First report of surgery for anencephaly in twin pregnancies: Technical notes and postoperative management.

Anencephaly, the most severe form of neural tube defect, has no known cure, and in most cases, patients die before or shortly after birth. To date, no surgical intervention has been reported in the management of anencephaly. This study presents a case of dichorionic-diamniotic twin pregnancy in which 1 twin was anencephalic and describes the surgical management of this complex case. We aimed to share the problems experienced during the follow up of a patient who survived for a long time after surgery. We also aimed to highlight several clinical issues, including the challenges of managing anencephaly in twin pregnancies, problems experienced during the follow up process in our case, diagnosis of brain death in anencephaly cases, and ethical dilemmas related to organ donation. This case is notable because of the challenging nature of the surgical procedure and complexity of postoperative care. By highlighting the difficulties encountered during the follow up period, we hope to provide insights to health professionals that can inform the management of similar cases in the future.

The Effect of Astaxanthin on Random Pattern Skin Flaps.

BACKGROUND: Skin flaps are the first-line treatment modality for skin defect reconstruction. With the increased importance and use of flap surgery, a growing number of studies have investigated the ways for the prevention of ischemia-reperfusion injury. The aim of this study was to investigate the effect of astaxanthin, which is an antioxidant molecule from the xanthophyll family, on the survival of random pattern skin flaps. METHODS: Thirty-two Sprague-Dawley rats with a caudally based random pattern skin flap (3 × 9 cm) were divided into 4 groups: group A (astaxanthin orally 1 mg/kg per day), group B (astaxanthin orally 4 mg/kg per day), group C (astaxanthin orally 16 mg/kg per day), and the control group. On postoperative day 7, the flaps were evaluated by photographic, scintigraphic, and histological methods. Photographs were taken to investigate the total flap, necrotic flap, and surviving flap areas. A scintigraphic evaluation was undertaken to analyze the surviving area. The flaps were evaluated histopathologically for vascularization, acute inflammation, and chronic inflammation. RESULTS: The rate of surviving flap areas was observed to increase in parallel to the increase in the astaxanthin dose. Surviving flap areas and flap perfusion values were higher in group C compared with the control group and group A (P < 0.05). The values were also significantly higher in group B compared with control group (P < 0.05). All study groups were shown to have statistically significantly higher vascular density than the control group (P < 0.05), whereas lymphocyte and neutrophil densities were similar among all groups (P > 0.05). The photographic and scintigraphic evaluations for the viable area percentages of the flaps correlated with each other (rs = 0.913, P < 0.001). CONCLUSIONS: Orally administered astaxanthin, if given at doses higher than 4 mg/kg, increases flap viability rates and vascularization and can be used as an adjunctive agent.

The Impact of Duration and Force of Centrifugation on Platelet Content and Mass in the Preparation of Platelet-Rich Plasma.

PURPOSE: Platelet-rich plasma (PRP) is an autologous prepared plasma enriched with platelets and obtained after a centrifugal separation and aggregation procedure. However, the optimized preparation protocol for PRP is still controversial and there are no standardized preparation protocols. The aim of this study is to show the effect of time and force of the centrifugation on the concentrations of platelets and to optimize the effective PRP preparation protocol. METHODS: For the study, whole blood was drawn into 24 different 6-ml standard tubes containing 0.6 ml anticoagulant citrate dextrose solution-formula A. The samples were centrifuged separately at forces of 45×g, 180×g, 400×g, 725×g, 1130×g and 1630×g for 5, 10, 15 and 20 min. Every sample was analyzed, and a comparison was made between all groups. RESULTS: No significant difference was observed in terms of platelet concentration, mean platelet volume or platelet mass between all groups (p > 0.05). The mean ± SD of platelet mass in baseline is 1890 ± 134 × 103 fL/µL. The mean ± SD of platelet mass in the high centrifugal force of 1630×g was 3395 ± 564 × 103 fL/µL, 2638 ± 425 × 103 fL/µL, 2355 ± 449 × 103 fL/µL and 2109 ± 41 × 103 fL/µL over times of 5, 10, 15 and 20 min, respectively. The mean ± SD of platelet mass in the low centrifugal force of 45×g was 2002 ± 1623 × 103 fL/µL, 2491 ± 1591 × 103 fL/µL, 2611 ± 876 × 103 fL/µL and 3003 ± 511 × 103/µL over times of 5, 10, 15 and 20 min, respectively. CONCLUSIONS: Platelets should be evaluated with platelet mass not including platelet concentrations alone, but also with mean platelet volume, which symbolizes the size of platelets while comparing platelet-rich plasma preparation protocols and kits. This could be a new starting point for comparison of PRP for all applications in the literature. All centrifugation forces and times could produce biologically reactive PRP. It may be only suggested that if high acceleration force is used, low durations should be selected, or if low acceleration force is used, long time of centrifugation should be selected. NO LEVEL ASSIGNED: 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 .

Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis.

BACKGROUND: The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. METHODS: The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. RESULTS: The maximum tensile strength until failure was 44.6±4.3 N in group 1, 35.7±5.2 N in group 2, and 56.7±17.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). CONCLUSIONS: This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.

An important and overlooked parameter in platelet rich plasma preparation: The mean platelet volume.

BACKGROUND: The platelets are the most heterogeneous cellular elements of the blood in size whereas larger platelets have more granules that make them more reactive rather than their smaller counterparts. OBJECTIVES: The aim of this study is to report the distribution of platelets in the plasma after centrifugation steps. METHODS: Twelve healthy male subjects were enrolled.5.4 mL of whole blood samples were collected for each tube containing 0.6 mL of acid citrate dextrose. Four samples were centrifuged at the force of 180 × g for 15 minutes. Then, 0.6 mL buffy coat was drawn from one of the four centrifuged tubes and 1/3 of the lower layer of the plasma (1.0 mL) from the second centrifuged tube; 1/3 of the middle(1.0 mL) and 1/3 of the upper layer (1.0 mL) of the plasma from third and fourth ones were drawn for blood analysis. RESULTS: Blood analysis including MPV and platelet concentrations were significantly different between the layers (P < .05). Together buffy coat and lower third of plasma layers contain 87% of the entire platelet mass. CONCLUSIONS: Platelets should not be argued only with their concentration, but it would be appropriate to evaluate with their yielded concentration and volume with MPV together while comparing PRP preparation protocols and kits.

Eight years of clinical experience with digit replantation: Demographic characteristics and outcomes.

BACKGROUND: Despite surgical and technical advances in microsurgery, it is still difficult to obtain satisfactory results after replantation of finger amputation. The aim of the present study was to discuss some of the many factors that can affect the success rate of replantation. METHODS: A retrospective analysis of 60 patients with 85 finger replantations was performed. Revascularizations and replantations proximal to the metacarpophalangeal joint were excluded. Demographic characteristics of the patients, place of injury, mechanism of injury, level of amputation, and success rate were examined. RESULTS: A total of 53 male and 7 female patients with mean age of 31 years were included in the study. Index finger (27%) was the most commonly replanted digit. Left side was the more affected, with 62%. Mechanism of injury was crush in 56%, guillotine in 23%, and avulsion in 21% of replanted digits. Success rate was 81%, 53%, and 36% in guillotine, crush, and avulsion injuries, respectively. CONCLUSION: In conclusion, the injury type and personal variables are very important in the rate of replantation success. Knowledge about the effects of different factors on the results of replantation surgery will provide guidance to hand surgeons in order to inform patients and their relatives properly.

Clinicopathological evaluation of Marjolin ulcers over two decades.

Malignant changes arising on the previously traumatized or chronically inflamed skin are defined as Marjolin ulcers. They can develop on many different lesions but frequently they are detected on burn scars. Histopathologically, Marjolin ulcers are mostly diagnosed as squamous cell carcinoma and they need special attention when especially located on the lower extremities. In this study, 63 patients treated for Marjolin ulcers between January 2000 and March 2015 were evaluated according to etiology, histological differentiation, primary tumor size, patient age and anatomical localization. Medical records of these patients were reviewed retrospectively. Mean age was 49.7 years. Average interval between the first injury and carcinoma development was 37.9 years. Most frequent etiologic factor was burn scars with 82.5%. Foot was the most frequently affected site with 28.6% and scalp was the second most frequent localization with 25.4%. Squamous cell carcinomas were detected in 88.9% of the patients and basal cell carcinomas were detected in 11.1% of the patients. For treatment, excision and grafting was performed for 48 patients (76.2%), excision and local flaps were used for 10 patients (15.9%) and excision and free flaps were used for five patients (7.9%). Regional lymph node dissection was performed for 12 patients (19%). Average follow up period was 46.5 months. Local recurrences were detected in nine patients (14.3%). In conclusion, Marjolin ulcers are aggressive tumors that require special care. In order to prevent life threatening sequelas of this entity, it is important to know basic aspects of clinical progress, prognostic factors and treatment modalities.

