Tahsin Görgülü

Fast and Painless Skin Tag Excision with Ethyl Chloride

Abstract Skin tags (acrochordon) are skin colored or hyperpigmented, usually pedunculated benign skin lesions and often occur on the neck, axilla, and groin regions. It is difficult choice to excise these multiple, widespread, and pedinculated lesions with or without local anesthesia. One option is to infiltrate local anesthesia to every single skin tag, while cutting pedicle with single move is another option. However, both of these options are painful to some degree. We routinely use ethyl chloride spray anesthesia for skin tag excision with micro-scissor and micro-forceps. We received positive feedback from patients, who underwent skin tag excision before with conventional techniques. They declare that ethyl chloride procedure is more comfortable and painless.Level of Evidence VLevel of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The accordion suture technique: A modified rhinoplasty spreader flap

In rhinoplasties, a spreader flap is a widely used alternative to dorsal reconstruction with spreader grafts; however, it has a limited ability to provide sufficient nasal dorsal width. The upper lateral cartilage (ULC) thickness is four times thinner than a spreader graft. This report presents an accordion suture technique for the ULC that involves simple sutures which fix each ULC (3 times folded) to the septum. We performed this technique in 64 primary rhinoplasties, and the patients were followed up for approximately 18 months. The patients completed a questionnaire 12 months postoperatively, and reported marked satisfaction with the aesthetics and function. Furthermore, rhinomanometric analysis showed that nasal airway resistance (NAR) decreased significantly in the postoperative period.

Reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap following gunshot injuries: Report of two cases

In this report we present two cases of gunshot injury related midfoot defects, reconstructed with a chimeric partial scapula and latissimus dorsi muscle flap and short perforator‐based skin flap. The first case, a 14 years old male, had 10 × 8 cm medial plantar and 6 × 4 cm dorsal foot defects and the second case, a 55 years old female, had only 8 × 6 cm dorsal foot defect. In both cases the defects were associated with fractures, one with lateral cuneiform and cuboid with 90% bone loss and the other with navicular bone, respectively. After 6 months, the patients could walk well without support, and radiographs confirmed bony union. A chimeric partial scapula and latissimus dorsi muscle flap and short perforator‐based skin flap may be used for the reconstruction of combined bony and soft tissue defects of the midfoot and to promote bone healing.

Combination of ischemic preconditioning and postconditioning can minimise skin flap loss: experimental study.

Abstract Objectives: Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap. Methods: The rats were divided into five groups: sham group, control group, pre-con group, post-con group, and pre + post-con group. On postoperative days 3 and 7, the entire flaps along with the margins of necrosis were traced onto transparent sheets. The areas of intact skin and tissue were recorded. Results: The flap necrosis area and percentage of necrosis were calculated for each animal. The necrotic area percentage of the control group was found to be significantly higher than those of the other groups on Days 3 and 7 (p = 0.01 and p = 0.03, respectively). The necrotic area percentage of the pre-con group was significantly higher than the pre + post-con group on Day 7 (p = 0.01). VEGFR-3 expression was observed at a rate of more than 50% in the post-con group. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels. The necrotic areas was reduced in the flaps of the pre-con, post-con, and pre + post-con groups and the combined preconditioning and postconditioning group has reduced necrotic area compared to preconditioning of the skin flap. Conclusion: The protective effect was observed on day 7 for combined ischaemic preconditioning and postconditioning. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels.

A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

An Alternative Low-Cost Illumination Apparatus for Surgical Procedures

Dear Editor, Illumination is an important element for conducting surgical procedures and is commonly provided by ceiling lamps in a standard operating room. While operating at deep tissues or narrow regions, using forehead lamps and/or lighted retractors are advantageous to avoid having miosis (ie, reduced ability of seeing of deep and poorly illuminated regions) in a strongly illuminated environment. Insufficient ceiling illumination could be listed as another reason for the need for additional illumination equipment. However, it is reported that such equipment can put the sterility of the operating area at risk. In addition, surgeons sometimes have difficulties while wearing forehead lamps since the position of the lamp could easily alter during an operation, leading to discomfort. Fiberoptic light sources mounted on retractors are usually the best option for working in deep regions; however, the direction of the light is limited by the fixed retractor. Even though they are defined as cold light sources, the temperature may rise on metal connections and harm the patient. Last but not the least, this kind of equipment is usually expensive. As an alternative approach, we build a mini-LED system to produce local cold illumination. This system is composed of 4.5 V LED(s) and single strand copper wire (coated) of varying thickness. As a power source, a variable (3-12 V) AC-DC power adapter (ATABA, Istanbul, Turkey) is used. LED(s) and wire are soldered together, and the junction is covered with heat-resistant silicon material to prevent short-circuit. Plastic heatshrinkable material is used to cover the cables from LED(s) to the power adapter connection port. A proper device can be chosen to connect the power adapter and the cable. The length of the system, which is sterilized with ethylene oxide, is 2 meters, and this distance protects it from any connection with nonsterile power source. The total cost of this specific configuration is detailed in Table 1. The approximate cost of this apparatus is

