Use of an Autologous Diced Cartilage Graft and Fat Graft Combination to Improve Regeneration in Rhinoplasty.

BACKGROUND: In rhinoplasty, many techniques are used to increase the permanence of the planned final shape of the nose. Cartilage grafts can be diced and applied directly to the nasal dorsum, or by wrapping with a material. We aim to show that mixing and using diced cartilage grafts with fat grafts can contribute to the viability of cartilage grafts by comparing our early postoperative and long-term results. MATERIALS AND METHODS: A total of 228 cases were analyzed. Postoperative 1-month, 6-month, and 1.5-year photographs of the patients were compared and the places that descended on the nasal dorsum were measured. In addition, dorsal height was measured and compared. Preoperative and postoperative first-year rhinoplasty outcome evaluation scales were performed. Specimens from 6 patients were examined histopathologically. RESULTS: After the first month, the mean regression in the dorsum was measured as 1.4 mm. The decrease in dorsal height between 1 month and 6 months was significantly greater than the decrease between 6 months and late periods. According to the rhinoplasty outcome evaluation (ROE) scale, the average preoperative score of the patients was 45, while the mean postoperative score was 81.5. The viability of chondrocyte cells was measured as 85-90% histopathologically. CONCLUSION: This approach has been evaluated as an application that satisfies both the surgeon and the patient due to the advantages of fat grafts such as preventing the cartilage and osteotomy lines from being palpated in thin-skinned patients, holding the diced cartilage grafts together by acting as a glue, increasing the viability of cartilage grafts. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Factors Affecting Patient Satisfaction in Breast Reduction Surgeries: A Retrospective Clinical Study.

BACKGROUND: Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire. METHODS: Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant. RESULTS: Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m2. Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001). CONCLUSIONS: In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. 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 .

Management of Composite Tissue Defect of the Midfoot With a Free Anterolateral Thigh Flap and Iliac Bone Graft: A Case Report.

Composite tissue defects of the midfoot with extensive bone and soft tissue loss represent a unique challenge because they can lead to primary amputation if not reconstructed. One should repair both the bone structure and the soft tissue to obtain satisfactory foot function for basic daily activities. In the present study, we report on a case in which we successfully reconstructed an extensive midfoot defect with iliac bone grafts for metatarsal reconstruction and an anterolateral thigh flap for soft tissue coverage. This technique is a safe, reliable, and functional method, offering single-stage reconstruction compared with other microsurgical techniques used for such defects.

Clinical results and health-related quality of life in otoplasty patients using cartilage resection and suturing methods.

In this study, we evaluated clinical results and health-related quality of life in our otoplasty patients in whom we used cartilage resection method (CRM) and suturing method (SM). A total of 132 ears of 77 patients (36 males, 41 females; mean age 14.6 ± 6.4) between January 2006 and February 2013 were included in this study. Patients were divided into two groups according to the type of surgery performed: Group 1 was the cartilage resection group (CRG) and Group 2 was the suturing group (SG). CRM was performed on 64 ears of 37 patients (unilateral in 10 cases and bilateral in 27 cases), and SM was performed on 68 ears of 40 patients (unilateral in 12 cases and bilateral in 28 cases). The parameters of the groups, including operation time, measurements of the auriculocephalic distances, complication rates, postoperative satisfaction rates, and health-related quality of life were compared. Mean operation time was 53.7 ± 7.8 min in the CRG and 44.9 ± 4.2 min in the SG (P ≤ 0.05). Mean postoperative auriculocephalic measurements were similar in both groups. The complications were more frequent in the CRG (10/37 patients, 27.02 %) than in the SG (3/40 patients, 7.54 %) with statistically significant difference (P < 0.05). Three months after the surgery, visual analog scale increased from 25 (preoperatively) to 70 in the CRG and from 30 to 90 in the SG, with a statistically significant difference (P < 0.05). Patients' health-related quality of life showed a statistically significant increase after the operation in both groups (P < 0.05). CRM and SM are effective treatment methods with high success rates for patients with prominent ears. In the selected cases, SM seems to represent a better option for otoplasty than CRM because clinical results, cosmetic outcomes, patient satisfaction, and health-related quality of life scores were better than CRM.

