Comparison of two pandemics: H1N1 and SARS-CoV-2

SUMMARY OBJECTIVE: We aimed to compare the clinical, epidemiological, and prognostic features of the H1N1 pandemic in 2009 and the severe acute respiratory syndrome coronavirus 2 pandemic in 2020. METHODS: This retrospective study involved subjects from seven centers that were admitted and found to be positive for H1N1 or COVID-19 real-time polymerase chain reaction test. RESULTS: A total of 143 patients with H1N1 and 309 patients with COVID-19 were involved in the study. H1N1 patients were younger than COVID-19 ones. While 58.7% of H1N1 patients were female, 57.9% of COVID-19 patients were male. Complaints of fever, cough, sputum, sore throat, myalgia, weakness, headache, and shortness of breath in H1N1 patients were statistically higher than in COVID-19 ones. The duration of symptoms until H1N1 patients were admitted to the hospital was shorter than that for COVID-19 patients. Leukopenia was more common in COVID-19 patients. C-reactive protein levels were higher in COVID-19 patients, while lactate dehydrogenase levels were higher in H1N1 ones. The mortality rate was also higher in H1N1 cases. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 pandemic is a major public health problem that continues to affect the world with its high rate of contagion. In addition, no vaccines or a specific drug for the benefit of millions of people have been found yet. The H1N1 pandemic is an epidemic that affected the whole world about ten years ago and was prevented by the development of vaccines at a short period. Experience in the H1N1 pandemic may be the guide to prevent the COVID-19 pandemic from a worse end.

Comparison of Neurosensory Assessment Methods in Plastic Surgery.

Sensory assessment of the skin is essential to document the function of the sensory fibers of the tested nerves. The Semmes-Weinstein monofilaments, disk-criminator, electrodiagnostic testing, and Pressure-Specified Sensory Device (PSSD) have been currently used to assess sensory function of peripheral nerves. None of these methods is optimal because of different drawbacks; however, an increasing number of articles, which recognize the reliability of PSSD, have been published during the last decade. In this review, following a short overview on basic physiology and assessment methods of the skin sensory receptors, we compared the sensory assessment methods and summarized the applications of the PSSD in the field of different clinical areas, mainly peripheral neuropathies, breast, and flap surgery.

Fetal Cleft Lip/Palate Surgery: End of a Dream?

Recognition that a fetus can scarlessly heal in intrauterine life led to various animal studies in the mid 1980s exploring the possibility of fetal cleft lip/palate surgery. The idea of scarless cleft repair seemed like a possible dream after the promising results from the early animal studies. In this review, we analyze the progress made in the 30 years since our first experience with animal models.

Effect of Allogeneic Platelet Lysate and Cyanoacrylate Tissue Glue on the Fibrovascularization of the Porous Polyethylene Implant.

Because of limited autogenous tissue sources, donor site morbidity, and difficulty of shaping the autologous tissue, surgeons often need to use alloplastic frameworks in reconstruction of 3-dimensional tissue defects. Synthetic porous polyethylene (PP) implant is widely used in plastic surgery for 3-dimensional reconstruction of the lost or highly deformed tissues. One of the main factors of PP implant exposure is delayed fibrovascular ingrowth. In the present study, the authors investigated the effect allogeneic plateletlysate (PL) and cyanoacrylate tissue glue (CTG) (2-octyl cyanoacrylate) on the fibrovascularization of the PP implant.Twenty adult female Wistar rats were divided into 4 groups equally, according to the different surgical techniques and implanted materials used. Only PP implant was implanted subcutaneously through a skin incision on the chest wall skin of the rats in the control group; however, CTG was applied with PP implant in the cyanoacrylate group, PL was applied with PP implant in the platelet group, CTG and platelet was applied together with PP implant in the combination group. All of the implants in each group were histologically assessed at postoperative second week. Determination of the collagen density in the tissues, inflammation, and necrosis and vascularization status was assessed semiquantitatively.A denser collagen structure, low inflammation, and necrosis were found in PL groups. There was, however, a significant decrease in vascular density with PL-treated groups. PL treatment may have a potential to reduce complications related to PP implants.

The Future of Plastic Surgery: Surgeon's Perspective.

