Simultaneous cheek and lower eyelid reconstruction with combinations of local flaps.

Cheek defects are common facial defects, especially after tumor ablation. Although primary repair yields the best aesthetic outcome, wide defects require flap resurfacing. Among the flap techniques, the cervicofacial rotation/advancement flap is one of the most common. In cases with eyelid involvement, it is very unlikely that a local flap would single-handedly resurface the defect and additional flaps must be used.This article presents our clinical experience with 14 patients with cheek defects for whom cervicofacial rotation/advancement flaps were used. In 3 of the 14 patients, local flaps that include the laterally based Tripier flap, the Fricke flap, the nasojugal flap, and the median forehead flap were combined with the cervicofacial flap to reconstruct the lower eyelid defects in accordance with the principle of individually reconstructing different anatomic subunits. All infraorbital defects were resurfaced with residual cheek and cervical skin with a good color and texture match. In patients whose eyelids were intact, no malposition was observed.Posteriorly based cervicofacial rotation/advancement flaps offer a very reliable and convenient method for resurfacing infraorbital and medial cheek defects. When a lower eyelid defect is also present, its individual reconstruction as a separate facial subunit needs to be considered using a combination of smaller local flaps.

The correction of maxillary defciency with internal distraction devices: a multidisciplinary approach.

AIM: The purpose of this case report is to present the orthodontic, surgical and restorative treatments in the case of an operated cleft lip and palate and severe maxillary defciency in a 14-year-old female patient. BACKGROUND: Only orthodontic treatment could be ineffcient for cleft lip and palate patients characterized with maxillary hypoplasia. Orthodontic and surgical treatment shows suffcient results, especially with severe skeletal defciency. CASE REPORT: A cleft lip and palate patient required complex multidisciplinary treatment to preserve health and restore esthetics. Dental leveling and alignment of the maxillary and mandibular teeth were provided before the surgery. Maxillary advancement and clockwise rotation of the maxillary-mandibular complex was applied by a Le Fort 1 osteotomy with two internal distraction devices. After the active treatment including orthodontic treatment and orthognathic surgery, upper full mouth ceramic restoration was applied. CONCLUSION: This report shows the efficiency of internal distraction devices in cleft lip palate patients and exemplifes the multidisciplinary care required for such diffcult cases. Clinical signifcance: Stable improved occlusion and skeletal relations were observed after a follow-up examination period of 12 months.

Auricle reconstruction with a radial forearm flap prelaminated with porous polyethylene (Medpor®) implant.

Severe auricular traumas with extensive involvement of the surrounding structures present with a serious defect necessitating free tissue transfers for reconstruction. In this case report, we present a case of whole left auricle reconstruction with a radial forearm flap prelaminated with porous polyethylene (Medpor®) implant in a 17-year-old female patient. First, a subdermal pouch was fashioned on the volar aspect of the left forearm along the projection of the radial artery and the Medpor implant was placed in this pouch. Four weeks later, the prelaminated radial forearm flap containing the Medpor implant was transferred to the recipient site. Resultant construct had a pliable skin cover, and the patient was pleased with the esthetic outcome even though revisions such as external auditory meatus widening, conchal cup deepening, and lobule defining were planned as further interventions. We believe that this method is a pertinent reconstructive option for extensive defects of the auricular region.

Reconstruction of hand injuries with multiple metacarpal defects using free fibular osteoseptocutaneous flap.

Hand injuries with multiple metacarpal involvements often include midpalmar muscle, extensor tendon, and skin defects. Reconstruction method is decided according to the type and amount of structures to be restored. Bone reconstruction and resurfacing of the skin is regarded as priority, and restoration of tendon function and joint mobility can be left for further procedures. An ideal flap for such defects should provide bone for multiple metacarpal defects and a large enough skin paddle. Such flaps are few, and one of the most suitable of them all is the free fibular osteoseptocutaneous flap (free FOSCF). In this report, our experience with the use of free FOSCF for reconstruction of the mutilating hand injury in five patients with extensive skin integument and metacarpal involvement has been presented. Total lengths of fibular flaps were averagely 11 cm in length and were divided into averagely 2.4 segments. Average dimensions of the skin paddles were 7.75 × 8.75 cm. Although the nature of the devastating traumas limited the ultimate functional recovery; wound closure, stability, and various degrees of mobility were restored in all patients. In our experience, reconstruction with free FOSCF proved to be an effective tool in mutilating hand injuries with metacarpal involvement.

