Lefort 1 Osteotomy Study of Maxillary Bone in Caprine Skull Model: Comparison of Different Osteotomy Techniques (Piezo Versus Lindemann Bur Versus Manual Chisel).

OBJECTIVE: In this study, we aimed to compare the efficiency of different osteotomy techniques for Lefort 1 osteotomy in an experimental caprine skull model. METHODS: Twelve caprine skulls were used for the study. Skulls were divided into 3 groups: (1) manual chisel group, (2) Lindemann bur group, and (3) piezo osteotomy group. Bilateral osteotomies were performed on each skull. Results were evaluated with three-dimensional computerized tomography scans and macroscopic observations of the mucosal tears and soft tissue. RESULTS: The mean length of the bone gap in the manual, Lindemann, and piezo groups was 4.8 (±0.7), 3.38 (±1.49), and 1.39 (±0.3) mm, respectively (P < 0.05). The mean number of comminuted fractures in the manual, Lindemann, and piezo groups was 5.5 (±1.4), 1.6 (±0.3), and 0.6 (±0.5), respectively (P < 0.05). Mucosal tearing and soft tissue damage based on subjective inspection observations were negligible in the piezo technique. Soft tissue and mucosal damage were observed significantly more in the manual chisel osteotomy method compared with the other 2 techniques. CONCLUSION: We anticipate that piezo, which has started to be used in new application areas besides rhinoplasty, will continue to be used more widely, especially in reconstructive orthognathic surgery, due to the minimal damage it causes to tissues. With the long-term results, much healthier interpretations can be made.

Impact of Different Osteotomy Techniques on Bone Reserve in the Osteotomy Line in Sagittal Split Osteotomy: Experimental In Vitro Study in Caprine Mandible Model.

OBJECTIVE: The objective of this study was to investigate of the effect of piezzo and conventional osteotomy techniques on bone reserve in the osteotomy line and comminuted fracture ratios that is able to compromise bone to bone contact negatively. METHODS: Bilateral sagittal split ramus osteotomy was performed on 12 fresh male Thracian curly caprine mandible. In the first group (n: 12) osteotomies were performed with piezzo device. In the second group (n: 12) osteotomies were performed with micromotor and manual osteotomes. Operative time was measured. The number of comminuted fractures, length and width of the osteotomy, and the space between the osteotomy lines was evaluated from 3-dimensional computed tomography scans. RESULTS: The mean value of procedure duration was 320.4±10.76 seconds for piezo osteotomy and 238.8±8.29 seconds for conventional micromotor ( P <0.0001). Number of comminuted fractures was 1.41±1.3 in piezoelectric group, 1.5±1.3 in conventional group and the difference was not statistically significant (p: 0,88). Osteotomy lengths and widths were 35.58±5.2, 2.196±1.9 and 36.23±5.05, 2.27±1.85 in the piezzo and conventional groups, respectively. (p lengths :0,75; p widths :0,92) The volume of the bony interface between the distal and proximal segments of the mandible after osteotomy was 166.3±184.2 mm 3 in the piezzo group and 163.5±129.3 mm 3 in the conventional group (p: 0,96). CONCLUSION: The piezo surgery and the conventional osteotomy were found to be similar in terms of the gap between the distal and proximal mandible and the number of comminuted fractures. The duration to perform the conventional osteotomy was found to be shorter than the piezo surgery.

Postoperative Clinical and Radiological Analysis of Deviated Noses.

BACKGROUND: Anatomical deformities can greatly alter nasal function, which can be largely corrected during septoplasty and septorhinoplasty operations. In this study, we aimed to objectively measure the results of septoplasty surgeries of deviated noses with radiological analysis and compare the results with clinical evaluations. PATIENTS AND METHODS: Forty patients who were undergoing septorhinoplasty were included in the study. Patients were evaluated with preoperative and postoperative paranasal computed tomography scan measurements and satisfaction surveys. RESULTS: Preoperative and postoperative mean ± SD septal deviation angle measurements were 11.9 ± 5.3 degrees and 6.5 ± 3.1 degrees, respectively. Preoperative and postoperative mean ± SD septal deviation distance measurements were 7.3 ± 4 and 3 ± 1.3 mm, respectively. Preoperative and postoperative mean ± SD oblique conchal measurement on the deviated side was 17.3 ± 3.2 and 13.4 ± 2.8, respectively. Preoperative and postoperative mean ± SD patient satisfaction survey scores were 17 ± 1.9 and 4.5 ± 1.9 points, respectively. DISCUSSION: To obtain a nose with a greatly improved functional gains, especially in heavy deviated noses, is an important goal in septorhinoplasty surgery. It is essential to apply the technique that will benefit the patient. The most important success criterion seems to be the regression of the clinical complaints of the patients, which can be proven objectively with computed tomography scan measurements.

