New Approach for Superthin Anterolateral Thigh Flap Elevation.

BACKGROUND: Anterolateral thigh (ALT) flaps are widely used for soft tissue reconstructions. They have several advantages, most notably a long pedicle, an appropriate pedicle caliber, low donor site morbidity, and the possibility of 2 teams working simultaneously. However, conventional, thick ALT flaps used for reconstructions of head and neck and lower extremity defects may cause postoperative range of motion limitations and cosmetic problems. The aim of this study was to develop and propose strategies to facilitate the harvest of superthin ALT flaps and minimize technical difficulties. This article provides step-by-step instructions for simple, quick, and reliable dissections of superthin ALT flaps. METHODS: This study retrospectively analyzed data from 60 free superthin ALT flaps used for soft tissue reconstructions in 56 patients between January 2018 and February 2019. Superthin flaps were elevated just above the superficial Scarpa's fascia using a vertical approach. RESULTS: Thirty-eight of the patients were operated on for lower extremity wounds, 16 were for head and neck defects, and 6 were for upper extremity wounds. The mean follow-up period was 7 months. The median hospital stay was 10 days. Total flap loss was observed in 4 cases (6.6%), and partial flap loss was observed in another 4 cases (6.6%). CONCLUSIONS: The superthin elevated ALT flap is a reliable and effective option for the reconstruction of soft tissue defects. In our vertical approach, the wide field of view of the flap perforator provides easy dissection, making it easier to elevate the superthin ALT flap.

Effects of external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation.

INTRODUCTION: Tamai zone 1 replantation poses a challenge due to the very small size of the vascular structures; often there is no vein for anastomosis. Replantation may have to be done with only an arterial anastomosis. In our study, we aimed to evaluate the success of replantation by combining external bleeding and hyperbaric oxygen treatment (HBOT) in Tamai zone 1 replantation. METHODS: Between January 2017 and October 2021, 17 finger replantation patients who underwent artery-only anastomosis due to Tamai zone 1 amputation received 20 sessions of HBOT with external bleeding after the 24th postoperative hour. Finger viability was assessed at the end of treatment. A retrospective review of outcomes was performed. RESULTS: Seventeen clean-cut finger amputation patients were operated on under digital block anaesthesia with a finger tourniquet. No blood transfusion was required. In one patient, complete necrosis developed and stump closure was performed. Partial necrosis was observed in three patients and healed secondarily. Replantation in the remaining patients was successful. CONCLUSIONS: Vein anastomosis is not always possible in fingertip replantation. In Tamai zone 1 replantation with arteryonly anastomosis, post-operative HBOT with induced external bleeding appeared to shortened the hospital stay and was associated with a high proportion of successful outcomes.

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from Istanbul

Background/aim: The aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey. Materials and methods: We retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in Istanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed. Results: There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively. Conclusion: This novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.

Salvage of the Exposed Cardiac Pacemakers With Fasciocutaneous Local Flaps.

OBJECTIVES: This study aims to investigate the efficacy of salvage of the mechanically exposed cardiac pacemakers with fasciocutaneous local flaps in elderly patients. METHODS: Between January 2014 and January 2018, ten patients (six females, four males; mean age 66.2 years) who were treated due to pacemaker exposition were retrospectively analyzed in this study. Exposed pacemaker and the wires were dissected, and capsulectomy was performed. The expose pacemaker was covered with the fascioutaneous flap. RESULTS: Only one patient had hematoma formation at early stage and revision was performed. All patients were treated successfully. No complication was observed during the follow-up period. CONCLUSION: Reconstruction with fasciocutaneous local flaps is an effective treatment modality in case of mechanically cardiac pacemaker expositions in elderly patients.

Evaluation of Neurotized Hypothenar Free Perforator Flaps Used for Fingertip Reconstruction.

