Sadık Şentürk

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.

Extensive cervicofacial necrotizing fasciitis of odontogenic origin: case report and literature review

Necrotizing fasciitis is a potentially fatal soft tissue infection characterized by generalized necrosis and gas formation in the subcutaneous tissues and fascia. It is rarely seen in the head and neck area. This report presents the case of a 62-year-old diabetic female patient with generalized cervicofacial necrotizing fasciitis extending to the front chest wall. The cause of the disease was the extraction of the infected second molar tooth. Debridement was performed on the generalized necrotic fascia, subcutaneous tissue, and the skin extending from the preauricular area to the front chest wall and nipples. A series of debridement procedures were necessary because of generalized necrosis. The patient received intensive medical supportive treatment. Following the debridement procedures, the defective area from the neck to the front chest wall was closed up with split-thickness skin graft. Abscessed tooth extraction can lead to cervicofacial necrotizing fasciitis. Necrotizing fasciitis still remains as a potentially fatal disease. Early diagnosis, early radical surgical debridement, and a multidisciplinary approach constitute the significant factors in preventing mortality in such patients.Level of Evidence: Level V, therapeutic study

Familial bilateral peritrochanteric lipomatosis

Sir, An unusual abnormal fat distribution of the lower part of the body is characterized by massive and symmetric deposits in the groins, trochanters, buttocks, and hips, which contrast sharply with the normal upper part of the body. The massive lipomatosis of the lower part of the body can be classified into three types: type 1, the familial symmetrical lipomatosis that affects the groins, trochanters, hips, buttocks, and thighs; type 2, the bilateral peritrochanteric familial lipomatosis; and type 3, the unilateral peritrochanteric lipomatosis. This deformity affects only women aged between 18 and 50 in the Mediterranean region [1]. Further, isolated abnormal bilateral peritrochanteric lipomatosis has rarely been reported in literature. We report two patients, a mother and her daughter, with isolated bilateral peritrochanteric lipomatosis, who had normal fat distribution of the upper half of the body which was in contrast with the abnormal lower half. The mother, a 42-year-old patient, presented with bilateral abnormal fat distribution of the lower part of the body. Peritrochanteric fat deposits had appeared at the age of 13 and increased with time. The physical examination revealed bilateral isolated, well-demarcated peritrochanteric lipomatosis and normal fat distribution of the upper half of the body (Fig. 1a). The patient was 167 cm tall and weighed 72 kg (body mass index [BMI]=25.8 kg/m). Laboratory and endocrinologic tests included the serum concentrations of lipoprotein, lipoprotein lipase activity, cholesterol, triglycerides, uric acid, fasting glucose, serum estradiol, and testosterone levels, and thyroid function parameters were within normal limits. Histological study of lipoaspirate showed subcutaneous fatty tissue. The daugther, a 22-year-old patient, also presented with bilateral abnormal fat distribution of the lower part of the body. The patients signs had appeared at age of 12 also increasing with time. The physical examination revealed bilateral isolated, well-demarcated peritrochanteric lipomatosis although it was more evident on the left side (Fig. 2a). The patient was 169 cm tall and weighed 67 kg (BMI=23.5 kg/m). Laboratory and endocrinological tests were within normal limits. Histological study of lipoaspirate showed subcutaneous fatty tissue. Both patients underwent general anesthesia and all procedures were initiated with infusion of tumescent solution (1 L normal saline solution, 30 mg lidocaine, and 1 mL of 1:1,000 epinephrine) [2]. A suction-assisted liposuction method was employed using 4and 6-mm cannulae. Suction started deep into the superficial fascia and ended with superficial liposuction [3]. Incisionswere closedwith6-0 polyprolene and dressings were applied. A second limited liposuction was planned to treat the irregularities in the first case. Results were satisfactory in both cases (Figs. 1b and 2b). Isolated abnormal bilateral peritrochanteric lipomatosis has rarely been reported in literature. In 2006, Goshtasby et al. presented a case of isolated bilateral peritrochanteric lipomatosis of the soft tissue overlying the trochanters [4]. The unusual distribution of fat in the lower body should be differentiated from the familial multiple nodular symmetrical lipomatosis, where the lipomas are nodular, circumscribed, subcutaneous in location, and more common on the extremities and trunk rather than around the neck, shoulder, or the upper torso [5]. Stavropoulos and his colleagues have suggested that the term symmetric lipomatosis referred to two separate disorders, benign multiple symmetric lipomatosis and female S. Şenturk (*) Department of Plastic and Reconstructive Surgery, Mevlana (Rumi) University Hospital, Konya, Turkey e-mail: drssenturk@hotmail.com