Electrocardiographic changes after breast reduction surgery.

Macromastia is associated with symptoms related to postural changes and decreased mobility. Breast reduction surgery (BRS) is the treatment of choice for these patients. Anatomical and structural changes in body posture and habitus might cause changes in electrocardiography (ECG). In this study, we aimed to evaluate the outcome of BRS on ECG changes of the patients after surgery. Study population included 33 female patients who had undergone BRS. ECG records of every patient before procedure and 6 months after procedure were analyzed retrospectively. Patients were naïve of known cardiac diseases and the patients did not have any known arrhythmia. The mean age of the study population was 40.8 ± 9.6. Total removed breast tissue from both sides was 1493 (1052-2138) mL, as 800 (513-1093) mL removed from right side and 740 (519-1050) mL removed from left side. There were significant changes in ECG of the patients in post-operative period. Atrial conduction parameters such as, PR duration (p<.001), Pmax duration (p<.001) and P wave dispersion (p<.001) were significantly decreased post-operatively. Additionally, ventricular conduction parameters such as, TPe duration (p<.001), TPe/QT (p=.013) and TPe/QTc (p=.005) ratios were found significantly decreased in ECGs of the patients. BRS as a treatment for macromastia does not only improve posture and mobility of the patients and also have positive impact on cardiac conductions. In patients those had BRS, atrial and ventricular conductions detected by ECG recordings were improved after surgery.

Electromyographic and Clinical Investigation of the Effect of Platelet-Rich Plasma on Peripheral Nerve Regeneration in Patients with Diabetes after Surgery for Carpal Tunnel Syndrome.

Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Studies have shown that results of CTS surgery are poorer in patients with diabetes. In this study, the effect of platelet-rich plasma (PRP) on nerve regeneration was investigated through clinical and electromyographic findings in patients with diabetes who underwent CTS surgery. Methods A retrospective analysis of 20 patients with diabetes who had surgically decompressed CTS was conducted. Patients were divided into two groups. The study group received PRP treatment following surgery. The control group did not receive any treatment. Patients were assessed using electromyography and the Boston Carpal Tunnel Syndrome Questionnaire preoperatively as well as postoperatively at 3-month, 6-month, and 1-year follow-ups visits. Results There was a decrease in complaints and an improvement in sensory and motor examinations in both groups. The Boston Carpal Tunnel Syndrome Questionnaire scores did not show any statistically significant differences between the two groups. However, electromyographic findings showed that there were statistical differences between preoperative and postoperative (3 months, 6 months, and 1 year) results in both groups. When the two groups were compared using preoperative and postoperative (3 months, 6 months, and 1 year) electromyographic values, no statistically significant differences were seen. Conclusion Single injections of PRP did not have a significant impact on median nerve regeneration following CTS surgery in patients with diabetes. The effectiveness of multiple PRP injections can be investigated in patients with diabetes in future studies.

Kaposi's sarcoma management from a plastic surgery perspective.

AIM OF THE STUDY: Kaposi's sarcoma (KS) is a low-grade angioproliferative tumor arising from endothelial cells and associated with Human Herpes Virus 8 infection. Although there are considerable number of patients referred for surgical excision, the plastic surgery literature on KS is exceptionally scarce. In this study, it was aimed to emphasize the differences in the management of Kaposi's Sarcoma and help to understand the importance of a multidisciplinary approach, accordingly the sake of choosing the ideal treatment method for each lesion. MATERIALS AND METHODS: Thirty patients who were operated with the diagnosis of KS between March 2015 and January 2020 were included. Preoperative HIV tests and detailed whole-body examinations of the patients were performed. As a surgical method, for lesions with sizes ranging from 0.5 * 1 cm to 2 * 3 cm, excisions were made over the deep skin fascia by placing a margin between 0.5-1 cm, considering the anatomical location and elasticity of the skin. RESULTS: Primary repair was performed in 23 patients (40 lesions) and 12 lesions of 8 patients were repaired with a skin graft. In four patients the repair was performed with local skin flaps. In a patient with a lesion on the finger, the defect that occurred after the excision of the lesion was repaired with a pedicled regional flap. CONCLUSIONS: One-stage surgical excision of the lesions provides remarkable advantages, compared to the therapies such as radiotherapy, laser, or chemotherapy which require several administrations.

Kaposi's sarcoma is a vascular tumor with five different clinical forms. The lesions in Kaposi's sarcoma are seen in the skin, oral mucosa, lymph nodes, and visceral organs. Most patients present with cutaneous lesions. In our study, surgical excision is performed for 57 cutaneous lesions of 30 patients. When we compared with literature data, higher upper extremity involvement, less systemic involvement and less pronounced male predominance were considerable differences. A multidisciplinary approach and the ideal treatment method for each lesion has remarkable importance in KS management.

The efficacy of angiotensin-converting enzyme inhibitors in preventing postoperative tendon adhesion formation: An experimental study in rats.

