Managing Severe Postburn Wrist Flexion Contracture by Proximal Row Carpectomy and Abdominal Interpolation Flap.

Introduction: Postburn upper extremity contractures can greatly diminish the quality of life. To successfully manage these contractures and achieve successful functional outcomes, an optimal surgical method should be planned to address all affected tissues on the extremities. Conventional soft tissue transfers after releasing the contracture, such as skin grafts or flaps, may be insufficient. In addition to capsulotomy, tendon release, and lengthening procedures, more aggressive modalities may be indicated. Methods: In this retrospective study, patients who developed wrist flexion deformities due to burn injuries and underwent proximal row carpectomy and abdominal interpolation flaps were included. Results: Between January 2019 and June 2020, 5 patients underwent surgery using this technique. All patients were male, 2 had thermal burns, 2 had electrical burns, and 1 had chemical burns. Preoperatively, all patients had severe flexion deformities ranging from 70° to 85°. There were no postoperative complications, and stable wrists with a good and functional alignment were achieved, although the preoperative and postoperative range of motion differences were limited, where a postoperative range of motions were ranging from 5 to 15 in terms of extension, 15 to 20 in terms of flexion. Preoperative QuickDash scores were between 79.5 and 95.5, postoperative scores ranged from 25 to 36.4. Conclusion Proximal row carpectomy shortens the length of the wrist, resurfaces the wrist joint, and provides a release in tendons and other soft tissues. Together with soft tissue transfer, this technique can be used for severe wrist flexion contractures.

Introduction: Les contractures du membre supérieur survenant à la suite d'une brûlure peuvent entraîner une importante altération de la qualité de vie. Pour gérer ces contractures avec succès et obtenir des résultats fonctionnels satisfaisants, une méthode chirurgicale optimale englobant tous les tissus affectés du membre doit être planifiée. Les transferts conventionnels de tissus mous après libération de la contracture, comme les greffes ou les volets cutanés peuvent ne pas suffire. Des modalités plus agressives peuvent être indiquées en plus d'une capsulotomie, de la libération des tendons et des procédures d'allongement. Méthodes: Cette étude rétrospective a inclus des patients ayant développé des déformations en flexion du poignet causées par des brûlures et ayant subi une carpectomie de la rangée proximale avec insertion de lambeaux abdominaux. Résultats: Cinq patients ont été opérés entre janvier 2019 et juin 2020 selon cette technique. Tous les patients étaient des hommes; deux avaient des brûlures thermiques, deux avaient des brûlures électriques et un avait des brûlures chimiques. En préopératoire, tous les patients avaient une déformation sévère en flexion allant de 70° à 85°. Il n'y a pas eu de complications postopératoires et des poignets stables avec un bon alignement fonctionnel ont été obtenus. Toutefois, les différences entre l'amplitude préopératoire et postopératoire étaient limitées: l'amplitude articulaire postopératoire était comprise entre 5° et 15° d'extension et entre 15° et 20° de flexion. Les scores QuickDash préopératoires étaient compris entre 79,5 et 95,5 et les scores postopératoires entre 25 et 36,4. Conclusion La carpectomie de la rangée proximale raccourcit la longueur du poignet, recrée la surface de l'articulation du poignet et procure une détente des tendons et autres tissus mous. Conjointement avec un transfert de tissu mou, cette technique peut être utilisée en cas de contractures en flexion sévères du poignet.

Modified bilateral fasciaperichondrial flap for prominent ear correction.

OBJECTIVE: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. METHODS: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. RESULTS: Between May 2017 and May 2021, 32 ears of 17 patients were operated on due to prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ±â€¯0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. CONCLUSION: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. LEVEL OF EVIDENCE: III.

Modified bilateral fasciaperichondrial flap for prominent ear correction

Abstract Objective: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. Methods: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. Results: Between May 2017 and May 2021, 32 ears of 17 patients were operated on dueto prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. Conclusion: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. Level of evidence: III.

Use of single-layer artificial dermal template in patients with trauma and burns.

OBJECTIVE: Artificial dermal templates (ADTs), were designed initially to provide extracellular matrix and skin substitute for extensive burn injuries. Use of ADTs in a variety of other indications, has also been described in the literature. In this study, we describe our experience of using ADTs for different indications in burn contractures and wound coverage. METHOD: In this retrospective study, patients requiring burn scar contracture release, permanent wound coverage for acute traumatic wounds and temporary wound coverage to prepare for complex reconstructions, and where the ADT Pelnac (Gunze Ltd., Japan) was applied, were evaluated. Data regarding patient sex, age, type and location of injury, comorbidities, operations and complications were recorded. RESULTS: A total of 24 patients were included in the study, of whom 12 patients were operated on for burn contractures. ADTs were used with split-thickness skin grafts (STSGs) or Z-plasties in a single-stage procedure. In six patients, ADT and STSGs were used to cover defects with exposed bone or tendon. Of the patients, six had their wounds covered temporarily while they were stabilised for complex reconstructions or were awaiting definitive histopathological results. Revisional surgeries due to graft failures or insufficient contracture releases were required by 12 patients. All temporary wound coverage patients had successful flap reconstructions after stabilisation of their general status, had tumour-free margins in the histopathological examination, and no necrosis or infection was seen on follow-up. CONCLUSION: In this study, ADTs had positive effects on selected patients, but comprehensive and comparative clinical studies are needed for different indications to choose between these templates.

