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1.
J Craniofac Surg ; 28(7): e713-e717, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28872513

RESUMO

Orbital floor fractures of varying sizes commonly occur after orbital injuries and remain a serious challenge. Serious complications of such fractures include enopthalmos, restriction of extraocular movement, and diplopia. There is a dearth of literature that can be applied widely, easily, and successfully in all such situations, and therefore there is no consensus on the treatment protocol of this pathology yet. Autogenous grafts and alloplastic and allogenic materials with a wide variety of advantages and disadvantages have been discussed. The value of preoperative and postoperative ophthalmological examination should be standard of care in all orbital fracture patients. An ideal reconstructed orbital floor fracture should accelerate the restoration of orbital function with acceptable cosmetic results. Management parameters of orbital fractures such as timing of surgery, incision type, and implant materials, though widely discussed, remain controversial. In this study, 55 patients with orbital floor fractures surgically reconstructed with conchal cartilage grafts between 2008 and 2014 were retrospectively evaluated. Complications and long-time follow-up visit results have been reported with clinical and radiographic findings. The aim of this study was to present the authors' clinical experiences of reconstruction of blow-out fractures with auricular conchal graft and to evaluate the other materials available for use.


Assuntos
Autoenxertos , Pavilhão Auricular , Órbita/cirurgia , Fraturas Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Autoenxertos/cirurgia , Autoenxertos/transplante , Pavilhão Auricular/cirurgia , Pavilhão Auricular/transplante , Humanos
2.
J Craniofac Surg ; 26(7): 2094-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26413957

RESUMO

BACKGROUND: Because of the complications of classical subciliary incision, some modified subciliary approaches have been described in recent literature. OBJECTIVES: The aim of this study was to compare 2 commonly used subciliary approaches according to development of postoperative complications (scar formation, and ectropion). MATERIALS AND METHODS: Ninety patients were included in this retrospective study. Subciliary skin flap technique (SF group) was performed to 39 patients, while the others were operated by using skin-muscle (stepped) flap technique (SMF group). Fitzpatrick skin types, genders, ages, scar scores, and ectropion scores of the patients also were recorded. RESULTS: The mean age of the patients was 39.3 (18-99) years, and the mean follow-up period was 2.1 (1-6) years. Fitzpatrick skin-type levels were between 2 and 4 (median = 3). No difference was found between 2 groups in terms of age, follow-up period, and Fitzpatrick skin-type levels. However, the scar values of the SMF group were significantly lower than the SF group statistically. Also, there was no significant difference between males and females in SF and SMF groups in terms of scar and ectropion formation. On the other hand, scar values were lower in SMF groups rather than SF group in males. Although ectropion values were not different between SF and SMF groups in females, ectropion values of SMF group were significantly lower than SF group in males statistically. CONCLUSION: Subciliary skin-muscle (stepped) flap technique can be more reliable than subciliary skin flap technique for approach to orbitozygomatic fractures.


Assuntos
Pálpebras/cirurgia , Músculos Faciais/transplante , Fraturas Orbitárias/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Fraturas Zigomáticas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicatriz/etiologia , Ectrópio/etiologia , Doenças Palpebrais/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
4.
Exp Clin Transplant ; 2023 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-37074001

RESUMO

OBJECTIVES: The aim of this study was to investigate the characteristics of de novo malignancies arising in kidney transplant recipients followed in a tertiary hospital in Turkey and to examine the tumors in the head and neck region as a subgroup. MATERIALS AND METHODS: Data from kidney transplant recipients treated at our institution between January 2010 and July 2022 were retrospectively analyzed in this single-center study. Data regarding malignancies were noted according to the pathologists' reports. In situ malignancies and those arising after graft loss were not evaluated. RESULTS: The study population comprised 231 patients (165 men; 71.4%) with a median follow-up of 11 years (2853 patient-years). The recipients had a higher cancer risk than the general population (standardized incidence rate = 3.04; 95% CI, 1.82-4.26). Thirty de novo malignant tumors were detected in 24 patients (10.4%). The mean age at diagnosis of cancer was 54.88 ± 11.44 years. The median time from transplant to cancer diagnosis was 11.5 years (range, 7-18.8 y). Nonmelanoma skin cancers (56.7% of all tumors) were the most common malignancies. Twenty-two lesions (73.3%) that developed in 17 patients (7.4%) were localized to the head and neck region: 15 (68.2%) were cutaneous and 7 (31.8%) were noncutaneous. The median time from transplant to head and neck cancer diagnosis was 12 years (range, 7.5-17.5 y). Mortality rate was higher in cancer patients (10 [41.7%] vs 17 [8.2%]; P < 0.01). CONCLUSIONS: The incidence of de novo malignancy in kidney transplant recipients was relatively higher compared with previous data. Nonmelanoma skin cancers were the most common type. Three-quarters of all lesions were in the head and neck region, and two-thirds were of cutaneous origin.

