Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities.

Cleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.

Triple Z flap technique for reconstruction of triangular defects in problem areas.

BACKGROUND: Reconstruction of defects close to important structures where standard flaps cannot easily be used may sometimes challenge surgeons. Classic reconstructive options for such defects close to problem areas may not always yield the best result. METHODS: The authors used the triple Z flap technique for triangular defects close to problem areas in 18 patients. The defects were triangular or close to triangular in shape, and three Z flaps were planned on each side of the defect. Flaps were transposed and the defects were reconstructed without any complications. RESULTS: The results were quite satisfying for both the patient and the surgeon. Neither retraction nor any distortion was observed. CONCLUSION: The triple Z flap technique can be used in selected cases where local flap choices are scarce and it is difficult to achieve good anatomical and aesthetic results.

In vivo observation of leukocyte-endothelium interaction in ischemia reperfusion injury with the dorsal window chamber and the effects of pentoxifylline on reperfusion injury.

OBJECTIVE: Ischemia reperfusion injury can cause failure in microsurgical operations. Interaction between leukocytes and endothelium is recognized as an integral step in ischemia reperfusion injury. Pentoxifylline is a methylxanthine derivative that has pharmacological properties that can be beneficial in ischemia reperfusion injury. The aim of this study was to investigate the in vivo effect of pentoxifylline on leukocyte-endothelium interaction in ischemia reperfusion injury. METHODS: Intravital fluorescent microscopy was used to observe leukocyte-endothelium interaction in a "dorsal window chamber" model. Twenty-eight postcapillary veins were analyzed in group 1, and twenty-two in group 2. Group 1 received 25 mg/kg pentoxifylline 20 min before reperfusion. Group 2 received an equivalent volume of 0.9% saline at the same time. The period of ischemia was 4 h. RESULTS: Quantification of leukocyte 'sticking' and 'rolling' was done before ischemia and at 30, 60, and 120 min after reperfusion. Offline video analysis was used for evaluating the results. Statistical evaluation showed that pentoxifylline significantly attenuated leukocyte 'sticking' and 'rolling' in postcapillary venules. It was also effective in preventing 'no-reflow' when compared with the control group. CONCLUSION: These results indicate pentoxifylline diminishes leukocyte-endothelium interaction, and may have a therapeutic role in preventing ischemia reperfusion injury in microsurgical operations.

Use of the spring graft for prevention of midvault complications in rhinoplasty.

BACKGROUND: Preservation of the middle nasal vault has increasingly become a topic of interest and concern in rhinoplasty. Resection of even a minute amount of roof during hump removal disturbs the stabilizing effect of the upper lateral cartilages, which then causes a fall of upper lateral cartilages medially toward the anterior septal edge, restricting airflow at the internal valves and creating midvault problems. METHODS: The resected alar cartilages were placed deep to the upper lateral cartilages as a strengthened spring to prevent midvault collapse and internal valve incompetency. Although weak and small alar cartilages are limitations of the technique, the authors think that this is not so frequent because the total force exerted on the upper lateral cartilages by the spring graft is higher than the force of each individual two cartilage pieces. RESULTS: It was easy to view the widening of the internal valve and the smooth appearance of the middle third of the nose intraoperatively. All patients were satisfied with the results both functionally and aesthetically. CONCLUSIONS: The spring graft technique, a modification of the splay graft, handles both the functional and aesthetic problems in the dorsal midvault. The spring graft, with its advantages and disadvantages, is a technique that solves the frequently encountered problems of incompetent internal nasal valve and midvault collapse without the need for a second donor site. It is a simple, reliable technique that is easy to learn and execute and must be kept in mind in selected patients.

A simple and effective procedure for treating burn contractures: releasing incision and quadra Z technique.

Burn contractures particularly involving the joints are challenging problems which might cause severe functional impairments. Many surgical techniques have been described for use, however, an ideal method yet to be found. Releasing incision is the most common and effective way to release the wide and severe contractures but it has some drawbacks. We propose a releasing incision technique combined with four Z plasty incisions to overcome the disadvantages of traditional releasing incision technique. We successfully used our releasing incision and quadra Z technique on seven consecutive patients with burn contractures between 2003 and 2005. We modified the classical releasing incision technique by adding four Z plasties; two of them with a common base on each corner of the incision line. In this technique, limitation of the webbing following the incision is made possible by the transposed flaps and unnecessary lateral extension of the incision and the defect was avoided, i.e. maximum release gain with minimal defect was provided. Satisfactory results were achieved in seven patients treated with this technique due to significant burn contractures between 2003 and 2005 with no significant complication. We propose this technique is suitable in all patients with severe burn contractures who require releasing incision and grafting.

Congenital midline upper lip sinus.

The congenital upper lip sinuses are rare and they have previously been reported only in 40 cases. We have presented a case report of congenital midline upper lip sinus in an elderly age. Although the treatment modality is very easy and successful in any cases, the etiology of this rare congenital situation has been obscure and further studies should be done to find out.

Caudal septal advancement for nasal tip projection and support in rhinoplasty.

BACKGROUND: Management of nasal tip projection and support for positioning of the tip represent an important part of rhinoplasty operations that must be handled properly for a final satisfying result. Manipulation of the nasal tip is complex and variable. Plastic surgeons use many techniques to achieve this goal. METHODS: The authors propose that the caudal septal advancement technique be used to manipulate the positioning of the nasal tip, especially in cases of an underprojected tip and those requiring tip support. The authors prepare a rectangular septal cartilage, which after advancement carries the nasal tip to the desired position. RESULTS: This technique is easy to use, and the results are dependable. All the patients who underwent surgery with this technique were satisfied with the result. CONCLUSION: The caudal septal advancement technique presents another good and reliable alternative for managing nasal tip projection and support.

Simple and reliable procedure for end-to-side microvascular anastomosis: the diamond technique.

In the last few decades, microsurgery has become a reliable technique in reconstructive surgery due to numerous technical and conceptual advances. End-to-side anastomosis is currently preferred by many microsurgeons. Many recent clinical and experimental studies showed no significant difference between the slit and hole techniques for end-to-side anastomosis. We propose a different technique, based on geometrical planning of arteriotomies on both the recipient and pedicle artery. The diamond technique is easy to execute, simple, and reliable, with many advantages, and should be kept in mind in selected patients.