Relationship between surgical rhinoplasty and Demodex infestation: a case-control study.

Background/aim: Human Demodex mites are parasites that live in the pilosebaceous unit and can cause demodicosis. While demodicosis may occur as a primary skin disease, it may also result from immunosuppression and topical or systemic immunosuppressive therapies. Surgical rhinoplasty is one of the most commonly performed cosmetic procedures, and it is the cause of a variety of cutaneous complications, particularly acne, as it affects the skin's adnexal structures. Thus, this study aimed to investigate whether the cutaneous changes in surgical rhinoplasty patients render them vulnerable to Demodex infestation. Materials and methods: Individuals who had undergone rhinoplasty (patients) and age- and sex-matched healthy volunteers (controls) were included in this prospective case-control study. To determine the Demodex density, samples were collected from the malar and nasal regions of both the patients and controls using the standard superficial skin biopsy method. Results: A total of 50 rhinoplasty patients and 50 healthy controls were enrolled in the study. The Demodex density on the nose was significantly higher in the rhinoplasty patients (p = 0.0001). Furthermore, the frequency of xerosis and pustules was significantly higher in the rhinoplasty patients compared to the control group (p = 0.046 and p = 0.001, respectively). Conclusion: Surgical rhinoplasty may be a risk factor for demodicosis, and patients will recover faster after surgery with proper diagnosis and treatment.

An idea for bringing the recipient pedicle of cross leg free flap closer: Fasciocutaneous flap above pedicle.

BACKGROUND: Cross leg free flaps are one of the salvage methods used for free tissue transfer in large tissue defects in the absence of recipient vessels. The fasciocutaneous flap above the posterior tibial artery can be harvested to protect the pedicle and to advance a distance to wound, which is equal to the length of fasciocutaneous flap. METHODS: Patients who were operated with cross leg free flap with the supporting fasciocutaneous flap on unwounded side were included in the study between years 2010 and 2020. Age, sex, location and size of the defects, arterial patencies, flap choices, fascio-cutaneous flap size, duration of operation, cross flap separation timing, complications, and time to return to work were evaluated. RESULTS: There were six patients with the etiology of high-energy electrical burns and trauma. There was only one arterial refilling for three patients and no refilling for others. Latissimus dorsi skin muscle flap was used in all but one patient. The mean defect size was 6.6×14.8 cm. The mean size of fasciocutaneous flaps was 4.08×5 cm. The mean operation time was 360 min. There was no complication except one dehiscence and one marginal necrosis and infection which were healed with wound care. Average time to return to work was 9 months. CONCLUSION: In similar cases, as wounded lower extremities with one or no artery refill, harvesting a fasciocutaneous flap with recipient vessels will be useful before considering the option of using a bridge free flap in medium to moderate sized defects.

Effects of different scar types on flap viability in a skin flap model: an experimental study.

BACKGROUND: The purpose of this study was to investigate the use of tissues with multiple traumas, scarred pedicles, and medial scarring as a flap. METHODS: Forty-eight rats were randomly divided into four equal groups. The modified McFarlane flap was chosen as the flap model. In Group 1 (control), a dorsal skin flap was elevated and then sutured back into original position. In the other groups, a two-phase procedure was used. In Group 2 (pedicle incision), scar tissue was created with a skin incision at the prospective pedicle site of the flap and then sutured to its original site. In Group 3 (preconditioning), multiple full-thickness traumas were performed along the entire flap body, and in Group 4 (middle incision) scar tissue was created with a skin incision at the prospective middle region of the flap. Then, after 45 days, dorsal flaps were raised in all rats and then sutured back into position. Seven days later, flap survival was evaluated through microangiography and histological evaluation of flap segments. Histopathological examination included assessment of the number of vessels, necrosis, infiltration with polymorphonuclear leukocytes, edema, fibrosis, inflammation, increase in fibroblast activity, and neovascularization. RESULTS: The flap survival rates were 66.78% in Group 1, 68.05% in Group 2, 68.5% in Group 3, and 60.01% in Group 4. The flap survival rate was significantly lower in Group 4 (p < 0.05). There was no significant difference in flap survival between Groups 1, 2, and 3. On microangiographic examination, the vascular network extended more distally and was densest around the scar line in Group 2. Vascularization was poorest in Group 4. On histological examination, the number of vessels tended to be greatest in Groups 3 and 4 but this was not significantly different between groups (p < 0.05). DISCUSSION: The study findings showed that it may be possible to raise a flap from a previously mutilated site secondary to scar formation and multiple full-thickness traumas along the flap body. However, distal necrosis may occur in situations when the scar is positioned in the middle region of the prospective flap.

