Mustafa Sütçü

Reconstruction of total lower lip defects using radial forearm free flap with subsequent tongue flap.

Subtotal and total reconstruction of the lower lip is a challenge for the plastic surgeon. Large defects extending to the chin area can be difficult to manage with only local flaps, and free flaps are better suited. In an attempt to restore the lower lip with the vermilion, the authors used the radial forearm free flap with anteriorly based ventral tongue flap in 5 patients. The tongue flap is used 3 months after the free flap procedure, and this flap is divided 3 weeks later. The tongue flap transfer, adaptation, and division are done under local anesthesia. In all patients, the aesthetic result was excellent compared with the complexity of the reconstructed defect. Patient compliance was uneventful. Although it is a 3-stage reconstruction, combination of radial forearm flap with the tongue flap offers functional and fine aesthetic results.

Necessity of Suction Drains in Gynecomastia Surgery

BACKGROUND The aim of gynecomastia surgery is to restore a normal chest contour with minimal signs of breast surgery. OBJECTIVE The authors examine the rate of complications in gynecomastia surgery when no closed-suction drains are placed. METHODS One hundred thirty-eight consecutive male patients who underwent gynecomastia surgery without drains were retrospectively analyzed to determine whether the absence of drains adversely affected patient outcomes. Patients were managed by ultrasonic-assisted liposuction both with and without the pull-through technique. RESULTS The mean age of the patients was 29 years, and the mean volume of breast tissue aspirated was 350 mL per beast. Pull-through was needed in 23 cases. There was only 1 postoperative hematoma. CONCLUSIONS These results are comparable with previously published data for gynecomastia surgery in which drains were placed, suggesting that the absence of drains does not adversely affect postoperative recovery. Routine closed-suction drainage after gynecomastia surgery is unnecessary, and it may be appropriate to omit drains after gynecomastia surgery.

Exposure to Tumescent Solution Significantly Increases Phosphorylation of Perilipin in Adipocytes.

Background Lidocaine and epinephrine could potentially decrease adipocyte viability, but these effects have not been substantiated. The phosphorylation status of perilipin in adipocytes may be predictive of cell viability. Perilipin coats lipid droplets and restricts access of lipases; phospho-perilipin lacks this protective function. Objectives The authors investigated the effects of tumescent solution containing lidocaine and epinephrine on the phosphorylation status of perilipin in adipocytes. Methods In this in vitro study, lipoaspirates were collected before and after tumescence from 15 women who underwent abdominoplasty. Fat samples were fixed, sectioned, and stained for histologic and immunohistochemical analyses. Relative phosphorylation of perilipin was inferred from pixel intensities of immunostained adipocytes observed with confocal microscopy. Results For adipocytes collected before tumescent infiltration, 10.08% of total perilipin was phosphorylated. In contrast, 30.62% of total perilipin was phosphorylated for adipocytes collected from tumescent tissue (P < .01). Conclusions The tumescent technique increases the relative phosphorylation of perilipin in adipocytes, making these cells more vulnerable to lipolysis. Tumescent solution applied for analgesia or hemostasis of the donor site should contain the lowest possible concentrations of lidocaine and epinephrine. Level of Evidence: 5

Reduction of the Areolar Diameter After Ultrasound-Assisted Liposuction for Gynecomastia

Background One of the clinical aspects characterizing gynecomastia is the enlargement of the nipple-areolar complex (NAC) due to hypertrophic breast glands, and the excessive fatty tissue underneath. Objective The purpose of this study was to quantify the reduction of the areolar diameter after ultrasound-assisted liposuction (UAL) of the male breast. Methods The horizontal diameters of the NACs of 30 men who underwent UAL were measured before surgery, 1 month after surgery and 6 months after surgery in a standard fashion. Those patients with surgical gland removals of any kind were not included in this study. Results The mean age of the patients was 27.9 years, and all of the patients had bilateral grade I, II, or III gynecomastia. The mean diameter of the NACs before surgery was 35.36 mm (range, 26–55 mm), and after surgery, the mean diameter of the NACs was initially reduced to 28.8 mm (range, 23–44 mm) and later to 28.57 mm (range, 23–42 mm). The mean volume of breast tissue aspirated was 382 mL per breast, and the percentage of reduction was 17.3%. The reduction of areola diameter was statistically significant after first month. A significant positive correlation was identified between the liposuction volume and areolar diameter reduction. Conclusions In cases of gynecomastia, the removal of the glandular and fatty tissue underneath the areola releases the expanding forces and pressure that enlarge it. In many cases of gynecomastia, UAL alone is effective in reducing the size of the NAC and allows the surgeon to avoid placing scars on the breast.

Foot and ankle reconstruction with vertically designed deep inferior epigastric perforator flap

The deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap.

Palmar epidermoid inclusion cyst mimicking Dupuytren's contracture

Epidermoid inclusion cyst in palmar localization is very rare. We present an unusual case of palmar epidermoid inclusion cyst which causes Dupuytren-like contracture in hand. A 32-year-old male patient was complaining of the traction feeling of the mass. The mass was excised surgically, it was a hairy nodule like structure and reported as epidermoid inclusion cyst. Cystic lesions are very common masses. However epidermoid inclusion cysts in the palmar region are important because they may arise from the eccrine ducts and may be relevant with HPV infections. Thus, HPV screening should also be done in such a case.

