Effects of Metoclopramide and Ranitidine on survival of flat template McFarlane skin flaps in a rat wound healing model.

Wound healing re-provides the morphological integrity after trauma. We investigated the effects of Metoclopramide and Ranitidine on survival of flat template McFarlane skin flaps in an experimental wound healing model.Rats (n:32) were randomly allocated in following groups: Flap control (Control), Metoclopramide(MET), Ranitidine(RAN) and Metoclopramide+Ranitidine (MET+RAN). After flap elevation, ip 10 mg/kg Ranitidin or 5 mg/kg Metoclopramide or the combination of both drugs were administered for 3 days. Next analgesia was maintained. No additional drugs were used for controls. On 10th day, whole cut skin flaps were excised, fixed in buffered formaldehyde and processed with histological techniques. Paraffine sections were stained with Hematoxylen-Eosin, Mallory-Azan and immunohistochemically with Desmin and Fibronectin and then evaluated with light microscopy.Experimental groups showed differences for epidermal degeneration, edema, hypertrophy of the hair follicles, neutrophil infiltration and areolar degeneration. Metoclopramide or Ranitidine administration positively impacts wound healing.This unique study emphasizes the importance of considering Metoclopramide or Ranitidine for possible adverse effects on flap survival in surgical clinics, therefore the combination of both drugs is not more effective.

Rare craniofacial anomaly: Tessier no. 2 cleft.

Four cases of facial cleft that fit the anatomic description of the rare Tessier no. 2 cleft, with two patients having the no. 12 cleft extending to the cranium as no. 2 clefts, are presented. In all patients, clinical expressions of the anomaly were different. Thus, diverse surgical procedures were used in all cases. These cases and review of the literature help to define the soft-tissue and bony course of these clefts, and also emphasize the role of three-dimensional computed tomography scan imaging to show the bony cleft route. The diagnosis and treatment plan of the no. 2 cleft as well as its cranial counterpart are discussed in this report.

Marjolin's ulcer of the scalp: report of 5 cases and review of the literature.

The formation of neoplastic changes in the scar tissue of chronically ulcerating wounds is a well-known process. This condition is most commonly seen after the postburn scars, but it may be seen after many kinds of scars. The term "Marjolin's ulcer" is used to describe this type of carcinoma. Although many different cell types can be seen in these lesions, the most commonly seen is squamous cell carcinoma. Squamous cell carcinomas resulting from the Marjolin's ulcer have a much greater tendency to metastasize than squamous cell carcinomas resulting from the other causes. Confusion continues about the precise pathophysiology of this lesion and the clinical behavior of this neoplasm, and the mortality and morbidity rates are also conflicting. As would be expected, there is a wide variety of suggested treatment protocols for this disease. This article, through case reports and review of the literature, offers criteria for the treatment of the Marjolin's ulcers that arise on the scalp, which is an uncommon site.

Marjolin's ulcers arising in burn scars.

Epidermoid carcinoma in nonhealing scar tissue, known as Marjolin's ulcer, is not uncommon and is thought to behave in a more aggressive fashion than those from other causes. Between 1982 and 1997, 56 patients with Marjolin's ulcer were treated at our center, Ege University Medical School, Izmir, Turkey. All lesions were secondary to various kinds of burns. Forty of these patients could be followed up 5 years or more. These 40 patients' medical records were reviewed retrospectively.

Nasal dermoid sinus cysts and the role of open rhinoplasty.

All suspected congenital abnormalities of the nose require further evaluation. The nasal dermoid sinus cyst (NDSC) is one of the many midline nasal masses that often pose diagnostic and treatment dilemmas for the plastic and reconstructive surgeon. NDSCs are distinct from other facial dermoids in their potential for involving deeper contiguous structures, and intracranial extension. Accurate diagnosis and effective treatment are essential to avoid craniofacial skeletal deformation, cyst rupture, and infection that could cause cutaneous, ocular, or intracranial complications. A comprehensive discussion of the embryogenesis, pathogenesis, diagnosis, and surgical management of the NDSC is presented to delineate the role of open rhinoplasty in optimizing the management of this congenital nasal deformity.

A rare craniofacial cleft: bilateral Tessier no. 5 cleft accompanied by no. 1 and no. 6 clefts.

A case of facial cleft that fits the anatomic description of the rare bilateral Tessier no. 5 cleft accompanied by unilateral no. 1 and no. 6 clefts is presented, and brings the total number of reported cases to 21. This case and a review of the literature help to define the soft-tissue and bony course of these clefts, and also emphasize the role of three-dimensional computed tomography to show the bony cleft route. The diagnosis and treatment plan of the no. 5 cleft as well as other rare clefts such as no. 1 and no. 6 clefts are discussed.

The role of periosteum and different dissection types on callus formation: quantitative analyses with scintigraphy in a rabbit mandible model.

