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1.
Dermatol Ther ; 34(1): e14734, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33389778

RESUMO

We present hybrid reconstruction of distal lateral "through-and-through" nasal defects (skin, cartilage, and mucosa) due to resection of tumor and/or infection. Retrospective descriptive study. The study was performed in multicenter clinics between July 2011 and September 2016. 13 patients with full thickness distal nasal defects secondary to tumor and/or infection were included. Defects included dorsal and/or caudal septum, upper lateral cartilage, or inner/outer nasal valve. Caudal-based turn-in flaps were planned and used to repair inner lining of nasal cavity. Conchal and septal cartilages were used as cartilage grafts. Skin defects were reconstructed with lateral nasal artery perforator flaps. All flaps healed uneventfully, without flap loss. Nasal passage collapse, adhesion, or difficulty in breathing were not seen. No hematoma, infection, and deformity at cartilage graft donor areas was observed. During nasal reconstruction, it is mandatory to consider 3D complex and functional structure of nose. The repair of skin defects may not be enough for functional restoration. We believe that single step reconstruction of full thickness nasal defects through hybrid reconstruction may lead to anticipated successful results.

2.
J Cutan Aesthet Surg ; 13(2): 154-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32792778

RESUMO

Background: Nicolau syndrome (NS) is a rare complication that develops after the administration of intramuscular diclofenac sodium. The etiology and surgical treatments of 11 patients with NS were evaluated and studies in the literature were examined. The aim of this study was to compose a basic algorithm for surgical approaches to treat NS. Materials and Methods: Eleven patients were evaluated for NS between December 2013 and January 2018. Two patients did not accept treatment, and nine patients underwent surgical debridement of necrotic tissues. The tissue defects of five patients were closed with a fasciocutaneous flap and, in four patients, the defects were repaired primarily. Results: No complications, such as wound infection, wound dehiscence, seroma, or flap necrosis, were encountered. Of the seven patients who received concurrent antibiotic therapy, no patient had any problems at their follow-up (2-30 months). The results were satisfactory from an aesthetic and functional point of view. Conclusion: NS was more frequent in women with a high body mass index and high fat in gluteal regions. We considered that any kind of medication could lead to NS. Different methods are discussed for treatment.

3.
Dermatol Ther ; : e14003, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32648954
4.
Int Wound J ; 17(5): 1424-1427, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32501604

RESUMO

COVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.

6.
Aesthetic Plast Surg ; 44(5): 1707-1715, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32424533

RESUMO

INTRODUCTION: The nasal septum plays an important role in nasal form and function. In this study, we describe a novel, alternative septoplasty approach that results in an aesthetically acceptable dorsal profile and improves airway function in patients with a crooked nose. PATIENTS AND METHODS: This study enrolled 26 patients who presented with crooked noses between 2012 and 2017. All patients underwent open rhinoplasty under general anesthesia. During correction of the cartilaginous part, a dorsal strip from the deviated septum was prepared and inverted in a 180° fashion to exert a counter-force to correct the remaining septum and fixed by suturation. This maneuver allowed application of the maximum possible force in the opposite direction to reset the deviation by its own force. RESULTS: The approach was used successfully in 26 patients with severe nasal septal deviations in the caudal septum and dorsal angulation of the nasal shape. There was no case of hematoma, synechia, septal perforation, dorsal irregularity, or saddle deformity. Temporary nasal obstruction occurred in 4 patients but improved in all of them by the third postoperative month. One patient had a recurrence of the septal deviation, dorsal angulation, and persistent nasal obstruction, which were treated by revision nasal valve surgery 14 months postoperatively. There was no subsequent recurrence during the long-term follow-up. The improvement between the preoperative and postoperative 12-month deviation angle measurements, Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores were significant (P < 0.05), Improvement in the NOSE score correlated strongly and significantly with deviation angle changes and patient satisfaction. CONCLUSION: Our counter-autografting technique in septoplasty is safe and effective in the correction of severe dorsal and/or caudal deviations, as long as the severely angulated cartilage septum remains in one piece after careful dissection. LEVEL OF EVIDENCE IV: 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 .

9.
Dermatol Ther ; 33(3): e13377, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32246549

RESUMO

To present the use of Limberg flap in the central midface reconstruction as an useful flap in elderly patients. A retrospective review of a total of 13 cases who underwent Limberg flap procedure to reconstruct various sizes of midfacial defects. Etiology, size, location, surgical procedures, outcomes, and complications, final evaluation according to the tumor-free survival and patient satisfaction in terms of aesthetic appearance were analyzed, the latter was evaluated by visual analog scoring system. The mean follow-up period was 11.53 months (2-22 months). The mean age of cases was 68 years (between 49 and 81 years). Average defect size was 7.76 cm2 (between 2.25 and 25 cm2 ). All operations were performed under local infiltration anesthesia. All patients were discharged on the same day of the operation. All the flaps survived with uneventful wound healing according to the patient satisfaction scores that were reliable and high. No any early or late recurrence was detected. Limberg flap is a safe and rapid option that could be applied in small- and medium-sized cutaneous defects in the central midface reconstruction in elderly patients.

