Sensory Changes in Nasal Subunits Following Open and Closed Rhinoplasty: A Randomized Controlled Trial.

BACKGROUND: Skin sensation changes are common after rhinoplasty and can be troublesome for patients postoperatively. The closed technique may be considered as causing less sensory loss compared to the open technique due to its conservative approach, minimal dissection and low tissue damage potential. A randomized study was planned to compare the sensory changes in the subunits of the nasal skin caused by the two main methods using objective and subjective parameters. METHODS: In the analysis of the patients, the nose was divided into seven subunits: nasion, rhinion, nasal tip, left alar wing, right alar wing, infratip lobule and columella base. Evaluations were done preoperatively and at the first, third, sixth and twelfth months postoperatively. Objective sensory evaluations were done using the Semmes-Weinstein monofilament test. The subjective sensory changes of each nasal unit were subjectively evaluated by the patients on a three-point Likert scale. RESULTS: Both objective and subjective evaluations showed a statistically significant decrease in sensation in the nasal tip and infratip lobule in the open group one month after surgery. In the closed group, no significant differences were observed between the preoperative and postoperative sensory values for nasal subunits across all periods. CONCLUSION: While a decrease in sensation was observed in the tip and infratip lobule in the open technique by the first month postoperatively, this loss of sensation returned to a normal level by the third month. In the closed technique, however, no significant loss of sensation was detected in the postoperative period. In light of our findings, surgeons can have a better insight into postoperative sensory changes in the subunits of nasal skin which makes them more confident and reassuring when there are concerns regarding altered sensation after rhinoplasty. Level of Evidence II 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 .

Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial.

BACKGROUND: The stability of nasal tip rotation and projection, as well as providing a flexible nasal tip, are important elements in rhinoplasty. Two common options to provide these requirements are the septal extension graft (SEG) and the columellar strut graft (CSG). This study aims to compare the nasal tip stability and flexibility between the two graft options. METHODS: A prospective randomized study was carried out on sixty patients operated on with either the CSG or SEG. Tip rotation and projection stability were analyzed with photographic evaluation at the immediate postoperative period, the first month and the first year. Nasal tip flexibility was evaluated with a Newton meter at the preoperative period and postoperative first, third, and sixth months and the first year. RESULTS: The CSG showed a significant loss of projection and rotation, while the SEG showed better preservation of projection and rotation. However, both options showed a greater loss of projection and rotation in the first month and then a slight decrease in the following months. Although the SEG had lesser flexibility compared to the CSG anteroposteriorly, there was no flexibility difference between them in the lateral direction in the long term. CONCLUSION: The SEG provides better nasal tip stability compared to the CSG. The biggest downside of the SEG is decreased flexibility compared to the CSG. Surgeons should be aware of the loss of projection and rotation with both graft options and adjust their operation plan according to these points.

Comprehensive Assessment of the Functional Outcomes of Partial Turbinectomy: A Prospective Clinical Trial.

OBJECTIVES: The inferior and middle turbinates have crucial roles in nasal function, but their enlargement can cause obstructive effects, which can lead to breathing difficulties, sleep and smell disorders, and headaches. Partial turbinectomy is a common surgical technique used to address this issue during septorhinoplasty, but it carries risks such as empty nose syndrome. A clinical trial was designed to evaluate the functional outcomes of middle and inferior partial turbinectomy with a holistic approach. METHODS: Patients with NOSE questionnaire scores of 30 or higher, and grade 4 inferior turbinates and/or advanced middle concha bullosa were included. Patients completed questionnaires related to breathing, empty nose syndrome, headache, and olfaction preoperatively and at one-month, three-month, six-month, and first-year periods postoperatively. The partial excisions of the inferior and middle turbinates were carried out with serrated scissors while trying to preserve adequate turbinate size to maintain function. RESULTS: This study found that NOSE scores, headache frequency, and severity improved postoperatively. The olfactory-related quality of life of the patients with impairments in this area significantly improved found to be improved at all postoperative evaluations. None of the patients experienced prolonged bleeding requiring surgical intervention. No cases of anosmia and empty nose syndrome were reported. CONCLUSION: Partial turbinectomy of middle and inferior turbinates during septorhinoplasty can alleviate symptoms of turbinate hypertrophy, such as breathing issues, olfactory disorders, and headaches. It is an easy, reliable, and efficient surgical maneuver. Proper technique can minimize the risk of empty nose syndrome and other complications of turbinectomy surgery. LEVEL OF EVIDENCE III: 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 .

