Serdar Gültan

THE EFFECTS OF L-ARGININE AND ILOPROST ON THE VIABILITY OF RANDOM SKIN FLAPS IN RATS

The effects of an intravenous infusion of L-arginine as a physiological precursor of endothelium-derived relaxing factor/nitric oxide (EDRF/NO), iloprost (a stable prostacyclin (PGI2) analogue), and L-arginine combined with iloprost on skin viability were studied in 9 x 3 cm random pattern skin flaps in rats. Intravenous infusion of all drugs was started at the beginning of the operation and continued for 60 minutes. At the end of infusion period the depth of fluorescein dye penetration in the skin flap was assessed visually from photographic records, and the flap survival area was measured by the grid method at the seventh postoperative day. There was a significant reduction in distal necrosis of random skin flaps after intravenous infusion of L-arginine, iloprost, and L-arginine combined with iloprost (p < 0.01). Possible mechanisms that may be responsible for impairment of endothelium-dependent vasodilation and vasospasm in the microvasculature of random skin flap and their prevention with L-arginine and iloprost include restoration of the depleted stores of NO which in turn causes vasodilatation and has an antithrombotic effect.

A RARE CRANİOFACİAL CLEFT: TESSIER NO. 7: A RETROSPECTIVE ANALYSIS

SUMMARY In this report we present a retrospective analysis of our craniofacial cleft cases, classified as Tessier no. 7.

Effects of free perichondrial graft replacement of epiphyseal cartilage on bone growth.

An experimental study in 24 lambs was carried out to find an alternative tissue for the distal epiphyseal cartilage of the femur. The animals were divided into three groups. In the first group (n = 12) the left femoral distal epiphyseal cartilage was completely removed and replaced by a free perichondrial graft taken from the distal half of the scapula. In the second group (n = 6) the epiphyseal cartilage was removed and was not replaced by any tissue. The third group (n = 6) was used as control. After six months the legs in the first and third groups were of the same normal length while the legs in the second group were significantly shorter. We conclude that free perichondrial graft seems to be able to replace the epiphyseal cartilage and prevent retardation of growth.

Pilomatricoma in the Upper Extremity after Vaccination: A Case Report

Pilomatricoma (also known as pilomatrixoma) is a rare benign skin tumor arising from hair follicle stem cells; it is also known as calcifying epithelioma of Malherbe. A definitive diagnosis can be made by histopathological examination. Surgical excision of the lesion is recommended for its treatment. The lesion can often be misdiagnosed when differential has not been considered. In the literature, there are few reports of pilomatricoma cases occurring after vaccination. A 21-month-old male patient was admitted to our clinic with a mass on his left arm that occurred after vaccination. The lesion was completely excised. The diagnosis of pilomatricoma was made after histopathological examination. As there were no predisposing factors other than vaccination, we concluded this to be a complication of the vaccination. The pathogenesis of pilomatricoma is unclear, but inflammation and trauma may promote neoplastic development. We report this case to draw attention to this rare lesion and to the possible etiopathogenetic association of vaccination with pilomatricoma.

A serious injury underlying an underestimated small laceration of the hand

In patients suffering from hand injuries, the most important diagnostic tools include patient history and physical examinations. Injuries of the hand caused by knives or drilling tools require careful attention because serious injuries can occur in the form of small skin incisions, depending on the distance and depth of the advance of the tool. Because stab wounds can appear minor superficially, whereas serious injuries can appear as small-access lacerations, the examining physician should be careful when evaluating wound severity. Here, we present a patient with an injury from a knife attack who was treated with an initial intervention that was insufficient to completely repair the injury. Upon initial examination, the only obvious sign of injury was a small laceration; however, the injury turned out to be much more serious in nature.

We are writing in response to the article "Uncommon foreign body reaction caused by botulinum toxin".

needle aspiration cytology, such as cystic fluid that generally possesses scant cellular material for evaluation, inconclusive results are common in preoperative cytological evaluation of inflamed neck cysts (as reported here). Ultrasonography is able to delineate the cystic nature of the cervical lesions. Computed tomography helps in preoperative planning and identifying the exact lesion size and the topographic relationships with the neighboring neck structures. The management of inflamed BCC is not well described in the literature. Although some indicated surgical excision of these lesions only 3Y4 weeks after antibiotic therapy, the role of antibiotics have been the target of criticism. In addition to antibiotics, a skin incision and drainage or aspiration of the cyst contents have also been used to the treatment of inflamed BCC. However, as surgical excision of BCC after improper surgical procedures (incision and drainage) will result in high recurrence rate, we and others are in favor of complete surgical excision without previous intervention. Different surgical approaches such as transoral excision, retroauricular incision, and endoscopic excision offering less visible scarring have been described. However, these techniques present higher risks of injuring the critical neck structures and of incomplete removal of the BCC. Thus, we and others give preference to the transcervical approach (transverse cervicotomy after a wide lateral neck incision), although the aesthetic result might be less acceptable. This approach provides adequate exposure for the complete and safe removal of inflamed BCC that is technically laborious due to the difficulty of identifying tissue planes for dissection.

