Investigation of the monocyte/high-density lipoprotein ratio as a prognostic criterion in burn patients.

In this study, it was aimed to investigate the monocyte/high-density lipoprotein ratio as a prognostic criterion in adult burn patients. A descriptive and cross-sectional method was adopted in this study. The sample included 177 patients with burn injuries. This study was conducted in a research and training hospital in Turkey. Data were collected by the researchers in the burn unit. Descriptive methods, Kruskal-Wallis, Mann-Whitney U, ROC curve, and correlation analyses were used for the statistical analyses of the data. While 66.1% of the patients were second-degree burn patients, 96.6% of all patients recovered and were discharged from the hospital, and the rest died. In this study, the monocyte/high-density lipoprotein ratios of the patients decreased as their clinical condition worsened. The mean C-reactive protein value of the patients was 8.52 ± 5.02 on the 7th day. A statistically significant correlation was found between an increase in monocyte counts and a decrease in high-density lipoprotein concentrations at the 24th hour, 3rd day and 7th day after the burn (p < 0.01). The monocyte/high-density lipoprotein ratio can be considered a biomarker in the identification and follow-up of sepsis and morbidity durations in burn patients. A low monocyte/high-density lipoprotein ratio in burn patients can provide an insight into the severity of sepsis.

Comparison of Transcutaneous Fixation-Assisted Method with Classical Needle-Assisted Method in Prominent Ear Surgery.

BACKGROUND: Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature. In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method. METHODS: Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the concha-scaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the concha-scaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis. RESULTS: A total of 52 patients were included in the study. There were 27 patients in Group 1and 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05). While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p<0.05). There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05). CONCLUSIONS: As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation. LEVEL OF EVIDENCE III: 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 .

Comparison of the Effects of Intratubal Injection of Adipose-Derived Mesenchymal Stem Cells in a Rat Sciatic Nerve Transection: An Experimental Study.

ABSTRACT: This study was designed to evaluate the efficacy of epineural tubulization (ENT) with or without intratubal application of adipose-derived mesenchymal stem cells (ASCs) in the rat model of sciatic nerve transection. After formation of 1-cm defect in the left sciatic nerve and ENT, 32 adults female Wistar albino rats were separated into 4 groups (n = 8 for each) including ENT per se (group 1; ENT group) and ENT plus intratubal ASC injection groups killed on day 21 (group 2; ENT-ASC-21-day group), 60 days (group 3; ENT-ASC-60-day group), and 120 days (group 4; ENT-ASC-120-day group). Functional (sciatic function index, hip circumference, withdrawal reflex latency, muscle weight ratio), electrophysiological, histomorphometric, and immunohistochemical analyses were performed in each group. Sciatic function index was significantly higher (-51.98 ± 5.94, P < 0.01) and withdrawal reflex latency was shorter (-6.21 ± 2.14, P < 0.01), in the group 4 as compared with all other groups on day 21. Amplitude of contraction was significantly lower in the group 4 as compared with all other groups (0.22 ± 0.05 vs 0.34 ± 0.07, 0.50 ± 0.11, and 0.61 ± 0.16, P < 0.01 for each). Immunohistochemical analysis revealed presence of green fluorescent protein, vimentin-stained cells, and single neural progenitor cells indicating that induction of neuronal differentiation by ASCs and direct involvement of ASCs within the axonal structure alongside extension of ASCs to the muscular layer of the group 4. In conclusion, our findings revealed that use of ENT plus intratubal ASC injection in a rat sciatic nerve transection model was associated with satisfactory functional outcome and improved peripheral axonal regeneration along with stem cell neural differentiation.

An Alternative Method for Midvault Restoration: "T-Splay Graft".

