Investigating the Effect of Korean Red Ginseng on the Viability of Random-Pattern Skin Flaps in Rats.

OBJECTIVE: This experimental study investigated the efficacy of Korean Red Ginseng (KRG) extract in reducing the partial losses of random flaps. METHOD: Forty Wistar Albino rats were randomly distributed into 4 groups as (A) control group, (B) stress group, (C) oral KRG group, and (D) intraperitoneal KRG group. The modified McFarlane flap of 9 × 3 cm with a caudal pedicle was harvested from the back of the rats in all the groups. Korean Red Ginseng was administered to groups C and D at standard doses for 10 days. After 10 days, the flaps were removed in all groups and were examined macroscopically, histopathologically, histochemically, and biochemically. The results were statistically analyzed and compared among the groups. RESULTS: The flap necrosis rates were significantly lower in groups C and D compared with groups A and B (P < 0.05). The vascular density, antioxidant activity, and hypoxia-inducible factor-1α levels were significantly higher in the groups C and D compared with the groups A and B (P < 0.05). Although vascular density, hypoxia-inducible factor-1α, and catalase levels were negatively correlated with the flap necrosis rates, there was a significantly positive correlation between malondialdehyde and necrosis rates. CONCLUSIONS: Korean Red Ginseng increases the viability of random pattern skin flaps, resulting in reduced rates of distal necrosis. Korean Red Ginseng has antioxidant activity and increases neovascularization.

Functional assessment of autologous platelet-rich plasma (PRP) after long-term storage at -20 °C without any preservation agent.

BACKGROUND: Platelet-rich plasma (PRP) is increasingly being used in the treatment of chronic wounds, pathologies of the musculoskeletal system, and in cosmetic medicine; however, the preparation of platelet-rich plasma is both time-consuming and requires invasive intervention. Additional costs are introduced if special equipment is used during preparation. The aim of the present study is to test whether autologous platelet-rich plasma (PRP) preserves the feature of growth factor release when stored at -20 °C after preparation. METHOD: Autologous PRP concentrates were prepared using whole blood samples obtained from 20 healthy subjects and divided into three parts to form three groups. Epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), platelet derived growth factor-AB (PDGF-AB), insulin-like growth factor 1 (IGF-1), transforming growth factor-beta (TGF-ß), and P-Selectin levels were immediately analysed in the control group. The other groups were defined as the experimental groups and were stored at -20 °C and analysed on the 7th and the 14th days. The same growth factors were tested in the experimental groups. RESULTS: The growth factors (EGF, VEGF, PDGF-AB, IGF-1, TGF-ß) and P-selectin levels were significantly decreased in the autologous PRP samples stored at -20 °C compared to the control group. CONCLUSION: The growth factor levels on days 7 and 14 suggest that autologous PRP can be stored at -20 °C without preservative agents, although in vivo studies are required in order to evaluate the clinical efficacy of the detected growth factor levels.

Retromandibular transparotid approach to mandibular subcondylar and high ramus fractures: two-point fixation.

BACKGROUND: Although the fractures of the mandibular condylar region are very common, the controversies about the treatment of this area is still ongoing. In recent years, general agreement has emerged that open treatment is more effective than closed approaches for extracapsular condylar fractures. However, this time, the method of surgical approach has become controversial. The aim of this study was to evaluate the effectiveness of the retromandibular transparotid approach for the fixation of subcondylar/high ramus mandible fractures. METHODS: Subcondylar/high ramus mandible fractures were operated via the retromandibular transparotid approach with a two-point fixation in 24 patients. The patients were evaluated for bleeding during the operation and for hematoma, infection, Frey's syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site, hypoesthesia of the ear, and temporomandibular (TME) joint movements in the postoperative period. RESULTS: Only one major complication was encountered in one (4.1%) patient, which was damage to the temporal branch of the facial nerve. CONCLUSION: The retromandibular transparotid approach appears to be a safe and effective method for the internal fixation of extracapsular condylar fractures.

Platelet-Rich Fibrin Improves the Viability of Diced Cartilage Grafts in a Rabbit Model.