Is it safe to harvest a proximally fractured fibula as an osseocutaneous anterograde pedicled flap for proximal tibial reconstruction in subacute period? A case report and literature review.

Osteoseptocutaneous fibula flap is commonly used as the workhorse flap for bone reconstruction. However, the use of previously fractured fibula as a free or pedicled flap for bone reconstruction has a limited knowledge in the literature. There is not any data in the literature about a case with proximal level of fibula fracture which was used as an anterograde pedicled osteocutaneous fibula flap for composite tibial reconstruction after high-energy injury. Based on a patient in whom the composite defect of the proximal tibial region was reconstructed with osteocutaneous fibula flap after a gunshot injury, it was tried to show that the fibula with a proximal level fracture could be used with anterograde flow in the subacute period and it is thought that the usability of this flap should be kept in mind. It is possible to harvest the pedicled fibula flap even in the subacute period with the evaluation of CT angiography preoperatively and with the checking the patency and flow direction of peroneal artery perioperatively. The success of the procedure may be increased through total dissection of inflammatory areas of pedicle which would extend into the injury zone during the subacute period.

Synchronous Pseudomonas Infection in Nose and Maxillery Sinus After Septorhinoplasty.

ABSTRACT: A 50-year-old patient who underwent secondary rhinoplasty 1 year after the operation presented with signs of localized infection on the postoperative twentieth day. An abscess due to Pseudomonas aeruginosa was detected in the nose and maxillary sinus. The infection regressed after surgical debridement combined with intravenous antibiotic therapy.Pseudomonas infection has been reported in only six patients after septorhinoplasty. Rhinoplasty was combined with other aesthetic procedures in three patients. The mean time of onset of complaints was 33.25 days. The most common complaint was pain. The mean time to complete regression of complaints after treatment was 44.5 days.Pseudomonas infection risk is especially increased in patients with combined surgical procedures and complicated revision rhinoplasty surgery. Careful examination of the patient, early and aggressive therapy, and surgical debridement are essential. The treatment of infection is incision and drainage of the affected areas. Antibiotic therapy followed by sensitivity-specific regimens should be administered."

Reconstruction of Large Meningomyelocele Defects with Bipedicled Fasciocutaneous Flaps: Technical and Clinical Points.

AIM: The aim of this study was to evaluate the bilateral vertical bipedicled procedure for the closure of large meningomyelocele defects and to emphasise some technical and clinical considerations. MATERIAL AND METHODS: This procedure was used to close large meningomyelocele defects in ten patients (six males and four females) between January 2016 and August 2020. Eight of the patients were operated on within the first 24 hours of birth, and the remaining two were operated on between 1-7 days from birth. The average defect size was 6 x 9 cm (5 x 7 and 8 x 13 cm). The location of the lesions was thoracolumbar in two patients and lumbosacral in eight patients. Patient demographics, including sex, gestational age, birth weight, age at operation, defect size, duration of the operation, intraoperative-postoperative blood transfusion, length of hospital stay and complications, were evaluated. RESULTS: In all patients, closure was successful. Two patients required reoperation because of wound dehis-cence, and healing was uneventful, without any complications. No patient experienced late breakdown of the wound during a mean follow-up period of 14.9 months (12-18 months). CONCLUSION: Bipedicled fasciocutaneous flaps can be used as an alternative method to repair large meningomyelo-cele defects due to their simple and reliable nature, which also causes less haemorrhage, and can be used in selected patients.

A Novel Method for Correction of the Tethered and Contracted Facial Scars: The Three-Dimensional Subcutaneous Z-Plasty.

