Özhan Çelebiler

Patients' and surgeons' perspectives on the scar components after inferior pedicle breast reduction surgery.

Background: Scarring is the most frequent cause of dissatisfaction both for the surgeons and for the patients in breast reduction surgery. Some of the techniques used today use the classic inverted T scar. An inverted T scar is a combination of three separate scars (periareolar, vertical, and inframammary). To the authors’ knowledge, no study has investigated the cosmetic outcome of these three scar components separately. The aim of this study was to determine the surgeons’ and patients’ perspectives on the cosmetic outcome of these three scar components. Methods: A total of 19 patients who had inferior pedicle reduction mammaplasties were included in the study. The patients’ perspectives on their reduction mammaplasty scars and the surgeons’ evaluations of scar hypertrophy, widening, and color match were assessed by Likert scales. Results: Patient evaluations revealed that periareolar scars were the most pleasing, whereas the inframammary scars were the least pleasing. Surgeon evaluations revealed no significant difference in scar hypertrophy, color match, or widening for the three scar components. However, the vertical scar had a tendency to widen and the inframammary scar color tended to match poorly. Conclusions: In this study, patients were most pleased with the periareolar scars and least pleased with the inframammary scars. Surgeons need to find ways of getting rid of the inframammary scar and should also deal with vertical scar widening. Scar hypertrophy was not a problem in this patient population.

Commissure-based buccal mucosal flap

&NA; Commissure‐based buccal mucosal flaps extending to the retromolar trigone have been used for anterior intraoral mucosal defects. The flap was utilized successfully in 26 patients who had vermilion defect (14 cases), obliteration of the anterior gingivobuccal sulcus (8 cases), and anterior maxillary defect (4 cases). (Plast. Reconstr. Surg. 101: 1223, 1998.)

Repair of critical size defects using bioactive glass seeded with adipose‐derived mesenchymal stem cells

Bioactive glass has been demonstrated as a biocompatible bone substitute. However bone healing process can be prolonged due to late resorption of the material. Adipose derived stem cells (ASC) have osteogenic differentiation potential and hence can be a cell source for bone regeneration. The aim of this study was to test whether combination of bioactive glass with ASCs would enhance bone regeneration. Following creation of critical sized defects on the calvaria of 32 Wistar rats, the animals were randomly divided into four groups: Group C (control): Defects were left untreated; Group G: Defects were covered with autologous bone graft; Group BG: Defects were filled with bioactive glass; Group BG/ASC: Defects were filled with bioactive glass seeded with ASCs. The defect size was significantly greater in Group C compared to all other groups. Bone density was significantly lower in Group C compared to Group G and Group BG/ASC. Bone regeneration score of Group C was significantly lower than other groups. Group BG/ASC demonstrated lamellar bone and havers canal formation. The results of this study demonstrated that bioactive glass implanted with ASC is a biocompatible construct stimulating radiologically and histologically evident bone regeneration similar to autologous bone grafting.

Risk assessment for free tissue transfers: is old age a determining factor?

Introduction:Free tissue transfers are more often performed in the elderly with the increase in geriatric patient population. The aim of this study was to investigate the effect of advanced age in reconstructive microsurgery procedures and analyze the association of other variables with complications and surgical success. Patients and Method:A retrospective review of 70 consecutive free tissue transfers between January 2012 and June 2013 was performed. Patients were divided into 2 groups: those younger than 60 years and those aged 60 years or older. Besides demographics, the American Society of Anesthesiologists (ASA) risk score, comorbid conditions, and anatomic locations for surgery (head and neck, extremities, trunk), operative time, need for reoperation, intensive care unit (ICU) admission and blood transfusion, length of hospital stay, medical and surgical complications, as well as partial and total flap loss were noted and analyzed. Results:A total of 71.4% of the patients were younger than 60 years (n = 50; average, 37.4 y), and 28.6% of the patients were 60 years or older (n = 20; average, 67.5 y). None of the other collected data showed significant difference between the groups. Although age was not associated with ICU admission, the location of the reconstruction site and the operative time were found to have a significant correlation with ICU referral. In this series, the operative time correlated with medical complications but not with surgical complications. Higher ASA scores did have a negative effect on the incidence of medical complications (P = 0.028). Conclusions:This retrospective review demonstrates that age alone is not an independent variable for increased risk in microvascular reconstruction. However, operative time, ASA risk score, and location of the reconstruction site are more associated with the overall success of free tissue transfers.