Comparison of Classic Mastopexy Method with Double-Pedicled Auto-augmentation Mastopexy with Conic-Shaped Modified Inferior Butterfly Flap.

BACKGROUND: In mastopexy surgery, extra skin and a specific amount of breast tissue are resected. Resected breast tissue is not in a large amount as in reduction surgery. In this study, we have investigated the results of an auto-augmentation mastopexy technique involving use of a superior pedicled mastopexy with conic-shaped inferior butterfly flap for augmentation without implant or fat injection. METHODS: A total of 80 patients, 40 patients in each group, were included in the study. In the first group, double-pedicled auto-augmentation mastopexy with conic-shaped modified inferior butterfly flap technique was used. In the second group, conventional superior pedicled wise-pattern mastopexy was utilized. The results were evaluated from photographic measurements performed from standardized preoperative and postoperative lateral photographs. RESULTS: No major complications were seen such as partial or total areola necrosis or breast volume loss. None of our patients has made a return with request for revision surgery. Minor complication seen in several patients was resolved with early intervention. The preoperative and postoperative photographic measurements of breast projection, upper pole projection, nipple position and lower pole level from preoperative and postoperative standardized lateral photographs revealed no significant difference between the groups. CONCLUSION: We obtained highly satisfactory results for our patients. Following the surgery, our patients protected the cup sizes of their bra. In spite of the fact that there was no real augmentation performed in this procedure, effective straightening and the compact breast structure patients that achieved were highly successful in creating an augmented breast image. LEVEL OF EVIDENCE III: 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 .

Evaluation of Factors Related to Postoperative Complications in Patients Who Underwent Reduction Mammoplasty.

OBJECTIVE: This study aimed to investigate whether there was an increase in the number of postoperative complications in patients undergoing reduction mammoplasty depending on the technique used (i.e., pedicle type, skin incision pattern), existence of concomitant diseases, and presence of other risk factors. MATERIALS AND METHODS: A total of 186 patients who underwent breast reduction between 2013 and 2018 (bilateral, n = 170; unilateral, n = 16) were included in the study. A retrospective review of the data of patients who underwent reduction mammoplasty, which was performed by the same surgical team in a single institution over a 6-year period, was carried out. Superomedial, superior, and inferior pedicles were used in 99, 55, and 32 patients, respectively. The median follow-up period was 4 years. RESULTS: The median patient age was 45 (range: 16-75) years. The median total reduction weight was 2,194 (range: 80-4,800) grams. The median distance between the sternal notch and nipple was 31 cm (range: 24-45 cm) for the right breast and 30 cm (range: 22-45 cm) for the left breast. The overall complication rate was 6.9%. The complication rates in patients with and without any concomitant diseases were 10.2% and 4.6%, respectively. The overall complication rate was significantly higher in patients with smoking habit, accessory breasts, progesterone use, cerebrovascular disease, morbid obesity (Body Mass Index ≥40 kg/m2), and thalassemia. CONCLUSION: Our analysis shows that the presence of concomitant diseases increases the risk for postoperative complications in patients who underwent reduction mammoplasty. Our findings do not suggest that any of the techniques have significant superiority to each other in terms of pedicle safety and overall complication rate.

Patient reported vaginal laxity, sexual function and stress incontinence improvement following vaginal rejuvenation with fractional carbon dioxide laser.

In this study, we have evaluated the efficiency of fractional carbon dioxide laser in the treatment of vaginal laxity and urinary incontinence. Thirty patients with vaginal laxity, sexual dysfunction and urinary incontinence complaints were treated with fractional carbon dioxide laser. Results were evaluated with patient questionnaires relating to comfort during the procedure and general satisfaction following the procedure. In the survey regarding comfort during the procedure, 90% (n:27) of the patients reported that they were comfortable during the procedure. The survey on the level of general satisfaction six months following the procedure revealed high-moderate level of satisfaction in 86% (n:26) of the patients. 66% (n:20) of the patients reported improved vaginal tightness and 63% (n:19) of the patients reported improvement in the quality of their sexual activity. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12) scores six months following the procedure were not significantly different when compared to the scores prior to the procedure. The average of Questionnaire for Urinary Incontinence Diagnosis(QUID) score prior to the procedure and six months following the procedure was 7.5 and 0.9 respectively (p < 0.05). Fractional carbon dioxide laser treatment results in high level of satisfaction and improvement in vaginal laxity, sexual dysfunction and urinary incontinence symptoms in patients with genitourinary syndrome.