BACKGROUND: The internal nasal valve is one of the highly important anatomical points in rhinoplasty procedures. As a key anatomical area, the anatomical and functional integrity of this region must be preserved or reconstructed during rhinoplasty procedures. Several techniques have been defined in the literature for midvault restoration, among which, the most common are spreader grafts and flaps. Both techniques achieve a natural and harmonic contour but may fail to provide the splay effect to the upper lateral cartilages in some cases. A new technique known as the "T-splay graft", to be used as an alternative approach in cases where there is a risk of midvault collapse, and in which the splay effect in the upper lateral cartilage is preferred to be augmented, is explained in the present study. METHODS: In the present study, a septal tunnel is opened of sufficient size for the cartilage graft planned for placement, at the planned level of the septum, to expand the midvault region and create a splay effect. A bilateral pocket is created in the inferior mucosa of the upper lateral cartilages. The harvested cartilage graft is passed through the septum in the horizontal plane. The cartilage graft is inserted into the bilateral pockets so as way to create convexity to the dorsum. RESULTS: As a result of the applied method, it was established that the internal nasal valve angle could be expanded to the desired extent and the dorsal aesthetic lines could be achieved in a normal anatomical structure. CONCLUSIONS: This technique enables the lateral direction of the tension between the graft and the upper lateral cartilages, and the creation of a splay effect. As such, we believe that this method is a highly effective alternative for use in appropriate cases. 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 .

Comparison of the Effect of Spreader and T-Splay Graft in Internal Nasal Valve Management.

BACKGROUND: The midvalve area is one of the most important anatomical points in rhinoplasty procedures. An additional intervention may be required to ensure there is no narrowing in this region. For this reason, several different techniques are used. Spreader graft technique is the most common of all these methods. T-splay graft technique is an alternative method that can effectively widen the angle of the midvalve. The present study compares the anatomical and functional outcomes of these two methods. METHODS: The study included 60 cases who presented to our clinic for rhinoplasty. The cases were evaluated demographically, anatomically, and functionally, and the acquired data were recorded. All cases were preoperatively administered the Visual Analogue Scale, the Nasal Obstruction Symptom Evaluation scale, and the modified Glatzel mirror test. By randomly selecting the cases, midvalve restoration was performed with a spreader graft in 30 cases and a T-splay graft in 30 cases. RESULTS: A comparison of the Visual Analogue Scale, the Nasal Obstruction Symptom Evaluation scale, and the modified Glatzel mirror test scores revealed that the scores of both groups at postoperative months 3 and 6 were significantly different from the preoperative measurement values. CONCLUSIONS: Although spreader graft technique is a very effective method in midvalve management, we believe that T-splay graft technique may also produce effective outcomes. In addition, the midvalve functions could be better simulated anatomically and functionally with T-splay graft technique. Therefore, we believe that T-splay graft technique is an alternative method that can be safely used in selected cases. LEVEL OF EVIDENCE III: 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 .

An analysis of cases presenting with a mass in the hand and an evaluation of treatment methods.

The aim of this study was to present and discuss our clinical experience of patients presenting with a mass in the upper extremity, in respect of demographic characteristics, localisation of the mass, clinical and pathological characteristics. A retrospective evaluation was made of 114 cases (60 females, 54 males) who presented at our clinic with complaints of localised pain and swelling in the upper extremity between 1 June 2016 and 31 December 2018. The cases were separated into 3 groups; Group 1 with a mass determined in the carpal region, Group 2 with localisation between the wrist and the metacarpophalangeal joint, and Group 3, in the distal of the metacarpophalangeal joint. The mass was of soft tissue origin in 90 cases, and of bone origin in 24 cases. The distribution of cases was 6 in Group 1, 20 cases in Group 2, and 88 in Group 3. The tumour was benign in 105 (92%) cases and a primary malignancy in 9 (7.8%) cases. Recurrence occurred in 4 cases, of which 2 were enchondroma, 1 was a giant cell tendon sheath tumour, and 1 was hemangioma The majority of painful masses seen in the hand are benign and very few are malignant. In the approach to hand tumours, clinical evaluation guided by demo- graphic data, and the evaluation of diagnostic and treatment options according to the radiological ap- pearance and anatomic localisation will determine the ideal approach providing a full cure.

Scalp Micropigmentation Procedure: A Useful Procedure for Hair Restoration.

