Recommendations for management of diabetic foot ulcers during COVID-19 outbreak.

COVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.

Double-Layer Reconstruction of the Achilles' Tendon Using a Modified Lindholm's Technique and Vascularized Fascia Lata.

Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles' tendon. A 37-year-old man suffered from tertiary Achilles' tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles' tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects. The patient was followed up for 12 months. No wound healing problems were reported, and the patient was able to walk and return to his daily ambulating activities without any support after 5 months postoperatively. This technique may be useful to achieve satisfactory outcomes in patients with ruptured Achilles' tendons following tertiary repair.

A New Splint for Dorsal Foot Burns.

The treatment of dorsal foot burns has always been posed as a challenge to reconstructive surgeons. Despite of numerous reconstruction methods and appropriate approaches to the dorsal foot burn in acute phase, burn scars and contractures cannot always be prevented. Results of 5 female patients operated for burn scar contracture release and a new splinting approach are reported here.

Effects of Cilostazol and Diltiazem Hydrochloride on Ischemia-Reperfusion Injury in a Rat Hindlimb Model.

OBJECTIVE: Free radicals and neutrophils are potent sources of ischemia-reperfusion injury (I/R) and they can be limited by the use of exogenous application of some therapeutic agents. The objective of this study was to compare the effects of cilostazol and diltiazem hydrochloride in a rat hind limb model of I/R injury. Methods: Skeletal muscles submitted to 2 hours of ischemia by placing an aneurysm clip to femoral artery and reperfused after 1, 2 and 4 hours. Seventy-two Wistar-Albino rats were randomly divided into mainly four groups according to treatment agents:  Group I (control group) was treated with saline; Group II was treated with diltiazem hydrochloride; Group III was treated with cilostazol in 30% dimethyl sulphoxide; and Group IV was treated with 30% dimethyl sulphoxide intraperitoneally. These four main groups also subdivided into three subgroups according to duration of the reperfusion times.  Blood samples were taken and all rats were sacrificed. Results: Cilostazol-treated groups demonstrated a significant decrease in tissue and serum malondialdehyde (MDA) levels, and tissue myeloperoxidase (MPO ) activity compared with other groups. Increase in serum nitric oxide (NOx) level was significantly higher in all subgroups of cilastazol, diltiazem hydrochloride, and dimethyl sulphoxide groups versus the control group. CONCLUSION: Although these results suggest the beneficial effects of cilostazol and diltiazem hydrochloride on I/R injury, the effect of cilostazol on I/R injury seems to be more efficient than diltiazem hydrochloride.

Effects of laser-assisted lipolysis on nipple-areola complex.

BACKGROUND: Gynecomastia, as a most common benign condition, represents itself as the enlargement of the male breast and also nipple-areola complex as the severity of the condition increases. With this study, we aimed to clarify the effects of 980-nm diode laser on nipple-areola complex (NAC). OBJECTIVES: Although numerous open techniques have been described to correct gynecomastia, nowadays trends have shifted to minimally invasive techniques such as laser-assisted lipolysis (LAL). METHODS: A total of 25 patients with bilateral gynecomastia treated with LAL by using a 980-nm diode laser. RESULTS: The resultant contour and reduced size of the complex were satisfactory. CONCLUSIONS: LAL leads to significant reduction of the size of NAC.

Determining the number of intraparotid lymph nodes: postmortem examination.

BACKGROUND: The parotid gland is one of the metastatic drainage areas for malignant tumours of the head and neck area. In this study, we aimed to define the accurate number and distribution of intraparotid lymph nodes in the 84 glands of 42 fresh cadavers for implementing the data for the clinical practice. METHODS: Bilateral total parotidectomies were performed. The lobes were separated, fixed with formalin, cut into thick slices, embedded in paraffin and serially sectioned. 2 µm thick sections were stained and examined histopathologically. RESULTS: No nodes were found in 4 of 84 superficial parotid lobes and in 58 of 84 deep parotid lobes. CONCLUSIONS: Sentinel lymph node biopsy failure may be related to the absence of intraparotid lymphoid tissue. Although the superficial intraparotid lymph nodes are a first echelon of head and neck tumours, involvement of these does not allow us to exclude the possibility of involvement of the deep lobes.

The infragluteal sulcus: a histologic and ultrasonographic study.

UNLABELLED: The buttocks are a major component of sexual attraction, and they have their place in the concept of beauty in most cultures and ethnic groups. The infragluteal sulcus, an important part of the gluteal region, determines the attractiveness of the buttocks. For that reason, any small change in the infragluteal sulcus makes a major cosmetic difference in the morphology of the buttock. In recent years, some flaps such as the infragluteal flap, the transverse upper gracilis flap, and the transverse musculocutaneous gracilis flap have become popular because of reduced donor area morbidity and their availability for hiding incision scars. In these cases, there may be distortion of the gluteal morphology and infragluteal sulcus. In this study, the anatomic and histologic features of the tissues that form the infragluteal sulcus were analyzed for their contribution to successful reconstruction of the infragluteal sulcus. 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 .

A novel approach to soft-tissue repair: reoverexpanded flaps.

Postburn sequelae or excisional defect reconstruction after significant burn injury or resection of giant hairy nevus continues to be a significant challenge for the reconstructive surgeon. Unfortunately, the quality and quantity of available tissue for the repair of extensive defects is often limited. The techniques of tissue expansion have been used for many years to expand normal skin adjacent to the defect for the reconstruction of even wider defects in various parts of the body with its numerous advantages.Nine patients in whom reoverexpanded neighboring skin flaps were used to improve the capacity of wider soft-tissue defect coverage for postburn scar revision or excisional defect of giant hairy nevus in the various parts of the body is reported here.

Resurfacing the dorsum of the hand in a patient with Xeroderma pigmentosum.

BACKGROUND: One of the most effective treatment methods of Xeroderma pigmentosum (XP) is full resurfacing of the exposed areas with skin grafts. OBJECTIVE: Introduction of a different surgical technique in order to minimize the undamaged skin removal in XP patients in whom multiple surgical procedures will often be necessary. METHOD: A special undulant incision of the graft margins around the metacarpal heads was performed. RESULTS: Both aesthetic and functional results were obtained. CONCLUSION: Although conservative surgical resection is primarily preferred in XP patients, in cases in whom radical surgical intervention is necessary, in order to minimize undamaged skin, surgical technique of choice should be individualized.