Prominent Ear Repair Surgery: Long-Term Results.

PURPOSE: Prominent ear is common in the white population at a rate of 5%. Many surgical incision and suture techniques have been described for its correction. The purpose of this article was to report the results of the prominent ear surgeries applied in our clinic for the last 5 years and to show the details of the surgical technique, to evaluate long-term results, complications, revisions and to compare them with previously published studies. MATERIALS AND METHODS: A total of 27 patients were included in the study. The patient age ranged from 7 to 60 at the time of surgery (mean age: 18.7). Of the 27 patients, 13 were female (48.2%) and 14 were male (51.8%). The procedure was bilateral in 19 cases (70.4%) and unilateral in 8 cases (29.6%). The patients were treated with the same technique by three surgeons. Aesthetic results were evaluated by patient and surgeon surveys. RESULTS: The follow-up was between 1 and 5 years (mean: 3 years). The patients very satisfied with the overall appearance of the ears, and the symmetry of the ears was rated as excellent by all patients, parents, and surgeons. CONCLUSION: Regardless of the technique used, patient satisfaction appears to be high. To reduce negative results and prevent recurrence, the authors recommend that the ear is preoperatively evaluated and the treatment algorithm is used accordingly.

Genital Beautification and Rejuvenation with Combined Use of Surgical and Non-surgical Methods.

AIM: In female genital rejuvenation and beautification, interest and demand for combined surgical and non-surgical methods are increasing. This study presents the results of our labia minora reduction technique and a vulvovaginal rejuvenation and beautification concept, where a combination of fat injection into the mons pubis and labia majora, if necessary, combined with fractional carbon dioxide (CO2) laser is used. PATIENTS AND METHODS: Genital rejuvenation and beautification were performed on 37 patients between January 2014 and January 2019. Postoperative follow-up for 1 year to obtain data on the satisfaction of surgical and non-surgical procedures was performed. RESULTS: Of the 37 female patients included in the study, 33 (94.5%) were satisfied or very satisfied with their postoperative appearance. Thirty (80%) patients were satisfied or very satisfied with functional results. CONCLUSION: The described genital beautification and rejuvenation technique combines different aesthetic female genital surgery techniques and non-surgical noninvasive procedures. These procedures, like other plastic surgeries and procedures, are designed for the subjective improvement of the patients' appearance and feelings. 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 .

Comparison of incisional delay patterns on a rat random flap model.

One of the simplest form of surgical delay can be performed by placing an incision around the flap without undermining, prior to flap elevation. In this study, we have compared the efficiency of different patterns of skin incision to improve flap survival. Twenty-eight animals were used in four groups. Incisional delay was performed prior to flap elevation in the three experiment groups. Complete incision of the three flap edges was performed in the all experiment groups with the exception of an intact skin section on the middle 1/3rd of the bilateral edges in group 1 (bilateral skin edge preserved delay: BSEPD), of a unilateral edge in group 2 (unilateral skin edge preserved delay: USEPD) and of the superior edge in group 3 (superior skin edge preserved delay: SSEPD) without any undermining. Two weeks following the delay procedure, dorsal skin flaps were raised and reinserted back to their place. The results were evaluated with the measurement of necrotic flap area, microangiographic imaging and histological evaluation. The mean percentage of necrotic flap area to whole flap area was 16.94%, 7.54%, 23.34% and 50.6% in the BSEPD, USEPD, SSEPD and control groups, respectively. In selected microangiographic images, vessels were more prominent in the delay groups. The results of the study indicate that three sided incision with an intact skin on the superior edge is not effective in providing a sufficient delay and flap survival improvement when compared to incisions with intact skin on the unilateral and bilateral edges.

The beneficial effects of subcutaneous Allium cepa injection on random flap survival in rats.

Random flaps are frequently used in the practice of reconstructive surgery. The aim of this experimental study was to investigate the effects of Allium cepa on random flap survival in rats. Fourteen Wistar rats were used for this experimental study. The subjects were divided into experiment and control groups. Rats in the experiment group received daily injections of A. cepa extract for 7 d before the elevation of the flaps. Following the treatment period, elevation and reinsertion of the dorsal flaps were performed. Necrotic and total flaps areas were marked and calculated 7 d after the flap elevation. Histological examinations and microangiography were performed to evaluate the results. The mean value of the proportion of necrotic flap areas to the total flap area was 25.06 and 50.6% in the A. cepa and control group, respectively (p = .0079). In the histological examination, number of vessels identified in the dermis were 23.75 ± 0.7 and 33.75 ± 9 in the A. cepa and control group, respectively (p = .7457). In angiographic images, vessels formations were more noticeable in the A. cepa group. We conclude that preoperative subcutaneous A. cepa injection increases dorsal flap survival in rats.

