Hulda Rifat Ozakpinar

A case of syngnathia, cleft palate and hypospadias: An isolated case or syndromic syngnathism?

Syngnathia occurs when an ectopic membrane forms a fibrous or bony adhesion between the maxillary and mandibular alveolar processes. A case of congenital syngnathia is presented.

Correction of hyperpigmented palmar grafts with full-thickness skin grafts from the lateral aspect of the foot.

Abstract The palmar surface of the hand possesses special features when compared with the hair-bearing parts of the body. The same quality of skin has to be used in reconstruction of the palmar skin defects to restore normal function. The lateral aspect of the foot has similar features with the palmar region histologically and can be used for palmar reconstruction. Seventeen patients who had hyperpigmentation after skin graft in the palmar region were treated. Scar contracture was combined in seven patients. The hyperpigmented grafts were excised and then the defects were full-thickness skin grafted from the lateral aspect of the foot. The mean follow-up period was 13.7 (4–22) months. Engraftment was successful in 16 patients, but one failed due to haematoma. The colour of the graft was initially reddish, and then became similar to the palmar area. The donor site healed without any problem within 3 weeks. At follow-up these grafts had good colour and texture match with adjacent palmar skin. There was no hyperpigmentation. Minimal marginal scarring and scar hypertrophy occurred in four patients (24%). The skin of the lateral aspect of the foot is a good choice for palmar skin defects, because of the similarities in their characteristics. Results are acceptable in terms of minimal recurrence of scar contracture, no hyperpigmentation, adequate colour and texture match, and minimal marginal scarring and scar hypertrophy.

Combination of rhomboid flap and double Z-plasty technique for reconstruction of palmar and dorsal web space burn contractures

BACKGROUND Web space contractures after a burn can cause severe impairments in hand function along with esthetic deformities. In this study we present our experience with the combined treatment technique consisted of rhomboid flap and double Z-plasty for palmar and dorsal web space contractures. MATERIALS AND METHODS Combined rhomboid flap and double Z-plasty was performed in eight patients with eleven web space contractures occurred after burn. The average follow-up was 10.9 months. RESULTS The average age of 8 patients was 16.3 years. The average duration of burn contractures was 6 years (range 1-13 years). The right third web of the patients was the most common contracted web space. In the postoperative period hematoma, infection, partial or total flap loss was not observed in any patient. Web and hand function and esthetic appearance of web spaces were satisfactory in the late postoperative period. CONCLUSION Rhomboid flap combined with a double Z-plasty technique was an effective choice for the treatment of palmar and dorsal web space contracture after burn.

The Versatile Facial Artery Perforator-Based Nasolabial Flap in Midface Reconstruction.

Introduction:Defects in the lower two thirds of the face occur due to trauma, tumoral masses, or infections. In this study, repairs of various defects located in the midface using facial artery perforator-based nasolabial flaps are presented. Patients and Methods:Between January 2009 and June 2013, 15 patients with defects in the lower two thirds of the face or the intraoral region underwent repairs with facial artery perforator-based nasolabial flaps. The etiology was malignant skin tumor excisions in 11 patients, infection in 2 patients, and trauma in 2 patients. Among the patients, 10 were male and 5 were female. Their mean age was 65.1 (range: 20–86) years. The mean duration of follow-up was 14 (7–24) months. The defects were located at the upper lip, cheek, lower lip, intraoral region, and the nasal area. The size of the defects varied between 10 × 10 mm and 40 × 50 mm. All the flaps were prepared as perforator flaps. The flap donor area was primarily closed. Results:No partial or total flap loss was observed in any of the flaps. The flap donor areas healed without problem. Full patient satisfaction was achieved both aesthetically and functionally. Conclusion:The nasolabial perforator flap has certain advantages such as the 1-stage application, repair using a similar tissue, a wider rotation arc around the pedicle compared to the other regional flaps, and the primary closure of the donor area. Based on these characteristics, it is an ideal alternative for the repairs of the defects located in the lower two thirds of the face or the intraoral region.

Suprathel®‐assisted surgical treatment of the hand in a dystrophic epidermolysis bullosa patient

Epidermolysis bullosa (EB) is a progressive familial disorder composed of dermal mucosal blisters, flexion contractures and pseudosyndactylies. Flexion contractures and pseudosyndactyly can be treated with surgery but usually require skin grafting. Because of poor wound healing, skin graft harvesting is a challenge in these patients. In order to prevent donor‐site morbidities due to skin graft harvesting some alloplastic materials were introduced. In this study, we focused on Suprathel® as a new allograft material for covering the skin defects of a patient with dystrophic EB.

A reliable option for wrist soft tissue defects: adipofascial flaps for immediate and late reconstruction.