ABSTRACT: Medical tattooing of the skin to camouflage scars or to mimic hair or nipple/areola regions has gained popularity in Aesthetic Surgery and Dermatology clinics. The SMP procedure was used in 22 patients to correct scalp pigmentary problems between 2017 and 2020. The study included 16 men and 6 women; all female subjects had female pattern hair loss, while one of them also had alopecia areata. There were 10 male patients with male pattern hair loss and 6 of them were corrected using micropigmentation. The rest were subjected to an adjunctive procedure for hair transplantation. There were six male patients that had scalp scars. All patients had three micropigmentation sessions weekly and a fourth touchup procedure that was included one month after the last session. The follow-up period ranged from 7 to 32 months with a mean of 20 months. The amount of fading observed after the follow-up was minimal. There was an allergic reaction in just one patient following the procedure. There were no serious adverse effects or complications due to the procedure. The questionnaire the authors sent the patients at least six months following the procedure showed 80% of the patients (100% of the women) were very satisfied with the result and 100% of the patients would recommend the procedure to others with similar problems. SMP appears to be good solution for patients who don't want the hair transplantation or who underwent previous hair transplantation surgeries with unsatisfactory results. Also, SMP can be used to camouflage any type of scalp scars.

A Study on the Effects of the Use of Propofol in Experimental Model Inferior Epigastric Island Flap on Ischemia-Reperfusion Injury.

Problems concerning vascular blood flow are the most frequently encountered ones after flap applications. The flap tissue starts to develop ischemia in patients with a vascular blood flow insufficiency. And reperfusion starts in those patients in whom the ischemia is temporary, triggering an ischemia-reperfusion injury depending on the duration of the ischemia. The aim of this study was to evaluate the effect of propofol, which is an anesthetic agent known to have an antioxidant effect and a free radical scavenging feature on the ischemia-reperfusion injury created on an experimental epigastric island flap.Thirty Sprague-Dawley rats were used in the study. The rats were divided into 3 groups of 10 rats each. Inferior epigastric artery-based abdominal flaps were prepared in all the groups. In group 1 (sham), the flap was elevated but no ischemia was applied. In groups 2 (control) and 3 (propofol), the flap was exposed to ischemia for 2 hours after it was elevated. All the rats were sacrificed and biochemical and histopathological assessments were made on the tissue samples taken on the 14th day. As a result of a comparison between the groups, the flap viability rates and the superoxide dismutase, total antioxidant capacity, and catalase values were found to be significantly higher (P < 0.001) in the propofol group while the malondialdehyde and total oxidative stress values were lower (P < 0.001). Based on the data obtained from the present study, the use of propofol was observed to have a protective effect against ischemia-reperfusion injuries in flap surgeries.

Surgeon-Manipulated Live Surgery Video Recording Apparatuses: Personal Experience and Review of Literature.

BACKGROUND: Visual recording of surgical procedures is a method that is used quite frequently in practices of plastic surgery. While presentations containing photographs are quite common in education seminars and congresses, video-containing presentations find more favour. For this reason, the presentation of surgical procedures in the form of real-time video display has increased especially recently. Appropriate technical equipment for video recording is not available in most hospitals, so there is a need to set up external apparatus in the operating room. Among these apparatuses can be listed such options as head-mounted video cameras, chest-mounted cameras, and tripod-mountable cameras. The head-mounted video camera is an apparatus that is capable of capturing high-resolution and detailed close-up footage. The tripod-mountable camera enables video capturing from a fixed point. Certain user-specific modifications can be made to overcome some of these restrictions. Among these modifications, custom-made applications are one of the most effective solutions. METHODS: The article makes an attempt to present the features and experiences concerning the use of a combination of a head- or chest-mounted action camera, a custom-made portable tripod apparatus of versatile features, and an underwater camera. RESULTS: The descriptions we used are quite easy-to-assembly, quickly installed, and inexpensive apparatuses that do not require specific technical knowledge and can be manipulated by the surgeon personally in all procedures. CONCLUSION: The author believes that video recording apparatuses will be integrated more to the operating room, become a standard practice, and become more enabling for self-manipulation by the surgeon in the near future. LEVEL OF EVIDENCE V: 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 .

Is Early Nasal Shaping With a Limited Alar Base Incision Possible in the Repair of Cleft Lips?

