Long-term results of migraine surgery and the relationship between anatomical variations and pain.

BACKGROUND: Migraine headache surgery has been recently reported and supported by studies as management to provide long-term relief in migraine sufferers. This study aimed to monitor the long-term results of patients who underwent migraine surgery in our clinic and determine the relationship between pain and anatomical anomalies. METHODS: A prospective review was conducted of 93 patients who underwent surgery for migraine headaches performed between 2017 and 2021 by the senior author (M.U.) and had at least 12 months of follow-up. Anatomical data were obtained by recording the findings during surgery. Migraine surgery was performed bilaterally in all patients. Anatomical symmetry differences between the right and left sides were recorded. RESULTS: A total of 79 (84.9%) patients experienced at least 50% reduction in migraine headache. Furthermore, 13 (14%) patients reported complete elimination of migraine headache. A significant difference was found before and after surgery in Migraine Disability Assessment score, migraine headache index, frequency, duration, and pain (p < 0.001). Also, 30 (32.3%) of the patients had bilateral headaches and 63 (67.7%) had primarily unilateral headaches. Then, 51 (81%) patients with mostly unilateral headache were anatomically asymmetrical and 12 (12%) were anatomically symmetrical. Patients with mostly unilateral headache were found to be anatomically highly asymmetrical (p < 0.005). CONCLUSIONS: This study shows that surgical treatment is effective and long-term protection and has mild complications that are easily tolerated by the patient. The fact that headache side and anatomical asymmetry were significant in this study supports the peripheral mechanism.

The Effect of Platelet-Rich Plasma on the Zone of Stasis and Apoptosis in an Experimental Burn Model.

BACKGROUND: The zone of stasis that forms in acute burn is initially viable, but coagulation progresses to necrosis in the process that follows. OBJECTIVE: This study investigates the effects of platelet-rich plasma (PRP) on apoptosis in the burn zone of stasis and on the viability of living tissue. METHODS: Burns were established in the right ears of 20 female New Zealand rabbits using the "comb burn" model. Platelet-rich plasma was obtained from blood collected from rabbits' ears (n = 10) and was injected subcutaneously into the zone of stasis (n = 10). The same amount of saline solution was injected into the zone of stasis of the control group rabbits (n = 10). Histological and immunohistochemical apoptosis analysis was performed to evaluate viable areas. RESULTS: Apoptosis levels were higher in the control group than in the experimental group. The area of viable tissue in the zone of stasis was greater than in the control group. Infection-induced neutrophil infiltration was statistically significantly lower in the experimental group. CONCLUSION: In this animal model, apoptosis count and viable tissue area measurement and the anti-inflammatory results in the burn area confirm that PRP therapy has a statistically significant positive impact on the survival of the zone of stasis and in acute burn injury.

HISTORIQUE: La zone de stase qui se forme après une brûlure aiguë est d'abord viable, mais la coagulation entraîne la nécrose dans le processus qui suit. OBJECTIF: La présente étude porte sur les effets du plasma riche en plaquettes (PRP) sur l'apoptose dans la zone de stase d'une brûlure et sur la viabilité des tissus vivants. MÉTHODOLOGIE: Les chercheurs ont établi les brûlures dans l'oreille droite de 20 lapins de Nouvelle-Zélande au moyen du modèle de brûlure par peigne. Ils ont obtenu le PRP dans le sang prélevé dans l'oreille des lapins (n = 10) et l'ont injecté par voie sous-cutanée dans la zone de la stase (n = 10). Ils ont injecté la même quantité de soluté physiologique dans la zone de la stase du groupe témoin de lapins (n = 10). Ils ont analysé l'apoptose histologique et immunohistochimique pour évaluer les secteurs viables. RÉSULTATS: Les taux d'apoptose étaient plus élevés dans le groupe témoin que dans le groupe expérimental. La région de tissus viables de la zone de stase était plus étendue que dans le groupe témoin. L'infiltration de neutrophiles induite par infection était statistiquement plus basse dans le groupe expérimental. CONCLUSION: Dans ce modèle animal, la numération de l'apoptose, la mesure de la région des tissus viables et les résultats anti-inflammatoires dans la région de la brûlure confirment que le traitement par PRP a des répercussions positives statistiquement importantes pour la survie de la zone de stase en cas de brûlure aiguë.