The Y-V-I principle for salvaging distal digit replantation.

The replantation and revascularization of a distal finger following a crush injury or avulsion are difficult because of the shortness of the vessels after debridement. The success rate of the anastomoses may decrease when they are under tension. To address this, many maneuvers have been described, such as shortening the amputated part or proximal finger stump for tensionless closing, interposing a vein graft between the vessel ends, and vessel transfer from a neighboring finger. Regardless of which of these techniques is chosen, it is an additional drawback for the already traumatized hand or amputation stump. Y-V-I pedicle lengthening is a method for providing extra pedicle length. This article presents a pediatric patient with a traumatic partial amputation at the fourth distal interphalangeal joint in whom the finger was salvaged by achieving anastomoses using the Y-V-I pedicle-lengthening principle.

Finger pulp reconstruction with free dorsoulnar artery perforator (DUAP) flap.

Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complications by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible.

Accordion-style pedicle suspension in inferocentral pedicled mammoplasty.

OBJECTIVE: In breast reduction surgery, while the primary objective may appear to be decreasing the breast volume, the ultimate goal is to achieve symmetrical, appealing, and sustainable breast cosmesis. To circumvent late-term ptosis following inferior pedicle mammoplasty, methods such as pedicle suspension to the ribs, support with dermal flaps and grafts, and the use of some alloplastic materials have been proposed. This paper presents a method of folding and fixing the inferocentral pedicle on itself and the underlying pectoral fascia. METHODS: Inferocentral pedicled, inverted T-scar reduction mammoplasties were performed on 50 patients from June 2009 to June 2014. The inferocentral pedicle, which was kept narrow and long, instead of the conventional inferior-based pyramidal design, was folded over its de-epithelialised surfaces in an accordion fashion and sutured. The confection was then sutured to the pectoral fascia by its lateral and superior borders for long-term preservation of breast moulding. RESULTS: In inferocentral breast reduction, the quest for a method that achieves appealing and lasting pyramidal breast shape continues. CONCLUSIONS: This technique is regarded as a simple and effective method for achieving good short- and long-term results for patients being considered for moderate and advanced breast reduction.

Effect of short-term use of oral smokeless tobacco on random- pattern skin flap survival in rats.

We investigated the effects of smokeless tobacco on the survival of random-pattern skin flaps in rats. Twenty rats were divided into two groups (n=10 each). In the experimental group 200 mg smokeless tobacco (Maras powder) (1 mg nicotine) was inserted intraorally once a day for seven days under general anaesthesia. It was not given to the control group, but the rats were similarly anaesthetised with ketamine. On day 8, plasma cotinine concentrations were measured. The random-pattern dorsal skin flaps measuring 3 x 10 cm were then raised and resutured. Percentage survival area was assessed after a further eight days. The mean (SD) survival was 39 (7)% in the experimental, and 65 (8.9)% in the control, groups (p=0.0001). The mean (SD) plasma cotinine concentrations were 124.4 (73) ng/ml and <10 ng/ml, respectively. Smokeless tobacco use increased the incidence of flap necrosis in random-pattern skin flaps in rats.

Radiologic and histological evaluation of otogenic sliced cartilage grafts at the tip of the chin of rabbits: an experimental study.

OBJECTIVES: Cartilage grafts have been commonly used in plastic and reconstructive surgery applications for many different goals, such as auricular reconstruction and rhinoplasty. The use of autologous cartilage is ideal for many reasons. An attempt was made to produce an experimental animal model to test the efficacy of otogenic Surgicel-wrapped sliced cartilage. METHODS: In this experimental study, cartilage grafts were harvested from rabbits' ears. These grafts were cut in pieces of 0.5 mm to 1 mm using a no. 11 blade. This cartilage mass was wrapped in one layer of Surgicel (oxidized regenerated cellulose) and inserted in the chin of the rabbits. MR analyses were made at 1 week and 6 months and histological analyses were made at 6 months. RESULTS: Cartilage grafts maintained approximately 80% of their dimensions in MRI. The proportion of necrosis was between 30% and 50% and the proportion of resorption was approximately 20% in the histological studies.

Subungual glomus tumours of the hand: diagnosis and treatment of 14 cases.

