Dorsal Preservation Surgery: A Novel Modification for Dorsal Shaping and Hump Reduction.

BACKGROUND: A new technique for dorsal preservation rhinoplasty that minimizes recurrent hump deformity is introduced. OBJECTIVES: The authors sought to present a novel dorsal roof flap (DRF) technique for modifying the nasal hump and dorsum while reducing morbidity. METHODS: Twenty-two primary and 3 secondary rhinoplasty patients had 1 of 2 types of nasal DRF depending on hump composition. A triangular roof flap was created utilizing 2 incisions from W-point to lateral Keystone junction in cartilaginous humps (cartilaginous DRF) and to the nasion in osseocartilaginous humps (osseocartilaginous DRF). Then, septal strip excisions were conducted to lower the profile followed by nasal base narrowing. The DRF was then lowered to the desired profile line, any excess lateral wall height trimmed, and the DRF sutured to the upper lateral cartilages. Preoperative and postoperative nasolabial and nasoglabellar angles were measured on the photos. RESULTS: Mean follow-up was 10.3 (standard deviation, 4.41) months (range, 6-20 months). A total 22 humps were V-shape and 3 were S-shape. The composition of the hump was cartilaginous in 5 cases, bone in 7 cases, and combined in 13 cases. A cartilaginous DRF was utilized for the 5 cases with a cartilaginous hump and osseocartilaginous DRF was employed in the other 20 cases. There were no complications observed in the follow-up period and thus no revisions. CONCLUSIONS: The DRF technique allows preservation of the nasal dorsum and elimination of the dorsal hump while minimizing hump recurrence.

Reducing Dorsal Hump Recurrence Following Push Down-Let Down Rhinoplasty.

BACKGROUND: Hump recurrence is a commonly encountered problem following dorsal preservation (DP) rhinoplasty when surgeons are learning the procedure. OBJECTIVES: The aim of this paper was to compare the different methods for the prevention and treatment of dorsal problems following DP surgery. METHODS: One hundred and fifty primary rhinoplasty patients were included in our study. Their noses were classified in terms of both hump shape (V- or S-shaped) and height. All patients had a DP rhinoplasty by either a push-down (PD) or a let-down (LD) technique. The PD method was used for humps <4 mm and the LD for humps >4 mm. Follow-up evaluations were made with physical examination and photographs at 1 week, 3 months, and 12 months. RESULTS: Mean follow-up was 12.68 [1.78] months. Seventy-eight humps were V-shaped and 72 were S-shaped. PD was used for 67 cases, LD for 83 cases. Eight patients (5.3%, 8/150) had a visible dorsal hump problem after DP surgery. Based on their preoperative hump shape, 3 cases were V-shaped and 5 were S-shaped. All recurrent cases had a preoperative hump deformity >4 mm. The revision procedures were as follows: 4 patients had a PD procedure, 3 had a LD procedure, and 1 patient was treated by classic open resection rhinoplasty. CONCLUSIONS: There is a correlation between preoperative hump height and eventual hump recurrence. The complication rate can be decreased with additional technical maneuvers and proper patient selection.

Scapular Bone Grafts: Good Options for Craniofacial Defects?

INTRODUCTION: There is still no consensus on the ideal material to be used in craniofacial defects. Autogenous bone grafts are mostly preferred owing to their use with fewer complications. The aim of this study was to evaluate whether the scapular bone graft can be used with equal or more advantages to other bone graft resources in orbital, maxillary sinus front wall, and frontal bone defects. PATIENTS AND METHODS: Twenty-four orbital, maxillary sinus front wall, and frontal bone defects were reconstructed with scapular bone grafts. Sixteen patients presented with complicated orbital fractures, 5 patients presented with isolated orbital floor fractures, and 3 patients presented with frontal bone fractures. The grafts were radiologically evaluated 1 day, 6 months, and 12 months postoperatively by 3-dimensional computed tomography scan. RESULTS: All orbital, maxillary sinus front wall, and frontal bone defects were reconstructed successfully with scapular bone grafts. Clinical evaluation of the patients at 6 to 24 months of follow-up was considered satisfactory. Minimal donor site morbidity was observed. Scapular bone grafts adapted nicely to the recipient area, and bony union was complete as demonstrated by 3-dimensional computed tomography scans. CONCLUSIONS: Reconstruction of orbital, maxillary sinus front wall, and frontal bone defects with scapular bone grafts is an easy and safe procedure with minimal donor site morbidity. Scapular bone graft is a good reconstructive option for orbital, maxillary sinus front wall, and frontal bone defects.

