Onder Tan

Comparison of techniques for long-term storage of fat grafts: an experimental study.

Background: Absorption of autologous fat graft in the recipient area necessitates recurrent fat transplantation. Harvesting extra tissue during the first operation and storing it for future use is considered a solution to this problem. Methods: Fat tissue was removed from the inguinal region of 40 Swiss albino mice, which were arranged into four equal groups, and treated as follows: immediately transplanted to the donor animal; dry-frozen; immersed in glycerol; or frozen in liquid nitrogen. The grafts that were frozen or immersed in glycerol were stored at –35°C for 6 months and then transplanted to their original donors. Transplantations were performed by injecting the fat under the scalp. Viability of the fat tissue was evaluated with the MTT reduction test before transplantation, and histology of the transplanted tissue was examined at the end of the study. Results: The viability and histology of grafts frozen in liquid nitrogen were similar to those of fresh tissue, whereas with other methods the grafts had a considerable loss of viability during storage that was reflected in the low number of adipocytes and high proportion of vacuolar and fibrotic areas. Conclusion: Freezing fat grafts in liquid nitrogen and storing them at –35°C is an effective way of preserving tissue for future use, with clear superiority over other methods.

Evaluation of dynamic magnetic resonance imaging in assessing velopharyngeal insufficiency during phonation.

Background: Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated. Materials and Methods: A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed. Results: During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm2 preoperatively and 0.21 cm2 postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure. Conclusions: In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.

Soft-tissue augmentation of the middle and lower face using the deepithelialized submental flap.

Background: Facial contour augmentation is an entity often encountered by reconstructive surgeons. To date, very different autologous tissues such as fat, dermofat, dermal fascia, muscle, cartilage, and bone in the manner of grafts or flaps according to the requirements of the defect have been used for facial augmentation. Although many free flap procedures have become popular in facial contouring, these microsurgical methods have some limitations and risks, especially in patients who are not suitable for microsurgery. Moreover, the patient may wish to be treated by means of a more conservative procedure. Methods: The authors used the submental flap in deepithelialized fashion successfully for augmentation of the face in three patients who presented with hemifacial microsomia (n = 2) and longstanding facial paralysis (n = 1). Results: Adequate augmentation was achieved in all cases, without any complications. All donor sites were closed primarily and healed well. Patient satisfaction was perfect in all cases. A second debulking procedure was performed in case 3 only. The average follow-up was 1 year. Conclusions: The authors believe that the deepithelialized submental flap can be used safely for all facial contour restorations of the lower and midface necessitated by various causes, including hemifacial microsomia and facial paralysis as a main or adjunct procedure. In these cases, this flap may be a good alternative, especially for patients who are not suitable for microsurgery.

Temporal flap variations for craniofacial reconstruction.

Learning Objectives: After studying this article, the participant should be able to: 1. Describe the anatomy of the temporal region. 2. Identify the types and possible indications of the temple group flaps to be selected depending on the defects, and then raise the flap safely for reconstruction. 3. Predict and manage successfully the potential complications of surgery. Background: Good harmony of color and texture with surrounding tissues, thinness and adequate pliability, good alignment, obliteration of the cavities, and minimal donor-site morbidity are the main features of an ideal flap to be used in the reconstruction of craniofacial defects. Despite the numerous local, regional, and free flaps that have been described, to date, there has not yet been an ideal flap. The authors discuss the reconstruction alternatives presented by the temporal site and its outcomes. Methods: The temporal group flaps can be raised using one or more tissues based on the superficial temporal artery and its branches, depending on the defect site and nature. They can be designed as axial skin flaps consisting of transposition or V-Y island flaps, composite flaps including more than one tissue, and chimeric flaps involving both the temple skin and temporal fascia based on the two distal branches of the superficial temporal artery. Results: The temporal region is a good donor site for closure of craniofacial defects, by means of its rich vascular network and almost all types of tissue, including skin, fascia, muscle, galea, calvarial bone, and periosteum. The charm of this region has gradually increased as clinical experiences have advanced and its anatomy has been better understood. Conclusions: The authors discuss the history, anatomy, surgical dissection techniques, and potential complications and their management of temporal flaps.

Skin perforators of back region: anatomical study and clinical applications.

