Murat Emiroğlu

Vaginal reconstruction with free jejunal flap.

Congenital absence of a vagina is a rare but outstanding anomaly of plastic surgery. Although many methods are described for reconstruction of vaginal agenesis, there is not a method yet to be approved as a perfect solution to this problem. With the aim of solving the problems faced with conventional methods, free jejunal transplantation was planned to construct a neovagina. For this method, we isolated a 15-cm jejunal segment, with its pedicle, transferred it to the preprepared vaginal pouch, and anastomosed the donor vessels of the mesentery to the inferior epigastric vessels. In the postoperative sixth month, problems of intercourse or the need to use any lubricator or stent were still not experienced and reported. In this paper, we judge and compare our approach by reviewing others.

THE EFFECTS OF L-ARGININE AND ILOPROST ON THE VIABILITY OF RANDOM SKIN FLAPS IN RATS

The effects of an intravenous infusion of L-arginine as a physiological precursor of endothelium-derived relaxing factor/nitric oxide (EDRF/NO), iloprost (a stable prostacyclin (PGI2) analogue), and L-arginine combined with iloprost on skin viability were studied in 9 x 3 cm random pattern skin flaps in rats. Intravenous infusion of all drugs was started at the beginning of the operation and continued for 60 minutes. At the end of infusion period the depth of fluorescein dye penetration in the skin flap was assessed visually from photographic records, and the flap survival area was measured by the grid method at the seventh postoperative day. There was a significant reduction in distal necrosis of random skin flaps after intravenous infusion of L-arginine, iloprost, and L-arginine combined with iloprost (p < 0.01). Possible mechanisms that may be responsible for impairment of endothelium-dependent vasodilation and vasospasm in the microvasculature of random skin flap and their prevention with L-arginine and iloprost include restoration of the depleted stores of NO which in turn causes vasodilatation and has an antithrombotic effect.

Island V-Y tensor fasciae latae fasciocutaneous flap for coverage of trochanteric pressure sores

&NA; The distal fasciocutaneous portion of the lateral thigh is supplied by the direct cutaneous branch of the lateral descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. This consistent vascular anatomy allows raising a distal skin island based on both arteries on the lateral thigh, and this flap can be advanced into a trochanteric defect according to the V‐Y technique. Based on anatomic and clinical study, a new design has been developed of the tensor fasciae latae fasciocutaneous flap, which is supplied by two pedicles. Seven island V‐Y tensor fasciae latae fasciocutaneous flaps have been used for the coverage of trochanteric pressure sores in six patients. It is believed that the island V‐Y tensor fasciae latae fasciocutaneous flap could overcome the traditional drawbacks of the conventional tensor fasciae latae flap and its modifications, and this is an ideal flap for covering trochanteric pressure sores without any donor site deformity and morbidity, which greatly improves the aesthetic result. (Plast. Reconstr. Surg. 102: 1524, 1998.)

A NEW SURGICAL APPROACH IN GENITAL LYMPHEDEMA

A new surgical approach has been used in a case of genital lymphedema. After resection of the lymphedematous mass, U-shaped flaps were made from the suprapubic region anteriorly and the posterior scrotal skin posteriorly. The denuded penis was transposed to its original place by passing it through a buttonhole incision made on the anterior flap. The testicles were placed and fixed in pouches prepared between the anterior and posterior flaps. The patient had an acceptable postoperative outcome both in testicular function and habitual sexual activities.

Malignant triton tumor of the maxilla : A patient report

Malignant Triton tumor (or malignant schwannoma with rhabdomyoblastic differentiation) is a rare entity with a very poor prognosis. This is the second report of this type of rare and aggressive sarcoma arising in the maxilla. The clinical course, therapeutic approach, and histopathological aspects of the case are presented.

Effect of platelet glycoprotein IIb/IIIa receptor antagonist on survival of epigastric island flaps in rats with total venous occlusions.

We evaluated the effect of tirofiban hydrochloride on the survival of epigastric island flaps in rats that had had all the veins occluded. Male Wistar Albino rats were randomly assigned to control (treated with sterile saline) and experimental (treated with tirofiban hydrochloride 1 mg/kg intravenously) groups. An epigastric island skin flap 3×6 cm was raised in each rat. All veins that drained the flap were ligated to give total venous occlusion. Blood flow was recorded by laser Doppler preoperatively (baseline), immediately after the flap had been sutured back to its original position (acute) and on postoperative days 1 and 3. The degree of necrosis was evaluated on day 3. Mean percentage necrosis and minimum laser Doppler values were compared in the two groups. Total necrosis was evident on day 1 in the control group and on day 3 in the experimental group. Macroscopic evidence was confirmed by histopathological examination. There were appreciable differences in blood flow and in the necrotic area of the flap in the experimental group compared with the control group on both days 1 and 3. Tirofiban hydrochloride might be effective in this flap model.

Analysis of radial forearm free flaps in 37 consecutive cases

Abstract Thirty-seven radial forearm free flap transfers have been performed in a three year period. The results obtained have proven that the radial forearm free flap, a pioneer in free flaps, is going to keep its useful position in reconstructive procedures. Out of 37 cases there was only one total flap loss (2.7%). Other complications experienced arose from the donor site; two partial skin graft losses and one transient radial nerve injury. Preparation of a better recipient bed for split skin grafting and application of silicone sheeting also reduced the morbidity of donor defect.

Combined use of medial thigh skin flaps and gracilis musculocutaneous flaps for the reconstruction of scrotum

SummaryA case of combined use of bilateral medial thigh skin flaps and gracilis musculocutaneous flaps for the reconstruction of a scrotal defect resulting from Fourniers gangrene is presented. The procedure provided a sac-like scrotum, and the donor sites were successfully reconstructed using bilateral gracilis musculocutaneous V-Y advancement flaps.

Acceleration of Medpor implant fibrovascularization with local vascular endothelial growth-factor injections: An experimental study -

Objective: Medpor is a biocompatible, high-density porous polyethylene implant that is used for multiple indications in plastic surgery. The most frequent complications associated with the Medpor implant are infection and implant exposure. The primary cause of these complications is poor fibrovascularization of the Medpor implant and poor nourishment of the overlying skin. The present experimental study aimed to determine whether vascular endothelial growth factor (VEGF) could accelerate and increase Medpor implant fibrovascularization in vivo, and thereby improve local nourishment and prevent complications. Materials and Methods: The Medpor implant was inserted under the dorsal skin area in 40 Sprague-Dawley rats. 20 rats receiving local VEGF injections comprised the study group. The control group received saline injections. Fibrovascularization of the Medpor implants was compared. Results: In the rats injected with VEGF, the Medpor implant fibrovascularized faster, and there were more newly formed blood vessels, as compared with those in the control group. Conclusion: These findings have led to our use of VEGF-like agents that the accelerate angiogenesis in the Medpor implant as a means to reduce the incidence of such complications as infection and implant exposure.

A new multipurpose retractor and dissector

SummaryDissection of large subcutaneous pockets has been fabricated using a new retractor dissector. Pockets for tissue expanders and various prostheses can be created through small incisions. Retraction during insertion of silastic prostheses is simplified.