The Effects of Vasonatrin Peptide on Fat Graft Viability: An Experimental Study.

Vasonatrin peptide (VNP) is a synthetic peptide that possesses vasodilatory, natriuretic, and anti-inflammatory properties. The authors aimed to analyze the effects of VNP on fat graft survival. Twenty Sprague-Dawley rats are randomly divided into two groups of 10. Fat grafts are harvested from the right inguinal region. After preparation, fat grafts are placed to the interscapular region. The first group of rats were administered VNP after their fat injection, while the second group received tail-vein injections of an equal volume of sterile saline following their fat injection. Experiment and control groups are evaluated according to their level of degeneration of adipocytes, fat necrosis, vacuolization, cyst formation in adipocytes, fibrosis of the fat tissue, capillary density, and CD31 immunohistochemical staining. Degeneration, vacuolization, and cyst formation in adipocytes were lower in the experiment group. Increased capillary density in the experiment group was demonstrated by CD31 antibody staining and by counting capillary density under a microscope. The average percentage of change in weight of the fat grafts in the experiment group was lower than that in the control group. The results indicate that VNP has some beneficial effects on fat graft survival by multiple independent mechanisms that influence both local and systemic homeostasis.

Discussion of Histopathological Findings of 954 Breast Reduction Specimens.

OBJECTIVES: Breast reduction is a frequently sought procedure by patients and one of the most commonly performed operations by plastic surgeons. Follow-up of histopathological results after reduction mammoplasty is very important. This study aimed to evaluate the histopathological results of patients undergoing bilateral reduction mammoplasty to determine the incidence of breast lesions and risk factors of high-risk breast lesions. METHODS: 477 patients who underwent reduction mammoplasty in the plastic surgery department between October 2013 and January 2020 were included in this study. Patients were evaluated according to age, body mass index (BMI), comorbidity factors, tobacco use, family history and histopathological findings. RESULTS: The mean age of patients was 42.43±12.05 years. Body mass index ranged from 23 to 34.6. As for comorbidity factors, 12 patients had hypertension, five patients had asthma and six patients had diabetes mellitus. Seventeen patients (3.6%) were smokers, and 25 (5.2%) patients had a family history of breast cancer. Among the patients, 2.3% were 20 years and under, 17.1% were between 21 and 30 years old, 21.5% were between 31 and 40 years old, 33.1% were between 41 and 50 years old, 18.2% were between 51 and 60 years old, and 7.5% were 60 years and above. 85.4% of histopathological findings consisted of normal breast tissue and nonproliferative breast lesion breast lesions. The incidences of proliferative breast lesions, atypical hyperplasia and in situ lesions were calculated as 5.7%, 2% and 0.4%, respectively. The mean follow-up period was 3.8±1.6 years. CONCLUSION: Although preoperative breast cancer screening methods are used before the reduction mammoplasty, high-risk lesions may be encountered afterwards. One of the biggest advantages of reduction mammoplasty in addition to psychophysiological recovery is breast cancer risk reduction.

Salvage of the Exposed Cardiac Pacemakers With Fasciocutaneous Local Flaps.

OBJECTIVES: This study aims to investigate the efficacy of salvage of the mechanically exposed cardiac pacemakers with fasciocutaneous local flaps in elderly patients. METHODS: Between January 2014 and January 2018, ten patients (six females, four males; mean age 66.2 years) who were treated due to pacemaker exposition were retrospectively analyzed in this study. Exposed pacemaker and the wires were dissected, and capsulectomy was performed. The expose pacemaker was covered with the fascioutaneous flap. RESULTS: Only one patient had hematoma formation at early stage and revision was performed. All patients were treated successfully. No complication was observed during the follow-up period. CONCLUSION: Reconstruction with fasciocutaneous local flaps is an effective treatment modality in case of mechanically cardiac pacemaker expositions in elderly patients.

Posterior Arm Perforator Flap for Axillary Reconstruction After Hidradenitis Suppurativa Excision.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease arising from the hair follicles in apocrine gland-rich areas. It is also one of the most common indications for axillary surgery. Reconstruction of the axillary region after such surgery must be performed meticulously due to its critical location and crucial content. In this report, we present our experience of reconstruction of axillary defects with posterior arm perforator flaps (PAPF) following radical excisions. METHODS: A total of 14 patients (9 male, 5 female) aged between 16 and 49 years who had presented with HS in the axillary region and, after surgery, underwent reconstruction with either island or skin bridge posterior arm flap between January 2015 and October 2016 were included in the study and evaluated retrospectively. All of the defects were reconstructed with PAPF following wide excision. RESULTS: Five of the flaps (over 4 patients) were designed as flaps with skin bridges, while the remaining 12 flaps in 11 patients were raised as island flaps. The flaps had areas ranging from 20 to 84 cm2 (mean 39.5 cm2), depending on the size of the defect after excision. The mean follow-up time after the operation was 6 months. Wound dehiscence was detected in one patient, and another patient developed marginal necrosis during the postoperative period; no other complications were observed. CONCLUSION: Posterior arm perforator flaps can provide sufficient amounts of soft tissue to cover axillary defects and should be considered as the flap of choice in axillary reconstruction.

