Single-stage ala nasi reconstruction: lateral nasal artery perforator flap.

Since its first description, the nasolabial flap is one of the most preferred methods for the ala nasi reconstruction. Because of its similarity in skin color and texture to the nose, completely concealed scar in the nasolabial sulcus makes it a better choice. The major drawback of this flap is that it necessitates a 2-stage procedure. To gain more freedom in the reconstruction of alar defects, we planned to harvest a perforator flap around the nasolabial fold, which was the one of fixed areas, and included perforators from the lateral nasal artery that is a branch of the facial artery. Lateral nasal artery perforator flap was obtained from 8 patients who have them in the perialar region. Mean age was 64 years. Mean follow-up time was 18 months. In all patients, defects occurred after excision of basal cell carcinoma. All of them were verified histopathologically. In all patients, we identified a suitable lateral nasal artery perforator to meet our reconstructive demand. All defects that occurred were not suitable for primary closure, and sizes of all flaps were bigger than 1.5 cm in width and 1.5 cm in length. All of the flaps survived, and venous congestion was seen in the first 24 hours after operation, but this resolved without any partial or complete necrosis in 3 flaps. As another perforator flap, lateral nasal artery perforator flap can be adopted for defects in any fashion without any mobilizing restrictions. The lateral nasal artery perforator flap can be rotated 90 and 180 degrees as a propeller flap or can be transposed or advanced.

A new glabellar flap modification for the reconstruction of medial canthal and nasal dorsal defects: "flap in flap" technique.

BACKGROUND: In considering periorbital reconstructive options, the goals of reconstruction are to obtain functional and esthetic results. At the medial canthus, reconstruction should maintain the normal concavity of the canthus without distortion of the surrounding tissues and should maintain normal eyebrow contour and symmetry. The authors represent their flap in flap technique that provides normal concavity of the canthus and does not cause any complex and undesirable scars. METHODS: A new modification of conventional glabellar flap which was named "flap in flap technique" was raised to cover medial canthal defect. We designed an inverted V-shaped advancement flap (123Delta-A flap) that contains both B (145Delta flap) and C (2345) flaps. The B flap is designed in the glabellar region, which is at medial side of the defect and is transposed to defect, and the C flap is planned in V-Y fashion to release tension over the B flap. RESULTS: To date, we have used this technique successfully in 5 patients (4 women and 1 man), requiring a glabellar flap to reconstruct the medial canthus and proximal nasal dorsum. All defects were secondary to excision of basal cell carcinoma. All were satisfied with the cosmetic and functional results. CONCLUSIONS: Our glabellar flap in flap technique for the reconstruction of medial canthal defects has several advantages such as maintaining concavity of the canthus without distortion of the surrounding tissues and providing normal eyebrow contour and symmetry.

Reconstruction of complicated scalp defect via skin traction.

Management of an open wound is a problem frequently faced, with skin defects that cannot be closed primarily. Functional and aesthetic outcome could be improved if primary approximation of skin in these large defects were possible. Primary closure may be assisted using the viscoelastic properties of the skin. The viscoelastic properties of mechanical creep and stress relaxation in the skin were described more than 40 years ago. If skin is stretched with a constant force, it will expand with time as long as it is kept under tension, a phenomenon known as mechanical creep. In contrast, if the skin is stretched to a constant distance, it will expand and lead to a decrease in the force or tension on the skin with time, a phenomenon known as stress relaxation. We have recently applied these stretching properties to close the scalp because of a defect, which previously would have undergone pericranial flap and split-thickness graft. Because of the partial necrosis of the pericranial flap, skin grafting failed. In the second stage, we inserted only the wrist part of elastic latex gloves to the wound edges in full thickness. The skin margins were advanced slowly and gently.

Use of wide bipedicled pericranial flap in anterior scalp reconstruction.

Pericranial flap is a composite flap involving the periosteum of the skull with its overlying loose areolar tissue termed subgaleal fascia. The multiple blood supply of the pericranial tissue enables this versatility, with a rich, anastomosing arterial supply from the supraorbital, supratrochlear, superficial temporal, posterior auricular, and occipital vessels. Thus, the shape, size, and location of the pericranial flap could be altered as long as a sufficient pedicle width could be fashioned to maintain a blood supply. In our study, we have performed wide bipedicled pericranial flap in scalp reconstruction in 2 cases. After tumor excision was completed, a pericranial flap was planned on the caudal side of the defect. A bipedicle-based pericranial flap was outlined with the use of a sharp dissection; this flap was elevated in a submusculoaponeurotic plane. The bipedicled pericranial flap, whose arterial supply was from the superficial and posterior auricular arteries, was transposed to the frontal defect.We preferred a bipedicled flap, whose arterial supply is from the superficial temporal and posterior auricular arteries to augment vascular supply. If a large, long pericranial flap is required, making the flap pedicled ensures stable blood supply.