A rare complication after septoplasty procedure in a misdiagnosed submucous cleft palate case: Palatal fistula

Nasal septoplasty is a common and low-risk procedure performed very frequently in plastic surgery as well as in otorhinolaryngology. The development of a palatal perforation following a nasal septoplasty procedure is a very rare event with only a few cases reported in the literature. A patient with palatal fistula formation after septoplasty procedure is presented here, who was later on diagnosed with submucous cleft palate during the repair of the palatal fistula.

A complication of nasotracheal intubation after mandibular subcondylar fracture.

Among the potential risks of nasotracheal intubation are nasal bleeding, sinusitis, bacteremia, accidental turbinectomy, and some other structural damages. Retropharyngeal dissection is reported as a very rare complication of nasotracheal intubation, mostly encountered in elective surgery patients. A case with traumatic subcondylar fracture of the mandible is presented here, which is suspected to be the cause of the nasopharyngeal dissection that was observed during attempted nasotracheal intubation.

A new test for superficialis flexor tendon function.

Diagnosis of flexor digitorum superficialis tendon injury is difficult if the profundus tendon functions properly. A new test, called the DIP extension test, to diagnose isolated flexor digitorum superficialis tendon injuries is described. The test is particularly useful for the index finger. During the test the patient is asked to flex the proximal interphalangeal joint of the injured finger while this finger is in a precision pinch position with the thumb. The distal interphalangeal (DIP) joint normally has to go in hyperextension after this action. Inability to hyperextend the DIP joint confirms a superficialis tendon injury. Fifteen isolated superficialis tendon injuries in 10 patients were evaluated with the DIP extension test. Nine of these patients were later explored and the diagnosis was confirmed in all patients.

Microvascular anastomosis using Ankaferd blood stopper: demonstration of long-term histopathologic effects on vascular tissue.

Ankaferd blood stopper (ABS) (Ankaferd Ilaç Kozmetik A.Ş., Turkey) is a medicinal plant extract, which is used in Turkish traditional medicine as a haemostatic agent. The aim of this study was to investigate the haemostatic effect of ABS in preventing microvascular leakage on an anastomosis site and to look into its long-term impact on vascular tissue. Twenty-one Wistar albino rats were randomly divided into three groups. The animals in the second and third groups were pretreated with acetylsalicylic acid. All of the right femoral arteries were divided and anastomosed in an end-to-end fashion. Following microvascular anastomosis, saline-soaked gauze tampons were applied in the first and second groups. In the third group, ABS-soaked tampons were applied to the anastomosis sites. The mean bleeding time of group 3 was significantly shorter than group 2 and group 1. Three weeks after the operation, there were aneurysms on all of the anastomosis sites in group 3 and none of the anastomoses were patent. Histologic examination demonstrated increased inflammatory cell infiltration, tunica media degeneration and contraction of tunica intima in group 3. This is the first study reporting the long-term effects of ABS on microvascular anastomosis. Contrary to previously reported studies, this agent is not appropriate for use on injured or anastomosed vessels.

Anterior Pillarplasty: A Modification in Cleft Palate Repair

After the primary repair of cleft palate, surgeons are frequently confronted with a short soft palate and a wide velopharyngeal space, both of which are known to diminish the quality of speech. We introduce a new modification of the primary repair of cleft palate that lengthens the soft palate and helps to reduce the volume of the velopharyngeal space. Ten patients younger than 12 months with nonsyndromic cleft palate were operated on with this technique. The incision at the cleft margin extended behind the uvula as a modification to the classic design of mucoperiosteal flaps. The sagittally divided mucosal layers of each anterior tonsillar pillar are sutured at the midline 1 cm posterior to the new uvula. The rate of postoperative fistula formation and other complications were evaluated postoperatively. One patient had a uvular and partly pillar detachment at the postoperative period. All other clefts healed without complication. The primary repair of the cleft palate with the anterior pillarplasty technique is a safe and easy-to-perform procedure. This modification can effectively reduce the transverse diameter of the velopharyngeal space and increase the anteroposterior length of the palate.

Duplication of the mandible in Klippel–Feil syndrome

The duplication of the mandible is an extremely rare case, which was first described by McLaughlin in 1948 as a case report of duplication of the mouth, the tongue and the mandible. Betty in 1956 and Davies in 1973 reported similar cases. The duplication of the mandible may be associated with the Klippel-Feil syndrome (KFS). A low hairline, short neck with cervical vertebral fusion and painless limitation of the head movement are the characteristic findings of this syndrome. The incidence of the syndrome varies from 1/30,000 to 1/40,000. Although autosomal recessive inheritance was suggested, no familial inheritance was found in some cases. A very rare case of mandibular duplication in association with KFS, whose duplicated mass was removed following distraction, has been reported.