Nilgün Markal Ertaş

Simplified and versatile use of gluteal perforator flaps for pressure sores.

As a first choice for treating pressure sores, we present our experiences with gluteal perforator flaps and a simplified surgical technique. Twenty-three gluteal perforator flaps were used in 20 patients (13 males, 7 females; aged, 8–68 years) with pressure sores. The pressure sores were sacral in 16 patients, ischial in 2, and trochanteric in 2 patients. During follow-up, recurrence in the same region did not occur. Our simplified operative technique includes finding a suitable perforator with a Doppler probe (it does not matter from which mother artery), outlining the flap, dissecting the perforator with just enough length, and transposing the flap to the defect. The gluteal region has numerous perforators, and there is no need to depend on strict anatomic landmarks to detect perforator vessels or to sacrifice main arteries, as has been the case when raising gluteal perforator flaps.

Treatment of recontracture with the subcutaneous pedicle rhomboid flap

Background: Treatment of recontractures that were previously skin grafted or treated with Z-plasty is a challenge. Application of a subsequent Z-plasty is risky because of the possibility of tip necrosis of the triangular flaps, whereas donor-site morbidity is undesirable if subsequent skin grafting is planned. The subcutaneous pedicle rhomboid flap is an effective technique for the treatment of every type of contracture. This article presents the clinical results of the rhomboid flap used in treatment of recontractures as an alternate technique to Z-plasty and skin grafting. Methods: The authors operated on seven patients with recontractures (aged 4 to 45 years) using 19 rhomboid flaps. Flaps were applied in the upper extremity (seven flaps), lower extremity (five flaps), trunk (five flaps), neck (one flap), and axilla (one flap). Z-plasty scars were present in three locations, whereas skin grafting was previously applied in 16 locations. Preoperative rhomboid flap designs were made regardless of previous scars as single flaps in six locations and multiple flaps in 13 locations. Operations were performed under local and general anesthesia. Results: Patients were followed up for at least 6 months. All flaps achieved adequate relaxation postoperatively and healed uneventfully. The subcutaneous pedicle of the flap provided a distinct advantage in terms of vascularity. Recurrence was not seen in any of the patients. Conclusions: The subcutaneous pedicle rhomboid flap is an effective and reliable technique for the treatment of recontractures. Preoperative planning is simple and independent of previous scars. Because the rhomboid flap resurfaces the emerged defects generated by relaxation incisions, one should consider that the flexibility of a single flap may not be adequate in some cases, and multiple flaps should be used.

Necrotizing Fasciitis of the Chest Wall With a Retropharyngeal Abscess : Case Report and Literature Review

We herein report a case of a diabetic 49-year-old woman with anterior chest wall necrotizing fasciitis that caused a retropharyngeal abscess and discuss the literature surrounding necrotizing soft tissue infections of the chest wall. The patient was treated with serial wound debridements, antibiotic therapy, and percutaneous drainage and serial irrigation of the retropharyngeal abscess with a silicone catheter. The resulting defect was grafted with a split thickness skin graft.

Comparison of elongations provided by subcutaneous pedicle rhomboid flap and Z-plasty in rat inguinal skin.

Background: The most commonly used technique in the treatment of contracture bands is Z-plasty. The subcutaneous pedicle rhomboid flap is a relatively new flap whose efficiency in the treatment of wide or linear contractures with two or more contracture bands has been demonstrated. This experimental study was planned to compare the lengthening provided by the subcutaneous pedicle rhomboid flap with that provided by the Z-plasty. Methods: The lower extremities of 10 male Sprague-Dawley rats were strained by hanging 500 g of weight to create tension lines over both inguinal areas. Z-plasty, with a 1-cm central limb and 60-degree angles, was planned over the inguinal tension line on one side. On the other side, a subcutaneous pedicle rhomboid flap was sketched, with a 1-cm-long axis and inner 60-degree angles located over the tension line. In the Z-plasty technique, triangular flaps were elevated over the muscle, transposed, and sutured. In the subcutaneous pedicle rhomboid flap technique, the flap was incised down to the muscle and freed from the tension line, which was later relieved by relaxation incisions. The resulting defects were then closed by suturing the rhomboid flap in V-Y advancement along the tension line and in Y-V advancement along the relaxation incisions. The final lengthening provided by both techniques was measured, and the results were analyzed statistically. Results: Both techniques were effective in relieving tension over the inguinal areas and in lengthening the tension lines. The lengthening provided by Z-plasties with 1-cm central limbs ranged from 3 to 3.8 cm. The difference between preoperative and postoperative Z-plasty measurements ranged from 2.0 to 2.8 cm (mean ± SD, 2.43 ± 0.28 cm). The lengthening provided by the flaps with 1-cm axes ranged from 3.9 to 5.0 cm and the difference in measurements before and after surgery ranged from 2.9 to 4.0 cm (3.27 ± 0.33 cm). Statistical analysis revealed that the elongation provided by the subcutaneous pedicle rhomboid flap was longer than that provided by Z-plasty (p < 0.0001). Conclusion: The subcutaneous pedicle rhomboid flap technique is a more effective than Z-plasty in lengthening the tension lines in rat inguinal skin.

Chondroid syringoma of the hand.

Chondroid syringoma is a rare cutaneous tumour that usually arises in the head and neck region and is rarely seen on the hands; it is rarely malignant at sites other than the head and neck. However, it should be included in the differential diagnosis of tumours of the hand. We present a 56-year-old man with a chondroid syringoma of the hand that clinically resembled a vascular tumour.

7-plasty technique for the surgical treatment of congenital longitudinal ear lobe cleft.

