Pulp Rotation Flap for Lateral Oblique Fingertip Defects.

BACKGROUND: Fingertip amputations are among the most common injuries seen in the hand. According to the geometry of the amputation, it may be classified as transverse or oblique (dorsal, volar, or lateral type). Although numerous repair techniques have been described in the literature, there are few alternatives suitable for lateral oblique type fingertip amputations. METHODS: Between 2012 and 2016, we operated on 16 patients with simple rotation flap from the remaining part of the pulpa in a rotation and advancement manner for the reconstruction of lateral oblique type fingertip amputations. RESULTS: All but two of the flaps healed completely with full flap survival. Superficial distal flap necrosis was observed in two patients. They healed by secondary intention. No obvious hooked nail occurred in patients. Cold intolerance was observed in one patient; joint stiffness or hypersensitivity was not observed in any of the patients. Stiffness of the proximal interphalangeal joint did not occur. Two point discrimination test results were found to be normal. CONCLUSION: This technique is simple, rapid, and free from relatively major complications. This flap allows for anatomical reconstruction of the fingertip by using a similar tissue in cases of lateral oblique fingertip amputations, where only a few flap options can be successful.

Effects of palatine bone denudation repair with periosteal graft on maxillary growth: an experimental study in rats.

BACKGROUND: The long-term goal of cleft palate repair is to provide normal maxillary growth and speech capacity. However, most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. It is widely acknowledged that palatal bone denudation and subsequent scar contracture resulting from cleft palate surgery can inhibit maxillary growth. METHOD: This study is designed to investigate the effect of the periosteum on growth patterns of the maxilla. A total of 32 three-week-old Sprague-Dawley rats were randomly divided into a control group and three experimental groups: a mucosa excision group, a mucosa-periosteum excision group and a periosteal graft group. Nine weeks postoperatively the skulls were prepared for study and palatal widths and lengths were determined. The experimental groups were investigated for various histological changes. RESULTS: There was no statistically significant difference for the maxillary measurements (palatal width and length) between the mucosa excision group and the periosteal graft group when compared with the control group. However, the mucosa-periosteum excision group compared to the control indicated a statistically significant decrease in the same measurements. There was also a statistically significant difference for the maxillary measurements between the periosteal graft group and the mucosa-periosteum excision group. It was demonstrated histologically that the density of the Sharpey's fibres and periodontal scar tissue showed a slight increase in the mucosa excision group and the periosteal graft group compared with the control group. In the mucosa-periosteum excision group, the density increased significantly as expected. CONCLUSIONS: All of these findings testify that retaining the periosteum or replacement with a periosteum graft after surgery can prevent the inhibition of maxillary growth.

Long-term clinical outcomes of fat grafting by low-pressure aspiration and slow centrifugation (Lopasce technique) for different indications.

Autologous fat grafts have been used successfully for structural fat grafting in facial, lip, and hand rejuvenation, body contour improvement, and traumatic defect restoration. The purposes of this study were to define a new fat graft harvesting and processing technique, which is named the "Lopasce technique" (low-pressure aspiration and slow centrifugation technique), and to evaluate the late clinical outcomes of fat grafting by this technique for different indications. A retrospective study was performed using the medical records of 21 patients (17 women and four men). The mean injected fat volume was 33.2 ± 34 cc (range 6-125 cc). The mean follow-up period was 13.2 ± 5.6 months (range 6-26 months). Postoperative results were evaluated by subjective and objective methods. In the subjective evaluation, 19 patients stated that there had been little resorption and that it was not necessary to repeat the fat grafting, one patient reported that the fat was resorbed in part, and one patient reported that the fat was resorbed completely. In the objective evaluation, the amount of fat graft taken in the recipient sites was between 60%-80% (average 70%) when compared with preoperative and late postoperative photographs of the patients at the 6- and 26-month follow-ups. Fat grafting is a simple, effective, and reproducible technique with a high satisfaction rate and few disadvantages or complications. We consider that structural fat grafting with the lopasce technique is an easy, effective, and long-lasting treatment for correction of congenital or acquired defects associated with various medical conditions.

Tanzer group IIB constricted ear repair with helical advancement and superior auricular artery chondrocutaneous flap.

Constricted ear deformity was first described by Tanzer and classified it into 3 groups according to the degree of constriction. The group IIB deformity involves the helix, scapha, and antihelical fold. The height of the ear is sharply reduced, and the soft tissue envelope is not sufficient to close the cartilage framework after expansion and reshaping.This study describes expanding the cartilage and increasing the height by advancing the helical root superiorly and repairing the skin-cartilage defect with a superior auricular artery chondrocutaneous flap in Tanzer group IIB constricted ear deformity.Six ears of 6 patients were treated with this technique during the past 3 years. All patients were satisfied with the appearance of their corrected ears, and the increase in height was maintained through the follow-up period.The described technique does not have the disadvantages and possible complications of harvesting a costal cartilage graft. Moving and fixing the root of helix to a more superior position provide the auricle with additional length. The superior auricular artery chondrocutaneous flap not only provides adequate soft tissue for primary closure of the anterior portion of the auricle but also aids in repairing the cartilage defect resulting from the superior advancement of the helix as well.

Isolated congenital partial absence of the left lower lateral nasal cartilage: case report.

Isolated congenital nasal anomalies are rare; the isolated absence of any specific nasal structure is even rarer. In this report, we present a patient with congenital isolated partial absence of the left lower lateral cartilage including only the lateral crura.

An unusual complication following eyelid ptosis surgery: superior rectus paralysis.

Blepharoptosis (ptosis) is one of the most common eyelid disorders encountered in ophthalmology. Several procedures have been developed to correct ptosis. The most common complications of ptosis surgery are well defined in the literature. Herein, we report a rare complication of superior rectus muscle paralysis following levator resection surgery for a blepharoptosis. Surgeons may well be aware of its occurrence.