BACKGROUND: Diced cartilage may be wrapped with synthetic or biological materials before grafting to a recipient site. These materials have unique advantages and disadvantages, and a gold standard is not available. OBJECTIVES: The authors investigated the effects of platelet-rich fibrin (PRF) on the survival of cartilage grafts in a rabbit model. METHODS: In this experimental study, diced cartilage pieces from the ears of 9 male rabbits were left unwrapped or were wrapped with PRF, oxidized regenerated cellulose, or fascia. Specimens then were placed into subcutaneous pockets prepared on the backs of the rabbits. The animals were sacrificed 2 months after the procedure, and the grafts were excised for macroscopic and histopathologic examination. RESULTS: The cartilage graft wrapped with PRF showed superior viability compared with the cartilage graft wrapped with oxidized regenerated cellulose. No significant differences were found among the other groups. The groups were not significantly different in terms of rates of inflammation, fibrosis, or vascularization. CONCLUSIONS: PRF enhances the viability of diced cartilage grafts and should be considered an appropriate biological wrapping material for cartilage grafting.

Use of dorsal intercostal artery perforator flap in the repair of back defects.

BACKGROUND: The dorsal intercostal artery perforator (DICAP) flap is a well-vascularised flap that is elevated above the dorsal branch of the vertebral segments of the posterior intercostal artery. The aim of this study was to repair back defects using DICAP flaps. MATERIALS AND METHODS: Eight patients who had undergone reconstruction with DICAP flaps for defects located on the back of the torso due to conditions of various aetiologies between 2011-2014 were included in this study. Patient age and gender, aetiology of the condition, dimensions of the defect and the flap, site of the defect, and postoperative complications were recorded. RESULTS: Three females and five males were included in this study. The age of the patients ranged between 19-71 years (mean = 53.6 years). The aetiology was skin tumour in five patients and pressure wound, gunshot injury, and plate screw exposition subsequent to spinal surgery in one patient each. The sites of the defects were successfully closed in all patients, and no flap loss was observed in any patient. CONCLUSIONS: DICAP flaps have some advantages compared to conventional muscle and muscle skin flaps, such as greater protection of muscle functions, less invasiveness, and lower donor site morbidity. This flap has a high mobilisation capacity due to its elevation above nine bilateral perforator arteries. Therefore, the DICAP flap is useful for the repair of median and paramedian back defects. Based on its advantages, it is suggested that the DICAP flap should be considered as a useful option for the repair of back defects.

Congenital Lateral Cleft Palate of Unknown Etiology.

The term cleft palate (CP) refers to midline defects extending from the prealveolar ark to the uvula, and these defects present with varying degrees. CP may be complete, incomplete, unilateral, bilateral, or submucosal. It is often observed with cleft lip (CL). In various studies, the incidence of isolated CP has been reported as 1.3 to 25.3 per 1000 births. As a result of deterioration of the anatomical structure of the palate, illnesses such as regurgitation, respiratory tract infections, otitis, and speech disorders may occur. These defects are often observed in the midline and are rarely laterally localized. Cleft palates with lateral localization are outside the natural midline cleft closure line and cause clinical complaints similar to other types of CP. Two cases of laterally localized CP have previously been published in the literature. The case presented here is the third known case to be reported.

Technical details of rotation palatoplasty in patients with Veau 1 cleft palate.

In cleft palate repair, elongation of the cleft toward the posterior is critically important to prevent velopharyngeal insufficiency. The purpose of many cleft palate repair techniques has been to ensure this elongation. Rotational palatoplasty is a recent cleft palate repair technique. In this technique, the soft palate is transformed into a rotational flap to allow the palate to elongate in patients with a cleft palate. This technique, which is used in all types of cleft palate and velopharyngeal insufficiency, is easy to use, practical, and efficient, especially in patients with a Veau 1 cleft palate. The aim of this study was to explain the technical details of the rotation palatoplasty technique in Veau 1 cleft palate with the aid of figures.

Comparison of the fistula risk associated with rotation palatoplasty and conventional palatoplasty for cleft palate repair.