Application of N-Butyl Cyanoacrylate to Split-Thickness Skin Grafts in Rats: An Experimental Study.

2.50 excluding the power adapter, because only 1 power adapter is enough to supply many systems. Our design is composed of 1 or 4 LEDs, 4 meters of cable (2 meters + 2 meters—polarization), a 2-meter plastic heat-shrinkable tube, and 5-cc heat-resistant silicon. To achieve stronger illumination and better duration, we can use this combination of multiple LEDs and thicker cables. Additionally, this system is suitable as a lighting retractor if cable thickness is increased. We have been routinely using these systems in our clinic for intraoral procedures, rhinoplasty, augmentation mammaplasty, and similar operations. Undoubtedly, our illumination system is an effective cold light source. This system could be attached to retractors (with sterile strips, etc) or used alone. The type of cable may vary to give the ideal flexibility and malleability for specific procedures. Batteries or a power adapter can be used as an energy source depending on operating conditions. The current apparatus is the first-generation design tested continuously in our clinic in case of need for extra 535861 SRIXXX10.1177/1553350614535861Surgical InnovationGörgülü et al research-article2014

A Complication of Management of Closed Incision with Negative-Pressure Wound Therapy

Abstract Skin grafts are a standard option for closing skin defects that cannot be closed primarily. A split -thickness skin graft entirely transfers the epidermis and a part of the dermal layer to the wound site. Using conventional techniques, the skin graft is fixed to the wound using sutures and kept closed for 3 to 7 days with a pressed bolster dressing. Continued care includes applying routine graft dressings after the bolster dressing has been removed. The use of fibrin glue and cyanoacrylate derivatives—which shortens the duration of surgery and improves graft fixation to the recipient bed—has become widespread. However, applying fibrin glue during skin graft surgery is limited because there are considerable disadvantages in terms of preparation and cost. Many studies have been conducted on the use of cyanoacrylate derivatives during skin grafting; however, few reports have investigated the effects of cyanoacrylate derivatives on skin graft survival and related histopathologic changes. In this study, the authors used n-butyl cyanoacrylate to prepare split-thickness skin grafts that were subsequently applied to Wistar albino rats, and the authors evaluated the results both histopathologically and macroscopically. The authors also statistically analyzed the effects of graft fixation according to surgical duration. The findings of authors suggest that n-butyl cyanoacrylate can be safely applied during split-thickness skin graft surgery because it significantly reduces surgical duration, demonstrates substantial advantages in terms of graft fixation and monitoring, and, most importantly, demonstrates no notable disadvantages in comparison with conventional methods.

The Goniometer Device: Special Equipment Designed for Symmetric Mammoplasty Planning and Photo-Symmetry Analysis Technique

Negative-pressure wound therapy is routinely utilized in plastic surgery for the treatment of open wounds. However, a newer system, known as closed-incision management (CIM), may minimize the likelihood of open wounds. CIM is designed for use after primary surgical skin closure. Many studies of the effects of CIM in various surgical disciplines have been published.1-3 The main features of CIM are increased perfusion, maintenance of a closed-wound environment, reduced seroma/hematoma incidence, and reduced tension of skin edges.1-3 CIM appeals to some plastic surgeons because of these advantages.4 However, to date, no publication has addressed the complications of CIM. We usually apply Steri-Strips (3 M, St. Paul, MN) after aesthetic surgery procedures, and their cost is nominal (approximately

Abstract: 8.20 Circumflex Scapular Artery Vascularized Scapular Chimeric Flaps

4 per package). CIM is rarely utilized in our clinic because of its high cost (approximately