OBJECTIVE: The aim of this study was to investigate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) in preventing postoperative tendon adhesion formation in a rat model of Achilles tendon repair. METHODS: In this study, 60 Sprague-Dawley male rats weighing 300 to 350 g were used. Rats were randomly divided into six groups (n = 10 per group): control-1, control-2, sham-1, sham-2, experiment-1, and experiment-2. The same surgical procedure was performed in all rats; a full thickness Achilles tenotomy was performed, and the tendon was repaired using a modified Kessler suture. Enalapril (10 mg/kg/day) was orally given to the Experiment-1 and Experiment-2 groups for three and six weeks, respectively. Thirty rats were sacrificed at three weeks (Control-1, Sham-1, Experiment-1); the remaining 30 rats were sacrificed at six weeks (Control-2, Sham-2, Experiment-2). Then, macroscopic, biomechanical, and histologic investigations were performed. RESULTS: Adhesion degree was found macroscopically lower in the Experiment-1 and 2 groups than others. In the histologic examination, the fibrosis level was found the lowest in the Experiment-2 group. Biomechanical evaluation indicated that mean maximum resistance before tendon rupture was significantly higher in the Experiment-2 group than in other groups. CONCLUSION: Evidence from this study has shown that ACEIs can decrease fibrosis and tendon adhesion during tendon recovery in rats due to their antifibrotic effects as the result of Angiotensin-II suppression.

Vertical Medial Thigh Lift with the 'Anchor L Liposculpture' Technique in Massive Weight Loss Patients: Preliminary results.

BACKGROUND: Among all post bariatric surgical procedures, vertical thigh lift has the highest complication rates. Many modifications have been described to achieve better aesthetic results and decrease complication rates. The study aimed to present ''Anchor L Liposculpture Technique'' and discuss the results in the light of current literature. METHOD: Between 2016 and 2020, 33 patients were operated with the Anchor L Liposculpture technique. In this technique, liposuction is performed similarly with the other techniques, but the liposuction area is not extended to posterior or anterior compartments to prevent complications. The technique also used a deepithelized flap to anchor the superficial fascial system to the pubic arch periosteum. The patients' characteristics (age, sex, body mass index, smoking history, amount of weight loss, comorbidities) volume of liposuction and postoperative complications were recorded. Results were compared between uncomplicated (group A) and complicated patients (group B). RESULT: Six (n=6, %18.2) out of 33 patients experienced complications (Group B). There were no major complication. The most common complications are wound dehiscence (n = 2) and lymphocele (n = 2). All complication cases managed conservatively. Age and amount of liposuction were found to be statistically associated with increased complications. Other comparisons between group A and B did not show any significant difference. Scar migration was not observed in any patient during follow-up. CONCLUSION: Anchor L Liposculpture technique is an easy-to-apply and reliable technique aimed better surgical results and lower complication rates. Surgeons especially at beginning of the learning curve or who experienced high complication rates can utilize this technique. 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 .

Reversed First Dorsal Metatarsal Artery Island Flap for First Ray Defects.

Reconstruction of the first ray is challenging because of poor skin laxity, bone and tendon exposure, and limited local flap options. Repair using full- or split-thickness skin grafts is generally not an option because of the bone and tendon exposure. Reconstructive options using local flaps from the distal foot area are restricted owing to insufficient soft tissue. Many reconstructive options have been described to overcome these difficult situations. We present 2 cases in which the great toe and first ray defect were repaired using a reversed first dorsal metatarsal artery island flap. The findings from these clinical cases and anatomic studies have shown that the reversed first dorsal metatarsal artery island flap is an alternative and suitable option for reconstruction of soft tissue defect of the distal foot, especially first and second ray defects, because it is thin and simple, has anatomic characteristics similar to those at the recipient site, and results in minimal donor site morbidity.

The Use of Submental Artery Perforator Island Flap Without Including Digastric Muscle in the Reconstruction of Lower Face and Intraoral Defects.

PURPOSE: For reconstruction of intraoral and lower face defects, it is important to use flaps that prevent reliable and pliable soft tissue and it is possible to use aesthetically most compatible with recipient site. In this study, the authors aimed to present their clinical experiences and results of lower face and intraoral defects reconstructions with submental artery island perforator flap without including the digastric muscle to have a thinner and useful flap. METHODS: Six patients with lower face and intraoral defects that were reconstructed using the submental artery island flap between November 2013 and February 2015 were retrospectively analyzed. Patient demographics, age, sex, defect etiologies, and complications were assessed. SURGICAL TECHNIQUE: Hand Doppler examination was performed and submental artery marked preoperatively. The superior border of the flap was designed at least 1 cm away from the mandibular border to avoid injury to the marginal mandibular nerve and prevent lip eversion. After the identification of the submental artery via the retrograde dissection, the anterior belly of the digastric muscle was not included the flap to prevent a thinner flap. After the dissection, the island flap was transferred to the defect site through a subcutaneous tunnel. The donor sites were closed primarily. RESULTS: A partially flap necrosis was occurred in 1 patient due to hematome in the tunnel around the pedicle. The wound healed uneventfully with conservative management. In the remaining patients there were no complications. CONCLUSION: The submental artery perforator island flap without including the digastric muscle is a reliable and suitable option for the medium-sized defects in the lower face and intraoral defects.