Reverse superior labial artery flap in reconstruction of nose and medial cheek defects.

BACKGROUND: Angular artery, lateral nasal artery, and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects. An alternative pedicle to raise a flap in the nasolabial area is the superior labial artery. Superior labial artery is a constant branch of the facial artery, arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip. This makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flap. PATIENTS AND METHODS: Reverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients. Eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose. Auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patients. RESULTS: All flaps survived completely. Temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days. All patients healed without any postoperative complications and the final results were considered satisfactory. CONCLUSIONS: Reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery-based nasolabial flaps where these arteries could also be used as pedicle.

Dorsal roof flap rhinoplasty: Updated results and a new classification of nasal dorsal deformity.

BACKGROUND: The dorsal roof flap (DRF) technique was developed as a modification of the retractable roof method, which is a variant of dorsal preservation (DP). OBJECTIVE: The paper aims to present new results of the DRF technique and dorsal deformity analysis created for the technique. METHODS: A total of 57 primary rhinoplasty patients treated with DRF technique between 2022-2023 years were included in the study. A dorsal deformity classification based on the anticipated amount of dorsal reduction, nasal bone shape, and hump content was used. According to the classification, the noses were categorized into 3 types. All data were obtained from patient records, computed tomography views, and pre-and postoperative photographs. Aesthetic and functional results were assessed pre-and postoperatively using a visual analog scale (VAS) (0-10, 0 points means very poor). RESULTS: The mean follow-up period was 10.1 ± 3.9 months. 23 cases were type 1, 14 were type 2, and 20 were type 3. The anticipated amount of dorsal reduction in type 1 was 2-4 mm, 5-7 mm in type 2, and 8-10 mm in type 3 deformity. Of the total, 27 cases had a V-shaped nasal bone and 30 had an S-shaped. The hump composition was cartilaginous in 13 cases and bone and cartilage in 44 cases. Pre- and postoperative aesthetic and functional VAS scores were significantly different (p ≤ 0.001). No complications and therefore no revisions were observed during the follow-up period. CONCLUSION: It is a versatile method to reshape the nasal dorsum and minimize the revisions associated with dorsal preservation when used in appropriate cases.

Clinical evaluation of gauze-based negative pressure wound therapy in challenging wounds.

The aim of this randomised clinical study was to evaluate the effectiveness and safety of gauze-based negative pressure wound therapy (NPWT) in patients with challenging wounds. A total of 50 consecutive patients who had wound drainage for more than 5 days, required open wound management and had existence of culture positive infection were included the study. In this study, gauze-based NPWT was compared with conventional dressing therapy in the treatment of patients with difficult-to-heal wounds. The patients were randomly divided into two groups. Group I (n = 25) was followed by conventional antiseptic (polyhexanide solution) dressings, and group II (n = 25) was treated with saline-soaked antibacterial gauze-based NPWT. The wounds' sizes, number of debridement, bacteriology and recurrence were compared between group I and group II. The mean age of the patients was 59·50 years (range 23-97). In group I, average wound sizes of pre- and post-treatment periods were 50·60 ± 55·35 and 42·50 ± 47·92 cm(2), respectively (P < 0·001). Average duration of treatment was 25·52 ± 16·99 days, and average wound size reduction following the treatment was 19·99% in this group. In group II, the wounds displayed considerable shrinkage, accelerated granulation tissue formation, decreased and cleared away exudate. The average wound sizes in the pre- and post-treatment periods were 98·44 ± 100·88 and 72·08 ± 75·78 cm(2) , respectively (P < 0·001). Average duration of treatment was 11·96 ± 2·48 days, and average wound size reduction following the treatment was 32·34%. The patients treated with antibacterial gauze-based NPWT had a significantly reduced recurrence (2 wounds versus 14 wounds, P = 0·001), and increased number of the culture-negative cases (22 wounds versus 16 wounds, P < 0·047) in a follow-up period of 12 months. There was a statistically significant difference between two groups in all measurements. As a result, we can say that the gauze-based NPWT is a safe and effective method in the treatment of challenging infective wounds when compared with conventional wound management.

