Selma Denktas Kuduban

Nerve sparing-distally based sural flap.

The management of soft‐tissue defects in the ankle and foot area is a challenging task. Distally based sural flap is widely used, however it leaves donor area paresthesia. For this purpose, the sural nerve was dissected and preserved in the distally based sural flap in five cases of ankle and foot soft tissue reconstruction. This modification did not cause any compromise in flap circulation. All flaps survived with one partial distal necrosis. We suggest that, the distally based nerve sparing sural flap can be securely elevated with only a 3–4 cm wide subcutaneous pedicle without any compromise in flap circulation.

Latissimus dorsi flap harvest with a short incision.

Latissimus dorsi (LD) flap is one of the most common options utilized in reconstructive armamentarium. In this report, we present our experience on harvest of the full LD muscle flap through a short incision. Twelve free and two pedicled full LD muscle flaps were raised in 14 patients (9 males and 5 females). In this technique, an oblique incision was placed 5–7 cm caudal to axillary apex, beginning from the posterior axillary line, so as to center the neurovascular hilus. The length of incision was 10 cm in adults and 8 cm in children. Mean dissection time was 45 min. All flaps survived totally. Seroma formation developed in two cases and treated with syringe aspiration and compressive dressing. In late postoperative period, donor site scars became inconspicuous and patient satisfaction was high. Short incision technique may be a good option to overcome scar problems in donor site of the LD flap. The technique reduces the dissection time and does not require sophisticated surgical devices and skill, when compared to endoscopic LD flap harvesting from the literature.

Total lower lip reconstruction using free neurotendinofasciocutaneous anterolateral thigh composite flap: a case report.

Total lower lip reconstructions are challenging procedures because of poor aesthetic and functional outcomes and limited availability of donor tissues that anatomically imitate the lip. We hereby report the free neurotendinofasciocutaneous anterolateral thigh composite flap as a new reconstructive option. A 48-year-old man presenting with a squamous cell carcinoma of the lower lip underwent wide resection of tumor, bilateral neck dissection, and lower lip reconstruction with the mentioned flap where the lateral femoral cutaneous nerve and tensor fascia lata tendon were included. No complication was encountered postoperatively. The flap survived totally. Understandable speech, oral competence, and uneventful nutrition were obtained. Furthermore, tactile, pain and heat sensations, and two-point discrimination of 12 mm at the flap were regained. In reconstruction of the lower lip, this flap was first described in the literature and can be a good candidate as a reconstructive option.

Versatile use of rhomboid flaps for closure of skin defects.

OBJECTIVE The aim of this study is to present our clinical experience with rhomboid flaps. MATERIALS AND METHODS Twenty-four patients who were operated on between January 2006 and October 2010 were included in the study. All defects were reconstructed using rhomboid flaps. RESULTS Twenty-four patients were operated on for various reasons, and 26 rhomboid flaps were performed. Eleven of the 24 cases were male, and the median age of participants was 47.5 years. Eight cases were operated on under general anesthesia, and 13 were locally anesthetized; the remaining cases were operated on under regional anesthesia. In 17 cases, the defect was due to a benign or malignant tumor excision, and five cases were operated on due to burn contracture. There were no occurrences of partial or total flap necrosis or hematoma in our series. CONCLUSION Our series indicates that rhomboid flaps can be safely used to reconstruct small to moderately sized skin defects.

The effect of hippophae rhamnoides extract on oral mucositis induced in rats with methotrexate

ABSTRACT Objective: To investigate the effect of HRE (Hippophae rhamnoides extract) on oral mucositis induced in rats with MTX. Material and Methods: Experimental animals were divided into groups as healthy (HG), HRE+MTX (HMTX), and control group, which received MTX (MTXC). HMTX group received 50 mg/kg HRE while MTXC and HG groups received equivolume distilled water with gavage once a day. After one hour of HRE and distilled water administration, HMTX and MTXC groups received a single dose of oral MTX 5 mg/ kg. This procedure was repeated for one month. Results: The levels of MDA, IL-1β, and TNF-α were found to be significantly higher in the cheek, lower lip, and tongue tissue of the animals receiving MTX, compared with HG and HMTX groups; however, these parameters were lower in the cheek and low lip tissue, and a milder damage ocurred in these tissues, compared with the tongue tissue in MTXC group. No histopathologic damage was observed in the cheek, lower lip, and tongue tissues of the rats treated with HRE. Conclusion: This findings indicate that HRE as a natural product is an important advantage compared with synthetic drugs for prophylaxis of oral mucositis developed due to MTX.

Early Skin Reaction of Polydioxanone Suture Material Following Septorhinoplasty

Patient: Male, 27 Final Diagnosis: Postoperatif healing Symptoms: Feeling of foreign body on the nasal tip Medication: — Clinical Procedure: Minor intervention and follow-ups Specialty: Otolaryngology Objective: Unusual clinical course Background: Septorhinoplasty is a frequent surgical procedure used for both cosmetic and functional purposes. The technique varies from surgeon to surgeon and according to which suture material is used. While some surgeons prefer non-absorbable sutures, others prefer sutures with delayed absorption. These materials sometimes protrude from the skin and they may cause skin reactions. While these reactions are common in the late period, a skin reaction in the early period because of polydioxanone suture is extremely rare and to the best of our knowledge, this is the first such reported case in the literature. Case Report: A 25-year-old male patient underwent endonasal septorhinoplasty procedure with endo-tracheal general anesthesia. We hereby present the skin reaction because of frequently used polydioxanone suture on the 24th postoperative day and the management of this patient. We cut the suture at skin level and prescribed antibiotherapy, and we scheduled a follow-up for 10 days afterwards. The patient had no complaint and the control examination result was normal. Conclusions: When performing septorhinoplasty operations, very rare complications of the procedure shouldn’t be ignored and an informed consent must be obtained after explaining possible complications before the operation. This approach is important for increasing the patient compliance and proper follow-up for the patient. This way, especially post-operative early complications as our case will be able to be solved with close follow-up and intervention, before causing permanent damage. The relationship between patient who underwent rhinoplasty and the physician also has an important role on these follow-up visits.