The ear lobe plays an important part in the aesthetic appearance of the auricle. The clefts of the ear lobe may vary in a wide range of severity from a simple notching to extensive tissue deficiency. We have operated on a congenital longitudinal ear lobe cleft using an alternative surgical method and obtained a favorable result. This method consists of a 7-plasty (or inverted L-plasty) that was performed to correct the deformity. The inner edges of the lobes were excised, and a medial extension incision was added. This helped to drop the medial part inferiorly like a back-cut so that the length of that lobe was increased. Eversion of the lateral lobe was also done, and the edges were approximated so that the angle between the extension incision and the excision line was increased to produce an obtuse angle between the 2 lines. We report an alternative method of reconstruction that can be used in longitudinal ear lobe clefts that offers a favorable result.

The effect of adipose stromal vascular fraction on transverse rectus abdominis musculocutaneous flap: an experimental study

Abstract Background: Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the options in reconstruction after breast cancer surgery for breast reconstruction. Tissue necrosis often occurs in the third and fourth perfusion zones of the flap. A study was planned to find out the effects of adipose stromal vascular fraction (SVF) cells on viability of TRAM flap and the experimental model was designed to be applicable in clinical practice. Methods: Right inferior epigastric artery pedicled, 5 × 2.5 cm sized TRAM flap was used as a flap model in 30 rats in three groups (group 1: sham; group 2: phosphate-buffered saline (PBS); group 3: SVF cell injected). The viability of the flaps were assessed on the postoperative 7th day with photographs and software for the calculations. Results: The mean viable flap percentage to total flap area was recorded as 51.8% ± 11.19, 49.5% ± 10.30, 82.3% ± 9.56, in group 1, group 2, and group 3, respectively (p < 0.05). The mean capillary density was noted as 5.15 ± 0.56, 4.37 ± 0.58, and 12.40 ± 1.17 in groups 1, 2, and 3, respectively (p < 0.05). The fibrosis gradient indicated no difference between the groups (p > 0.05). The in-vivo differentiation of SVF cells to endothelial cells was noted. The blood VEGF levels showed a marked increase in the experimental group (p < 0.05). Conclusion: The adipose SVF cells were found out to improve the TRAM flap viability and decrease necrosis, especially in zone 3 and 4.

Double opposing rectangular advancement flap is an alternative technique in the treatment of wide linear postburn scar contractures.

BACKGROUND Double opposing rectangular advancement is a new and alternative technique in the treatment of postburn scar contractures. The technique consists of opposing two adjacent subcutaneously pedicled rectangular flaps by advancement and lengthening a contracture band. Experimental studies demonstrated that the technique is efficient to elongate a tension line as much as Z-plasty in the rat inguinal skin. In this clinical study we investigated the efficiency and versatility of the technique in the treatment of wide linear postburn scar contractures in various parts of the body. MATERIALS AND METHOD We applied 16 double opposing rectangular advancement in 7 patients (aged 4-56). Flaps were applied in the upper extremity (11 flaps), lower extremity (4 flaps) and trunk (1 flap). RESULTS Average follow-up was 1-year. All flaps achieved adequate relaxation postoperatively and healed uneventfully. Postoperative measurements indicated that the lengthening provided with the technique ranged from 72 to 100%. The subcutaneous pedicle of the rectangular flaps provided a distinct advantage in terms of vascularity. Recontracture was seen in one patient to whom two double opposing rectangular flaps in series were applied in the axilla. CONCLUSION Clinical results indicated that double opposing rectangular advancement is effective in the treatment of wide linear postburn scar contractures. Preoperative planning and application of flaps are simple. One knows preoperatively the exact elongation along the contracture line and narrowing perpendicular to this line which will be provided with the technique. Since the flaps are subcutaneously pedicled, the vascularity of the flaps are reliable. However the technique may not avoid recontracture in the axilla.

Three Years' Survival after Diagnosis of Finger Metastasis from End-Stage Lung Cancer

There are cases in the literature presenting digital skin metastasis from a primary cancer. The majority of primary foci are reported as being lung carcinomas (40%). We present a patient having finger metastasis from end-stage squamous cell carcinoma of the lung that had already metastasized to the brain and liver. The unusual point about our case was 3 years’ survival of the patient after detection of digital skin metastasis and amputation of the finger, which is a remarkable finding, compared to similar cases in the literature.

Omega (Ω) Advancement Flap: A Circular Flap Design for the Aesthetic Closure of Circular Skin Defect

BackgroundMost skin defects that require reconstruction with a local skin flap have a circular- or oval-shaped pattern. The majority of the skin flaps are planned in an angled shape. Therefore, it may be necessary to modify the shape of the defect or the distal flap border to minimize tissue distortion. We have designed a circular-shaped advancement flap to be compatible with the circular defect.MethodsEighteen cases of reconstruction of skin defects in the face, chest wall, hand and buttock area were performed using the omega advancement flap between 2010 and 2014. In this technique, a circular-shaped flap that has an equal diameter with the defect is planned adjacent to the defect. To facilitate the advancement of the flap and to avoid standing cones, deepithelialized equilateral triangular flaps are designed on both sides of the main circular flap. The circular flap is easily moved to the defect by pulling of the triangular flaps with minimal tension.ResultsAll flaps survived without complication such as infection, hematoma or flap necrosis. No secondary surgery was required to correct contour deformities such as standing cones and trap-door deformities. The results were satisfactory aesthetically and functionally.ConclusionsThe omega advancement flap is an easy and reliable procedure for reconstruction of circular skin defects located on various anatomical regions.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.