Rhinoplasty in the Black Sea Region.

We have retrospectively evaluated the charts of 120 patients who had undergone rhinoplasties. The noses were divided into 2 types. Type 1 (42 cases) was characterized by a normal radix, high dorsum, and prominent vault. These noses were corrected by dorsal reduction, lateral osteotomy when needed, and caudal septal resection. Type 2 (78 cases) was characterized by a dependent tip with inadequate projection and a low radix with an excessive projected dorsal hump. These noses were corrected by tip support with cartilage graft and/or various suturing techniques and dorsal reduction. Secondary revision was necessary in 26 patients (21.6% of the total number) mostly due to inadequate septal correction in the first operation and irregularities of the dorsum. The postoperative result was considered as good in 88 (81%), fair in 27 (15%), and poor in 5 (4%) by the patients. Although the cases presented in this series were mostly difficult ones, experience was found to be the major determinant in success while dealing with the challenging noses of the Black Sea Region.

Reconstruction of full-thickness cheek defects with using free osseocutaneous radial forearm flap.

PURPOSE: The aim of the present clinical study was to evaluate the feasibility of free osseocutaneous radial forearm flap in the reconstruction of full-thickness cheek defect after ablative cancer surgery. METHODS: A retrospective review of data was obtained from consecutive patients requiring free osseocutaneous radial forearm flap to recover both the cutaneous and bone deficit in major full-thickness cheek defect after oncologic resection. RESULTS: Two patients had advanced cheek squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The free osseocutaneous radial forearm flap measuring 10 × 8 cm to 14 × 10 cm was used to reconstruct the major through-and-through cheek defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 1 patient was living with no evidence of disease, and 1 had died of local recurrence. CONCLUSIONS: The free osseocutaneous radial forearm flap to reconstruct major through-and-through cheek soft tissue and bone defects is reliable and an excellent alternative to other options for patients who have full-thickness defect of cheek.

Clinical Experience With the Use of Gauze-based Negative Pressure Wound Therapy.

UNLABELLED:  Purpose. In this preliminary study, gauze-based negative pressure wound therapy (NPWT) was used to accelerate granulation tissue forma- tion and promote closure in a number of wound types. The authors aimed to evaluate the efficacy of gauze-based NPWT using the Chariker-Jeter technique for wounds requiring delayed closure. METHODS: A retrospective review was conducted of 50 patients with wounds not suitable for imme- diate primary closure. After initial irrigation, debridement, and antibiotic therapy, Chariker-Jeter technique NPWT was used and dressings were changed at 24- to 48-hour intervals before secondary closure or primary closure. In addition, a 4-point category scoring system (severe, moderate, mild, and none) was used to evaluate pain. Semi-quantitative data also were obtained. RESULTS: Wound size decreased considerably, granulation tissue formation was accelerated, and exudate was reduced and removed by the end of the treatment. The patients were followed for 12 months. Pre- and post-treatment averages of the wound surface areas were 90.21 ± 74.97 cm2 and 35.71 ± 53.63 cm2, respectively (P < 0.001). Average duration of treatment was 12.98 ± 3.18 days and average wound size reduction following the treatment was 64.61% ± 30.42%. Granulation tissue was clinically observed in all wounds by day 5. Six cases healed without any operation; the others required various reconstructive methods to cover the wounds. After surgical intervention, only 3 patients treated with gauze-based NPWT had a recurrence. No infections were observed during the follow-up period. According to the pain form, only 2 patients had severe pain. CONCLUSION: The gauze-based NPWT was found to be a safe and cost-effective method in temporary soft-tissue management of chronic nonhealing wounds suitable delayed closure. .

