Effects of repetitive injections of hyaluronic acid on peritendinous adhesions after flexor tendon repair: a preliminary randomized, placebo-controlled clinical trial.

BACKGROUND: The aim of this study was to investigate the efficacy of three injections of hyaluronic acid (HA) versus placebo (saline) over a two-week period on functional outcomes after zone-II flexor tendon repairs. METHODS: Twenty-two patients with isolated zone-II flexor tendon injury of the index fingers were included in this study. Before tenorrhaphy, fingers were randomly divided into two groups; 11 were treated with three injections of HA around the tenorrhaphy site and 11 served as a placebo group and were treated with saline in the same way. The first dose was given at the time of tenorrhaphy and two additional doses were given at one-week intervals. A Kleinert rehabilitation protocol was employed postoperatively. Range of motion was assessed with total active and passive movement evaluation systems at 3 weeks, 3 months and long-term. Functional outcome was evaluated using the Strickland classification. RESULTS: There were no differences between the two groups in terms of range of motion at 3 weeks. However, at 3 months and long-term, a significant improvement was observed in fingers treated with HA compared to placebo. CONCLUSION: This preliminary placebo-controlled study suggests that repetitive injections of HA can improve clinical outcomes presumably due to the effect on decreasing adhesions in primary tendon repairs.

Preventing Flap Necrosis With Adrenomedullin and Glucagon-like Peptide-1.

UNLABELLED:  Many factors are known to play a role in flap necrosis, such as inadequate blood flow and disturbed venous drainage, which lead to decreased flap nutrition and necrosis. The aim of this study was to determine whether adrenomedullin (ADM) and glucagon-like Peptide-1 (GLP-1) administered at various doses directly to the superficial inferior epigastric artery (SIEA) had an effect on the normal healing process of flap tissue. METHODS: Under 3% isoflurane anesthesia, the rats were put in the dorsal decubitus position before the surgery. A cutaneous flap 8 cm x 3 cm in size was marked on the abdominal wall, divided into four equal sections, and marked from 1 to 4 (proximal to distal). A laser Doppler flowmeter was used to measure the blood supply of each area in the flap tissue. On the seventh postoperative day, an image of the final condition of the flap was obtained with a 5-megapixel camera; the rats were sacrificed afterward. RESULTS: Groups treated with ADM or GLP-1 showed a statistically significant increase in the blood flow of the four separate regions compared to the saline group. The percent necrosis area decreased in a statistically significant manner in the groups treated with ADM and GLP-I. CONCLUSION: The authors believe that both peptides play an important role in the normal flap recovery process. .

Isolated lower lip fistulas in Van der Woude syndrome.

Van der Woude syndrome (VWS) is a dominantly inherited disease of orofacial region. Characteristic features of this syndrome are bilateral lower lip sinuses along with cleft lip or palate deformity. However, isolated lower lip pits in VWS without any cleft syndrome is uncommon. Lip pits in VWS are usually asymptomatic; however, patients may complain of watery drainage and/or infection. In this report, asymptomatic isolated lower lip sinuses without any cleft syndrome in a patient and his father are presented.

Facial asymmetry in young healthy subjects evaluated by statistical shape analysis.

Statistical shape analysis, a relatively a new method for biological research, compares body forms by using specific landmarks determined by anatomical prominences. In this study, we aimed to identify normal facial asymmetry between the right and the left sides of the face. Facial landmark data were collected from two-dimensional digital images of 321 young healthy subjects (150 males and 171 females). These data were analysed using Euclidean distance matrix analysis. The number of significantly asymmetric linear distances between the two halves of the face was greater in females than in males. We found that the left side of the face was most commonly dominant in both males and females. Such data may be useful in establishing a database for future similar studies.

Nasal shapes and related differences in nostril forms: a morphometric analysis in young adults.

