perforators of the posterior tibial artery on the leg and the ankle region and their clinical use.

Background: There are many treatment alternatives for reconstruction of leg and foot defects. One of these treatment alternatives includes local flaps. A detailed understanding of the blood flow of the leg region is essential for producing new alternatives for the reconstruction of defects of this region. Methods: The leg and foot region blood flow was examined on 11 fresh cadavers, and perforators of this region were examined in three zones. Perforator numbers and their diameters were defined at this region. It was determined in cadaver studies that especially zones I and II were more suitable for the planned flaps based on perforators of the posterior tibial artery. In a clinical study that accompanies this anatomical study, eight patients underwent reconstruction by flaps based on the perforators of the posterior tibial artery. Results: Patients were followed for 3 to 14 months. In three patients, venous drainage problems had developed, and in one of them, partial flap loss had developed. This partially necrosed region was left to heal by secondary intention. Venous drainage problems resolved in 5 to 7 days in the two remaining patients. No other complications were seen. Conclusion: Regarding the results of the clinical study, the authors observed that this flap can provide the desired soft-tissue support for defects that expose the bones, tendons, and neural and vascular bundles.

Clinicopathological Evaluation of Parotid Gland Tumors : A Retrospective Study

Two hundred and thirty sequential parotid tumors seen from March 1985 to 1995 were reviewed for their clinical presentation, diagnostic evaluation, pathological diagnosis, treatment modalities, and age and sex distribution.An asymptomatic mass was the most common clinical presentation. All of the operations were performed by the same surgical team. Total and superficial parotidectomy was used for the treatment of the lesions and none of the patients underwent limited excision. Retrograde approach in 79 (34.4%) patients and anterograde approach in 151 (65.6%) was used. Eighteen patients with malignant tumors were followed up in cooperation with the radiation oncology clinic. Tumors were classified according to their histopathologic diagnosis. Among 192 (83%) benign and 38 (17%) malignant tumors, the most common benign tumor of parotid gland was pleomorphic adenoma (79.1%) while the most common malignant lesion was adenocystic carcinoma (44.7%). Incidences of pleomorphic adenoma, adenocystic and epidermoid carcinoma were greater in male patients. Complication rates in benign and malignant tumors were presented and statistically significant difference could not be found between anterograde and retrograde approach in terms of facial nerve injury (P > 0.05).

Silicon in temporomandibular joint ankylosis surgery.

Temporomandibular joint ankylosis frequently occurs succeeding untreated or not adequately treated mandible fractures. Treatment of this condition with combined condylectomy and silicon sheet/block application was investigated in the literature. Thirty-eight patients with temporomandibular joint ankylosis were included in this study, and postoperative results were presented. Mean preoperative and postoperative sixth-month interincisor opening values were 5.8 and 28.8 mm, respectively. In two patients (5.2%), another operation to remove silicon material was needed because of infection and exposure of the silicon. One patient (2.6%) was operated on again for limited mouth opening. It was concluded that interpositional arthroplasty with silicon was proved to be a low-cost, easy approach with satisfactory long-term results.

Innervated dorsal adipofascial turnover flap for fingertip amputations.

Traumatic or thermal injury to the fingertip may result in composite tissue loss. Exposed tendon, bone, or joint surface is best treated by flap coverage. The authors present their experience with a new technique that provides coverage for fingertip defects using the innervated dorsal adipofascial turnover flap, which consists of adipofascial tissue only and relies on the arterial anastomotic network of this tissue layer to sustain its vascularization. Eight digital amputations between the distal phalanx proximal to the nail matrix and midportion of the middle phalanx were resurfaced successfully with the innervated dorsal adipofascial turnover flap. The flaps survived completely; the mean follow-up was 9 months. This technique seems to be a relatively simple way of achieving early recovery. It does not require the use of distant flap immobilization of adjacent digits, nor does it require the use of homodigital flaps, which may jeopardize an already injured finger. The main advantages of the innervated dorsal adipofascial turnover flap are its ready availability from the local tissue, its sensation, and the absence of functional and aesthetic disturbance at the donor site.

Reconstruction of saddle nose deformity with three-dimensional costal cartilage graft.

