Murat Livaoğlu

Effects of lidocaine plus epinephrine and prilocaine on autologous fat graft survival.

Abstract Although fat grafting is frequently used in plastic surgery practice, debate about the viability of the graft still persists owing to its questionable long-term success. The ultimate aim is to obtain long-term graft viability. Vascularization of the graft is essential for this purpose. The effects of 2 different local anesthetic preparations frequently used during harvesting of fat grafts on long-term graft survival were compared with angiogenesis and volumetric measurements. Twenty-four male Wistar rats were divided into 3 groups. The inguinal region was selected as the fat graft donor site. The first group was injected with isotonic saline, the second was injected with lidocaine plus epinephrine, and the third was injected with prilocaine. Fat grafts were implanted into the dorsal regions of rats, and volumetric measurements were performed initially and on days 30 and 180 at which microvascular angiogenesis were also analyzed. Microvascular angiogenesis was assessed both with the reverse transcription–polymerase chain reaction and immunohistochemistry through determination of vessels stained with factor VIII. No significant difference was obtained between the 3 groups in graft volume or microvascular angiogenesis at any stage of the study. Results from this experimental study indicate that there is no negative effect of lidocaine plus epinephrine or prilocaine on microangiogenesis and the survival of fat grafts.

Effects of Human Amniotic Fluid on Fracture Healing in Rat Tibia

BACKGROUND Human amniotic fluid (HAF), including hyaluronic acid (HA) and several growth factors, has been used experimentally in tendon, nerve, and cartilage regeneration and in bone defects because of its positive stimulating effects on regeneration potential. This study was performed to investigate whether HAF was effective on fracture healing. MATERIALS AND METHODS We created 36 tibial fractures in 20-week-old Wistar rats that were divided into three groups. In group 1, fracture lines were instilled with HAF collected at 18th week of the gestation and, in group 2, fracture lines were instilled with HAF obtained at the end of the gestation. HAF which was collected from different period of gestation was used, because the concentration of HA and growth factors in HAF varies considerably during gestation. Group 3 was used as an operative control group. RESULTS Fracture-healing score was highest in group 1 radiologically at the 3rd and 5th week (P = 0.037, P = 0.018, respectively). In the scintigraphic evaluation, metabolic activity at the fracture site was observed in group 1 more than the others at the 3rd week (P = 0.010). Histologically, the highest scores were obtained from group 1 as compared to other groups at the 3rd and 5th week. In the 5th week, predominant cartilage with some woven bone was observed in group 3, while predominantly woven bone with some cartilage was observed in group 1 (P = 0.036). CONCLUSIONS Our data suggest that HAF had a positive effect on fracture healing in rat tibia, and also this positive effect was observed more in group 1.

The effect of Hirudoid on random skin-flap survival in rats

BACKGROUND One of the main fields of research in flap surgery is to increase the viability of flaps. Many materials have been tested for this purpose. This study shows that topical application of Hirudoid, an organoheparinoid, increases flap survival of dorsal flaps in rats. METHODS Hirudoid was used topically every day in eight of 16 rats in which 10x3-cm dorsal flaps were prepared. The flaps were taken for analysis on the 10th day. Analysis of the flaps was performed using digital measurement and scintigraphy. RESULTS Analysis revealed that the flap necrosis area was smaller in the Hirudoid group compared to the control group. In addition, the area exhibiting radioactive uptake in scintigraphy was greater in the treatment group. CONCLUSION Topical administration of Hirudoid may significantly improve flap survival.

Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): A case report

Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region. The surgical management of this complication is also discussed. Cicatricial alopecia was treated by two-stage surgery with tissue expanders. There were no complications in the postoperative period and healing was uneventful. We conclude that although FUE has many advantages, necrosis of the donor site may be a serious problem.

Soft tissue augmentation with autologous fat graft: The dissected pouch technique

Background: Soft tissue augmentation with autologous fat graft has been increasingly used by plastic surgeons despite unpredictable results. Several techniques have been described to prevent the main setback of this technique, fat graft resorption. However, there is no ideal technique described for this purpose. Materials and Methods: Twenty patients with subcutaneous tissue loss, atrophy or hypoplasia were treated with lipofilling. A subcutaneous pouch is dissected at the deformed area and later it is filled with autologous fat graft. Results: Graft maintenance during the postoperative period was satisfactory. Overcorrection was not performed except for the first three cases. Patient, surgeon and layman satisfaction was surveyed. Satisfaction was rated between 0 and 10. The mean score was 7.67 ± 1.22. Conclusion: The authors describe a technique for soft tissue augmentation which effectively corrects contour deformities, provides a low resorption rate and a relatively non-visible scar without causing irregularities.