INTRODUCTION: In reconstruction of digital amputations of the upper extremity, composite tissue alternatives with similar features are limited for finger tip reconstruction. Among these alternatives, free perforator flaps elevated from the hypothenar region (HFPFs) are defined, but reluctancy goes on for utilization of these flaps.In this study, we aimed to highlight the sensory results of HFPFs when a neural repair is incorporated to the flap and also to justify their usage by presenting functional and aesthetic outcomes of the reconstructions performed with HFPFs. METHODS: This clinical study was conducted from June 2015 to June 2017. Twelve patients with acute finger tip amputations were examined. Distal amputation levels were subgrouped according to Ishikawa classification. Patient demographics and amputation etiology were listed. All fingertip defects were reconstructed with a neurotized HFPF. All perforator anastomoses were performed in an end-to-end fashion. During follow-up, 2-point discrimination and dynamometric test were conducted. In addition, the Michigan Hand Outcomes Questionnaire was carried out. Evaluation of the results from a cosmetic standpoint was also conducted, with 4 blinded, independent surgeons using the visual analog scale. RESULTS: Of 12 digital amputations reconstructed with neurotized HFPFs, 10 were totally viable during follow-up, whereas partial loss was observed in 2 flaps. The mean age was 38.8 ± 11.8 years. Most of the amputations were classified as Ishikawa subgroup 2 (50%). The mean dynamic 2-point discrimination was 3.2 ± 0.11 mm and slightly greater compared with contralateral digit (P = 0.003). Also minor decreases were measured in forced grip and pulp-to-pulp grip strengths (P = 0.003). Overall satisfaction was 92.7% in Michigan Hand Outcomes Questionnaire. Average visual analog scale score was 7.25 out of 10. CONCLUSIONS: Hypothenar free perforator flaps, with incorporation of neural repair, give promising results for reconstruction of the fingertip. In addition to superior sensorial outcomes, HFPFs yield satisfying results from aesthetic and functional perspectives.

Salvage of Exposed Cardiac Implants Using Fasciocutaneous Rotation Flaps.

INTRODUCTION: Implantation rates of cardiac implantable electrophysiological devices (CIEDs) are rising, mainly because of the expansion of implantable cardioverter-defibrillators indications for primary prevention. As the CIED usage increases, CIED-related complications are also in rise. Transvenous approach and laser utilization techniques are replacing the open heart surgeries, for removal of CIED systems that are suspected to be infected. In this study, we aimed to share our new method of fasciocutaneous flap coverage results of patients with exposed CIED systems who were not eligible for the CIED replacement surgery for various reasons. PATIENTS AND METHODS: Patients operated with rotational fasciocutaneous flaps with addition of pectoralis fascia, owing to their exposed CIEDs between June 2016 and January 2019, were enlisted. Patients with signs of infection whether systemic or limited to the CIED pocket with or without positive blood cultures were referred to infectious diseases department and not included in this study. Patients included in the study were evaluated retrospectively in terms of demographic data, implanted CIED type, time elapsed from implantation to exposure, from referral to flap coverage operation, total follow-up time, survival ratios during follow-up, and complications related to flap coverage operation. In addition, indications for CIED implantation, patient comorbidities, and culture results obtained from the capsule encompassing the CIED battery unit were included to the evaluation. RESULTS: A total of 13 patients with exposed CIEDs have undergone total capsulectomy and CIED system coverage with rotational fasciocutaneous flaps. The mean patient age ± SD was 60.2 ± 13.4 years. The average time elapsed from CIED implantation to exposure was 27.3 ± 15.4 months. The average time spanned from initial referral to operation was 6 ± 1.6 days. The most prevalent comorbidity was diabetes mellitus. The average time elapsed during operation for pectoral fascia incorporated rotation flaps was 90 ± 10.6 minutes. Coagulase negative staphylococci were the dominant species (46.5%) obtained from capsule cultures. Apart from 1 case of hematoma, no early or late operation-related complication was encountered. CONCLUSIONS: A more precise definition of contamination and infection has to be made in guidelines, which may lead the first group to be treated without extraction. Surgical method defined in this study can be used for the treatment of patients in contaminated CIED subgroup, conserving individuals from risks of device extraction.

Complications of Percutaneous Release of the Trigger Finger.

