Salih Onur Basat

Five-Years Trigger Finger Due to Partial Flexor Tendon Laceration in a Child

Trigger finger (TF) is a condition that affects quality of life and one of the most common causes of hand pain and disability. TF is characterized by catching, snapping or locking of the involved finger flexor tendon, associated with pain. TF in the children occurs rarely than in adults and partial tendon laceration is an uncommon cause of TF in the children. Thus, our aim in this study to define TF due to partial flexor tendon laceration in a child.

Preventing Suture Extrusion and Recurrence in Mustarde and Furnas Otoplasties by Using Laterally Based Postauricular Dermal Flap, Long-Term Results.

Background:Prominent ear deformity (PD) is an unacceptable condition of pinna that affects 5% of the population and is associated with emotional stress, behavioral disturbances, and social restrictions in relationships. Conchal hypertrphy, inadequate formation of antihelical fold, earlobe placement ahead than it should be, or various combinations of these changes are main characteristics of PD. Many surgical techniques have been described for the PD.The authors’ aim was to present laterally based postauricular dermal flap combination with cartilage-sparing methods and effectiveness of this technique in suture extrusion prevention and reducing the rate of recurrence with long-term results. Methods:Forty-one patients had bilateral and 6 patients had unilateral PD, a total of 47 patients with a mean age of 14.48 were operated by using this combined procedure. A laterally based supraperichondrial dermal flap was prepared from a deepithelized elliptical postauricular incision. Mustarde and Furnas suture techniques were used solely for PD correction. The dissected laterally based dermal flap was fixed to the mastoid bone with sutures in stretched position after reshaping the auricular cartilage with sutures. Results:The average helix–mastoid distance was (mm) 16.28 ± 2.36, concha-mastoid angle was 25.71 ± 0.96° on 12-month measurements. The helix–mastoid distance showed an increase of 1 to 3 mm, in the concha-mastoid angle measurements of 1° to 2°. Statistically significant changes were observed between the average preoperative, postoperative 1. month, postoperative 12. month helix–mastoid distances (mm), and month concha-mastoid angle (°) measurements (P = 0.0001). Conclusions:The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.

Digital artery perforator flaps: an easy and reliable choice for fingertip amputation reconstruction.

OBJECTIVE The aim of this study was to evaluate the use and efficacy of digital artery perforator (DAP) flaps in fingertip reconstruction. METHODS From 2007 to 2011, 7 fingers of 5 patients (4 male, 1 female) underwent fingertip reconstruction with extended DAP flaps following traumatic fingertip amputation. Average flap size was 4.25 cm². RESULTS All flaps survived except one case in which partial skin necrosis was observed and treated with wet-dressing. Donor sites were closed with full-thickness skin grafting in 5 and primarily in 2 fingers. We did not observe hypersensitivity or cold intolerance in repaired fingers. CONCLUSION The DAP flap is a reliable, free-style perforator flap that can be used for all types of fingertip injuries.

Creating a neoconchal complex using the adjustable conchal sliding technique in prominent ear correction.

Abstract An oversized aural concha plays a significant role in prominent ear deformities and should be taken into consideration during preoperative examination. In the current study, we present a procedure known as the conchal sliding technique as an alternative to more disruptive methods. Twenty-four patients (9 females and 15 males; 47 ears in total) underwent a conchal sliding procedure between 2006 and 2010. During the surgery, a wide subperichondrial dissection is performed after a posterior elliptical incision. After the concha is exposed as a hemisphere, it is split along its long axis to reveal the medial and lateral cartilage segments. These segments are gently scrolled upon each other. Transposition of the lateral segment posteriorly to the medial segment replaces the whole ear toward the posterior direction. Three mattress sutures (4–0 polypropylene) reliably secure the repositioned and setback conchal bowl. If needed, an antihelix can be formed using neoconchal-scaphal mattress sutures. Median follow-up period was 24.3 months (range, 6–48 mo). A unilateral hematoma developed in 1 patient and an anterior step deformity occurred in another. No recurrence, infection, necrosis of the skin, distortion of the auditory canal, or formation of keloid was observed in any of the patients. The median cephaloauricular angle was measured as 46 degrees before the surgery and 26 degrees after the surgery, whereas the distance between the helix and the mastoid was 23 mm before the surgery and 11 mm after the surgery. All the patients were satisfied with the results. This technique provides stable and natural results by creating a safe neoconchal complex. It may be a safe and reliable solution to an oversized aural concha, enabling natural-looking and positive cosmetic results.

The Effects of Mucoperichondrial Flap Elevation on Septal L-strut Cartilage: A Biomechanical and Histologic Analysis in a Rabbit Model

Background: The harvesting of septal cartilage following mucoperichondrial flap elevation has almost become a standard step in rhinoplasty. However, the strength of the remaining septum has not yet been evaluated. In the current experimental study of a rabbit rhinoplasty model, the remaining septum following a graft harvest was analyzed both biomechanically and pathologically. Methods: Forty New Zealand rabbits were classified into four equal groups. Group 1 consisted of the animals in which unilateral elevation of the mucoperichondrial flaps was undertaken before the graft harvest, group 2 consisted of the animals in which bilateral elevation was undertaken, group 3 included the animals where the septum was exposed and left untouched after a bilateral mucosal flap elevation, and group 4 was designated as the control group. Specimens were analyzed under light microscopy for multiple parameters. Biomechanical analyses were performed with a universal testing device at the Department of Engineering, Biomechanical Laboratories, Istanbul Technical University. Results: Biomechanical analysis in terms of maximum tension revealed significant results among the groups (p = 0.008). Although insignificant results were observed overall using a pathologic analysis, the amount of chondrocytes was lower in group 2 than in group 1 (p = 0.099). The amounts of matrix collagen (p = 0.184) and fibrosis were (p = 0.749) higher in group 2 than in group 1. Conclusions: From these data, the authors conclude that mucoperichondrium integrity plays a crucial role in the biomechanical strength of the septum. More sophisticated studies with further pathologic analysis are required to determine the exact mechanism of strength loss observed with mucoperichondrial flap elevation.

