Nedim Savaci

Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot.

Defective wounds in diabetic foot are difficult to manage. Several studies reported the use of reverse sural flap in a small number of patients with varying success. We presented our experience with the reverse sural island flap (RSIF) in a series of 37 patients associated with diabetic foot using the delay procedure. The ages of the patients ranged between 36 and 73 years. We did not perform angiographic evaluation to determine the existence of vascular connections between the branches of the peroneal and posterior tibial artery; however, Doppler ultrasound evaluation was done to determine the patency of anterior and posterior tibial arteries, as well as lesser saphenous vein before the operation. The flaps were transferred using a 3-step delay procedure. While all the first and second steps of the operations were done under local anesthesia, the third steps were performed using general anesthesia in 12 and spinal anesthesia in 25 patients. All flaps survived except 4 showing partial necrosis due to venous insufficiency. Delaying the RSIF is a reliable procedure for diabetic foot skin defects.

Hyperphosphatemic tumoral calcinosis.

Tumoral calcinosis is a rare syndrome characterized by progressively growing and painless masses of calcium phosphate deposits within periarticular areas. Biochemical findings are normal except for an association with hyperphosphatemia. This report describes hyperphosphatemic tumoral calcinosis in a 22-year-old man who had been operated on five times in 5 years because of painless extremity swellings.

Vacuum–assisted closure of wounds and anxiety

The aim of this study was to investigate the degree of anxiety in patients in whom the vacuum-assisted closure (VAC) of wounds was used. Psychological evaluations were made on the day before VAC was applied and at the 10th day of treatment in 20 patients with traumatic wounds of the lower extremity. Anxiety was measured with the Hamilton Rating Scale for Anxiety and with the State Anxiety Inventory test. The same measurements were also made in 20 further patients with similar wounds but managed with classic treatment as controls. Both groups showed a significant increase in anxiety during the 10 days. The mean (SD) differences in the anxiety scores measured during the 10-day period were significantly higher in the group treated by VAC than in the control group, State Anxiety Inventory test (14.0 (2.3) compared with 2.6 (1.2), p<0.001) and Hamilton Rating Scale for Anxiety test (4.4 (0.6) compared with 1.3 (0.6), p<0.001). Although we think that VAC is an effective tool for treating lower extremity wounds, we have concerns about possible accompanying psychological effects.

Use of reverse triangular V-Y flaps to create a web space in syndactyly.

The authors describe a new technique for division in syndactyly. The web space is reconstructed using two reverse V-Y island triangular flaps. The flaps are raised both on the dorsal and the palmar aspect of the hand. This technique does not require the use of a skin graft. Fourteen syndactylies in 9 children-three incomplete (two congenital and one secondary to burn) and six complete-were treated using this technique. The results after a maximum 4-month follow-up and the advantages of the technique are discussed.

A nonanimal model for microsurgical training with adventitial stripping.

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The effect of combined use of platelet-rich plasma and adipose-derived stem cells on fat graft survival.

BackgroundFree fat grafts have an unpredictable survival rate that limits their successful use. To increase the viability of fat grafts, it is important to minimize the reabsorption rate. ObjectiveOur aim was to investigate whether the combined use of platelet-rich plasma (PRP) and adipose derived stem cells (ADSCs) would contribute an improvement in lower resorption rates of fat grafts. MethodsInbred Fischer 344 rats were randomized into 4 groups (n = 10). Fat grafts were mixed with Dulbecco modified Eagle medium in group A, with PRP in group B, with ADSC in group C, and with PRP + ADSC in group D and were injected to the scalp.In vitro growth factor (vascular endothelial growth factor, transforming growth factor-&bgr;, and fibroblast growth factor) levels were compared using enzyme-linked immunoassay method. After 12 weeks weight, volume and histology of the transplants were evaluated. ResultsThe mean weight and volume of the fat grafts were highest in group D. Histopathological investigations revealed that the number of viable adipocytes and blood vessels were highest in group D. The level of growth factors was significantly higher in stem cell plus PRP group. ConclusionAdipose-derived stem cells combined with PRP can enhance the survival of transplanted fat tissue.

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.

Allogenous Cartilage Graft Versus Autogenous Cartilage Graft in Augmentation Rhinoplasty: A Decade of Clinical Experience

Cartilage grafts have great value in augmentation rhinoplasty. For most surgeons, an autogenous cartilage graft is the first choice in rhinoplasty because of its resistance to infection and resorption. On the other hand, an allogenous cartilage graft might be preferred over an autogenous graft to avoid additional morbidity and lengthened operating time. Allogenous cartilage grafts not only have the advantage of averting donor site morbidity but also are resistant to infection, resembling autogenous cartilage grafts. The authors present their experience with 41 patients who underwent augmentation rhinoplasty using 22 autogenous and 19 allogenous cartilage grafts between June 1994 and August 2004. For evaluation of adequate augmentation rates, photographic analyses were performed on preoperative, early postoperative, and late postoperative photographs from all the patients. To assess patient satisfaction, the Facial Appearance Sorting Test (FAST) was applied preoperatively and late postoperatively in both groups. These results were compared, and it was concluded that in terms of resorption, there was no difference in the early and late postoperative follow-up data between allogenous and autogenous cartilage grafts. Evaluation of the preoperative and early postoperative photographic outcomes showed statistically significant differences with respect to adequate augmentation rates between the two groups. The FAST scores showed statistically significant differences between preoperative and late postoperative outcomes. There were no infections in the two groups of patients.

Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis.

BACKGROUND Temporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis. METHODS Twenty patients (female: male; 15:5; age 26, 3 ± 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success. RESULTS There was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group. CONCLUSIONS This study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis.

Simultaneous occurrence of facial fibrous dysplasia and ameloblastoma

BACKGROUND Both fibrous dysplasia (FD) and ameloblastoma are benign but locally aggressive tumours of the craniofacial region. In this case report, we present the unique synchronous occurrence of these two tumours in the facial skeleton. CASE REPORT A 16-year-old woman presented with complaints of swelling of the upper right face and at the inferior border of the mandible. She was diagnosed as FD of the maxilla, temporal bone and sphenoid sinus together with ameloblastoma of the mandible after surgery and histopathological evaluation. CONCLUSION The case that we present here is unique in that two separate pathological conditions, FD of the upper face, and ameloblastoma of the mandible coexisted. Although cases of synchronous or metachronous occurrence of FD and ameloblastoma with other pathology have been previously described, this to our knowledge, is the first reported case of true coexistence of FD and ameloblastoma.