Surgical Burr-Assisted Lateral Osteotomy Technique in Septorhinoplasty.

ABSTRACT: Achieving aesthetic and functional results in rhinoplasty requires meticulous techniques, and postoperative edema, ecchymosis, and pain can deteriorate the desired outcomes. Different osteotomy techniques are defined to have optimal outcomes while reducing edema, ecchymosis, and pain. In this study, the authors compared conventional and power-assisted surgical burr osteotomy techniques in terms of early postoperative complications. Patients who underwent primary open septorhinoplasty were included in the study and were divided into 2 groups. The first group had lateral endonasal osteotomy with conventional guided osteotomes, and the second group had lateral osteotomy with surgical round burr. Edema and ecchymosis scoring systems were used on the postoperative first, third, and seventh day to evaluate postoperative edema and ecchymosis, and the visual analog scale was used to evaluate pain severity on the postoperative period. Out of 70 patients who had undergone septorhinoplasty, 36 received conventional osteotomy and 34 received surgical round burr osteotomy. Periorbital ecchymosis scores were significantly lower in the second group on the postoperative first, third, and seventh days. The periorbital edema scores were significantly lower in the second group on the first postoperative day but no difference was found between postoperative days 3 and 7. Also, the pain scores were significantly lower in the second group. Osteotomy with surgical round burr yields less ecchymosis, edema, and pain in the early postoperative period than conventional osteotomy in primary septorhinoplasty patients.

The Impact of the Informed Consent Process on the Anxiety Levels of Patients Undergoing Rhinoplasty.

ABSTRACT: Septorhinoplasty is one of the most common elective surgical procedures in otolaryngology. The present study aimed to evaluate the anxiety levels of patients who underwent septorhinoplasty at different times, compare the information methods, and determine the understanding of the informed consent through recall rates of the complications explained in the informed consent process. The patients were divided into the following 2 groups: Group 1 (giving information 14 days before the surgery) and Group 2 (giving information 3 days before the surgery). For the preoperative anxiety measurement, the State anxiety scale of the State-Trait Anxiety Inventory (STAI) was used. All patients were asked to recall the complications they remembered from the consent form on the day before the surgery. Each group has consisted of 25 patients. No significant difference was found between the STAI-1 and STAI-2a anxiety scores between groups. In Group 1, the STAI-2b anxiety score was significantly lower than the STAI-1 and STAI-2a scores (P < 0.05). In Group 2, the mean score of STAI-2b was not significantly higher than the STAI-1 and STAI-2 scores (P > 0.05). When the STAI-2b scores of the two groups were compared, the scores of Group 2 were significantly higher (P < 0.05). The most commonly remembered complications were bruising and swelling in both of the groups. In conclusion, the authors believe that long-term cooperation between the surgical team and the patient will reduce the anxiety levels of the patients and increase patients' satisfaction, resulting in a significant reduction in the amount of potential legal processes.Level of Evidence: 2.

Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap.

ABSTRACT: Nasal reconstruction is one of the most challenging procedures in plastic surgery. To get optimal aesthetic and functional results, the surgeon should know all the options well. Forehead flap is the gold standard technique for closure of medium to large defects of the nose. Although it provides a very good color and texture match, it may become a difficult option in patients with poor condition. The aim of this study was to define a simpler technique for nasal reconstruction using combined local flaps.Twelve patients, operated using a dorsal nasal flap combined with a nasolabial perforator propeller flap, were presented in the study. Properties of the patients, defect size and locations, and complications were evaluated.The mean size of the reconstructed defects was 10.1 cm2. No flap loss was observed. Venous congestion was the most common complication and resolved spontaneously in all cases. Two cases had partial distal necrosis, which also healed spontaneously.Closure was achieved successfully in all cases with a medium to large nasal defect using a combined dorsal nasal flap and nasolabial perforator propeller flap. This method can be used as an alternative to forehead flap.

Total nasal reconstruction with pre-laminated, super-thin anterolateral thigh flap: A case report.