Comparison of nerve, vessel, and cartilage grafts in promoting peripheral nerve regeneration.

Peripheral nerve injury primarily occurs due to trauma as well as factors such as tumors, inflammatory diseases, congenital deformities, infections, and surgical interventions. The surgical procedure to be performed as treatment depends on the etiology, type of injury, and the anatomic region. The goal of treatment is to minimize loss of function due to motor and sensory nerve loss at the distal part of the injury. Regardless of the cause of the injury, the abnormal nerve regeneration due to incomplete nerve regeneration, optimal treatment of peripheral nerve injuries should provide adequate coaptation of proximal and distal sides without tension, preserving the neurotrophic factors within the repair line. The gold standard for the treatment of nerve defects is the autograft; however, due to denervation of the donor site, scarring, and neuroma formation, many studies have aimed to develop simpler methods, better functional results, and less morbidity. In this study, a defect 1 cm in length was created on the sciatic nerve of rats. The rats were treated with the following procedures: group 1, autograft; group 2, allogeneic aorta graft; group 3, diced cartilage graft in allogeneic aorta graft; and group 4, tubularized cartilage graft in allogeneic aorta graft. Group 5 was the control group. The effects of cartilage tissue in nerve regeneration were evaluated by functional and histomorphological methods.Group 1, for which the repair was performed with an autograft, was evaluated to be the most similar to the control group. There was not a statistically significant difference in myelination and Schwann cell rates between group 2, in which an allogeneic aorta graft was used, and group 3, in which diced cartilage in an allogeneic aorta graft was used. In group 4, myelination and Schwann cell formation were observed; however, they were scattered and irregular, likely due to increased fibrosis.In all of the groups, nerve regeneration at various rates was observed both functionally and histomorphologically. This study demonstrates that cartilage tissue has promoting effects in nerve regeneration.

Surgical management of immature teratoma involving the oral cavity and orbit in a neonate.

Teratomas are congenital germ cell tumors composed of elements from 1 or more of the embryonic germ layers and contain tissues usually foreign to the anatomic site of origin. In the head and neck region, these lesions are rare, and 90% of head and neck teratomas present during the neonatal and infantile periods. Besides, in neonates, it carries serious risk for respiratory distress as well as feeding problems due to oral cavity and airway obstruction.Here, an unusual case of intraoral teratoma involving the orbit in a newborn who underwent immediate surgical excision successfully is described.

Surgical modalities in gunshot wounds of the face.

Maxillofacial traumas caused by gunshot wounds may cause quite varied defects. The objective of this study was to evaluate the reconstruction methods in 12 patients with gunshot wound-related mandibular and maxillofacial bony and soft tissue defects. Twelve patients who were operated on for maxillofacial gunshot wounds at our clinic between 2002 and 2012 were included in the study. Seven patients were wounded in a suicide attempt, and 5 were wounded as a result of an accident or in assaults. Two patients underwent reconstruction using free fibula osteocutaneous flap, 4 patients received the free radial forearm osteocutaneous flap, 2 patients received costal bone graft, and 3 patients received iliac bone grafts. Satisfactory functional and aesthetic outcomes were achieved in cases where staged secondary reconstruction, balloon treatment, and consecutive fat and steroid injections into the depressed scar areas were applied. In conclusion, the basic goal in maxillofacial reconstruction is the functional and aesthetic reconstruction of the contours. Because it is not easy to get perfect results with only 1 clinical approach or 1 method, the proper timing and reconstruction method should be selected.

Modified temporary eyelid margin suture for correction of congenital horizontal tarsal kink: a novel surgical technique.

