Fixation of the Cartilaginous Vault with Barbed Suture in Closed-Approach High-Septal-Resection Dorsal Preservation Rhinoplasty.

Fixation of the cartilaginous vault is an important maneuver in preservation rhinoplasty to reduce hump recurrences. This paper presents a cartilaginous vault fixation technique with a barbed suture. Forty-six patients who underwent closed-approach high-septal-resection dorsal preservation rhinoplasty between August 2019 and March 2020 were included in this retrospective study. According to the cartilaginous vault fixation sutures applied, the patients were divided into two main groups as follows: (1) barbed suture and (2) conventional suture. Standardized postoperative 1-month lateral view photographs were scanned for the presence of any degree of hump recurrence. The Rhinoplasty Outcome Evaluation (ROE) scale was applied at 12 months. Hump recurrence was detected in one patient in the barbed suture group (n = 21) and one patient in the conventional suture group (n = 25; p > 0.05). For the ROE scores and number of satisfied patients, no statistically significant difference was found between the barbed and conventional suture fixation techniques (p > 0.05). Fixation with barbed suture showed similar results to conventional suture fixation. Barbed sutures can be used for cartilaginous vault fixation, taking advantage of the ease of placement in closed rhinoplasty. This study reflects level of evidence IV.

The Repairing of the Recto-Neovaginal Fistula in a Male-to-Female Transgender Through Perineal Graciloplasty.

Rectovaginal fistulas, which are abnormal epithelial-lined connections between the rectum and vagina, are challenging to treat. Treatment of recto-neovaginal fistulas is more complicated due to the altered perineal anatomy in individuals undergoing gender reassignment surgery. We present a recto-neovaginal fistula that occurred after reassignment surgery male-to-female transgender case of a was successfully treated with restorative perineal graciloplasty.

The effects of oral mucosa-derived heterotopic fibroblasts on cutaneous wound healing.

An intriguing observation that has recently found support through clinical and experimental studies is that wounds of the oral mucosa tend to display faster healing and result in less scarring than in the skin. We aimed to investigate the potential of heterotopic oral mucosal fibroblasts in cutaneous wounds while determining the main differences between wounds conditioned with either the oral mucosa or dermis-derived human fibroblasts. A total of 48 nude mice were divided into four groups: control, sham, dermal fibroblast (DF), and oral fibroblast (OF). Fibroblasts were isolated, cultured, and seeded onto fibrin scaffolds for transfer to full-thickness dorsal wounds. Cell viability, wound area, healing rate, vascularization, cellular proliferation, dermal thickness, collagen architecture, and subtypes were evaluated. Both cell groups had a viability of 95% in fibrin gel prior to transfer. None of the wounds fully epithelialized on day 10, while all were epithelialized by day 21, which resulted in scars of different sizes and quality. Healing rate and scars were similar between the control and sham groups, whereas fastest healing and least scarring were noted in the OF group. Dermal thickness was highest in the DF group, which was also supported by highest levels of collagen types I and III. Proliferative cells and vascular density were highest in the OF group. DF result in healing through a thick dermal component, while oral fibroblasts result in faster healing and less scarring through potentially privileged angiogenic and regenerative gene expression.

Aesthetically Thriving through Coronavirus Disease 2019 (COVID-19): An Evaluation of Patient Motivation and Perception on Aesthetic Surgery and Minimally Invasive Procedures.

Although the cancellation of elective procedures due to the COVID-19 outbreak has been a vital precaution, it has resulted in the suspension of aesthetic procedures and surgeries worldwide. Consequently, this postponement and other factors might have a negative impact on patients planning to undergo aesthetic procedures. Understanding the changes in patient motivation and perception in comparison to the prepandemic period is imperative for proper adjustment of plastic surgery clinics.A prospective questionnaire study was conducted on patients with cancelled aesthetic surgeries or procedures to determine the effects that coronavirus disease 2019 (COVID-19) had on patient motivation regarding cosmetic surgery and procedures and to establish a relationship between patient characteristics and the overall effect of pandemia on the perception of cosmetic surgery.Although most patients felt angry or frustrated due to the cancellation of their surgeries or procedures, the majority accepted that it was a necessary precaution. Patients with a history of previous minimally invasive procedures had a significantly higher ratio of acceptance for cancellations, whereas single patients were more likely to want to have their treatments done if the decision were left up to them. A subset of patients considered undergoing additional cosmetic procedures in the setting of self-isolation, and all patients stated that they would reschedule once the pandemia was under control.Patients with established motivation for plastic surgery and minimally invasive procedures ultimately plan to resume their normal treatments alongside others after the pandemia subsides. Plastic surgeons must actively communicate with their patient population during this time to properly educate, embrace, and direct them under scientific guidelines.

