Impact of the COVID-19 Pandemic on Diabetic Foot Patients: A Shift in the Infectious Agent Profile Toward Nonfermentative Gram-Negative Bacilli.

BACKGROUND: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality. METHODS: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]). RESULTS: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP. CONCLUSIONS: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.

A single K-wire to prevent poor outcomes in closed soft-tissue mallet finger management due to patient non-compliance.

INTRODUCTION: Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6-8 weeks is the gold standard for conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting. MATERIALS AND METHODS: In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (n = 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (n = 23). Patients in the third group were treated with K-W only (n = 47), and the fourth group did not accept surgical treatment nor conservative treatment (n = 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years. RESULTS: At 20th week postoperatively, average DIP extension lag was 6 degrees (0-30) for the first group, 6.1 degrees (0-30) for the second group, 3.8 degrees (0-25) for the third group, and 17.3 degrees (7-30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results. CONCLUSION: Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.

Evaluation of nasal pathologies accompanying rhinoplasty cases at otorhinolaryngology and plastic, reconstructive, & aesthetic surgery clinics.

BACKGROUND AND OBJECTIVES: Rhinoplasty is a frequently performed surgical procedure. Besides an aesthetically successful outcome, determination of additional nasal pathologies and making a simultaneous intervention on these are also essential for a successful functional outcome. This study aims to determine the rates of accompanying nasal pathologies in patients undergoing rhinoplasty and reveals whether any additional interventions were performed during operation. MATERIALS AND METHODS: In this cross-sectional study, 496 Caucasian Turkish patients who underwent rhinoplasty at the Plastic, Reconstructive & Aesthetic Surgery and Otorhinolaryngology clinics of our research hospital between 2015 and 2018 were retrospectively examined. Among them, the results of 271 patients who had preoperative paranasal computerized tomography scans were evaluated. RESULTS: The mean age of the 271 patients was 28.8 years (Range: 17-55). Among them, 156 (57%) were female and 115 (42%) were male. The numbers of patients with septal deviation, inferior concha hypertrophy, unilateral/bilateral concha bullosa, nasal polyp, mucosal thickening, and retention cysts at the Otorhinolaryngology clinic were found to be 126 (82%), 77 (50%), 20 (13%), 10 (6.5%), 77 (50%), and 41 (27%), respectively, and these numbers were respectively 97 (82%), 60 (51%), 11 (9.3%), 2 (1.7%), 57 (48%), and 17 (14%) at the Plastic, Reconstructive & Aesthetic Surgery clinic. A statistically significant difference was found in terms of the presence of retention cysts between the clinics (95% CI -0.11% to 0.16%; P=.014; P<.005), and the presence of retention cysts was significantly higher at the Otorhinolaryngology clinic. A total of 18 (12%) patients were found to have additional surgical interventions. CONCLUSIONS: This study showed that additional nasal pathologies were frequently present in patients undergoing rhinoplasty operations. Hence, for a successful operation, it is essential to have Otorhinolaryngology consultation and detect accompanying pathologies in rhinoplasty cases which will be performed by Plastic, Reconstructive & Aesthetic Surgery specialists. LEVEL OF EVIDENCE: 4.

Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications.

Ankle fractures are among the most common orthopaedic surgical procedures. Skin-related complications of these surgeries are difficult to reconstruct due to the inadequacy of soft tissue in the region. Although free flaps are generally considered as the first choice in reconstruction of this area, free flaps may not be a suitable option especially in patients with advanced age and comorbidities. Perforator flaps offer a fast and safe alternative in lower extremity reconstruction. In the literature, there are a limited number of studies using perforator flaps in managing the postoperative complications of the lower extremity trauma surgeries. In our study, we report our experience with reconstruction of soft-tissue defects of medial malleolar region using posterior tibial artery perforator flap for postoperative complications of ankle fracture-related surgeries.

Extracorporeal Free Flap Perfusion Using Extracorporeal Membrane Oxygenation Device: An Experimental Model.

Extracorporeal perfusion of organs has a wide range of clinical applications like prolonged vital storage of organs, isolated applications of drugs, bridging time to transplant, and free composite tissue transfer without anastomosis, but there are a limited number of experimental models on this topic.This study aimed to develop and evaluate a human extracorporeal free flap perfusion model using an extracorporeal membrane oxygenation device. Five patients undergoing esthetic abdominoplasty participated in this study. Deep inferior epigastric artery perforator flaps were obtained abdominoplasty flaps, which are normally medical waste, used in this model. Deep inferior epigastric artery perforator flaps were extracorporeally perfused with a mean of 6 days. The biochemical and pathological evaluations of the perfusions were discussed in the article.

Preventing Suture Extrusion and Recurrence in Mustarde and Furnas Otoplasties by Using Laterally Based Postauricular Dermal Flap, Long-Term Results.