Since the days of Sushruta, innovation has shaped the history of plastic surgery. Plastic surgeons have always been known as innovators or close followers of innovations. With this descriptive international survey study, the authors aimed to evaluate the future of plastic surgeons by analyzing how plastic surgery and plastic surgeons will be affected by new trends in medicine. Aesthetic surgery is the main subclass of plastic surgery thought to be the one that will change the most in the future. Stem cell therapy is considered by plastic surgeons to be the most likely "game changer." Along with changes in surgery, plastic surgeons also expect changes in plastic surgery education. The most approved assumption for the future of plastic surgery is, "The number of cosmetic nonsurgical procedures will increase in the future." If surgeons want to have better outcomes in their practice, they must at least be open minded for innovations if they do not become innovators themselves. Besides the individual effort of each surgeon, international and local plastic surgery associations should develop new strategies to adopt these innovations in surgical practice and education.

Anatomy of the Anterior Deep Temporal Nerve: Implications for Neurotization in Blinking Restoration in Facial Paralysis.

Facial paralysis can lead to dysfunctions in eyelid closure, which is called lagophthalmos. A number of surgical procedures, both dynamic and static, have been described to restore the innervation of the orbicularis oculi muscle that closes the eyelids. This cadaver-based anatomical study aimed to evaluate the anatomy of the anterior, middle, and posterior deep temporal nerves; nerves to the temporalis muscle; and their availability for direct muscle neurotization of the orbicularis oculi. A total of 10 hemisectioned head specimens from 5 adult cadavers (2 men and 3 women) were used in this study. The adequacy of the length of the anterior deep temporal nerve was assessed for direct neorotization of the orbicularis oculi muscle. The mean distances between the originating point of the deep temporal nerves from the mandibular nerve in the infratemporal fossa and their terminal entry points into the muscle were 46.4 (42-51 mm), 42.2 (38-46 mm), and 33.4 mm (26-40 mm) for the anterior, middle and posterior branches of the nerves, respectively. We conclude that the anterior deep temporal nerve is a versatile nerve that can be used for direct muscle neurotization, nerve transfer, and babysitter procedures in selective blinking restoration. Before proceeding with any further clinical use, an anatomical study should be performed with fresh specimens from cadavers.

Experimental stem cell therapies on burn wound: do source, dose, timing and method matter?

Stem cell therapy has been introduced as a new and promising modality of wound covering in recent decade. It has been used for improvement of burn wound, post burn scar and saving stasis zone of burn with good results. However, there have been some differences between the various experimental burn wound trials in stem cell source, therapeutic dose, delivery method and timing of stem cell delivery. In our study, we aimed to review stem cell biology and investigate discrepancies in animal trials of use of stem cells in burn wound account for the variation in, stem cell source, therapeutic dose, delivery method and timing of stem cell delivery.

Breast reconstruction using de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy in macromastia.

INTRODUCTION: Prophylactic mastectomy is performed to reduce the risk of breast cancer in high-risk conditions, and expectations about reconstruction are too high. Implant coverage with healthy tissue and skin reducing as an envelope are two concerns in the treatment of macromastia cases. We present our results obtained with a prosthetic reconstruction technique using an inferior pedicled de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy in this retrospective study. METHODS: Fourteen patients with macromastia and with a high risk of breast malignancy were treated with breast prosthesis using an inferior pedicled de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy, and were followed for 6 months to 2 years. RESULTS: Good aesthetic results were obtained in all of the patients with increased patient satisfaction. There were no serious complications and the patients were all satisfied. DISCUSSION: Since there is no dangerous T-point in vertical-pattern skin-sparing mastectomy in contrast to an inverted-T wise-pattern technique, where flaps are connected under great tension and susceptible to separation, it can be used safely in macromastia cases, as in smaller breasts. In addition, a de-epithelialized dermal flap is quite useful to cover the inferior pole of the prosthesis and it eliminates the need for an acellular dermal matrix.

A new approach to objective evaluation of the success of nasal septum perforation.