Lateral Osteotomy Fixation Technique in Rhinoplasty.

Rhinoplasty is the most challenging facial aesthetic surgical procedure according to many plastic surgeons. Nasal bone osteotomies, especially lateral osteotomies, have a complicated history. If lateral osteotomy is not stable after osteotomy during intraoperative period, stabilization is attempted with internal and external nasal splints but it is not possible to be confident about the stabilization since it is not fully fixed and cannot be observed directly. The authors presented the technique stabilization of the lateral osteotomy inferior tip with cerclage wire, if there is a stabilization problem or step-off deformity after lateral osteotomy.

Evaluation of the Extent of Vessel Avulsion Injury: An Experimental Study Using a Rabbit Model.

BACKGROUND: Determining the extent of damage in vascular avulsion type injuries still represents a challenge for the microsurgeon. Excision of the damaged section is critical for the success of anastomosis. The purpose of this study was to determine which among vascular endothelial and adventitia damage findings is most effective in determining the extent of avulsion injury. METHODS: Varying degrees of avulsion were applied to the aorta of 12 (n = 12) adult female New Zealand rabbits. Avulsion was first determined using adventitial findings and then with endothelial findings. The definitive extent of damage was determined histopathologically. RESULTS: The mean area of the histopathological sections was 16.7 ± 6.9 mm. The extent of damage measured from the adventitia was 15.8 ± 7.9 mm (the difference in histopathological examinations was not significant, p = 0.590, paired t-test), while the extent of damage from the lumen was 13.3 ± 8.2 mm (the difference in histopathological examinations was significant p = 0.004, paired t-test). CONCLUSION: Excision based on adventitia findings is more effective in case of avulsion injury.

The effect of low molecular weight heparin on salvaging the zone of stasis in an experimental burn model

Background/aim: Multiple zones of injuries are formed after burns, consisting of a zone of coagulative necrosis, a zone of hyperemia, and a zone of stasis, in which progressive microcirculatory thrombosis leads to degeneration and deepening of the wound. We used an experimental rat comb burn model to test the hypothesis that use of low molecular weight heparin (LMWH) may save the zone of stasis. Materials and methods: Adult female rats were randomly divided two groups: the LMWH group (n = 8) rats received subcutaneous LMWH injections, while the saline group (n = 8) rats were injected with the same volume of saline solution by the same route. The zone of stasis was evaluated macroscopically and histologically, and functional capillary density was evaluated. Results: Histological assessments revealed higher macrophage numbers and PML density, fibroblast proliferation, and angiogenesis in the LMWH group than in the saline group. Functional capillary density measurement in the stasis zones revealed no significant difference between the two groups in the first 4 days, although a significant difference in favor of the LMW group was observed in the last 3 days. Conclusion: The results of this experimental study show that LMWH is effective in saving the zone of stasis.

Percutaneous Screws and External Fixation in Frontal Sinus Anterior Wall Fractures.

Fractures of the frontal sinus are frequently encountered injuries of maxillofacial fractures. The most common causes are traffic accidents, followed by sports-related injuries. There is still no consensus regarding the optimal management of frontal sinus fractures. The authors report a patient with depressed anterior wall fracture of the frontal sinus and superior orbital rim fracture. Reduction was performed by traction from 2 screws applied percutaneously to the depressed fragments and external fixation with an aluminum nasal splint. This technique is both minimally invasive and permits easy fixation in suitable patients.

Microsurgical Replantation of Two Consecutive Traumatic Total Scalp Avulsions.

Total scalp avulsion is a rare but severe injury frequently ending in hair loss, and one that can even be life-threatening. It frequently occurs in women and in men with long hair and as a result of injuries by industrial or agricultural equipment or of animal attacks. The first option in treatment is replantation of hairy skin with microsurgery.The authors report 2 consecutive patients with total scalp avulsion presenting to our clinic. Similar injury mechanisms and total scalp avulsions were present in both patients. However, the noteworthy aspect of this report is the different outcomes in terms of scalp viability, which the authors think depends on the number of vessels repaired.

Congenital nail abnormalities: a review of the literature.

