Ramazan Hakan Özcan

Comparison of static and dynamic splinting regimens for extensor tendon repairs in zones V to VII

Abstract The aim of this prospective, randomised, controlled trail was to compare two methods of rehabilitating extensor tendon repairs in zones V–VII. Patients who incurred simple and complete lacerations of their extensor tendons in zones V–VII enrolled into the study and underwent either static splinting (n = 25) or dynamic splinting (n = 27) after primary acute repair of tendons. Extension lag, flexion deficit, total active motion (TAM), grip strength, and functional status of upper extremities were measured. TAM was improved in the dynamic group when compared with the static group in the injured digits at 4 weeks (p = 0.001), at 12 weeks (p = 0.05), and at 6 months (p = 0.001). Grip strength outcomes demonstrated improved grip force for the dynamic group when compared with the static group at 12 weeks (p = 0.001). There were no ruptures in either group. Also, a better functional level was found in the dynamic splinting group at 6 months (p = 0.001). The findings of the current study suggest that dynamic splinting of complex lacerations of the extensor tendons in zones V–VII provides improved functional outcomes at 4 and 12 weeks and 6 months when compared with static splinting.

Survival of Minced Cartilage Grafts with Comparison Surgicel® Original and Fibrillar

BackgroundCartilage grafts are commonly used in nasal surgery for structural and/or esthetic purposes. The viability of cartilage grafts has been investigated in many forms since the use of cartilage grafts in surgical procedures.ObjectivesThe objective of this study was to investigate the viability of minced cartilage grafts and whether there is a difference between grafts wrapped in Surgicel® Original and Surgicel Fibrillar.MethodsA total of ten New Zealand rabbits were used for the study. Cartilage grafts were harvested from one side ear. Four groups were formed. Group 1: minced cartilage graft wrapped in Surgicel Fibrillar; Group 2: minced cartilage graft wrapped in Surgicel Original; Group 3: bare minced cartilage graft; and Group 4: bare diced cartilage graft. Four small subcutaneous pockets were made in the backs of the rabbits, and the grafts were placed in these pockets. All of the rabbits were sacrificed at the end of 3 months, and the samples were collected. The sections were stained with hematoxylin and eosin (H&E), toluidin blue, safranin-O, masson trichrome, and glial fibrillary acidic protein immunohistochemical. All specimens were assessed histopathologically under a light microscope.ResultsThere was no statistically significant difference between the Surgicel Fibrillar and Surgicel Original groups with respect to any of the parameters. Bone formation, calcification, inflammation, fibrosis, and basophilia were similar in all groups, with no significant difference among them. In the Surgicel Fibrillar and Surgicel Original groups, a heavy chondrocyte nucleus loss accompanied by a minimal peripheral proliferation was observed.ConclusionsThe viability of bare minced cartilage grafts was found to be similar to that of bare diced cartilage in this study. Minced cartilage grafts can be used in the correction of minor dorsal defects and irregularities in persons with thin nasal skins, especially in primary and revision rhinoplasty. Although there is no statistically significant difference between the Surgicel Fibrillary and Surgicel Original groups, we think that, if it is necessary to use oxidized regenerated cellulose, it should be in the fibrillar form.No Level AssignedThis 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 http://www.springer.com/00266.

The Use of the PlasmaBlade and Acellular Dermal Matrix in Rhinophyma Surgery A Case Report

Background: Rhinophyma is a rare, disfiguring disease characterized by a slow progressive overgrowth of the soft tissue of the nose associated with end-stage severe acne rosacea. Objective: We present a case of severe rhinophyma treated successfully using PlasmaBlade and acellular dermal matrix with split-thickness skin graft. Methods: This procedure combines deep excision with PlasmaBlade followed by coverage with an acellular dermal matrix for dermal substitution and split-thickness skin graft. Results: Functional and aesthetic results were satisfactory. Conclusion: We offer a new approach to surgical treatment of rhinophyma. Total excision of phymatous tissue and single session replacement of epidermal-dermal components is an effective treatment for patients with severe rhinophyma, resulting in satisfactory functional and aesthetic outcome. This combined treatment modality prevents the recurrence of rhinophyma. It should be considered an appropriate alternative in cases of severe rhinophyma.

Investigation of the relationship between severity of injury, return to work, impairment, and activity participation in hand and forearm injuries

BACKGROUND Forearm and hand injuries are the main cause of work-related disability. This study was planned to investigate the relationship between severity of injury, time of return to work, impairment, and activity participation of patients with hand and forearm injuries. METHODS One hundred and thirty patients who had patients who had had forearm or hand injuries with a mean age of 31±11.13 years participated in this study. Injury severity was evaluated using Modified Hand and Forearm Injury Severity Scoring (MHISS) after surgery. Patients were evaluated using the Jebsen Hand Function Test (JHFT) and Buck-Gramko scoring eight weeks after injury. Additionally, grip strength was evaluated with a dynamometer, and disability/symptom score was evaluated using the Turkish version of the Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire twelve weeks after injury. RESULTS A significant relationship between MHISS, hand strength, time of return to work, DASH-T, and Buck-Gramko scores of patients with forearm and hand injuries was identified (p≤0.05). Higher impairment was significantly related to body structure and body functions (1.86±1.47), and the most limited activity was writing (2.06±1.50) regarding ICF framework. CONCLUSION Higher MHISS scores were associated with delays in returning to work and lower activity participation. The DASH-T score was the most strongly associated with time of return to work. Furthermore, there is a positive relation between time of return to work and activity participation of patients.