PURPOSE: Tarsal kink is a rare congenital eyelid anomaly that may lead to corneal opacity and amblyopia secondary to severe entropion. The authors aimed to describe a modified temporary lid margin suture method for tarsal kink correction. METHOD: In this novel surgical technique, a double-armed 6/0 prolene suture was passed through the upper eyelid and the lower eyelid margins to correct the tarsal kink under topical anesthesia. RESULT: The authors found that this procedure was very effective and successful for correction of tarsal kink with no incision of the tarsus or eyelid skin, providing a low risk of amblyopia. CONCLUSION: The modified temporal lid margin suture is a simple, practical, and effective procedure for tarsal kink correction.

Synovial chondromatosis of the temporomandibular joint: radiologic and histopathologic findings.

Synovial chondromatosis is a formation of multiple intrasynovial nodules resembling osteochondromas, resulting from proliferative changes in the synovial linings of joints; as the disorder progresses, nodules increasingly withdraw from the intrasynovial areas for the joint cavities. This is a relatively unusual case that can arise at unilateral large joints, such as knee, hip, and elbow, with the temporomandibular joint being the rarest one of them. Early recognition of the signs and symptoms with resultant accurate diagnosis, as well as proper surgical treatment, offers patients the best hope of recovery and improved quality of life. We report a conventional radiologic film, computed tomography, magnetic resonance imaging, and histopathologic findings of the synovial chondromatosis presenting as a large right preauricular mass arising from the temporomandibular joint without bone destruction.

An autoprosthesis technique for better breast projection in free nipple graft reduction mammaplasty.

BACKGROUND: Reduction mammaplasty for macromastia provides relief from uncomfortable symptoms and improves self-confidence and the ability to participate in sports activities. Reduction mammaplasty using the free nipple graft technique may result in bottoming-out deformity and a lack of upper-pole projection. We describe a modified breast reduction technique that combines the Graf and Thorek methods. METHODS: We operated on 26 patients with gigantomastia using this novel technique. Preoperative markings were planned according to the classic Thorek amputation technique using a Wise pattern. A 10-cm × 14-cm pyramidal inferior-based dermoglandular flap was prepared, passed under a transverse pectoral muscle loop, and then back-folded over the pectoral loop, thereby establishing an autoprosthesis to increase upper-pole fullness and prevent bottoming-out deformity. RESULTS: The average weight of the removed breast tissue was 1,634 g (range = 1,120-2,140 g) for the right breast and 1,630 g (range = 1,110-2,120 g) for the left breast. The average follow-up period was 22 months (range = 11-37 months). All samples were pathologically assessed. Minor complications included wound breakdown at the T-junction, fat necrosis, hypertrophic scarring, and partial necrosis of the nipple-areola complex (NAC). Loss of nipple projection and partial hypopigmentation of the NAC occurred in most patients. Mild glandular ptosis was observed in two patients, with no flattening or deflation, but no severe bottoming-out deformity was observed during long-term follow-up. CONCLUSIONS: All patients were happy with their new bra size, breast projection, and breast weight. Our combined autoprosthesis technique resulted in satisfactory long-term breast projection and upper-pole fullness. 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 .

Effectiveness of Fasciocutaneous Superomedial Thigh Flap in Reconstruction of Fournier Gangrene Defects.

Background: Fournier gangrene (FG) is a necrotizing fasciitis involving perianal and abdominal regions. It progresses quickly and requires urgent intervention. With the use of vacuum-assisted closure (VAC) treatment applied during clinical follow-up and the use of superomedial thigh flap in the region, the treatment is completed with an effective, functional, and rapid approach. This study examines the clinical details of this method for reconstruction. Methods: The study included 15 patients who underwent superomedial thigh flap in VAC treatment reconstruction for tissue defect after FG debridement from 2016 to 2020. The patients were examined in the form of clinical evaluation with hospital admission and surgical evaluation in the postop process. Results: In patients with wound maturation and sufficient granulation, superomedial thigh flap application followed by VAC treatment soon after shortened the operation time, shortened the postop drain time, and provided effective treatment of dead space. An aesthetic and functional result was obtained with the proximity of the flap to the area. In addition, due to the sensory branches present in the flap, a sensory result was obtained according to the ratio of flap size. Conclusions: Superomedial thigh flap provides a practical, effective, and fast solution to the tissue defect that occurs after FG debridement. Effective results can be obtained when combined with VAC therapy.

