New Approach for Superthin Anterolateral Thigh Flap Elevation.

BACKGROUND: Anterolateral thigh (ALT) flaps are widely used for soft tissue reconstructions. They have several advantages, most notably a long pedicle, an appropriate pedicle caliber, low donor site morbidity, and the possibility of 2 teams working simultaneously. However, conventional, thick ALT flaps used for reconstructions of head and neck and lower extremity defects may cause postoperative range of motion limitations and cosmetic problems. The aim of this study was to develop and propose strategies to facilitate the harvest of superthin ALT flaps and minimize technical difficulties. This article provides step-by-step instructions for simple, quick, and reliable dissections of superthin ALT flaps. METHODS: This study retrospectively analyzed data from 60 free superthin ALT flaps used for soft tissue reconstructions in 56 patients between January 2018 and February 2019. Superthin flaps were elevated just above the superficial Scarpa's fascia using a vertical approach. RESULTS: Thirty-eight of the patients were operated on for lower extremity wounds, 16 were for head and neck defects, and 6 were for upper extremity wounds. The mean follow-up period was 7 months. The median hospital stay was 10 days. Total flap loss was observed in 4 cases (6.6%), and partial flap loss was observed in another 4 cases (6.6%). CONCLUSIONS: The superthin elevated ALT flap is a reliable and effective option for the reconstruction of soft tissue defects. In our vertical approach, the wide field of view of the flap perforator provides easy dissection, making it easier to elevate the superthin ALT flap.

The evaluation of the effect of free gracilis muscle transfer on cheek tone and oral competence in long-standing facial paralysis of patients by using Blasco index.

PURPOSE: Smile and eyelid reanimation are generally emphasized in facial reanimation, but the loss of cheek tone provided by the buccinator muscle is not adequately addressed. The use of free gracilis muscle flap for facial reanimation has become widespread since it was used in head and neck reconstruction by Harii et al. The effect of free gracilis muscle transfer on drooling is not clearly defined in the literature. In our study, we aimed to evaluate the effect of free gracilis muscle transfer on drooling in patients with facial paralysis (FP) by using Blasco index. Smile function was overemphasized in the literature, but drooling was not evaluated. What happens to drooling after free functional muscle transfer was not clear, so this study was designed to evaluate improvement in drooling. PATIENTS AND METHODS: Drooling and smile were evaluated in 11 patients (4 male, 7 female) who underwent facial reanimation with a free functional gracilis muscle transfer (FFGMT), in long-standing FP. The mean age was 39.9 years (range 22-56 years). Etiology was idiopathic in two patients, trauma in five patients, and intracranial tumor in four patients. Photographs and video recordings were taken preoperatively and at the first year postoperatively. The muscle was stitched to the upper lip, corner of the mouth, lower lip and the preauricular region. Masseteric nerve was preferred as donor nerve. Smile restoration was evaluated according to the five-stage classification defined by Terzis and Noah. RESULTS: Flap dimensions differed from 12 cm× 5 cm to 15 cm× 6 cm. Oral intake was stopped for 5 days, and speaking was restricted postoperatively. Patients exercised for about 1 h starting from the postoperative third month. Patients were followed up for an average of 26.5 (14-48) months postoperatively. Postop courses were uneventful, and we did not observe any complications in these patients. Preoperative Blasco index score was 3 in 6 patients, 2 in 5 patients and the mean scores were 2.54 ± 0.52. Patients were followed for 1 year. No drooling was observed in the postoperative first year. The Blasco index score was 0 for all patients. The decrease in postoperative scores was found to be statistically significant (p < .01). Smile restoration was evaluated according to the five-stage classification defined by Terzis and Noah for facial reanimation after muscle transfer. Excellent results (grade 5) were obtained in 6 patients, good results (grade 4) in 4 patients and moderate results (grade 3) in 1 patient. CONCLUSION: Free functional gracilis muscle transfer improves chewing functions and prevents drooling. This case series reveals that FFGMT can be a good option to enable cheek tone in long-standing FP of patients.

Total nasal reconstruction with pre-laminated, super-thin anterolateral thigh flap: A case report.

