The Effects of Colchicine-Impregnated Oxidized Regenerated Cellulose on Capsular Contracture.

Capsular contracture is the most common complication of breast augmentation. Oxidized regenerated cellulose can be used as a matrix for drug transport. Colchicine is an antimitotic drug that interferes with various steps of wound healing. The aim of this study was to evaluate the effects of oxidized regenerated cellulose alone or in combination with colchicine on capsular contracture. Twenty-one adult female Wistar-Albino rats were divided into 3 groups. In group 1 silicone blocks only, in group 2 oxidized regenerated cellulose-wrapped silicone blocks, and in group 3 colchicine-impregnated oxidized regenerated cellulose-wrapped silicone blocks were inserted in the dorsal region. Four weeks later, implants were removed and histopathological examination was performed. Capsular thickness, inflammatory infiltrate degree, collagen fiber organization, and myofibroblast density were evaluated. Macroscopic examination revealed a distinct capsule formation only in group 1 animals, with average measurement being 134.65 µm on histopathological examination. In groups 2 and 3 animals, no distinct capsule formation was seen. Inflammatory infiltrate degree was found to be less in groups 2 and 3 animals than in group 1 animals. Collagen fiber organization around the implants was found to be parallel and organized in group 1 animals, whereas it was random and disorganized in animals in both groups 2 and 3. High myofibroblast density was observed in animals in groups 1 and 2, while no myofibroblast was found in animals in group 3. The results of our study suggest that coating silicone implants with oxidized regenerated cellulose or with colchicine-impregnated oxidized regenerated cellulose may be effective in preventing capsular contracture.

Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study.

BACKGROUND: There are numerous clinical and experimental studies reporting unfavourable effects of cigarette smoke on skin flaps. OBJECTIVE: To investigate whether unfavourable effects of cigarette smoke on flap survival could be reduced by botulinum toxin type A. METHODS: Twenty-eight male Wistar albino rats (15 months of age, mean weight 210 g [range 180 g to 230 g]) were included. They were divided into four groups of seven animals each. The control group underwent the surgical procedure alone. Surgical procedure was performed after administration of botulinum toxin type A in the botulinum toxin (BTX) group, after exposure to cigarette smoke in the cigarette smoke (CS) group, and after BTX type A administration and exposure to CS in the CS+BTX (CS+BTX) group. Random pattern cutaneous flaps (3 cm × 9 cm) were elevated from the dorsum of all rats. Necrosis area was calculated in percentages (%) using Image J computer software. Tissue samples were examined histopathologically. RESULTS: The mean necrotic area in the control group (26%) and in the BTX group (21%) were similar (P=0.497), whereas administration of BTX type A significantly decreased flap necrosis area in the rats exposed to CS (the mean necrosis areas were 41.5% in the CS group, and 26% in the CS+BTX group; P<0.001). Histopathological examination findings corroborated the unfavourable effects of CS and preventive effects of BTX type A. CONCLUSION: Preoperative administration of BTX significantly enhanced flap viability in the rats exposed to CS. Further human studies are warranted to verify whether BTX type A could be used as an agent to reduce the risk of flap necrosis in patients who smoke.

HISTORIQUE: De nombreuses études cliniques et expérimentales font état des effets défavorables de la fumée de cigarette (FC) sur les lambeaux cutanés. OBJECTIF: Examiner s'il est possible de réduire les effets défavorables de la FC sur la survie des lambeaux grâce à la toxine botulique (TXB) de type A. MÉTHODOLOGIE: Vingt-huit rats albinos Wistar (15 mois, poids moyen de 210 g [plage de 180 g à 230 g]) ont participé à l'étude. Ils ont été répartis en quatre groupes de sept animaux. Le groupe témoin a subi seulement l'intervention chirurgicale. Après l'intervention, le groupe TXB a reçu de la TXB de type A, le groupe FC a été exposé à la FC et le groupe FC+TXB s'est fait administrer de la TXB de type A et a été exposé à la FC. Les chercheurs ont prélevé des lambeaux cutanés prélevés de manière aléatoire (3 cm × 9 cm) sur le dos de tous les rats. Ils ont calculé les zones nécrotiques en pourcentages (%) au moyen du logiciel ImageJ et fait l'examen histopathologique des échantillons de tissu. RÉSULTATS: Les zones nécrotiques moyennes étaient similaires dans le groupe témoin (26 %) et le groupe TXB (21 %) (P=0,497), mais l'administration de TXB de type A réduisait considérablement les zones nécrotiques des lambeaux chez les rats exposés à la FC (zones nécrotiques moyennes de 41,5 % dans le groupe FC et de 26 % dans le groupe FC+TXB; P<0,001). Les résultats de l'examen histopathologique corroboraient les effets défavorables de la FC et les effets préventifs de la TXB de type A. CONCLUSION: L'administration préopératoire de TXB améliore considérablement la viabilité des lambeaux chez les rats exposés à la FC. Il faudra réaliser d'autres études sur des humains pour vérifier si la TXB de type A peut être utilisée pour réduire le risque de nécrose des lambeaux chez les patients fumeurs.

