Sarper Yılmaz

viability of Diced, Crushed Cartilage Grafts and the Effects of Surgicel (oxidized Regenerated Cellulose) on Cartilage Grafts

The viability of cartilage grafts has been well documented; however, controversy still exists about the viability of crushed cartilage. Recently, there has been a tendency to use diced cartilage grafts wrapped with oxidized regenerated cellulose (Surgicel) sheets for improving dorsal contour in rhinoplasty. The viability of diced cartilage grafts and the effect of Surgicel on cartilage grafts are not well known. In this study, we used ear cartilage from 18 New Zealand rabbits. Cartilage grafts were transplanted to surgically created subcutaneous pockets on the back of the rabbits on both the left and right sides. There were three groups: (1) intact cartilage grafts, (2) crushed cartilage grafts, and (3) diced cartilage grafts. The grafts that were transplanted to the right side were wrapped with Surgicel. Cartilage grafts in all groups were viable. In grafts that were wrapped with Surgicel, a marked increase in the collagen content was investigated. Grafts that were wrapped with Surgicel demonstrated no evidence of proliferation, whereas the bare cartilage grafts demonstrated significant amounts of proliferation.

Diabetic ketoacidosis and rhino-orbital mucormycosis

Mucormycosis often develops in immunocompromised patients, particularly in patients with diabetic ketoacidosis. Unless early diagnosis and treatment is established mucormycosis leads rapidly to death. A 38-year-old woman was admitted to the hospital with a severe diabetic ketoacidosis. Her clinical status improved in 4 days as a result of aggressive medical treatment. She has complained left cheek pain on the 10th day and had a swelling of her left cheek, facial edema, a black eschar on the palate and nasal cavity in association with visual disturbance and total ophthalmology in a short time. CT scan revealed left orbital cellulitis and pansinusitis. Excessive surgical treatment was performed and liposomal amphotericin-B, 4 mg/(kg day) was applied. Extensive fungal invasion of the orbit and the sinuses was demonstrated in the pathological species and Rhizomucor species were yielded with culture. Repeated superficial debridement was also performed. After 10 weeks, she was discharged with suggestion of insulin treatment and liposomal amphotericin-B with progressively decreasing doses. At the 13th month following the presentation, the patient was free of disease as confirmed by serial imaging and under good glycaemic control with insulin treatment. Although mucormycosis is a fatal infection, early diagnosis and aggressive treatment may decrease mortality.

The seven flap Z-plasty revisited

Although multiple Z-plasties are widely used for burn contractures, the seven flap Z-plasty procedure has not gained wide acceptance in plastic surgery practice. However, the technique has the advantage of achieving more elongation than other Z-plasty techniques. The technique safely performed with satisfactory results in 31 cases.

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.

THE EFFECTS OF TISSUE EXPANSION ON SKIN LYMPH FLOW AND LYMPHATICS: AN EXPERIMENTAL STUDY IN RABBITS

Histomorphological, physiological, and biomechanical changes of the skin and tissue that are being expanded have been extensively studied in the past. The purpose of this study was to investigate whether the skin lymph flow and lymphatics may be influenced during tissue expansion, and also to study different pattern of vascular supply of skin on lymph flow during tissue expansion. The skin lymph flow was quantitatively assessed by 99mTc-dextran lymphoscintigraphy, and the structure of dermal lymphatics was evaluated by histological examination in 12 rabbits. Lymphoscintigraphic results showed that lymph flow is significantly reduced both in expanded and non-expanded (sham-operated) skin. Histologically, we saw widespread lymphatic distension in both expanded and non-expanded skin. There were no quantitative differences in the number of lymphatic vessels compared with control skin. We did not see any lymphatic capillaries in the subdermal capsule of either expanded or non-expanded skin. These results show that lymphostasis has an obstructive (mechanical) aetiology, and the tissue expander itself reduces the lymph flow regardless of expansion, and interferes with the formation of new lymphatic vessels.