A novel approach for the reconstruction of medial canthal and nasal dorsal defects: frontal hairline island flap.

Medial canthal and dorsal nasal defects after surgery have been a challenging problem for surgeons and patients. The main purpose in reconstruction is not solely covering the defects with similar skin and soft tissue, but also causing minimal donor-area morbidity. The authors described an elliptical fashioned frontal island flap at the level of the frontal hairline, nourished by the vascular network composed of supraorbital and supratrochlear arteries, then carried subcutaneously to the defect area at medial canthus and upper nose. Any extra incisions above the eyebrow to control the pedicles were not necessary. Donor region was closed primarily; thus, scarring was hidden at the hairline. We present our frontal hairline island flap design and results in our series of 10 patients.In our study, we aimed to reduce scarring at donor area by planning a forehead island flap in an elliptical fashion at the frontal hairline. There are no more incisions than the elliptical incision over the hairline. Primary closure of skin flaps at the donor ensures a final scar that is hidden at the frontal hairline border. Forehead hairline island flap is an important flap for small- and medium-size defects as an alternative to conventional paramedian forehead flap.

[Electrophysiologic and histopathologic evaluation of peripheral nerve regeneration at different nerve segments and with different repair techniques]. / Farkli seviyelerde ve onarim tiplerindeki periferik sinir iyilesmesinin elektrofizyolojik ve histopatolojik olarak degerlendirilmesi.

OBJECTIVES: We compared the electrophysiologic and histopathologic results of early primary nerve repair and grafting of transections made at different levels. METHODS: Twenty-two male Sprague-Dawley rats were divided into three groups. In one group (distal group, n=8), the right sciatic nerve was transected near the proximal segment of, and in another (proximal group, n=7) at 15 mm proximal to, its branching. In the graft group (n=7), the nerve was resected from 5 mm to 15 mm proximal to its branching and the defect was repaired with the removed segment. All the nerves were repaired using the epiperineural technique. Electrophysiologic studies were performed before and after surgery. In the third month, bilateral biopsies were taken from the L4-5 dorsal root ganglion and from distal nerve segments for histopathologic examination and neuron and axon counts. RESULTS: At two months, the distal group exhibited significantly shorter latency (p=0.001) and higher amplitude (p=0.05) values. However, at three months, all the groups had similar values of latency, amplitude, and conduction velocity. At three months, the number of the dorsal root ganglion neurons was significantly greater in the distal group compared to the graft group (p<0.001), but this did not differ from the proximal group (p>0.05). Axon counts per square millimeter were similar (p>0.05), but axon diameter was greater in the distal group (p<0.05). In correlation analyses, increases in the number of L4-5 dorsal root ganglion neurons were significantly associated with increases in the percent changes in distal latency (p<0.05) and conduction velocity (p=0.018). CONCLUSION: Our findings suggest that distal injuries and primary repair of the sciatic nerve result in a faster and better recovery.

Decreased FENDRR and LincRNA-p21 expression in atherosclerotic plaque.

OBJECTIVE: Cardiovascular diseases are the most important cause of mortality worldwide, particularly atherosclerosis. Recently, lncRNAs affecting atherosclerotic progression have been reported in vascular smooth muscle cells, endothelial cells, and monocytes, suggesting that lncRNAs play an important role in atherosclerosis. METHODS: In recent clinical studies, nowadays, it was determined that internal mammary bypass grafts are closest to ideal grafts in coronary artery bypass surgery. In this study, we used tissue samples taken from atherosclerotic coronary arteries and the internal mammary artery (IMA) during coronary artery bypass surgery. Using RT-PCR, we investigated the role of two lncRNAs, FENDRR and LincRNA-p21, by comparing their expression levels in coronary artery plaques and normal mammary arteries of 20 atherosclerotic patients. RESULTS: We found that the FENDRR and LincRNA-p21 expressions decreased by approximately 2 and 7 fold in coronary artery plaques, respectively, compared with those in IMA, which is known to have no plaque development. CONCLUSION: This study was the first to use mammary artery tissues of the same patients as a control and to study FENDRR expression. Our data may provide helpful insights regarding the association of lncRNAs and atherosclerosis.

Histogram Planimetry Method for the Measurement of Irregular Wounds.