OBJECTIVES: The aims of the cleft palate repair techniques are to reduce the velopharyngeal insufficiency risk and oronasal fistula development to minimal levels without affecting the maxillofacial development. In this article, we present a retrospective study comparing the conventional palatoplasty techniques with the new technique of rotation palatoplasty for the risk of development of oronasal fistula. MATERIALS AND METHODS: Of the 100 patients who were operated on because of cleft palate between the years 2002 and 2008, 12 patients had Furlow palatoplasty, and 88 patients received the Veau-Wardill-Kilner (V-Y pushback) operation (group C). A total of 67 patients who were operated on between 2008 and 2011 had rotation palatoplasty (group R). RESULTS: One hundred patients were men, and 67 were women. Among all the patient groups, 22.8% were classified as Veau 1, 24.6% were classified as Veau 2, 37.1% were classified as Veau 3, and 15.6% were classified as Veau 4. The rate of fistula was found to be 17.7% in all patients. Fistula development was found in 6% of the patients in group R (4/67) and in 18% of the patients in group C (18/100). The difference between group R and group C regarding the number of patients who developed fistula was statistically significant (P = 0.011). CONCLUSIONS: The Veau classification of the cleft palate affects the risk of fistula development, and the risk for fistula after rotation palatoplasty is lower than that associated with the V-Y pushback technique.

Technical details concerning myomucosal advancement method in the repair of large lower lip defects.

The most important decision that a surgeon has to make in large lower lip defect reconstruction is whether to use a free flap or local flap. Despite efficient transplantation, serious cosmetic problems can occur in total or in near-total lower lip reconstruction with a free flap. On the other hand, better cosmetic results can be brought about in reconstructions with local flaps when a repair is made in tissues with similar properties in terms of color, thickness, or pilosity. However, functional problems such as microstomy can be encountered when inefficient transplantation is carried out during local flap repairs. If a repair technique with local flap that enables efficient transplantation can be applied, satisfactory cosmetic as well as functional results can be provided. In this text, the technical details of the myomucosal advancement flap method, which is a successful functional local flap application with good cosmetic results, were reported and explained with the help of schematic drawings.

Removal of metallic foreign bodies embedded in soft tissues by stereotaxic approach.

BACKGROUND: A trial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke and death. Patients with hypertensive have an increased risk of developing atrial fibrillation. RDW (Red blood cell distribution width) levels are elevated in cardiovascular disorders including heart failure, stable coronary disease, acute coronary syndrome, slow coronary flow and stroke. OBJECTIVE: To investigate the relation between RDW and AF in patients with hypertensive. METHOD: We retrospectively examined 126 consecutive hypertensive patients (63 hypertensive patients with AF and 63 hypertensive patients without AF matched with age and sex. RESULTS: The mean age of the study population was 71,09± 8,50 (af group) and 70,97±8,24 (non-af group) years. RDW level was different among patients with atrial fibrillation and without atrial fibrillation.(15,13±1,58 and 14,05±1,15 p<001). Logistic regression analysis showed that RDW and left atrial dimension were only independently risk factory associated with atrial fibrillation. (Rdw odds ratio:1,846 CI; 1,221-2,793 p<0,05). Roc curve analyses were applied to determine the cut-off point. Cut-off point was at 14,195 and Sensitive, specificity was %71,4, %56 respectively. CONCLUSION: RDW levels were higher in hypertensive patients with atrial fibrillation. An increased RDW level in the patient with hypertension may alert physician on developing or presence of atrial fibrillation.

Effect of brow lifting using botulinum a toxin on upper eyelid height in patients with ptosis undergoing the frontal sling technique.

In this study, brow lifting with botulinum A toxin was performed on patients whose ptosis was corrected using the frontal sling technique, and the effects of this application on ptosis were investigated. Seven patients (with 12 eyelids) on whom the frontal sling procedure was performed using a tensor fascia lata graft were enrolled in the study. The patients underwent brow lifting using botulinum A toxin. Digital photographs of the patients were obtained before and 21 days after botulinum A injection. In digital imaging analysis, although a statistically significant elevation was detected in the eyelids and brows of the patients following botulinum A injection, it did not to lead to a significant difference in the degree of lagophthalmos. In the current study, this procedure was found to reduce the degree of ptosis without increasing the degree of lagophthalmos in patients who had previously undergone ptosis correction using the frontal sling.

