Sevgi Kurt Yazar

Sensory recovery of the reverse homodigital island flap in fingertip reconstruction: a review of 66 cases

OBJECTIVES The location of the fingertip entitles it to have significant cosmetic and functional values, but also places it at high risk for injury. During repair, finger length and function should be maintained, and stiffness and neuroma should be avoided. Various flaps have been described for reconstruction of distal finger defects with bone, tendon, or joint exposures, including reverse flow homodigital island flap. In this study, we present our experience of reverse flow homodigital island flap in terms of sensory recovery. METHODS Sixty-six patients (70 fingers) with fingertip amputations were included in the study. Patients were treated with homodigital island flaps. All patients underwent sensitivity assessment by 2-point discrimination and Semmes-Weinstein monofilament tests at 6, 12, and 18 months during follow-up, and complications were recorded. RESULTS Monofilament testing results were normal in 64 fingers (91.4%), and diminished light touch was found in six fingers. Two-point discrimination results were normal (<6 mm) in 40 fingers and fair (6-10 mm) in 30 fingers (mean 5.7 mm, range 4-9 mm). Complications included one partial flap necrosis, three flexion contractures, and two neuromas. CONCLUSION In repair of injuries to areas in which sensory feedback is critical, such as the index finger, the homodigital flap may be the treatment of choice.

Cosmetic closure of pilonidal sinus defects with bilateral transpositional adipofascial flaps

Abstract The optimal treatment of the pilonidal sinus has not currently been defined. This study described the use of a modified bilateral transpositional adipofascial flap technique that effectively serves to flatten the deep natal cleft while keeping the scar limited to the intergluteal fold for good cosmesis. Between June 2007 and September 2011, 83 patients (61 men, 22 women) were included in the study. Duration of pilonidal sinus symptoms ranged from 1–15 (median 5) years; 15 patients had recurrent disease. Before the operation, perforating branches of the four pairs of lateral sacral arteries were identified with a Doppler audioscope. After complete excision of the sinus cavity and adequate undermining of the skin, bilateral adipofascial flaps were raised in order to realise a Yin-Yang pattern, with the lateral sacral artery perforators at the base of each flap. Complementary flaps were then transposed into the defect and inset to completely obliterate dead space. Skin was closed primarily in two layers. The median (range) defect size after total excision of the sinus cavity was 38 (19–60) cm2. All flaps survived. There was no wound infection or dehiscense. Median (range) follow-up was 26 (6–52) months. No recurrences were observed. Extensive scarring or asymmetry in the gluteal prominences was not observed. Transient paraesthesia over the flap donor region occurred in 14 cases (16%) and resolved completely within 6 months. The bilateral adipofascial transpositional flap method is an alternative to previously described treatment options in pilonidal sinus surgery. It is a safe, reliable, and easily applicable method, which provides cosmetically acceptable coverage of pilonidal sinus defects of moderate size.

Key and Keyhole Model for Dorsal Onlay Cartilage Grafts in Correcting Nasal Deformities.

BackgroundThe shaping of the cartilage and keeping it in place is very significant for patients who need nasal reconstruction with costal grafts at traumatic or secondary rhinoplasties. In this study, a template is prepared during the surgery that shows the dorsal defect in a 3-dimensional manner and acts as a guide while shaping the cartilage. MethodsSeventeen patients who required secondary rhinoplasties because of trauma or previous operations were included in this study. The patients were operated on between the years 2009 and 2013. The mean age of the patients was 24 years (19–38 years). According to the surgical technique, bone wax was placed in a sheath prepared from the finger of a sterile nylon surgical glove before the dorsal reconstruction. It was placed to the nasal dorsum and shaped over the skin with digital maneuvers. Afterward, the bone wax was stripped off the nylon glove, and it was used as a template to shape the cartilage graft. ResultsNo need for revision rhinoplasties was seen in any of the patients during the mean follow-up period of 19 months. The patients stated that they were satisfied by both the functional and the aesthetic results. ConclusionsThe bone wax template and the defect fit in a key and keyhole fashion. It is supported by multiple points on the nasal bone and the septum. Thus, it does not slide and its warping is avoided. We think that it gives satisfactory results and it shortens the learning process.