Comparison of the Efficacy of Combined Silver Nitrate Coagulation and Shave Excision With Surgical Excision and Linear Closure in the Treatment of Pyogenic Granuloma.

BACKGROUND: Pyogenic granuloma (PG) is a common benign vascular neoplasia. Optimal treatment should have an aesthetically pleasant scar and a low recurrence rate. No treatment method that is fully effective in solving these has been demonstrated. Silver nitrate cauterization is another method for the management of PG lesions. OBJECTIVE: The effects of silver nitrate on the treatment of PG have not been sufficiently investigated and should be investigated with objective data and a controlled study. METHODS: The prospective clinical trial was designed to compare silver nitrate cauterization with surgical excision treatment. Procedure times and procedure costs, comfort and satisfaction scales, recurrences, the Patient and Observer Scar Assessment Score, and the Vancouver Scar Scale were compared to evaluate treatments. RESULTS: Silver nitrate treatment had lower procedure times, costs, and better satisfaction and comfort scale scores. The scar assessment scores were better for the silver nitrate treatment. The patients in both groups were successfully treated and no recurrence was seen. CONCLUSION: Silver nitrate cauterization is low-cost, fast, safe, reliable, and effective with good aesthetic results for the treatment of PG lesions. This study shows that silver nitrate cauterization is a good alternative to surgical excision in the management of PG.

Comparison of the effect of the autogenic and xenogenic use of platelet-rich plasma on rabbit chondrocutaneous composite graft survival.

The platelet-rich plasma (PRP) has become popular in the medical world due to its content of growth factors and numerous studies are experimental. In experimental studies, the preparation and application of PRP are problematic and allogenic PRP transfers have been preffered, because of the difficulties in preparation of autogenic PRP in animal experiments. Xenogenic transfers and their effects have not been studied in this topic. This study aimed to investigate the effect of autogenic and xenogenic use of PRP on composite graft viability.Methods: Two composite grafts are prepared for each ear of nine rabbits. Each ear was randomly divided into three groups. After the procedure, the wound edges and base were injected with 1 cc serum physiologic, autogenic PRP or 1 cc human-derived xenogenic PRP. At 3 weeks, samples were taken, photographic and histopathological evaluations were made.Results: The graft viability was better in autogenic and xenogenic group compared to the control group. In comprasion of autogenic and xenogenic groups, although the macroscopic evaluation revealed better graft viability and less necrosis in the group which had been treated with autogenic PRP, the difference was not statistically significant. The three groups did not significantly differ in terms of inflammation. Vascularization examined histopathologically. CD31 staining, which was used to evaluate angiogenesis, was significantly higher in the autogenic PRP group than the remaining two groups.Conclusion: Although autogenic PRP has better results histopathologically, the xenogenic use of PRP may be an alternative for studies, when macroscopic evaluation is necessary.

Autologous Conditioned Serum Increases Fat Graft Viability More than Platelet-Rich Plasma in a Controlled Rat Model.

BACKGROUND: Platelet-rich plasma has been used to support fat graft retention, but it may include inflammatory mediators such as interleukin-1ß. Autologous conditioned serum also contains high levels of various anti-inflammatory cytokines. The authors hypothesized that combining autologous conditioned serum with fat graft would increase fat graft survival more than platelet-rich plasma. METHODS: Twenty-seven adult, male, Sprague-Dawley rats were divided into three groups of nine. Ten nonstudy rats were used to prepare platelet-rich plasma, autologous conditioned serum, and fat grafts. Next, 0.7-ml fat graft with a combination of 0.2 ml of autologous conditioned serum, platelet-rich plasma, or phosphate-buffered saline was applied to their dorsa. Fat graft volume was assessed on postoperative day 2 and on the day of euthanization at 1, 3, and 5 months postoperatively. Histopathologic analysis was performed to measure integrity, inflammation, fibrosis, and vascularization. RESULTS: The median volume percentages and interquartile ranges at 1 month postoperatively were 97.3 percent (77.3 to 119.6 percent), 40.4 percent (30.9 to 46.9 percent), and 72.1 percent (53.6 to 84.9 percent) in autologous conditioned serum plus fat graft, phosphate-buffered saline plus fat graft, and platelet-rich plasma plus fat graft, respectively (p < 0.05); at 3 months postoperatively, values were 82.3 percent (70.3 to 88.3 percent), 36.6 percent (29.4 to 43.1 percent), and 48.3 percent (31.4 to 57.9 percent) (p < 0.001); and at 5 months postoperatively, values had increased to 83.9 percent (58.3 to 102.4 percent), 40.3 percent (20.1 to 50.6 percent), and 56.3 percent (37.7 to 74.9 percent), respectively (p < 0.05). CONCLUSIONS: Autologous conditioned serum and platelet-rich plasma improved fat graft outcomes compared to saline, whereas autologous conditioned serum was associated with less inflammation, greater fat viability, and more integrity. CLINICAL RELEVANCE STATEMENT: Combining fat graft with autologous conditioned serum may be a better option to minimize resorption rate and improve graft survival.

Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery.

BACKGROUND: Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery. PATIENTS/METHODS: Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variable on the decision for surgery were analyzed. RESULTS: The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery. CONCLUSION: Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful conditions. LEVEL OF EVIDENCE: Level 4, Case-control study.

Standardization of the Rat Dorsal Random Pattern (McFarlane) Flap Model and Evaluation of the Pharmacological Agents Aiming to Salvage Partial Flap Necrosis: A Systematic Review and a Meta-analysis.

INTRODUCTION: Partial flap necrosis is a common complication after surgery. McFarlane flap model has been used for assessment of various agents' effects on random flap survival. The aim of this study was to review the methodology of studies using this flap model and reveal the most successful agents. MATERIALS AND METHODS: PubMed, Scopus, and Web of Science databases were screened for words "McFarlane flap," "flap survival," and ("flap" and "rat") by using time limits between 1965 and 2019. A total of 71 original articles were reviewed. Dimensions and base (cranial/caudal) of the flap, treatment protocol, follow-up period, and survival rates were extracted. Modified survival rates were calculated. Coefficients of variation of cranial/caudally based control group flaps and most commonly used flap models were calculated to assess interstudy variability. RESULTS: A total of 165 different treatment regimens were studied. One-hundred twelve regimens (67.9%) were found to increase flap survival. Most common flap dimensions were 9 cm × 3 cm, followed by 10 cm × 3 cm, 8 cm × 2 cm and 6 cm × 2 cm. Studies using caudally based flaps showed less interstudy variability, but survival rates were similar. Pentoxifylline, sildenafil, chlorpromazine, phenoxybenzamine, and phentolamine were reported to be successful in multiple studies. CONCLUSIONS: There are numerous agents found to be effective for treatment of partial flap necrosis, but further clinical research is needed. To overcome standardization problems, use of commonly used flap dimensions with a caudal base and interpretation of results after 7 days of follow-up seems appropriate.

Impact of COVID-19 outbreak on plastic surgery: Taken precautions, distribution of surgical procedures and changes in admissions to outpatient clinic.

The COVID-19 outbreak is a global problem affecting the world in many respects. In the medical field, its impact on surgical branches as well as clinical branches is inevitable. From the plastic surgery perspective, the COVID-19 outbreak affects the number and distribution of surgeries, patient admissions and educational activities. Although these impacts are predictable, it is beneficial to document these data that would contribute to the proper response to a similar crisis in the future. From this standpoint, the present study aims to analyze the effect of the COVID-19 pandemic on plastic surgery practice in some aspects. Epidemiologic data of the two-time frames, routine period, and pandemic period of plastic surgery were reviewed retrospectively. The ratios of the listed data were compared between the two periods; admissions to the outpatient clinic, surgeries, consultations, anesthesia type, hospitalizations, and demographic data. While the number of outpatient clinic patients was 3511 in the routine period, it was 490 in the pandemic period. Compared to the routine period, the number of surgical interventions was decreased from 793 to 129 during the pandemic period. In particular, a statistically significant increase was observed in the rate of hand trauma and maxillofacial trauma cases during the pandemic period compared with the routine period (p < 0.001, and p = 0.032, respectively). Therefore, high rates of hand trauma and maxillofacial trauma should be taken into consideration when making arrangements such as personnel distribution, use of medical resources, and regulation of hospital infrastructure in extraordinary situations like COVID-19 pandemics.