Many techniques for nasal reconstruction have been described to achieve aesthetically and functionally favorable results. Local tissues, specifically the forehead flap, provide the best tissue match with the nose. However, when local tissue donor sites are limited, alternative options such as free tissue transfers should be considered. Herein, we describe a case of a 72-year-old male patient who had a total nasal and left malar defect reconstructed with a two-staged, pre-laminated, super-thin anterolateral thigh (ALT) flap. The patient's nasectomy was performed 15 years ago. The adjacent left malar defect was due to recent squamous cell carcinoma excision. Local tissues were unavailable for reconstruction due to previous tumor excisions. For the 8.5 × 5 cm defect, a 12.5 × 8 cm ALT flap was planned, with 7.5 × 8 cm for nasal reconstruction and 5 × 4 cm for malar reconstruction. During the first stage, a super-thin fascial ALT flap was raised without dissecting the perforators, and the nasal skeleton was laminated between these two flaps. Costal cartilages were harvested for the nasal skeleton and positioned between the suprafascial and the fascial ALT flaps. During the second stage, two perforators were dissected to the pedicle on the pre-laminated flap, and the flap was divided from the donor site. The nasal skeleton was fixed and anastomosis with the facial vessels was established. After both stages, no complications were observed. After one month, a revision surgery was performed to enhance the transition between the reconstructed nose and the cheek, and improve the nasal projection. Postoperatively, after one year, the patient had a stable nasal reconstruction with good breathing. Prelaminated, super-thin ALT flaps provide the advantages of a wide and versatile donor site and an acceptable donor site scar. They may be an option for patients who are not amenable to traditional reconstruction methods.

Reconstruction of burn contractures with free anterolateral thigh flap in various anatomic sites.

BACKGROUND: Burn contractures that cause a restriction in extremity movements have to be reconstructed. Free microvascular flaps are generally needed in cases of severe contractures. The ideal free flap for severe contracture defects has to have a large skin island without bulk and a long pedicle for preventing recurrence and tension-free adaptation. Anterolateral thigh flap (ALT flap) that meets these features has widely been used for several indications in reconstructive surgery. Usage of ALT flap in burn contracture was described for burn and axillary contractures in literature. In this study, the usage of free ALT flaps in various anatomic contracture sites was reported. METHODS: Fifteen free ALT flaps were performed in 14 (12 male, two female) patients with a mean age of 36.6. Burn contracture defects in neck, axilla, popliteal, cubital region, plantar foot and hand were reconstructed with ALT flap. RESULTS: No total flap loss was encountered. Distal flap necrosis was seen in one case. All patients had significant improvement in a range of motions. Recurrence in contracture was seen in one patient with hand flexor contracture due to lack of physical treatment. CONCLUSION: ALT flap can safely be used in various anatomic contracture sites. Suprafascial elevation of the flap can be preferred for better adaptation in the neck, hand and foot and prevention of bulky appearance.

Effects of oxidative stress and apoptosis on vascularity and viability of perforator flaps.

We investigated lateral thoracic and posterior thigh perforator flaps for viability, vascularization, perfusion and apoptosis in a rat model. Wistar albino rats were divided into six groups: lateral thoracic artery perforator flap (LTPF) sham, 3 × 2 cm2 LTPF, 3 × 6 cm2 LTPF, posterior thigh perforator flap (PTPF) sham, 3 × 2 cm2 PTPF, and 3 × 6 cm2 PTPF. Flap viability was determined on postoperative days 1 and 7. On day 7, flaps were photographed and their viability was measured using two-dimensional planimeter paper. Tissue samples were harvested for examination by histology and immunohistochemistry. Viability differences were statistically significant. Epithelial thickness, vascularity and number of fibroblasts were reduced in the 3 × 6 cm2 groups. Neovascularization and apoptosis based on molecular tests were not significantly different among groups. Flap size and location are important factors for closure of surgical or traumatic defects. We suggest that for clinical application, wound complications will occur less frequently with perforators that nourish large areas of flaps.