Effects of taurine and apocynin on the zone of stasis.

BACKGROUND: Among the zones of coagulation, hyperemia and stasis that occur in the burned area, the most intense metabolic process and the highest sensitivity to recovery with treatment is the zone of stasis.This metabolic process is related to how well the tissues in the zone of stasis can cope with oxidative stress. If the tissues in the zone of stasis are saved, the burn area will potentially heal faster and with less scar. In this study, we examined the effects of taurine amino acids and apocynin molecules on saving the tissues in the burn zone of stasis. METHODS: The study was conducted with 48 rats. The burn zone of stasis was created according to the pattern previously described in the literature as comb burn model. In the 21-day study, biopsies were taken for histological examination on the 3rd, 7th and 21st days of the study. In addition, macroscopic photographic analysis was performed. Biopsies were taken for biochemical analysis on the 21st day. Histologically, inflammation, reepithelialization, and collagenization were evaluated, and the CD34 immunoreactivity was analysed. Biochemically, CAT, SOD, tGSH, TAS, TOS, MDA and PPC values were determined. RESULTS: In the histological examination, on the 3rd, 7th and 21st days, inflammation was found to be reduced in the groups given taurine and apocynin on the 3rd day. On the 7th day, better reepithelialization and collagenization were observed in the group given taurine. Significant reepithelialization, collagenization and hair follicle development were observed in the groups given taurine and apocynin on the 21st day. In the biochemical analysis, the effects of apocynin on antioxidant enzymes were determined to be prominent. While we found no significant difference on the 3rd and 7th days in the photographic analysis, taurine and apocynin were observed to act synergistically on the 21st day and significantly reduced the burned areas. CONCLUSION: On the 3rd day, taurine and apocynin prevented inflammation, the effects of taurine in the zone of stasis in the early period (7th day) are more pronounced, the effect of apocynin on antioxidant enzymes is more pronounced. In the late period (21st day), taurine and apocynin were found to be more effective in saving the zone of stasis by creating a synergistic effect.

Histopathological effects of fibrin glue on penile fracture in a rat model.

PURPOSE: To evaluate both histopathological effects and potential clinical application of fibrin glue on the penile cavernosal tissue. METHODS: Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to four main groups of eight animals each. In the control group, the incision was not repaired and it was left to secondary healing. In the primary repair group, the incision was primarily repaired. In the fibrin glue group, glue was applied only to the incision. In the final group, fibrin glue was applied to the incision following primary repair. Three weeks later, penectomy tissue was examined histopathologically. RESULTS: When the control group was compared with primary repair+fibrin glue group, the differences in cavernous tissue healing with fibrosis and inflammation were statistically significant (p = 0.04 and 0.01, respectively). The primary repair+fibrin glue group, showed the best cavernous healing with fibrosis observed in only one rat. . There was no significant difference between the control group and the other groups according to cavernous tissue healing with fibrosis and inflammation (p = 0.11 and 0.12). Hyperemia was observed in the all groups of rats. CONCLUSIONS: Fibrin glue can be used in cavernoseal surgeries due to its adhesive and potentially anti-inflammatory features.

Viability of cartilage grafts in various forms.