Hunter's technique without Hunter's rod.

Silicon rods initially advocated by Hunter have been widely used in two-stage flexor tendon reconstruction. Two-stage tendoplasty is an expensive procedure; with the addition of the high cost of rods, it is still more expensive. An experimental study investigated cheaper alternatives to silicon rods, but no clinical studies seem to have been reported so far. This study involved 17 patients undergoing two stage flexor tendon grafting. In all fingers, silicon urinary catheters were used as tendon prosthesis. The Wehbe et al modification of the Boyes and Stark classification was used for preoperative classification and Strickland formulation and Buck-Gramcko criteria for postoperative analysis. This clinical study showed that comparable clinical results and proper pseudosheaths for tendon grafting with similar histological and physical features can be obtained using a silicon urinary catheter which is fifty times less costly than Hunter's rod.

Presence of accompanying head injury in patients with maxillofacial trauma.

BACKGROUND: Patients with maxillofacial fractures are at high risk of accompanying traumatic cranial injuries. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery. METHODS: The records of 246 patients with maxillofacial fractures referred to the emergency department of our hospital between January 2006 and September 2009 were reviewed in this retrospective study. The patients' age and gender, cause, type and location of the maxillofacial fracture, and the cranial injuries were analyzed. RESULTS: The mean age of the patients was 23.61±16.75 years (83.3% males and 16.7% females). Cranial injury was observed in 38 patients with maxillofacial trauma. While the risk of head injury was found to be 3.44-fold lower among patients with single facial bone fracture (p<0.001), the risk of experiencing head injury significantly increased in patients with multiple facial bone fractures (p<0.001). The risk of head trauma significantly increased in patients with fractures of the nasal bone, maxillary bone, mandibular bone, and with frontal region fractures (p<0.05 in each group). CONCLUSION: The patients with multiple facial bone fractures should be investigated with regard to head injury even if they do not have clinical findings.

Is the coexistence of intraoral synechia and cleft palate anomaly a sequence?

Intraoral synechia is a rarely seen intraoral anomaly. As a result of intraoral synechiae, fusion of the palatal shelves may be prevented because of the abnormal interposition of the tongue. Hence, cleft palate anomaly accompanies intraoral synechiae in many patients. The main problem for these patients is the inadequate oral opening for feeding. Flexible nasopharyngeal examination before intubation may help the anesthetist for simple excision of synechiae in the newborn period. In this article, a newborn who had a congenital synechia between the mandible and the maxilla has been presented, and the etiopathogenesis of intraoral synechia and the importance of flexible nasal endoscopy before endotracheal intubation are discussed.

Kutlay technique for hypospadias repair.

OBJECTIVE: Although many techniques have been described, new techniques with a wide range of therapeutic options are needed. The Kutlay technique is a novel technique that is based on the reconstruction of the neourethra with two horizontal meatal-based skin flaps. In the present study, the data of 31 patients who underwent surgery with the Kutlay technique are presented. PATIENTS AND METHODS: Thirty-one patients with hypospadias with an average age of 5.6 years who did not have previous hypospadias repair were operated on with the Kutlay technique. Ten patients had chordee. Among those patients, three patients were circumcised. RESULTS: The patients were followed up for 4-13 months (average, 9.3 months). During the follow-up period, a fistula was observed in only one patient. None of the patients developed neourethral dehiscence, meatal stenosis, urethral stricture, wound infection, penile torsion, hematoma, or persistent or recurrent chordee. On uroflowmetry studies, the maximum flow rate of the patients was approximately 10.5 ml/s (range, 6-17 ml/s). The patients were observed to void with a single straight urinary stream in a forward direction. CONCLUSION: The Kutlay technique is a technique that is easily applied in patients with chordee and that provides a low risk of fistulas and acceptable functional and esthetic results. The factors that reduce the risk of fistula are the lack of the superposition of the suture lines of the skin and the urethra, the reconstruction of the urethra with well-vascularized flaps, and the replacement of the neourethra in its appropriate location through the tunnel created in the glans.

Upper extremity injuries due to threshing machine.

