Modified Diamond-Shaped Umbilicoplasty in Abdominoplasty.

BACKGROUND: The aim in umbilicoplasty is to obtain a scar that is less visible, the appropriate navel shape and depth. In our study, we aimed to achieve a more natural and younger appearance of the navel which significantly affects the aesthetic result after abdominoplasty. Modification of diamond-shaped umbilicoplasty technique and clinical results were evaluated. PATIENTS AND METHODS: Fifty-three patients were included in the study. Modified diamond-shaped umbilicoplasty was performed in 21 patients, and diamond-shaped umbilicoplasty was performed in 32 patients. Demographic data, complications, revision surgery, and follow-up periods of the patients were reviewed retrospectively. Different from the standard technique, we deepithelialized the diamond-shaped skin over the abdomen flap and designed four triangular flaps. Then, the navel was inset over these four flaps. RESULTS: Forty-six (86.8%) of the patients were females and 7 (13.2%) were males, with a mean age of 39.49 ± 9.18 years, ranging from 22 to 57 years. Complications were occurred in 9 patients in total. There was no difference between groups in complication rates. The mean VAS value of the patients in the MDSU group was 9.48 ± 0.75, it was 8.28 ± 0.99 in the DSU group, and the difference was statistically significant (p:0.001). The mean age of the MDSU group was found to be significantly higher than the DSU group (p:0.008). The BMI of the MDSU group was found to be significantly higher between two groups (p:0.009). DISCUSSION: In our study, there was no difference between the complication rates of the two techniques. Therefore, MDSU is a reliable technique. High VAS score of the patients of MDSU was statistically significant. This shows that this modification provides good aesthetic results. CONCLUSION: Modified diamond-shaped umbilicoplasty is easy to perform and provides better aesthetic results. LEVEL OF EVIDENCE IV: 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 external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation.

INTRODUCTION: Tamai zone 1 replantation poses a challenge due to the very small size of the vascular structures; often there is no vein for anastomosis. Replantation may have to be done with only an arterial anastomosis. In our study, we aimed to evaluate the success of replantation by combining external bleeding and hyperbaric oxygen treatment (HBOT) in Tamai zone 1 replantation. METHODS: Between January 2017 and October 2021, 17 finger replantation patients who underwent artery-only anastomosis due to Tamai zone 1 amputation received 20 sessions of HBOT with external bleeding after the 24th postoperative hour. Finger viability was assessed at the end of treatment. A retrospective review of outcomes was performed. RESULTS: Seventeen clean-cut finger amputation patients were operated on under digital block anaesthesia with a finger tourniquet. No blood transfusion was required. In one patient, complete necrosis developed and stump closure was performed. Partial necrosis was observed in three patients and healed secondarily. Replantation in the remaining patients was successful. CONCLUSIONS: Vein anastomosis is not always possible in fingertip replantation. In Tamai zone 1 replantation with arteryonly anastomosis, post-operative HBOT with induced external bleeding appeared to shortened the hospital stay and was associated with a high proportion of successful outcomes.

Evaluation of Life Improvement in Trans Men After Mastectomy: A Prospective Study Using the TRANS-Q.

BACKGROUND: Mastectomy is the most common and sometimes the only surgery performed in FtM transgender individuals. In this study, it was aimed to evaluate the improvement in life standards of patients who underwent double incision mastectomy with free nipple-areolar complex graft and periareolar mastectomy by using TRANS-Q in trans men. MATERIALS AND METHODS: TRANS-Q was performed in 71 trans men at the preoperative and postoperative 1st year, and the revision and complication rates in both groups were compared. RESULTS: A statistically significant difference was observed in the postoperative satisfaction rates in both groups. We observed that the patients who underwent periareolar mastectomy had significantly higher satisfaction rates than the patients who underwent double incision mastectomy with free nipple areolar complex graft. In both groups, postoperative satisfaction rates were found to be significantly higher. CONCLUSION: Improvement in life standards has been observed in trans men who underwent mastectomy, and late results should be evaluated with further prospective studies. LEVEL OF EVIDENCE IV: 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 .

Complications of Percutaneous Release of the Trigger Finger.

