A Study on the Effects of the Use of Propofol in Experimental Model Inferior Epigastric Island Flap on Ischemia-Reperfusion Injury.

Problems concerning vascular blood flow are the most frequently encountered ones after flap applications. The flap tissue starts to develop ischemia in patients with a vascular blood flow insufficiency. And reperfusion starts in those patients in whom the ischemia is temporary, triggering an ischemia-reperfusion injury depending on the duration of the ischemia. The aim of this study was to evaluate the effect of propofol, which is an anesthetic agent known to have an antioxidant effect and a free radical scavenging feature on the ischemia-reperfusion injury created on an experimental epigastric island flap.Thirty Sprague-Dawley rats were used in the study. The rats were divided into 3 groups of 10 rats each. Inferior epigastric artery-based abdominal flaps were prepared in all the groups. In group 1 (sham), the flap was elevated but no ischemia was applied. In groups 2 (control) and 3 (propofol), the flap was exposed to ischemia for 2 hours after it was elevated. All the rats were sacrificed and biochemical and histopathological assessments were made on the tissue samples taken on the 14th day. As a result of a comparison between the groups, the flap viability rates and the superoxide dismutase, total antioxidant capacity, and catalase values were found to be significantly higher (P < 0.001) in the propofol group while the malondialdehyde and total oxidative stress values were lower (P < 0.001). Based on the data obtained from the present study, the use of propofol was observed to have a protective effect against ischemia-reperfusion injuries in flap surgeries.

Repairs of Large Defects of the Lower Lid and the Infraorbital Region With Suspended Cheek Flaps With a Dermofat Flap.

After the repair of large defects of the lower lid and the infraorbital region using larger flaps without adequate support, retractions of the lower lid may be observed due to the weight of the flap. In this study, the authors' aim is to present the outcome of the repairs they performed on large defect areas in the lower lid and the infraorbital region using cheek flaps suspended by a dermofat flap.The method was performed on 7 patients between 2011 and 2015. Among the patients, 4 were female, while 3 were male. The mean age of the patients was 61.3 (54-69) years. In all the patients, the defects were secondary to tumor excisions. The mean size of the defects was 4.4 × 5 cm (4 × 4 cm to 6 × 5 cm). In all the patients, the repair of the defect was performed using the Mustarde flaps prepared in the subcutaneous plane. After the flap was advanced to the defect area, a dermofat flap was prepared from the part at the lateral canthal area and was sutured to the periosteum superiorly to the lateral canthus.Patient satisfaction and functionality was high during the long-term follow-up. While minimal scleral show occurred in 1 patient, the lid position was normal in the other patients.The authors are of the opinion that the method they used may reduce the risk of lid deformities that may develop with the cheek flaps used to repair large lid defects.

Toe Amputation After Minor Surgery in a Patient with Behçet's Disease: A Case Report.

Behçet's disease is a systemic autoimmune vasculitis. Although various clinical findings can be observed depending on the pathologic features caused by the blood vessels involved, the classic triad of the disease includes oral aphthae, genital ulcers, and uveitis. Although complications involving the aorta or the vena cava inferior can prove fatal, thrombophlebitis in the superficial veins of the lower extremities are more commonly observed. Some patients can remain asymptomatic for a long period after the diagnosis. In patients with positive pathergy test findings, trauma can trigger the inflammatory cascade. This case report presents a patient with vasculitis that occurred subsequent to minor surgery and led to amputation of the great toe in a female patient with a 14-year old history of Behçet's disease.

Comparison of Effects of Pulsed Electromagnetic Field Stimulation on Platelet-Rich Plasma and Bone Marrow Stromal Stem Cell Using Rat Zygomatic Bone Defect Model.

BACKGROUND: Reconstruction of bone defects that occur because of certain reasons has an important place in plastic and reconstructive surgery. The objective of the treatments of these defects was to reinstate the continuity of tissues placed in the area in which the defect has occurred. In this experimental study, the effect of pulsed electromagnetic field stimulation on platelet-rich plasma (PRP) and bone marrow stromal cell, which propounded that they have positive impact on bone regeneration, was evaluated with the bone healing rate in the zygomatic bone defect model enwrapped with superficial temporal fascia. METHODS: After creating a 4-mm defect on the zygomatic bone of the experiments, the defect was encompassed with a superficial temporal fascial flap and a nonunion model was created. After surgery, different combinations of the PRP, bone marrow stromal cell, and electromagnetic field applications were implemented on the defective area. All the experiments were subjected to bone density measurement. RESULTS: The result revealed that the PRP and pulsed electromagnetic field implementation were rather a beneficial and an effective combination in terms of bone regeneration. CONCLUSIONS: It was observed that the superficial temporal fascial flap used in the experiment was a good scaffold choice, providing an ideal bone regeneration area because of its autogenous, vascular, and 3-dimensional structures. As a result, it is presumed that this combination in the nonhealing bone defects is a rather useful treatment choice and can be used in a reliable way in clinical applications.

