Reconstruction of Orbital Floor With Auricular Concha.

Orbital floor fractures of varying sizes commonly occur after orbital injuries and remain a serious challenge. Serious complications of such fractures include enopthalmos, restriction of extraocular movement, and diplopia. There is a dearth of literature that can be applied widely, easily, and successfully in all such situations, and therefore there is no consensus on the treatment protocol of this pathology yet. Autogenous grafts and alloplastic and allogenic materials with a wide variety of advantages and disadvantages have been discussed. The value of preoperative and postoperative ophthalmological examination should be standard of care in all orbital fracture patients. An ideal reconstructed orbital floor fracture should accelerate the restoration of orbital function with acceptable cosmetic results. Management parameters of orbital fractures such as timing of surgery, incision type, and implant materials, though widely discussed, remain controversial. In this study, 55 patients with orbital floor fractures surgically reconstructed with conchal cartilage grafts between 2008 and 2014 were retrospectively evaluated. Complications and long-time follow-up visit results have been reported with clinical and radiographic findings. The aim of this study was to present the authors' clinical experiences of reconstruction of blow-out fractures with auricular conchal graft and to evaluate the other materials available for use.

A rare type of burn injury due to butane gas inhalation.

BACKGROUND: Abusive inhalation of butane gas is becoming a serious public health problem among teenagers and young adult population; however, there has been little reporting on explosion burns associated with abuse of butane cigarette lighter fluid. METHODS: Retrospective study was conducted of 22 patients who were burned in last 2 years in explosion of butane gas, a flammable, odorless, and colorless aliphatic hydrocarbon. RESULTS: Details of sociodemographic profile of the patients, any underlying psychiatric illness, alcohol abuse, depth of burn injury, any associated injury, duration of hospitalization, and percentage of burned area were recorded and analyzed. CONCLUSION: All of the patients were young men, and most had superficial burn injury. Hospital stay ranged from 0 to 11 days. All of the patients were treated with conservative management.

Omega (Ω) Advancement Flap: A Circular Flap Design for the Aesthetic Closure of Circular Skin Defect.

BACKGROUND: Most skin defects that require reconstruction with a local skin flap have a circular- or oval-shaped pattern. The majority of the skin flaps are planned in an angled shape. Therefore, it may be necessary to modify the shape of the defect or the distal flap border to minimize tissue distortion. We have designed a circular-shaped advancement flap to be compatible with the circular defect. METHODS: Eighteen cases of reconstruction of skin defects in the face, chest wall, hand and buttock area were performed using the omega advancement flap between 2010 and 2014. In this technique, a circular-shaped flap that has an equal diameter with the defect is planned adjacent to the defect. To facilitate the advancement of the flap and to avoid standing cones, deepithelialized equilateral triangular flaps are designed on both sides of the main circular flap. The circular flap is easily moved to the defect by pulling of the triangular flaps with minimal tension. RESULTS: All flaps survived without complication such as infection, hematoma or flap necrosis. No secondary surgery was required to correct contour deformities such as standing cones and trap-door deformities. The results were satisfactory aesthetically and functionally. CONCLUSIONS: The omega advancement flap is an easy and reliable procedure for reconstruction of circular skin defects located on various anatomical regions. 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 .

The protective effect of cilostazol on transverse rectus abdominis myocutaneous flap in rats.

OBJECTIVE: Transverse Rectus Abdominis Myocutaneous (TRAM) flap is commonly used in breast reconstruction. The aim of this study is to demonstrate the effects of cilostazol on TRAM flap viability in a rat TRAM model. METHODS: Twenty-four Wistar rats were used. They were divided into four groups. Rats in Group 1 were applied TRAM flap. In Group 2, cilostazol 30 mg/kg was administered to rats via oral gavage 3 hours before the flap surgery. After the flap surgery, cilostazol 30 mg/kg was administered via oral gavage twice a day for 7 days. In Group 3 before the flap surgery, cilostazol 30 mg/kg was administered via oral gavage twice a day for 7 days, and treatment continued for 7 more days after the flap surgery. In Group 4 before the flap surgery, cilostazol 30 mg/kg was administered via oral gavage twice a day for 7 days and treatment was discontinued after the flap surgery. RESULT: The mean necrosis rate in Group 1 was 41.69%, in Group 2 it was 27.0%, in Group 3 it was 6.66%, and in Group 4 it was 11.2%. The necrosis rate in Group 1 was found to be statistically significantly higher than other groups (p < .01), the necrosis rate in Group 2 was found to be statistically significant higher than Groups 3 and 4 (p < .01), and the necrosis rate in Group 4 was found to be statistically significant higher than Group 3 (p < .01). CONCLUSION: Cilostazol treatment seemed to increase the viability of TRAM flap, especially when administered as adjuvant therapy.

