Blunt Trauma Induced Closed Femoral Bone Fracture in a Rat Model: Are Vessels Safe to Use for Microsurgery? Further Insight into the Zone of Injury Concept.

BACKGROUND: The study aims to investigate the zone of injury for major vessels after high-velocity traumas, as it is unclear whether avoiding vascular structures is necessary during microvascular anastomosis or how long it takes for them to be used again. METHODS: This study uses Doppler ultrasonography and a rat model to evaluate the histopathological changes and flow velocity of major vessels in the zone of injury after high-velocity trauma with closed femoral bone fracture. Osteosynthesis was performed using an intramedullary wire. Samples were collected from day 3 and week 3. The unaffected contralateral side is used as control. RESULTS: Results from arterial and venous flow assessments showed no evidence of ischemia in the extremities. Both arteries and veins were patent in both intervals and on the control side. The evaluation of the vessels showed arterial injury with a slightly reduced arterial flow on day 3 and week 3. The venous flow was slightly reduced on day 3 but not on week 3. Statistically, arterial endothelial injury was higher on day 3 than on week 3 (p = 0.006). Media inflammation was also higher on day 3 (p = 0.06). Arterial endothelization distribution was higher in week 3 (p = 0.006). No significant differences were found in arterial media irregularity, necrosis, platelet aggregation, bleeding, and wall rupture. Venous samples showed no significant differences in any parameter (p < 0.05). CONCLUSION: High-velocity trauma increases the risk of thrombosis in vessels. Intravascular repair can start on day 2 and continue till week 3 with significant endothelization. Although physiologic findings do not alter arterial or venous flow, histologic findings support vessel injuries leading to potential complications. Microsurgery should be considered out of the injury zone until adequate vessel healing is achieved.

A New Convenient Incision Model of the Nipple-Sparing Mastectomy: Lateralized Parabolic Multiplanar Incision.

BACKGROUND: In this study, a lateralized parabolic multiplanar incision was defined. It was aimed to reduce necrosis in the nipple-areola complex (NAC) and, in the long run, to prevent the scar from pulling the areola laterally by maintaining healthy skin tissue between the scar and the areola and preserving the natural round appearance of the areola. Moreover, we purposed the scar not to be visible from the anterior view. METHODS: The study included 243 patients who underwent nipple-sparing mastectomy and immediate implant-based breast reconstruction. The incision was made 4-5 cm away from the lateral border of the NAC. The incision was completed after passing the anterior axillary line by drawing a parabolic curve in superolateral axis. RESULTS: The mean follow-up period was 24.6 months, and the mean age of the patients was 42.3 years. Full-thickness necrosis of the NAC occurred in 3.6% of breasts. In long-term follow-ups, the incision scar measured an average length of 8.6 cm. None of the patients had lateral displacement of the NAC. The NAC preserved its round appearance, except for 12 breasts that had full-thickness NAC necrosis. Ten breasts had an unnatural breast appearance. CONCLUSION: The lateralized parabolic multiplanar incision is an ideal incision model for nipple-sparing mastectomy, as it allows for the exposure and reconstruction of all breast quadrants. We maintain areolar circulation; there are no visible scars when viewed anteriorly. Furthermore, it prevents lateral displacement of the NAC, ensuring that the natural round form of the NAC is not distorted. 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 .

Expanding Usage of Superior Pedicled Techniques with Reducing Resistance in the Pedicle by Lipoaspiration.

BACKGROUND: Despite the advantages of the superior pedicles in breast reduction, there are some limitations with this technique. The mobility of the pedicle may be augmented by liposuction in the pedicle area which may relieve tissue resistance and decrease pedicle compression in order to overcome circulation problems. In fact, the indications of breast reduction using superior pedicles may be expanded by liposuction in the pedicle area. METHODS: The patients who underwent breast reduction with superior pedicle techniques between March 2014 and November 2020 and whose pedicle resistances were decreased by liposuction were included in this study. Internal breast morphology was classified into three groups based on the morphology of the periareolar tissues. Group 1 breasts were lipomatous, Group 2 breasts were lipo-glandular and Group 3 breasts were fibroglandular. During the short-term follow-up, the circulation of the nipple-areola complex (NAC) was evaluated both clinically and with an hand held Doppler device. The long-term aesthetic results were evaluated at the postoperative twelfth month with a visual analogue scale. RESULTS: One hundred eighty-nine patients with either Group 1 or Group 2 breasts were included in this study. The mean age of the patients was 38.3 years. The mean follow-up period was 31.7 months. Neither partial nor total NAC loss was observed and none of the patients had bottoming-out deformity. CONCLUSION: Liposuction to the pedicle area is an effective and reliable method that both reduces the resistance in the pedicle and overcomes the circulation problems in certain patient groups (groups 1 and 2), increases the mobilization of the pedicle, reduces the breast to the desired size and prevents bottoming-out in the long term and increases the use of superior pedicle techniques. According to our clinical results, it was demonstrated that pedicle vascular mapping with preoperative Doppler sonography was not necessary in these patients. 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 .

