Experience with vertical mammaplasty: advantages and drawbacks of Hall-Findlay's superomedial pedicle technique and improving the results by adding modifications to the technique.

BACKGROUND: Vertical techniques have become a growing area in reduction mammaplasty. Although it has many advantages such as a smaller scar and durable results, some problems still persist. The Hall-Findlay superomedial pedicle technique is one approach to obtain better results but is not without drawbacks. Some modifications are suggested to overcome its problems. METHODS: Superior pedicle vertical mammaplasty was performed for mastopexy, and superior, superomedial, and modified superomedial techniques were used for the reduction cases. Patients were followed up for at least 2 years and the complications were determined. RESULTS: Mastopexy cases had almost no complications. In reduction cases, the most common problems involved circulation and scar widening with the superior pedicle technique and bottoming-out deformity with the superomedial Hall-Findlay technique. These were negligible in its modified form. CONCLUSIONS: The tightness in the infra-areolar site is very important for a durable breast shape. Although the Hall-Findlay superomedial pedicle technique offers a versatile composite block nipple-areola complex with its sensation maintained, the inferior part of the pedicle that makes the medial pillar is in excess and the same amount of tissue must be removed from the lateral pillar to ensure tightness. LEVEL OF EVIDENCE IV: 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 www.springer.com/00266 .

Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.

This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection.

A positive Tinel sign as predictor of pain relief or sensory recovery after decompression of chronic tibial nerve compression in patients with diabetic neuropathy.

Predictive ability of a positive Tinel sign over the tibial nerve in the tarsal was evaluated as a prognostic sign in determining sensory outcomes after distal tibial neurolysis in diabetics with chronic nerve compression at this location. Outcomes were evaluated with a visual analog score (VAS) for pain and measurements of the cutaneous pressure threshold/two-point discrimination. A multicenter prospective study enrolled 628 patients who had a positive Tinel sign. Of these patients, 465 (74%) had VAS >5. Each patient had a release of the tarsal tunnel and a neurolysis of the medial and lateral plantar and calcaneal tunnels. Subsequent, contralateral, identical surgery was done in 211 of the patients (152 of which had a VAS >5). Mean VAS score decreased from 8.5 to 2.0 (p <0.001) at 6 months, and remained at this level for 3.5 years. Sensibility improved from a loss of protective sensation to recovery of some two-point discrimination during this same time period. It is concluded that a positive Tinel sign over the tibial nerve at the tarsal tunnel in a diabetic patient with chronic nerve compression at this location predicts significant relief of pain and improvement in plantar sensibility.

Lung age and respiratory muscle strength in female volleyball players.

OBJECTIVE: Lung age estimation is a useful approach to determine pulmonary pathologies. In literature, no studies have evaluated and compared lung age in athletes with healthy volunteers. This study aims to compare lung age and respiratory muscle strength in female volleyball players and age-matched healthy volunteers. METHODS: A total of 18 female volleyball players (22.39±4.97 years) and 20 female healthy volunteers (24.85±3.33 years) were included. Pulmonary functions and respiratory muscle strength were assessed using a spirometer and mouth pressure device, respectively. The lung age was calculated using reference equations associated with gender, height, and forced expiratory volume in 1 second. RESULTS: Lung age was significantly lower, and forced expiratory volume in 1 L, forced vital capacity, and maximal inspiratory and expiratory pressure (cmH2O, %) were higher in female volleyball players compared with healthy volunteers (p≤0.05). CONCLUSION: The lung age and respiratory muscle strength of female volleyball players were better than healthy volunteers. Regular training in female volleyball players may improve respiratory functions and lung age.

Treatment of facial burn scars with CO2 laser resurfacing and thin skin grafting.

BACKGROUND: Facial burns are very common and have significant clinical impact. Facial scars are easily recognized in the community and become a source of lifelong guilt, shame, and regret for the patients. In the presented clinical study, we aimed to investigate the effectiveness of CO2 laser resurfacing and thin skin grafting for burn scars of face. METHODS: Sixteen white men, whose ages ranged from 20 to 26 years (mean, 22 y), were operated on for elimination of facial burn scars. Burn areas were de-epithelialized by CO2 laser. Each area was grafted with a split-thickness skin graft. The follow-up period for these patients ranged from 3 to 15 months, with a mean follow-up period of 9 months. RESULTS: The scars were successfully treated and converted to a socially acceptable appearance. The color match was good or excellent in all patients. No new hypertrophic scar developed. CONCLUSIONS: Facial burn scars may be dermabraded in a short time, and a bloodless and smooth raw surface may be created by a flashed-scanned CO2 laser. The CO2 laser resurfacing and thin skin grafting method is effective in treating facial burn scars.