Munchausen's Syndrome: A Rare Self-Mutilation Syndrome

Munchausen’s syndrome is a rare condition, in which the patient recurrently seeks medical care for a factitious illness. The patients with this syndrome may travel to several hospitals feigning acute, usually spectacular illnesses. The most common factitious conditions are infection, impaired wound healing, pain, hypoglycemia, anemia, bleeding, rashes, neurologic symptoms, vomiting, diarrhea, fevers of undetermined origin, and symptoms of autoimmune or connective tissue disease. They may undergo multiple dangerous operations for diagnostic and therapeutic reasons. Our case was operated 15 times for therapeutic reasons. In patients with Munchausen’s syndrome, the goal of the physician is early recognition of the psychiatric condition.

The effect of maxillary sinus surgery on its development

Conclusion. The study showed that surgery in the maxillary sinus can affect its development. Objective. To quantitatively evaluate the long-term impact of sinus surgery on its development in the rabbit. Materials and methods. This was an experimental study performed at an academic tertiary medical center using 20 4-week-old New Zealand white rabbits. The rabbits underwent unilateral right maxillary sinus surgery. The contralateral maxillary sinus used as a control did not undergo the operation. The maxillary sinus ostium was enlarged on the operated side. Volumetric analysis of the maxillary sinus was performed 1 year post-surgery. The maxillary sinus volumes of both sides were calculated using Multidedector CT and the volumetric measurements of the operated side were compared with the non-operated side. Results. Maxillary sinus development was significantly reduced on the surgical side. Maxillary sinus growth on the surgical side was determined as 87% compared with the non-surgical side.

Nasal obstruction may alleviate bruxism related temporomandibular joint disorders

Temporomandibular disorder (TMD) is a collective term used to identify a group of musculoskeletal conditions of the temporomandibular region. Bruxism is a non-functional activity characterized by repeated tooth clenching or grinding in an unconscious manner. Over the time bruxism may lead to TMD by the uploading it causes. Nasal obstruction is a common complaint that necessitates mouth breathing when severe. The treatment of bruxism is frequently performed by oral appliances, which induce occlusal disengagement and relax jaw musculature and therefore reduce the force on the temporomandibular joint (TMJ). We believe that nasal obstruction may indirectly have a preemptive and therapeutic effect on sleep bruxism related TMD by causing mouth breathing.

Necrotizing fasciitis with ruminococcus.

Necrotizing fasciitis is a life- and limb-threatening soft tissue infection. Due to its underlying predisposition and rapid progression, treatment should be started quickly using antibiotherapy and surgical intervention. Although necrotizing fasciitis is mainly caused by streptococci and staphylococci, it may also be polymicrobial. Other peptostreptococci have been reported as necrotizing fasciitis agents in the literature, though we encountered no cases of necrotizing fasciitis caused by Ruminococcus productus. Here, we describe a case of necrotizing fasciitis caused by R. productus, a Gram-positive, obligatory anaerobe.

An objective evaluation of an injured vessel wall using fluorescein sodium before microvascular anastomosis in an experimental rat model.

The aim of this study was to establish an objective evaluation method for intraoperative detection of damaged vascular endothelium in avulsion injuries. Twenty male Fischer rats were randomly assigned to control or experimental groups ( N = 10, each). Crush-avulsion injury was performed on right femoral arteries. Resection of damaged segments was performed according to operative microscopic findings in the control group; fluorescein sodium was applied to the artery lumen before resection in the experimental group to help visualize the damaged endothelium. Microvascular repair was performed in five rats in each group. In the other animals, the whole length of the femoral arteries was resected to assess the actual extent of injury histologically. At the end of the follow-up period, patency of microvascular anastomoses was examined and the lengths of the resected segments were compared with the actual length of the injured segment measured histologically. The difference between these two measurements was statistically significant in the control group ( P < 0.05) but not in the experimental group ( P > 0.05). Anastomosis patency was significantly higher in the experimental group ( P < 0.0001). In conclusion, fluorescein sodium may help to accurately determine the length of the injured vascular segment in avulsion injuries.