Reduction of the scar burden at the donor area of the radial forearm flap with the aid of an endoscopic pedicle preparation.

BACKGROUND: The radial forearm flap is one of the most commonly used flaps of reconstructive microsurgery with its long pedicle and thin structure. The donor site at the forearm is a visible anatomic region that has high mobility and functional importance. In this study, a longitudinal and large scar was avoided on the forearm during pedicle dissection of the conventional radial forearm flap with the utilization of an endoscope. Furthermore, arterial, venous, and nervous injuries were avoided by performing a separate inci-sion of 2-3 cm at the cubital fossa to reduce flap failure and donor site morbidity. METHODS: The patients who underwent pedicle dissection of the radial forearm flap with the aid of an endoscope for head-neck reconstruction between 2014 and 2021 were included in this study. The flap was harvested from the subfascial plane. The cephalic vein was used in all of the patients. When the pedicle dissection reached the antecubital region, an incision of 2-3 cm was performed from the skin. Two vein anastomoses were performed for each patient. RESULTS: This retrospective study consists of 51 patients. While 45 of the patients were the result of head and neck cancer, six of them had a defect caused by trauma. The average area of skin islands was 40.3 cm2, while the full-thickness skin graft size was 24.2 cm2. An average of 2.6 cm of scar tissue was formed at the antecubital region. No venous or arterial compromise was observed in the post-operative period. There was no partial or total flap loss in any patient. Localized numbness persisted in the skin area where the superficial sensory branch of the radial nerve is located in 6 (11.7%) patients. CONCLUSION: With endoscopic radial forearm flap harvesting, the longitudinal incision in the forearm and wound healing prob-lems are avoided. The absence of partial or total flap loss has shown that endoscopic harvesting of the radial forearm flap is a safe and reliable method.

Implant selection in natural and stable direct-to-implant reconstruction with ten steps at nipple-sparing mastectomy.

Direct-to-implant reconstruction is one of the breast repair techniques after mastectomy. Implant selection is critical in the short- and long-term success of direct-to-implant reconstruction after nipple-sparing mastectomy. In this study we developed a 10-step algorithm that we use before and during surgery. We aimed to obtain natural and stable breast reconstruction with this algorithm. In addition, we also aimed to evaluate which implants were selected using this algorithm and their short- and long-term outcomes. This retrospective study included 218 patients aged 27 to 60 years who underwent mastectomy and direct-to-implant reconstruction between November 2018 and December 2021. The patients were assigned into 4 groups according to amount of breast tissue removed. We developed a 10-step algorithm and these included: breast base, amount of breast tissue removed, evaluation of mastectomy skin flap, breast projection, ptosis, unilateral/bilateral reconstruction, chest wall deformity, patient's request, comorbid conditions and stabilization and arrangement of novel sulcus. The evaluation was made when the patient's photographs were taken at least 1 year after the surgery. The highest number of patients was recorded in group 3; in addition, mean age was also highest in group 3. The lowest number of patients was recorded in group 4. The body mass index showed a progressive increase from group 1 to group 4. Medium height moderate profile prosthesis was used in 81.7% while medium height moderate plus profile prosthesis was used in 18.3% of breasts included. We used larger prosthesis up to 58.1% when compared to the tissue removed in group 1 while we used smaller prosthesis by 25.6% in group 4. In the anterior view, the medial and lateral arch of the lower pole of the breast was obtained in all patients. Obvious asymmetry developed in 4 patients. In lateral and oblique views, upper and lower pole natural breast images were obtained in all patients, except for 5 patients. There was no sulcus inferior displacement in any patient. Implant extrusion did not occur in any patient. This algorithm is an easy to use and effective method to obtain a stable and natural breast image in the long-term.

Optimal treatment of zygomatic fractures: a single-center study results.