Comparing the results of limited incision technique and standard longitudinal incision technique for carpal tunnel decompression by numerical grading system.

The carpal tunnel syndrome is the most common nerve entrapment syndrome. Many different methods have been described for treatment. We performed a novel method to release the carpal tunnel. Subsequently, we compared the surgery results of this novel limited incision technique and the standard longitudinal incision technique by using a 'Numerical Grading System'. There is no reported study about the use of 'Numerical Grading System' for assessment of carpal tunnel syndrome in the literature. The novel technique is simple and effective, employs inexpensive instruments, and has a low complication rate. The aim of this paper is to record a novel limited incision technique and a new assessment method for the carpal tunnel syndrome.

Effects of neuromuscular electrical stimulation of quadriceps on the quadriceps strength and functional performance in nursing home residents: A comparison of short and long stimulation periods.

AIM: To determine the effect of two neuromuscular electrical stimulation (NMES) periods on quadriceps strength (QS) and functional performance in nursing home residents. METHODS: A total of 53 older adults living in a nursing home were randomized into two groups: NMES with a short stimulation period and NMES with a long stimulation period. The quadriceps muscles were bilaterally stimulated three times a week for 6 weeks in both groups. Strength was measured with a digital handheld dynamometer and 30-s chair stand test. Functional performance was evaluated with the Berg balance scale, Timed Up and Go test and 6-min walking test. RESULTS: Analysis was carried out on 44 older adults, who completed the study protocol. The isometric QS did not change within groups or between groups. Interestingly, the 30-s chair stand test score increased for both groups, but the improvements were similar among groups. The Berg balance scale score, Timed Up and Go test time and 6-min walking test distance also improved in both groups. However, no difference in any of the functional outcome measures was observed between groups. CONCLUSIONS: The present findings showed that both NMES protocols might be an alternative to achieve an improvement in functional strength of the lower extremities and functional performance in nursing home residents, whereas neither of the two protocols seems effective for improving isometric QS. Both methods might contribute to maintaining isometric QS during the aging process. Geriatr Gerontol Int 2019; 19: 409-413.

Three-layer primary closure of the bipedicled TRAM flap donor site for unilateralbreast reconstruction: a 15-year experience with 124 consecutive patients.

BACKGROUND/AIM: The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains widely used as a breast reconstruction technique. The bipedicled TRAM flap is not as preferable as it was formerly, mainly because of its donor site complications. However, in a number of situations, a bipedicled TRAM flap may be the only alternative. Therefore, a three-layer primary closure technique used with bipedicled TRAM flap breast reconstructions that can avoid donor site complications without using a mesh is presented. MATERIALS AND METHODS: A retrospective study was performed that included patients who underwent bipedicled TRAM flap breast reconstruction with the three-layer primary closure technique. Between 2000 and 2015, 124 breast reconstruction patients were reviewed for donor site morbidity. RESULTS: During the 15-year study period, 106 patients had conventional bipedicled TRAM flaps and 18 had bipedicled TRAM flaps with a surgical delay procedure. For all groups, none of the patients developed abdominal wall hernia, but three patients had bulging. Partial flap loss was the most common flap complication, present in 6 flaps (4.8%). CONCLUSION: The suturing technique studied provided abdominal wall closure without the use of a mesh even when utilizing a bilateral pedicle with very low complication rates.

Lung age and respiratory muscle strength in female volleyball players

SUMMARY OBJECTIVE: Lung age estimation is a useful approach to determine pulmonary pathologies. In literature, no studies have evaluated and compared lung age in athletes with healthy volunteers. This study aims to compare lung age and respiratory muscle strength in female volleyball players and age-matched healthy volunteers. METHODS: A total of 18 female volleyball players (22.39±4.97 years) and 20 female healthy volunteers (24.85±3.33 years) were included. Pulmonary functions and respiratory muscle strength were assessed using a spirometer and mouth pressure device, respectively. The lung age was calculated using reference equations associated with gender, height, and forced expiratory volume in 1 second. RESULTS: Lung age was significantly lower, and forced expiratory volume in 1 L, forced vital capacity, and maximal inspiratory and expiratory pressure (cmH2O, %) were higher in female volleyball players compared with healthy volunteers (p≤0.05). CONCLUSION: The lung age and respiratory muscle strength of female volleyball players were better than healthy volunteers. Regular training in female volleyball players may improve respiratory functions and lung age.

