Versatility of perforator-based V-Y advancement flaps in reconstruction of complex mid back wounds.

Reconstruction of complex mid back wounds is challenging due to the patient comorbidities and scarcity of reliable regional flap alternatives. Four consecutive cases treated with perforator based V-Y advancement flaps are reported. An effective repair was achieved in all the patients and the mean follow up period was 28 months. Our results indicate the efficacy of adipocutaneous flaps in complex spinal soft tissue repair and may help to refine the relevant algorhythm.

Pretreatment with octreotide modulates iNOS gene expression, mimics surgical delay, and improves flap survival.

We aimed to evaluate the role of a synthetic somatostatin analogue in delay procedure of experimental skin flaps. Thirty-six rats were randomly divided into 2 groups of 18 each to compare the possible local ischemic effect of octreotide with that of surgical delay in the dorsal random pattern skin flap model. The inducible nitric oxide synthase gene expression was assessed in the flap territory at intervals of immediate, 24 and 48 hours after preconditioning. Histologic analysis was performed in rats at 48th hour and 3 additional rats were used for microangiography. A gradual increase of daily transcript levels was detected in both groups (P < 0.05). The differences of molecular and histologic findings between the groups were not distinctive. Pharmacologically preconditioned rat displayed relevant microvascular features. Forty rats were further grouped randomly into 4 groups of 10 each. In group 1 rats, flaps were raised and reinserted without any prior intervention. Group 2 rats underwent surgical delay procedure, whereas flap territories of the others received either saline solution or octreotide 1 week before the ultimate flap harvest. After another 7-day period, both delay procedures were found effective in improving flap viability (P < 0.01). Ischemia induced by octreotide favored to investigate its utility in delay phenomenon. Although it was not as effective as the surgical delay procedure, it may be a safe pharmacologic alternative to improve the flap survival.

Airway management in neonates with Pierre Robin sequence.

Neonates with Pierre Robin sequence (PRs) suffer from varying degrees of airway obstruction and feeding difficulties, the courses of which differ from patient to patient, due to mandibular deficiency. We aimed to evaluate the course and prognosis of upper airway obstruction in 20 newborns with PRs. Among 15 isolated and 5 syndromic cases, 7 patients fell into Group I, 5 into Group II and 8 into Group III, respectively, according to the clinical classification system proposed by Caouette-Laberge. The 12 patients in Groups I and II were treated with positioning and gavage feeding, whereas the 6 patients in Group III underwent bilateral mandibular distraction. Decannulation or avoidance of tracheostomy was achieved in all of them. A patient who had a significant comorbidity was managed with tracheostomy and one patient expired due to pulmonary problems. When conservative measures fail, mandibular distraction osteogenesis should be considered to obviate tracheostomy in newborns with micrognathia.

A novel approach to cleft lip nose deformity: posterior dome graft technique.

The pathology of "nasal tip complex" remains as a problem to be solved in unilateral cleft lip nose deformity wherein open rhinoplasty and cartilage grafts are used frequently. For this reason, the research for the treatment of cleft-side tip projection lost and ala depression still continues. Our technique is to put the cartilage graft at posterior dome area after the release of cleft-side ala from vestibular mucosa and skin to elevate the ala depression and tip projection. This technique has been used on 16 patients between the years 2003 and 2007. This technique, different from the augmentation methods, aims to increase the direct lateral crura's elastic support strength and to support the new position of alar cartilage. This method will particularly be helpful in obtaining the long-term results in delayed and serious cases.

Dorsal V-Y advancement flap for amputations of the fingertips.

Amputations of the fingertip are the most common injuries to the upper limbs, and they cause greatest socioeconomic losses. The first choice of the technique of repair should be the simplest and fastest, with rapid restoration of function and an acceptable aesthetic appearance, and should return the worker to his job rapidly to prevent economic loss. Volar V-Y advancement flaps should therefore be considered first, but unless the dorsal loss is greater than the volar, this first choice of flap cannot be used because of the inadequate donor area. We present here a method for amputations that are proximal to the matrix of the nail. Seven volar oblique or transverse amputations were treated with dorsal V-Y advancement flaps with or without volar V-Y advancement flaps. All flaps survived. The procedure is simple, versatile, and a reliable way of reconstructing amputations of the fingertip that are proximal to the nailbed.

Uses of scapular island flap in pediatric axillary burn contractures [correction of conractures].