Saddle nose deformity is characterized by depression of the nasal bone and the cartilage dorsum associated with a collapse in the upper lateral and alar cartilages. Etiopathogenesis usually involves trauma or invasive excision of the bone and cartilage. Surgical treatment for functional and aesthetic recovery relies on the use of grafts. Options for grafting include autogenous tissue such as bone or cartilage and alloplastic augmentation. Nine patients with saddle nose deformity underwent surgical reconstruction with autogenous costal cartilage. The deformity was the result of trauma in seven patients and secondary to surgery in two patients. Cartilage obtained from the sixth and seventh ribs was used as the graft material to compensate for the low nasal dorsum. Cartilage was used as a single unit and shaped to cover the nasal dorsum and the lateral nasal walls completely. The upper lateral cartilages were fixed to shaped cartilage graft. Additional cartilage grafts into the columella and septum were also placed in all patients. Functional and aesthetic outcome was satisfactory in all patients. As a result, using costal cartilage graft, a single unit allowed more predictable and reliable reconstruction of the saddle nose deformity than the conventional dorsal grafts.

A new approach to retroauricular flap transfer: parietal branch-based reverse flow superior auricular artery island flap.

The retroauricular region provides adequate tissue of excellent color and texture match for the reconstruction of small- and medium-sized facial defects. In this study, parietal branch of the superficial temporal artery (STA) was used as the pedicle for the retroauricular island flap. Anastomoses between the parietal branch of STA, occipital artery, and contralateral STA were observed to deliver adequate nutritional blood supply to the flap. Total upper eyelid defect in 1 case, malar defect in 1 case, and forehead defects of various sizes in 4 cases were included in our study. Sizes of the flaps varied from 4 × 4.5 cm to 6 × 8 cm (mean 4.7 × 6.6 cm). All cases had venous congestion for 2–4 days (mean 3.4 days). Only 1 case experienced a superficial dermal necrosis of 1 × 3 cm in size in the distal part of the flap. Esthetic and functional results were satisfactory during the 1- to 14-month (mean 7) follow-up period. This flap is thought to be advantageous for the repair of defects and traumas of the forehead and upper eyelid as the pedicle does not develop torsion and dissection is easy.

Supraorbital artery island flap for periorbital defects.

The forehead skin has the same color and texture as the periorbital region as well as the other parts of the face. The forehead is a local flap donor area for the reconstruction of full-thickness periorbital defects. This report presents eight cases in which full-thickness defects resulting from tumor resection have been repaired with supraorbital artery island flaps. Of eight patients, one was female and the rest were male with a mean age of 72.8 years (range, 64-88 years). Defects were located in the medial canthal region, lateral canthal region, glabella, and lateral part of the orbita. The flaps ranged from 2 × 3 cm to 6 × 7 cm in size. The patients were followed for 7 to 18 months. No complications occurred, except for decreased sensation on the forehead, and trapdoor deformity was seen in one case. The outcome was functionally and aesthetically satisfactory in all cases and all patients were happy with the outcome. The supraorbital artery island flap is a good alternative for the repair of defects around the orbita in that the color and texture of this flap match up with the orbital region and that it is pliable, simple, safe, and sensorial and requires only a single-session procedure.

Effect of caffeic acid phenethyl ester on survival of axial pattern flaps in rats with ischaemia–reperfusion injuries

Oxygen–derived free radicals have been implicated in the pathogenesis of tissue injury after ischaemia–reperfusion. Caffeic acid phenethyl ester (CAPE), an active ingredient of honeybee propolis, has been identified as having potent antioxidant and anti-inflammatory properties. We evaluated the ability of CAPE applied intraperitoneally in reducing tissue injury after ischaemia–reperfusion. To investigate whether treatment with CAPE modifies the concentrations of the endogenous indices of oxidant stress, we examined its effects on a model of flap ischaemia–reperfusion injury in rats. CAPE (10 µmol/kg) was given through the peritoneum before reperfusion. CAPE given intraperitoneally had an inhibitory effect on tissue injury after ischaemia–reperfusion comparable to that of a control group. The anti-inflammatory and antioxidant properties of CAPE may contribute to its suppression of tissue injury.

A novel flap to repair medial and lateral malleolar defects: anterior tibial artery perforator-based adipofascial flap.

Soft tissue coverage of the ankle is a difficult challenge. The adipofascial flap based on perforators of the anterior tibial artery was harvested from the dorsum of the foot and used for repairing of soft tissue defects either on the lateral or medial malleolar region in 7 patients. Two medial and 5 lateral malleolar defects were covered using the flap described. The size of flaps varied from 3.5 × 10 cm to 4.5 × 12 cm. All flaps had good perfusion and survived completely. Donor-site morbidity was minimal in all cases. Both functional and esthetical results were satisfactory. Because of thin and pliable features, this flap is suitable for repair of defects around the ankle region. In addition, donor-site morbidity of this flap is minimal, with an acceptable scar hidden in the shoe-wearing area.