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.

The evaluation of nosocomial infection during 1-year-period in the burn unit of a training hospital in Istanbul, Turkey.

An analysis of the burned patients, admitted to our eight bed burn unit and treated between 1 January and 31 December 2000, was performed. Prevalence, etiologic agents, length of hospitalization, cost of treatment and mortality rates caused by nosocomial infections (NIs) were studied. The study included 63 patients. Eighteen of these (Group-A) had 24 NI episodes. The most common NI observed was burn-wound infection (58.3%), followed by bacteraemia-sepsis (16.7%). NIs were not detected in the rest at all (Group B). The mean length of hospitalization was 38.5+/-19.7 days in Group A, and 20.3+/-7.6 days in Group B. The mean total burned surface area (TBSA) was 43+/-21 in Group A and 29+/-18 in Group B, while the most important independent risk factor for NI was TBSA in burned patients (OR, 1.08; CI(95), 0.93-1.24). NI prolonged the mean hospital stay to 18 days and increased the cost of treatment by 502 US dollars. The most common bacteria isolated was Pseudomonas aeruginosa (41.7%) and the second was methicillin resistant Staphylococcus aureus (MRSA-25.0%). All of the NI-free patients survived, while, five (28.5%) patients with NI died (P<0.01). These findings emphasized the need for careful disinfection and conscientious contact control procedures in areas that serve immunosupressed individuals, such as burned patients.

Effect of various nerve decompression procedures on the functions of distal limbs in streptozotocin-induced diabetic rats: further optimism in diabetic neuropathy.

It is known that diabetic neuropathy is the result of endoneurial edema caused by various biochemical reactions triggered by hyperglycemia. This sequence of events can cause cessation of circulation at the perineurial level, or the tough layer, which is not resilient enough to spread intraneural pressure. Internal and external limiting structures create a double crush phenomenon to the nerve structure. Decompression of the nerve trunk at separate levels is one of the adjuncts to the overall treatment plan for diabetic neuropathy. In this study, the right sciatic nerves of 30 rats with streptozotocin-induced diabetes were used; three groups were created. In the control group, the sciatic nerves were explored and dissected only. In group II, tarsal tunnel release was performed and accompanied by epineurotomy of the sciatic nerve and its peroneal and tibial extensions. In group III, in addition to the procedures performed in group II, perineural sheaths, exposed through the epineurotomy sites at both the peroneal and tibial nerves, were incised for decompression of the fascicles. Improvement in diabetic neuropathy was evaluated by using footprint parameters. The last print length values, estimated according to the 38-month measurements, were 26.1 +/- 0.12 mm in the control group, 23.2 +/- 0.07 mm in group II, and 22.2 +/- 0.1 mm in group III. The toe spread and intermediate toe spread values of the groups were parallel to improvements in print lengths throughout the study. The best improvement was observed in the perineurotomy group. Finally, an electron microscopic study revealed variable degenerative changes in all groups, but they were milder in groups II and III. This experimental study reveals that adding internal decompression to external release doubled the effect in reducing derangement in the sciatic nerves of the rats and, in the authors' opinion, offers cause for further optimism in the treatment of diabetic neuropathy.

Double-Pedicle Tram Flap Breast Reconstruction: Following.

After using various techniques with various results, Bostwick's principles for breast reconstruction were used in mastectomy cases and their early results are presented. The breast reconstructions were performed to 12 cases, of which eight patients had one or two risk factors and four had more. The double-pedicle technique was used in the former and vascular delay preceding double-pedicle technique was used in the latter. No vascular compromises, arterial or venous, were observed on the flaps in the acute phase and no fat necrosis ensued lately. All patients were satisfied with these principles and we did not observe any problems with the flaps. We have concluded that Bostwick's principles offered a reliable and minimal risk basis for breast reconstructive surgeons.

Reconstruction of postburn cervical contractures using expanded supraclavicular artery flap.

Postburn cervical contractures involving the anterior neck represent a serious social, public, and medical problem. The expanded supraclavicular artery flap is a good reconstructive option for these defects to improve functional and aesthetic appearance. Its main vascular supply is the supraclavicular artery, and it may be harvested as either a skin pedicled flap or an island flap. In our clinic, 10 patients with severe cervical burn contractures were reconstructed with preexpanded supraclavicular artery flaps between 2005 and 2012. All the flaps primarily healed with good functional and cosmetic results, and the donor sites primarily closed without any tension. A complete range of motion at the cervical region was obtained in all patients by the end of the reconstruction period. The preexpanded supraclavicular artery flap is a suitable alternative for coverage of the cervical defects after the release of the burn contractures. It is a thin tissue of both good color and texture, and is easy to harvest.