AIM: Trigger finger is a common cause of hand pain and dysfunction. In this study, we aimed to evaluate retrospectively short and long-term outcomes of patients with trigger fingers who underwent percutaneous release operations. MATERIALS AND METHODS: Thirty-nine patients who underwent percutaneous release of the trigger finger were analyzed retrospectively. The patients were evaluated for digital nerve injury (hypoesthesia), recurrence, painful scar, and tendon rupture. RESULTS: The patients' median age was 54 years (minimum 32 years - maximum 63 years). Hypoesthesia was most frequently seen at the first and fourth fingers. At the end of the first year, one patient developed tendon rupture (fourth finger). Recurrences were seen at the end of the first (n=5) and third (n=9) years. Recurrence was mostly seen in the fourth finger, followed by the third finger. Painful scars were observed in two patients. CONCLUSION: Percutaneous release is a blindly performed intervention and the emergence of unexpected complications should not be forgotten.

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations.

BACKGROUND: Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures. METHODS: Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2nd, 3rd, and 4th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9-23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes-Weinstein monofilament test, and cold intolerance test for the development of neuroma on the donor site. RESULTS: In 5 patients, replantation procedure failed. In such failed patients, after the removal of necrotic tissues, the stump was either repaired or reconstruction with a flap was applied. Wound dehiscence was observed at the lateral sides of the flaps in 2 patients who underwent reposition procedures. CONCLUSION: Reposition flap repair can be a good cost-effective alternative to other fingertip repair procedures in appropriately selected patients who are not amenable to microsurgery. It preserves the length and sensory functions of fingertips and enables patients to return to their daily life as soon as possible.

Evaluation of sexual function in women with labia minora hypertrophy: A preliminary study.

OBJECTIVE: To compare the sexual functions in women with labia minora hypertrophy and age-matched healthy controls. MATERIAL AND METHOD: 43 patients with labia minora hypertrophy and 30 age-matched healthy controls were enrolled in the present study. The sexual functions of the women were evaluated by using the index of female sexual function (IFSF). RESULTS: Mean ages of the patients and controls were 30.06±7.11 and 31.34±4.12 (p=0.41), respectively. Mean total IFSF scores of the patients and controls were 24.18±3.24 and 27.53±4.43 (p<0.05), respectively. The subscale scores of IFSF-lubrication, orgasm, satisfaction and pain in the patient group were significantly lower than in the control group (respectively, p<0.001, p<0.05, p<0.001 and p<0.05). There was no statistically significant difference between IFSF-arousal scores of the patient and control groups (p=0.30). The mean IFSF-desire scores of the patient group was higher than the controls (p<0.001). Labia minora hypertrophy was significantly associated with female sexual dysfunction (odds ratio [OR]=14.97, 95% confidence interval [Cl]=[3.66-61.21], p<0.001). CONCLUSION: This study suggests that patients with labia minora hypertrophy have poorer lubrication, satisfaction, pain, and orgasm scores on the IFSF scale compared to age-matched healthy controls.

Giant lipoma extending into two thigh canals: A case report.

Giant lipomas, although rare, represent a real diagnostic and therapeutic challenge. We report an unusual giant lipoma of the thigh extending into two thigh canals and it's diagnostic and therapeutic processes.

Fingertip Replantation Without and With Palmar Venous Anastomosis: Analysis of the Survival Rates and Vein Distribution.

BACKGROUND: The purpose of this study was to compare the results of fingertip replantations without (artery anastomosis only replantations) and with venous anastomosis (replantations in which both arterial and palmar venous anastomoses were performed). Also, distribution of the veins used for anastomosis was analyzed retrospectively. PATIENTS AND METHODS: First 53 digits (47 patients) received only arterial anastomosis (group 1). For relieving venous congestion, external bleeding method was used. Last 41 digits (38 patients) received both arterial and palmar venous anastomoses without external bleeding (group 2). RESULTS: There was statistical significance of the survival rate between group 1 [77.3% (41/53)] and group 2 [92.6% (38/41)] (P = 0.039). Venous congestion was encountered at 10 digits in group 1 (all underwent necrosis totally) and at 3 digits in group 2 (both were moderate and could be salvaged partially) (P = 0.094, no statistical significance). There was statistical significance of the mean operation time for single-fingertip replantation between group 1 (80 ± 7.8 minutes) and group 2 (105 ± 14.5 minutes) (P < 0.001). The average external bleeding period was 7.2 days. The mean hospital stay was 12.4 ± 1.5 days for group 1, which was significantly longer when compared with group 2 (5.2 ± 0.5 days, P < 0.001). CONCLUSIONS: Although palmar vein anastomosis did not show a statistically significant effect on relieving venous congestion, it reduced the rate and the severity of venous congestion. Also, replantations with palmar venous anastomosis have simpler postoperative care and lower drawbacks as compared with artery anastomosis-only replantations.

Invasive squamous cell carcinoma originating from a giant penile condyloma.