INTRODUCTION: Irregularly shaped wounds or flap borders usually require specified software or devices to measure their area and follow-up wound healing. In this study, an easy way of area measurement called histogram planimetry (HP) for wounds with irregular geometric shapes is defined and compared to conventional millimetric wound measurement. MATERIALS AND METHODS: Ten irregularly bordered geometric shapes were measured by 4 different individuals working as surgical assistants using both HP and manual millimetric measurement tools. The amount of time for each wound shape calculation as well as the measurements of the wound areas were noted. All measurements were compared for each method and between each individual using the Wilcoxon signed-rank test. RESULTS: There was no statistically significant difference between 2 measurement methods by means of measured areas; however, measurement time was significantly lower when the HP method was used. There also was no significant difference between the individuals' measurements and calculation times. These results indicated that HP is useful as a conventional millimetric square wound measurement technique with significantly lower measurement times. CONCLUSION: Due to the development of photo-editor software technologies, measurements in the surgical field have become more accurate and rapid than conventional manual methods without consuming the time and energy needed for other studies. A future study including comparisons between the presented method and complex computerized measurement methods, in terms of duration and accuracy, may provide additional supportive data for the authors' method.

Hepatitis B carriage and Brucella seroprevalence in urban and rural areas of Bolu province of Turkey: a prospective epidemiologic study.

BACKGROUND/AIMS: In this study, we aimed to investigate the prevalence of hepatitis B surface antigen positivity and antibodies against Brucella in rural and urban areas of Bolu province of Turkey. METHODS: A total of 4,234 [corrected] people were screened from the urban and rural regions (3084 [corrected] versus 1150, respectively). All sera were evaluated for HBsAg and Brucella antibody. RESULTS: HBsAg, rose bengal and serum tube agglutination positivity were found to be 2.85%, 1.0%, 0.46%, respectively, in the urban area, versus 2.6%, 1.7%, 1.1%, respectively, in rural areas (P>0.05). CONCLUSIONS: HBsAg seropositivity in Bolu is lower than in many other centers in Turkey. Brucella prevalence is 1%, which is higher than that in the Ministry of Health records. This shows that the recording system in our country is not very efficient. Similar studies should be carried out in different regions of our country to determine the actual values, which requires the cooperation of scientific foundations and the Ministry of Health.

Retrospective analysis of 132 patients with orbital fracture.

BACKGROUND: The aim of this study was to evaluate the clinical and epidemiological features of 132 patients with orbital wall fracture who were treated at Sisli Etfal Teaching and Research Hospital, Istanbul, between 2005-2012. METHODS: The medical records of the patients with a diagnosis of orbital fracture were reviewed and analyzed. The patients were evaluated by age, gender, etiology, symptoms, examination findings, fracture location, associated injuries, treatment, and complications. RESULTS: The mean follow-up time was 9 (6-16) months. The male-to-female ratio was 5.3-1. The average age was 32 (6-82) years. The leading causes of orbital fractures were traffic accidents (36%) followed by assaults (32%). The most frequently affected orbital wall was the medial wall (33%). The main symptom was throbbing pain in the traumatized area (100%), and the main examination finding was periorbital edema and ecchymosis (100%). The most frequent associated injury was cerebral trauma (14%). Sixty-seven patients (50.1%) were managed with medical treatment, and 65 patients (49.9%) underwent surgical treatment. The most common complication in the late period was dermatomal sensory loss (11%). CONCLUSION: This study makes clear that the frequency of orbital injuries may be decreased by preventing traffic accidents, by taking precautions in the event they occur, and by promulgating social and educational work against violence.

Compliance and efficacy of hand rubbing during in-hospital practice.

OBJECTIVE: To compare alcohol-based hand rubbing with hand washing using antimicrobial soap regarding antimicrobial efficacy and compliance with routine practice in hospital and intensive care units. SUBJECTS AND METHODS: From February to June 2003, 35 nurses were randomly selected from a nursing staff of 141 and divided into two groups: hand rubbing and hand washing groups. Hand cultures were obtained before and after health care procedures. The nurses were observed on days 1, 7 and 14 of the study, in order to determine compliance and efficacy of the hand hygiene methods. RESULTS: A total of 368 routine patient care activities were observed during the study period. Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap (54 and 27%, respectively; p < 0.01). Compliance was also better in the hand rubbing group than in the hand washing group (72.5 and 15.4%, respectively; p < 0.001). Compliance with hand rubbing was markedly lower among the nurses who had experience of more than 3 years in hospital practice. Both hand rubbing and hand washing compliance were poorer among nurses working in intensive care units than among nurses working in the other hospital wards. Generally, after taking off gloves, nurses preferred hand washing to hand rubbing. CONCLUSION: These data indicate that alcohol-based hand rubbing reduces mean bacterial counts on the hands of nurses more effectively than hand washing with antimicrobial soaps, and compliance rates with hand rubbing were also higher than with hand washing. Nevertheless, the compliance with hand rubbing was markedly lower in more experienced nurses.