Effect of reduction mammoplasty on the pulmonary function tests

Introduction Bilateral breast reduction surgery is the surgical treatment of bilateral breast hypertrophy. This is one of the most common breast surgery requested by women, and performed by plastic surgeons. The reasons that patients want this surgery are to re-size sagging breasts aesthetically, and to get rid of somatic symptoms such as shoulder, chest, back, and neck pain. We believe that the objective positive effects of breast reduction surgery exist beside aesthetic. In our study, our aim is to elicit positive effects of surgery on lungs, if there are, by making pulmonary function test and carbon monoxide diffusion test before surgery and after 6 months of surgery. Materials and Methods Thirty patients agreed to participate in the study. Study is completed with 19 patients. Pulmonary function test and carbon monoxide diffusion test were made to all patients in preoperative and 6 months of postoperative period. Lung roentgenogram of all patients was performed and height, weight, body mass index were measured. Saturation level was measured. Result There was a meaningful increase in FEV1 and FVC values in the postoperative period in comparison with pulmonary function test performed in preoperative period. DLCO in postoperative period decreased meaningfully as compared to the preoperative period. Conclusions Breast reduction surgery seems to have positive effects on pulmonary function test values and relaxes patients clinically. Patients with big breasts should be evaluated from this perspective if they apply chest diseases clinic with shortness of breath.

Surgical Treatment of Classic Kaposi’s Sarcoma in the Lower Extremity

Objective: Classic Kaposi’s sarcoma is an indolent, angioproliferative tumor that is usually observed in the lower extremities of elderly men. Depending on their stages, skin lesions are maculonodular or vegetative ulcerated masses. Visceral organ or lymph node involvement may rarely occur. There is no gold standard treatment for local diseases. Surgical excision, radiotherapy, chemotherapy, and cryotherapy can be performed. This retrospective study aimed to evaluate the long-term results of surgical excision and skin graft repair of stage I and II classic Kaposi’s sarcoma skin lesions around the foot and ankle.

A rare cause of carpal tunnel syndrome: Fibroma of the tendon sheath

A fibroma of tendon sheath (FTS) is most commonly found in the hand. FTSs are usually seen in the fingers after the age of fifty and are clinically slow-growing well-defined mass. Here, we report the case of a 26-year-old man who featured a compression of the median nerve at the carpal tunnel secondary to a FTS of the flexor digitorum superficialis. Fibromas of a tendon sheath that compress the median nerve (MN) are rare causes of carpal tunnel syndrome (CTS). The patient was admitted with chief complaints of a growing bulge, numbness and pain in the left palm for 6 months (Figure 1A). There was a history of wrist fracture w8 months prior. Upon examination of the left-hypothenar region, a nonmobile, solid mass was detected, with no associated edema, erythema, or increased warmth. Following magnetic resonance imaging (MRI) the diagnosis of a regular soft-tissue mass under the hypothenar muscle, which was applying pressure to the carpal tunnel (Figure 1B) was suspected. Neurological and vascular examinations were unremarkable, and electrophysiological studies were not performed. The mass was totally excised under regional anesthesia. Macroscopically, the tumor was a smooth, dense, well-circumscribed, multinodular mass (Figure 1C). Final histological examination showed a circumscribed and lobulated hypocellular mass containing dense fibrocollagenous stroma with scattered spindleshaped fibroblasts without inflammatory cells. Narrow, slit-like vascular spaces were also present (Figure 1D). These histological findings were diagnostic of FTS. There were no operative or postoperative complications, and after surgery, the patient’s complaints of pain and numbness passed. Two years later, the patient remained free of symptoms and showed no recurrence.

Surgical repair of the isolated incomplete median cleft lip

Median cleft lip refers to a vertical cleft on the midline of the upper lip. It is a rare congenital craniofacial anomaly brought about by a fusion failure in the medial nasal prominence. A novel surgical approach to median cleft lips and their repair is reported herein, with reference to a clinical case. The patient had a cleft in the lower half of the upper lip. There were no other craniofacial anomalies in this patient other than the cleft. Within the framework of the patients surgical treatment, a functional and cosmetically satisfactory result was achieved by performing a V-Y advancement flap on the columella base, Z-plasty in the vermillion zone, and Z pattern muscular tissue repair, without having to resort to any tissue excisions.

The treatment of tissue defects related to the compartment syndrome occurring in the fibula osteocutaneous free flap donor area with vacuum assisted closure therapy.

Today, fibula osteocutaneous flap is commonly used for the reconstruction of segmental mandible defect. Early and late donor site complications have been reported in the literature. The most serious early complication of flap donor sites is compartment syndrome. Compartment syndrome in the donor area may develop depending on the increase in the intracompartmental pressure as a result of the largeness of skin flap and the primary closure of the donor area. In this letter, we present a case of the compartment syndrome which is developed in osteocutaneous fibula flap donor area containing 4-cm wide skin area, and the treatment of related tissue defect with vacuum-assisted closure (VAC) therapy. A 58-year-old male patient applied to our clinic complaining of wounds in the jaw and mouth existing for 5 months. In physical examination, a 9 3 6 cm expansive mass was identified as fixed to mandible and invaded in the mouth. Bone destruction was observed in radiological examination. Routine laboratory examinations were in normal range. In surgical treatment, segmental mandibulectomy and unilateral neck dissection was performed. Fibula osteocutaneous flap was planned for oral cavity mucosa defect and segmental mandible reconstruction. On the posterior crural intermuscular septum, perforator artery was determined with Doppler ultrasound. Under the pneumatic tourniquet, with standard lateral approach 12 3 4 cm flap