A glomus tumour is a rare tumour of the hand, which presents with a classic triad of symptoms of temperature sensitivity, pain, and localised tenderness. We report a series of 14 patients with glomus tumours in the subungual region. There were four men and 10 women, whose mean age was 46 years (range 28-65). All patients complained of pain and localised tenderness and six of temperature sensitivity. The bony lesion was seen on radiographs in four patients. We used a transungual approach in all cases. A detailed history and clinical findings are the best way of making the diagnosis. The treatment of glomus tumour consists of complete excision and repair of the nailbed. Inadequate excision of the tumour usually causes local recurrence.

Use of longitudinal invaginating matrix sutures in microarterial sleeve anastomoses.

A different approach to end in end anastomosis was tested to minimise the undesirable traits of classic and sleeve (telescoping) methods. Our approach aimed to maintain full contact at the level of the anastomosis by using longitudinal matrix sutures as a new invaginating suture technique in microarterial sleeve anastomosis. Classic end-to-end anastomosis with seven to eight stitches, Lauritzen's end-in-end anastomosis with four stitches, and our modified end-in-end anastomosis with two horizontal matrix sutures were made in 10, 20, and 25 rat femoral arteries, respectively. Nine, 17, and 18, respectively were patent at early evaluation; and eight, 13, and 14 at the time of late evaluation. There was no significant difference in between the patency rates of the groups. Histopathological examination showed large strictures and the formation of intra-luminal organised thrombus with thin intramural fibrin precipitation in occluded specimens. The longitudinal matrix sutures in the sleeve anastomoses, which passed through all layers of the vascular wall, injured the intima (a vertical rupture) and constricted the lumen.

Versatility of the pinwheel flap to reconstruct circular defects in the temporal and scalp region.

The pinwheel flap technique involves raising four small rotation flaps, which are 90° apart from each other and converge into a defect in their centre. It is suitable for resurfacing defects of the scalp, which offers limited skin mobility. It may also be used for certain circular skin defects on the hairless temporal region. This study first re-formularised the original description of this flap technique via a laboratory study. Thanks to a new smaller flap design, closure was achieved with a lesser scar. Afterwards, the technique was used on the 14 patients who had circular skin defects of the temple and scalp. Defect diameters and resultant scar lengths were recorded. When the new design was used, scarring required for defect closure was less than half of that required for the original design. Thus, it was easier to avoid distortion to the anatomical subunits such as eyebrows and hairline. It is believed that this technique is quite appropriate for closing circular defects of scalp up to 50 mm, and temporal defects up to 40 mm. Also, Z-plasties can be added to the design when needed to increase flap rotation and decrease skin distortion.

The synergy between endoscopic assistance and extraoral approach in subcondylar fracture repair: a report of 13 cases.

BACKGROUND: We aimed to present the primary experience of one surgeon with a new surgical technique performed on the first 13 cases and to evaluate outcomes following an extraoral endoscopic approach to subcondylar fractures. METHODS: Fifteen subcondylar fractures in 13 patients, who were treated at Ondokuz Mayis University Hospital between January 2010 and June 2011, were included in this study. Patients were operated on using either endoscopic or open approach. RESULTS: Rigid plate fixation was completed endoscopically using extraoral approach in nine fractures, while six fractures were plated by conversion to a full-open approach. In all six fractures that could not be fixed endoscopically, the proximal fragments were medially displaced, whereas seven of nine fractures that were successfully fixed endoscopically were laterally displaced. CONCLUSION: An extraoral endoscopic approach for subcondylar fractures is feasible and can be carried out with decreased morbidity. This approach is recommended for those with limited experience in endoscopy to treat low laterally displaced subcondylar fractures as their initial cases.

Giant fibrolipoma with osseous metaplasia on the thigh.

Fibrolipomas are characterised by fat lobules embedded in perivascular oval fibrocytes and thick bundles of collagen. Actively growing superficial fibrolipomas rarely display a pedunculated protrusion and, thus, cosmetic and functional problems are uncommon. We present an exceptional case. While trauma and ischaemia can lead to fibrosis and dystrophic calcification in fibrolipomas as late sequelae, osseous and cartilaginous metaplasia can infrequently manifest after a long, chronic persistence. Further, depending on the chronic irritation, ulcerated wounds may develop on the surface, and these can be clinically confused with malignancy. In this article, we present a case of a pedunculated giant fibrolipoma manifesting metaplasic changes in its structure.