OBJECTIVES: This study aims to investigate the epidemiological and operative characteristics of patients undergoing surgery for zygomatic fractures. PATIENTS AND METHODS: Between May 2008 and October 2013, a total of 121 patients (98 males, 23 females; mean age 27 years; range, 9 to 63 years) who were operated for zygomatic fractures in our clinic were retrospectively analyzed. Age and sex of the patients, symptoms, fracture and incision sites, length of hospital stay, plate type, treatment options, and complications were recorded. RESULTS: Assault was the leading cause of trauma (39%), followed by traffic accidents (24%). The most common symptom or clinical sign was the periorbital ecchymosis/hematoma. Conservative treatment was applied in 14 patients (12%). Surgery was performed with a closed reduction in 17 patients (14%) and open reduction in 90 patients (74%). The most common fracture site was the infraorbital rim in 76 patients (62.8%). A total of 48% patients had three-site, 35% had two-site and 12% had one-site of fixations. The major material used for the orbital floor reconstruction was porous polyethylene in 43.7% patients. CONCLUSION: Our study results show that surgery is required in the majority of the patients with zygomatic fractures. However, further large studies are required to determine many parameters such as incision sites, plate locations, and the material to be used in orbital floor reconstruction.

Evaluation of the Retro-Orbital Fatty Tissue Volume in Delayed Orbital Blow-Out Fractures.

PURPOSE: In patients where diplopia and enophthalmia are manifest, surgical intervention is usually necessary. The pathogenesis of these symptoms usually includes the prolapse of orbital tissues into the sinus or compression by the surrounding bone structures. Although the retro-orbital fatty tissue, orbital fascia, and the muscle tissue can be reduced to the original place after being incarcerated into the maxillary space, it is obvious that the procedure can lead to significant fibrosis in these structures. The authors have aimed to carry out a quantitative evaluation of the fatty tissue volumes in patients with repair delayed for more than two weeks. METHODS: The preoperative and postoperative fatty tissue volumes and the changes in total orbital volume were evaluated by using CT on the patients (n = 9) who were consulted to the authors' clinic from other health centers. RESULTS: Although no significant correlation was observed between the prolapsed volume and the postoperative reduction in the fatty tissue, the reduction in the retro-orbital fatty tissue was statistically significant. CONCLUSION: Evaluating postoperative retro-orbital fatty tissue volumes may have implications for surgical intervention in the future.

Comparison of somatotype values of football players in two professional league football teams according to the positions.

This study compared the somatotype values of football players according to their playing positions. The study aimed to determine the physical profiles of players and to analyze the relationships between somatotypes and playing positions. Study participants were members of two teams in the Turkey Professional Football League, Gençlerbirligi Sports Team (GB) (N = 24) and Gençlerbirligi Oftas Sports Team (GBO) (N = 24). Anthropometric measurements of the players were performed according to techniques suggested by the Anthropometric Standardization Reference Manual (ASRM) and International Biological Program (IBP). In somatotype calculations, triceps, subscapular, supraspinale and calf skinfold thickness, humerus bicondylar, femur bicondylar, biceps circumference, calf circumference and body weight and height were used. Statistical analysis of the data was performed using the Graph Pad prism Version 5.00 for Windows (Graph Pad Software, San Diego California USA); somatotype calculations and analyses used the Somatotype 1.1 program and graphical representations of the results were produced. Analysis of non-parametric (two independent samples) Mann-Whitney U Test of the player data showed that there were no statistically significant differences between the two teams. The measurements indicated that, when all of the GB and GBO players were evaluated collectively, their average somatotypes were balanced mesomorph. The somatotypes of GBO goalkeepers were generally ectomorphic mesomorph; GB goalkeepers were balanced mesomorphic, although they were slightly endomorphic.

Secular changes in the height of the inhabitants of Anatolia (Turkey) from the 10th millennium B.C. to the 20th century A.D.

We use human-skeleton samples to estimate the height of adults living in Anatolia during the Neolithic period. We also report the results of surveys taken in the 20th century on the height of the Turkish population. Neolithic and the Chalcolithic (5000-3000 B.C.) male heights are estimated as 170.9 cm and 165.0 cm, respectively. Pronounced increases were observed for both sexes between the Chalcolithic and Iron (1000-580 B.C.) periods and sharp decreases among both males and females in the Hellenistic-Roman period (333 B.C. to 395 A.D.). Moreover, recovery to the Iron Age levels was achieved in the Anatolian Medieval period (395-1453 A.D.) for both sexes (169.4 cm for males and 158.0 cm for females). In 1884 the mean height of men was 162.2 cm and by the beginning of the 1930s it increased to 166.3 cm. In the first nationwide survey in 1937 males mean height was 165.3 cm, and females was 152.3 cm, where today current heights are 174.0 cm and 158.9 cm, respectively.

Prevalence of overweight and obesity in Turkish adults.

