Lip cancer: Reconsidering the at-risk patients with pathological assessment.

OBJECTIVES: This study was aimed to overview the treatment protocols of lip cancer and find out a cutoff point of tumor diameter and depth of invasion (DOI) for the survival parameters. MATERIALS AND METHODS: One hundred and ninety-one patients with lip SCC were studied. RESULTS: The average age of the patients was 62 years. Among 191 patients, 82.7% of the patients were men, 96.4% of them had lower lip cancer, and 84% were staged as early (pT1, pT2 ). Primary tumor excision with neck dissection was applied to 62.3% of the patients. Lymph node metastases rate was found to be 11%, and recurrence rate was 6.3%. There was statistically significant difference in between the tumor diameters and DOI values of patients with and without metastasis, and recurrence (p < 0.01, p < 0.05, respectively). Regarding to the lymph node metastasis, the optimal cutoff point was found to be 7.5 mm for DOI and 21.5 mm for tumor diameter. Regarding to the recurrence, the optimal cutoff point was found to be 7.5 mm for DOI and 24.5 mm for tumor diameter. CONCLUSION: T2 lip cancer patients also seem to be in at-risk group for metastasis and recurrence. As a conclusion, elective neck dissection and frequent follow-up are recommended for these early-stage lip cancer patients.

Extended Central Artery Perforator Propeller Flap for Large Nasal Defects.

Various local flaps have been defined for small skin defects of the nose. However, the repair of large nasal defects is only possible with flaps allowing a large tissue transfer, such as a free flap, forehead flap, and nasolabial flap. In this study, large nasal defects were reconstructed with extended central artery perforator propeller (CAPP) flaps in an attempt to describe a single-stage procedure as an alternative technique to the median forehead flap. Thirteen large nasal skin defects, including dorsum and nasal sidewall and/or dome, were repaired with a CAPP flap between January 2015 and March 2018. A total of 13 patients aged 19 to 92 years were included. The mean follow-up period was 14.9 months. Pathological diagnoses were basal cell carcinoma in 5 patients, squamous cell carcinoma in 6 patients, and trauma in 2 patients. Defect size ranged between 3 × 3 and 4 × 5 cm. Flap size ranged between 3 × 7 and 5 × 10 cm. No major complications including total flap failure, hematoma, or infection were observed. However, a partial flap necrosis occurred in 1 patient. In 3 patients, scar revision surgery was performed at the postoperative period. In conclusion, CAPP flap use is a safe and reliable option to repair large nasal defects. This flap is able to cover large nasal defects including dorsal, dome, and nasal sidewall defects in a single-stage procedure. Requiring no pedicle separation, this flap is an alternative option to the conventional median forehead flap.

Posterior Lamellar Reconstruction of the Lower Eyelid With a Gingivoalveolar Mucosal Graft.

The anterior and posterior lamellae should be simultaneously reconstructed to repair the upper and lower eyelid's full thickness defects after resection of a malignant tumor. The author described a gingivoalveolar mucosal graft for posterior lamellar reconstruction of the lower eyelid. Between November 2014 and September 2017, 11 patients (6 women, 5 men; mean age 62.7 years) with 13 posterior lamellar defect of lower eyelid underwent reconstruction with gingivoalveolar mucosal graft. The defects ranged from 10 x 8 mm to 20 x 10 mm. For 11 lower eyelid defects, the anterior lamellar defect was previously reconstructed with an appropriate local flap. The remaining 2 defects were repaired with graft only. The mean follow-up period was 15.3 months. The pathologic diagnoses were squamous cell carcinoma for 8 lower eyelid lesions and basal cell carcinoma for the remaining 5 lower eyelid lesions. No case of necrosis and infection was observed in any flap or graft. Also, there was not observed ectropion or lid laxity at lower eyelids. However, redness developed in 1 eye, but healed in 1 week. Donor areas completely improved with secondary healing with no any complication. Gingivoalveolar mucosal graft is a reliable and easy accessible choice for posterior lamellar reconstruction of eyelid defects. While the gingival mucosal part provides a stable and tight structural support for marginal palpebral area, the alveolar part occupies the conjunctival side without causing corneal irritation.

Subunit Reconstruction of Mid-Facial Defects With Free Style Facial Perforator Flaps.

INTRODUCTION: Reconstruction of facial defects is not only important for cosmesis but also for the function. Local flaps are considered the best reconstruction method for facial defects. The authors want to show the feasibility of free style facial perforator flap for the reconstruction of moderate sized mid-facial defects. METHODS: Free style facial artery and lateral nasal artery perforator flaps were performed in 22 patients (11 males and 11 females) who had removal of facial tumor between March 2015 and December 2016 RESULTS:: The median age of patients was 62 years (range: 35-84). The mean follow-up period was 12.6 months (range: 5-24). Pathology results were basal cell carcinoma in 13 patients, squamous cell carcinoma in 6 patients, and other skin tumors in 3 patients. The defect size ranged from 2 × 2 to 5 × 5 cm. No major or minor complication happened but 1 flap had venous congestion that healed without any intervention CONCLUSION:: Free style facial perforator flaps are highly reliable flaps with wide range of motion. In addition, they provide single-stage closure with esthetic subunit reconstruction. With the current knowledge of reconstruction and skills of microsurgery, they can be easily the first choice for the closure of mid-facial defects.