The repair of cleft lips has an important place in plastic and reconstructive surgery. In the treatment of these deformities, the aim was to restore the normal lip morphology in the cleft area as well as repairing any coexisting nasal deformities. Various methods are in use for this purpose. One of the most commonly employed surgical methods is Millard repair. However, this method may lead to additional scarring in the alar base on the cleft side subsequent to the incision. In this study, the results obtained from a group who have been applied alar base incisions during the modified Millard repair are compared to a group who have undergone intranasal wide dissections.The patients enrolled in the study were randomized into 2 groups. The first group were applied the modified Millard repair. In the second group, the rotation, advancement, and C-flaps were prepared according to Millard surgical repair technique; however, instead of an alar base and nasofacial groove incision on the cleft side, a nasal and maxillary supraperiosteal wide dissection was made through the incision in the mucosa of the nostril.The intranasal dissection performed during the study was observed to provide the targeted outcome and a more satisfactory cosmetic result through the modified Millard repair. In conclusion, the authors are of the opinion that the limited alar base incision and the wide supraperiosteal dissection performed in patients with cleft lips is an alternative method that can be employed in a wide range of patients.

Comparison of Effects of Pulsed Electromagnetic Field Stimulation on Platelet-Rich Plasma and Bone Marrow Stromal Stem Cell Using Rat Zygomatic Bone Defect Model.

BACKGROUND: Reconstruction of bone defects that occur because of certain reasons has an important place in plastic and reconstructive surgery. The objective of the treatments of these defects was to reinstate the continuity of tissues placed in the area in which the defect has occurred. In this experimental study, the effect of pulsed electromagnetic field stimulation on platelet-rich plasma (PRP) and bone marrow stromal cell, which propounded that they have positive impact on bone regeneration, was evaluated with the bone healing rate in the zygomatic bone defect model enwrapped with superficial temporal fascia. METHODS: After creating a 4-mm defect on the zygomatic bone of the experiments, the defect was encompassed with a superficial temporal fascial flap and a nonunion model was created. After surgery, different combinations of the PRP, bone marrow stromal cell, and electromagnetic field applications were implemented on the defective area. All the experiments were subjected to bone density measurement. RESULTS: The result revealed that the PRP and pulsed electromagnetic field implementation were rather a beneficial and an effective combination in terms of bone regeneration. CONCLUSIONS: It was observed that the superficial temporal fascial flap used in the experiment was a good scaffold choice, providing an ideal bone regeneration area because of its autogenous, vascular, and 3-dimensional structures. As a result, it is presumed that this combination in the nonhealing bone defects is a rather useful treatment choice and can be used in a reliable way in clinical applications.

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations.

BACKGROUND: Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss. METHODS: Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively. RESULTS: Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5. CONCLUSION: The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

A comparison of the effects of epidural and spinal anesthesia with ischemia-reperfusion injury on the rat transverse rectus abdominis musculocutaneous flap.

The purpose of this study is to compare the effects of spinal and epidural anesthesia on a rat transverse rectus abdominus myocutaneous flap ischemia-reperfusion injury model.Forty Sprague-Dawley rats were divided into 4 experimental groups: group I (n = 10), sham group; group II (n = 10), control group; group III (n = 10), epidural group; and group IV (n = 10), spinal group. After the elevation of the transverse rectus abdominus myocutaneous flaps, all groups except for the sham group were subjected to normothermic no-flow ischemia for 4 hours, followed by a reperfusion period of 2 hours. At the end of the reperfusion period, biochemical and histopathological evaluations were performed on tissue samples.Although there was no significant difference concerning the malonyldialdehyde, nitric oxide, and paraoxonase levels in the spinal and epidural groups, the total antioxidant state levels were significantly increased, and the total oxidative stress levels were significantly decreased in the epidural group in comparison to the spinal group. The pathological evaluation showed that findings related to inflammation, nuclear change rates and hyalinization were significantly higher in the spinal group compared with the epidural group.Epidural anesthesia can be considered as a more suitable method that enables a decrease in ischemia-reperfusion injuries in the muscle flaps.

Reconstruction of large meningomyelocele defects with rotation-transposition fasciocutaneous flaps.

Meningomyelocele is one of the most common congenital defects of the central nervous system. Reconstruction of these defects must be performed immediately after delivery to prevent complications such as primary meningitis and to protect the neural tissues. The most important factors in the surgical treatment of meningomyelocele defects are the size of the defect, its location, the presence of kyphosis, and the quality of the surrounding tissue. The chosen method must be a simple one that causes minimal blood loss, requires a short duration of surgery, and covers the surface of the neural defect with a soft-tissue mass enabling closure without tension. In our study, satisfactory results have been obtained using 1 or 2 fasciocutaneous flaps based on the midline in 20 patients with large meningomyelocele defects where primary closure was not possible. A single flap based superiorly on the midline was sufficient to close the defects in patients without kyphosis. In patients with concurrent kyphosis, a second flap based inferiorly on the midline has been used. All flaps survived, except for a distal partial necrosis observed in 1 patient. In the method we used, we adopted a defect reconstruction that is similar to the normal anatomic structures and resistant to trauma and infections, and does not sacrifice any muscle tissue. According to our clinical experiences, this method is useful for large meningomyelocele defects that are unsuitable for primary closure.