INTRODUCTION: La maladie de Verneuil (MV), ou hidrosadénite suppurée, est une maladie inflammatoire chronique qui touche les follicules pileux situés près des glandes apocrines. C'est également l'une des indications les plus courantes de chirurgie axillaire. Il faut procéder à une reconstruction méticuleuse de la région axillaire après l'opération en raison de son emplacement difficile et de son contenu crucial. Dans le présent rapport, les auteurs présentent leur expérience de reconstruction des anomalies axillaires à l'aide de lambeaux perforants du bras postérieur (LPBP) après des excisions radicales. MÉTHODOLOGIE: Au total, 14 patients (neuf hommes, cinq femmes) de 16 à 49 ans atteints d'une MV dans la région axillaire qui ont subi une reconstruction par lambeau en îlots ou par pont cutané prélevé sur le bras postérieur entre janvier 2015 et octobre 2016 ont participé à l'étude et fait l'objet d'une évaluation rétrospective. Les chirurgiens ont reconstruit toutes les anomalies à l'aide de LPBP après une large excision. RÉSULTATS: Cinq des lambeaux (sur quatre patients) étaient sous forme de ponts cutanés, et les 12 autres (sur 11 patients) ont été prélevés en îlots. Les lambeaux étaient d'une taille de 20 à 84 cm2 (moyenne de 39,5 cm2), en fonction de la dimension de l'anomalie après l'excision. Le suivi moyen était d'une durée de six mois après l'opération. Un patient a présenté une déhiscence de la plaie et un autre, une nécrose marginale pendant la période postopératoire. Aucune autre complication n'a été observée. CONCLUSION: Le LPBP peut fournir une quantité suffisante de tissus mous pour couvrir les anomalies axillaires. Il faut le considérer comme le lambeau de première intention lors d'une reconstruction axillaire.

Tip Reinforcement Flap: An Original Technique for Improving Nasal Tip Support and Definition.

BACKGROUND: Middle crura support deficiency and short middle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip. METHODS: Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created from the excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps. RESULTS: There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21 months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34) mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for the middle crura and increased definition, projection, and stability to the domal area. CONCLUSIONS: The tip reinforcement flap technique offers advantages for tip plasty in those cases with middle crural deficiency, short middle crura, and middle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.

Comparison of venous repair results using either arterial or vein grafts in a crush-avulsion injury model

Background/aim: Venous insufficiency after replantation or revascularization is one of the most common causes of limb loss in either the short or the long term. The aim of this study was to evaluate the results of a new technique to overcome venous insufficiency. Materials and Methods: A crush-avulsion type of injury was formed in the femoral veins of rats of 3 separate groups. In the control group, primary repair was applied to the damaged veins and the remaining 2 groups were repaired with either an arterial graft or a vein graft. The success rates of anastomosis were then compared. Results: In the control group the patency rate was 25% in the 2nd hour, 12.5% on the 2nd day, and 12.5% on the 10th day. The patency rate in the vein group was 87.5% in the 2nd hour, 50% on the 2nd day, and 37.5% on the 10th day, whereas the patency rates in the artery group were 100% in the 2nd hour, 87.5% on the 2nd day, and 75% on the 10th day. Conclusion: Microsurgery requires experience and patience. It can be considered that the use of arterial grafts for venous repair in replantation after crush-avulsion type amputations can increase the success rate of replantation.

Comparison of piezosurgery, percutaneous osteotomy, and endonasal continuous osteotomy techniques with a caprine skull model.