Correction of pincer nail deformity with dermal flap: a new technique in pincer nail deformity surgery.

Pincer nail deformity is the extreme, transverse, proximal-to-distal overcurvature of the finger, caused by osteophyte of the distal phalanx, and causing clamp effect on soft tissues and nail ingrowth. We report a new technique consisting of removal of the osteophyte causing clamp effect. Depressed areas of both side of the nail bed (lateral nail fold) were corrected with dermal flaps prepared from the side. Depressed areas were filled by these flaps, creating a smooth surface for the nail bed, and adequate correction was obtained.

Pincer Flap for Reconstruction of Nasal Tip Defects.

INTRODUCTION: Reconstruction of the nasal tip defects is challenging because of variable contours of the region and the unique texture, thickness, color, and limited amount of available skin. There are several well-known local flaps for this purpose. Unfortunately, most of these flaps are suitable for small sized defects up to 2 cm in diameter. In this study, the authors are presenting a new flap for reconstruction of nasal tip and supratip defects larger than 2 cm in diameter. METHODS: Pincer flap was used for reconstruction of nasal tip defects in 12 patients, between 2011 and 2014. The mean age was 67 (43-88). All patients had a basal cell carcinoma. Defects were located at the central nasal, lateral nasal, and supratip areas. All tumors were excised with safe margins. After the excision, defects were reconstructed with pincer flap in the same session. RESULTS: The mean follow-up period was 11 (6-18) months. There was not any flap loss. Infection and venous congestion was observed in 2 patients but the patient did not require any further surgical intervention, and healed with local and systemic antibiotherapy. No recurrence occurred and the outcome was aesthetically favorable. CONCLUSIONS: The authors concluded that pincer flap is reliable and may provide a single-stage reconstruction for the nasal tip defects larger than 2 cm and up to 3 cm in diameter.

Intranasal Extramucosal Access: A New Access for Lateral Osteotomy in Open Rhinoplasty.

BACKGROUND AND OBJECTIVE: Different accesses have been used to perform lateral osteotomies in rhinoplasty. All of them have some disadvantages. The aim of this paper was to report a new access to overcome drawbacks of the other techniques in lateral osteotomy during open rhinoplasty. METHODS: An anatomical study was designed to search possibility of intranasal extramucosal access (open sky access) for the lateral osteotomy in open rhinoplasty. It was performed directly on the lateral wall of piriform aperture, and then possible advantages of this technique were investigated. Five fixed cadavers were used for this purpose. No drawbacks were observed during procedure in cadavers. Then the same procedure was performed in 23 consecutive rhinoplasty patients. Nineteen operations were primary and 4 operations were secondary. Median oblique osteotomies were added to the procedure in all patients. The mean follow-up was 17 months. RESULTS: Intranasal extramucosal access during lateral osteotomy was easily performed in all patients. Hemorrhage due to angular vessel injury was not occurred during intraoperative period. Edema and ecchymosis was minimal. Intranasal examination did not show any sign for nasal mucosal tearing in all patients. Residual bone spurs or bone irregularities were not observed in any patients. CONCLUSION: Intranasal extramucosal access that produces precise, predictable, and reproducible aesthetic and functional results could also provide better exposure during lateral osteotomy. Additionally, open sky access minimizes scars because it does not need additional incisions on the skin and mucosa. Protection of the internal periosteum of the nasal bones may be the main advantages of this technique.

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.

Comparison of Subciliary Approaches in Orbito-Zygomatic Fractures: Skin Flap Versus Skin-Muscle Flap.