The aims of this study were to assess the prevalence and patterns of adult overweight and obesity in Turkey and discuss the impact of socio-environmental factors. A cross-sectional nationwide survey was carried out on 2100 adults (1050 males and 1050 females) aged 18 to 65 years from 7 geographic regions of Turkey. Data on height and weight were measured according to the Anthropometric Standardization Reference Manual and a questionnaire was applied to access the socio-economic status. The body mass index (BMI) (kg/m2), overweight and obesity were calculated, and percentiles were developed by LMS method. Mean BMI was 26.24 for males and 28.02 for females. Results showed that obesity was more pronounced among females (34.19%) than among males (20%). Logistic regression analysis revealed that older age and education level among females, and older age and occupational status among males have impact on obesity. Comparison of the present results with former nationwide studies conducted in Turkey showed that height and weight for both sexes have increased with the improved socio-economic conditions. In addition, increased weight and BMI needed to be monitored particularly for females in terms of acute health problems.

Evaluation of the gonial angle in the Anatolian populations: from past to present.

Biometrical studies on ancient skeletal series and comparison with modern people by using radiological methods are quite limited in Turkey. Previous studies showed that measurements obtained from orthopantomographs are highly correlated with the actual size of the bones. The aim of the present study is to determine the possible change in gonial angle over time in ancient Anatolian populations with the present. Also an aim was attempted to demonstrate the symmetry of the gonial angle in the jaws and the sexual dimorphism. Gonial angle values (right and left) were taken from 267 Turkish adults with no craniomandibular disorders, orthodontic history or treatment by using panoramic radiographs. Data of the past populations were collected from previous studies. Comparison between right and left sides and the sexual differences were tested by paired student t-test and discriminant analyses were conducted. The results showed that there were no significant differences between the right and left gonial angles of the individuals but there was a significant difference at the left gonial angle between sexes (p < 0.01). Furthermore, no statistically significant difference was found for the gonial angle between the selected past populations with the present sample.

Estimation of stature in Turkish adults using knee height.

Body height is an important clinical indicator to derive body mass index (BMI), which is a useful screening tool for both excess adiposity and malnutrition. Height measurement in the elderly may impose some difficulties and the reliability is doubtful. Stature estimation from knee height is one of the commonly used methods; nevertheless no study has been carried out so far on the Turkish population. A cross sectional anthropometric study was conducted to develop body height estimation equations by using knee height measurement for Turkish people. Measurements of height and knee height were taken according to the International Biological Programme procedures from 1422 adults (610 males, 812 females) aged 18-90 years from Ankara, the capital city of Turkey. Samples were randomly split into two sub-samples, training and validation (control group) sub-samples. Height estimation equations were developed from the knee height measurements by linear regression analysis according to age groups and sexes. Males were significantly taller and have higher knee height values than females in all age groups. Height and the knee height variables showed a gradual decrease (P 50) with aging in females and males. Evaluated knee height equations for stature estimation were tested through the validation sample and the results showed high accuracy. The study presents sex and age specific regression equations for height estimation by using the knee height measurement for Turkish adults and suggests facilitating the accurate usage of knee height.

Sex determination using the scapula in medieval skeletons from East Anatolia.

Sex determination from skeletal human remains by discriminant function analysis is one of the methods utilized in the forensic and osteoarcheological sciences. The purpose of the present study is to establish metric standards for sex determination for medieval Anatolian populations using scapular measurements. The database for this research consisted of 93 adult skeletal remains (47 males and 46 females) from the Dilkaya medieval collection. Four measurements were taken: maximum scapular height, maximum scapular breadth, glenoid cavity height, glenoid cavity breadth, and subjected to discriminant function analysis. All measurements demonstrated some degree of sexual dimorphism, with the highest accuracy of sex determination (94.8%) obtained using maximum scapular breadth. Overall accuracies of the functions ranged from 82.9% to 95.0%, with a higher accuracy rate obtained for female skeletons than for males. Population specific discriminant formulas were developed using combinations of measurements, which can be used in ancient Anatolian populations.

Estimation stature from X-rays of metacarpals in the Turkish population.

Determination of stature is as important as the determination of sex and age when analyzing and identifying the remains of skeletons. Stature, in an approximate and widespread manner, is determined by the femur and tibia, i.e. those long bones that affect stature directly. However, when long bones are not available or when they are found in a very badly preserved condition that does not permit any estimation on stature, then other bones of the body can also be used for this purpose. The aim of this study is to determine stature with the help of metacarpals in the Turkish population. In this study, by using the X-ray films of metacarpal bones of 100 females and 100 males, regression equations have been set up for 5 metacarpal bones. The coefficients of correlation existing between the metacarpal bones and stature, together with the standard errors of these equations, have been intensively examined in this study. The results of studies conducted by other researchers such as Musgrave & Harneja (1978) and Meadows & Jantz (1992) have been compared with the results of our study. As a result of this comparison, the difference existing between them has been found to be significant according to the results of the t-test (p < 0.05, p < 0.01 and p < 0.001). The significance of such results proves that the general body characteristics and body proportions of populations are differing from each other and therefore specific regression equations for the different populations have to be set up.