Use of human amniotic membrane as an interpositional material in treatment of temporomandibular joint ankylosis.

PURPOSE: The aim of the study was to demonstrate whether the human amniotic membrane (HAM) as an interpositional material could prevent temporomandibular joint (TMJ) reankylosis in the randomized rabbit model. MATERIALS AND METHODS: In our experimental study, 24 New Zealand white rabbits were used and all right joints were operated. The rabbits were divided into 2 groups. The first group was specified as the demonstration group (n = 8). In this group, fibrous ankylosis formation was shown experimentally. The rabbits in the second group, the treatment group (n = 16), were divided into 2 subgroups: gap arthroplasty, performed in group A (n = 8); and HAM, used as an interpositional arthroplasty material in group B (n = 8). RESULTS: In all rabbits, the range of jaw movements and weight decreased after induction of ankylosis. After surgical treatment of fibrous ankylosis, the vertical, right, and left movements of the jaw and weights of rabbits increased immediately. The results were evaluated clinically, macroscopically, histologically, and radiologically. There was a statistically significant difference in the jaw movements between groups A and B (P < .05). All operated joints in group A showed fibrous adhesions across the gap, and the articular surface was irregular with osteophytes and bony islands on the joint surface. In group B, no fibrous adhesions were observed. CONCLUSION: It was concluded that interpositional arthroplasty with HAM was superior to gap arthroplasty in the rabbit model in preventing ankylosis.

The Probable Reasons for Dorsal Hump Problems following Let-Down/Push-Down Rhinoplasty and Solution Proposals.

BACKGROUND: Nasal hump relapse and its probable reasons or mechanisms have been less discussed after dorsal preservation rhinoplasty. In this article, the authors would like to share their experiences and offer solutions regarding this subject. METHODS: Five hundred twenty patients who underwent primary rhinoplasty between the years 2016 and 2018 were included in the study. The push-down method was used for noses with a hump less than 4 mm and the let-down procedure was performed for others. Hump height was measured from profile photographs. The cases were evaluated in terms of nasal dorsal problems and their probable mechanisms. RESULTS: Five hundred twenty patients, 448 with a straight nose and 72 with a deviated nose, were enrolled in this study. Mean follow-up was 13 months (range, 9 to 16 months). Visible dorsal hump recurrence was observed in 63 patients, and they appeared at 1 to 4 months postoperatively. Forty-one of these had a dorsal hump more than 4 mm preoperatively. Hump recurrence was not more than 2 mm in 34 patients, and they did not wish to have any revision intervention because of cosmetic satisfaction. In 11 cases, the height of the hump recurrence was 2 to 3 mm. These patients were treated with only minimal rasping. The remaining 18 patients had a hump recurrence with a height of 3 to 4 mm. They underwent secondary surgery using let-down rhinoplasty. CONCLUSION: The authors recommend subperichondrial/subperiosteal dissection, subdorsal excision of cartilaginous and bony septum, scoring the resting upper part of the septum just below the keystone area, and performing lateral keystone dissection and preferring let-down procedure for kyphotic noses to prevent hump relapse after dorsal preservation rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

An Extremely Rare Condition: Unilateral and Isolated Temporalis Muscle Hypertrophy.

Unilateral and isolated temporalis muscle hypertrophy is an extremely rare condition causing cosmetic problems and pain in the temporal region. Up to date, 8 isolated and unilateral cases were reported in the English literature. In this article, the authors report 2 new cases of unilateral isolated temporal muscle hypertrophy.