AIM: Trigger finger is a common cause of hand pain and dysfunction. In this study, we aimed to evaluate retrospectively short and long-term outcomes of patients with trigger fingers who underwent percutaneous release operations. MATERIALS AND METHODS: Thirty-nine patients who underwent percutaneous release of the trigger finger were analyzed retrospectively. The patients were evaluated for digital nerve injury (hypoesthesia), recurrence, painful scar, and tendon rupture. RESULTS: The patients' median age was 54 years (minimum 32 years - maximum 63 years). Hypoesthesia was most frequently seen at the first and fourth fingers. At the end of the first year, one patient developed tendon rupture (fourth finger). Recurrences were seen at the end of the first (n=5) and third (n=9) years. Recurrence was mostly seen in the fourth finger, followed by the third finger. Painful scars were observed in two patients. CONCLUSION: Percutaneous release is a blindly performed intervention and the emergence of unexpected complications should not be forgotten.

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations.

BACKGROUND: Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures. METHODS: Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2nd, 3rd, and 4th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9-23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes-Weinstein monofilament test, and cold intolerance test for the development of neuroma on the donor site. RESULTS: In 5 patients, replantation procedure failed. In such failed patients, after the removal of necrotic tissues, the stump was either repaired or reconstruction with a flap was applied. Wound dehiscence was observed at the lateral sides of the flaps in 2 patients who underwent reposition procedures. CONCLUSION: Reposition flap repair can be a good cost-effective alternative to other fingertip repair procedures in appropriately selected patients who are not amenable to microsurgery. It preserves the length and sensory functions of fingertips and enables patients to return to their daily life as soon as possible.

Evaluation of sexual function in women with labia minora hypertrophy: A preliminary study.

OBJECTIVE: To compare the sexual functions in women with labia minora hypertrophy and age-matched healthy controls. MATERIAL AND METHOD: 43 patients with labia minora hypertrophy and 30 age-matched healthy controls were enrolled in the present study. The sexual functions of the women were evaluated by using the index of female sexual function (IFSF). RESULTS: Mean ages of the patients and controls were 30.06±7.11 and 31.34±4.12 (p=0.41), respectively. Mean total IFSF scores of the patients and controls were 24.18±3.24 and 27.53±4.43 (p<0.05), respectively. The subscale scores of IFSF-lubrication, orgasm, satisfaction and pain in the patient group were significantly lower than in the control group (respectively, p<0.001, p<0.05, p<0.001 and p<0.05). There was no statistically significant difference between IFSF-arousal scores of the patient and control groups (p=0.30). The mean IFSF-desire scores of the patient group was higher than the controls (p<0.001). Labia minora hypertrophy was significantly associated with female sexual dysfunction (odds ratio [OR]=14.97, 95% confidence interval [Cl]=[3.66-61.21], p<0.001). CONCLUSION: This study suggests that patients with labia minora hypertrophy have poorer lubrication, satisfaction, pain, and orgasm scores on the IFSF scale compared to age-matched healthy controls.

Evaluation of sexual function in women with labia minora hypertrophy: a preliminary study / Evaluación de la función sexual en las mujeres con hipertrofia en los labios vaginales menores: un estudio preliminar

Objective. To compare the sexual functions in women with labia minora hypertrophy and age-matched healthy controls. Material and method. 43 patients with labia minora hypertrophy and 30 age-matched healthy controls were enrolled in the present study. The sexual functions of the women were evaluated by using the index of female sexual function (IFSF). Results. Mean ages of the patients and controls were 30.06±7.11 and 31.34±4.12 (p=0.41), respectively. Mean total IFSF scores of the patients and controls were 24.18±3.24 and 27.53±4.43 (p<0.05), respectively. The subscale scores of IFSF-lubrication, orgasm, satisfaction and pain in the patient group were significantly lower than in the control group (respectively, p<0.001, p<0.05, p<0.001 and p<0.05). There was no statistically significant difference between IFSF-arousal scores of the patient and control groups (p=0.30). The mean IFSF-desire scores of the patient group was higher than the controls (p<0.001). Labia minora hypertrophy was significantly associated with female sexual dysfunction (odds ratio [OR]=14.97, 95% confidence interval [Cl]=[3.66-61.21], p<0.001). Conclusion. This study suggests that patients with labia minora hypertrophy have poorer lubrication, satisfaction, pain, and orgasm scores on the IFSF scale compared to age-matched healthy controls