Far From Luck's Way: A Concurrence of Kaposi Sarcoma and Cutaneous Angiosarcoma in the Setting of Chronic Lymphocytic Leukemia.

Kaposi sarcoma and cutaneous angiosarcoma are rare forms of skin malignancies that are vascular in nature and are frequently encountered in the immunosuppressed population. Although synchronous angiosarcoma and Kaposi sarcoma have been documented, to our knowledge, the coexistence of these vascular malignancies with underlying chronic lymphocytic leukemia has not been previously reported. A 51-year-old male patient with chronic lymphocytic leukemia presented with Kaposi sarcoma located on his left ankle. Shortly after, the patient presented with de novo lesions located on the plantar region of the right foot, reported as angiosarcoma. Following a multidisciplinary decision, treatment with adjuvant chemotherapy consisting of paclitaxel and carboplatin with consolidation radiotherapy was planned. The patient's Kaposi sarcoma has remained unchanged throughout this period. In such cases, the treatment is advised to be planned around the more aggressive malignancy. These patients should also be followed-up by dermatology due to the higher risk of secondary cutaneous malignancies.

Aesthetic Earlobe Reduction: A Practical Geometric Modification with Natural Contour Preservation.

Earlobe elongation is one of the signs of aging process and surgical correction is warranted for earlobe ptosis. Most of the earlobe reduction techniques result with scars on the anterior or inferior aspect of the earlobe or unnatural appearance. The authors present a modified technique for earlobe reduction and reshaping that results with an acceptable scar set on the natural groove of the anterior surface of the earlobe. Nine healthy female patients were operated for earlobe reduction. The postoperative and preoperative otobasion inferius (O)-subaurale (S) distances of these patients were evaluated. According to the measurements, the preoperative mean O-S distance of the right lobule was 13.1 ± 1.8 mm and the left lobule was 12.8 ± 1.9 mm, while the postoperative O-S distance of the right side was 3.4 ± 1 mm and the left side was 3.4 ± 0.7 mm (Table 2). This translated to an approximate pre- and postoperative O-S distance difference of 9 mm, a significant reduction that resulted with ideal O-S values. The presented approach has numerous advantages including inconspicuous scarring, smooth lateral earlobe contours, and undisturbed free borders. This was a Level IV therapeutic study.

Delayed Primary Closure of Traumatic Tension Wounds Using Plastic Straps and Kirschner Wires.

Tension of the wound edges should be overcome with precise surgical planning, which is recognized as one of the major contributors to local complications by compromising circulation of the wound edges. In this article, it was aimed to present the clinical results of a surgical technique, in which the plastic straps and Kirschner wires are used for delayed primary closure of traumatic tension wounds. Depending on the assessment of the wound localization, wound dimension, and mobility of adjacent soft tissue, the technique was performed in 9 patients with a male to female ratio of 8:1. Gunshot injury was the leading cause (n = 5), and in most cases, the wounds were located at the lower extremities (n = 6). The mean time between performing the technique and closing the wound primarily and the mean hospitalization time were 4.8 ± 1.1 and 13.5 ± 3.9 days, respectively. In each case, wound closure and healing were achieved successfully without any serious complications. The presented technique provides advantages of using a low cost as well as a very simple equipment, improved and reliable stability during tightening process due to self-locking feature of the plastic straps, no donor site morbidity, short operating time with low rate of post-operative complications, and short hospitalization time. We recommend using this invaluable technique reliably for the treatment of traumatic tension wounds. However, further studies are needed for better evaluation of cosmetic and functional outcomes of the presented technique.