10.
Dermatol Ther ; 33(3): e13315, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32181980
14.
J Hand Microsurg ; 10(1): 49-51, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29706738

RESUMO

Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles' tendon. A 37-year-old man suffered from tertiary Achilles' tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles' tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects. The patient was followed up for 12 months. No wound healing problems were reported, and the patient was able to walk and return to his daily ambulating activities without any support after 5 months postoperatively. This technique may be useful to achieve satisfactory outcomes in patients with ruptured Achilles' tendons following tertiary repair.

15.
Aesthetic Plast Surg ; 41(6): 1311-1317, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28698934

RESUMO

BACKGROUND: Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger's horizontal septum and inferior pedicle techniques. METHODS: This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger's horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm. RESULTS: The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g). CONCLUSIONS: This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction. LEVEL OF EVIDENCE IV: 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 .


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Mamilos/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Mama/cirurgia , Estudos de Coortes , Estética , Feminino , Seguimentos , Humanos , Hipertrofia/diagnóstico , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Cicatrização/fisiologia , Adulto Jovem
16.
Int Wound J ; 14(6): 1183-1188, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28707450

RESUMO

We present a new surgical modification to allow propeller perforator flaps to cover pressure sores at various locations. We used a propeller perforator flap concept based on the detection of newly formed perforator vessels located 1 cm from the wound margin and stimulated by the chronic inflammation process. Between January 2009 and January 2017, 33 wound edge-based propeller perforator flaps were used to cover pressure sores at various locations in 28 patients. In four cases more than one flap was used on the same patient. The patients comprised 18 males and 10 females with a mean age of 41·25 (range, 16-70) years. All patients underwent follow-up for 0-12 months. The mean follow-up duration was 5·03 months. Venous congestion was observed in three flaps that were rotated by 180° (9·1%). However, there was a significant difference between flaps rotated by 90° and 180° according to the complication rate (P = 0·034). Out of 33 flaps, 29 flaps healed uneventfully. Patients were able to sit and lie on their flaps three weeks after surgery. In our study, we were able to obtain satisfying final results using these novel flaps.


Assuntos
Retalho Perfurante , Lesão por Pressão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/etiologia , Lesão por Pressão/patologia , Resultado do Tratamento , Cicatrização , Adulto Jovem
18.
Aesthetic Plast Surg ; 41(1): 153-160, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28008458

RESUMO

INTRODUCTION: Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however, the resultant columellar scar of the open approach is directly considered as a disadvantage. This study focuses on the columellar scar awareness and its implications on overall satisfaction of the patients after open rhinoplasty. PATIENTS AND METHODS: A total of 91 patients who have undergone open rhinoplasty were included in this study. A written questionnaire algorithm consisting of 4 sequential questions was applied. Except for the first question [Do you have any scar(s) caused by any trauma, operation or any other reason on your face?], every question was answered on a scale from 1 to 5. The respondents were given the 25-question "Modified Body Cathexis Scale (MBCS)"and their scars graded using the "Columellar Scar Assessment Scale" (CSAS). The data were statistically interpreted. RESULTS: Of the 91 open rhinoplasty patients, 12 of them responded with a "yes" to the first question reporting their columellar scars. There was no significant difference with regards to patient satisfaction regarding these patients (p > 0.05). However, those who reported the scar yielded a significantly lower MBCS scores. 9 patients declared that they exerted effort to conceal their scars. Those who concealed their scars and those who did not yielded a significant difference in patient satisfaction. The CSAS scores of those who reported the columellar scar were significantly higher than those who did not. CONCLUSION: Our study suggests that MBSC can be a valuable tool for determining the impact of outcomes from the patient's standpoint, and awareness of the columellar scar is not related to patient satisfaction but with bodily perception. LEVEL OF EVIDENCE IV: 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 .