Posterior tibial artery cross-leg perforator flap: a case report.

Lower extremity traumatic injuries with exposed vessels mandate prompt repair. Here the authors present a traumatic case in which a contralateral “septocutaneous tibialis posterior artery perforator”–based cross-leg flap was used to cover an open wound.

Creating a neoconchal complex using the adjustable conchal sliding technique in prominent ear correction.

Abstract An oversized aural concha plays a significant role in prominent ear deformities and should be taken into consideration during preoperative examination. In the current study, we present a procedure known as the conchal sliding technique as an alternative to more disruptive methods. Twenty-four patients (9 females and 15 males; 47 ears in total) underwent a conchal sliding procedure between 2006 and 2010. During the surgery, a wide subperichondrial dissection is performed after a posterior elliptical incision. After the concha is exposed as a hemisphere, it is split along its long axis to reveal the medial and lateral cartilage segments. These segments are gently scrolled upon each other. Transposition of the lateral segment posteriorly to the medial segment replaces the whole ear toward the posterior direction. Three mattress sutures (4–0 polypropylene) reliably secure the repositioned and setback conchal bowl. If needed, an antihelix can be formed using neoconchal-scaphal mattress sutures. Median follow-up period was 24.3 months (range, 6–48 mo). A unilateral hematoma developed in 1 patient and an anterior step deformity occurred in another. No recurrence, infection, necrosis of the skin, distortion of the auditory canal, or formation of keloid was observed in any of the patients. The median cephaloauricular angle was measured as 46 degrees before the surgery and 26 degrees after the surgery, whereas the distance between the helix and the mastoid was 23 mm before the surgery and 11 mm after the surgery. All the patients were satisfied with the results. This technique provides stable and natural results by creating a safe neoconchal complex. It may be a safe and reliable solution to an oversized aural concha, enabling natural-looking and positive cosmetic results.

Predicting skin deficits through surface area measurements in ear reconstruction and adult ear surface area norms.

AbstractEar reconstruction is one of the most challenging procedures in plastic surgery practice. Many studies and techniques have been described in the literature for carving a well-pronounced framework. However, just as important as the cartilage framework is the ample amount of delicate skin coverage of the framework. In this report, we introduce an innovative method of measuring the skin surface area of the auricle from a three-dimensional template created from the healthy ear.The study group consisted of 60 adult Turkish individuals who were randomly selected (30 men and 30 women). The participant ages ranged from 18 to 45 years (mean, 31.5 years), and they had no history of trauma or congenital anomalies. The template is created by dividing the ear into aesthetic subunits and using ImageJ software to estimate the necessary amount of total skin surface area required.Reconstruction of the auricle is a complicated process that requires experience and patience to provide the auricular details. We believe this estimate will shorten the learning curve for residents and surgeons interested in ear reconstruction and will help surgeons obtain adequate skin to drape over the well-sculpted cartilage frameworks by providing a reference list of total ear skin surface area measurements for Turkish men and women.

Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes

Objective Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. Material and Methods 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. Results Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. Conclusion Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.

Intravascular Papillary Endothelial Hyperplasia of the Foot

A case of intravascular papillary endothelial hyperplasia is presented. This proliferation usually forms inside thrombotic processes. It is critical to be able distinguish these lesions from low-grade angiosarcomas because they can have similar pathologic findings.

Aneurysmal fibrous histiocytoma

Aneurysmal fibrous histiocytoma (AFH) is a type of fibrohistiocytic tumour. We present a case of a patient who presented with a skin papule on the thigh region. Histopathological examination following total excision of the lesion revealed an AFH. No sign of recurrence was present 6 months after surgery.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats

PURPOSE To investigate the effect of subcutaneous sildenafil on random flap survival. METHODS Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. RESULTS The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). CONCLUSION The subdermal high dose sildenafil has a positive effect on flap survival.