Otoplasty with an unusual cartilage scoring approach

Abstract Background: An ideal otoplasty procedure should minimise the possible risk of severe complications of otoplasty and provide a good aesthetic outcome; however, there is no standart technique to be applied to all types of auricular deformities in different populations. The aim of this study was to present an otoplasty technique with posterior approach in which small incomplete cartilage incisions and suture fixations were used to form the auricle without a need for anterior skin incision and dissection. Methods: This study involved 42 patients who had bilateral prominent ears with unfurled antihelixes associated with or without conchal excess. The otoplasty procedure mainly consisted of a posterior skin excision, incomplete cartilage incisions in the shape of greater mark, “>”, mattress sutures of the posterior cartilage, earlobe correction, and conchal reduction if necessary. Results: This otoplasty technique consists of easy, simple, and rapid surgical steps without a need for anterior skin dissection and cartilage scoring, so it has a low rate of complications in both early and late postoperative periods. Follow-up time of patients ranged from 1–9 years, with an average of 3 years. No major complications such as haematomas, chondritis, wound infection, skin necrosis, asymmetry, recurrence, hypertrophic scars, granulomas, or irregularities developed in the early and late postoperative periods. A good symmetry and natural appearence were achieved with this otoplasty technique. Patients were satisfied with the results. All over complication rate in the postoperative period was 7%. Conclusion: The presented technique overcomes the drawbacks of anterior skin dissection and anterior scoring, and minimises the risk of severe complications such as anterior skin necrosis, cartilage necrosis or destruction, and ear irregularities. It also reduces the operation time, swelling, bruising, and possibility of suture extrusion and recurrence.

Management of scar contractures of the hand using Z advancement rotation flap

Functional consequences of hand contractures may lead to extreme impairment in hand functions so repair of the contractures can solve the problems related to hand functions. Different forms of z plasties have widely been used for the release of scar contractures. In this study, a useful z plasty technique, z advancement rotation flap (ZAR) was adapted for the release of hand contractures in the way of using only local tissues. Fourteen consecutive patients who had hand contractures, were treated successfully with z advancement rotation flap technique. They suffered from hand contractures for at least one year which were localized in wep spaces, flexor surfaces of the digits, first wep space, palmar area and extensor surface of the hand. Contractures are all in mild severity, restricting some of the hand motions moderately. In all patients, hand contractures released completely and clinically normal joint motions were achieved, improving extension, flexion and abduction ranges of fingers without any difficulty. All advanced and rotated flaps healed uneventfully. No major complications appeared such as infection, hematoma, suture dehiscence, flap congestion or necrosis. When dealing with this technique for release of hand contractures, it may offer a versatile alternative to well known z-plasty methods used particularly for hand contractures.

An easy, rapid, and reproducible way to create a split-thickness wound for experimental purposes.

Abstract Partial-thickness wound models of rat skin have some difficulties in creating the wounds in equal size and depth. Moreover, making a split-thickness wound on the rat skin seems not to be simple and rapid. A new alternative method was presented here to overcome these obstacles, by using a waterjet device to create a split-thickness wound on rat skin. Twenty-four male Wistar rats were randomly divided into 3 groups. An area of 4 × 4 cm in diameter was marked on the center of the dorsal skin. Waterjet hydrosurgery system was used to create a wound on the dorsal rat skin, by removing the outer layers of the skin. In group 1, rat skin was wounded with setting 1 to create a superficial skin wound. In group 2, it was injured with setting 5 to make a deeper wound, and in group 3, skin wound was performed with setting 10 making the deepest wound in the experiment. After the wounds were created on the rat skin, a full-thickness skin biopsy was taken from the middle of the cranial margin of the wound, including both the wound surface and the healthy skin in a specimen. Healing time of the wounds of animals was recorded in the experiment groups. Then, the results were compared statistically between the groups. In the histologic assessment, both the thickness of the remnant of the epidermis in the wound surface and the thickness of the healthy epidermis were measured under light microscope. Thickness of the epidermis remaining after wounding was statistically compared among the groups and with the healthy epidermis. The mean thickness of the remaining epidermis was determined for each group. It was higher in the superficial wounds than in the deep wounds, because of the removal of the skin from its outer surface through the deep layers of the skin with waterjet device. The most superficial wound in the experiment was observed in group 1, which was statistically different from the wounds of group 3, whereas there was no difference between the wounds of groups 1 and 2. Compared with the wounds of groups 1 and 2, the wounds in group 3 were significantly deeper than the wounds of other groups, which was statistically significant. In all groups, mean thickness of epidermis in the wound surface showed statistically significant difference from that in the healthy skin. When compared with the healing times of the wounds in the groups, a statistically significant difference was found between them. Creation of a split-skin wound, by using the waterjet system, provides a wound in reproducible size and depth, also in a standardized and rapid manner. Moreover, it makes precise and controlled wound creation in the rat skin.