5.
Ann Otol Rhinol Laryngol ; 115(3): 239-42, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16572615

RESUMO

The treatment of total columellar defects is very difficult, and there is not any first choice in reconstruction of these defects. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. We report a pediatric patient with a defect involving the entire columella. Reconstruction of the defect was accomplished with laterally based bilateral nostril sill flaps. An acceptable cosmetic result was obtained. This method can be done as a single-stage operation with an excellent color and texture match. We think that this method leads to good aesthetic results, and should be considered for total columellar reconstruction.


Assuntos
Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Retalhos Cirúrgicos , Criança , Humanos , Masculino
6.
Surg Neurol ; 62(5): 387-92; discussion 392, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15518839

RESUMO

BACKGROUND: Despite the existence of various nerve coaptation techniques, functional results of nerve repair are still inadequate. Potential benefits of developing modified coaptation techniques cannot be disregarded. METHODS: The authors report a new coaptation technique in which the epineural sutures were performed with an external metallic circle to increase the coaptation surface. The sciatic nerves of 30 male Wistar albino rats were used in the study. RESULTS: The mean Sciatic Function Index values in external metallic circle repair (n:11) and conventional epineural repair (n:10) groups were -42.35 +/- 22.95 and -69.34 +/- 17.96, respectively (p = 0.020). Electrophysiological studies revealed that the duration of compound muscle action potentials (CMAP) was (p = 0,012) shorter in conventional nerve repair group than it was in external metallic nerve repair. When external metallic circle repair and conventional epineural repair groups were examined for distal nerve segments, there were significant findings for the diameter of axons (p = 0.005), diameter of nerves (p = 0.000), and for G ratios (p = 0.000). The mean intraepineural cross sectional areas of external metallic circle repair and conventional epineural repair groups were 3.57 +/- 0.21 and 2.92 +/- 0.23 mm(2), respectively (p = 0.000). CONCLUSION: The external metallic circle repair technique enhances nerve regeneration by enabling a larger sprouting and contact area for nerve fibers.


Assuntos
Regeneração Nervosa/fisiologia , Procedimentos Neurocirúrgicos/métodos , Nervo Isquiático/cirurgia , Técnicas de Sutura , Animais , Eletrofisiologia , Masculino , Procedimentos Neurocirúrgicos/instrumentação , Ratos , Ratos Wistar , Nervo Isquiático/patologia
7.
BMC Surg ; 4: 14, 2004 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-15469611

RESUMO

BACKGROUND: Biliary-enteric anastomosis especially Roux-en Y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. In this study, we present the results of hepaticojejunostomy with external metallic circle. METHODS: Hepaticojejunostomy with external metallic circle were performed in eight male Sprague-Dawley rats. At the end of the third month, anastomoses were analysed for patency and stability of external circles. RESULTS: Relaparotomy revealed that all the anastomoses were patent and circles were in original places. CONCLUSION: To provide the patency of narrow hepaticojejunostomy anastomoses, external metallic circle can be a good alternative to use of internal stents in suitable cases.


Assuntos
Ducto Colédoco/cirurgia , Jejunostomia/métodos , Jejuno/cirurgia , Anastomose em-Y de Roux/instrumentação , Anastomose em-Y de Roux/métodos , Animais , Jejunostomia/instrumentação , Laparotomia , Masculino , Ratos , Ratos Sprague-Dawley , Técnicas de Sutura
8.
Plast Reconstr Surg ; 121(2): 443-450, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18300960

RESUMO

BACKGROUND: Reconstruction of large full-thickness defects of the upper eyelids is challenging because of their complex anatomy and specialized functions. The authors present and discuss a new, simple surgical technique for upper eyelid reconstruction. This is a single-stage procedure and has produced satisfactory to excellent results in the authors' patients. It presents the reconstructive surgeon with several advantages over other techniques. METHODS: The eyelid tumor is excised surgically until clear margins are obtained. The V-shaped orbicularis oculi myocutaneous advancement flap is marked on the remaining superior eyelid tissue and mobilized, leaving the base of the pedicle intact with submuscular tissue attachment. Posterior lamella reconstruction is performed with mucoperiosteal graft harvested from the hard palate in patients with full-thickness defects. Then, the flap is advanced to the defect and the donor site is closed primarily. RESULTS: Eight patients, aged 17 to 72 years, have been operated on with this technique for upper eyelid reconstruction. Follow-up included assessment of position, closure, length of palpebral rim, eyelid opening, aesthetic balance, presence of corneal erosion, ulcer or entropion, levator function, and donor-site morbidity. The flap was viable in every patient, without total or partial necrosis. No patient required surgical revision. The oncologic result was good, and no recurrence was noted. CONCLUSIONS: This method is a simpler, single-stage operation; does not damage the lower lid; provides a thin, mobile eyelid; and, above all, is less invasive than other techniques, and at the same time allows a good functional and aesthetic reconstruction.