Background:Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region. Materials and Methods:The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap. Results:Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases. Conclusion:Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.

Bilobed fasciocutaneous flap closure of large meningomyeloceles

Background: Closure of large meningomyelocele defects presents a challenging problem. In this paper, the procedure and outcome of bilobed fasciocutaneous flap closure of large meningomyeloceles have been discussed. Materials and Methods: Bilobed fasciocutaneous flap was used in 20 patients with large meningomyelocele defects, the largest of which was 77 cm2. A fasciocutaneous dissection was performed and the defect area was covered by tension-free closure. Results: In the follow-up period of 6 weeks, partial flap loss in a patient and cerebrospinal fluid leak inferior to the flap in another 2 were observed. These patients recovered by dressing without flap loss. Conclusions: Utilization of bilobed flaps for closure of large meningomyelocele defects seems to be an effective and reliable procedure, with advantages of decreased operative time, minimal bleeding, the suture lines for dura and flap not superimposed, and low morbidity.

Nerve sparing-distally based sural flap.

The management of soft‐tissue defects in the ankle and foot area is a challenging task. Distally based sural flap is widely used, however it leaves donor area paresthesia. For this purpose, the sural nerve was dissected and preserved in the distally based sural flap in five cases of ankle and foot soft tissue reconstruction. This modification did not cause any compromise in flap circulation. All flaps survived with one partial distal necrosis. We suggest that, the distally based nerve sparing sural flap can be securely elevated with only a 3–4 cm wide subcutaneous pedicle without any compromise in flap circulation.

Triangular with Ala nasi (TAN) repair of unilateral cleft lips: a personal technique and early outcomes.

The triangular flap repair is one of the most common techniques used in cleft lip surgery. However, inability to address the nasal deformity and loss of orbicularis wholeness accompanied with incomplete reorientation have been two major handicaps of the triangular repair. Therefore, we developed our personal technique, called the triangular with ala nasi (TAN) repair, including a perialar incision and a distinct approach to the skin and muscle. We applied the TAN technique to 32 consecutive (19 male and 13 female) patients with unilateral cleft. The mean age at repair was 2.5 (1-32) years. The cleft lip appeared completely and incompletely in 11 and 21 patients, respectively. The postoperative outcomes were assessed subjectively by Williams test and objectively by Lindsay-Farkas method. The mean follow-up time was 17.1 months. No early complication involving hematoma, infection, wound dehiscence, or partial or total flap loss was encountered. The recoveries of 79.1% and 86.2% on average, when compared with the noncleft side, were obtained postoperatively. With our technique, we aimed at combining the useful properties of the two popular techniques, Millard and Tennison-Randall. The TAN repair lengthens the vertical lip using a triangular flap, resulting in a nonlinear, zig-zag scar on the philtral ridge and forming a symmetrical cupids bow, superiorities of the Tennison-Randall repair. On the other hand, our method also presents an excellent approximation of both the deep and superficial muscle groups and reduces the nasal deformity with a perialar incision, features of the Millards technique.

RECONSTRUCTION OF THE COLUMELLA USING THE PREFABRICATED REVERSE FLOW SUBMENTAL FLAP: A CASE REPORT

The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture‐ and color‐matched tissue in one stage has been determined to date.

Plastic surgical solutions for melkersson-rosenthal syndrome: facial liposuction and cheiloplasty procedures.

Objective:Melkersson-Rosenthal Syndrome (MRS) is a rare granulomatous disease characterized by a triad, including orofacial swelling, facial palsy and lingua plicata with usually recurrent or progressive course. Orofacial swelling, the most often sign of MRS, leads to the both esthetic and functional deformities. Because of its unknown etiology, a rational treatment is difficult and management of MRS still remains symptomatic, aiming at to remove orofacial swelling mainly. Although the many nonsurgical therapies have been mentioned in the literature, none has been proved uniformly and predictably successful to date. In this paper, we present different surgical procedures and their outcomes in a series of 4 cases with MRS. The procedures including mucosa, submucosa and tangential muscle resection, crescent shaped commissuroplasty, and facial liposuction may be considered in surgical armamentarium when orofacial swelling becomes persistent. We think that the plastic surgeons may act more effectively in the management of the syndrome in the future.