BACKGROUND: Osteotomy is a crucial step in rhinoplasty, which can have a significant impact on the outcome. In addition to previous percutaneous (external perforating) and endonasal (internal) approaches, piezosurgery has been used in rhinoplasty practice since 2007. This experimental model was planned to compare the three osteotomy techniques. MATERIALS AND METHODS: This study was performed on a caprine skull osteotomy model. Three groups were created from 12 animals, namely, endonasal continuous, external perforating, and piezosurgery groups. All the groups were evaluated for bone gaps, comminuted fractures, and nasal mucosa damage. RESULTS: There were no comminuted fractures and mucosal defects in any of the samples in the piezo osteotomy group. The average amount of bone gap at the osteotomy site and the nasal mucosa damage was lower in the piezo group than in the other groups. The time required for the osteotomy was shorter in the endonasal group, similar to that in the external and piezo groups. CONCLUSION: New techniques are constantly being developed to achieve better results in rhinoplasty. As a natural consequence to technological developments, new devices are being introduced to rhinoplasty practice. Piezo is one such device. We have found that piezo osteotomy has resulted in lower amounts of nasal mucosal damage and comminuted fractures. We believe that piezo can safely be used in rhinoplasty practice until newer and more reliable technologies are being developed.

Approach to Patients with Malignant Melanoma of Unknown Primary Origin.

OBJECTIVES: Although malignant melanoma accounts for 3% of skin cancers, it is responsible for 75% of deaths associated with skin cancer. In our study, all melanoma cases diagnosed and treated at our clinic were retrospectively reviewed, and the cases of unknown primary origin among them were examined in detail in terms of diagnosis and treatment. METHODS: The patients with malignant melanoma treated at the inpatient services of our clinic between January 1991 and April 2017 were retrospectively screened in the records. These patients were evaluated for age, sex, tumor type, Breslow depth, metastasis, and treatment. Among these patients, four cases of unknown primary origin were examined in detail. RESULTS: During January 1991 and April 2017, 173 patients received inpatient care for malignant melanoma at our clinic. As regards to the melanoma subtypes, nodular type in 45 patients, acral lentiginous type in 43 patients, superficial spreading type in 63 patients, lentigo maligna melanoma in 15 patients, subungual type in 7 patients, and either unidentified melanoma or other subtypes in 10 patients were identified. CONCLUSION: The ideal treatment of a patient with melanoma is multidisciplinary, with plastic surgery having a central role.

Requirement of the Preservation of Mental Nerve During the Transfer of Depressor Anguli Oris Composite Flap.

OBJECTIVES: Reconstruction of wide lower lip defects is still a challenging subject in terms of obtaining functional and aesthetically acceptable results. Lower lip reconstruction with depressor anguli oris muscle was first described by Tobin in 1983. Since the sensory innervation of this composite muscle flap is provided by the mental nerve, it has been advocated that the mental nerve should be preserve during flap elevation. However, no further study has been conducted about this subject since then. METHODS: Sixteen patients with lower lip mass have undergone excisional biopsy. The resultant defects were higher than 30% of the total lower lip. All the defects were reconstructed with Depressor anguli oris composite flaps. In 9 of the patients, the mental nerve was preserved and included to the flap, while in remaining patients it was sacrificed. The results were evaluated in terms of sensation, function, and aesthetic appearance. RESULTS: In unilaterally reconstructed cases, the results regarding sensation and general complications were similar. However, in bilaterally reconstructed cases, especially where the mental nerve was preserved, the limited arc of rotation has resulted in functional complications, such as whistle deformity in the midline and drooling. CONCLUSION: The mental nerve does not just limit the arc of rotation of the Depressör anguli oris composite flap but also remains as a potential route for metastasis via perineural invasion. Preservation and inclusion of the mental nerve during reconstruction with Depressor anguli oris flap do not provide any superior outcome; on the contrary, these results in various unfavorable events make this flap a poor option. The skin and mucosa of the DAO flap are innervated by the buccal branch of the trigeminal nerve; thus, the mental nerve should not be preserved during surgery.

Coexistance of Gynecomastia and Poland Syndrome: Case Report.

Coexistence of the Poland syndrome and gynecomastia is a rare condition. Poland syndrome requires soft tissue augmentation of the affected side, whereas gynecomastia necessitates reduction of the breast tissue. To provide symmetry, breast reduction and fat grafting techniques should be combined. We report a 29-year-old male patient with left gynecomastia and right sided Poland syndrome. In order to correct his asymmetry on the anterior chest wall, left breast tissue resection and fat grafting to the right breast were performed. Having these two opposite conditions at the same time and on the same patient makes the deformities look more dramatic than they are separately. Accurate planning and selection of proper techniques enable to provide symmetry in such cases.

Combination of ischemic preconditioning and postconditioning can minimise skin flap loss: experimental study.

