Samet Vasfi Kuvat

Oropharyngeal airway changes following bimaxillary surgery in Class III female adults.

AIM The aim of this study was to evaluate oropharyngeal airway changes following Le Fort I maxillary advancement and impaction with mandibular setback in Class III deformity. SUBJECTS AND METHODS 53 female Class III patients (mean age: 24.9+/-0.8 years) had Le Fort I maxillary advancement with impaction, and mandibular setback osteotomies. Lateral cephalograms were taken before (T0), one week postoperatively (T1) and 1.3+/-0.2 years after (T2) bimaxillary surgery. Paired t and Pearson tests were used to evaluate the changes. RESULTS The mandibular plane-hyoid, upper retropalatal airway space (URP) and hyoid to horizontal reference plane (HY-HOR) distances significantly increased and the third vertebra to menton, hyoid to vertical reference plane (HY-VER) distances decreased in the T0-T1 period. Relapses were found in mandibular plane to hyoid (MP-HY), URP, HY-HOR, third cervical vertebra to menton (C3-Me) and HY-VER distances in T1-T2 period. Correlations were found between the mandibular retraction and increases of the narrowest retropalatal (r: 0.29, p<0.05) and lowest retropalatal airway spaces (r: -0.30, p<0.05) and posterior movement of hyoid (r: 0.60, p<0.001). CONCLUSIONS Bimaxillary surgery caused an increase in the URP, together with posterior and inferior movement of hyoid bone one week postoperatively. Some relapse was found in these changes over one year later.

Changes in soft tissue profile after mandibular setback surgery in Class III subjects

The aim of this study was to investigate changes in hard and soft tissue profile after mandibular setback surgery. Lateral cephalograms of 25 Class III subjects were assessed before and 1.5+/-0.4 years after mandibular setback surgery. Paired t test, Pearson correlation test and linear regression analysis were used to evaluate the changes in soft tissue profile. Significant changes were found in skeletal (SNB -3.6+/-0.9 degrees, ANB 3.7+/-1.0 degrees, overjet 5.0+/-1.2 and overbite 2.5+/-1.1 mm, P<0.001), soft tissue (facial convexity 5.9+/-1.6 degrees, P<0.001; labiomental fold 0.6+/-0.6 mm, P<0.001; upper and lower lip protrusion 0.5+/-0.8 mm, P<0.01; -3.3+/-1.2 mm, P<0.001), and upper and lower lip lengths (0.9+/-1.2mm, P<0.01; -1.8+/-2.1 mm, P<0.001). Correlations were found between facial convexity and SNB and ANB angles and between upper lip length and SNB and ANB angles. The change in lower lip length was correlated with SNB, ANB, overjet and overbite. Lower lip retrusion was correlated with overjet and a significant correlation was found between the retrusion of lower incisor and lower lip. Mandibular setback surgery was effective in producing an orthognathic profile in adult Class III subjects with mandibular prognathism.

Current Concepts in the Management of Marjolin's Ulcers: Outcomes From a Standardized Treatment Protocol in 16 Cases

Marjolins ulcer is a malignant lesion observed in chronic wounds and in areas where the integrity of the skin is compromised because of any one of several reasons. The aim of this study was to define etiology, topography, and histopathology for Marjolins ulcer and its surgical management. Sixteen cases were diagnosed and treated as Marjolins ulcers. The mean age was 57.1 years (range, 32–85 years) and 15 of the patients (93.75%) had history of ulcer of 30 years or more. In 10 cases (62.5%), Marjolins ulcer occurred after a flame burn and in 6 cases (37.5%) after a scalding burn injury. In six cases (37.5%), there was history of chronic trauma due to contact with the clothing. Primary lesions were at the leg, gluteal region, thigh, scalp, trunk, and hand in four (25%), three (18.7%), two (12.5%), two (12.5%), three (18.7%), and two (12.5%) cases, respectively. Amputation was carried out to treat two cases, and repair of the defects with partial-thickness skin grafting was performed in 14 cases after tumor resection on the skin. Superficial inguinal lymph node dissections were performed in four cases with tumor in the thigh and a positive inguinal lymph node. Squamous cell carcinoma was diagnosed in 14 cases (87.5%) and basal cell carcinoma in two cases (12.5%) postoperatively. The authors conclude that diagnosis and surgical planning based on the recent literature must be carried out even more intensively to improve the prognosis of Marjolins ulcer.