Assuntos
Catexia , Cicatriz/fisiopatologia , Septo Nasal/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Rinoplastia/métodos , Adaptação Psicológica , Adulto , Fatores Etários , Conscientização , Distribuição de Qui-Quadrado , Cicatriz/psicologia , Estudos de Coortes , Estética , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Percepção , Estudos Retrospectivos , Rinoplastia/efeitos adversos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Inquéritos e Questionários , Técnicas de Sutura , Adulto Jovem
19.
Ulus Travma Acil Cerrahi Derg ; 22(3): 278-82, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27598594

RESUMO

BACKGROUND: Electrical burns are the third most common cause of burn injuries, after scald and flame burns. In spite of decreasing mortality rates as advancements are made in treatment modalities and medical equipment, significant complications and socioeconomic consequences still accompany electrical burns. Analyzed in the present study were data from patients hospitalized for electrical burns between 2008 and 2012 in the Samsun Training and Research Hospital, the only burn care center in the Black Sea region of Turkey. METHODS: Data from 94 patients (84 males, 10 females) hospitalized for electrical burns between 2008 and 2012 were retrospectively evaluated. Patient age, gender, occupation, presence of coexisting trauma, burn degree, burned percentage of total body surface area (TBSA), voltage of the electric current (low or high), medical cost (per day and total), and infection rates were analyzed. RESULTS: Mean patient age was 26.4±13.2 years. Ten patients were female (10.6%) and 84 were male (89.4%). High-voltage burns were sustained by 47 patients (50%) and low-voltage burns by 42 (44.7%); the remaining 5 were flash burns. Mean burned TBSA was 21.8±19.8% in high-voltage injuries and 11.9±6.9% in low-voltage injuries. Seven patients had accompanying soft tissue lacerations, major bone fractures, or epidural hematomas. Findings of infection were encountered in 31 patients (32.9%), and appropriate treatments were initiated according to culture results. Mean duration of hospitalization was 21.3±19.8 days in patients with high-voltage burns and 8.6±6.2 days in patients with low-voltage burns. Mean hospital stay was 2.5-fold longer, and total medical costs were 4-fold higher in patients with high-voltage burns. CONCLUSION: Young adult males who were injured in industrial accidents constituted the majority of high-voltage burn patients. Incidence of these injuries may be reduced by improvements in training regarding the safe use of electrical devices, and correct installation and safe maintenance of power grids, as well as by a review of occupational safety regulations.


Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras por Corrente Elétrica/epidemiologia , Adolescente , Adulto , Idoso , Superfície Corporal , Queimaduras por Corrente Elétrica/complicações , Queimaduras por Corrente Elétrica/patologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Estudos Retrospectivos , Turquia/epidemiologia , Adulto Jovem
20.
Microsurgery ; 36(5): 402-409, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25726839

RESUMO

PURPOSE: In this study, we evaluated the individual and combined effects of mesenchymal stem cells (MSCs) and sildenafil citrate (SC) on the viability of pedicled perforator flaps in which ischemia/reperfusion injury developed after induction of primary ischemia. MATERIALS AND METHODS: Seven Sprague-Dawley rats were used as donors of cells. Rectangular flaps (7 × 7 cm2 ) were created featuring the right second epigastric musculocutaneous perforator in 63 male Sprague-Dawley rats. The animals were randomly divided into two experimental groups (based on the ischemia time of 4 or 8 hours) and a control group. Each of the experimental group was further divided into four subgroups with no treatment, subcutaneous administration of MSCs after termination of ischemia, intraperitoneal administration of SC after termination of ischemia, and combined MSCs and SC treatments at the end of the period of ischemia (n = 7 for each subgroup). A sham group with no-ischemia to flap was used as the control (n = 7). On day 7, viable areas on the flaps were calculated from photographs. The levels of the antioxidative enzymes, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX), were analyzed in tissue samples obtained from the most distal regions of the flap prior to ischemia and on day 7 after induction of ischemia. RESULTS: No difference was detected between the no-ischemia group and 4-hours SC-treated subgroup, 4-hours combined MSC and SC treated subgroup, 8-hours MSC-treated subgroup, or 8-hours SC-treated subgroup (P > 0.05). In 4-hours ischemia group, the viable flap area of combined MSC and SC treated subgroup was significantly greater than that of the ischemia subgroup (17.17 ± 12.56 cm2 vs. 7.24 ± 7.17 cm2 ; P = 0.015). However, in 8-hours ischemia group, the viable flap area of MSC- treated subgroup was significantly greater than that of the ischemia subgroup (2.69 ± 3.71 cm2 vs. 14.52 ± 8.57 cm2 ; P = 0.004). There were no significant differences in SOD, CAT, and GPX levels detected between no-ischemia group and any of the treated subgroups in 4- and 8-hours ischemia groups (P > 0.05). However, SOD, CAT, and GPX levels in the no-ischemia group were lower than that in 4-hours ischemia control subgroup or 8-hours ischemia control subgroup (P < 0.05). CONCLUSION: In this rat pedicled perforator based abdominal flap, we found that after primary ischemia, application of MSCs and SC, either individually or in combined form, significantly enhanced antioxidant enzyme levels compared with those in the control group, and provided protection against ischemia/reperfusion injury. The two treatments acted synergistically to protect against damage after 4 hours of ischemia, but either treatment alone more effectively enhanced viable flap area after 8 hours of ischemia, although some flap damage was apparent. © 2015 Wiley Periodicals, Inc. Microsurgery 36:402-409, 2016.

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