Many techniques for nasal reconstruction have been described to achieve aesthetically and functionally favorable results. Local tissues, specifically the forehead flap, provide the best tissue match with the nose. However, when local tissue donor sites are limited, alternative options such as free tissue transfers should be considered. Herein, we describe a case of a 72-year-old male patient who had a total nasal and left malar defect reconstructed with a two-staged, pre-laminated, super-thin anterolateral thigh (ALT) flap. The patient's nasectomy was performed 15 years ago. The adjacent left malar defect was due to recent squamous cell carcinoma excision. Local tissues were unavailable for reconstruction due to previous tumor excisions. For the 8.5 × 5 cm defect, a 12.5 × 8 cm ALT flap was planned, with 7.5 × 8 cm for nasal reconstruction and 5 × 4 cm for malar reconstruction. During the first stage, a super-thin fascial ALT flap was raised without dissecting the perforators, and the nasal skeleton was laminated between these two flaps. Costal cartilages were harvested for the nasal skeleton and positioned between the suprafascial and the fascial ALT flaps. During the second stage, two perforators were dissected to the pedicle on the pre-laminated flap, and the flap was divided from the donor site. The nasal skeleton was fixed and anastomosis with the facial vessels was established. After both stages, no complications were observed. After one month, a revision surgery was performed to enhance the transition between the reconstructed nose and the cheek, and improve the nasal projection. Postoperatively, after one year, the patient had a stable nasal reconstruction with good breathing. Prelaminated, super-thin ALT flaps provide the advantages of a wide and versatile donor site and an acceptable donor site scar. They may be an option for patients who are not amenable to traditional reconstruction methods.

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17-88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap Procedure for Lower Extremity Reconstruction.

When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.

An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip.

Microvascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.

Periorbital Aesthetic Surgery: A Simple Algorithm for the Optimal Youthful Appearance.

BACKGROUND: Blepharoplasty is one of the most common procedures performed. To achieve optimal results in periorbital rejuvenation, a systematic approach to patients that addresses all the problems in the periorbital region is important. The aim of this study is to analyze blepharoplasty patients according to preoperative deformities and postoperative results and to create a basic algorithm for periorbital aesthetic surgery. METHODS: Patients who underwent periorbital aesthetic surgery were examined retrospectively. Patients' medical records and preoperative and postoperative photographs were analyzed. Preoperative and postoperative photographs were analyzed for 6 main criteria: brow position, blepharoptosis, canthal tilt, excess skin or deficiencies, excess subcutaneous tissue or deficiencies, and periorbital skin rhytides. After the anatomical analyses, researchers rated the results as optimal or suboptimal. RESULTS: In total, 176 patients' medical records were analyzed. Among them, 154 were women and 22 were men. The mean age was 43.8 years. No comorbid situation was detected in 133 of these patients. The postoperative result was evaluated as suboptimal in 151 patients (86%) and optimal in 25 patients (14%). An algorithm was proposed for the systematic evaluation of periorbital surgery patients to achieve satisfactory results. CONCLUSIONS: A simple 6-step checklist is designed to define periorbital deformities and to achieve the optimal youthful appearance.

Effects of adipose derived stromal vascular fraction on diabetic neuropathy: an experimental study.

The stromal vascular fraction (SVF) obtained from inguinal adipose tissue was injected into the sciatic nerve region in diabetic rats. The effects of the SVF on the sciatic nerve and functional, electrophysiological and histopathological changes were examined in this study. Rats were divided into five groups; a non-diabetic control group, and four diabetic groups. In the first diabetic rat group, the SVF was obtained from inguinal adipose tissue. The remaining diabetic groups included a sham control group, a phosphate-buffered saline (PBS) injection group and an SVF injection group. Injections were made into the sciatic nerve region. Electromyography and walking track analyses were conducted on all groups at the beginning of the experiment. Diabetes was induced via a single dose of streptozotocin. Walking track analysis and electromyography measurements were repeated in week 8. SVF or PBS was injected into the right sciatic nerve region on week 8 of experiment group rats. Walking track analysis and electromyography were repeated in week 12 and all sciatic nerves were examined histopathologically. In the diabetic SVF group, the sciatic functional index calculated from walking track analysis in week 12 was better than week 8. Additionally, the myelin sheaths of the right sciatic nerve were thicker and more uniform and the nerve fibers were thicker than those of the left, untreated sciatic nerve. No statistical differences were detected in electromyographic measurements. The adipose-derived SVF may be beneficial for nerve regeneration in diabetic neuropathy.

Simultaneous repair of cutaneous and subcutaneous wounds using a single suture technique.

OBJECTIVE: To describe a single suture technique for the simultaneous repair of cutaneous and subcutaneous wounds. METHOD: Skin and subcutaneous wounds of >3cm in size were repaired using a single suture technique. Different suture sizes were chosen for different wounds. Timing of suture removal was decided according to body area and wound healing status. RESULTS: A total of 78 patients were treated (41 women and 37 men). Mean age was 31.7 years (range: 14-72 years). At one month postoperatively, 56 patients attended a follow-up visit and 27 patients attended at six months postoperatively. Local infection was observed in one patient and wound dehiscence observed in two patients after suture removal. Resulting scars were similar to those of other types of suture techniques. CONCLUSION: This study describes a single suture technique for the simultaneous repair of cutaneous and subcutaneous wounds. It is easy to learn and perform. This technique reduces the risk of infection, cost and procedure time.