Changes in head posture and hyoid bone position in Turkish Class III patients after mandibular setback surgery

The aim of this study was to determine the changes in head posture and hyoid bone position after mandibular setback osteotomy in Turkish adult Class III patients. Serial lateral cephalograms of 42 Turkish Class III patients (24 female, 18 male patients, mean age: 25.4+/-1.2 years) who underwent mandibular setback surgery were evaluated preoperatively, 1.2+/-0.6 years, 2.3+/-0.8 and 4.2+/-0.9 years postoperatively. A mean mandibular setback of 5.6+/-0.8mm was associated with a posterior and inferior movement of the hyoid bone and a significant flexion in the neck posture. Surgical correction of mandibular prognathism altered the position of the hyoid bone by downward repositioning carrying the root of the tongue downwards immediately postoperatively, but followed with a tendency to return to its original position.

The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats

Previous studies have shown that nicotine increases the risk of necrosis in skin flaps. We investigated the effect of hyperbaric oxygen (HBO(2)) treatment on the survival of random skin flaps in nicotine-treated rats. Thirty-two Sprague-Dawley rats were divided into four groups with eight rats in each group. Group 1 (n=8) was the control, group 2 (n=8) received HBO(2) treatment without being exposed to nicotine, group 3 (n=8) received nicotine and group 4 (n=8) received HBO(2) treatment with exposure to nicotine. The rats in the nicotine-treated groups were prepared by treating them with nicotine for 28 days. At the end of the 28th day, standard McFarlane-type random skin flaps were lifted from the backs of all the rats. In groups 2 and 4, HBO(2) treatment started at the 30th min following the surgery and continued once a day for 7 days. The flap survival rates and histopathological evaluation results related to neovascularisation and granulation tissue formation were significantly better in the HBO(2)-treated groups (groups 2 and 4) than in the groups that did not receive HBO(2) treatment (groups 1 and 3) (p < 0.05). The flap survival rates, neovascularisation and granulation tissue formation were highest in group 2 and lowest in group 3 (p ≤ 0.001). No significant difference was observed between group 4, which received HBO(2) treatment with nicotine exposure, and the control group (group 1) (p > 0.05). In conclusion, our study demonstrates that HBO(2) treatment has a positive effect on flap survival in nicotine-treated rats.

Ultrasonographically determined pedicled breast reduction in severe gigantomastia.

Background: The free nipple breast reduction method has certain disadvantages, such as nipple hyposensitivity, loss of lactation, and loss of projection. To eliminate these risks, the authors describe a patient-based breast reduction technique in which the major supplier vessels of the nipple-areola complex were determined by color Doppler ultrasonography. Pedicles containing these vessels were designed for reductions. Methods: Sixteen severe gigantomastia patients with a mean age of 41 years (range, 23 to 60 years) were included in the study. Major nipple-areola complex perforators were determined with 13- to 5-MHz linear probe Doppler ultrasonography before surgery. Pedicles were designed according to the vessel locations, and reductions were performed with superomedial-, superolateral-, or mediolateral-based designs. Results: Different combinations of internal mammary and lateral thoracic artery perforator–based reductions were achieved. None of the patients had areola necrosis. Mean reduction weight was 1795 g (range, 1320 to 2280) per breast. Conclusions: Instead of using standard markings for severe gigantomastia patients, custom-made and sonographically determined pedicles were used. This technique can be considered as a “guide” for the surgeon during very large breast reductions.

Improving bony stability in maxillofacial surgery: use of osteogenetic materials in patients with profound (≥5 mm) maxillary advancement, a clinical study

PURPOSE LeFort I osteotomy is a part of the standard surgical regimen in the treatment of patients with Class III dentofacial deformity. Inadequate osteosynthesis between the segments is a problem in patients with profound (> or =5mm) maxillary advancement. In this study an ideal ossification is aimed for by applying a combination of osteoinductive and osteoconductive materials. PATIENTS AND METHODS Ten patients with Class III deformity were included in this study. At least 5mm of advancement was performed on each patient, while mean maxillary advancement was 5.7 mm. Human demineralised bone matrix (DBM, 1 cc) and 20 mg bovine bone collagen-protein extracts (Colloss) were applied in between the segments following rigid fixation. Recurrence rates were calculated via cephalometric analyses. Multislice tomography images were collected after the 3 and 12 months in an effort to document ectopic or abnormal bone growth patterns, if any present. Four patients underwent a second operation for plate removal 12 months postoperatively. Bone biopsies were collected from the anterior maxillary wall. RESULTS The cephalometric analyses performed after 3 and 12 months were identical to the analyses calculated 1 week postoperatively for each patient, ruling out recurrences. No abnormal or ectopic bone growth was observed. Peroperative examination of four patients revealed a complete or near to complete osteosynthesis line at the anterior maxillary wall. The microscopic examinations of the bony samples retrieved from these borders revealed abundant osteoblasts, osteocytes, osteoclasts and a bony regeneration mimicking intramembranous ossification with its trabecular organisation. CONCLUSIONS It is possible to achieve an acceptable line of osteosynthesis in cases in need of profound maxillary advancement by applying DBM and Colloss inbetween the bony segments.

