Nedim Sarifakioglu

Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects.

Closure of large meningomyelocele wounds and defects always requires durable and safe coverage of the dural repair. A new technical method for the reconstruction of large thoracolumbar meningomyelocele defects is described in which bilateral musculocutaneous flaps are advanced and transposed medially in a V-Y sliding manner, based on the thoracolumbar perforatiors of the latissimus dorsi. This procedure provides a reliable, well-vascularized soft tissue coverage over the neural repair with minimum donor-site morbidity. Additionally, this method is particularly appropriate to the thoracolumbar area, as it preserves the lateral adjacent regions of the defect, for later alternative and/or reconstructive options.

The prepuce and circumcision: Dual application as a graft

Circumcision is probably one of the first plastic surgery operations that has been used for centuries. The aim of this study was to apply the bilamellar tissue (skin and mucosa) obtained from circumcision to various defects and to evaluate the clinical results. During the last 2 years, 19 patients have been operated, and the skin and mucosal grafts were applied individually or simultaneously. The etiology was trauma for the whole series of patients (12 burns and 7 strap injuries). In 15 patients the defect was localized to the hand whereas in 4 patients it was located on the dorsum of the foot. In 10 patients, mucosa and skin graft were applied to the same defect as a single, compact layer. In 9 patients, skin and mucosa were applied separately to multiple defects. Using these methods, comparative evaluation of the consequences of prepuce mucosal and skin graft applications could be made. Four obvious differences were observed: (1) in mucosal grafts, early graft edema that resolves spontaneously after 48 hours; (2) better adaptation of the mucosal grafts to the recipient bed; (3) hyperpigmentation in both graft types, but the skin part was slightly darker than the mucosa; and (4) less secondary contraction was seen in mucosal grafts. The results were evaluated in light of the authors’ knowledge of the prepuce as an alternative full-thickness donor site. The relative differences in the dual anatomic structure of mucosa and skin, and the role of circumcision as a medical, cultural, and religious application in some societies are discussed.

New technique of one-stage reconstruction of a large full-thickness defect in the upper lip: bilateral reverse composite nasolabial flap.

Lips are important features because of their location, function, and aesthetics. Reconstruction of the upper lip presents the surgeon with one of the greatest challenges. Total upper lip reconstruction is a frequent and demanding procedure, and its difficulty is related to the size and the site of the loss of the aesthetic subunits such as the Cupid’s bow and the philtral columns.

The medical use of a nonmedical product: Melted tar

The use of hot tar in industry is widespread, and burns caused by this agent remain a problem. Instead of being classified as chemical injuries, these burns compose a unique class of thermal injury because of the difference of mechanisms of injury and the difficulties in removing the agent from the skin. Tar burns usually are occupational in nature and are observed mostly in male patients. This report presents a female burn case that had occurred after she applied hot tar to her skin for the treatment purposes of pain relief.