Effect of Platelet-Derived Concentrated Growth Factor on Single-Layer, Multi-Layer, and Crushed Onlay Cartilage Grafts.

BACKGROUND: The main concern with utilizing cartilage grafts to achieve structural integrity and volume restoration is the loss of volume over time and their unpredictable viability. Preservation of the volume of cartilage grafts is necessary to ensure their long-term success. OBJECTIVES: The main aim of this study was to investigate the effect of concentrated growth factor (CGF) sheet on single-layer, multi-layer, and crushed block cartilage grafts. METHODS: Cartilage grafts obtained from the ears of rabbits were prepared in 3 different forms: single-layer, triple-layer, and crushed. After measuring the weight and thickness of the cartilage grafts, the grafts in the experimental group were wrapped with the prepared autologous CGF. These cartilage grafts were placed in subcutaneous pouches created on the backs of the rabbits. After 4 months, the rabbits were killed. The weight and thickness of the cartilage grafts were measured and the cartilage viability and peripheral changes were examined microscopically. RESULTS: The percentage changes in the weights and thicknesses of the single-layer, multi-layer, and crushed cartilage grafts wrapped with CGF were found to be statistically significantly lower than in the control group. When the cartilage viability and changes in peripheral tissue were evaluated, CGF-wrapped cartilage groups did not achieve statistically significantly better scores than the untreated control groups. CONCLUSIONS: In cases planned to receive a block cartilage graft, especially if graft resorption is not desired or should be minimized, wrapping the graft with autologous CGF is a feasible option.

The Effect of Astaxanthin on Random Pattern Skin Flaps.

BACKGROUND: Skin flaps are the first-line treatment modality for skin defect reconstruction. With the increased importance and use of flap surgery, a growing number of studies have investigated the ways for the prevention of ischemia-reperfusion injury. The aim of this study was to investigate the effect of astaxanthin, which is an antioxidant molecule from the xanthophyll family, on the survival of random pattern skin flaps. METHODS: Thirty-two Sprague-Dawley rats with a caudally based random pattern skin flap (3 × 9 cm) were divided into 4 groups: group A (astaxanthin orally 1 mg/kg per day), group B (astaxanthin orally 4 mg/kg per day), group C (astaxanthin orally 16 mg/kg per day), and the control group. On postoperative day 7, the flaps were evaluated by photographic, scintigraphic, and histological methods. Photographs were taken to investigate the total flap, necrotic flap, and surviving flap areas. A scintigraphic evaluation was undertaken to analyze the surviving area. The flaps were evaluated histopathologically for vascularization, acute inflammation, and chronic inflammation. RESULTS: The rate of surviving flap areas was observed to increase in parallel to the increase in the astaxanthin dose. Surviving flap areas and flap perfusion values were higher in group C compared with the control group and group A (P < 0.05). The values were also significantly higher in group B compared with control group (P < 0.05). All study groups were shown to have statistically significantly higher vascular density than the control group (P < 0.05), whereas lymphocyte and neutrophil densities were similar among all groups (P > 0.05). The photographic and scintigraphic evaluations for the viable area percentages of the flaps correlated with each other (rs = 0.913, P < 0.001). CONCLUSIONS: Orally administered astaxanthin, if given at doses higher than 4 mg/kg, increases flap viability rates and vascularization and can be used as an adjunctive agent.

Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction: Analysis of Frequency, Preoperative Complaints and Benefit from Surgery.

INTRODUCTION: Modern rhinoplasty has an aesthetic and a functional component that cannot be separated. Functional rhinoplasty generally concentrates on optimizing nasal airflow. Numerous techniques have been described for correction of each pathology. There seems to be a consensus on the benefit of surgery to patients with nasal obstruction. Present study aimed to determine if specific airway pathologies have differential effects on patient complaints and techniques addressing them have differential effects on perceived benefit from surgery. PATIENTS/METHOD: The records of 300 patients complaining nasal obstruction and had computerized tomography (CT) between April 2015 and April 2018 were retrospectively reviewed. Based on surgical notes, surgical techniques used for each patient were recorded. A survey using Nasal Obstruction Symptom Evaluation (NOSE) scale is done by phone. After descriptive statistics, preoperative complaint-diagnosed pathology, and postoperative relief-treated pathology relationships were evaluated. RESULTS: Preoperative and postoperative NOSE scores showed statistically significant difference (P <0.001). The CT analysis showed that septal deviation rate among patients complaining nasal obstruction is 85%, internal valve insufficiency rate is 34.4%, mild and severe inferior turbinate hypertrophy was 71% and 6%, respectively. Bullous and total concha bullosa of middle turbinate was 17.3%. Nearly 90% of patients had 2 or more types of pathology in CT analysis. Preoperative and postoperative NOSE scores showed no statistically significant relationship with singular intranasal pathologies and techniques used for correcting them, respectively. CONCLUSION: Despite general fall in NOSE scores in the whole study group, treatment of a specific pathology does not change NOSE score more than a patient who already does not have the pathology. None of the pathologies or treatments addressing them have a dominating effect on preoperative complaints or obtained relief after the surgery. So, success of functional rhinoplasty cannot rely on correction of a specific pathology. A comprehensive analysis and correction of every pathology is paramount.

