Tamer Seyhan

Simplified and versatile use of gluteal perforator flaps for pressure sores.

As a first choice for treating pressure sores, we present our experiences with gluteal perforator flaps and a simplified surgical technique. Twenty-three gluteal perforator flaps were used in 20 patients (13 males, 7 females; aged, 8–68 years) with pressure sores. The pressure sores were sacral in 16 patients, ischial in 2, and trochanteric in 2 patients. During follow-up, recurrence in the same region did not occur. Our simplified operative technique includes finding a suitable perforator with a Doppler probe (it does not matter from which mother artery), outlining the flap, dissecting the perforator with just enough length, and transposing the flap to the defect. The gluteal region has numerous perforators, and there is no need to depend on strict anatomic landmarks to detect perforator vessels or to sacrifice main arteries, as has been the case when raising gluteal perforator flaps.

An effective antioxidant drug on prevention of the necrosis of zone of stasis: N-acetylcysteine

The zone of stasis, the encircling area of the zone of coagulation, is a critical area which determines the depth and width of the necrosis in burns. Many agents were proposed to salvage the zone of stasis. Due to the known preventive and therapeutic effects of N-acetylcysteine on hepatotoxicity, nephrotoxicity, pulmonary injury, and multiple organ failure in humans, the effect of N-acetylcysteine on saving the zone of stasis was investigated in this experimental study. The effects of N-acetylcysteine administration via oral or intraperitoneal route was compared in a rat comb-burn model. The extent of burn wounds was evaluated by photography and planimetry in the groups. Additionally, skin samples were obtained to analyze malondialdehyde levels to see the antioxidant effect of N-acetylcysteine. In control group (no treatment), the burn areas went to near total necrosis. In intraperitoneal and oral treatment groups, skin survival occurred in the interspace area of the comb. There was no difference between the groups in terms of MDA concentrations. In conclusion, this study showed us the possible saving effect of N-acetylcysteine on the zone of stasis. N-acetylcysteine may be used in the cases of severe burns, not only for its effects on wound healing but also the systemic effects of the drug.

Pedicled Deep Inferior Epigastric Perforator Flap for Lower Abdominal Defects and Genital Reconstructive Surgery

The pedicled deep inferior epigastric perforator (DIEP) flap can be used successfully to reconstruct the lower abdominal, inguinal, and genital regions. This muscle-sparing technique offers many advantages, such as minimal donor-site morbidity, a wide arch of rotation, and more versatile flap design, and provides for easier reconstruction than free flaps. Four pedicled DIEP flap cases are described in this article. The flaps were used to reconstruct lower abdominal defects and groin defects and to perform a penile reconstruction. To the best of our knowledge, ours is the first report in the English literature to describe the use of a pedicled DIEP flap for penile reconstruction. The donor sites were closed directly, and morbidity in all cases was minimal.

Severe Complete Pachydermoperiostosis (Touraine-Solente-Golé Syndrome)

Background The thickened, folded skin of Touraine-Solente-Golé syndrome (pachydermoperiostosis) can result in cosmetic and fuctional deformities. Objective To illustrate that simple surgical procedures can improve cosmetic and functional status. Methods Case report of a 33-year-old male with bilateral eyelid ptosis, enlargement of the eyelids, and a leonine facies owing to deep skin furrows managed with bilateral blepharoplasties and tarsal wedge resections, along with excision of multiple skin furrows. Results A greatly improved cosmetic appearance was achieved with these standard procedures. Conclusions The appearance of patients with pachydermoperiostosis can be greatly improved with standard surgical procedures.