Congenital nail abnormalities (CNAs) are rare conditions in which the nail tissue appears abnormal compared with the fingers and the toes. They usually present accompanying deformities and disorders. Our purpose was to review the current literature on the clinical aspects of CNA. We reviewed the literature to evaluate peer-reviewed articles on the topic. Detailed reports have characterized many types of CNA. In this article, we provide a review of the literature based on the current understanding of CNAs and the clinical varieties thereof.

Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty.

BACKGROUND: This randomized, double-blind study was designed to assess the effect of perioperative remifentanil with controlled hypotension on intraoperative bleeding, postoperative edema, and ecchymosis. METHODS: Fifty-two patients undergoing rhinoplasty were divided into 2 groups. The remifentanil group received 1 µg · kg(-1) intravenously as a bolus before induction of anesthesia, 0.5 to 1 µg · kg(-1) · h(-1) by continuous intravenous infusion during the operation. After anesthesia induction with propofol (2-3 mg · kg(-1)) and fentanyl (1-15 µg · kg(-1)), muscle relaxation was achieved with rocuronium (0.45-0.90 mg · kg(-1)). Mean arterial pressure was maintained at 50 to 60 mm Hg in controlled hypotensive anesthesia achieved using remifentanil infusion. Perioperative hemodynamics and bleeding; early postoperative pain and agitation scale; postoperative first, third, and seventh day edema; and ecchymosis were evaluated. Edema and ecchymosis were evaluated using graded scale from 0 to 4. RESULTS: Remifentanil reduced mean arterial pressure during the entire operative period and the first 30 minutes postoperatively (P < 0.05 for these comparisons). Intraoperative bleeding also decreased (P < 0.001). There was a significant decrease in edema in both upper and lower eyelid edema on the first and third days in the remifentanil group, although this difference was not detected on the seventh day (P(1upper) = 0.000, P(1lower) = 0.000, P(3upper) = 0.008, and P(3lower) = 0.002). Ecchymosis decreased significantly in both upper and lower eyelids on the first, third, and seventh days in the remifentanil group (P(1upper) = 0.000, P(3upper) = 0.000, P(3upper) = 0.002, P(3lower) = 0.002, P(7upper) = 0.049, and P(7lower) = 0.038). There were no differences in postoperative pain and agitation between 2 groups. CONCLUSIONS: Remifentanil with controlled hypotension may reduce edema and ecchymosis of the upper and lower eyelids, by reducing mean arterial pressure and amount of bleeding in rhinoplasty.

An evaluation of five different dressing materials on split-thickness skin graft donor site and full-thickness cutaneous wounds: an experimental study.

The objective of this study was to investigate the healing effect of five different products on split-thickness skin graft (STSG) donor sites and full-thickness cutaneous wounds (FTCWs) using an occlusive dressing model. Six groups were included: 1 control and 5 experimental groups, with a total of 24 rats, using an occlusive dressing model. STSG donor sites and FTCWs were established in two separate areas, to the right and left on the animals' backs. Wound sites were dressed with one of the following materials: fine mesh gauze, microporous polysaccharide hemosphere (MPH), clinoptilolite, alginate, hydrogel or biosynthetic wound dressing (Biobran(®) ). These materials were compared in terms of healing rate, healing quality and histopathological findings. Occlusive dressings were applied to each wound on days 0, 3, 5, 7, 10 and 14. Area measurements were taken using images of each dressing. The alginate and clinoptilolite groups gave the best healing rate results for both STSG donor sites (P = 0·003) and FTCWs (P = 0·003). MPH came third in each group. The alginate group produced better results in terms of healing quality criteria, followed by hydrogel, MPH, clinoptilolite and Biobran(®) , in that order. Statistically significant results were obtained in all groups compared to the control group (P < 0·0007). Rapid and good healing quality for both the STSG donor sites and FTCWs were obtained with alginate. Healing with clinoptilolite and MPH was rapid, but poor quality, while slower but good healing quality was obtained with hydrogel. Slower and worse quality healing was obtained with Biobran(®) .

Effects of lidocaine plus epinephrine and prilocaine on autologous fat graft survival.

