Lütfi Eroğlu

Natural-Looking Umbilicus as an Important Part of Abdominoplasty

The umbilicus is an important and essential aesthetic component of the abdomen. Many surgeons use different methods to relocate umbilicus during abdominoplasties. We prefer to use a simple combination of different well-known principles to form the neo-umbilicus. The main steps of the procedure are to make an elliptical vertical incision, to do vertical abdominal fascial plication, to embed the umbilical stalk in this plication by suturing the umbilical skin and the rectus fascia together to maintain the umbilical dimple, to place it at the vertical incision made in the abdominal skin at a predetermined point. Silk sutures are used for the abdominal fascial plication and neo-umbilical fixation. Liposuction from the neo-umbilicus to xiphoid along the midline of the upper abdomen creates a minimal superior sulcus. In each patient, a three-dimensional umbilicus with sufficient depression was obtained. All patients, including one case with complications, were pleased by the final aesthetic results.

Subungual glomus tumours of the hand: diagnosis and treatment of 14 cases.

A glomus tumour is a rare tumour of the hand, which presents with a classic triad of symptoms of temperature sensitivity, pain, and localised tenderness. We report a series of 14 patients with glomus tumours in the subungual region. There were four men and 10 women, whose mean age was 46 years (range 28-65). All patients complained of pain and localised tenderness and six of temperature sensitivity. The bony lesion was seen on radiographs in four patients. We used a transungual approach in all cases. A detailed history and clinical findings are the best way of making the diagnosis. The treatment of glomus tumour consists of complete excision and repair of the nailbed. Inadequate excision of the tumour usually causes local recurrence.

Reconstruction of columella, membranous septum, and upper lip in a single stage operation

Reconstruction options for columellar defects together with membranous septum, nasal base, and upper lip are restricted. We present a case successfully treated with bilateral cheek advancement flaps with upper medial, perialar skin flaps to reconstruct the upper lip, columella, nasal base and membranous septum in a single session. This method provides adequate tissue with minimal cosmetic deformity in a single stage for repairing such compound defects.

Unilateral osteotomies for externally deviated noses.

Despite the many methods described for correction of the deviated nose, it still continues to be one of the most challenging problems in rhinoplasty. It is obvious from the literature that the deformities present in the deviated nose can be quite different from patient to patient and that there is no one method that should be used for every deviated nose. Although unilateral osteotomy technique is not a new concept, so far it has not received the interest of plastic surgeons. Shorter operation time, lessened surgical trauma to the nose, lessened intraoperative bleeding, lessened postoperative edema, and lessened recurrence of the deviation are distinct features of the unilateral osteotomy technique that should be considered when planning surgery on such a complex deformity. We present our experiences with unilateral osteotomy and recommend it for patients who have a deviation related to only one side of the nose.

CHIN AUGMENTATION USING DICED CARTILAGE

Abstract Eight patients with microgenia have undergone augmentation with diced nasal cartilage. Cartilage grafts were harvested from the nose during rhinoplasty. These grafts were cut into 0.5 to 1.0 mm pieces using a #11 blade and were wrapped in one layer of Surgicel (oxidized regenerated cellulose). This cartilage mass was inserted into the chin pocket. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and photography. These investigations showed that diced cartilage grafts maintained 75% of their dimensions at six months after implantation. The follow-up period was 12 months, and the aesthetic results were satisfactory.

Finger pulp reconstruction with free dorsoulnar artery perforator (DUAP) flap.

Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complications by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible.

Use of longitudinal invaginating matrix sutures in microarterial sleeve anastomoses

A different approach to end in end anastomosis was tested to minimise the undesirable traits of classic and sleeve (telescoping) methods. Our approach aimed to maintain full contact at the level of the anastomosis by using longitudinal matrix sutures as a new invaginating suture technique in microarterial sleeve anastomosis. Classic end‐to‐end anastomosis with seven to eight stitches, Lauritzens end‐in‐end anastomosis with four stitches, and our modified end‐in‐end anastomosis with two horizontal matrix sutures were made in 10, 20, and 25 rat femoral arteries, respectively. Nine, 17, and 18, respectively were patent at early evaluation; and eight, 13, and 14 at the time of late evaluation. There was no significant difference in between the patency rates of the groups. Histopathological examination showed large strictures and the formation of intra‐luminal organised thrombus with thin intramural fibrin precipitation in occluded specimens. The longitudinal matrix sutures in the sleeve anastomoses, which passed through all layers of the vascular wall, injured the intima (a vertical rupture) and constricted the lumen.

Giant fibrolipoma with osseous metaplasia on the thigh

Fibrolipomas are characterised by fat lobules embedded in perivascular oval fibrocytes and thick bundles of collagen. Actively growing superficial fibrolipomas rarely display a pedunculated protrusion and, thus, cosmetic and functional problems are uncommon. We present an exceptional case. While trauma and ischaemia can lead to fibrosis and dystrophic calcification in fibrolipomas as late sequelae, osseous and cartilaginous metaplasia can infrequently manifest after a long, chronic persistence. Further, depending on the chronic irritation, ulcerated wounds may develop on the surface, and these can be clinically confused with malignancy. In this article, we present a case of a pedunculated giant fibrolipoma manifesting metaplasic changes in its structure.

Myiasis infestation: a rare complication of decubitus ulcer

Abstract. Myiasis infestation is a rare complication of decubitus ulcer which in the case described was caused by Sarcophaga spp. The 32-year-old debilitated woman, having previously been treated for decubitus ulcer on her left heel, had a recurrence on the same heel in which there was a myiasis infestation. After removal of the larvae, the wound was irrigated by ivermectin solution and further medical and surgical treatment of the wound was carried out.

Effect of short-term use of oral smokeless tobacco on random-pattern skin flap survival in rats

We investigated the effects of smokeless tobacco on the survival of random-pattern skin flaps in rats. Twenty rats were divided into two groups (n=10 each). In the experimental group 200 mg smokeless tobacco (Maras powder) (1 mg nicotine) was inserted intraorally once a day for seven days under general anaesthesia. It was not given to the control group, but the rats were similarly anaesthetised with ketamine. On day 8, plasma cotinine concentrations were measured. The random-pattern dorsal skin flaps measuring 3×10 cm were then raised and resutured. Percentage survival area was assessed after a further eight days. The mean (SD) survival was 39 (7)% in the experimental, and 65 (8.9)% in the control, groups (p=0.0001). The mean (SD) plasma cotinine concentrations were 124.4 (73) ng/ml and <10 ng/ml, respectively. Smokeless tobacco use increased the incidence of flap necrosis in random-pattern skin flaps in rats.