Comparison of ischaemic preconditioning with surgical delay technique to increase the viability of single pedicle island venous flaps: an experimental study.

The aim of the present study was to investigate the effect of ischaemic preconditioning compared with the surgical delay procedure in an effort to increase the survival rate of single pedicle island venous flaps. Eighteen male Wistar albino rats (250-350 g) were included. A 3 × 4 cm flap was planned at the right lower abdomen of the rat. Superficial epigastric vein constituted the pedicle of the flap. The rats were divided into three groups, each consisting of six rats. In the control group, a single pedicle venous island flap was elevated on each rat and no other surgical procedure was performed. In the ischaemic preconditioning group, ischaemic preconditioning was performed and, in the surgical delay procedure group, the surgical delay technique was performed before flap elevation. The mean necrosis areas were 56.85 ± 14.60%, 28.73 ± 15.60%, and 12.08 ± 3.65% in the control, ischaemic preconditioning, and surgical delay procedure groups, respectively. The necrosis areas were significantly smaller in the ischaemic preconditioning group and surgical delay procedure groups compared to the control group (p = 0.004 and p < 0.001, respectively). The necrosis areas were similar in the ischaemic preconditioning and surgical delay procedure groups. Histopathological parameters including necrosis, abscess formation, and skin ulceration scores were significantly lower in the ischaemic preconditioning group than in the control group, whereas the study groups were similar. In conclusion, ischaemic preconditioning may serve as an adjuvant technique in increasing venous island flap viability.

Reconstruction of vermilion deficiencies: the running V-flap technique.

Notching, or 'whistle deformity', is a common vermilion deformity among patients with cleft lips. Vermilion volume deficiency may also be present secondary to trauma or tumour excision. Herein, we present a new flap model to repair such vermilion deformities. Six patients were included in the study. Running V-flaps prepared from the oral mucosa were used. While the underlying cause of vermilion deficiency was cleft-lip surgery in four of the patients, the indication for surgery was trauma related in two patients. In all patients, the volume deficiency was corrected. No patient exhibited scarring, colour mismatch or asymmetry. We believe that our new flap model can be a reliable alternative in secondary vermilion deficiencies.

Follicular unit transplantation for male-pattern hair loss: Evaluation of 120 patients.

The main aim in surgical hair restoration is to restore hair, making the scalp look natural. Interviews with earlier patients who received hair transplants revealed that their complaints were - a straight anterior hairline that looked unnatural, and hair that looked like 'sprouted grass'. The use of follicular unit transplantation (FUT) technique, where hair roots are harvested under magnification, is becoming widespread. In this technique, hair roots are harvested into natural follicular units that contain 1-4 hair roots. In this article, we present our results related to hair transplantation by FUT technique, performed on 120 patients between the ages of 21 and 75 years with male-pattern hair loss. We made simple yet useful interventions to avoid the occurrence of the above-mentioned problems. Initially, drawings based on the middle line and the two temporal regression points were made for a natural-looking anterior hairline. Following this, irregular seeding was done instead of seeding in rows, to obtain a natural hairline. To avoid the 'sprouted grass' look, single hair roots were placed on the anterior hairline taking into consideration the direction of hair growth. However, the FUT technique is not adequate on its own for natural-looking hair restoration. Good planning and creation of an anterior hairline suited to the individual's forehead structure is fundamental for successful results. In addition, we believe that hair texture is very important in hair transplantation and additional care should be given particularly to patients with dark-coloured and hard hair.

The thenar index: an objective assessment and classification of thenar atrophy based on static hand imprints and clinical implications.

BACKGROUND: The aims of this study were to test the effectiveness of the subjective clinical evaluation and to search for any possibility of constituting an objective assessment system for the diagnosis of thenar atrophy based on static hand imprints. METHODS: Static hand imprints were obtained from normal subjects (group A, n = 116) and carpal tunnel syndrome patients with thenar atrophy (group B, n = 26). Thenar index and the bilateral thenar index ratio were defined. Cutoff values were considered by analyses with receiver operating characteristic curves. RESULTS: No statistically significant difference could be demonstrated in thenar index values of dominant and nondominant hands between genders and age groups (p > 0.05). A statistically significant difference was observed between severity groups in group B (p < 0.05). There was a statistically significant difference between thenar index and bilateral thenar index ratio values of groups A and B (p < 0.05). Cutoff values were considered a thenar index of 31 and a bilateral thenar index ratio of 0.8, which revealed acceptable specificity (95.3 percent) and sensitivity (77.4 percent). A new quantitative classification for thenar atrophy severity is proposed. CONCLUSIONS: Understanding the true onset and natural progression of thenar atrophy can only be anticipated with the aid of an objective assessment system. Currently, this method should be regarded as a system for patient records and comparison for presurgical and postsurgical data. The authors believe that the thenar index classification has some merit for future use. It seems that additional objective and scientific evaluation systems and novel approaches are still needed to demystify the true nature of carpal tunnel syndrome.

