Polidocanol injection for chemical delay and its effect on the survival of rat dorsal skin flaps.

BACKGROUND AND AIM: Surgical delay is an invasive method requiring a two-stage surgical procedure. Hence, methods that may serve as an alternative to surgical delay have become the focus of interest of research studies. From a conceptual view, any technique that interrupts the blood flow along the edges of a proposed flap will render the flap ischemic and induce a delay phenomenon. Polidocanol (Aethoxysklerol(®)-Kreussler) was initially used as a local anesthetic. Nowadays, it has been used as a sclerosing agent to treat telangiectasias and varicose veins. The aim of this experimental study was to investigate the effects of polidocanol injected around the periphery of a random flap as a sclerosing agent on flap delay and survival in a random flap model. METHODS: A preliminary histopathologic study was performed on two rats to evaluate the sclerosing effect and distribution of polidocanol injection. After the preliminary study, the main study was carried out with three groups: group 1: dorsal flap (n = 10); group 2: dorsal flap + surgical delay (n = 10), group 3: dorsal flap + chemical delay (n = 10). RESULTS: Tissue samples obtained from the flap and injection area revealed destruction of intradermal vessels. The area affected with sclerosis was limited to 0.1 cm beyond the injection site. Mean viable flap areas were 52.1 ± 4.38% (44.0-58.2) in group 1, 64.8 ± 8.92% (57.2-89.2) in group 2, and 71.8 ± 5.18% (64.0-84.0) in group 3. A statistically highly significant difference was found between the surgical delay and chemical delay groups versus the group without delay (p < 0.001 and p < 0.001, respectively). The difference between the mean viable flap areas was not statistically significant in the surgical and chemical delay groups (p = 0.056). CONCLUSION: In conclusion, this study has shown that polidocanol injection around the dorsal flap in the rat is a safe and easy method for nonsurgical delay. The results have shown a flap survival benefit that is superior to controls and equivalent to surgical delay. The clinical application of polidocanol, already in clinical practice for occlusal of telangiectasias, for surgical delay appears feasible.

[Repair of soft tissue defects of the nose]. / Burun yumusak doku defektlerinin onarimi.

OBJECTIVES: Soft tissue defects of the nose resulting from lesions may cause aesthetic and functional problems if they are not properly repaired. PATIENTS AND METHODS: In this study, a retrospective analysis was conducted of 104 patients (59 females, 45 males; mean age 53 years; range 33 to 89 years) who were operated in our clinic between November 2005 and July 2009. Nasal soft tissue defects resulting from excision were closed with a primer closure for 16 patients, a procerius muscle skin flap for 11 patients, a nasolabial flap for 26 patients, a dorsal nasal flap for 12 patients, a forehead flap for three patients, an orbicularis oculi muscle skin flap for three patients, a V-Y advancement flap for seven patients, a bilateral V-Y advancement flap for one patient, a Banner flap for nine patients, a bilobe flap for eight patients, an interpolation flap for two patients, a skin graft for 10 patients. RESULTS: We did not observe any occurances of flap necrosis in any of the patients being treated with skin and muscle skin flaps. After we recognised that two patients' excision margins were positive, re-excision was performed on them. Tumor recurrence was observed in one patient, and was repaired with skin graft. CONCLUSION: In this study, we present our successful results in the treatment of soft tissue defects. Reconstructive strategy should be considered from simple to more complex planning. Skin flaps should be elevated according to nasal aesthetic units. Which reconstructive technique to employ should be decided with respect to the localization of the nasal defect.

Cartilage Z plasty on lateral crus for treatment of alar cartilage malposition.

BACKGROUND: Alar cartilage malposition is an anatomical variation. Axis of the lateral crus lies cephalically and can be parallel to the cephalic septum. The characterised findings of the malposition are broad and bulbous nasal tip, abnormal lateral crural axes, long alar creases that extend to the nostril rims, alar wall hollows, frequent nostril deformities and associated external valvular incompetence. This article presents a new technique for the repositioning of the lateral crus in this article. METHODS: Open rhinoplasty was conducted. A cartilage Z plasty was performed on the lateral crus of the alar cartilage to treat for malposition. The 14 women and 8 men included in the study had an average age of 27 years (range, 18-46 years). The average follow-up period was 12 months (range, 4-20 months). RESULTS: Alar cartilage malposition was successfully corrected in patients with aesthetic and functional improvements. CONCLUSIONS: Cartilage Z plasty can effectively correct alar cartilage malposition. Advantages of this technique can be listed as follows: it does not require extra graft material and protects the lateral crural complex; it does not disrupt movements of the alar muscles and can also serve to adjust projection of the nasal tip.