Assuntos
Blefaroplastia/métodos , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Músculo Esquelético/transplante , Transplante de Pele/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
9.
Plast Reconstr Surg ; 117(4): 1308-14, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16582805

RESUMO

BACKGROUND: The knee region is a good free skin flap donor site, as it has minimal subcutaneous tissue and provides a hidden donor site. Acland et al. first used the skin over the medial side of the knee as a "saphenous flap" based on the saphenous branch of the descending genicular artery. METHODS: The authors studied the descending genicular artery and its saphenous branch in six cadaver limbs and elevated the skin over the medial side of the knee as a free flap in six patients to reconstruct lower extremity defects. RESULTS: In all clinical cases, the authors were able to elevate a skin flap from the skin on the medial side of the knee. The saphenous branch was absent in one cadaveric limb and one patient limb; instead, a direct cutaneous branch from the femoral artery reached the skin and had nearly the same caliber as the saphenous branch of the other cases. All the flaps survived and the defects healed well. CONCLUSION: The medial side of the knee is a good donor site, as it provides thin skin with innervation potential by means of the medial femoral cutaneous nerve and leaves an inconspicuous donor-site scar.


Assuntos
Joelho/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Humanos , Masculino , Veia Safena/anatomia & histologia , Retalhos Cirúrgicos/inervação , Coleta de Tecidos e Órgãos
10.
Ann Plast Surg ; 56(4): 423-6, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16557077

RESUMO

Hypospadias fistula may be persistently recurrent in some patients. In distal hypospadiac fistula cases, carrying the fistulous opening to the glans tip may be possible with extensive urethral mobilization and advancement. In 9 patients who were operated for urethrocutaneous fistula, we used the urethral advancement technique. Patient ages ranged from 5 to 14 years (mean, 8 years). In all of the cases, the urethra was mobilized proximally to at least penoscrotal junction, and in some cases, the bulbar urethra was mobilized partially. Follow-up ranged from 6 months to 16 months. In all but 1 child, a straight penis with the neomeatus at the glans tip was maintained without any urethrocutaneous fistula. In 1 child, chordee, which was already present, could not be prevented.Urethral advancement technique may effectively solve the problem of persistently recurrent hypospadias fistula. We recommend the technique to plastic surgeons' armamentarium.


Assuntos
Hipospadia/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Uretra/anormalidades , Uretra/cirurgia , Adolescente , Criança , Pré-Escolar , Humanos , Masculino , Recidiva
11.
Ann Plast Surg ; 54(6): 600-3, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15900143

RESUMO

Dorsum of the hand is an ideal skin-flap donor site for coverage of hand or finger defects. We elevated 8 reverse-flow first dorsal metacarpal artery flap in 9 patients for soft-tissue cover of index fingertip injuries distal to distal interphalangeal joint with exposed bone. In 3 patients, the digital branch of the superficial radial nerve was coapted to the digital nerve. All flaps healed uneventfully, except for 1 patient in which partial necrosis of the flap occurred. Postoperative follow-up was 4-12 months (mean, 8 months). Reverse-flow first dorsal metacarpal artery flap is a good alternative for reconstruction of index fingertip injuries.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Ann Plast Surg ; 55(5): 503-7, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16258303

RESUMO

The aim of this study is to assess the feasibility of rat penile replantation as a new microsurgical training model. The study was performed in 2 parts. ANATOMIC STUDIES: Fifteen Wistar albino rats were used to study and document the penile vascular anatomy. In 5 rats, dissections were performed after colored silicone injections, while 5 rats were operated under anesthesia to develop the strategy of flap elevation. In the remaining 5 rats, microangiographic study was performed with silicone-lead oxide mixture. FLAP STUDIES: As flap studies in 5 rats, penis were elevated based on right-side internal pudendal artery and internal pudendal vein and resutured. In 6 rats, penis were elevated as free flaps, and in 3 rats the penis were implanted in right thigh of the rats being the femoral artery and vein recipient. In the remaining 3 rats, penis were resutured in their original place, with saphenous artery and vein being the recipient and rerouted to the pubic region. At postoperative fifth day, the penis were examined for viability, and selected ones were histologically examined. Rat penis has a dual blood supply from bilateral internal pudendal arteries. Venous drainage is via both crural veins and dorsal vein. One side of the internal pudendal artery and anastomotic vein (branch of pudendal plexus) may be used as the vascular pedicle of the flap. Rat penis may be successfully elevated as a free flap and also may be replanted in its original place.