In this experimental study, the effects of different dissection types and the role of the periosteum on callus formation were investigated. Forty-five rabbits were divided into three groups of 15 rabbits. In the first group, a classic subperiosteal dissection was performed to reach the mandible. In the second group, the dissection was done extraperiosteally between the periosteum and the muscle. In the third group, the periosteum at the osteotomy line was stripped out bilaterally both on the lingual and the buccal sides (1.5 cm wide on each side). In all groups, linear vertical osteotomy was performed using an oscillating saw, and fracture fragments were fixed with surgical wire. The animals were evaluated using biomechanical (traction test), histological, and scintigraphic methods. The most durable callus in the traction test and, scintigraphically, the most rapid remodeling were seen in the second group. The histological study performed during week 3 revealed immature callus formation in the first and second groups, and no such formation in the third group. At week 8 the callus was mature in the first two groups and in the third group it was seen but not mature.

Transsacral usage of a pure island TRAM flap for a large sacral defect: a case report.

A pedicled transverse rectus abdominis musculocutaneous (TRAM) flap was used to reconstruct a large sacral defect retroperitoneally. Muscle and superiorly located skin were elevated on the deep inferior epigastric pedicle. The flap was transposed retroperitoneally from the abdominal wall to the sacral region of the patient. The selection criteria for this particular flap are discussed and compared with other reconstructive choices.

Modified McIndoe procedure for vaginal agenesis.

Between 1982 and 1997, 29 patients with congenital absence of the vagina underwent modified McIndoe vaginoplasty at the Division of Plastic and Reconstructive Surgery, Ege University Medical School, Izmir, Turkey. As a modification, an X incision was utilized instead of a straight-line horizontal or sagittal incision. During the first postoperative week, a perforated Pyrex rigid mold was used. This was replaced with an unperforated mold at the end of the first week. These patients' medical records were reviewed retrospectively. Complications encountered included infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, and vaginal stricture. All complications were treated except the stress urinary incontinence, and the final results were satisfactory.

Management of frontoethmoidal (sincipital) encephalocele.

Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the frontal, orbital, and nasal regions. As the term implies, with frontoethmoidal encephaloceles, intracranial material has herniated through the dural and skull defect. In this report, 21 patients with frontoethmoidal encephalocele operated by a craniofacial team are presented, and accompanying anomalies, results, and complications are discussed.

Congenital infiltrating lipomatosis of the face.

Congenital infiltrating lipomatosis of the face is a rare clinical entity. Since it was first described by Slavin and colleagues in 1989, only a few cases have been reported in the literature. A 6-year-old girl with congenital infiltrating lipomatosis of the right side of the face is presented, and treatment modalities are discussed.

Intraorbital osteoma and surgical strategy.

The most common tumoral lesion of the bony orbital region is osteoma. It is an infrequent and benign tumor, and generally attacks the craniofacial skeleton, but intraorbital involvement is extremely rare. After necessary radiologic examinations (radiographs and computed tomography scanning), surgery should be planned according to the tumor's localization. In the case presented here, osteoma originated mainly from the medial orbital wall. Therefore, for better surgical exposure, extra- and intracranial approaches were planned and carried out. The mass was removed successfully. At the 3-year follow-up, no recurrence was shown.

Benign giant schwannoma located in the upper arm.

A 72-year-old-female presented with a giant schwannoma on the medial side of her right upper arm. Ultrasonographic and magnetic resonance imaging examinations showed that it was almost a totally cystic lesion. It was initially misdiagnosed as a hydatid cyst. After excision of the tumor, histopathological examination revealed that it was a schwannoma composed of two types of regions known as Antoni A and B regions. The tumor was 15 x 8 x 7 cm in size. There were no neurological sequelae after the operation. This is probably the biggest schwannoma of the upper extremity reported.

Comparison of fixation methods in treating mandibular fractures: scintigraphic evaluation.

The effects of rigid and nonrigid fixation methods in the treatment of long bones have been studied by many authors. A comparison of these two methods has been undertaken on long bones and documented in previous studies. However, there appears to be no such research on facial bone fractures. In this study a mandibular model was selected as an appropriate model for fracture site mobility in the face. Twenty-three patients with mandibular fractures were admitted to the study. Two groups were formed. The first group consisted of intermaxillary fixation patients and the second group was comprised of internal rigid fixation-treated patients. The callus deposit was evaluated by the technetium 99m methylene diphosphonate scintigraphic method on days 1, 10, 20, 30, and 40 postoperatively. The results of the study showed that the greatest level of callus formation is in the second exposure (days 1 to 10) for the first group and in the third exposure (days 10 to 20) for the second group. This study demonstrates that minimal motion on the fracture line after intermaxillary fixation increases local blood circulation and osteoblastic activity. The callus deposit reaches maximum in a short period of time with nonrigid fixation.

Late results of split-grafted penoscrotal avulsion injuries.

Penoscrotal avulsion injuries are rare surgical emergencies. The best treatment for penile avulsions is split skin graft, although late results of split-grafted scrotal avulsions are not superior. Scrotal skin avulsions require additional judgment for the treatment, because there are several available treatment options. Scrotal skin remnants must be used to cover whenever possible.