BACKGROUND: Perforations in the nasal septum (NSP) give rise not only to disintegration of the septum anatomy but also impairment in normal nasal physiology. The successes of these surgical techniques are usually equated to anatomical closure of the perforation. The goal of this study is to evaluate the subjective and objective results of our surgical technique for septal perforation surgery. METHODS: All NSPs in the six patients were closed by inferior turbinate flap. The Nasal Obstruction Symptom Evaluation (NOSE) instrument was used to evaluate the preoperative and postoperative subjective sensation of nasal obstruction. Measurement of preoperative and postoperative nasal airway resistance was performed using active anterior rhinomanometry which is an objective test. Wilcoxson signed rank test and Spearman correlation test were used to analyze correlation between NOSE scores and rhinomanometric measurements. RESULTS: The full closure of the septal perforations was noted in 100% of patients. The total NOSE score was 14 preoperatively and one postoperatively. The improvement in NOSE scores was statistically significant (P≤0.002). The mean preoperative total resistance (ResT150) value was 0.13 Pa/cm(3)s(-1), which is below the normal range (0.16-0.31 Pa/cm(3)s(-1)), while the mean postoperative ResT150 value was 0.27 Pa/cm(3)s(-1). The correlation between the improvement in NOSE scores and improvements in ResT150 values was statistically significant. CONCLUSIONS: Surgical approaches should aim to solve both the anatomical and physiological problems of NSP. The application of subjective and objective tests in the postoperative period will help surgeons assess the applied techniques.

Experimental assessment of the neo-vascularisation of acellular dermal matrix in the wound bed pretreated with mesenchymal stem cell under subatmospheric pressure.

Neo-vascularisation of the acellular dermal matrix (ADM) is an essential procedure if a full-thickness wound is closed with ADM and skin is grafted over the ADM. In this study, we aimed to improve the neo-vascularisation of ADM by combining the effects of negative pressure wound therapy (NPWT) and mesenchymal stem cells (MSCs) on angiogenesis. In this study, 28 female Sprague-Dawley rats were used and divided into four groups. Full-thickness dorsal skin defects were created in 2 × 2 cm dimensions. The wounds were treated with only the ADM in group 1, the ADM and NPWT in group 2, the ADM and MSCs in group 3 and the ADM, NPWT and MSCs in group 4. By the ninth day of surgery, the excisional biopsy samples were histologically examined to identify the rates of ADM adherence to the recipient bed; the newly formed blood vessels which penetrate the ADM vertically and vascularisation were evaluated by immunohistochemical staining. The graft adherence rates were higher in group 4 than in the other groups statistically, p = 0.003. The numbers of cluster of differentiation 31 (CD31)-stained newly formed microvessels were higher in group 4 than in the other groups statistically, p < 0.05. All subjects in group 4 had the vertical vessels in normal calibration with open lumen vessels which penetrate the ADM. These findings suggest that MSC transplantation induces angiogenesis more efficiently than NPWT. The combination of the NPWT with MSC in this study has shown a synergistic effect on angiogenesis and has affected the neo-vascularisation of the ADM significantly.

Quality of life and functionality of patients with heel reconstruction after landmine explosions.

BACKGROUND: Landmine injuries cause extensive soft and bony tissue loss of the weight-bearing areas, particularly the heel. Reconstruction of these injuries is challenging, and there are no studies that report long-term functional results. OBJECTIVE: To determine the quality of life and long-term functionality of patients who had heel reconstruction with free muscle flap after landmine injuries. DESIGN: A case-control study. PARTICIPANTS: Nine male patients who had heel reconstruction with free muscle flap. Ten male volunteers without any gait disorder were included in the study as the control group. METHODS AND INTERVENTIONS: Functional ambulation scale, visual analog scale, energy expenditure index, 6-minute walking test, 10-m walking test, and Short Form 36 were performed to determine the quality of life and functionality of the participants. RESULTS: There were no statistically significant differences between the 2 groups in terms of functional ambulation scale, energy expenditure index, 6-minute walking test, and 10-m walking test. Regarding Short Form 36 scores, all subgroup values were lower in the reconstruction group, whereas only those of general health, vitality, and physical-emotional role limitation subgroups showed statistical significance. Mean visual analog scale scores were found to be statistically different between the groups (P < .05). Mean Freiburg Ankle scores showed moderate functionality. CONCLUSION: Despite the associated physical and emotional trauma, combat-injured veterans with heel reconstruction after landmine injuries had adequate and functional ambulation at long-term follow-up. Early rehabilitation and close cooperation between surgeons and rehabilitation physicians during the care of these patients will enhance patient outcomes.