Savaş Serel

Effect of chronic and short-term erythropoietin treatment on random flap survival in rats: an experimental study.

Objective The use of perioperative erythropoietin (EPO) therapy is gaining popularity to avoid blood transfusion and correct anemia in head and neck cancer surgery. The purpose of the study was to determine the effect of various doses and durations of EPO treatment on random flap survival.

Hatchet-shaped tensor fascia lata musculocutaneous flap for the coverage of trochanteric pressure sores: a new modification.

The tensor fascia lata flap is one of the appropriate choices for the coverage of trochanteric pressure sores. The authors designed a new, hatched-shaped tensor fascia lata musculocutaneous flap with distal Z-plasty closure and applied it to four trochanteric defects in 4 patients. Satisfactory results were obtained in all patients. The hatchet-shaped tensor fascia lata musculocutaneous flap is very safe, reliable, and practical. Designing the flap in a hatchet shape allows one to use the proximal and well-vascularized portion of the flap in the trochanteric pressure sore area. Another important advantage is the possibility of reuse resulting from recurrence. Prevention of a “dog-ear” deformity at the recipient site provides a smooth contour on the lateral aspect of the thigh. Another advantage is the tension-free Z-plasty closure of the donor site without need of grafting.

Is it Possible to Prefabricate a Vascularized Peripheral Nerve Graft

The ideal technique to repair a damaged peripheral nerve is primary repair. Unfortunately, most damaged peripheral nerves have gaps making primary repair impossible. Autologous nerve grafts that are used to repair damaged nerves can either be conventional nonvascularized nerve grafts or vascularized nerve grafts. Vascularized nerve grafts are proposed to be superior to conventional nerve grafts especially in recipient beds that are scarred, with poor vascular supply. One of the disadvantages of vascularized nerve grafts is the limited donor site. It is possible to eliminate this problem by prefabricating vascularized nerve grafts. In this study, to prefabricate a vascularized nerve, segments harvested from left sciatic nerves of 10 Wistar albino rats were implanted on right femoral vessels, and intact right sciatic nerves were used as controls to evaluate the function, electrophysiologic studies, and histopathologic examination, were performed on these grafts 4 weeks after implantation. Prefabricated sciatic nerve grafts showed vascularization, but they did not show compound action potential activity to electrical stimulation and demonstrated diffuse and severe vacuolar degeneration and myelin loss. We were unable to prefabricate a functional vascularized nerve graft by this method.

Aplasia Cutis Congenita

A case of cutis aplasia with a full thickness defect involving scalp and cranium is presented. After a failedsurgical procedure healing was obtained conservative local treatment with the use of silvadene cream.

Comparison of the effects of systemic sildenafil, tadalafil, and vardenafil treatments on skin flap survival in rats

Abstract Objective: The most important issue in flap surgery is flap viability. This study aimed to compare the effects of most commonly used phosphodiesterase type 5 (PDE5) inhibitors on flap survival. Methods: A 3 × 9 cm flap was elevated from the dorsum of 32 Wistar albino rats. In the control group, saline was administered 2 hours before the flap elevation and continued for 2 days after the surgery. In the sildenafil, tadalafil, and vardenafil groups, the related drug was administered. Blood flow in the flaps was monitored with laser Doppler flowmetry. On postoperative day 7, flaps were photographed and biopsies were obtained. Results: The ratios of flap necrosis area in the tadalafil, sildenafil, and vardenafil groups were lower than that in the control group, but without significant difference (p = 0.077). Histopathological evaluation revealed no significant difference among the groups. Conclusion: The ratio of flap necrosis area tended to be lower in the groups receiving oral PDE5 inhibitors than in the control group, although not statistically significant. The role of PDE5 inhibitors needs to be evaluated in larger studies before a conclusion can be made regarding their effects on flap viability.

Tolerance of prefabricated skin flaps to ischaemia and reperfusion: Experimental study☆

Custom prefabrication of tissues allows the surgeon to build what is required for the reconstruction and has enabled the surgeon to reinforce new blood supply into selected blocks of tissue without vessel anastomosis. However, prefabricated flaps have several drawbacks and characteristics that differentiate them from conventional flaps. The objective of this study was to test the tolerance of prefabricated flaps to ischaemia/reperfusion injury in rats. In the first stage, the unilateral-inferior-epigastric pedicle was ligated and divided, and then a skin flap was fabricated by implantation of distally ligated femoral arteriovenous pedicle beneath the abdominal skin. The femoral vessels were implanted either in skeletonised or in muscle-cuffed fashion beneath the abdominal skin, a portion of which was raised as an island flap, based on these vessels. Prefabricated flaps (3×6 cm) were raised 6 weeks after, and were subjected to 10 h ischaemia and followed by 12 h reperfusion. Flap survival and histological changes at the pedicle-skin junction were evaluated at 7 days. Flap necrosis in the sham group was 0%, whereas the control group (conventional) had 47.27±13.50% necrosis. Flaps prefabricated with skeletonised femoral pedicle demonstrated an insignificant pattern with 63.74±10.62% necrosis when compared with prefabricated flaps with muscle-cuffed pedicle with the percentage of necrosis of 64.51±11.24. The area of necrosis was significantly increased when both the prefabricated flaps were compared with the control group or with the sham-prefabricated group (p<0.05). Skin flaps prefabricated with either pedicle-alone or pedicles with muscle cuff are more susceptible to ischaemia and following reperfusion in comparison with the normal flaps.