Il faut une planification chirurgicale précise pour éviter la tension au pourtour des plaies, qui est reconnue comme l'un des principaux éléments responsables des complications locales. En effet, la tension compromet la circulation au pourtour des plaies. Dans le présent article, les auteurs ont cherché à présenter les résultats cliniques d'une technique chirurgicale qui fait appel à des bandes de plastique et à des broches de Kirschner pour retarder la fermeture primaire des plaies de tension traumatiques. Compte tenu de l'évaluation du foyer de la plaie, de la dimension de la plaie et de la mobilité des tissus mous adjacents, neuf patients (huit hommes et une femme) ont été soumis à cette technique. Les blessures par balle étaient la principale cause des plaies (n = 5), et dans la plupart des cas, celles-ci étaient situées sur les jambes (n = 6). La période moyenne entre l'exécution de la technique et la fermeture primaire de la plaie était de 4,8 ± 1,1 jours et le séjour hospitalier moyen, de 13,5 ± 3,9 jours. Dans chaque cas, la plaie s'est fermée et a guéri sans complications graves. La technique présentée a l'avantage de faire appel à du matériel peu coûteux et très simple, à assurer une stabilité fiable et plus importante pendant le processus de resserrement grâce à l'autoblocage des bandes de plastique, à éviter la morbidité au site du donneur, ainsi qu'à favoriser une opération de plus courte durée, un faible taux de complications et un court séjour hospitalier. Les auteurs recommandent cette technique inestimable pour traiter les plaies de tension traumatiques. Il faudra toutefois mener des études plus approfondies pour mieux en évaluer les résultats esthétiques et fonctionnels.

The Effect of Minocycline on Fat Graft Survival and Apoptotic Pathway.

Variable absorption rate is one of the biggest problems of fat grafting and one of the most important causes of fat graft volume loss is apoptosis. Minocycline is a tetracycline derivative and besides its antibacterial capacity, it has been widely using for anti-apoptotic effects. This study was designed to investigate the effect of minocycline on fat graft survival and adipocyte apoptosis. A total of two main and eight subgroups were designed and a total of 48 experimental animals, 6 in each group, were used. Fat grafts are obtained from Wistar albino rats and implanted to dorsal area of rats. Local and systemic minocycline was applied in the study groups. On the 9th day, apoptotic cells were detected by the terminal deoxynucleotidyl transferase dUTP nick end labeling method and on the 90th day morphologic characteristics and viability of adipocytes were evaluated using histologic and immunohistochemical methods and statistically compared. This study revealed that the fat grafts were bigger, and they kept their structures better and they were more vascular in the minocycline groups and apoptosis was significantly lower in the minocycline groups. The authors demonstrated that minocycline increases fat graft survival and statistical improvement in apoptosis inhibition via using minocycline therapy has been shown.

Defining a New Variable That May Impact Long-term Postoperative Nasal Tip Support: The Biomechanical Properties of the Columellar Strut Graft.

BACKGROUND: Although columellar strut grafts (CSGs) are considered among the fundamental steps for providing nasal tip support, a downward rotation of the nasal tip in patients with strut grafts can still be encountered. Patient-related factors such as nasal skin thickness can allow the plastic surgeon to anticipate certain drawbacks that can be encountered in the healing phase, but patient-based differences of nasal cartilage and the resulting impact have yet to be investigated. The purpose of this study was to evaluate the effect of the biomechanical properties of CSGs on late postoperative nasal tip position and support. METHODS: The study was undertaken with the participation of 20 patients undergoing closed-technique primary rhinoplasty with CSGs. Each cartilage specimen was biomechanically analyzed to calculate the modulus of elasticity. Preoperative and postoperative images were obtained to determine nasal tip position and rotation with quantitative measurements. Postoperative 3- and 12-month measurements were evaluated according to their relationship with the elasticity modulus of the utilized cartilages. RESULTS: The evaluation demonstrated that the elasticity modulus can impact the long-term support of the nasolabial angle in which an increase in the coefficient of elasticity can result in a decrease in long-term nasal tip support. CONCLUSION: The results of the study reveal a new objective variable that can impact nasal tip dynamics and patient-related differences following rhinoplasty. This study not only brings forth a different perspective in the evaluation of nasal tip dynamics but can also provide data for determining ideal values for cartilage prefabrication.

The Excision of the Buccal Fat Pad for Cheek Refinement: Volumetric Considerations.