Being aware of the morphologic differences in the nasal anatomy between men and women during the cosmetic rhinoplasty is essential because feminization of a male nose is not a very rare complication. Although there is no difference in the techniques of male and female rhinoplasty, the anthropometric differences have to be considered. This morphometric study evaluated the nasal shapes in both sexes and the related differences in the nostril forms. The nostril forms were separated into 4 main groups such as teardrop, heart shaped, round, and triangular. In this landmark-based morphometric study, significant relations of nostril forms to the nasal shape, frontonasal, and nasolabial angles were found. The results of this study should make us think about these relations of nostril forms to the nasal shapes and should be a basement for further clinical studies enhancing the plans of the corrective surgery.

Statistical shape analysis of nose in Turkish young adults.

There are several anthropometric studies regarding the nose, however none of them involves data about a statistical shape analysis. In this study, a landmark-based geometric morphometric technique was used to analyze the nasal shapes in a young Turkish adult population.A population of 75 female and 75 male volunteer Turkish young adults whose ages ranged 18-39 years (24.82 +/- 5.64 year) was examined. The stratified sampling method was used to determine the subjects according to the seven main geographic regions of Turkey. All data was obtained from standardized digital photographic images taken from anterior, lateral and inferior aspects by using standard anthropometric measurement methods. Euclidean Distance Matrix Analysis (EDMA) is used to calculate all possible linear distances among landmarks by creating matrixes for each subject.Today, the anthropometric methods and surgical practice intersected at a point to treat the congenital or post-traumatic facial disfigurements in various racial or ethnic groups. Rhinoplasty surgeons require access to facial databases based on accurate anthropometric measurements to perform optimum correction in both sexes. There should be some points brought to mind during the cosmetic nasal surgery for men because of different expectations, which is not technically different from the one for women. This study is a way to clarify these important points and a basis for further clinical studies enhancing the plans of the corrective surgery.

Negative pressure wound therapy on diabetic foot ulcer.

The effects of negative pressure wound therapy ([NPWT], V.A.C.® Therapy, KCI, San Antonio, Tex) were compared with standard dressings in 45 patients with diabetic foot ulcers who were admitted to the Department of Plastic and Reconstructive Surgery, Medical Park Hospital, Bursa, Turkey. Twenty-four patients were randomly divided into 2 groups-NPWT group and control group. Initially, the mean surface area of wounds in the NPWT group was 109 cm2, the control group 94.8 cm2. The mean duration of open wound care was 11.25 days in the NPWT group and 15.75 days in the control group (P = 0.05). After wound management, mean surface area of the diabetic wounds was 88.6 cm2 in the NPWT group, and 85.3 cm2 in the control group (P < 0.05). The use of NPWT may be an effective initial wound therapy to achieve faster wound bed granulation in diabetic foot ulcers. Further studies are needed to clarify the effects and indications and to modify the technique of this alternative treatment for use on nonhealing wounds.

Milking technique for reimplanted digits with insufficient venous drainage.

The most common problem after finger replantation is congestion because of insufficient venous drainage. A simple method--milking technique--is described as an additional method for the treatment of venous congestion.

The effect of delayed admission in burn centers on wound contamination and infection rates.

BACKGROUND: Since wound infection rates in patients with delayed admission seemed to be significantly higher, a retrospective study of bacteriology in 320 burn patients, over a 5-year period was carried out in order to analyze the relation between delayed admission and wound infection rates in our Burn unit of Uludag University, Faculty of Medicine. METHODS: The patients were separated into moderate or major burn groups according to burn severity. Wound infection and contamination frequencies were analyzed according to time-delay between burn injury and hospitalization time. RESULTS: Delayed admission was found to be an important factor that causes an increase in wound infection and contamination frequency. This increase was significant especially among patients with moderate burn wounds. In patients with severe burns, wound infection and contamination frequencies were found to be higher for all admission time points. CONCLUSION: Systemic antibiotic prophylaxis should be discussed in patients with moderate burns whose admission-delay is more than 78 hours. Wound infection and contamination rates were high in patients with major burns independent of the admission time. Therefore, systemic antibiotic prophylaxis should also be discussed in this group of patients, although it results in elimination of the normal skin flora.