Biomechanical analysis of a modified suture technique for septal extension grafts: Transloop suture.

BACKGROUND: A successful rhinoplasty procedure requires a well-defined and properly projected nasal tip; however, surgical control of the nasal tip is difficult. The aim of this investigation was to assess the efficacy and safety of a modified suture technique, which can be used to fix the caudal septal extension graft during primary rhinoplasty of the Asian population and revision septorhinoplasties of the Caucasian population, and to compare it with those of other commonly used techniques. METHODS: After peeling of perichondrium of scapular cartilages, cartilage pieces of 3 × 1 cm in size and 2 mm in thickness were divided into two from the midline. These pieces were repaired end-to-end using three different repair techniques: two simple interrupted in Group A (n = 40), vertical figure-of-eight in Group B (n = 40) and modified vertical figure-of-eight (transloop) in Group C (n = 40). All repaired cartilage specimens were subjected to a biomechanical analysis, in which four different forces were applied: tension, lateral bending, shearing and buckling. RESULTS: According to the tensile test, Group C had statistically significantly higher strength than Group A at 2 mm range. The lateral bending test similarly revealed that Group C had statistically significantly higher strength at 1.5 mm and 2 mm range than Group A. However, there was no statistically significant difference between the three groups in the assessment of shearing and buckling forces. CONCLUSION: The modified transloop suture technique provides a more stable repair, and we consider that it can be used as an alternative suture repair method.

The Impact of Duration and Force of Centrifugation on Platelet Content and Mass in the Preparation of Platelet-Rich Plasma.

PURPOSE: Platelet-rich plasma (PRP) is an autologous prepared plasma enriched with platelets and obtained after a centrifugal separation and aggregation procedure. However, the optimized preparation protocol for PRP is still controversial and there are no standardized preparation protocols. The aim of this study is to show the effect of time and force of the centrifugation on the concentrations of platelets and to optimize the effective PRP preparation protocol. METHODS: For the study, whole blood was drawn into 24 different 6-ml standard tubes containing 0.6 ml anticoagulant citrate dextrose solution-formula A. The samples were centrifuged separately at forces of 45×g, 180×g, 400×g, 725×g, 1130×g and 1630×g for 5, 10, 15 and 20 min. Every sample was analyzed, and a comparison was made between all groups. RESULTS: No significant difference was observed in terms of platelet concentration, mean platelet volume or platelet mass between all groups (p > 0.05). The mean ± SD of platelet mass in baseline is 1890 ± 134 × 103 fL/µL. The mean ± SD of platelet mass in the high centrifugal force of 1630×g was 3395 ± 564 × 103 fL/µL, 2638 ± 425 × 103 fL/µL, 2355 ± 449 × 103 fL/µL and 2109 ± 41 × 103 fL/µL over times of 5, 10, 15 and 20 min, respectively. The mean ± SD of platelet mass in the low centrifugal force of 45×g was 2002 ± 1623 × 103 fL/µL, 2491 ± 1591 × 103 fL/µL, 2611 ± 876 × 103 fL/µL and 3003 ± 511 × 103/µL over times of 5, 10, 15 and 20 min, respectively. CONCLUSIONS: Platelets should be evaluated with platelet mass not including platelet concentrations alone, but also with mean platelet volume, which symbolizes the size of platelets while comparing platelet-rich plasma preparation protocols and kits. This could be a new starting point for comparison of PRP for all applications in the literature. All centrifugation forces and times could produce biologically reactive PRP. It may be only suggested that if high acceleration force is used, low durations should be selected, or if low acceleration force is used, long time of centrifugation should be selected. NO LEVEL ASSIGNED: 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 .

Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis.

BACKGROUND: The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. METHODS: The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. RESULTS: The maximum tensile strength until failure was 44.6±4.3 N in group 1, 35.7±5.2 N in group 2, and 56.7±17.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). CONCLUSIONS: This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.

Innovation in the planning of V-Y rotation advancement flaps: A template for flap design.

Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

Triple Combination Therapy for Pincer Nail Deformity: Surgical Matricectomy, Thioglycolic Acid, and Anticonvex Sutures.

BACKGROUND: Pincer nail deformity (PND) is characterized by an excessive transverse curvature of the nail plate that increases along the longitudinal axis of the nail. Although many conservative and surgical techniques have been used in clinical practice, an established consensus for the correction of PND has not been present yet. OBJECTIVE: Aim of the technique described in this article is to provide to restore the suitable nail-matrix system curvature by a simplified and quick approach, which could be seen as a synthesis of conservative and surgical treatments described in the literature. MATERIALS AND METHODS: Nineteen cases of pincer nail of the great toe in 14 patients were analyzed. After softening nail plate with 5% thioglycolic acid solution for at least half an hour, surgical bilateral matricectomy and 2 anticonvex sutures with 1-0 polypropylene were performed to ensure proper nail plate shape. Besides demographic data, visual analog scale (VAS) score for pain, width index, height index, patient and surgeon satisfaction scores, operation time, and the day of painless return to the daily activities were investigated. RESULTS: A statistical significance was observed in VAS score for pain, width, and height indices between preoperative and postoperative values. CONCLUSION: This report gives acceptable outcomes with a combination of surgery and conservative treatments.

Eight years of clinical experience with digit replantation: Demographic characteristics and outcomes.

BACKGROUND: Despite surgical and technical advances in microsurgery, it is still difficult to obtain satisfactory results after replantation of finger amputation. The aim of the present study was to discuss some of the many factors that can affect the success rate of replantation. METHODS: A retrospective analysis of 60 patients with 85 finger replantations was performed. Revascularizations and replantations proximal to the metacarpophalangeal joint were excluded. Demographic characteristics of the patients, place of injury, mechanism of injury, level of amputation, and success rate were examined. RESULTS: A total of 53 male and 7 female patients with mean age of 31 years were included in the study. Index finger (27%) was the most commonly replanted digit. Left side was the more affected, with 62%. Mechanism of injury was crush in 56%, guillotine in 23%, and avulsion in 21% of replanted digits. Success rate was 81%, 53%, and 36% in guillotine, crush, and avulsion injuries, respectively. CONCLUSION: In conclusion, the injury type and personal variables are very important in the rate of replantation success. Knowledge about the effects of different factors on the results of replantation surgery will provide guidance to hand surgeons in order to inform patients and their relatives properly.

Clinicopathological evaluation of Marjolin ulcers over two decades.

Malignant changes arising on the previously traumatized or chronically inflamed skin are defined as Marjolin ulcers. They can develop on many different lesions but frequently they are detected on burn scars. Histopathologically, Marjolin ulcers are mostly diagnosed as squamous cell carcinoma and they need special attention when especially located on the lower extremities. In this study, 63 patients treated for Marjolin ulcers between January 2000 and March 2015 were evaluated according to etiology, histological differentiation, primary tumor size, patient age and anatomical localization. Medical records of these patients were reviewed retrospectively. Mean age was 49.7 years. Average interval between the first injury and carcinoma development was 37.9 years. Most frequent etiologic factor was burn scars with 82.5%. Foot was the most frequently affected site with 28.6% and scalp was the second most frequent localization with 25.4%. Squamous cell carcinomas were detected in 88.9% of the patients and basal cell carcinomas were detected in 11.1% of the patients. For treatment, excision and grafting was performed for 48 patients (76.2%), excision and local flaps were used for 10 patients (15.9%) and excision and free flaps were used for five patients (7.9%). Regional lymph node dissection was performed for 12 patients (19%). Average follow up period was 46.5 months. Local recurrences were detected in nine patients (14.3%). In conclusion, Marjolin ulcers are aggressive tumors that require special care. In order to prevent life threatening sequelas of this entity, it is important to know basic aspects of clinical progress, prognostic factors and treatment modalities.