Reconstruction of lower lip defects with free super-thin anterolateral thigh flap.

BACKGROUND: Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. PATIENTS AND METHODS: Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full-thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32-85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension. RESULTS: Overall flap survival was 100%. The flap size ranged from 8 × 6 cm to 14 × 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speaking and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance. CONCLUSION: Super-thin ALT flaps seem to be a useful option for functional and aesthetic reconstruction of extensive lip defects.

Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap Procedure for Lower Extremity Reconstruction.

When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.

An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip.

Microvascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.

Angular artery island flap for eyelid defect reconstruction.

Eyelid reconstruction is a challenging surgical procedure because of the special function and structure of the eyelids. There are various useful techniques which can be used to reconstruct eyelid defects. In this report, the authors aimed to present the clinical results of angular artery-based island flap for the repair of the full thickness eyelid defects. This presented series consists of eight patients with full-thickness eyelid defects. Oncologic resection was the reason for all of them. Five of the patients had lower eyelid defects and the other three had upper eyelid defects. Nasojugal angular artery-based axial flap was used in reconstruction in all patients. The inferior limit of the flap was the alar rim level in order to make the flap totally axial. A tunnel was created under the orbicularis oculi muscle in cases where the medial portion of the eyelids was left intact and healthy. Septal chondromucosal graft was used to repair posterior lamella of the eyelid. The follow-up period of the cases was from 12 months to 22 months, with a mean follow-up period of 16 months. There was only one patient with reconstructed upper eyelid needed flap defatting. There was no ectropion or wound healing problem observed during the follow-up period. This presented series shows that angular artery-based axial flap and septal chondromucosal graft combination is a simple and safe technique for both upper and lower eyelid full-thickness defect reconstruction. The donor site of this flap heals with an inconspicuous scar concealed in the nasojugal area.

Anterolateral Thigh Flap Design by Using Suprafascial Course of the Perforator.

OBJECTIVES: Recently, anterolateral thigh flap has become one of the most commonly used free flaps in reconstructive surgery. Although its pedicle has relatively sufficient length, it falls short in some circumstances. Eccentric perforator location can be used to lengthen the pedicle, but flap tip viability can be a problem in this case. In addition, partial flap loss can be encountered in perforator flaps. The aim of this study was the use of multidetector computed tomographic angiography in preoperative mapping to overcome these problems. MATERIALS AND METHODS: Anterolateral thigh perforator flap was planned for various soft-tissue reconstructions in 19 patients. There were 15 males and 4 female patients with ages ranging from 19 to 65 years. These patients were evaluated with preoperative multidetector computed tomographic angiography to choose and to trace the course of the perforators. Flaps were designed according to the suprafascial course of the perforators. Perforators were safely located eccentrically when needed. Pedicle length and complications, such as infection, wound dehiscence, and partial or total flap loss, were recorded. RESULTS: Perforators were located eccentrically in 8 patients and centrally in the other 11 patients. Eleven flaps were used in lower leg reconstruction, 2 flaps in popliteal region, and 6 flaps in head and neck. All flaps survived and any partial or total loss did not occur. There was not any infection and wound problem. CONCLUSIONS: Multidetector computed tomographic angiography can reveal the suprafascial course of the perforator and help design anterolateral thigh perforator flap. By using this kind of mapping, perforators can be safely located eccentrically to lengthen the pedicle and partial flap loss can be prevented.

Increasing topical anesthetic efficacy with microneedle application.

INTRODUCTION: Since topical anesthetics alone seldom provide adequate analgesia for laser resurfacing procedures, injectable forms of anesthesia are often required. However, their application is uncomfortable for the patient. In this study, it is investigated whether microneedle application would enhance the efficacy of topical anesthetics. METHODS: Forty-seven patients participated in the study. Topical anesthetic agent EMLA was applied to the whole face of the patients. Microneedle treatment was applied to one side of the face with a roller-type device. Whole-face carbon dioxide laser resurfacing therapy was carried out then. The pain that patients experienced was assessed by using visual analog scale (VAS) method. VAS scores of two sides of the face were compared by using Wilcoxon signed-rank test. RESULTS: The mean of VAS score of the microneedle treated side was 2.1 ± 1.1 while that of the untreated side was 5.9 ± 0.9 and this difference was statistically significant (Wilcoxon signed-rank test, the Z-value is - 5.9683 and the p-value is < 0.001). SUMMARY: This study revealed that microneedle application, with a roller-type device, is a safe and easy procedure in providing sufficient anesthesia for facial laser resurfacing without the need for supplementary nerve blocks or injections.