Does crossover innervation really affect the clinical outcome? A comparison of outcome between unilateral and bilateral digital nerve repair.

Digital nerve injuries are the mostly detected nerve injury in the upper extremity. However, since the clinical phenomenon of crossover innervation at some degree from uninjured digital nerve to the injured side occurs after digital nerve injuries is sustained, one could argue that this concept might even result in the overestimation of the outcome of the digital nerve repair. With this knowledge in mind, this study aimed to present novel, pure, focused and valuable clinical data by comparing the outcomes of bilateral and unilateral digital nerve repair. A retrospective review of 28 fingers with unilateral or bilateral digital nerve repair using end-to-end technique in 19 patients within 2 years was performed. Weber's two-point discrimination, sharp/dull discrimination, warm/cold sensation and Visual Analog Scale scoring were measured at final 12-month follow ups in all patients. There was no significant difference in recovery of sensibility after unilateral and bilateral digital nerve repairs. Though there is crossover innervation microscopically, it is not important in the clinical evaluation period. According to clinical findings from this study, crossover innervations appear to be negligible in the estimation of outcomes of digital neurorrhaphy.

Analysis of Fractured Mandible Over Two Decades.

Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important.In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4-69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus-parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation.In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary.

Four flap suspension technique for prevention of bottoming out after breast reduction.

PURPOSE: Bottoming-out deformity is accepted as the most important disadvantage of inferior pedicle breast reduction. For prevention of this deformity, different techniques are used in combination with inferior pedicle. In this study, we aimed to prevent bottoming-out deformity by producing an internal bra effect through combination of inferior pedicle technique with 2 superior and 2 inferior dermal flaps that were raised from each side of the pedicle. METHODS: Thirteen patients whose medical records became available during the follow-up period at Ankara Training and Research Hospital from January 2010 to January 2015 were included in this study. We retrospectively obtained patient medical records including demographic characteristics and clinical data. Superior dermal flaps were planned on both sides of the pedicle 2 cm inferior to the lower border of areola and inferior dermal flaps were planned 6 cm inferior to the superior dermal flaps. The superior and inferior dermal flaps were secured to the periosteum of the 2nd and 4th ribs respectively with permanent sutures. RESULTS: Preoperatively, the average distance between the inframammary fold and areola was 13.9 cm (range, 11-18 cm). The average amount of breast parenchymal resection was 745 g (range, 612-1,496 g). The average distance between the inframammary fold and the lower border of the areola was 7.9 cm (range, 7.5-9 cm) on the postoperative first-year measurements. CONCLUSION: In conclusion, according to our study, suspension technique to prevent bottoming-out deformity is associated with an easier technique without the need for alloplastic or allogenic materials. Since fixation is performed to the ribs instead of soft tissues like the pectoral fascia or muscle, we believe that this fixation is more long lasting and can be an effective alternative to other suspension techniques.

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap.

OBJECT: Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. METHODS: Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. RESULTS: For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50-0.66 and 0.16-0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. CONCLUSIONS: With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.

Effect of topically applied sildenafil citrate on wound healing: experimental study.

Wound healing is a complex process that necessitates organization of different cell types and several signalling molecules. The aim of this study is to evaluate the effect of different concentrations of sildenafil citrate, which decreases cGMP degradation, on wound healing by secondary intention.This study was performed using 25 Sprague Dawley rats weighing 200-250 grams. 4 dorsal defects were created. Four different treatment modalities which were 1% and 5% sildenafil citrate gel prepared with carbopol, pure carbopol gel without any drug in it and 0,9% NaCl solution; were applied to each lesion of the same rat. Randomly selected five rats (25 rats in total) were sacrificed on 3rd, 5th, 7th, 10th, and 14th days; and the effect of each modality was evaluated by means of defect area measurement, histopathological examination and measurement of tissue hydroxyproline levels.Sildenafil citrate gel application decreased the defect areas in a dose independent manner starting from 3rd day and dose dependent manner after 7th day. By means of vascularization, sildenafil citrate increased vascularity starting from 3rd day. The strength of acute inflammation was superior in sildenafil groups starting from 5th day; and the amount and maturation of granulation in the wound bed, as well as the strength of chronic inflammation were superior in defects treated with sildenafil citrate as early as 7th day.

