Naci Karaçal

Reverse-flow submental artery flap for periorbital soft tissue and socket reconstruction

The submental artery island flap is a recently described local flap that may be used for reconstruction of the lower and middle thirds of the face and oral cavity. The reverse‐flow manner of the flap has been used in limited cases because of possible drawbacks such as venous congestion. We present our experience with the use of reverse‐flow submental artery flap and describe the surgical technique.

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.

Juvenile hyaline fibromatosis: a case report

Juvenile hyaline fibromatosis ( JHF ) is a rare autosomal recessive disease characterized by papulonodular skin lesions, gingival hyperplasia, joint contractures, and bone lesions. The skin lesions may consist of multiple large tumors, commonly on the scalp and around the neck, and small pearly, pink papules and plaques on the trunk, chin, ears, and around the nostrils. Here, we report a 2‐year‐old boy with characteristic stiffness of the knees and elbows and pink confluent papules on the paranasal folds, and periauricular and perianal regions. He also had hard nodules all over the scalp and around the mouth, and severe gingival hyperplasia. The lesions were totally excised and clinicopathological diagnosis was JHF.

Nonsurgical delay of cutaneous flaps using the flashlamp pumped pulsed dye laser

&NA; The surgical delay procedure is an effective method for improving skin flap survival. However, it has many disadvantages, such as bleeding, infection, and pain. It also requires an additional operation and a long time for wound management. Nonsurgical delay has a great importance, but pharmacological efforts for delay phenomena have never found clinical application. In this study, the authors attempted to reproduce the delay phenomena via the flashlamp pumped dye laser. Forty Sprague‐Dawley rats were studied in four groups of 10 rats each. The experimental and control flaps were on the same rat. Flaps were planned on the ventral skin of the rats, and were symmetrical, three sided, based caudally, and were 2 cm in width, extended to the measured midpoint between the xiphoid and the sternal notch. The laser was applied to the different areas of the experimental flaps 15 days before flap elevation. A week later flap survival was determined by overlaying millimeter‐grid acetate paper. Full‐surface and perimeter “lased” experimental flaps showed a marked increase in surviving areas when compared with the control flaps. This kind of flap delay has a great potential in clinic application. Aslan G, Karaçal N, Görgü M, Erdoğan B. Nonsurgical delay of cutaneous flaps using the flashlamp pumped pulsed dye laser. Ann Plast Surg 2000;44:277‐281

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.

New tumor formation on split-thickness skin grafted areas in xeroderma pigmentosum.

Xeroderma pigmentosum is a relatively rare systemic disease transmitted through an incomplete sex-linked recessive gene. It is characterized by malignant skin degeneration. One of the most effective treatment choices for the malignant changes is full-face resurfacing with skin grafts. Grafts harvested from areas that have some freckles may show malignant degeneration by ultraviolet exposure. The authors present a patient whose face was resurfaced with a split-thickness skin graft and was admitted due to new tumor formation on her resurfaced face.

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.

Giant cementoblastoma of the impacted mandibular incisor.

The cementoblastoma is a relatively rare type of all odontogenic tumors. The incisor and impacted or unerupted tooth involvement by a cementoblastoma is extremely rare. We present a case report of a giant cementoblastoma that involved an impacted mandibular incisor.

Relation between serum ischemia-modified albumin levels and rectus abdominis muscle flap viability.

Ischemia is a major cause of flap failure in reconstructive surgery. To detect circulatory compromise, many flap monitoring methods are used; however, there is no any optimal standard method. Ischemia-modified albumin (IMA) is an ischemia marker, which has recently been investigated in many studies and largely validated for early detection of ischemia. In this study, we investigated possible relationship between muscle flap viability and serum IMA levels in experimental flap model. The rectus abdominis muscle flap model was used in 18 New Zealand white rabbits. The study was planned using 3 groups. In group 1, the rectus abdominis muscle flap was harvested as a superior pedicle-based flap in which the inferior pedicle was sacrificed. In group 2, the flap was harvested by severing the superior pedicle. Both pedicles were harvested in group 3. Serum IMA levels were measured before the procedure and 1 hour, 6 hours, and 7 days postoperatively and then compared. In group 3, in which the ischemia was evident, and in group 1, IMA levels were significantly high 1 hour postoperatively (P < 0.05). There was no other significant difference in any of the other studied parameters between the groups. In conclusion, IMA can be used as a biochemical parameter for monitoring muscle flap viability.