Mehmet Bayramiçli

The mental V-Y island advancement flap in functional lower lip reconstruction.

&NA; Various flap procedures for the reconstruction of lower lip defects have been described to achieve the basic requirements of a functional repair, namely muscle function and sensation. Flaps elevated from the upper lip or the adjacent cheek may provide a solution, but for larger lower lip defects, preservation of function is difficult. In this article, a new functional lower lip reconstruction technique that includes the transfer of a myocutaneous flap based on the mental neurovascular bundle and on the branches of the facial artery is described. The principle of this reconstructive procedure is to advance the tissues from both sides of the chin as myocutaneous flaps upward to the lip defect, reorienting the muscles of the flap for sphincteric function, and preserving the mental nerve for sensation. The depressor anguli oris and remnants of the orbicularis muscle together with their motor nerve branches are included in the V‐Y advancement flap. (Plast. Reconstr. Surg. 100: 1682, 1997.)

Rare variation of the axillary artery

The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery). The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery. It continues its course in the arm lateral to the median nerve and terminates by giving a minute twig to the radial artery. The superficial brachial artery is larger in caliber than the deep brachial artery and gives no branches in the arm region. In the cubital fossa it gives the ulnar and the radial arteries. This case is a variant of the axillary artery that has been rarely (0.12–3.2%) documented in the literature. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures in this region. Clin. Anat. 13: 66–68, 2000.

Reliability of primary vein grafts in lower extremity free tissue transfers.

Free flaps transferred to the lower extremity have a higher risk of failure, which may be expected to increase further with the use of vein grafts. The results of 103 consecutive free flaps to the lower extremities of 98 patients who were operated from March 1994 to December 1999 were evaluated to assess the reliability of vein grafts in lower extremity reconstruction. Five flaps were lost and the overall success rate was 95.1%. Eighty-four free tissue transfers in 79 patients were performed for the reconstruction of traumatic cases, and 81 of these flaps were performed in a delayed manner, between 1 week and 4 months after the injury. Interpositional vein grafts were used primarily in 22 flaps—all in traumatic cases—and 21 of them survived completely (95.4%). Primary vein grafts were used both for arteries and veins in 15 flaps and for arteries only in 7 flaps. The most common cause of tissue loss in these patients was a crush injury in earthquake survivors, followed by electrical injuries, gunshot injuries, motor vehicle accidents, and chronic infections. Free muscle flaps in 13 patients, skin flaps in 4 patients, osseous flaps in 2 patients, and temporal fascial flaps in 2 patients were the flaps of choice in vein graft reconstructions. Although a higher incidence of flap loss has been reported with the use of interpositional vein grafts than with regular transfers, and the technical and pathophysiological problems in flap transfers are also high in the lower extremity, the success rate in vein-grafted free flaps did not differ from that of the simple free flap transfers in the current series. This appears to be the result of meticulous preoperative planning and proper selection of recipient vessels during optimal operative conditions.

Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps

Neurotized fasciocutaneous flaps and split-skin grafted muscle flaps are the most frequently used free flap alternatives for the reconstruction of weight-bearing surfaces of the foot. An objective comparison of the innate characteristics of these two flap types, with respect to long-term stability, has not been possible because sensory reinnervation in the fasciocutaneous flaps has been a confounding factor. This study compares nonsensate fasciocutaneous flaps (n = 9) with nonsensate split-skin grafted muscle flaps (n = 11), with mean follow-up periods of 34.3 and 31.3 months, respectively. Patients completed a form that included questions regarding degree of pain at the operative site, presence of ulcers, ability to wear normal shoes, employment status, and time spent standing on foot. Touch and deep sensation were evaluated with Semmes-Weinstein and vibration tests, respectively. Significantly less pain and less ulceration (p < 0.05) were observed in the fasciocutaneous group. Semmes-Weinstein monofilament tests revealed poorer results with split-skin grafted muscle flaps, compared with fasciocutaneous flaps. These results indicate that even if the sensory protection of fasciocutaneous flaps is not considered, these flaps have superior properties, compared with split-skin grafted muscle flaps.