Although fat grafting is frequently used in plastic surgery practice, debate about the viability of the graft still persists owing to its questionable long-term success. The ultimate aim is to obtain long-term graft viability. Vascularization of the graft is essential for this purpose. The effects of 2 different local anesthetic preparations frequently used during harvesting of fat grafts on long-term graft survival were compared with angiogenesis and volumetric measurements. Twenty-four male Wistar rats were divided into 3 groups. The inguinal region was selected as the fat graft donor site. The first group was injected with isotonic saline, the second was injected with lidocaine plus epinephrine, and the third was injected with prilocaine. Fat grafts were implanted into the dorsal regions of rats, and volumetric measurements were performed initially and on days 30 and 180 at which microvascular angiogenesis were also analyzed. Microvascular angiogenesis was assessed both with the reverse transcription-polymerase chain reaction and immunohistochemistry through determination of vessels stained with factor VIII. No significant difference was obtained between the 3 groups in graft volume or microvascular angiogenesis at any stage of the study. Results from this experimental study indicate that there is no negative effect of lidocaine plus epinephrine or prilocaine on microangiogenesis and the survival of fat grafts.

Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): a case report.

Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region. The surgical management of this complication is also discussed. Cicatricial alopecia was treated by two-stage surgery with tissue expanders. There were no complications in the postoperative period and healing was uneventful. We conclude that although FUE has many advantages, necrosis of the donor site may be a serious problem.

Giant cementoblastoma of the impacted mandibular incisor.

The cementoblastoma is a relatively rare type of all odontogenic tumors. The incisor and impacted or unerupted tooth involvement by a cementoblastoma is extremely rare. We present a case report of a giant cementoblastoma that involved an impacted mandibular incisor.

An objective evaluation of an injured vessel wall using fluorescein sodium before microvascular anastomosis in an experimental rat model.

The aim of this study was to establish an objective evaluation method for intraoperative detection of damaged vascular endothelium in avulsion injuries. Twenty male Fischer rats were randomly assigned to control or experimental groups ( N = 10, each). Crush-avulsion injury was performed on right femoral arteries. Resection of damaged segments was performed according to operative microscopic findings in the control group; fluorescein sodium was applied to the artery lumen before resection in the experimental group to help visualize the damaged endothelium. Microvascular repair was performed in five rats in each group. In the other animals, the whole length of the femoral arteries was resected to assess the actual extent of injury histologically. At the end of the follow-up period, patency of microvascular anastomoses was examined and the lengths of the resected segments were compared with the actual length of the injured segment measured histologically. The difference between these two measurements was statistically significant in the control group ( P < 0.05) but not in the experimental group ( P > 0.05). Anastomosis patency was significantly higher in the experimental group ( P < 0.0001). In conclusion, fluorescein sodium may help to accurately determine the length of the injured vascular segment in avulsion injuries.

Rare occupational disease of hair dressers: interdigital pilonidal sinus.

Interdigital pilonidal sinus is a rare occupational disease related to work with short hair. Hair dresser's disease is the interdigital pilonidal sinus encountered in male barbers. A case of pilonidal sinus in the interdigital web is reported. We performed surgical excision and primary closure. There were neither complications nor recurrence in the third month after excision. We propose that surgical excision is inevitable and that any primary treatment can improve the patients' postoperative comfort. Thus, primary closure or closure with a flap, instead of secondary healing, should always be the first choice of treatment for a defect due to excision of an interdigital pilonidal sinus.

A new approach to alar rim defects: mucocartilaginous turnover flap.

The main principle of reconstructive surgery is replacement of the defective tissues with like tissues. A full-thickness defect of the nasal ala should be reconstructed in three layers: innermost mucosal layer, outermost skin, and the cartilage in-between. The aim of this study is to describe a technique for single-stage, three-layer reconstruction of the full-thickness ala nasi defects. This technique was used on three patients with tumors involving the nasal ala. Resulting full-thickness defects are reconstructed with a mucocartilaginous turnover flap planned from the contralateral side. Aesthetically acceptable results are obtained without the compromise of the nasal airway and with minimal donor site morbidity. None of the patients requested a revision operation. In conclusion, this is a novel technique with minimal donor site morbidity and good postoperative results. Moreover, lost tissues are replaced with exactly the same kind of tissues.