Repair of Full-Thickness Nasal Alar Defects Using Nasolabial Perforator Flaps.

BACKGROUND: The repair of full-thickness nasal alar defects presents difficulties because of their complex 3-dimensional structure. Reconstructions using inappropriate methods may lead to asymmetries and dissatisfying functional results. In this study, our aim was to present the repairs of full-thickness alar defects performed using cartilage-supported nasolabial perforator flaps. MATERIALS AND METHODS: Eight patients who presented to our clinic between January 2011 and April 2014 with full-thickness defects in the alar wings were included in this study. The nasolabial perforator flap was prepared on the basis of the closest perforator to the defect area and in a way to include 2 to 3 mm of subcutaneous adipose tissue. The medial section of the flap was adapted to form the nasal lining. In the 7 patients in whom cartilage support was used, the cartilage graft was obtained from the septum nasi. After the cartilage was placed on the flap, the lateral section of the flap was folded over the medial section and the defect was repaired. In 1 patient in whom cartilage support was not required, the flap was folded over itself before the repair was performed. The flap donor area was primarily repaired. RESULTS: No detachment around the suture lines, infection, venous insufficiency in the flap, or partial or total flap losses were observed in any of the patients. Retraction developed in 1 patient in whom no cartilage support was used. No retraction was observed in any of the patients in whom cartilage support was used. The results were functionally and esthetically satisfying in all the patients. CONCLUSIONS: The greatest advantage of perforator-based nasolabial flaps is the greater mobilization achieved in comparison with the other nasolabial flaps. Thus, full-thickness defects can be repaired in 1 session in some patients, no revision is required around the flap pedicle, and much less donor area morbidity occurs. Nasal alar reconstructions performed using this type of flap lead to both esthetically and functionally satisfying results.

The Versatile Facial Artery Perforator-Based Nasolabial Flap in Midface Reconstruction.

INTRODUCTION: Defects in the lower two thirds of the face occur due to trauma, tumoral masses, or infections. In this study, repairs of various defects located in the midface using facial artery perforator-based nasolabial flaps are presented. PATIENTS AND METHODS: Between January 2009 and June 2013, 15 patients with defects in the lower two thirds of the face or the intraoral region underwent repairs with facial artery perforator-based nasolabial flaps. The etiology was malignant skin tumor excisions in 11 patients, infection in 2 patients, and trauma in 2 patients. Among the patients, 10 were male and 5 were female. Their mean age was 65.1 (range: 20-86) years. The mean duration of follow-up was 14 (7-24) months. The defects were located at the upper lip, cheek, lower lip, intraoral region, and the nasal area. The size of the defects varied between 10 × 10 mm and 40 × 50 mm. All the flaps were prepared as perforator flaps. The flap donor area was primarily closed. RESULTS: No partial or total flap loss was observed in any of the flaps. The flap donor areas healed without problem. Full patient satisfaction was achieved both aesthetically and functionally. CONCLUSION: The nasolabial perforator flap has certain advantages such as the 1-stage application, repair using a similar tissue, a wider rotation arc around the pedicle compared to the other regional flaps, and the primary closure of the donor area. Based on these characteristics, it is an ideal alternative for the repairs of the defects located in the lower two thirds of the face or the intraoral region.

Reconstruction of periorbital region defects: A retrospective study.