A tie-over dressing using a silicone tube to graft deep wounds.

BACKGROUND: The most common cause of skin graft failure is the collection of blood or serous fluid underneath the graft. In our study, we describe the use of silicone tube for tie-over dressing to secure the skin graft margins with the aim of decreasing loss of the skin graft, particularly in grafting of deep wounds. METHODS: Between March 2008 and July 2011, we used this technique in 17 patients with skin defects with depths ranging from 3.5 to 8 mm (mean, 5.5 mm). First, the skin graft was sutured with 3/0 silk suture material from its corners. Then, a silicone round drain tube was sutured with 3/0 absorbable polyglactin 910 over the margins of the graft. Finally, long silk threads were tied over the bolus dressing, and the tie-over dressing was completed in the usual fashion. RESULTS: The mean follow-up was 7 months (range, 2-10 months) in the outpatient clinic. Graft loss on the graft margins due to hematoma or seroma was not developed. The results of adhesion between the graft and wound bed peripherally was excellent. CONCLUSIONS: In our study, we suggest that use of a silicone tube for additional pressure on the edges of skin grafts in case of reconstruction of deep skin defects.

Scintigraphic and histopathologic evaluation of combined bone grafts.

OBJECTIVES: We aimed to assess various bone grafts on bone formation using bone scintigraphy and histology, especially the first study that evaluated the demineralized bone matrix (DBM) + tricalcium phosphate (TCP) + hyaluronic acid (HA) combination. MATERIALS AND METHODS: A total of 44 pieces in groups of autogenous bone graft, TCP, DBM, DBM + TCP combination, and DBM + TCP + HA combination were applied to parietal bones of 24 New Zealand rabbits. Bone scintigraphies of the rabbits were performed at 2, 6, and 12 weeks. The uptake ratios were compared for the different types of grafts. In addition, in 2, 6, and 12 weeks, the graft areas were taken from the sacrificed rabbits and examined histologically. RESULTS: In the 2-week evaluation, DBM + TCP combination and DBM + TCP + HA combination had more osteoblastic activity accumulation than the TCP and DBM groups. These findings supported that the DBM + TCP combination group showed new bone formation earlier in the histopathological evaluation. The DBM + TCP + HA combination had more uptake than the TCP and DBM groups on bone scintigraphy at 2 weeks, and this uptake ratio decreased in the following weeks. It was thought that the increased uptake in DBM + TCP + HA combination at 2 weeks was due to severe inflammation seen in the histopathological evaluation. CONCLUSION: The DBM + TCP + HA combination should not be used for graft repair, although it was thought to be a good combination in the early weeks.

The effect of reduction mammaplasty on the vertebral column: a radiologic study.

Some studies emphasized that anatomic mechanisms of vertebral aberrations could be associated with large breasts. The effect of mammaplasty operation on the vertebral column and body posture seems to be beneficial; in this trial, it was planned to investigate the objective radiologic effect of reduction mammaplasty on the posture of the vertebral column in a group of patients operated due to the large breasts. Thirty-four white women with large breasts were enrolled in this study. The patients were divided into three groups according to their breast cup sizes. Anteroposterior and lateral radiographs of the lumbosacral and thoracic spine were taken at baseline preoperatively, and the same radiographic images were taken in an average of 12 months later than the reduction mammaplasty operation. All were evaluated and compared for thoracic kyphosis angle and lumbar lordosis angle both preoperatively and postoperatively. The mean thoracic kyphosis angle was 40,53 preoperatively and 39,38 postoperatively. However, there was no statistically significant difference between the preoperative and postoperative measurements in all groups (P > 0,05). The mean lumbar lordosis angle was 54,71 preoperatively and 53,18 postoperatively. Regarding the preoperative and postoperative measurements of lumbar lordosis angles, no statistically significant difference was found between the groups (P > 0,05). Although breast size may be an important factor that affects body posture, reduction mammaplasty operations have little or no radiologic effect on the vertebral column.

The effect of microneedling with a roller device on the viability of random skin flaps in rats.