Pediatric axillary post-burn contractures one of the most challenging problems which follow treatment of the upper extremity burns. We preferred to use scapular flaps for surgical treatment of pediatric axillary contractures instead of skin grafting or Z-plasties. In this clinical study we present 13 pediatric cases treated with scapular island flaps. In pediatric scapular flap cases, the technique which we used was to extend the flap's pedicle dissection was continued to the level of bifurcation of subscapular artery. Bypassing the flap triangular space allowed us to cover the anterior part of the axillary contractures. We observed that the scapular flap repairs have many benefits to skin grafting including no recurrence of contracture and stable coverage of the shoulder joint. The other advantages of scapular island flap are that the donor site is closed primarily, and it provides an adequate amount of pliable skin while not compromising the function and range of motion of joints. In conclusion, the island scapular flap is a good choice for reconstruction of various axillary contractures in pediatric population.

The role of cannula diameter in improved adipocyte viability: a quantitative analysis.

BACKGROUND: Fat injection for soft tissue augmentation is a common procedure in plastic surgery. Because the limitation of fat injection is its resorption, understanding how different handling techniques affect adipocyte survival is crucial to optimizing long-term results. OBJECTIVE: In this study; we sought to determine the effect of aspiration and injection cannula diameters on adipocyte viability. METHODS: Fat aspiration samples were obtained from 6 female patients undergoing abdominoplasty. Viable adipocytes were counted at fat suspension, which was obtained with 2-, 3-, and 4-mm-diameter aspiration cannulas and injected with 1.6-, 2-, and 2.5-mm-diameter injection cannulas. RESULTS: A greater number of viable adipocytes were detected using a 4-mm-diameter aspiration cannula (419 x 10(4) cell/1 mL, P < .05) and a 2.5-mm-diameter injection cannula (410 x 10(4) cell/1 mL, P < .05). CONCLUSIONS: The use of wider-diameter cannulas can potentially improve fat graft survival and reduce fat graft resorption.

Is HBOT treatment effective in recovering zone of stasis? An experimental immunohistochemical study.

Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Hypoxia and oedema at that zone may cause irreversible changes. Due to anti-oedematous and antihypoxic effects of hyperbaric oxygen treatment (HBOT), it may be beneficial in recovering the zone of stasis. We performed an experimental study using 20 Sprague-Dawley rats, each weighing 350-450 g. The rats were first divided into two groups as 24h and 5 days. Subsequently, control and treatment groups (five rats in each group) were formed. For burn wounds, we used the burn comb model, which was described by Regas and Ehrlich. In the treatment group, 2.5 ATA HBOT was applied for 90 min twice daily. A 0.8-cm punch biopsy was performed and samples for histological examination were taken from the centre of burn area. The rats were sacrificed by administering '3 mci technetium-99m methoxy butyl nitrite' ((99)Tc(m) MIBI) through the femoral vein. Biopsy materials were evaluated by histological and immunohistochemical methods. Dorsal skin fragment, excised to 1cm margin, was imaged by scintigraphic measurements with a gamma camera. Wet and dry weight measurements of excised skin fragments were taken. As a result, HBOT showed a positive effect at the cellular level in the first 24h. It increased recovery potential by augmenting neovascularisation and decreasing oedema in the 5-day group.

L-myc polymorphism in head and neck nonmelanoma skin and lower lip cancers.

OBJECTIVE: To evaluate the presence of L-myc gene variations as a genetic predisposition to head and neck nonmelanoma skin cancer (HNNMSC) and lower lip cancer (LLC). DESIGN: A case-control study. SETTING: An academic institute laboratory. PARTICIPANTS: Twenty-four patients with HNNMSC and 27 with LLC were compared with 51 age- and sex-matched control subjects. MAIN OUTCOME MEASURES: Polymerase chain reaction restriction fragment length polymorphism and agarose gel electrophoresis were used to determine the L-myc oncogene genotypes. RESULTS: The presence of the LS genotype was found to be significantly increased in the study group, whereas the LL genotype was not detected. The S allele was also more frequent in the study group. The SS genotype was found to correlate with aggressive tumor behavior in patients with HNNMSC and a family history of cancer. Patients with LLC displayed significantly less of the SS genotype. CONCLUSIONS: The L-myc gene polymorphism may help detect and prevent HNNMSC and LLC in susceptible individuals. It may also contribute to estimation of tumor behavior in patients with HNNMSC.