Pediatrik Mandibular Miksoma: Görüntüleme Bulguları

Miksoma, nispeten az siklikta gorulen bir tumor olup genellikle eriskinlerde ve kardiyak yerlesimli olarak izlenir. Pediatrik grupta ve fasiyal kemiklerde gorulmesi oldukca nadirdir. Tumorun lokal agresif bir karakteri vardir. Genellikle yavas ilerleyen bir kitle seklinde ortaya cikar ve fasiyal kemiklerde lokalize olursa bu bolgenin diger yer kaplayan lezyonlariyla karisabilir. Goruntuleme bulgulari spesifik olmadigindan kesin tani genellikle histopatolojik olarak konur. Tumorun nuksetme potansiyeli nedeniyle agresif rezeksiyonun yani sira enukleasyon ve yakin takip tedavi secenekleri arasindadir. Tedavi sekline etki eden faktorler hastanin yasi, tumorun yerlesimi, buyuklugu, daha once nuks etmis olmasi ve hayati organlara yakinligi seklinde sayilabilir. Bu bildiride tanisal amacli elde edilen radyolojik goruntuleme bulgulari ve taniya faydalari tanimlanmis ve ayirici tanida yer alan lezyonlar tartisilmistir.

Pediatrik Mandibular Miksoma: Görüntüleme Bulguları Pediatric Mandibular Myxoma: Imaging Findings

88 Miksoma, nispeten az sıklıkta görülen bir tümör olup genellikle erişkinlerde ve kardiyak yerleşimli olarak izlenir. Pediatrik grupta ve fasiyal kemiklerde görülmesi oldukça nadirdir. Tümörün lokal agresif bir karakteri vardır. Genellikle yavaş ilerleyen bir kitle şeklinde ortaya çıkar ve fasiyal kemiklerde lokalize olursa bu bölgenin diğer yer kaplayan lezyonlarıyla karışabilir. Görüntüleme bulguları spesifi k olmadığından kesin tanı genellikle histopatolojik olarak konur. Tümörün nüksetme potansiyeli nedeniyle agresif rezeksiyonun yanı sıra enükleasyon ve yakın takip tedavi seçenekleri arasındadır. Tedavi şekline etki eden faktörler hastanın yaşı, tümörün yerleşimi, büyüklüğü, daha önce nüks etmiş olması ve hayati organlara yakınlığı şeklinde sayılabilir. Bu bildiride tanısal amaçlı elde edilen radyolojik görüntüleme bulguları ve tanıya faydaları tanımlanmış ve ayırıcı tanıda yer alan lezyonlar tartışılmıştır.

Perforatör fleplerle klinik deneyimlerimiz

Giris: Perforator flepler ozellikle kasin korunmasindan kaynaklanan verici alan morbiditesindeki azalma basta olmak uzere, sagladiklari avantajlar nedeniyle son on yilda popularite kazanmislar ve geleneksel kas-deri fleplerinin yerini almaya baslamislardir. Gerec ve Yontem: Bu calismada klinigimizde gerceklestirilen yumusak doku rekonstruksiyonu olgulari sunulmus ve mevcut literatur isiginda perforator fleplerin avantaj, dezavantaj ve kasderi fleplerine ustunlukleri tartisilmistir. Aralik 2004 – Nisan 2005 tarihleri arasinda klinigimizde perforator fleplerle bes yumusak doku rekonstruksiyonu olgusu gerceklestirildi. Olgularin dordunde anterolateral uyluk perforator flebi, birinde derin inferior epigastrik perforator flebi kullanildi. Bulgular: Uygulanan fleplerin ucunde herhangi bir komplikasyon gozlenmezken, 1 flepte alici damarlar uzerindeki deride yuzeyel nekroz gelisti, 1 flep ise gelisen venoz yetmezlik nedeniyle kaybedildi. Bes olgunun dordunde fonksiyonel ve estetik acidan basarili sonuclar elde edildi. Sonuc: Perforator fleplerle ilgili sinirli sayida deneyimimizin olmasina ragmen gunluk pratik uygulamamizda, cogu olguda kas-deri fleplerinin yerini perforator fleplerin alacagini dusunmekteyiz.

Dermabrader: a different use in preparing scalp defects without periosteum for immediate skin grafting

SummaryTo cover a very large scalp defect, one may mobilize the remaining scalp to effect closure. However, sometimes skin grafting may be unavoidable. For this procedure, the prepared raw surface should be smooth and well vascularized. To achieve this in one case, a dermabrader has been used as an osteoabrader to remove the outer table to provide a surface with punctate bleeding. A good result was obtained with minimal hospitalization.