Extensive volar injuries are common and devastating because of the long‐term adhesion potency. The gliding effect of the adipose tissue is essential in preventing tendon adhesions after injury. In this study, we present the results of performing adipofascial flaps for the reconstruction of soft tissue defects following wrist trauma. The study included 15 patients. Adipofascial flaps were performed for immediate coverage of the tissue defect in 2 patients and for late adhesion‐related problems in 13 patients. Flap dimensions varied from 8 × 14 to 8 × 20 cm. All but one of the flaps and skin grafts survived uneventfully. None of the patients, whether immediate or late, required another operation to address further adhesion problems. Since adipofascial flaps provide a gliding surface, they are a good choice for immediate coverage of soft tissue defects in the wrist that are not suitable for skin grafting alone as well as for late adhesion‐related problems.

Intranasal Extramucosal Access: A New Access for Lateral Osteotomy in Open Rhinoplasty.

Background and Objective: Different accesses have been used to perform lateral osteotomies in rhinoplasty. All of them have some disadvantages. The aim of this paper was to report a new access to overcome drawbacks of the other techniques in lateral osteotomy during open rhinoplasty. Methods: An anatomical study was designed to search possibility of intranasal extramucosal access (open sky access) for the lateral osteotomy in open rhinoplasty. It was performed directly on the lateral wall of piriform aperture, and then possible advantages of this technique were investigated. Five fixed cadavers were used for this purpose. No drawbacks were observed during procedure in cadavers. Then the same procedure was performed in 23 consecutive rhinoplasty patients. Nineteen operations were primary and 4 operations were secondary. Median oblique osteotomies were added to the procedure in all patients. The mean follow-up was 17 months. Results: Intranasal extramucosal access during lateral osteotomy was easily performed in all patients. Hemorrhage due to angular vessel injury was not occurred during intraoperative period. Edema and ecchymosis was minimal. Intranasal examination did not show any sign for nasal mucosal tearing in all patients. Residual bone spurs or bone irregularities were not observed in any patients. Conclusion: Intranasal extramucosal access that produces precise, predictable, and reproducible aesthetic and functional results could also provide better exposure during lateral osteotomy. Additionally, open sky access minimizes scars because it does not need additional incisions on the skin and mucosa. Protection of the internal periosteum of the nasal bones may be the main advantages of this technique.

New autologous material for the frontalis suspension technique: superficial temporal fascia

The frontalis suspension technique, which is a well-known surgical procedure, has been used for congenital ptosis for many years[1]. Several autologous and foreign grafts or materials have been preferred for this suspension, such as collagen, tensor fascia lata, palmaris longus tendon, deep temporal fascia, catgut, prolene, silicone, stainless steel, and supramid suture[2]–[3]. Each of these have their own advantages and disadvantages; however, the superficial temporal fascia has not been used for the frontalis suspension method before. This article reports the case of a child with congenital blepharoptosis, who was treated with the superficial temporal fascia, which is a new autologous graft for the frontalis suspension technique.

Reconstruction of Orbital Floor With Auricular Concha

Abstract Orbital floor fractures of varying sizes commonly occur after orbital injuries and remain a serious challenge. Serious complications of such fractures include enopthalmos, restriction of extraocular movement, and diplopia. There is a dearth of literature that can be applied widely, easily, and successfully in all such situations, and therefore there is no consensus on the treatment protocol of this pathology yet. Autogenous grafts and alloplastic and allogenic materials with a wide variety of advantages and disadvantages have been discussed. The value of preoperative and postoperative ophthalmological examination should be standard of care in all orbital fracture patients. An ideal reconstructed orbital floor fracture should accelerate the restoration of orbital function with acceptable cosmetic results. Management parameters of orbital fractures such as timing of surgery, incision type, and implant materials, though widely discussed, remain controversial. In this study, 55 patients with orbital floor fractures surgically reconstructed with conchal cartilage grafts between 2008 and 2014 were retrospectively evaluated. Complications and long-time follow-up visit results have been reported with clinical and radiographic findings. The aim of this study was to present the authors’ clinical experiences of reconstruction of blow-out fractures with auricular conchal graft and to evaluate the other materials available for use.

Trigger thumb and finger in pediatric patients

Objectives: Trigger finger in pediatric patients is not as commonly seen as it is in adults. With that, it is ten times less likely to be seen than trigger thumb. Trigger finger usually presents in children less than 8 years old. It may be associated with anatomic, metabolic, inflammatory, and central nerve disorders. Flexion deformity of the finger is reported as the most frequent presentation of triggering. Diagnosis may be delayed because of the characteristic flexion posture of the newborn. Material and Methods: Between 2009 and 2014, we treated 37 trigger thumbs and fingers in 28 children. Results: Standard surgical techniques were used to release the A1 pulley in 32 digits of 27 patients. One patient that had five trigger digits was treated with steroid injections. Conclusion: Surgical release is recommended by many for the treatment of trigger finger in children if there is no discernible connection with either metabolic or inflammatory disease. We did not prefer conservative treatment after one year of age because of its failure and recurrence rates with the misbehavior and disobedience of children during physical therapy. Therefore, we maintain the recommendation of the standard surgical technique to release the A1 pulley for the treatment of triggering in childhood.