BACKGROUND: Because of the complications of classical subciliary incision, some modified subciliary approaches have been described in recent literature. OBJECTIVES: The aim of this study was to compare 2 commonly used subciliary approaches according to development of postoperative complications (scar formation, and ectropion). MATERIALS AND METHODS: Ninety patients were included in this retrospective study. Subciliary skin flap technique (SF group) was performed to 39 patients, while the others were operated by using skin-muscle (stepped) flap technique (SMF group). Fitzpatrick skin types, genders, ages, scar scores, and ectropion scores of the patients also were recorded. RESULTS: The mean age of the patients was 39.3 (18-99) years, and the mean follow-up period was 2.1 (1-6) years. Fitzpatrick skin-type levels were between 2 and 4 (median = 3). No difference was found between 2 groups in terms of age, follow-up period, and Fitzpatrick skin-type levels. However, the scar values of the SMF group were significantly lower than the SF group statistically. Also, there was no significant difference between males and females in SF and SMF groups in terms of scar and ectropion formation. On the other hand, scar values were lower in SMF groups rather than SF group in males. Although ectropion values were not different between SF and SMF groups in females, ectropion values of SMF group were significantly lower than SF group in males statistically. CONCLUSION: Subciliary skin-muscle (stepped) flap technique can be more reliable than subciliary skin flap technique for approach to orbitozygomatic fractures.

Fujimori gate flap: an old flap for reconstruction of lower lip defects due to lower lip carcinoma resection.

OBJECTIVES: This study aims to present our clinic experiences on the Fujimori gate flap used for reconstruction of lower lip defect due to lower lip carcinoma. PATIENTS AND METHODS: This retrospective study included 19 patients (7 females, 12 males; mean age 60.3 years; range 41 to 79 years) who underwent reconstruction with the Fujimori-gate flap between January 2006 and March 2011. Demographic features of all patients and postoperative long-term functional and aesthetic results were reviewed. RESULTS: The mean size of the defects was 34.2 mm (range, 10 to 60 mm). Totally 27 flaps were elevated. No complication was observed after surgical procedure. In the long-term, nine patients underwent minor revisions. None of the patients showed local recurrence. CONCLUSION: Fujimori gate flap may be used for the reconstruction of the soft tissue loss after tumor surgery at lower lip.

A reliable option for wrist soft tissue defects: adipofascial flaps for immediate and late reconstruction.

Extensive volar injuries are common and devastating because of the long-term adhesion potency. The gliding effect of the adipose tissue is essential in preventing tendon adhesions after injury. In this study, we present the results of performing adipofascial flaps for the reconstruction of soft tissue defects following wrist trauma. The study included 15 patients. Adipofascial flaps were performed for immediate coverage of the tissue defect in 2 patients and for late adhesion-related problems in 13 patients. Flap dimensions varied from 8 × 14 to 8 × 20 cm. All but one of the flaps and skin grafts survived uneventfully. None of the patients, whether immediate or late, required another operation to address further adhesion problems. Since adipofascial flaps provide a gliding surface, they are a good choice for immediate coverage of soft tissue defects in the wrist that are not suitable for skin grafting alone as well as for late adhesion-related problems.

Treatment of hyperdynamic nasal tip ptosis in open rhinoplasty: using the anatomic relationship between the depressor septi nasi muscle and the dermocartilaginous ligament.

BACKGROUND: Smiling causes a deformity in some rhinoplasty patients that includes drooping of the nasal tip, elevation and shortening of the upper lip, and increased maxillary gingival show. The depressor septi muscle leads this deformity. The dermocartilaginous ligament originates from the fascia of the upper third of the nose and extends down to the medial crus, merging into the depressor septi muscle. METHODS: In this study, 100 primary rhinoplasty patients were studied for hyperdynamic nasal tip ptosis. Of these patients, 36 had hyperdynamic nasal tip ptosis due to hyperactive depressor septi nasi muscle. The dermocartilaginous ligament was used as a guide to reach the depressor septi muscle in open rhinoplasty. Muscle excision was performed just below the footplates of the medial crura. A strong columellar strut graft was placed between the medial crura to avoid narrowing of the columellar width resulting from tissue excision and to withstand activation of depressor septi muscle remnants. RESULTS: No complications such as infection or hematoma occurred in the early postoperative period. The technique corrected the hyperdynamic nasal tip ptosis, increased upper lip length, and decreased gingival show when patients smiled. There was no narrowing of the columellar width. No depression in the columellar-labial junction due to distal resection of the depressor septi muscle was observed. CONCLUSION: The dermocartilaginous ligament can be used as a reliable guide to reach the depressor septi muscle in open rhinoplasty. Therefore, the hyperactive depressor septi muscle can be definitively identified and treated without an intraoral approach. 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 at www.springer.com/00266.