BACKGROUND: Although the periorbital region forms less than 1% of the total body surface, it has a very complex anatomy; therefore, it requires a detailed approach. In this work, we aim to present the clinical applications and related literature for the algorithm of the technique which will be applied, according to the location of the defect, in choosing the surgery treatment method. Factors affecting the results and different treatment methods of the anatomical region, including its difficult reconstruction, will also be included. MATERIALS AND METHODS: A review of 177 periorbital region defect reconstructions was performed. RESULTS: As a treatment method, in 76 (43%) patients primary closure was chosen, 39 (22%) patients had grafts and in 62 (35%) patients a flap was chosen as a treatment alternative. With respect to postoperative complications, there were a total of 6 (3.38%) patients observed with venous congestion. In 11 (6.21%) patients ectropion developed, in 1 (0.56%) patient minimal space between the eyelids while monitoring recovery was observed and in 1 (0.56%) patient, flap loss was observed due to a circulatory disorder. CONCLUSIONS: The aim of reconstruction is to repair the defect suitable to normal physiological and anatomical values. As a result, before the surgical treatments in this difficult anatomical region, the defect width and anatomical localization must be evaluated. The most suitable reconstruction method must be identified, using an evaluation of the algorithm and the required functional and esthetical results can be obtained with intraoperative flexible behavior and a change of method, when necessary.

An alternative surgical procedure for anterosuperior dislocation of intact mandibular condyle.

Superolateral and anterolateral dislocations of the intact mandibular condyle can be easily overlooked because of their rarity among maxillofacial injuries. In this report, we present the surgery of delayed anterosuperior dislocation of intact mandibular condyle into the temporal fossa. A 17-year-old adolescent girl with anterosuperior dislocation of left intact condyle and associated mandible and zygomatic body fracture underwent surgery 33 days after trauma because of priority accompanied life-threatening intracranial and intra-abdominal injuries. Temporalis muscle shortening with soft tissue attachment prevented closed reduction of the temporomandibular joint; therefore, the temporalis muscle was divided from its insertion on coronoid in a process that, to our knowledge, has never before been described. Although good occlusion was achieved at operation, open bite deformity and laterognathism were observed at the sixth month of follow-up.

Inverted nipple correction with dermal flaps and traction.

BACKGROUND: Inverted nipple occurs when part of or the entire nipple is abnormally located below the areola. Surgical repair of severe cases involves suture or flap techniques. Complications include recurrence, lactation problems, hypopigmented scar formation in the areola, and loss of sensation. We describe an alternative repair technique using a dermal flap and traction, which leads to less apparent scarring and preserves lactation function and sensation. METHODS: Between January 2010 and January 2013, we treated 28 inverted nipples in 16 patients using two areola-based triangular dermal flaps and traction. The scar was aligned with the junction of the nipple and the areola. Postoperatively, traction was applied through an apparatus prepared from a 50-cc syringe. Patients were followed up for 8-24 months (mean = 16.5 months). RESULTS: Adequate projection was achieved in all patients and no wound dehiscence or complications such as infection occurred. Unilateral recurrence occurred in one patient on the 10th postoperative day. This patient was reoperated on successfully using the same method. No loss of sensation was observed in any of the patients during the postoperative period. CONCLUSIONS: This dermal flap technique for treating inverted nipple was effective and preserved lactation function. The alignment of the scar with the junction of the nipple and the areola led to a more aesthetic appearance with no apparent scarring. The traction method helped maintain traction for a longer period, which in our opinion increased the success rate of the surgery. LEVEL OF EVIDENCE V: 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.

The reconstruction of full-thickness ear defects including the helix using the superior pedicle postauricular chondrocutaneous flap.

The ear is a complex structure with specific anatomical landmarks and different surface contour properties. In this article, we present the results that we obtained after reconstruction of full-thickness defects of the upper and middle third of the ear including the helix using a superior auricular artery (SAA) pedicled chondrocutaneous flap.In this study, 8 patients underwent reconstructions with postauricular SAA pedicled chondrocutaneous flaps between March 2009 and May 2011. Seven patients were male (88%), and 1 patient was female (12%). The age range was between 27 and 78 years, with a mean age of 57 years. The causes of the defects were tumor excisions in 6 patients and trauma in 2 patients. No serious postoperative complications such as wound infection, wound dehiscence, or partial or total flap loss were observed in any of the patients. A good cosmetic result was obtained with this technique with maximum preservation of the anatomical landmarks and without an effect on the vertical height or projection of the ear.In our experience, the postauricular SAA pedicled chondrocutaneous flap can be used as an appropriate alternative for the treatment of full-thickness defects of the upper and middle thirds of the ear including the helix.

Antioxidant support in composite musculo-adipose-fasciocutaneous flap applications: an experimental study.