The effect of perineurotomy on nerve regeneration in diabetic rats.

BACKGROUND: One of the main causes of diabetic neuropathy is endoneurial edema, which increases the internal pressure of the perineurium, which has a tight structure. The treatment used to reduce internal pressure is perineurotomy, in which a surgical incision is made into the perineurium. METHODS: Forty male Sprague-Dawley rats were used in the study. They were classified into four groups. Streptozotocin-induced diabetes was created in groups III and IV. The sciatic nerve was transected and repaired epineurally in all groups. Perineurotomy was performed additionally in group II and IV to the sciatic, peroneal, tibial, and sural nerves from the most proximal side to their most distal ends. The sciatic function indices were calculated for functional assessment. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated and degenerated fibers were counted in all groups. RESULTS: The sciatic function indices of the diabetic perineurotomy group were found to be significantly higher than those of the other groups (p < 0.05). Based on the myelinated fiber counts, there was insignificant difference between group I and group II, whereas the difference was significant (p < 0.05) between group III and group IV. Presence of peripheric nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in group I and group II. The myelinated axon profile in group IV was similar to that of groups I and II in electron microscopic evaluation. CONCLUSION: It is concluded that perineurotomy may be established as a useful adjunctive procedure for nerve repair in diabetic patients.

Burn assault with paint thinner ignition: an unexpected burn injury caused by street children addicted to paint thinner.

The frequency of assault by burning among all burn patients varies from country to country. Assault by burning, although uncommon, is a serious form of trauma and a significant source of morbidity and mortality. The aim of this retrospective study was to identify the epidemiologic features, current etiological factors, and the mortality of nine patients admitted to our burn unit between January 1999 and January 2009 after unexpected burn assault by paint thinner ignition caused by street children addicted to paint thinner. The circumstances of this injury and preventive measures are discussed.

Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars.

We compared the efficacy of silicone gel (Scarfade), silicone gel sheet (Epi-Derm), and topical onion extract including heparin and allantoin (Contractubex) for the treatment of hypertrophic scars. Forty-five postburn scars were included in the study. Patients with scars less than 6 months from injury were assigned at random to three groups each containing 15 scars, and their treatment was continued for 6 months. Scars were treated with Scarfade, Epiderm and Contractubex. Scar assessment was performed at the beginning of the treatment, and at the end of the sixth month when the treatment was completed by using the Vancouver scar scale. The difference between before and after treatment scores for each three groups was statistically significant. The difference between Scarfade group and Epi-Derm group was not significant; however, the differences of the other groups (Scarfade-Contractubex, Epiderm-Contractubex) were significant. Silicone products, either in gel or sheet, are superior to Contractubex in the treatment of the hypertrophic scar. The therapist should select the most appropriate agent according to the patient's need and guidelines of these signs.

Early and late results of nerve decompression procedures in diabetic neuropathy: a series from Turkiye.

We researched the effect of nerve decompression procedures on diabetic neuropathy cases just in the following day after surgery as well as later, at 6 months. Twenty-four patients with diabetic neuropathy who underwent surgical decompression were entered into this study. The common peroneal, the posterior tibial, and the deep peroneal nerves were decompressed. Visual analog scale was used for management of the pain. Patients were screened with neurosensory testing by using a Pressure-Specified Sensory Device. Preoperative values as well as values on the postoperative first day and 6 months postoperatively were compared. We found pain relief rate to be 80% at postoperative first day and 85% at 6 months postoperatively. Mean two-point discrimination length improvement rates were found to be 72.6% at postoperative first day and 89% at 6 months postoperatively, which mean excellent and good improvement. We concluded that peripheral nerve decompression can be used effectively in the treatment of diabetic neuropathy patients.

Burn disasters in shooting range areas.

Shooting range injuries are generally caused by ballistic accidents, and so far no burn disaster has been reported. In this article we reported a disaster caused by a gunpowder explosion in an indoor shooting range area in Istanbul, Turkey. Fourteen injured people were evacuated from the scene. Our burn center accepted 7 of them. Of the 7 injured people, 2 who were accepted by our burn center, and 3 people who were admitted by another center died. It is clearly identified how this mechanism of injury differs from that of usual burn injuries, due to both the high temperature generated, and the combination of hot and toxic gases produced by the explosion. We described the features of burn injury, and possible reasons of burn disasters.