The viability of cartilage grafts, in many forms, has been researched since the using of cartilage grafts in surgical procedures. Cryopreservation period and viability of cartilage grafts have remained unclear. This study was performed to investigate the durability, viability, and behavior of fresh or cryopreserved cartilage grafts when used as autografts or allografts in various forms.Six cartilage grafts (1 of each preparation type; 3 blocks and 3 diced) were prepared by wrapping with Surgicel or autogenous fascia, or they were left bare. After the graft preparation stage, the cartilage grafts were inserted into pockets prepared on the dorsum of each rabbit. Groups 1, 2, 3, and 4 (6 rabbits in each group) received autogenous fresh grafts, allogenous fresh grafts, autogenous cryopreserved grafts, and allogenous cryopreserved grafts, respectively. All cartilage grafts were implanted for 2 months.At the end of the second month, specimens were harvested and analyzed. The bare grafts provided the most viable specimens. There was no significant difference between the frozen or fresh and allograft or autograft groups with respect to viability and resorption ratios. The bare block graft, in all groups, survived significantly more than the other graft types.Allografts (homografts), similar autografts, did not create major problems, and they had excellent host tolerance and low antigenicity, especially when the perichondrium was removed. Viability and durability of the bare grafts (diced and block) were better than fascia or Surgicel-wrapped cartilage graft forms.

Our Clinical Algorithmic Approach for Meningomyelocele Defects Reconstruction with Fasciocutaneous Flaps.

AIM: To evaluate fasciocutaneous flaps used for reconstruction of meningomyelocele defects in our clinic and to suggest an algorithm for flap selection. MATERIAL AND METHODS: A retrospective analysis of 45 patients with meningomyelocele, who underwent repair with fasciocutaneous flaps, was carried out. Preoperative and postoperative photos were analyzed. The defect areas were measured by Adobe Photoshop CC. Limberg flap, bilateral Limberg flaps, bilateral bipedicled advancement flaps, bilobed flap and reading man flap were performed. RESULTS: Wound dehiscence and partial necrosis occurred in 8 patients. All wounds were managed conservatively and healed successfully. No other complications were observed. The mean defect size for all patients was 36 cm². The mean defect size was 45.3 cm² in bilateral bipedicled flaps cases; 33.5 cm² in bilateral Limberg flaps cases; and 19.6 cm² in the unilateral Limberg flap cases. According to the algorithm, a unilateral Limberg flap or bilobed flap or reading man flap can be used for the defects smaller than 25 cm²; bilateral Limberg flaps can be used for the defects between 25 and 35 cm²; and bilateral bipedicled advancement flaps can be used for the defects larger than 35 cm². CONCLUSION: Fasciocutaneous flaps can be preferred in meningomyelocele defect reconstruction due to the easy planning of flaps, easy and fast flap elevation, and low complication rates due to their reliable circulation. The measurement of the defect area allows this algorithm selecting a flap in a more practical way.

Effects of montelukast on burn wound healing in a rat model.

PURPOSE: Montelukast, a selective cysteinyl leukotriene D4-receptor antagonist, is used in the treatment of asthma. In a rat model, our aim was to investigate the effects of montelukast, alone or in combination with topical antibiotics, on local burn wound healing. METHODS: Rats were randomly allocated to four groups after local burn development: Group 1; rats were left to secondary healing without treatment, Group 2; a dose of 10 mg/kg montelukast was given by gastric gavage once a day for 10 days, Group 3; rats were treated with topical pomade (bacitracin neomycin sulphate), and Group 4; rats were treat with a combination of topical antibiotic and montelukast (10 mg/kg were given by gastric gavage once a day for 10 days). Skin biopsies were taken on days 3, 10, 14, and 20 relative to burn induction. RESULTS: Reepithelialization in the pomade and montelukast+pomade groups on the 10th day was significantly greater, in comparison with control and montelukast groups (p < 0.05). For the montelukast group, edema (on the 14th day) and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 20th day) were statistically improved in comparison with the control group (p < 0.05). For the montelukast+pomade group, angiogenesis, fibroblast proliferation and macrophage infiltration (on the 10th day), and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 14th and 20th days) were statistically improved in comparison with the control group (p < 0.05). CONCLUSION: In conclusion, montelukast was effective on burn wound healing. Moreover, the effect was amplified when combined with topical antibiotics applied in the early stage of burn wound healing.