In this case study, we present an unusual case with squamous cell carcinoma originating from a giant condyloma acuminata completely surrounding the penis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 20 years. Incisional biopsy revealed acanthosis of the squamous epithelium. The patient was operated on under spinal anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. The penile skin was constructed with a split thickness skin graft. Histopathological analysis of the lesion revealed an invasive and well-differentiated squamous cell carcinoma arising on a condyloma, and the surgical margins were free from tumour. The patient was staged as G2 T1 N0 M0 and was followed for one year. He did not have any erectile dysfunction and could engage in intercourse. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. When encountering patients with giant condyloma acuminata, it should not be forgotten that it may be accompanied by squamous cell carcinoma. In addition, tissue excision should be as extensive as possible while keeping in mind the importance of the function. This is the first case of a penile-degloving surgery for giant penile condyloma, supporting conservative and preserving penile surgery for such tumours.

Sexual function and hormone profile in young adult men with idiopathic gynecomastia: Comparison with healthy controls.

OBJECTIVES: To compare sexual function and hormone profile in male patients with gynecomastia with matched controls. MATERIALS-METHODS: Forty-seven male subjects with gynecomastia and thirty healthy controls were enrolled in this study. Serum free T3, free T4, TSH, FSH, prolactin, estradiol, total testosterone, free testosterone, DHEA-SO4, LH and total PSA were measured in the patients and controls. Sexual function of the patients and controls were evaluated using International Index of Erectile Function (IIEF). The hormone values and IIEF scores of the patients were statistically compared with the controls'. RESULTS: The mean of age, body mass index, right and left testicular volume in the patient and control group were similar. The mean FSH and free T3 values of the patients were significantly lower than the controls (p = 0.007 and p = 0.03, respectively). The mean of the other hormone values in the both groups were found to be statistically similar (p > 0.05). The mean ±SD of total IIEF scores in the patient and control group were 60.14 ± 8.78 and 65.24 ± 5.52, respectively (p = 0.007). Although the mean IIEF-erectile function, orgasmic function and intercourse satisfaction scores in the patient group were significantly lower than the control group (p < 0.001, p = 0.004 and p = 0.001, respectively), the mean IIEF-desire score of the patients was significantly higher than the controls (p = 0.002). CONCLUSION: We found that the hormone profiles (except FSH and free T3) of the patients with gynecomastia were similar with the controls. However, gynecomastia adversely affected male sexual function.

Increasing topical anesthetic efficacy with microneedle application.

INTRODUCTION: Since topical anesthetics alone seldom provide adequate analgesia for laser resurfacing procedures, injectable forms of anesthesia are often required. However, their application is uncomfortable for the patient. In this study, it is investigated whether microneedle application would enhance the efficacy of topical anesthetics. METHODS: Forty-seven patients participated in the study. Topical anesthetic agent EMLA was applied to the whole face of the patients. Microneedle treatment was applied to one side of the face with a roller-type device. Whole-face carbon dioxide laser resurfacing therapy was carried out then. The pain that patients experienced was assessed by using visual analog scale (VAS) method. VAS scores of two sides of the face were compared by using Wilcoxon signed-rank test. RESULTS: The mean of VAS score of the microneedle treated side was 2.1 ± 1.1 while that of the untreated side was 5.9 ± 0.9 and this difference was statistically significant (Wilcoxon signed-rank test, the Z-value is - 5.9683 and the p-value is < 0.001). SUMMARY: This study revealed that microneedle application, with a roller-type device, is a safe and easy procedure in providing sufficient anesthesia for facial laser resurfacing without the need for supplementary nerve blocks or injections.

Effect of Reduction Mammaplasty on Sexual Activity.

AIM: This study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. MATERIALS AND METHODS: Thirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls' scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. RESULTS: The mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). CONCLUSIONS: We found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners' erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.

A novel method to prevent complications of nasal osteotomy: matress suture which traverses lateral walls and septum.

OBJECTIVES: This study aims to investigate long-term nasal wall stability and prevention of nasal osteotomy complications using thin osteotomes without a nasal splint. PATIENTS AND METHODS: Between March 2012 and August 2014, 16 male patients (mean age 24 years; range 18 to 42 years) who were admitted with the complaint of appearance of nose to our clinic and were diagnosed with nasal deformity were included in this study. Primary rhinoplasty was performed on 15 patients, while secondary rhinoplasty due to open roof deformity was applied in one patient. After hump resection, two holes were made cranially and caudally over the each nasal bone. The mattress suture was performed by passing these holes to stabilize the nasal bone in a desired position following osteotomy. With this technique, only adhesive tapes were applied postoperatively. No external nasal splint was used. RESULTS: The mean follow-up was nine (range, 7 to 13) months. None of the patients experienced open roof deformity, inverted V deformity, nasal bone collapses or wall irregularities. CONCLUSION: Our study results show that our technique is useful to reduce osteotomy complications and to reach the optimal cosmetic outcomes in rhinoplasty.

