Mubin Hosnuter

Complications of Minor Cutaneous Surgery in Patients Under Anticoagulant Treatment

Anticoagulant use is common in the elderly population. The role of these medications in the postoperative period is not well defined. We designed a prospective study to evaluate the incidence of postoperative complications in patients taking aspirin and warfarin. A prospective study was performed on 102 patients undergoing minor cutaneous plastic surgery. The number of subjects using regular aspirin, warfarin, and that of the patients with no anticoagulant medication were 37, 21, and 44, respectively. Complications were defined as minor, moderate, or major based on predetermined criteries. Of patients taking warfarin, 57% had some complication, significantly more than complications in the control group. The number of major complications in the warfarin group was significantly higher than those of the control and aspirin groups (p = 0.02). Also, the total number of complications in the warfarin group was significantly higher than the control group, but there was no significant difference between aspirin and control groups (p > 0.05). Cutaneous surgery in patients who receive warfarin is associated with a risk of major complication, but this risk does not exist in the patients receiving chronic aspirin treatment.

The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic.

Recently, it has been shown that tramadol was an effective local anesthetic in minor surgery. In this study, its efficacy for relieving postoperative pain was evaluated. Forty patients undergoing minor surgery (lipoma excision and scar revision) under local anesthesia were included. The patients were randomly allocated into two groups: In group T (n = 20), 2 mg/kg tramadol, and in group L (n = 20), 1 mg/kg lidocaine were given subcutaneously. In both groups, the injection volume was 5 mL containing 1/200,000 adrenalin. The degree of the erythema, burning sensation, and pain at the injection site were recorded. Incision response, which is a degree of the pain sensation during incision, was recorded and graded with the visual analog scale (VAS) 0–10. After incision, VAS values were recorded at 15-min intervals. When the VAS score of the pain during surgery exceeded 4, an additional 0.5 mg/kg of the study drug was injected and this dosage was added to the total amount. Patients were discharged on the same day. Subjects with VAS ≥4 were advised to take paracetamol as needed. No side effects were recorded in either group except for 1 patient complaining of nausea in group T at the 30th min of operation. After 24 h, patients were called and the time of first analgesic use and total analgesic dose taken during the postoperative period were recorded. During the 24 postoperative hours, 18 of 20 (90%) subjects did not need any type of analgesia in group T, whereas this number was 10 (50%) in group L (P < 0.05). The time span before taking first analgesic medication was longer (4.9 ± 0.3 h) in group T than that of group L (4.4 ± 0.7 h) (P < 0.05). We propose that tramadol can be used as an alternative drug to lidocaine for minor surgeries because of its ability to decrease the demand for postoperative analgesia.

Effect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty

A double-blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty. Sixty rhinoplasty patients undergoing hump resection and lateral osteotomy were included in the study and were divided into 6 groups: group 1 (n = 10), single dose of 8 mg intravenous (IV) dexamethasone 1 hour before the operation; group 2 (n = 10), single dose of 8 mg IV dexamethasone at the beginning of the operation; group 3 (n = 10), 3 doses of 8 mg IV dexamethasone 1 hour before the operation, and 24 and 48 hours after the operation; group 4 (n = 10), 3 doses of 8 mg IV dexamethasone at the beginning of the operation, and 24 and 48 hour after the operation; group 5 (n = 10), 3 doses of 8 mg IV dexamethasone immediately after the operation, and 24 and 48 hours after the operation; group 6 (n = 10), control, no dexamethasone administration before or after the operation. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and days 2, 5, 7, and 10. For the postoperative evaluation of periorbital ecchymosis and edema, a scale of 0 to 4 points was used. There was no significant difference between groups in terms of bleeding (P > 0.05). In the groups using steroid before osteotomy, edema and ecchymosis were significantly lower during the first 2 days compared with the control group (P < 0.05). No significant difference was seen between groups 1 and 2. When patients were evaluated on day 5, edema and ecchymosis were significantly lower in groups 3 and 4 (P < 0.05) compared with other groups, but there was no difference between them. Group 5 had a significantly higher level of edema and ecchymosis compared with groups 1 through 4 at 24 hours and at days 2, 5, and 7 (P > 0.05). There was no significant difference between groups on day 10. In conclusion, if the first dose is given before osteotomy, triple-dose steroid application is the best bet for decreasing postoperative edema and ecchymosis. None of the patients had any complications related to the use of dexamethasone.

Hyperphosphatemic tumoral calcinosis.

Tumoral calcinosis is a rare syndrome characterized by progressively growing and painless masses of calcium phosphate deposits within periarticular areas. Biochemical findings are normal except for an association with hyperphosphatemia. This report describes hyperphosphatemic tumoral calcinosis in a 22-year-old man who had been operated on five times in 5 years because of painless extremity swellings.

Dual preconditioning: effects of pharmacological plus ischemic preconditioning on skin flap survival.

To enhance skin flap viability, pharmacological and ischemic preconditioning methods were investigated intensively. This study was designed to determine whether combined local dexamethasone administration and pedicle clamping would result in an additive enhancement of skin flap survival in the rat model. Twenty-eight male Sprague–Dawley rats were included in dexamethasone injection, clamping, clamping plus dexamethasone injection, and control groups. A rectangular random skin flap (3 × 11 cm) was outlined as bipedicled on the back of the animals. The dexamethasone or saline injection points in the flap were standardized. In the dexamethasone injection group, after raising the flaps, a total of 2.5 mg/kg dexamethasone was injected into the flaps. In the ischemic preconditioning group, 1 hour after saline injection, the cranial pedicle was clamped for 20 minutes and then 40 minutes reperfusion was performed. The clamping-plus-dexamethasone injection group was the same as the clamping group except dexamethasone was injected instead of the saline. In the control group, saline was injected instead of dexamethasone. Regardless of the group, all flaps were cut at the cranial side at the end of the 2 hours and were sutured back. On day 7, the surviving area was significantly greater in all experimental groups compared with the control group (p < 0.05). Furthermore, the clamping-plus-dexamethasone group demonstrated the highest flap viability.