The Use of Platelet-Rich Plasma for Storage of Surplus Harvested Skin Grafts

Background: There is a need for improved methods and storage media to sustain the tissue viability of autologous skin grafts. Objective: To compare histological changes in human skin grafts stored in platelet-rich plasma (PRP) with those of grafts stored in saline. Methods: Eight circular, 3-mm full-thickness skin graft samples were harvested from the abdominal skin of each of 5 patients scheduled to undergo an abdominoplasty procedure. Four of these graft samples were stored in saline, and the other 4 were stored in saline mixed with PRP prepared from the patient’s own venous blood. Histological assessment of the microscopic appearance of the samples was performed on days 5, 8, 11, and 14. The integrity of the epidermal–dermal junction, number of keratinocytes with perinuclear halos, collagen organization, and number of fibroblasts per field were assessed. The cellular apoptosis rate was also measured on these same days. Results: On day 5, significant differences were observed microscopically between the PRP- and saline-stored grafts (P < .05). The grafts preserved in saline exhibited early marked cellular and nuclear swelling with pleomorphism, as well as early nuclear halo formation. The cell viability rate of the PRP group was significantly higher than that of the saline-stored group on day 8 (P < .05). Conclusion: Platelet-rich plasma and its inherent growth factors supported longer graft survival; however, its effect lasted only until day 8. Platelet-rich plasma may be beneficial if grafts need to be stored for delayed application(s).

An Effective Method for Ectropion Correction: The Smith Modification of Kuhnt Szymanowski Techniqe

İletişim Bilgisi / Correspondence 82 Yard. Doç. Dr Furkan Erol Karabekmez, Abant İzzet Baysal Üniversitesi Tıp Fakültesi Plastik, Rekonstrüktif ve Estetik Cerrahi AD 14280 Bolu Türkiye E-mail: drfurkanerol@yahoo.com Tel: +90 374 2534656 Geliş tarihi / Received: 29.11.2012 Kabul tarihi / Accepted: 16.12.2012 Çıkar Çatışması / Conflict of Interest: Yok / None Ektropion Düzeltilmesinde Etkin Bir Yöntem: Kuhnt Szymanowski Tekniğinin

Drains in Aesthetic Surgery: Should They BeRadio-opaque or Not?

Drains are used to obliterate dead spaces and to remove liquid components from seromas and hematomas. They must be composed of nonallergic materials to obtain optimum wound healing [1]. Drains were first used by Hippocrates for pleural collections [3]. Silicone drains became available in 1959, and Santos et al. [2] reported on their advantages. In modern surgery, drains still are the main components of surgery. Lost surgical drains under a skin flap are rare but serious problems, especially in aesthetic surgery. It is very important to determine the location of the drain without increasing morbidity. Drains with radioopaque markers help us to determine their placement. A classic abdominoplasty operation was performed for a 36-year-old woman from our clinic. At the end of the operation, two radio-opaque silicone penrose drains (Sewoon Medical Co. Ltd., Seoul, Korea, No. 0120) were placed in both lateral sites subcutaneously. The drains were fixed in place with 3/0 polyamide stitches. On postoperative day 2, the drain on the right side could not be located even after a search through the patient s dressing materials. It was assumed that the drain had slipped under the skin. An abdominal radiography dosage of 70 kv and 50 mA with the patient in the standing position showed radio-opaque linear densities on the right site in the abdomen region (Fig. 1), The drain was removed easily with an instrument from the incision line. The fixation stitch for the drain had broken off, and this is why the drain had escaped under the skin. The selection of drain material is very important in aesthetic surgery. This is why we selected a silicon penrose drain for our patient. Drains are helpful adjuncts to surgery, but they are not innocuous, Many reported complications have been related to the use of drains. Dislodgement of the fixation suture because of insecure suturing is the most common complication [3]. For this reason radio-opaque markers have been added to silicone penrose drains. In our case, there was no problem fixing our drain, but a stitch became dislodged. Drains with radio-opaque markers can be detected easily using direct radiography, negating the problem of a potential second surgery to locate lost drains. Eliminating a secondary procedure is especially important in aesthetic surgery because such procedures can lead to increased complication rates, morbidity, and cost. What kind of complications can be seen if a lost drain is not removed? Foreign body reactions may not occurr from lost silicone penrose drains, but in some cases, the lost drain is palpable under the skin flap. Drains not made of silicone can lead to foreign body reactions and can provoke reactive exudates as well as the development of granulation tissue around the drain [2]. We conclude that the use of silicone penrose drains with radio-opaque markers makes detection of lost drains easy. Fig. 1. Abdominal radiography showed linear radio-opaque densities, mimics as in our drain. Aesth. Plast. Surg. 29:210–211, 2005 DOI: 10.1007/s00266-004-0112-7