Effect of Reduction Mammaplasty on Sexual Activity.

AIM: This study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. MATERIALS AND METHODS: Thirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls' scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. RESULTS: The mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). CONCLUSIONS: We found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners' erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.

Assessment of sexual function in women with macromastia and their partners / / Evaluación de la función sexual en mujeres con macromastia y sus parejas

Objective. To investigate the sexual function in patients with macromastia and their partners. Materials and methods. 48 patients with macromastia and 30 healthy controls and their partners were enrolled in the study. The sexual function of the women and their partners was evaluated by using the Index of Female Sexual Function (IFSF) and International Index of Erectile Function (IIEF), respectively. Results. Mean ages of the patients and controls were respectively, 33.27 ± 5.24 and 32.06 ± 3.91 (p > 0.05). Mean IFSF scores of the patients and controls were 23.21 ± 3.16 and 27.33 ± 4.94 (p = 0.00), respectively. All of the subscale scores of IFSF in the patient group were significantly lower than in the control group. Mean IIEF scores of the patients’ and controls’ partners were 60.33 ± 11.46 and 65.25 ± 6.18 (p = 0.04), respectively. Conclusion. In this study, Macromastia was shown to affect sexual function of women and their partners adversely (AU)

Objetivo. Investigar la función sexual en pacientes con macromastia y en sus parejas. Material y método. 48 pacientes con macromastia y 30 controles sanos y sus parejas fueron inscritos en el estudio. La función sexual de las mujeres y sus parejas fueron evaluadas usando el Índice de Función Sexual Femenina (IFSF) y el Índice Internacional de Función Eréctil (IIEF), respectivamente. Resultados. La edad media de los pacientes y controles era de respectivamente 33,27 ± 5,24 y 32,06 ± 3,91 (p > 0,05). Las puntuaciones medias de los pacientes y los controles eran de respectivamente 23,21 ± 3,16 y 27,33 ± 4,94 (p = 0,00). Todas las puntuaciones en subescalas de IFSF en el grupo de los pacientes eran significativamente más bajas con respecto al grupo de control. La media de las puntuaciones del IIEF en las parejas de los pacientes y de los controles eran de respectivamente 60,33 ± 11,46 y 65,25 ± 6,18 (p = 0,04). Conclusiones. En este estudio, se demostró que la macromastia afecta la función sexual de las mujeres y sus parejas negativamente (AU)

Basosquamous carcinoma: is it an aggressive tumor?

Basosquamous carcinoma is a rare cutaneous tumour that is considered an aggressive type of basal cell carcinoma with an increased risk of recurrence and metastases. This impression has been perpetuated in the literature, despite limited scientific data and conflicting results of some authors. This present study was aimed to evaluate the clinical-pathological features of this tumour and follow-up of a series of basosquamous carcinoma. Basosquamous carcinoma patients who underwent surgical excision between January 2000 and February 2012 were analyzed retrospectively. Their medical files were reviewed and the corresponding routinely stained sections (with hematoxylin-eosin) were re-evaluated by two pathologists. Thirty-five patients with basosquamous carcinoma were operated on in this period. Most tumurs were located in the head and neck area (94%), and the mean age of the patients was 69.8 years. Margin involvements were seen in 11 patients (31.4%) and all of them underwent re-excision. There was only one local recurrence. There was neither regional lymph node nor distant metastasis in this series. The recurrence rate of basosquamous carcinoma is found as 4%, lower than that of most other similar studies. Further pathologic studies are needed to better classify basosquamous carcinoma and to increase consistency between the results of studies. Surgical excision and regular follow-up are considered as the treatment of choice.