Objetivo. Comparar las funciones sexuales en mujeres con hipertrofia de labios menores y un grupo control. Material y método. En el presente estudio se incluyeron 43 pacientes con hipertrofia de labios menores y 30 controles sanos de la misma edad. Las funciones sexuales de las mujeres fueron evaluadas utilizando el Índice de Función Sexual Femenina (IFSF). Resultados. La edad promedio de las pacientes y controles fueron 30,06±7,11 y 31,34±4,12 (p=0,41), respectivamente. La puntuación total media del IFSF de las pacientes y controles fueron 24,18±3,24 y 27,53±4,43 (p<0,05), respectivamente. Las puntuaciones de la subescala de lentificación, orgasmo, satisfacción y dolor en el grupo estudio fueron significativamente menores que en el grupo control (p<0,001, p<0,05, p<0,001 y p<0,05). No hubo diferencias estadísticamente significativas entre las puntuaciones de excitación del IFSF de las pacientes y los grupos control (p=0,30). El promedio de las puntuaciones del deseo del IFSF del grupo de pacientes fue mayor que en el grupo control (p<0,001). La hipertrofia de labios menores se asoció significativamente con disfunción sexual femenina (odds ratio [OR]=14,97; intervalo de confianza [lC] del 95%=[3,66-61,21]; p<0,001). Conclusión. Este estudio sugiere que las pacientes con hipertrofia de labios menores tienen peor puntuación en cuanto a lubricación, satisfacción, dolor y orgasmo en la escala del IFSF en comparación con el grupo control

Giant lipoma extending into two thigh canals: A case report.

Giant lipomas, although rare, represent a real diagnostic and therapeutic challenge. We report an unusual giant lipoma of the thigh extending into two thigh canals and it's diagnostic and therapeutic processes.

Fingertip Replantation Without and With Palmar Venous Anastomosis: Analysis of the Survival Rates and Vein Distribution.

BACKGROUND: The purpose of this study was to compare the results of fingertip replantations without (artery anastomosis only replantations) and with venous anastomosis (replantations in which both arterial and palmar venous anastomoses were performed). Also, distribution of the veins used for anastomosis was analyzed retrospectively. PATIENTS AND METHODS: First 53 digits (47 patients) received only arterial anastomosis (group 1). For relieving venous congestion, external bleeding method was used. Last 41 digits (38 patients) received both arterial and palmar venous anastomoses without external bleeding (group 2). RESULTS: There was statistical significance of the survival rate between group 1 [77.3% (41/53)] and group 2 [92.6% (38/41)] (P = 0.039). Venous congestion was encountered at 10 digits in group 1 (all underwent necrosis totally) and at 3 digits in group 2 (both were moderate and could be salvaged partially) (P = 0.094, no statistical significance). There was statistical significance of the mean operation time for single-fingertip replantation between group 1 (80 ± 7.8 minutes) and group 2 (105 ± 14.5 minutes) (P < 0.001). The average external bleeding period was 7.2 days. The mean hospital stay was 12.4 ± 1.5 days for group 1, which was significantly longer when compared with group 2 (5.2 ± 0.5 days, P < 0.001). CONCLUSIONS: Although palmar vein anastomosis did not show a statistically significant effect on relieving venous congestion, it reduced the rate and the severity of venous congestion. Also, replantations with palmar venous anastomosis have simpler postoperative care and lower drawbacks as compared with artery anastomosis-only replantations.

Sexual function and hormone profile in young adult men with idiopathic gynecomastia: Comparison with healthy controls.