Triphalangeal Thumb with Polydactyly: An Alternative Surgical Method

Triphalangeal thumb (TPT) is congenital hand anomaly which a thumb consists of three phalanges. Thumb appearance can differ widely; the thumb can be longer than usual or it can be deviated in the radio-ulnar plane. Thumb strength and function can be significantly diminished. The goals of surgical treatment are to reduce the elongated thumb length, establish normal thumb function, maintain a stable joint and improve thumb position if necessary. In general, surgical treatment is performed for improvement of thumb function. The case presented here had a TPT with pre-axial polydactyly. The TPT was well developed but it had no movement at the proximal or distal interphalangeal joints. The rudimentary thumb had a well-developed and functioning interphalangeal (IP) joint. So as an alternative surgical technique we planned to transfer the functioning IP joint of rudimentary thumb to the TPT.

Histologic and Biomechanical Evaluation of the Effects of Social Stress and the Antidepressant Fluoxetine on Tendon Healing in Rats

Impaired wound healing in humans under psychological stress and the positive effects of antidepressant drugs on wound healing were also shown in the literature. However, there are currently no studies regarding the effects of antidepressant drugs on tendon healing. The aim of this study was to compare tendon healing under normal conditions versus social stress. We also aimed to perform a histological and biomechanical analysis of the effects of the antidepressant drug fluoxetine on tendon healing. Sixty Sprague Dawley rats were divided into six groups. A social stress regimen was used to stress the rats. The use of fluoxetine in the social stress group yielded significantly better biomechanical results and the collagen organizations of the fluoxetine group were more similar to the normal tendon collagen organization. Fluoxetine seems to inhibit the negative effects of stress on tendon healing and seems to improve tendon healing.Levels of Evidence: Level 5

Unusual burn injury in a child caused by a cleaning agent.

Cleaning agents are rarely responsible for chemical burn injuries. They are capable of causing severe burns even after a short exposure. This kind of chemical burn injury is uncommon for pediatric age group. We would like to report an unusual presentation of a domestic alkali burn in an infant. A 13-month-old male infant was referred to our clinic with a 3 6-cm size dark colored skin lesion on his right gluteal region. The parents reported an accidental contamination of the child’s diapers with a cleaning agent. The initial look of the lesion resembled an eschar tissue resulting from a third-degree burn. A closer examination of the skin revealed that an intact area of dark discolored skin was surrounding the damaged tissues. The pediatrics department was consulted to rule out other etiologies and child abuse. The manufacturer of the cleaning agent suggested an exothermic reaction between urine and domestic alkali as a possible cause of burn injury besides the caustic actions of the cleaning agent. Other chemical reactions between urine and contents of the cleaning agent produced pigments, which resulted in staining of skin. The patient was treated initially with local wound care, and the wound was subsequently covered with a partial thickness skin graft. Burns caused by domestic alkalis has some unique features. They are usually painless, and the development of a thick eschar is rapid, which makes estimation of the depth of the burn during the initial examination difficult. Other chemicals in the environment can react with domestic alkalis causing further damage or confounding clinical picture. Production of safer containers must be promoted to prevent injuries in pediatric group related to cleaning agents. Abuse or neglect has been recognized in 10 to 25% of childhood burn injuries. Appropriate measures including hospitalization should be taken because the risk of subsequent injury is high if the child returns to same environment. In our case, controversial history of trauma and isolated injury to buttocks were two findings associated with neglect and abuse. A thorough investigation proved that no abuse or neglect was present. Medical professionals dealing with pediatric burn cases should be aware of relevant social problems.

PSEUDOANGIOMATOUS STROMAL HYPERPLASIA (PASH) OF THE BREAST IN AN ADOLESCENT: A CASE REPORT AND LITERATURE REVIEW

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative lesion of the breast stroma characterized by slit-like pseudovascular spaces lined by endothelial-like spindle cells. It is frequently found as incidental microscopic foci in the female breast and in gynecomastia of the male breast, but it rarely presents as a clinical problem. We report a case of bilateral extreme breast enlargement caused by PASH in an adolescent girl who was treated with subcutaneous mastectomy and reconstruction with breast implants following a recurrence after treatment with free nipple graft breast reduction. Keywords: Pseudoangiomatous stromal hyperplasia, mammaplasty, breast implants.

The effects of limited adventitiectomy on vascular anastomosis: An experimental study in rats

Abstract Objective: Blockages in anastomotic vessels cause complete loss of free tissue transfer and replanted limb. Many studies have been conducted in the last 30 years to solve this problem. There are insufficient studies dealing with the effects of the limited adventitiectomy done before surgery for sympathetic overactivity leading situations. The aim of this experimental study is to reveal the effects of limited adventitiectomy. Methods: In this study, limited adventitiectomy was performed in a wide area before surgery, and the effect of this practice on the vessel diameter and anastomosis was investigated. Results: Rapidly growing dilatation and increase in vessel diameter was observed, and dilatation continued in the limited adventitiectomy group. Conclusions: The preoperative performed limited adventitiectomy is a useful preparation for super microsurgery. Especially in clinical practice before the free flap surgery, limited adventitiectomy can be applied if the recipient site is expected to have vascular problems.