BACKGROUND: Although the excision of the buccal fat pad has become very popular for achieving a slimmer midface, not all patients are good candidates for this procedure. Unfortunately, studies that provide guidelines by emphasizing volumetric and technical details are limited. OBJECTIVES: The study compared preoperative and postoperative volumetric data to identify the amount of tissue that can safely be removed and important technical concepts involved in lower cheek contouring with buccal fat pad excision. METHODS: Patients complaining of cheek fullness were evaluated to determine if they were good candidates for the procedure. Eligible patients were screened with transbuccal ultrasound to determine tissue volumes and anatomical details. Intraoperative and postoperative, 6th-month volume measurements were undertaken and residual tissues and vascular pedicles reevaluated. RESULTS: Ultrasound imaging showed that the mean preoperative volume of the fat pads was 11.67 ± 1.44 mL, and the mean postoperative volume was 8.58 ± 1.07 mL. The mean volume of the excised tissues was 2.74 ± 0.69 mL. Postoperative buccal fat pad volume values correlated with the reported average in the literature for the same age group. CONCLUSIONS: Buccal fat pad removal is an effective technique for refining the facial silhouette that should be reserved for patients with increased buccal fat pad volume. Removal of only the excessive portion of the fat pad is important because this structure provides significant volume in the midface that can be difficult to restore once aging affects the surrounding soft and bony tissue.

Efficacy of adhesive strips to reduce postoperative periorbital edema and ecchymosis following rhinoplasty

Background/aim: Periorbital edema and ecchymosis may develop following rhinoplasty. The aim of this study was to assess the efficacy of adhesive strip application on the upper and lower eyelids to reduce postoperative edema and ecchymosis following rhinoplasty. Materials and methods: The eyelids of one side were randomly selected, and an adhesive strip of standard size and number was applied at the end of the operation. The strips were removed at postoperative day 3; photos of the eyes were taken at days 3 and 7. Edema and ecchymosis were graded on a scale from 1 to 4. The ecchymosis areas on the lower and upper eyelids were measured and compared in square centimeters. Results: The mean ecchymosis area of the lower eyelid on the side of the adhesive strip and on the side without the strip was 1.63 cm2 and 3.32 cm2 in the early period, respectively. It was 1.15 cm2 on the upper eyelid on the side of the adhesive strip, and 1.87 cm2 on the side without the strip. It was 0.224 cm2 on the side of the adhesive strip, and 0.498 cm2 on the side without the adhesive strip in the late period. Conclusion: Applying adhesive strips reduces periorbital edema and ecchymosis.

Capecitabine-Induced Bilateral Ectropion: A Rare Ocular Manifestation Requiring Surgical Intervention.

It has been established that many chemotherapeutic agents are associated with a variety of ocular side effects. As an antineoplastic agent, 5-fluorouracil (5-FU) is the chemotherapeutic agent that is frequently linked with cicatricial ectropion. Capecitabine is a prodrug of 5-FU and has a more favorable side effect profile than 5-FU. Frequent side effects of capecitabine include gastrointestinal events and hand-foot-mouth syndrome; cicatricial ectropion is rather uncommon. Enzyme deficiencies affecting the capecitabine metabolism have been reported to be associated with exaggerated generalized systemic and cutaneous side effects; however, there are no cases in the literature reporting capecitabine-induced isolated bilateral-progressive ectropion. Although cessation of the agent is frequently sufficient for the treatment of ectropion, close follow-up is indicated in such patients as permanent damage may occur if the problem is left untreated. We report a case of capecitabine-induced bilateral cicatricial ectropion refractory to treatment cessation, ultimately requiring surgical treatment.

A Practical Technique for Reduction of the Bony Nasal Dorsum Height Using Kazanjian Bone-Cutting Forceps.