BACKGROUND: Prominent ear deformity (PD) is an unacceptable condition of pinna that affects 5% of the population and is associated with emotional stress, behavioral disturbances, and social restrictions in relationships. Conchal hypertrphy, inadequate formation of antihelical fold, earlobe placement ahead than it should be, or various combinations of these changes are main characteristics of PD. Many surgical techniques have been described for the PD.The authors' aim was to present laterally based postauricular dermal flap combination with cartilage-sparing methods and effectiveness of this technique in suture extrusion prevention and reducing the rate of recurrence with long-term results. METHODS: Forty-one patients had bilateral and 6 patients had unilateral PD, a total of 47 patients with a mean age of 14.48 were operated by using this combined procedure. A laterally based supraperichondrial dermal flap was prepared from a deepithelized elliptical postauricular incision. Mustarde and Furnas suture techniques were used solely for PD correction. The dissected laterally based dermal flap was fixed to the mastoid bone with sutures in stretched position after reshaping the auricular cartilage with sutures. RESULTS: The average helix-mastoid distance was (mm) 16.28 ±â€Š2.36, concha-mastoid angle was 25.71 ±â€Š0.96° on 12-month measurements. The helix-mastoid distance showed an increase of 1 to 3 mm, in the concha-mastoid angle measurements of 1° to 2°. Statistically significant changes were observed between the average preoperative, postoperative 1. month, postoperative 12. month helix-mastoid distances (mm), and month concha-mastoid angle (°) measurements (P = 0.0001). CONCLUSIONS: The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.

Sarcoidosis Nodules on the Lateral Nasal Osteotomy Lines.

UNLABELLED: Sarcoidosis is a multisystem inflammatory disease that manifests as noncaseating granulomas, commonly in the lungs and intrathoracic lymph nodes. Subcutaneous manifestations of sarcoidosis that are caused by granulomas are referred to as specific for sarcoidosis, whereas other lesions are considered nonspecific. The authors present "sarcoidosis nodule formation on the lateral nasal osteotomy lines" in a sarcoidosis patient undergoing rhinoplasty surgery as a rare patient. LEVEL OF EVIDENCE: V.

Pulp Rotation Flap for Lateral Oblique Fingertip Defects.

BACKGROUND: Fingertip amputations are among the most common injuries seen in the hand. According to the geometry of the amputation, it may be classified as transverse or oblique (dorsal, volar, or lateral type). Although numerous repair techniques have been described in the literature, there are few alternatives suitable for lateral oblique type fingertip amputations. METHODS: Between 2012 and 2016, we operated on 16 patients with simple rotation flap from the remaining part of the pulpa in a rotation and advancement manner for the reconstruction of lateral oblique type fingertip amputations. RESULTS: All but two of the flaps healed completely with full flap survival. Superficial distal flap necrosis was observed in two patients. They healed by secondary intention. No obvious hooked nail occurred in patients. Cold intolerance was observed in one patient; joint stiffness or hypersensitivity was not observed in any of the patients. Stiffness of the proximal interphalangeal joint did not occur. Two point discrimination test results were found to be normal. CONCLUSION: This technique is simple, rapid, and free from relatively major complications. This flap allows for anatomical reconstruction of the fingertip by using a similar tissue in cases of lateral oblique fingertip amputations, where only a few flap options can be successful.

Recurrent Ameloblastoma in the Free Fibula Flap: Review of Literature and an Unusual Case Report.

Ameloblastoma is the second most common odontogenic tumor of the oral cavity with the primary site being the mandible. The ratio of maxillomandibular involvement however is 5:1 in favor of the mandible. The most common complaint is a painless swelling over the mandibular area. Despite its benign nature, ameloblastoma has a high local recurrence rate, with the most recurrences seen within 5 years after operation. Biopsy and radiological evaluation may be helpful in differentiating the subtypes of ameloblastoma. Differentiation is important because some subtypes are more aggressive than the others. Preoperative planning may be done according to this classification, which can help decrease the recurrence rate. In our case, a 26-year-old female patient with recurrent ameloblastoma which developed on the fibular flap is presented. The free fibular flap and the left parasymphyseal part of the mandible were totally excised. Ameloblastoma was confirmed on pathological examination. We reconstructed the left mandibular site with a reconstruction plate and recurrence was not seen during follow up period.

New otoplasty approach: a laterally based postauricular dermal flap as an addition to Mustarde and Furnas to prevent suture extrusion and recurrence.

Prominent ear is the most common deformity of the external ear. The major causes can be an underdeveloped antithetical fold, concha hypertrophy, and prominence of the ear lobule. Since Ely's first aesthetic correction of the prominent ear in 1881, more than 200 different techniques have been described, but the choice of procedure still remains the surgeon's preference. This report presents the laterally based posterior auricular dermal flap technique as an adjunct to the conventional cartilage-sparing otoplasty. An elliptical skin incision was planned according to the classic prominent ear correction technique. Instead of the excision, skin was deepithelialized. From the inferior border of the incision, the dermal flap was incised and elevated in a medial-to-lateral direction. The posterior auricular dermal flap was used to support and cover the suture material. This method was used in the treatment of 17 consecutive patients. After a follow-up period of 6-32 months (mean 16 months), the patients were evaluated in terms of the recurrence and suture line problems. No suture line problems or recurrences were observed at the end of the follow-up period. Use of the posterior auricular dermal flap both prevents suture extrusion and decreases recurrences. 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 .