BACKGROUND: In a random pattern skin flap, distal flap necrosis occurs as a result of inadequate blood flow. Microneedling with a handheld roller device is a new treatment modality, especially for facial rejuvenation. In this study, the authors used microneedling to increase flap viability. METHODS: Forty adult male Sprague-Dawley rats were divided into two groups of 20. The study group was exposed to McFarlane flap elevation and repositioning. The microneedling procedure was performed four times: 3 days before, on the day of, and on the third and sixth days after surgery. The control group was only exposed to surgery. The skin flap necrosis area was measured on the seventh postoperative day topographically by digital imaging and scintigraphy. After determination of necrosis area, the amount of neovascularization and number of vascular structures within the papillary dermal layer were counted histopathologically. RESULTS: The mean percentages of necrosis in the flap area as determined by the Digimizer analysis program were 37.51 ± 5.08 in the control group and 29.42 ± 7.37 in the study group. The mean percentages of flap necrosis of the control group and the study group as determined by radionuclide scintigraphy were 31.4 ± 4.1 and 22.8 ± 5.0, respectively. The comparison of flap necrosis percentages showed that the study group had significantly lower values (p < 0.001). Vessel counts in the study group also showed significant increase (p < 0.05). CONCLUSIONS: The authors' study showed that the microneedling method applied directly on the flap could be a faster, safer, and more effective therapy modality to increase flap viability.

Monitorization of asymmetric dimethylarginine (ADMA) levels in an experimental ischemia-reperfusion flap model: a preliminary report.

One of the most important endothelium-derived vasoactive mediators is nitric oxide (NO). Endothelial dysfunction by the loss of NO is a critical event during ischemia. Asymmetric dimethylarginine (ADMA) is a competitive inhibitor of NO synthase (NOS) that inhibits vascular endothelial NO production in concentrations found in pathophysiological conditions. The goal of this study was to monitorize overexpression of ADMA in an experimental ischemia-reperfusion flap model. This study was performed using 20 rats. The baseline ADMA levels were measured preoperatively. In Group I (n = 10, control) abdominal flaps were harvested and replaced in situ without creating ischemia. The plasma ADMA levels were measured at 1, 12, and 24 hours postoperatively. In Group II (n = 10, study) abdominal flaps were harvested, and clamping the vascular pedicle created a subsequent 8-hour period of warm ischemia. Clamps were removed and provided tissue reperfusion. The ADMA levels were taken after 1 hour of reperfusion, and at 12th and 24th hours. The mean preoperative ADMA levels in group I and group II were calculated to be 0.37 ± 0.06 (µmol/L) and 0.40 ± 0.06 (µmol/L), respectively. The differences between the preoperative ADMA levels were not statistically significant (p > 0.05). The mean postoperative ADMA levels in group I (control) were calculated to be 0.39 ± 0.09 (µmol/L) at the first hour, 0.42 ± 0.07 (µmol/L) at the 12th hour, and 0.40 ± 0.08 (µmol/L) at the 24th hour. Respectively, the mean postoperative ADMA levels in group II were calculated to be 0.68 ± 0.14 (µmol/L) after 1 hour of reperfusion, 0.62 ± 0.09 (µmol/L) at the 12th hour, and 0.60 ± 0.12 (µmol/L) at the 24th hour. All postoperative ADMA levels were significantly higher in Group II (p < 0.05). These experimental results suggest that systemic production of ADMA is greater in animals having ischemia reperfusion injury of the skin flaps. The strategy of decreasing levels of ADMA may be beneficial to prevent ischemia-reperfusion injury of flaps or composite transplants; thus, ADMA might be an important candidate of therapeutic target in flap or transplantation surgeries.

A local flap that never disappoints: V-Y rotation advancement flap.

BACKGROUND: There are lots of ways to close a defect according to the reconstruction ladder. In this article, we would like to share our experience with V-Y rotation advancement flap on different parts of the body. PATIENTS AND METHODS: Between 2006 and 2009, we performed V-Y rotation advancement flap on 68 patients (average age, 50 years). We performed this flap for decubitus and neuropathic ulcer on 33 patients, for defect reconstruction after tumor removal on 29 patients, and for trauma on 6 patients. RESULTS: The sizes of the defects ranged between 2 × 2 and 26 × 16 cm. All flaps survived without any major complications. Patients were satisfied with their scar appearance, and no sensory impairment was seen. CONCLUSIONS: V-Y rotation advancement flap restores the defect with a perfect color match and leaves an aesthetically acceptable scar. With its surgical flexibility and durability, this flap disappoints neither the surgeon nor the patient.