Digital Block With and Without Epinephrine During Chemical Matricectomy with Phenol

BACKGROUND Digital block with epinephrine is safe in selected patients. Chemical matricectomy with phenol is a successful, cheap, and easy method for the treatment of ingrown nails. OBJECTIVE To determine the effect of digital block with epinephrine in chemical matricectomy with phenol. MATERIAL AND METHODS Forty‐four patients with ingrown toenail were randomly divided into two groups. The plain lidocaine group (n=22) underwent digital anesthesia using 2% plain lidocaine, and the lidocaine with epinephrine group (n=22) underwent digital anesthesia with 2% lidocaine with 1:100,000 epinephrine. In the postoperative period, the patients were evaluated for pain, drainage, and peripheral tissue destruction and were followed for up to 18 months for recurrence. RESULTS The mean anesthetic volume used in the epinephrine group (2.2±0.4 mL) was significantly lower than the plain lidocaine group (3.1±0.6 mL). There was no statistically significant difference in postoperative pain and recurrence rates, but duration of drainage was significantly shorter in the epinephrine group (11.1±2.5 days) than in the plain lidocaine group (19.0±3.8 days). CONCLUSION Digital block with epinephrine is safe in selected patients, and epinephrine helps to shorten the postoperative drainage period. The authors have indicated no significant interest with commercial supporters.

Relaxation incision and fascia lata grafting in the surgical correction of penile curvature in Peyronie's disease.

The purpose of this study was to evaluate the effects of treatment of curvature in Peyronie’s disease with a relaxation incision and fascia lata grafting. Between 2000 and 2002, this technique was used for 12 patients with a 1-year history of plaque and curvature of more than 35 degrees. Penile degloving was performed with a circumferential incision. The tunica defect was closed with fascia lata grafting after a relaxation incision. For all patients, penile curvature was corrected and normal erections were achieved. No complication was observed in 9 to 24 months (mean, 10 months) of follow-up monitoring. The initial results suggested that tunica albuginea incision and fascia lata grafting could represent an alternative for the treatment of curvature in Peyronie’s disease. Further studies are warranted.

A nonanimal model for microsurgical training with adventitial stripping.

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Dual synergistic effect: the effect of dexamethasone plus carnitine on skin flap survival.

Dexamethasone has well-known useful effects in dealing with the progression of necrosis. Carnitine is an endogenous cofactor, for having a regulatory action on the energy flow from different oxidative sources. The aim of this study was to determine whether combined local dexamethasone and systemic carnitine administration would result in an additive enhancement of skin flap survival in the rat model. A rectangular (3 cm × 11 cm) dorsal random skin flap was elevated on the rats and then sutured back into its original site with separate sutures. Overall, 40 rats were allocated randomly into 4 groups: Group 1 (control group, n = 10), group 2 (Dexamethasone group, n = 10, 2.5 mg/kg), group 3 (carnitine group, n = 10, 100 mg/kg), group 4 (dexamethasone plus carnitine group, n = 10). The mean flap survival area was 57.50 ± 5.2% (mean survival area ± SD) in control group (group 1), 71.5 ± 4.8% in the dexamethasone group (group 2), 73.0 ± 5.5% in the carnitine group (group 3), 85.30 ± 6.1% in the dexamethasone plus carnitine group (group 4). In conclusion, based on the findings of this experimental study, the synergistic effect of carnitine and dexamethasone on skin flap viability is determined.

No-Vertical-Scar Technique Versus Inverted T-Scar Technique in Reduction Mammoplasty: A Two-Center Comparative Study

Currently, a reverse T-shaped scar remains in the infraareolar area after most of the frequently used techniques for reduction mammoplasty. A two-center study was performed for an understanding of the effects from the amount of scars on the aesthetic satisfaction of patients. Long-term follow-up results for 24 patients who underwent the McKissock (inverted T-scar) technique (group 1) in a university hospital were compared with the results for 29 patients who underwent a “no-vertical-scar technique” (group 2) at another hospital in terms of aesthetic results. With this aim, a questionnaire was designed to assess the patients’ degree of aesthetic satisfaction with different aspects. Additionally, the most current photos of each patient were evaluated for aesthetic results by four physicians and four medical students. Areola-fold and nipple-notch distances were measured as an objective evaluation. The significance of the results was tested using dependent or independent sample t tests. Notch-nipple and areola-fold distances both were greater in group 2 than in group 1, both preoperatively and postoperatively (p < 0.001). The personal satisfaction questionnaire showed that the group 2 patients rated scar satisfaction and postoperative activity levels higher (p < 0.001) than the group 1 patients (p < 0.05), but that group 1 rated nipple position higher (p < 0.05). There was no significant difference between the two groups in terms of general aesthetic satisfaction. Physicians who evaluated patient photos ranked the scars of group 2 as significantly superior to those of group 1 (p < 0.01), whereas they did not rate other features as significantly different. However students could not determine any superiority of any feature between the two groups. The no-vertical-scar technique gives the impression of a breast that has not undergone surgery because it leaves no scars in the infraareolar area and invisible scars in other areas. This situation improves the degree of satisfaction for patients in the postoperative period. When the general aesthetic success and the ratio of complications were evaluated, the no-vertical-scar technique was found to be just as successful as the T- scar technique, which is practiced widely.