Physical Effects of Unilateral Mastectomy on Spine Deformity

Micro‐Abstract As mastectomy is known to effect body posture, we evaluated the long‐term physical effects of unilateral mastectomy on spine deformity by radiographic examination of 60 women taken before and 12 months after the mastectomy. The results indicated long‐term spinal deformation in women with unilateral mastectomy, suggesting informing patients of the possible change in body posture in the long‐term. Objective: Mastectomy is known to effect body posture after a change in the center of gravity of women due to a missing breast. Although previous studies on short‐term postural changes in mastectomy patients using photogrammetry or Moiré topography suggested ipsilateral inclination of the trunk, our clinical observations during breast reconstruction surgeries indicated a contralateral shoulder elevation in women with unilateral mastectomy. Because the change in body posture can affect spinal alignment, we aimed to evaluate the long‐term physical effects of unilateral mastectomy on spine deformity by radiographic examination. Methods: Posteroanterior chest radiographs of 60 women (mean age 56.3 ± 8.5 years) taken before and 12 months after the mastectomy were evaluated for Cobb angle and the presence or absence of a tilt from the midline in the coronal plane of vertebral body alignment. Results: Cobb angle decreased in 14 and increased in 38 of 60 patients after unilateral mastectomy, and the angular change was found to be independent of the mastectomy side (P < .001). A shift in Cobb angle to the mastectomy side was observed in 11 of 53 patients (P > .05), whereas a statistically significant shift in Cobb angle to the opposite of the mastectomy side was observed in 33 of 53 patients (P < .001). The results of this observational retrospective study indicated long‐term spinal deformation in women with unilateral mastectomy. Two patients with idiopathic scoliosis before mastectomy even developed scoliosis. Conclusion: We recommend informing the patients of the possible change in body posture in the long term, which should be supported or limited with physical therapy.

Effect of platelet glycoprotein IIb/IIIa receptor antagonist on survival of epigastric island flaps in rats with total venous occlusions.

We evaluated the effect of tirofiban hydrochloride on the survival of epigastric island flaps in rats that had had all the veins occluded. Male Wistar Albino rats were randomly assigned to control (treated with sterile saline) and experimental (treated with tirofiban hydrochloride 1 mg/kg intravenously) groups. An epigastric island skin flap 3×6 cm was raised in each rat. All veins that drained the flap were ligated to give total venous occlusion. Blood flow was recorded by laser Doppler preoperatively (baseline), immediately after the flap had been sutured back to its original position (acute) and on postoperative days 1 and 3. The degree of necrosis was evaluated on day 3. Mean percentage necrosis and minimum laser Doppler values were compared in the two groups. Total necrosis was evident on day 1 in the control group and on day 3 in the experimental group. Macroscopic evidence was confirmed by histopathological examination. There were appreciable differences in blood flow and in the necrotic area of the flap in the experimental group compared with the control group on both days 1 and 3. Tirofiban hydrochloride might be effective in this flap model.

Congenital retiform hemangioendothelioma

Background: Retiform hemangioendothelioma (RH) is an extremely rare and distinct variant of low-grade, well-differentiated cutaneous angiosarcoma seen in young adults and is characterized by a high recurrence rate, but low metastatic potential. To the best of our knowledge, this is the first report of the congenital RH. The lesion was treated by wide surgical resection. Biopsy revealed RH. We herein describe a congenital case of this rare vascular tumor, arising on the left foot, which was diagnosed when the patient was 21 years old. Results and Conclusions: There was no recurrence or lymph node metastasis during a follow-up period of 6 months. The authors expand the concept of RH by adding a congenital case.

Pigmented mammary Paget disease mimicking cutaneous melanoma

variants with increased fitness for alternative/novel niches. The bacterial capsule, which is absent from NG, contributes to NM virulence and possibly IMD. Unlike NG, antimicrobial resistance is rare in NM in the United States. According to the Centers for Disease Control and Prevention (CDC), clinicians should treat NM urethritis in both patients and partners with a single 250 mg dose of intramuscular Ceftriaxone plus a single 1 g of oral zithromycin. Moreover, vaccines developed to protect against serogroup B invasive NM appeared to be protecting against urethritis. Neisseria meningitidis urethritis raises major public health issues because of: increasing prevalence of ST11 worldwide; a reported “notable genetic diversity” in the meningococci; the difficulty to diagnose NM urethritis conventionally; the diversity of the subgroups involved and their respective sexual behaviors; an increase in NG resistance and a failure in oropharyngeal NG clearance. Consequently, increases in the likelihood of NG/NM nasopharynx colonization would provide an opportunity for further genetic exchange between the two pathogens and for emergence of new variants.