Patient-reported quality-of-life outcomes of breast reduction evaluated with generic questionnaires and the breast reduction assessed severity scale.

BACKGROUND: The effects of breast reduction on quality of life (QOL) have been evaluated in patients with macromastia, but few investigators have performed condition-specific assessments. OBJECTIVES: The authors employed generic and condition-specific questionnaires to examine the QOL of patients with macromastia and determined the responsiveness of the Turkish version of Breast Reduction Assessed Severity Scale (BRASS). METHODS: This prospective cohort study included patients with breast hypertrophy who underwent breast reduction (n = 94). Patients completed the Turkish versions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the BRASS, and the Rosenberg Self-Esteem Scale preoperatively and 4 months postoperatively. Differences in responses were evaluated by paired t-test and by comparing change effect sizes. Multiple regression analyses were performed to evaluate improvements in QOL in response to adjustments in baseline differences across patients. RESULTS: Preoperative and postoperative questionnaires were completed by 78 patients (83%). Significant postoperative improvements in self-esteem (Rosenberg Self-Esteem Scale; P < .001) and in all domains of the BRASS (P < .001) were noted. Mean preoperative scores for 5 of 8 domains in the SF-36 were lower than those of a normative population. Postoperatively, all 5 mean scores improved significantly, but the score for bodily pain remained less than that of a normative population. CONCLUSIONS: The results of this study indicate significant improvements in health-related QOL at 4 months after breast reduction in a population of patients with macromastia. The authors also demonstrate excellent responsiveness of the BRASS.

Effects of breast reduction on pulmonary function.

Macromastia causes several health problems, and reduction surgery alleviates them successfully. The purpose of this study was to investigate whether reduction mammaplasty improves possible impairments on pulmonary functions related to macromastia. Thirty-one patients participated in the study. Pulmonary function tests were performed before and 3 months after surgery with a spirometry. Preoperative and postoperative pulmonary function values were compared using a paired t test. Two patients were found to have mild restriction in preoperative spirometric analysis, and they went to normal range in postoperative analysis. All other patients were assessed as having normal values in both preoperative and postoperative analyses. Preoperative and postoperative forced vital capacity values were 2.72±0.06 and 2.79±0.05 L, respectively. The difference was statistically significant (paired t test, P=0.014). The other parameter in which breast reduction had statistically significant improvement was forced vital capacity performed/predicted ratio (paired t test, P=0.041). Additionally, the weight of resected breast tissue correlated significantly with the change of forced vital capacity (Pearson correlation coefficient=0.379, P=0.036). Breast reduction surgery improves the pulmonary function parameters that are mainly influenced by restrictive states. This result led us to consider that macromastia causes a relative restriction in chest wall compliance, and reduction of breast weight may enhance chest wall compliance and improve pulmonary function.

Prediction of resection weight in reduction mammaplasty based on anthropometric measurements.

BACKGROUND: The aim of this study was to develop a simple, clinically useful method to accurately predict resection weight in women undergoing reduction mammaplasty. PATIENTS AND METHODS: 39 women undergoing breast reduction participated in the study. Sternal notch to nipple distance, nipple to inframammary fold distance (NIMF), medial end point to nipple distance (MN), lateral endpoint to nipple distance (LN), superior border of the breast to nipple distance (SN), breast circumference (BC), and chest circumference (CC) were measured. 5 other predicting variables were also derived; horizontal breast measurement (H) by adding MN to LN, vertical breast measurement (V) by adding NIMF to SN, the product of H and V (H*V), the product of H and NIMF (H*NIMF), and the difference between BC and CC (D). Regression analysis was used to compose a formula for predicting resection weight. RESULTS: Among the predicting variables, H*NIMF measurements had the highest correlation coefficient value (Pearson correlation = 0.809) with the resection weight. The following formula was obtained with regression analysis: Predicted resection weight = (1.45 × H*NIMF) + (31.5 × D) - 576. CONCLUSION: Breast resection weights can be accurately predicted by the presented method based on anthropomorphic measurements.

A cost-effective method for obtaining standard platelet-rich plasma.