A Rare Case of Endochondral Pseudocyst of the Auricle.

Endochondral pseudocyst of the auricle is a very rare, benign, non-inflammatory cystic lesion. It most commonly develops in the scaphoid or triangular fossa of the ear. In this case report, we present a 46-year-old man with a painless lesion on the scaphoid fossa of the right ear. We removed the hypertrophic perichondrium forming the anterior wall of the pseudocyst, curetted the ear cartilage, and dressed it with compression. No complications, such as infection, seroma, or hematoma, occurred during the postoperative period. A good cosmetic result was ultimately obtained. The patient experienced no recurrence within a 14-month follow-up period. LEVEL 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 .

Intramuscular myxoma: clinical and surgical observation notes on eleven cases.

PURPOSE: Intramuscular myxoma (IM) is a benign, soft tissue neoplasm of mesenchymal origin. We report our experience with this tumour. METHOD: This clinical study comprised 11 cases of IM that were operated on between March 2008 and June 2016. Tumour location and size, results of pre-operative radiological studies, preop-erative biopsies, pathology examinations, applied surgical method and post-operative complications were reported for all patients. RESULTS: In total, nine patients with 11 IMs with a mean age of 60.0 years were assessed. Mean follow-up was 39.2 months. Tumours were located in the right thigh (5 patients, 7 IM), left gluteal area (2 patients, 2 IM), right gluteal area (1 IM) and left thigh (1 IM) ranging from 2 × 1 cm to 10 × 17 cm Pre-operative radiological diagnoses were cystic lesion, abscess, bursitis, fibrosarcoma, fibroma, lipoma, malign mesenchymal tumour and IM. Pre-operative biopsy was performed for five cases. All tumours were removed via simple excision and were pathologically consistent with IM. No complication or recurrence was observed during the follow-up period. CONCLUSION: IM is a relatively rare benign tumour, the pre-operative diagnosis of which using radiological and clinical methods is quite difficult, creating pre-operative diagnostic confusion. It is generally diagnosed by microscopic examination. Simple excision with a small margin of surrounding tissue is considered to be sufficient for its treatment.

The Effect of Platelet-Rich Plasma on the Temporomandibular Joint After Radiotherapy in Rabbits.

OBJECTIVES: Platelet-rich plasma (PRP) was administered into the temporomandibular joint (TMJ) space, which had been exposed to radiotherapy (RT), in an attempt to prevent and/or treat the late-term complications associated with RT when used for the treatment of head and neck cancers (nasopharyngeal cancer in particular) on the musculoskeletal system. METHODS: A total of 13 adult male New Zealand ( Oryctolagus cuniculus) rabbits were used in the study. The animals were classified into 3 groups: 6 in the RT group, 6 in the RT+PRP group, and 1 in the control group (exposed to neither). The TMJ space of each rabbit was exposed to 2240 cGy external RT in total, and PRP was administered into the TMJ space 1 month later. The joints were surgically removed 1 month later and examined histopathologically. RESULTS: In the group given RT+PRP, the level of inflammation, amount of muscle fibrosis, vascular wall fibrosis, synovial membrane and condyle cartilage thickness, temporal extrabone fibrous cell layer count, and intramuscular changes were similar to those recorded in the control group, although the positive effects of PRP were not found to be statistically significant. CONCLUSIONS: The findings of the present study demonstrate that injections of PRP may increase joint inflammation and therefore enhance blood supply, resulting in the onset of regeneration. These favorable effects of PRP may be helpful in the fight against late-term musculoskeletal complications of RT and may minimize such side effects as sore jaw, malnutrition, and weight loss.

The reduction of extraneural scarring with buccal mucosa graft wrapping around the sciatic nerve: an experimental study in a rat model.

BACKGROUND: The postoperative development of epineural and extraneural scar tissue adversely affects peripheral nerve surgery outcomes. Although several surgical methods, pharmacological agents, and chemical materials have been used to prevent epineural scar formation in both clinical and experimental models, the results are still unsatisfactory. The purpose of this study was to investigate the efficacy of buccal mucosa graft (BMG) wrapping on epineural scarring in an adult rat model. METHODS: Bilateral sciatic nerves were carefully exposed in 24 adult Sprague-Dawley rats, and a circumferential segment of epineurium (0.5 cm) was excised from both nerves. The epineurectomised left nerve segment was wrapped with a BMG (experimental side), while the right nerve segment did not receive any surgical procedure other than the epineurectomy, and served as the control side. To perform gross and histopathological examinations, 12 randomly selected rats were euthanised at 4 weeks postoperatively, and the remaining rats were euthanised at 8 weeks. RESULTS: The left sciatic nerve that was wrapped with a BMG following epineurectomy showed significantly less nerve adhesion at 8 weeks (p = .018), and less epineural scar tissue at both 4 (p = .014) and 8 weeks (p = .025). Inflammation of the BMG-wrapped nerves was increased at 4 weeks (p = .029), but not at 8 weeks. CONCLUSION: BMG wrapping decreases postoperative adhesion and scar tissue formation of epineurectomised healthy nerves, despite the presence of increased inflammation in the early postoperative period.