Maxillofacial Fracture Experiences: A Review of 152 Cases

OBJECTIVE The fractures of facial structures lead to great morbidity. Cross-sectional studies are needed to evaluate the current state of maxillofacial traumas. Thus, this study aims to evaluate these experiences and to compare these results with the current literature. MATERIALS AND METHODS The medical records of the maxillofacial fracture cases hospitalized between January 2004 and November 2011 were examined. The age, sex, etiology, fracture localization and treatment method for each case were documented. The affected facial bones were grouped as mandible, maxilla, zygoma, naso-orbitoethmoid complex (NOEC) and blow-out. Nasal fractures were excluded. The cases were assigned to 3 groups with respect to age (below 16, above 65 and between 17 and 64). The chi Square test was used to assess the significance of the difference in mandibular fracture rates in the pediatric population compared to others. RESULTS The total number of cases was 152. The total number of fractures was 185. Of the 152 cases, 117 were male and 35 were female. The average age was 31.4 (±18.3), ranging between 2 and 81. Thirty-one cases were 16 years old or less. Nine cases were 65 years old or more. Mandibular and zygomatic fractures were the most prevalent fractures in the adult group. Mandibular fractures were significantly more common in the pediatric age group compared to rest of the population (X(2), p<0.05). Traffic accidents were the most common etiological factor, with a 55.3% ratio. Open reduction and internal fixation was the most frequently conducted treatment modality in all age groups. CONCLUSION Retrospective studies are important for the projection of future prospects. In summary, our results indicate that pediatric fractures are mostly in the lower face and usually affect the condylar region, which is consistent with the literature.

A new use for an old instrument: Laborde tracheal dilator for endonasal rhinoplasty

Sir, Rhinoplasty is a plastic surgical procedure for aesthetically enhancing and reshaping the nose and restoring function; both open and endonasal approaches are used. In open rhinoplasty, an incision is made along the columella (soft tissue between the nostrils), and in endonasal rhinoplasty, all of the incisions are inside the nostril. Open rhinoplasty has the advantage of direct visualization of the cartilages as well as manipulating and altering nasal shape with more control and precision in ways not possible with endonasal rhinoplasty. Endonasal rhinoplasty preserves anatomical integrity and is associated with shorter operative time, less swelling, rapid postoperative healing and avoidance of a scar along the columella; none of which are advantages of open rhinoplasty. However, limited exposure and difficulty placing sutures and grafts are difficulties with an endonasal approach. We propose a novel use of the Laborde tracheal dilator, a well-known instrument, in endonasal rhinoplasty to increase exposure and ease of suturing and graft applications. The Laborde tracheal dilator has three arms and is used routinely in tracheostomy (Fig. 1). We more clearly evaluate the nasal dorsum including the septal cartilage, midvault, keystone area and nasal bones and apply spreader grafts (Fig. 2) and intercartilaginous sutures (Fig. 3) with greater ease by placing the tool on the nasal dorsum through the intercartilaginous space and placing transfixing or hemitransfixing incisions in combination. The Laborde tracheal dilator is of particular benefit in patients with saddle nose or serious primary deformity where sutures and grafts are commonly used. The adjustment degree of the Laborde dilator is variable; however, its fixed horizontal and vertical dilatation ratios prevent its use in every scenario because of the increased risk of tissue trauma and excessive exposure. Compared with Aufricht’s dorsal retractor, the Laborde retractor may provide wider and easier access in upper lateral cartilage augmentation. Alternative methods are being used more often in alar cartilage reconstruction; therefore, this dilator may not be necessary in this reconstruction.

Reconstruction of an Extensive Plantar Defect with Two Simultaneous Free Flaps

Heel reconstruction after tumor ablative surgery or trauma presents the patient and the clinician with difficult treatment choices1-3. The heel region has complex osseous interactions, ligamentous slings, and unique skin coverage that provides sufficient cushion, all of which are crucial for normal gait4. Although there are regional pedicle flap options, reconstruction of these complex tissue defects usually requires free flaps. Regional fasciocutaneous flaps can resurface the defect efficiently. However, when there is a complex tissue defect that includes the calcaneus, more complex treatment options are needed5. In this case report, we describe how we reconstructed the heel region in a patient with an extensive plantar defect, with simultaneous use of free iliac crest and latissimus dorsi muscle flaps. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-nine year-old man presented with a Marjolin ulcer on the right heel. He had an ulcerated and vegetating mass that measured 14 × 7 cm (Fig. 1). An incisional biopsy revealed squamous-cell cancer. Physical examination and preoperative computed tomography (CT) demonstrated calcaneal invasion and excluded lymph node involvement. He had difficulty walking and had moderate pain. The American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score was 626. The tumor was stage III, which necessitated amputation of the foot. However, because the patient would not consent to amputation, the surgical team formulated an alternative plan. Fig. 1 Preoperative photograph of the ulcerated mass, which covered nearly the entire sole region. The calcaneus, the flexor hallucis longus tendon, the posterior tibial tendon, and the flexor digitorum longus tendon were resected along with two-thirds of the sole of the foot. The Achilles tendon was stripped off of the calcaneus. After wide resection of the tumor and …