Free radicals are chemicals that play roles in the etio-pathogenesis of ischaemia-reperfusion injury. Various antioxidants have been used in an attempt to mitigate the damage induced by these chemicals. In the present study, the antioxidative effects of grape seed extract (proanthocyanidin), tomato extract (lycopene), and vitamin C (ascorbic acid) on a composite re-established-flow inferior epigastric artery based rectus abdominis muscle-skin flap model on which experimental ischaemia was induced were investigated. The rats have been administered antioxidants for 2 weeks prior to the surgery and for 2 more weeks thereafter. Macroscopic, histopathological, and biochemical analyses were carried out at the decision of the experiment. It was found that flap skin island necrosis was significantly reduced in the proanthocyanidin, lycopene, vitamin C groups (p < 0.001). Statistical analyses showed significant decreases in inflammation, oedema, congestion, and granulation tissue in the proanthocyanidin and lycopene groups compared to the vitamin C and control groups (p < 0.001). When the viability rates of fat and muscle tissues were examined, significant improvements were found in the proanthocyanidin and lycopene groups in comparison to the other groups (p < 0.001). Serum antioxidant capacity measurements revealed significant differences in the lycopene group compared to all other groups (p < 0.001). It is concluded that lycopene and proanthocyanidin are protective antioxidants in rat composite muscle-skin flap ischaemia-reperfusion models.

Risk factors for nosocomial burn wound infection caused by multidrug resistant Acinetobacter baumannii.

Acinetobacter baumannii infections in burn patients may lead to delays in wound healing, graft losses, and development of sepsis. Determining the risk factors for multidrug resistant A. baumannii (MDR-AB) infections is essential for infection control. In the present study, the authors aimed to evaluate risk factors for wound infections caused by A. baumannii in burn patients. The study was conducted at Dicle University Hospital Burn Center, from April 2011 to July 2012, to investigate the risk factors for MDR-AB infections. The data of both the case and control group patients and the result of wound cultures were recorded on a daily basis, on individual forms given for each patient, and analyzed. A total of 30 cases infected with MDR-AB, and 60 uninfected control patients, were included in the study. The mean age (±SD) was 7.7 ± 15.4 years in infected patients and 11.4 ± 16.5 years in uninfected patients. The mean total burn surface area was 13.5 ± 10.9% in uninfected patients and 34.7 ± 16.2% in infected patients. The mean total burn surface area, the abbreviated burn severity index, acute physiological and chronic health evaluation II score, day of admission to hospital, length of hospital stay, first excision day, prior usage of third-generation cephalosporins, and stay in intensive care unit of the infected patients were significantly higher (P < .001) than those of patients without infection. Univariate analysis found that high acute physiological and chronic health evaluation II score, first excision time of wound, invasive device usage, admission day to hospital, and prior usage of broad-spectrum antibiotics were risk factors for nosocomial infections. This study showed that multiple factors contribute to multidrug resistance in A. baumannii. A combination of an early diagnosis of wound infections, appropriate antimicrobial treatments, surgical debridement, and early wound closure may be effective in the management.

Evaluation of the sufficiency of pedicled temporoparietal fascial flap on rat head and neck defects: detailed anatomical study.

The temporoparietal flap containing the temporal fascia has a wide spectrum of applications in head and neck surgery. The aim of this study is to demonstrate a temporoparietal fascial flap model that can be used in various head and neck defects in rats. Ten male Sprague-Dawley rats weighing 250-300 g were used in this study. Temporoparietal fascial flaps were elevated with the axial pedicle from the rats using microsurgical techniques. The arc rotations of the flaps on the pedicles were examined and the dimensions of the defects these flaps could cover were identified. The flaps were observed to be the right size for use with defects of the occipital, temporal and mastoid regions, ear, facial nerve and the mandible. The temporoparietal fascial flap is an experimental flap model, which can be useful in experimental studies related to complex head and neck defects.

Spontaneous bilateral corneal perforation in a patient with ichthyosis.

We present an 8-month-old female patient with bilateral spontaneous corneal perforation and lamellar ichthyosis. On examination, the skin of the body and face of the patient was completely dry and scaly. Cicatricial ectropion and descemetocele with small perforations were seen. Double-layered amniotic membrane transplantation on the cornea with eyelid construction was performed on both eyes. At the 6-month follow-up, lower eyelid minimal ectropion formation and inferior corneal leukoma were seen bilaterally. In ichthyosis patients, the cornea should be monitored closely due to the risk of severe visual loss and corneal perforation.

Evaluation of the effect of thymoquinone treatment on wound healing in a rat burn model.