Importance of the pedicle length measurement in reduction mammaplasty

Various measurements are still considered to be important for making decisions regarding the approach in reduction mammaplasty, even though the vast majority of techniques used are based on an inferior pedicle. This study was performed to analyze the variability of the suprasternal notch-to-nipple and nipple-to-inframammary fold distance measurements when using the inferior pedicle technique. In 92 patients, 184 breasts having various volumes were measured preoperatively, and the variability of the measurements of the suprasternal notch-to-nipple and nipple-to-inframammary fold distance was analyzed. The values of the distance from the suprasternal notch to nipple were dispersed over a wide range with a trimodal distribution, with peaks at the intervals of 23 to 27 cm, 28 to 33 cm, and 34 to 45 cm. In contrast, the values of the nipple-to-inframammary fold distance showed a normal distribution pattern, with the peak at 14 cm. The distance from the suprasternal notch to nipple has a fair relationship to the inframammary fold-to-nipple distance, the latter being concentrated in a smaller range (r = 0.51). The former is often used to decide whether a free-nipple graft should be performed. However, the relative consistency of the latter measurement has led to the conclusion that the free-nipple graft technique need never be considered.

Plastic surgical techniques in the fifteenth century by Serafeddin Sabuncuoğlu.

Serafeddin Sabuncuoğlu (A.D. 1385-1468) is the author of the first illustrated surgical textbook in the Turkish-Islamic literature, namely, Cerrahiyet-ül Haniyye (Imperial Surgery). A pioneer in all fields of surgery. Sabuncuoğlu developed numerous original techniques. He was a keen observer and inventor and a prolific writer who combined his fortune with knowledge of his era. He described a mass reduction procedure for the management of gynecomastia, probably one of the first attempts at reduction mammaplasty. He gave detailed descriptions of different eyelid pathologies and their surgical managements. The aim of this study is to investigate the contributions of this remarkable pioneer to the field of plastic surgery.

Age-related loss of stress-induced nuclear proteasome activation is due to low PARP-1 activity

Changes in protein turnover are among the dominant metabolic changes during aging. Of special importance is the maintenance of nuclear protein homeostasis to ensure a coordinated cellular metabolism. Therefore, in the nucleus a special PARP-1-mediated mechanism of proteasomal activation exists to ensure a rapid degradation of oxidized nuclear proteins. It was already demonstrated earlier that the cytosolic proteasomal system declines dramatically with aging, whereas the nuclear proteasome remains less affected. We demonstrate here that the stress-mediated proteasomal activation in the nucleus declines during replicative senescence of human fibroblasts. Furthermore, we clearly show that this decline in the PARP-1-mediated proteasomal activation is due to a decline in the expression and activity of PARP-1 in senescent fibroblasts. In a final study we show that this process also happens in vivo, because the protein expression level of PARP-1 is significantly lower in the skin of aged donors compared to that of young ones. Therefore, we conclude that the rate-limiting factor in poly(ADP-ribose)-mediated proteasomal activation in oxidative stress is PARP-1 and not the nuclear proteasome itself.

Two Patients With Penile Keloids: A Review of the Literature

Keloid formation on the penis is exceptionally rare even though the penis is frequently subjected to surgical manipulations such as circumcision. Review of the literature revealed a few reports of patients with penile keloids. A 13-year-old Caucasian boy who had a pronounced penile keloid after circumcision and a 56-year-old Caucasian male who had keloid formation on the dorsum of the shaft of the penis after several attacks of penoscrotal hidradenitis suppurativa are presented. They comprise the fifth and the sixth cases of keloid formation in the literature to our knowledge. Intralesional steroid injection and surgical excision are the treatment modalities for this malady. Surgical excision appears to be the choice of treatment for larger lesions that are disabling. Recurrence is still possible, of course.

An unusual variation of extensor digitorum brevis manus: a case report and literature review.

An unusual variation of the extensor digitorum brevis manus in a male cadaver is presented. The band-shaped muscle was located at the ulnar side of the hand between the fourth and fifth extensors. It originated from the deep carpal fascia and inserted to the extensor tendons of the fourth and fifth fingers with a tendon and a slip, respectively. The origin, insertion, and location of the muscle differ from those previously reported; with these anatomic features, the muscle variation cannot be placed into the current classifications. The phylogenetic and ontogenetic implications of the muscle are reviewed.

Commissure-based buccal mucosal flap

&NA; Commissure‐based buccal mucosal flaps extending to the retromolar trigone have been used for anterior intraoral mucosal defects. The flap was utilized successfully in 26 patients who had vermilion defect (14 cases), obliteration of the anterior gingivobuccal sulcus (8 cases), and anterior maxillary defect (4 cases). (Plast. Reconstr. Surg. 101: 1223, 1998.)