Effects of palatine bone denudation repair with periosteal graft on maxillary growth: an experimental study in rats.

BACKGROUND: The long-term goal of cleft palate repair is to provide normal maxillary growth and speech capacity. However, most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. It is widely acknowledged that palatal bone denudation and subsequent scar contracture resulting from cleft palate surgery can inhibit maxillary growth. METHOD: This study is designed to investigate the effect of the periosteum on growth patterns of the maxilla. A total of 32 three-week-old Sprague-Dawley rats were randomly divided into a control group and three experimental groups: a mucosa excision group, a mucosa-periosteum excision group and a periosteal graft group. Nine weeks postoperatively the skulls were prepared for study and palatal widths and lengths were determined. The experimental groups were investigated for various histological changes. RESULTS: There was no statistically significant difference for the maxillary measurements (palatal width and length) between the mucosa excision group and the periosteal graft group when compared with the control group. However, the mucosa-periosteum excision group compared to the control indicated a statistically significant decrease in the same measurements. There was also a statistically significant difference for the maxillary measurements between the periosteal graft group and the mucosa-periosteum excision group. It was demonstrated histologically that the density of the Sharpey's fibres and periodontal scar tissue showed a slight increase in the mucosa excision group and the periosteal graft group compared with the control group. In the mucosa-periosteum excision group, the density increased significantly as expected. CONCLUSIONS: All of these findings testify that retaining the periosteum or replacement with a periosteum graft after surgery can prevent the inhibition of maxillary growth.

Digital artery perforator flaps: an easy and reliable choice for fingertip amputation reconstruction.

OBJECTIVE: The aim of this study was to evaluate the use and efficacy of digital artery perforator (DAP) flaps in fingertip reconstruction. METHODS: From 2007 to 2011, 7 fingers of 5 patients (4 male, 1 female) underwent fingertip reconstruction with extended DAP flaps following traumatic fingertip amputation. Average flap size was 4.25 cm². RESULTS: All flaps survived except one case in which partial skin necrosis was observed and treated with wet-dressing. Donor sites were closed with full-thickness skin grafting in 5 and primarily in 2 fingers. We did not observe hypersensitivity or cold intolerance in repaired fingers. CONCLUSION: The DAP flap is a reliable, free-style perforator flap that can be used for all types of fingertip injuries.

Endoscopic repair of isolated anterior table frontal sinus fractures without fixation.

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

Use of scalp flaps as a salvage procedure in reconstruction of the large defects of head and neck region.

AIM: Large defects of the scalp, head and neck region are often encountered by plastic surgeons. The repair of such defects is dependent upon their location, size and depth. This study describes the use of large scalp flaps as a salvage procedure in the reconstruction of large scalp, head and neck region defects in elderly patients with poor general condition or advanced malignancy. MATERIAL AND METHODS: The presented study includes 22 patients operated between 2007 and 2011 for the reconstruction of large defects of the hair-bearing skin and head/neck region with large scalp flaps. A defect exceeding 25 cm² area was classified as "large" as defined in the previous studies. The patients' medical records were analyzed. RESULTS: Scalp flaps provided a satisfactory and durable reconstruction in the late follow-up term. All flaps were completely survived except in one case in which a partial necrosis in the distal margin occurred. Major complications were recorded in 4.5% of patients while minor complications were recorded in 13.5% of them. CONCLUSION: In conclusion, large scalp flaps should be considered as a salvage procedure for reconstruction of large scalp, head and neck defects especially for palliative situations in elderly patients with significant comorbidities and advanced malignancies.

Tanzer group IIB constricted ear repair with helical advancement and superior auricular artery chondrocutaneous flap.

Constricted ear deformity was first described by Tanzer and classified it into 3 groups according to the degree of constriction. The group IIB deformity involves the helix, scapha, and antihelical fold. The height of the ear is sharply reduced, and the soft tissue envelope is not sufficient to close the cartilage framework after expansion and reshaping.This study describes expanding the cartilage and increasing the height by advancing the helical root superiorly and repairing the skin-cartilage defect with a superior auricular artery chondrocutaneous flap in Tanzer group IIB constricted ear deformity.Six ears of 6 patients were treated with this technique during the past 3 years. All patients were satisfied with the appearance of their corrected ears, and the increase in height was maintained through the follow-up period.The described technique does not have the disadvantages and possible complications of harvesting a costal cartilage graft. Moving and fixing the root of helix to a more superior position provide the auricle with additional length. The superior auricular artery chondrocutaneous flap not only provides adequate soft tissue for primary closure of the anterior portion of the auricle but also aids in repairing the cartilage defect resulting from the superior advancement of the helix as well.

Effective use of negative pressure wound therapy provides quick wound-bed preparation and complete graft take in the management of chronic venous ulcers.

Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.