Basosquamous carcinoma: is it an aggressive tumor?

Basosquamous carcinoma is a rare cutaneous tumour that is considered an aggressive type of basal cell carcinoma with an increased risk of recurrence and metastases. This impression has been perpetuated in the literature, despite limited scientific data and conflicting results of some authors. This present study was aimed to evaluate the clinical-pathological features of this tumour and follow-up of a series of basosquamous carcinoma. Basosquamous carcinoma patients who underwent surgical excision between January 2000 and February 2012 were analyzed retrospectively. Their medical files were reviewed and the corresponding routinely stained sections (with hematoxylin-eosin) were re-evaluated by two pathologists. Thirty-five patients with basosquamous carcinoma were operated on in this period. Most tumurs were located in the head and neck area (94%), and the mean age of the patients was 69.8 years. Margin involvements were seen in 11 patients (31.4%) and all of them underwent re-excision. There was only one local recurrence. There was neither regional lymph node nor distant metastasis in this series. The recurrence rate of basosquamous carcinoma is found as 4%, lower than that of most other similar studies. Further pathologic studies are needed to better classify basosquamous carcinoma and to increase consistency between the results of studies. Surgical excision and regular follow-up are considered as the treatment of choice.

Patient-reported quality-of-life outcomes of breast reduction evaluated with generic questionnaires and the breast reduction assessed severity scale.

BACKGROUND: The effects of breast reduction on quality of life (QOL) have been evaluated in patients with macromastia, but few investigators have performed condition-specific assessments. OBJECTIVES: The authors employed generic and condition-specific questionnaires to examine the QOL of patients with macromastia and determined the responsiveness of the Turkish version of Breast Reduction Assessed Severity Scale (BRASS). METHODS: This prospective cohort study included patients with breast hypertrophy who underwent breast reduction (n = 94). Patients completed the Turkish versions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the BRASS, and the Rosenberg Self-Esteem Scale preoperatively and 4 months postoperatively. Differences in responses were evaluated by paired t-test and by comparing change effect sizes. Multiple regression analyses were performed to evaluate improvements in QOL in response to adjustments in baseline differences across patients. RESULTS: Preoperative and postoperative questionnaires were completed by 78 patients (83%). Significant postoperative improvements in self-esteem (Rosenberg Self-Esteem Scale; P < .001) and in all domains of the BRASS (P < .001) were noted. Mean preoperative scores for 5 of 8 domains in the SF-36 were lower than those of a normative population. Postoperatively, all 5 mean scores improved significantly, but the score for bodily pain remained less than that of a normative population. CONCLUSIONS: The results of this study indicate significant improvements in health-related QOL at 4 months after breast reduction in a population of patients with macromastia. The authors also demonstrate excellent responsiveness of the BRASS.

Prediction of resection weight in reduction mammaplasty based on anthropometric measurements.

BACKGROUND: The aim of this study was to develop a simple, clinically useful method to accurately predict resection weight in women undergoing reduction mammaplasty. PATIENTS AND METHODS: 39 women undergoing breast reduction participated in the study. Sternal notch to nipple distance, nipple to inframammary fold distance (NIMF), medial end point to nipple distance (MN), lateral endpoint to nipple distance (LN), superior border of the breast to nipple distance (SN), breast circumference (BC), and chest circumference (CC) were measured. 5 other predicting variables were also derived; horizontal breast measurement (H) by adding MN to LN, vertical breast measurement (V) by adding NIMF to SN, the product of H and V (H*V), the product of H and NIMF (H*NIMF), and the difference between BC and CC (D). Regression analysis was used to compose a formula for predicting resection weight. RESULTS: Among the predicting variables, H*NIMF measurements had the highest correlation coefficient value (Pearson correlation = 0.809) with the resection weight. The following formula was obtained with regression analysis: Predicted resection weight = (1.45 × H*NIMF) + (31.5 × D) - 576. CONCLUSION: Breast resection weights can be accurately predicted by the presented method based on anthropomorphic measurements.

Histopathologic findings in breast reduction specimens.