Assuntos
Pênis/cirurgia , Reimplante , Animais , Masculino , Pênis/citologia , Ratos , Ratos Wistar
13.
J Reconstr Microsurg ; 21(2): 107-12, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15739146

RESUMO

The free lateral arm flap may be harvested as a fascial, fasciocutaneous, or osteofasciocutaneous flap. Simultaneous flap elevation with preparation of the recipient site, easy dissection, minimal donor-site morbidity, and a constant vascular anatomy with long pedicle are advantages of the flap. In this study, the authors present 18 patients operated on between January, 2002 and August, 2003 in whom 18 free lateral arm flaps were utilized. There were four women and 14 men, and the mean patient age was 40 years. Thirteen fasciocutaneous, three fascial, and two osteofasciocutaneous flaps were used. Flaps were employed for the reconstruction of the lower extremity in five patients, upper extremity in nine patients, and head and neck in four patients. Thirteen flaps were elevated under axillary block and five flaps under general anesthesia. Aspirin, dipirydamol, dextran, and chlorpromazine were administered postoperatively. Venous insufficiency developed in two lower-extremity reconstructions on postoperative day 1. Venous thromboses were detected, anastomoses were re-done, and flaps healed uneventfully. No other postoperative complication was observed in the other patients. The free lateral arm flap may be used in various anatomic defects with various indications. It may be elevated under axillary block for extremity reconstructions.


Assuntos
Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Criança , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Medição de Risco , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/cirurgia , Resultado do Tratamento , Extremidade Superior , Cicatrização/fisiologia
14.
Plast Reconstr Surg ; 115(7): 2025-31, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15923851

RESUMO

BACKGROUND: Free transfer of the medial arm flap has not gained popularity despite the hidden donor-site scar as well as the hairless and elastic skin. This may be because of variations in vascular anatomy, leading to confusion during dissection of the flap. METHODS: In five preserved cadaver arms, the vascular pattern of medial arm skin was examined. Twenty-two upper extremity angiograms were examined, and 12 free medial arm flaps were elevated for various defects in 12 patients. RESULTS: In cadaver and clinical dissections, the authors found that blood supply to the flap is multiple: from the superior ulnar collateral artery, the direct cutaneous artery, or both. A superficial brachial artery may also be present, which was observed in four angiograms and two clinical cases (15 percent). Dissections showed that the medial arm skin may be elevated based on the superficial brachial artery, direct cutaneous artery, or superior ulnar collateral artery. A neurosensory flap may be obtained by including the medial brachial cutaneous nerve of the arm. CONCLUSIONS: A medial arm free flap is a plausible reconstructive option with good knowledge of the anatomical variations, as the defect on the medial arm is cosmetically more acceptable and has a better color match for head and neck reconstructions.


Assuntos
Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Braço/cirurgia , Artéria Axilar/anatomia & histologia , Artéria Braquial/anatomia & histologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos/irrigação sanguínea , Coleta de Tecidos e Órgãos , Artéria Ulnar/anatomia & histologia , Nervo Ulnar/irrigação sanguínea
15.
Microsurgery ; 24(4): 332-4, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15274193

RESUMO

A new experimental free flap model, the cocygeofemoral muscle flap of the rabbit, is introduced in this study. The coccygeofemoral muscle is a superficially located triangular muscle originating from the sacrum and inserting into the lateral condyle of the tibia, and it abducts the thigh. Anatomical dissection and microangiographic studies revealed that it has a major and a minor pedicle, the former originating from the caudal gluteal artery, and the latter originating from the caudal femoral artery. Its major pedicle contains the 0.7-mm artery, 1-mm vein, and the single nerve originating from the inferior gluteal nerve. In flap studies in 10 animals, the distal minor pedicle was ligated, and muscle was dissected up to its major pedicle and denervated, and the free muscle was transferred to the contralateral inguinal region via end-to-end anastomosis to the recipient vessels (i.e., the femoral artery and vein). At postoperative day 7, the transferred muscles were harvested and histologically examined. Nine of 10 muscles were viable; the coccygeofemoral muscle free flap is believed to be an easy-to-dissect and bulky flap model, having a relatively thick pedicle. It may serve as a good model in free muscle flap studies.


Assuntos
Microcirurgia/métodos , Músculos/transplante , Retalhos Cirúrgicos/irrigação sanguínea , Animais , Coelhos
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