Thymoquinone (TQ) is a plant extract that has been shown to have antimicrobial, anti-inflammatory, and antioxidant effects. Because of these activities, the authors hypothesized that TQ would reduce inflammation and oxidative stress and accelerate wound closure in a rat model of deep second-degree burns. For the purposes of this study, 40 Sprague-Dawley rats were divided into five groups of eight rats each. Group 1 was the control group, group 2 was the silver sulfadiazine group, group 3 was treated with systemic TQ, group 4 received topical TQ, and group 5 was administered topical and systemic TQ. After the deep second-degree burn damage was created, daily dressing changes and TQ administration were continued in the study groups for a period of 21 days. Systemic TQ was administered intraperitoneally at a dose of 2 mg/kg/day, whereas the topical treatment was applied using a 0.5% solution. The changes in the wound site were observed macroscopically, histopathologically, microbiologically, and biochemically in all groups. The smallest necrotic areas were observed at the end of the study in the groups that were administered a combination of systemic and topical TQ, or solely topical TQ (6.1 ± 1.6 cm and 6.7 ± 0.4 cm, respectively), whereas the largest necrotic areas were observed in the control group (11.2 ± 1.2cm). The total antioxidant state levels in the control group were significantly lower than in the other groups (P < .05), whereas the total oxidative stress levels were lower in the TQ groups compared with the control group (P < .05). The lowest bacterial counts were observed in the groups treated with both topical and systemic TQ (P < .05). TQ given systemically and/or topically reduced inflammation and oxidative stress and accelerated the rate of wound closure or reepithelialization.

Multiple disseminated pyogenic granuloma after second degree scald burn: a rare two case.

Pyogenic granuloma is a benign lesion and usually occurs after trauma. Disseminated pyogenic granuloma, is a rare form of pyogenic granuloma. There are 9 cases of disseminated pyogenic granuloma in literature and most of them are hot milk burns. First case describes an 18- month-old girl who developed disseminated pyogenic granulomas on her right cheek, neck, and right nasal ala. Lesions on her right cheek and neck were excised and sutured primarily. Lesion on right nasal ala was excised and repaired with full thickness skin graft. Second case describes a 7-years- old boy who developed pyogenic granulomas on his left forearm. These lesions were excised and sutured primarily. In both cases lesions were developed after scald burn. During 6-month follow-up, no recurrence was observed in both cases.

Reconstruction of vaginal agenesis with pudendal thigh flaps thinned with liposuction.

AIM: The aim of this study is to describe a technique for and data from vaginoplasty surgeries performed using a pudendal thigh flap (PTF) thinned with liposuction. METHOD: A total of six patients diagnosed with Müllerian agenesis underwent vaginoplasty procedures using this technique between January 2009 and April 2012. The age range of the patients was 19-24 years. In the first stage, the subcutaneous fat tissue under the planned skin flap islands was thinned with liposuction. After 3 months, the second stage of the procedure was carried out and the PTFs were elevated. RESULTS: Complications such as infection, dehiscence of the suture line and haematoma were not observed in any of the patients. Although a partial flap loss was observed at the distal aspect of a flap in one patient, total healing was achieved through debridement and local wound care. Mean tissue flap thickness was found to be thinner, and adequate vaginal depth was achieved in all patients on average 13 months following surgery. CONCLUSION: We are of the opinion that PTFs thinned with liposuction enable both a thinner tissue flap and a vaginal reconstruction that more closely resembles natural anatomy.

Cartilage-supported paramedian forehead flaps for reconstruction of full-thickness nasal defects.

The nose is an important esthetic structure of the human face, and its defects may lead to serious esthetic and functional losses. In the current study, our aim was to present the results of the repairs that we performed using cartilage-supported forehead flaps in patients with full-thickness nasal defects in various locations.Between March 2009 and March 2012, a total of 6 patients with full-thickness nasal defects underwent repairs using cartilage-supported forehead flaps. Among the patients, 4 were women, whereas 2 were male. The median age of the patients was 60.3 (38-67) years. The defects were caused by either tumor excision or burn wounds. Defect areas were at the dorsum of the nose, the medial canthal area, and the distal half of the nose. The repairs in all patients were performed using cartilage-supported median forehead flaps. In the method we applied, to provide framework support, a cartilage graft was placed into the pouch formed between the frontal muscle and the subcutaneous tissue within the flaps to be adapted to the defect area. The patients were followed up for a median period of 11 (4-27) months. In the long-term follow-up of all patients, satisfactory results in terms of the functional and cosmetic outcomes were obtained.Through the technique we applied, a simple and safe repair with adequate framework support and full color and texture harmony is achieved.