OBJECTIVE: Scar revision is 1 of the basic surgery in the field of plastic and reconstructive surgery. The classic treatment of the scar is excision scarless tissue, wide undermining and suture by planes. This method has had unsatisfying results on contracted and tethered scars. The aim of this study is to present the three-dimensional subcutaneous z-plasty technique for correction of tethered facial scars without scar lengthening. MATERIALS AND METHODS: Twenty tethered scars were corrected using this technique. All scars were located on the face. Objectively, the final result was evaluated by using the Stony Brook Scar Evaluation Scale. Subjectively, patients' overall satisfaction was assessed 1 year after the surgical operation. In addition, the information on the age, gender, etiology, scar location, scar length, type of anesthesia, and follow-up period were examined. RESULTS: This procedure was used in nineteen patients (8 males and eleven females). The mean follow-up period was 15.3 months. There was a mean increase of 2.85 points increase in the Stony Brook Scar Evaluation Scale value. The overall success rates for the procedure, as assessed by the patients, were: very satisfied in 12 patients, satisfied in 5 patients, and slightly satisfied in 2 patients. One patient had minimal wound dehiscence. No complications including hypertrophic scar, infection, hematoma, and suture reaction were observed in any patients. CONCLUSIONS: The three-dimensional subcutaneous z-plasty technique is a procedure that uses only basic plastic surgery principles. It offers a good solution for the correction of tethered and contracted scars without recurrence. This technique combines the advantages of elliptical excision and z-plasty by enabling the augmentation of the depressed area without extending the scar length.

A Simple Solution for Infractured Lateral Nasal Osteotomy Lines During Revision or Primary Rhinoplasty: Osseos Stabilization With Polydioxanone Sutures.

ABSTRACT: In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV).

First Report of Pai Syndrome With Upper Alveolar Cavernous Hemangioma: Diagnosis and Surgical Treatment.

ABSTRACT: This case describes the surgical methodology and the procedure for follow-up in a patient who had midline cleft of the upper lip, mid-alveolar cleft, double frenulum, and alveolar mass. Our patient is the first who meets the criteria for Pai syndrome with cavernous hemangioma and is also the fourth case with concomitant double frenulum.

Reversed Palmaris Longus Muscle With Median Nerve Compression Symptoms: A Case Report and Review of the Literature.

BACKGROUND: The palmaris longus (PL) is one of the most anatomically variable muscles in the body. Although these variations are often asymptomatic, symptoms related to nerve compression can sometimes be encountered. If treatment is indicated, correct diagnosis is important for successful management. In cases of upper extremity nerve compression, variations of the PL should be included in the differential diagnosis. We report a case of reversed PL (RPL) with symptoms of median nerve compression and review the literature, emphasizing the rare and challenging character of these lesions. METHODS: The literature review was performed using Google Scholar and PubMed databases. Keywords were "reversed palmaris longus," "reversed palmaris longus median nerve compression," "anomolous palmaris longus muscle," and "symptomatic palmaris longus." Only clinical RPL muscle cases with at least one of the symptoms of paresthesia and pain in the median nerve sensory area or swelling on the wrist were included. RESULTS: In the literature review, 21 publications including 30 patients, matched the search criteria between 1973 and 2018 and were evaluated. CONCLUSION: In carpal tunnel syndrome, in cases with atypical presentation, RPL should be considered in the differential diagnosis.

Cutaneous adverse effects of methylene blue in an animal skin-flap model.

Background and objectives: Sentinel lymph node biopsy is important for metastasis surveillance in the management of a number of human cancers. Identification of sentinel lymph nodes may be facilitated by the use of several methods including methylene blue injection. However tissue necrosis is a known effect of methylene blue application. This study aimed to investigate the effects of methylene blue injection on skin flaps using a rodent model.Methods: Modified McFarlane flaps were prepared using Wistar Albino rats. Local injection of methylene blue was given to one group while saline was injected into the control group. A third group received systemic methylene blue via intraperitoneal injection. Observational and histological comparison was made between the groups to investigate the necrotic effects of methylene blue on skip flaps.Results: The control group's surviving flap areas were significantly larger than local methylene blue group's surviving flap area. However, there was no significant difference in skin flap survival area between the control group and the systemic methylene blue group. Furthermore, there is no significant difference between local and systemic methylene blue group's surviving flap areas.Conclusions: Local methylene blue injection increases skin necrosis and decreases rates of surviving flap areas in an experimental rat models.