Combined cervical and vaginal reconstruction with prefabricated pudendal thigh flap in a case with cervical and vaginal agenesis (MURCS syndrome): a new and original technique.

In the presence of functional endometrium, in addition to the construction of anatomically, functionally normal and sensitive neovagina and cervix, the preservation of the uterus for future possible pregnancies must also be considered as the main goal in this process. So far, hysterectomy was the general treatment modality in such cases. For maintaining cervical patency, there were no reports in the literature related to cervical prefabrication using flaps. In this report we present a case with cervical and vaginal agenesis (MURCS syndrome). In this case combined cervical and vaginal reconstructions were successfully performed by using bilateral pudendal thigh flaps; a real-like cervix and cervical canal had been previously prefabricated on the distal part of one of the pudendal thigh flaps. Sensitivity and function were both preserved and maintained at the end of this operation.

Management of necrotizing fasciitis in diabetic patients.

Necrotizing fasciitis is a life-threatening condition in diabetic patients; its management and salvage of the patient is a formidable challenge. Diabetes mellitus is one of the serious conditions associated with necrotizing fasciitis. It is a disorder that primarily affects the microvascular circulation. We review our experience and present our approach to necrotizing fasciitis in patients with diabetes mellitus. All cases of necrotizing fasciitis treated at Inonu University, Turgut Ozal Medical Center, from January 1997 to December 2003 were reviewed. A review of 59 charts identified 11 cases that met the study criteria. Cases with necrosis due to other obvious causes were excluded. Three patients had spread of infection with no fatality. An average of 42 hospital days (22-64 days), 17 intensive care unit days (7-28 days), and three surgical procedures (2-7) per patient was required. Necrotizing fasciitis is an extremely serious exceptional infectious process affecting subcutaneous soft tissue with skin gangrene and vascular thromboses. Clearly, the mortality and morbidity associated with necrotizing fasciitis even in diabetes can be decreased with clinical awareness, early diagnosis, effective surgical debridement, and intensive supportive care.

Comparison of the effects of PRP and hyaluronic acid in promoting peripheral nerve regeneration An experimental study with vascular conduit model in rats'.

AIM: Peripheral nerve defects generally occur due to mechanical, chemical, thermal and pathologic causes and the reconstruction is still a challenging problem. In the present study, we aimed to compare the effects of platelet rich plasma (PRP) that has high levels of growth factors and hyaluronic acid (HA) that is known to have positive effects on nerve regeneration by decreasing scar formation in a rat model where they were injected through allogeneic aorta graft in peripheral nerve defects using histopathologic and functional methods. MATERIAL AND METHODS: The study involved 20 Wistar Albino male rats that weighed 200 to 250 grams and aged about 1 year old. Of the rats, two were used as donor for PRP and aorta graft harvest. Three random groups of 6 rats were composed. In all of the groups, the left sciatic nerves were used and 1 cm of defects were created. The right sciatic nerves were used as control groups. Group 1 was the group repaired with autograft, Group 2 was the group repaired with HA injected through aorta graft and Group 3 was the group repaired with PRP injected through aorta graft. The findings were evaluated in terms of functional (electromyography and walk test analysis) and histopathologic parameters at 12 weeks. RESULTS: In all of the groups varying degrees of axonal regeneration was observed. Group 1 was the closest group to the control group showing highest rate of nerve regeneration followed by Group 3 where PRP was injected through aorta graft and group 2 where ha was used respectively. CONCLUSION: The study demonstrates that PRP enhances peripheral nerve regeneration more than HA when used in a vascular conduit model. KEY WORDS: Hyaluronic acid, Peripheral nerve regeneration, PRP.