Reduction mammaplasty is a commonly performed operation for treatment of breast hypertrophy. It allows examination of specimens from a seemingly healthy population. Although there are many publications reporting the incidence of occult breast carcinomas, only a few studies have specifically examined the incidence of other breast lesions in reduction mammaplasty specimens. The authors conducted a single-centre retrospective chart review examining the incidence of benign and precancerous lesions in breast reduction specimens. Both age and the number of tissue sections were evaluated for the association with important pathologic findings. Of the 95 patients who underwent reduction mammaplasty, eight patients (8.4%) had atypical lesions. Fourteen patients (15%) had proliferative and 54 patients (57%) had non-proliferative breast lesions. No occult invasive breast cancer was identified in the breast reduction specimens. The existence of significant pathologic findings was not associated with age (p = 0.231, student t-test). On the other hand, it was found to be associated with the number of tissue sections (p = 0.046, Mann-Whitney U-test). This study reveals that breast reduction specimens should be analyzed histologically since a considerable amount of patients have breast lesions with increased cancer risk. Therefore, this analysis would guide the management of these patients in the follow-up period.

Validation of the Turkish version of the Breast Reduction Assessed Severity Scale.

BACKGROUND: Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. There is no validated questionnaire in Turkish to evaluate quality-of-life issues for patients with mammary hypertrophy. OBJECTIVES: The authors describe the reliability and validity of a translated Breast Reduction Assessed Severity Scale (BRASS) in evaluating Turkish patients. METHODS: The BRASS, developed by Sigurdson et al, was translated into Turkish adhering strictly to the guidelines of questionnaire translations. Statistical analysis was carried out with Cronbach's α to test the internal consistency and intraclass correlation coefficient for test-retest reliability. Exploratory factor analysis was carried out using principal component analysis with oblimin rotation to test its construct validity. Correlations between subscales identified in the factor analysis and corresponding domains in the Short Form-36 and Rosenberg Self-Esteem Scale were analyzed. RESULTS: The total instrument was found to have an α coefficient of 0.92 and subscale α coefficients ranging from 0.76 to 0.87. Intraclass correlation coefficient was 0.93 for the total scale and ranged from 0.81 to 0.91 for the subscales. Exploratory factor analysis resulted in a 5-factor structure: physical implications, body pain, physical appearance, poor self-concept, and negative social interactions. CONCLUSIONS: With this study, the reliability and validity of the Turkish version of the BRASS were revealed. This translated version can be used to evaluate the effect of mammary hypertrophy on quality of life in Turkish patients.

Increasing versatility of the distally based sural flap.

Repairing distal lower limb soft tissue defects remains challenging for reconstructive surgeons. Relatively few procedures have real efficiency and low morbidity. Since its initial description, the distally based sural flap has been used increasingly for this indication. However, controversy exists about the upper limit of the skin paddle of the sural flap. In the present series, 11 patients underwent surgery with distally based sural flaps. In 6 patients, the flap skin paddle was partially or totally placed beyond this controversial limit on the proximal calf region. To increase the skin irrigation of this region, whole mesenteric tissue under the deep fascia of the leg was included in the flap. Venous congestion and distal tip necrosis can impair the success of flap surgery. To overcome these problems, the flap pedicle was not passed through the subcutaneous tunnel. All flaps survived completely, and no cases of venous congestion developed. Thus, extending the donor area to the upper part of the leg is a reliable maneuver to repair more distal defects of the leg and foot, and abstaining from passing the pedicle through a subcutaneous tunnel could contribute to a decreased risk of venous congestion.

Three-dimensional modeling of nasal septal deviation.

BACKGROUND: Some deviated nasal septa can never be straightened completely due to their 3-dimensional (3-D) nature. Based on a study of models and clinical cases, a basic classification and treatment strategy was proposed for 3-D septal deviations. METHODS: Basic types of 3-D septal L struts were crafted from pieces of thick plastic sheeting. By a carefully placed through-and-through incision in the angle area and overlapping the resultant segments, the models became 2 dimensional (2-D). We used this technique intraoperatively, in some cases resecting the overlapping area of septal tissue, along with a septal extension graft, in 11 patients who were followed up for more than 6 months. RESULTS: External nasal deviation due to a deviated septum was obvious in 5 cases, and all were relieved postoperatively. Preoperative breathing difficulties were improved in 7 of 8 patients. CONCLUSION: Correction of 3-D septal L deformity can be successfully performed by constructing 2-D L struts by making a full-thickness incision of the angle area and then overlapping the segments. This approach is especially beneficial in those having a septal extension graft that need a perfectly straight caudal septum upon which to fix the extension graft.