Subdermal nitrous oxide delivery increases skin microcirculation and random flap survival in rats.

Random skin flaps are essential tools in reconstructive surgery. In this study, we investigated the effect of subdermal nitrous oxide (N2O) application on random flap survival. In this experimental study, we used 21 female rats in three groups. In the N2O and air groups, gases were administrated under the proposed dorsal flap areas daily for seven days. Following the treatment period, flaps were raised and inserted back into their place from the dorsal skin. In the control group, the flaps were elevated and inserted back to their place without any pretreatment. Calculation of necrotic flap areas, histological examination and microangiography was performed to evaluate the results 7 days after the flap surgery. The average of necrotic flap area in the N2O, air and control group was 13.45%, 37.67% and 46.43%, respectively. (N2O vs air p = .044; N2O vs control p = .003). The average number of capillary formations identified in the histological analysis was 7.0 ± 1.58, 3.75 ± 2.36 and 4.4 ± 0.54 in the N2O, air and control group, respectively. (N2O vs air p = .017; N2O vs control p = .037). The average number of capillary structures identified in the angiography images were 6.3 ± 1.52, 1.6 ± 1.15 and 1.3 ± 0.57 in the N2O, air and control group, respectively. (N2O vs air p = .04; N2O vs control p = .02). We conclude that subdermal N2O application increases random flap survival through an increase in the skin microcirculation and could be promising for future clinical applications.

Comparison of subdermal and perforator delay techniques on a rat flap model.

BACKGROUND: In this study, we investigated the subdermal and perforator delay phenomena as a method to improve flap survival. MATERIALS AND METHODS: In this experimental study, we used 24 rats in three groups. In the control group, the dorsal flaps were elevated and reinserted back to their place. In the experimental groups, we practiced the delay phenomena with two different techniques. In the first experimental group, cranial and lateral side incisions were performed; however, the flaps were not cut-off from the underlying fascia. In the second experimental group, we placed a silicon sheet under the planned flap to cut-off the circulation from the perforator vessels. Four weeks after the delay procedure, the flaps were raised completely and reinserted back to their place. RESULTS: The average of necrotic area in the control group was 21.9% (±7.70). There was no necrosis in both experimental groups (P < 0.0001). Histological examination revealed that collagen density in both of the experimental groups was increased in comparison to the control group, it has only been found a significant first experimental group (P = 0.0315). We have not found any significant difference in lymphocyte density between the groups. Angiographic imaging has showed an increase in the vascular density in the flaps of the first experimental group. CONCLUSION: We believe that both of these delay techniques can be adapted to clinical applications and used safely to increase flap survival.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats.

PURPOSE: To investigate the effect of subcutaneous sildenafil on random flap survival. METHODS: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. RESULTS: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). CONCLUSION: The subdermal high dose sildenafil has a positive effect on flap survival.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats

Abstract Purpose: To investigate the effect of subcutaneous sildenafil on random flap survival. Methods: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. Results: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). Conclusion: The subdermal high dose sildenafil has a positive effect on flap survival.

Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes.

OBJECTIVE: Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. MATERIAL AND METHODS: 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. RESULTS: Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. CONCLUSION: Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.

Intravascular Papillary Endothelial Hyperplasia of the Foot.

A case of intravascular papillary endothelial hyperplasia is presented. This proliferation usually forms inside thrombotic processes. It is critical to be able distinguish these lesions from low-grade angiosarcomas because they can have similar pathologic findings.

Transungual resection of subungual glomus tumour.

Glomus tumours are benign soft tissue neoplasms. In this paper, we present a case with subungual glomus tumour. Transungual resection was performed to remove tumour. The patient was doing well 6 months after the surgery with no sign of recurrence or nail deformity.

Trichoblastic carcinoma of the scalp with rippled pattern.

Trichoblastic carcinoma (TC) is a rare type of malignancy which is derived from the hair follicles. In this paper, we report a case with TC on the scalp characterized with rippled pattern. There have been reports of rippled pattern in trichoblastomas, sebaceomas, and basal cell carcinomas. To the best of our knowledge, this is the first case in the literature to report a rippled pattern in TCs.