Tayfun Aköz

Complications of the reverse homodigital island flap in fingertip reconstruction.

Twenty-four digital artery island flaps with reversed flow were used to reconstruct 23 patients with fingertip injuries in the authors’ clinic between June 1998 and August 2000. No nerve coaptation was performed in these patients. Patient age ranged between 18 and 35 years. All patients were evaluated at clinical follow-up for active range of motion, appearance, patient satisfaction, two-point discrimination, hypersensitivity and cold intolerance, previous hand injury, and flap viability in the repaired finger. Based on their experience, the authors consider that this procedure has several disadvantages: relatively high flap loss, sacrifice of one of the two major arteries of the finger, it is a time-consuming method, it is a difficult flap dissection, there is a requirement for loupe and microsurgical equipment. The authors think that this flap should not be the first choice for fingertip reconstruction especially for patients who have possibility of reinjuring their hands because of their jobs.

Multiple Occurrence of Pilomatrixoma

Multiple occurrences of pilomatrixoma are rare. Although it has been known as a benign lesion, there are reports of some tumors that have histopathologic features of malignancy. A case of a 68-year-old Caucasian women with multiple pilomatrixoma is presented. She was operated on to remove three other pilomatrixomas on the arms 3 years after the initial excision from the face. Two years after excision of the lesions on the arms, no recurrences were evident.

Simultaneous Multiple Pilomatrixomas

Abstract:u2002 We report a 10‐year‐old girl with synchronous multiple pilomatrixomas. Pilomatrixomas are generally solitary tumors; synchronous multiple tumors are very rare. Multiple or recurring tumors may be found in association with various syndromes, and multiple tumors may be familial. Concurrent disorders were not identified in our patient and the etiology of her pilomatrixomas was not understood. Thorough examination of the patient and long‐term follow‐up are necessary with these tumors.

Bilaterally involved Tessier No. 4 cleft: case report.

Craniofacial clefts are rare among facial anomalies, with an incidence of 1.5 to 5 per 100,000 births, and 1 per 100 cases of cleft lip and palate. The Tessier No. 4 oro-ocular cleft is one of the rarest, with 33 unilateral and bilateral clefts reported in the literature. Among the bilateral clefts only 3 of 9 involved Tessier No. 4 cleft bilaterally. We report a case of bilateral Tessier No. 4 craniofacial cleft and our approach to surgical correction.

Localization and removal of ferromagnetic foreign bodies by magnet.

Foreign bodies should be removed from wounds during the primary wound management stage whenever possible. Metallic fragments can be identified and localized by conventional radiography, computed tomography, sonography, x-ray image intensifier, or electromagnetic metal detector. Locating metallic objects may still cause problems for the surgeon during the removal procedure. Detection and removal of superficial ferromagnetic fragments (iron, nickel, and cobalt) by a magnet is possible. In the literature the authors found no report about using the magnet for this purpose. Having conferred with the manufacturer KANAT (Istanbul, Turkey), the authors used a magnet made of neodymium. The power of the magnet was 12,000 gauss. It was cylindrical and 1.3 x 0.8 cm in diameter. This method was used in 6 patients successfully for localization and removal of ferromagnetic foreign bodies. Use of a magnet is an easy and cost-effective method that does not require education and specific staff.

Rhinocerebral mucormycosis: report of two cases.

Rhinocerebral mucormycosis is a rare opportunistic infection caused by fungi. It is commonly fatal and aggressive infection localised paranasal sinuses and orbit. We report two cases had necrotising infection on the left nasolabial region. Despite aggressive surgical debridement and medical treatment, the patients died 6 and 7 days after admission. Plastic Surgeons should be aware when they have a patient with rapidly developing soft tissue infection over the paranasal sinuses and periorbital region. Combined treatment is mandatory for these patients. It usually results in death, but powerful efforts may save the patient.

The preputium: An overlooked skin graft donor site

Plastic surgeons often encounter tissue defects consisting of the superficial layer of the skin. Fortunately, many of these defects are reconstructed easily with skin grafts. The authors have used the preputium as a skin graft for the reconstruction of skin defects of various sizes and locations in children. The defect size ranged from 2.3 × 4.0 cm to 4.8 × 6.5 cm. The average defect size was 3.5 × 5.5 cm. The defects were caused from trauma, acute burn, and release of burn contractures, and were located in the lower extremity, upper extremity, and scalp. All patients were treated successfully. No complications of the donor area or recipient area were seen. The prepuce should be included as an additional tool in the reconstructive surgeons armamentarium because of its many advantages, including easy harvest, high viability and elasticity, and low donor area morbidity.

Application of external fixators in major foot contractures

Extremity contractures are one of the most common deformities faced by the reconstructive surgeon. Major deformities with ankylosis of the related joint have to be managed by both soft tissue and bone operations. Contractures existing for a long period of time cannot be brought into anatomic position easily because of shortened tendons, nerves, and vessels or ankylosed joints. Although tendons can be lengthened in one operation, this is not the case for neural and vascular structures. The authors use external fixators associated with soft tissue procedures to gradually correct major foot dorsiflexion contractures.

Congenital lateral cleft palate : a new anomaly ?

A case of atypical cleft palate abnormality that had not been identified before in a 9-year-old girl is presented. The cleft was localized laterally and in an oblique position at the soft palate. The patient had cleft palate repair. Finally, she had acceptable soft palate movements and speech.

Use of distally based saphenous neurofasciocutaneous and musculofasciocutaneous cross-leg flaps in limb salvage.

Neurocutaneous island flaps have been very popular in soft-tissue coverage of the lower extremities. These flaps are based on the arterial network around the superficial sensory nerves. The advantages of these flaps are easy and quick dissection (hence a time-saving operation), acceptable donor site morbidity, and preservation of major arteries of the leg. The authors used five neurofasciocutaneous and three musculofasciocutaneous flaps successfully as cross-leg flaps for the coverage of relatively large defects of the lower two thirds of the leg and foot in 8 patients. They conclude that reverse saphenous neurofasciocutaneous and musculofasciocutaneous flaps as a cross-leg flap in patients who cannot be reconstructed with other flap alternatives have many advantages over traditional cross-leg procedures, such as short vascularization time, minimal patient discomfort, wide arc of rotation and great versatility, and a safe vascular pattern.