Thermal injury due to electrosurgery.

Since the electrosurgical instruments are commonly used in a wide variety of surgical specialties, understanding of the properties of these instruments is very important to prevent the potential complications. We report the case of a patient who sustained a third-degree dermal burn caused by contact with the ground plate of the electrosurgical system. This burn healed with surgical treatment. Since electrosurgery causes serious complications, surgeon and operating suite personnel should pay attention to the electrosurgical system during the operation. Additionally, patients must be informed about these complications.

The Use of Vacuum-Assisted Closure and GranuFoam Silver® Dressing in the Management of Diabetic Foot Ulcer.

PURPOSE: The aim of this retrospective study was to evaluate the efficacy of vacuum-assisted closure (VAC) and GranuFoam Silver® dressing (KCI, San Antonio, TX) compared with conventional GranuFoam® dressing in the management of diabetic foot ulcers. PATIENTS AND METHODS: Twenty-one consecutive patients treated with conventional or silver-coated foam dressing were reviewed retrospectively. The wound duration was 6 mo. Group 1 (n=10) received conventional foam dressing (GranuFoam) and group 2 (n=11) received silver-coated foam dressing (GranuFoam Silver). The wound surface area, duration of treatment, bacteriology, and recurrence were compared between the groups. The mean age of the patients was 61.70±10.52 y in group 1 and 67.27±11.28 y in group 2. RESULTS: In group 1, the average surface area of the wounds was 45.30±46.96 cm2 and 18.40±23.48 cm2 in the pre-treatment and post-treatment periods, respectively. There was a statistically significant difference between two measurements (p=0.005). Average duration of the treatment was 25.50±27.13 d in this group. In group 2, average surface area of the wounds in the pre-treatment and post-treatment periods were 41.55±36.03 cm2 and 7.64±3.91 cm2, respectively. There was a statistically significant difference between two measurements (p=0.003). Average duration of the treatment was 10.09±3.51 d in this group. The patients treated with silver-impregnated polyurethane foam dressing had reduced recurrence (2 vs. 7 wounds, p=0.030) and increased number of the culture-negative cases at the end of the treatment. CONCLUSION: With the results of the study, it was concluded that VAC GranuFoam silver dressing can be superior to conventional GranuFoam dressing in reducing the recurrence rate of infected diabetic foot ulcers.

The Effect of Autologous Fat Graft with Different Surgical Repair Methods on Nerve Regeneration in a Rat Sciatic Nerve Defect Model.

BACKGROUND: The aim of this study was to evaluate the efficacy of autologous fat graft with different surgical repair methods on reconstruction of a 10-mm-long rat sciatic nerve defect model. METHODS: One hundred forty-four sciatic nerves were operated on in 72 Wistar rats. The right limbs were assigned as group A (n = 72) and the left limbs as group B (n = 72). In group B, autologous fat graft was added to the surgical area so as to stay in contact with the coaptation site. Nerve regeneration was evaluated by walking track analysis, Sciatic Functional Index, pin-prick, and electrophysiologic and histologic tests at commencement and at 4 and 12 weeks after the operation. RESULTS: The rats receiving fat graft showed better regeneration, but the difference was only significant according to Sciatic Functional Index and pin-prick test (p < 0.05). Primary repair, autogenous nerve graft, acellularized nerve graft, vein filled with fresh and denatured muscle graft subgroups in group B showed significantly better regeneration than those in group A according to the Sciatic Functional Index (p < 0.05). In terms of latency and amplitude, all subgroups in groups A and B were found significantly different from the commencement of the study, but there was no difference between groups A and B (p < 0.05). CONCLUSIONS: Although there was no significant difference between the groups, rats receiving autologous fat graft showed better regeneration. Combined use of autologous fat graft with surgical repair methods induced significantly better regeneration. It was concluded that autologous fat grafting may have a beneficial effect on nerve regeneration when it is present in the coaptation site during healing.