INTRODUCTION: Platelet-rich plasma (PRP) is used in several different areas of surgery to enhance natural healing and the regenerative process by delivering increased concentrations of autologous platelets. However, there are controversies in the literature regarding the potential benefits of PRP, due partly to the lack of optimized and standardized preparation protocols. The aim of this study was to develop a standardized PRP preparation protocol. MATERIAL AND METHODS: Whole blood was drawn from 18 healthy participants. Double centrifugation protocol was applied. The blood from each person was divided into 6 tubes according to second stage centrifugation force applied, varying from 300 g to 2000 g. Platelet counts and platelet concentration factors were determined and the data obtained were submitted to statistical analysis (repeated measures ANOVA, Bonferroni, P < 0.05). RESULTS: When compared to whole blood, the mean platelet counts increased significantly in all centrifugation groups, and this increase is common with centrifugation force increase. While there was no significant difference between the 300 g and 500 g groups (P = 0.051), there were differences between the 500 g and 750 g groups (P < 0.001), and the 750 g and 1000 g groups (P < 0.001). The mean platelet counts were not different between upper g groups (1000g, 1500g, 2000g, P = 0.114). The platelet concentration factor varied from 1.92-fold to 3.76-fold. There were differences between the 500 g and 750 g groups (P < 0.001), and between the 750 g and 1000 g groups (P < 0.001). CONCLUSION: The present study indicates it may be possible to get a standard platelet concentration by adjusting centrifugation force individually according to each baseline value.

Histopathologic findings in breast reduction specimens.

Reduction mammaplasty is a commonly performed operation for treatment of breast hypertrophy. It allows examination of specimens from a seemingly healthy population. Although there are many publications reporting the incidence of occult breast carcinomas, only a few studies have specifically examined the incidence of other breast lesions in reduction mammaplasty specimens. The authors conducted a single-centre retrospective chart review examining the incidence of benign and precancerous lesions in breast reduction specimens. Both age and the number of tissue sections were evaluated for the association with important pathologic findings. Of the 95 patients who underwent reduction mammaplasty, eight patients (8.4%) had atypical lesions. Fourteen patients (15%) had proliferative and 54 patients (57%) had non-proliferative breast lesions. No occult invasive breast cancer was identified in the breast reduction specimens. The existence of significant pathologic findings was not associated with age (p = 0.231, student t-test). On the other hand, it was found to be associated with the number of tissue sections (p = 0.046, Mann-Whitney U-test). This study reveals that breast reduction specimens should be analyzed histologically since a considerable amount of patients have breast lesions with increased cancer risk. Therefore, this analysis would guide the management of these patients in the follow-up period.

Validation of the Turkish version of the Breast Reduction Assessed Severity Scale.

BACKGROUND: Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. There is no validated questionnaire in Turkish to evaluate quality-of-life issues for patients with mammary hypertrophy. OBJECTIVES: The authors describe the reliability and validity of a translated Breast Reduction Assessed Severity Scale (BRASS) in evaluating Turkish patients. METHODS: The BRASS, developed by Sigurdson et al, was translated into Turkish adhering strictly to the guidelines of questionnaire translations. Statistical analysis was carried out with Cronbach's α to test the internal consistency and intraclass correlation coefficient for test-retest reliability. Exploratory factor analysis was carried out using principal component analysis with oblimin rotation to test its construct validity. Correlations between subscales identified in the factor analysis and corresponding domains in the Short Form-36 and Rosenberg Self-Esteem Scale were analyzed. RESULTS: The total instrument was found to have an α coefficient of 0.92 and subscale α coefficients ranging from 0.76 to 0.87. Intraclass correlation coefficient was 0.93 for the total scale and ranged from 0.81 to 0.91 for the subscales. Exploratory factor analysis resulted in a 5-factor structure: physical implications, body pain, physical appearance, poor self-concept, and negative social interactions. CONCLUSIONS: With this study, the reliability and validity of the Turkish version of the BRASS were revealed. This translated version can be used to evaluate the effect of mammary hypertrophy on quality of life in Turkish patients.