Groin and thigh reconstructions with pedicled rectus abdominis myocutaneous flaps.

BACKGROUND/AIM: Resection of tumors from the groin and thigh regions with safe margins often results in significant soft tissue defects, which preclude primary closure. This study presents a series of rectus abdominis myocutaneous flaps for irradiated thigh and groin wounds with the purpose of evaluating the efficacy and outcomes of these flaps in this population. MATERIALS AND METHODS: From 2008 to 2015, all patients who underwent resection of thigh or groin region tumors and reconstruction with an inferiorly based rectus abdominis myocutaneous flap were retrospectively identified. Medical records of the patients were reviewed. RESULTS: A total of 27 patients, aged 20-67 years, were operated on for defects in the groin and upper thigh region. Nine patients underwent immediate reconstruction. The remaining 18 patients underwent late reconstruction. There was neither total flap loss nor partial flap loss. We chose to utilize 15 ipsilateral and 12 contralateral pedicles. The mean length of stay in hospital was 13.7 days. CONCLUSION: A rectus abdominis myocutaneous flap can be successfully used in patients with groin and upper thigh defects due to its predictable and robust vascular supply, bulky muscle content, wide arc of rotation, and large skin island.

Central artery perforator propeller flap for nasal and medial canthal defects.

INTRODUCTION: Non-melanoma skin cancer is the most common type of skin cancer of the nasal dorsum and the medial canthal region, which is caused by chronic sun exposure. Limited adjacent tissue and the need for aesthetically pleasing result make the reconstruction of these regions very challenging. To overcome this challenge, we designed a perforator propeller flap based on the central artery. METHODS: Between January 2014 and November 2015, we covered the nasal or medial canthal defects of 22 patients with central artery perforator propeller flaps. RESULTS: The mean age of the patients was 60.4 years (range: 47-81 years). The median follow-up period was 7.5 months (range: 2-23 months). The pathological diagnoses were basal cell carcinoma for 14 patients and squamous cell carcinoma for the remaining eight patients. The size of the defects ranged from 2 × 2 to 3.5 × 4 cm, and that of the flaps ranged from 2 × 3.5 to 3.2 × 6 cm. We did not observe any major complications requiring surgery, such as total flap loss, hematoma, or dog-ear deformity. However, venous congestion was seen in five patients and partial flap necrosis (that healed without intervention) in two patients. CONCLUSION: The central artery perforator propeller flap is a reliable and versatile flap for the reconstruction of the nasal dorsum and medial canthal region. Reconstruction with this flap is a single-stage procedure that can cover large defects without causing dog-ear deformity or eyebrow asymmetry compared with other local flap options.

The Effects of Reduction Mammaplasty on Serum Leptin Levels and Insulin Resistance.

Background. The reduction mammaplasty has been a well-executed and known procedure in which considerable amount of fatty tissue is removed from the body. The authors aimed to show the effects of the reduction mammaplasty on serum leptin levels and insulin resistance. Methods. 42 obese female patients who had gigantomastia were operated on. We recorded patients' demographic and preoperative data, including age, weight, height, and body mass index. Fasting serum leptin, glucose, and insulin levels were noted. Homeostasis model assessment scores were calculated. At the postoperative 8th week, patients were reevaluated in terms of above parameters assessing the presence of any difference. Results. Serum leptin levels were decreased postoperatively and the decrease was statistically significant. We were able to show a decrease in homeostasis model assessment score, which indicated an increase in insulin sensitivity, and this change was statistically significant. A significant correlation between body mass index and leptin change was found postoperatively. Conclusion. Reduction mammaplasty is not solely an aesthetic procedure but it decreases serum leptin levels and increases insulin sensitivity, which may help obese women to reduce their cardiovascular risk.

A new, simple technique for gradual primary closure of fasciotomy wounds.

BACKGROUND: The aim of this study was to demonstrate a new, easy and safe technique, which has not been defined in the literature previously, that enables the gradual primary closure of fasciotomy wounds using barbed sutures. METHODS: The technique was performed on five patients who presented with fasciotomy wounds on both upper and lower extremities, varying in size, observed after compartment syndrome due to different causes. The average width of the defects for which primary closure was planned was 8.8 cm. Following the fasciotomy incision, absorbable barbed sutures were inserted through the dermal tissue around the wound similar to that of a subcuticular closure, but left loose, after which closed dressing was applied. During the clinical follow-up, with the decrease in tissue edema and tightness around the wound, the barbed suture was tightened at bedside every 48-72 hours. RESULTS: At the end of this gradual closure, all the fasciotomy defects were primarily closed within an average of 8.6 days. All the patients had complete and uncomplicated primary closure with the exception of one with high-voltage electrical burn injury, who developed necrosis in the distal part of the defect, and was treated by secondary healing. CONCLUSION: The gradual fasciotomy closure technique with barbed suture seems to be an easy, rapid and effective method.