BACKGROUND: Resection of the nasal hump is one of the most critical steps of the rhinoplasty procedure, which is quite prone to complications when performed improperly or inappropriately. In this article, a practical, facile and minimally traumatic hump resection technique using Kazanjian bone-cutting forceps is presented with excellent cosmetic and functional results. METHODS: Fifty-seven consecutive primary (septo-)rhinoplasty patients with wide nasal bases, and various sizes of nasal humps, were enrolled in the study. Following reduction of the cartilaginous dorsum height, L-strut shaping of the septum, and septoplasty procedures, Kazanjian bone-cutting forceps were used for resection of the bony nasal hump. Lateral osteotomies were then performed, and the surgery was completed following insertion of the structural grafts, tip procedures and turbinate surgery. A computer software was used to measure the nasal hump. The "Rhinoplasty Outcome Evaluation" questionnaire was used to evaluate patient satisfaction 12 months after the operation. RESULTS: The technique presented here was performed on 19 male and 38 female patients with a mean age of 24.95 ± 6.07 years. The mean height of the nasal hump was 4.65 ± 1.56 mm. No patient had complications requiring further corrective surgery. The "Rhinoplasty Outcome Evaluation" questionnaire showed that all patients remained in the group of happy subjects. CONCLUSIONS: Long-term patient satisfaction indicates that the proposed technique could be used as an alternative procedure to other hump resection techniques. The technique described is an effective, reliable and atraumatic method of resection of any size nasal hump. LEVEL OF EVIDENCE V: 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 http://www.springer.com/00266 .

Superiorly based nasolabial island flap for reconstruction of the lateral lower eyelid

Background/aim: Various flap procedures have been described and used for the lower eyelids; however, the nasolabial flap is rarely employed. We herein aimed to present the clinical results of using the superiorly based nasolabial island flap for repair of surgical defects extending to the lateral lower eyelid. Materials and methods: Nine patients with a mean age of 62 +- 6 years underwent surgery for reconstruction of the lower eyelid.Results: The diagnosis of lesions was nodular basal-cell carcinoma (n = 5), superficial basal-cell carcinoma (n = 1), well-differentiated squamous-cell carcinoma (n = 1), and basosquamous-cell carcinoma (n = 2). According to the classification reported by Spinelli and Jelks, 6 surgical defects were located at zones II and IV, while 3 were at zones II and V. Five patients required posterior lamellar reconstruction. Lagopthalmos (n = 1), ectropion (n = 1), and transient numbness of the ipsilateral upper lip (n = 1) were noted as postoperative complications. Conclusion: Despite the low number of patients, the present series demonstrated that lower eyelid defects involving zone IV or zone V can be repaired safely and reliably with the superiorly based nasolabial island flap, along with its use shown in the literature for zone II or zone III defects. The technique for raising the flap is fairly simple, with predictable surgical results. In addition, the superiorly based nasolabial island flap provides a reliable means of obtaining good wound healing with acceptable aesthetics, as well as functional results of both the donor site and reconstructed area.

The Effect of Hyaluronic Acid Application on the Perisilicon Capsule Structure.

BACKGROUND: Silicon implants constitute a major part of plastic surgery practice. Although materials with high biocompatibility have been used around the implants, capsule formation still develops and progressive nature of this process results in capsule contraction. The aim of this study is to evaluate the effects of hyaluronic acid injected around the silicon block on the capsule structure. METHODS: Twenty Wistar albino rats were used in the study. Rats were divided into two main groups (group 1 and group 2) and two subgroups. Rats in group 1 were sacrificed in week 4 and rats in group 2 were sacrificed in week 8. A subcutaneous pouch was created in the dorsum of the rats and a silicon block was placed into the pouch in groups 1A and 2A. 0.2 ml of hyaluronic acid was injected around the silicon block in group 1B and group 2B. Rats were sacrificed and capsule structure and thickness were analyzed following macroscopic evaluation. Concentrations of transforming growth factor-ß1 (TGF-ß1) and heat shock protein-47 (HSP-47) were evaluated immunohistochemically, and statistical comparisons were made. RESULT: Capsule structure consisted of three layers in all the groups. A more intense collagen structure was observed in the middle layer. The capsule was thinnest in group 1A and thickest in group 2B; the difference between the groups was statistically significant. TGF-ß1 was most intense in group 2B and it was correlated with the amount of collagen. Involvement of HSP-47 was observed mainly in collagen and also in fibroblasts and vascular structures, and its concentration was found to be lower in groups 2A and 2B. CONCLUSION: Exogenously added cross-linked hyaluronic acid increased the capsular thickness and may increase the risk of developing capsular contracture around silicone implants. LEVEL OF EVIDENCE II: Evidence was obtained from the well-designed controlled trials without randomization.