“Reading Man Flap” Design for Reconstruction of Circular Infraorbital and Malar Skin Defects

BACKGROUND Surgical complications such as lid retraction and ectropion from graft or flap scar contracture make reconstruction of skin defects in the malar and infraorbital regions challenging. OBJECTIVE A new flap design, the reading man flap, was used to overcome these problems. The Limberg and bilobed flap were compared with the reading man flap. METHODS The reading man flap consists mainly of a superiorly based quadrangular flap and an inferiorly based triangular flap. Malar and infraorbital circular skin defects measuring 14 × 14 to 40 × 40 mm were reconstructed with a reading man flap in 13 patients. The defects occurred after basal cell carcinoma in all patients. The Limberg flap, bilobed flap, and reading man flap were planned for same-sized defects on the abdominoplasty resection material. The results were compared in terms of total scar area, scar length, and total healthy skin area discarded. RESULTS When comparing the 3 flap designs, the reading man flap was the most suitable flap in terms of total scar area and length. CONCLUSION The reading man flap can be used to reconstruct malar and infraorbital circular defects with good cosmetic results and without creating any tractional forces to the eyelids.

Necrotizing Fasciitis of the Chest Wall With a Retropharyngeal Abscess : Case Report and Literature Review

We herein report a case of a diabetic 49-year-old woman with anterior chest wall necrotizing fasciitis that caused a retropharyngeal abscess and discuss the literature surrounding necrotizing soft tissue infections of the chest wall. The patient was treated with serial wound debridements, antibiotic therapy, and percutaneous drainage and serial irrigation of the retropharyngeal abscess with a silicone catheter. The resulting defect was grafted with a split thickness skin graft.

Metatarsal artery perforator-based propeller flap.

Soft‐tissue defects of the distal foot that involve an exposed tendon and bone demonstrate a reconstructive challenge for plastic surgeons. This report investigates the feasibility and reliability of metatarsal artery perforator (MAP)‐based propeller flap for reconstruction of the distal foot soft‐tissue defects. Between July 2011 and June 2012, six patients underwent distal foot reconstruction with seven MAP‐based propeller flaps. Five flaps were based on the third metatarsal artery and two flaps were based on the first metatarsal artery. The flap size ranged from 4 × 2 cm to 8 × 4 cm. All flaps completely survived. Two patients developed transient distal venous congestion, which subsided spontaneously without complications. There were no donor site complications. All patients were ambulating without difficulty within the first month of surgery. MAP‐based propeller flaps can be used to repair the distal foot soft‐tissue defects, providing sufficient skin territory and excellent esthetic and functional recovery.

The radix nasi island flap: a versatile musculocutaneous flap for defects of the eyelids, nose, and malar region.

A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.

Emergency wounds treated with cyanoacrylate and long-term results in pediatrics: a series of cases; what are the advantages and boards?

BackgroundEthyl-2-cyanoacrylate (ECA) is a tissue adhesive material applied to close superficial wounds. The aim of this study was to explore the benefits of cyanoacrylates in the emergency department in children with current application with regard to cost-effectiveness, satisfaction and long follow up.FindingsPatients were treated after assignment of the consent with an explanation by the relatives in a tertiary emergency department (ED), 2007.The evaluation was based on different superficial wound repairs due to blunt trauma within a 2-hour time period (<6 hours), and small wounds (≤3 cm). These wounds were cleansed with serum sale and then dried with gauze. Wound repairs were observed for six months in order to observe the tissue changes. The patients age, sex, indication, application time, pain score, cost, additional tending (if needed), complications, and cosmetic satisfaction were recorded.A total of 9 patients were evaluated and followed for 6 months. Except for one, all children were treated without any serious complications. ECA was cost-effective, time-saving, and provided successful repair satisfaction by a blinded plastic surgeon and patient/parents.ConclusionThis report displayed the pediatric effective use of cyanoacrylates, even in non- traditional repairs in the emergency departments.

Neonatal asymmetric crying face

affected areas. Histologically it is classified into two types, namely the nodular (common) and diffuse (rare) plexiform neurofibromas. Between 5 and 6% of plexiform neurofibromas undergo malignant transformation, known as malignant peripheral nerve sheath tumour (MPNST). Plexiform neurofibromas most commonly involve the head and neck regions along the distribution of the trigeminal nerve and, rarely, the periphery. Though there are reports of a solitary neurofibroma involving the digit, this is an unusual case of plexiform neurofibroma involving the digit (Figure 2).