Repair of nostril stenosis using a triple flap combination: boomerang, nasolabial, and vestibular rotation flaps.

Tissue losses within the nose due to various reasons result in the loss of normal anatomy and function. The external nasal valve area is one of the most important functional components of the nose. The columella, lobule, nostril, and alar region are among the components forming the external nasal valve area. Deformities of the nostrils are among the most frequently observed features that interfere with the functional anatomy of the nose. Malformations of the nostrils often emerge subsequent to cleft lip repairs. Stenoses are a common type of pathology among nostril deformities. In cases where a stenosis has formed, breathing problems and developmental anomalies may occur. In the patient with nostril stenosis presented in this report, there was a serious alar collapse and contracture subsequent to a cleft lip repair. In order to repair the nostril stenosis, a "boomerang flap" was chosen. This boomerang flap was used in combination with a nasolabial flap, a vestibular rotation flap, and a conchal cartilage graft to achieve a satisfactory repair.

An unusual etiology of a scrotal dog bite injury and review of the literature.

Soft tissue injuries from animal bites are encountered occasionally in rural areas, resulting from attacks by, for example, dogs, wolves, horses, donkeys, and cats. The commonly affected body parts include the face, head and neck, nose, ears, hands, arms, and legs. The traumatic exposure of the external genital organs following an animal bite is a highly rare condition. Dog bite injuries in this area are a clinical condition that requires careful management due to the bacterial density of the oral flora of dogs, and also the potential bac-terial flora in the genital area, resulting in a high risk of infection. Tissue defects following dog bites to the genital area are at high risk of morbidity, and may even result in life-threatening conditions in the event of a major infection. The classical treatment approaches to soft tissue defects resulting from animal bites include wound irrigation, debridement, rabies and tetanus immunoprophylaxis, antibiotic therapy, and reconstruction after the elimination of the infection. Recently, however, the early acute approach seems to have replaced the conventional late period treatment, with studies recommending surgical repair in the early stage where possible. In this article, an unusual etiology of scrotal defect was determined under the light of detailed literature data. The present study reports on a case in which an early repair was made after wound cleaning and care, debridement, and then prophylactic antibiotic therapy, soon after the referring of the case to the hospital. No signs of local or systemic infection were noticed at the wound site during follow-up. Post-op-erative recovery was uneventful and the repair performed on the case had a satisfactory outcome. Based on our clinical experience, we believe that reconstruction accompanied by an early prophylactic antibiotherapy can produce satisfactory outcomes in genital defects caused by animal bites.

Investigation of the relationship of growth hormone, insulin-like growth factor (IGF)-1, and IGF-binding protein-3 levels with graft viability in autograft-transplanted pediatric patients with major burns.

BACKGROUND: In our study, we investigated graft viability, Growth Hormone (GH), Insulin-like growth factor (IGF)-1, and IGF-binding protein (IGFBP)-3 in autograft-transplanted pediatric major burn cases. METHODS: This descriptive study was conducted with the participation of pediatric patients with major burn wounds. The laboratory data and characteristics of the patients were accessed retrospectively, and the obtained data were recorded in the data form developed by the researchers. In the analysis of the data, descriptive statistical methods, chi-squared test, Wilcoxon signed-rank test, one-way ANOVA, and post hoc analyses were used. RESULTS: The sample of our study consisted of 93 pediatric major burn patients with a total burnt body surface area of more than 20%. It was found that 65.59% of the patients were between the ages of 1 and 5, 63.43% of them were in the 41-55 percentile range, 58.06% had a hot liquid burn, 74.2% had a second-degree burn, 60.21% had a burn percentage in the range of 21-40 of their total body surface area. It was determined that the GH and IGF-1 levels of the patients who experienced loss after graft transplantation remained below the normal value in the first 14 days, and the differences in the GH and IGF-1 values between the patients with good functioning grafts and those with graft loss were statistically significant (p < 0.01). It was found that the IGFBP-3 value remained low on the 14th day in the patients with good functioning grafts, and the difference in the IGFBP-3 values between the patients with good functioning grafts and those with graft loss was statistically significant (p < 0.05). CONCLUSION: Today, it is known that the parameters of GH, IGF-1, and IGFBP-3 are related to many problems. However, no study examining their relationships with graft viability in autograft-transplanted pediatric patients with major burns was encountered. Our study may be the first to determine that changes in these three laboratory parameters negatively affect the healing of burn wounds.