A variant course of the superficial palmar branch of the radial artery

The objective of this report was to present a case of superficial palmar branch of the radial artery (SPBRA) with a variant course, which to the best of our knowledge, has not been reported in the literature. During anatomical dissections that were carried out in the Department of Anatomy of Suleyman Demirel University School of Medicine to demonstrate the superficial palmar arch, a variation in the course of the SPBRA was noted in the right hand of an adult cadaver. This variant branch ran superficial to, and in contact with, the flexor retinaculum, and ran transversely to join the ulnar artery.

Efficacy of the Combination of Intraoperative Cold Saline-Soaked Gauze Compression and Corticosteroids on Rhinoplasty Morbidity

Objective. The basic aim of this study was to minimize intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis and to reduce morbidity with a combination of cold saline-soaked gauze compression and intraoperative single-dose corticosteroids. Study Design. The study was designed as a prospective, double-blind, randomized controlled study. Three hundred patients who underwent septorhinoplasty were included. Setting. A tertiary referral hospital in Turkey. Subjects and Methods. Three hundred patients undergoing septorhinoplasty were divided into 2 groups. A single dose of 10 mg dexamethasone was intravenously administered in all cases at the beginning of the operation. In the study group, the nasal dorsum was continuously compressed with cold saline-soaked gauze during the operation. In the control group, the nasal dorsum was compressed with dry gauze continuously during surgery. The operation time and amount of bleeding were recorded during surgery. Degree of eyelid edema and periorbital soft tissue ecchymosis was recorded at 24 hours and on postoperative days 2, 3, 5, and 7 by 2 investigators. Results. The operation time was significantly shorter in the study group than in the control group. Eyelid edema and periorbital ecchymosis were significantly decreased in the study group at the following postoperative days 1, 3, 5, and 7 (P < .05). Conclusion. Bleeding, edema, and ecchymosis are the main morbidities of rhinoplasty. It is highly probable that cold compression and intraoperative corticosteroids have synergistic effects on these morbidities, especially by the intraoperative control of bleeding.

Electrothermal Bipolar Vessel Sealer in Endoscope-Assisted Latissumus Dorsi Flap Harvesting

LigaSure™ is a new bipolar vascular sealing system commonly used in various fields of surgery. However, no reports have been published about its use in plastic surgery, particularly for endoscopic flap harvesting. In this study, we present the use of LigaSure in endoscope-assisted latissimus dorsi (LD) flap harvesting for breast reconstruction. Between 2006 and 2008, 11 female patients with the mean age of 33.4 (range, 20-49 years) who had previously undergone mastectomy operations were included in the study. First stage of reconstruction was performed with the ipsilateral LD harvested by the help of LigaSure and a tissue expander placed beneath the LD and pectoralis major muscles. Secondary reconstruction was done by a definitive silicon gel-filled implant placed after an average of 6.6 months of expansion (range, 6-9 months). Data concerning the hospitalization and operation times, drainage amounts, complications, etc., were recorded. Mean follow-up was 13 months (range, 8-18 months). Mean flap harvesting time was recorded as 74.2 minutes (range, 50-125 minutes), which shortened as the surgeon got used to the procedure. Patients were hospitalized for 3-7 days, with a mean hospitalization period of 5.5 days. The total mean drainage amount postoperatively was found to be 950 mL (range, 725-975 mL), which is relatively lower than the previously reported values. LigaSure use in endoscope-assisted LD harvesting is easy, safe, and time sparing with almost no complications observed in this small initial series. Although more controlled studies with larger number of patients need to be done to verify its effectiveness in terms of hospitalization, drainage amounts, etc., it holds promise for a wide spectrum of operations in the field of plastic surgery.