OBJECTIVES: To compare sexual function and hormone profile in male patients with gynecomastia with matched controls. MATERIALS-METHODS: Forty-seven male subjects with gynecomastia and thirty healthy controls were enrolled in this study. Serum free T3, free T4, TSH, FSH, prolactin, estradiol, total testosterone, free testosterone, DHEA-SO4, LH and total PSA were measured in the patients and controls. Sexual function of the patients and controls were evaluated using International Index of Erectile Function (IIEF). The hormone values and IIEF scores of the patients were statistically compared with the controls'. RESULTS: The mean of age, body mass index, right and left testicular volume in the patient and control group were similar. The mean FSH and free T3 values of the patients were significantly lower than the controls (p = 0.007 and p = 0.03, respectively). The mean of the other hormone values in the both groups were found to be statistically similar (p > 0.05). The mean ±SD of total IIEF scores in the patient and control group were 60.14 ± 8.78 and 65.24 ± 5.52, respectively (p = 0.007). Although the mean IIEF-erectile function, orgasmic function and intercourse satisfaction scores in the patient group were significantly lower than the control group (p < 0.001, p = 0.004 and p = 0.001, respectively), the mean IIEF-desire score of the patients was significantly higher than the controls (p = 0.002). CONCLUSION: We found that the hormone profiles (except FSH and free T3) of the patients with gynecomastia were similar with the controls. However, gynecomastia adversely affected male sexual function.

Increasing topical anesthetic efficacy with microneedle application.

INTRODUCTION: Since topical anesthetics alone seldom provide adequate analgesia for laser resurfacing procedures, injectable forms of anesthesia are often required. However, their application is uncomfortable for the patient. In this study, it is investigated whether microneedle application would enhance the efficacy of topical anesthetics. METHODS: Forty-seven patients participated in the study. Topical anesthetic agent EMLA was applied to the whole face of the patients. Microneedle treatment was applied to one side of the face with a roller-type device. Whole-face carbon dioxide laser resurfacing therapy was carried out then. The pain that patients experienced was assessed by using visual analog scale (VAS) method. VAS scores of two sides of the face were compared by using Wilcoxon signed-rank test. RESULTS: The mean of VAS score of the microneedle treated side was 2.1 ± 1.1 while that of the untreated side was 5.9 ± 0.9 and this difference was statistically significant (Wilcoxon signed-rank test, the Z-value is - 5.9683 and the p-value is < 0.001). SUMMARY: This study revealed that microneedle application, with a roller-type device, is a safe and easy procedure in providing sufficient anesthesia for facial laser resurfacing without the need for supplementary nerve blocks or injections.

Effect of Reduction Mammaplasty on Sexual Activity.

AIM: This study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. MATERIALS AND METHODS: Thirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls' scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. RESULTS: The mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). CONCLUSIONS: We found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners' erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.

A novel method to prevent complications of nasal osteotomy: matress suture which traverses lateral walls and septum.

OBJECTIVES: This study aims to investigate long-term nasal wall stability and prevention of nasal osteotomy complications using thin osteotomes without a nasal splint. PATIENTS AND METHODS: Between March 2012 and August 2014, 16 male patients (mean age 24 years; range 18 to 42 years) who were admitted with the complaint of appearance of nose to our clinic and were diagnosed with nasal deformity were included in this study. Primary rhinoplasty was performed on 15 patients, while secondary rhinoplasty due to open roof deformity was applied in one patient. After hump resection, two holes were made cranially and caudally over the each nasal bone. The mattress suture was performed by passing these holes to stabilize the nasal bone in a desired position following osteotomy. With this technique, only adhesive tapes were applied postoperatively. No external nasal splint was used. RESULTS: The mean follow-up was nine (range, 7 to 13) months. None of the patients experienced open roof deformity, inverted V deformity, nasal bone collapses or wall irregularities. CONCLUSION: Our study results show that our technique is useful to reduce osteotomy complications and to reach the optimal cosmetic outcomes in rhinoplasty.