The hatchet flap for reconstruction of fingertip amputations.

BACKGROUND: Emmett has described a single triangular flap that contains a partial skin bridge on one of its sides and called it the hatchet flap. It was successfully used for defects located on various body parts. The aim of this study was to present the authors' experience and results obtained with this flap in fingertip amputations. METHODS: Nine patients who have completed their 1-year follow-up period were included in the study. Two-point discrimination and stiffness were tested, and the patients were queried about the existence of cold intolerance, hypersensitivity, numbness, and pain in the early (3 months) and late (1 year) postoperative periods. RESULTS: The amputations were located on the thumb in three patients, index finger in one patient, middle finger in three patients, and ring finger in two patients. The average defect size was 2.1 x 1.5 cm. Partial wound dehiscence was observed in one patient. The flap has provided good protective padding and aesthetic contour for the fingers. All incisions healed with inconspicuous scars. Average two-point discrimination was 6.3 mm (range, 4 to 8 mm). Cold intolerance was observed in two (22.2 percent) and paresthesia in one patient (11.1 percent). Joint stiffness was not noted. Most patients could return to their normal routine in approximately 4 to 5 weeks. CONCLUSIONS: The hatchet flap is a good alternative for transverse and lateral oblique fingertip amputations and valuable for volar oblique amputations (defects <2 cm) with more extensive flap designs. The technique is simple and safe and provides good protective padding and acceptable tactile gnosis.

Reconstruction of small to medium defects in the soft tissues of the nose with nasalis musculocutaneous V-Y advancement flaps.

Defects in the soft tissues of the nose are usually reconstructed with skin grafts or frontal flaps. However, skin grafts may cause scar tissue and changes in colour. Frontal flaps, however, may be thicker than normal skin and may give unsatisfactory results. Nasalis musculocutaneous V-Y advancement flaps avoid these disadvantages. We suggest an algorithmic approach for the use of these flaps in the reconstruction of small to medium defects in the soft tissues of various regions of the nose. The pedicles of these flaps are the dorsal and lateral nasal arteries. This approach provides a simple, safe, and reliable reconstruction for small and medium defects in the soft tissues of the nose.

The propeller flap for postburn elbow contractures.

Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture. Sufficient extension and an acceptable aesthetic outcome were obtained. Other benefits include easy design and rapid flap elevation that permits a single stage correction of the deformity without further sacrificing an artery or muscle. We think that the main disadvantage of the propeller flap is using the same skin that has suffered from the burn insult which has a poorer cosmetic result. Other than this and excluding deep burn injuries, we believe that the propeller flap is a useful alternative for elbow contracture release.

Squamous cell carcinoma of the lower lip: exact location match in siblings.

BACKGROUND: In recent years, genetic contribution to the development of skin cancers is under the magnifying glass of several authors and is now regarded as the main initial etiology in carcinogenesis. OBJECTIVE: Two siblings who had squamous cell carcinoma of the lower lip showing an exact location match are presented. PATIENTS: They did not share common environmental factors, and there was no history of tobacco and/or alcohol abuse. CONCLUSIONS: It would be scientifically deceptive to draw generous conclusions for the cases here, other than being a very interesting and unusual coincidence, because further evaluation could not be done to scientifically prove a possible genetic contribution.

Hemangioma of the lower lip associated with schistosomiasis: a case report.

Hemangiomas may occur in any region of the body, and is the most common tumour of the childhood age. The first case report of multiple Schistosoma mansoni larvae associated with hemangioma of the lower lip is presented. A 7-year-old boy presented with hemangioma of the lower lip. The tumour was subtotally excised under general anaesthesia for aesthetic reasons. The histopathologic diagnosis was multiple Schistosoma mansoni larvae associated with the hemangioma. Patient was treated with an antischistosomal drug.

The rate of upper-extremity deep-structure injuries through small penetrating lacerations.