An alternative frontalis suspension technique: triband suspension--a modified Garcia's procedure.

Blepharoptosis surgery is one of the most common oculoplastic procedures, and the aim is to clear the visual axis. Many surgical techniques for the correction of ptosis have been described and performed, but the operative approach is based on the extent of eyelid excursion, the amount of levator function, and the degree of ptosis.In this study, the frontalis sling procedure with triband suspension was performed on 32 eyelids of 23 patients. All the patients had visual loss because of blepharoptosis with only 0 to 3 mm of measurable levator function. Postoperatively, the palpebral fissure was increased in all the patients. The purpose of this study was to report the use of a modified frontalis sling procedure for congenital ptosis patients with minimal to no levator function. In conclusion, this modified frontalis sling technique if used maximizes the frontalis muscle, creating sufficient eyelid elevation, with stable effect over time.

Y-to-V setback for prominent lobule correction in otoplasty.

Prominent ears may be very distressing for the patient and they need to be corrected. The situation is especially important for school children or the teenagers as it may cause peer criticism and psychological issues. Various techniques have been suggested, and it is possible to obtain a successful result with one of these techniques chosen according to the patient's specific needs and the surgeon's preference. However, there are not many publications regarding the finer details of this operation such as the correction of the prominent lobule. There are few techniques available with limited success. In this study, we humbly present our Y-to-V setback technique for correction of the prominent lobule, as an individual operation or as an adjunct to a successful otoplasty. A total of 22 cases in which prominent lobule correction had to be performed during otoplasty were included in our study. Mean age of the patients was 21.3 years. Of the 22 patients, 14 were female and 8 were male. All cases underwent bilateral lobule transposition together with bilateral otoplasty. All cases have been followed up for at least 12 months. Mean follow-up was 20 months. The lobule incisions were inconspicuous, and they were well hidden in the postauricular sulcus. Hypertrophic scars or keloid were not seen in any cases. No relapse of lobule prominence was seen during the follow-up period. All patients were satisfied with their results. One of the reasons the ears may look unnatural or "operated" after an otoplasty is the disharmony of the lobule with the corrected parts. Even normal lobules may become relatively prominent after medialization of the helix. It is suggested that the use of a "v"-shaped advancement flap elevated from the posterior surface of the lobule may be a very useful technique to set the lobule back to the desired extent.

Our treatment approaches in head-neck injuries caused by animal bites.

Several approaches exist for the treatment of animal attacks targeting the head and neck region. The treatment options and timing vary depending on the animal species, the nature of the defect, and the experience of the surgeon. In this study, early surgical treatment options used in head-neck injuries caused by domesticated or wild animal attacks are presented.We consider 12 patients who were admitted to our clinic between June 2006 and May 2010 with head-neck injuries caused by animal attacks. Tissue defect had developed in 10 patients due to half-wild dog bite and in 2 patients due to wolf bite. The ages of the patients ranged from 3 to 45 years (mean, 21.3 years). Among the patients included in the study, 4 had facial injury, 3 had ear, 3 had scalp, 1 had eye, and 2 had nose injuries. In all patients, early surgical reconstruction was performed after irrigation, antisepsis, and debridement. Concurrent rabies and tetanus prophylactic antibiotherapy program was started.Infection or surgical complications were not observed in any of the patients. Rabies symptoms were determined in one of the quarantined dogs under surveillance. There were no positive findings in the patient bitten by the dog. The surgical treatment results from all patients were at satisfactory levels.As a result, it is observed that, in the treatment of head and neck injuries resulting from animal bites, early acute approach has replaced the traditional long-term treatment. We believe that debridement and early surgical reconstruction used in combination with medical support and prophylactic treatment are the best treatment method.