Bilateral synchronous primary orbital lymphoma.

Extranodal marginal zone B-cell non-Hodgkin's lymphoma affecting bilateral orbital regions was diagnosed in an 80-year-old man. He was given chemotherapy and external beam irradiation therapy. Two months after treatment, repeat orbital magnetic resonance imaging showed dramatically improved lesions. In this case report, orbital non-Hodgkin's lymphoma and treatment options are discussed.

The gluteal fasciocutaneous rotation-advancement flap with V-Y closure in the management of sacral pressure sores.

The sacral region is one of the most frequent sites of pressure sore development, and local flaps in the gluteal region are usually preferred when surgical closure is needed. The authors used the gluteal fasciocutaneous rotation-advancement flap with V-Y closure to manage sacral pressure sores in 15 patients. The design was a combination of the classic rotation and V-Y advancement flap patterns. When the wound was closed, the tension at the distal end of the rotation flap was relieved by flap advancement and the combined rotation-advancement action was supported laterally with V-Y closure. A wide skin pedicle was preserved at the inferomedial part of the flap. This pedicle augmented the blood supply to the flap skin and kept the surgical incision small, thus helping to reduce the risk of fecal contamination and associated wound-healing problems. This flap can also be converted to any design of fasciocutaneous or musculocutaneous V-Y advancement flap, should such a change be required. The largest defects that were closed with a unilateral rotation-advancement flap and bilateral rotation-advancement flaps were 12 and 18 cm in diameter, respectively. In 1.5 to 35 months of follow-up, none of the patients developed wound dehiscence or flap necrosis requiring repeated surgery. This technique is simple, can be performed quickly, has minimal associated morbidity, and yields a good outcome.

Periorbital reconstruction using variations of the upper eyelid flap.

Tissues that have characteristics identical or similar to periorbital soft tissue are preferred for reconstruction in the eye region. The upper eyelid is part of the periorbital area that provides an ideal reserve of tissue for this purpose, without producing a donor-site deformity. We used the upper eyelid flap with different pedicle designs in various parts of the periorbital region in 21 patients, and achieved favourable results. The flap was medially-based in five, superomedially-based in seven, laterally-based in eight, and superolaterally-based in one. The tissue defects were the result of the excision of tumours in 18 patients, and of injury in three. The defects were located in the upper eyelid in two, the lower eyelid in five, the medial canthus in eight, the lateral canthus in four, and in the neighbouring orbitonasal zones in two. Different sized flaps were used according to the dimensions of the defects, which ranged from about 1 to 8 cm2. The upper eyelid flap is versatile, and provides tissue of ideal colour and texture. The procedure can be done quickly in one stage with minimal morbidity.

Wound healing at adaptation zones of skin flaps harvested from acute burned skin.

BACKGROUND: Early reconstruction of burn defects culminates in more successful results. The wound healing process of the burned skin affects not only the curative phase of the burned area but also result of any reconstructive procedure including the regional flaps. Thus, in this study, we have evaluated the wound healing process at the distal incisions of random-pattern skin flaps prepared from burned dorsal skin of rats. MATERIALS AND METHODS: Thermal burn damage was performed with dimensions of 3cm×3cm on Wistar albino rats. In group 1 (n=12), no burn was produced and 3cm×3cm caudally based, random-pattern skin flaps were elevated. In group 2 (n=12), a 5cm×5cm area of partial-thickness thermal damage was produced and after three days a 3cm×3cm random-pattern skin flap was elevated as in group 1 inside the burned skin site. In group 3 (n=12), 3cm×3cm area of partial-thickness thermal damage was produced and after three days 3cm×3cm random-pattern skin flap was elevated. In group 4 (n=12), 3cm×3cm area of partial-thickness thermal damage was produced and after three days a 3cm×3cm random-pattern skin flap was elevated at the distal margin of the burned area. The flaps were adapted to the donor sites in all groups. The histopathological evaluation was done and hydroxyproline levels were measured. RESULTS: There were no significant differences between groups regarding presence of epithelialization, myofibroblast numbers, and collagen texture (p>0.05). Neovascularization level was significantly higher in group 2 than the other groups (p<0.05). There were no statistically significant difference among the hydroxyproline levels in all four groups (p>0.05). CONCLUSION: The preference of the incision site in a burn zone while designing a flap during the acute burn period was proposed to possess no difference in terms of wound healing in an animal model.

Technique for blepharoptosis correction using double-breasted orbicularis oculi muscle flaps.

BACKGROUND: The technique that uses the orbicularis oculi muscle flap to elevate the upper eyelid has become a popular surgical alternative for blepharoptosis. This method is especially effective in cases of severe blepharoptosis with poor levator muscle function. In this technique, the superiorly based orbicularis oculi muscle flap (which is connected to the frontalis muscle anatomically) is advanced and attached to the tarsal plate, thus enabling dynamic elevation of the upper eyelid. However, a temporary period of lagophthalmos occurs with the original method. Although the problem is temporary, it typically lasts 2 to 6 months and may lead to serious eye emergencies. METHODS: We describe a modification that eliminates lagophthalmos, which is the main drawback of the original technique. Two orbicularis oculi muscle flaps are created, one superiorly based and one inferiorly based. The inferiorly based flap corresponds to the strip of pretarsal orbicularis oculi that is considered "excess" and is discarded in other methods. Our aim with this modified technique is to preserve as much of the pretarsal part of the orbicularis oculi muscle as possible, and thus enable immediate tight eyelid closure postoperatively and achieve dynamic, powerful eyelid-opening action. RESULTS: We have used this technique in 7 patients (11 eyelids total) during the past 5 years and have achieved favorable results. All 11 operated eyelids showed immediate tight closure postoperatively, as well as dynamic, powerful eyelid-opening action. CONCLUSION: This operation is a good alternative for patients with severe ptosis who have insufficient levator function and for cases that have recurred after operations with other methods. Local native tissues are used and dynamic correction is achieved with a single incision. The need for intensive eye care is eliminated and there is less risk of corneal damage in the early postoperative period. Above all, this technique yields predictable eyelid-opening action.

Modified free nipple graft reduction mammaplasty to increase breast projection with superior and inferior dermoglandular flaps.

Classic free nipple graft reduction mammaplasty often yields flat, boxy breasts with poor projection. The authors modified this technique using superior and inferior pyramidal dermoglandular flaps to increase the fullness and projection of the breast. Six patients (12 breasts) with gigantomastia underwent breast reduction by this method. The results were aesthetically pleasing, with conically shaped breasts and good projection. The technique is easy to perform and it is possible to switch from pedicled nipple-areolar transposition to this method intraoperatively in patients in whom perfusion of the nipple is questionable.

Vascular pedicles of infrahyoid muscles: an anatomical study.

This study was designed to determine the entering sites of vascular pedicles of the infrahyoid muscles. The neck regions of 12 cadavers were investigated bilaterally. The vascular pedicles of the infrahyoid muscles (except the thyrohyoid and inferior belly of the omohyoid muscle) were dissected and measurements taken with a caliper in reference to the attachments of the muscles. For the sternothyroid muscle, two vascular pedicles were found bilaterally in all cadavers. Two vascular pedicles were found bilaterally for the sternohyoid muscle in 11 cadavers; in one cadaver the inferior vascular pedicle was absent bilaterally. One vascular pedicle was found bilaterally for the superior belly of the omohyoid muscle in all cadavers. These data regarding the vascular pedicles of the infrahyoid muscles might be useful for preserving the vascular supply of the infrahyoid muscles during flap preparation.