Despite the abundance of epidemiologic studies concerning hand injuries, there is no study that emphasizes the significance of the initial laceration size. The aim of this study is to investigate the incidence of tendon, nerve, and artery injuries that may result from small, penetrating lacerations of the hand and forearm. A total of 226 patients with small lacerations were included in the study. Glass (68.7%) and knife (31.3%) lacerations were the only etiological factors. One hundred thirty-four patients (59.3%) had at least 1 deep-structure injury. One hundred twenty-four patients (92.5%) had at least 1 tendon, 25 patients (18.7%) had at least 1 nerve, and 20 patients (14.9%) had at least 1 artery injury. Extensor tendons were more commonly injured (61.3%). Combination injuries were found in 20 (14.9%) patients. The most-encountered combination was the injury of all 3 structures. Small laceration injuries of the upper extremity have the potential to conceal an underlying deep injury.

Effects of 360-degree pedicle torsion on island skin flaps: experimental study in rats.

This study was carried out to observe the isolated effects of pedicle torsion on island skin flaps, without further damaging the pedicle. Twelve adult male Sprague-Dawley rats, weighting 240 to 300 gr, were used, and hexagonal flaps with edges measuring 1.5 cm and pedicles measuring 1 cm in length were raised in the inguinal region. The animals were divided into two groups. In Group A, flaps were re-sutured to the donor beds without any rotation. In Group B, flaps were rotated 360 degrees, applying the same degree of torsion to their pedicles before re-suturing. After 7 days, the percentage of surviving skin areas of the flaps was determined by planimetry, and transverse sections of the flaps and pedicles were taken and evaluated in terms of signs of arterial or venous insufficiency. Statistically significant differences between the groups were determined by analyses using the multiple comparisons test. Pedicle torsion in Group B did not affect flap viability, both macroscopically and microscopically. The presented study shows that 360-degree torsion applied to the pedicle of the flap in this model had no effect on flap viability.

Animal bites.

OBJECTIVE: The aim of this study was to put forward a retrospective analysis of animal bites treated in our department. METHODS: A total of 1315 patients treated in the Department of Plastic Reconstructive and Aesthetic Surgery of Ankara Education and Research Hospital, Ankara, Turkey between January 2002 and March 2004 are included in the study. The fundamental treatment approaches were; copious saline irrigation, attentive debridement, appropriate antibiotic protocol, elevation and immobilization. RESULTS: Bites were produced by tamed (23.4%) and untamed animals (76.6%). The mostly encountered bites were from dogs (76.2%) followed by cats (21.7%). The injury sites were mostly in the lower (35.0%) and upper (33.0%) extremities. Overall infection rate was found to be 4% which were mainly due to cat bites. A very low infection rate (0.03%) was found in the group of patients who did not receive prophylaxis. CONCLUSION: Prophylactic antibiotics are recommended for severe injuries. Deep, dirty and defective injuries should be treated with delayed reconstruction. The majority of animal bite injuries in our country are consequence of untamed dogs and cats. The excessive lower extremity injuries can be attributed to this fact.

Transverse carpal muscle in association with carpal tunnel syndrome: report of three cases.

Anomalous muscles of the upper extremity are common, however, symptomatic anomalies causing CTS are rare. Three cases of CTS that are believed to be caused by an anomalous muscle located palmar to the transverse carpal ligament with transversely oriented muscle bundles is presented. Despite the arguments in literature, this is certainly an anomalous muscle that can be encountered during carpal tunnel release and be problematic to manipulate when minimally invasive approaches are chosen.

Multiple occurrences of different histologic types of the glomus tumor.

A patient with 3 glomus tumors that occurred at different locations and times is presented. Two of the 3 tumors were of the same histologic type. The third tumor was a different type. Although it is rare, a solitary type of glomus tumor on initial presentation may exhibit multiple occurrences in the same patient.

Periareolar-transareolar-perithelial incision for the surgical treatment of gynecomastia.

Gynecomastia is an abnormal enlargement of the breast tissue in men. It is the most common disorder of the male breast. Surgical sharp resection of the excess breast tissue is still the mainstay of treatment when medical treatment modalities are proved to be ineffective. The authors believe that areolar incisions give the best results, especially for grades I and IIA gynecomastia. The authors review the ever-increasing areolar incision techniques that have been previously recommended, propose a classification for these techniques, and introduce an alternative technique for areolar resection of the enlarged gland in gynecomastia. An inferior pole, periareolar-transareolar-perithelial (PTP) incision was designed and 15 patients were operated successfully using this technique. Twelve cases were bilateral and 3 were unilateral (27 breasts). A 65-mm access port can be obtained from a 30-mm-diameter areola. No color changes or slough was observed in any of the patients. Areolar access incisions can be classified into 4 main groups: circumareolar, periareolar, transareolar, and circumthelial, and their subgroups. Like every incision proposed, the PTP incision cannot be recommended for every grade of gynecomastia. It is best suited for grades I, IIA, and IIB gynecomastia. Its wide exposure and potential advantage for areolar reduction makes this incision a good alternative to other areolar approaches.