OBJECTIVES: Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap. METHODS: The rats were divided into five groups: sham group, control group, pre-con group, post-con group, and pre + post-con group. On postoperative days 3 and 7, the entire flaps along with the margins of necrosis were traced onto transparent sheets. The areas of intact skin and tissue were recorded. RESULTS: The flap necrosis area and percentage of necrosis were calculated for each animal. The necrotic area percentage of the control group was found to be significantly higher than those of the other groups on Days 3 and 7 (p = 0.01 and p = 0.03, respectively). The necrotic area percentage of the pre-con group was significantly higher than the pre + post-con group on Day 7 (p = 0.01). VEGFR-3 expression was observed at a rate of more than 50% in the post-con group. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels. The necrotic areas was reduced in the flaps of the pre-con, post-con, and pre + post-con groups and the combined preconditioning and postconditioning group has reduced necrotic area compared to preconditioning of the skin flap. CONCLUSION: The protective effect was observed on day 7 for combined ischaemic preconditioning and postconditioning. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels.

Use of platelet-rich plasma solution applied with composite chondrocutaneous graft technique: an experimental study in rabbit model.

PURPOSE: Composite chondrocutaneous grafts have been used widely for patients with cleft lip nasal deformity, alar defects, and septal perforations; however, the graft viability can be easily compromised. The aim of the present study was to extend the safe length of the composite chondrocutaneous grafts by enhancement of angiogenesis and re-epithelialization through platelet-rich plasma (PRP) and to investigate the changes that occur when PRP is administered to the graft and the recipient site. MATERIALS AND METHODS: Composite grafts of critical sizes (1.5, 2.0, and 2.5 cm) were planned on the rabbit ears on 1 side. Group A consisted of grafts pretreated with PRP, group B consisted of recipient beds pretreated with PRP, and group C was the control group in which defects 1.5, 2.0, and 2.5 cm in size were formed on the right ears of the rabbits. On postoperative day 7, matching size chondrocutaneous grafts were adapted to the defect areas without PRP. In all groups, graft viability was evaluated 7 days after graft adaptation in group C and 14 days after PRP administration in groups A and B. Wound healing was scored histopathologically and immunohistologically using hematoxylin and eosin, CD34, and smooth muscle actin staining. The terminal transferase fluorescein-dUTP nick end labeling assay was performed to quantitatively demonstrate the apoptosis ratio among the groups. RESULTS: In groups A, B, and C, the mean graft survival of the 2.0-cm equilateral triangle-shaped composite grafts was 65.43% ± 15.7%, 78.12% ± 12.8%, and 41.31% ± 37.4%, respectively (P = .0364). CONCLUSIONS: PRP pretreatment accelerated composite graft survival in the 2.0-cm equilateral triangle grafts by increasing epithelial regeneration and fibrosis, inducing neovascularization, and ameliorating apoptosis rates.

Human fingernail as interpositional graft material in the treatment of nasal septal perforations.

PURPOSE: The etiology of nasal septal perforations involves iatrogenic, traumatic, inflammatory, infectious, neoplastic, and caustic causes. To ensure successful closure, an appropriate interpositional graft material should be selected, and this graft material should be covered with healthy tissue. MATERIALS AND METHODS: The study included 18 New Zealand white rabbits weighing 2 to 2.5 kg. Nasal septal perforations were created in group 1. After the creation of defects in group 2, repair was performed with cartilage graft and bilateral mucoperichondrial advancement flaps. After septal nasal perforations in group 3, the defect was covered with fingernail and bilateral mucoperichondrial flaps. RESULTS: At week 12, the rabbits were sacrificed. The septum site that had been repaired with fingernail was intact. No nail exposition, wound site decomposition, or re-perforation was observed. No findings of a breach of the structural integrity of the fingernails or disintegration were encountered. CONCLUSION: Fingernails can be used as an interpositional graft material in place of cartilage in eligible cases for the repair of nasal septal perforations. Fingernails have several properties that enable their use in such cases, such as form preservation that is similar to cartilage, the lack of live cells, easy availability, and a lack of donor-site morbidity at removal.

Severe symmetrical facial lipoatrophy in a patient with discoid lupus erythematosus.

Acquired partial lipodystrophy is a rare disorder, and it is characterized by the absence of subcutaneous fat from the face, the neck, the trunk, and the upper extremities. The etiology of acquired partial lipodystrophy includes scleroderma and discoid lupus erythematosus. Literature review reveals studies involving 10 patients until today with lipoatrophy due to or after the onset of discoid lupus erythematosus; all are female patients. We want to report a young male patient with progressive symmetrical facial lipoatrophy. In addition, he has discoid lupus erythematosus and celiac disease. Fat grafting and adjuvant oral coenzyme Q10 tablets (Deka-none; Deka Pharmaceuticals, Istanbul, Turkey) were administered for treatment. To our knowledge, this case involves the first male patient in the literature presenting with symmetrical facial lipoatrophy with very prominent periorbital lipoatrophy and bitemporal hollowing symptoms.

Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.