Mehmet Ozkose

Nitric oxide in flow-through venous flaps and effects of L-arginine and nitro-L-arginine methyl ester (L-NAME) on nitric oxide and flap survival in rabbits.

Object:Venous flaps are relatively recent practices in plastic surgery, and their life mechanisms are not known exactly. Partial necroses frequently occur in these flaps; therefore, their survival should be enhanced. Nitric oxide (NO) is an endogenous compound which has recently been dwelt upon frequently in flap pathophysiology, and its effect on viability in conventional flaps has been demonstrated. However, its role in venous flaps is unknown. The purpose of this study is to determine possible changes in the NO level in venous flaps and to investigate the possible effects of NO synthesis precursor and inhibitor on the venous flap NO level and flap survival. Material and Methods:Thirty white male rabbits of New Zealand type, aged 6 months, were divided into 3 groups as control (n = 10), l-arginine (n = 10), and nitro-l-arginine methyl ester (l-NAME) (n = 10). Blood and tissue samples were taken from one ear of 10 rabbits in the control group for the determination of NO basal levels 2 weeks before flap practice. The 3-×-5-cm flow-through venous flaps, which are sitting on the anterior branch of the central vein, were elevated on each ear of 10 rabbits in all groups. After flaps were sutured to their beds, 2 mL/d saline, 1 g/kg/d l-arginine (NO synthesis precursor), and 50 mg/kg/d l-NAME (NO synthesis inhibitor) were administered intraperitoneally in control, l-arginine, and l-NAME groups, respectively, for 3 days. At the 24th postoperative hour, blood and tissue samples were taken from all animals for biochemical analyses. At day 7, flap survivals were assessed. Results:Mean NO levels in the blood following the flap elevation (129 ± 76 &mgr;mol/mg protein) increased in comparison with basal levels (59 ± 44 &mgr;mol/mg protein) (P < 0.06); however, the tissue level remained unchanged. NO levels in the blood in the l-arginine and l-NAME groups were alike compared with the control group. The tissue NO level in l-NAME group (0.08 ± 0.03 &mgr;mol/mg protein) decreased significantly compared to the control group (0.46 ± 0.36 &mgr;mol/mg protein) (P < 0.001). Mean flap survival in the l-arginine group (95% ± 6) increased according to the control group (61% ± 14) (P < 0.001), whereas it did not change in the l-NAME group (55% ± 13). Conclusion:In our model of venous flap, NO level in the blood increased, while it did not change in the tissue; l-arginine significantly enhanced flap viability without affecting NO level. Additionally, l-NAME decreased NO level, but it did not affect flap survival. In light of these findings, NO increases in venous flaps; the change in its level does not affect flap survival, though. However, l-arginine enhances venous flap survival if not by virtue of NO.

The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial

BackgroundThere is a rich blood flow to the mucosa in the nasal region. In rhinoplasty, surgical procedures are performed in a narrow and confined space. So bleeding during surgery reduces visibility which can complicate the procedure. This study investigated the effects of the patient position on amount of intraoperative bleeding during surgical procedures.Patients and MethodsThis randomized controlled trial was conducted on 71 patients who underwent elective rhinoplasty. The patients were operated on in three groups. Group 1 consisted of 23 patients who were operated on in the supine position; Group 2 included 28 patients who were operated on using a 15° angle reverse Trendelenburg position; Group 3 consisted of 20 patients who were operated on at a 20° angle reverse Trendelenburg position.ResultsThere were statistically significant differences between the groups in regard to surgeon satisfaction and the amount of intraoperative bleeding. The amount of intraoperative bleeding in Group 1 was significantly higher than those of Groups 2 and 3, and surgeon satisfaction was lower.ConclusionsReverse Trendelenburg position reduces intraoperative bleeding in rhinoplasty patients while facilitating the procedure compared to the supine position. Surgery at a 15° angle reverse Trendelenburg position provides the optimum working conditions by both significantly reducing intraoperative bleeding and allowing for comfortable conditions for the surgeon.Level of Evidence IThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Late postoperative massive bleeding in septorhinoplasty: A prospective study.

Background There are various complications that can occur in septorhinoplasty, most of which are related to postoperative failure to achieve the desired aesthetic result. However, there are also many other complications, including postoperative bleeding, which is one of the most common nonaesthetic-related complications. Objective The present study was a prospective analysis involving a total of 750 septorhinoplasty patients, and included individuals who experienced massive bleeding after postoperative day 8. Results The incidence of bleeding was 2% among all patients. One percent of cases with bleeding occurred between postoperative days 8 and 14. None of the patients exhibited an abnormality in preoperative or postoperative coagulation tests. Mean blood loss was approximately 1 unit. In all patients, clots in the nose were cleaned, bleeding was subsequently controlled by placement of a polyvinyl alcohol sponge tampon soaked in adrenalin and tranexamic acid, and intravenous administration of 250 mg tranexamic acid in isotonic saline solution. This treatment was sufficient for all cases. None of the patients expereinced recurrent bleeding nor did they require a blood transfusion. Conclusion Late bleeding in septorhinoplasty is rare. It may be prevented by completely filling the nasal cavity so that there is no dead space between the septal mucosal membranes and the drainage opening. If bleeding occurs, it can be treated by placement of a tampon soaked in adrenalin and tranexamic acid plus intravenous administration of 250 mg tranexamic acid.

Late Postoperative Massive Bleeding in Peptorhinoplasty: A Prospective Study

BACKGROUND There are various complications that can occur in septorhinoplasty, most of which are related to postoperative failure to achieve the desired aesthetic result. However, there are also many other complications, including postoperative bleeding, which is one of the most common nonaesthetic-related complications. OBJECTIVE The present study was a prospective analysis involving a total of 750 septorhinoplasty patients, and included individuals who experienced massive bleeding after postoperative day 8. RESULTS The incidence of bleeding was 2% among all patients. One percent of cases with bleeding occurred between postoperative days 8 and 14. None of the patients exhibited an abnormality in preoperative or postoperative coagulation tests. Mean blood loss was approximately 1 unit. In all patients, clots in the nose were cleaned, bleeding was subsequently controlled by placement of a polyvinyl alcohol sponge tampon soaked in adrenalin and tranexamic acid, and intravenous administration of 250 mg tranexamic acid in isotonic saline solution. This treatment was sufficient for all cases. None of the patients expereinced recurrent bleeding nor did they require a blood transfusion. CONCLUSION Late bleeding in septorhinoplasty is rare. It may be prevented by completely filling the nasal cavity so that there is no dead space between the septal mucosal membranes and the drainage opening. If bleeding occurs, it can be treated by placement of a tampon soaked in adrenalin and tranexamic acid plus intravenous administration of 250 mg tranexamic acid.

Severe contact dermatitis induced by an unusual blend of pure henna

Henna is a natural dye extracted from Lawsonia inermis leaves and is commonly used all over the world to dye skin, hair and leather. Pure henna is rarely reported as a cause of contact dermatitis. However, in many reports, additives of henna, especially paraphenylenediamine, have been accused of irritant and allergic contact dermatitis. This report is not only exhibiting a rare form of contact dermatitis resembling a chemical burn, but is also providing an insight into henna, which is widely used and commonly seen as safe.