Mesut Özcan

Neovaginal construction with buccal mucosal grafts.

Several surgical techniques have been designed to construct a neovagina that will be satisfying in appearance, function, and feeling when the vagina is congenitally absent. However, no method has yet been approved as a perfect solution. With the aim of solving the problems with conventional methods, the authors describe a new surgical technique that is simple and safe for treating vaginal agenesis. This technique consists of creating a mucosal lining of the neovaginal cavity using multiple full-thickness buccal mucosal patch grafts. Four patients with congenital absence of the vagina treated with this technique are presented. This surgical procedure created a mucus-providing lining inside the neovagina. Selecting the donor site in the oral region resulted in an inconspicuous donor-site scar. Histologically, the neovaginal lining was confirmed as mucosal, and the cream-colored viscous fluid found in the neovaginal cavity was confirmed as mucus. At a mean follow-up period of 15 months, the neovagina remained adequate in depth and width. All of the patients were interviewed to evaluate the function of the neovagina. Each patient reported having regular sexual intercourse and that the neovagina had felt normal to their partners. The encouraging results obtained in four cases suggest that this new technique deserves further application.

Percutaneous treatment of trigger finger 34 fingers followed 0.5-2 years

We performed percutaneous A1 pulley release on 34 trigger fingers in 30 patients with an angiocath needle. Complete release was achieved in all fingers. There were no complications and no recurrences during mean 0.5 (1-2) years follow-up.

Comparison of the biological activities of high-density porous polyethylene implants and oxidized regenerated cellulose-wrapped diced cartilage grafts.

The use of alloplastic materials in plastic surgery has become more extensive with advancement of autogenous-tissue reconstruction techniques for the repair of defects, tissue augmentation, and the stabilization of bones. An ideal alloplastic material should be nonallergenic, noncarcinogenic, sterilizable, and easy to shape and should not cause rejection. Alloplastic material used for tissue augmentation should have a low rate of resorption and distortion. High-density porous polyethylene implants (Medpor) have been used widely and successfully for tissue augmentation. The Turkish Delight is a material composed of diced cartilage grafts wrapped in oxidized regenerated cellulose (Surgicel). Its indications are similar to those of the Medpor implant, and an additional donor site is usually not needed. Both materials are used in the same anatomical locations, especially for augmentation. Therefore, the authors evaluated the long-term stability of and suitable anatomical sites for these materials. Medpor implants or Turkish Delights were placed subperiosteally or subfascially in 10 young rabbits, and the resultant changes were evaluated 16 weeks after the operation by macroscopy and histopathology. Changes in projections were measured with an ocular micrometer. Medpor implants were neither resorbed nor distorted when placed subperiosteally or subfascially, and were highly stabilized by the surrounding tissues. Turkish Delight also enabled tissue augmentation, but had a significantly higher rate of resorption compared with the Medpor implant and was loosely bound to the surrounding tissue. The Turkish Delight was less resorbed and better fixed to adjacent tissues when placed subperiosteally than when placed subfascially.

A new approach to the reverse dorsal metacarpal artery flap

The distally based dorsal hand flap on the recurrent cutaneous branch was dissected as a reverse flap based on the connection between the dorsal branch of the proper digital artery and the terminal branches of the dorsal metacarpal artery at the level of the proximal phalanx. The reverse dorsal metacarpal artery flap dissected by this new approach was applied in five cases for coverage of some areas in the fingers. Two flaps were raised on the second and three on the third intermetacarpal space. All flaps survived completely. The donor areas were closed by direct approximation.

Delay in neurovenous flaps: Experimental and clinical experience

The objective of this study was to examine the effects of the standard surgical delay in the flaps based on the cutaneous branches of the vascular axis around a superficial sensory nerve. The delay procedure was experimentally tested in rats and subsequently used in patients. In the experimental study, the survival of a delayed inferior epigastric neurovenous flap was compared with that of a nondelayed inferior epigastric neurovenous flap. One type of clinically applicable delay pattern (standard bipedicled technique) was employed. A 3 × 3 cm flap was raised in 20 female Wistar rats assigned randomly to 2 groups. Each group consisted of 20 flaps. The standard bipedicled delay pattern increased the percentage survival of the delayed inferior epigastric neurovenous flap. The survival percentage of the delayed flaps was 59.8 ± 185.0 (P < 0.5). The histologic findings of the skin revealed that our delay procedure enhanced the perfusion of the flap by dilating the arterial network. Stimulated by our experimental findings, we used the island bipedicled surgical flap delay or combined strategic-standard delay in the distally pedicled sural flap successfully on 9 cases.

Heating-pad burn as a complication of abdominoplasty

As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.

Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand.

&NA; A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle. The authors treated five male patients with metacarpal bone and soft‐tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged from 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow‐up period ranged from 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one‐stage reconstruction of the metacarpal bone and soft‐tissue defects in the hand. (Plast. Reconstr. Surg. 109: 982, 2002.)

Temporomandibular joint reconstruction with free microvascular transfer of the metatarsophalangeal joint: A case report

Free microvascular transfer of the second metatarsophalangeal joint was performed for the treatment of temporomandibular joint ankylosis in a 15‐year‐old male patient. The result is excellent in one‐year follow‐up. The technique seems to be a good alternative to the problem in selected patients.

The beneficial effect of cyclosporin-A on the no-reflow phenomenon in rat skin island flaps

The no-reflow phenomenon is one of the factors that increase morbidity in flap and replantation surgery. Prevention and treatment of the phenomenon is an area of intense current research. This study investigated the possible effect of cyclosporin administered systemically on survival of skin flaps subjected to ischaemia-reperfusion injury. Cyclosporin treated flaps showed a statistically significant increase in survival areas regardless of the time of infusion (p < 0.01). These findings suggest that cyclosporin could be valuable in preventing or treating no-reflow in critical flaps. Possible mechanisms of action are discussed.

A new flap from the dorsum of the first intermetacarpal area : The first dorsal intermetacarpal flap

&NA; Soft‐tissue reconstruction of the hand still remains a challenge for plastic and reconstructive surgeons. Several flaps have been described to cover soft‐tissue defects of the digits and the hand. In the first web region, there are some communications between the intermediate artery arising from the dorsal branch of the radial artery and the volar arteries of the thumb and the index finger. Depending on these communications, a new distally based flap is raised from the first dorsal intermetacarpal area. This flap has been used to cover various defects of the thumb in four patients and the distal radial side of the palmar area in one patient. Donor sites have been closed primarily except in one patient. There were no complications, and the results show that this flap is useful to cover soft‐tissue defects of the thumb and proximal phalanx of the index finger as well as the radial side of the palmar and dorsal surfaces of the hand. (Plast. Reconstr. Surg. 100: 914, 1997.)