Kutlu Sevin

Pilomatrixoma of the earlobe.

BACKGROUND Pilomatrixoma most commonly occurs in the head and neck region, appearing primarily in the first two decades of life. The lesion is described as a tumor with differentiation toward hair cells and surgical excision is the treatment of choice. OBJECTIVE We report an uncommon localization of a perforating type pilomatrixorna of 5 × 4 × 4 cm in size that developed from the earlobe. METHODS Histopathological examination revealed pilomatrixorna. Total resection of the tumor was performed. The earlobe was reconstructed by forming a posterior‐superior pedicled skin flap. RESULTS No recurrence was observed and a good cosmetic result was obtained. CONCLUSION Local recurrence does not generally occur if the tumor is completely removed. The case we present is of interest in having a history of trauma to the region and a relatively rapid growth with perforation of the overlying skin.

Augmentation mammaplasty: retrospective analysis of 210 cases.

Since its introduction in 1895, augmentation mammaplasty has gained widespread acceptance. The choice of breast augmentation procedure is determined almost entirely by three variables: the selection of incision location, the pocket plane for implant placement (either subpectoral or completely subglandular), and the appropriate implant. The current study evaluated 210 cases of augmentation mammaplasty retrospectively. A capsular contracture rate of 8% was found. Rupture and gel bleeding were observed in eight cases (4%). For various reasons, such as capsular contracture or implant rupture, the prostheses were renewed once in 16 patients (8%) and twice in 5 patients (2%). Submammary incision was used in 42 cases (20%). The patients in 23 cases responded that they had implant folds or edges they could feel (11%). Only 4 of these 23 patients stated that feeling the edge of the implant was a concern for them. Of the 210 augmented breasts, 5 had diminished sensation postoperatively (2%), as interpreted by the patient.

A NEW SURGICAL APPROACH IN GENITAL LYMPHEDEMA

A new surgical approach has been used in a case of genital lymphedema. After resection of the lymphedematous mass, U-shaped flaps were made from the suprapubic region anteriorly and the posterior scrotal skin posteriorly. The denuded penis was transposed to its original place by passing it through a buttonhole incision made on the anterior flap. The testicles were placed and fixed in pouches prepared between the anterior and posterior flaps. The patient had an acceptable postoperative outcome both in testicular function and habitual sexual activities.

A New Method for Umbilicus Reconstruction: Preliminary Report

The umbilicus is a very important component of the abdominal aesthetic view. However, loss of the umbilicus for any reason is a challenging problem. Various methods for umbilicus reconstruction have been published. Most of these methods are complex, and the surgical outcome is mostly unsatisfactory for the patients. The authors have developed a simple method for umbilicus reconstruction using a bilobed flap.

Open Rhinoplasty Without Transcolumellar Incision

Traditional open rhinoplasty leaves a scar on the columella. No one can say that this scar is invisible. It is less noticeable in Caucasian patients but it is a problem in non-Caucasian patients like in our country. To avoid such a scar and still obtain a wide exposure of the nasal framework, the bilateral paramarginal incisions close to the columella were extended down to the nasal floors. The lower lateral cartilages forming the nasal tip could then be delivered out through one of the nostrils. An exposure similar to the traditional open rhinoplasty was then achieved. The technique has been used in 23 patients with satisfactory results. In conclusion, the open rhinoplasty without transcolumellar incision can replace the traditional transcolumellar open rhinoplasty technique in selected patients.

A Useful Method for Planning Hump Resection of Deviated Nose

The deviated nose is a particular challenge because both functional and aesthetic problems must be addressed. A most important challenge is resection of the hump. The nasal bones often are asymmetric in deviated noses. Several methods have been used for resection of the hump. Using the authors’ method, it is possible to calculate the extent of hump resection. Clinical analysis of the nasal deviation is performed preoperatively. Digital photographs are taken, and all the landmarks are marked on the life-size photo prints. Planning begins on the deviated side. The ideal dorsal line is drawn, and the extent of hump resection is planned according to the preoperative measurements. Measurements on the deviated side are applied to the other side using the medial canthi and the most prominent part of the alar creases as landmarks. Classical methods emphasize the importance of the chisel position during hump removal. According to the classical approach, the chisel should be positioned lower on the deviated side to resect more bone. However, there is no method for calculating how the chisel should be positioned exactly during hump resection. Therefore, a precise plan has been devised to leave symmetric nasal bones after hump resection. The authors have applied this method in eight cases, achieving satisfactory results.

Otoplasty with Mustarde Suture, Cartilage Rasping, and Scratching

Many techniques have been developed for the treatment of protruding ears. However, the best technique is one that is reproducible, simple, and versatile. Modern otoplasty techniques consist of two main surgical categories, cartilage sparing and cartilage cutting, along with many variations. A retrospective review of 58 patients who underwent otoplasty was conducted. Mustarde suturing and cartilage softening were applied for the treatment of protruding ear. The authors use 4–0 braided white polyesther suture. For four patients, a secondary revision was performed for recurrence. The remaining patients were satisfied with their outcome.

The Fate of Folded and Unfolded Dermal Grafts: A Histopathologic and Structural Study of Rabbits

Currently, both autogenous and nonautogenous materials are used to treat contour deformities. Autogenous grafts are preferable to nonautogenous grafts because they cause less reaction and are both inexpensive and easy to obtain. Currently, however, no consensus exists on an ideal autogenous graft. As autogenous materials, dermal grafts can be obtained from scar tissue, allowing simultaneous revision of scars, quicker vascularization than with other autogenous tissues, and a very short immobilization for their stabilization (i.e., they interact with surrounding tissues). The operation can be performed with the patient under local anesthesia, providing regular contours easily. Alternative techniques are needed to increase the viability and mass effects of autogenous grafts in the long term. With this as the objective, folded dermal grafts were used to increase the mass effects of dermal grafts. The current study compared long-term histopathologic and structural changes in unfolded and folded dermal autogenous grafts used for correction of soft tissue contour deformities. Thicknesses and histopathologic changes of the unfolded and folded dermal autogenous grafts were evaluated 6 and 12 months after placement of the grafts in the abdomens of 10 rabbits. Both the authors’ observations and histopathologic examinations showed that the folded dermis caused a more severe granulomatous reaction and fibrosis. Graft thicknesses considerably increased in the first 6 months, but then almost leveled off in the following months. Increased fibrosis in the folded grafts had a masslike effect, which was preserved in the long term, suggesting that folded dermal grafts can be used clinically.

Hemimandibular reconstruction with bipedicled scapular osteocutaneous free flap

A case report is presented on the successful use of a bipedicled scapular osteocutaneous free flap in a young woman, whose hemimandible was resected because of sarcoma, 1 year prior to presentation. The postoperative course was uneventful and donor site morbidity minimal.

Free vascularized osteocutaneous flap from scapula to the tibia

SummaryMicrovascular transfer of a free vascularized osteocutaneous flap from the scapula to the tibia is presented. The patient had a 10 cm tibial bone defect and also required overlying soft tissue reconstruction. A scapular osteocutaneous flap was successfully transferred to the proximal tibial defect. No complications were seen during an 18 month follow-up. Although the contralateral fibula is a popular choice for tibial reconstruction, if it is not available, the free vascularized scapular osteocutaneous flap may be an alternative choice of treatment.