BACKGROUND: The aim of this study was to report the patients who were admitted to our hospital with upper extremity injuries due to threshing machine, to determine the most appropriate classification, to estimate the treatment modalities, and to discuss the prevention methods. METHODS: Twenty-five patients who had suffered injuries sustained by a threshing machine were retrospectively investigated. The patients were analyzed with respect to age, gender, admission month, hospitalization period, the type of injured tissue, and the treatment modality. RESULTS: Twenty-four of the patients were male and one was female, and the mean age of the patients was 19.4 (2-51) years; 60% of the patients were under the age of 15. The patients were admitted most commonly in the month of August. CONCLUSION: We believe that shielding the rotating components of farming machinery that cause injuries, informing and educating farming families (by physicians), forbidding the entrance of children to areas with agricultural machines, providing information to children in schools (in those regions with developing agriculture) about agricultural accidents and their prevention methods, and adjusting the working hours of farming personnel, especially in the hottest months of the year, may be beneficial in preventing accidents due to farming machinery.

Clinical outcomes of suture delay in forehead flap.

The delay phenomenon is a surgical procedure performed to raise a wider skin flap and to improve the survival of skin flaps. Surgery, chemicals, sutures, and lasers can be used for the delay procedure. In this study, delayed forehead flaps created by suturing were used for coverage of nasal skin defects in eleven patients. In 7 patients, the cross-paramedian forehead flap was used to increase the extent of flap lengthening. In the first session, suture delay was performed on both sides of the forehead flap margin. In the second session, the flap was elevated and sutured to its new position, 7 to 10 days after the initial surgery. All flaps were completely viable, and patient satisfaction was optimal in all cases. The positive effect of surgical delay on flap survival has been shown in experimental and clinical studies. However, experimentally, suture delay or chemical delay procedures have been shown to be beneficial in flap survival only. Suture delay seems to be an inexpensive, effective, easily performed, atraumatic, and safe technique, especially among patients with systemic diseases such as diabetes or cardiovascular diseases, smoking patients who may lose the flap, or patients who need very wide and long flaps.

Reconstruction of lower lip with myomucosal advancement flap.

BACKGROUND: In this article, a new surgical procedure that can be used for reconstruction of lower lip defects of any size is described. METHODS: In this prospective study, the surgical procedure was applied in 16 patients. In this procedure, the mucosa and the orbicularis oris muscle of the lower lip are repaired with a composite flap, and the skin defect is closed using local skin flaps. The patients were assessed in terms of complications, mouth opening, sphincter function of the mouth, and sensation in the lower lip. RESULTS: The aesthetic results obtained in all patients were satisfactory. Sufficient oral sphincter function was achieved in all patients. CONCLUSION: Reconstruction of lower lip defects using the procedure described here can be performed in patients with lower lip defects of any size as long as the mucosal and skin repair lines are not superimposed. This procedure yielded good sphincter function and aesthetic results.

Island volar advancement flap for reconstruction of thumb defects.

BACKGROUND: The volar advancement flap of the thumb described by Moberg has been used for pulp defects up to 1 to 1.5 cm since its mobility is quite limited due to the stiff nature and fibrous connections of the regional skin with underlying structures. There have been several attempts to increase the mobility of this useful flap by adding V-Y and Z-plasty concepts into the technique. These modifications could provide a slight increase in the flap advancement and achieve closure of defects up to 2 cm in length at best. METHODS: In this study, we describe the island volar advancement flap of the thumb in which all attachments, except the neurovascular pedicle of the flap, were divided to provide maximum mobility and advancement. This technique was used in 12 patients for reconstruction of traumatic defects of the distal thumb up to 3 to 3.5 cm in length. RESULTS: The flaps healed uneventfully in all patients. There was no patient with flap failure. All patients were followed up for 2 to 6 years (4 years on an average). Our results revealed sensible and durable skin coverage with maximum preservation of the thumb length. CONCLUSIONS: The island volar advancement flap seems to be a safe and useful procedure for thumb reconstruction. Providing a 1.5 cm of extra flap advancement, this new procedure enables us 1-stage closure of considerably large defects and is a critical achievement in thumb reconstruction.