Assessment of sexual function in women with macromastia and their partners / / Evaluación de la función sexual en mujeres con macromastia y sus parejas

Objective. To investigate the sexual function in patients with macromastia and their partners. Materials and methods. 48 patients with macromastia and 30 healthy controls and their partners were enrolled in the study. The sexual function of the women and their partners was evaluated by using the Index of Female Sexual Function (IFSF) and International Index of Erectile Function (IIEF), respectively. Results. Mean ages of the patients and controls were respectively, 33.27 ± 5.24 and 32.06 ± 3.91 (p > 0.05). Mean IFSF scores of the patients and controls were 23.21 ± 3.16 and 27.33 ± 4.94 (p = 0.00), respectively. All of the subscale scores of IFSF in the patient group were significantly lower than in the control group. Mean IIEF scores of the patients’ and controls’ partners were 60.33 ± 11.46 and 65.25 ± 6.18 (p = 0.04), respectively. Conclusion. In this study, Macromastia was shown to affect sexual function of women and their partners adversely (AU)

Objetivo. Investigar la función sexual en pacientes con macromastia y en sus parejas. Material y método. 48 pacientes con macromastia y 30 controles sanos y sus parejas fueron inscritos en el estudio. La función sexual de las mujeres y sus parejas fueron evaluadas usando el Índice de Función Sexual Femenina (IFSF) y el Índice Internacional de Función Eréctil (IIEF), respectivamente. Resultados. La edad media de los pacientes y controles era de respectivamente 33,27 ± 5,24 y 32,06 ± 3,91 (p > 0,05). Las puntuaciones medias de los pacientes y los controles eran de respectivamente 23,21 ± 3,16 y 27,33 ± 4,94 (p = 0,00). Todas las puntuaciones en subescalas de IFSF en el grupo de los pacientes eran significativamente más bajas con respecto al grupo de control. La media de las puntuaciones del IIEF en las parejas de los pacientes y de los controles eran de respectivamente 60,33 ± 11,46 y 65,25 ± 6,18 (p = 0,04). Conclusiones. En este estudio, se demostró que la macromastia afecta la función sexual de las mujeres y sus parejas negativamente (AU)

Vacuum-assisted closure therapy leads to an increase in plasma fibronectin level.

An extensive research has been performed to investigate the mechanisms of action by which the application of subatmospheric pressure to wounds increases the rate of healing. Increased blood flow with vacuum-assisted closure (VAC) use is the most popular aspect. Fibronectin, which is an adhesion molecule, has several functional domains mediating chemotaxis, adhesion and migration. This is thereby involved in differentiation, proliferation, inflammation and thus in wound healing. In this study, plasma fibronectin levels were measured before and after VAC in patients with wounds. The results showed that there was an increase in pre- and post-VAC levels of plasma fibronectin. This statistically significant increase could be another explanation of how VAC therapy promotes wound healing.

Reconstruction of the oral commissure with the use of a new technique: the asterisk design.

Microstomia reconstruction due to the presence a blunted oral commissure is a challenging task because it requires the restoration of intricately balanced distinct layers of tissues: the oral mucosa, the orbicular muscle, the vermilion border, and the perioral skin. The reliability of commissural reconstruction depends on 2 factors: the first one is breaking the contraction vectors causing blunting of the commissure and the second one is restoring the integrity of the oral sphincter. We have used local skin, vermilion border-muscle, and mucosa flaps designed in an asterisk pattern to break the contraction vectors and have paid certain attention to the restoration of the sphincter function of the circular muscle fibers. Our results have shown that, with the use of our asterisk design, a new commissure aesthetically comparable to the natural one can be created with the reestablishment of reliable oral competence.

Reconstruction of extensive pilonidal sinus defects with the use of S-GAP flaps.

Pilonidal sinus is a chronic intermittent inflammatory condition that is predominantly located in the sacrococcygeal region. For the closure of uncomplicated small pilonidal sinuses, conventional therapeutic techniques including total excision of the sinus and leaving the defect open for secondary healing have been reported with varying success rates. However, the treatment of recurrent and extensive disease remains as a difficult condition. The ideal treatment should be associated with short hospital stay, minimal complication rates, and no disease recurrence. Secondary wound healing after large excision results in a chronic wound that requires cleansing and dressing changes for a long time. The condition also negatively affects the patient's social life. With the progression of reconstructive techniques, the lowest recurrence rates for the treatment of extensive disease have been reported after local flap usage. The purpose of the current article is to report the efficacy of superior gluteal artery perforator flap in the reconstruction of extensive sacrococcygeal pilonidal sinus defects. This perforator flap is a refinement of the classic gluteal musculocutaneous flaps, which have been popularly used for the closure of sacral pressure sores over many years.